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Tastet L, Ramakrishna S, Lim LJ, Bibby D, Olgin JE, Connolly AJ, Moffatt E, Tseng ZH, Delling FN. Mechanical Dispersion Discriminates Between Arrhythmic and Nonarrhythmic Sudden Death: From the POST SCD Study. JACC Clin Electrophysiol 2024; 10:771-773. [PMID: 38363275 DOI: 10.1016/j.jacep.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Lionel Tastet
- University of California, San Francisco, California, USA
| | | | - Lisa J Lim
- University of California, San Francisco, California, USA
| | - Dwight Bibby
- University of California, San Francisco, California, USA
| | | | | | - Ellen Moffatt
- City and County of San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- University of California, San Francisco, California, USA
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Ciuffo L, Tung M, Dukes JW, Vittinghoff E, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Ramchandani VA, Gerstenfeld EP, Marcus GM. Acute alcohol exposure and electrocardiographic changes: Finding from the HOLIDAY trial. J Electrocardiol 2024; 83:26-29. [PMID: 38295539 DOI: 10.1016/j.jelectrocard.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Alcohol consumption is associated with a higher increased risk of atrial fibrillation (AF), but the acute effects on cardiac electrophysiology in humans remain poorly understood. The HOw ALcohol InDuces Atrial TachYarrhythmias (HOLIDAY) Trial revealed that alcohol shortened pulmonary vein atrial effective refractory periods, but more global electrophysiologic changes gleaned from the surface ECG have not yet been reported. METHODS This was a secondary analysis of the HOLIDAY Trial. During AF ablation procedures, 100 adults were randomized to intravenous alcohol titrated to 0.08% blood alcohol concentration versus a volume and osmolarity-matched, masked, placebo. Intervals measured from 12‑lead ECGs were compared between pre infusion and at infusion steady state (20 min). RESULTS The average age was 60 years and 11% were female. No significant differences in the P-wave duration, PR, QRS or QT intervals, were present between alcohol and placebo arms. However, infusion of alcohol was associated with a statistically significant relative shortening of the JT interval (r: -14.73, p = 0.048) after multivariable adjustment. CONCLUSION Acute exposure to alcohol was associated with a relative reduction in the JT interval, reflecting shortening of ventricular repolarization. These acute changes may reflect a more global shortening of refractoriness, suggesting immediate proarrhythmic effects pertinent to the atria and ventricles.
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Affiliation(s)
- Luisa Ciuffo
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Monica Tung
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Joshua D Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Randall J Lee
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Byron K Lee
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Zian H Tseng
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Vasanth Vedantham
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Melvin M Scheinman
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Henry Hsia
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | - Edward P Gerstenfeld
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
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Cozen AE, Carton T, Hamad R, Kornak J, Faulkner Modrow M, Peyser ND, Park S, Orozco JH, Brandner M, O'Brien EC, Djibo DA, McMahill-Walraven CN, Isasi CR, Beatty AL, Olgin JE, Marcus GM, Pletcher MJ. Factors associated with anxiety during the first two years of the COVID-19 pandemic in the United States: An analysis of the COVID-19 Citizen Science study. PLoS One 2024; 19:e0297922. [PMID: 38319951 PMCID: PMC10846720 DOI: 10.1371/journal.pone.0297922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.
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Affiliation(s)
- Aaron E Cozen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, LA, United States of America
| | - Rita Hamad
- Dept of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States of America
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Madelaine Faulkner Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Noah D Peyser
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jaime H Orozco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Matthew Brandner
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
| | - Emily C O'Brien
- Duke Clinical Research Institute, Durham, NC, United States of America
| | | | | | - Carmen R Isasi
- Department of Epidemiology, Albert Einstein College of Medicine, The Bronx, NY, United States of America
| | - Alexis L Beatty
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
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Wong CX, Modrow MF, Sigona K, Tang JJ, Vittinghoff E, Hills MT, McCall D, Sciarappa K, Pletcher MJ, Olgin JE, Marcus GM. Preceding Night Sleep Quality and Atrial Fibrillation Episodes in the I-STOP-AFIB Randomized Trial. JACC Clin Electrophysiol 2024; 10:56-64. [PMID: 37921790 DOI: 10.1016/j.jacep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Chronic sleep disruption is associated with incident atrial fibrillation (AF), but it is unclear whether poor sleep quality acutely triggers AF. OBJECTIVES The aim of this study was to characterize the relationship between a given night's sleep quality and the risk of a discrete AF episode. METHODS Patients with symptomatic paroxysmal AF in the I-STOP-AFIB (Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation) trial reported sleep quality on a daily basis. Participants were also queried daily regarding AF episodes and were provided smartphone-based mobile electrocardiograms (ECGs) (KardiaMobile, AliveCor). RESULTS Using 15,755 days of data from 419 patients, worse sleep quality on any given night was associated with a 15% greater odds of a self-reported AF episode the next day (OR: 1.15; 95% CI: 1.10-1.20; P < 0.0001) after adjustment for the day of the week. No statistically significant associations between worsening sleep quality and mobile ECG-confirmed AF events were observed (OR: 1.04; 95% CI: 0.95-1.13; P = 0.43), although substantially fewer of these mobile ECG-confirmed events may have limited statistical power. Poor sleep was also associated with longer self-reported AF episodes, with each progressive category of worsening sleep associated with 16 (95% CI: 12-21; P < 0.001) more minutes of AF the next day. CONCLUSIONS Poor sleep was associated with an immediately heightened risk for self-reported AF episodes, and a dose-response relationship existed such that progressively worse sleep was associated with longer episodes of AF the next day. These data suggest that sleep quality may be a potentially modifiable trigger relevant to the near-term risk of a discrete AF episode.
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Affiliation(s)
- Christopher X Wong
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Madelaine Faulkner Modrow
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
| | | | - Janet J Tang
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
| | | | | | | | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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5
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Durstenfeld MS, Peluso MJ, Lin F, Peyser ND, Isasi C, Carton TW, Henrich TJ, Deeks SG, Olgin JE, Pletcher MJ, Beatty AL, Marcus GM, Hsue PY. Association of nirmatrelvir for acute SARS-CoV-2 infection with subsequent Long COVID symptoms in an observational cohort study. J Med Virol 2024; 96:e29333. [PMID: 38175151 PMCID: PMC10786003 DOI: 10.1002/jmv.29333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Oral nirmatrelvir/ritonavir is approved as treatment for acute COVID-19, but the effect of treatment during acute infection on risk of Long COVID is unknown. We hypothesized that nirmatrelvir treatment during acute SARS-CoV-2 infection reduces risk of developing Long COVID and rebound after treatment is associated with Long COVID. We conducted an observational cohort study within the Covid Citizen Science (CCS) study, an online cohort study with over 100 000 participants. We included vaccinated, nonhospitalized, nonpregnant individuals who reported their first SARS-CoV-2 positive test March-August 2022. Oral nirmatrelvir/ritonavir treatment was ascertained during acute SARS-CoV-2 infection. Patient-reported Long COVID symptoms, symptom rebound and test-positivity rebound were asked on subsequent surveys at least 3 months after SARS-CoV-2 infection. A total of 4684 individuals met the eligibility criteria, of whom 988 (21.1%) were treated and 3696 (78.9%) were untreated; 353/988 (35.7%) treated and 1258/3696 (34.0%) untreated responded to the Long COVID survey (n = 1611). Among 1611 participants, median age was 55 years and 66% were female. At 5.4 ± 1.3 months after infection, nirmatrelvir treatment was not associated with subsequent Long COVID symptoms (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.80-1.64; p = 0.45). Among 666 treated who answered rebound questions, rebound symptoms or test positivity were not associated with Long COVID symptoms (OR: 1.34; 95% CI: 0.74-2.41; p = 0.33). Within this cohort of vaccinated, nonhospitalized individuals, oral nirmatrelvir treatment during acute SARS-CoV-2 infection and rebound after nirmatrelvir treatment were not associated with Long COVID symptoms more than 90 days after infection.
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Affiliation(s)
- Matthew S. Durstenfeld
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
| | | | - Feng Lin
- Department of Epidemiology and Biostatistics, UCSF, USA
| | | | - Carmen Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | | | | | - Steven G. Deeks
- Division of HIV, Infectious Disease, & Global Medicine, UCSF, USA
| | | | | | - Alexis L. Beatty
- Department of Epidemiology and Biostatistics and Division of Cardiology, Department of Medicine, UCSF, USA
| | | | - Priscilla Y. Hsue
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
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6
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Lin TY, Mai QN, Zhang H, Wilson E, Chien HC, Yee SW, Giacomini KM, Olgin JE, Irannejad R. Cardiac contraction and relaxation are regulated by distinct subcellular cAMP pools. Nat Chem Biol 2024; 20:62-73. [PMID: 37474759 PMCID: PMC10746541 DOI: 10.1038/s41589-023-01381-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/08/2023] [Indexed: 07/22/2023]
Abstract
Cells interpret a variety of signals through G-protein-coupled receptors (GPCRs) and stimulate the generation of second messengers such as cyclic adenosine monophosphate (cAMP). A long-standing puzzle is deciphering how GPCRs elicit different physiological responses despite generating similar levels of cAMP. We previously showed that some GPCRs generate cAMP from both the plasma membrane and the Golgi apparatus. Here we demonstrate that cardiomyocytes distinguish between subcellular cAMP inputs to elicit different physiological outputs. We show that generating cAMP from the Golgi leads to the regulation of a specific protein kinase A (PKA) target that increases the rate of cardiomyocyte relaxation. In contrast, cAMP generation from the plasma membrane activates a different PKA target that increases contractile force. We further validated the physiological consequences of these observations in intact zebrafish and mice. Thus, we demonstrate that the same GPCR acting through the same second messenger regulates cardiac contraction and relaxation dependent on its subcellular location.
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Affiliation(s)
- Ting-Yu Lin
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Quynh N Mai
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Hao Zhang
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Emily Wilson
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Huan-Chieh Chien
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, California, CA, USA
| | - Sook Wah Yee
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, California, CA, USA
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, California, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Roshanak Irannejad
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
- Department of Biochemistry & Biophysics, University of California, San Francisco, CA, USA.
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7
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Ng MY, Olgin JE, Marcus GM, Lyles CR, Pletcher MJ. Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients. J Med Internet Res 2023; 25:e51238. [PMID: 38133910 PMCID: PMC10770794 DOI: 10.2196/51238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Web- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment. OBJECTIVE This study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign. METHODS We conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019. RESULTS The email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance. CONCLUSIONS This study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers.
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Affiliation(s)
- Madelena Y Ng
- School of Public Health, University of California, Berkeley, CA, United States
- Department of Medicine (Biomedical Informatics), Stanford University, Stanford, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Jeffrey E Olgin
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Gregory M Marcus
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Courtney R Lyles
- School of Public Health, University of California, Berkeley, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Public Health Sciences, University of California, Davis, CA, United States
| | - Mark J Pletcher
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
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8
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Ruan H, Mandla R, Ravi N, Galang G, Soe AW, Olgin JE, Lang D, Vedantham V. Cholecystokinin-A signaling regulates automaticity of pacemaker cardiomyocytes. Front Physiol 2023; 14:1284673. [PMID: 38179138 PMCID: PMC10764621 DOI: 10.3389/fphys.2023.1284673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Aims: The behavior of pacemaker cardiomyocytes (PCs) in the sinoatrial node (SAN) is modulated by neurohormonal and paracrine factors, many of which signal through G-protein coupled receptors (GPCRs). The aims of the present study are to catalog GPCRs that are differentially expressed in the mammalian SAN and to define the acute physiological consequences of activating the cholecystokinin-A signaling system in isolated PCs. Methods and results: Using bulk and single cell RNA sequencing datasets, we identify a set of GPCRs that are differentially expressed between SAN and right atrial tissue, including several whose roles in PCs and in the SAN have not been thoroughly characterized. Focusing on one such GPCR, Cholecystokinin-A receptor (CCKAR), we demonstrate expression of Cckar mRNA specifically in mouse PCs, and further demonstrate that subsets of SAN fibroblasts and neurons within the cardiac intrinsic nervous system express cholecystokinin, the ligand for CCKAR. Using mouse models, we find that while baseline SAN function is not dramatically affected by loss of CCKAR, the firing rate of individual PCs is slowed by exposure to sulfated cholecystokinin-8 (sCCK-8), the high affinity ligand for CCKAR. The effect of sCCK-8 on firing rate is mediated by reduction in the rate of spontaneous phase 4 depolarization of PCs and is mitigated by activation of beta-adrenergic signaling. Conclusion: (1) PCs express many GPCRs whose specific roles in SAN function have not been characterized, (2) Activation of the cholecystokinin-A signaling pathway regulates PC automaticity.
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Affiliation(s)
- Hongmei Ruan
- *Correspondence: Hongmei Ruan, Vasanth Vedantham,
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9
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McLaughlin MM, Hsue PY, Lowe DA, Olgin JE, Beatty AL. Development of text messages for primary prevention of cardiovascular disease in persons with HIV. Cardiovasc Digit Health J 2023; 4:191-197. [PMID: 38222100 PMCID: PMC10787147 DOI: 10.1016/j.cvdhj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Objective Persons with HIV (PWH) have increased risk for atherosclerotic cardiovascular disease (CVD). Despite this increased risk, perceived cardiovascular risk among PWH is low, and interventions that are known to be beneficial in the general population, such as statins, have low uptake in this population. We sought to develop a bank of text messages about (1) the association between HIV and CVD and (2) advice on reducing cardiovascular risk. Methods We developed an initial bank of 162 messages. We solicited feedback from 29 PWH recruited from outpatient clinics providing HIV care at a large urban tertiary medical center and a public hospital in San Francisco, California. Participants reviewed 7-10 messages each and rated message usefulness, readability, and potential impact on behavior on a scale from 1 (least) to 5 (most). We also collected open-ended feedback on the messages and data on preferences about message timing. Results The average score for the messages was 4.4/5 for usefulness, 4.4/5 for readability, and 4.0/5 for potential impact on behavior. The text messages were iteratively revised based on participant feedback, and lowest-rated messages were removed from the message bank. The final message bank included 116 messages on diet (30.2%), physical activity (24.8%), tobacco (11.2%), the association between HIV and cardiovascular disease (9.5%), general heart health (6.9%), cholesterol (5.2%), blood pressure (4.3%), blood sugar (2.6%), sleep (2.6%), and weight (2.6%). Conclusion We describe an approach for developing educational text messages on primary prevention of cardiovascular disease among PWH.
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Affiliation(s)
- Megan M. McLaughlin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dylan A. Lowe
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California
| | - Alexis L. Beatty
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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10
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Siontis KC, Abreau S, Attia ZI, Barrios JP, Dewland TA, Agarwal P, Balasubramanyam A, Li Y, Lester SJ, Masri A, Wang A, Sehnert AJ, Edelberg JM, Abraham TP, Friedman PA, Olgin JE, Noseworthy PA, Tison GH. Patient-Level Artificial Intelligence-Enhanced Electrocardiography in Hypertrophic Cardiomyopathy: Longitudinal Treatment and Clinical Biomarker Correlations. JACC Adv 2023; 2:100582. [PMID: 38076758 PMCID: PMC10702858 DOI: 10.1016/j.jacadv.2023.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Artificial intelligence (AI) applied to 12-lead electrocardiographs (ECGs) can detect hypertrophic cardiomyopathy (HCM). OBJECTIVES The purpose of this study was to determine if AI-enhanced ECG (AI-ECG) can track longitudinal therapeutic response and changes in cardiac structure, function, or hemodynamics in obstructive HCM during mavacamten treatment. METHODS We applied 2 independently developed AI-ECG algorithms (University of California-San Francisco and Mayo Clinic) to serial ECGs (n = 216) from the phase 2 PIONEER-OLE trial of mavacamten for symptomatic obstructive HCM (n = 13 patients, mean age 57.8 years, 69.2% male). Control ECGs from 2,600 age- and sex-matched individuals without HCM were obtained. AI-ECG output was correlated longitudinally to echocardiographic and laboratory metrics of mavacamten treatment response. RESULTS In the validation cohorts, both algorithms exhibited similar performance for HCM diagnosis, and exhibited mean HCM score decreases during mavacamten treatment: patient-level score reduction ranged from approximately 0.80 to 0.45 for Mayo and 0.70 to 0.35 for USCF algorithms; 11 of 13 patients demonstrated absolute score reduction from start to end of follow-up for both algorithms. HCM scores were significantly associated with other HCM-relevant parameters, including left ventricular outflow tract gradient at rest, postexercise, and with Valsalva, and NT-proBNP level, independent of age and sex (all P < 0.01). For both algorithms, the strongest longitudinal correlation was between AI-ECG HCM score and left ventricular outflow tract gradient postexercise (slope estimate: University of California-San Francisco 0.70 [95% CI: 0.45-0.96], P < 0.0001; Mayo 0.40 [95% CI: 0.11-0.68], P = 0.007). CONCLUSIONS AI-ECG analysis longitudinally correlated with changes in echocardiographic and laboratory markers during mavacamten treatment in obstructive HCM. These results provide early evidence for a potential paradigm for monitoring HCM therapeutic response.
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Affiliation(s)
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua P. Barrios
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Thomas A. Dewland
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Priyanka Agarwal
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Aarthi Balasubramanyam
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Yunfan Li
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Steven J. Lester
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahmad Masri
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew Wang
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy J. Sehnert
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Jay M. Edelberg
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Theodore P. Abraham
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California-San Francisco, San Francisco, California, USA
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11
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Nguyen N, Peyser ND, Olgin JE, Pletcher MJ, Beatty AL, Modrow MF, Carton TW, Khatib R, Djibo DA, Ling PM, Marcus GM. Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study. PLoS One 2023; 18:e0289058. [PMID: 37703257 PMCID: PMC10499225 DOI: 10.1371/journal.pone.0289058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression. METHODS We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome. RESULTS In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression. CONCLUSIONS Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.
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Affiliation(s)
- Nhung Nguyen
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Noah D. Peyser
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeffrey E. Olgin
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Alexis L. Beatty
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Madelaine F. Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas W. Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, United States of America
| | - Rasha Khatib
- Advocate Aurora Health, Downers Grove, Illinois, United States of America
| | | | - Pamela M. Ling
- Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America
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12
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Ruan H, Mandla R, Ravi N, Galang G, Soe AW, Olgin JE, Lang D, Vedantham V. Cholecystokinin-A Signaling Regulates Automaticity of Pacemaker Cardiomyocytes. bioRxiv 2023:2023.01.24.525392. [PMID: 36747643 PMCID: PMC9900793 DOI: 10.1101/2023.01.24.525392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aims The behavior of pacemaker cardiomyocytes (PCs) in the sinoatrial node (SAN) is modulated by neurohormonal and paracrine factors, many of which signal through G-protein coupled receptors (GPCRs). The aims of the present study are to catalog GPCRs that are differentially expressed in the mammalian SAN and to define the acute physiological consequences of activating the cholecystokinin-A signaling system in isolated PCs. Methods and Results Using bulk and single cell RNA sequencing datasets, we identify a set of GPCRs that are differentially expressed between SAN and right atrial tissue, including several whose roles in PCs and in the SAN have not been thoroughly characterized. Focusing on one such GPCR, Cholecystokinin-A receptor (CCK A R), we demonstrate expression of Cckar mRNA specifically in mouse PCs, and further demonstrate that subsets of SAN fibroblasts and neurons within the cardiac intrinsic nervous system express cholecystokinin, the ligand for CCK A R. Using mouse models, we find that while baseline SAN function is not dramatically affected by loss of CCK A R, the firing rate of individual PCs is slowed by exposure to sulfated cholecystokinin-8 (sCCK-8), the high affinity ligand for CCK A R. The effect of sCCK-8 on firing rate is mediated by reduction in the rate of spontaneous phase 4 depolarization of PCs and is mitigated by activation of beta-adrenergic signaling. Conclusions (1) PCs express many GPCRs whose specific roles in SAN function have not been characterized, (2) Activation of the the cholecystokinin-A signaling pathway regulates PC automaticity.
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13
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Avram R, Olgin JE, Ahmed Z, Verreault-Julien L, Wan A, Barrios J, Abreau S, Wan D, Gonzalez JE, Tardif JC, So DY, Soni K, Tison GH. CathAI: fully automated coronary angiography interpretation and stenosis estimation. NPJ Digit Med 2023; 6:142. [PMID: 37568050 PMCID: PMC10421915 DOI: 10.1038/s41746-023-00880-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Coronary angiography is the primary procedure for diagnosis and management decisions in coronary artery disease (CAD), but ad-hoc visual assessment of angiograms has high variability. Here we report a fully automated approach to interpret angiographic coronary artery stenosis from standard coronary angiograms. Using 13,843 angiographic studies from 11,972 adult patients at University of California, San Francisco (UCSF), between April 1, 2008 and December 31, 2019, we train neural networks to accomplish four sequential necessary tasks for automatic coronary artery stenosis localization and estimation. Algorithms are internally validated against criterion-standard labels for each task in hold-out test datasets. Algorithms are then externally validated in real-world angiograms from the University of Ottawa Heart Institute (UOHI) and also retrained using quantitative coronary angiography (QCA) data from the Montreal Heart Institute (MHI) core lab. The CathAI system achieves state-of-the-art performance across all tasks on unselected, real-world angiograms. Positive predictive value, sensitivity and F1 score are all ≥90% to identify projection angle and ≥93% for left/right coronary artery angiogram detection. To predict obstructive CAD stenosis (≥70%), CathAI exhibits an AUC of 0.862 (95% CI: 0.843-0.880). In UOHI external validation, CathAI achieves AUC 0.869 (95% CI: 0.830-0.907) to predict obstructive CAD. In the MHI QCA dataset, CathAI achieves an AUC of 0.775 (95%. CI: 0.594-0.955) after retraining. In conclusion, multiple purpose-built neural networks can function in sequence to accomplish automated analysis of real-world angiograms, which could increase standardization and reproducibility in angiographic coronary stenosis assessment.
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Affiliation(s)
- Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
- Division of Cardiology, Department of Medicine, Montreal Heart Institute - Université de Montréal, 5000 Rue Belanger, Montreal, QC, H1T 1C8, Canada
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
- Cardiovascular Research Institute, University of California, San Francisco, CA, 94143, USA
| | - Zeeshan Ahmed
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Louis Verreault-Julien
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Alvin Wan
- Cardiovascular Research Institute, University of California, San Francisco, CA, 94143, USA
| | - Joshua Barrios
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Derek Wan
- Department of Electrical Engineering and Computer Science, RISE Lab, University of California, Berkeley, Soda Hall, Berkeley, CA, 94720-1770, USA
| | - Joseph E Gonzalez
- Department of Electrical Engineering and Computer Science, RISE Lab, University of California, Berkeley, Soda Hall, Berkeley, CA, 94720-1770, USA
| | - Jean-Claude Tardif
- Division of Cardiology, Department of Medicine, Montreal Heart Institute - Université de Montréal, 5000 Rue Belanger, Montreal, QC, H1T 1C8, Canada
| | - Derek Y So
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Krishan Soni
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
- Cardiovascular Research Institute, University of California, San Francisco, CA, 94143, USA.
- Department of Electrical Engineering and Computer Science, RISE Lab, University of California, Berkeley, Soda Hall, Berkeley, CA, 94720-1770, USA.
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 94158, USA.
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14
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Augusto DG, Murdolo LD, Chatzileontiadou DSM, Sabatino JJ, Yusufali T, Peyser ND, Butcher X, Kizer K, Guthrie K, Murray VW, Pae V, Sarvadhavabhatla S, Beltran F, Gill GS, Lynch KL, Yun C, Maguire CT, Peluso MJ, Hoh R, Henrich TJ, Deeks SG, Davidson M, Lu S, Goldberg SA, Kelly JD, Martin JN, Vierra-Green CA, Spellman SR, Langton DJ, Dewar-Oldis MJ, Smith C, Barnard PJ, Lee S, Marcus GM, Olgin JE, Pletcher MJ, Maiers M, Gras S, Hollenbach JA. A common allele of HLA is associated with asymptomatic SARS-CoV-2 infection. Nature 2023; 620:128-136. [PMID: 37468623 PMCID: PMC10396966 DOI: 10.1038/s41586-023-06331-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
Studies have demonstrated that at least 20% of individuals infected with SARS-CoV-2 remain asymptomatic1-4. Although most global efforts have focused on severe illness in COVID-19, examining asymptomatic infection provides a unique opportunity to consider early immunological features that promote rapid viral clearance. Here, postulating that variation in the human leukocyte antigen (HLA) loci may underly processes mediating asymptomatic infection, we enrolled 29,947 individuals, for whom high-resolution HLA genotyping data were available, in a smartphone-based study designed to track COVID-19 symptoms and outcomes. Our discovery cohort (n = 1,428) comprised unvaccinated individuals who reported a positive test result for SARS-CoV-2. We tested for association of five HLA loci with disease course and identified a strong association between HLA-B*15:01 and asymptomatic infection, observed in two independent cohorts. Suggesting that this genetic association is due to pre-existing T cell immunity, we show that T cells from pre-pandemic samples from individuals carrying HLA-B*15:01 were reactive to the immunodominant SARS-CoV-2 S-derived peptide NQKLIANQF. The majority of the reactive T cells displayed a memory phenotype, were highly polyfunctional and were cross-reactive to a peptide derived from seasonal coronaviruses. The crystal structure of HLA-B*15:01-peptide complexes demonstrates that the peptides NQKLIANQF and NQKLIANAF (from OC43-CoV and HKU1-CoV) share a similar ability to be stabilized and presented by HLA-B*15:01. Finally, we show that the structural similarity of the peptides underpins T cell cross-reactivity of high-affinity public T cell receptors, providing the molecular basis for HLA-B*15:01-mediated pre-existing immunity.
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Affiliation(s)
- Danillo G Augusto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Biological Sciences, The University of North Carolina at Charlotte, Charlotte, NC, USA
- Programa de Pós-Graduação em Genética, Universidade Federal do Paraná, Curitiba, Brazil
| | - Lawton D Murdolo
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Demetra S M Chatzileontiadou
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Joseph J Sabatino
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Tasneem Yusufali
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Noah D Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Xochitl Butcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Kerry Kizer
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Karoline Guthrie
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Victoria W Murray
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Vivian Pae
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Sannidhi Sarvadhavabhatla
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Fiona Beltran
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Gurjot S Gill
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Cassandra Yun
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Colin T Maguire
- Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Timothy J Henrich
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michelle Davidson
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Cynthia A Vierra-Green
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Stephen R Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | | | - Michael J Dewar-Oldis
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development Brisbane, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Peter J Barnard
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Sulggi Lee
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Martin Maiers
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Stephanie Gras
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jill A Hollenbach
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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15
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Aras MA, Abreau S, Mills H, Radhakrishnan L, Klein L, Mantri N, Rubin B, Barrios J, Chehoud C, Kogan E, Gitton X, Nnewihe A, Quinn D, Bridges C, Butte AJ, Olgin JE, Tison GH. Electrocardiogram Detection of Pulmonary Hypertension Using Deep Learning. J Card Fail 2023; 29:1017-1028. [PMID: 36706977 PMCID: PMC10363571 DOI: 10.1016/j.cardfail.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/23/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) is life-threatening, and often diagnosed late in its course. We aimed to evaluate if a deep learning approach using electrocardiogram (ECG) data alone can detect PH and clinically important subtypes. We asked: does an automated deep learning approach to ECG interpretation detect PH and its clinically important subtypes? METHODS AND RESULTS Adults with right heart catheterization or an echocardiogram within 90 days of an ECG at the University of California, San Francisco (2012-2019) were retrospectively identified as PH or non-PH. A deep convolutional neural network was trained on patients' 12-lead ECG voltage data. Patients were divided into training, development, and test sets in a ratio of 7:1:2. Overall, 5016 PH and 19,454 patients without PH were used in the study. The mean age at the time of ECG was 62.29 ± 17.58 years and 49.88% were female. The mean interval between ECG and right heart catheterization or echocardiogram was 3.66 and 2.23 days for patients with PH and patients without PH, respectively. In the test dataset, the model achieved an area under the receiver operating characteristic curve, sensitivity, and specificity, respectively of 0.89, 0.79, and 0.84 to detect PH; 0.91, 0.83, and 0.84 to detect precapillary PH; 0.88, 0.81, and 0.81 to detect pulmonary arterial hypertension, and 0.80, 0.73, and 0.76 to detect group 3 PH. We additionally applied the trained model on ECGs from participants in the test dataset that were obtained from up to 2 years before diagnosis of PH; the area under the receiver operating characteristic curve was 0.79 or greater. CONCLUSIONS A deep learning ECG algorithm can detect PH and PH subtypes around the time of diagnosis and can detect PH using ECGs that were done up to 2 years before right heart catheterization/echocardiogram diagnosis. This approach has the potential to decrease diagnostic delays in PH.
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Affiliation(s)
- Mandar A Aras
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | - Sean Abreau
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | - Hunter Mills
- Bakar Computation Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Lakshmi Radhakrishnan
- Bakar Computation Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Liviu Klein
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | - Neha Mantri
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | - Benjamin Rubin
- Bakar Computation Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Joshua Barrios
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | | | - Emily Kogan
- Janssen Pharmaceuticals, Inc, Raritan, New Jersey
| | - Xavier Gitton
- Actelion Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | | | - Atul J Butte
- Bakar Computation Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California
| | - Geoffrey H Tison
- UCSF Department of Medicine, Division of Cardiology, San Francisco, California; Bakar Computation Health Sciences Institute, University of California, San Francisco, San Francisco, California; Division of Cardiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California.
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16
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Tastet L, Ramakrishna S, Lim LJ, Bibby D, Olgin JE, Connolly AJ, Moffatt E, Tseng ZH, Delling FN. Mechanical Dispersion Discriminates between Arrhythmic and Non-Arrhythmic Sudden Death: From the POST SCD Study. medRxiv 2023:2023.05.22.23290353. [PMID: 37293041 PMCID: PMC10246127 DOI: 10.1101/2023.05.22.23290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Global longitudinal strain (GLS) and mechanical dispersion (MD) by speckle-tracking echocardiography can predict sudden cardiac death (SCD) beyond left ventricular ejection fraction (LVEF) alone. However, prior studies have presumed cardiac cause from EMS records or death certificates rather than gold-standard autopsies. Objectives We sought to investigate whether abnormal GLS and MD, reflective of underlying myocardial fibrosis, are associated with autopsy-defined sudden arrhythmic death (SAD) in a comprehensive postmortem study. Methods We identified and autopsied all World Health Organization-defined (presumed) SCDs ages 18-90 via active surveillance of out of hospital deaths in the ongoing San Francisco POstmortem Systematic InvesTigation of Sudden Cardiac Death (POST SCD) Study to refine presumed SCDs to true cardiac causes. We retrieved all available pre-mortem echocardiograms and assessed LVEF, LV-GLS, and MD. The extent of LV myocardial fibrosis was assessed and quantified histologically. Results Of 652 autopsied subjects, 65 (10%) had echocardiograms available for primary review, obtained at a mean 1.5 years before SCD. Of these, 37 (56%) were SADs and 29 (44%) were non-SADs; fibrosis was quantified in 38 (58%). SADs were predominantly male, but had similar age, race, baseline comorbidities, and LVEF compared to non-SADs (all p>0.05). SADs had significantly reduced LV-GLS (median: -11.4% versus -18.5%, p=0.008) and increased MD (median: 14.8 ms versus 9.4 ms, p=0.006) compared to non-SADs. MD was associated with total LV fibrosis by linear regression in SADs (r=0.58, p=0.002). Conclusion In this countywide postmortem study of all sudden deaths, autopsy-confirmed arrhythmic deaths had significantly lower LV-GLS and increased MD than non-arrhythmic sudden deaths. Increased MD correlated with higher histologic levels of LV fibrosis in SADs. These findings suggest that increased MD, which is a surrogate for the extent of myocardial fibrosis, may improve risk stratification and specification for SAD beyond LVEF. PERSPECTIVES Competency in medical knowledge: Mechanical dispersion derived from speckle tracking echocardiography provides better discrimination between autopsy-defined arrhythmic vs non-arrhythmic sudden death than LVEF or LV-GLS. Histological ventricular fibrosis correlates with increased mechanical dispersion in SAD.Translational outlook: Speckle tracking echocardiography parameters, in particular mechanical dispersion, may be considered as a non-invasive surrogate marker for myocardial fibrosis and risk stratification in SCD.
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Avram R, Barrios JP, Abreau S, Goh CY, Ahmed Z, Chung K, So DY, Olgin JE, Tison GH. Automated Assessment of Cardiac Systolic Function From Coronary Angiograms With Video-Based Artificial Intelligence Algorithms. JAMA Cardiol 2023:2804713. [PMID: 37163297 DOI: 10.1001/jamacardio.2023.0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Importance Understanding left ventricular ejection fraction (LVEF) during coronary angiography can assist in disease management. Objective To develop an automated approach to predict LVEF from left coronary angiograms. Design, Setting, and Participants This was a cross-sectional study with external validation using patient data from December 12, 2012, to December 31, 2019, from the University of California, San Francisco (UCSF). Data were randomly split into training, development, and test data sets. External validation data were obtained from the University of Ottawa Heart Institute. Included in the analysis were all patients 18 years or older who received a coronary angiogram and transthoracic echocardiogram (TTE) within 3 months before or 1 month after the angiogram. Exposure A video-based deep neural network (DNN) called CathEF was used to discriminate (binary) reduced LVEF (≤40%) and to predict (continuous) LVEF percentage from standard angiogram videos of the left coronary artery. Guided class-discriminative gradient class activation mapping (GradCAM) was applied to visualize pixels in angiograms that contributed most to DNN LVEF prediction. Results A total of 4042 adult angiograms with corresponding TTE LVEF from 3679 UCSF patients were included in the analysis. Mean (SD) patient age was 64.3 (13.3) years, and 2212 patients were male (65%). In the UCSF test data set (n = 813), the video-based DNN discriminated (binary) reduced LVEF (≤40%) with an area under the receiver operating characteristic curve (AUROC) of 0.911 (95% CI, 0.887-0.934); diagnostic odds ratio for reduced LVEF was 22.7 (95% CI, 14.0-37.0). DNN-predicted continuous LVEF had a mean absolute error (MAE) of 8.5% (95% CI, 8.1%-9.0%) compared with TTE LVEF. Although DNN-predicted continuous LVEF differed 5% or less compared with TTE LVEF in 38.0% (309 of 813) of test data set studies, differences greater than 15% were observed in 15.2% (124 of 813). In external validation (n = 776), video-based DNN discriminated (binary) reduced LVEF (≤40%) with an AUROC of 0.906 (95% CI, 0.881-0.931), and DNN-predicted continuous LVEF had an MAE of 7.0% (95% CI, 6.6%-7.4%). Video-based DNN tended to overestimate low LVEFs and underestimate high LVEFs. Video-based DNN performance was consistent across sex, body mass index, low estimated glomerular filtration rate (≤45), presence of acute coronary syndromes, obstructive coronary artery disease, and left ventricular hypertrophy. Conclusion and relevance This cross-sectional study represents an early demonstration of estimating LVEF from standard angiogram videos of the left coronary artery using video-based DNNs. Further research can improve accuracy and reduce the variability of DNNs to maximize their clinical utility.
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Affiliation(s)
- Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua P Barrios
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Cheng Yee Goh
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zeeshan Ahmed
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Chung
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Derek Y So
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
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Kany S, Rämö JT, Hou C, Jurgens SJ, Nauffal V, Cunningham J, Lau ES, Butte AJ, Ho JE, Olgin JE, Elmariah S, Lindsay ME, Ellinor PT, Pirruccello JP. Assessment of valvular function in over 47,000 people using deep learning-based flow measurements. medRxiv 2023:2023.04.29.23289299. [PMID: 37205587 PMCID: PMC10187336 DOI: 10.1101/2023.04.29.23289299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Valvular heart disease is associated with a high global burden of disease. Even mild aortic stenosis confers increased morbidity and mortality, prompting interest in understanding normal variation in valvular function at scale. We developed a deep learning model to study velocity-encoded magnetic resonance imaging in 47,223 UK Biobank participants. We calculated eight traits, including peak velocity, mean gradient, aortic valve area, forward stroke volume, mitral and aortic regurgitant volume, greatest average velocity, and ascending aortic diameter. We then computed sex-stratified reference ranges for these phenotypes in up to 31,909 healthy individuals. In healthy individuals, we found an annual decrement of 0.03cm 2 in the aortic valve area. Participants with mitral valve prolapse had a 1 standard deviation [SD] higher mitral regurgitant volume (P=9.6 × 10 -12 ), and those with aortic stenosis had a 4.5 SD-higher mean gradient (P=1.5 × 10 -431 ), validating the derived phenotypes' associations with clinical disease. Greater levels of ApoB, triglycerides, and Lp(a) assayed nearly 10 years prior to imaging were associated with higher gradients across the aortic valve. Metabolomic profiles revealed that increased glycoprotein acetyls were also associated with an increased aortic valve mean gradient (0.92 SD, P=2.1 x 10 -22 ). Finally, velocity-derived phenotypes were risk markers for aortic and mitral valve surgery even at thresholds below what is considered relevant disease currently. Using machine learning to quantify the rich phenotypic data of the UK Biobank, we report the largest assessment of valvular function and cardiovascular disease in the general population.
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Marcus GM, Rosenthal DG, Nah G, Vittinghoff E, Fang C, Ogomori K, Joyce S, Yilmaz D, Yang V, Kessedjian T, Wilson E, Yang M, Chang K, Wall G, Olgin JE. Acute Effects of Coffee Consumption on Health among Ambulatory Adults. N Engl J Med 2023; 388:1092-1100. [PMID: 36947466 PMCID: PMC10167887 DOI: 10.1056/nejmoa2204737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Coffee is one of the most commonly consumed beverages in the world, but the acute health effects of coffee consumption remain uncertain. METHODS We conducted a prospective, randomized, case-crossover trial to examine the effects of caffeinated coffee on cardiac ectopy and arrhythmias, daily step counts, sleep minutes, and serum glucose levels. A total of 100 adults were fitted with a continuously recording electrocardiogram device, a wrist-worn accelerometer, and a continuous glucose monitor. Participants downloaded a smartphone application to collect geolocation data. We used daily text messages, sent over a period of 14 days, to randomly instruct participants to consume caffeinated coffee or avoid caffeine. The primary outcome was the mean number of daily premature atrial contractions. Adherence to the randomization assignment was assessed with the use of real-time indicators recorded by the participants, daily surveys, reimbursements for date-stamped receipts for coffee purchases, and virtual monitoring (geofencing) of coffee-shop visits. RESULTS The mean (±SD) age of the participants was 39±13 years; 51% were women, and 51% were non-Hispanic White. Adherence to the random assignments was assessed to be high. The consumption of caffeinated coffee was associated with 58 daily premature atrial contractions as compared with 53 daily events on days when caffeine was avoided (rate ratio, 1.09; 95% confidence interval [CI], 0.98 to 1.20; P = 0.10). The consumption of caffeinated coffee as compared with no caffeine consumption was associated with 154 and 102 daily premature ventricular contractions, respectively (rate ratio, 1.51; 95% CI, 1.18 to 1.94); 10,646 and 9665 daily steps (mean difference, 1058; 95% CI, 441 to 1675); 397 and 432 minutes of nightly sleep (mean difference, 36; 95% CI, 25 to 47); and serum glucose levels of 95 mg per deciliter and 96 mg per deciliter (mean difference, -0.41; 95% CI, -5.42 to 4.60). CONCLUSIONS In this randomized trial, the consumption of caffeinated coffee did not result in significantly more daily premature atrial contractions than the avoidance of caffeine. (Funded by the University of California, San Francisco, and the National Institutes of Health; CRAVE ClinicalTrials.gov number, NCT03671759.).
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Affiliation(s)
- Gregory M Marcus
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - David G Rosenthal
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Gregory Nah
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Eric Vittinghoff
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Christina Fang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Kelsey Ogomori
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Sean Joyce
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Defne Yilmaz
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Vivian Yang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Tara Kessedjian
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Emily Wilson
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Michelle Yang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Kathleen Chang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Grace Wall
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Jeffrey E Olgin
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
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Feeny AK, Barrios J, Abreau S, Olgin JE, Aras M, Tison GH. ASSOCIATION BETWEEN ECG-BASED DEEP LEARNING PREDICTION OF PULMONARY HYPERTENSION AND TRANSTHORACIC ECHOCARDIOGRAM ESTIMATION OF PULMONARY ARTERY SYSTOLIC PRESSURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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21
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Block VJ, Cheng S, Juwono J, Cuneo R, Kirkish G, Alexander AM, Khan M, Akula A, Caverzasi E, Papinutto N, Stern WA, Pletcher MJ, Marcus GM, Olgin JE, Hauser SL, Gelfand JM, Bove R, Cree BAC, Henry RG. Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis. Mult Scler 2023; 29:363-373. [PMID: 36573559 PMCID: PMC9972237 DOI: 10.1177/13524585221143726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. OBJECTIVE Evaluate the association of structural central nervous system pathology with ambulatory disability. METHODS Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. RESULTS Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). CONCLUSION These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.
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Affiliation(s)
- Valerie J Block
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Physical Therapy and Rehabilitation
Science, University of California San Francisco, San Francisco, CA,
USA
| | - Shuiting Cheng
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeremy Juwono
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Richard Cuneo
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Gina Kirkish
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amber M Alexander
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Mahir Khan
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amit Akula
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Eduardo Caverzasi
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Brain and Behavioral Sciences, University
of Pavia, Pavia, Italy
| | - Nico Papinutto
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | | | - Mark J Pletcher
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA/Department of
Medicine, University of California San Francisco, San Francisco, CA,
USA
| | - Gregory M Marcus
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Bruce AC Cree
- BAC Cree UCSF Weill Institute for
Neurosciences, Department of Neurology, University of California, 1651 4th St
Suite 252, San Francisco, San Francisco, CA 94158, USA.
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Ciuffo L, Tung M, Dukes JW, Vittinghoff E, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia HH, Gerstenfeld EP, Marcus GM. ACUTE ALCOHOL EXPOSURE AND ELECTROCARDIOGRAPHIC CHANGES: FINDING FROM THE HOLIDAY (HOW ALCOHOL INDUCES ATRIAL TACHYARRHYTHMIAS) TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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23
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Chaudhari GR, Mayfield JJ, Barrios JP, Abreau S, Avram R, Olgin JE, Tison GH. Deep learning augmented ECG analysis to identify biomarker-defined myocardial injury. Sci Rep 2023; 13:3364. [PMID: 36849487 PMCID: PMC9969952 DOI: 10.1038/s41598-023-29989-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
Chest pain is a common clinical complaint for which myocardial injury is the primary concern and is associated with significant morbidity and mortality. To aid providers' decision-making, we aimed to analyze the electrocardiogram (ECG) using a deep convolutional neural network (CNN) to predict serum troponin I (TnI) from ECGs. We developed a CNN using 64,728 ECGs from 32,479 patients who underwent ECG within 2 h prior to a serum TnI laboratory result at the University of California, San Francisco (UCSF). In our primary analysis, we classified patients into groups of TnI < 0.02 or ≥ 0.02 µg/L using 12-lead ECGs. This was repeated with an alternative threshold of 1.0 µg/L and with single-lead ECG inputs. We also performed multiclass prediction for a set of serum troponin ranges. Finally, we tested the CNN in a cohort of patients selected for coronary angiography, including 3038 ECGs from 672 patients. Cohort patients were 49.0% female, 42.8% white, and 59.3% (19,283) never had a positive TnI value (≥ 0.02 µg/L). CNNs accurately predicted elevated TnI, both at a threshold of 0.02 µg/L (AUC = 0.783, 95% CI 0.780-0.786) and at a threshold of 1.0 µg/L (AUC = 0.802, 0.795-0.809). Models using single-lead ECG data achieved significantly lower accuracy, with AUCs ranging from 0.740 to 0.773 with variation by lead. Accuracy of the multi-class model was lower for intermediate TnI value-ranges. Our models performed similarly on the cohort of patients who underwent coronary angiography. Biomarker-defined myocardial injury can be predicted by CNNs from 12-lead and single-lead ECGs.
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Affiliation(s)
- Gunvant R. Chaudhari
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158 USA
| | - Jacob J. Mayfield
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158 USA ,grid.34477.330000000122986657Division of Cardiology, University of Washington, Seattle, USA
| | - Joshua P. Barrios
- grid.266102.10000 0001 2297 6811Division of Cardiology, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Sean Abreau
- grid.266102.10000 0001 2297 6811Division of Cardiology, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Robert Avram
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158 USA ,grid.266102.10000 0001 2297 6811Division of Cardiology, University of California, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158 USA ,grid.266102.10000 0001 2297 6811Division of Cardiology, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Geoffrey H. Tison
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158 USA ,grid.266102.10000 0001 2297 6811Division of Cardiology, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Cardiovascular Research Institute, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Bakar Institute of Computational Health Sciences, University of California, San Francisco, USA
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24
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Durstenfeld MS, Peluso MJ, Peyser ND, Lin F, Knight SJ, Djibo A, Khatib R, Kitzman H, O’Brien E, Williams N, Isasi C, Kornak J, Carton TW, Olgin JE, Pletcher MJ, Marcus GM, Beatty AL. Factors Associated With Long COVID Symptoms in an Online Cohort Study. Open Forum Infect Dis 2023; 10:ofad047. [PMID: 36846611 PMCID: PMC9945931 DOI: 10.1093/ofid/ofad047] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Background Few prospective studies of Long COVID risk factors have been conducted. The purpose of this study was to determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are associated with Long COVID. Methods In March 26, 2020, the COVID-19 Citizen Science study, an online cohort study, began enrolling participants with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection. Adult participants who reported a positive SARS-CoV-2 test result before April 4, 2022 were surveyed for Long COVID symptoms. The primary outcome was at least 1 prevalent Long COVID symptom greater than 1 month after acute infection. Exposures of interest included age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, variant wave, number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, and exercise. Results Of 13 305 participants who reported a SARS-CoV-2 positive test, 1480 (11.1%) responded. Respondents' mean age was 53 and 1017 (69%) were female. Four hundred seventy-six (32.2%) participants reported Long COVID symptoms at a median 360 days after infection. In multivariable models, number of acute symptoms (odds ratio [OR], 1.30 per symptom; 95% confidence interval [CI], 1.20-1.40), lower socioeconomic status/financial insecurity (OR, 1.62; 95% CI, 1.02-2.63), preinfection depression (OR, 1.08; 95% CI, 1.01-1.16), and earlier variants (OR = 0.37 for Omicron compared with ancestral strain; 95% CI, 0.15-0.90) were associated with Long COVID symptoms. Conclusions Variant wave, severity of acute infection, lower socioeconomic status, and pre-existing depression are associated with Long COVID symptoms.
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Affiliation(s)
- Matthew S Durstenfeld
- Correspondence: M. S. Durstenfeld, MD, MAS, Division of Cardiology, UCSF, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, 5G8, San Francisco, CA 94110, ()
| | - Michael J Peluso
- Division of HIV, Infectious Disease, Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Noah D Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Sara J Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Audrey Djibo
- CVS Health Clinical Trial Services, Blue Bell, Pennsylvania, USA
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, Texas, USA
| | - Emily O’Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Natasha Williams
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, New York, USA
| | - Carmen Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Thomas W Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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25
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Howell SJ, Dukes JW, Vittinghoff E, Tang J, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Gerstenfeld EP, Marcus GM. Premature Atrial Contraction Location and Atrial Fibrillation Inducibility. Circ Arrhythm Electrophysiol 2023; 16:e011623. [PMID: 36688298 PMCID: PMC9974680 DOI: 10.1161/circep.122.011623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stacey J. Howell
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Janet Tang
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Joshua D. Moss
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Randall J. Lee
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Byron K. Lee
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Zian H. Tseng
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Vasanth Vedantham
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Jeffrey E Olgin
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Melvin M. Scheinman
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Henry Hsia
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Edward P. Gerstenfeld
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Gregory M. Marcus
- Section of Electrophysiology, Division of Cardiology, University of California, San Francisco
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Abstract
This cohort study examines time trends in officially reported SARS-CoV-2 case counts and unreported home test positivity.
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Affiliation(s)
- Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | | | - Rita Hamad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Family and Community Medicine, University of California, San Francisco
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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Qiu H, Zhang H, Han DD, Derakhshandeh R, Wang X, Goyal N, Navabzadeh M, Rao P, Wilson EE, Mohammadi L, Olgin JE, Springer ML. Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products. Heart Rhythm 2023; 20:76-86. [PMID: 36603937 PMCID: PMC10006068 DOI: 10.1016/j.hrthm.2022.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The emergence of a plethora of new tobacco products marketed as being less harmful than smoking, such as electronic cigarettes and heated tobacco products, and the increased popularity of recreational marijuana have raised concerns about the potential cardiovascular risk associated with their use. OBJECTIVE The purpose of this study was to investigate whether the use of novel tobacco products or marijuana can cause the development of proarrhythmic substrate and eventually lead to arrhythmias. METHODS Rats were exposed to smoke from tobacco, marijuana, or cannabinoid-depleted marijuana, to aerosol from electronic cigarettes or heated tobacco products, or to clean air once per day for 8 weeks, following by assays for blood pressure, cardiac function, ex vivo electrophysiology, and histochemistry. RESULTS The rats exposed to tobacco or marijuana products exhibited progressively increased systolic blood pressure, decreased cardiac systolic function with chamber dilation, and reduced overall heart rate variability, relative to the clean air negative control group. Atrial fibrillation and ventricular tachycardia testing by ex vivo optical mapping revealed a significantly higher susceptibility to each, with a shortened effective refractory period and prolonged calcium transient duration. Histological analysis indicated that in all exposure conditions except for air, exposure to smoke or aerosol from tobacco or marijuana products caused severe fibrosis with decreased microvessel density and higher level of sympathetic nerve innervation. CONCLUSION These pathophysiological results indicate that tobacco and marijuana products can induce arrhythmogenic substrates involved in cardiac electrical, structural, and neural remodeling, facilitating the development of arrhythmias.
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Affiliation(s)
- Huiliang Qiu
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Hao Zhang
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Daniel D Han
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Ronak Derakhshandeh
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Xiaoyin Wang
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Natasha Goyal
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Mina Navabzadeh
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Poonam Rao
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Emily E Wilson
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Leila Mohammadi
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco, California; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Matthew L Springer
- Division of Cardiology, University of California, San Francisco, San Francisco, California; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California; Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California.
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28
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Durstenfeld MS, Peluso MJ, Peyser ND, Lin F, Knight SJ, Djibo A, Khatib R, Kitzman H, O’Brien E, Williams N, Isasi C, Kornak J, Carton TW, Olgin JE, Pletcher MJ, Marcus GM, Beatty AL. Factors Associated with Long Covid Symptoms in an Online Cohort Study. medRxiv 2022:2022.12.01.22282987. [PMID: 36523412 PMCID: PMC9753782 DOI: 10.1101/2022.12.01.22282987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Prolonged symptoms following SARS-CoV-2 infection, or Long COVID, is common, but few prospective studies of Long COVID risk factors have been conducted. Objective To determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute SARS-CoV-2 infection are associated with Long COVID. Design Cohort study with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection, and cross-sectional assessment of Long COVID symptoms using data from the COVID-19 Citizen Science (CCS) study. Setting CCS is an online cohort study that began enrolling March 26, 2020. We included data collected between March 26, 2020, and May 18, 2022. Participants Adult CCS participants who reported a positive SARS-CoV-2 test result (PCR, Antigen, or Antibody) more than 30 days prior to May 4, 2022, were surveyed. Exposures Age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, time of infection (variant wave), number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, exercise. Main Outcome Presence of at least 1 Long COVID symptom greater than 1 month after acute infection. Sensitivity analyses were performed considering only symptoms beyond 3 months and only severe symptoms. Results 13,305 participants reported a SARS-CoV-2 positive test more than 30 days prior, 1480 (11.1% of eligible) responded to a survey about Long COVID symptoms, and 476 (32.2% of respondents) reported Long COVID symptoms (median 360 days after infection).Respondents' mean age was 53 and 1017 (69%) were female. Common Long COVID symptoms included fatigue, reported by 230/476 (48.3%), shortness of breath (109, 22.9%), confusion/brain fog (108, 22.7%), headache (103, 21.6%), and altered taste or smell (98, 20.6%). In multivariable models, number of acute COVID-19 symptoms (OR 1.30 per symptom, 95%CI 1.20-1.40), lower socioeconomic status/financial insecurity (OR 1.62, 95%CI 1.02-2.63), pre-infection depression (OR 1.08, 95%CI 1.01-1.16), and earlier variants (OR 0.37 for Omicron compared to ancestral strain, 95%CI 0.15-0.90) were associated with Long COVID symptoms. Conclusions and Relevance Variant wave, severity of acute infection, lower socioeconomic status and pre-existing depression are associated with Long COVID symptoms. Key Points Question: What are the patterns of symptoms and risk factors for Long COVID among SARS-CoV-2 infected individuals?Findings: Persistent symptoms were highly prevalent, especially fatigue, shortness of breath, headache, brain fog/confusion, and altered taste/smell, which persisted beyond 1 year among 56% of participants with symptoms; a minority of participants reported severe Long COVID symptoms. Number of acute symptoms during acute SARS-CoV-2 infection, financial insecurity, pre-existing depression, and infection with earlier variants are associated with prevalent Long COVID symptoms independent of vaccination, medical history, and other factors.Meaning: Severity of acute infection, SARS-CoV-2 variant, and financial insecurity and depression are associated with Long COVID symptoms.
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Affiliation(s)
| | | | | | - Feng Lin
- Department of Epidemiology and Biostatistics, UCSF
| | - Sara J. Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah
| | | | | | | | - Emily O’Brien
- Department of Population Health Sciences, Duke University School of Medicine
| | - Natasha Williams
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Grossman School of Medicine
| | - Carmen Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - John Kornak
- Department of Epidemiology and Biostatistics, UCSF
| | | | | | | | | | - Alexis L. Beatty
- Division of Cardiology, Department of Medicine, UCSF,Department of Epidemiology and Biostatistics, UCSF
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29
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Ramakrishna S, Salazar JW, Olgin JE, Moffatt E, Tseng ZH. Heart Failure Burden by Autopsy, Guideline-Directed Medical Therapy, and ICD Utilization Among Sudden Deaths. JACC Clin Electrophysiol 2022; 9:403-413. [PMID: 36752450 DOI: 10.1016/j.jacep.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Studies of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) report high sudden cardiac death (SCD) rates but presume cardiac cause. Underlying causes, guideline-directed medical therapy (GDMT), and implantable cardioverter-defibrillator (ICD) use in community sudden deaths with heart failure (HF) are unknown. OBJECTIVES This study aims to assess the burden of HF, GDMT, and ICD use among autopsied sudden deaths in the POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study, a countywide postmortem study of all presumed SCDs. METHODS Incident WHO-defined (presumed) SCDs for individuals of ages 18 to 90 years were autopsied via prospective surveillance of consecutive out-of-hospital deaths in San Francisco County from February 1, 2011, to March 1, 2014. Sudden arrhythmic deaths (SADs) had no identifiable nonarrhythmic cause (eg, pulmonary embolism), and are thus considered potentially rescuable with ICD. RESULTS Of 525 presumed SCDs, 100 (19%) had HF. There were 85 patients with known HF (31 HFpEF, 54 HFrEF) and 15 with subclinical HF (postmortem evidence of cardiomyopathy and pulmonary edema without HF diagnosis). SADs comprised 56% (293 of 525) of all presumed SCDs, and 69% (69 of 100) of HF SCDs. The rates were similar in HFrEF (40 of 54 [74%]) and HFpEF (19 of 31 [61%], P = 0.45). Four SAD patients (4%) had ICDs, 3 of which experienced device failure. Twenty-eight SCDs had ejection fraction ≤35%: 22 (79%) with arrhythmic and 6 (21%) with noncardiac causes. Of the 22 SAD patients, 8 (36%) had no identifiable barrier to ICD referral. Complete use of GDMT in HFrEF was 6%. CONCLUSIONS One in 5 community sudden deaths had HF; two-thirds had autopsy-confirmed arrhythmic causes. ICD prevention criteria captured only 8% (22 of 293) of all SAD cases countywide; GDMT and ICD use remain important targets for HF sudden death prevention.
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Affiliation(s)
- Satvik Ramakrishna
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James W Salazar
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA.
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30
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Augusto DG, Yusufali T, Sabatino JJ, Peyser ND, Murdolo LD, Butcher X, Murray V, Pae V, Sarvadhavabhatla S, Beltran F, Gill G, Lynch K, Yun C, Maguire C, Peluso MJ, Hoh R, Henrich TJ, Deeks SG, Davidson M, Lu S, Goldberg SA, Kelly JD, Martin JN, Viera-Green CA, Spellman SR, Langton DJ, Lee S, Marcus GM, Olgin JE, Pletcher MJ, Gras S, Maiers M, Hollenbach JA. A common allele of HLA mediates asymptomatic SARS-CoV-2 infection. medRxiv 2022:2021.05.13.21257065. [PMID: 34031661 PMCID: PMC8142661 DOI: 10.1101/2021.05.13.21257065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite some inconsistent reporting of symptoms, studies have demonstrated that at least 20% of individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will remain asymptomatic. Although most global efforts have focused on understanding factors underlying severe illness in COVID-19 (coronavirus disease of 2019), the examination of asymptomatic infection provides a unique opportunity to consider early disease and immunologic features promoting rapid viral clearance. Owing to its critical role in the immune response, we postulated that variation in the human leukocyte antigen (HLA) loci may underly processes mediating asymptomatic infection. We enrolled 29,947 individuals registered in the National Marrow Donor Program for whom high-resolution HLA genotyping data were available in the UCSF Citizen Science smartphone-based study designed to track COVID-19 symptoms and outcomes. Our discovery cohort (n=1428) was comprised of unvaccinated, self-identified subjects who reported a positive test result for SARS-CoV-2. We tested for association of five HLA loci (HLA-A, -B, -C, -DRB1, -DQB1) with disease course and identified a strong association of HLA-B*15:01 with asymptomatic infection, and reproduced this association in two independent cohorts. Suggesting that this genetic association is due to pre-existing T-cell immunity, we show that T cells from pre-pandemic individuals carrying HLA-B*15:01 were reactive to the immunodominant SARS-CoV-2 S-derived peptide NQKLIANQF, and 100% of the reactive cells displayed memory phenotype. Finally, we characterize the protein structure of HLA-B*15:01-peptide complexes, demonstrating that the NQKLIANQF peptide from SARS-CoV-2, and the highly homologous NQKLIANAF from seasonal coronaviruses OC43-CoV and HKU1-CoV, share similar ability to be stabilized and presented by HLA-B*15:01, providing the molecular basis for T-cell cross-reactivity and HLA-B*15:01-mediated pre-existing immunity.
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Affiliation(s)
- Danillo G. Augusto
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Programa de Pós-Graduação em Genética, Universidade Federal do Paraná, Curitiba, Brazil
- Department of Biological Sciences, The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Tasneem Yusufali
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Joseph J. Sabatino
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Noah D. Peyser
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lawton D. Murdolo
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Xochitl Butcher
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Victoria Murray
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vivian Pae
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sannidhi Sarvadhavabhatla
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fiona Beltran
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gurjot Gill
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kara Lynch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cassandra Yun
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Colin Maguire
- University of Utah, Clinical and Translational Science Institute, Salt Lake City, UT
| | - Michael J. Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy J. Henrich
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven G. Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michelle Davidson
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Cynthia A. Viera-Green
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Stephen R. Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - David J. Langton
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, UK
| | - Sulggi Lee
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie Gras
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria 3086, Australia
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | | | - Jill A. Hollenbach
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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31
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Tison GH, Barrios J, Avram R, Kuhar P, Bostjancic B, Marcus GM, Pletcher MJ, Olgin JE. Worldwide physical activity trends since COVID-19 onset. The Lancet Global Health 2022; 10:e1381-e1382. [PMID: 36057269 PMCID: PMC9432866 DOI: 10.1016/s2214-109x(22)00361-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA; Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.
| | - Joshua Barrios
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | | | | | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA
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32
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Chow EJ, Chen Y, Armstrong GT, Baldwin LM, Cai CR, Gibson TM, Hudson MM, McDonald A, Nathan PC, Olgin JE, Syrjala KL, Tonorezos ES, Oeffinger KC, Yasui Y. Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer. J Am Heart Assoc 2022; 11:e024735. [PMID: 35674343 PMCID: PMC9238650 DOI: 10.1161/jaha.121.024735] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Determine the prevalence and predictors associated with underdiagnosis and undertreatment of modifiable cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, glucose intolerance/diabetes) among adult survivors of childhood cancer at high risk of premature CVD. Methods and Results This was a cross‐sectional study of adult‐aged survivors of childhood cancer treated with anthracyclines or chest radiotherapy, recruited across 9 US metropolitan regions. Survivors completed questionnaires and in‐home clinical assessments. The comparator group was a matched sample from the National Health and Nutrition Examination Survey. Multivariable logistic regression estimated the risk (odds ratios) of CVD risk factor underdiagnosis and undertreatment among survivors compared with the National Health and Nutrition Examination Survey. Survivors (n=571; median age, 37.7 years and 28.5 years from cancer diagnosis) were more likely to have a preexisting CVD risk factor than the National Health and Nutrition Examination Survey (n=345; P<0.05 for all factors). While rates of CVD risk factor underdiagnosis were similar (27.1% survivors versus 26.1% National Health and Nutrition Examination Survey; P=0.73), survivors were more likely undertreated (21.0% versus 13.9%, P=0.007; odds ratio, 1.8, 95% CI, 1.2–2.7). Among survivors, the most underdiagnosed and undertreated risk factors were hypertension (18.9%) and dyslipidemia (16.3%), respectively. Men and survivors who were overweight/obese were more likely to be underdiagnosed and undertreated. Those with multiple adverse lifestyle factors were also more likely undertreated (odds ratio, 2.2, 95% CI, 1.1–4.5). Greater health‐related self‐efficacy was associated with reduced undertreatment (odds ratio, 0.5; 95% CI, 0.3–0.8). Conclusions Greater awareness of among primary care providers and cardiologists, combined with improving self‐efficacy among survivors, may mitigate the risk of underdiagnosed and undertreated CVD risk factors among adult‐aged survivors of childhood cancer. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03104543.
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Affiliation(s)
- Eric J Chow
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA.,Department of Pediatrics Seattle Children's HospitalUniversity of Washington Seattle WA
| | - Yan Chen
- University of Alberta Edmonton Alberta Canada
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | | | - Casey R Cai
- School of Medicine University of Texas Southwestern Dallas TX
| | - Todd M Gibson
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville MD
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN.,Department of Oncology St. Jude Children's Research Hospital Memphis TN
| | - Aaron McDonald
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | - Paul C Nathan
- Department of Pediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Jeffrey E Olgin
- Division of Cardiology Department of Medicine University of California San Francisco CA
| | - Karen L Syrjala
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA
| | - Emily S Tonorezos
- Division of Cancer Control and Population Science National Cancer Institute Rockville MD
| | | | - Yutaka Yasui
- University of Alberta Edmonton Alberta Canada.,Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
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Block VJ, Waliman M, Xie Z, Akula A, Bove R, Pletcher MJ, Marcus GM, Olgin JE, Cree BAC, Gelfand JM, Henry RG. Making Every Step Count: Minute-by-Minute Characterization of Step Counts Augments Remote Activity Monitoring in People With Multiple Sclerosis. Front Neurol 2022; 13:860008. [PMID: 35677343 PMCID: PMC9167929 DOI: 10.3389/fneur.2022.860008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ambulatory disability is common in people with multiple sclerosis (MS). Remote monitoring using average daily step count (STEPS) can assess physical activity (activity) and disability in MS. STEPS correlates with conventional metrics such as the expanded disability status scale (Expanded Disability Status Scale; EDSS), Timed-25 Foot walk (T25FW) and timed up and go (TUG). However, while STEPS as a summative measure characterizes the number of steps taken over a day, it does not reflect variability and intensity of activity. Objectives Novel analytical methods were developed to describe how individuals spends time in various activity levels (e.g., continuous low versus short bouts of high) and the proportion of time spent at each activity level. Methods 94 people with MS spanning the range of ambulatory impairment (unaffected to requiring bilateral assistance) were recruited into FITriMS study and asked to wear a Fitbit continuously for 1-year. Parametric distributions were fit to minute-by-minute step data. Adjusted R2 values for regressions between distributional fit parameters and STEPS with EDSS, TUG, T25FW and the patient-reported 12-item MS Walking scale (MSWS-12) were calculated over the first 4-weeks, adjusting for sex, age and disease duration. Results Distributional fits determined that the best statistically-valid model across all subjects was a 3-compartment Gaussian Mixture Model (GMM) that characterizes the step behavior within 3 levels of activity: high, moderate and low. The correlation of GMM parameters for baseline step count measures with clinical assessments was improved when compared with STEPS (adjusted R2 values GMM vs. STEPS: TUG: 0.536 vs. 0.419, T25FW: 0.489 vs. 0.402, MSWS-12: 0.383 vs. 0.378, EDSS: 0.557 vs. 0.465). The GMM correlated more strongly (Kruskal-Wallis: p = 0.0001) than STEPS and gave further information not included in STEPS. Conclusions Individuals' step distributions follow a 3-compartment GMM that better correlates with clinic-based performance measures compared with STEPS. These data support the existence of high-moderate-low levels of activity. GMM provides an interpretable framework to better understand the association between different levels of activity and clinical metrics and allows further analysis of walking behavior that takes step distribution and proportion of time at three levels of intensity into account.
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Affiliation(s)
- Valerie J. Block
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew Waliman
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Zhendong Xie
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Amit Akula
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gregory M. Marcus
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey E. Olgin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce A. C. Cree
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey M. Gelfand
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Roland G. Henry
- Department of Neurology, University of California San Francisco (UCSF) Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,Department of Radiology, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Roland G. Henry
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Howell S, Dukes JW, Vittinghoff E, Tang J, Moss JD, Lee RJ, Lee B, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia HH, Gerstenfeld EP, Marcus GM. PO-683-03 PREMATURE ATRIAL CONTRACTION LOCATION AND ATRIAL FIBRILLATION INDUCIBILITY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Higuchi S, Im SI, Bibby D, Stillson C, Lee AC, Marcus GM, Olgin JE, Abraham TP, Gerstenfeld EP. PO-625-01 FIBROSIS AND SLOW CONDUCTION PERSIST AFTER RECOVERY OF PREMATURE ATRIAL CONTRACTION INDUCED ATRIAL MYOPATHY IN A SWINE MODEL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tison GH, Siontis KC, Abreau S, Attia Z, Agarwal P, Balasubramanyam A, Li Y, Sehnert AJ, Edelberg JM, Friedman PA, Olgin JE, Noseworthy PA. Assessment of Disease Status and Treatment Response With Artificial Intelligence-Enhanced Electrocardiography in Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1032-1034. [PMID: 35272798 PMCID: PMC10101773 DOI: 10.1016/j.jacc.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 01/27/2023]
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Lai M, Cheung C, Olgin JE, Pletcher M, Vittinghoff E, Lin F, Hue T, Lee BK. PREDICTORS OF ARRHYTHMIC DEATH AND OVERALL MORTALITY FOLLOWING MI: RESULTS FROM THE VEST TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Eastman JA, Kaup AR, Bahorik AL, Butcher X, Attarha M, Marcus GM, Pletcher MJ, Olgin JE, Barnes DE, Yaffe K. Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study. JMIR Form Res 2022; 6:e30410. [PMID: 35107430 PMCID: PMC8851369 DOI: 10.2196/30410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Adults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations. Objective We conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment. Methods We recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function. Results CVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance. Conclusions Self-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation.
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Affiliation(s)
- Jennifer A Eastman
- San Francisco VA Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Allison R Kaup
- San Francisco VA Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States.,The Neurology Center of Southern California, Carlsbad, CA, United States
| | - Amber L Bahorik
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Xochitl Butcher
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Mouna Attarha
- Posit Science Corporation, San Francisco, CA, United States
| | - Gregory M Marcus
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Jeffrey E Olgin
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Deborah E Barnes
- San Francisco VA Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, CA, United States
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Dewland TA, Whitman IR, Win S, Sanchez JM, Olgin JE, Pletcher MJ, Santhosh L, Kumar U, Joyce S, Yang V, Hwang J, Ogomori K, Peyser N, Horner C, Wen D, Butcher X, Marcus GM. Prospective arrhythmia surveillance after a COVID-19 diagnosis. Open Heart 2022; 9:openhrt-2021-001758. [PMID: 35058344 PMCID: PMC8783964 DOI: 10.1136/openhrt-2021-001758] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiac arrhythmias have been observed among patients hospitalised with acute COVID-19 infection, and palpitations remain a common symptom among the much larger outpatient population of COVID-19 survivors in the convalescent stage of the disease. Objective To determine arrhythmia prevalence among outpatients after a COVID-19 diagnosis. Methods Adults with a positive COVID-19 test and without a history of arrhythmia were prospectively evaluated with 14-day ambulatory electrocardiographic monitoring. Participants were instructed to trigger the monitor for palpitations. Results A total of 51 individuals (mean age 42±11 years, 65% women) underwent monitoring at a median 75 (IQR 34–126) days after a positive COVID-19 test. Median monitoring duration was 13.2 (IQR 10.5–13.8) days. No participant demonstrated atrial fibrillation, atrial flutter, sustained supraventricular tachycardia (SVT), sustained ventricular tachycardia or infranodal atrioventricular block. Nearly all participants (96%) had an ectopic burden of <1%; one participant had a 2.8% supraventricular ectopic burden and one had a 15.4% ventricular ectopic burden. While 47 (92%) participants triggered their monitor for palpitation symptoms, 78% of these triggers were for either sinus rhythm or sinus tachycardia. Conclusions We did not find evidence of malignant or sustained arrhythmias in outpatients after a positive COVID-19 diagnosis. While palpitations were common, symptoms frequently corresponded to sinus rhythm/sinus tachycardia or non-malignant arrhythmias such as isolated ectopy or non-sustained SVT. While these findings cannot exclude the possibility of serious arrhythmias in select individuals, they do not support a strong or widespread proarrhythmic effect of COVID-19 infection after resolution of acute illness.
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Affiliation(s)
- Thomas A Dewland
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Isaac R Whitman
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sithu Win
- Department of Medicine, ZSFGH, San Francisco, California, USA
| | - Jose M Sanchez
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Jeffrey E Olgin
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | | | - Uday Kumar
- Element Science, Inc, San Francisco, California, USA
| | - Sean Joyce
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Vivian Yang
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Janet Hwang
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Kelsey Ogomori
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Noah Peyser
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Cathy Horner
- Department of Medicine, UCSF, San Francisco, California, USA
| | - David Wen
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Xochitl Butcher
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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40
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Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, Olgin JE, Hollenbach J, Bove R, Cree BAC, Gelfand JM. Identifying falls remotely in people with multiple sclerosis. J Neurol 2022; 269:1889-1898. [PMID: 34405267 PMCID: PMC8370664 DOI: 10.1007/s00415-021-10743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE To evaluate fall risk in people with MS. METHODS Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
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Affiliation(s)
- Valerie J. Block
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Erica A. Pitsch
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Arpita Gopal
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Chao Zhao
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Mark J. Pletcher
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gregory M. Marcus
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jill Hollenbach
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Riley Bove
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Bruce A. C. Cree
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Jeffrey M. Gelfand
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
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Abstract
IMPORTANCE Little is known about the factors associated with COVID-19 vaccine adverse effects in a real-world population. OBJECTIVE To evaluate factors potentially associated with participant-reported adverse effects after COVID-19 vaccination. DESIGN, SETTING, AND PARTICIPANTS The COVID-19 Citizen Science Study, an online cohort study, includes adults aged 18 years and older with a smartphone or internet access. Participants complete daily, weekly, and monthly surveys on health and COVID-19-related events. This analysis includes participants who provided consent between March 26, 2020, and May 19, 2021, and received at least 1 COVID-19 vaccine dose. EXPOSURES Participant-reported COVID-19 vaccination. MAIN OUTCOMES AND MEASURES Participant-reported adverse effects and adverse effect severity. Candidate factors in multivariable logistic regression models included age, sex, race, ethnicity, subjective social status, prior COVID-19 infection, medical conditions, substance use, vaccine dose, and vaccine brand. RESULTS The 19 586 participants had a median (IQR) age of 54 (38-66) years, and 13 420 (68.8%) were women. Allergic reaction or anaphylaxis was reported in 26 of 8680 participants (0.3%) after 1 dose of the BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccine, 27 of 11 141 (0.2%) after 2 doses of the BNT162b2 or mRNA-1273 vaccine or 1 dose of the JNJ-78436735 (Johnson & Johnson) vaccine. The strongest factors associated with adverse effects were vaccine dose (2 doses of BNT162b2 or mRNA-1273 or 1 dose of JNJ-78436735 vs 1 dose of BNT162b2 or mRNA-1273; odds ratio [OR], 3.10; 95% CI, 2.89-3.34; P < .001), vaccine brand (mRNA-1273 vs BNT162b2, OR, 2.00; 95% CI, 1.86-2.15; P < .001; JNJ-78436735 vs BNT162b2: OR, 0.64; 95% CI, 0.52-0.79; P < .001), age (per 10 years: OR, 0.74; 95% CI, 0.72-0.76; P < .001), female sex (OR, 1.65; 95% CI, 1.53-1.78; P < .001), and having had COVID-19 before vaccination (OR, 2.17; 95% CI, 1.77-2.66; P < .001). CONCLUSIONS AND RELEVANCE In this real-world cohort, serious COVID-19 vaccine adverse effects were rare and comparisons across brands could be made, revealing that full vaccination dose, vaccine brand, younger age, female sex, and having had COVID-19 before vaccination were associated with greater odds of adverse effects. Large digital cohort studies may provide a mechanism for independent postmarket surveillance of drugs and devices.
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Affiliation(s)
- Alexis L. Beatty
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Noah D. Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Xochitl E. Butcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jennifer M. Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco
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Marcus GM, Modrow MF, Schmid CH, Sigona K, Nah G, Yang J, Chu TC, Joyce S, Gettabecha S, Ogomori K, Yang V, Butcher X, Hills MT, McCall D, Sciarappa K, Sim I, Pletcher MJ, Olgin JE. Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation: The I-STOP-AFib Randomized Clinical Trial. JAMA Cardiol 2021; 7:167-174. [PMID: 34775507 DOI: 10.1001/jamacardio.2021.5010] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Atrial fibrillation (AF) is the most common arrhythmia. Although patients have reported that various exposures determine when and if an AF event will occur, a prospective evaluation of patient-selected triggers has not been conducted, and the utility of characterizing presumed AF-related triggers for individual patients remains unknown. Objective To test the hypothesis that n-of-1 trials of self-selected AF triggers would enhance AF-related quality of life. Design, Setting, and Participants A randomized clinical trial lasting a minimum of 10 weeks tested a smartphone mobile application used by symptomatic patients with paroxysmal AF who owned a smartphone and were interested in testing a presumed AF trigger. Participants were screened between December 22, 2018, and March 29, 2020. Interventions n-of-1 Participants received instructions to expose or avoid self-selected triggers in random 1-week blocks for 6 weeks, and the probability their trigger influenced AF risk was then communicated. Controls monitored their AF over the same time period. Main Outcomes and Measures AF was assessed daily by self-report and using a smartphone-based electrocardiogram recording device. The primary outcome comparing n-of-1 and control groups was the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score at 10 weeks. All participants could subsequently opt for additional trigger testing. Results Of 446 participants who initiated (mean [SD] age, 58 [14] years; 289 men [58%]; 461 White [92%]), 320 (72%) completed all study activities. Self-selected triggers included caffeine (n = 53), alcohol (n = 43), reduced sleep (n = 31), exercise (n = 30), lying on left side (n = 17), dehydration (n = 10), large meals (n = 7), cold food or drink (n = 5), specific diets (n = 6), and other customized triggers (n = 4). No significant differences in AFEQT scores were observed between the n-of-1 vs AF monitoring-only groups. In the 4-week postintervention follow-up period, significantly fewer daily AF episodes were reported after trigger testing compared with controls over the same time period (adjusted relative risk, 0.60; 95% CI, 0.43- 0.83; P < .001). In a meta-analysis of the individualized trials, only exposure to alcohol was associated with significantly heightened risks of AF events. Conclusions and Relevance n-of-1 Testing of AF triggers did not improve AF-associated quality of life but was associated with a reduction in AF events. Acute exposure to alcohol increased AF risk, with no evidence that other exposures, including caffeine, more commonly triggered AF. Trial Registration ClinicalTrials.gov Identifier: NCT03323099.
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Affiliation(s)
- Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Madelaine Faulkner Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Christopher H Schmid
- Department of Biostatistics, Center for Statistical Sciences and Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
| | - Kathi Sigona
- Health eHeart Alliance member and atrial fibrillation patient
| | - Gregory Nah
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Jiabei Yang
- Department of Biostatistics, Center for Statistical Sciences and Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
| | - Tzu-Chun Chu
- Department of Biostatistics, Center for Statistical Sciences and Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island
| | - Sean Joyce
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Shiffen Gettabecha
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Kelsey Ogomori
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Vivian Yang
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Xochitl Butcher
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Mellanie True Hills
- Health eHeart Alliance member and atrial fibrillation patient.,StopAfib.org, American Foundation for Women's Health, Greenwood, Texas
| | - Debbe McCall
- Health eHeart Alliance member and atrial fibrillation patient
| | | | - Ida Sim
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco
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Hughes JW, Olgin JE, Avram R, Abreau SA, Sittler T, Radia K, Hsia H, Walters T, Lee B, Gonzalez JE, Tison GH. Performance of a Convolutional Neural Network and Explainability Technique for 12-Lead Electrocardiogram Interpretation. JAMA Cardiol 2021; 6:1285-1295. [PMID: 34347007 PMCID: PMC8340011 DOI: 10.1001/jamacardio.2021.2746] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/04/2021] [Indexed: 01/12/2023]
Abstract
Importance Millions of clinicians rely daily on automated preliminary electrocardiogram (ECG) interpretation. Critical comparisons of machine learning-based automated analysis against clinically accepted standards of care are lacking. Objective To use readily available 12-lead ECG data to train and apply an explainability technique to a convolutional neural network (CNN) that achieves high performance against clinical standards of care. Design, Setting, and Participants This cross-sectional study was conducted using data from January 1, 2003, to December 31, 2018. Data were obtained in a commonly available 12-lead ECG format from a single-center tertiary care institution. All patients aged 18 years or older who received ECGs at the University of California, San Francisco, were included, yielding a total of 365 009 patients. Data were analyzed from January 1, 2019, to March 2, 2021. Exposures A CNN was trained to predict the presence of 38 diagnostic classes in 5 categories from 12-lead ECG data. A CNN explainability technique called LIME (Linear Interpretable Model-Agnostic Explanations) was used to visualize ECG segments contributing to CNN diagnoses. Main Outcomes and Measures Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for the CNN in the holdout test data set against cardiologist clinical diagnoses. For a second validation, 3 electrophysiologists provided consensus committee diagnoses against which the CNN, cardiologist clinical diagnosis, and MUSE (GE Healthcare) automated analysis performance was compared using the F1 score; AUC, sensitivity, and specificity were also calculated for the CNN against the consensus committee. Results A total of 992 748 ECGs from 365 009 adult patients (mean [SD] age, 56.2 [17.6] years; 183 600 women [50.3%]; and 175 277 White patients [48.0%]) were included in the analysis. In 91 440 test data set ECGs, the CNN demonstrated an AUC of at least 0.960 for 32 of 38 classes (84.2%). Against the consensus committee diagnoses, the CNN had higher frequency-weighted mean F1 scores than both cardiologists and MUSE in all 5 categories (CNN frequency-weighted F1 score for rhythm, 0.812; conduction, 0.729; chamber diagnosis, 0.598; infarct, 0.674; and other diagnosis, 0.875). For 32 of 38 classes (84.2%), the CNN had AUCs of at least 0.910 and demonstrated comparable F1 scores and higher sensitivity than cardiologists, except for atrial fibrillation (CNN F1 score, 0.847 vs cardiologist F1 score, 0.881), junctional rhythm (0.526 vs 0.727), premature ventricular complex (0.786 vs 0.800), and Wolff-Parkinson-White (0.800 vs 0.842). Compared with MUSE, the CNN had higher F1 scores for all classes except supraventricular tachycardia (CNN F1 score, 0.696 vs MUSE F1 score, 0.714). The LIME technique highlighted physiologically relevant ECG segments. Conclusions and Relevance The results of this cross-sectional study suggest that readily available ECG data can be used to train a CNN algorithm to achieve comparable performance to clinical cardiologists and exceed the performance of MUSE automated analysis for most diagnoses, with some exceptions. The LIME explainability technique applied to CNNs highlights physiologically relevant ECG segments that contribute to the CNN's diagnoses.
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Affiliation(s)
- J. Weston Hughes
- RISE Lab, Department of Electrical Engineering and Computer Science, University of California, Berkeley, Berkeley
| | - Jeffrey E. Olgin
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
- Cardiovascular Research Institute, San Francisco, California
| | - Robert Avram
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
- Cardiovascular Research Institute, San Francisco, California
| | - Sean A. Abreau
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
- Cardiovascular Research Institute, San Francisco, California
| | - Taylor Sittler
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco
| | - Kaahan Radia
- RISE Lab, Department of Electrical Engineering and Computer Science, University of California, Berkeley, Berkeley
| | - Henry Hsia
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
| | - Tomos Walters
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
| | - Byron Lee
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
| | - Joseph E. Gonzalez
- RISE Lab, Department of Electrical Engineering and Computer Science, University of California, Berkeley, Berkeley
| | - Geoffrey H. Tison
- RISE Lab, Department of Electrical Engineering and Computer Science, University of California, Berkeley, Berkeley
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco
- Cardiovascular Research Institute, San Francisco, California
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco
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Marcus GM, Vittinghoff E, Whitman IR, Joyce S, Yang V, Nah G, Gerstenfeld EP, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Gladstone R, Fan S, Lee E, Fang C, Ogomori K, Fatch R, Hahn JA. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events. Ann Intern Med 2021; 174:1503-1509. [PMID: 34461028 DOI: 10.7326/m21-0228] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients' self-reports suggest that acute alcohol consumption may trigger a discrete atrial fibrillation (AF) event. OBJECTIVE To objectively ascertain whether alcohol consumption heightens risk for an AF episode. DESIGN A prospective, case-crossover analysis. SETTING Ambulatory persons in their natural environments. PARTICIPANTS Consenting patients with paroxysmal AF. MEASUREMENTS Participants were fitted with a continuous electrocardiogram (ECG) monitor and an ankle-worn transdermal ethanol sensor for 4 weeks. Real-time documentation of each alcoholic drink consumed was self-recorded using a button on the ECG recording device. Fingerstick blood tests for phosphatidylethanol (PEth) were used to corroborate ascertainments of drinking events. RESULTS Of 100 participants (mean age, 64 years [SD, 15]; 79% male; 85% White), 56 had at least 1 episode of AF. Results of PEth testing correlated with the number of real-time recorded drinks and with events detected by the transdermal alcohol sensor. An AF episode was associated with 2-fold higher odds of 1 alcoholic drink (odds ratio [OR], 2.02 [95% CI, 1.38 to 3.17]) and greater than 3-fold higher odds of at least 2 drinks (OR, 3.58 [CI, 1.63 to 7.89]) in the preceding 4 hours. Episodes of AF were also associated with higher odds of peak blood alcohol concentration (OR, 1.38 [CI, 1.04 to 1.83] per 0.1% increase in blood alcohol concentration) and the total area under the curve of alcohol exposure (OR, 1.14 [CI, 1.06 to 1.22] per 4.7% increase in alcohol exposure) inferred from the transdermal ethanol sensor in the preceding 12 hours. LIMITATION Confounding by other time-varying exposures that may accompany alcohol consumption cannot be excluded, and the findings from the current study of patients with AF consuming alcohol may not apply to the general population. CONCLUSION Individual AF episodes were associated with higher odds of recent alcohol consumption, providing objective evidence that a modifiable behavior may influence the probability that a discrete AF event will occur. PRIMARY FUNDING SOURCE National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Gregory M Marcus
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Isaac R Whitman
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania (I.R.W.)
| | - Sean Joyce
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Vivian Yang
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Gregory Nah
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Edward P Gerstenfeld
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Joshua D Moss
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Randall J Lee
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Byron K Lee
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Zian H Tseng
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Vasanth Vedantham
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Jeffrey E Olgin
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Melvin M Scheinman
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Henry Hsia
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Rachel Gladstone
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Shannon Fan
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Emily Lee
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Christina Fang
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Kelsey Ogomori
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Robin Fatch
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
| | - Judith A Hahn
- University of California, San Francisco, San Francisco, California (G.M.M., E.V., S.J., V.Y., G.N., E.P.G., J.D.M., R.J.L., B.K.L., Z.H.T., V.V., J.E.O., M.M.S., H.H., R.G., S.F., E.L., C.F., K.O., R.F., J.A.H.)
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Beatty AL, Peyser ND, Butcher XE, Carton TW, Olgin JE, Pletcher MJ, Marcus GM. The COVID-19 Citizen Science Study: Protocol for a Longitudinal Digital Health Cohort Study. JMIR Res Protoc 2021; 10:e28169. [PMID: 34310336 PMCID: PMC8407439 DOI: 10.2196/28169] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 01/29/2023] Open
Abstract
Background The COVID-19 pandemic has catalyzed a global public response and innovation in clinical study methods. Objective The COVID-19 Citizen Science study was designed to generate knowledge about participant-reported COVID-19 symptoms, behaviors, and disease occurrence. Methods COVID-19 Citizen Science is a longitudinal cohort study launched on March 26, 2020, on the Eureka Research Platform. This study illustrates important advances in digital clinical studies, including entirely digital study participation, targeted recruitment strategies, electronic consent, recurrent and time-updated assessments, integration with smartphone-based measurements, analytics for recruitment and engagement, connection with partner studies, novel engagement strategies such as participant-proposed questions, and feedback in the form of real-time results to participants. Results As of February 2021, the study has enrolled over 50,000 participants. Study enrollment and participation are ongoing. Over the lifetime of the study, an average of 59% of participants have completed at least one survey in the past 4 weeks. Conclusions Insights about COVID-19 symptoms, behaviors, and disease occurrence can be drawn through digital clinical studies. Continued innovation in digital clinical study methods represents the future of clinical research. International Registered Report Identifier (IRRID) DERR1-10.2196/28169
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Affiliation(s)
- Alexis L Beatty
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Noah D Peyser
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Xochitl E Butcher
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas W Carton
- Louisiana Public Health Institute, New Orleans, LA, United States
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
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Voskoboinik A, Im SI, Higuchi S, Lee AC, Rahmutula D, Marcus GM, Olgin JE, Vittinghoff E, Bibby D, Abraham T, Gerstenfeld EP. B-AB04-02 FREQUENT PREMATURE ATRIAL CONTRACTIONS LEAD TO ADVERSE ATRIAL REMODELING AND ATRIAL FIBRILLATION IN A SWINE MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tung M, Vittinghoff E, Nah G, Rosenthal DG, Badhwar N, Dukes JW, Moss JD, Lee RJ, Lee B, Tseng ZH, Walters TE, Vedantham V, Gladstone RA, Mei-ling Fan S, Fang CD, Ogomori K, Lee E, Hue TF, Olgin JE, Scheinman MM, Ramchandani V, Hsia HH, Gerstenfeld EP, Marcus GM. B-PO02-152 ELECTROCARDIOGRAPHIC CHANGES IN A DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED TRIAL OF ETHANOL VERSUS PLACEBO. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheung CC, Lai M, Olgin JE, Pletcher M, Hue TF, Vittinghoff E, Lin F, Lee BK. B-PO04-154 TIME OF DAY OF VENTRICULAR TACHYARRHYTHMIAS AFTER MYOCARDIAL INFARCTION: RESULTS FROM THE VEST TRIAL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Semaan S, Dewland TA, Tison GH, Nah G, Vittinghoff E, Pletcher MJ, Olgin JE, Marcus GM. Physical activity and atrial fibrillation: Data from wearable fitness trackers. Heart Rhythm 2021; 17:842-846. [PMID: 32354448 DOI: 10.1016/j.hrthm.2020.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regular physical activity is an important determinant of cardiovascular health and quality of life. Previous investigations examining the association between exercise and atrial fibrillation (AF) have been limited by self-reported, retrospectively collected activity data. OBJECTIVE The purpose of this study was to objectively quantify differences in daily physical activity among individuals with and those without AF using electronic wearable activity trackers. METHODS Daily exercise data were directly obtained from wrist-worn activity trackers (Fitbit, San Francisco, CA) among participants in the Health eHeart (HeH) study. Average daily step count was compared between individuals with and those without AF both before and after adjusting for comorbidities. AF severity was quantified using the Atrial Fibrillation Effect on QualiTy of Life (AFEQT) survey. RESULTS Among 171,284 HeH study participants, 3333 individuals (234 with AF [7%]) submitted activity data. In unadjusted analysis, AF participants ambulated an average of 723 fewer steps per day (95% confidence interval [CI] 292-1154; P = .001) compared to individuals without AF. After adjustment for demographics and comorbid diseases, participants with AF demonstrated 591 fewer steps per day (95% CI 149-1033; P = .009). Among AF patients, AF severity was associated with less physical activity. For each single point decrease in AFEQT score (corresponding to more symptomatic AF), physical activity decreased by a mean 24 steps per day (95% CI 1-46; P = .04). CONCLUSION Objective, automatically collected step count data demonstrate that individuals with AF engage in significantly less average daily physical activity. In addition, worsening AF symptom severity is associated with reduced daily exercise.
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Affiliation(s)
- Sarah Semaan
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Geoffrey H Tison
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Gregory Nah
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Gregory M Marcus
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California.
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Marcus GM, Olgin JE, Peyser ND, Vittinghoff E, Yang V, Joyce S, Avram R, Tison GH, Wen D, Butcher X, Eitel H, Pletcher MJ. Predictors of incident viral symptoms ascertained in the era of COVID-19. PLoS One 2021; 16:e0253120. [PMID: 34138915 PMCID: PMC8211176 DOI: 10.1371/journal.pone.0253120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background In the absence of universal testing, effective therapies, or vaccines, identifying risk factors for viral infection, particularly readily modifiable exposures and behaviors, is required to identify effective strategies against viral infection and transmission. Methods We conducted a world-wide mobile application-based prospective cohort study available to English speaking adults with a smartphone. We collected self-reported characteristics, exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was incident symptoms of viral infection, defined as fevers and chills plus one other symptom previously shown to occur with SARS-CoV-2 infection, determined by daily surveys. Findings Among 14, 335 participants residing in all 50 US states and 93 different countries followed for a median 21 days (IQR 10–26 days), 424 (3%) developed incident viral symptoms. In pooled multivariable logistic regression models, female biological sex (odds ratio [OR] 1.75, 95% CI 1.39–2.20, p<0.001), anemia (OR 1.45, 95% CI 1.16–1.81, p = 0.001), hypertension (OR 1.35, 95% CI 1.08–1.68, p = 0.007), cigarette smoking in the last 30 days (OR 1.86, 95% CI 1.35–2.55, p<0.001), any viral symptoms among household members 6–12 days prior (OR 2.06, 95% CI 1.67–2.55, p<0.001), and the maximum number of individuals the participant interacted with within 6 feet in the past 6–12 days (OR 1.15, 95% CI 1.06–1.25, p<0.001) were each associated with a higher risk of developing viral symptoms. Conversely, a higher subjective social status (OR 0.87, 95% CI 0.83–0.93, p<0.001), at least weekly exercise (OR 0.57, 95% CI 0.47–0.70, p<0.001), and sanitizing one’s phone (OR 0.79, 95% CI 0.63–0.99, p = 0.037) were each associated with a lower risk of developing viral symptoms. Interpretation While several immutable characteristics were associated with the risk of developing viral symptoms, multiple immediately modifiable exposures and habits that influence risk were also observed, potentially identifying readily accessible strategies to mitigate risk in the COVID-19 era.
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Affiliation(s)
- Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Noah D. Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Eric Vittinghoff
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Vivian Yang
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Sean Joyce
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - David Wen
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Xochitl Butcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Helena Eitel
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
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