tbuckley/cabot-search huggingface dataset:
Abstract 4137065: Efficacy and Safety of Extracorporeal CPR in Out-of-Hospital Cardiac Arrest Survival and Neurological Integrity: a Meta-Analysis of Randomized Controlled Trials
Authors: Muhammed Melih Dogan
Journal: Circulation (2024)

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a significant public health challenge, with conventional cardiopulmonary resuscitation (CPR) often yielding limited success. Extracorporeal CPR (eCPR) has emerged as a potential adjunctive therapy to improve outcomes in OHCA patients. Purpose: To evaluate the efficacy and safety of eCPR compared to conventional CPR in OHCA. Methods: A comprehensive search of Cochrane CENTRAL, PubMed, Ovid Medline, and Web of Science databases was conducted independently until November 10, 2023. Randomized controlled trials (RCTs) comparing eCPR with conventional CPR in OHCA were included. Primary efficacy outcome was defined as survival to hospital discharge, while primary safety outcome was assessed for bleeding events. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. A sensitivity analysis was performed regarding whether the conclusions reached might differ substantially if a single study was omitted. Statistical analyses were performed with “meta” package in R (version 4.3.2) and Revman 5.4. Results: Four unique RCTs involving 435 patients were included in the analysis. ECCPR was associated with a significantly higher rate of survival at 1 month with good neurological outcome (Risk Ratio [RR] 1.55, 95% Confidence Interval (CI) 1.06 to 2.27, I 2 : 0%) but comparable at survival to hospital discharge (RR 1.10, 95% CI 0.16 to 7.30, I 2 : 47%) compared to conventional CPR. Furthermore, no significant differences were observed between eCPR and conventional CPR groups in survival rates at 3 months (RR 1,33, 95% CI 0.92 to 1.94, I 2 : 64%), survival at 6 months with good neurological outcome (RR 1.39, 95% CI 0.97 to 1.99, I 2 : 0%), and survival at 6 months (RR 2.79, 95% CI 0.33 to 23.28, I 2 : 63%). eCPR demonstrated a statistically significant elevation in bleeding events compared to conventional CPR (RR 4.25, 95% CI 2.37 to 7.64, I 2 : 0%). Sensitivity analysis revealed that none of the studies significantly influenced the pooled risk estimate to any great extent. Conclusion: eCPR shows beneficial results in improving short-term survival and neurological outcomes at 1-month post-OHCA. However, it is associated with an elevated risk of bleeding when compared to conventional CPR. Further investigations are imperative to delineate the specific patient populations that stand to gain the most benefit from ECPR intervention.
Abstract 4136846: Sex Differences in Hypertension Diagnosis among Young Adults
Authors: Jaejin An, Anna Novelli, Xuan Huang, Heidi Fischer, Kristi Reynolds, Liang Ni, Soon Kyu Choi, Kerresa Morrissette, Yiyi Zhang
Journal: Circulation (2024)

Background: Young adults, especially men, may experience delays in diagnosis of hypertension, which subsequently affect timely treatment and control of high blood pressure (BP). Question: Compared with young adult women, how soon are young adult men diagnosed with hypertension after having high BPs during clinical encounters? Aim: To estimate the time to first diagnosis of hypertension in young adult men and women, and to identify factors associated with a delayed diagnosis of hypertension. Methods: Using electronic health records, we identified adults aged 18-39 years with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on average of three consecutive separate outpatient BPs within two years of each other, between 2009-2016 from Kaiser Permanente Southern California. We followed them from the third qualifying BP until hypertension diagnosis, membership disenrollment, end of study (12/31/2019), or death, whichever occurred first. We used the cumulative incidence function and Cox proportional hazards models to estimate the time to first diagnosis of hypertension and identify factors associated with diagnosis. Results: Among 2,443 young adults (mean age 31 years, 57% men) with high BP, 37% were diagnosed with hypertension during a median of 5.9 years. Compared with women, a lower percentage of men were diagnosed with hypertension (30% vs 47%) and men received their diagnoses later (median time to diagnosis: 2.3 vs 1.4 years) ( Figure ). Among the total population, 19% of men and 12% of women did not have follow-up BP measures within one year following their third qualifying high BP. Among those diagnosed, 80% initiated with antihypertensive medications within one year following their diagnosis. Factors associated with a delayed diagnosis of hypertension included being male, younger, having lower systolic or diastolic BP, a lower body mass index, and the absence of dyslipidemia or (pre)diabetes. Conclusion: This study highlights that young adult men are at a higher risk of delayed hypertension diagnosis, emphasizing the need for healthcare system level interventions to improve the recognition, diagnosis, and treatment of hypertension in this population.
Abstract 4136745: How do sleep quality and heart failure symptoms impact functional status among patients with heart failure?
Authors: Jia-Rong Wu, Chin-Yen Lin, Martha Biddle, JungHee Kang, Abigail Latimer, Geunyeong Cha, Ashmita Thapa, Terry Lennie, Debra Moser
Journal: Circulation (2024)

Background: Patients with heart failure (HF) frequently experience poor sleep quality and multiple HF symptoms, both of which are linked to diminished functional status. Poor sleep quality can manifest as prolonged latency, short duration, low efficiency, or difficulty staying asleep. HF symptoms encompass different dimensions: presence, frequency, severity, and distress of HF symptoms. Different dimensions of sleep quality and HF symptoms may uniquely influence functional status, necessitating tailored interventions, yet how individual dimensions of sleep quality and HF symptoms impact functional status remains unexplored. Research Question: how do individual dimensions of sleep quality and HF symptoms impact functional status in patients with HF? Methods: We studied 197 adults with HF (male: 66%, age: 62±11 yrs). The Pittsburgh Sleep Quality Index was used to assess seven dimensions of sleep quality: subjective sleep quality, latency, duration, efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month. Four dimensions (i.e., presence, frequency, severity, distress) of 7 HF symptoms (e.g., shortness of breath, fatigue, swelling) were assessed using the Symptom Status Questionnaire-HF. Functional status was measured using the Duke Activity Status Index. Correlations and two multiple linear regression models (1 st model: 7 dimensions of sleep quality on functional status, and 2 nd model: 4 dimensions of HF symptoms on functional status) were conducted for data analysis. Results: Worse subjective sleep quality, longer latency, more sleep disturbances, use of sleeping medications, and higher levels of daytime dysfunction were correlated with poor functional status. All four dimensions of HF symptoms were negatively correlated with functional status. In the 1 st multiple linear regression model, more sleep disturbances (B=-3.91, p =.006) and higher daytime dysfunction (B=-5.70, p &lt;.001) were predictive of poor functional status (model R 2 =0.23, p &lt;.001). In the 2 nd multiple linear regression model, only higher frequency of HF symptoms (B=-.70, p =.022) predicted poor functional status (model R 2 =0.34, p &lt;.001). Conclusion: Increased sleep disturbances, daytime dysfunction, and frequency of HF symptoms were associated with poorer functional status in patients with HF. These findings underscore the importance of developing tailored interventions to address individual sleep problems and HF symptoms to improve functional status.
Abstract 4137169: Artificial Intelligence-Enabled Electrocardiography For The Prediction of Future Type 2 Diabetes Mellitus
Authors: Libor Pastika, Konstantinos Patlatzoglou, Ewa Sieliwonczyk, Joseph Barker, Boroumand Zeidaabadi, Kathryn McGurk, Sadia Khan, Danilo Mandic, James Ware, Nicholas Peters, Daniel Kramer, Jonathan Waks, Arunashis Sau, Fu Siong Ng
Journal: Circulation (2024)

Background: Undiagnosed diabetes and prediabetes present a significant global health challenge. Artificial Intelligence-enabled electrocardiography (AI-ECG) has shown promise in identifying subtle ECG changes in a wide range of subclinical diseases. Opportunistic ECG screening could identify prediabetic patients, enabling early interventions to prevent T2DM and adverse cardiovascular events. Aims: To develop the AI-ECG Risk Estimator to diagnose prevalent T2DM and predict future T2DM (AIRE-DM) Methods: AIRE-DM was trained on a real-world secondary care cohort from Beth Israel Deaconess Medical Center (BIDMC) of 1,163,401 ECGs and externally validated in the UK Biobank (UKB, N = 65,606). AIRE-DM employs a residual neural network architecture with a discrete-time survival loss function. Results: AIRE-DM accurately identifies prevalent T2DM (AUROC: BIDMC – 0.712 (0.705-0.719), UKB - 0.731 (0.725 - 0.741) and predicts future T2DM (C-index: BIDMC - 0.666 (0.658-0.675), UKB 0.689 (0.663-0.715). In subjects without T2DM, the high-risk quartile shows a markedly increased risk of future T2DM (HR: BIDMC - 4.67 (4.01-5.45), UKB - 10.10 (5.87-17.40), adjusted for age and sex. Adding AIRE-DM to clinical risk factors in BIDMC and to the American Diabetes Association (ADA) score in the UKB significantly enhanced predictive accuracy for future T2DM (C-index improvement: BIDMC - 0.0359 (0.0354-0.0363), UKB: 0.0337 (0.0324-0.0350), continuous net reclassification index: BIDMC - 0.407 (0.360-0.445), UKB - 0.391 (0.259-0.503)). Using phenome- and genome-wide association studies, we identified biologically plausible associations for AIRE-DM, including glucose regulation, cardiac morphology, diastolic dysfunction, arterial stiffness and lipid metabolism. We identified variants adjacent to CASQ2 , TBX3 , NOS1AP , TKT , VGLL2 and PRDM6 , which are known regulators of cardiac morphology, arterial stiffness and glucose metabolism. Conclusion: AIRE-DM can predict future T2DM in non-diabetics and enhances T2DM risk prediction when integrated with clinical risk scores. Its application holds promise for early identification of individuals at high risk of T2DM, enabling early lifestyle and pharmacological interventions.
Abstract 4136796: The effect of replacing typical snacks with pecans on vascular health and diet quality: a randomized controlled trial
Authors: Tricia Hart, Penny Kris-Etherton, Kristina Petersen
Journal: Circulation (2024)

Background: Poor diet quality accounts for approximately half of all deaths from cardiometabolic diseases. Food pattern modelling using nationally representative U.S. data suggests that replacing typical snacks consumed with tree nuts will improve diet quality. However, few clinical trials have assessed the potential for tree nuts to improve diet quality. Pecans are rich in polyphenols, which may improve endothelial and vascular function. This study aimed to examine how substitution of usual snack foods with 2 oz/day of pecans affects flow mediated dilation (FMD), carotid-femoral pulse wave velocity (cf-PWV), blood pressure and diet quality after 12 weeks in individuals at increased risk for cardiometabolic disease. Hypothesis: Intake of 2 oz/day of pecans in place of habitually consumed snacks will improve vascular health and diet quality compared to habitual intake. Methods: In this single-blind RCT, adults (46 ± 13 years, 29.8 ± 3.7 kg/m 2 ) with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease, type 2 diabetes and other chronic diseases were included. The experimental group was provided with 2 oz/day of pre-portioned raw, unsalted pecans (~392 kcal) and instructed to replace the snacks they currently consume with the provided pecans. The control group was instructed to continue their usual diet. FMD (primary outcome), cf-PWV, brachial and central blood pressure were measured at baseline and following the intervention period (~12 weeks). At three timepoints (baseline, week 6, and week 12) during the study, participants completed three 24-hour recalls (total 9 recalls). The Healthy Eating Index-2020 (HEI-2020) was calculated to assess diet quality. Results: A total of 138 (69 per group) participants were randomized. No between-group difference in FMD, cf-PWV, or blood pressure was observed. The HEI-2020 was 11.1 points higher (95% CI 5.1, 17.2) in the pecan group compared to the usual diet group at week 12. The following HEI-2020 components were improved in the pecan group vs. the usual diet group: total protein foods (0.5 points [95% CI 0.1, 1.0]), seafood and plant proteins (2.5 points [95% CI 1.6, 3.4]), fatty acids (4.1 points [ 95% CI 2.6, 5.5]), and sodium (1.8 points [95% CI 0.3, 3.2]). Conclusion: Replacement of usual snacks with 2 oz of pecans improved adherence to the Dietary Guidelines for Americans but did not improve endothelial function, blood pressure, or arterial stiffening.
Abstract 4136762: Association Between Circadian Rest/Activity Rhythms and Incident Dementia in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Wendy Wang, Amal Wanigatunga, Lacey Etzkorn, Jill Rabinowitz, Priya Palta, James Pike, Ryan Dougherty, Vadim Zipunnikov, Francesca Marino, Ciprian Crainiceanu, Adam Spira, Jennifer Schrack, Lin Chen
Journal: Circulation (2024)

Introduction: Alterations in circadian rest/activity rhythms (RARs) are common among older adults. RARs can be derived from accelerometry data and are routinely used as proxy measures. Evidence suggests that altered (e.g., fragmented, delayed) RARs may be risk factors for dementia. However, results have been mixed. Using data from the ARIC Study, a community-based cohort, we assessed the association between RARs and incident dementia. Methods: ARIC participants without dementia who wore the Zio XT ECG Patch in 2016-17 for &gt; 3 days were included. RARs were obtained from an accelerometer within the Zio XT ECG Patch and measures of interdaily stability (IS; consistency), intradaily variability (IV; fragmentation), and relative amplitude (RA; strength) were derived. Dementia cases were identified through 2020 using in-person and phone-based cognitive assessments, hospitalization discharge codes, or death certificates. Cox proportional hazards models were used. Results: Of the 2,183 participants (mean [SD] age 79 [4.5] years, 58% female, 24% identified as Black), 176 (8%) developed dementia. Median follow-up time was 3 years and mean Zio XT ECG Patch wear time was 12 days. After multivariable adjustment, lower RA and higher IV were associated with incident dementia (HRs [95% CIs] per 1-SD increment: 0.65 [0.56-0.76], 1.19 [1.02-1.38]). No significant association between IS and dementia was noted; however, there was an interaction by race (p=0.03). Stratified results were not significant, but effect estimates were in opposite directions: (HRs [95% CIs] per 1-SD increment in IS: 0.78 [0.59-1.02] in Black participants and 1.17 [0.96-1.41] in white participants, respectively). No interactions by sex or APOEε4 were noted (p&gt;0.10). Conclusion: In this community-based cohort of older adults, weaker circadian rhythm strength and fragmentation were associated with dementia risk. The association between IS and dementia may differ by race; however, this needs to be further examined in future research. Overall, measures of circadian RARs may be risk factors for dementia. Additional research is warranted to determine whether they can be novel targets for dementia prevention.
Abstract 4136839: HBI-3000: Pharmacological Conversion of Atrial Fibrillation With Unique Defense Against Excessive QT Interval Prolongation
Authors: Jay Mason, Denis Roy, Gary Elliott, Suzanne Romano, Charles Pollack, Dr Mireille Gillings, Jerome Riebman
Journal: Circulation (2024)

Background: HBI-3000 (Sulcardine sulfate) is a new antiarrhythmic drug (AAD) that inhibits multiple cardiac ion channels (INa-peak, INa-late, ICa,L and IKr (hERG)) with uniquely similar potencies. A major AAD limitation is malignant proarrhythmia due to excessive hERG-mediated delay in repolarization, manifested by QT prolongation with proportional J to T peak [JTp] prolongation. While sulcardine inhibits hERG, it also possesses an intrinsic protective mechanism, inhibiting inward INa-late and ICa,L early repolarization currents. In Phase 1 volunteers in sinus rhythm (SR) therapeutic levels of sulcardine not only reduced but reversed the lengthening of the rate-corrected JTp (JTpc), reducing the extent of hERG-related QT prolongation. We investigated this protective JTpc effect in atrial fibrillation (AF) patients at the anticipated clinical dose, and examined the relationships between plasma concentration, QT prolongation, and the JTPc reduction. Methods: Ten patients received 350 mg HBI-3000 IV over 30 min in a Phase 2 open-label study of patients with acute AF. Sulcardine plasma concentrations and ECG intervals (from 5-min summary ECGs) were obtained at baseline and several time points. Mean baseline-subtracted, heart rate-corrected QTcF (dQTcF) and JTp (dJTpc; Johannesen’s method) were calculated at each time point. AF patient data were compared to those of volunteers in SR. Results: In AF patients, dQTcF prolonged with a linear relationship to plasma concentration as expected (Fig 1A, blue). HBI-3000 IV produced a large linear reduction in JTpc contribution to the QT interval (Fig 1A, red). This is consistent with findings in SR (Fig 1B [350 mg dose] and 1C [360 mg dose]) and unique among AADs that inhibit IKr along with INa-late and/or ICa,L. Calculated dQTcF changes without the JTpc effect were greater than the observed dQTcF (Fig 1A, green) by 27%-76% at Cmax in the three studies. Conclusions: HBI-3000 (Sulcardine) exhibits dQTcF prolongation protection in both AF and SR due to a unique pattern of channel fluxes that shortens early repolarization. This shorter dJTp interval acts as a mechanism for effectively limiting excessive QT prolongation and reducing proarrhythmic risk. [Registration: NCT04680026]
Abstract 4136869: Time Course and Predictors of PVC Recurrence After Acutely Successful Catheter Ablation
Authors: Michael Cimmino, Sean Dikdan, Juergen Kloo, Anuj Basil, chethan gangireddy, David Laslett, Jeffrey Smietana, Isaac Whitman, Joshua Cooper, Edmond Cronin
Journal: Circulation (2024)

Introduction: In prior studies, predictors of long-term success following acutely successful radiofrequency (RF) ablation have included female-sex, single-PVC morphology and EGM-QRS &gt; 24ms. Time course and predictors of PVC recurrence following acutely successful ablation has been less well documented. Use of extended ambulatory monitoring in the immediate post-procedural period can help to identify those with early recurrence. Goals: To define time to recurrence and predictors of recurrence of PVCs after RF ablation following acutely successful ablation. Methods: Consecutive patients from January 1 st , 2016 through December 31 st , 2023 undergoing PVC ablation with available post-ablation extended ambulatory monitoring (Zio, iRhythm, San Francisco, CA) were retrospectively analyzed. Recurrence was defined as an increase in PVC burden to &gt;5% during monitoring after acute success or failure to have sustained reduction in PVC burden of &gt;80%. Acute success was defined as elimination of the targeted PVC after the last ablation lesion. Long-term succes was defined as absence of targeted PVC's during all follow-up visits and PVC-burden &lt; 5% on follow-up monitoring. Results: Among 121 patients who underwent successful PVC ablation, 101 (83.4%) had long-term success and 20 (17%) had recurrence. Patients with recurrence were older (62.4 ± 12 vs 55 ± 13., p = 0.019), had a higher incidence of CAD (13 (13%) vs 9 (45%), p = 0.001) and CHF (40 (40%) vs 15 (75%), p = 0.004). At time of ablation, the recurrence group was also more likely to have &gt;1 PVC morphology (6 (6%) vs 8 (40%), p = &lt;0.001). Location and earliest activation time of the predominant PVC were not assocated with likelihood of recurrence. Within the recurrence group, 13 (65%) had recurrence in the immediate 2 week post-procedural period with an average time to recurrence of 3.9 days. Conclusion: Recurrence occured in slightly less than 20% of cases with a relatively high proportion of those occuring within the immediate 2 week post-procedural period during extended ambulatory monitoring. The presence of greater than 1 PVC morphology at time of ablation is a risk factor for recurrence suggesting a higher likelihood of acute suppression without durable resolution in those instances.
Abstract 4136799: Disparities in Diagnosis and Treatment of Heterozygous Familial Hypercholesterolemia
Authors: Rachel Shustak, Abigail Perlstein, Amanda Artis, Alexis Zavez, Vicky Tam, Giordana Martino, Julie Brothers
Journal: Circulation (2024)

Introduction: The prevalence of heterozygous familial hypercholesterolemia (HeFH) is 1:250. Untreated individuals have up to a 20-fold increased risk for premature coronary artery disease (CAD). In adults, low socioeconomic status (SES) individuals, bear a disproportionate share of the CAD burden. In this context, we sought to examine the association of social determinants of health and age at HeFH diagnosis and treatment. Methods: We performed a retrospective single-center study of children with HeFH who presented to the Lipid Heart Clinic at the Children’s Hospital of Philadelphia (2012-2022). The primary outcome was age at HeFH diagnosis. The secondary outcome was age at statin initiation. Multivariable linear regression models were used to examine the association between the primary exposure of interest, Child Opportunity Index (COI) and the outcomes. Secondary exposures included race, ethnicity, health insurance, and primary language. To explore potential referral bias, we compared the COI of the study cohort to that of the institution’s catchment area, defined as within a two-hour drive of the primary clinic. Results: We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin with a median age of statin initiation of 13 (10, 15) years. The median COI for the cohort was 84 (62, 95). There was no association between COI, ethnicity, health insurance, or primary language and the age at HeFH diagnosis or statin initiation. On multivariable analysis, black race was associated with older age at HeFH diagnosis compared to white race (adjusted estimate 1.2 +/- 0.49 yrs, p = 0.014). There was no difference in age at statin initiation by race. Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at statin initiation. The COI distribution of the study cohort was significantly different than that of the catchment area (p &lt; 0.001). 70% of the study cohort were of high and very high COI compared to 57% of the catchment area. Conclusion: Black race was associated with older age at HeFH diagnosis, however, there were no disparities in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area suggesting that low COI populations are under-referred for HeFH evaluation. Future efforts should focus on improving barriers to universal screening and identifying obstacles to HeFH diagnosis and referrals.