tbuckley/cabot-search huggingface dataset:
Abstract 17321: Cardiometabolic Risk Increased in All Socioeconomic Status During the Venezuelan Humanitarian Crisis: The EVESCAM Cohort Study
Authors: Diana De Oliveira Gomes, Ramfis Nieto Martinez, Juan Pablo Gonzalez Rivas, Masih Babagoli, Eunice Ugel, Maria I Marulanda, Maritza DURAN, Jeffrey mechanick, Goodarz Danaei
Journal: Circulation (2023)

Background: Social determinants of health (SDOH) significantly impact cardiovascular disease (CVD). Poverty is the most important underlying cause of preventable death, disease, and disability, and interacts with other SDOH. Venezuela was declared as suffering a humanitarian crisis, and besides the increase in poverty, other SDOHs such as traumatic stressors, violence, food insecurity, and treatment interruptions increased. This study aimed to estimate the changes in cardiometabolic risk factors (CMRF) in different socioeconomic statuses (SES) during the humanitarian crisis in Venezuela. Methods: Data from the EVESCAM Study was analyzed. The nationally-representative baseline assessment was conducted in 2014-2017 (N=3414) using a multi-stage stratified sampling and further follow-up on a subset of 35% of participants was undertaken in 2018-2020 (N=1257). Changes in CMRF and their prevalence among three SES (Low-SES N=657[52.3%], Middle-SES N=384[30.5%], and High-SES N=216[17.2%]) were compared. Results: There was a decrease in the prevalence of obesity (p=0.001), but an increase in the prevalence of dyslipidemia (total cholesterol ≥200mg/dL, and Low-Density Lipoprotein cholesterol ≥130mg/dL, P=0.001), low Mediterranean diet adherence (p=0.001), and depression (p=0.001) in all SES. Diabetes prevalence decreased only in middle-SES (p=0.01) and low-SES (p=0.03). Anxiety and hypertension did not change significantly. The prevalence of participants with high CVD risk (Globorisk score &gt;20%) increased in all SES (P=0.001). Conclusion: There was an increase in multiple CMRF in all SES during the Venezuelan humanitarian crisis. This scenario could determine a particular pattern of morbidity determined by the interaction of several factors, including a shortage of basic goods, severe hyperinflation, and a breakdown of the healthcare infrastructure. Efforts are needed to improve the health and CVD risk of populations facing humanitarian crises.
Abstract 16255: Unraveling the Complex Interplay: Atrial Flutter in a Patient With Prior Double Outlet Right Ventricular Repair
Authors: Vidit Majmundar, kriti mehra, Ahmed Mohamed, Eddison Ramsaran, Michelle Hadley
Journal: Circulation (2023)

Introduction: Double Outlet Right Ventricle (DORV) is a rare complex congenital heart disease (CHD) in which both the great arteries arise predominantly or entirely from the right ventricle. It is one of the rare CHD lesions with a prevalence of about 0.9%. These patients have complex anatomy, which increases their risk of recurrent arrhythmias. We present a challenging case of Atrial Flutter (AFL) in a patient with DORV. Case: A 31-year-old male with a history of DORV repair presented with palpitations and chest pain for 2 days. His heart rate (HR) was 240 bpm. EKG showed AFL with variable block [Figure 1]. Labs were unremarkable. The patient remained in AFL with HR above 120 bpm despite receiving diltiazem and adenosine. Considering his underlying complex anatomy, ablation was deferred, and the patient was cardioverted to sinus rhythm [Figure 1]. A loop monitor was placed and was started on flecainide with outpatient follow-up at a higher centre. Discussion: Infundibulotomy, removal of obstructive muscle bundles, and a patch to widen the passageway from the right ventricle to the pulmonary arteries are all steps in DORV repair. These surgeries result in scar tissue, an akinetic right ventricular outflow tract, and pulmonary valve insufficiency. Reentrant tachycardias may form due to surgical scars. In DORV patients, Atrial tachyarrhythmias have undesirable outcomes resulting in congestive heart failure, stroke, and mortality. Antiarrhythmics and cardioversion are the cornerstones of managing AFL in patients with DORV due to increased failure rates of catheter ablation. Conclusion: This case illustrates persistent atrial arrhythmias more likely due to DORV repair, resulting in cardiac remodeling. The abnormal anatomy makes localization of irritated ectopic foci and ablations ineffective and difficult.
Abstract 17612: Are There Changes in Cardiac Valve Morphology or Valve Disease Progression After CD19 CAR T-cell Therapy-Induced Cytokine Release Syndrome? An Echocardiographic Study
Authors: Andres E Daryanani, Sebastian Santos Patarroyo, Muhannad Abbasi, Diana Collantes, Carolina Ricaurte, Rafael Toro-Manotas, Jonas Paludo, Yi Lin, Hector R Villarraga
Journal: Circulation (2023)

Background: CD19 CAR T-cell therapy is a novel cancer treatment for B-cell malignancies. Systemic inflammation due to Cytokine Release Syndrome (CRS) can occur. Elevated levels of cytokines have been linked to valve damage. Hypothesis: Evaluate changes in valve morphology or progression of valvular heart disease in adult patients after CD19 CAR T-cell therapy and by clinical CRS grade. Methods: Patients that underwent CD19 CAR T-cell therapy with both a baseline and a post-treatment transthoracic echocardiogram (TTE) were included. Patient characteristics and outcomes were abstracted from the electronic medical record. CRS was categorized as CRS&lt;2 and CRS ≥2 for all patients using the ASTCT 2019 criteria. Valve thickening was graded as a dichotomous variable. Valve disease (regurgitation or stenosis) was ranked on a 1-to-6-point numeric scale (none, mild, mild-moderate, moderate, moderate-severe, severe) and grade point value difference was calculated. Variables were compared by Chi Squared and Student’s t tests. Results: 114 patients were included with a median TTE follow-up of 44 days, 54% developed CRS ≥2 (Table 1a). Overall, no statistically significant changes in valve morphology and valve disease progression were observed in the cohort (Figure 1a, 1b). Among CRS groups, valve morphology changes and valve disease progression were similarly distributed (21% in CRS &lt;2 vs 19% in CRS ≥2, p=0.623 and 28% in CRS &lt;2 vs 24% in CRS ≥2, p=0.62 respectively) (Fig. 1a). In the cases that progression was observed, it was mostly mild, and regurgitation was the most common pattern (Fig. 1c). Conclusions: This is the first study to evaluate the incidence of cardiac valve disease progression or thickening in patients treated with CD19 CAR T therapies. We can conclude that no progression of valve disease or changes in valve morphology were observed in its entirety or by CRS groups. Longer follow up is needed to validate these findings.
Abstract 13984: Obstructive Sleep Apnea and Quality of Life in Patients With Heart Failure or Coronary Heart Disease
Authors: Jia Rong Wu, Chin-Yen Lin, JungHee Kang, Misook L Chung, Jennifer Miller, Gia Mudd Martin, Martha Biddle, Mary Kay Rayens, Terry A Lennie, Chizimuzo C Okoli, Mary Beth Fisher, Frances J Feltner, Debra K Moser
Journal: Circulation (2023)

Background: Obstructive sleep apnea (OSA), prevalent in patients with heart failure (HF) and those with coronary heart disease (CHD), is associated with poor quality of life (QoL) but underlying mechanisms are not well understood. Depressive symptoms and low perceived control, also common in these patients, may explain associations between OSA and QoL. Objective: To determine whether depressive symptoms and perceived control mediate the association of OSA with QoL among patients with HF or CHD. Method: We performed a serial mediation analysis using baseline data from an ongoing randomized comparative effectiveness trial from 222 adults with HF or CHD (male: 55%, age: 59±13 years, married: 65%). Obstructive sleep apnea was measured using the STOP-BANG that included information on s noring, t iredness, o bserved apnea, high blood p ressure, b ody mass index, a ge, n eck circumference, and g ender. Depressive symptoms were measured using the Patient Health Questionnaire-9. Perceived control was measured using the Control Attitude Scale-Revised (CASR). Quality of life was measured using the Functional Outcomes of Sleep Questionnaire. The analysis was conducted using PROCESS (Model 6) for SPSS. Results: Ninety-nine (45%) of participants had OSA. Obstructive sleep apnea was indirectly associated with QoL through the following paths: 1) depressive symptoms; 2) perceived control; 3) serially through both depressive symptoms and perceived control (Figure), indicating a mediating role for depressive symptoms and perceived control in the association of OSA with QoL. Conclusion: Because the relationship between OSA and poor QoL is mediated by depressive symptoms and perceived control, it is critical to screen patients for these conditions. As important, interventions need to be developed to reduce depressive symptoms and improve perceived control in order to improve patients’ QoL.
Abstract 17275: Clinical Outcomes Following Maze and Left Atrial Appendage Occlusion Procedures for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgeries: Insights From the National Readmission Database
Authors: Yaman Mkhaimer, Nikhil Mehta, kevin kennedy, Islam Shatla, Alan P Wimmer
Journal: Circulation (2023)

Background: Maze procedure and left atrial appendage occlusion (LAAO) are often done as adjunctive procedures during mitral valve surgery in patients with atrial fibrillation (AF). We examined the effect of the Maze procedure and LAAO on AF-related clinical outcomes. Methods: We identified patients with AF from the Nationwide Readmission Database who underwent mitral valve surgery in the years 2016-2019 using ICD 10 codes. Patients were grouped by procedure type (Maze+/LAAO+, Maze+/LAAO-, Maze-/LAAO+, Maze-/LAAO- (control)). Outcomes were in-hospital and 180-day readmission rate for stroke and mortality, and 180-day AF/atrial flutter readmission. Multivariate regression analysis was conducted adjusting for demographics, hospital characteristics, comorbidities, and cardiac surgery type. Results: Of 14,979 patients with AF who underwent mitral valve surgery, adjunctive procedures were performed as follows: 2427 Maze+/LAAO+, 997 Maze+/LAAO-, 4052 Maze-/LAAO+, and 7503 Maze-/LAAO-. Stroke during the index admission and within 180 days occurred less frequently in the adjunctive procedure groups than in control group (2.5%, 2.3%, 3.4%, and 4.9% respectively, P&lt;0.001). Similar results were observed for in-hospital and 180-day mortality (3.9%, 7.6%, 4.8%, and 6.8% respectively, P&lt;0.001). However, readmission within 180 days for AF/atrial flutter was higher in the adjunctive procedure groups than the control group (5.6% vs 4.2% vs 5.4% vs 3.8%, P&lt;0.001). On multivariate analysis, patients who had either Maze or LAAO procedures (Maze+/LAAO+, Maze+/LAAO-, Maze-/LAAO+) had a lower 180-day stroke risk when compared to the control group (hazard ratio (HR) 0.7, P=0.01; HR 0.66, P=0.55; and HR 0.79, P=0.01 respectively). Similarly, 180-day mortality was lower in patients who underwent LAAO compared to the control group (HR 0.71, P=0.002; HR 1.27, P=0.05; and HR 0.78, P=0.004 respectively). Conclusion: Patients with AF who underwent Maze and/or LAAO procedures during mitral valve surgery had lower 180-day stroke and mortality rates. There was a higher rate of readmission for AF/atrial flutter, which may be a short-term proarrhythmic effect of these procedures or may reflect differences in AF type and rhythm control goals in the control group.
Abstract 15485: Nationally Representative Trends of Overall Physical Activity and Its Subtypes Among US Adults With Diabetes, Hypertension, and Dyslipidemia: Findings From NHANES 2007-2020
Authors: Wafa Nabi, Arya Aminorroaya, Lovedeep S Dhingra, Rohan Khera
Journal: Circulation (2023)

Background: Physical activity is associated with reduced risk of CV events. Evaluating the nature of physical activity is essential to target improving CV outcomes. Methods: We identified US adults from NHANES 2007-2020 with CV risk factors of DM, hypertension, and dyslipidemia based on self-report, medication history, and lab values. We examined self-reported physical activity, disaggregated into vocational, recreational, and transportational physical activity. We defined adequate physical activity according to AHA guidelines and assessed trends using weighted logistic regression models and complex survey methods. Results: Based on 40,336 adult participants of NHANES during 2007-2020 who reported their physical activity, an estimated 68% (95% CI: 67-69) of US adults adhered to the physical activity recommendations in 2017-2020 compared with 62% (60-64) of those with hypertension, 57% (53-61) of those with DM, and 66% (63-69) of those with dyslipidemia. From 2007-2020, overall physical activity significantly increased among US adults and those with hypertension and DM, but not among those with dyslipidemia. Among those at risk for CVD, vocational, recreational, and transportational physical activity accounted for 51-54%, 35-38%, and 10-13% of overall physical activity, respectively, in 2017-2020 (Fig). Conclusions: While those with CV risk factors had lower physical activity, with a third of them not adhering to physical activity recommendations, overall physical activity improved during 2007-2020. Vocational physical activity accounts for half of the overall physical activity among those at risk for CVD.
Abstract 217: Chest Compression on Aortic Valve Decreases Chance of Return of Spontaneous Circulation for Patients Experiencing Out-of-Hospital Cardiac Arrest
Authors: Sheng-En Chu, Jen-Tang Sun, Matthew H Ma, Kuan-Chen Chin, Min-Shan Tsai, Wen-chu Chiang
Journal: Circulation (2023)

Background: Current CPR guidelines recommend applying chest compression at "the center of the chest" for patients undergoing out-of-hospital cardiac arrest (OHCA). However, studies revealed that following this recommendation, around half of OHCA patients would receive compressions on the aortic valve (AV), potentially obstructing blood flow and worsening prognosis. Hypothesis and Aim: We aimed to use transesophageal echocardiography (TEE) during cardiopulmonary resuscitation (CPR) to test the hypothesis of the impact of AV compression vs AV non-compression on adult OHCA patients' outcomes. Methods: This prospective cohort study included OHCA patients receiving TEE exams during CPR. Exclusion criteria were the return of spontaneous circulation (ROSC) before TEE, unidentifiable compression site, or unqualified TEE image. Patients were divided into AV-compressed or non-compressed groups based on initial TEE findings. Patient characteristics, TEE recordings, resuscitation data, and critical time points were analyzed. Primary outcome was sustained ROSC. Secondary outcomes included any ROSC, survival to admission, survival to discharge, and favorable neurological outcomes upon discharge defined by MRS ≤ 2. The sample size was pre-estimated as 37 patients per group. Results: A total of 76 patients from October 2020 to January 2023 were enrolled for analysis, with 39 in the AV non-compressed group and 37 in the AV-compressed group. Baseline characteristics were similar between groups. Compared to the compressed group, the non-compressed group had a better chance of sustained ROSC [adjusted odds ratio (aOR) 4.72, p=0.010], any ROSC (aOR 3.30, p=0.033), and survival to admission (aOR 6.74, p=0.010). The main results were tabulated as below. Conclusions: CPR with compressed AV decreased the chances of ROSC among OHCA patients.
Abstract 18519: Inhibition of G Protein-Coupled Receptor 35 Accelerates Wound Healing Through Augmenting Endothelial Function
Authors: Hainan Li, Liping Xu, Jie-Mei Wang
Journal: Circulation (2023)

Introduction: G protein-coupled receptor 35 (GPR35) is associated with various pathologies, including diabetes, but the precise function and underlying mechanisms are less understood. Oxidative stress responsive 1 (OXSR1) is a serine/ threonine protein kinase participating in cell cytoskeleton morphology in response to environmental stress. We hypothesized that GPR35 inhibition pace wound healing by augmenting endothelial function by targeting OXSR1. Methods and Results: Human dermal microvascular endothelial cells (HDMVECs) from healthy subjects and type 2 diabetic (T2D) patients at passages 5-7 were cultured in vitro . The transfection of an adenovirus carrying the GPR35 gene (Ad-GPR35) resulted in impaired migration of T2D HDMVECs (n = 3) or healthy HDMVECs exposed to high glucose (25mM, n =5). Meanwhile, Ad-GPR35 diminished OXSR1 protein expression (Western Blot, n=5). Fluorescent staining suggested that the decreased OXSR1 in HDMVECs exposed to high glucose was reversed by GPR35 siRNA (n=5, p&lt;0.05). The GPR35 siRNA in HDMVECs improved cell migration, and this was reversed by simultaneously knocking down OXSR1 (Modified Boyden Chamber assay, n=5, p&lt;0.05). In type 2 diabetic db/db mice, systemic delivery of adeno-associated virus carrying shRNA against GPR35 via tail-vein injection accelerated wound closure (7-mm full-thickness excisional wound, n=4, p&lt; 0.05). Conclusions: Our data suggested that the inhibition of GPR35 can accelerate wound closure, possibly through boosting OXSR1 signaling in endothelial cells. This study provided novel evidence for a potential therapeutic target in tissue repair in hyperglycemia.
Abstract 14974: Spontaneous Coronary Dissection: A Challenging Case of Young Weightlifter
Authors: Yimeng Lina Du, Andrea Soares, Surabhi M Atreja
Journal: Circulation (2023)

A 26-year-old weightlifter with no significant past medical history presented with chest pain while performing his routine exercise. ECG showed anterior ST elevation myocardial infarction with subsequent angiography revealing 99% occlusion in the proximal LAD with extensive thrombus burden along with a 100% occluded distal RCA with left to right collaterals present, indicating an RCA subacute/chronic lesion (see image). An intra-aortic balloon pump was inserted, and the patient was transferred to UC Davis Medical Center. Repeat angiography revealed thrombus and dissection in the proximal LAD and RCA, stabilized with heparin drip and Gp2b3a inhibitor. Transthoracic echocardiogram showed a severely reduced ejection fraction of 15%. After heart team discussion, the patient was deemed high risk for surgery, so he underwent percutaneous coronary intervention with balloon angioplasty and deployment of drug eluting stents to the LAD and RCA with resulting TIMI-3 flow. He was initiated on guideline directed medical therapy and discharged home with LifeVest. Unfortunately, he presented with ventricular tachycardia (VT) after LifeVest shock on the following day. Repeat angiogram did not show any in-stent restenosis or thrombus. Implantable cardioverter-defibrillator (ICD) was implanted, and the patient was started on amiodarone. The patient continued to have recurrent VT. Lidocaine was added and MRI was done, which showed a large scar burden. Left ventricular assist device Impella 5.5 was placed, and the patient eventually underwent successful cardiac transplant. This case report highlights weightlifting causing spontaneous coronary dissection. It is rare but has devastating complications with limited options for acute management. Revascularization options have limited success in a patient with such an extensive scar burden and a severely reduced ejection fraction.
Abstract 14705: Diastolic Function is Uniquely Augmented by Direct Mechanical Ventricular Actuation in the Failing Heart
Authors: Benjamin A Schmitt, Yirong Zhou, Mark P Anstadt
Journal: Circulation (2023)

Introduction: Diastolic dysfunction represents a significant pathophysiology in cardiomyopathies and heart failure (HF), yet limited therapies exist for treatment. Direct Mechanical Ventricular Actuation (DMVA) is a non-blood contacting device highly unique in its ability to provide both diastolic and systolic support. The purpose of this study was to further evaluate DMVA’s effect on diastolic function in the failing heart. Methods: Adult canine (63.7 ± 13.4 lb, n=9) underwent repeated cycles of ventricular fibrillation to generate progressive levels of acute HF. DMVA was applied to support HF after defibrillation. Intracardiac echocardiography was used to quantify LV longitudinal strain/strain rates using speckle-tracking algorithms. Strain/strain rate peak magnitudes and composite waveforms were analyzed during baseline (n = 35), DMVA (n = 127), and non-support HF (n = 127). One-way ANOVA with post-hoc Tukey’s HSD was used to assess statistical differences (p&lt;0.05) for all comparisons. Results: LV strain metrics were augmented during DMVA support (strain: 20.0 ± 0.5 %, strain rate: systolic, -1.64 ± 0.03 1/s, diastolic, 1.68 ± 0.04 1/s) versus non-supported HF (strain: 9.9 ± 0.2 %, p&lt;0.001, strain rate: systolic, -0.83 ± 0.02 1/s, p&lt;0.001, diastolic, 0.86 ± 0.02 1/s, p&lt;0.001). All strain metrics were increased during DMVA compared to baseline (strain: 14.2 ± 0.4 %, p&lt;0.001, strain rate: systolic, -1.11 ± 0.03 1/s, p&lt;0.001, diastolic, 1.14 ± 0.04 1/s, p&lt;0.001). Composite strain waveforms aligned by systolic peak revealed an early diastolic boost during DMVA relative to baseline (see figure). Conclusions: Diastolic strain dynamics were significantly improved during DMVA in this model of progressive HF. Direct cardiac compression devices can impair diastolic function, which limits feasibility for circulatory support. This study further validates that DMVA restores near physiologic LV strain patterns during HF and uniquely augments diastolic function.
Abstract 16233: Paradoxical Coronary Embolus Associated With Right Atrial Thrombus in Cardiac Amyloidosis
Authors: Brendan P O'Gorman, Girish Pathangey, Augustin J DeLago, Kajal P Shah, Sheena N Amin, David B Min
Journal: Circulation (2023)

Introduction: This case highlights amyloidosis’ risk for intracardiac thrombosis with an atypical presentation of paradoxical coronary embolism due to right atrial thrombus. Clinical Presentation: An 87-year-old male with atrial fibrillation not on anticoagulation, HFrEF, severe mitral regurgitation, CKD3B, and recent medically managed NSTEMI, presented with shortness of breath. Labs showed elevated Troponin-T HS (174 ng/L) and proBNP (11,955 pg/mL). Echocardiogram revealed EF 25-30% with new lateral and anterior wall akinesis, concerning for NSTEMI I. Coronary catheterization revealed possible thrombus in the left circumflex artery (Figure 1A), but distal perfusion was intact. CT angiogram was negative for coronary artery dissection, providing clearance to initiate treatment with Eliquis. Intriguingly, cardiac MRI suggested intracardiac thrombus within the right atrial appendage and patent foramen ovale (Figure 1B), and possible amyloidosis from delayed gadolinium uptake. Despite negative serologic amyloid workup, pyrophosphate scan confirmed transthyretin amyloidosis. The patient was diuresed for decompensated heart failure but hypotension and acute-on-chronic kidney disease limited Guidelines-Directed Medical Therapy at discharge. Discussion: This case elucidates the importance of recognizing the thromboembolic risk in cardiac amyloidosis patients. Studies indicate up to 30% of cardiac amyloidosis patients have intracardiac thrombi, particularly those with primary amyloidosis subtype. Notably, no correlation exists between the CHA2DS2-VASc score and the presence of left atrial appendage thrombus in patients with cardiac amyloidosis and atrial fibrillation. Despite the left atrial appendage being twice more susceptible to thrombus formation, the right atrial appendage requires attention. Timely screening in high-risk patients could enable early thrombus detection, potentially improving prognosis.