tbuckley/cabot-search huggingface dataset:
Abstract 18015: Cardiopulmonary Exercise Testing Parameters-Based Phenogroups of Patients With Heart Failure With Reduced Ejection Fraction Using an Unsupervised Machine Learning Algorithm
Authors: Thanat Chaikijurajai, Silvio N Augusto, Timothy Engelman, Erik H Van Iterson, J. Emanuel Finet, Wai Hong W Tang
Journal: Circulation (2023)

Introduction: Although cardiopulmonary exercise testing (CPET) is the standard test for functional capacity and risk stratification in patients with HFrEF, the integrative use of different CPET parameters for prognostication is warranted. Hypothesis: A differential prognostication of HFrEF phenogroups can be achieved by means of an unsupervised machine learning algorithm of CPET parameters. Methods: We reviewed medical records of 1,067 patients with HFrEF (EF ≤ 40%) undergoing CPET from 12/2012 to 9/2020. Patients with hypotensive or bradycardic response during exercise were excluded. Unsupervised machine learning using partition around medoids (PAM) algorithm was used to create clusters based on CPET parameters. Primary outcome was LVAD/heart transplant-free survival. Kaplan-Meier plots along with log-rank test and multivariable Cox regression analysis with adjustment for co-morbidities, age, smoking, and LVEF were used to compare prognosis across clusters. Results: Among 935 patients with HFrEF included in the algorithm (mean age 56±12 years, EF 24±8%, 73% men, and 73% with RER &gt; 1.05), 329 (35 %) patients had adverse events (median follow up time 964 days). Using the PAM algorithm, we created 3 clusters using CPET parameters. Median (IQR) of age (53 [43-62], 58 [50-64] and 61 [54-68] years for cluster 1,2, and 3, respectively) and LVEF (30 [22-25], 25 [19-30] and 21 [16-26] % for cluster 1,2, and 3, respectively) were significantly different ( P &lt;0.001). No differences in sex of BMI were observed. Co-morbidities burden was higher in cluster 2 and 3, compared to cluster 1 ( Figure 1A) . Compared to cluster 1, cluster 2 and 3 had worse LVAD/heart transplant-free survival (adjusted HR 2.15 [95% CI 1.46-3.17] and 5.68 [95% CI 3.89-8.30], respectively; Figure 1B ). Conclusions: Patients with HFrEF could be risk-stratified into low-, medium- and high-risk using PAM algorithm solely based on CPET parameters that tracked with increasing comorbidity burden.
Abstract 19041: The Role of Social Support in Functional Status and Physical Activity in Patients With Coronary Heart Disease: A 20-Year Analysis From the Heart and Soul Study
Authors: Abdelaziz Elnaggar, Thomas J Hoffmann, Mary A Whooley, Rochelle Szuba, Caroline A Dancu, Linda G Park
Journal: Circulation (2023)

Introduction: Living with coronary heart disease (CHD) significantly impacts patients’ daily activities and physical exercise. Social support influences functional status and physical activity in patients with CHD. Multiple dimensions of social support may be associated with activities of daily living (ADL) and physical activity (PA) outcomes in patients with CHD. Hypothesis: Is higher perceived social support positively associated with ADLs and PA in patients who have lived with CHD for over 20 years? Methods: We analyzed data from the Heart and Soul prospective cohort study from 3-time points: 2000-2002, 2005-2007, and new data that were collected in 2022 among survivors of the original cohort. We measured social support using the Interpersonal Support Evaluation List (ISEL) with appraisal, belonging, and tangibility dimensions. Functional status was assessed using the Lawton (instrumental ADLs [IADLs]) and Katz scales (ADLs) and self-reported PA. Logistic mixed-effects models were employed, adjusting for ISEL dimensions, age, gender, socioeconomic status, ethnicity, marital status, and time. Results: Among 680 patients [(mean age at baseline 65.9 (SD10.2); 121 females (17.8%)], higher levels of appraisal (OR: 1.08; CI: 1.01-1.16) and belonging support (OR: 1.12; CI: 1.05-1.20) were significantly associated with higher IADL scores in the Lawton scale. Only belonging was significant in the Katz ADL scale (OR: 1.11; CI: 1.00-1.29). The tangible dimension was not significant in both scales. All dimensions exhibited significant positive associations with PA, with belonging support showing the strongest association (OR: 1.11; CI: 1.05-1.18) (P &lt;.05 &amp; 95% CI). A positive trend was observed between ADL and PA with ISEL dimensions, warranting further investigation of potential time-dependent effects. Conclusions: In this study examining 3-time points over 20 years, social support dimensions emerged as predictors of improved ADL and increased PA in patients with CHD. Results emphasize the need to foster social support as part of long-term care strategies.
Abstract 15792: COVID-19 and Pericoronary Fat Attenuation Index; Is There a Link?
Authors: Malek Nayfeh JR, Ahmed Ibrahim Ahmed, Fares Alahdab, Mahmoud Al Rifai, Mouaz Al-Mallah
Journal: Circulation (2023)

Introduction: Pericoronary fat attenuation index (pFAI) is a marker of coronary inflammation, a key step in atherosclerotic plaque formation. COVID-19 infection has also been shown to be associated with significant systemic inflammation. The aim of this study is to assess the impact of active COVID-19 infection on pFAI. Methods: Cases consisted of patients with acute or subacute COVID-19 infection who underwent clinically indicated coronary computed tomography angiography (CCTA) and were matched 1:3 on clinical and cardiovascular risk factors to controls having no prior or active COVID-19 infection. pFAI was measured for all 3 major epicardial coronary vessels (LAD, LCx and RCA). Per-vessel and per-patient analysis were done. SARS-COV-2 variant was determined as the predominant variant at the time of diagnosis. Results: We included 102 cases matched to 386 controls (64 ± 12 years, 42% men). Mean pFAI in overall cohort was higher in COVID-19 cases vs controls on both per patient (mean: -75.16 vs -77.15, p=0.024; LAD: -75.98 vs -78.65, p=0.004, LCx: -72.56 vs -74.38, p=0.047) (Figure 1a) and per-vessel (-75.17 vs -77.13, p=0.0001) analyses. Results of subgroup analysis of patients with no CAD and patients with CAD-RADS 0 showed a similar trend (Figure 1b-1c) . In univariable linear regression, there was a positive association between COVID-19 and pFAI for mean per patient (beta coefficient=1.90, 95% CI: 0.26 - 3.53, p=0.02) and per-vessel (beta coefficient=1.96, 95% CI: 0.85 - 3.07, p=0.00) analyses. The association remained significant after adjusting for age, sex, and cardiovascular risk factors. Conclusions: There is a weak but statistically significant association between COVID-19 infection and elevated pFAI.
Abstract 15534: Identification of Narciclasine, a Potential Drug to Treat PAH by Unbiased Pharmaco-Transcriptomic Study
Authors: ANTONELLA ABI SLEIMAN, EL-Kabbout Reem, MABROUKA SALEM, Sandra Breuils Bonnet, Sandra Martineau, Alice Bourgeois, Charlie Theberge, Charlotte Romanet, Sarah-Eve S Lemay, Yann Grobs, Olivier Boucherat, Sebastien Bonnet, Steeve Provencher, Francois Potus
Journal: Circulation (2023)

Introduction: Pulmonary arterial hypertension (PAH) is a life-threatening vascular disorder characterized by persistent vasoconstriction and detrimental remodeling of the pulmonary blood vessels. This incurable disease is marked by a complex gene expression reprogramming that triggers, among other, metabolic disorders, heightened by inflammation, and the development of a pro-survival phenotype in pulmonary arterial smooth muscle cells (PASMC).We conducted an unbiased transcriptomic study using lung samples from 16 PAH patients and 12 non-PAH controls and identified 4013 differentially expressed genes. Leveraging in silico pharmaco-transcriptomic analysis (utilizing the Lincs and Sigcom databases), we identified narciclasine as a potential drug. Hypothesis: Consequently, we hypothesized that narciclasine could offer improvements in PAH. Methods and Results: In vivo , we administered narciclasine treatment (1 mg/kg, 2 weeks, gavage) in a murine model of PH (monocrotaline model, 60 mg/kg, sc.) and observed improved PH hemodynamics (RVSP, PAAT, TPR), reduced inflammation (CD68 immunofluorescence (IF)), decreased PASMC survival (PCNA and cleaved caspase 3 IF), and alleviated adverse vascular remodeling (Elastic van Gieson Stain Kit). In vitro , narciclasine exhibited a dose-dependent reduction of cell proliferation (IF: ki67; Western blot Survivin, PCNA and PLK1) and increased apoptosis PAH-PASMC (IF: cleaved caspase 3; Wb: Bax and Bcl2). Transcriptomic study (conducted in treated PASMCs) reveals that the therapeutic effects of narciclasine in PAH may be attributed to decreased glycosylation (Gene Ontology analysis). We further observed increased glycosylation in remodeled arteries from PAH lungs, PH preclinical models, and cultured PASMC (Periodic Acid Schiff Kit). Subsequently, we validated that narciclasine reduced glycosylation and downregulated the expression of glycosylation enzymes (by wb: GFAT, NGT, OGT) both in vitro and in vivo. Statistical tests used: unpaired t (2 groups), ANOVA (&gt; 2 groups). Conclusions: In conclusion, our unbiased pharmaco-transcriptomic study identifies narciclasine as a potential therapeutic drug for PAH. Notably, its efficacy appears to be mediated by the reduction of glycosylation.
Abstract 17455: Heart in Crisis: Graves’ Thyrotoxicosis-Induced Cardiomyopathy
Authors: Ekendilichukwu Nnadi, Nazima Khatun, Suzette Graham-Hill
Journal: Circulation (2023)

Background: We present a case of a young healthy male who presented with signs and symptoms of congestive heart failure and was subsequently diagnosed with dilated cardiomyopathy secondary to an unknown history of Graves’ disease. Case Presentation: A 40-year-old male with no medical history presented to the hospital with scrotal and bilateral lower leg edema for 4 days with associated shortness of breath. Physical examination was significant for an irregularly irregular heart rhythm. Electrocardiogram showed atrial fibrillation with a rapid ventricular response (Image B). Initial laboratory findings were elevated NT-proBNP of 1,240 pg/mL (&lt;125 pg/mL). Chest x-ray revealed significant cardiomegaly (Image A). Echocardiogram demonstrated an ejection fraction of 20% with a severely dilated bilateral atrium, left ventricle with severe diffuse hypokinesis of the left ventricle, and severe mitral regurgitation (Images C and D). Endocrine was consulted for abnormal thyroid function tests with TSH of &lt;0.010 mU/L (0.27-4.2 mU/L), free T4 of 6.06 ng/dL (.93-1.70 ng/dL), T3 of 258 ng/dL (80-200 ng/dL), thyroid-stimulating immunoglobulin of 9.51 IU/L (0.00-.55 IU/L) and TSH receptor antibody 14.00 IU/L (0.00-1.75 IU/L). The patient was started on methimazole and metoprolol with close follow-up with cardiology and endocrinology. Discussion: Severe Cardiomyopathy in adult patients with hyperthyroidism is rare occurring in approximately 6% of patients with less than 1% developing dilated cardiomyopathy with impaired left ventricular systolic function. Although the mechanism of dilated cardiomyopathy is still being researched it has been suggested that prolonged uncontrolled hyperthyroidism and autoimmunity as the potential causes. Further studies are needed to develop optimal management studies as it has been shown that the management of thyrotoxicosis can reverse cardiovascular manifestations and prevent irreversible cardiomyopathy.
Abstract 18213: Predictors of Left Atrial Appendage Occlusion Device-Related Thrombus
Authors: Ethan Morgan, Sarah Baghdadi, Ross Smith, Carine Tabak, Riya Parikh, Matthew Bajaj, Robert Enders, Cody Uhlich, Jacob Baer, Sania Jiwani, Christopher Harvey, PRASAD GUNASEKARAN, Eric Hockstad, Raghuveer Dendi, Madhu Reddy, Amit Noheria
Journal: Circulation (2023)

Background: Left atrial appendage (LAA) occlusion (LAAO) is preformed to prevent LAA thrombus and cardioembolic stroke in patients with atrial fibrillation (AF). There is however up to 4% risk of device related thrombus (DRT) on the left atrial (LA) side of LAAO device that is a cause for stroke. Predicting which patients are at high risk of DRT would enable more aggressive anticoagulation strategies and closer surveillance to prevent stroke post LAAO. Objective: To develop a risk score to predict DRT. Methods: From the LAAO registry at University of Kansas Medical Center we identified 26 patients with DRT. We chose 3 controls per case at random from other LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram (TEE) reports and images, transthoracic echocardiogram reports and detailed clinical chart review. LAAO device depth was measured from the center of the device to the peak of the left atrial ridge in 45° TEE view. Results: We analyzed 26 DRT patients (age 77.7±9.7 yr, 34.6% female) and 78 controls. Univariate predictors of DRT included history of venous thromboembolism (VTE, 23.1% vs 5.1%, P=0.01), presence of spontaneous LA echocontrast (SEC) on TEE (26.9% vs 7.7%, p=0.02), implant depth &gt;2 cm (34.6% vs 12.8%, p=0.02) and rhythm at implant being AF (50.0 % vs 11.5%, p=0.0001). Using a multivariate model with these variables we devised a risk score with 1 point each factor except 2 points for AF rhythm. A total score of ≥3 had odds ratio 13.6 (95% CI 3.8-48.4, p&lt;0.0001) of DRT (see Tables). Discussion: We present a DRT risk score comprising history of VTE, LA SEC, implant depth &gt;2 cm (1 point each) and AF rhythm (2 points). Score of ≥3 identified patients at high risk of DRT. This score needs to be validated in an independent dataset.
Abstract 18481: Paroxysmal Atrial Fibrillation and Sleep Apnea: Diurnal Patterning of Autonomic Function and Influence of CPAP Therapy
Authors: Sepideh Khazaie, Lu Wang, kaffashi farhad, Ahana Sandhu, Mina K Chung, Catherine M Heinzinger, David R Van Wagoner, Kenneth Loparo, Reena Mehra
Journal: Circulation (2023)

Introduction: Autonomic nervous system (ANS) dysfunction is implicated in sleep-disordered breathing (SDB) and atrial fibrillation (AF). Hypothesis: We hypothesize that ANS measures of heart rate variability (HRV) exhibit diurnal differences in paroxysmal AF(PAF) relative to SDB severity and is impacted by continuous positive airway pressure (CPAP). Methods: Data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study including PAF (7-24 day ECG monitoring), concomitant actigraphy and SDB from polysomnography at baseline and 3-months post-CPAP were analyzed. Linear mixed-effects models were used to assess SDB (apnea hypopnea index (AHI), hypoxia (%sleep time with SaO2&lt;90% and nadir SaO2) and diurnal average HRV (frequency domain (sympathovagal)): low-frequency range (LF), high-frequency range (HF), LF/HF; time domain: mean of normal RR interval (MNN), standard deviation of NN intervals (SDNN), SD1(Poincare plot standard deviation) and effect of 3-month CPAP. Results: In 44869 five-minute epochs from 109 participants with SDB and PAF, during wakefulness, associations of AHI and LFP, nadir SaO2 with sympathovagal measures (LFP, LHR) and time domain measures (SDNN, SD2) were observed. A sleep-wake significant interaction was observed with all HRV measures and stronger associations in wake than sleep. Baseline to follow-up CPAP time domain measures were increased during wakefulness (MNN, SDNN, RMSSD, CV, SD1, and SD2) and increased during sleep (MNN, SD2, LHR). Conclusions: Diurnal variation of autonomic measures in moderate to severe SDB was observed and association with SDB severity was more pronounced during wakefulness; CPAP influenced autonomic function. These findings in earlier onset AF may contribute to electrophysiological remodeling with implications for ANS-specific chronobiology in SDB.
Abstract 13641: Cardiovascular Safety of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass
Authors: Karine Suissa, Sebastian Schneeweiss, Robert J Glynn, Ali Tavakkoli, Deborah Wexler, Elisabetta Patorno
Journal: Circulation (2023)

Introduction: Surgical treatment for obesity, a major risk factor for diabetes and cardiovascular disease, may lead to important improvements in cardiovascular health. Sleeve gastrectomy (SG) procedures have gained popularity over Roux-en-Y gastric bypass (RYGB), though it is unclear which procedure results in better cardiovascular (CV) outcomes. Our objective was to evaluate the comparative cardiovascular effectiveness of SG vs. RYGB for CV outcomes. Methods: Using two commercial claims databases, we identified a cohort of patients &gt;18 years with a BMI ≥40 kg/m 2 , who underwent a SG or RYGB procedure between 2010 and 2023. Patients undergoing a SG were propensity-score (PS) matched 1:1 to RYGB patients, adjusting for &gt;75 baseline covariates. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were computed to assess the risk of a primary composite CV outcome, comprising of atherosclerotic CV events (myocardial infarction, stroke, coronary procedure, and unstable angina) and hospitalization for heart failure (HHF). Secondary outcomes were the individual components of the composite outcome and all-cause mortality. Subjects were followed until the first of occurrence of an outcome, end of patient data or enrollment or death. Results: A total of 30,375 patients undergoing SG were PS-matched to 30,375 patients undergoing RYGB and followed for a median of 1.5 years (IQR: 0.6, 2.8) ( Table 1 ). Mean age was 46 years and 78% were female. Compared to RYGB, patients undergoing SG had a similar risk of the composite atherosclerotic outcome (HR: 1.03; 95% CI: 0.86, 1.23), a lower risk of HHF (HR: 0.78; 95% CI: 0.67, 0.93), and a lower risk of mortality (HR: 0.72; 95% CI: 0.58, 0.89). Conclusions: SG was associated with a similar risk of atherosclerotic cardiovascular outcomes and a lower risk of HHF compared to RYBG. In addition, SG was associated with a lower risk of mortality compared to RYGB.
Abstract 13139: Preliminary Efficacy of a Cognitive Restorative Nature Intervention to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure
Authors: Miyeon Jung, Liana Apostolova, Debra K Moser, Irmina Gradus-Pizlo, Sujuan Gao, Suzanne Wang, Elham Algashgari, Asa Smith, Jeff Rogers, Susan Ofner, Susan J Pressler
Journal: Circulation (2023)

Background: Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL). Goal: The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) on improving attention, HF self-care, and HRQL. Methods: In this 2-group randomized controlled trial, 73 patients with Stage C HF were enrolled. The Nature-VR intervention group (n=37) viewed 3-dimensional nature pictures delivered by a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks. The attention control group (n=36) viewed 3-dimensional urban pictures (Urban-VR) delivered by a virtual reality headset at the same frequency of Nature-VR. Outcomes were: attention measured by Oral Trail Making A and Digit Span Forward; HF self-care measured by Self-care of Heart Failure Index; and HRQL measured by Minnesota Living with Heart Failure Questionnaire. Outcomes were assessed at baseline, 4, 8, 26, and 52 weeks by telephone interviews due to COVID-19 pandemic. Linear mixed models with intention-to-treat analysis were used to test effects of group, time, and group-by-time interactions. Results: Of 73 patients, 41 were women. Self-reported race was 1 Asian, 12 African American, and 60 White. Mean age was 66 years. NYHA class was I/II=33, III=30, and 10 were missing. Sixty-eight patients (93%) completed the interventions; 56 (79% of 68) had ≥ 80% adherence; 51 (70%) completed the study. In mixed models, no significant group-by-time interactions were found in attention, HF self-care, and HRQL. HF self-care (maintenance, management, symptom perception, and confidence) significantly improved over time (p &lt; .001) in both groups. There was significant improvement on symptom perception (p= .004, better in Nature-VR). HRQL showed significant group (p = .041, worse in Nature-VR) and time effects (p = .047, both groups improved). Conclusions: Although preliminary efficacy of Nature-VR compared with Urban-VR was not supported, HF self-care and HRQL improved over 52 weeks. Future testing is indicated of multimodal interventions that include Nature-VR to improve improving self-care and HRQL.
Abstract 13922: Reducing Health Care Disparities by Improving ICD Knowledge in a Diverse Population, a Quality Improvement Initiative to Align ICD Settings With Goals of Care
Authors: Sarah Godfrey, Christopher G Viamontes, Brenden Garrett, Nakul Patel, Nainesh Shah, kelley Newcomer, Melanie Sulistio
Journal: Circulation (2023)

Background: Patients with implantable cardioverter defibrillators (ICDs) often lack understanding of ICD functioning, most dramatically in at-risk populations. Patient knowledge gaps preclude adequate communication regarding goals of care and informed decision-making with the potential for unwanted shocks at end of life (EOL). Both ICD studies and ICD patient education tools historically lack both diversity and accessibility. Ways to improve patient ICD comprehension in populations with barriers to care have not been well established. Research Questions: Does a patient-centered educational video improve ICD knowledge and/or affect patients’ ICD preferences in hypothetical EOL scenarios? Methods: We surveyed 30 admitted heart failure patients with ICDs using 10 validated true-false ICD knowledge questions, 4 preference questions in hypothetical EOL scenarios, and multiple qualitative questions at a diverse urban, safety-net hospital. A novel 7-minute ICD educational video narrated by real patients with ICDs, using 3 rd grade or below language was then shown either in English or Spanish. Post viewing, the same questions were repeated to assess knowledge and preferences. (Link to video: https://youtu.be/8n_M--33Ia w ) Results: The mean age was 58 years, and 38% identified as female. Of the 30 patients, 63% were Black, 37% were White, and 17% were Hispanic. Patients had a mean ejection fraction of 31%, and 50% of participants had prior ICD shocks (1 to 14 times). The mean pre-test knowledge score was 50% (SD 22.8) and mean post-test score significantly improved to 82% (SD 15.1) correct (W=346, p&lt;0.00001). Scores did not significantly vary by age, sex, race, or prior shock status. After watching the video, 66% of patients changed their EOL ICD preferences in at least 1 scenario. All participants rated the video as either very helpful or helpful. Conclusion: In a diverse group of admitted heart failure patients with ICDs, intervention with an educational video on ICDs and shocks at EOL significantly improved patient knowledge. Educational materials designed for diverse patient populations can reduce healthcare disparities, by expanding patient knowledge and therefore empowering patients to make informed decisions on ICDs at EOL.