tbuckley/cabot-search huggingface dataset:
Abstract 4147907: Validation of PAINESD Score to Predict Outcomes of Catheter ablation of Structural Ventricular Tachycardia
Authors: Tiffany Woelber, Pragyat Futela, Suganya Arunachalam Karikalan, Aastha Poddar, Kiyan Heybati, aishwarya pradeep, Narut Prasitlumkum, Hina Amin, Abhishek Deshmukh, Gurukripa Kowlgi
Journal: Circulation (2024)

Background: PAINESD score was established as a predictor of periprocedural acute hemodynamic instability, long-term mortality and heart failure among patients undergoing catheter ablation for ventricular tachycardia (VT-CA). Objective: To assess the validity of PAINESD score and compare outcomes of high-risk patients undergoing catheter ablation for ventricular tachycardia (VT) with and without mechanical circulatory support (MCS) use during procedure. Methods: We conducted an observational dual-center study of consecutive patients with SHD undergoing VT-CA over a decade (2012-2022). The PAINESD score, based on 7 variables (COPD, age &gt;60 years, general anesthesia, ischemic cardiomyopathy, NYHA class III or IV, ejection fraction &lt;25%, VT storm, and diabetes mellitus), was calculated and categorized into low risk (&lt;10), intermediate risk (10-16), and high risk (&gt;16) as previously reported. Two survival analyses were performed to compare outcomes between different groups: one using all-cause mortality or heart transplant as the event, and another using recurrent or repeat ablation as the event. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios for each PAINESD category and to determine the hazard ratio for the use of MCS among high-risk patients. Results: We found that between 2012 to 2022, 559 ablations were performed on 441 patients. There were 296 (53%), 182 (32.6%) and 81(14.5%) patients in low, medium, and high risk. Using low risk as reference, aHR for medium risk was 2.1 (1.24-3.7; p=0.006) and for high risk was 4.6(2.54-8.3; p &lt;0.001). Among patients with high PAINESD score (n=81), 5 patients (6.2%) required MCS (Intra-arterial balloon pump (IABP)=1, ECMO only=1, ECMO+IABP=1, bypass=2). 4/5 (80%) patients on MCS stayed on them post procedure, except one patient on IABP. In this cohort, there was no difference between patients with and without MCS in primary outcome [aHR= 1.6 (0.48-5.4); p=0.43] and in secondary OUTCOME [1.29 (0.3-5.5; p=0.735)]. Conclusion: PAINESD was a significant predictor of mortality or heart failure, but it did not help in prediction of recurrence of VT, or repeat VT-CA.
Abstract Sa402: CPR Coaches Improve Cardiopulmonary Resuscitation Guideline Adherence in Pediatric In-Hospital Cardiac Arrest
Authors: Savannah Jensen, Bin Zhang, Zachary Paff, Kelly Ely, Kelly Collins, Abigayle Gibson, Kyesha James, Daniel Loeb, Andrew Lautz, Matthew Zackoff, Kenneth Tegtmeyer, James Gray, Maya Dewan
Journal: Circulation (2024)

Introduction: Despite advances in resuscitation science and training, the quality of CPR performed during pediatric IHCA remains suboptimal in many cases. CPR coaches provide real-time guidance on CPR performance metrics to improve chest compression depth, rate, and fraction using a defibrillator with audiovisual feedback. While studies in simulation show improved guideline adherence with CPR coaches, there remains a gap in clinical data for IHCA. Hypothesis: CPR coaches using Zoll feedback defibrillators improve adherence to CPR quality metrics in IHCA patients in the PICU. Methods: This was a retrospective single center study at Cincinnati Children’s Hospital Medical Center of chest compression quality before and after CPR coach implementation for PICU patients with IHCA from August 2017 to October 2022. Study population included all patients &lt;18 years of age who had a cardiac arrest occurring entirely within the PICU. Measured CPR quality metrics included chest compression rate, depth, and fraction obtained using data collected from the Zoll defibrillator. Statistical analysis used Student’s t-test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Compliance was defined as the average depth, rate, and fraction over the entire event meeting guideline recommendations. Results: During the study period, there were 93 IHCA patients, 12 patients were excluded due to incomplete data. Of the remaining 81 events, 29 were pre-CPR coach implementation and 52 patients were post-CPR coach. Depth compliance improved from 14% pre-CPR coach to 56% post-CPR coach (p &lt;0.001). Improvement in depth compliance was most noticeable for IHCA events &gt;20 minutes, 0% pre-CPR coach to 62% post-CPR coach (p=0.006). Compression rate improved from 76% to 89% (p=0.206), and compression fraction improved from 72% to 81% (p=0.386). Return of spontaneous circulation increased from 38% to 69% with the implementation of CPR coaching (p=0.006). Total CPR duration was similar between the pre (25 ± 28 minutes) and post-CPR coach groups (18 ± 18 minutes, p=0.218). The average age for the pre-CPR coach group was lower (4.2 ± 5 years) compared to the post-CPR coach (6.8 ± 6 years, p= 0.05). Immediate causes of CPR were similar between the two groups. Conclusion: CPR coach presence was associated with improved adherence to CPR depth guidelines.
Abstract Sa606: Analysis of Ventricular Fibrillation Waveform Response to Asphyxial Hemodynamics in an Infant Swine Model of Out-of-Hospital Cardiac Arrest
Authors: Aaron Jackson, Jorge Gumucio, James Menegazzi, David Salcido
Journal: Circulation (2024)

Background: Asphyxia can be a common cause of cardiac arrest in infants, in which survival rates remain low even for in-hospital arrests. Amplitude spectrum area (AMSA) is a numerical value based on the sum of weighted frequencies in ECGs. The greater the AMSA value, the greater probability of ventricular fibrillation (VF) reversal. During the decompensation phase of asphyxia, it is not known how compensatory hemodynamic mechanisms impact subsequent episodes of VF. Hypothesis: We hypothesized that the level of hemodynamic compensation during asphyxia will correlate directly with AMSA level during subsequent VF. Methods: In 4-week-old infant piglets, we induced cardiac arrest via asphyxia for 9 minutes. If the animals were not in VF by that point, a 3-second transthoracic shock was administered to induce VF. During the asphyxial phase, each animal was classified with one of 3 types of compensatory hemodynamic response based on peak mean arterial pressure (MAP) relative to baseline: hypo, normal, and hyper. AMSA measures were computed for artifact-free ECG at the 9-minute mark. ANOVA was used to compare mean AMSA value by response category. Results: We used 34 animals (16 females, 18 males) that were approximately 4 weeks old. They had a combined average AMSA of 3.875 mV-Hz, weight of 10.62 kg, and MAP of 77.29 mmHg. The hyper responders (7) had an average AMSA of 4.5 mV-Hz and were 28.6% female. Normal responders (10) had had an average AMSA of 4.22 mV-Hz and were 60% female. Lastly, hypo responders (17) had an average AMSA of 3.47 mV-Hz and were 47.06% female. AMSA values differed between groups (p = 0.045). Conclusions: Hyper responders had higher AMSA values compared to both normal and hypo responders. Future study could examine the mechanisms behind this action.
Abstract Sa310: Temporal Dynamics of Perfusion Pressures After Changing Methods of Cardiopulmonary Resuscitation
Authors: Aidan Paradis, Norman Paradis
Journal: Circulation (2024)

Introduction: Developing multi-modal cardiopulmonary resuscitation (CPR) in animal models of cardiac arrest is challenging because of the exponential increase in the number of possible combinations of n modalities. As the number of modalities under investigation increases the number of studies necessary become unwieldy. To mitigate this issue, we have considered two methodologic approaches: 1) a variant of the n-of-1 design in which we divide experiments into time-limited epochs with alternating treatment pairs, and 2) using the changes (delta) in perfusion pressures across epochs as the hemodynamic variable. However, the temporal dynamics of perfusion pressures during the alternation of CPR modes remains poorly investigated so the optimal epoch length remains unknown. Hypothesis: After changes in CPR efficacy, changes in perfusion pressures reach their new plateau rapidly, allowing for relatively short experimental epochs. Methods: In a porcine model of VF (n=6), we compared standard circumferential constriction CPR ( CC-CPR ) with and without interposed abdominal counterpulsation (IAC-CPR) . Both treatments were administered by a custom circumferential pneumatic system. Alternating 30-second epochs of each treatment were performed. Aortic ( Ao ) and Right Atrial ( RA ) pressures were measured via micromanometer catheters, and coronary perfusion pressures ( CPP ) were calculated. Results: IAC-CPR Ao trended upwards after each change from standard CC-CPR to IAC-CPR. (See Fig.) However, it didn’t reach a clear plateau in 30 sec. Conclusions: Relatively short experimental epochs, with changes in hemodynamic indicators as the basis for study, appear to be a promising approach to limited experimental populations. After changing to a CPR therapy of different effectiveness, Ao begins to increase relatively rapidly but does not reach its new equilibrium within 30 sec. So longer experimental epochs may be needed. Additionally, these observations have important implications for the development of new combination CPRs and the application of precision “play the winner” algorithms during actual clinical use.
Abstract 4147927: Gut Microbiome Clusters and Their Clinical Correlates in Cardiovascular Disease Risk Assessment
Authors: Negin Mahmoudi Hamidabad, Brad Lewis, Lilach Lerman, Amir Lerman
Journal: Circulation (2024)

Background: Recent studies have reported associations between alterations in gut microbiome composition (GMC) and cardiovascular disease risk factors (CVR). However, data regarding the use of GMC as a biomarker of CVR is scarce. Aims: The current study was designed to assess the distinct patterns in GMC among patients with varying degrees of CVR and/or atherosclerotic cardiovascular disease (ASCVD). Methods: Patients with a range of CVR including hypertension (HTN), hyperlipidemia (HLD), diabetes (DM), and/or ASCVD referring to Mayo Clinic from 2013 to 2018 were prospectively enrolled. DNA extracted from stool samples was analyzed using the V3-V5 region of the 16s data. Microbial α-diversity was assessed by the observed taxonomic units, Shannon, and Chao1 indices. β-diversity was assessed using Bray-Curtis dissimilarity and plotted using principal coordinates analysis. Hierarchical clustering was used to identify patterns in the GMC samples. Random Forest analysis was used to identify the most important clinical factors differentiating the clusters. Results: A total of 211 patients with a median age of 60 [IQR: 50,70] years and with 90 (42.7%) males were included. Two clusters of GMC were identified (Figure 1A) . Cluster 1 and 2 had 104 (49.3%) and 107 (50.7%) patients, respectively. Among CVRs, age and body mass index were the most prominent factors contributing to the difference in GMC among clusters ( Figure 1B ). Cluster 2 had a better α diversity profile than Cluster 1 (Figure 1C-E) . There was no significant difference in TMAO between clusters (P=0.6). Cluster 2 patients were younger (P&lt;0.001), leaner (P=0.007), more physically active (P&lt;0.001), less male (P=0.009), and had a lower prevalence of ASCVD (P=0.003), HTN (P=0.010), and HLD (P=0.005). There was no significant difference in the prevalence of DM (P=0.063), smoking (P=0.446), and alcohol intake (P=0.134) between the clusters. Conclusion: This study suggests the potential of GMC profiling as a valuable biomarker for assessing CVRs, with age and BMI as the most prominent factors associated with GMC clustering.
Abstract Sa206: Characterization of TAT-PHLPP9c Pharmacokinetics and Stability
Authors: Jing Li, Xiangdong Zhu, Shaoxia Lin, Terry Vanden Hoek
Journal: Circulation (2024)

Introduction: Cardiac arrest (CA) affects about 650,000 people annually. The overall survival rate for OHCA is less than 10% and 25% for IHCA. Early intervention after CA during CPR is essential to the likelihood of survival. We have demonstrated that a novel peptide TAT-PHLPP9c, when administered during CPR, improves survival following asystole, ventricular fibrillation, and pulseless electrical activity arrest in mouse and swine models. To further optimize the use of this peptide for resuscitation, we investigated two clinically relevant factors that could affect TAT-PHLPP9c effectiveness, degradation and storage stability. Hypothesis: TAT-PHLPP9c plasma concentrations could be affected by proteases and its activity by changes in storage temperature. Methods: TAT-PHLPP9c (7.5 mg/kg) was administered to mice via retro-orbital injection. Plasma concentrations were measured at 5, 10 min, up to 1 h by ELISA assay. An in vitro study was also performed by adding 100 nM of TAT-PHLPP9c to the plasma of mice, pigs and humans. The concentrations at baseline, 30, 60, and 120 min were measured. To study the stability, the lyophilized powder of TAT-PHLPP9c was stored at -80, -20, 4, and 20 °C for 6 months. The peptide bioactivity was Akt activation measured by Western blot. In C57BL/6 retired female mice (n=20), a 12-min asystolic arrest was induced with KCl followed by CPR and blinded randomized administration of TAT-PHLPP9c or saline control during CPR. Survival (4h) was assessed. Results: The baseline concentration of TAT-PHLPP9c was about 94 µg/ml. Its concentration was 3 µg/ml at 5 min, 0.5 µg/ml at 10 min, and disappeared by 30 min post-injection. In vitro studies demonstrated that its plasma concentration at baseline was 25 nM in mice, 50 nM in pigs, and 60 nM in humans, respectively. The concentration was decreased by 50% in mice and about 20% in pigs and humans, which was abrogated by the protease inhibitor complex III. Despite its rapid degradation by proteases, TAT-PHLPP9c administered during CPR in the mouse CA model improved CA outcomes after 12 min arrest. For the stability study, Akt phosphorylation was significantly reduced after 3 months for all the storage temperatures except for -80 °C. Conclusions: TAT-PHLPP9c degradation in plasma is primarily mediated by proteases, but despite degradation can retain significant activity. Formulation modifications will be needed to improve stability during storage conditions common to the ambulance environment.
Abstract Sa202: Detection of Spontaneous Circulation During Chest Compressions with Hands-Free Carotid Doppler. An Animal Study.
Authors: Bjoern Faldaas, Benjamin Storm, Knut Tore Lappegård, Ole-jakob How, Bent Aksel Nilsen, Gabriel Kiss, Eirik Skogvoll, Erik Nielsen, Hans Torp, Charlotte Ingul
Journal: Circulation (2024)

Background: During cardiopulmonary resuscitation (CPR), identifying the return of spontaneous circulation (ROSC) is challenging. Methods such as manual palpation, end-tidal carbon dioxide, and point-of-care ultrasound to detect ROSC are inaccurate, time-consuming, or intermittent. They may also require halting or prolonging no-compression time to identify signs of circulation. Maintaining a high compression fraction is associated with an increased likelihood of achieving ROSC. Aim: This study aimed to investigate if using a novel continuous hands-free carotid Doppler system (RescueDoppler (RD)) could identify ROSC during chest compressions by distinguishing between spontaneous and chest compression-generated carotid blood flow velocity. Methods: We used a porcine cardiac arrest model to investigate the RD. The RD probe was positioned and fixated over the carotid artery. An invasive blood pressure catheter was inserted in the contralateral carotid artery. An implantable cardioverter defibrillator (ICD) was utilized to induce sequences of ventricular fibrillation followed by defibrillation and chest compressions (cardiac arrest sequences). Compressions were administered manually at a rate of 100 or 50 compressions per minute or using a mechanical chest compression device (LUCAS). Doppler blood flow velocity curves were retrospectively analyzed for signs of ROSC by examining both spontaneous and/or compression-generated velocities (Fig. 1,2). We combined color M-mode and Doppler spectrum (Fig. 1) to differentiate between chest compression and spontaneous velocities. Results: Data from eight animals (mean weight 30 kg) and 56 cardiac arrest sequences were included. In the analysis, chest compressions were identified as tissue movements through the whole spectrum of the color M-mode, in the spectral display (Fig. 1), or both. Spontaneous velocities were identified in a specific carotid depth of the color M-mode and between compression-generated peak velocities in the Doppler specter (Fig. 1). ROSC was confirmed by pausing chest compressions and evaluating ECG and invasive blood pressure. We identified spontaneous circulation during manual and mechanical chest compressions in 55 of 56 sequences. Conclusions: In a porcine cardiac arrest model, with ROSC, we could differentiate between spontaneous circulation and chest compression-generated blood flow velocity of the carotid artery using RescueDoppler.
Abstract 4147722: Clinical impact of new severe tricuspid regurgitation following device lead extraction
Authors: SUGANYA Arunachalam Karikalan, Michael O'Shea, Hema Srikanth Vemulapalli, Siva Mulpuru, Ammar Killu, Konstantinos Siontis, Gurukripa Kowlgi, yong cha, Malini Madhavan, fatima m ezzedine, Christopher Desimone, Alan Sugrue, Ratnasari Padang, Hicham El Masry, Justin Lee, Abhishek Deshmukh
Journal: Circulation (2024)

Introduction: Tricuspid regurgitation (TR) is a common complication of right ventricle lead extraction (RVLE) in 5 to 10% of cases. This study aims to identify clinical outcomes such as predictors of heart failure hospitalization, need for tricuspid valve intervention, and death among patients with new severe TR after device lead removal (DLR). Methods: Patients who underwent DLR (pacemaker/ICD) between 3/1997 and 3/2024 were identified. Those who had an echocardiogram before and after RVLE with evidence of new severe TR were included. Cox univariable regression controlling for current age was used to assess association with death. Prentice Williams Peterson total time (PWPTT) Cox univariable regression was used to determine the rate of heart failure hospitalization up to three events per subject. Bivariable cox regression was used to control for ejection fraction for ICD and coil removal. Analysis was conducted using Stata IC16. Results: We identified 2,122 people who underwent RVLE, of whom 90 (4.24%) developed new severe TR and were included in the analysis. There were 68 hospitalizations among 38 people at a median of 2 years following lead extraction (IQR 0.57 to 4.5 years). The rate of hospitalization was 11.60 [9.14 to 14.71] per 100 person-years. Removal of an ICD was associated with increased hospitalization (HR 5.48 p&lt;0.001) but not mortality (HR 1.21, p=0.707). Removal of a single coil ICD lead was associated with increased hospitalization rate (HR 3.01, p=0.031) but not mortality (HR =0.51, p=0.380). Removal of dual coil ICD lead was associated with more than a tenfold increase in hospitalization rate (HR 11.55, p=0.001) and four times the mortality rate (HR 4.05, p=0.031) (Figures 1&amp;2). The presence of an abandoned (pacemaker/ICD) lead was associated with increased hospitalization (HR 5.75, p=0.004) and mortality (HR4.95, p=0.034). There was no change in hospitalization rate following tricuspid valve replacement (HR 1.33, p=0.716, n=18). Conclusion: Among people with new severe TR following DLR, the characteristics of the leads are strongly correlated with morbidity and mortality.
Abstract 4147962: Resource Utilization and Short-term Readmissions After Implantation of Left Ventricular Assist Devices and Heart Transplantations in Adults in the United States – A Contemporary Insight from the National Readmission Database: 2018 - 2021
Authors: Phanidhar Mogga, Karanrajsinh Raol, Ashwin Pillai, Kerry Singh, prathyusha Mudduluru, Aditya Saholi, Zeina Jedeon, Greeshma kambam, Abhishek Jaiswal
Journal: Circulation (2024)

Introduction: Heart transplants (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. We sought to describe outcomes with each modality, highlighting each option's strengths and clinical utility. Aim: To assess costs related to index hospitalization, 30-day (30DRC) and 90-day (90DRC) readmission categories for both subgroups. Method: We analyzed the National Readmission Database (NRD) from January 1, 2018, to December 31, 2021, identifying patients with HT and LVAD via ICD-10-CM codes. We selected this recent time frame to limit the influence of older LVAD technology and heart allocation schemes. We excluded patients &lt;18 and patients with HT and LVAD during the index hospitalization. The primary outcomes were 30-day and 90-day readmission rates after index hospital discharge. Secondary outcomes included the cost of hospitalization during the index hospitalization and readmissions. Results: We identified 27,308 weighted index hospital admissions from January to December 2018-2021; LVAD was implanted in 14295 (52.4%). The median index admission cost is lower in the HT subgroup than in the LVAD subgroup across all studied years (Figure 1a). Both groups, however, show an increase in median costs from 2018 to 2021, with an 11.8% rise in the LVAD subgroup and a 32.42% rise in the HT subgroup. In the 30DRC, we identified 22,723 index hospitalizations, of which 11378 (50.07%) were LVAD recipients. LVAD recipients were significantly more likely to be hospitalized within 30 days (3164, 27.8% vs 2838, 25.01%; p=0.001). However, the HT group had higher readmission costs [$16660 ($9483 - $31173) vs$11732 ($6037 - $27059)), p=0.001]. Similar findings were noted in the 90DRC group (Figure 1b and Figure 2). Conclusion: Both LVAD and HT had comparable burdens on resource and short-term rehospitalization risk. Index hospitalization costs were higher for the LVAD group, whereas HT was associated with higher readmission-related costs.