tbuckley/cabot-search huggingface dataset:
Abstract 14922: Cardiovascular Genetic Testing: Insights Into Patient Demographics, Provider Characteristics, and Indications
Authors: Quan M Bui, Jeffrey Ding, Jorge Silva, Marcus A Urey, Neil Chi, Eric Adler, Kimberly Hong
Journal: Circulation (2023)

Introduction: Genetic testing offers the opportunity for early diagnosis of cardiovascular disease (CVD). Despite guideline recommendations, genetic testing is vastly underutilized in CVD. Methods: This single-center, retrospective study included CVD patients who underwent outpatient genetic testing, using Invitae kits, at UCSD Sulpizio Cardiovascular Center from September 2018 to February 2023. Patient demographics, provider characteristics, indications for testing, genetic testing data, and genetic counselor referrals were collected. Results: A total of 374 patients were included with a median age of 57 years. Patients were predominantly male (58.6%) and Caucasian (64.7%). Prevalence of genetic testing increased yearly from 2019 (n = 51) to 2022 (n = 142). The most common indication for genetic testing was cardiomyopathy (76.7%) followed by aortopathy (13.6%) and hyperlipidemia (5.3%). Heart failure (71.3%) providers were most likely to order genetic testing followed by adult congenital (14.4%) providers (Figure 1). There were 79 (21.1%) patients who had either a pathogenic (P) or likely pathogenic (LP) mutation, 166 (44.4%) patients who had a variant of uncertain significance, and 44 (55.7%) patients who had more than one gene mutation present. The most common genes implicated were those that cause cardiomyopathy, MYBC3 (n = 9) and TTR (n= 9). For patients who had either a P or LP mutation, 59.5% of them were referred to a genetic counselor and only 36.7% were actually seen by one. Conclusion: In this study, the prevalence of outpatient genetic testing for CVD is increasing with a significant proportion ordered by heart failure physicians for cardiomyopathy. Of the patients who tested positive, less than half received genetic counseling. These data suggest an opportunity for research focused on improving access to and patient acceptance of genetic counseling. As genetic testing becomes more prevalent, genetic counseling should increase in parallel.
Abstract 14936: Integrated Text Messaging for Patients Attending Cardiac and Pulmonary Rehabilitation: A Multicentre Randomised Controlled Trial
Authors: Julie Redfern, Anna C Singleton, Rebecca Raeside, Karla Santo, Nashid Hafiz, Lissa Spencer, Regina W Leung, Mary Roberts, Meredith King, Jin-Gun Cho, Bridie Carr, Christine Jenkins, Stephanie Partridge, Alison Hayes, Clara K Chow, Karice HYUN
Journal: Circulation (2023)

Introduction: People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. Hypothesis/Aims: Support via text message alongside cardiac and pulmonary rehabilitation (rehab) improves clinical, lifestyle and attendance. Aim was to test effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes among patients attending cardiac and pulmonary rehab and evaluate program acceptability and utility for patients. Methods: Multicentre randomised controlled trial (3:1, intervention:control) among patients attending cardiac and pulmonary rehab. Control received usual care. Intervention received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, medication adherence and rehab program attendance. Results: Of the 316 participants (mean age±standard deviation, 66.7±10.1years) randomised, 60% were male (190/327), 156 were recruited from cardiac rehab. At 6 months, 6MWD improved in both groups and was significantly greater among intervention than control participants (unadjusted mean difference [95% CI]: 43.4m [4.3 to 82.4];p=0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2m [-21.2 to 25.6];p=0·85), medication adherence or cardiovascular risk factors. At 6 months, intervention participants reported significantly lower depression scores (adjusted mean diff [95%CI] -1.3 [-2.2 to -0.3], p=0.012) and anxiety (adjusted mean diff [95%CI] -1.1 [-2.1 to 0.0], p=0.046). Sub-group analysis of cardiac rehab participants found a clinically meaningful increase in 6MWD at 6 months in the intervention compared to control group (mean diff 18.9m, 95% CI -29.2 to 67.1). The majority of participants found the messages easy to understand (99%) and useful (86%). Conclusion: An education and support-based text message program for cardiac and pulmonary rehab attendees improved anxiety and depression plus program attendance, was useful for patients and suitable for implementation.
Abstract 16114: Heart Failure Hospitalizations and In-Hospital Outcomes Among Patients With Schizophrenia - Nationwide Study
Authors: Francisco Flavio Costa Filho, Aditya Sharma, Ibrahim Zahid, Jaspreet Kaur, Tushar Mishra
Journal: Circulation (2023)

Introduction: There is limited data regarding hospital outcomes in patients admitted with heart failure (HF) exacerbation and schizophrenia. Hypothesis: We sought to determine the characteristics and in-hospital outcomes of patients with schizophrenia admitted due to HF exacerbation in the United States. Methods: We performed a retrospective cohort study using the National Inpatient Sample database from January to December 2019. Patients with HF exacerbation (defined by ICD-10 codes) were categorized into two groups: patients with versus without schizophrenia and associated psychoses (defined by ICD-10 codes). Baseline variables and in-hospital outcome trends were compared between the 2 groups. Using logistic regression, we assessed the odds of use of invasive ventricular support device, and of in-hospital mortality. Results: In total, 9,780 hospitalizations for HF in patients with schizophrenia were identified, equivalent to 0.76% of all HF hospitalizations (n = 1,295,395). Patients with schizophrenia were younger (mean age 60 vs 71 years, p&lt;0.05), more likely to be men (57% vs 52%, p&lt;0.05), and more likely to have chronic pulmonary disease, obesity or be currently smoking. Comparing to overall HF patients, those with schizophrenia were more likely to be African American and live in zip codes at the lowest quartile of national income. After adjusting for patient-level, hospital-level demographics, and coexisting clinical conditions in a multivariable logistic regression there was no significant difference in the odds of in-hospital mortality between the two groups (OR 0.99, 95% CI, 0.63-1.60; P=0.99). No discrepancies in access to invasive ventricular support device were found (OR 0.42, 95% CI, 0.15 - 1.06, P=0.07). Conclusions: Patients with HF exacerbation and schizophrenia are more than one decade younger than overall HF population. Our study did not find difference in the odds of in-hospital mortality in patients admitted with HF exacerbation and schizophrenia in the United States.
Abstract 17814: Naltrindole Mitigates Rigor During Myocardial Ischemia by a Novel Mechanism and Shows Translational Cardioprotection in Myocardial Ischemia-Reperfusion Injury Models
Authors: Logan Clair, James Ramsarran, Desmond Boakye Tanoh, Annam Humayun, Juliet Melnik, Tameka Dean, Qian CHEN, Robert Barsotti, Lindon Young, Wangde Dai, Robert A Kloner
Journal: Circulation (2023)

Introduction: Naltrindole (NTI) was cardioprotective in both ex-vivo (5μM) and in-vivo (7.5mg/kg) rat myocardial ischemia-reperfusion (MIR) models. Recently, we showed that NTI 50-200μM (~2-7.5mg/kg, in-vivo) attenuated phorbol ester-induced PMN superoxide release by a novel mechanism devoid of opioid receptors. We hypothesize that NTI exerts its cardioprotective effects (and therefore, its effects on the infarct size) in a dose-dependent manner. Methods: Ex-vivo studies were done with Sprague Dawley male rats using a Langendorff apparatus. Excised hearts were pretreated with Krebs buffer (controls), NTI 1.25μM, NTI 2.5μM, or NTI 5μM for 5 min, followed by 30 min of global ischemia (I) and a 45 min reperfusion (R) period. In-vivo studies were performed with Sprague Dawley female rats which received infusions (NTI 0.2-1.0 mg/kg, 3.75 mg/kg, or 7.5 mg/kg) through the jugular vein (0.4mL/min) over 5 mins before regional I was induced by occluding the LAD artery for 30 min followed by a 3 hr R period. Cardiac function was measured in both studies through a pressure transducer placed into the left ventricle. Results: Ex-vivo: NTI 5μM, 2.5μM and 1.25μM reduced infarct size by 66% (4.8±1%, n=5, p&lt;0.05), 52% (6.8±0.8%, n=6, p&lt;0.05), and 13% (12.2±3%, n=5) respectively compared to control (14.1±1%, n=7). NTI 5μM (1358±300 mmHg) had significantly improved dP/dt max at the end of R compared to untreated controls (576±163, p&lt;0.05). In-vivo: High Dose (7.5 mg/kg x 5 min = 37.5 mg/kg [total dose]), Intermediate Dose (3.75 mg/kg x 5 min = 18.75 mg/kg [total dose]), and Low Dose (0.2-1.0 mg/kg x 5 min = 1.0-5.0 mg/kg [total dose]) NTI reduced infarct size by 81% (11±4%, n=5, p&lt;0.05), 55% (26±7%, n=5, p&lt;0.05), and 4% (55±4%, n=18) respectively compared to untreated controls (57±2%, n=15). DP/dt max was similar among all study groups at the end of R. Conclusions: Both ex-vivo and in-vivo MIR models showed a dose-dependent effect on reducing infarct size. This effect is most likely correlated with a reduction in rigor during myocardial ischemia. Future in-vivo studies will test 2 mg/kg and 7.5 mg/kg in rat and porcine MIR respectively. The infarct reducing effect of NTI might benefit patients who will opt for elective PCI, CABG, and transplant.
Abstract 13203: CD36 Regulates Factor VIII Secretion From Liver Endothelial Cells
Authors: Paula Reventun, Pablo Toledano Sanz, Nunzio Alcharani, Maria Viskadourou, Alanna C Morrison, Maria Sabater-lleal, Alisa S Wolberg, Paul De Vries, Nicholas L Smith, William Osburn, Marios Arvanitis, Charles J Lowenstein
Journal: Circulation (2023)

Introduction: Abnormal levels of the coagulation factor VIII (FVIII) are a risk factor for venous thromboembolism (VTE). Genome-wide association studies have identified novel candidate gene associations that may regulate FVIII levels in humans, including CD36. Hypothesis: We hypothesized that CD36 regulates FVIII release from endothelial cells. Methods and Results: We identified a subset of human liver endothelial cells (HLEC) expressing FVIII and purified them using a differentially expressed cell surface protein CD32. CD32+ HLEC expressed FVIII, transported FVIII in intracellular vesicles, and secreted FVIII. We stimulated CD36 signaling or silenced CD36 to test the effect of CD36 on FVIII release. Oxidized LDL (oxLDL), a CD36 agonist, increased endothelial release of FVIII. Conversely, silencing CD36 decreased FVIII release. We searched for an intracellular signaling pathway that mediates CD36 stimulation of FVIII secretion and found that oxLDL increased p38 activity and a p38 inhibitor decreased FVIII release. Conclusions: Taken together, our data show that CD36 stimulates FVIII release through a p38 dependent pathway in specialized liver endothelial cells. These results validate genetic epidemiology data linking CD36 to FVIII levels in humans and provide new insights into the regulation of FVIII levels.
Abstract 14956: Outcomes of Leadless Pacemaker Implantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device: A Systematic Review
Authors: Min Choon Tan, Jian Liang Tan, Soon Tzeh Tay, Dan Sorajja, Luis Scott, Yong-Mei Cha, Andrea M Russo, Ayman Hussein, Justin Lee
Journal: Circulation (2023)

Background: The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED) are not well-established. Objective: This study sought to describe the outcomes of LP implantation following TLR of infected CIED. Method: We conducted a literature search using PubMed and Embase for a combination of term including leadless pacemaker implantation, transvenous lead extraction, transvenous lead removal , transvenous lead explant , infected cardiac implantable electronic device . The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for non-infectious reason. Study end-points were procedural complications and LP infection. Result: Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 69% males) were included. Amongst, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus Aureus was the most common causative organism in 33% of the reported patients. Of 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during TLR procedure, and 36 patients (14.2%) had transvenous pacing as a bridge from TLR to LP implantation. During the LP implantation, 1 patient (0.4%) had an intra-procedural complication requiring sternotomy. Post-LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. Conclusion: This study suggests that LP implant is feasible and safe post-removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%.
Abstract 13198: Assessment of the Clot Real-Time Risk Prediction Model of Hospital-Associated Venous Thrombosis in Children After Congenital Heart Surgery
Authors: Sudeep D Sunthankar, Ryan P Moore, Daniel W Byrne, Henry J Domenico, Allison P Wheeler, Shannon C Walker, Prince J Kannankeril
Journal: Circulation (2023)

Introduction: Children with congenital heart disease (CHD) are at high risk for hospital-associated venous thromboembolism (HA-VTE) after cardiac surgery. The Children's Likelihood Of Thrombosis (CLOT) trial validated a real-time predictive model for HA-VTE using data extracted from the EHR for pediatric inpatients with an available online application (https://cqs.app.vumc.org/shiny/PediatricVTEPrediction/). Hypothesis: We tested the hypothesis that addition of CHD surgical specific data would improve the CLOT model for HA-VTE prediction in the CHD surgical population. Methods: The performance of the model in CHD patients from 2010-2022, was assessed using three iterations of the CLOT model: 1) the original CLOT model, 2) the original model refit using only data from the CHD cohort, and 3) the model updated with the addition of cardiopulmonary bypass time, surgical severity (STAT category), and BMI as covariates. The discrimination of the three models was quantified and compared using AUROC. Results: Our cohort included 1457 patients (median 2.0 IQR[0.5-5.2] y/o) following cardiac surgery. HA-VTE was present in 5% of our CHD cohort compared to 1% in the general pediatric population. The AUROC for the original (0.80 [95% CI: 0.74-0.85]), refit (0.85 [0.80-0.88]), and updated (0.86 [0.81-0.90]) models demonstrated excellent discriminatory ability within the CHD cohort (Figure 1). Conclusions: The addition of cardiac specific features improved model performance for discrimination of HA-VTE; however, this benefit was marginal compared to refitting the original model to the CHD cohort. This suggests strong predictive models, such as CLOT, can be optimized for cohort subsets without additional data extraction, thus reducing cost of model development and deployment. Identification of high-risk individuals using real-time predictive models deployed in the EHR may allow for prophylactic therapy and reduction of thrombosis in CHD surgical patients.
Abstract 17090: Prognostic Value of Creatinine versus Cystatin C-Based Estimation of Glomerular Filtration Rate for Mortality in Heart Failure
Authors: Bethany Roehm, Jonathan Gordon, Meredith McAdams, Justin L Grodin, Susan Hedayati
Journal: Circulation (2023)

Introduction: Serum creatinine and cystatin C are filtration markers used to calculate estimated glomerular filtration rate (eGFR). Lower eGFR using both is associated with increased mortality in heart failure with reduced ejection fraction (HFrEF). Cystatin C may be more accurate in advanced HFrEF with sarcopenia. Prognostic ability of each (eGFRcr or eGFRcys) or their weighted average (eGFRcr-cys) has not been compared. Hypothesis: eGFRcr-cys is more predictive of mortality in HFrEF than eGFRcr or eGFRcys. Methods: We analyzed data from 310 participants from Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life with baseline serum creatinine and cystatin C. Primary outcome was all-cause mortality. Cox models were adjusted for age, sex, race, diabetes mellitus, and NYHA class. Results: Median eGFR by cr, cys and cr-cys were 60, 58 and 60 ml/min/1.73m 2 . During 2-year follow-up, 45 participants died. Within each patient, the difference of eGFRcr and eGFRcys varied from -49 to 50 ml/min/1.73m 2 . Among all estimates, those with baseline eGFR &lt;60 ml/min/1.73m 2 had worse survival (Figure). Lower baseline eGFRcr [HR 0.97, 95% CI (0.96-0.99), P =0.008, C= 0.67], eGFRcys [HR 0.98 (0.97-0.99), P= 0.006, C= 0.68], and eGFRcr-cys [HR 0.98 (0.96-0.99), P= 0.004, C= 0.68] were associated with higher mortality. C-statistic comparison did not show a significant difference for predictive ability: eGFRcr vs. eGFRcys, P=0.7; eGFRcr vs. eGFRcr-cys, P=0.9; eGFRcys vs. eGFRcr-cys, P=0.3). Conclusions: Using all three estimates, lower eGFR was associated with higher mortality, although all had relatively poor predictive performance. eGFRcys was expected to be similar to or lower than eGFRcr due to decreased muscle mass, yet at the individual level there was wide variability between estimates which could in part explain their poor predictive abilities. There is need for more specific kidney filtration markers for prediction of mortality in HFrEF.
Abstract 19103: Prognostic Factor for Cardiac Dysfunction in Severe Patients With Heat Stroke
Authors: Moon Seung SOH, Jin-Sun Park, Joon-han Shin
Journal: Circulation (2023)

Introduction: Heat stroke is defined by failure of thermoregulation and central nervous abnormalities as a result of high core body temperature from exposure to high temperatures or hard exercise. The cardiovascular system is one of the most vital targets with heat stroke, and the early prediction for cardiovascular dysfunction is very important. Hypothesis: We aimed to investigate the prognostic value of numerous factors and scoring system for predicting cardiac function in emergency patients with heat stroke. Methods: We analyzed the data and clinical outcomes of the patients with heat stroke who were admitted from 2017 to 2021. Glasgow Coma Scale (GCS) was measured based on the patient's level of consciousness and responsiveness, and the APACHE (Acute Physiology and Chronic Health Evaluation) score was calculated by vital signs, GCS, and laboratory data on admission. Clinical variables including echocardiogram were compared according to the median, and receiver operating characteristic (ROC) curve for predicting critical outcomes such as death, ventilator, and dialysis were analyzed. Results: We enrolled 67 patients (60 ± 21year-old, 52 males). The median of APACHE score and GCS were 16.3 and 11, and the patients were classified into two groups (high and low) by median respectively. In the low GCS group, left ventricle ejection fraction (LVEF) was lower and the proportion with wall motion abnormalities was higher ( p =0.008; 0.020). Also, LVEF was lower in the high-APACHE score group ( p= 0.046). ROC curve analysis for predicting critical outcomes showed that GCS and APACHE score had the highest area under the curve value of 0.744 and 0.734 ( p =0.001; 0.001). Conclusions: Echocardiography should be recommended earlier for evaluating LV function in severe patients of heat stroke with lower GCS and higher APACHE score.
Abstract 15672: Cerebral and Renal Saturation Trendings in Neonates With Congenital Heart Disease in the Pre-Intervention Period: A Prospective Study
Authors: Carolina Michel, Marina Mir, Shrian Sara Moore, Punnanee Wutthigate, Jessica Simoneau, Daniela Villegas Martinez, Sam Shemie, Marie Brossard-Racine, Adrian Dancea, Gianluca Bertolizio, Gabriel Altit
Journal: Circulation (2023)

Introduction: Limited data exists on the trends of cerebral (CSat) and renal (RSat) saturations measured by near infrared spectroscopy (NIRS) of neonates with a congenital heart defect (CHD) during the first days of life in the pre-interventional setting. Hypothesis: We hypothesized that retrograde aortic flow in aorta as an indicator of diastolic steal would be associated with adverse CSat/Rsat profiles. Methods: We conducted a single-center prospective study recruiting newborns with CHD. CSat/ RSat were monitored until day 7 and averaged every hour. Daily echocardiograms were performed. Presence/ absence of holodiastolic retrograde flow in post-ductal aorta was assessed by an expert blinded to NIRS measurements and clinical status. Random mixed effect models were constructed to evaluate the association between NIRS trends and retrograde flow. Results: We included 49 newborns, of which 27 (55%) had retrograde flow. CSat remained stable throughout the monitoring period in the non-retrograde group, while it progressively declined in those with retrograde flow. An association was found between retrograde flow and negative trends CSat (β= -9.1%, 95%CI [-14.3 — -3.8]) and RSat (β= -8.4%, 95%CI [-14.5— -2.3]). Conclusions: In infants with CHD, retrograde flow in the descending aorta was associated with a CSat/RSat decline within the first week of life. Future studies should evaluate whether normalization of these parameters decreases the burden of neurological injury.