tbuckley/cabot-search huggingface dataset:
Abstract 4137441: Online Cognitive Behavioral Therapy Targeting Psychological Distress Following Open Heart Surgery: An Uncontrolled Pilot Study
Authors: Josefin Sarnholm, Tove Wahlund, Ian Kronish, MAJA BERGMAN, Ulrik Sartipy, Malin Stenman
Journal: Circulation (2024)

Background: Cardiac surgery is a significant procedure that reduces mortality and alleviates symptom burden in individuals with cardiovascular diseases. However, many patients develop depression and cardiac-related anxiety postoperatively, which negatively affects long-term prognosis and rehabilitation. There is a clinical need to develop scalable psychological treatments to mitigate these negative health effects. Objective: To investigate the feasibility and potential efficacy of a brief internet-delivered cognitive behavioral therapy (internet-CBT) intervention to reduce psychological distress in patients following cardiac surgery. Methods: The pilot study included 32 cardiac surgery patients (i.e., CABG, heart valve repair/replacement, aortic repair, or combined CABG and valve repair/replacement) with endorsed postoperative psychological distress and/or interference with daily life who underwent surgery from eight weeks to nine months prior to enrollment. Exclusion criteria included prior cardiac surgery with a ventricular assist device or heart transplant and severe medical or psychiatric illness. The internet-CBT targeted cardiac anxiety and depressive inactivity, lasted for five weeks, and was guided by clinical psychologists via text-based interactive online treatment modules. It included interoceptive exposure, in-vivo exposure, and behavioral activation. Self-assessments were completed at pre-treatment, post-treatment, and at 6-month follow-up. Results: Preliminary analyses post-treatment showed substantial pre-post improvements across multiple domains. Notable findings included significant reductions in depressive symptoms (Cohen’s d = 0.70; p = 0.04), cardiac anxiety (Cohen’s d = 1.53; p &lt; 0.001), and perceived severity of post-operative symptoms (Cohen’s d = 1.06; p = 0.006). Participants demonstrated high adherence to the treatment, with the large majority of participants completing all five treatment modules (83.3%). Satisfaction with the treatment was also high (25.5 points out of 32), as measured by the Client Satisfaction Questionnaire, and no adverse events were reported. Conclusion: This novel internet-CBT intervention post-cardiac surgery appears to be feasible, acceptable, and clinically promising in reducing postoperative psychological distress. It could be used as a viable adjunct treatment to enhance recovery post-cardiac surgery. These preliminary findings warrant further testing in a randomized controlled trial.
Abstract 4137975: 9-Year Longitudinal Assessment of the 12-lead Electrocardiogram of Volunteer Firefighters
Authors: Alexander Bae, Dillon Dzikowicz, Chi-Ju Lai, Wendy Brunner, Nicole Krupa, Mary Carey, Wai Cheong Tam, Yichen Yu
Journal: Circulation (2024)

Introduction: In the US, the most common cause of death among active-duty firefighters is sudden cardiac death (SCD). Underlying heart diseases are important propagator of ventricular tachyarrhythmias that cause SCD. The objective of this abstract is to assess the incidence of underlying heart disease, identified on 12-lead electrocardiograph (ECG), that may place firefighters at greater risk of SCD. Methods: We digitalized 12-lead ECGs recorded among firefighters who visited a firefighter health screening program at least 4 times from 2011-2019. We extracted the interval measurements (Heart Rate, T-axis, QRS-axis, QRS duration, QTc duration) and interpretation statements from each of the 12-lead ECGs and grouped potential propagators of ventricular tachyarrhythmias including left ventricular hypertrophy (LVH), coronary artery disease (CAD), and cardiac conduction disease. We used simple mean imputation to handle missing data. Descriptive statistics including means and frequencies were used to analyze the sample. Results: Among 465 firefighters (90.1% male) with a mean age of 47.1 (±13.6) whom 1,296 12-lead ECGs were analyzed, 21.5% (n=278) of Heart Rate, 0.39% (n=5) T-axis, 26.4% (n=342) QRS-axis, 40.0% (n=518) QRS duration, 5.40% (n=70) QTc duration were abnormal. In addition to intervals, the 12-lead ECGs generated 1,970 interpretation statements of which 28.2% (n=555) were deemed possible pathoanatomical substrates including 3.1% (n=34) LVH, 24.7% (n=137) CAD, and 69.2% (n=384) cardiac conduction diseases. Among cardiac conduction diseases, intraventricular conduction disease was the most prevalent (n=204, 36.8%), followed by vertical axis (n=70, 12.6%), right bundle branch block (n=59, 10.6%), left anterior fascicular block (n=34, 6.1%), and left bundle branch block (n=17, 3.1%). Interestingly, we did not observe a temporal relationship regarding the number of pathoanatomical substrates over the screening period. Conclusions: Nearly 30% of the interpretation statements generated from 12-lead ECGs were indicative of possible pathoanatomical substrates that cause SCD, which reflects the apparently negative effect of fire suppression activity on one’s cardiopulmonary health. Our result justifies the imperative need of effective prevention method for cardiac conduction diseases among firefighters. Further research is needed to collect 12-lead ECG systematically amongst other measures such as diet and BMI which reflect work culture and lifestyle of firefighters.
Abstract 4134384: Sotagliflozin, a Dual Inhibitor of Sodium-Glucose Transporters 1 and 2, Elicits Cardioprotective Effects Through Attenuation of Platelet Activation and Thrombosis
Authors: Livia Stanger, Andrew Rickenberg, Pooja Yalavarthi, Mariane Flores, Adriana Yamaguchi, Bertram Pitt, Michael Holinstat
Journal: Circulation (2024)

Sodium-glucose cotransporter (SGLT) inhibitors are used in the treatment of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). In the SCORED trial, sotagliflozin (SOTA), a dual SGLT1/2 inhibitor, demonstrated significant reductions in both myocardial infarction (MI) and stroke in patients with T2DM and CKD. These results suggest a cardiovascular (CV) benefit of SOTA in patients with T2DM and CKD who are at increased risk of thromboembolic disease. To investigate the underlying mechanism of CV protection, we evaluated the effects of SOTA on platelet activation and thrombus formation, in both in vivo and ex vivo models, to understand its effects on MI and stroke. Washed human platelets treated with SOTA were stimulated with various agonists and platelet activation was assessed via lumi-aggregometry and flow cytometry. In whole blood, SOTA was evaluated for its potential to reduce platelet adhesion and thrombus formation in the perfusion flow chamber and Total Thrombus formation Analysis System (TTAS) assays. In vivo , mice dosed with SOTA were assessed for thrombus formation at the site of injury in real-time in the cremaster arteriole injury model. To determine the effect of SOTA on hemostasis, we assessed coagulation parameters ex vivo in human whole blood using thromboelastography. Finally, bleeding time was measured in vivo in mice dosed with SOTA using the tail bleeding assay. In washed platelets, SOTA inhibits platelet activation and aggregation in a dose-dependent manner. Similarly, a dose-dependent decrease in platelet adhesion and thrombus formation was observed in whole blood assays. In vivo , platelet accumulation and fibrin formation were decreased in mice dosed with SOTA, however no effect is observed in coagulation parameters or bleeding time. SOTA inhibits platelet activation and thrombus formation with no impact on coagulation parameters or bleeding potential. These findings highlight a potential mechanism through which SOTA reduces the risk of stroke and MI in patients with T2DM and CKD, underscoring the importance of further investigation into the role of SOTA in CV protection, particularly in patients suffering from both T2DM and CKD at high risk of thromboembolic events.
Abstract 4138030: Eustachian Valve Endocarditis Successfully Extracted Using the Angio-Vac Aspiration System
Authors: Hannah Schimmer, William Howe, Jessica Landau, John Medamana, Brett Yarusi, Nicholas Kiefer, Samuel Bernard, Carlos Alviar, Sripal Bangalore
Journal: Circulation (2024)

Introduction: Eustachian valve endocarditis is a rare right-sided endocarditis that is often poorly visualized on transthoracic echocardiography (TTE). Here is a case of eustachian valve endocarditis first identified on TTE. It was refractory to intravenous antibiotic therapy and was successfully treated using the AngioVac aspiration system for percutaneous debulking. Case: A 36-year-old female with a past medical history of depression, intravenous heroin use, and substance-induced mood disorder presented with altered mental status and respiratory distress. She was found to have methicillin-sensitive staphylococcus aureus (MSSA) bacteremia, a gluteal abscess, multiple septic pulmonary emboli, and a left-sided empyema. She was started on broad-spectrum antibiotics that were narrowed to cefazolin. Her gluteal abscess was drained, and a left-sided chest tube was placed with pleural cultures growing MSSA. TTE demonstrated a mass on the eustachian valve. Subsequent transesophageal echocardiography (TEE) demonstrated two echogenic masses adherent to the eustachian valve, one measuring 17 by 9 millimeters and one measuring 15 by 8 millimeters, consistent with eustachian valve endocarditis. Despite appropriate antibiotic therapy, she continued to have intermittent fevers with persistently positive blood cultures. The patient underwent TEE-guided extraction of the eustachian valve vegetation using the AngioVac aspiration system. TEE at the end of the case demonstrated complete removal of her eustachian valve masses. Blood cultures cleared post-procedure, and she was eventually discharged to acute rehabilitation. Conclusion: In cases of eustachian valve endocarditis refractory to appropriate antibiotic therapy, the AngioVac aspiration system offers an option for percutaneous extraction of eustachian valve vegetations.
Abstract 4134707: Metabolomics Discovery and Epicardial Adipose Tissue : a PROMISE Clinical Trial Substudy
Authors: Jessica Regan, Caroline He, Neha Pagidipati, Clary Clish, Megan Ramaker, Khurram Nasir, Borek Foldyna, Pamela Douglas, Svati Shah
Journal: Circulation (2024)

Introduction: Epicardial adipose tissue (EAT) is a metabolically active tissue associated with cardiometabolic disease. EAT likely has local paracrine inflammatory and atherogenic effects on coronary vessels, but the metabolic underpinnings related to systemic metabolic pathways has not been evaluated. Hypothesis: We hypothesized that metabolic markers of lipid and fatty acid oxidation will be positively associated with volume of EAT. Methods: In a biomarker substudy of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) clinical trial which randomized participants to computed tomography angiography (CTA) vs. stress testing, we analyzed 1542 participants randomized to the CTA arm with available plasma at baseline. CTA phenotyping of EAT volume indexed to body surface area (cm 3 /m 2 ) was determined using a validated deep-learning algorithm. Comprehensive metabolomic profiling was performed on plasma samples using mass spectrometry. Principal components analysis (PCA) was used for dimensionality reduction of 571 named metabolites. Linear regression tested the association of metabolomic factors with EAT. Univariate models were adjusted for multiple comparisons and multivariate models were adjusted for age, race and ethnicity, sex, diabetes, BMI, LDL-C, HDL-C and metabolic syndrome. Results: Of 82 PCA-derived metabolomic factors, 16 were associated with EAT in univariate models and nine were associated with EAT in multivariate models (p=0.001-0.046); 116 individual metabolites heavily loaded within these factors were significantly associated with EAT volume in multivariate models ( Figure 1 ). This included three linoleic acid derivatives, six cholesterol esters, and glycine that were inversely associated with EAT volume (p&lt;0.04) and 106 metabolites positively associated with EAT volume including di- and triacylcerols, glycerophospholipids, fatty acyls and dimethylguanidino valeric acid (p&lt;0.05). Conclusions: Leveraging a large clinical trial of CTA to study metabolomics of EAT, we have identified circulating lipid species associated with EAT independent of BMI and conventional lipids. These findings highlight biomarkers of systemic metabolic dysregulation as risk modifiers and therapeutic targets in cardiometabolic disease prevention and treatment.
NCCN Guidelines® Insights: Management of Immunotherapy-Related Toxicities, Version 2.2024
Authors: John A. Thompson, Bryan J. Schneider, Julie Brahmer, Mohammad Abu Zaid, Amaka Achufusi, Philippe Armand, Meghan K. Berkenstock, Bonnie Bermas, Tawnie Braaten, Lihua E. Budde, Saurin Chokshi, Zachary D. Crees, Marianne Davies, Changchun Deng, Yaron Gesthalter, Michael Jain, Prantesh Jain, Andrew Jallouk, Benjamin H. Kaffenberger, Maya Khalil, Melissa G. Lechner, Tianhong Li, Alissa Marr, Suzanne McGettigan, Jordan McPherson, Theresa Medina, Nisha A. Mohindra, Anthony J. Olszanski, Olalekan Oluwole, Sandip P. Patel, Jason Prosek, Sunil Reddy, Pankti Reid, John Ryan, Mabel Ryder, Huda Salman, Bianca Santomasso, Scott Shofer, Jeffrey A. Sosman, Yinghong Wang, Vlad G. Zaha, Stephen Zucker, Megan Lyons, Ajibola Awotiwon, Lisa Hang
Journal: Journal of the National Comprehensive Cancer Network (2024)

The NCCN Guidelines for the Management of Immunotherapy-Related Toxicities are intended to provide oncology practitioners with guidance on how to manage the wide-ranging and potentially fatal toxicities that may occur with cancer immunotherapy. The guidelines address immune-related adverse events related to immune checkpoint inhibitors, CAR T-cell therapies, and lymphocyte engagers (which include T-cell–engaging bispecific antibodies). These NCCN Guidelines Insights highlight recent guideline updates pertaining to the management of emerging toxicities related to cancer immunotherapy.
Abstract 4137986: Evaluation of an AI-Based Clinical Trial Screening Method Through a Randomized Controlled Implementation Study
Authors: Ozan Unlu, Matthew Varugheese, Samantha Subramaniam, Marian McPartlin, Jiyeon Shin, Kavishwar Wagholikar, Michael Oates, Fei Wang, Charlotte Mailly, Benjamin Scirica, Samuel Aronson, Alexander Blood
Journal: Circulation (2024)

Background: Clinical trial screening is labor-intensive, time-consuming, and error prone. We have developed RECTIFIER, an AI-based clinical trial screening tool, to enhance the efficiency and accuracy of patient recruitment. This study aims to evaluate RECTIFIER's effectiveness compared to manual screening in a randomized implementation study. Methods: This study was designed as an implementation study as part of an active heart failure trial named COPILOT-HF (NCT05734690). Potential eligible patients were identified via a structured electronic medical record query and randomized to be screened for clinical trial eligibility either by RECTIFIER or manually by clinical staff. The outcome measures included the number of patients contacted, and the number of patients reached for clinical trial enrollment. Data was collected over a period of 3 months. Results: A total of 3834 patients were included in the study, with 1919 patients randomized to the RECTIFIER group and 1915 patients to the manual screening group (Figure). Study staff could manually screen only 1367 patients at the end of the 3-month period. RECTIFIER identified more eligible patients compared to manual screening (833[43.4%] vs. 284[14.8%], p&lt;0.001). The most common reason for exclusion was absence of symptomatic heart failure in both groups (287 in RECTIFIER 304 in manual screening). Screening via RECTIFIER also led to a higher contact rate, with 455 patients being contacted compared to 216 in the manual group (23.7% vs. 11.3%, p&lt;0.001). The percentage of patients who could be reached for an enrollment call was also higher in the RECTIFIER group, with 330 patients responding versus 164 in the manual group (17.2% vs. 8.6%, p&lt;0.001). Conclusion: Screening via RECTIFIER significantly outperformed manual screening in identifying eligible patients, contacting them, and eliciting responses. These results suggest that integrating AI into clinical trial recruitment processes can enhance efficiency and effectiveness, potentially leading to increased patient participation in clinical trials. Future studies with sufficient power should assess recruitment endpoints and explore scalability.
Abstract 4134772: Optimizing Heart Failure with Preserved Ejection Fraction Management: Quality Review of SGTL2 Inhibitor Use
Authors: Abeeha Naqvi, Andrew Boshara, Namit Rohant, Bimal Padaliya
Journal: Circulation (2024)

Heart failure with preserved ejection fraction (HFpEF) remains a diagnostic challenge despite a 50% incidence of HF admissions. H2FPEF tool is a validated scoring system that estimates HFpEF probability with a sensitivity of 69% and positive predictive value of 85%. Despite clinical research interest and therapeutic advances in HFpEF, implementation of therapies remain inconsistent. Currently ACC/AHA guidelines classify sodium-glucose cotransporter 2 inhibitors (SGLT2i) use a 2A recommendation with benefits for reducing hospital admissions. We assess the utilization of current guidelines. An observational retrospective analysis was performed of patients &gt;18 years with a left ventricular ejection fraction of &gt;50% seen in cardiology clinic with an ICD.10 code of diastolic heart failure from January 2022 to 2024 at a large tertiary hospital. Electronic records were reviewed for patient demographics, documentation of heart failure diagnosis, medication list and echocardiogram parameters. Primary outcome was HF related hospitalization. The study screened 79 patients, 51% females and 49% males. 20.2% of the patients were on SGLT2i, a quarter of which were female. Of those on SGLT2i, 56% were on diuretics, 81% had H2FpEF score &gt; 5, 56% had diabetes, and 19% had a HF hospitalization. SGLT2i was stopped in 1 patient due to cost. Of the (63) 79.8% of patients not on SGLT2I, 65% were on diuretics, 90% had H2FPEF score &gt; 5, 23% had diabetes and 32% had a HF hospitalization. 43% were males, with an average age of 71 for males and 62 for females. Ten patients had documented reasons for not being on SGLT2i including CKD, dialysis, yeast infection and denied insurance coverage. Unadjusted effect measures for HF hospitalization (HR 0.59, RRR 40.9%, OR 0.496; p 0.134). As guidelines are readily investigated and updated by expert consensus groups, evaluating practice patterns is key. Unlike other cardiac medications, SGLT2is are primarily initiated by cardiologists and recognizing barriers can identify generalizability of current guidelines. Our data looked at both objective and clinical endpoints for HFPEF diagnosis. Interestingly, women were less often started on SGLT2i and coverage was not a frequent cause for not using SGLT2i. Our quality metric analysis shows a potential protective effect of HF readmission with SGLT2i use in a highly symptomatic cohort, and suggests future directives need to focus on broadening educational reach among cardiologists.
Abstract 4134687: Takotsubo Cardiomyopathy Complicating Stroke
Authors: Seon Ho Jang, Luciano Sposato, Yun-Hee Choi, Amir Geressu, Mamas Mamas, Rodrigo Bagur
Journal: Circulation (2024)

Background: There have been studies suggesting Takotsubo cardiomyopathy (TCM) as a potential complication following cerebrovascular accident (CVA), but the association, contributing factors, and prognosis significance have not been well-characterized. Aims: 1) To assess the incidence, factors and prognosis associated with TCM-complicated CVA, and 2) to determine the 30-day unplanned readmission rates for TCM after discharge for CVA and the associated factors. Methods: The U.S. Nationwide Readmission Database was queried using ICD-codes to gather information on discharges with primary diagnosis of CVA between January 2010 and November 2020. Incidence and factors associated with TCM-complicated CVA and 30-day readmissions with primary diagnosis of TCM were assessed. Results: Of 3,696,202 patients hospitalized with primary diagnosis of CVA, 5,526 (0.15%) individuals developed TCM during the admission. Patients with TCM were more likely to be women (80% vs. 52%, P&lt;0.001), present with hemorrhagic (as opposed to ischemic stroke, P&lt;0.001), and have a higher comorbidity burden, adverse events, and longer hospital stay. Mortality rate was significantly higher among those with TCM vs no-TCM (20% vs. 6.4%, P&lt;0.001). Of 3,690,676 patients who were discharged without experiencing TCM during index admission for CVA, 255,947 (6.9%) patients had unplanned readmissions within 30 days of discharge, and 250 (0.1%) of these were with a primary diagnosis of TCM. These individuals with TCM were more likely to be women (78% vs. 51%, P&lt;0.001), had a higher comorbidity burden, and experienced higher mortality rate during readmission compared to those without TCM (12% vs. 5.7%, P=0.009). Conclusions: Although rare, a TCM-complicated CVA can be highly fatal. Female sex, presentation with hemorrhagic stroke and pre-existing health conditions were strong factors associated with TCM-complicated CVA. Readmission for TCM after discharge for CVA is also uncommon but carries a significantly elevated risk of mortality. Our study presents an opportunity to improve processes and clinical outcomes by monitoring and recognizing TCM post-CVA, both during and after hospitalization.