tbuckley/cabot-search huggingface dataset:
Abstract 4147830: Association Between Subcutaneous versus Visceral Adiposity and Type 2 Diabetes in United States Adults
Authors: Aayush Visaria
Journal: Circulation (2024)

Introduction: Visceral abdominal (VA) fat is an established risk factor for type 2 diabetes. It is still unclear, however, whether subcutaneous abdominal (SA) fat independently also increases diabetes risk. Aims: We aimed to 1) describe the distribution of abdominal fat composition by sex, and 2) determine the independent association between SA fat and diabetes. Methods: We included U.S. adults 20-59 years from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) with whole body DEXA scans. DEXA scans were performed using Hologic Discovery model A densitometers. Visceral&amp;subcutaneous fat mass (in lbs) were estimated via Hologic software (APEX v4.0) at the L4-L5 interspace. We used multivariable logistic regression to determine the association between SA, VA,&amp;SA-to-VA fat ratio and diabetes (A1c ≥6.5%, fasting glucose ≥126 mg/dl or known diabetes diagnosis). All analyses were stratified by sex, accounted for the complex survey design to obtain nationally representative estimates, and were adjusted for potential confounders. Results: Among 7,125 adults (48% female, 61% non-Hispanic White), 33% had BMI ≥30, 49% had high waist circumference (&gt;88cm for female, &gt;102cm for male), and 7% had diabetes. Females had a median 0.9 lbs (IQR, 0.5-1.3) of VA fat, median 3.9 lbs (2.9-5.2) of SA fat, and a SA-to-VA ratio of 4.6 (3.5-6.2). Males had a median 1.0 lbs (IQR, 0.7-1.5) of VA fat, median 2.7 lbs (1.8-3.5) of SA fat, and a SA-to-VA ratio of 2.3 (1.8-3.0). After adjusting for VA and confounders, every 1 lb increase in SA fat was associated with a lower, albeit insignificant, odds of diabetes in females and males (OR [95% CI]; female: 0.84 [0.65,1.08], male: 0.87 [0.71,1.07]). In contrast, every 1 lb increase in VA fat was associated with a &gt;2.5x higher odds of diabetes (female: 3.36 [2.26,4.99], male: 2.58 [1.69,3.98]). Every 1 unit increase in SA-to-VA ratio was associated with a significant 33-35% lower odds of diabetes (female: 0.67 [0.57,0.78], male: 0.65 [0.53,0.80]). Conclusion: U.S. females typically have four-to-sixfold more SA than VA fat, whereas males have one-to-threefold more SA than VA fat. In both females and males, SA was independently associated with lower likelihood of diabetes, suggesting subcutaneous abdominal adiposity may not contribute to, and potentially protect against, diabetes risk, akin to appendicular (arm/leg) adiposity.
Abstract 4147967: Increased Mortality Risk in Masquerading STEMI Presentations Compared with True STEMI Patients
Authors: Sina Fathieh, Tu Hao Tran, Amir Faour, Viet Dang, Reece Pahn, Mitchell Long, Gladys Tam, Craig Juergens, James Xu, John French
Journal: Circulation (2024)

Background: Prehospital identification of STEMI reduces time to reperfusion by timely primary PCI or fibrinolytic therapy. We previously reported that 40-50% of prehospital ECG transmissions were so-called ‘masquerading STEMI’ defined as ECGs meeting Glasgow algorithm (GA) criteria for STEMI but not meeting STEMI criteria on adjudication using the 4th Universal Definition of MI (4UDMI). We set out to determine late mortality of patients with these presentations. Methods: From June 2010 to October 2021, 2,992 patients at Liverpool Hospital in Sydney met GA criteria for STEMI via prehospital ECG and were classified as confirmed or masquerading STEMI per 4UDMI. Mortality risk between the two groups was compared using a Kaplan-Meier plot and further assessed using the Cox regression model, which was also used to further assess the mortality predictive value of patient baseline characteristics in the masquerading group. Results: Patients presenting with masquerading STEMI had a hazard ratio (HR) of 2.28 (CI=1.79-2.91, p&lt;0.001) compared with true STEMI for all-cause mortality (figure). Amongst patient characteristics in the masquerading STEMI group, age (HR=1.06[1.05-1.07]), history of stroke (HR=1.42[1.00-2.04]), CKD (HR=1.97[1.47-2.64]) and diabetes (HR=1.49[1.13-1.95]) were positively correlated with increased mortality risk while dyslipidaemia was associated with a lower risk (HR=0.64[0.48-0.86]), potentially confounded by unmeasured statin-therapy. Conclusions: Patients presenting with masquerading STEMI have a higher risk of mortality compared to true STEMI patients, highlighting need to better charcterise these patients, and develop therapies and/or interventions that may improve outcomes.
Abstract 4147678: Distinct Echocardiographic Signatures Predict Mortality in Scleroderma Pulmonary Vascular Disease
Authors: Vivek Jani, Mario Naranjo, Ethan Knight, Leonid Mirson, Catherine Simpson, Laura Hummers, Fredrick Wigley, Ami Shah, Steven Hsu, Paul Hassoun, Stephen Mathai, Monica Mukherjee
Journal: Circulation (2024)

Background: Right ventricular (RV) contractile reserve is a main determinant of outcome in pulmonary arterial hypertension (PAH). PAH and RV maladaptation are common and portend a poor prognosis in the autoimmune disease systemic sclerosis (SSc). Clinical phenotyping of this subgroup of patients, however, remains imprecise. In the present study, we sought to identify whether unique speckle-tracking echocardiography (STE) derived phenotypic signatures predict outcomes in SSc. Methods: In a case-complete study design, 86 SSc patients with technically adequate echocardiograms referred for evaluation of possible PAH, right heart catheterization (RHC), serum laboratories, and pulmonary function testing (PFTs) were included for analysis. RV contractility was assessed using conventional and STE-derived RV free wall strain (RVFWS). Cluster analysis was used to identify sub-groups, which were sub-stratified to adjust for differences in RV afterload as indexed by pulmonary vascular resistance (PVR). A Mann-Whitney test was used for groups comparisons, and Kaplan-Meier survival analysis and Cox regression were used to test association with mortality. Results: Cluster analysis identified two distinct echocardiographic phenotypes in SSc, one with elevated pulmonary pressures (mean PA pressure 44±12 vs. 27±10, p&lt;0.001), markedly elevated PVR (10±6 vs. 4±3 Wood units, p&lt;0.001), and globally reduced RVFWS (-21±6 vs. -13±6 %, p&lt;0.001) compared to the other. This group was associated with increased all-cause mortality (p=0.006). These differences may be driven by the increased PVR in one sub-group vs. another. To test whether RV dysfunction independent of PVR portends poor prognosis, we sub-stratified the cohort into one of three groups ( Figure ), one with relatively lower PVR (&lt;5 WU) and preserved RVFWS, one with lower PVR but reduced RFWS, and one with markedly elevated PVR (&gt;5 WU). This analysis found that patients with low PVR and reduced RVFWS had equally reduced survival (p=0.49) compared with those patients with elevated PVR. Conclusion: Echocardiographic phenotyping utilizing STE-derived RVFWS as a marker of contractile reserve revealed clinically relevant subgroups of RV dysfunction with diminished survival even after adjustment for RV afterload. These findings highlight the utility of STE in identifying SSc patients at greatest risk for poor clinical outcomes.
Abstract 4147312: Retrospective Analysis of Patients with Intermediate-Risk Pulmonary Embolism: Demographics, Management, and Outcomes from a Large Academic Referral Center
Authors: Kelly McKay, Monica Ferrante, William Jensen, Frances Howard, Jean Elwing, Louis Louis, Saad Ahmad, Suzanne Bennett, Evan Ramser, JOSE ARROYO
Journal: Circulation (2024)

Introduction: Risk stratification and treatment for pulmonary embolism (PE) have evolved significantly in recent years. It is proposed that patients with intermediate-risk PE, including low and high intermediate-risk categories, may benefit from percutaneous interventions in addition to heparin monotherapy. With the increasing availability of catheter-directed therapy (CDT) and percutaneous mechanical thrombectomy (PMT), more information is needed to optimize these resources. Methods: We retrospectively analyzed data from an institutional pulmonary embolism response team (PERT) registry (n=591) from 2018 to 2022. Patients were stratified as intermediate-low and intermediate-high risk based on European Society of Cardiology guidelines. Survival time was recorded from the initial PERT consult to the last clinical encounter. Survival events were defined as 1) death within 90 days, or 2) a composite endpoint including death, cardiac arrest, ECMO or vasopressor use, or death within 90 days. Cox proportional hazards and Kaplan-Meier methods estimated the risk of 90-day all-cause mortality and the composite endpoint. Results: We studied 211 intermediate-risk patients, including intermediate-low (n=112, 53.1%) and intermediate-high risk (n=99, 46.9%). The sample was predominantly female (51.2%) with a mean age of 64.8 years (SD 15.6). Median PESI scores were 103 and 100 for intermediate-low and high risk, respectively. Among patients, 27% had active cancer, and 17% had recent surgery or hospitalization within 30 days prior. A history of PE and DVT was present in 8% and 11% of patients, respectively. Interventions included heparin monotherapy (n=164, 77.7%), CDT (n=27, 12.8%), and PMT (n=20, 9.5%). Within 90 days, 29 patients (13.7%) expired, and 43 patients (20.4%) met the composite endpoint. Active cancer and baseline oxygen requirement were linked to a higher likelihood of meeting the composite endpoint. CDT and PMT were associated with better 90-day survival (log-rank p = 0.024) and a lower probability of meeting the clinical endpoint (log-rank p = 0.052) compared to heparin monotherapy, with no significant difference between CDT and PMT. Conclusion: In intermediate-risk PE patients, CDT or PMT were associated with better 90-day survival and showed a trend towards a lower likelihood of meeting the composite outcome.
Abstract Sa808: Validation of a Modified Pediatric Sequential Organ Failure Assessment Score Following Cardiac Arrest in Children with Cardiac Disease
Authors: Lucas Zeida Haar, Rithika Prakash, Sierra Foster, Xilong Li, Priya Bhaskar, Javier Lasa, Lakshmi Raman, Priscilla Yu
Journal: Circulation (2024)

Introduction: The Pediatric Sequential Organ Failure Assessment (PSOFA) is a severity of illness score that has not been validated in children after IHCA. Hypothesis: A modified PSOFA (mPSOFA) score, adjusted for post-cardiac arrest care with additional adjustments if ECMO is utilized, measured after pediatric IHCA in a cardiac intensive care unit (CICU) is associated with survival to hospital discharge (SHD). Methods: This was a retrospective cohort study of IHCA events in children admitted to a single-center pediatric CICU from 9/2016 to 4/2023. Patients were grouped into those who utilized ECMO (including ECPR) and those who did not after ROC. PSOFA was modified for all patients by removing the neurologic score. For days that ECMO was utilized, patients were assigned the maximum cardiovascular and respiratory scores. Total mPSOFA was scored from 0 to 20 with higher scores indicating greater organ dysfunction. Mean mPSOFA scores were calculated daily for 28 days after ROC, or until hospital discharge or death, if they came first. Univariate and multivariable logistic regression models were used to assess the association between mean mPSOFA scores and SHD. A secondary outcome was SHD with favorable neurologic outcome (FNO), defined by Pediatric Cerebral Performance Category (PCPC) discharge score of 1 to 3, or no change from admission. Results: Of 102 index events, overall SHD was 60.8% (N=62) and SHD w/FNO was 55.9% (N=57). There were 59 patients in the ECMO subgroup. Compared to non-survivors, survivors had lower CPR duration (p=&lt;0.01), ECPR use (p=0.01), and mean mPSOFA scores (3.95±2.32 vs 6.95±4.45, p=0.02). In univariate analysis, increased mean mPSOFA scores were associated with decreased SHD (OR 0.85, 95% CI 0.73-0.98, p=0.03) and SHD w/FNO (OR 0.85, 95% CI 0.74-0.99, p=0.04) in the ECMO subgroup, but only decreased SHD (OR 0.58, 95% CI 0.35-0.96, p=0.03) in patients not requiring ECMO. On multivariable analysis controlling for CPR duration and ECPR use, increased mPSOFA scores were associated with decreased SHD (OR 0.79, 95% CI 0.66-0.95, p=0.01) and SHD w/FNO (OR 0.79, 95% CI 0.66-0.96, p=0.02) for ECMO patients, but were not associated with any measured outcomes for patients not requiring ECMO. Conclusion: This retrospective study of children admitted to a single-center CICU demonstrates that increased mean mPSOFA scores captured for 28 days after IHCA are associated with decreased SHD for children utilizing ECMO during or after cardiac arrest.
Abstract 4147593: Improving Pediatric Heart Failure 30-Day Readmission Rates
Authors: Anna Ambrose, Loreitha Butler, Sydney Carrington, Curtis Dubke, Tamara Handley, Felicia Hicks, Ryan Butts
Journal: Circulation (2024)

Introduction: Pediatric heart failure (HF) 30-Day readmission rates are high (~20%) and contribute to resource utilization. Methods: A quality improvement project was initiated with the aim to reduce the pediatric HF 30-day readmission rate from above 20% to below 10% through utilization of four primary key drivers; Family directed self-care through variable diuretic dosing, early HF hospitalization follow-up, obtaining guideline directed medical therapy, and addressing iron deficiency in the hospital. Patients 18 years of age and younger admitted to the hospital with symptomatic systolic or combined (systolic and diastolic) HF were included. HF patients that were discharged after transplant or with ventricular assist device support were excluded. Electronic Health Record (EHR)-based interventions, including implementation of a HF discharge checklist, were used to deliver care and track key datapoints. Results: Since implementing the project on January 1, 2023, the HF 30-day readmission rate within our facility improved from 22% to 10%. The percentage of patients discharged with variable diuretic dosing plans is currently 50%. Patients discharged on at least three of five classes of HF medications increased from 75% to 80%. The percentage of patients that received early HF hospitalization follow-up decreased. Patients with iron assessed during their HF admission increased from 25% to 80%, and those with iron deficiency who received appropriate treatment increased from 75% to 100%. Summary: Pediatric HF 30-day readmission rates can be improved through EHR-based interventions using evidence-based adult heart failure practices. This was achieved despite the heterogeneity and lack of randomized trials in pediatric HF. Continuing efforts will focus on improving early HF hospitalization follow-up.
Abstract 4147291: Examination of pre-mRNA from cardiomyocytes at single-cell resolution from post-infarcted mouse hearts
Authors: Sriram Ravindran, Christoph Rau
Journal: Circulation (2024)

Background: RNA-seq provides a powerful tool to dissect cellular heterogeneity in diseased hearts. It generates reads from both mature RNA and pre-mRNA. Traditionally, only mature RNA transcripts are considered for analysis, but studying both species of transcripts from single-cell RNA-seq of cardiomyocytes in post-infarcted hearts can reveal novel insights into the dynamic transcriptional changes and regulatory mechanisms that occur during heart repair and regeneration Research question: Do nascent transcriptional events from pre-mRNA forecast the biological processes in failing hearts better than the mRNA and unravel the complexity of cardiomyocyte diversity? Aim: Execute an exon-intron analysis on cardiomyocyte single-cell RNAseq data obtained from post-infarcted mouse hearts Methods: Cardiomyocytes from mice (n=4) post-LAD ligation were isolated and single-cell RNAseq was performed using MegaKit v.2 (Parse Biosciences) on a NovaSeq 6000. Data was analyzed via the Parse pipeline and Seurat v5 . Pre-mRNA reference was built with AGAT . Gene set enrichment was done using fgsea . Sham mice without ligation (n=4) served as controls Results : We analyzed at least 70K cells for each transcript type and compared their enrichment profiles for post-infarcted hearts to sham. Infarction resulted in enrichment for biological processes predominantly for development and fatty acid metabolism, especially from pre-mRNA mapping (mRNA vs pre-mRNA; p= 4.2 x 10 -18 vs 4.8 x 10 -32 ). At the level of individual clusters, cardiomyocyte heterogeneity was revealed with cells enriched for distinct processes. Common to both types of transcripts were terms enriched for cell death (mRNA vs pre-mRNA; p=7.6 x 10 -3 vs 4.2 x 10 -3 ) , tissue remodeling ( p=4.3 x 10 -4 vs 9.6 x 10 -4 ) , and respiratory&amp;metabolic activity ( p=8.9 x 10 -5 vs 7.2 x 10 -8 ). However, compared to mRNA, the pre-mRNA had more cell clusters enriched for terms related to increased protein production activity ( p = 7 x 10 -4 ), activation of key signaling pathways ( p =8.5 x 10 -4 ), and defense response ( p =2.1 x 10 -6 ). These additional processes show adaptive mechanisms that promisingly forecast cardiomyocyte repair and could be visualized by mapping pre-mRNA Conclusion: Examining pre-mRNA offers a realistic view of stressed cardiomyocytes’ transcriptional dynamics. This study could identify new biomarkers to predict the onset of heart failure. Further insights into transitioning cells could aid in developing therapies for regeneration
Abstract Sa505: Cerebral Oxygen Saturation Measurement Using Near-Infrared Spectroscopy During In-Hospital Cardiac Arrest Predicts Early Outcome
Authors: Mateusz Putowski, Magdalena Dudzikowska, Zbigniew Siudak
Journal: Circulation (2024)

Introduction: The effectiveness of cardiopulmonary resuscitation is dependent on maintaining optimal cerebral perfusion. NIRS provides a non-invasive method of monitoring cerebral oxygen saturation (rSO2), providing real-time information on the quality of resuscitation. Dynamics of rSO2 changes in the peri-resuscitation period and depending on the drugs administered have not yet been fully investigated. Hypothesis: It was assumed that continuous monitoring of rSO2 using NIRS during CPR can serve as an indicator of resuscitation quality and outcome. Moreover, a positive correlation between rSO2 and EtCO2 was assumed. Goals: The aim of the study was to assess the dynamics of rSO2 changes during CPR and in the period up to 24 hours after successful resuscitation. Moreover, the relationship between rSO2 and EtCO2 levels and ROSC was determined, as well as the influence of adrenaline and NaHCO3 supply on rSO2 values. Methods: A prospective observational study was performed at the University Hospital in Krakow (Poland). The study included 104 consecutive patients who experienced IHCA. The rSO2 and EtCO2 levels were monitored (using Masimo Open Connect™ MOC-9™). CPR was performed by the Early Response Team. Once ROSC was obtained rSO2 and EtCO2 monitoring were continued for 24 hours or until cardiac arrest resumed. Patients were divided into three groups: no ROSC, ROSC with survival &lt; 30 days, ROSC with survival ≥ 30 days. Results: ROSC was achieved in 54 patients and survival was ≥30 days in 16 patients. It was found that rSO2 values were statistically significantly higher during the entire CPR process in patients with ROSC compared to patients without ROSC (p&lt;0.001). See Figure 1. A positive correlation was obtained between EtCO2 and rSO2 in the ROSC group. There were no significant changes in rSo2 values after the administration of adrenaline and NaHCO3 (p=0.604). Conclusions: Monitoring rSO2 during CPR can be a valuable prognostic tool. Higher rSO2 values correlate positively with the achievement of ROSC, demonstrating the effectiveness of real-time NIRS measurements as an indicator of effective cerebral perfusion. The average rSO2 values after adrenaline administration remained at a similar level in all groups. Cerebral oxygen saturation remains a more stable measurement than EtCO2.
Abstract 4147572: Sex, Adiposity-Related Anthropometrics, and Clinical Outcomes in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Trials
Authors: John Ostrominski, Mats Lassen, Jawad Butt, Brian Claggett, Inder Anand, Akshay Desai, Pardeep Jhund, Carolyn Lam, Marc Pfeffer, Bertram Pitt, Faiez ZANNAD, Michael Zile, John McMurray, Scott Solomon, Muthiah Vaduganathan
Journal: Circulation (2024)

Background: Important sex-related differences in body composition exist and may influence the predictive utility of body mass index (BMI) in heart failure (HF) populations. However, whether sex modifies the association between BMI and other adiposity-related anthropometrics and outcomes in HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) has not been rigorously explored. Methods: In this participant-level pooled analysis of five international, multicenter, randomized-controlled trials enrolling adults HFmrEF/HFpEF, the association between sex and adiposity-related anthropometrics (BMI, waist circumference [WC], and waist-to-height ratio [WHtR]) and the primary composite outcome of time-to-first HF hospitalization or cardiovascular (CV) death was evaluated using multivariable adjusted Cox proportional hazards models (stratified by age, treatment, and trial) and restricted cubic splines. Results: Overall, BMI was available in 21,606 participants (mean age, 71±9 years; 83% White; mean BMI: 30±6 kg/m 2 ), of whom 10,681 (49%) were female and 10,925 (51%) were male. WC was available in 7,854 participants. Female participants were more likely to be older, have higher BMI, WHtR, and left ventricular ejection fraction. Males had higher rates of the primary outcome compared with females across the BMI, WC, and WHtR spectra ( P comparison &lt;0.01 for all), but higher BMI, WC, and WHtR were similarly associated with a higher rate of the primary outcome irrespective of sex ( Figure ). However, among those with BMI 18.5 to &lt;25 kg/m 2 , WC was elevated in 8% of males, but 34% of females. Higher WC was associated with a higher rate of primary events (adjusted hazard ratio per 10 cm increase, 1.13, 95% CI 1.08-1.19; P &lt;0.001) independent of BMI, with consistent findings by sex ( P interaction =0.25). Conclusions: In this participant-level pooled analysis of HFmrEF/HFpEF trials, higher BMI, WC, and WHtR were similarly associated with HF hospitalization or CV death in females and males. However, use of BMI alone disproportionately underestimated abdominal adiposity among females, stressing the importance of implementing additional anthropometrics to mitigate sex-based differences in risk stratification in the HF population.