tbuckley/cabot-search huggingface dataset:
Abstract 10273: The Use of Direct Oral Anticoagulation Therapy in Transcatheter Aortic Valve Implantation in Patients with Concurrent Indications for Anticoagulation; A Systematic Review and Meta-Analysis
Authors: Mahmoud El Iskandarani, Ahmad Al Tamari, Muhammad Khalid, Timir K Paul
Journal: Circulation (2021)

Introduction: The optimal antithrombotic regimen in patients after transcatheter aortic valve implantation (TAVI) in the setting of concurrent indication for anticoagulation remains unclear. Recently multiple studies have investigated the role of direct oral anticoagulation therapy (DOAC) in comparison to Vitamin K antagonist (VKA) in this category of patients. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of this approach Hypothesis: DOAC is a safe and effective alternative anticoagulation therapy in TAVI patients Methods: Unrestricted search of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2021, for studies comparing DOAC with VKA in TAVR patients with concurrent indication for anticoagulation. Relevant data were extracted and analyzed using Revman 5.3 software. Relative Risk (RR) and 95% Confidence interval (CI) were calculated using the random-effects model. Results: A total of 8 studies (7 Observational, and 1 Randomized clinical trial) were included examining 4,158 TAVI patients (1,500 DOAC vs 2,658 VKA). There was no difference between DOAC and VKA in terms of all-cause mortality RR 0.89 (95% CI 0.65-1.21), all-bleeding events RR 0.90 (95% CI 0.76-1.07), and stroke risk RR 1.42 (95% CI 0.96-2.11). Conclusions: DOAC is probably non-inferior to VKA in TAVI patients with concurrent indications for anticoagulation therapy. Further studies are needed to validate our findings.
Abstract 11977: Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmia
Authors: Ido Goldenberg, Mehmet Aktas, Wojciech Zareba, Arwa Younis, Valentina Kutyifa
Journal: Circulation (2021)

Introduction: Cardiac Resynchronization Therapy (CRT) was shown to be associated with clinically significant benefit by lowering mortality, heart failure hospitalizations, and improving quality of life in patients with reduced left ventricular function and a wide QRS. However, there are conflicting data on the effect of CRT on the risk of ventricular tachycardia or ventricular fibrillation (VT/VF) in implantable cardioverter defibrillator (ICD) recipients. Methods: The study population comprised 4531 patients enrolled in the 5 landmark ICD trials (MADIT-II, MADIT-CRT, MADIT-RIT, MADIT-RISK, and RAID) implanted with an ICD. Three patient groups were generated: ICD with a narrow QRS complex (n=2208), ICD alone with a wide QRS (n=1105), and patients with both ICD and a CRT (CRT-D) (n=2198). We compared the cumulative incidence of VT/VF in each group while accounting for the competing risk of non-arrhythmic mortality using the Fine and Gray Method. Results: Recipients of a CRT-D were more likely to be female, to use a beta blocker, and have a higher New York Heart Association Functional Class. The cumulative incidence of VT/VF at 4 years of follow-up in patients with a CRT-D was significantly lower (24%) as compared with patients with an ICD with or without a wide QRS (31% for both; p&lt;0.001 for the overall difference). Findings were consistent for the endpoints of appropriate ICD shocks and fast VT/VF (&gt;200 bpm). Multivariate analysis showed that compared to ICD-only therapy (with wide QRS), treatment with CRT-D was associated with a significant 20% (p=0.006), in the endpoint of VT/VF and 36% reduction in the endpoint of appropriate shock for VT/VF (p&lt;0.001). Conclusion: Our data from 5 landmark clinical trials suggest that cardiac resynchronization therapy exerts important antiarrhythmic properties, leading to a significant reduction in the risk of ventricular tachyarrhythmia and appropriate ICD shocks in patients implanted with an ICD for primary prevention.
Abstract 11775: Association of Hypertension With Mortality in Patients Hospitalised With COVID-19
Authors: Kunwardeep S Bhatia, Hari P Sritharan, Jonathan Ciofani, Usaid Allahwala, Karina Chui, Daniel Nour, Sheran Vasanthakumar, Dhanvee Kandadai, Rohan Bhagwandeen, David Brieger, Christopher Choong, Anthony Delaney, Girish Dwivedi, Benjamin Harris, Graham Hillis, Bernard Hudson, George Javorsky, Nigel Jepson, Logan Kanagaratnam, George Kotsiou, Astin Lee, Sidney Lo, Andrew I Macisaac, Brendan McQuillan, Isuru Ranasinghe, Tony Walton, James Weaver, William Wilson, Andy Yong, John Zhu, William van Gaal, Leonard Kritharides, Clara K Chow, Ravinay Bhindi
Journal: Circulation (2021)

Introduction: To assess whether hypertension is an independent risk factor for mortality amongst patients hospitalised with COVID-19 and to evaluate the impact of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on mortality in patients with a background of hypertension. Methods: This observational cohort study included all consecutive index hospitalisations with laboratory proven COVID-19 aged 18 years or older across 21 Australian hospitals entered in the AUS-COVID Registry by 22nd January 2021. Patients were excluded if their past medical or medication history was not available or if they were transferred to another hospital in which case mortality outcomes were not available. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs. Results: 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (aOR 1.09, 95% CI 1.07-1.12, p&lt;.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13-6.53, p=.026), chronic kidney disease (aOR 2.33, 95% CI 1.02-5.32, p=.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06-4.85, p=.035) (Figure 1). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48-1.77, p=.81). Amongst patients with hypertension, ACE inhibitors (aOR 1.37, 95% CI 0.61-3.08, p=.61) and ARBs (aOR 0.64, 95% CI 0.27-1.49, p=.30) did not affect mortality. Conclusions: In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.
INNV-21. COMPLETE RESPONSE TO ADJUVANT TEPOTINIB IN A PATIENT WITH NEWLY DIAGNOSED DISSEMINATED GLIOBLASTOMA (GBM) HARBORING MET AMPLIFICATION
Authors: Lily Pham, Claudia Gann, Karl Maria Schumacher, Soetkin Vlassak, Todd Swanson, Kaitlyn Highsmith, Alexander Ou, Nathan Clarke, Ashley Aaroe, Lindsay Robell, Barbara O'Brien, Sebnem Nash, John DeGroot, Nazanin Majd
Journal: Neuro-Oncology (2021)

Abstract MET oncogene encodes a receptor-tyrosine-kinase which drives cell proliferation, invasion and angiogenesis in a number of solid cancers including GBM where the incidence of MET amplification is 2-5%. Tepotinib is a highly selective blood-brain-barrier penetrant oral c-MET inhibitor recently FDA approved for MET-exon-14 altered non-small cell lung cancer (NSCLC). Here, we report complete radiographic response to tepotinib in a patient with newly-diagnosed disseminated GBM harboring MET amplification. A 29-years-old male presented with progressive headache. MRI brain showed a large heterogeneously enhancing intraventricular mass with epicenter in the right lateral ventricular trigone and enhancing nodules in bilateral cerebellum. MRI spine showed multifocal enhancement along the periphery of the cervicothoracic spinal cord and cauda equina concerning for leptomeningeal disease. He underwent right temporal lobectomy and subtotal resection of the mass. His KPS was 90 post-surgery due to dizziness. Pathology was consistent with GBM, IDH wild-type, MGMT-unmethylated and MET amplification at 7q31.2. He completed proton craniospinal irradiation at 3600cGy followed by boost to the tumor bed at 2400cGy without concurrent temozolomide (TMZ) due to the large radiation field. He completed two cycles of adjuvant TMZ which was put on hold due to myelosuppression. He subsequently started tepotinib monotherapy at 1000mg daily obtained on a compassionate IND. MRIs after one month of therapy showed resolution of areas of enhancement in the brain and spine. He had grade 1 creatinine elevation and abdominal discomfort and dose was reduced to 500mg daily after two cycles. Nineteen weeks after initiation of tepotinib, his complete response persists, and he remains clinically stable with mild chronic dizziness. Trials of targeted therapy in molecularly-unselected GBM have been largely disappointing, however, this case demonstrates the promise of targeting MET using tepotinib in GBM. A clinical trial of tepotinib in MET-amplified GBM and NSCLC brain metastasis is currently underway at MD Anderson.
Abstract 13362: Patient-centered Assessment Of Risk Of Stroke Vs. Bleeding In Patients With Atrial Fibrillation
Authors: Davit Sargsyan, Yajie Duan, William J Kostis, Cande Ananth, John B Kostis, Javier Cabrera
Journal: Circulation (2021)

Introduction: Clinicians use CHA 2 DS 2 -VASc to predict stroke at one year and HAS-BLED to predict bleeding at one year in patients with atrial fibrillation. However, the scores do not consider the fear of the two outcomes in the individual patient. Hypothesis: A new algorithm predicting the relative risk of stroke versus bleeding at one year implemented as a web application will classify individual patients with high degree of precision. Methods: Using the Myocardial Infarction Data Acquisition System (MIDAS) database, we developed an algorithm that considers the preferences of each individual patient as estimated from data from history in predicting the risk of bleeding or stroke from CHA 2 DS 2 -VASc and HAS-BLED. Given the patient demographics and comorbidities, the confidence intervals of predicted risks of the outcomes were first obtained by fitting a multinomial regression model. The estimates were fed into a Deming regression model to correlate the risks of the outcomes in subgroups of patients with similar risk factors. The line of best fit between the two outcomes represented the objective relationship between the outcomes. Each patient would state their fears of the outcomes on a 0 to 100 scale and adding up to 100, e.g. 20 vs. 80 for fear of stroke vs. fear of bleeding respectively. A prediction region around the line of best fit was then calculated based on the patient’s fears. Results: Based on the predicted risks of stroke and bleeding and the patient’s fears of bleeding, the algorithm produces a graph with two regions corresponding to whether the patient should be treated with anticoagulants. Thus, patients who feared stroke more than bleeding would be more likely to receive anticoagulation compared to a decision based on objective data. Conclusions: The algorithm shown in the figure and implemented as a web application helps clinicians make decisions on whether to prescribe anticoagulants or not based on objective data modified by individual patient preferences.
Abstract 9753: Use of Dobutamine in Supraventricular Tachycardia Ablations is Associated with Similar Occurrence of Repeat Ablations as Compared to Isoproterenol
Authors: Parmanand Dasrat, Bruce Goldner
Journal: Circulation (2021)

Introduction: Arrhythmia induction during an ablation is most commonly achieved with isoproterenol. However, isoproterenol has become more expensive and its side effect profile is not benign (particularly hypotension at high doses). Dobutamine is a predominantly beta-1 agonist that is being used more often in ablations given its cost benefit and lower risk of hypotension. Hypothesis: It has previously been shown that high-dose dobutamine is similar to high-dose isoproterenol in terms of induction of atrial fibrillation and incidence of complications. Given this similar efficacy, it is hypothesized that the occurrence of repeat ablation will be similar among patients who undergo an ablation with dobutamine vs. isoproterenol. Methods: A retrospective analysis of medical records, particularly ablation reports, was performed on 1,172 patients who underwent supraventricular tachycardia (SVT) ablations at North Shore University Hospital from 2006 to 2019. This included 969 patients who had ablations using isoproterenol and 203 patients who had ablations using dobutamine. Each outpatient record was examined for any instances of a repeat ablation having been performed, as well as for any procedural complications. Dobutamine was first used in an ablation in this study population beginning in 2015. Results: Among the 969 patients who underwent SVT ablations using isoproterenol (mean age at time of ablation 54 years, 37% female, 94% atrial fibrillation), 11% had a repeat ablation (103 cases). Among the 203 patients who underwent SVT ablations using dobutamine (mean age at time of ablation 58 years, 33% female, 97% atrial fibrillation), 8% had a repeat ablation (16 cases). Statistically significant difference was not observed between the two groups (p = 0.31). The need for more than one repeat ablation was minimal, 1% in each group. There was only one complication observed - hypotension in an isoproterenol case. Conclusions: In conclusion, there was a similar occurrence of repeat ablations among patients who underwent procedures using isoproterenol vs. dobutamine. Given that dobutamine is becoming more commonly used in ablations, this analysis demonstrates that doing so is not associated with a higher need for repeat ablation or a greater risk of complications.
Abstract 10568: The Impact of Gender: Rates of Significant Coronary Artery Disease in Women and Men Undergoing Non-Invasive and Invasive Ischemic Evaluation for Acute Coronary Syndromes
Authors: Jesse Kane, Jeanwoo Yoo, Eyal Menashe, Jessica Hotelling, Puja Parikh, William E Lawson
Journal: Circulation (2021)

Introduction: Key differences in the presentation and pathophysiology of cardiovascular disease (CVD) between men and women exacerbate diagnostic challenges when evaluating patients with acute coronary syndromes (ACS). Hypothesis: We aimed to better understand the impact of gender on diagnostic approaches and findings in similar cohorts of men and women who presented to rule out ACS and were evaluated with non-invasive cardiac imaging (NI) including Computed Tomography Coronary Angiography (CTCA) or Nuclear Stress Test (NST) prior to coronary angiography (CA). Methods: We performed a retrospective chart review to evaluate all patients referred to our catheterization laboratory for ACS over 1 year. Patients with a history of CVD, end stage renal disease or who underwent CA without NI were excluded. Statistical analysis was performed with Paired-T and Mann Whitney U Testing, and CHI-Square analysis. Results: 150 patients (45 women and 105 men) met our study criteria. There were no significant differences between men and women in age, BMI, GFR, Troponin, BNP, rates of hypertension, diabetes mellitus, hyperlipidemia, obesity, smoking history or utilization of aspirin, or statins. Grace Scores and Diamond Forrester Risk were similar. Women were less likely than men to have significant coronary disease on CA (M:66% W:34% p=0.00) or require intervention (M:73% W:34% p=0.00). There were no significant differences in rates of reported coronary disease on NI testing (M:53%, W:55% p=0.81), however, rates of artifact in NI testing were significantly higher in women (M:26% W:55% p=0.00). Women were significantly more likely to undergo NST rather than CTCA (M:22%, W:45% p=0.00). Conclusions: Our study found that women were far less likely to have significant coronary disease on CA after a NI workup, were more likely to have NI studies with reported artifact and were more likely to undergo NST than CTCA. We highlight differences between genders in significant CAD and need for intervention that may be related to higher rates artifact in NI results in women. Furthermore, we demonstrate the correlation with gender and physician decision making when selecting NI imaging, a finding which warrants further study.
Abstract 11676: Do Heart Failure Admission Rates Change Around Holidays? The Atherosclerosis Risk in Communities (ARIC) Study
Authors: David T Saxon, Hannan Yang, Quefeng Li, Matthew S Loop, Stuart D Russell, Joseph Rossi, Richard Stacey, Patricia Chang
Journal: Circulation (2021)

Introduction: Heart failure (HF) exacerbations are often precipitated by dietary noncompliance, which is common around holidays. We examined whether HF hospitalizations would increase after major national holidays. Methods: The ARIC Study performed surveillance of HF admissions among patients age ≥55 years in 4 US communities from 2005-2014. HF admissions were identified by ICD-9 codes and validated by physician review. For each holiday (H), 4 days before the holiday (H-4 to H-1), and 4 days after the holiday (H+1 to H+4), we compared average daily HF admission rates, hospital length of stay (LOS), 28-day mortality, and 1-year mortality to the remaining days in each holiday’s month using Poisson regression using a complex sampling design. Results: ARIC identified 92,354 HF admissions (weighted). Patients admitted in holiday months were 46% male and 71% white, with average age 75 years. Compared to the holiday months, patients admitted on H were older (78 years, p&lt;0.01). Race, community, and HF by ejection fraction were similar among time periods. Average daily admissions around each holiday are shown in Figure 1. For all holidays combined, average daily admissions compared to the remainder of the holiday months (25.1 per day) were less frequent on both H-1 (18.5, p=0.002) and H-1/H combined (19.5, p=0.005). Hospital LOS was shorter for patients admitted on H for Thanksgiving (5.3 v 6.9 days, p=0.02) and Christmas (4.8 v 7.5, p=0.01), on H-1 for Christmas (5.3 v 7.5, p=0.04) and during H-4 to H-2 for New Year’s Day (6.7 v 8.7, p=0.02). 28-day mortality was lower for patients admitted on H-1 (p&lt;0.001) for Christmas. 1-year mortality was similar for all holidays and time periods. Conclusions: HF admission rates, hospital LOS, and mortality were similar in the 4 days following a holiday compared to the remainder of each holiday’s month. However, the day before and/or day of a holiday were associated with lower HF admission rates, shorter hospital LOS, and lower 28-day mortality.
Abstract 10428: Bad Fall, Good Catch: Diagnosing a Rare Condition Presenting as Acute Coronary Syndrome
Authors: Leila Haghighat, Barbara Hamilton, Anatoly Urisman, Ramin Beygui, Kirsten Tolstrup
Journal: Circulation (2021)

A 72 year-old mountain bicyclist suffered a biking accident. The following week, he presented to the emergency room with abdominal pain, where he was treated for superior mesenteric artery thrombosis and new-onset atrial fibrillation. Two months later, he presented with intermittent left scapular pain that radiated to the chest. Pharmacologic stress testing revealed a large reversible perfusion defect in the anterior wall with an ejection fraction of 41%. Left heart catheterization showed narrowing of the distal left main coronary artery and the proximal left anterior descending (LAD) and circumflex arteries, by what appeared to be external compression. Follow-up CT angiogram demonstrated two sinus of Valsalva aneurysms (SOVA) originating from the left and right coronary cusps. A transesophageal echocardiogram confirmed these findings and showed tremendous thrombus within the larger aneurysm. The patient was admitted to cardiothoracic surgery. Troponin was elevated to 0.16 μg/L, with EKG showing 1 mm ST-segment depressions in V4-6, prompting treatment for a non-ST segment myocardial infarction. He underwent complex surgery involving thrombus extraction and closure of the SOVA with pericardial patch repair, and coronary artery bypass grafting of the LAD and obtuse marginal arteries. After a prolonged ICU course in which the patient was managed for cardiogenic shock, he was discharged to a hospital equipped with a rehabilitation facility. Unfortunately, he developed profound lactic acidosis from ischemic bowel and passed away. SOVA are rare lesions that arise from congenital or acquired etiologies, such as this patient’s biking accident. Multi-modality imaging is important for quantifying size and anatomy. Unruptured SOVA can present as embolic phenomenon from thrombus, valvular regurgitation, or chest pain from compression of the coronary arteries. Rupture is a highly morbid condition, and so urgent referral to cardiothoracic surgery is recommended.
Abstract 13689: The Center-Volume Effect on Congenital Heart Surgery Revised: Is It Time to Consider Regionalization of Care?
Authors: Rachel Zmora, Jessica Knight, Amanda S Thomas, John Bass, James St Louis, Logan Spector, Lazaros Kochilas
Journal: Circulation (2021)

Introduction: Regionalization of congenital heart surgery (CHS) has been debated in the U.S. and other countries. Previous reports demonstrated a variable effect of a center’s volume on in-hospital postoperative mortality. However, the volume-outcome relationship for CHS remains incompletely understood without considering outcomes beyond hospital discharge. Hypothesis: We sought to determine, whether procedure-specific center volume predicts postoperative mortality for infants undergoing three complex benchmark procedures (Norwood procedure, arterial switch operation and complete atrioventricular canal repair) and used ventricular septal defect (VSD) closure as a simple benchmark procedure comparison. Methods: We used data from the Pediatric Cardiac Care Consortium, a multi-center U.S.-based clinical registry of CHS, enriched with post-discharge death data after linkage with the National Death Index. We used generalized estimating equations to assess the association between procedure-specific volume and mortality from the time of CHS and up to three years after CHS. Models were adjusted for patient age and weight at CHS, presence of a chromosomal abnormality, and surgical era and accounted for clustering at the center-level. Results: Analysis included 6,656 infants operated at 42 centers between 1982 and 2003. We found an absolute reduction in post-operative risk of death ranging from 6-12% for every additional surgery performed in the same center for Norwood, ASO, and CAVC repair and at all time points examined (Table). There was no statistically significant association between VSD center volume and mortality at any time point. Conclusions: In-hospital and longer-term survival after infantile CHS is improved with increased center case volume for complex CHS. These findings support the regionalization of complex CHS in the U.S.. Decision-makers should consider feasibility of such regionalization to improve outcomes after complex CHS.