tbuckley/cabot-search huggingface dataset:
Abstract 11566: Use of Temporary Mechanical Circulatory Support Devices in Heart Failure Patients with Cardiogenic Shock
Authors: Aroosa Malik, TANIMA BASU, Supriya Shore
Journal: Circulation (2021)

Objective: Contemporary use of temporary mechanical circulatory support devices (tMCS) for heart failure (HF) without acute myocardial infarction (AMI) is not well described. Accordingly, we evaluated use patterns for tMCS in HF patients. Methods: This was a retrospective study of a large administrative claims dataset between 01/01/06 and 12/31/19. We included patients with HF or cardiogenic shock who received tMCS i.e. Impella, intra-aortic balloon pump (IABP) or extra-corporeal membrane oxygenator (ECMO) in the absence of AMI or coronary revascularization. Multinomial logistic regression model was used to identify predictors for type of tMCS device. Temporal trends in use of tMCS was also evaluated. Results: We included 2722 HF patients receiving tMCS: 1836 (68%) with ischemic cardiomyopathy (ICM) and 886 (32%) with non-ischemic cardiomyopathy (NICM). There were no gender or racial differences in device use. Table shows adjusted odds ratio for predictors associated with receipt of ECMO or Impella compared to IABP. After multivariable adjustment, patients with ICM or NICM placed on ECMO compared to IABP, had a higher comorbidity burden. For both groups, patients with valvular disease were more likely to receive IABP and patients with peripheral vascular disease an Impella. Over time, there was an increase in Impella and ECMO use with a decrease in IABP use (p &lt;0.05; Figure). Conclusions: In a real world cohort of HF patients with cardiogenic shock without AMI, use of Impella and ECMO has increased over the last decade and IABP has decreased. Patients receiving ECMO have a higher co-morbidity burden, whereas patients receiving IABP are more likely to have valvular heart disease.
Abstract 13828: Lesion Length and Left Ventricular Function Predict Outcome in Patients Undergoing Orbital Atherectomy Prior to Stenting for Severely Calcified Coronary Lesions
Authors: Carson Smith, Matthew Hodge, Francis Zirille, George Revtyak
Journal: Circulation (2021)

Introduction: Orbital atherectomy prior to stenting (OAptS) of severely calcified coronary lesions may improve procedural outcomes. However, there is little data identifying specific procedural/clinical factors influencing these outcomes. In this study, we examined the hypothesis that both lesion length and left ventricular ejection (LVEF) influence overall clinical outcomes for OAptS. Methods: Between November 1, 2015 and December 31, 2019, clinical data and coronary angiograms for all patients undergoing OAptS for severely calcified coronary lesions at our institution were retrospectively reviewed. Patients were first grouped by lesion length (focal ≤24mm and diffuse &gt;24mm), then subdivided into normal (≥50%) and reduced (&lt;50%) LVEF groups. Demographics, procedural variables and clinical outcomes for all four groups were then analyzed and compared. Results: In total, 213 lesions were analyzed (74 focal and 139 diffuse). There was no significant difference in demographics between all four patient groups. Average target lesion stent lengths were longer for diffuse compared to focal lesions (38.1±1.7mm vs. 17.2±0.8mm; p&lt;0.001). Fluoroscopy time was longer in patients with diffuse lesions (p&lt; 0.05), with no significant difference in contrast volumes between all groups (p=NS). The baseline LVEF was lower in patients with diffuse lesions (50.6±13% vs. 54.8±12%; p&lt;0.05). Thirty-day time-to-event analysis (Mantel-Cox) demonstrated earlier and more frequent death/MACE/bleeding in the patient group with both diffuse lesions and reduced LVEF (p&lt;0.01). Death, MACE and bleeding was not statistically different between the other three subgroups. Conclusions: In conclusion, our single center, retrospective analysis demonstrates the general safety of OAptS for treating severely calcified coronary lesions of different lengths in patients with normal and reduced LVEF. In addition, it identifies a high-risk patient subgroup (diffuse lesion length and reduced LVEF) at increased risk for a worse procedural outcome.
Abstract 16336: Development of an RNA Interference Therapeutic Targeting Angiopoietin-Like Protein 3 for Treatment of Hyperlipidemia
Authors: So C Wong, Rui Zhu, Julia Hegge, Casi Schienebeck, Gary Christensen, Lucas Trilling, Holly Hamilton, Jeremy Briggs, Meredith Hinkes, Stephanie Bertin, Aaron Andersen, Mark Seefeld, Zhen Li
Journal: Circulation (2018)

Introduction: Human genetic analysis identified that individuals with loss-of-function mutations in angiopoietin-like protein 3 (ANGPLT3) have very low plasma levels of triglycerides (TGs) and low-...
Abstract 10684: Aortic Dissection During Pregnancy and Puerperium: Contemporary Incidence and Outcomes in the United States
Authors: Yunda Wang, Kanhua Yin, Karl J Karlson, Niloo M Edwards, Nikola Dobrilovic
Journal: Circulation (2021)

Background: Aortic dissection (AD) during pregnancy and puerperium is a rare yet potentially fatal catastrophe for both parent and fetus, yet population-level trends in incidence and outcomes are undetermined. Objectives: To investigate the incidence and in-hospital outcomes of AD during pregnancy and puerperium in a US national database. Methods: The National Inpatient Sample, a large and publicly available all-payer inpatient care database, was queried to identify pregnancy-related AD hospitalizations using codes from the International Classification of Diseases (ICD-9 and ICD-10). Identified hospitalizations were stratified into Stanford type A AD (TAAD) and type B AD (TBAD) using the associated procedure codes. The weighted values of the hospitalizations were used to generate national estimates. Results: From January 2002 to December 2017, a total of 471 pregnancy-related AD hospitalizations were identified, with 106 (22.5%) being TAAD and 365 (77.5%) being TBAD. The mean age of the entire cohort was 30.9 ± 0.6 years; 52.1% were White, 20.6% were Hispanic, and 9.4% were Black. Marfan syndrome, primary hypertension, and pre-eclampsia/eclampsia were found in 21.9%, 11.3%, and 13.2%. Although trimester information was only available in hospitalizations with ICD-10 codes (18.0% of the entire cohort), we found that 58.8% of AD occurred in the third trimester. Overall, the incidences of AD, TAAD, and TBAD were 0.66, 0.15, and 0.51 per 100,000 pregnancy-related hospitalizations. We observed a trend of increasing incidence for pregnancy-related AD (Fig 1) during the 16-year study period - predominantly driven by TBAD. The in-hospital mortalities of AD, TAAD, and TBAD were 7.3%, 4.3%, and 8.1%. Conclusions: For the first time, we quantified the population-level incidence and in-hospital outcomes of AD during pregnancy and puerperium in the US; while its incidence is increasing, its in-hospital mortality appears better than that of the general population.
Abstract 13934: Ventricular Pulsed Field Ablation Using a Focal Lattice-Tip Catheter: The Impact of Repetitive Applications
Authors: Iwanari Kawamura, jacob s Koruth, Mohit Turagam, Daniel Musikantow, Edward Chu, Marc Miller, William Whang, Srinivas Dukkipati, Vivek Y Reddy
Journal: Circulation (2021)

Introduction: Pulsed field ablation (PFA) is being increasingly studied for catheter ablation of atrial arrhythmias. However, there is little published on the efficacy of ventricular PFA. Recently, a 7.5-Fr ablation catheter with a 9mm compressible lattice-tip linked to a magnetic electroanatomical mapping system has been introduced (Sphere-9 and HexaMap, Prism-1, respectively; Affera, Inc). In contrast to radiofrequency ablation, there is little understating how to create an adequate lesion depth on the myocardial using PFA. Accordingly, we assessed the feasibility and effectiveness of repetitive PFA pulses in creating ventricular lesions using the lattice-tip catheter in porcine preclinical studies. Methods: Under general anesthesia, low dose 1-sec PFA pulses were delivered in 4 healthy swine ventricles using lattice-tip catheter and its compatible PF generators (HexaPulse, Affera, Inc). Three strategies were assessed: 2, 3 or 4 applications at each location. Pulses were repeated at 10-15 sec intervals. After survival for ~ 24 hrs, swine were sacrificed humanely, and TTC staining was performed to ascertain lesion dimensions on gross pathology. Results: Discrete PFA lesions (n=51) were successfully delivered: 24 in the RV and 27 in the LV. Dimensions were obtained for 49 of 51 discrete lesions. Transmurality was observed in 9 of 23 (39%) RV and 1 of 26 (4%) LV lesions. Significantly larger ventricular lesions were noted with the 4-application strategy: length 17.6±3.9 mm, width 13.4±1.8 mm and depth 6.1±2.1 mm (see Figure ). The myocardium was trabeculated at 40 of 49 lesion locations: all lesions projected uniformly into the tissue without surface gaps. No sustained ventricular arrhythmias were observed during PFA. Conclusion: Focal PFA using a lattice-tip ablation catheter revealed clinically-relevant ventricular lesions without complications; repetitive applications significantly increase lesion dimensions.
Abstract 11760: Reducing Pulmonary Capillary Wedge Pressure During Exercise Does Not Improve Exercise Capacity in Heart Failure With Preserved Ejection Fraction
Authors: James P Macnamara, Satyam Sarma, Bryce Balmain, Christopher Hearon, Andrew R Tomlinson, Margot Morris, Sheryl A Livingston, Raksa Moran, Jessica N Alcala, Mitchel Samels, Marcus Payne, Tevrick Boyd, Tony Babb, Benjamin D Levine
Journal: Circulation (2021)

Background: Exercise intolerance is a defining characteristic of heart failure with preserved ejection fraction (HFpEF). A marked rise in pulmonary capillary wedge pressure (PCWP) during exertion is pathognomonic for HFpEF and is thought to be a key cause of exercise intolerance. If true, acutely lowering PCWP would improve exercise capacity. To test this hypothesis, we evaluated peak exercise capacity with and without nitroglycerin (NTG) to acutely lower PCWP during exercise in patients with HFpEF. Methods: In a preliminary analysis of a clinical trial, 15 patients with HFpEF (69±6 years, 60% female) underwent 2 upright, seated cycle exercise tests dosed with sublingual NTG or placebo control (CON), every 15 minutes in a single-blind, cross-over design. A right heart catheter was used to measure end-expiratory PCWP and cardiac output (Qc, direct Fick). Oxygen uptake was measured using breath-by-breath system. Measures were made at rest, 20W, and peak exercise. Results: PCWP increased from 6.0±2.4 to 33.7±7.4 mmHg from rest to peak exercise with placebo. With NTG, PCWP increased significantly less from 4.5±3.1 to 26.3±5.9 mmHg (drug x exercise p = 0.019). There was no change in peak VO 2 with NTG (CON: 1.25±0.36 vs NTG: 1.26±0.41 L/min, drug x exercise p = 0.986, Figure ). Peak Qc was similar between conditions (Qc: CON 10.4±2.3 vs 10.8±3.2 L/min). During submaximal exercise, PCWP was lower with NTG with no difference in VO 2 (PCWP: CON 21.2±6.5 vs NTG 16.6±6.4 mm Hg, VO 2 CON:0.87±0.17 vs NTG 0.86±0.17 L/min) but with a lower stroke volume (NTG: 90±18 vs CON: 98±21 ml). Conclusions: Sublingual nitroglycerin effectively lowered PCWP during submaximal and maximal exercise. Despite this reduction in PCWP, peak VO 2 was not changed. These results suggest acutely lowering PCWP is insufficient to improve exercise capacity and raises the possibility that high PCWP during exercise is a secondary phenomenon rather than a primary cause of exercise intolerance in patients with HFpEF.
Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications
Authors: Lakshmi Swaminathan, Scott Flanders, Jennifer Horowitz, Qisu Zhang, Megan O’Malley, Vineet Chopra
Journal: JAMA Internal Medicine (2021)

Peripherally inserted central catheters (PICCs) and midlines are frequently used for short-term venous access; whether one is safer than the other in this setting has not been adequately reported.To compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days.This cohort study analyzed data from a multihospital registry including patients admitted to a participating site from December 2017 through January 2020 who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Data were analyzed from October 2020 to March 2021.PICC and midline placement.Major complications, including a composite of symptomatic catheter-associated deep vein thrombosis (DVT), catheter-related bloodstream infection, and catheter occlusion. Logistic regression and Cox proportional hazards regression models (taking into account catheter dwell) were used to estimate risk for major complications, adjusting for patient and device characteristics and the clustered nature of the data. Sensitivity analyses limiting analyses to 10 days of device dwell were performed.Data on 10 863 patients, 5758 with PICCs and 5105 with midlines (median [IQR] age of device recipients, 64.8 [53.4-75.4] years; 5741 [52.8%] were female), were included. After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% CI, 1.61-2.47). Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74). Results were robust to sensitivity analyses.In this cohort study among patients with placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Randomized clinical trials comparing these devices for this indication are needed.
Abstract 11058: Pooled Analysis of Six Randomized Trials Comparing Device Closure of Patent Foramen Ovale After Stroke to Medical Treatment: Overall Effects and Patient Selection Using a Causal Classification System
Authors: David M Kent, Jeffrey L Saver, Scott E Kasner, Jason Nelson, John D Carroll, Gilles CHATELLIER, Geneviéve Derumeaux, Anthony J Furlan, Howard C Herrmann, Peter Juni, Jong S Kim, Benjamin Koethe, Pil Hyung Lee, Bénédicte Lefebvre, Heinrich P Mattle, Bernhard Meier, Mark Reisman, Richard W Smalling, Lars Soendergaard, Jae-kwan Song, Jean-Louis Mas, David E Thaler
Journal: Circulation (2021)

Introduction: Patent foramen ovale (PFO)-associated strokes account for ~10% of ischemic strokes in adults aged 18-60. Despite overall beneficial effects of device closure on stroke recurrence risk, the best treatment option for any individual patient is often unclear. Methods: We pooled individual participant-level data from all 6 RCTs comparing PFO closure with percutaneous devices plus medical therapy vs medical therapy alone. The primary outcome was recurrent ischemic stroke. We used Cox proportional hazards models to estimate adjusted HRs, with study-specific baseline hazards and a fixed treatment effect. Pre-specified primary subgroup analyses used the Risk of Paradoxical Embolism (RoPE) Score (a 10 point score with higher scores reflecting younger age and absence of vascular risk factors) and the PFO-Associated Stroke Causal Likelihood (PASCAL) algorithm, a classification system that combines the RoPE Score with presence/absence of high risk PFO features (either atrial septal aneurysm or large-sized shunt) to group patients into 3 causal relatedness categories: Unlikely (RoPE&lt; 7 and no high risk PFO feature); Possible (either RoPE &gt; 7 or any high risk PFO feature); or Probable (both RoPE &gt; 7 and any high risk PFO feature). The protocol was registered at PROSPERO. Results: A total of 121 recurrent strokes occurred in 3740 patients over median follow up of 57 months (IQR 24-64). The annualized incidence of stroke was lower with device vs medical therapy: 0.47% (0.34-0.65) vs 1.09% (0.87-1.36); adjusted HR 0.41 (0.27-0.60), p &lt; 0.001. The main results were robust to alternative analytic approaches. The primary subgroup analyses (Figure) showed statistically significant and clinically important interaction effects. Discussion: PFO closure reduces recurrent ischemic stroke in a robust manner. However, patients with neither a RoPE Score &gt; 7 or a high risk PFO feature (i.e. PASCAL Unlikely) do not appear to benefit, even in the well-selected trial population.
Abstract 13230: Bone Morphogenetic Protein 10 - A Novel Biomarker of Ischemic Stroke in Patients With Atrial Fibrillation
Authors: Ziad Hijazi, Alexander P Benz, Johan Lindback, Stuart J Connolly, John W Eikelboom, Peter Kastner, Andre Ziegler, Jonas Oldgren, Agneta Siegbahn, Lars Wallentin
Journal: Circulation (2021)

Background: Biomarkers specifically related to the atrial tissue might increase the understanding of the pathophysiology and improve risk prediction in atrial fibrillation (AF). Bone morphogenetic protein 10 (BMP10) is a novel biomarker expressed in atrial myocardium. We evaluated the association between BMP10 and the risk of stroke, bleeding, and death in patients with AF not treated with oral anticoagulation. Methods: BMP10 was measured in 2,974 plasma samples collected at randomisation in patients with AF randomized to aspirin in two cohorts, the ACTIVE-A (n=951) and AVERROES (n=2023) trials, median follow-up of 3.8 and 1.2 years, respectively. BMP10 was analysed with a prototype Elecsys electrochemiluminescence immunoassay. Associations between BMP10 and outcomes were evaluated by Cox-regression analyses adjusted for clinical characteristics, kidney function, and NT-proBNP. Results: Median age was 71 years, 58.1% were men. The median concentration of BMP10 was 2.46 (25 th -75 th percentiles, 2.09 - 2.94) ng/L. The variables most strongly associated with higher BMP10 levels were: heart rhythm (AF vs sinus), older age, female sex, lower BMI, and kidney dysfunction. BMP10 was the baseline variable most strongly associated with ischemic stroke during follow-up (Figure). After adjustments, the hazard ratio for ischemic stroke (BMP10 3rd vs 1st quartile) was 1.57 [95%CI 1.08-2.28], p=0.025), and the discriminatory value (c-index) was 0.643 (vs 0.634 of CHA 2 DS 2 -VASc score) and improved the full model from 0.737 to 0.746. BMP10 was not associated with bleeding or death. The results were consistent across both cohorts and irrespective of cardiac rhythm at blood sampling. Conclusions: In patients with AF, circulating plasma levels of BMP10 are independently associated with the risk of ischemic stroke but not with bleeding or death. BMP10 has an incremental discriminatory value for the risk of ischemic stroke, and may be a novel specific biomarker in patients with AF.
NIMG-21. VARIABLE RESOLUTION HYPERPOLARIZED [2-13C]PYRUVATE MRI IN HEALTHY VOLUNTEERS AND PATIENTS WITH IDH-MUTANT GLIOMA
Authors: Sana Vaziri, Yaewon Kim, Adam Autry, Hsin-Yu Chen, Jeremy Gordon, Marisa LaFontaine, Jasmine Hu, Janine Lupo, Jennifer Clarke, Javier Villanueva-Meyer, Nancy Ann Oberheim-Bush, Susan Chang, Duan Xu, Peder Larson, Daniel Vigneron, Yan Li
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION Mutations in isocitrate dehydrogenase (IDH) have been investigated as a prognostic biomarker in glioma. The presence of the IDH mutation (IDHm) is associated with 2-hydroxyglutarate (2HG) production and inhibition of glutamate synthesis (McBrayer, Cell 2018). Hyperpolarized carbon-13 (HP-13C) MRI enables dynamic measurements of in-vivo metabolism using a [2-13C]pyruvate labeled probe that undergoes conversion to [2-13C]lactate and [5-13C]glutamate. Here, we present HP [2-13C]pyruvate data from healthy volunteers and patients with IDHm diffuse glioma. Due to its intrinsic low signal-to-noise ratio (SNR), we demonstrate the ability of post-processing denoising to improve its utility and aid in detection of metabolic changes associated with IDHm. METHODS Dynamic HP 13C data were acquired following intravenous injection of [2-13C]pyruvate from five healthy volunteers and one patient with IDHm grade III astrocytoma. A novel multi-resolution frequency specific multislice EPI sequence was used to obtain [2-13C]pyruvate, [5-13C]glutamate, and downfield and upfield [2-13C]lactate signals (3s temporal resolution, pyruvate/lactate/glutamate spatial resolutions = 0.75x0.75cm2/ 2.25x2.25cm2/ 2.25x2.25cm2, 5 slices 3cm thick). Following phase correction, patch-based tensor decomposition denoising was applied to metabolite images. Metabolite differences between normal-appearing white matter (NAWM) and T2 lesion were examined for the patient data. RESULTS HP [2-13C]pyruvate imaging is able to simultaneously probe glycolytic ([2-13C]lactate) and oxidative ([5-13C]glutamate) metabolism. Denoised pyruvate/lactate/glutamate signals achieved a 4-9/3-6/3-7 fold increase in SNR. T2 lesion exhibited decreased glutamate-to-pyruvate and glutamate-to-lactate AUC ratios versus contralateral NAWM (p&amp;lt; 0.018, p &amp;lt; 1.5e-5), consistent with IDH mutant status. CONCLUSION We successfully demonstrated the feasibility of applying variable resolution HP [2-13C]pyruvate metabolic imaging to detect IDHm specific metabolism. This technique addresses a major hurdle in HP 13C MRI by improving SNR while permitting robust metabolism quantification. Future studies will optimize methods for acquiring and processing data to evaluate further data acquired from IDHm glioma patients. Supported by NIH T32 CA151022, P01 CA118816, and NICO.