tbuckley/cabot-search huggingface dataset:
Abstract 16203: A Case for Cardiomems Use in Cardiac Amyloidosis to Prevent Hospitalization
Authors: Michael Pascoe, Andrew Kolodziej, Mindy Thompson, Andrew Yackzan, Megan Crabtree, Emma Birks, Gaurang Vaidya
Journal: Circulation (2023)

Background: Patients with cardiac amyloidosis (CA) have recurrent hospital admissions for heart failure (CHF). However, CardioMEMS placement is still considered ‘investigational’ by various insurance payers, requiring peer-to-peer review for approval. Landmark CardioMEMS trials did not identify CA patients in their cohort, so the benefit is unclear. Results and Discussion: Three patients with symptomatic CA (2 with light-chain, one with transthyretin CA) are presented. All the patients had chronic kidney disease stage 3, worsening orthostatic symptoms with heart failure medical therapy and a history of ≥ 2 hospitalizations/year for CHF with acute kidney injury. To prevent further hospitalizations, CardioMEMS was planned but denied by their respective insurance companies as ‘investigational use’, which required a rigorous appeal process to overturn. One year prior to CardioMEMS, there were 8 hospitalizations due to CHF between all three candidates. After implantation, there was only 1 CHF-related hospitalization. This represents a 88% decrease in hospital admissions for CHF, saving a potential 7 CHF hospitalizations in the succeeding year and potentially adding one quality-adjusted life-year (QALY)/patient. Decompensated CHF adversely affects the quality of life of CA patients. CardioMEMs costs $20,000/device on average and $100/month of monitoring cost. The average cost of heart failure hospitalization is $14,000. Amongst the 3 patients, there was a total expenditure of $112,000 in hospitalizations prior to CardioMEMS placement. With an 88% reduction in hospitalization and correcting for the cost of device placement and monitoring, there was a $11,653/patient/year decrease in spending with CardioMEMS placement. Additionally, the cost of adding 1 QALY/patient was only $21,200 with CardioMEMS. The Institute for Clinical and Economic Review values one QALY at $50,000 to $150,000 as an acceptable cost and the expenditure with CardioMEMS comes significantly lower. Conclusion: CardioMEMs has been shown to decrease the number of hospitalizations in patients with HF and has a similar benefit in patients with CA. The CardioMEMs device has the capability to improve patient quality of life and decrease the cost of medical care of CA patients.
Abstract 17703: Sequential Validation of a Cuffless Photoplethysmography-Based Wristband for Blood Pressure Measurement: Algorithm Building to Regulatory Standard Trial
Authors: Eelko Ronner
Journal: Circulation (2023)

Introduction: Hypertension increases cardiovascular risk. Measuring reliable blood pressure (sBP and dBP for systolic and diastolic BP) is challenging. A photoplethysmography (PPG)-based wristband with a custom BP algorithm could provide continuous BP. The algorithm was made by PPG channel aggregation, band-pass filtering and segment creation and evaluated the different PPG colors. Noise and interference were removed. PPG segments were created with a quality factor based on pulse quality. The AI model learned patterns from structured data, including pre-processed features and initialization measurements, ranking their importance. Hypothesis: cuffless PPG-based-wristband method for continuous BP monitoring is compatible with ISO 81060-2:2019. Methods: Compare PPG-guided BP algorithm predictions with subclavian arterial reference measurements during cardiac catheterization. Consecutive patients meeting ISO 81060-2:2019 criteria were included. Reference measurements used a validated invasive BP device (100Hz). PPG signals were collected at 128Hz using six light emission diodes and two photodiodes. Three initialization measurements with a validated cuff were taken before catheterization. Machine learning-based BP algorithm utilized 100+ features. Correlation, mean error, and standard deviation (SD) and sBP and dBP were determined. Results: 97 patients provided 420 samples. Mean age, weight, and height were 67 years, 183.7 lbs, and 5'8.5" respectively. sBP swas ≤100mmHg (11%) and ≥160mmHg (25%). dBP was ≤70mmHg (53%) and ≥85mmHg (24%). BP algorithm predictions correlated strongly with reference measurements for sBP (r = 0.985) and dBP (r = 0.961) BP. Mean error was ±3.7mmHg (SD 4.4 mmHg) for sBP and ±2.5mmHg (SD 3.7 mmHg) for dBP. Results were consistent across gender and skin color categories (Fitzpatrick I-VI), but also for different strata of BP values. Conclusions: Wristband-based PPG with the developed BP algorithm provides accurate continuous BP monitoring across various BP ranges. It offers a valid and less burdensome alternative to cuff BP measurements for in-hospital and at-home monitoring. Further research is needed to evaluate algorithm precision during movement and for long-term prediction stability.
Abstract 16992: Superior Vena Cava Syndrome in a Patient With Metastatic Primary Cardiac Diffuse Large B-cell Lymphoma - Case Report
Authors: Dorota Magdon, Patrycja Galazka, Suhail Q Allaqaband
Journal: Circulation (2023)

Introduction: Primary cardiac tumors are uncommon, with an estimated incidence of 0.02%. Primary cardiac lymphomas (PCL), a subtype of non-Hodgkin lymphoma, account for about 10% of malignant and 1% of all primary cardiac tumors. Diffuse large B-cell lymphomas (DLBCLs) emerge as the predominant histological subtype within PCL cases. Case presentation: 54-year-old White male with no medical history presented with a few weeks of exertional dyspnea, nonproductive cough, and neck fullness. Exam was notable for tachycardia, jugular venous distension, bilateral upper extremity edema, and distended chest wall vasculature. Labs showed elevation of alkaline phosphatase and CRP. CT of the chest showed a right atrial mass extending into and obstructing the superior vena cava (SVC) and mediastinal lymphadenopathy (Panel A &amp; B). Coronary CTA performed a few years earlier showed normal interatrial septum (Panel C) and coronary arteries. Transthoracic echo (TTE) confirmed a 7.6 x 5.0cm mass visualized in the interatrial septum extending to both atria. Cardiac MRI redemonstrated a large cardiac mass with malignant features suggestive of cardiac lymphoma vs angiosarcoma (Panel D-F). PET-CT showed enhanced fluorodeoxyglucose (FDG) uptake within cardiac mass, mediastinal, and intraabdominal lymph nodes (Panel G). Lymph node biopsy confirmed DLBCL. Patient underwent three cycles of EPOCH (etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride) chemotherapy with excellent response. TTE following cycle 2 demonstrated decreased tumor size, and PET-CT after cycle 3 confirmed complete resolution of lymphadenopathy and minimal residual intracardiac FDG uptake. Conclusion: SVC syndrome can be a rare presentation of PCL. Multimodality imaging is important in cardiac mass characterization, diagnosis, treatment planning, and follow-up. Timely diagnosis and initiation of chemotherapy results in improved outcomes.
Abstract 17801: Age-Specific Normal Values for Myocardial Blood Flow on 82rb Positron Emission Tomography
Authors: Mark P Metzinger, Ali Ibrahim, A I McGhie, Randall C Thompson, Timothy M Bateman, Brett W Sperry
Journal: Circulation (2023)

Introduction: Positron emission tomography (PET) myocardial perfusion imaging (MPI) is utilized to evaluate ischemia along with myocardial blood flow (MBF). The ability to adequately augment blood flow, measured by myocardial blood flow reserve (MBFR), is a measure of overall health of the coronary circulation and associated with lower major adverse cardiovascular events (MACE) and all-cause mortality. The age-specific ranges of MBFR in patients without demonstrable coronary artery disease (CAD) has not been well established. Hypothesis/Aim: To determine the effect of age on MBF and MBFR in a cohort of patients without demonstrable CAD. Methods: Patients who underwent PET MPI studies from 2012-2022 on Siemens PET/CT cameras were included if Summed Stress Score=0, coronary calcium score=0, and left ventricular ejection fraction ≥50%. Those with prior history of MI or coronary intervention, heart/kidney/liver transplant, cirrhosis, or CKD stage IV+ were excluded. MBF was calculated using a net retention model (ImagenQ, Cardiovascular Imaging Technologies, Kansas City, MO) and multivariable linear regression models were developed to predict MBF. Results: Among 3,235 patients (age 59.5+/-12.6 years, 24.2% male) with median rest MBF 0.74 [0.61-0.92] and stress MBF 1.71 [1.41-2.10], MBFR was 2.28 [1.93-2.72]. With increasing age, rest MBF remained fairly stable while stress MBF and MBFR decreased, such that for every 10 years of age, stress MBF decreased by 0.07 [95% CI 0.05-0.08] mL/min/g and MBFR decreased by 0.12 [95% CI 0.11-0.14] after multivariable adjustment. Age-specific predicted MBFR values are documented in the Table. Conclusions: In patients without demonstrable CAD, the MBFR decreases with age. Abnormal MBFR values under 2.0 may be seen in a significant number of older patients.
Abstract 16780: Single Cell Profiles of Human Heart Failure and Myocardial Diseases
Authors: Olof Gidlof, Tomasz Czuba, Neha Pimpalwar, Selvi Celik, Kristina Vukusic, Jakob Lundgren, Entela Bollano, Philipp Rentzsch, Molly Martorella, Erik Linner, Sebastian Albinsson, Jan Boren, Anders Jeppsson, Johan Nilsson, Pradeep Natarajan, Tuuli Lappalainen, Joakim Sandstedt, Malin Levin, Gustav Smith
Journal: Circulation (2023)

Background: Heart failure represents the end-stage of a range of diseases which adversely impact the heart muscle. The extent by which cellular and molecular mechanisms differ between myocardial diseases in heart failure remains incompletely understood. Methods: We performed isolation and droplet-based RNA-sequencing of 394 247 single nuclei from 103 explanted hearts from transplant and ventricular assist device recipients and 7 unused donor hearts without heart disease. After sample and nuclei level quality control, doublet removal and sample integration; principal component analysis and shared nearest neighbor clustering were used to identify distinct cell populations. Cell type composition and transcriptomic profiles were compared across donor hearts and 10 myocardial diseases (hypertrophic, dilated, ischemic, restrictive, arrythmogenic and non-compaction cardiomyopathy; rheumatic and congenital heart disease; cardiac amyloidosis and graft rejection; n=1-45/group). Results: We identified and manually annotated 14 distinct cell populations that were present across controls and myocardial diseases, including transcriptionally diverse subgroups of cardiomyocytes, endothelial cells and pericytes. Compared to controls, we observed disease-specific differences in cell populations with regards to composition, heterogeneity, and specific transcriptional profiles. Conclusions: Our results reveal differences in single cell profiles of individual heart muscle diseases compared to controls without heart disease.
Abstract 15486: In-Hospital Outcomes After Cardiac Transplantation in Patients With Autism Spectrum Disorders: Insights From the National Inpatient Sample 2011-2019
Authors: Ian Ergui, Rahul Sheth, Michael Dangl, Bertrand Ebner, Karla Inestroza, Michael Albosta, Carlos Vergara, Jelani K Grant, LOUIS VINCENT, Jennifer Maning, Rosario Colombo, Luanda Grazette
Journal: Circulation (2023)

Introduction: Many governing bodies and major international societies recommend against heart transplantation (HTx) in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with Autism Spectrum Disorders (ASD) may face systematic discrimination when being evaluated for HTx. There is a lack of data regarding outcomes after HTx in patients with ASD. Methods: The NIS was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients with and without ASD who underwent HTx. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for significantly different baseline characteristics (p&lt;0.05). Results: We identified a weighted sample of 25,456 patients who underwent HTx, of which 80 had a concurrent diagnosis of ASD. Because less than .05% of the adult HTx population had ASD, the outcome analysis was restricted to the pediatric population. After restriction there were 3,769 pediatric patients who underwent HTx, of which 70 had a diagnosis of ASD. There were no significant differences in mortality, transplant related complications (acute graft rejection, acute graft failure, acute cardiac allograft vasculopathy and unspecified complications), cardiac arrest, periprocedural sepsis, mechanical circulatory support, stroke and bleeding/vascular complications between groups. While unadjusted values signaled a difference in the rate of complete heart block (CHB), there was no significant difference after application to a binary logistic regression model (CHB aOR: 1.83, 95% CI .70 to 4.77, p=0.22) Total cost of stay was significantly higher in the ASD group ($2,017,389±$2,136,742 versus $1,675,459±$1,604,926, p&lt;0.05) while total length of stay was higher in the non ASD group (79.6±72 days versus 64.8±53.7 days, p&lt;0.05). Conclusion: There are no significant differences in outcomes after HTx between pediatric patients with and without ASD. The exclusion of patients with ASD from some transplant programs represents a major disparity in healthcare and transplant teams should consider a multidisciplinary approach to evaluating ASD patients for Htx.
Abstract 14432: Self-Care Clustering in Adults With Type 1 Diabetes
Authors: Austin M Matus, Lea Ann Matura, Michael R Rickels, Barbara J Riegel
Journal: Circulation (2023)

Poor glycemic control in type 1 diabetes (T1D) may result in cardiovascular disease. Self-care, or the process of maintaining health through health-promoting behaviors and managing illnesses when changes are detected, may improve glycemic control and outcomes. However, self-care in T1D is ill-defined. We examined how self-care maintenance, monitoring, and management cluster in adults with T1D and identified unique characteristics of individuals within each cluster. Adults ( n =200, 27% Black, 61% female) with T1D (median[IQR] age: 35 [22] years, T1D duration: 19 [19] years, insulin pump use: 68%) reported personal, clinical and social determinants of health (SDH; modified PRAPARE tool, scored 0-22; higher is worse) and the Self-Care of Diabetes Inventory (3 self-care scales: maintenance, monitoring, management; 1 confidence scale; scored 0-100; scores ≥ 70 are adequate). Cluster analysis was performed with self-care domains as criteria via Ward’s method. To compare clusters, Kruskal-Wallis and chi-square tests were used for continuous and categorical variables, respectively. Three self-care clusters were found and labeled: Mastery (n= 70, 70% White, insulin pump use: 63%, median [IQR] age: 41 [28] years, T1D: 22 [22] years, Self-Care Maintenance: 85.4 [10.4], Monitoring: 82.4 [8.8], Management: 72.2 [13.9], Confidence: 95.5 [11.4], SDH: 2 [2]); Inconsistent (n= 112, 75% White, Insulin Pump use: 75%, median[IQR] age: 34 [22] years, T1D: 19 [18] years, Self-Care Maintenance: 79.2 [12.5], Monitoring: 67.7 [11.8], Management: 58.3 [13.9], Confidence: 88.6 [15.9], SDH: 3 [2]); and Novice (n= 18, 39% White, Insulin pump use: 44%, median[IQR] age: 25 [9] years, T1D: 14 [10] years, Self-Care Maintenance: 53.1 [9.9], Monitoring: 52.9 [13.2], Management: 44.4 [9.7], Confidence: 64.8 [27.8], SDH: 6 [7]). Significant differences were found for age (p&lt;.001), race (p&lt;.01), insulin pump use (p&lt;.05), Self-Care Maintenance (p&lt;.001), Self-Care Monitoring (p&lt;.001), Self-Care Management (p&lt;.001), Self-Care Confidence (p&lt;.001), and SDH (p&lt;.01). No differences were found in T1D duration. Three distinct profiles of self-care were found in this sample of adults with T1D. Older patients using insulin pumps with fewer SDH risk were more likely to master self-care.
Abstract 15579: Stem Cell Modeling of a Candidate Genetic Variant in a Family With Complex Inherited Cardiomyopathy
Authors: Anna Kirillova, Siyi Jiang, Yassmin Al Aaraj, Chloe Reuter, Yunshan Yue, Rashmi Rao, Michael Creager, Robert Barndt, Haodi Wu, Stuart Scott, Satoshi Okawa, Victoria N Parikh, Stephen Y Chan
Journal: Circulation (2023)

Introduction: Inherited cardiomyopathies, such as arrhythmogenic right (or left) ventricular cardiomyopathy (ARVC; ALVC) and dilated cardiomyopathy (DCM), can lead to sudden cardiac death. Mechanisms of arrhythmogenesis in these cardiomyopathies are not fully understood, with ~ 20% of patients carrying a pathogenic variant in a validated cardiomyopathy-associated gene. Aims: Here, we investigate a family with highly variable expression of arrhythmogenic cardiomyopathy. The two affected siblings have differential ventricle involved and arrhythmia burden: with one fulfilling criteria for ARVC, and the other for ALVC. Their father has a non-ischemic cardiomyopathy with ventricular arrhythmias and a family history of sudden death. The maternal side is unaffected. The sibling with ALVC harbors a paternally inherited rare missense variant of uncertain significance (VUS) in plakoglobin ( JUP) (c.356C&gt;T; p.Pro119Leu), an ARVC-associated gene that does not segregate in the sibling with ARVC. Hypothesis: Study of patient-specific inducible pluripotent stem cell-derived cardiomyocytes (iPSC-CM) can define an elusive genetic etiology as well molecular pathways associated with cardiomyopathy in the affected family members. Methods: We reprogrammed iPSC lines from 3 affected family members and 2 unaffected maternal controls and differentiated them into cardiomyocytes. Results: Differentiation to iPSC-CMs resulted in transcriptionally upregulated markers of cardiac stress and contractile function in affected family members ( NPPA, NPPB, MYH7 ). iPSC-CM harboring JUP c.356C&gt;T did not differ in plakoglobin RNA or protein expression. Hypertrophy was observed in the iPSC-CMs from affected family members after isoproterenol stimulation. Whole exome sequencing results revealed rare candidate variants (MAF&lt;5x10 -5 , REVEL&gt;0.7) that segregated in affected family members. Conclusions: iPSC-CMs from affected family members recapitulate cardiomyopathy phenotypes. Affected family members harbor novel candidate variants not previously associated with cardiomyopathies. Future work will utilize base editing to evaluate for compound contributions of several novel VUS on cardiomyopathy phenotypes in iPSC-CM from family members.
Abstract 15052: The Association Between Sleep Duration With Cardiovascular Disease and All-Cause Mortality: Results From the National Health and Nutrition Examination Survey (NHANES)
Authors: Farah Allouch, Erin Peacock, Katherine T Mills, Joshua D Bundy, Ling Tian, Jing Chen, Jiang He
Journal: Circulation (2023)

Background: In 2022, the American Heart Association (AHA) updated the list of modifiable lifestyle factors most important for cardiovascular health to include sleep. Sleep disturbances, such as insomnia and sleep apnea, have been associated with an increased risk of incident cardiovascular disease (CVD). However, the relationship between sleep duration and mortality remains to be fully elucidated. Methods: We used National Health and Nutrition Examination Survey (NHANES) data linked to National Death Index records to examine the association between sleep duration and CVD and all-cause mortality. A representative sample of 37,975 adults aged ≥20 years participated in the survey, which included assessments of social, behavioral, and metabolic factors, including usual weekday sleep duration. Sleep duration was categorized as (1) ideal (6-&lt;9 hours); (2) insufficient (&lt;6 hours); and (3) excessive (≥9 hours). Cox proportional hazards regression models were used to determine the relationship between sleep duration and CVD and all-cause mortality. Models were adjusted for age, sex, and race. Results: Over an average of 7.5 years of follow-up, 2,406 CVD deaths were confirmed. In adjusted models, compared to ideal sleep duration (6-&lt;9 hours), excessive sleep (≥9 hours) was associated with a 65% increase in CVD mortality (HR = 1.65; 95% CI: 1.39, 1.96), a 53% increase in cerebrovascular disease mortality (HR = 1.53; 95% CI: 1.22, 1.92), and a 52% increase in all-cause mortality (HR = 1.52; 95% CI: 1.40, 1.66). Insufficient sleep (&lt;6 hours) was associated with a 38% increase in CVD mortality (HR = 1.38; 95% CI: 1.08, 1.75) and a 54% increase in all-cause mortality (HR = 1.54; 95% CI: 1.38, 1.71). Conclusion: We found that both insufficient and excessive sleep were associated with increased risk of CVD and all-cause mortality, and the risk was more pronounced for excessive sleep. These findings emphasize the importance of recognizing sleep as a modifiable risk factor for CVD. Further research is needed to explore the relationship between sleep and CVD, including incorporating sleep quality into risk assessments and defining clinically meaningful categorizations of sleep metrics.
Abstract 19050: Polysomnography and Sleep Symptom-Based Patient Profiles Associated With Atrial Fibrillation Development
Authors: Catherine M Heinzinger, Brittany Lapin, Nicolas Thompson, Alex Milinovich, Nancy Foldvary-Schaefer, David R Van Wagoner, Mina K Chung, Reena Mehra
Journal: Circulation (2023)

Introduction: Although sleep disorders are linked to atrial fibrillation (AF), the complex interplay remains unclear. Investigating sleep-based profiles associated with AF can deepen understanding and identify at-risk patients. Hypothesis: We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF. Methods: This retrospective cohort study of Cleveland Clinic patients (age&gt;18) who underwent PSG 11/27/2004-12/30/2015 identified patient clusters using latent class analysis of 23 sleep-related symptoms, Epworth Sleepiness Scale (ESS) score, and 24 PSG measures of sleep disordered breathing and architecture. Cox proportional hazards models with cluster membership as the independent variable and incident AF as the dependent variable were adjusted for age, sex, race, BMI, cardiopulmonary disease and risk factors, anti-arrhythmic medication, and positive airway pressure with follow up 7.6±3.4 years. Results: Of the sample (n=43,433, age 52±15, 52% male, 74% White) 9% developed AF. Five clusters were identified: 1) Hypoxic + Sleepy (n=3,245): highest % time SaO 2 below 90%, highest ESS, 2) Apneas + Arousals (n=4,592): highest AHI, highest arousal index, 3) Short sleep + Low %REM (n=6,126): shortest sleep duration, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep + High %REM (n=26,809): longest sleep duration, shortest REM latency, highest %REM (reference). Compared to reference, Hypoxic + Sleepy had 48% (HR=1.48, 95%CI=1.34-1.64), Apneas + Arousals had 22% (HR=1.22, 95%CI=1.11-1.35), and Short Sleep + Low %REM had 11% (HR=1.11, 95%CI=1.01-1.22) higher risk of AF development. Internal validation indicated reasonable predictive accuracy. Sensitivity analysis excluding split night studies confirmed the associations observed. Conclusions: Of 5 patient profiles identified, Hypoxic + Sleepy conferred the strongest AF risk. Consistent with prior evidence of hypoxia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiology illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation will focus on external validation of these findings.