tbuckley/cabot-search huggingface dataset:
Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022
Authors: Jesus Vargas
Journal: Circulation (2023)

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.
Abstract 16057: Utilization of Advanced Cardiac Imaging Prior to Structural Ventricular Tachycardia Ablation
Authors: William H Swain, Konstantinos Siontis
Journal: Circulation (2023)

Introduction: Advanced imaging with cardiac magnetic resonance (CMR) or computed tomography (CCT) can be helpful for planning of ventricular tachycardia (VT) ablation procedures by defining the arrhythmogenic substrate. The frequency with which these modalities are utilized in the pre-ablation setting and the associated outcomes remain poorly studied. Objectives: (1) Determine the utilization of advanced cardiac imaging prior to structural VT ablation; (2) establish factors associated with improved VT ablation outcomes Methods: We retrospectively evaluated all VT ablations performed in patients with structural heart disease at a tertiary referral institution during a 2.5 year period (1/2020 - 7/2022). We documented pre-ablation use of cardiac imaging modalities and investigated their association with acute and long-term ablation outcomes. The primary outcome was time to VT recurrence, cardiac transplant, or death. Results: Our dataset included n = 129 subjects. Median post-ablation follow-up was 17 months. Recent echocardiogram, CMR, or CCT (&lt;3 months pre-ablation) had been performed in 113 (88%), 48 (37%), and 31 (24%) patients, respectively. CMR was not associated with procedural success, post-ablation VT recurrence (p = 1), or the composite primary outcome (p = 0.72). Similarly, recent CCT was not associated with procedural success (p = 0.5), VT recurrence (p = 0.3), or the composite primary outcome (p = 0.31). When adjusted for other variables, EF (p = 0.048), recent echo (p = 0.02), and procedural success (p = 0.013) were associated with the primary outcome, but recent CCT (p = 0.11) and CMR (p = 0.4) were not. These results did not differ significantly in patients with ischemic and non-ischemic cardiomyopathy. Conclusions: In this large tertiary care ablation center, CMR and CCT were utilized in only a fraction of patients prior to VT ablations. In multivariate analysis, CMR or CCT were not associated with improved acute or long-term ablation outcomes.
Abstract 14415: Aortic Strain and Stiffness in Patients With Turner and Marfan Syndrome: Non-Invasive Phenotyping of Aortic Biomechanical Properties
Authors: John Iguidbashian, Adam Carroll, Matthew Stone, Max B Mitchell, James Jaggers, Kathryn Chatfield, Amber Khanna, Roni Jacobsen, Alexander J Barker, Michal Schafer, T B Reece
Journal: Circulation (2023)

Introduction: Turner and Marfan Syndromes (TS and MFS) are hereditary connective tissue disorders with increased risk of aortic aneurysm and rates of dissection. Prior studies suggest that TS and MFS have increased aortic stiffness when compared to healthy controls but comparative phenotyping of central aortic stiffness between the two syndromes has not yet been performed. Hypothesis: Non-invasively derived aortic biomechanical properties will differ between MFS and TS patients. Methods: Patients underwent cardiac MRI to evaluate central aortic strain and stiffness. Circumferential strain was evaluated using relative area change (RAC) for both the ascending and descending aorta and longitudinal aortic strain (LAS) was measured in the ascending aorta. Stiffness was evaluated using pulse wave velocity (PWV) and by wave-intensity analysis derived backward compression wave (BCW) ratio measuring stiffness of arch and abdominal vessels. Results: Patients with TS (N=53, mean age: 17.2±5.4) and MFS (N = 22, mean age: 17.8±6.2) had similar ascending aortic size and z-score. When compared to TS, MFS patients had reduced RAC in both ascending (33 vs 16%, P &lt; 0.05) and descending aorta (24 vs 14%, P &lt; 0.01) (Figure). PWV was increased in MFS in both ascending (4.0 vs 3.0 m/s, P &lt; 0.01) and descending aorta (3.8 vs 4.7 m/s, P &lt; 0.01). LAC was reduced in MFS patients as well (14 vs 8%, P &lt; 0.01). Lastly, MFS had increased BCW ratio for arch vessel stiffness (0.11 vs 0.26, P &lt; 0.01) with no difference in abdominal vessels (0.35 vs 0.36, P = NS). Conclusion: In contrast to TS, MFS patients have comparably increased stiffness and reduced compliance throughout the central aorta including aortic arch vessels. These differences are in parallel with clinical observations describing higher rate of aortic events throughout the entire aorta in patients with MFS. Our results might also be critical given the increasingly dominant role of biomechanical indices in the risk assessment for aortic events.
Abstract 13149: Sociodemographic Factors and Prevalence in Physical Inactivity: Analysis of Rural and Non-Rural Counties in the United States, 2004-2019
Authors: Hanieh Sadat Tabatabaei Yeganeh, Brian Lahr, Michelle Mielke, Adrian Vella, Kent Bailey, Sagar Dugani
Journal: Circulation (2023)

Introduction: US rural areas have a disproportionate burden of CVD and hypertension. Physical inactivity is a major risk factor, with 25% prevalence in US adults. However, rural disparities in physical inactivity are incompletely described. The aim was to evaluate differences in prevalence of physical inactivity based on county-level rurality. Methods: We used CDC county-level data for adults aged ≥20 years, 2004–2019, available for 97.6% of US counties (n=3148/3226). CDC defined physical inactivity as self-reported lack of leisure time physical activity in the month preceding the survey. Rurality was based on six categories ordered from least rural (large central metro) to most rural (noncore). We used weighted least squares regression to compare prevalence by rurality level, adjusting for 13 county-level sociodemographic factors; results reported as prevalence ratios (95% CI) with partial F -tests and P -values. Results: In age and sex ratio adjusted analysis (model 1), we observed a gradient in the prevalence of physical inactivity across levels of rurality, with significantly higher rates in small metro (1.03 [1.00–1.06]), micropolitan (1.05 [1.02–1.07]), and noncore (1.05 [1.02–1.08]) compared with large central metro counties ( F -statistic=7.5; P &lt;.001). With further adjustment for other sociodemographic factors (model 2), the relative differences were negated in noncore counties (0.99 [0.97-1.02]), attenuated in intermediate counties, and accentuated in large fringe metro counties (1.06 [1.04-1.08]) ( F -statistic=14.3; P &lt;.001). Further adjustment for obesity (model 3) largely attenuated the association of rurality with physical inactivity, resulting in no significant differences relative to large central metro counties ( F -statistic=4.8; P &lt;.001). Conclusions: County-level rurality was associated with prevalence of physical inactivity. These disparities were largely accounted for by obesity, which may be targeted for intervention.
Abstract 149: The Effect of Lumbar Cerebrospinal Fluid Drainage on Mortality Reduction and Neuro-Prognostic Improvement in Out of Hospital Cardiac Arrest Patients Underwent Targeted Temperature Management
Authors: Yeonho You, Changshin Kang, Hong Joon Ahn, Jung Soo Park, Won-joon Jeong, Jinhong Min, Yong Nam In, So Young Y Jeon
Journal: Circulation (2023)

Cerebral edema and increased ICP in post OHCA patients can be harmful due to the brain’s rigid encasement, although the increase is small. Lumbar CSF drainage (LD) may be a valuable treatment for refractory increased ICP in patients with discernible basal cisterns. Furthermore, much of the CSF volume is located in the subarachnoid spaces, which are not accessible for drainage by ventriculostomies. However, there has been no study on the effect of LD in OHCA patients. Therefore, we investigaed whether LD reduces mortality and improves neurological prognosis in OHCA patients who underwent TTM. This was a prospective single-center study conducted from July 2021 to April 2020 (CNUH IRB201907033003, NCT04328974). The target temperature of 33°C was maintained for 24 h, and LD was initiated when ICP exceeded 15 mmHg at the rate of 10 ml per hour via a LD catheter until ICP was less than 15 mmHg. We performed propensity score matching with the CAHP score variables between the group with and without LD. We used the binary logistic regression and the Cox proportional hazard regression with the NULL PLEASE score variables. After propensity score matching, 50 patients were selected in each group (Fig.1, Table 1). Serum levels of NSE and the percentage of brain tissue with ADC value &lt; 650 X 10 -6 mm 2 /s (PV 650 ) obtained 72 h after ROSC were lower in the group with LD (Table 2). The analysis revealed that LD was associated with good neurological prognosis and increased the probability of survival (Table 3, Fig. 2). The subgroup analysis, focusing on OHCA patients with moderate severity based on the rCAST score, yieded consistent results (Table 4, Fig. 2).This study demonstrated that LD significantly improved neurological prognosis and reduced mortality in OHCA patients with moderate severity.
Abstract 12281: Association Between Extremely High HDL-C Levels and Mortality: A Systematic Review and Meta-Analysis
Authors: Isadora Mamede, Marcelo Antonio Pinheiro Braga, Anne Estefane Oliveira Franchini, Otavio C Martins, Rodrigo B Silveira Filho, Marcel Catao
Journal: Circulation (2023)

Background: Recent research challenges previous findings that linked higher levels of high-density lipoprotein cholesterol (HDL-C) to lower cardiovascular (CV) mortality. New evidence suggests that extremely high HDL-C may increase the risk of adverse CV outcomes. Research Question: What is the relationship between very high levels of HDL-C and mortality in patients without coronary artery disease (CAD)? Goal: To perform a meta-analysis of the association between extremely high HDL-C and mortality endpoints in patients without CAD. Methods: We systematically searched PubMed, Embase, and Cochrane for studies comparing very high (≥80 mg/dL) HDL-C levels to normal (40-60 mg/dL) levels in individuals without CAD. Heterogeneity was examined using I2 statistics, and a random-effects model was employed. Review manager 5.4 was used for statistical analyses. Results: Among 1,044,699 patients without CAD from 7 studies, 88,676 (8.5%) had very high HDL-C levels, and 535,742 (51.3%) had normal HDL-C levels. Overall, there was no significant difference in all-cause mortality between the groups (OR 0.93; 95% CI 0.86-1.00; p=0.06). However, stratified by sex, very high HDL-C levels were associated with a significantly higher all-cause mortality in men (OR 1.30; 95% CI 1.01-1.67; p=0.04; Figure 1A) and a significantly lower all-cause mortality in women (OR 0.85; 95% CI 0.77-0.93; p=0.0005; Figure 1A) (p=0.002 for interaction). CV mortality was significantly lower in patients with very high HDL-C (OR 0.82; 95% CI 0.71-0.93; p=0.002), although again there was a significant interaction (p=0.0004) between women (OR 0.73; 95% CI 0.62-0.85; p=0.0001; Figure 1B), in whom high HDL-C was protective, and men (OR 1.34; 95% CI 0.99-1.80; p=0.06; Figure 1B). Conclusions: These findings indicated that very high levels of HDL-C (≥ 80 mg/dL) are associated with increased mortality in men, but lower mortality in women.
Abstract 15577: Diagnostic Performance of Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography versus Coronary Angiography Fractional Flow Reserve in Estimating Myocardial Blood Flow and Flow Reserve: A Diagnostic Accuracy Meta-Analysis
Authors: Muhammed K Elfaituri, Ahmed BenGhatnsh, Hazem Abdelkarem A Faraj, Taha Khaled, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: Precisely estimating myocardial blood flow and flow reserve is crucial in diagnosing and managing ischemic heart disease. Coronary angiography fractional flow reserve (FFR) has been a standard tool. However, the recent emergence of Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography (CZT-SPECT) has provided an innovative diagnostic approach. Consequently, a comprehensive comparative analysis of their efficacies in evaluating myocardial blood flow and flow reserve is necessary. Hypothesis: This study aims to determine the diagnostic accuracy of CZT-SPECT compared to coronary angiography FFR in estimating myocardial blood flow and flow reserve. Methods: A systematic search until July 2022 was conducted across databases such as PubMed, Embase, and Web of Science, focusing on studies comparing CZT-SPECT and coronary angiography FFR in the estimation of myocardial blood flow and flow reserve. Utilizing the mada package in R software (version 4.0.3), we conducted diagnostic accuracy analysis by pooling metrics like sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios (LR), all of which were presented with a 95% Confidence Interval (CI). Results: The meta-analysis incorporated 6 studies with a total patient population of 346. Our findings reveal that CZT-SPECT exhibited a pooled sensitivity of 79.1% (95% CI: 71.8-84.9%, I^2=0) and a specificity of 78.5% (95% CI: 70.4-84.8%, I^2=25.3%). The false-positive rate was 21.5% (95% CI: 15.2-29.6%). Moreover, CZT-SPECT demonstrated a diagnostic odds ratio of 13.75 (95% CI: 7.67-24.65), while the positive likelihood ratio was 3.67 (95% CI: 2.59-5.19), and the negative likelihood ratio stood at 0.26 (95% CI: 0.19-0.37). Conclusions: This study provides valuable insights into the diagnostic accuracy of CZT-SPECT compared to coronary angiography FFR in estimating myocardial blood flow and flow reserve. These findings indicate that while CZT-SPECT shows promising diagnostic potential, its performance is similar to coronary angiography FFR. The results will be instrumental in informing clinical decision-making and shaping future research directions in the field of cardiovascular imaging.
Abstract 18202: Sex Differences in Transthyretin Amyloid Cardiomyopathy
Authors: Artrish Jefferson, Joban Vaishnav, Kavita Sharma, Nisha A Gilotra, Michael Polydefkis, Mark J Ranek, Abby Hubbard, Lisa Yanek, Bairavi Shankar
Journal: Circulation (2023)

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) predominantly affects men. It is unknown if women are underdiagnosed or if female sex is protective. We investigated sex differences in clinical presentation and disease outcomes in ATTR-CM. Methods: Patients seen with ATTR-CM at our institution were included for analysis. Chi-squared or Fisher’s exact tests, and Wilcoxon tests were used to assess associations between clinical variables and sex in the overall cohort as well as by genotype (wtATTR and V122I). Hazard ratios with 95% confidence intervals were used to assess outcomes. Results: Of 293 subjects, 235 (80%) were men and 58 (20%) were women. Women vs men were more likely Black in the entire cohort (65% v 39%) and in the wtATTR group (70% v 8.7%, p&lt;0.05). Women were significantly older in wtATTR (84 [6.6] v 79 [7.2] yrs) and V122I (75 [6] v 71 [8.3] yrs), had higher HR (83 v 75 bpm), lower eGFR (54 v 62 mL/min/1.73 m2), and thinner intraventricular septum diameter (1.54 [0.3] v 1.71 [0.3] cm) than men at time of diagnosis (p&lt;0.05). Women with wtATTR had significantly higher mean RAP (14.8 [6.9] v 8.69 [4.8] v mmHg, p&lt;0.05) and a trend toward higher PASP (55.5 [17.0] v 42.9 [12.8] and PCWP (22.5 [6.7] v 17.3 [6.4] mmHg, p=0.06) vs men. There was no difference in HF hospitalization or death at 5 years (HR 0.93 [0.59-1.45], p=0.70) and no significant increase in proportion of women diagnosed over disease eras (pre-2013, 2013-2018, and 2019-2023). Conclusions: In a well characterized cohort with ATTR-CM, women were diagnosed less frequently and at an older age with markers of more advanced disease including higher HR, worse renal function, and higher filling pressures compared to men. Disease recognition in women did not increase over time. While this may be due to the nature of the disease, the characteristics we identified at diagnosis support that women with ATTR-CM are under detected. Future sex-based screening studies are needed to increase detection of ATTR-CM in women.
Abstract 16602: The PlGF-Nrp1 Interaction Promotes the Splenic Immune Response in Hypertension After Neuroimmune Activation
Authors: Sara Perrotta, Lorenzo Carnevale, Fabio Pallante, Marialuisa Perrotta, Francesco Mastroiacovo, Agnese Migliaccio, Giuseppe Lembo, Daniela Carnevale
Journal: Circulation (2023)

Introduction: We previously discovered that Placental Growth Factor (PlGF) is released in the spleen by a sympathetic discharge to elicit hypertension. Neuropilin1 (Nrp1) is one of PlGF receptors and, interestingly, is a transmembrane protein expressed on precursors of Dendritic cells (DCs). Hypothesis: Here we investigated the involvement of Nrp1 as the PlGF receptor mediating the neuroimmune activation of immune response during hypertension. Methods: We used flow cytometry and tail cuff to evaluate the involvement of PlGF-Nrp1 pathway in neuroimmune activation of splenic immune response in hypertension. Results: To define Nrp1 role in transducing PlGF effect during hypertension, we evaluate its expression by flow cytometry finding that monocyte-derived DCs (MoDCs) increased Nrp1 expression in response to AngII (12.7±1.3 vs 28.8±3 % Nrp1 Veh vs AngII; p&lt;0.01). This effect was blocked by splenic sympathetic denervation obtained by celiac ganglionectomy (CGX) (28.8±3 vs 14±1.5 % Nrp1 Sham AngII vs CGX AngII; p&lt;0.01). To test the relevance of PlGF-Nrp1 pathway in hypertension, we generated a transgenic mouse model with a selective deletion of Nrp1 in myeloid lineage utilizing the LysMcre (Nrp1 myeKO mice). By using an in vitro standard differentiation protocol of maturation of monocytes in DCs, we observed that CD86 and MHCII expression was up-regulated in MoDCs from the spleen of WT mice cultured in the standard medium plus rmPlGF (0.014±0.001 vs 0.035±0.005 CD86+ DCs/total cells count respectively, p&lt;0.05; 0.010±0.003 vs 0.030±0.003 MHCII+ DCs/total cells count respectively, p&lt;0.01). On the contrary, CD86 and MHCII were similarly expressed on MoDCs from Nrp1 myeKO mice cultured with and without rmPlGF indicating that PlGF is involved in the maturation of MoDCs through its interaction with Nrp1. To confirm the involvement of Nrp1 in blood pressure (BP) increase, we infused AngII to Nrp1 myeKO mice, finding that they were protected from hypertension as compared to WT control mice (Systolic BP 106±1 vs 126±2 mmHg respectively, p&lt;0.001). Conclusions: These data demonstrate that PlGF-Nrp1 pathway is a key mechanism that promote the immune response involved in hypertension and blocking the splenic innervation, hampered this response and BP increase.
Abstract 14233: Checkpoint Kinase 1 Combines PKM2 C-domain to Stimulate Endogenous Cardiomyocyte Renewal and Cardiac Repair by Activating Cardiac Metabolic Reprogramming in a Porcine Model of Myocardial Ischemia/Reperfusion Injury
Authors: tianwen wei
Journal: Circulation (2023)

Background: The regenerative capacity of adult mammalian hearts is limited. We previously reported CHK1 in adult mice could promote cardiac regeneration after MI. However, the specific mechanism of CHK1 needs more comprehensive and in-depth interpretation. Methods: I/R injury was induced in pigs, recombinant human checkpoint kinase 1 (rhCHK1) protein encapsulated in hydrogel was injected into the infarct border zone. The therapeutic efficacy of rhCHK1 was evaluated by echocardiography, cMRI, hematological indices and immunofluorescence. Multi-omics analysis were performed to explore the potential mechanisms of rhCHK1. Further, protein interaction prediction and CO-IP experiments were conducted to verify the specific interaction pattern and domains between CHK1 and PKM2. Hipsc-CMs and porcine were used for confirming whether rhCHK1 promotes cardiac regeneration through combining with the PKM2 C-domain. Results: RhCHK1 protein stimulated CMs proliferation and reduced cardiac inflammation at 3 dpi, improved cardiac function and attenuated ventricular remodeling, and reduced the infarct area at 28 dpi. Mechanistically, multiomics analysis showed that glycolysis and mTOR pathways were significantly enriched in this process. Further CO-IP experiments and protein docking prediction showed that CHK1 directly bound to and activated the S37 and Y105 sites of PKM2 to promote metabolic reprogramming. We further constructed plasmids that knock out different CHK1 and PKM2 domains, and transfected them into H293T cells for CO-IP experiments. It was found that the 391-476 domain of CHK1 directly binds to the 157-400 amino acids of PKM2. Further hipsc-CMs and pig experiments both demonstrated that CHK1 stimulates CMs renewal and cardiac repair by activating PKM2 C-domain-mediated cardiac metabolic reprogramming and mTORC1 pathway. Conclusion: This study demonstrates that rhCHK1 could combine with PKM2 391-476 amino acid domain to mediate metabolic reprogramming and mTORC1 pathways to promote CM proliferation and myocardial repair. This study is the first to clarify the specific functional mechanism of CHK1 in pigs. Our results underscore the potential of the local applied rhCHK1 as a safe and simple feasible treatment option for repairing heart.