tbuckley/cabot-search huggingface dataset:
Abstract Or113: Response Times and Survival for Out-of-Hospital Cardiac Arrest Patients in Public Housing.
Authors: Louise Flarup, Carolina Malta Hansen, Sofie Have Kjaerholm, Florian Ettl, Mario Krammel, Patrick Sulzgruber, Konstantin Krychtiuk, Remy Stieglis, Hans van Schuppen, Hanno Tan, Sebastian Schnaubelt, Annette Kjær Ersbøll, Fredrik Folke, Anne Juul Grabmayr
Journal: Circulation (2024)

Introduction: Public housing areas have a high incidence of out-of-hospital cardiac arrest (OHCA) and are potential targets to improve OHCA survival. A fast emergency medical services (EMS) response is crucial to achieve OHCA survival. However, EMS response times in public housing areas remain unexplored. Research Question: Are EMS response times longer in public housing areas than in other residential areas? Aim: The primary objective was to investigate EMS response times for OHCA in public housing compared to other residential areas; differences in initial shockable rhythm and 30-day survival were secondary objectives. Method: Non-EMS witnessed OHCAs within residential areas from Amsterdam (2016-2021), Copenhagen (2016-2021), and Vienna (2018-2021) were included from the Amsterdam Resuscitation Studies and the Danish and Viennese Cardiac Arrest registries, excluding missing data on age, sex, and EMS response times. OHCAs were divided into public housing and other residential areas. Early dispatch was defined as &lt;90 seconds from incoming call until dispatch of EMS vehicle; early arrival as &lt; 6 minutes from dispatch of EMS vehicle until arrival on scene. We compared early dispatch, early arrival, initial shockable rhythm, and 30-day survival in public housing vs. other residential areas using a generalized estimation equation model adjusted for age, sex, and city and presented as adjusted odds ratios (aOR). Results: We included 8,659 patients, of which 2,883 (33,3%) occurred in public housing areas. OHCA patients in public housing areas were younger, more often female, less likely bystander witnessed, and less often received bystander interventions compared to other residential areas (Table 1). Comparing OHCAs in public housing vs. other residential areas (reference), early dispatch was 38.0% vs. 39.3%, aOR 0.83 [95% CI 0.73-0.93]; early arrival, 41.6% vs. 45.7%, aOR 0.84 [95% CI 0.76-0.92]; initial shockable rhythm, 17.0% vs. 22.8%, aOR 0.70 [95% CI 0.62-0.78]; and 30-day survival, 8.7% vs. 14.1%, aOR 0.57 [95% CI 0.48-0.66] (Figure 1). Conclusion: Dispatch and arrival of EMS vehicles took longer for OHCA patients in public housing compared to other residential areas, followed by a lower probability of initial shockable rhythm and 30-day survival. These findings suggest the EMS system as a relevant target for improving OHCA survival in public housing areas.
Abstract 4147751: Outcomes of Concomitant Longitudinal Sleeve Gastrectomy and Mechanical Circulatory Support in Patients with Morbid Obesity
Authors: Anju Bhardwaj, Sanjay Annigeri, R Gehring, Sachin Kumar, Sriram Nathan, Rajko Radovancevic, Biswajit Kar, Igor Gregoric
Journal: Circulation (2024)

Introduction/Background: Obesity and heart failure often co-exist as either a cause or effect of one another. Patients with morbid obesity have few options in terms of definitive therapies to treat heart failure. There is limited outcome data on patients with obesity and left ventricular assist devices (LVADs). Our institution has used a concomitant procedure that implants a gastric sleeve at the same time as an LVAD. Research Question/Hypothesis: We hypothesize that the concomitant procedure enables subjects to attain transplant eligibility while limiting complications. Goals/Aims: Analyze institutional data to identify baseline outcome statistics for the concomitant procedure. Methods/Approach: We retrospectively reviewed records from patients with morbid obesity (body mass index &gt; 35 kg/m 2 ) who underwent concomitant longitudinal sleeve gastrectomy (LSG) and LVAD implantation between November 2013 and March 2022. A minimum of 2 years of follow-up data was collected. The primary endpoint was transplant listing or LVAD explantation. Secondary outcomes included mortality and related complication rates. Results/Data: A total of 56 patients were included for analysis. The concomitant LSG and LVAD procedure has enabled 82.1% (46/56) of patients to reduce their BMI to below 35 kg/m 2 . Overall, 60.7% (34/56) of subjects met the primary endpoint; the median number of days to listing or explantation was 401. Thirty-two patients were listed for transplant, and 17 have been successfully transplanted. Two patients demonstrated recovery and underwent successful explant of the LVAD and remained New York Heart Association Class II at follow-up. Six subjects died before receiving a transplant, with two being listed at the time of death (Figure). Complications were noted, but they do not seem to limit the ultimate goal of transplantation. Conclusions: A significant portion of patients who were ineligible for heart transplantation were able to reduce their BMI and become eligible. The incidence of complications for this concomitant procedure is low. Multicenter studies are needed to establish this approach as a standard of care for patients with morbid obesity and stage D heart failure.
Abstract 4147977: The association of Fontan fenestration patency on cardiopulmonary exercise performance in children and adults
Authors: Laura Ortega Aviles, Sebastian Santos Patarroyo, Derek Opp, Frank Cetta, Thomas Allison
Journal: Circulation (2024)

Background: Many children born with single ventricle physiology are palliated with Fontan operation, which may include a fenestration creation. This has been demonstrated to improve short-term outcomes after surgery. Reduced exercise capacity has been shown to be a predictor of prognosis in Fontan patients. Aim: We sought to compare cardiopulmonary exercise test (CPET) data between fenestrated and non-fenestrated Fontan patients. Methods: We conducted a retrospective cohort study of 185 patients referred for CPET from 2011 to 2024. Patients with complete CPET data were included. Type of Fontan, comorbidities, and echocardiogram data were ascertained electronically. Patients were divided into 2 different groups according to the fenestration patency. Fisher’s exact test or chi-square was used to compare categorical variables. T-test and Turkey-Kramer were used to compare continuous variables. Adjustment using General Lineal Models procedure were used to identify any confounder that could affect the results. P value &lt;0.05 was considered significant. Results: 142 patients were classified in the non-fenestrated (NF) group, and 43 in the fenestrated group (FF). Baseline characteristics of both groups are shown in Table 1. From the evaluated CPET variables, the minute ventilation-carbon dioxide production (VE/VCO2) was higher in the FF (p=&lt;0.001), and oxygen saturation at peak exercise (SatO2) was lower in this group (p= &lt;0.001) (Figure 1). There was no significant difference between peak oxygen consumption (VO2) between groups. When adjusted by comorbidities only VE/VCO2 nadir, slope and peak SatO2 were statistically significant different between groups (Table 2). Conclusion: Ventilatory variables showed significant differences when fenestration was presented, secondary to V-Q mismatch from increased right to left shunt. Despite the theoretical advantage of increased cardiac output from Fontan fenestration, exercise performance was similar between both groups.
Abstract 4148214: Missing the Point: Readability Analysis of Online Patient Information for Cardiac Amyloidosis
Authors: Stefano Byer, Udhayvir Grewal
Journal: Circulation (2024)

Background: Advancements in diagnostics and increased awareness have led to higher identification of cardiac amyloidosis. This condition, characterized by the abnormal deposition of amyloid proteins in the heart, has created a greater need for comprehensive educational materials for patients and their families. Patients with cardiac amyloidosis often require specialized care from subspecialists at academic medical centers (AMCs). Our study aims to evaluate whether the readability of patient education materials provided by AMCs meets the National Institutes of Health (NIH) standard of an 8th-grade reading level or below. Methods: We conducted a Google search to find educational materials on cardiac amyloidosis from AMCs. Text from these websites was analyzed using 10 readability assessment tools, including Flesch-Kincaid Grade Level and Gunning Fog Index. We used simple linear regression to assess the relationship between readability scores and independent variables such as word count, U.S. News ranking, and Google Search ranking. Results: We identified 32 AMC websites with information on cardiac amyloidosis. The overall median reading level was 11.3 (IQR 10.5 – 11.9). There was no significant correlation between readability scores and word count (r2= 0.00, p = 0.95), Google ranking (r2 = 0.021, p = 0.42), or U.S. News ranking (r2 = 0.013, p = 0.65). This indicates that the readability of the materials is independent of text length and AMC authority. Conclusion: This study is the first to examine the readability of patient educational materials on cardiac amyloidosis. The 32 AMC websites had a median reading grade level of 11.3, which does not meet the NIH readability standard. The lack of significant correlation between readability and Google or U.S. News rankings suggests that AMC status does not affect communication effectiveness. The absence of a relationship between word count and readability highlights the need for better content quality. There is a critical shortage of accessible patient education materials on cardiac amyloidosis. Providing materials that meet NIH readability standards is essential to alleviate patient anxieties and improve adherence to treatment protocols. Academic medical centers, along with cardiology and oncology groups, should ensure patient education materials are both accessible and informative, enhancing patient outcomes and quality of life.
Abstract Sa104: Ventilation Efficacy of Automatic Oxygenators for Patients with Out-of-Hospital Cardiac Arrests at Different Pressure Limits in Prehospital Settings
Authors: Chi-Hsin Chen, Cheng-Yi Fan, Edward Pei-Chuan Huang
Journal: Circulation (2024)

Background: Automatic oxygenators can be used for ventilation in out-of-hospital cardiac arrest (OHCA) patients. However, their efficacy under different pressure limits is unknown. Research Question: Does the ventilation efficacy of Ambu bag and automatic oxygenators under different pressure limits differ in OHCA patients during prehospital resuscitation? Aims: To compare the ventilation efficacy of Ambu bag and automatic oxygenators under different pressure limits and investigate the association of different ventilation settings with patient outcomes. Methods: This retrospective study included adult patients with non-traumatic OHCA who received prehospital advanced airway in Hsinchu county, Taiwan, in 2023. Patients were categorized into three groups: Group A (ventilated by Ambu bag), Group B (automatic oxygenators, pressure limit at 45 cmH2O), and Group C (automatic oxygenators, pressure limit at 60 cmH2O). Ventilation efficacy was monitored by recording tidal volume using Zoll® X-series monitors. The median and maximum tidal volume and percentage of adequate ventilation (tidal volume between 500-600 ml) of each patient among 3 groups were compared. Associations between ventilation settings, efficacy, and patient outcomes were analyzed using multivariable logistic regression. Results: Group A, Group B, and Group C consisted of 57 (32.0%), 41 (23.0%), and 80 (45.5%) OHCA patients, respectively. The demographics and prehospital managements, including advanced airway type (laryngeal mask [LMA] or endotracheal tube [ETT]), did not differ between groups. The median tidal volume was highest in Group B, followed by Group A and C (Group A: 363.0 ml, Group B: 403.0 ml, Group C: 275.0 ml, p = 0.016). The median maximum tidal volume was highest in Group A, followed by Group C and B (Group A: 644.0 ml, Group B: 534.0 ml, Group C: 567.5 ml, p = 0.024). The median percentages of adequate ventilation were equally low in 3 groups, (Group A: 5.7%, Group B: 3.1%, Group C: 2.0%, p = 0.372). Different ventilation settings or efficacy were not associated with prehospital or in-hospital return of spontaneous circulation. However, patients receiving prehospital ETT insertion had better outcomes than those with LMA. Conclusion: This study presents the ventilation efficacy of OHCA patients ventilated by Ambu bag or automatic oxygenators under different pressure limits. Despite slight differences in tidal volumes measured across groups, patient outcomes did not differ significantly.
Abstract 4147837: Task Effectiveness, Usability, and Acceptability of mHealth Technologies among Older Adults at Risk for Cardiovascular Disease: A Feasibility Study
Authors: Andrew Thomas Reyes, Dion Candelaria, Reimund Serafica, Janett Hildebrand, MARYSOL CACCIATA, Axel Sta. Maria, Jung-Ah Lee, Anna Stromberg, Lorraine Evangelista
Journal: Circulation (2024)

Background: New research shows the benefits of mobile health (mHealth) interventions for older adults. However, older adults adopt digital technology less than younger ones. Few technology acceptance theories focus on older adults. The research upon which these models are derived either employed a restricted sample size of older adults or completely excluded them from the study. Purpose: This study measures the task effectiveness, perceived usability, and acceptability of a mHealth intervention (i.e., Get FIT +) consisting of a wearable activity tracker, access to the MyFitnessPal app, and personalized text messages to promote healthy behaviors in older adults. Methods: Participants used the Get FIT + intervention for 12 weeks and engaged in monthly clinic visits with an advanced practice nurse (APRN) to monitor their progress. The monthly sessions instructed them to use the think-aloud process while doing specific tasks (e.g., using the app). Participants also completed the USABILITY Survey and provided feedback on the intervention's acceptability after the 12-week trial. Results: Thirty older adults (mean age 66.6 ± 5.9 years, 60% female, 60% married, 50% Asian, 37% White, and 13% Hispanic) participated in this sub-analysis. Participants were able to complete the assigned tasks efficiently. The usability satisfaction assessment suggests a high level of satisfaction. The participants responded positively to Get FIT + and successfully incorporated it into their routines. Conclusion: Our findings show that Get FIT + technologies, including smartphones, smartphone-based applications, and integrated sensors, are practical, usable, and acceptable for older adults at risk for cardiovascular disease. These scalable, low-cost technologies offer methods to monitor and promote a healthy lifestyle and enhance overall well-being.
Abstract 4147677: Exercise Pulmonary Vascular Resistance relates to impaired RV-PA coupling and effort intolerance in HFpEF
Authors: Radu Tanacli, Vivek Jani, Masih Tajdini, Virginia Hahn, Kavita Sharma
Journal: Circulation (2024)

Introduction: Elevated pulmonary vascular resistance (PVR) during exercise is a proposed marker of negative prognosis in patients with heart failure with preserved ejection fraction (HFpEF), however its pathophysiology is incompletely characterised. We investigate here the relative contribution to exercise-induced PVR on right ventricular (RV) functional and structural remodelling and pulmonary artery (PA) coupling during exercise in HFpEF patients. Methods: We included 67 consecutive patients from the Johns Hopkins HFpEF Clinic where supine bicycle exercise right heart catheterisation (RHC) was available. In agreement with previous studies, we defined 2 distinct subgroups: patients with elevated exercise-induced PVR (HFpEF-highPVR), including patients with PVR ≥ 1.74 WU at maximal effort and those without exercise-induced PVR (HFpEF-normalPVR) patients with PVR &lt; 1.74 WU at maximal effort. Echocardiography and RV endomyocardial biopsy (EMB) data were analysed to assess cardiac structural and functional remodelling associated with HFpEF-highPVR. Results: From the total of 67 patients, 23 (34%) had elevated PVR at rest (PVR≥2 WU) of which 17 (74%) continued on to have exercise-induced PVR (PVR≥1.74 WU). From 44 (66%) patients without elevated PVR at rest, 4 (9.1%) further developed PVR at maximal exercise. ( Figure1A ). HFpEF-highPVR were older, had lower eGFR and higher NT-proBNP, than HFpEF-normalPVR. Maximal exercise tolerance was severely reduced in the HFpEF-highPVR group (14.0±13.7 vs 31.4±16.9 watts, P&lt;0.001; Figure 1B ). HFpEF-highPVR was associated with lower PA compliance (2.7±1.0 vs 5.2±1.7 mL/mmHg, P&lt;0.001), higher PA elastance (840±320 vs 441±138 mmHg/mL, P&lt;0.001) and higher diastolic pulmonary gradient (4.71±4.23 vs 2.07±2.69 mmHg, P=0.014). Patients with HFpEF-highPVR had a higher frequency of RV dilatation (OR=5.42, 95%CI 1.36-21.70, P=0.012), LV restrictive diastolic filling (OR=3.80, 95%CI 1.08-13.37, P=0.031) by echocardiography, and, higher frequency of moderate and severe hypertrophy (OR=4.80, 95%CI 1.48-15.61, P=0.007) and presence of fibrosis (OR=4.71, 95%CI 1.18-18.80, P=0.021) on EMB. Conclusion: Patients with elevated PVR during exercise had more pronounced maladaptive RV remodelling and less compliant PA, which contributed to impaired hemodynamic and lower endurance. Assessing exercise PVR can offer an important distinct insight into HFpEF phenotype classification and further stratify clinical risk.
Abstract 4147821: Physical Activity Impacts Cardiac Tissue Mitochondrial Respiration During Anthracycline Chemotherapy
Authors: Angelica Riojas, Shona Harbert, Jessica Lacy, Jemima Piloso, Philip Kramer, Jared Weis, Giselle Melendez
Journal: Circulation (2024)

Background: Increasing physical activity (PA) mitigates left ventricular (LV) declines in breast cancer patients undergoing Anthracycline (Anth) treatment. There is evidence that Anth induces mitochondrial dysfunction in cardiac and skeletal muscle (SM), contributing to LV dysfunction. However, the underlying mechanisms by which PA may be an effective therapy remain elusive. Objective: To evaluate the association between cardiac and SM mitochondrial function with LV function of mice treated with Anth. We hypothesize exercise improves mitochondrial function which ameliorates Anth-induced tissue injury. Methods: Twenty 12-week-old female mice treated with 5 mg/kg of doxorubicin (Dox, IP once a week for 4 weeks) were randomized to low-intensity treadmill exercise (Dox+Ex) or no exercise (Dox+no-Ex). In a blinded analysis, we measured LV function by echocardiography (LV ejection fraction, LVEF) before and after Dox treatment. At the experimental endpoint, tissues were collected to measure LV collagen volume fraction (CVF) and high-resolution respirometry (Oroboros, O 2 flux per mass pmol/(s*mg)) of LV and SM. An additional cohort of mice injected with saline that did not exercise (Saline-no-Ex, n=5) were used as controls for respirometry experiments. Results: Animals that did not exercise during Dox treatment experienced LV dysfunction (Pre-Dox: 66.6±2.9% vs. Post-Dox: 57.4±7.2%, p =0.01), while exercise ameliorated such declines (Pre-Dox: 67.2±3.8% vs. Post-Dox: 66.5±7.8%, p =0.43). Mice that exercised experienced lower levels of CVF (Dox+Ex: 0.9±0.1 % vs. Dox-no-Ex: 1.5±0.5%; p &lt;0.02). Importantly, mice treated with Dox that did not exercise exhibited lower complex I maximal respiratory capacity (CI-Max) compared to controls (Dox+no-Ex: 29.4±25.5 vs. Saline-no-Ex: 92.3±56.1, p = 0.04) and exercise during Dox treatment prevented such declines (Dox+no-Ex: 29.37±25.45 vs. Dox+Ex: 139.6±66.3 p =0.01). There were no changes in CI-Max in SM between groups ( p&gt; 0.05). Cardiac tissue CI-Max was significantly correlated with post-Dox LVEF (r=0.82, p =0.03). No associations were observed between LVEF and SM CI-max ( p =0.66). Conclusions: Exercise mitigated LV dysfunction, cardiac fibrosis, and cardiac CI-linked respiration declines after Dox treatment. Our results add to the evidence suggesting that exercise may be an effective therapy to prevent Anth-induced LV dysfunction in patients undergoing Anth therapies. Mitochondrial complex I represents a promising therapeutic target.
Abstract 4147856: A TTN Frameshift Mutation Leads to Dysfunctional Sarcomere and Calcium Handling in iPSC-derived Atrial Cardiomyocytes
Authors: Abhinaya Baskaran, Mahmud Arif, Hanna Chen, Michael Hill, Miles Barney, Asia Owais, Arvind Sridhar, Jaime DeSantiago, Anish Shah, Decebal Griza, Yining Chen, Annette Diaz, Dawood Darbar
Journal: Circulation (2024)

Background: Increasingly, rare variants in genes encoding sarcomeric proteins like titin, have been associated with early-onset atrial fibrillation (EOAF) in part by the development of an atrial myopathy. Although TTN truncating variants (TTNtvs) have been causally linked with cardiomyopathy syndromes, their role in the pathogenesis of atrial myopathy and EOAF is poorly understood. Hypothesis: Atrial myopathy due to a TTNtv creates an arrhythmogenic substrate for EOAF by disrupting sarcomere structure and calcium handling. Aims: We investigated electrophysiologic (EP) mechanisms by which a TTNtv (TTN-Val23653 frameshift [FS]) in the A-band of titin causes an atrial myopathy and EOAF utilizing mature human induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCMs) generated from a large Caucasian kindred with a strong cardiac phenotype. Methods: We performed clinical phenotyping and genetic testing of the proband and family members. hiPSC-aCMs generated from the proband and wild-type (WT) were characterized by immunofluorescence (IF) and calcium transients to determine contractility and calcium handling properties. Results: The proband presented with EOAF at age 57 years. Transthoracic echocardiography revealed moderate left atrial enlargement and reduced left ventricular ejection fraction (25-30%). Cascade screening of the TTN-FS kindred confirmed co-segregation of the variant with EOAF, dilated cardiomyopathy, heart failure, stroke, and ventricular arrhythmias (Fig. 1A-B). IF staining revealed disrupted sarcomere structures and shortened sarcomere length in TTN-FS iPSC-aCMs vs. WT (Fig. 1C). Calcium transient analysis revealed that TTN-FS iPSC-aCMs had a shorter latency to peak and smaller peak calcium transient amplitudes as compared to WT (Fig. 1D). However, the TTN-FS iPSC-aCMs exhibited a similar time to baseline vs. WT iPSC-aCMs which suggested that the TTNtv was critically involved in the contractile amplitude and peak formation kinetics, but not the relaxation phase. Conclusions: Our results suggest that a TTNtv disrupts sarcomere structure and calcium handling leading to an atrial myopathy and EOAF. Therapeutic targeting of the atrial myopathy may prevent the development of EOAF.