tbuckley/cabot-search huggingface dataset:
Abstract 9157: Which Patients with Heart Failure Have the Poorest Health Literacy?
Authors: Debra K Moser, Michele M Pelter, Thomas Nesbitt, Susan Robinson, Martha J Biddle, Lawton Cooper, Kathleen Dracup
Journal: Circulation (2011)

Background: Emerging interest in health literacy has resulted in appreciation of poor health literacy as a major obstacle to engaging in self-care of heart failure (HF), yet little is known about health literacy in this population. Objective: To determine predictors of health literacy in a sample of patients with HF from among relevant sociodemographic, clinical and psychosocial variables. Methods: We enrolled 612 patients with HF living in rural areas of the United States in a randomized controlled trial of a self-care intervention. This report includes baseline data from the 516 (mean age 65 ± 13 years; 41.3% female; 33.8% NYHA class III/IV) on whom we have full data on health literacy. Potential predictors were age, gender, education level, income, employment status, marital status, NYHA class, comorbidity burden, body mass index, anxiety, depression and perceived control. We measured health literacy using the Short Test of Functional Health Literacy Assessment, comorbidity burden using the Charlson comorbidity index, anxiety using the anxiety scale of the Brief Symptom Inventory, depression using the Patient Health Questionnaire-9, and perceived control using the Control Attitudes Scale-revised. Multiple hierarchical linear regression was used to determine predictors of health literacy. Results: The model explained 26% of the variance in health literacy (p &lt; 0.001 for model). The following variables were significant independent predictors of poor health literacy: lower income (p = 0.006), education level of less than high school (p &lt; 0.001), male gender (p &lt; 0.001), older age (p &lt; 0.001), and perceptions of low control related to HF (p = 0.007). None of the clinical variables and neither anxiety nor depression were significant predictors. Conclusion: A well-defined group of HF patients at risk for poor health literacy can be identified by sociodemographic variables and perceptions of control. This information can provide clinicians with information about which patients with HF may have problems with health literacy. Patients with poor health literacy often are not recognized by clinicians. When a patient possesses one or more of the characteristics identified in this study, the clinician should have a high index of suspicion for poor health literacy.
Abstract 232: Sensitivity of Individual Data Modalities for Detecting Return of Spontaneous Circulation and Rearrest with Defibrillator Data
Authors: Matthew Sundermann, David D Salcido, James J Menegazzi
Journal: Circulation (2012)

Background Determining the presence of return of spontaneous circulation (ROSC) and re-arrest (RA) in out-of-hospital cardiac arrests offers a challenge for health care providers and researchers. A better understanding of how different data streams reflect patient vital status could improve patient care by reducing time to identification of ROSC and RA and by improving the efficiency of retrospective analyses. We hypothesized that some data streams in the absence of others may be insufficient in determining rhythm status and we sought to determine the extent of these insufficiencies. Methods Defibrillator data for non-traumatic cardiac arrests collected by the Resuscitation Outcomes Consortium’s (ROC) Pittsburgh site from 2006-2008 and 2011 were analyzed. Custom software was used to identify ROSC/RA status during the resuscitation and post-resuscitation phases of EMS treatment. The data streams included audio, force of compression (COMP), transthoracic impedance (IMP) and patient care reports (PCR). Official ROSC/RA status was established using all available channels. We then analyzed each channel for indicators of ROSC/RA at those time-points when ROSC/RA were noted in the initial analysis. Sensitivities and specificities for detecting ROSC/RA were calculated for each channel relative to the clinical benchmark, a combination of ECG +IMP signals in Stata 12. Results The ROSC sensitivities for each signal compared to our clinical benchmark were .890(audio), .912(ECG), .934(IMP), .868(COMP) and .813(PCR). ROSC/RA combined sensitivities were calculated to be .851(audio), .900(ECG), .933(IMP), .880(COMP) and .719(PCR). The RA sensitivities were calculated to be .767(audio), .860(ECG), .933(IMP), .833(COMP) and .430(PCR) while specificities were calculated to be 1(audio), 1(ECG), 1 (IMP), 1(COMP) and 0(PCR). Conclusion The ECG and IMP individual signals produced the highest sensitivity in detecting ROSC/RA when compared to our benchmark of ECG + IMP. When analyzing a case with just one signal, the sensitivity for detection of ROSC/RA may be grossly inadequate particularly with only PCR information. However, the most commonly available pairing of data streams in modern defibrillators, ECG and transthoracic impedance, is accurate.
Abstract 19679: Mitochondrial Aldehyde Dehydrogenase 2 (ALDH2) Ameliorates Angiotensin II-Induced Cardiac Remodeling and Myocardial Dysfunction through Inhibition of Mitochondrial Oxidative Stress and Induction of Autophagy
Authors: Yingmei Zhang, Jun Ren
Journal: Circulation (2012)

Angiotensin II-induced cardiac damage is associated with oxidative stress, mitochondrial injury, cardiac remodeling and contractile dysfunction. ALDH2, a mitochondrial enzyme governing mitochondrial and cardiac function, displays distinct polymorphism and predisposes increased prevalence of hypertension. This study was designed to evaluate the role of ALDH2 in angiotensin II-induced myocardial remodeling and contractile dysfunction. Echocardiographic, cardiomyocyte contractile and intracellular Ca 2+ properties were examined in WT and ALDH2 transgenic mice with or without angiotensin II perfusion. Cardiac histology and autophagy, a process governing hypertrophy and oxidative stress, were evaluated. Myocardial contractile function and intracellular Ca 2+ handling were compromised in angiotensin II-perfused WT mice, the effects of which were significantly attenuated by ALDH2. H&amp;E and Masson trichrome staining revealed cardiomyocyte hypertrophy and interstitial fibrosis associated with greater echocardiographic LV mass and wall thickness. ALDH2 ameliorated angiotensin II-induced cardiomyocyte hypertrophy, cardiac interstitial fibrosis, cardiomyocyte apoptosis, and cardiac atrial natriuretic peptide mRNA levels. The beneficial effect of ALDH2 was independent of blood pressure regulation and was linked to decreased ER stress, autophagy, and 5' AMP-activated protein kinase phosphorylation. Myocardial ER stress and autophagy were facilitated by angiotensin II associated with higher phosphorylation of AMPK. Mitochondria from angiotensin II perfused WT hearts showed clustered mitochondrial patterns, decreased numbers, and volume fractions but increased trans-sectional areas. All of these effects were reduced in ALDH2 mice. The ALDH2 activator Alda-1 ameliorated angiotensin II-induced mitochondrial injury and autophagy induction. Human study also revealed a positive correlation between high blood pressure prevalence and ALDH2 gene mutation. In summary, ALDH2 may provide a blood pressure-independent protection against angiotensin II-induced mitochondrial remodeling and cardiac contractile dysfunction, possibly through modulation of mitochondrial oxidative stress and autophagy induction.
Abstract 19130: Referral to Cardiac Rehabilitation: A Quality Indicator Associated with Reduced Mortality
Authors: Billie-Jean Martin, Trina Hauer, Leslie D Austford, Danielle A Southern, Merill L Knudtson, Ross Arena, Sandeep Aggarwal, James A Stone
Journal: Circulation (2012)

Background: Cardiac Rehabilitation (CR) is an efficacious, evidence based treatment for reducing mortality and hospitalization in subjects with coronary artery disease (CAD). CR referral is an indicator of quality care in CAD patients. However, not all eligible subjects are referred for CR. The objective of this study was to assess predictors of referral to CR and the association between referral and mortality. Methods: All subjects who underwent coronary angiography between 1995 and 2009 and were found to have CAD were included in this study (n=25,958, 24.6% female). Referral to CR and subsequent attendance were evaluated. Baseline characteristics were compared between those who were referred and not. Logistic regression models predicting referral were developed. Using cox proportional hazards models, survival was then compared across those who were not referred (NR), referred and did not attend, and referred and did attend. Results: Of those subjects with CAD, 10236 (39.4%) were referred to CR; 58.4% of those referred attended CR. Rates of referral increased from 20.7 to 65.3% over the course of the study (p&lt;0.0001). In multivariate models, older age, being female, and diabetes all predicted non-referral (all p&lt;0.0001). Relative to the NR, those who were referred and did not attend had a hazard ratio (HR) for mortality of 0.55 (95% CI 0.51, 0.60); those who were referred and attended had a HR of 0.26 (95% CI 0.24, 0.29). When adjusted for age, sex, CAD severity, treatment (surgical, interventional, medical) and all clinical covariates, subjects who were referred and did not attend had a HR of 0.76 (95% CI 0.70, 0.82) and subjects who were referred and attended had a HR of 0.42 (95% CI 0.38, 0.46) for death relative to those who were NR. Conclusion: While CR referral rates have improved over time, they remain suboptimal. High-risk subjects are the most likely to remain un-referred. Given the association between CR referral and reduced mortality, referral to CR is a justifiable quality indicator for CAD patient care. Efforts to improve referral should be undertaken.
Abstract 8715: Multidirectional Left Ventricular Performance Using Three-Dimensional Speckle-Tracking Strain in Patients with Chronic Right Ventricular Pacing and Preserved Ejection Function
Authors: Hidekazu Tanaka, Kensuke Matsumoto, Kazuhiro Tatsumi, Mana Hiraishi, Tatsuya Miyoshi, Akihiro Kaneko, Takayuki Tsuji, Keiko Ryo, Yuko Fukuda, HIroya Kawai, Ken-ichi Hirata
Journal: Circulation (2011)

Background: Right ventricular (RV) pacing has a detrimental effect on global left ventricular (LV) function even in some patients with preserved ejection fraction (EF), but its mechanism remains unclear. Our objective was to evaluate early subtle changes by chronic RV pacing in patients with preserved EF using novel three-dimensional (3-D) speckle-tracking strain. Methods: We studied 112 subjects; 52 patients with chronic RV pacing and preserved EF (all ≥ 50%), an EF-matched 20 normal controls, and 30 heart failure (HF) patients with chronic RV pacing and reduced EF (all≤35%). Radial, circumferential and longitudinal dyssynchrony and function were quantified as standard deviation of time-to-peak strain and global peak strain using 3-D speckle-tracking strain from all 16 LV segments (Aplio Artida, Toshiba Corp.). Results: The degree of radial and circumferential dyssynchrony and function in patients with chronic RV pacing and preserved EF and controls were similar (radial dyssynchrony: 28±20ms vs. 26±19ms, circumferential dyssynchrony: 31±14ms vs. 29±14ms, and global radial strain: 37±20% vs. 39±12%, global circumferential strain: 27±14% vs. 30±11%, respectively). Patients with chronic RV pacing and preserved EF, however, had greater longitudinal dyssynchrony with 42±22ms vs. 27±13ms, and lower global longitudinal strain with 21±13% vs. 30±19% compared to controls (both p&lt;0.05). Furthermore, longitudinal strain in septum was significantly lower than that in posterior-lateral wall (19±9% vs. 27±10%, p&lt;0.05), and longitudinal dyssynchrony at apex was significantly larger compared to mid and basal level (51±14ms vs. 40±9ms and 38±8ms, p&lt;0.05) in patients with chronic RV pacing and preserved EF. In contrast, HF patients with chronic RV pacing and reduced EF had greater radial, circumferential and longitudinal dyssynchrony, and lower global radial, circumferential and longitudinal strain compared to controls (all p&lt;0.001). Conclusion: Longitudinal dyssynchrony was observed in patients with chronic RV pacing and preserved EF with impaired longitudinal function. 3-D speckle-tracking strain was useful at evaluating early subtle changes by chronic RV pacing, and may play a clinical role at predicting future global LV dysfunction.
Abstract 19189: Aldosterone and Diabetic Heart Disease: Relevance to Diffuse Myocardial Fibrosis and Coronary Microvascular Dysfunction
Authors: Ravi Shah, Ajay Rao, Rajesh Garg, Michael Jerosch-Herold, Raymond Kwong, Todd Perlstein, Marcelo Di Carli, Gail Adler
Journal: Circulation (2012)

BACKGROUND: Early diabetic heart disease is characterized by expansion of the cardiac interstitial matrix and impaired myocardial blood flow. Aldosterone is implicated in the pathophysiology of cardiac fibrosis and vascular injury. We hypothesized that aldosterone is associated with interstitial expansion and microcirculatory dysfunction in Type 2 diabetes mellitus (T2DM). METHODS: We studied 53 subjects with T2DM (68% male; age [mean±SD] 53±7 years, body mass index 32.2±4.3 kg/m2) without evidence of infarction or ischemia by cardiac magnetic resonance (CMR) and PET. After ≥3 months ACE inhibition (enalapril 20 mg daily ± amlodipine for BP control) and optimal glycemic and lipid control, subjects consumed 5 days of high salt diet. 24-hr urinary aldosterone excretion and angiotensin II-stimulated increase in serum aldosterone were measured. CMR to assess extracellular volume fraction (ECV), cardiac PET to assess coronary flow reserve (CFR) and echocardiography were performed. RESULTS: T2DM subjects (HbA1c 6.8±0.7%, BP-systolic 126±14, diastolic 76±9 mmHg) had normal left ventricular structure by CMR and normal diastolic function (transmitral E/A 1.13±0.28, tissue Doppler e’ 0.11±0.03 m/s). CFR (2.51±0.83) was not associated with aldosterone. Myocardial ECV (0.36±0.05) was positively associated with 24-hr urinary aldosterone excretion (r=0.37, P=0.01) and angiotensin II-stimulated increase in aldosterone (r =0.35, P=0.02). In a best-overall stepwise multivariate model (with age, BMI, HbA1c, systolic BP and CFR as covariates), 24-hr urinary aldosterone excretion was still associated with myocardial ECV (P=0.004). CONCLUSIONS: Aldosterone is associated with CMR measures of interstitial matrix expansion in individuals with T2DM without evidence of epicardial coronary artery disease or diastolic dysfunction and on chronic ACE inhibition. These results implicate aldosterone in early myocardial remodeling in T2DM.
Abstract 19681: Endothelial PGC-1alpha Mediates Vascular Dysfunction in Diabetes
Authors: Naoki Sawada, Aihua Jiang, Fumihiko Takizawa, Kevin Croce, Andre Manika, Yevgenia Tesmenitsky, Kyu-Tae Kang, Joyce Bischoff, Hermann Kalwa, Thomas Michel, Yasutomi Kamei, Laura Benjamin, Masataka Sata, Yoshihiro Ogawa, Zolt Arany
Journal: Circulation (2012)

Naoki Sawada, 2012 Finalist and Presenting Author
Abstract 19125: Mortality and Risk Factors for Malignant Ventricular Arrhythmias in Carriers of the Phospholamban R14del Mutation
Authors: Paul A van der Zwaag, Ingrid A van Rijsingen, Eline A Nannenberg, Judith A Groeneweg, Imke Christiaans, Isabelle C van Gelder, Richard N Hauer, Maarten P van den Berg, Arthur A Wilde, J. Peter van Tintelen
Journal: Circulation (2012)

Introduction: The phospholamban ( PLN ) R14del mutation causes dilated and/or arrhythmogenic cardiomyopathy and is associated with an increased risk of malignant ventricular arrhythmias (MVA) and end-stage heart failure. Objectives: To determine risk factors that predict MVA in carriers of PLN R14del and to assess their mortality risk. Methods and results: With non-invasive tools (ECG, echocardiography, Holter, exercise testing, and magnetic resonance imaging), we retrospectively evaluated clinical risk factors for MVA, defined as cardiopulmonary resuscitation (CPR), appropriate ICD treatment, and sudden cardiac death, in a multicenter cohort of 295 PLN R14del carriers. In a median follow-up period of 42 months (interquartile range: 6 to 111 months), 55 (19%) persons experienced a first episode of MVA: 8 persons received successful CPR, 38 received appropriate ICD treatment, and 9 persons died suddenly in the absence of heart failure. The youngest age at which an MVA was observed was 20 years (CPR). Independent risk factors for MVA were non-sustained or sustained ventricular tachycardia and left ventricular ejection fraction &lt;45%, with hazard ratios of 2.4 (95% CI: 1.5-4.5) and 4.0 (95% CI: 1.8-9.1), respectively. In addition, we analyzed all-cause mortality (main outcome measure: standardized mortality ratio [SMR]). All-cause mortality of PLN R14del carriers was increased (SMR 1.7; 95% CI: 1.4-2.0) with significant excess mortality starting from the age of 25 years. Conclusions: Carriers of the PLN R14del mutation are at high risk for MVA and all-cause mortality. Implantation of an ICD could therefore be justified in PLN R14del carriers with a left ventricular ejection fraction &lt;45%, even in the absence of ventricular arrhythmias. Excess mortality is observed starting from the age of 25 years. Cardiological screening of PLN R14del carriers is thus recommended to be initiated at the beginning of adulthood to prevent malignant outcomes.
Abstract 89: Does Neighborhood Really Matter? How Location Influences Bystander CPR Rates
Authors: Jason E Buick, Joel G Ray, Alex Kiss, Laurie J Morrison
Journal: Circulation (2012)

Introduction: Numerous studies have investigated determinants of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. Socioeconomic status and ethnicity have been linked to who receives bystander CPR, and recent studies have showed geographical differences in CPR rates. Research from other disciplines has suggested that location is a strong determinant of health and health related interventions and outcomes. Therefore, the objective of this study was to determine the role of neighborhoods in bystander CPR rates in a Canadian population. Hypothesis: We hypothesized that neighborhood factors are associated with bystander CPR rates. Methods: All treated OHCA within the City of Toronto between April 2006 and March 2010 were included. Geographic Information Systems were used to assign patients to census tracts (CT) based on their pick-up address and linked to neighborhood factors (instability, dependency, deprivation, ethnic diversity, crime rate and density of family physicians). Bivariate and hierarchical logistic modeling was performed to assess which factors were associated with bystander CPR. Results: A total of 5,139 OHCA were eligible for enrollment and contained the required information for geographic mapping. The bystander CPR rate was 41.1%. The bystander CPR rate varied across census tracts (0 - 92%, IQR: 25.0 - 50.0%), where 10% had a bystander CPR rate lower than 15%. The CTs deprivation and density of family physicians were associated with bystander CPR (see table). After adjusting for individual characteristics, no CT level variables were associated with bystander CPR. Conclusion: Deprivation and the density of family physicians were associated with higher rates of bystander CPR. However, after adjustment for patient characteristics, neighborhoods were not associated with CPR. Future research should explore the relationship between location and witnessed status and its role in bystander CPR.
Abstract 9364: MADIT-CRT: Resynchronization Patients Experience More Complications Than ICD-Only Patients but Outcomes are Not Significantly Impacted
Authors: James P Daubert, Patrick M Hranitzky, Scott McNitt, Helmut U Klein, Michael R Gold, David J Wilber, Mary Brown, David S Cannom, Wojciech Zareba, Arthur J Moss
Journal: Circulation (2011)

BACKGROUND and METHODS: MADIT-CRT randomized 1820 patients with mild or asymptomatic heart failure symptoms, ejection fraction below 0.30 and QRS wider than 0.13 s in a 3:2 ratio to cardiac resynchronization therapy (CRT) with an ICD versus ICD alone and demonstrated a 41% reduction in heart failure (HF) events. CRT therapy requires additional lead(s) over a standard ICD. The additional LV (and RA) leads may contribute to an excess of complications with CRT. Lead or procedure-related complications could in turn lead to increased morbidity (such as heart failure (HF) events) and mortality in patients experiencing them. In this MADIT-CRT sub-study we sought to determine if complications were greater in the CRT arm and if patients experiencing a complication had unfavorable outcomes. Complications were classified by timing (0-30 days, &gt; 30 days) and severity (non-severe and severe). HF and mortality events were adjudicated by a blinded events committee. RESULTS: Within the first 30 days, severe complications occurred significantly more frequent in the CRT arm than in the ICD-only arm, 5% vs 3% respectively (p=0.033). Between 30 days and end of follow-up, severe complications were similar in frequency in the two arms (p=0.223). Non-severe complications also were more frequent in the CRT arm than the ICD arm both within the first 30 days, 23% vs 9% respectively (p&lt;0.01), and between day 30 and end of follow-up, 24% vs 15% (p,0.01). Patients experiencing either non-severe or severe complications had a similar HF or death event rate compared with patients free from complications (Figure). CONCLUSIONS: Severe complications occurred more frequently during the first 30 days in the CRT arm of MADIT-CRT and non-severe complications were more frequent throughout follow-up in the CRT arm. Fortunately, patients experiencing these complications as a group did not suffer more HF or death event rates.