tbuckley/cabot-search huggingface dataset:
Abstract 13552: Prognostic Value of Modified Body Mass Index in Acute Decompensated Heart Failure Patients With Reduced, Mildly-Reduced and Preserved Left Ventricular Ejection Fraction
Authors: Takahisa Yamada, Tetsuya Watanabe, Takashi Morita, Masato Kawasaki, Atsushi Kikuchi, Takumi Kondo, Tsutomu Kawai, Yuji Nishimoto, Jun Nakamura, Takeshi Fujita, Masanao Taniichi, Yongchol Chang, Masatake Fukunami
Journal: Circulation (2023)

Backgrounds: Malnutrition is associated with poor outcome in patients with acute decompensated heart failure (ADHF). Although conventional body mass index (cBMI) and serum albumin level are commonly used as indicators of malnutrition, these variables are influenced by fluid balance, and it has been recently reported that the modified BMI (mBMI, serum albumin х cBMI) would be a better prognostic marker than cBMI and serum albumin level in ADHF patients. However, it remains unclear whether mBMI on admission or discharge would have more prognostic information in patients admitted with ADHF after the discharge, and there is no information available on the prognostic impact of mBMI in ADHF patients, relating to reduced (HFrEF), mildly-reduced (HFmrEF), and preserved left ventricular ejection fraction (HFpEF). Methods and Results: We studied 263 ADHF patients (HFrEF:n=103, HFmrEF:n=59, HFpEF:n=101) discharged with survival. We calculated mBMI on admission and discharge. During a follow up period of 5.1±4.3 yrs, 67 patients had cardiovascular death (CVD). AUC of mBMI at discharge (0.697[0.625-0.769]) was greater than that on admission (0.661[0.585-0.737], p=0.055). At multivariate Cox analysis, mBMI at discharge (adjusted hazard ratio 0.965[0.948-0.982], p&lt;0.001) was significantly associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure, eGFR and serum sodium level. Patients with lower mBMI (&lt;median value=75.4) had an increased risk of CVD than those with higher mBMI (≥75.4) in all three subgroups (HFrEF: 43% vs 21%, p=0.013, HFmrEF; 32% vs 11%, p=0.025, HFpEF: 41% vs 12%, p=0.008). Conclusion: Modified BMI at the discharge might be better prognostic marker than that on admission and provides long-term prognostic information in patients admitted for ADHF, regardless of reduced, mildly-reduced or preserved left ventricular ejection fraction.
Abstract 300: An Opportunity for Awareness: The International Academy of Emergency Medical Dispatch's Stroke Diagnostic Tool is Predictive, but Underutilized, for Hospital Confirmed Large Vessel Occlusion Strokes
Authors: Codee Gorman, Christian Young, Eyobed Fanuel, Tiffany Familara, Derek Cox, DAVID SLATTERY
Journal: Circulation (2023)

Background: Accurate identification of ischemic stroke from large vessel occlusion (LVO) by 9-1-1 professionals can facilitate prompt patient transfer to stroke centers that perform endovascular thrombectomy. We sought to determine the proportion of LVO stroke patients that were evaluated using the Medical Priority Dispatch System's (MPDS) Stroke Diagnostic Tool (SDxT). Methods: Structured, retrospective review of our institution’s stroke registry, EMS Records, and dispatch codes between January 1, 2019 and November 30, 2022. Inclusion: Adult (age &gt;17), accessed the 9-1-1 system and transported by a ground EMS agency for an acute stroke. Exclusion: age &lt;18, pregnant, incarcerated, cases with missing 9-1-1 data, and intracranial hemorrhage. Two trained/monitored abstractors, blinded to the study purpose, used a standardized data collection tool/dictionary to extract data. Data included MPDS codes, SDxT outcome, EMS care, demographics, hospital NIHSS score, advanced imaging, tPA administration, and mechanical thrombectomy. Primary outcome: the proportion of LVO cases that had an acute stroke (28 protocol) dispatch code. Secondary outcome: the proportion of LVO cases that that a SDxT score indicating “strong or clear evidence of a stroke”. We report proportions and 95% CI's as appropriate. Results: 60 patients met inclusion/exclusion criteria. 11/60, 18.3 % (95%CI= 10.4, 30) of the patients had complete data and a LVO. 54% were male, the median (IQR) age was 69.5 (61.3-77.5), and the median (IQR) NIHSS was 16 (5-19.75). Primary outcome: 45.5 % (95% CI= 21.3.72.0) of the LVO’s were coded as an Acute Stroke by the 9-1-1 center. Of those, 3/5 utilized the stroke diagnostic tool, all 3 of these were determined to have "Clear Evidence of Stroke". Limitations: Retrospective, unlinked data, small number of LVO's. Conclusion: When utilized, the SDxT correctly identified all LVO’s. There is an opportunity to increase awareness and utilization of the SDxT by 9-1-1 centers. Future research should focus on identifying barriers to stroke recognition and provide additional tools to address the real-life challenges our 9-1-1 communications specialists face when rapidly assessing for an acute stroke over the phone.
Abstract 187: Diabetes is Associated With Mortality Among Comatose Survivors of Cardiac Arrest but Does Not Interact With Blood-Pressure Targets
Authors: Jakob Josiassen, Rasmus Paulin Beske, henrik Schmidt, Jesper Kjaergaard, Jacob Moller, Christian Hassager
Journal: Circulation (2023)

Introduction: The prevalence of diabetes (DM) is increasing and associated with cardiovascular morbidity and mortality. Whether patients with DM may benefit from other treatment targets after cardiac arrest remain sparsely described. Aim: This study aimed to assess blood-pressure targets among patients with and without DM successfully resuscitated from out-of-hospital cardiac arrest (OHCA). Methods: In a large double-blind RCT, a mean arterial blood-pressure (MAP) of 63 mmHg (Low) vs 77 mmHg (High) was targeted among OHCA patients with a presumed cardiac cause. Patients were stratified according to DM and the primary endpoint was all-cause 365-day mortality. In addition, a Cox regression model with DM and treatment allocation interaction was used and adjustment for age and sex was additionally performed. Results: A total of 789 patients were included of which 110 (14 %) had DM. The DM patients were older (median 67 vs 63 years) and had more comorbidities including hypertension (75 vs 41 %) and ischemic heart disease (31 vs 20 %) p&lt;0.05 for all. The DM and non-DM patients showed similar characteristics with regards to prehospital management including bystander CPR (87 vs 88 %), time to advanced life support (median 7 vs 7 min), shockable rhythm (87 vs 90 %) and time to ROSC (median 19 vs 18 min), p NS for all. Upon hospital arrival the DM patients presented with higher lactate (median 6.7 vs 4.6 mmol/L p&lt;0.001) and higher blood glucose (median 17.4 vs 12.8 mmol/L p&lt;0.001). An increased 365-day mortality was observed among DM patients, Figure. Adjusted p=0,07. In the Cox model no modifying effect of the MAP targets was observed (p DM x MAP =0.24). Hazard ratio CI 95 % High vs Low for DM 0.81 [0.46;1.44], p= 0.48 and non DM 1.18 [0.91;1.53], p= 0.21. Upon adjustment (p DM x MAP =0.27). Conclusion: Diabetes was associated with mortality among OHCA patients which was partly driven by age. No difference was however observed whether a MAP of 63 mmHg or 77 mmHg was targeted.
Abstract 18895: Myocardial Injury After Non-Cardiac Surgery (MINS) in the High Sensitivity Troponin Era: Current Trends of Preoperative Risk Stratification in a Large Urban Healthcare System
Authors: Brototo Deb, Luke Lawrence, Jose Vargas, Allen J Taylor, Monvadi Srichai-Parsia
Journal: Circulation (2023)

Introduction: Myocardial Injury after Non-Cardiac Surgery (MINS) is a significant cause of perioperative morbidity and mortality. Recognizing and understanding the patient characteristics and potential predictors of MINS can contribute to more effective patient risk stratification and management. Hypothesis: Certain preoperative risk factors are associated with a higher risk of developing MINS among patients undergoing noncardiac surgery. Methods: We retrospectively reviewed the data on 2458 noncardiac surgeries performed within the MedStar System between 2022-2023 in which patients underwent routine pre- and postoperative high sensitivity troponin I (hsTnI) and EKG monitoring over 72 hours. MINS was defined as any elevation in hsTnI &gt;99 th percentile for gender (&gt;34 ng/L: females, &gt;53 ng/L :males). Multivariable logistic regression models were used to identify the factors associated with MINS which included demographics, surgical details, comorbidities, relevant preoperative labs and vitals. Results: Out of the 2,458 patients, 889 (36%) were diagnosed with MINS. Patients with MINS were older, nonsmokers, and females with prior congestive heart failure (CHF), coronary artery disease (CAD), chronic kidney disease (CKD), atrial fibrillation, and preoperatively lower blood pressure and higher creatinine compared to patients without MINS (Table 1). In multivariable adjusted models, CHF [aOR=1.6, 95%CI: (1.1, 2.3)], CAD [aOR=2.1(14, 2.9)], CKD [aOR=1.4(1.2, 1.8)] were associated with higher odds of developing MINS. RCRI score was not associated with postop MINS. Figure 1 shows rates of developing MINS among surgical specialties. Conclusions: Our study demonstrates that risk factors including age, gender, pre-existing cardiovascular and renal disease, preoperative blood pressure, and certain surgery types are associated with MINS. Research is needed to further define how to utilize this information to identify and minimize the risk of MINS.
Abstract 17456: Inositol 1,4,5-Trisphosphate Receptors (ITP3Rs) and Activation of Cardiac Fibroblasts in Ischemia/Reperfusion Injury
Authors: Urna Kansakar, Stanislovas S Jankauskas, Jessica Gambardella, Fahimeh Varzideh, Xujun Wang, Gaetano Santulli
Journal: Circulation (2023)

Introduction: Inositol 1,4,5-trisphosphate receptors (ITP3Rs) are Ca 2+ release channels on the endoplasmic reticulum (ER). The role of ITP3Rs in cardiomyocytes has been previously investigated for hypertrophy and arrhythmias, however, the exact function in the activation of cardiac fibroblasts (FBs) is yet to be determined. The main goal of this project is to investigate the mechanisms linking FB ITP3Rs to post-ischemia/reperfusion (I/R) cardiac fibrosis. Hypothesis: We hypothesize that ITP3Rs activate FB via a direct transcriptional regulation of αSMA and other genes involved in myoFB activation. Indeed, myoFB differentiation and persistence is regulated by a balance between pro-and anti-apoptotic signaling pathways. Methods: We generated myoFB-specific ITP3Rs KO mice (ITP3R KO ) and isolated FBs as well as cardiomyocytes via collagenase digestion and performed immunoprecipitation (IP) assays showing that ITP3Rs bind p53 upregulated modulator of apoptosis (PUMA). Cytosolic levels of Cytochrome C (Cyt C) were assessed in myoFB isolated from areas remote from injury and scar areas 7 d after I/R. After having immunoprecipitated for ITP3R1 we blotted the isolated FBs for PUMA and, vice versa. PUMA levels were measured in cytosol, ER, and mitochondria of FBs isolated from regions remote from injury and scar areas 7 d post I/R. Results: Our data show reduced levels of cytosolic Cyt C following I/R, which was prevented by IP3Rs ablation, providing an explanation for the persistence of myoFBs in remote areas. We found that the mitochondrial expression of PUMA was significantly decreased - while ER levels were markedly increased - in myoFBs isolated from areas remote from I/R injury, indicating a sequestration of PUMA by ITP3Rs; this phenotype was rescued by ITP3Rs ablation. Instead, in myoFBs isolated from the scar areas, mitochondrial PUMA levels were increased both in ITP3R fl/fl and ITP3R KO mice, and no sequestration was observed, consistent with the absence of ITP3R upregulation. Conclusions: Using a specific Cre/lox KO model, we provide the first assessment of functional contribution of ITP3R to post-I/R activation of cardiac FBs and understanding the molecular mechanisms underlying excessive reactive fibrosis in the heart.
Abstract 14595: Leveraging Deep Learning to Elucidate Subclinical Aortic Stenosis Risk
Authors: Shinwan Kany, Joel Rämö, Cody Hou, Sean J Jurgens, Victor Nauffal, Jonathan Cunningham, Emily Lau, Atul Butte, Jennifer E Ho, Jeffrey Olgin, Sammy Elmariah, Mark E Lindsay, Patrick T Ellinor, James Pirruccello
Journal: Circulation (2023)

Background and Aims: Aortic stenosis (AS) is associated with a high global burden of morbidity. Current guidelines do not fully define normal aortic valve (AV) function or mild AS. We aimed to study normal variation in AV function and address current gaps in knowledge. Methods: We developed a deep learning model to study velocity-encoded magnetic resonance imaging (MRI) in 47,223 UK Biobank participants. We calculated aortic valve area (AVA), peak velocity (PV), and mean gradient (MG). Results: In healthy individuals, we found an annual decrement of 0.03 cm2 in AVA. Normal variation in AV function was predictive of future AV surgery (HR 2.4 per SD increase in PV, P2.6E-110), heart failure (HR 1.23 per SD, P=2.4E-07), and coronary disease (HR 1.23 per SD, P=2.0E-14). Risk was still elevated when excluding participants with moderate-to-severe AS. We determined thresholds for abnormal AV function as being &gt;95% for all age groups in 31,909 healthy people. This established the boundary between normal variation and mild AS as any of: PV &gt;1.65m/s, MG &gt;4.9mmHg, and AVA &lt;2.1cm2 (men) or &lt;1.7cms2 (women). A total of 3,288 participants (7.0%) met the definition of mild AS which was associated with high risk for AV surgery (HR 57.2, P=4.4E-29). Over a mean 3.1±2.0 years of follow-up, the incidence of AV surgery was 0.02% in those with normal AV function and nearly 20% among participants with MG ≥10mmHg. Greater levels of ApoB, triglycerides, Lp(a), and inflammatory markers were associated with higher AV gradients. Conclusion: In this study, we report the largest analysis of AV function and cardiovascular disease in the general population with MRI using deep learning. We propose thresholds to define the lower bounds of mild AS and demonstrate a step change in cardiovascular risk between normal AV function and mild AS. Atherogenic and inflammatory biomarkers were associated with increased AV gradients. These findings may inform earlier surveillance and efforts to prevent complications of AS.
Abstract 17003: Associations of SGLT2 Inhibitor-Related Plasma Proteins With Incident Heart Failure: The Atherosclerosis Risk in Communities Study
Authors: Leo Buckley, Victoria Lamberson, Pranav Dorbala, Bing Yu, Brian Claggett, Josef Coresh, Morgan Grams, Weihong Tang, Christie M Ballantyne, Ron C Hoogeveen, Brandon Lennep, Michael Bancks, Patricia Chang, Amil M Shah
Journal: Circulation (2023)

Introduction: The mechanisms by which SGLT2 inhibitors reduce heart failure (HF) hospitalization is unclear. Data from EMPEROR-Reduced and two pilot clinical trials identified 288 plasma proteins modifiable by SGLT2 inhibitors. Methods: Among participants in the community-based ARIC study who were free of HF and had aptamer-based proteomic measurements (SomaLogic, Boulder, CO) at Visit 2 (mid-life, n=10,983; 1991-1993) and Visit 5 (late-life, n=4,321; 2011-2013), we studied the association of these 288 SGLT2 inhibitor-related proteins with incident HF after Visit 2 (1149 incident HF events) and Visit 5 (453 events) using multivariable Cox proportional hazards regression models, cardiometabolic traits using multivariable linear regression and Mendelian randomization to assess for potential causal effects. Results: The mean age was at 57±6 at Visit 2 and 76±5 at Visit 5 and 55% were women. Of 288 plasma proteins reported to be modulated by SGLT2 inhibition, 39 associated with incident HF after both Visit 2 and Visit 5: 24 with HFpEF [LVEF&gt;50%], 2 with HFrEF, and 8 with both ( Figure ). These proteins also associated with plasma glucose levels, hematocrit and urine albumin-to-creatinine ratio and were enriched with immune signaling pathways and the fatty acid binding pathway. Two sample Mendelian randomization suggested causal effects of higher IGFBP1, lower CHRDL1 and higher B2M on higher incident HF risk (P&lt;0.05). Conclusions: Proteins impacted by SGLT2 inhibition and associated with risk of HF suggest glucose metabolism, erythropoiesis and kidney damage as potential contributors to the effect of SGLT2 inhibitors on HF outcomes.
Abstract 12610: Outcomes of Patients With Cancer and Acute Myocardial Infarction-Associated Cardiogenic Shock Managed With Temporary Mechanical Circulatory Support
Authors: Orly Leiva, Eric H Yang, Richard K Cheng, Sunil Pauwaa, Jason N Katz, Jose Alvarez-Cardona, Samuel Bernard, Carlos L Alviar
Journal: Circulation (2023)

Introduction: Cardiogenic shock (CS) is a leading cause of in-hospital death among patients with acute myocardial infarction (AMI). Temporary mechanical circulatory support (tMCS) is used in AMI-CS and may improve end-organ perfusion at the risk of bleeding/thrombosis. Patients with cancer are at high risk of AMI and CS and are at risk of bleeding and thrombosis. However, there is limited data on the outcomes of patients with cancer and AMI-CS managed with tMCS. Methods: Adult patients with AMI-CS managed with tMCS from January 2006 to December 2018 with and without cancer were identified within the National Inpatient Sample. Propensity score matching (PSM) was performed to match 1 cancer patient to 10 non-cancer controls. Primary outcome was in-hospital death and secondary outcomes were major bleeding and thrombotic complications. Temporal trends of tMCS use in cancer patients were investigated. Results: Patient characteristics after PSM are described in Table. After PSM, 1,287 individuals with and 12,870 without cancer were included. Patient characteristics were well-balanced between cancer and non-cancer groups after PSM. After PSM, there was no difference in death (OR 1.00, 95% CI 0.88 - 1.13) or thrombotic complications (OR 1.10, 95% CI 0.91 - 1.34) between patients with and without cancer. Patients with cancer had higher risk of major bleeding (OR 1.29, 95% CI 1.15 - 1.46). Conclusions: Among patients hospitalized for AMI-CS managed with tMCS, cancer was associated with increased major bleeding but similar mortality and thrombotic risk. Future investigation is needed in order to further characterize and improve outcomes for this increasingly common patient population.
Abstract 15148: How Reassuring is an Initial Echocardiogram With Normal Coronary Arteries for Patients Presenting With Acute Kawasaki Disease?
Authors: Michael Khoury, Jennifer A Nelson, Simon Lee, Michael A Portman, Angela T Yetman, Nagib Dahdah, Nilanjana Misra, Todd Nowlen, Pei-Ni Jone, Marianna Fabi, Seda S Tierney, Elisa Fernandez-Cooke, Matthew Elias, Daniel Mauriello, Frederic Dallaire, Kambiz Norozi, Paul Dancey, Pedrom Farid, Cedric Manlhiot, Brian W McCrindle
Journal: Circulation (2023)

Background: We sought to determine the utility of current echocardiography surveillance recommendations for coronary artery (CA) involvement for children with Kawasaki disease (KD) with normal baseline studies. Methods: The International KD Registry enrolled 1200 patients (36 sites, 7 countries) with a site diagnosis of KD from 01/2020 to 01/2023; 139 with positive/possible COVID-19 infection/exposure and 174 with no echo within 10 days of admission were excluded, leaving 887 patients for analysis of results of serial echos and associated factors. Results: An initial echo was performed within 5 days of admission for 96% and within 10 days of symptom onset for 83% of patients; the max Z score in any CA branch at initial echo was normal (Z &lt;2) 78.9%, dilation (Z 2-&lt;2.5) 6.6%, small aneurysm (CAA; Z 2.5-&lt;5) 10.5%, medium CAA (Z 5-&lt;10) 2.9% and large CAA (Z ≥10) for 1.2% of patients. Higher CA Z score/Z score category were both significantly related to greater time from symptom onset to echo (p&lt;0.001). For those with initial normal CAs, a second echo (median of 16 days after admission) was normal for 94.2%, dilation 1.9%, small CAA 2.7%, medium CAA 0.6%, and large CAA for 0.6%. For those with 2 normal echos, a third echo (median of 44 days after admission) was normal for 97.6%, dilation 1.4%, small CAA 0.5%, and 1 patient each with medium and large CAA. Additionally, after up to 6 normal echos, 3 patients had developed small CAA, 1 medium and 1 large CAA. Overall, a total of 24 (2.8%) patients had large CAA (13 admitted &gt;10 days after symptom onset). Of these, 10 had large CAA evident at initial echo performed at day 0-3 after admission, 9 had lesser involvement at initial echo that then progressed to large CAA, and 5 had normal initial and subsequent echos and then were noted to have large CAA at an echo performed 14, 17, 21, 23 and 53 days after admission (the patient with a large CAA first detected at 53 days had no interim echos performed since their first normal echo). Conclusions: Current recommendations for serial echo assessment are effective in detecting all patients with large CAA. For rare patients, despite a normal initial echo large CAA may nonetheless develop. Additionally, important CA involvement may be evident at presentation (often delayed presentation), precluding prevention.
Abstract 14051: The Associations Between Loneliness and Circulating Lipoproteins as Well as Diabetes Risk in African-American Women Residing in Resource-Limited Neighborhoods: Data From the Step It Up Physical Activity Intervention
Authors: Sandy Reynolds, Yvonne Baumer, Ayushi Dave, Manuel Cintron, Hannatu Tarfa, Mario Pita, Lola Ortiz-Whittingham, Kameswari Potharaju, Andrew Baez, Keitra Thompson, Foster Osei Baah, Colby Ayers, Sam Neally, Kaveri Curlin, Nithya Vijayakumar, Valerie Mitchell, Marie Marah, Billy Collins, Abhinav Saurabh, Maureen Sampson, Alan Remaley, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Background: Loneliness is a public health crisis and recent reports suggest that people suffering from loneliness have increased cardiovascular disease (CVD) risk. A potential link between loneliness and CVD is an atherogenic shift in the lipoprotein profile. We investigated associations between loneliness and lipoproteins in African American (AA) women residing in resource-limited neighborhoods of Washington, DC. Methods: Participants were enrolled in Step It Up, a technology-based, community-engaged PA intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using nuclear magnetic resonance (NMR) technology. The Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker, was calculated. Loneliness was measured using the UCLA Loneliness scale. Associations between loneliness, lipoprotein particles and LP-IR were analyzed using multivariable regression adjusted for BMI, ASCVD 10-year risk score, and lipid-lowering therapy. Results: 106 AA women with CVD risk (Age 55.9±13, BMI 36.3±6.7) were enrolled into Step It Up. We found that higher loneliness at baseline was associated with higher Apo-B, LDL concentration (LDL-c), and LDL particle number (LDL-p) but not with LDL particle size (LDL-z, Table). We observed that higher loneliness associated with increased triglyceride rich lipoprotein size (TRL-z). This relationship seems to be due to very large and large TRL particles (TRL-p, Table). No significant associations were found with the HDL-related measures. Lastly, loneliness significantly associated with LP-IR, a new diabetes risk marker (Table). Conclusions: Thus, our data show that higher loneliness in AA women from under resourced neighborhoods is associated with increased hyperlipidemia and diabetes risk. This highlights a potential mechanism by which loneliness may accelerate CVD risk and support the urgent need for multilevel interventions to reduce loneliness and CVD risk in at-risk populations.