tbuckley/cabot-search huggingface dataset:
Abstract 13014: Cardiac Arrhythmias, Hypotension and Need for Vasopressors Following Admissions for Addisonian Crisis; an Analysis via the 2016-2020 National Inpatient Sample
Authors: Abhimanyu Ravalani, Kamleshun Ramphul, Rahat A Memon, Shaheen Sombans, Petras Lohana
Journal: Circulation (2023)

Introduction: Addisonian crisis(AC) is a life-threatening complication secondary to acute adrenal insufficiency. Various cardiac arrhythmias and complications can be seen during such episodes. While fluids and glucocorticoid replacement therapies are the main steps in management, critically ill patients often also require vasopressors (VP) to maintain an adequate Mean Arterial Pressure. Methods: We queried adults with AC from the 2016-2020 National Inpatient Sample. The incidence of several cardiac arrhythmias and cardiac events was estimated. The need for VP among hypotensive cases and their impact on mortality were also analyzed. Results: There were 28430 adult cases of AC with a mean age was 55.59 years (SEM 0.106) and involved predominantly females (62.9% of all cases). Several cardiac arrhythmias were also reported, such as atrial fibrillation (12.6%), supraventricular tachycardia (1.7%), ventricular tachycardia (1.5%), ventricular fibrillation (1.8%), and atrial flutter (1.8%). A diagnosis of hypotension was also reported in 23.2% (6590 cases) of cases, while 16.7% (4755 cases) had hyperkalemia. Among patients with hypotension, 305 (4.6%) cases also needed VP. Higher use of VP in hypotensive cases was observed among Hispanics (vs. Whites, aOR 1.772, 95% CI 1.195-2.627), Males (aOR1.826, 95% CI 1.407-2.371, p&lt;0.01), history of hypertension (aOR1.670, 95% CI 1.232-2.263, p&lt;0.01), prior stroke (aOR 1.741, 95% CI 1.111-2.726, p=0.015), or cirrhosis (aOR 2.185, 95% CI 1.084-4.406, p=0.029). Hypotensive patients requiring the use of VP were older (mean age 62.10 vs. 55.53 years, p&lt;0.01), and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.44 vs. 2.97, p&lt;0.01) than those not requiring VP. Overall, 18.0% of hypotensive patients using VP died (vs. 2.2% not requiring VP, aOR 4.950, 95% CI 2.974-8.238, p&lt;0.01). Conclusions: AC presents with multiple cardiac arrhythmias. VP use in hypotensive cases was more common in Hispanics, Males, patients with a history of hypertension, stroke, or cirrhosis. Hypotensive patients requiring VP were also sicker and had a higher mortality rate. Thus, AC management and diagnosis must be prompt to reduce the odds of mortality.
Abstract 247: Assessing Feasibility of Proposed Extracorporeal Cardiopulmonary Resuscitation Programs in Scotland via Geospatial Modelling
Authors: K.H. Benjamin Leung, Louise Hartley, Stuart Gillon, Lyle Moncur, Timothy Chan, Steven Short, Gareth Clegg
Journal: Circulation (2023)

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) may improve outcomes for out-of-hospital cardiac arrest (OHCA) where return of spontaneous circulation (ROSC) is not achieved. We estimated the number of patients who may benefit from proposed in-hospital or pre-hospital ECPR programs in Scotland. Methods: EMS-treated atraumatic OHCAs occurring in Scotland between Apr. 2017-Mar. 2022 were included. We identified those likely to benefit (age 16-70, initial rhythm VF/pVT, no ROSC) and those possibly likely to benefit (age 16-70, initial rhythm PEA, no ROSC) from ECPR. To achieve timely ECPR initiation within 60 mins, we computed the number of eligible OHCAs within 15 mins’ drive time surrounding each of the 3 ECPR-capable hospitals, 6 percutaneous coronary intervention (PCI)-capable hospitals, and 28 adult emergency departments (ED) for in-hospital ECPR programs. We then computed the number of eligible OHCAs within a 45-minute drive time surrounding each of the 28 EDs and 140 ambulance stations and determined locations allowing one dedicated pre-hospital ECPR service to reach the greatest number of eligible OHCAs. We accounted for service availability based on 8 and 16-hour availability on weekdays and 24/7 availability. Results: Of the 8,962 OHCAs included, 1,108 (12.3%) were classified likely to benefit, 4,675 (52.2%) possibly likely to benefit, and 3,179 (35.5%) unlikely to benefit from ECPR. In-hospital ECPR scenarios covered up to 12.5% of eligible OHCAs at ECPR-capable hospitals, 20.9% at PCI-capable hospitals, and 64.6% at all EDs. Pre-hospital ECPR scenarios with one crew covered up to 51.0% and 54.1% when based at an ED or ambulance station respectively, which were higher than respective in-hospital scenarios at ECPR-capable or PCI-capable hospitals, and were generally comparable to ECPR availability at all 28 EDs. Conclusion: A pre-hospital ECPR service can generally reach greater numbers of OHCAs compared to in-hospital ECPR programs.
Abstract 13021: Double-Peaked Trajectory of the Corrected QT Interval and Its Sex Differences During the Clinical Course of Takotsubo Syndrome
Authors: Mari Kitagawa, Ken Kato, Yusuke Kondo, Yoshio Kobayashi
Journal: Circulation (2023)

Background: In the general population, the normal value of the corrected QT (QTc) interval for women is under 450 ms, which is longer than that of men (under 430 ms). There have been reported several sex differences in characteristics of takotsubo syndrome (TTS). Prolonged QTc interval is a relatively common electrocardiographic finding in TTS. Research Question: Little is known about the sex differences in the trajectory of QTc interval during the clinical course of TTS. Aim: The aim of this study was to determine the change in the QTc interval from the acute onset to one year later by sex. Methods: This study retrospectively included 85 consecutive patients with TTS admitted to our hospital from 2015 to 2023. A total of 848 twelve-lead electrocardiograms (ECG) performed from the date of diagnosis (day 0) within one year were analyzed. Mean QTc intervals were calculated by the day from day 0 to day 16, and after day 17, by defined periods (day 17-30, 31-60, 61-90, 91-180, 181-360). Results: Fifty-eight (68%) patients were women. There were no significant differences between women and men in age (71 ± 13 years vs. 67 ± 10 years, P =0.13), preceding physical trigger (55% vs. 70%, P =0.24), and all-cause mortality within one year (17% vs. 19%, P &gt;0.99). On day 0, the QTc intervals within the normal range were observed both in women and men. The first peak of the QTc interval was observed on day 2 with the mean QTc interval of 475 ± 70 ms in women, and 474 ± 60 ms in men. Once the QTc interval shortened after the first peak, it prolonged again and the second peak was observed around the second week from the onset. In the second peak, the QTc interval was found to be longer in men (503 ± 32 ms) compared to women (471 ± 56 ms). After the second peak, the QTc interval gradually normalized, and never prolonged again until one year. Conclusions: The double-peaked trajectory of the QTc interval was clearly observed during the clinical course of TTS. The variability of the QTc interval was greater in men than in women.
Abstract 233: Out-of-Hospital Cardiac Arrest Survival When CPR is Initiated by First Responders
Authors: Rayan El-Zein, Kevin Kennedy, Paul S Chan
Journal: Circulation (2023)

Background: In most patients with out-of-hospital cardiac arrest (OHCA), life-saving cardiopulmonary resuscitation (CPR) is initiated by first responders (non-transporting firefighters or police) or emergency medical service (EMS) personnel. Whether survival outcomes differ when CPR is initiated by first responders vs. EMS is unclear. Research Question: Do survival outcomes differ when CPR is initiated by first responders vs. EMS personnel for OHCA? Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified 162,896 patients with a OHCA in whom CPR was initiated by first responders or EMS. Using multivariable hierarchical logistic regression to adjust for demographics, cardiac arrest characteristics and time to first CPR, we compared rates of survival to hospital admission and to discharge between patients in whom CPR was initiated by first responders and EMS. Results: CPR was initiated by first responders in 70,889 (43.5%) and by EMS in 92,007 (56.5%) patients. Time to first CPR was shorter when first responders initiated CPR (median: 8.0 [5.0-13.0] vs. 10.0 minutes [IQR: 6.0-14.0]; standardized difference 16.1%). The likelihood of survival to hospital admission was similar when CPR was initiated by first responders (27.1% [first responders] vs. 26.8% [EMS]; adjusted OR: 0.98 [0.96, 1.01], P=0.15) whereas survival rates to hospital discharge were higher with CPR initiated by first responders (9.4% [first responders] vs. 7.7% [EMS]; adjusted OR: 1.17 [1.02- 1.21], P&lt;0.001). After adjustment for time to first CPR, rates of survival to discharge were similar between the first responder and EMS groups (adjusted OR: 1.04 [1.00-1.08]; P=0.07). Conclusions: CPR initiated by first responders for OHCA is associated with higher overall survival rates and was explained by earlier response times.
Abstract 12985: Trends and Disparities in Cardiovascular Death in Sarcoidosis: A Population-Based Retrospective Study in the United States From 1999 to 2020
Authors: Min Choon Tan, Noreen Mirza, Yong Hao Yeo, Boon Jian San, Jian Liang Tan, Justin Lee, Joanne Mazzarelli, Andrea M Russo
Journal: Circulation (2023)

Background: Sarcoidosis is a multisystem inflammatory disease that could result in debilitating cardiac manifestations. Despites, data on the cardiovascular deaths (CVDs) among patients with sarcoidosis are limited. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid sarcoidosis by age, sex, and race in the United States. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid sarcoidosis among patients aged 25 and above. Diseases of the circulatory system (ICD-10 I00-I99) were listed as the underlying cause of death, and sarcoidosis (ICD-10 D86) as contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint Regression Program. Results: In the 22-year study period, 5,630 CVDs with comorbid sarcoidosis in the United States were identified between 1999 and 2020. The AAMRs from CVDs with comorbid sarcoidosis increased from 1.03 (95% CI, 0.88-1.17) in 1999 to 1.38 (95% CI, 1.24-1.52) in 2020. Overall, women recorded a higher AAMRs compared to men (1.25 [95% CI, 1.21-1.30] vs. 1.10 [95% CI, 1.06-1.15]). Black individuals had higher AAMRs than White individuals (5.17 [95% CI, 4.97-5.37] vs. 0.68 [95% CI, 0.66-0.71]). A higher percentage of CVDs with comorbid sarcoidosis was seen in the age groups of 55-64 in men (24.68%) and 65-74 in women (22.62%). Conclusion: The CVDs in sarcoidosis have increased over the last two decades, with disparities seen in women and Black individuals. Most CVDs with comorbid sarcoidosis occurred at a younger age compared to general population. This highlights the importance of early screening for cardiovascular diseases in sarcoidosis individuals.
Abstract 254: Patients With Signs of Life on Hospital Arrival Have a Higher Chance of Survival and Favorable Neurological Outcomes Following Traumatic Cardiac Arrest
Authors: Takafumi obara, Takashi Hongo, Tsuyoshi Nojima, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao
Journal: Circulation (2023)

Introduction: The clinical impact of signs of life (SOL) in traumatic cardiac arrest (TCA) remain to be elucidated. A previous study compared TCA patients with pulseless electrical activity (PEA) to those with asystole, but survival was not significantly different between the groups. Other obvious SOL (i.e., fine extremity/eye movement, light reflection, agonal respiration) have not yet been examined in TCA. Hypothesis: We hypothesized that TCA patients with SOL on hospital arrival have a higher chance of survival and good neurological outcomes. Aim: To examine survival and neurological outcomes in TCA patients with or without SOL. Methods: Retrospective review of data from the Japan Trauma Data Bank (2019-2021). The inclusion criteria were patients with TCA on arrival. The exclusion criteria were patients with burns, abbreviated injury scale score&gt; 6 in any region, and missing survival or SOL data. SOL was defined as follows: extremity or eye movement, light reflex, gasping, pulseless electrical activity with electrical heart activity &gt; 40 beats per minute. The primary outcome was survival at discharge. The secondary outcome was favorable neurological outcome (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. Patients with and without SOL were compared using univariable analysis. Results were described with odds ratio (ORs) and 95% confidence intervals (CI). Results: A total of 2,136 patients (121 with SOL and 2,015 without SOL) were included. The characteristics of patients with or without SOL were as follows: age (median age 60.5 years old [interquartile range: 42-80 years] vs. 55.2 [38-75]), gender (male: 83/121 (68.6%) vs. 1,321/2,015 (65.9%), Injury Severity Score (32.9 [22-43] vs. 33.7 [22-41]), blunt trauma (97/121 (82.2%) vs. 1,711/2,015 (84.9%)), and transportation time (15.1 min [7-18] vs. 13.3 [7-16]). The patients with SOL showed higher survival compared with the patients without SOL (11/121 (8.5%) vs. 24/2015 (1.2%), OR 1.9 [CI 1.38-2.85]). A similar trend was observed for favorable neurological outcomes (5/95 (5.3%) vs. 7/1,440 (0.5%), OR 2.41 [CI 1.26-3.60]). Conclusions: TCA patients with SOL at arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOL.
Author Correction: Enhanced CD19 activity in B cells contributes to immunodeficiency in mice deficient in the ICF syndrome gene Zbtb24
Authors: Zhengzhou Ying, Swanand Hardikar, Joshua B. Plummer, Tewfik Hamidi, Bin Liu, Yueping Chen, Jianjun Shen, Yunxiang Mu, Kevin M. McBride, Taiping Chen
Journal: Cellular and Molecular Immunology (2023)

In the sentence beginning 'To trace cell proliferation, FO and MZ B cells' and the sentence beginning 'For cell activation, naïve B cells or CH12F3 cells' in this article, the [10 ng/ml] 'F(ab') 2 fragment goat anti-mouse IgM' should have read '10 μg/ml F(ab') 2 fragment goat anti-mouse IgM'.The original article has been corrected.
Abstract 18532: Cardiomyopathy Diagnoses in a General Population Study of <i>TTN</i> Pathogenic Variants: A Missed Opportunity to Diagnose Familial Cardiomyopathy?
Authors: Kirk U Knowlton, Nephi Walton, Gabriel Najarian, G B Christensen, Jared M Evans, Heidi T May, Jeffrey L Anderson, Lincoln Nadauld, Stacey Knight
Journal: Circulation (2023)

Introduction: Intermountain Health’s HerediGene Population Study has been collecting samples from over 175,000 individuals since 2018 to identify those that could potentially benefit from early interventions. Variants in the TTN gene are the most common genetic causes of cardiomyopathy (CM). Here we examined all individuals with TTN pathogenic or likely pathogenic variants to determine differences in clinical characteristics among those with and without a clinical CM diagnosis (Dx). Methods: Whole genome sequence was analyzed in 32,159 individuals. 411 (1.3%) had a pathogenic/likely pathogenic TTN variant . Of these 135 (32.8%) had a CM Dx and 276, (67.2%) did not. Differences in health histories, ECHO results, treatments, and major CV events were evaluated by presence or absence of CM Dx using the chi-square, Fisher exact, and Wilcoxon rank sum tests. Results: Demographic and clinical characteristics were significantly different among those with and without a CM Dx (Table). In those without CM Dx, a total of 75 (27%) had some clinical indication of potential CM: 37 having a BNP ≥100, 7 had an LVIDd ≥ 5.5, 33 with an EF ≤55%, 3 experiencing cardiac arrest, and 45 with a heart failure Dx. Of these, 21 (28%) had 2 of these indications, 13 (17%) had 3 indications, and 1 (1%) had 4 indications. Among these with indication of CM without a Dx, 12 (16%) have died, and 22 (23%) have been hospitalized for heart failure. Only 8 individuals had a clinical genetic test for CM with a positive result for TTN variant. Conclusion: About 1/3 of potential pathogenic TTN variant carriers had a CM Dx and 27% without a CM Dx had indication of possible CM. A small percentage of TTN variant carriers with a CM Dx and none of those with possible CM have undergone clinical genetic testing. This demonstrates a missed opportunity to diagnose potential TTN -related familial CM for earlier intervention and treatment of patients and family members.
Abstract 245: A Validated Score to Predict Poor Neurological Outcome After 72 Hours of Refractory VF/VT in Out of Hospital Cardiac Arrest Patients Requiring Extracorporeal Cardiopulmonary Resuscitation
Authors: Nelly Carolina C Rojas-Salvador
Journal: Circulation (2023)

Introduction: The challenge with neuroprognostication is finding a multimodal prediction model that yields the lowest false positive rate for a poor outcome. Objectives: To develop and validate a score that accurately predicts poor neurological outcome after 72 hours of ECPR initiation. Methods: Single-center, retrospective cohort study included 361 OHCA patients who underwent ECPR at the University of Minnesota between December 2015-January 2023. In a 50% random modeling sample, we obtained a derivation (n=180) and validation sample (n=181). The primary outcome was poor neurological outcome (defined as CPC 3-5) at hospital discharge. Neurological predictors were neuro specific enolase (NSE)&gt;3ULN on day 1, myoclonus status epilepticus on day 1-3, neurological pupillary index (NPI)&lt;2 on day 3-6, Glasgow motor=3 on day 3-6, highly malignant pattern on EEG (hmEEG) on day 3-6, CT with anoxic brain injury on day 3, and absent of brainstem reflexes on day 3-6. Univariate and multivariate analysis were performed on each predictor. A simple prediction score tool was constructed and evaluated through ROC analysis. A youden index was used for optimal cut-off. Results: Of 361 patients, 170 (47%) survived to hospital discharge. Of these, 85% (145/170) survived with favorable neurological outcome. The final multivariate logistic regression model in the derivation sample retained eight predictors: Absence of witnessed status and bystander CPR; downtime≥ 7min, lactate≥ 9mmol, low flow≥ 55min, NSE&gt;3ULN, hmEEG, CT with anoxic brain injury and absence of brainstem reflexes, which were combined to develop an 8-point risk scoring model Minnesota OHCA using ECPR (MECPR). Model discrimination had an AUC of 0.87 [95%CI 0.82-0.92] in the derivation sample and 0.86 [95% CI 0.85-0.92] in the validation sample, and calibration (goodness of fit p=0.04). MECPR≥6 predicted poor neurological outcome with a sensitivity ~21%, specificity 100% and a FPR 0%. A MECPR ≥4 and ≥6 had an 89% and 97% probability of poor neurological outcome, respectively. Conclusions: A simple, accurate prediction scoring tool (MECPR) based on a multimodal approach after 72hrs of refractory cardiac arrest provides estimates of probability of poor neurological outcome among patients treated with ECPR.
Abstract 11583: Association Between Baseline and Trajectories of Preserved Ratio Impaired Spirometry (PRISm) and Mortality in Chinese Adults: Results From the Prospective Urban Rural Epidemiology (PURE) Study
Authors: Mengya Li, Yang Li, Wei Li, Tse Lap Ah
Journal: Circulation (2023)

Introduction: Longitudinal studies on preserved ratio impaired spirometry (PRISm) are scarce, especially in Chinese population. Objectives: To investigate the prevalence of PRISm in the general Chinese population, and to compare all-cause and cardiovascular diseases (CVD) mortality in PRISm subjects with normal spirometry. Methods: This study was based on PURE-China study with 40,279 individuals aged 35-70 years from 115 urban and rural communities in 12 provinces of China at baseline during 2005-2009. Participants were classified into PRISm, airflow obstruction (AO), and normal groups according to spirometry. Cox frailty proportional hazards model were performed to evaluate all-cause and CVD mortality in association with the baseline and trajectories of spirometry. Results: The prevalence of PRISm at baseline was 29.3%. During a median of 11.9 years follow-up, 2214 participants died, 773 of whom died from CVD. After adjustment of the confounders, participants with baseline PRISm had higher risks of all-cause mortality (HR=1.42, 95%CI: 1.29-1.58), CVD mortality (HR=1.35, 95%CI: 1.14-1.60). Trajectories analysis showed that subjects with PRISm at baseline but transitioned to normal during the follow-up demonstrated a substantially lower risk of all-cause mortality and CVD mortality than those with persistent PRISm, while such risk levels were close to people maintaining normal spirometry. Conclusions: PRISm is likely a risk factor to increase all-cause mortality and CVD mortality, comparing with normal spirometry in Chinese general population. Early detection and control of PRISm may be an effective approach for mitigating long-term disease burden. Keywords: preserved ratio impaired spirometry (PRISm), trajectories, mortality, cardiovascular disease, cohort
Abstract 318: Glibenclamide May Have a Neuroprotective and Cardioprotective Role Beyond Cerebral Edema in an Asphyxial Model of Cardiac Arrest
Authors: Zhen W zhuang, Ming-qiang Zheng, Rachel Beekman, Kevin N Sheth, Henry Huang, Michael Simons
Journal: Circulation (2023)

Background: Cardiac arrest (CA) is a leading cause of mortality and long-term disability. There are no therapeutics approved for neuro- and cardio-protection. Novel therapeutics are urgently needed to improve patient outcomes. Glibenclamide is a second-generation sulfonylurea drug and inhibitor of SUR1-TRPM4. Little is known about its role in cardioprotection and synaptic density. Aims: To evaluate the effect of glibenclamide on coronary flow reserve (CFR), blood-brain barrier (BBB) permeability, and synaptic density in an asphyxial mouse model of CA. Methods: We used an asphyxial mouse model of CA; potassium chloride was injected into the right internal jugular vein, resulting in asystole. Chest compressions and epinephrine were administered following 12 minutes of no-flow time. Successfully resuscitated mice (n=24) were randomized to receive intravenous glibenclamide or vehicle; the glibenclamide group received a loading dose of 10 μg/kg immediately upon return of spontaneous circulation followed by 1.6 μg every 12 hours up to day 3. Pulse Doppler Velocity (PWV) was used to monitor the CFR and left carotid artery velocity. Synaptic density was quantified with ex vivo autoradiographs after injection of 18 F-SynVesT-2 in the brain (3, 24, and 72 hrs). Evans blue staining and general neurologic deficit scores were assessed 24 hours post-resuscitation. Results: Treatment with glibenclamide resulted in an increase in CFR (1.37±0.11 vs. 1.17±0.06, p=0.01) and carotid peak velocity (61.38±12.81 cm/s vs. 46.83±6.3 cm/s, p&lt;0.05). Whole brain synaptic density was increased in the mice treated with glibenclamide, suggesting a reduction in synaptic density loss. BBB disruption in the cerebrum was significantly lower in Glibenclamide treated mice (0.00022±0.000014/mg vs. 0.000471±0.000088/mg, p&lt;0.01). Mice treated with Glibenclamide had lower neurologic deficit scores (1.83±2.89 vs 4.75±3.84, p&lt;0.05). Conclusions: Glibenclamide given immediately following the return of spontaneous circulation improved CFR, decreased BBB disruption, reduced synaptic density loss, and improved neurologic deficit scores, suggesting both cardio- and neuro-protective effects.