tbuckley/cabot-search huggingface dataset:
Abstract 4147680: Epidemiology of Disease State Transitions Among Patients with New-Onset Heart Failure with Preserved Ejection Fraction
Authors: Neil Keshvani, Shireen Rabiei, Kayla Tao, Or Shimoni, Ambarish Pandey
Journal: Circulation (2024)

Introduction: The presentation of new-onset HFpEF varies among older adults, from progressive exercise intolerance in outpatients to acute HF hospitalization (HFH). The natural history of HFpEF based on its clinical presentation at the time of diagnosis (outpatient vs. HFH) is not well-characterized. Methods: Patients with new-onset HFpEF were identified in the Optum database from 2016-2022. Patients were grouped into 4 strata based on their clinical presentation at time of diagnosis (outpatient vs. HFH) and subsequent transition in disease state (subsequent HFH, yes vs. no). The predictors of progression in disease state (outpatient to first HFH to repeat HFH) and risk of mortality associated with each disease state transition were assessed using adjusted Cox models. Results: 99,370 patients (age 73.5y, 11.2% Black) were included, of which 38.6% were outpatient-diagnosed and 41.4% following an HFH. Patients with HFH-based HFpEF diagnosis (vs. outpatient) were younger, had lower burden of comorbidities, and had earlier follow-up with PCP or HF cardiologist following diagnosis (12 [IQR 4-59] vs.15 [4-72] days; p &lt;0.001). 42.6% of outpatient-diagnosed HFpEF progressed to a subsequent HFH event, while 55.3% with HFH-based HFpEF diagnosis had a subsequent HFH (median time to event: 363 days[IQR 106-790] vs. 162 [IQR 34-505]days, p&lt;0.001). In adjusted analyses, patients with outpatient diagnosis without subsequent HFH had the highest 12-month survival (88%), followed by inpatient-diagnosed patients with HFH (82%). Patients with HFH-based HFpEF diagnosis without subsequent HFH had the lowest 12-month survival (74%, Table ). Significant predictors of HFH in the outpatient-diagnosed group included older age, worse kidney disease, and prior right heart cath. Significant predictors of rehospitalization included older age, higher blood pressure, obesity, worse kidney disease, and prior PCI ( Table ). Conclusion: 1/3 rd of patients with HFpEF are outpatient-diagnosed, of which 42% progress to have an HFH within 1 year of diagnosis. Progressive disease state transitions from an outpatient setting to HFH is more common among older patients with a higher burden of comorbidities and is associated with a higher risk of mortality.
Abstract Sa705: Knowledge and Perceptions of Hands-Only Cardiopulmonary Resuscitations in Chinese Americans Who Speak Mandarin as a First Language
Authors: Ethan Wang, Jasmine Jiang, Lyric Li, Alexis Chase, Sarah Perman, David Yang
Journal: Circulation (2024)

Introduction: Bystander Cardiopulmonary Resuscitation (CPR) is crucial to the survival of out of hospital cardiac arrest (OHCA) patients, but only 40.2% received bystander CPR in 2023. Asian Americans are less likely to receive bystander CPR in witnessed OHCA versus Non-Hispanic Whites. Existing literature identifies language comprehension as one barrier. For Mandarin speaking populations, there has been a demonstrated need for CPR education but a paucity of research regarding the effect of Mandarin language CPR classes. Our project hopes to fill this need and research gap. Hypothesis: Teaching CPR in Mandarin will improve CPR knowledge and perception in Mandarin speakers, including willingness to perform CPR. Methods: This pre- and post-test cohort study included 40 parents of students at a Chinese language school. First, pre-surveys were administered, collecting demographics, perceptions, and knowledge. There was a presentation of Hands-Only CPR and Automated External Defibrillator (AED) by native Mandarin speakers, a video and live demonstration on a CPR manikin, and then small group practice. Participants filled out a post-survey and were tested on CPR/AED usage by trained CPR instructors. This pilot analysis provides describe data of our results. Results: Of the 40 participants who completed the course, 37 completed both pre- and post-surveys. Of these, 26 (70%) were female, none were native English speakers, 32 (86%) have never learned CPR. Additional demographics are provided in Table 1. There was an improvement in knowledge related to CPR after the hands-only CPR course. Most were willing to perform CPR on those they knew (94%) and strangers (86%) post- course. There was an increase in agreement (from disagree to neutral) for all positive perception questions except for comfort speaking in Chinese with 911 operators. There was also a decrease in agreement for all negative perception questions. Further data is provided in Table 2 and 3. In the final proctored assessment, 36/37 participants passed (one did not participate). Conclusion: This novel, proof-of-concept study shows that our Mandarin-language CPR class positively improved knowledge and perceptions related to CPR in both written and performance assessments. Our findings align with existing literature and addresses a critical gap in improving bystander CPR rates. We plan to conduct additional classes with Mandarin-speaking community members and expand this class to other Asian subgroups.
Abstract 4147496: Lack of CD8 T Cells impacts cerebral perfusion and cognitive function without altering cerebral vascular reactivity
Authors: Jacopo Pacella, Fabio Pallante, Valentina Fardella, Agnese Migliaccio, Daniela Carnevale, Giuseppe Lembo, Lorenzo Carnevale
Journal: Circulation (2024)

It is well known the role of CD8 T cells in the onset hypertension and associated injury. We and others have recently shown the role of CD8 in hypertensive cerebral vascular damage, mediated by the secretion of interferon gamma leading to capillary rarefaction in both cortex and white matter and loss of cognitive functions. Thus, our aim was to explore whether CD8 can exert a physiological role in the cerebral vasculature in absence of any cardiovascular challenge. We assessed advanced neuroimaging and behavioural phenotyping in mice lacking CD8 T cells (CD8 KO) and matched wildtype controls (CD8 WT). We performed perfusion imaging of the brain by 7T MRI to evaluate the cerebral blood flow, Morris water maze (MWM) test and Novel Object Recognition (NOR) to evaluate learning and memory function. The reactivity of the middle cerebral artery (MCA) was also analyzed by pressure myography. CD8 KO showed a slight but significant hypoperfusion in the cerebral cortex (Figure A, ANOVA F on genotype effect F=13.58, p=0.0042), paired with a slower learning capability shown at MWM (Figure B, ANOVA F on genotype effect F=8.561, p=0.0104), and worse recognition capabilities at NOR (Figure C, t=2.537, p=0.0442). To understand whether the impact of CD8 cells on CBF was associated with abnormal cerebral vascular tone we evaluated MCA myogenic tone, evidencing no differences between CD8 WT and KO mice (Figure D). Our results shown that the presence of CD8 T cells is crucial for an adequate cerebral perfusion and such a condition realizes a cognitive dysfunction. This phenotype is independent of any cardiovascular challenge and of alteration of cerebral myogenic tone.
Abstract 4147077: Early Reported Events with the TriClip™ System for Transcatheter Tricuspid Valve Repair: Insights from FDA's MAUDE Database
Authors: Tejasvini Khanna, Pragyat Futela, Kannu Bansal, Arka Chatterjee
Journal: Circulation (2024)

Background: Tricuspid regurgitation (TR) worsens heart failure symptoms and perpetuates right ventricular failure (RVF). Given the limited efficacy of medicines and high risk of surgical mortality, percutaneous therapeutic options are gaining importance. The TRILUMINATE study reported an 86% reduction in TR severity and 4% mortality rate using Triclip G4 tricuspid transcatheter edge-to-edge repair (T-TEER) system with improvement in health status. Triclip subsequently gained FDA approval for TR on April 2, 2024. Objective: To evaluate reported device and patient related adverse events during early experience with Triclip system for T-TEER. Methods: The events reported for Triclip since it gained FDA approval were extracted from the FDA MAUDE database. Previously published reports, duplicates and events before FDA approval were excluded. Grades of TR at baseline and after T-TEER associated with single leaflet device attachment (SLDA) were compared using Wilcoxon rank sum test. Results: After excluding 14 reports, 45 were included, dating from 04/02/24 to 05/31/24. Of these, 31 (67.4%) featured patient complications, with SLDA being the most frequent (n=24, 53%).(Figure-1) Cause of SLDA was reported in 8 reports.(Figure-2) SLDA led to regression of TR to pre-procedure levels in 10 patients and Polymorphic VT in one patient. Other patient issues included damage to leaflets (n=7, 15.6%) which necessitated surgery in one case and prompted consideration of the same in another. There were 4 reports of clip entrapment in the chordae. Device-related issues included 3 cases of leaks in the steerable guide catheter affecting its ability to hold the column, knotting on the lock line, difficulties with positioning the second clip above the valve, clip reopening beyond the expected 5°, clip opening while locked but staying closed post-deployment, delays in clip delivery, and challengers in guiding catheter positioning. No acute deaths were reported in the MAUDE database within 2 months of device approval. Conclusion: Our research findings summarize the reported adverse events during the early period following FDA approval of Triclip G4 T-TEER system. This provides valuable insights into common failure modes and complications, offering guidance on their optimal utilization. Multiple adverse events can be noted soon after approval of the Triclip, underscoring the importance of good initial training and proctoring.
Abstract 4147578: Temporal Trends in Stroke-related Mortality in Canada Over the Past 30 Years
Authors: Ahmad Alayyat, Zaid Abdulelah, Ahmed Abdulelah, Mansoor Rahman, Dua' Al-Husni, Ahmad damlakhy, Hussein abdulelah, Jesus Diaz, Kais Al Balbissi
Journal: Circulation (2024)

Introduction: Stroke is among the leading global health burdens worldwide due to the resultant morbidity and mortality. Accordingly, thorough evaluation of the temporal trends in stroke-related mortality in Canada is mandatory to effectively tackle the associated global and socioeconomic burden. Research Question: Are there temporal trends in stroke-related mortality in Canada during the last 3 decades? Aim: To evaluate the temporal trends in stroke-related mortality in Canada over the past 3 decades. Methods: Mortality trends of stroke in Canada have been evaluated by initially retrieving data from Global Burden of Diseases 2019 database. JoinPoint Analysis software was utilized to calculate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC). Results: There was a total of 1,269,854 stroke-related death reported during the period of 1990-2019. There is an overall decline in stroke-related death, with females displaying a higher decline in mortality from 1990 to 2019 with AAPC of -1.00 (95%CI: - 1.04 to -0.96; p&lt;0.001) than males (AAPC -0.68 95%CI: -0.73 to -0.62; p&lt;0.001). Additionally. There is a declining mortality among all age groups, most significantly in the group of 50-74 years of age (AAPC -1.23, 95%CI: -1.31 to -1.15; p&lt;0.001) followed by the 75 years and older age group (AAPC -1.20, 95%CI: -1.27 to -1.12; p&lt;0.001), while the group of the 15-49 year old had the smallest decrease in mortality (AAPC - 0.97, 95%CI: -1.16 to -0.72; p&lt;0.001). Conclusion: A noticeable decline in the stroke-related mortality across both genders and all age groups in Canada has been demonstrated across the past 30 years. Comparison of these trends with other international and global trends is warranted to identify the factors associated with this decline.
Abstract 4147508: Targeting Angiotensin II Type 2 Receptor Skeletal Muscle Stem Cells to Prevent Skeletal Muscle Atrophy and Fibrosis in Congestive Heart Failure
Authors: Tadashi Yoshida, C. Lott, Patrice Delafontaine
Journal: Circulation (2024)

Introduction: We have previously shown that angiotensin II (Ang II) type 2 receptor (AT2R) positively regulates skeletal muscle stem cell (MuSC) differentiation. Systemic angiotensin II (Ang II) increase or congestive heart failure (CHF) suppress AT2R expression, likely contributing to the development of skeletal muscle atrophy and fibrosis associated with these conditions. Hypothesis: We hypothesized that AT2R overexpression in MuSCs could prevent skeletal muscle atrophy and fibrosis associated with CHF. Approach: Two mouse models, systemic Ang II infusion and left anterior descending coronary artery (LAD) ligation were used in this study. MuSC differentiation, muscle atrophy and muscle fibrosis were assessed by analyzing gene expressions (e.g. myogenin and atrogin-1), myofiber cross sectional area, and the collagen deposition (Collagen I immunohistochemical staining and picrosirius red staining). Primary MuSCs were isolated from mouse hindlimb muscles. MuSC-specific AT2R-overexpressing transgenic mice were generated by crossing Pax7 CreER/+ mice (tamoxifen-inducible cre recombinase is expressed under Pax7 promoter) and CAG-stop flox -AT2R mice (AT2R is expressed under CMV early enhancer element, chicken β-actin gene promoter upon cre-mediated excision of floxed stop codon). Results: AT2R expression was robustly increased during MuSC differentiation both in vitro and in vivo . In both Ang II infusion and LAD ligation models, AT2R induction in MuSCs was significantly suppressed, associated with reduced muscle regeneration and increased atrophy and fibrosis. Consistently, AT2R knockdown significantly suppressed MuSC differentiation in vitro and skeletal muscle regeneration in vivo , leading to increased skeletal muscle fibrosis. Restoring AT2R levels via MuSC-specific AT2R overexpression in vivo increased muscle regenerative capacity (increased regenerative marker expressions), reduced muscle atrophy (reduced atrophy markers and increased myofiber cross sectional area) and fibrosis (decreased collagen) in CHF models. Conclusions: AT2R induction in MuSC is suppressed in CHF, possibly via increased Ang II. Decreased AT2R expression and its downstream signaling in MuSC lead to lowered muscle regenerative capacity and increased muscle atrophy and fibrosis. AT2R overexpression in MuSCs restores their regenerative potential, and prevent muscle atrophy and fibrosis in CHF condition.
Abstract 4147436: Cardiac Sarcoma Mimicking as Rheumatic Mitral Disease
Authors: Sri Sai Kaumudi Chirumamilla, Hartzell Schaff, Mackram Eleid, Sorin Pislaru
Journal: Circulation (2024)

Description of Case: A 40-year-old woman presented with a 3-month history of dyspnea. A murmur was found on examination. Echocardiography reported moderate mitral stenosis and regurgitation with diffuse thickening and calcification of the anterior mitral leaflet (Fig1.A), thought to be due to rheumatic disease. She had runs of supraventricular tachycardias not controlled with diltiazem. Her dyspnea progressively worsened; transesophageal echocardiography(TEE) showed severe mitral stenosis and mitral regurgitation (mean gradient 18 mmHg; Fig1.B) with a dense CW Doppler (Fig 1.C) and a mass on left atrial free wall. Cardiac MRI revealed diffuse left atrial thickening with delayed enhancement of the left atrium, left atrial appendage, and extending into the right upper and left inferior pulmonary veins. The mass was initially suspected to be a thrombus. She was placed on rivaroxaban and scheduled to undergo mitral valve replacement. When she presented to our emergency department with dizziness she was found to have paroxysmal atrial fibrillation and pulmonary embolism. On admission she had an intermittent opening snap and a 1/6 mid-diastolic rumble with a 2/6 holosystolic murmur at the apex. Work-up for infectious disease and antiphospholipid syndrome was negative. NT-proBNP was mildly elevated. At surgery the mass invaded the mitral valve and the anterior, septal, and superior part of the left atrial lateral wall and could only be partially excised (Fig1.D). Pathology showed high-grade undifferentiated pleomorphic cardiac sarcoma. Discussion: This case highlights the diagnostic challenges associated with primary cardiac tumors masquerading as valvular pathology. The presentation included dyspnea, typical auscultation of mitral stenosis and features of stenosis on echocardiography. Presumptive diagnoses included rheumatic heart disease, calcific degeneration, infective endocarditis, and autoimmune processes; the atrial mass was initially thought to be a thrombus. A thorough, multidisciplinary approach to diagnosis, utilizing multimodality imaging techniques and ultimately tissue biopsy were required to make the correct diagnosis. Maintaining a broad differential when dealing with valvular masses is key, since relying solely on imaging findings may not suffice for definitive tissue diagnosis.
Abstract Sa901: In-Hospital Cardiac Arrest After Cardiac Surgery: Incidence, Prognostic Features, and Outcomes at a Single Institution From 2011-2024
Authors: James Goodman, Vikram Fielding-Singh, Melissa Vogelsong
Journal: Circulation (2024)

Introduction: In the United States, the incidence of in-hospital cardiac arrest (IHCA) ranges from 0.1-0.5% and most larger studies report about 20% of patients survive to hospital discharge. IHCA after cardiac surgery is unique because patients are often monitored closely and arrest etiologies are frequently reversible. This may contribute to improved survival, however current data on cardiac arrest outcomes that reflect the rapidly evolving landscape of cardiac surgery and intensive care are lacking. Aims: To identify the incidence, prognostic features, and outcomes of cardiac arrest following cardiac surgery at a single high-volume academic center. Methods: We identified all adult (≥18 years) patients who underwent cardiac surgery and experienced in-hospital cardiac arrest at our institution from 2011-2024 in our local Society of Thoracic Surgery database. The primary outcome was the incidence of cardiac arrest after cardiac surgery. In an exploratory analysis, we fit a multivariable logistic regression for death before discharge, adjusting for variables noted in Tables 1 and 2. All analyses were performed in R (Version 2024.04.1+748). A p value &lt; .05 was considered significant. No adjustment for the family-wise error rate was made – all analyses should be considered hypothesis-generating. Results: Of 10,152 surgeries, 263 cases (2.6%) of postoperative cardiac arrest were identified. Survival to discharge occurred in 123 (50%) of cases. Median age was 67 (IQR 57-75) and 103 (39%) patients were female (Table 1). In adjusted analyses, death before discharge was significantly associated with use of extracorporeal membrane oxygenation (OR 3.52, CI 1.51-8.23, p=0.003), postoperative dialysis (OR 3.27, CI 1.57-6.77, p=0.001), pre-operative stroke (OR 2.28, CI 1.17-4.46, p=0.016), post-operative stroke (OR 3.01, CI 1.04-8.73, p=0.042), and age (OR 1.03, CI 1.01-1.05, p=0.016) (Figure 1). Survival to discharge was associated with placement of permanent pacing device (OR 0.30, CI 0.11-0.81, p=0.017). Conclusions: Incidence of IHCA after cardiac surgery is much higher than in the general inpatient population. However, survival to discharge is also common, suggesting that cardiac surgical patients have distinctly different outcomes after IHCA compared to other inpatient populations. In an exploratory analysis, we identified several factors associated with survival to hospital discharge after cardiac arrest which can be examined in future studies.
Abstract 4147375: Temporal Patterns in Atrial Fibrillation and Flutter Mortality 1999-2022: A Racial Comparative Analysis in the United States
Authors: Ziad Qadadeh, Bilawal Nadeem, Saeed Abughazaleh, Ahmad Al Nawaiseh, Dariush Jahandideh
Journal: Circulation (2024)

Background: Atrial fibrillation is the most common cardiac arrhythmia in the United States. It is a tachyarrhythmia characterized by irregular electrical impulses in the atria. It poses a significant risk of stroke and is a major concern in cardiovascular health. Understanding mortality trends related to AF across racial groups is crucial for guiding targeted treatment strategies, particularly for marginalized populations. Methods: Data were obtained from the CDC WONDER database. Age-adjusted mortality rates for atrial fibrillation and flutter between 1999-2022 were calculated relative to the standard US population. Time trends were assessed using annual percentage change (APC) and average APC (AAPC), employing Joinpoint Regression Software (version 8.4.2, NCI). Monte Carlo permutation analysis was utilized to determine the most parsimonious trend. Results: In 2022, atrial fibrillation and flutter caused 28,932 deaths in the United States. Analyzing mortality trends from 1999 to 2022 across all racial groups revealed a significant increase in the average annual percentage change (AAPC) of 3.6% (95% CI 3.1-4.2, p &lt;0.001), with mortality rates rising from 4.8 to 10.6 deaths per 100,000. Breakdown by race indicated AAPC increases of 4.0% among non-Hispanic whites, 3.9% among non-Hispanic blacks, and 3.7% among Hispanics. Among non-Hispanic whites, two distinct periods of change were observed: an APC of 4.9% (95% CI 4.5-5.4, p &lt;0.001) from 1999-2015 and an APC of 1.8% (95% CI 0.2-3.4, p &lt;0.001) from 2015-2022. For non-Hispanic blacks, the mortality trend remained uniform, with an APC of 3.9% from 1999-2022. Hispanics displayed two join points: an APC of 4.6% (95% CI 4.0-5.3, p &lt;0.001) from 1999-2016 and an APC of 1.1% (95% CI -2-4.3, p=0.5) from 2016-2022. Conclusion: In conclusion, our study highlights significant increases in mortality rates attributed to atrial fibrillation and flutter across all racial groups in the US from 1999 to 2022. Non-Hispanic whites exhibited a slowdown in the rate of increase between 2015 and 2022, contrasting with uniform trends among non-Hispanic blacks and fluctuating patterns among Hispanics. These findings emphasize the importance of tailored interventions to address racial disparities in mortality rates associated with atrial fibrillation and flutter, particularly targeting areas where trends deviate from the overall trajectory. Further research should explore the underlying cause for these observed disparities in outcome.