tbuckley/cabot-search huggingface dataset:
Abstract 17730: Facilitated Peer Mentoring: A Novel Model for Promoting Equitable and Inclusive Mentoring for Underrepresented Trainees in Academic Medicine
Authors: Anita Osabutey, Yetunde A Fatade, Oreoluwa Olakunle, Tre'Cherie A Crumbs, Martin L Campbell, Chidi Amah, Allen Sanyi, Nathan R Steele, Franck H Azobou Tonleu, Alexis K Okoh, Modele O Ogunniyi
Journal: Circulation (2023)

Introduction: Underrepresented minoritized(URM) cardiologists represent less than 8% of the US cardiology workforce. A positive role model, access to mentorship, and a diverse workforce influences the choice of cardiology as a subspecialty. Recognizing this, we established a novel facilitated peer-mentoring research group, the “Ogunniyi Research Group (ORG),” with the goal of creating a supportive and inclusive learning environment for trainees to develop cardiovascular research proficiencies. Methods: Our team consists of a lead mentor(cardiologist), 2 co-facilitators(cardiology fellows), and 4 resident-led teams of medical students and residents(Figure 1). Our mission is to advance cardiovascular health and equity through research, advocacy, and service; built on core pillars of mentorship, scholarship, leadership, community, and service. Mentees complete an individual development plan and meet regularly with the lead mentor to ensure milestones are met. Teams engage in research and quality improvement projects, which are reviewed at virtual monthly meetings. Quarterly academic medicine research seminars focus on building research skills. Results: 26 trainees participated during the 2021-22 and 2022-23 academic year. Most trainees (&gt;95%) self-identified as Black, with equal sex representation. Major accomplishments include &gt;16 abstracts presented at conferences, co-authorship on &gt;10 publications, and several prestigious awards, grants, honors, and scholarships. 4 team members were selected as chief medical residents. To date, we have secured 100% residency and cardiology fellowship match rate. Conclusion: Our novel, multilevel, facilitated peer mentoring group has increased access to research and professional development opportunities, especially for URM trainees interested in cardiology. The ORG can serve as a model sustainable pathway for equitable mentorship, promoting diversity and inclusion in the cardiology workforce.
Abstract 15370: Excellent Short-Term Outcomes Achieved With Minimally Invasive Right Infra-Axillary Incision and Transaortic Modified Morrow Procedure
Authors: Shuwei Wang, Zhenzhen Wang, Bing Zhou, Zhifang Liu, Chentao Luo, Changhao Wu, Erlei Han, Fuyang Mei, Xiaofeng Lu, Yong Cui
Journal: Circulation (2023)

Introduction: The Morrow procedure serves as the gold standard surgical intervention for hypertrophic obstructive cardiomyopathy. However, the conventional approach has its limitations. Minimally invasive approaches have been proposed, but exposure, mitral valve disruption, and cosmetic outcomes remain challenging. This study presents a single-port mini-incision thoracotomy through the right infra-axillary region with no surgical scar on the anterior chest wall. The procedure has achieved excellent short-term surgical outcomes. Methods: A comprehensive retrospective analysis was conducted, examining clinical data from 110 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure between August 2021 and March 2023. The patient cohort comprised 62 males and 48 females, ranging in age from 15 to 71 years. Echocardiography was employed to confirm moderate mitral regurgitation in 50 patients and severe mitral regurgitation in 24 patients. Preoperatively, 102 patients exhibited systolic anterior motion (SAM). All 110 patients underwent the transaortic modified Morrow procedure, utilizing a 4-cm incision in the right infra-axillary region, with femorofemoral cardiopulmonary bypass. Results: There was no conversion to full sternotomy. Postoperative gradients across the left ventricular outflow tract were (7.7±4.3) mmHg. Impressively, extubation was successfully performed on the operating table for 102 patients, who experienced a median postoperative hospital stay of (9.2±3.0) days. Drainage volume in the first 24 hours was (160.4±56.0) ml. Postoperative septal thickness was (11.0±1.8) mm, and no iatrogenic ventricular septal perforation or residual SAM was observed. Follow-up at 3~22 months showed no major complications. Conclusions: The single-port mini-incision thoracotomy through the right infra-axillary region is a safe and effective approach for the Morrow procedure, with excellent short-term surgical outcomes and no visible surgical scar. The procedure offers several advantages, including minimal invasiveness, reduced trauma, faster recovery, and improved cosmetic outcomes. The technique is feasible and reproducible and may be a promising alternative to traditional approaches.
Abstract 14389: Mitigating Health Disparities by Improving Access to Advanced Multidisciplinary Care for Vulnerable Patients With Intermediate and High-Risk Pulmonary Embolism
Authors: Carlos L Alviar, Robert Zhang, Mireia Padilla-Lopez, Radu Postelnicu, Lindsay Elbaum, Kah-Loon Wan, Allison Greco, Usman Alam, Kerry Hena, Vikramjit Mukherjee, Constantine Tarabanis, Rafael Harari, Sylvie Hall, Norma Keller, Sripal Bangalore
Journal: Circulation (2023)

Background: Vulnerable patients, including minorities and underserved populations whose care rely on public hospitals, have limited access to advanced pulmonary embolism (PE) treatment, particularly when catheter-based therapies (CBT) and escalation of care are needed. Our aim is to describe the multidisciplinary pulmonary embolism response team (PERT) program for the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care. Methods: We collected clinical, demographic and socioeconomic data from patients with intermediate-high and high-risk PE undergoing CBT at Bellevue Hospital, a PERT referral center and level 1 shock center for New York City’s Health and Hospitals’ network. Outcomes included in-hospital mortality and complications from CBT. Results: Sixty-one patients were included (42.6% women, age 57 ± 13.7 years) between October, 2022 to April 2023; 80.3% had intermediate-risk PE, 19.7%% had high-risk PE. The majority were black (57.4%), followed by Hispanic (13%). A total of 13% were uninsured, 9.8% were undocumented and 50.8% lived below the poverty level for New York City. The level of education was 8th grade or less in 4.9% of patients, high school in 29.5%, at least 2 years of college in 6.6%, &gt;4 years of college in 8.2%, master’s degree in 4.9% and unknown in 46%. Disease severity markers (CPES, PESI, BOVA, lactate, troponin and BNP) did not vary by ethnic group. There were no differences in mortality between white and non-white patients (figure); 3(4.9%) patients required rescue extracorporeal support and there were no procedural related complications. Conclusions: Our multidisciplinary PERT program demonstrates feasibility to provide care to underserved and vulnerable populations with excellent outcomes, serving as a strategy to help decrease healthcare disparities, particularly for advanced therapies for a challenging condition such as intermediate and high-risk PE.
Abstract 14628: Residual Stroke Risk Among Atrial Fibrillation Patients Treated With Warfarin or Novel Oral Anticoagulants: A Patient Level Meta-Analysis From Combine AF
Authors: Linda S Johnson, Alexander P Benz, John W Eikelboom, Lars C Wallentin, Manesh R Patel, Stuart Connolly, Jeff S Healey
Journal: Circulation (2023)

Introduction: Despite oral anticoagulation treatment atrial fibrillation (AF) patients have residual risk of ischemic stroke and systemic embolism (SE) which could potentially be mitigated. Methods: Harmonized individual patient data from five landmark trials testing direct oral anticoagulants (DOAC) were pooled in the COMBINE-AF dataset, which we used to calculate annual rate of ischemic stroke/SE according to CHA 2 DS 2 -Vasc score, history of stroke, and AF type. Results: We included 71,794 subjects (median age 72 IQR 65-78 years 61.3% male) with CHA 2 DS 2 -Vasc scores≥2 randomized to either standard- or lower-dose DOAC or warfarin, and followed for a median of 2.1 (IQR 1.5-2.7) years. The median CHA 2 DS 2 -VASc score was 4 (IQR 3-5), and 18.8% had a history of stroke and 76.4% had non-paroxysmal AF. The overall annual stroke/SE rate was 1.33%/year (95%CI 1.27-1.39%). Subjects with non-paroxysmal AF had higher stroke/SE rates, 1.38%/year (95%CI 1.31-1.45%) compared to 1.15%/year (95%CI 1.05-1.27%) with paroxysmal AF. The rate increased by a RR 1.36 (95%CI 1.32-1.41%) per CHA 2 DS 2 -VASc point; in subjects with CHA 2 DS 2 -VASc≥4, the stroke/SE rate was 1.67%/year (95%CI 1.59-1.75%). Annual stroke/SE rates were higher in subjects with a prior stroke, 2.51%/year (95%CI 2.33-2.71%), and increased with higher CHA 2 DS 2 -VaSc score; RR 1.11 (95%CI 1.05-1.18), Figure 1 . After premature permanent discontinuation of study drug, which occurred in 22% of individuals, stroke/SE rates were 3.6%/year (95%CI 3.4-3.9%) overall; 6.5%/year (95%CI 5.7-7.4%) in those with prior stroke. During follow-up 8.9% of subjects died. Conclusions: Despite treatment with oral anticoagulation in a clinical trial setting, there remains an 8.4% risk of stroke/SE over five years in subjects with CHA 2 DS 2 -Vasc≥4, and 12.5% over five years in subjects with a prior stroke. Permanent discontinuation is common, and associated with stroke/SE risks of almost 20% over five years.
Abstract 15948: Highly Suspicious Yet Diagnostically Unrevealing Left Ventricular Free-Wall Rupture Following STEMI
Authors: Astha Prasai, Omofolarin Babayale, Mohamed Salah Mohamed, Ahmad N Latifi, Rawa Sarji
Journal: Circulation (2023)

Introduction: Left ventricular wall rupture is a rare but lethal complication following a ST elevation myocardial infarction (STEMI). We present a case of left ventricular free-wall rupture not identified on echocardiography and CT angiography (CTA) despite high suspicion who underwent emergent lifesaving mediastinal exploration and repair. Case: A 52-year-old male with past medical history of hypertension presented with typical chest pain. He was found to have STEMI with 100% left anterior descending (LAD) artery occlusion and underwent percutaneous coronary intervention to mid LAD. Post procedure, he developed atrial fibrillation with rapid ventricular rate, pericarditis, increasing pericardial effusion (Figure 1), and cardiogenic shock. He underwent intra-aortic balloon pump placement with no improvement in hemodynamics and subsequently an Impella 5.5 was placed. On post MI Day 3, he underwent pericardial window in the setting of shock and increasing pericardial effusion. Intraoperative TEE showed signs of tamponade physiology (Figure 2). Repeat echocardiograms and CTA was unrevealing of a rupture. Post MI day 6, he had increasing output from the drains and increasing pericardial effusion with complete right ventricular collapse on bedside echocardiogram. Emergent mediastinal exploration revealed left ventricular (LV) free-wall rupture which was repaired with a bovine patch. Hemodynamics improved and goal directed medical therapy was started. Discussion: Free wall rupture is a rare complication post MI and is reported in only 0.01% of STEMI. It usually occurs within 1 week, majority occurring within 24 h of MI. Small LV wall rupture can be challenging to diagnose on cardiac imaging. This case emphasizes the importance of having a high index of suspicion for diagnosing free wall rupture in patients presenting with hemodynamically unstable pericardial effusion post STEMI. Prompt pericardiocentesis and surgical intervention lead to a good outcome.
Abstract 16593: The DEAD-Box RNA Helicase Ddx41 Contributes to Adverse Cardiac Remodeling During Pressure Overload Through Modulation of RNA Metabolism
Authors: Wenhao Liu, Yasutomi Higashikuni, Takumi Obana, Yu Tanaka, Yoichiro Hirata, Masataka Sata
Journal: Circulation (2023)

Introduction: RNA metabolism represents an essential biochemical process that governs protein biosynthesis, an operation that is modulated by RNA-binding proteins. Although shifts in RNA metabolism have been implicated in the pathogenesis of heart failure, the role of RNA-binding proteins in the heart remains largely unknown. Methods: Whole-genome CRISPRi screening was performed in HL-1 cardiomyocyte cell line transduced with dCAS9-KRAB. Phenylephrine, cobalt chloride and hydrogen peroxide were used as pathological stressors. Neonatal rat ventricular myocytes (NRVMs) were used for further in vitro experiments. DNA damage and mitochondrial function were assessed by phospho-H2AX detection and mitochondrial membrane potential assay, respectively. Transcriptome was assessed in NRVMs treated with Ddx41 or control siRNA. RNA Immunoprecipitation sequencing (RIP-seq) was performed by using NRVMs overexpressing FLAG-tag-labelled Ddx41. 8- to 12-week old wild-type and transgenic mice with cardiomyocyte-specific overexpression of Ddx41 were used for animal experiments. Pressure overload was induced by transverse aortic constriction (TAC). Cardiac phenotype was assessed by echocardiographic and histological analyses. Results: CRISPRi screening and validation experiment identified Ddx41, a DEAD-box RNA helicase, as one of molecules whose inhibition protects HL-1 cardiomyocytes against various pathological stressors. Knockdown of Ddx41 showed protective effect in NRVMs against doxorubicin stress with improvement of DNA damage, whereas overexpression of Ddx41 induced mitochondrial dysfunction. Transcriptome analysis using NRVMs demonstrated that Ddx41 knockdown alters expression levels of genes related to cardiac hypertrophy, energy metabolism, extracellular matrix formation and wound healing. RIP-seq analysis revealed that Ddx41 binds to mRNAs of genes related to inflammatory responses. Ddx41-Tg mice showed higher mortality and exacerbated adverse cardiac remodeling after TAC, compared with wild-type mice. Conclusions: Our results suggest that Ddx41 contributes to adverse cardiac remodeling during pressure overload through modulation of RNA metabolism. Ddx41 might be a novel therapeutic target for heart failure.
Abstract 16395: Caregiver Challenges, Needs, and Health Outcomes After Left Ventricular Assist Device Implantation
Authors: Jonathan Auld, Megan M Streur, Elaine Thompson, Jennifer Beckman, Cynthia M Dougherty
Journal: Circulation (2023)

Introduction: Caregivers of patients with left ventricular assist devices (LVAD) experience significant strain in caring for patients after device implant, yet few studies have captured underlying caregiver needs and the impact on caregiver health. Aim: To describe caregiver challenges, needs, and health outcomes at three distinct time points following LVAD implant. Method: Using a cross-sectional, concurrent mixed methods design, patients were interviewed at 1 of 3 time points during LVAD recovery: at hospitalization after LVAD implant (n=3), at 1 month (n=9) , or 3 months (n=7) after returning home. Key health outcomes (measures) included caregiver Roles and Responsibilities (CRRS), mental health (SF-12 MCS), and physical function (Duke Activity Status Index, DASI). Qualitative interviews were transcribed verbatim and analyzed using thematic analysis; qualitative and quantitative findings were integrated using matrix displays across time points. Results: Caregivers (N=19) were 60.0±9.6 years old, 68% married, 88% female, 56% with 2 or more comorbidities, and 56% caring for Destination Therapy patients. Three phases of caregiving were characterized. At 1 month, caregiver burden was highest (CRRS: hospitalization after implant= 32±12.7; 1 mo = 51.6±7.8; 3 mo = 47.3±8.9); physical function lowest (DASI: hospitalization after implant = 53.7±5.3; 1 mo = 38.1±9.7; 3 mo = 42.1±15.6); and mental health highest (SF-12: hospitalization after implant = 43.4±7.8; 1 mo = 55.8±25.9; 3 mo = 48.3±26.8). Qualitative analyses validated caregiving challenges and health impact at 1 month (isolation, constant caregiving, uncertainty) and low physical function (work of caregiving, disrupted sleep), while simultaneously underscoring positive mental health effects (gratitude for a second chance, establishing routines, experiencing support). Conclusion: The characterization of three phases of caregiving after LVAD implantation provides important new insights necessary for targeted interventions for LVAD caregivers. Identified targets to relieve caregiver burden and improve adjustment after patients are discharged home include the need for relief from isolation and 24/7 caregiving, promotion of sleep and routines, and social support.
Abstract 16372: Prognostic Value of Baseline Right Ventricular Dysfunction Using TAPSE and TAPSE to PASP Ratio in Patients Undergoing Mitra-Clip: Systematic Review and Meta-Analysis
Authors: Anan Abu Rmilah, Ramy Ghaly, Carlos Pfeiffer, Victor Camba, MOHAMED HAG SAEED, Abdulrahman Khojah, Anjula Chib, Aziz Tabash, John Raper, Suhaib Jaber, Paul Volansky, mandar jagtap
Journal: Circulation (2023)

Introduction: Transcatheter edge-to-edge mitral valve repair (TEER) using Mitra-clip is an established therapy for high-risk surgical candidates who are refractory to optimal medical treatment. Several reports have shown that right ventricular dysfunction (RVD) is associated with increased morbidity and mortality in heart failure (HF) patients. Emerging data on the relationship between baseline RVD and post-TEER mortality has been published. Objective: Our main goal is to assess the prognostic impact of baseline RV function markers; tricuspid annular plane excursion (TAPSE) and TAPSE/PASP (pulmonary arterial systolic pressure) ratio, as an expression of the right ventricle-pulmonary artery coupling following Mitra-Clip. Methods: MEDLINE and EMBASE were searched for studies discussing outcomes of Mitra-Clip in patients with and without RV dysfunction as expressed by TAPSE or TAPSE:PASP ratio. Two reviewers independently screened the studies and extracted the pertinent survival data. Odds ratios (OR) with 95% confidence interval were calculated using a random-effects model. Results: Twelve reports enrolling 3515 patients (1443 with and 2072 without pre-existing RVD) were included. Patients with RVD had OS reduction after Mitra-Clip by 55% at 6 months, 60% at one year, and 63% at two years [OR: 0.45 (0.35-0.58), 0.40 (0.33-0.48), 0.37 (0.31-0.45) respectively; P &lt; .001] compared to normal RV group. Likewise, HR readmission free survival was minimized among RVD patients by 53% at 6 months, 56% at one year, and 59% at two years compared to normal RV group [OR: 0.47 (0.35-0.65), 0.44 (0.35-0.55), 0.41 (0.30-0.56) respectively; P &lt; .00001]. TAPSE:PASP ≤ 0.30-0.37 was associated with lower OS and HF re-admission free survival at 6 months (OR: 0.37, 0.44; P &lt; .00001) and 1 year (OR: 0.35, 0.41; P &lt; .00001) after Mitra-Clip. Furthermore, TAPSE ≤ 15-16 negatively impacted the OS at 6 months (OR: 0.40 P &lt; .00001) and 1 year (OR: 0.50; P &lt; .00001) after Mitra-Clip. Conclusions: Pre-existing RV dysfunction as expressed by TAPSE ≤15-16 or TAPSE:PASP ratio ≤ 0.30-0.37 decreased the overall survival and HF readmission free survival after Mitra-Clip therapy. Further research is warranted to guide interventional timing based on the degree of RV dysfunction.
Abstract 16957: <i>PRKAG2</i> Directly Interacts With Myosin Heavy Chains to Modulate Myocyte Electrical and Morphological Changes in Cardiac Hypertrophy
Authors: Wandi Zhu, Kusumika Saha, Micah Burch, Ashmita KC, Max Homilius, Rachelle Victorio, Dajun Quan, Alexander Williams, Chiara Evans, Calum Macrae
Journal: Circulation (2023)

Introduction: Mutations in the PRKAG2 gene cause a complex myocardial disorder characterized by hypertrophic cardiomyopathy (HCM) and conduction disturbances. While prior studies associated PRKAG2 -linked hypertrophy with increased glycogen storage, many HCM phenotypes in the disorder remain unexplained by this effect alone. We aimed to uncover the molecular mechanisms by which PRKAG2 mutations induce myocyte hypertrophy and electrical changes during cardiac development. Methods: We created transgenic zebrafish expressing WT (Tg WT ) and pathological mutant (Tg R299Q ) murine Prkag2 cDNA under a myocardium-specific promoter. Using these models, we studied the impact of Prkag2 variant on myocyte electrical activity, metabolism, and cytoarchitecture across cardiogenesis and in mature hearts. Results: Tg R299Q adult fish showed hypertrophic cardiomyocytes, swollen mitochondria, and shortened sarcomere length compared to Tg WT and WT, mirroring human HCM phenotypes. The glycogen content was elevated in adult hearts but not during early cardiogenesis. Despite the absence of glycogen accumulation at 6-day post fertilization, Tg R299Q hearts showed electrical abnormalities, including a reduced conduction velocity, decreased Ca 2+ amplitude, and prolonged action potential durations in both atria and ventricles, compared to Tg WT and WT. Co-immunoprecipitation and proximity ligation assay revealed physical interactions between Prkag2 and myosin heavy chain (MYH), with the R299Q variant enhancing this interaction and altering the subcellular localization of Prkag2 from mitochondria to sarcomeres. Knockdown of the fish homolog of MYH7 ( vmhcl ) restored the early electrical disturbances caused by Tg R299Q . This abnormal MYH-Prkag2 interaction disturbed mitochondria and sarcomere organization contributing to altered myocyte cytoarchitecture observed in Tg R299Q . Conclusions: Mutant PRKAG2 altered cardiac excitability and Ca 2+ handling during embryogenesis, preceding glycogen accumulation. Enhanced binding between Prkag2 and MYHs contributed to these early changes. Our study revealed a novel link between sarcomere proteins and metabolic regulators in cardiac hypertrophy, suggesting a new therapeutic avenue for treating HCM.
Abstract 13027: Hospital Outcomes and Predictors of Spontaneous Coronary Artery Dissection With Concurrent Ventricular Arrhythmias
Authors: Min Choon Tan, Yong Hao Yeo, Qi Xuan Ang, Eric Yang, Joanne Mazzarelli, Justin Lee, Wilber Su, Kwan S Lee
Journal: Circulation (2023)

Background: While spontaneous coronary artery dissection (SCAD) patients can present with ventricular arrhythmias (VAs), the in-hospital outcomes among these patients are not well-established. Objective: This study aimed to analyze the in-hospital outcomes of patients with SCAD and concurrent VAs, and to determine the predictors of VAs occurrence in this population. Methods: Using the Nationwide Readmissions Database, our study included patients aged 18 years or older who had SCAD between 2017 and 2020. We categorized the cohort into two groups depending on the presence of VAs during hospitalization. The in-hospital outcomes were assessed between two groups. Through multivariable analysis, we further analyzed the predictors of VAs occurrence among SCAD patients. Results: Our study included 160 (13.45%) SCAD patients with concurrent VAs and 1,030 (86.55%) SCAD patients without concurrent VAs between 2017 and 2020. SCAD patients with concurrent VA were associated with higher rates of early mortality (11.88% vs. 2.04%, p&lt;0.01), prolonged index hospital stay (≥7 days) (31.25% vs. 12.82%, p&lt;0.01), and non-home discharge (21.88% vs. 6.50%, p&lt;0.01). The length of hospital stay was longer in the SCAD with concurrent VAs group (6.93 days vs. 3.73 days, p&lt;0.01), and the median cumulative cost of hospitalization was also higher in this group ($31,450 vs. $14,664, p&lt;0.01). SCAD with concurrent VAs patients also had poorer in-hospital adverse events. In multivariable analysis, the independent predictors for VAs occurrence among SCAD patients were chronic liver disease (aOR: 2.18; 95% CI: 1.15- 4.12, p=0.02) and heart failure (aOR: 3.40; 95%CI: 2.30- 5.02, p&lt;0.01). Conclusion: Ventricular arrhythmias among SCAD patients were associated with poorer in-hospital outcomes. Heart failure and chronic liver disease were the predictors of VAs in SCAD patients. This highlights the importance of closely monitor and aggressive VAs management among these high-risk patients.