tbuckley/cabot-search huggingface dataset:
Abstract 4147355: Tracking Mood Phenotypes in TIA and Ischemic Stroke Patients Using Smartphone Sensors: Preliminary Results from a Real-World Data Pilot Study
Authors: Stephanie Zawada, Oana Dumitrascu, Ali Ganjizadeh, Clint Hagen, Ehab Harahsheh, Bart Demaerschalk, Bradley Erickson
Journal: Circulation (2024)

Background: Although no tests are currently available to predict post-stroke depression (PSD), a risk factor for diminished quality of life and stroke-related death, emerging evidence suggests that ischemic stroke (IS) may induce behavioral changes by damaging connections throughout the brain rather than via localized injury. Hypothesis: We sought to determine if active (surveys) and passive (accelerometer, GPS, and other sensors) smartphone data could quantify exploratory behavioral proxies of PSD. Methods: Thirty-four adults with a recent IS (n = 12) or transient ischemic attack (TIA) (n = 22) diagnosis were followed for 3 months. Participants used the Beiwe app to complete a weekly Patient Health Questionnaire-8 (PHQ-8) survey and were evaluated every 30 days with the Montgomery-Asberg Depression Rating Scale (MADRS). Results: Preliminary analysis of app survey compliance was adequate (86%), and the quantity of data collected was greater for Android than iOS phones. PHQ-8 indicated depression (moderate or severe) in 20% of participants. MADRS highly correlated with the most recent PHQ-8 ( r = 0.92, 95% CI (0.19, 0.99), P = 0.028). Several exploratory passive physical activity and social measures showed statistically significant change over time and/or associations with PHQ-8 and MADRS. Conclusion: Low-burden smartphone data holds promise for developing novel IS and TIA outcome measures as well as identifying patients most at risk of PSD.
Abstract 4147448: The Associations of Cardiovascular-Kidney-Metabolic (CKM) Syndrome Stages with Incident Cardiovascular Disease and Cardiovascular Mortality in Middle-Aged Adults: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Bige Ozkan, Sui Zhang, Janani Rangaswami, Vijay Nambi, Justin Echouffo, Timothy Chow, Junichi Ishigami, Roger Blumenthal, Christie Ballantyne, Sadiya Khan, Josef Coresh, Chiadi Ndumele
Journal: Circulation (2024)

Background: In 2023, the American Heart Association defined Cardiovascular-Kidney-Metabolic (CKM) Syndrome, reflecting the connections among cardiovascular, kidney, and metabolic risk, and outlined a staging system for CKM Syndrome. The associations of CKM Stages with cardiovascular disease (CVD) subtypes have not yet been quantified. Methods: We categorized ARIC Visit 4 (1996-98) participants by CKM Stages: Stage 0, no CKM risk factors; Stage 1, excess/dysfunctional adiposity; Stage 2, metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, or diabetes) and/or moderate- to high-risk chronic kidney disease (CKD); Stage 3, ≥20% predicted CVD risk per PREVENT calculator or very high-risk CKD; and Stage 4, clinical CVD. We used Cox regression to estimate relative risk associations of CKM stages with atherosclerotic CVD (ASCVD), heart failure (HF), total CVD (ASCVD + HF), and CVD mortality over 10 years and through 12/30/2021. We calculated population attributable fractions (PAFs) to estimate how much of CVD risk is attributable to CKM Syndrome for each CVD subtype. We further assessed time to CVD events and mortality across stages. Results: Among 8,937 participants (mean age 63 years, 55% female, 18% Black), 3.8% were at Stage 0, 12.8% at Stage 1, 57% at Stage 2, 5.7% at Stage 3, and 20.6% at Stage 4 of CKM Syndrome. There was a stepwise increase in CVD risk with higher CKM stages (Table), with CKM stage 3 vs 0 associated with HRs of 4.1 for ASCVD, 11.2 for HF and 4.8 for total CVD, and CKM stage 4 vs 0 with a HR of 5.9 for CVD mortality. At 10 years, the PAFs associated with CKM Syndrome were 55% for ASCVD, 80% for HF, 62% for total CVD, and 62% for CVD mortality. Patterns were similar but attenuated over the full follow-up. Over the full study period, CVD events occurred 6-7 years earlier in CKM stage 3 vs 0, and CVD mortality 7 years earlier in CKM stage 4 vs 0. Conclusion: Higher CKM syndrome stages are associated with greater risk of and earlier onset of CVD events, with CKM syndrome contributing the highest attributable risk for HF among CVD subtypes. These findings highlight the role of CKM staging for facilitating the prevention of CVD, especially HF, in the general population.
Abstract 4147079: Effects of Oral LT3 in Participants with Isolated Low T3 levels and Heart Failure: A Randomized, Placebo-controlled, Crossover Trial
Authors: Anne Cappola, Robert Gallop, David Lin, KRISTEN KOBALY, Julio Chirinos, Thomas Cappola
Journal: Circulation (2024)

Introduction: Observational studies in heart failure (HF) patients have shown that low levels of the thyroid hormone triiodothyronine (T3) with otherwise normal thyroid testing (‘low T3 syndrome’) is a risk factor for adverse clinical outcomes. Preclinical studies have shown beneficial effects from T3 therapy on myocardial contractility, myocardial relaxation, and vascular resistance, but human studies are lacking. Research Question: In patients with HF and low T3 syndrome, is oral liothyronine (LT3) safe, and does it impact cardiovascular clinical and physiologic phenotypes? Aims: Primary aim: To evaluate the safety of oral LT3 therapy in HFrEF and HFpEF. Secondary aim: To evaluate the feasibility and preliminary efficacy of oral LT3 therapy in HFrEF and HFpEF. Methods: A total of 28 participants with HFrEF and 28 with HFpEF aged 18+ years enrolled in a single-center, randomized, double-blind, placebo-controlled, crossover trial and were prescribed LT3 or placebo for 8 weeks with a 2-week washout period. Primary outcomes were safety as assessed by T3 level; arrhythmic events by EKG, 14-day adhesive patch monitoring, and ICD (HFrEF only); and adverse events. Secondary efficacy outcomes included Kansas City Cardiomyopathy Questionnaire, NT-proBNP level, peak O2 consumption during a cardiopulmonary exercise test, and actigraphy. Secondary mechanistic outcomes included non-invasive assessments of cardiac and arterial function measured via echocardiography and arterial tonometry. Results: Low T3 syndrome was present in 20% of screened participants. After LT3 treatment, T3 levels markedly increased compared with placebo. Heart rate was higher on LT3 (mean difference 2.4 beats per minute, p &lt;0.05), but otherwise, primary safety and secondary efficacy endpoints were not different between LT3 and placebo. In HFrEF participants, secondary mechanistic endpoints indicated an increase in LV ejection fraction and the intensity of forward compression and backward suction waves generated by the LV (p &lt;0.05), despite GDMT and beta-blockade. Conclusion: In participants with HF and low T3 syndrome, oral LT3 titrated to T3 levels in the upper reference range was safe. LT3 increased heart rate, and, among HFrEF participants, increased LV ejection fraction and other parameters of LV inotropic and lusitropic function. A larger clinical trial of LT3 in HFrEF patients with low T3 syndrome is required to determine if these efficacy signals translate into clinical benefit.
Abstract 4147100: The Association between Perceived Stress and Left Ventricular Mass Index (LVMI)
Authors: sumayya shurovi, Michelle David, Brandon Fernandez Sedano, Talea Cornelius, Joseph Schwartz, Marwah Abdalla
Journal: Circulation (2024)

Introduction: Perceived stress is known as the feeling of uncontrollability in one’s life and the inability to cope with the amount of stress one is experiencing due to one’s circumstances. There is evidence indicating that perceived stress may be a risk factor for cardiovascular disease (CVD). However, it is unclear whether perceived stress is associated with higher left ventricular mass index (LVMI), a measure of target organ damage and strong predictor of CVD. Aim: We examined the association between perceived stress and LVMI. Methods: The Masked Hypertension Study is a multi-site study that assessed the prevalence and predictors of masked hypertension in working adults from the New York Metropolitan area. A total of 1011 participants were recruited for the study; 826 participants completed the Perceived Stress Scale questionnaire and an echocardiogram. The perceived stress scale is a 14-item likert scale that assesses different situations that affects our perceived stress or our feelings in certain situations. It has a scale of 1 to 5 with 1 being never to 5 being very often. LVMI was determined according to the 2D method based on the American Society of Echocardiography (ASE) recommendations. Linear regression models were specified predicting LVMI from perceived stress. Covariates were sex, race/ethnicity, age, BMI, systolic bp, diastolic bp, and caregiving status. Results: Of the 826 participants, 40.7% were male, 6.9% were Black, 11.9% were Hispanic/Latinx , and 48.79% were caregivers. Mean (SD) age was 45.3 (10.3) years, mean body mass index was 27.6 (5.3) kg/m 2 , and mean SBP and DBP were 114.7 (12.0) and 74.8 (8.5). Mean perceived stress score was 21.8 (7.6) and mean LVMI was 63.3 (15.7) gm/m 2 . Contrary to our hypothesis, perceived stress was not significantly associated with LVMI, B = -0.00, 95% CI: -0.13, 0.13, p= 0.98. Conclusion: There was not an association between perceived stress and LVMI. Future research should examine whether other types of stresses/stressors are related to LVMI and the implications of this for patients and their health.
Abstract Or110: Baseline Measurements of Cellular Respiration Affect the Response to Thiamine Treatment in Post-arrest Patients
Authors: Jacob Vine, John Lee, Lakshman Balaji, Noa Berlin, Michael Simpson, Ari Moskowitz, Xiaowen Liu, Katherine Berg, Anne Grossestreuer, Michael Donnino
Journal: Circulation (2024)

Introduction: Lactic acidosis and impaired oxygen extraction due to mitochondrial dysfunction are common post-arrest. Thiamine, a cofactor for pyruvate dehydrogenase, is necessary for aerobic metabolism. In two randomized controlled trials (RCTs) testing the effect of thiamine vs. placebo in out-of-hospital and in-hospital post-arrest patients (NCT03450707 and NCT02974257), no relationship was found between thiamine treatment and the primary outcome of change in lactate over 24 hours. Cellular oxygen consumption rates (OCRs) were measured in a subset of patients at baseline. Maximal and spare OCRs measure the capacity of mitochondria to increase cellular respiration from their basal state when stimulated, and may identify patients likely to benefit from thiamine. We conducted a post-hoc analysis of the two RCTs to evaluate the primary outcome in subgroups defined by baseline OCRs. Hypothesis: Patients with higher maximal and spare OCRs at baseline are more likely to benefit from thiamine treatment, as indicated by lower lactate levels. Methods: Basal, maximal and spare OCRs, collected at enrollment, were measured in peripheral blood mononuclear cells using an XFe96 Extracellular Flux Analyzer and XF Cell Mito Stress Test Kit (Seahorse Bioscience). Lactates (at 6, 12, and 24 hours) were log-transformed and analyzed using a linear mixed model controlling for baseline lactate. In patients who expired &lt;24 hours, lactate was imputed using the last available value with a 20% increase. Subgroups were defined by baseline OCR values above or below the median. The primary outcome was lactate at 24 hours, presented as a geometric mean difference (GMD). Results: A total of 74 patients had baseline OCR measurements. There was no statistically significant difference in lactate at 24 hours between placebo and thiamine in all patients (p=0.179) or in the low OCR (below median) groups. In patients with baseline maximum or spare OCRs above the median, lactate levels were significantly lower in those receiving thiamine (24 hour GMDs of 0.61 (95% CI: 0.45-0.82; p=0.001), and 0.53 (95% CI: 0.38-0.74; p&lt;0.001), respectively; Figure 1). Conclusion: In a post-hoc analysis of two RCTs, thiamine significantly improved the primary outcome in the subgroup of patients with higher spare and maximal oxygen consumption rates at baseline. Baseline OCRs could potentially identify post-arrest patients likely to benefit from thiamine.
Abstract 4146790: Circadian Variation of ST Elevation Mycardial Infarction is Associated Not Only With Chest Pain Onset But Also Infarct Related Artery and TIme Delays to Treatment.
Authors: Zbigniew Siudak, Filip Tkaczyk, Kamil Pytlak, Dardzinska Natalia, Paulina Jaskulska, Michal Zabojszcz
Journal: Circulation (2024)

Introduction: Available data suggest there is some regularity in the time of the day when patients experience their first clinical symptoms (pain) of ST Elevation Myocardial Infarction (STEMI). It has been noticed that the largest number of cases of myocardial infarction are observed in the early morning. Some studies, especially in Asian populations, have found a shift into the afternoon hours. Additionally, some publications suggest the existence of secondary peaks of incidence in the evening hours. There also seems to be a relationship between night hours and the occurrence of myocardial infarctions in patients with sleep apnea. Although the risk of myocardial infarction is highest in the morning, there are differences depending on the region and population which might indicate the influence of local and individual factors on the circadian rhythm of the disease. Objective: To analyze circadian variation of STEMI first chest pain onset occurence on one of the largest populations tested so far and to see if there is an association with time delays to Percutaneous Coronary Intervention (PCI). Methods: Data from the Polish National PCI Registry (ORPKI Registry) on patients with confirmed STEMI diagnosis who underwent either coronary angiography and/or PCI from 2014 untill 2022 were analyzed. Results: There were 153 543 individual patients in the analyzed time period with 68% of males. Circadian variation in the probablity of STEMI occurence in both men and women is presented in Figure 1 (p&gt;0.05). Median time from chest pain onset to first medical contact (FMC) was 180 minutes (60-260; 95% CI) at 3 am and 90 minutes (59-196; 95% CI) at 1 pm respectively (p&lt;0.001). Median tIme from FMC to PCI was 77 minutes (53-120; 95%CI) at 1 pm vs 87 minutes (60-140; 95% CI) at 7 am. Likewise the total time of ischemia from chest pain onset to PCI has been similiary affected. No differences in the periprocedural mortality was found. We have found no influence of diabetes, age and presence of chronic pulmonary obstructive disease on the circadian pattern. Interestingly, we have seen a circadian variation of LAD vs RCA ratio with LAD nadir at noon hours and peak during midnight and RCA the opposite (p&lt;0.001). Conclusiions: Strong circadian variation exists in the probablity of occurence of STEMI in both males and females with peak incidence at 8 am. STEMI chest pain onset time had influence on time delays to PCI. A circadian variaiton in LAD/RCA occlusion was observed.
Abstract 4147047: Assessing Knowledge, Attitudes, and Practices Regarding the American Heart Association’s Framework for Cardiovascular Health in Pediatrics
Authors: Robin Ortiz, Debra Chan, Abigail Nita, Sean Heffron, Nikita Nagpal, Carol Duh-Leong
Journal: Circulation (2024)

Background: Despite emphasis on establishing cardiovascular health (CVH) early in life with an intergenerational approach, it remains unknown if child health professionals are aware of the American Heart Association (AHA) framework and recommendations. Methods: Survey design included: 1) Likert scales of AHA CVH framework awareness (Simple 7 (LS7) and/or Life’s Essential 8 (LE8), 2) a knowledge assessment, and 3) introduction of the LE8 framework with mixed methods assessment of perceived attitudes and practice implications. The survey was distributed via professional organizations (American Academy of Pediatrics, Regional Academic Pediatric Association, National Med-Peds Residents Association) to members with a gift card incentive and snowball sampling approach. Response rate (RR) reporting was limited by organizational dissemination with snowball sampling, but was calculated by number of opened surveys (link clicks). Descriptive statistics summarized results. Results: There were 221 respondents to the awareness items with 169 surveys fully completed (91.7, and 70.1% of opened surveys), from across all US regions (34 states + Puerto Rico), who were mainly senior residents or practicing physicians in general pediatrics or Med-Peds (33±7yrs, 68% female). Most were “not aware at all” of either framework (64.5, 68%, Figure ). Mean knowledge score was 40% (3.2/8). While majority (56.1%) reported increased need to clinically address CV risk over time, only 37.3% were comfortable addressing risk/counseling in pediatric practice (most often diet, physical activity). Over half found the framework valuable for pediatric patients and adult caregivers (54.1, 55.2%, Figure ) and ~¾ reported that knowledge of it would change their practice, including for patient education, risk stratification, and sub-specialty engagement. Nearly all (92.4%) felt a joint AHA-Pediatrics organization CVH collaboration (e.g., task force, statement) would be valuable. Conclusions: Most pediatric professionals surveyed reported no awareness of the AHA CVH framework, but valued its utility in working with children and caregivers in practice, highlighting a need for engagement of child health professionals in LE8 dissemination and implementation.
Abstract 4147594: Improving Pregnancy Outcomes through Remote Monitoring and Rewards for Participation
Authors: Marlo Vernon, Dustin Tracy, Elinita Pollard, Alisha Patel
Journal: Circulation (2024)

Background: Mental health issues, preeclampsia, and eclampsia were among the leading causes of pregnancy-related deaths from 2018-2020 in Georgia. Studies from other countries have suggested that self-measured blood pressure (SMBP) among pregnant and postpartum women is a feasible method for reducing the risk for hypertension-related pregnancy complications (e.g., preeclampsia, eclampsia). Long-term risks of CV issues during pregnancy are known to increase the risk of stroke and heart attack later in life. Despite the benefits of SMBP, its impact is understudied among at-risk women during and after pregnancy. Therefore, we aimed to explore if incentives are associated with an increase in blood pressure (BP) reporting among pregnant and postpartum women utilizing the VidaRPM application. Methods: 91 women (67.5% HS or less, 58.8% Black, Mean Age = 27.01y) were randomized to the control (usual care, n=30), regular (SMBP through VidaRPM, n=30), or incentivized (SMBP with incentives, n=31). All women were between 13 and 34 weeks of pregnancy. All participants received a blood pressure monitor, and online education resources, and were asked to record BP three times a week and one mental health survey a week during pregnancy until the 12 th week postpartum. Regular SMBP participants received additional education, self-efficacy assessment, and ongoing support. Incentive participants received an additional $25 gift card for full engagement between 34 weeks of pregnancy and 6 weeks postpartum. Women who reported BP outside the normal range were instructed to follow up with their providers. Results: Moms in the Control Group had full engagement for 5 out of 304 weeks, regular SMBP arm for 56 out of 245 weeks, and Incentive arm, for 76 out of 254 weeks. The difference among all three groups is statistically significant (p-value = 9.7e-15) however the difference between the two treatment groups is not. Discussion: The incentive and regular SMBP groups demonstrated significantly increased adherence to reporting compared to control, and the incentive group more than regular group. This result supports incentivized SMBP during and after pregnancy, possibly reducing missed hypertensive issues and reducing the risk of unmonitored long-term cardiovascular outcomes. Improving women’s self-efficacy and knowledge of risk among at-risk populations will positively impact short and long-term CV health.
Abstract 4147071: Lupus Mitral Valve Disease Masquerading as an Absent Posterior Mitral Valve Leaflet
Authors: Helene DiGregorio, Madiha Khan, Elia El Hajj, Aneesh Dhore, David Yao, Ross Reul, Nadeen Faza
Journal: Circulation (2024)

Introduction/Background: Marantic endocarditis and valvulitis are cardiovascular manifestations of autoimmune disease that can be challenging to diagnose. Case Presentation: A 23-year-old female with SLE presented with brief episodes of intermittent left eye vision loss and left sided weakness. She also reported fevers, a malar rash, and new onset dyspnea on exertion. Serologic work-up was consistent with an SLE flair. MRI of the brain/orbits demonstrated two acute infarcts in the frontal and parieto-occipital lobes. CTA head and neck did not show any large vessel vasculitis. Transthoracic echocardiography showed thickening of the mitral valve (MV) leaflets, with moderate MR and an elevated MV gradient of 11 mm Hg. The posterior leaflet was not visualized, concerning for absent or hypoplastic posterior leaflet. A transesophageal echocardiogram was performed and showed severe thickening of posterior mitral leaflet with restricted motion and shortening secondary to extensive thrombus burden. In addition, there was evidence of thrombus at the tip of the anterior MV leaflet. The patient was managed with high dose steroids and warfarin for SLE flair and marantic endocarditis, respectively. Two months later, she presented with amaurosis fugax. Cardiac MRI showed thickened MV leaflets with delayed enhancement along the posterior leaflet and MV annulus consistent with an organized thrombus. After multidisciplinary discussion, the patient underwent surgical MV replacement with a bioprosthetic valve. Intraoperative evaluation revealed severely thickened MV leaflets with fused commissures. In addition, there was fusion of the posterior leaflet and lateral side of the anterior leaflet to the papillary muscles as a result of thickened and shortened chordae. These findings were believed to be due to inflammatory changes involving the MV apparatus. Surgical pathology confirmed the diagnosis of valvulitis. The patient has done well post operatively. Conclusion: Valvulitis and marantic endocarditis can have devastating consequences if not treated promptly. Use of multimodality imaging can aid in the diagnosis. Multidisciplinary discussion is critical in achieving desired clinical outcomes.