tbuckley/cabot-search huggingface dataset:
Abstract 12986: Aorta Gene: Polygenic Prediction Improves Detection of Thoracic Aortic Aneurysm
Authors: James P Pirruccello, Shaan Khurshid, Honghuang Lin, Lu-Chen Weng, Siavash Zamirpour, Shinwan Kany, Mark E Lindsay, Patrick T Ellinor
Journal: Circulation (2023)

Introduction: Thoracic aortic disease is an important cause of morbidity and mortality in the US, and aortic diameter is a heritable contributor to risk. Question: Could a polygenic prediction of ascending aortic diameter improve detection of aortic aneurysm? Methods: We used deep learning to measure ascending thoracic aortic diameter in 56,556 UK Biobank participants and conducted a genome-wide association study (GWAS) in 39,524. We built a 1.1-million SNP polygenic score using PRScs . In 4,896 non-GWAS participants (“training set”), we built linear models from clinical variables and the polygenic score (“AORTA Gene”) and simpler comparators. The models were assessed in the remaining 4,962 unrelated UK Biobank participants with imaging (“test set”). The models were externally validated in All Of Us participants over the age of 40. Results: In the test set, the AORTA Gene model explained 39.9% (95% CI 37.8-42.0%) of the variance in thoracic aortic diameter compared to 29.2% for the clinical model (95% CI 27.1-31.4%). For diameter ≥ 4cm, the area under the receiver operating characteristic curve (AUROC) was 0.834 for AORTA Gene, superior to the clinical model (0.765, P=7.3E-10). Thresholding at the top 10% of the score, AORTA Gene had a sensitivity of 52% and a specificity of 91.2% (F1: 0.197) for detecting the 113 participants with diameter ≥ 4. For the clinical score, the respective values were 36.3%, 90.9%, and 0.137. In 610 All Of Us participants with genetic data and aortic measurements, the AORTA Gene model had a correlation of 0.591 (95% CI 0.537-0.640) with aortic diameter vs 0.538 (95% CI 0.479-0.592) for the clinical model (P=2.2E-13 against a null hypothesis of the genetics being uninformative beyond clinical factors). It had an AUROC of 0.827 for identifying diameter ≥4cm vs 0.791 for the clinical model (P=7.8E-03). AORTA Gene also had a higher AUROC for prevalent thoracic aneurysm diagnoses (0.760 vs 0.739 for the clinical score, N=1,904 cases, P=2.4E-16) and incident diagnoses (0.748 vs 0.729, N=1,632 events, P=9.5E-10). Conclusions: Genetic information improved prediction of thoracic aortic diameter and aneurysm when added to clinical risk factors. Larger and more diverse samples will be needed to develop more powerful scores.
Abstract 13161: Efficacy of Thoracic Endovascular Aortic Repair versus Best Medical Therapy in Treatment of Type B Aortic Dissection: A Meta-Analysis
Authors: Karam R.Motawea, Samah S. Rozan, Rowan H. Elhalag, Abdelrhamam M. Abdelwahab, Hussam Al Hennawi, Salem Elshenawy, Mai Mohamed, Pensée Chébl, Mohamed Salem Madian, Mostafa Elsayed Elsayed Hewalla, Sarya Swed, Bruce Klugherz
Journal: Circulation (2023)

Background and aim: Techniques in endovascular therapy have evolved offering a promising alternative to medical therapy alone in Type B aortic dissections (TBADs). The aim of this meta-analysis is to compare mortality and overall complications in thoracic endovascular aortic repair (TEVAR) with best medical therapy (BMT) in patients with TBADs. Methods: We included any randomized control trials, case controls, prospective or retrospective cohort and cross sectional studies that compared TEVAR versus BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched to identify relevant articles including PubMed, Scopus, and Web of Science. Review Manager (RevMan) software, version 5.4 was used to perform the analysis. Results: A total of 1966 studies were screened with 32 studies included. Thirty-two cohort studies including 150836 patients (19512 TEVAR and 131324 BMT) were included. TEVAR was associated with a significantly lower 30-day mortality rate compared to BMT (RR= 0.79, CI= 0.63, 0.99, P = 0.04) notably in patients ≥ 65 years of age (RR=0.78, CI=0.64, 0.95, P=0.01). TEVAR group had a statistically significant prolonged length of hospital (MD= 3.42, CI= 1.69, 5.13, P = 0.0001), and ICU stay (MD= 3.18, CI= 1.48, 4.89, P = 0.0003) compared to BMT. BMT was associated with increased overall complications (RR= 1.50, CI= 1.20, 1.86, P = 0.0003) and stroke (RR= 1.52, CI= 1.29, 1.79, P &lt; 0.00001). No statistically significant difference in late mortality (1, 3, and 5 year), intervention-related (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis), was noted between both groups. Conclusion: In patients with TBAD, TEVAR was associated with a decreased risk of 30-day mortality rate and overall complications compared to BMT. More randomized control trials are needed to support our findings.
Abstract 13012: Impact of End-Stage Renal Disease on Short-Term Outcomes Among Adults Undergoing Percutaneous Mitral Valve Repair
Authors: Jasninder S Dhaliwal, Rahat A Memon, Shruti Aggarwal, Kamleshun Ramphul, Nomesh Kumar, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: Patients with end-stage renal disease (ESRD) are predisposed to multiple complications following invasive and non-invasive procedures. With the recent introduction of percutaneous mitral valve repair (PMVR), there needs to be more data on ESRD patients' outcomes following such procedures. Our analysis aims to bridge data via national hospitalization records. Methods: We used de-identified data of adults(ages 18 and more) undergoing PMVR between 2016-2020 via the National Inpatient Sample. Patients were separated into two groups based on the presence of a diagnosis of ESRD. We excluded all other forms of Chronic kidney disease classifications from our control group. Differences in outcomes were studied via logistic regression models. Results: Between 2016-2020, a total of 24680 procedures of PMVR were performed in the United States that met our selection criteria. Among them, 1655 (6.7%) patients were reported with a diagnosis of ESRD, while 23025 (93.3%) were without any diagnosis of CKD or ESRD. Patients with ESRD consisted of a younger cohort (mean age 68.68 years) compared to the non-ESRD group (mean age 77.39 years, p&lt;0.01). Furthermore, the ESRD group showed a higher mean Charlson Comorbidity Index Score (CCI) score (6.47) compared to the non-ESRD group (score of 2.20). Most procedures were conducted in Urban teaching centers (90.4% of non-ESRD patients and 93.4% of ESRD patients). ESRD patients recorded higher odds of sepsis (aOR 1.747, 95% CI 1.191-2.560, p&lt;0.01), major bleeding (aOR 8.316, 95% CI 7.336-9.426, p&lt;0.01), postprocedural respiratory failure (aOR 2.531, 95% CI 1.441-4.445, p&lt;0.01), and mortality (aOR 2.109, 95% CI 1.513-2.940, p&lt;0.01). The two groups showed no differences in acute myocardial infarction events (aOR 1.235, 95% CI 0.899-1.697, p=0.193) during their hospitalization for the procedure. Conclusions: Patients with ESRD experienced poorer outcomes following PMVR as they had higher odds of mortality, postprocedural respiratory failure, major bleeding, and sepsis. Thus, physicians must adequately address the potential complications with and without the procedure and closely monitor the post-operative progress.
Abstract 13173: Loss of ACE2 in a Diabetic Obese Setting Exacerbates Cardiovascular Dysfunction in the Setting of Gut Dysbiosis
Authors: Mahmoud Gheblawi, Faqi Wang, Ratnadeep Basu, Ram Prasad, Maria B Grant, Gavin Y Oudit
Journal: Circulation (2023)

Introduction: COVID-19 disproportionately affects older, male obese patients leading to a high prevalence of adverse outcomes. SARS-CoV-2 mediated ACE2 loss may further increase the susceptibility of these patients to adverse outcomes. Loss of ACE2 may be a causative factor in cardiovascular (CV) injury independent of primary viral-mediated injury. Methods: Male, 6-month-old, diabetic, obese db/db Ace2 -/y (double mutant, DM) mice and respective WT, Ace2 -/y , and db/db controls (n=12) were assessed for injury across the gut-heart axis. Cardiovascular parameters were evaluated by echocardiography, pressure-volume loops, and histology. Alterations in gut permeability were determined by measuring plasma peptidoglycan (PGN) levels and immunological staining of microvilli structure. Metagenomics and metatranscriptomics determined the functional and phyla alterations of the gut microbiota. Results: Loss of ACE2 in diabetic obese mice led to increased left atrium diameter (P&lt;0.001) and elevated left ventricular end-diastolic pressures (P&lt;0.05) compared to db/db mice. Cardiac remodeling was prevalent in DM hearts with increased cardiomyocyte hypertrophy (P&lt;0.001), cardiac fibrosis (P&lt;0.05), lipid accumulation (P&lt;0.01), and reactive oxygen species (ROS; P&lt;0.01) compared to db/db mice. This was associated with elevated aortic ROS (P&lt;0.001), and impaired femoral artery vasodilation (P&lt;0.001). DM mice had increased gut-blood barrier permeability, with elevated plasmalemma vesicle-associated protein-1 staining (P&lt;0.05) and plasma PGN levels (P&lt;0.01). Principal coordinates analysis of gut microbial β diversity showed distinct populations across the experimental groups (P&lt;0.05). Loss of ACE2 in db/db mice resulted in the divergence of metatranscriptomics profiles with increased expression of neutral amino acid metabolism, PGN and toxin production pathways. Conclusions: Loss of ACE2 in diabetic obese mice worsened cardiovascular dysfunction and adverse remodeling and was associated with an altered gut-cardiovascular axis characterized by elevated gut permeability and dysbiosis. Our results support worsening CV injury arising from the loss of ACE2 and may indicate a pathway of SARS-CoV-2 infection mediated CV injury.
Abstract 13019: Differences in Outcomes Among Elderly Patients on Medicare Undergoing Transapical Access and Non-Transapical Access Transcatheter Aortic Valve Replacement
Authors: Jasninder S Dhaliwal, Rahat A Memon, Shruti Aggarwal, Kamleshun Ramphul, Abhimanyu Ravalani, Shaheen Sombans, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: While a recent study reported a decreasing trend in the use of transapical access (TA) transcatheter aortic valve replacement (TAVR) over non-transapical access (non-TA) TAVR, their burden on Medicare remains considerable. We aim to investigate differences in outcomes among elderly patients covered by Medicare undergoing TA and non-TA-TAVR. Methods: Medicare-insured elderly (ages≥ 60 years) undergoing TAVR (TA and non-TA) were recruited from the National Inpatient Sample (2016-2020), and differences in outcomes between the two procedures were evaluated. Results: We found 259385 procedures of TAVR involving 256145 (98.8%) cases of non-TA-TAVR and 3240(1.2%) cases of TA-TAVR. Between 2016-2020, a continuous drop in TA-TAVR use was observed (vs. non-TA-TAVR). Mortality rates among non-TA-TAVR patients also decreased from 1.8% in 2016 to 1.1% in 2020. Meanwhile, patients with TA-TAVR experienced a rise in mortality from 3.8% in 2016 to 5.8% in 2018, which decreased in 2019(3.7%) and 2020 (2.2%). TA-TAVR cases had a higher mean Charlson Comorbidity Index (CCI) score (3.65 in TA-TAVR cases vs. 3.02 in non-TA-TAVR patients) and higher odds of major bleeding (aOR 1.554, 95% CI 1.442-1.675, p&lt;0.01), postprocedural pneumothorax (aOR 2.853, 95% CI 1.689-4.820, p&lt;0.01), postprocedural respiratory failure (aOR 5.106, 95% CI 4.149-6.284, p&lt;0.01), use of mechanical ventilation (aOR 3.077, 95% CI 2.653-3.569, p&lt;0.01), or Major Adverse Cardiac Events (MACE) (aOR 1.512, 95% CI 1.325-1.727, p&lt;0.01) vs. non-TA-TAVR cases. No differences in cardiac tamponade (aOR 1.350, 95% CI 0.957-1.904, p=0.087) were seen. Finally, TA-TAVR cases required a longer stay (mean length of stay 7.15 vs. 3.76 days). Conclusions: The use of non-TAVR over TA-TAVR continued between 2016-2020 with favorable short-term survival rates and fewer complications such as major bleeding, postprocedural pneumothorax, respiratory failure, MACE, and the need for mechanical ventilation.
Abstract 11589: Late Complications After Interrupted Aortic Arch Repair
Authors: John F Keaney, Jeremy Asnes, Roland Assi, Tony Pastor
Journal: Circulation (2023)

Description of Case: A 38-year-old man with known type B interrupted aortic arch (IAA), bicuspid aortic valve, and a complex surgical history (including IAA repair with an ascending-descending aortic conduit, later conduit graft revision, and left pulmonary artery [LPA] stent) presented after many years of loss to follow-up and was found to have hypertensive urgency. Echocardiogram showed turbulent flow in the proximal descending aorta concerning for arch obstruction. Computed tomography angiography (CTA) (Fig. 1 A–C) showed: narrowed proximal graft anastomosis, dilation of the aortic root and ascending aorta, a large pseudoaneurysm arising from the distal graft anastomosis, and LPA stenosis due to compression from the descending aorta. Following improved hypertension, the patient underwent placement of a left carotid-subclavian bypass graft followed by thoracic endovascular aortic repair (TEVAR) with an endograft positioned across the distal aortic jump graft suture line. CTA one month postoperatively (Fig. 1 D–F) confirmed exclusion of the pseudoaneurysm. Discussion: Type B IAA is considered the most common subtype of IAA among cases diagnosed in infancy, though recent data regarding IAA epidemiology are scarce. IAA is associated with other congenital abnormalities, such as ventricular septal defect (VSD), LV outflow tract abnormalities, and 22q11 deletion syndrome. Additional surgical aortic arch procedures in these patients are not uncommon, perhaps especially among patients who required reintervention for LV outflow tract obstruction. While most studies examining long-term outcomes after IAA repair have not commented specifically on late risk of aneurysm or pseudoaneurysm, such findings have been described in the literature. Additionally, use of polytetrafluoroethylene material in arch repair and arch repair by a method other than direct anastomosis—such as were seen in our patient—have been observed to be risk factors for late reintervention.
Abstract 12990: Income and Outcomes in Atrial Fibrillation and Atrial Flutter: Insights From the National Inpatient Sample
Authors: Nelson I Barrera, Mushrin Malik, Khaled Elfert, Salomon Chamay, Francisco J Gallegos Koyner, Angelina Dhani Mohamed, Carlos A Espiche, Kamil Nazer, Roberto C Cerrud-Rodriguez
Journal: Circulation (2023)

Background: Socioeconomic factors are well-established, important determinants of cardiovascular health. In the United States, the association of personal income on the outcomes of patients with Atrial fibrillation (AF), and atrial flutter is unclear. Hypothesis: Lower socioeconomic status is associated with worse outcomes of patients with AF and atrial flutter. Methods: Utilizing the National Inpatient Sample (NIS), a retrospective descriptive study was conducted. We identified patients admitted for AF and atrial flutter from 2016-2020, our cohort was categorized based on patient income, which was determined using the median income for the patient's zip code. The low-income group(&lt;$50000) included patients in the first quartile of income, while the high-income(≥$50000) group included patients in the second, third, and fourth quartiles of income. We excluded patients who were younger than 18 years of age. Baseline characteristics, presence of comorbidities, and outcomes of the two groups were described. Hypothesis testing for categorical variables was performed using Chi-Square. Continuous variables were tested with a t-test. Statistical significance was defined as a two-tailed P -value of &lt;0.05. The clinical outcomes we evaluated included inpatient mortality, length of stay (LoS), total cost of hospitalization, acute kidney injury (AKI), blood transfusion, and cerebral vascular diseases. Results: In-hospital mortality was observed in 1% of the low-income group and 0.8% in the higher-income group ( P -value &lt;0.0001). LoS was 3.57+/- 0.013 in the low-income group and 3.27+/- 0.008 in the higher-income group. Total cost was $15081.22 in the low-income group and $16307.40 in the higher-income group, AKI (13.8% vs 12.6% in high-income group P -value &lt;0.0001), blood transfusions (1.4% vs 1.1% in the high-income group P -value &lt;0.0001), cerebrovascular disease (4.7% vs 4.5% in high-income group P -value &lt; 0.0006). Conclusion: Our cross-sectional study observed that patients in a lower socioeconomic population had higher mortality during hospitalizations, and increased risk of cerebrovascular disease.
Abstract 107: Accelerated Intramuscular Epinephrine and Survival in Adult, Non-Traumatic Out-of-Hospital Cardiac Arrest: A Before-After Study
Authors: Helen N Palatinus, Michael Johnson, Henry E Wang, Scott T Youngquist
Journal: Circulation (2023)

Introduction: Survival after out-of-hospital cardiac arrest is poor. Treatment with early epinephrine is associated with improved survival but delays in vascular access may impact its timely delivery. Outcomes may be improved by novel methods to administer epinephrine prior to vascular access. We previously established that intramuscular epinephrine reduced time from 911 call to drug administration. Aim: To determine whether accelerated intramuscular epinephrine (IM-Epi) is associated with improved OHCA survival compared with standard IV/IO epinephrine. Methods: We conducted a before-after analysis of the implementation of an IM-Epi EMS protocol. We included adult OHCAs treated by the Salt Lake City Fire Department. Interventions were: pre-IM Epi (Jan 2010-Nov 2019), standard care IV or IO epinephrine; post-IM Epi (Dec 2019-Mar 2023), a single dose of 5 mg IM epinephrine prior to the initiation of IV/IO access. All other care followed standard ACLS, including additional dosing of epinephrine via IV/IO. Using multivariable logistic regression, we determined the association between IM-Epi and hospital survival, ROSC, and good neurologic function adjusted for Utstein variables. Results: Among 1,283 OHCAs, 307 (23.9%) received IM-Epi and 976 (76.1%) received usual care. Groups had similar sex, witnessed arrest, arrest location, initial rhythm, and response time, but younger age (57.3 vs. 59.5 years old; p=0.05) and higher bystander CPR (68.3% vs. 56.0%; &lt;0.001) in the IM-Epi group. Time to epinephrine administration was faster for the IM-Epi group (12.0 vs. 15.3 min; &lt;0.001). IM-Epi was associated with improved hospital survival (adjusted OR, 1.87; 95% CI, 1.12-3.10) and good neurologic outcome at discharge (adjusted OR, 1.76; 95% CI 1.02-3.01). IM-Epi first was not associated with differential rates of ROSC (adjusted OR, 1.02; 95% CI, 0.78-1.35) when compared to standard IV/IO first administration. Conclusion: In this before-and-after analysis, IM-Epi was associated with increased survival to hospital discharge and favorable neurologic function compared to standard care IV and IO epinephrine. Prospective randomized trials are needed to determine whether the observed effects of IM-Epi in OHCA improves outcomes.
Abstract 16025: Impact of COVID-19 on Major Adverse Cardiovascular and Cerebrovascular Events in Metabolically Healthy Obese (MHO) Individuals: A National Inpatient Sample Analysis, 2020
Authors: Sai Gautham Kanagala, Dinesh Kumar Vuddandam, Durga Mounika Muvva, Alpha James, Prathistitha Mallapu, Shantha Nallapothula, Nishanth Katukuri, Swetha Chiluka, Raja Anvesh Reddy Adelli, Devi Meghana Kotharu, Vaibhavi Polavarapu, Leela Krishna prasad Mandadi, Rupak Desai
Journal: Circulation (2023)

Background: The obesity paradox is a phenomenon observed in certain chronic diseases, particularly cardiovascular diseases, where individuals with obesity have better outcomes compared to those of normal weight. We aimed to study how COVID-19 affects MACCE results in metabolically healthy obese (MHO) individuals who have a BMI &gt;30. Methods: Using the National Inpatient Sample (2020) and appropriate ICD-10-CM codes, we identified adult hospitalizations with COVID-19 and grouped them into two cohorts with and without obesity (MHO+ and MHO-, omitting hypertension, diabetes, and hyperlipidemia). MACCE (all-cause inpatient mortality, cardiac arrest, including ventricular fibrillation, and stroke) in COVID-19-related hospitalizations was the primary outcome. Results: 84,145 (21.9%) of 397,040 COVID-19 hospitalizations were MHO+. The MHO+ group was younger (median 43 vs 52 years), female (56.9% vs. 49.4%), black (19.4% vs 15.1%), Hispanic (35.2% vs 30.5%), and Native American (1.5% vs 1.2%) (p&lt;0.001). Tobacco use disorder, past PCI, prior VTE, depression, chronic pulmonary disease, hypothyroidism, and other thyroid problems were more common in MHO+ patients (p&lt;0.05). MHO+ patients were discharged routinely (76% vs. 66.7%) but stayed longer (5 days vs 4 days). After correcting for baseline variables, the MHO+ cohort had a lower rate of MACCE than the MHO- cohort (8% vs. 11.3%, OR 0.81, 95CI 0.74-0.89, p&lt;0.001), and lower all-cause mortality (6.6 % vs 9.4%) compared to the MHO- cohort. On subgroup analysis, females had lower odds (aOR 0.79) than males (aOR 0.82), older individuals ≥65 years old had lower odds (aOR 0.71) vs 45-64 (aOR 0.79), and race- wise comparison, whites had lower odds of MACCE events (aOR 0.76). Conclusions: MHO+ patients had lower odds of MACCE events. The MHO group was younger, suggesting higher cardiorespiratory fitness, which could explain the obesity paradox and reduced odds of MACCE outcomes.
Abstract 338: Temporal Characteristics of a Smartphone Alert System for CPR in a Mid-Sized Metropolitan Area
Authors: Leo Kates, Jorge A Gumucio, Alexandria Chiaberta, Ryann DeMaio, Leonard Weiss, Ankur A Doshi, David Salcido
Journal: Circulation (2023)

Introduction: Smartphone alert systems (SAS) mobilize trained volunteers to initiate CPR prior to Emergency Medical Services (EMS) arrival. Among the potential factors affecting the probability of a successful response is time; time of day, day of the week, and season each present plausible barriers to response. We sought to examine the temporal characteristics of an SAS in order to better understand this relationship between time and system performance. Methods: Operational records were obtained from the PulsePoint deployment in Allegheny County, Pennsylvania, USA for the period June 2016 to May 2023. PulsePoint sends alerts including nearby AED locations to volunteer responders within a 400m radius of public cardiac arrest events. Case data included alert time and number of responders and AEDs within range of the event. We associated each PulsePoint event with an 8-hour Timeframe (TF) {1 (00:00-07:59), 2 (08:00-15:59), and 3 (16:00-23:59)}, a day of the week, and a season. For each, we calculated the median number of associated responders and AEDs, and the total number of events. We then compared each across each time variable with a Mann-Whitney U-test or Kruskal-Wallis test. Results: There were a total of 2354 events in the capture period. Alerts were least common on Sundays (12.4%) and most common on Tuesday (15.6%). Alerts most frequently occurred in TF2 (45.6% vs TF1: 18.3, TF3: 36.1) and were similar between seasons. Weekday alerts had a higher median number of responders than weekend alerts {3 (1-5) vs 2 (1-4), p=0.004}. Responder count was lower for TF1 than TF2 and TF3 {2 (1-4) vs 3(1-5) vs 3(1-5), p &lt; 0.001}. Count of proximal AEDs did not vary by any of the temporal characteristics. Conclusion: Both event frequency and number of notified responders were associated with day of the week and time of day. Either feature is more complicated than meets the eye, and may include associations with diurnal population movement cycles, overall patterns in emergency services utilization, and responder device configuration preferences. All could be influential in optimizing such SAS deployments.