tbuckley/cabot-search huggingface dataset:
Abstract 4140549: Association of Liver Stiffness measured by Transient Elastography with All-Cause Mortality in Heart Failure patients: Trinetx Database 2015-2023
Authors: Vinithra Varadarajan, Nirav Agrawal, Mitchell Karpman, Ahmad Busaileh, william maxted
Journal: Circulation (2024)

Introduction: Persistently elevated filling pressure leading to central venous congestion is associated with poor prognosis. This central venous congestion stimulates connective tissue hyperplasia causing tissue fibrosis and stiffness of the liver. However, risk stratification involving hepatic fibrosis in heart failure is limited. Research Question: Is liver stiffness associated with higher mortality in heart failure? Aims: To utilize liver stiffness measured by transient elastography as an imaging phenotype in HF risk stratification and prevention. Methods: De-identified data from 285 HF patients without pre-existing liver disease/cirrhosis, with liver stiffness measured (kPa) by transient elastography from 2015-2023 were extracted from TriNetX, a real-time, electronic, federated data network of 34 healthcare organizations. Liver stiffness was further classified as high and low with 8kPa as a cut-off. Comparisons employed the chi-square or Fisher’s exact test for categorical variables and the student’s t-test or Mann-Whitney-Wilcoxon test, as appropriate. Multivariable Cox proportional hazards models were applied to evaluate the association with mortality and readmissions in 30 days. Results: The mean age of the cohort is 65±11 years. The majority were women (57.9%). Participants were followed for a median of 3.8 (1.52-6.67) years; 83 out of 285 patients died. Multivariable analysis showed that 1 SD increase in liver stiffness was associated with increased mortality (HR 1.13, 95% CI 1.05-1.21; p&lt;0.01) and 30-day readmissions (HR 1.13, 95% CI 1.06-1.21; p&lt;0.01). The adjusted HR for all-cause mortality for the high liver stiffness (≥8 kPa) group was 2.30 (95% CI 1.21-4.37; p=0.01). The analysis of liver stiffness association with mortality stratified by heart failure preserved ejection fraction (HFpEF) was HR 1.14 (95% CI 1.06-1.24, p&lt;0.01). There were no significant differences in mortality when stratified by heart failure with reduced ejection fraction, gender, and race. Conclusion: In a multi-ethnic cohort of heart failure patients with HFpEF and no preexisting cirrhosis, higher liver stiffness was independently associated with excess mortality and 30-day readmissions.
Abstract 4140634: Instantaneous Classification of Myocardial No-Reflow Size from a Carotid Pressure Waveform: A Physics-Based Machine Learning Approach
Authors: Jiajun Li, Rashid Alavi, Wangde Dai, Ray Matthews, Robert Kloner, Niema Pahlevan
Journal: Circulation (2024)

Introduction: It was recently shown that the Intrinsic Frequency (IF) method, a systems approach for evaluating cardiovascular dynamics, combined with machine learning (ML) algorithms, instantaneously detects acute myocardial infarction (MI) or ischemia in rats (Alavi et al., European Heart Journal Open, 2023, PMID:37849787). Here, we aim to classify myocardial no-reflow size (NR) from carotid pressure waveforms using a hybrid physics-based ML approach. Methods: We used the standard occlusion/reperfusion MI rat model (Sprague Dawley; Female; n=88) and induced necrosis via a 30-minute proximal left coronary artery occlusion followed by 3 hours of reperfusion. IFs were computed from carotid pressure waveforms measured 2 hours post-reperfusion. NR sizes (i.e., mass percentage of no-reflow over total left ventricle (LV)) were determined via histopathology (visualized by non-fluorescent area which did not receive thioflavin-S, Fig.1), ranging from NR=0.8% to 38.8%. NR=15% was used as the classification cut-off for mild and severe NR size classes. A support vector machine (SVC) model was developed using IFs and diastolic pressure of n=66 rats. K-fold cross-validation (k=5) was used to prevent overfitting. Finally, the model was blindly tested on n=22 additional rats. Results: Our ML classifier model showed overall accuracy of 92% for all data when predicting the true class of NR, i.e., severe or mild (Fig.1). The model also showed a high accuracy of 73% using blind test rats. Conclusions: Our results suggest that a hybrid IF-based ML approach can determine the severity of no-reflow zone using a single arterial pressure waveform, independent of advanced imaging techniques. The no-reflow phenomenon is clinically significant (distinct from infarct size) as it is linked to LV microvascular damage, LV remodeling, and thus patient recovery after reperfusion. Since IFs can be measured remotely and noninvasively e.g., via smartphones or wearables, our approach has significant potential for instantaneous pre-hospital identification of patients at risk for outcomes post-MI (e.g., heart failure or mortality).
Abstract 4140625: Does the Cord predict the Course? Trend And Outcome of Myocardial Infarction in Patients With Spinal Cord Injury; a Retrospective Population-Based Analysis
Authors: Emmanuel Ukenenye, Endurance Evbayekha, Arthur Dilibe, Oluwasegun Akinti, Jamal Perry, Akanimo Antia, Adarsh Balaji, Nikola Stojanovic, Olayemi Adeniran, Gabriel Alugba
Journal: Circulation (2024)

Introduction: Spinal cord injury (SCI) has been shown to increase the risk of cardiovascular diseases such as myocardial infarction (MI), atrial fibrillation, and heart failure. Impaired mobility and dysautonomia have been suggested to play a role. We evaluated MI outcomes in patients with SCI. Methods: This retrospective cohort study used the National Inpatient Sample (2016-2020) database. We identified hospitalizations with a diagnosis of MI using their ICD-10 codes and then stratified them based on the presence or absence of SCI. Our outcome of interest was in-hospital mortality. A multivariate logistic regression model was used to account for confounders and estimate the probability of the outcome. Results: The number of patients hospitalized with MI and a history of SCI was 560, while 3,190,369 patients had MI with no history of SCI. The mean age of the SCI population was 66.9 years, compared to 62 years in the group without SCI. The SCI group were predominantly male 85%, 72% White, 14% Black, and 7% Hispanic. The SCI population had a higher association with in-patient mortality (adjusted odds ratio: 2.5, p= 0.013, CI 1.21 - 5.03) than the group without SCI. Conclusions: Our analysis showed that among the population admitted for MI, those with SCI had a higher association with in-hospital mortality than those without SCI. Also, SCI patients admitted for MI tend to be of male sex. More research is needed to explore our findings further.
Abstract 4140630: Serum Metabolites Predict Mortality or Transplant in Pre-capillary and Combined Pre- and Post-capillary Pulmonary Hypertension in the PVDOMICS Cohort
Authors: Matthew Dreier, Samuel Chung, Alexandra Racanelli, Jonathan Chacon-Barahona, Evelyn Horn
Journal: Circulation (2024)

Introduction: Efforts to stratify mortality risk in pulmonary hypertension (PH) have focused on the minority of patients in WSPH group 1. Metabolomic studies in group 1 identify histidine, polyamines, tRNA metabolites, and homoarginine as predictors of mortality. Little is known about the role of metabolomics to predict mortality in the larger group of PH patients. Question: Which serum metabolites predict a composite of mortality or transplant in pre-capillary, post-capillary, and combined pre- and post-capillary PH (Cpc-PH), irrespective of WSPH group? Aims: To identify predictive metabolites in the Pulmonary Vascular Disease Phenomics Program (PVDOMICS) cohort and understand the pathobiology relating predictors to mortality/transplant. Methods: We generated peripheral venous metabolomic data in 649 PH subjects. We defined pre-capillary PH as pulmonary vascular resistance (PVR)&gt;2 WU and pulmonary capillary wedge pressure (PCWP)≤15 mmHg (n = 453), post-capillary PH as PVR≤2 WU and PCWP&gt;15 mmHg (n=25), and Cpc-PH as PVR&gt;2 WU and PCWP&gt;15 mmHg (n = 171). We used Cox models with multiple testing correction to identify predictive metabolites in each group. We then correlated select predictors with hemodynamic, laboratory, and echocardiographic data. Results: The hemodynamic groups included a mix of WSPH groups. We identified 249 predictors in pre-capillary PH, 0 in post-capillary PH, and 7 in Cpc-PH. Homoarginine predicts mortality/transplant in pre-capillary PH (HR=0.56, p&lt;0.001) and Cpc-PH (HR=0.59, p=0.025). In pre-capillary PH, low homoarginine is associated with high PVR (r=-0.26, p&lt;0.001), high BNP (r=-0.49, p&lt;0.001), RV dilation (p&lt;0.001 for moderately dilated, p&lt;0.001 for severely dilated vs. normal), and RV free wall longitudinal strain (r=-0.31, p&lt;0.001). Conclusions: Many metabolites predict mortality/transplant in pre-capillary PH and Cpc-PH, including those previously identified in group 1 as well as newly identified predictors. To our knowledge, this is the first report of such predictors in hemodynamic subsets rather than in WSPH groups. Our data suggest low homoarginine contributes to increased PVR, RV failure, and mortality/transplant in pre-capillary PH. More studies on homoarginine are needed.
Abstract 4140494: Postpartum linkage to primary care: Does screening for social needs identify those at risk for loss to follow-up?
Authors: Mara Murray, Julianne Dugas, Lois McCloskey, Kaku So-Armah, Christina Yarrington, Pablo Buitron de la Vega, Emelia Benjamin, Tracy Battaglia
Journal: Circulation (2024)

Background: Primary care after pregnancy is recommended, especially for individuals with recent adverse pregnancy outcomes (APOs, such as preeclampsia or gestational diabetes), who are at increased risk for future heart disease. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. We sought to (1) describe the pregnancy-related prevalence of HRSNs, and (2) assess associations between pregnancy-related HRSNs and subsequent linkage to primary care. Methods: We analyzed electronic health record data for individuals with prenatal care and delivery (2018-2021) at our urban safety-net hospital. HRSNs were assessed via a routine screener, and we summarized individual responses during pregnancy through 6 weeks post partum as: any positive, all negative, or never screened. Postpartum linkage to primary care was defined as a completed primary care visit after 6 weeks through 1 year post partum. We analyzed the prevalence of HRSNs and their associations with linkage to primary care, using adjusted log-linked binomial regression models. In stratified models we assessed for effect modification by APO history and other variables. Results: Of 4941 individuals in our sample, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 HRSN screening. Nearly 1 in 4 screened positive for any HRSN, most often food insecurity (14%) or housing instability (12%), and 53% linked to primary care. Compared with those who screened negative for all HRSNs (n=3491), linkage to primary care was similar among those who screened positive for any HRSNs (n=1079; adjusted risk ratio, aRR 1.04, 95% confidence interval, CI: 0.98-1.10) and lower among those never screened (n=371; aRR 0.77, 95% CI: 0.68-0.86). We found no evidence of effect modification by APO history, race/ethnicity, insurance, language, or Covid-19 pandemic exposure. Conclusions: In this diverse postpartum sample, we identified a 24% prevalence of pregnancy-related HRSNs and 53% subsequent linkage to primary care. Linkage to primary care was not associated with HRSN screening result (positive versus negative) but was significantly negatively associated with being missed by HRSN screening. Further research is needed to better understand HRSN screening practices and who is missed by screening, and to identify modifiable barriers to postpartum primary care especially after APOs.
Abstract 4140622: Systemic hypotension triggered by stretching of shoulder and upper back muscles: A possible basis for ‘stretch-syncope’ in humans
Authors: Marinos Kosmopoulos, Jorge Reyes, Sima Patel, Hannah Simpson, Richard Sutton, Jan van Dijk, Roland Thijs, David Benditt
Journal: Circulation (2024)

Background: Stretch induced syncope (SIS) is a well-known but rare condition of uncertain pathophysiology. Proposed but unproven mechanisms include Valsalva-like straining, transient vertebral artery occlusion, carotid baroreceptor activation or a combination of these. We hypothesized that shoulder and upper back stretching, possibly acting through skeletal muscle mechanoreceptors, may trigger a hypotensive response, similar to that induced by stretch of other large skeletal muscles (e.g., legs and forearms), but opposite in direction. Objective: This study evaluated the impact of shoulder and upper back stretch on autonomic and hemodynamic findings in otherwise healthy patients with SIS by history compared to controls being evaluated for syncope or near syncope unrelated to stretch. Methods: The study comprised 18 otherwise healthy patients presenting for hemodynamic and autonomic evaluation of syncope or near-syncope. None had evidence of underlying structural cardiovascular disease or abnormal neurological findings on exam. Autonomic evaluation was performed in included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) Valsalva maneuver, and iii) respiratory sinus arrhythmia. Suspected SIS patients also underwent carotid sinus massage while seated. In addition, seated patients were instructed to undertake active extension of the neck and shoulders for approximately 10 seconds while keeping their forearms still and breathing normally. HR and systolic and mean BPs were recorded using beat-by-beat non-invasive plethysmography. Results: The patient population comprised 5/18 patients with a history suggesting SIS and 13/18 controls. With stretching, both SIS and control patients exhibited decreased systolic and mean arterial pressure (MAP), and increased HR. Further, SIS patients had a greater decrease in SBP and MAP during stretch than controls (p=0.021 and 0.029). Syncope or near-syncope developed in four SIS patients (80%) during stretch while no control experienced syncope or near-syncope (p&lt;0.001). Conclusion: Stretching of upper body musculature induces a previously unrecognized transient hypotensive response within humans. SIS patients manifesting more marked hypotension than controls. Thus, vasodepression, possibly initiated by stretch-induced mechanoreceptor activation within upper back and neck muscles, offers a basis for systemic hypotension in stretch-induced syncope.
Abstract 4140555: Sleep Quality Mediates the Relationship Between Sleep Hygiene Practices and Psychological Stress Among Adults With Multiple Cardiovascular Risk Factors
Authors: Xiaoyue Liu, Junxin Li, Jinyu Hu, Jason Fletcher, Yvonne Commodore-Mensah, Cheryl Dennison Himmelfarb
Journal: Circulation (2024)

Background: Psychological stress and poor sleep quality are interrelated and disproportionately affect adults who have multiple risk factors of cardiovascular disease (CVD). Sleep hygiene practices, such as maintaining an optimal household environment and engaging in healthy bedtime behaviors, are essential to sleep health. These practices may also impact psychological stress; however, their relationships remain under-studied. This study aimed to examine the associations among sleep hygiene practices, sleep quality, and psychological stress in adults with multiple CVD risk factors. Methods: Adults diagnosed with hypertension and type 2 diabetes completed an online survey (N = 300). Psychological stress and sleep quality were assessed using the Perceived Stress Scale 4 and the Pittsburgh Sleep Quality Index, respectively. A sleep hygiene instrument was used to examine 8 individual factors focusing on negative household environment (safety, physical comfort, temperature, and light) and poor in-bed behaviors (watching TV, playing video games, using screens, and eating). Multiple regression was employed to examine the association of each sleep hygiene factor with sleep quality and psychological stress. Subsequently, mediation analyses were conducted to examine the mediating role of sleep in the association between the composite sleep hygiene score and psychological stress. Results: Of the sample, 78% reported poor sleep quality and 44% reported high psychological stress. Individual sleep hygiene factors (e.g., unsafe household and eating at bedtime), as well as the composite sleep hygiene score, were significantly associated with poorer sleep quality and higher psychological stress. Sleep quality partially mediated the association between the composite sleep hygiene score and psychological stress (Indirect effect: 0.183; 95% bootstrap confidence interval: 0.057-0.339). Conclusions: The findings showed strong links between sleep hygiene practices, sleep quality, and psychological stress. Although causality cannot be inferred, current evidence suggests that promoting sleep hygiene education and implementing strategies to enhance sleep quality may alleviate psychological burdens in adults with multiple CVD risk factors.
Abstract 4140515: Children’s Heartbeat: Improving Global Knowledge and Care of Pediatric Arrhythmias
Authors: Lindsey Gakenheimer-Smith, Susan Etheridge, Anjan Batra, Shubhayan Sanatani, Hannah Holiman, Tara Nahey, Seshadri Balaji
Journal: Circulation (2024)

Background: Expertise in pediatric electrophysiology (PEP) is lacking in most low- and middle- income countries (LMIC), yet arrhythmias are a ubiquitous and common pediatric clinical problem. Strategies to disseminate PEP education are essential to improve patient care. Children’s Heartbeat (CHB) is a video-conferencing program using the Extension for Community Healthcare Outcomes (ECHO TM ) model to disseminate PEP knowledge to clinicians in LMIC. The impact of CHB in disseminating PEP is unknown. Objective: We evaluated the impact of CHB in improving clinicians’ confidence in PEP. Methods: Since CHB inception in December 2020, monthly cross-sectional surveys of CHB participants, including longitudinal evaluation of participants’ confidence caring for PEP patients, were performed using a 5-point Likert scale, with 1 being low-confidence and 5 high-confidence. Average session participation and post-session evaluations were used as indicators of viewer engagement. Results: CHB currently has 181 registrants from 31 countries, with 53% working in an LMIC (Figure 1). Participants include nurses, medical students, physician assistants, general cardiologists, and pediatric and adult electrophysiologists. Only 30% have PEP training; 53% do not have access to PEP consultation in their workplace. Average session participation was 64, with an additional 121 viewing recorded sessions posted after the live program. On average, participants’ confidence in PEP increased from 2.8 before to 4.0 after CHB sessions (Figure 2). Conclusions: CHB successfully disseminates PEP knowledge to LMIC globally and increases clinicians’ confidence in PEP conditions. Future directions include increasing viewership by pediatric cardiology trainees and pediatric cardiologists in rural regions in high-income countries, partnering with international pediatric and cardiology groups to expand program outreach, and evaluating the direct impact of CHB on patient care in LMIC.
Abstract 4140628: Guideline-Directed Medical Therapy Rates in Patients with Human Immunodeficiency Virus and Heart Failure with Reduced Ejection Fraction
Authors: Suyu Zhang, Krishan Patel, Apoorva Gangavelli, Rebecca Steinberg, Jeffrey Wang, Alanna Morris, Alexis Okoh
Journal: Circulation (2024)

Introduction: Human immunodeficiency virus (HIV) infection increases the risk of heart failure, particularly Heart Failure with Reduced Ejection Fraction (HFrEF). Guideline-directed medical therapy (GDMT), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i), has been shown to decrease morbidity and mortality in patients with HFrEF. Hypothesis: Lower GDMT prescription rates would be associated with higher 30-day readmission or mortality rates in patients with HIV and HFrEF Aims: To assess GDMT prescription rates and their impact on short-term morbidity and mortality in patients with HIV and HFrEF. Methods: Patients diagnosed with HIV and HFrEF who were admitted with acute heart failure within Emory Healthcare from 2010 to 2020 were identified using ICD codes. Diagnoses were confirmed by physician review. Baseline demographics, CD4 count, viral load (VL), prescriptions for GDMT and antiretroviral medications at the time of admission were assessed. A simple GDMT score was created, assigning 1 point for each medication prescribed (0-3, excluding SGLT2i given the study timeframe). Multivariable logistic regression was used to determine the association of the GDMT score with 30-day readmission or death, adjusting for age, sex, race, hypertension, diabetes, estimated glomerular filtration rate (eGFR), and VL. Results: The study included 161 patients (mean age 56 years, 22.9% women, 86.3% Black, 55% with VL &lt;200 copies/ml). Of these, 96 (59.6%) were prescribed BB, 82 (50.9%) RASi, and 18 (11.1%) MRA. This distribution resulted in 38 patients (26.7%) with a GDMT score of 0, 62 patients (43.7%) with a score of 1, 49 patients (34.5%) with a score of 2, and 12 patients (8.5%) with a score of 3. During the 30-day follow-up period, 22 patients (13.7%) were re-hospitalized or died. After adjusting for risk factors, a higher GDMT score was associated with a lower risk of 30-day readmission or death (OR 0.24, CI 0.06 – 0.88, p = 0.032). Male sex was also associated with a lower risk of this endpoint (p = 0.045). Conclusion: GDMT is under-prescribed in patients with HIV and HFrEF. Lower rates of GDMT prescription are associated with worse short-term outcomes in this population. Further efforts are required to ascertain reasons for under-prescription in these comorbid patients and to improve adherence to GDMT guidelines to enhance patient outcomes.
Abstract 4140484: Socioeconomic Status and Outcomes of Patients with In-Hospital Cardiac Arrest
Authors: Hannah Irwin, nadhem abdallah, Abdilahi Mohamoud
Journal: Circulation (2024)

Background: Some studies illustrate an association between adverse outcomes and lower socioeconomic status (SES) in patients with cardiovascular disorders. Limited data exist on in-hospital cardiac arrest outcomes in the context of SES. Objectives: Using mean income as a surrogate for SES, we assessed the association of SES on outcomes and resource utilization for patients with in-hospital cardiac arrest. Methods: We queried the 2016-2019 Nationwide Inpatient Sample and identified inpatient cardiac arrest as the primary diagnosis. We compared in-hospital outcomes based on zip code mean income quartiles (≦2 (&lt; $59,000) vs. ≧3). The primary outcome was inpatient mortality, while secondary outcomes included Palliative Care involvement, vasopressor use, mechanical ventilation use, targeted temperature control, mean length of stay (LOS), and total hospitalization cost (THC). Multivariable regression models were used to adjust for potential confounders. Results: Of 2,122,805 cases of in-hospital cardiac arrest, 1,146,314 (54%) involved patients with a lower income quartile. Lower quartiles were associated with higher odds of in-hospital mortality (adjusted OR [aOR] 1.08, 95% CI 1.05–1.11) and mechanical ventilation use (aOR 1.11, 95% CI 1.08-1.15), while they had lower odds of vasopressor use (aOR 0.62, 95% CI 0.55–0.71, p&lt;0.001), Palliative Care involvement (aOR 0.95, 95% CI 0.92-0.99), and targeted temperature control (aOR 0.76, 95% CI 0.67-0.85), with less THC ($171,639 vs. $183,247, p &lt;0.001) compared to patients in higher quartiles. Conclusion: In cases of in-hospital cardiac arrest, patients with lower income quartiles had higher mortality and less healthcare resource utilization compared to patients with higher income.