tbuckley/cabot-search huggingface dataset:
Abstract 14670: A Meta-analysis of Survival Outcomes Between Two Uncommon Mechanical Circulatory Support Device Combinations
Authors: Kaushik Amancherla, Jay Patel, Tara Holder, Jared O'Leary
Journal: Circulation (2020)

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella devices are being used in increasing frequency for cardiogenic shock. Left ventricular unloading strategies are often used in VA-ECMO. The combination of simultaneous left- and right-sided Impellas, colloquially called “BIPELLA”, also offers biventricular support. There is a paucity of data regarding these combinations of platforms. We performed a systematic review of the literature to assess clinical outcomes in patients treated with ECPELLA and BIPELLA for cardiogenic shock. Methods: A systematic search of PubMed using the terms “ECMO”, “ECPELLA”, “BIPELLA”, and “Impella” was performed. Included studies evaluated mortality and complications associated with use of ECPELLA and/or BiPELLA. Reference lists of eligible studies helped identify additional publications meeting inclusion criteria. Case reports and conference abstracts were excluded. Heterogeneity among eligible studies was assessed using the I2 statistic. Publication bias was assessed using Egger’s regression and visual inspection of funnel plots. The primary outcome was in-hospital or 30-day mortality. Secondary outcomes assessed complications. Results: The results of publication bias assessment are provided in Figure 1A. Egger’s test was not significant (p = 0.56). A total of 139 patients underwent ECPELLA implantation and 20 underwent BIPELLA implantation. Mortality for the overall cohort was 51% with no significant difference between groups (p = 0.93) (Figure 1B). There was no significant difference between the groups with bleeding (p = 0.74), hemolysis (p = 0.34), and limb ischemia (p = 0.58). Conclusion: These data suggest no differences in short-term mortality and certain complications between ECPELLA and BIPELLA strategies. However, the available literature is sparse, with small sample sizes and suffers from a paucity of significant hemodynamic data. Further prospective data are needed.
Abstract 13790: Area Deprivation Index and Cardiac Readmissions: Evaluating Risk-prediction in an Electronic Health Record
Authors: Amber E Johnson, Jianhui Zhu, William Garrard, Floyd W Thoma, Suresh R Mulukutla, Kiarri N Kershaw, Jared W Magnani
Journal: Circulation (2020)

Introduction: Social determinants of health (SDOH) affect cardiovascular outcomes. Our objective was to examine the association between neighborhood-level SDOH, and risk of readmission and mortality for atrial fibrillation (AF), heart failure, (HF) and myocardial ischemia (MI). Hypothesis: We hypothesized that neighborhood-level SDOH 1) is associated with readmission and death, 2) would significantly contribute to risk-prediction. Methods: We conducted a retrospective analysis from a regional health center to test the predictive ability of the area deprivation index (ADI) on 30-day and one-year readmission and mortality among patients admitted to hospital. Covariates included age, sex, race, comorbidity, number of medications, length of stay, and insurance. We used Cox proportional hazards and log rank analyses. To evaluate the discriminative power of the prediction models, we used the C-statistic and net reclassification methods after adding ADI into the model. Results: Our cohort of 31,633 adult patients followed was for 49.88 months (interquartile range 47.99). The cohort was 51.4% male and 90.6% white. Almost half (15,543, 49.1%) lived in neighborhoods in the two highest (worst) ADI quintiles. Patients living in areas with highest ADI were 28% less likely to be admitted within one year of index AF admission (HR=0.72, 95% CI [0.59, 0.87]). Patients in the highest ADI quintile were 30% more likely to be admitted within one year of index HF admission (HR=1.30, 95%CI [1.11, 1.52]). For MI, patients in the highest ADI quintile had a one-year risk for readmission that was twice that of those in the lowest quintile (HR=2.08, 95%CI [1.53, 2.81]). As ADI increased, risk of cardiac readmission and all-cause readmission increased at 30 days and one year. Reclassification of readmission risk was significantly improved when including ADI in the models. Patients in the highest ADI quintile were 46% more likely to die within 30 days when compared with those in the lowest quintile (HR=1.46, 95% CI [1.04, 2.06]) and 26% more likely to die within a year (HR=1.26 [1.10, 1.43]). Conclusions: Residence in disadvantaged communities predicts rehospitalization and mortality. ADI can be used to identify vulnerable cardiac patients after discharge.
Abstract 14160: Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: Comparison of Early, Intermediate and Late Onset Cases
Authors: Simrat Kaur, Gursharan Samra, Manpreet Kaur, Nabin Shrestha, Steven Gordon, Samir R Kapadia, Amar Krishnaswamy, Grant W Reed, Rishi Puri, Lars G Svensson, Wael A Jaber, Brian P Griffin, Bo Xu
Journal: Circulation (2020)

Introduction: Transcatheter aortic valve replacement associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate versus late onset TAVR-IE. Methods: We studied the risk factors, microbiological patterns, diagnostic and treatment strategies in patients with early (&lt;60 days), intermediate (60-365 days) and late onset (&gt;1 year) TAVR-IE. Results: Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019, were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. Most (90%) TAVR procedures were performed via transfemoral route, and one underwent transapical TAVR. Baseline comorbidities were common, with mean BMI 33.1 ± 5.5 kg/m2, diabetes and hypertension in 60% and chronic kidney disease in 50% of cases. Mean STS risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). Diagnostic modalities and complications are described in Table 1. Two cases had early onset TAVR-IE, one of which was due to Pseudomonas aeruginosa, and underwent successful surgical treatment. Late onset TAVR-IE was observed in 20% of cases. 18-fluorodeoxyglucose positron emission tomography (18-FDG-PET) aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow up of 709 ± 453 days. Two patients underwent surgery, of whom one died day 30 post-operatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate onset groups, while there was 100% mortality in the late onset group. Conclusions: In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Late onset TAVR-IE was associated with higher mortality at follow-up.
Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center
Authors: Patrick M Hyland, Jiaman Xu, Changyu Shen, Lawrence Markson, Warren J Manning, Jordan B Strom
Journal: Circulation (2020)

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with &lt; 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p &lt; 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p &gt; 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.
Abstract 14918: Mitral Valve Replacement With a Melody™ Valve Improves Survival for Young Children Compared to Mechanical Mitral Valve Replacement - A Case-Matched Control Study
Authors: Devin Chetan, Adrienn Szabo, Steve Fan, Conall Morgan, olivier villemain, Rajiv Chaturvedi, Lee Benson, Osami Honjo
Journal: Circulation (2020)

Introduction: Melody™ valve in the mitral position has been described for use in infants. Hypothesis: Melody™ valve (Medtronic) in the mitral position would improve survival compared to mechanical mitral valves for young children. Methods: Charts were retrospectively reviewed for children who had undergone a Melody™ valve insertion (MEL) between 2014 and 2020. MEL were case-matched by age and weight to those with a mechanical mitral valve (MECH). We compared transplant free survival and cumulative incidence of re-intervention. A sub-analysis was performed for children &lt;1 year of age (8 MEL patients and their matches). Data are presented as median (interquartile range) or frequency (percentage). Results: Eleven children underwent Melody™ mitral valve replacement (MVR) over the study period. Age was 157 (104-402) days and weight 5.0 (4.2-7.4) kg. Indications for MVR were insufficiency in 6 (55%), stenosis in 3 (27%), and mixed disease in 2 (18%). MEL underwent a total of 13 repairs and 4 replacements (2 mechanical, 2 bioprosthetic) prior to Melody™ valve replacement. Final valve dilation size was 18 (15.5-18.5)mm. Two (18%) children salvaged from ECMO before MEL subsequently died. Three (33%) of the 9 survivors have required subsequent MVR at 9, 17, and 23 months; 1 for severe insufficiency, and 2 for severe mixed disease. The MECH cohort was not different in age, weight, valve size, bypass or cross-clamp times, indications for replacement, or number of prior repairs or replacements (p&gt;0.10). At 1 and 3 years, transplant free survival (MEL: 80%, 80%; MECH: 82%, 64%; p=0.180) and re-intervention (MEL: 11%, 39%; MECH: 0%, 20% p=0.32) were equivalent between groups. For children &lt;1 year of age, survival was higher in MEL (Figure; p=0.046) but rate of re-intervention remained equivalent (MEL: 17%, 34%; MECH: 0%, 29%; p=0.56). Conclusions: Melody™ MVR represents a better surgical strategy for infants less than 1 year of age requiring mitral valve replacement.
Abstract 14205: Aortic Vorticity, Helicity and Aortopathy in Adult Patients With Tetralogy of Fallot: Preliminary Study Using Four-dimensional Flow Magnetic Resonance Images
Authors: Yumi Shiina, Kei Inai, Michinobu Nagao
Journal: Circulation (2020)

Introduction and hypothesis: Flow hemodynamic parameters may relate to aortopathy in adults with tetralogy of Fallot. We aimed to employ quantitative analysis in the vorticity and helicity of the aortic root and the ascending aorta (AAo) in adults with tetralogy of Fallot (TOF), and to evaluate aortopathy and the relevant factors. Methods: Prospectively, 51 consecutive adults with TOF underwent 4 dimensional flow magnetic resonance imaging study for the assessment of vorticity and helicity of in the aortic root and AAo, wall shear stress (WSS), viscous energy loss (EL), and the left ventricular outflow tract - aortic root (LVOT-Ao) angle. Patients were divided into the two groups: dilated aortic root and/or AAo (indexed dimeter&gt;25mm/cm2), Group A (15 patients); non-dilated aortic patients, Group B (36 patients). Ten age matched controls were also enrolled. Results: Group A showed acute LVOT-Ao angle, higher incidence of aortic regurgitation, and initial anatomy of pulmonary atresia, compared to Group B (P&lt;0.0001, 0.02, 0.043). Group A showed greater vorticity at the level of Valsalva, AAo, and proximal arch, helicity, WSS, and EL than in Group B (P&lt;0.001, &lt;0.001, 0.049, 0.02, 0.026). Acute LVOT-Ao angle correlated with the diameter of the aortic root and AAo, vorticity, helicity, WSS, and EL (P=0.004, 0.023, 0.045, 0.004, 0.0004, 0.017). On a univariate logistic analysis, age, acute LVOT-Ao angle, AAo vorticity, AAo helicity, and maximum WSS were relevant factors of AAo dilatation (P=0.03, 0.02, 0.004, 0.03, 0.046). On a multivariate analysis, LVOT-Ao angle was the most important factor of AAo dilatation (odds ratio 0.66, 95%CI 0.46-0.95, P&lt;0.024). Conclusions: TOF Adults with TOF presenting dilated AAo have greater vorticity, helicity, and acute LVOT-Ao angle. Flow eccentricity correlates with vorticity and helicity, which may affect the aortopathy in adults with TOF. AAo vorticity and helicity are also relevant factors of aortic dilatation, and these flow hemodynamic parameters may be adjunctive predictions of aortopathy in this population.
Abstract 15440: Bleeding Complications May Outweigh the Risk of Thrombosis in Patients With End-stage Liver Disease Taking Dual Antiplatelet Therapy After Percutaneous Coronary Intervention
Authors: Sami J Natour, May Myint Thanda Kyaw, Ronald W Busuttil, Jonathan M Tobis, Henry M Honda
Journal: Circulation (2020)

Introduction: Randomized trials have demonstrated the safety and efficacy of one month of dual antiplatelet therapy (DAPT) after placement of drug-eluting stents in patients with high bleeding risk. Patients with end-stage liver disease (ESLD) are underrepresented in these trials. Patients who undergo percutaneous coronary intervention (PCI) in preparation for orthotopic liver transplantation (OLT) exhibit a high incidence of bleeding complications on DAPT. The rates of bleeding versus thrombotic complications in ESLD patients placed on DAPT following PCI are poorly described. Methods: We retrospectively collected data from 61 patients who were evaluated for OLT between 2016 and 2019 and underwent PCI prior to listing. Bleeding events were classified using the Bleeding Academic Research Consortium (BARC) definitions and included if the following criteria were met: events occurred in the setting of DAPT, were non-procedural in etiology, and occurred during the time following PCI and prior to OLT. Ischemic complications were evaluated by the incidence of myocardial infarction (MI), stent thrombosis, in-stent restenosis (&gt;50%) and all-cause mortality at 1 year follow-up. Results: A total of 55/61 patients (90%) were placed on DAPT following PCI. Among them, 21/55 patients (38%) bled while taking DAPT, including 15 patients (27%) with BARC types 3-5 first-time bleeding events and 10 patients (18%) requiring early discontinuation of therapy. The median time to first bleeding event was 8 days (range 1 to 477 days, 85 th percentile 17 days). Among ischemic complications, MI occurred in 11/55 patients (20%) however only one patient had a type 1 MI with the remaining being type 2 in etiology. There were no episodes of stent thrombosis and 2 episodes of in-stent restenosis during the 1 year follow-up. A total of 12/55 patients (22%) went on to receive OLT and 18/55 (33%) passed away by 1 year post-PCI. Conclusions: Patients with ESLD exhibit a high rate of clinically significant bleeding on DAPT when compared to overall thrombotic events. The majority of bleeds occurred within the first month after PCI. These findings illustrate the need for larger studies to assess the safety of single instead of dual antiplatelet therapy in patients with ESLD who receive PCI.
Abstract 13913: Single Dose Safety, Pharmacokinetics, and Pharmacodynamics of a Potent PCSK9 Synthesis Inhibitor, AZD8233, in Subjects With Elevated Ldl Cholesterol
Authors: Catarina Nilsson, Brett P Monia, Kristina Ryden-Bergsten, Dinko Rekic, Eva Hurt-Camejo, Sanjay Bhanot, Sotirios Tsimikas, Richard Geary, Alexis Hofherr, Rosanne M Crooke, jane knöchel, Linda Wernevik, Cecilia Arfvidsson, Rikard Isaksson, Bjorn Carlsson, David Han, scott henry
Journal: Circulation (2020)

Background: AZD8233 is a chemically modified 16-mer antisense oligonucleotide linked to N-acetyl galactosamine (GalNAc) for efficient targeting of PCSK9 mRNA in hepatocytes to prevent the synthesis of PCSK9. We are reporting preliminary data from the first in human study. The aim with the study was to evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of single doses of AZD8233 in subjects with LDL-C ≥100 mg/dL. Methods: This was a randomized, single-blind, placebo-controlled; single ascending dose study (NCT03593785) of AZD8233 administered subcutaneously (SC) to 56 subjects enrolled in 7 cohorts (6 on active and 2 on placebo in each cohort). Doses studied ranged from 4 to 120 mg. Serial blood samples were collected to assess PK, PCSK9 and LDL-C profiles after administration of AZD8233. PK parameters were calculated using non-compartmental methods. Results: After SC administration, AZD8233 was generally well tolerated, no clinically relevant safety and tolerability findings were observed and no serious adverse events were reported. Peak plasma concentrations were achieved within 1 to 3 hours after dosing. After peaking, plasma concentrations declined biphasically with a terminal half-life of 2 to 3 weeks. A dose dependent decrease in plasma levels of PCSK9 and LDL-C was observed. The largest mean percent reductions from baseline were &gt;90 % for PCSK9 and 70% for LDL-C. PCSK9 and LDL-C levels slowly returned to baseline or close to baseline levels over the 16 weeks post dose follow up period. Conclusions: The safety, PK and PD support further evaluation of AZD8233 in multiple ascending dose studies. The PD data indicate that a high level of PCSK9 and LDL-C reduction can be maintained over a dose interval of once monthly or less frequent at a dose below 100mg.
First Data from the Phase 3 HOPE-B Gene Therapy Trial: Efficacy and Safety of Etranacogene Dezaparvovec (AAV5-Padua hFIX variant; AMT-061) in Adults with Severe or Moderate-Severe Hemophilia B Treated Irrespective of Pre-Existing Anti-Capsid Neutralizing Antibodies
Authors: Steven W. Pipe, Michael Recht, Nigel S. Key, Frank W.G. Leebeek, Giancarlo Castaman, Susan U. Lattimore, Paul Van Der Valk, Kathelijne Peerlinck, Michiel Coppens, Niamh O'Connell, John Pasi, Peter Kampmann, Karina Meijer, Annette von Drygalski, Guy Young, Cedric Hermans, Jan Astermark, Robert Klamroth, Richard S. Lemons, Nathan Visweshwar, Shelley Crary, Rashid Kazmi, Emily Symington, Miguel A. Escobar, Esteban Gomez, Rebecca Kruse-Jarres, Adam Kotowski, Doris Quon, Michael Wang, Allison P. Wheeler, Eileen K Sawyer, Stephanie Verweij, Valerie Colletta, Naghmana Bajma, Robert Gut, Wolfgang A. Miesbach
Journal: Blood (2020)
Abstract 19050: Racial Differences in Patient Characteristics and Oral Anticoagulation Use at Discharge Among Patients With Atrial Fibrillation
Authors: Kevin L Thomas, Roberta A James, Victoria Marcsisin, Shah R Bimal, Gregory J Fermann, Susan M Mashni, Michael B Streiff, Elaine M Hylek, Christopher B Granger
Journal: Circulation (2017)

Background: Despite a lower prevalence of AF, black patients with AF are at an increased risk of stroke compared with white patients. Objective: To assess for racial differences in patient characte...
Risk Marker Fatigue—Is There an Actionable Outcome?
Authors: Sanjiv J. Shah
Journal: JAMA Cardiology (2020)

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Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial
Authors: Isla S Mackenzie, Ian Ford, George Nuki, Jesper Hallas, Christopher J Hawkey, John Webster, Stuart H Ralston, Matthew Walters, Michele Robertson, Raffaele De Caterina, Evelyn Findlay, Fernando Perez-Ruiz, John J V McMurray, Thomas M MacDonald, J. Aziz, G. Dobson, A.S.F. Doney, R.W.V. Flynn, J. Furnace, J.W.K. Grieve, G. Guthrie, D. Jamieson, C.G. Jennings, S. Kean, L.C. Lund, A. McConnachie, F. Pigazzani, P.L. Riches, M. Rix Hanson, A Rogers, E.D.M. Rooke, J. Thomson, M. Warren, K. Wetherall, R. Wilson, C.P. Hall, A. Maseri, H.A. Bird, G. Murray, J.W. Dear, M. Petrie, M. MacDonald, P.S. Jhund, E. Connolly, D.J. Murphy, N. Paul, A. Olsson, P.T. Koskinen, A. Fuat, A. Foster, W. Saywood, R.J. Barr, L. McConnachie, L.F. Wilson, L. Larsen Rasmussen, A.R. McGinnis, H. Birrell, M. Keiller, I.S. Bremner, G.J. Forbes, J.S. Dumbleton, J. Rhodes, T. Waller
Journal: The Lancet (2020)