tbuckley/cabot-search huggingface dataset:
Abstract 4147453: Use of a Mobile Application and Improved Mental Health for Adults with Coronary Heart Disease: Results from the Mobile4Meds Randomized Clinical Trial
Authors: Linda Park, Abdelaziz Elnaggar, Thomas Hoffmann, Julia von Oppenfeld, Eileen Collins, Krishan Soni, Celina Yong, DAVID WINCHESTER, Nicole Minniefield, Mary Whooley
Journal: Circulation (2024)

Background: Adherence to cardiovascular medications is critical for avoid morbidity and mortality and may influence mental health. The use of text messaging (TM) or mobile applications (apps) for medication adherence may be supportive for mental health in patients with cardiovascular disease (CVD). Objective: This study sought to compare self-reported mental health (symptoms of depression, anxiety, and post-traumatic stress disorder) in participants of a 3-arm randomized clinical trial (RCT): 1) TM, 2) mobile app, 3) control groups. The primary goal of the parent study was to compare differences in antiplatelet medication based on group assignment. Methods: We analyzed data among Veteran and non-Veteran patients with CVD who were recruited from 4 Veterans Affairs (VA) and 2 non-VA Northern California medical centers from 2018 to 2022. Patients were followed at 3, 6, and 12 months. The variable of interest was change in self-reported mental health status after the mobile health intervention, which was measured from the 5-item mental health questions of the Short Form Survey (SF-20) questionnaire, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder scale (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL) through repeated measures. We used linear mixed models with predictor variables of group (with the control group as reference), time (baseline, 3, 6 months), and group-by-time interactions to detect group differences. Results: The mean age was 66.9 (SD 11), 49.5% female (N=99). Scores from the mental health questions of the SF-20 showed significant main effects of group-by-time interactions for the TM group at 3 and 6 months (B=11.89, standard error [SE]=4.84, p&lt;.05; B=10.91, SE=5.03, p&lt;.05, respectively), compared to the control group. The App group had significant group differences at 3 months (B=11.89, SE=5.29, p&lt;.05); however, effects did not remain at 6 months. No significant group differences were detected from the other questionnaires measuring mental health. Conclusions: The findings of this RCT present the potential for mobile technology to improve mental health status in patients who were recently discharged after a cardiac event from one scale; however, not corroborated by other questionnaires. Further intervention development and measurement in fully powered RCTs can illuminate the impact of technology to improve mental health status, as these patient-reported outcomes remain a major public health priority for individuals with CVD.
Abstract 4147249: Estimating Effects of Magnesium Supplement Use on Preventing Heart Failure in Diabetic Patients via Target Trial Emulation
Authors: Yan Cheng, Andrew Zullo, Ying Yin, Yijun Shao, Ali Ahmed, Simin Liu, Qing Zeng, Wen-Chih Wu
Journal: Circulation (2024)

Introduction: Magnesium (Mg) deficiency may increase the risk of heart failure (HF) in diabetic patients. Less is known about whether the use of Mg supplements is associated with a lower risk of HF in these patients. Research Questions: We emulated target trials to estimate the effects of Mg supplement use on preventing HF in diabetic patients. Methods: We analyzed data from the US Veterans Health Administration to identify eligible diabetic patients for a Mg supplement target trial from 01/01/2006 to 12/31/2020. Eligibility was checked at an outpatient visit with following criteria: 1) aged 40+ years, 2) free of outcomes, 3) had a HbA1C test in the past year, and 4) no prior Mg use. Mg supplement use was obtained by natural language processing of electronic health record. Mg supplement use was defined as use within 30 days of the eligible outpatient clinic visit. HF diagnosis was the primary outcome; Major adverse cardiac events (MACE), including death and HF hospitalization, was secondary outcome. Patients were followed up to 10 years until the outcome, censored due to no further Mg supplement use for Mg users or starting Mg supplement use for non-users, or receipt of a new Mg prescription. We used Inverse probability weighting to account for differences in baseline characteristics between Mg user and non-users. We conducted a Cox regression model on the weighted cohort to compare the effect of Mg Supplement use on outcomes. Results: A total of 94,239 patients were enrolled in the target trials (17,619 Mg users; mean age, 67.3 years; 4.9% females, 18.5% Blacks). The mean duration of Mg supplement use was 3.7±3.3 yrs. The incidence of HF was slightly lower in Mg users compared to non-users (16.9 vs. 17.9 events per 1000 person-years). Mg supplement use was associated with a lower risk of HF and MACE (Figure 1). Conclusion: Our study showed that long-term Mg supplementation was associated with a lower risk of HF and MACE in diabetic patients. The potential benefits of Mg supplement use should be further confirmed in a randomized-controlled trial.
Abstract Sa1007: Chest Compressions to the Left of the Sternum are Associated with Higher Systolic Blood Pressure than to the Lower Sternum
Authors: Kevin Frank, allison cohen, Ghania Haddad, Alaina Berruti, Timmy Li, Elizabeth Young, Lance Becker, Daniel Jafari, Daniel Rolston
Journal: Circulation (2024)

Introduction/Background: Despite over 60 years of cardiopulmonary resuscitation (CPR), there is a paucity of evidence assessing the optimal location to perform chest compressions during cardiac arrest. Some recent imaging studies with transesophageal echocardiography (TEE) and computed tomography (CT) show that the left ventricular outflow tract (LVOT) is often the site of maximum compression with CPR, if using the AHA recommended site of the lower half of the sternum. Research Questions/Hypothesis: We hypothesize that chest compressions performed to the left of the sternum, where the left ventricle is more likely to be located, will be associated with higher systolic blood pressure (SBP) than those performed at the AHA-recommended lower half of the sternum. Goals/Aims: Our primary aim was to compare the highest SBP, measured on a femoral arterial line, during a chest compression (CC) interval at the AHA recommended location (Zone 1, Figure) versus those performed to the left of the sternum (Zone 2, 3, or 4, Figure). Secondarily, we compared the highest end-tidal CO2 (ETCO2) for chest compression intervals performed at Zone 1 vs. Zone 2, 3, or 4. Methods/Approach: We conducted a retrospective cohort study of video-recorded, adult, cardiac arrest resuscitations with changes in chest compression location in a quaternary care Emergency Department (ED) from 3/9/2021 to 2/20/2024. We excluded chest compressions at Zone 5 or 6. Wilcoxon rank sum tests were used to assess differences in SBP and ETCO2 among chest compressions performed at Zone 1 vs. Zones 2, 3, or 4. Results/Data: 24 patients had SBP or ETCO2 recordings, 11 patients with SBP recordings, 18 patients with ETCO2 recordings, and 5 patients with both. For SBP, there were 28 CC intervals in Zone 1 and 32 CC intervals in Zone 2 or 4. The median SBP for Zone 1 was 67 mmHg (IQR 52.25-86.75 mmHg) vs. 103 mmHg (IQR 79-125 mmHg) for Zone 2 or 4 (p&lt;0.001). For ETCO2, there were 44 CC intervals for Zone 1 and 32 for Zone 2, 3, or 4. The median ETCO2 in Zone 1 was 16 mmHg (IQR 12.75-23.75 mmHg) vs. 17.5 mmHg (IQR 13-31.25 mmHg) in Zone 2, 3, or 4 (p=0.517). Conclusions: Chest compressions to the left of the sternum are associated with higher SBP than compressions at the AHA recommended lower half of the sternum. ETCO2 was similar regardless of chest compression location.
Abstract Su104: Neuronal Damage in Elderly Cerebral Ischemia/Reperfusion Injury: Role of Small Extracellular Vesicles from Senescent Microvascular Endothelial Cells
Authors: Wen Ma, Peng Yao, Lu Gan, Yu Cao
Journal: Circulation (2024)

Background: The incidence of cardiac arrest (CA) increases with age, leading to poorer neurological outcomes after the return of spontaneous circulation (ROSC) in the elderly. The neurovascular unit, particularly the interaction between brain microvascular endothelial cells (BMECs) and neurons, is crucial in cerebral ischemia/reperfusion (I/R) injury. Senescent BMEC-derived small extracellular vesicles (sEVs), as part of the senescence-associated secretory phenotype (SASP), play a role in signaling between these cells. These sEVs can exacerbate damage by changing their cargo, but the mechanisms are not fully understood. Methods: Young(8-10weeks) and aged(20-24months) C57BL/6J mice were utilized to establish the CA-CPR-ROSC model via electrical stimulation through the esophagus. Primary BMECs and neurons were used in vitro experiments. Senescence in BMECs was induced in vitro using D-(+)-Galactose. sEVs were isolated by ultracentrifugation thereafter. Aging-related proteins, BMEC-sEVs secretome and neuronal damage were evaluated by western blot analysis and immunofluorescence staining. High-throughput sequencing is employed to identify disparities in miRNAs within plasma sEVs obtained from both young and aged mice. Results: Aged mice exhibited a significantly higher rate of neuronal apoptosis after ROSC, with decreased levels of neuronal synaptic proteins. More pronounced senescence in BMECs and increased secretion of plasma sEVs were observed in age mice. In vitro, senescent BMECs secreted more sEVs compared to young BMECs. Furthermore, early intravenous administration of senescent BMEC-sEVs exacerbated neuronal apoptosis and the reduction in synaptic protein levels in young mice after ROSC, whereas young BMEC- sEVs mitigated these effects. And the sequencing results of plasma sEVs from young and aged mice have revealed a total of 17 significantly differentially expressed miRNAs. Conclusion: As components of the SASP, sEVs secreted by senescent BMEC-sEVs may partially explain the enhanced neuronal damage observed in aged mice following the ROSC. The modulatory impact of senescent BMEC-sEVs on neuronal apoptosis and synaptic protein expression alterations is mediated by variations in the sEVs cargos, which correlate with the miRNAs they carry. This provides evidence for cell communication within neurovascular units after I/R injury in the elderly, however, the specific regulatory mechanism requires further investigation.
Abstract 4147006: Relationship between Triglyceride-Glucose Index, Subclinical Myocardial Injury, and Cardiovascular Mortality in NHANES III
Authors: Chuka Ononye, Santul Bapat, Sneha Chebrolu, Zachary Pruitt, Elsayed Soliman, Richard Kazibwe
Journal: Circulation (2024)

Background: Subclinical myocardial injury (SCMI) and the triglyceride-glucose index (TyG), a marker for insulin resistance, are each linked to cardiovascular (CV) mortality. The impact of both SCMI and TyG on CV mortality is unclear. Objective: To investigate the relationship between TyG, SCMI, and CV mortality. Methods: This study utilized data from the third National Health and Nutrition Examination Survey (NHANES-III) including participants without cardiovascular disease (CVD). Baseline TyG was calculated as ln(fasting triglyceride level [mg/dL] × fasting plasma glucose [mg/dL]/2). High TyG was defined as ≥75th percentile, and low TyG as &lt;75th percentile. SCMI was identified by an electrocardiogram (ECG) cardiac infarction injury score ≥10. CV mortality data was sourced from the National Death Index. Associations of TyG with SCMI were analyzed using multivariate logistic regression, and Cox proportional hazards models assessed the individual and combined associations of TyG and SCMI with CV mortality. Results: Of 7,082 participants (mean age 59.3±13.4 years; 52.8% women; 49.4% White), 1,775 (25.1%) had high TyG and 1,860 (26.3%) had SCMI. High TyG was associated with higher odds of SCMI (odds ratio (OR): 1.38, 95% CI: 1.21–1.57, p&lt;0.0001) and each unit increase in TyG corresponded to increased SCMI risk (OR: 1.27, 95% CI: 1.16–1.39, p&lt;0.0001). High TyG and SCMI were linked to 32% and 38% higher CV mortality risk, respectively. Participants with both high TyG and SCMI had a significantly higher risk of CV mortality (Hazard ratio (HR): 1.78, 95% CI: 1.46–2.19) compared to those with low TyG and no SCMI (see Table) . The interaction between SCMI and TyG in the fully adjusted Cox Model 2 (see Table) was not statistically significant (p=0.45). Conclusions: In NHANES III adults without CVD, TyG was associated with SCMI. Both high TyG and SCMI independently increased CV mortality risk, with the greatest risk observed in individuals with both conditions. Further research is needed to evaluate the effectiveness of these markers in CVD risk assessment and explore interventions to mitigate this risk.
Abstract 4147178: A Rare Case of Loeffler Endocarditis and Intracardiac Thrombus in the setting of FIP1L1-PDGFRA Mutation
Authors: Aleesha Shaik, Varayini Pankayatselvan, Michael Mazar, Pooya Bokhoor
Journal: Circulation (2024)

Background: Loeffler endocarditis is a rare and clinically challenging presentation of hypereosinophilic syndrome (HES). Early detection and treatment are critical for this disease that otherwise carries a high risk of morbidity and mortality. We present a complex case of a patient with HES and sequelae. Case: A 41-year-old male with history of asthma presented with cough, dyspnea on exertion, orthopnea, and right arm pain. He noted a 15-pound weight loss in the past few months. In addition to right upper superficial vein thrombus, he was initially diagnosed with pneumonia, but labs were concerning for significant leukocytosis (WBC 54.23 10 3 /uL) and hypereosinophilia (45%), as well as anemia and thrombocytopenia. Cardiology was consulted for evidence of cardiac involvement with high sensitivity troponin 480 ng/L and BNP 399 pg/mL. Transthoracic echocardiography and cardiac MRI showed mild apical biventricular dilatation with moderate apical hypokinesis. There was nonenhancing T2 hypointense eccentric signal in both apices, suggestive of organized thrombus. Circumferential mid-cavity subendocardial delayed enhancement in the left ventricle and right ventricular apex was noted. Systolic function was preserved, but there were signs of pulmonary arterial hypertension. These findings were consistent with Loeffler endocarditis. He underwent bone marrow biopsy, which confirmed diagnosis of FIP1L1-PDGFRA+ HES. The presence of the FIP1L1-PDGFRA mutation is correlated with an increased risk of cardiac involvement in patients with HES and is also associated with worse prognosis. Following an interdisciplinary discussion between the hematology, rheumatology, and cardiology teams, he was started on imatinib, methylprednisolone followed by prednisone taper, and apixaban. His symptoms and blood counts have since drastically improved, and he is being monitored closely for resolution of the thrombi and for any signs of heart failure. Conclusion: HES complicated by Loeffler endocarditis is a unique presentation of infiltrative disease causing inflammatory, thrombotic, and fibrotic cardiac sequelae. It can portend deadly complications, including valvular involvement, thromboembolic events, and heart failure. A high clinical suspicion is required due to the multitude of possible symptom presentations. Multimodality imaging and interdisciplinary management with early accurate diagnosis and treatment are necessary to slow disease progression and reduce morbidity risk.
Abstract 4147718: Effectiveness of Intensive Blood Pressure Control on Cardiovascular Disease in Diabetes: A Subgroup Analysis of the China Rural Hypertension Control Project
Authors: Guozhe Sun, Farah Allouch, Ning Ye, Chang Wang, Songyue Liu, Wei Miao, Lixia Qiao, Nanxiang Ouyang, Chung-shiuan Chen, Katherine Mills, Hua He, Jing Chen, Danxi Geng, Chuning Shi, Linlin Zhang, Pengyu Zhang, Yangzhi Yin, Ziyi Xie, Yao Yu, Jiang He, Yingxian Sun
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) is the leading cause of death among individuals with diabetes. However, evidence regarding optimal blood pressure (BP) targets in these patients remains uncertain. Aim: We assessed the effectiveness of a community health worker (CHW)-led intensive BP intervention on CVD and all-cause mortality in participants with and without diabetes. Methods: The China Rural Hypertension Control Project (CRHCP) involved 33,995 hypertensive individuals (6,300 with diabetes and 27,695 without diabetes) aged ≥40 years from 326 villages in rural China. A total of 163 villages were randomly assigned to a CHW-led intervention, while the other 163 villages were assigned to usual care. Diabetes status was defined as a self-reported history of diabetes or a fasting blood glucose level ≥126 mg/dL at the baseline visit. In the CRHCP, CHWs were trained village doctors who initiated and titrated antihypertensive medications using a stepped-care protocol to achieve a BP goal of &lt;130/80 mmHg. The primary effectiveness outcome was a composite of myocardial infarction, stroke, heart failure, or CVD death during the 48-month follow-up period. Results: At the end of follow-up, the mean systolic BP in the intervention group was 127.5 mm Hg compared to 149.3 mm Hg in the usual care group among participants with diabetes. Among participants with diabetes, there were 462 CVD events (3.8% per year) in the intervention group, compared to 539 CVD events (4.8% per year) in the usual care group. The intensive BP intervention resulted in a 22% reduction in CVD (hazard ratio 0.78; 95% CI 0.69 to 0.87) in participants with diabetes. Additionally, all-cause deaths were reduced by 14% (hazard ratio 0.86; 95% CI 0.74 to 0.99) among participants with diabetes in the intervention group compared to the usual care group. There was no significant difference in safety outcomes examined at 48 months, including hypotension or syncope. Overall, results were similar for participants without diabetes, and there was no evidence of interaction between the intervention and diabetes status. Conclusion: This study showed that an intensive BP intervention targeting &lt;130/80 mm Hg effectively reduced CVD and mortality in participants with and without diabetes. Intensive BP control in patients with diabetes should be scaled up to reduce the burden of cardiovascular disease among this population worldwide.
Abstract 4147768: Demographic Variations in Ischemic heart disease-related Mortality of Breast Cancer
Authors: Nikky Maharjan, Bibek Karki, Samjhana Belbase, Bikal Lamichhane, Ajit Brar
Journal: Circulation (2024)

Methods: Data were collected using Surveillance, Epidemiology, and End Results, SEERS at 8.4.2 database using Incidence-Based Mortality. The analysis included 17 SEER Registries and data from 2000 to 2020. Selection criteria included malignant breast cancer cases with known ages. Age-adjusted rates were displaced as cases per 100,000, standardized to the 2000 US Standard Population and confidence intervals (95% using Tiwari modification), and standard errors were calculated. Results: Our study included a total of 25,027 breast cancer cases related to ischemic heart disease. The ischemic heart disease-related incidence-based mortality for breast cancer was 1.4 per 100,000 populations. When stratified by gender, the rate was significantly lower among males (0.1) compared to females (2.3). Ischemic heart disease related death also exhibited racial disparities, higher in Black individuals (1.7), compared to White (1.5), American Indian/Alaska Native individuals (0.7) and Asian or Pacific Islanders (0.7). Temporal trends, spanning from 2000 to 2019 in five-year intervals, revealed a consistent decline in ischemic heart disease-related mortality rates, with rates dropping from 0.7 in 2000-2004 to 0.1 in 2015-2019. Incidence-based mortality, ischemic heart disease-related mortality rates were influenced by household income, with rates decreasing as income levels rose. The rates were highest for those with incomes below $35,000 (1.7) and lowest for those earning above $75,000 (1.3). Discussion: The findings of our study shed light on the socioeconomic factors associated with ischemic heart disease-related mortality of breast cancer. The observed variations in incidence-based mortality rates among genders and racial groups emphasize the complex interplay of biological and sociodemographic factors. Temporal trends reveal declining mortality rates signify potential improvements in healthcare interventions and early detection. The association between higher household income and lower mortality rates suggests a socio-economic dimension in breast cancer outcomes. Notably, the lower ischemic heart disease-related mortality rates in breast cancer underscore the importance of understanding and addressing treatment-related cardiovascular risks. These insights underscore the need for integrated healthcare strategies that consider both breast cancer and cardiovascular health, aiming to provide comprehensive care for affected individuals.
Abstract Sa503: Serum lactate/albumin ratio at hospital arrival and neurological outcome of patients 30 days after the occurrence of out-of-hospital cardiac arrest: a nationwide multicenter observational study
Authors: toshinari kawama, Toshihiro Hatakeyama, Takashi Sano, Koki Nakada, Tasuku Matsuyama, Takeyuki Kiguchi, Benjamin Berg, Tetsuhisa Kitamura, Hisao Matsushima
Journal: Circulation (2024)

Background: Previous studies have shown that a lower serum lactate/albumin ratio was positively correlated with the survival of severely ill patients, such as those with septic shock, in critical care. However, there is limited knowledge regarding the association between the serum lactate/albumin ratio and neurological outcome in patients with out-of-hospital cardiac arrest. Thus, we investigated whether a lower serum lactate/albumin ratio at hospital arrival was associated with good neurological outcomes in such patients. Methods: This was a multicenter observational study using data from The Japanese Association for Acute Medicine out-of-hospital cardiac arrest Registry. We reviewed records of patients aged ≥18 years with out-of-hospital cardiac arrest of medical etiology and hospitalized after return of spontaneous circulation, with serum lactate and albumin levels recorded at hospital arrival, between June 1, 2014 and December 31, 2021. The medical etiology excluded trauma, drowning, poisoning, burns, asphyxia, or hanging. We excluded cases with missing data, patients who were treated with extracorporeal membrane oxygenation, and those for whom the time period from the emergency call to the measurement of laboratory data was &gt;120 mins. The primary outcome was 30-day survival with good neurological outcome, defined as cerebral performance category scale 1 or 2. Analyzed patients were divided into quartiles based on the serum lactate/albumin ratio. Multivariable logistic regression analysis was performed to adjust for several factors. Results: We analyzed 5,016 patients. The proportions of good neurological outcome were 56.0% (709/1,267), 27.9% (348/1,246), 11.3% (142/1,253), and 2.8% (35/1,250) in the first (serum lactate/albumin ratio ≤ 2.06), second (2.06 &lt; serum lactate/albumin ratio ≤ 3.24), third (3.24 &lt; serum lactate/albumin ratio ≤ 4.59), and fourth (4.59 &lt; serum lactate/albumin ratio) quartiles, respectively. The multivariable logistic regression analysis showed that the adjusted odds ratio (95% confidence interval) values for good neurological outcome in the second, third, and fourth quartiles, compared with the first quartile, were 0.34 (0.28–0.42), 0.19 (0.15–0.25), and 0.06 (0.04–0.08), respectively. Conclusions: In the Japanese national registry, a lower serum lactate/albumin ratio at hospital arrival was significantly associated with good neurological outcome in patients with out-of-hospital cardiac arrest.