tbuckley/cabot-search huggingface dataset:
Abstract 11808: Direct Oral Anticoagulant Use in Preventing Ischemic Stroke in Patients With Left Ventricular Thrombus
Authors: George Skaf, Diana Daftari, samantha gelman, Javad Savoj, Napatkamon Ayutyanont, Mimi S Biswas
Journal: Circulation (2021)

Background: Left Ventricular thrombus are commonly associated with systolic heart failure and acute myocardial infarctions. It is thought to be associated with an increased risk of embolic events. Current guidelines recommend the use of Warfarin for these patients. Off label use of Direct Oral Anticoagulants (DOAC) for these patients are becoming increasingly frequent as Warfarin may be inappropriate for many of these patients. DOACs have already been shown to be advantageous to warfarin in the treatment of pulmonary embolisms, deep vein thrombosis, non-valvular atrial fibrillation and is even now being looked at some instances of valvular atrial fibrillation with updated mechanical valves. Methods: This is a retrospective study on patients diagnosed with a Left Ventricular thrombus discharged on a DOAC versus warfarin looking for ischemic stroke admissions, length of stay and comparing severities of stroke using NIHSS controlling for demographic, comorbid conditions, ED and ICU admissions. Data was collected from 144 HCA hospitals. Results: There were 1704 patients in the warfarin group and 2210 in the DOAC group. There was no statistically significant difference in the odds of being readmitted for ischemic stroke by DOAC compared to warfarin (OR=1.08, [95% CI (0.82, 1.44)], p=0.582). Patients discharged on DOAC had a 81% lower odds of being readmitted within 30 days compared to warfarin (OR=0.19, 95%CI [0.05, 0.76], p = 0.019). The patients with left ventricular thrombus discharged on warfarin showed a higher average length of stay (8.21 ± 9.73) compared to DOAC (6.35 ± 7.61) (p &lt; .001). There was no statistically significant differences in the NIHSS scores by discharge medications (warfarin vs. DOACs, p=0.340). Conclusion: Our study showed no statistically significant difference in using DOAC’s compared to warfarin, the standard of care, in preventing a stroke in patients with a left ventricular thrombus. We were also able to show a decreased readmission rate, a decreased length of stay and no difference in the severity (NIHSS) of stroke. If this data holds true many patients and physicians will chose DOACs over warfarin to improve medication compliance, dosing burden and potential adverse drug interactions.
Abstract 12845: Use of IABP as a Bridge to Transcatheter Mitral Valve Edge-to-Edge Repair in a Patient With Pre and Post Capillary Pulmonary HTN
Authors: Safwan Gaznabi, Senthil S Balasubramanian, Luis H Paz Rios, Mark J Ricciardi, Robert Gordon
Journal: Circulation (2021)

An 83 yr old male with history of HLD &amp; prior tobacco use presented with worsening dyspnea for the last 6 month and PND. Physical examination revealed BP 150/100 mmHg, holosystolic murmur in left 2nd intercostal space, diastolic murmur at the apex, decreased bibasilar lung sound &amp; left leg swelling. CXR demonstrated cardiomegaly without evidence of pulmonary edema. ECG showed sinus rhythm with left atrial enlargement. Labs were remarkable for proBNP: 6,886 pg/mL and D dimer: 1.99 mg/L. Echocardiogram showed LV EF of 61%, dilated left atrium, severe mitral regurgitation (MR) with P2 focal cord rupture and moderate pulmonary hypertension (pHTN). He underwent a CT scan of his chest which revealed small right pulmonary embolism. He underwent cardiac catheterization which revealed mild CAD, increased left ventricular filling pressures (20 mmHg) severe pHTN without response to inhaled nitric oxide, PVR: 14 woods units, SVR: 2575 dynes/seconds/cm5, transpulmonary gradient: 41 mmHg &amp; cardiogenic shock with cardiac output (CO) 2.77 and Cardiac Index (CI) 1.4. He was diuresed, started on milrinone, endothelin receptor antagonist (macitentan) and later guanylate cyclase stimulator (riociguat). Days later he underwent insertion of an IABP for afterload optimization &amp; repeat hemodynamics showed normalized intracardiac filling pressures &amp; improvement of cardiac index and SVR. The next day the patient underwent successful transcatheter mitral edge-to-edge repair (TEER). Echocardiogram showed mild MR with mean trans-mitral gradient of 5mmHg &amp; RVSP of 47 mmHg. IABP was removed the next day and he returned home within a week of TEER. There is a paucity of data for the use of IABP in acute MR in the setting of mixed precapillary and post capillary pHTN which necessitates the use of endothelin receptor antagonist and guanylate cyclase stimulator as a bridge to TEER. Our case demonstrates the importance and success of a multidisciplinary strategy in this complex valvular cardiac condition.
Abstract 14358: Bacteremia in Continuous-Flow Left Ventricular Assist Device and Increased Risk for Intracranial Hemorrhage: Insights From National Inpatient Sample Database
Authors: Tawseef A Dar, Diego Celli, Shady Abohashem, Ahmed Alnajar, Taimur Abbasi, Imran Mohiuddin, Ahmed Hanfy, Walid Ibrahim, Wesam Aldosoky, Sibghat Tul LLah FNU, Waqas Qureshi
Journal: Circulation (2021)

Introduction: Implantable continuous-flow left ventricular assist devices (LVADs) are used in patients with end-stage heart failure as a bridge to transplant or as a destination therapy. In order to prevent pump malfunction as well as strokes, long term warfarin therapy is prescribed which puts them at risk of bleeding at the same time. Small retrospective studies have suggested the relationship between bloodstream infections and increased risk for intracranial hemorrhages (ICH). Hypothesis: Accordingly, we sought to test the hypothesis that “bacteremia is associated with increased ICH risk in LVAD dependent patients” in a large national database. Methods: National Inpatient Sample (NIS) database was queried to identify LVAD patients admitted between 2011-2018, using Internal Classification of Diseases 9th and 10th Revision Clinical Modification procedure codes. Outcomes of interest were bacteremia and ICH. A logistic regression model was used for the statistical analysis while adjusting for potential confounders using Elixhauser index score. Results: Between 2011-2018, a total of 120,050 (median age 58 yrs, 23.4% female) LVAD dependent patients were admitted to hospitals across the United States. Bacteremia was encountered in 4.3 % of patients. A total of 2.4% of patients developed hemorrhagic stroke during the same hospitalization. Presence of bacteremia (vs. no bacteremia) was associated with 2.3-fold increased risk of ICH (Odds ratio [95% CI] =2.38 [1.79, 3.17], p&lt;0.0001. Fig A ) after adjustment for age, sex, race, and Elixhauser index score. The yearly incidence trends of bacteriemia and ICH in LVAD dependent patients are shown in Fig B . Conclusions: In LVAD dependent patients, presence of bacteremia is associated with significantly increased risk of ICH. Since these patients are on warfarin, further studies are needed to evaluate if lowering the goal prothrombin time (PT), while septic, would alleviate this increased risk of ICH in such population.
ATG-010 Plus Low-Dose Dexamethasone (Sd) in Chinese Relapsed/Refractory Multiple Myeloma (RRMM) Patients Previously Received Chimeric Antigen Receptor T-Cell (CAR-T)
Authors: Weijun Fu, Lugui Qiu, Zhongjun Xia, Zhengzheng Fu, Wenming Chen, Chunkang Chang, Baijun Fang, Gang An, Yongqiang Wei, Zhen Cai, Sujun Gao, Jianyu Weng, Lijuan Chen, Hongmei Jing, Li Fei, Zhuogang Liu, Xiequn Chen, Jing Liu, Yang Yu, Aihua Wang, Zhinuan Yu, Yijun Yang, Kevin Lynch
Journal: Blood (2021)
Abstract 12243: Overview of In-Patient Burden of Lower Extremity Peripheral Artery Disease in Hispanics
Authors: Paulina Luna, Kristie Harris, Yulanka Castro-Dominguez, Severiche-Mena Carolina, Kim G Smolderen, Carlos Mena-hurtado
Journal: Circulation (2021)

Background: Hispanics have high rates of cardiovascular risk factors and prior data suggests that they undergo more amputations than non-Hispanic Whites (NHW) for peripheral artery disease (PAD). Little is known of treatment patterns and outcomes for this group in contemporary data. Thus, this study examined revascularizations, amputations, and mortality in Hispanics and NHW hospitalized with PAD. Methods: Data from the 2011-2017 National Inpatient Sample were used. Cross-sectional analysis of revascularizations and amputations were done by ethnicity using standardized differences ( d≥ 0.20 considered significant). Temporal trends in revascularizations and amputations by year were evaluated with the Cochran-Mantel-Haenszel test and stratified by ethnicity. Data were combined across years and multivariable logistic regression was used to evaluate the association of ethnicity with revascularization, amputation, and mortality, adjusting for risk factors. Results: From 2011-2017, 141,551 Hispanics were admitted with PAD (12-16% of annual admissions). Hispanics had higher rates of amputations (32% vs. 21%, d =0.31) and lower rates of revascularizations (43% vs. 60%, d =0.38) than NHW in the overall sample and over time (Fig. 1, all P trend &lt;0.0001). Hispanic ethnicity was associated with lower odds of revascularization and mortality but higher odds of amputation (Fig. 2). Conclusion: A growing number of Hispanics are hospitalized for PAD. Despite an overall decline, amputations were more prevalent in Hispanics, suggesting that earlier systemic strategies for PAD awareness, diagnosis, and prevention are needed in Hispanic populations to eradicate this disparity.
Abstract 14428: The Effect of Menopause on Coronary Blood Flow in Females Presenting With Angina and Non-Obstructive Coronary Artery Disease
Authors: Ali Ahmad, Ilke Ozcan, Takumi Toya, Michel Corban, Jaskanwal D Sara, Lilach Lerman, Amir Lerman
Journal: Circulation (2021)

Introduction: Changes in coronary artery diameter (CAD) and coronary blood flow (CBF) in reaction to acetylcholine are important surrogates of endothelial health, and abnormalities in these parameters might represent early atherosclerosis. Menopause is associated with an increased risk of coronary artery disease, yet the role of menopause on the endothelium is not well described. Hypothesis: The vasodilatory response of the endothelium to acetylcholine (Ach) decreases after menopause. Methods: A total of 1271 (42% pre-menopausal) females with angina and non-obstructive coronary artery disease (&lt;50% angiographic stenosis) that underwent coronary reactivity study were enrolled. A doppler wire was positioned and incremental Ach doses were injected (10 -6 , 10 -5 , and 10 -4 mol/L). CBF was then calculated from CAD and doppler-derived flow velocity. Comparisons between the pre-and post-menopause groups were performed. Results: Mean age of the pre-menopausal group was 44±10 years, while that of the post-menopausal 59±9 years. Pre-menopausal females had higher baseline CAD as compared to post-menopausal females (2.22 [1.90; 2.65] vs. 2.20 [1.85; 2.55] mm, P=0.03). However, this difference was nullified with subsequent doses of Ach (Figure 1A&amp;B ). Pre-menopausal females had a higher baseline CBF than post-menopausal females (32.1 [21.7; 44.9] vs. 29.2 [19.8; 42.0] mL/min; P=0.01). This difference progressively increased with successive doses of Ach (10 -4 :49.5 [30.3; 77.0] vs. 41.7 [24.4; 69.0] mL/min; P=0.0002), revealing a greater microvascular vasodilatory response in pre-menopausal females (Cumulative %ΔCBF after highest dose= 60 [2.6; 122] vs 45 [-4; 98], P=0.002) ( Figure 1C&amp;D ). Conclusions: Premenopausal females have greater sensitivity of the microvascular endothelium to Ach compared to post-menopausal, suggesting a possible role for estrogen in mediating the effect of stress on the microvasculature through the endothelium.
Abstract 10366: Comparative Evaluations of Six Risk Scores Proposed for Baseline Prediction of Atrial Fibrillation Recurrence Post Catheter Ablation
Authors: Lisa Y Tang, Nathaniel Hawkins, Laurent Macle, Kendall Ho, Roger Tam, Marc Deyell, Michael Lim, Paul Khairy, Jason Andrade
Journal: Circulation (2021)

Background: Being able to identify patients who are at risk of arrhythmia recurrence following catheter ablation is important for prognostication, shared-decision making, etc. While numerous predictive models for atrial fibrillation recurrence (AFR) have been proposed, few models have underwent external validation, and few studies compared multiple models using the same patient cohort. Aims: To evaluate six prediction models using an external dataset. Methods: Data from 632 patients was pooled from two independent clinical trials that enrolled patients with anti-arrhythmic drug refractory atrial fibrillation who underwent catheter ablation. Primary outcome for both trials was documented atrial tachyarrhythmia (atrial fibrillation/flutter/tachycardia as adjudicated by a clinical committee blinded to treatment strategy). We compared 6 models for predicting AFR recorded between days 91-365 post ablation using standard metrics and ranked them according to the positive and negative clinical utility indices. Results: As the figure shows, the top performing model was CHA2DS2-VASc, followed by DR-FLASH, albeit both achieved positive and negative predictive values lower than 65%. Many models achieved high specificity but low sensitivity, except for CAAP-AF, which achieved high sensitivity but low specificity. In summary, all achieved area under receiver operating characteristic curve lower than 56% and were deemed to have poor clinical utility (less than 0.5 out of 1) when evaluated on our dataset. Conclusion: All models performed poorly and had objectively limited clinical utility. There remains a need to develop generalizable tools for predicting post ablation AFR.
Abstract 13898: Redo Catheter Ablation for Atrial Fibrillation: Assessment of Quality of Life and Clinical Outcomes Using Patient Reported Outcomes
Authors: Medhat Farwati, Oussama Wazni, Khaldoun Tarakji, Mohamed Diab, Anna Scandinaro, Mustapha Amin, Mohammad Zmaili, Hiroshi Nakagawa, Shunsuke Kuroda, Mohamed H Kanj, Thomas J Dresing, Thomas D Callahan, Mandeep Bhargava, Bryan Baranowski, John Rickard, Daniel J Cantillon, Patrick Tchou, Walid I Saliba, Ayman Hussein
Journal: Circulation (2021)

Background: Catheter ablation for symptomatic atrial fibrillation (AF) is frequently used for sustained rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data is scarce on patient-centered outcomes in patients undergoing redo AF ablation. Objective: To investigate QoL and clinical outcomes using a large prospectively maintained automated patient reported outcomes (PRO) database. Methods: All patients undergoing redo AF ablation (2013-2016) at our center were enrolled and assessed for QoL effect using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). This analysis included data over 3 years of follow-up. The atrial fibrillation severity scale (AFSS) was used as the main measure for QoL assessment. Additional variables collected included patient-reported clinical improvement, AF burden, as well as AF related healthcare utilization including ER visits and hospitalizations. Results: A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; P&lt;0.0001), with ≥70%of patients reported marked improvement in their overall AF-related symptoms. The proportion of patients in AF at the time of completion of the baseline survey was 36%, and this decreased to &lt;8% across all time points during follow-up (P&lt;0.0001). Further, AF burden was significantly reduced (including frequency and duration of episodes; P&lt;0.0001), with associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; P&lt;0.0001). The proportion of patients on anticoagulants, antiarrhythmics, or rate control medications decreased on follow-up across all time points (P&lt;0.0001 for all variables). Conclusions: Most patients derive significant QoL benefit from redo AF ablation. A fully automated PRO system enhanced collection of AF-specific outcomes and showed improvement in QoL, AF burden, and healthcare utilization after redo ablation procedures.
Abstract 13694: Remote Cardiovascular Health Program Improved Risk Factor Control in Patients With Diabetes
Authors: Alexander J Blood, Kira Chaney, David Zelle, William Gordon, Thomas A Gaziano, Jorge Plutzky, Naomi D Fisher, Christopher P Cannon, Benjamin M Scirica
Journal: Circulation (2021)

Introduction: Patients with diabetes are at significantly increased risk of developing future cardiovascular events. Systematic approaches to optimally control cholesterol and blood pressure (BP) can reduce the morbidity and mortality associated with diabetes. Methods: The Digital Care Transformation (DCT) program screens and refers patients for remote cholesterol and hypertension management and subsequently educates, starts and titrates medications and monitors laboratory values through expert-designed algorithms. Patients referred into the DCT program who had established diabetes were assessed to understand therapy decisions and BP and cholesterol outcomes. Results: 3,294 patients with known diabetes have been enrolled from the DCT program. 249 patients have completed only BP management, 951 completed only cholesterol management and 58 completed both programs. ~26% of patients in both programs also had ASCVD. Mean office BP measurements were146/79 mmHg. Patients without white coat hypertension had a weekly average home BP of 134/77 mmHg. Patients in BP management who were hypertensive on home monitoring and completed the program attained a mean BP fall of 9.3/5.4 mmHg, with a mean 2.9 medication changes over an average of 3.9 months. Patients in cholesterol management had a mean baseline LDL cholesterol of 118 mg/dL. These patients underwent 1.5 medication changes to attain a mean 50.6 mg/dL LDL-c reduction over an average of 4.2 months. Conclusions: A population health management tool implemented by an algorithm-based medication management approach can appropriately prescribe therapy and improve hypertension and cholesterol control in patients with diabetes. Patients at high risk of developing a future cardiovascular events can reduce their risk through the DCT program. Further study is warranted to assess the cost-effectiveness of these interventions at scale.
Abstract 14211: In-Hospital Mortality and Length of Stay Among Patients Hospitalized With Acute Heart Failure and Vitamin D Deficiency: A Study From National Inpatient Sample 2016-2017
Authors: Govinda Adhikari, Olga Santiago-Rivera, Nischit Baral, Rohit Rauniyar, Mahin Khan, Sagar Mallikethi Lepakshi Reddy, Parul Sud, Kavitha Kesari, Hameem Changezi, Mustafa Hassan
Journal: Circulation (2021)

Introduction: Vitamin D deficiency (VDD) is highly prevalent in patients with Congestive Heart Failure (CHF) and associated with adverse clinical outcomes. VDD is thought to over-activate neurohormonal and inflammatory responses leading to left ventricular dysfunction. Hypothesis: VDD status is associated with increased in-hospital mortality rate and length of stay (LOS) in patients with acute heart failure. Methods: We used the National Inpatient Sample (NIS) data from 2016-2017 to examine a possible association between VDD and in-hospital mortality or LOS among patients hospitalized with acute heart failure (AHF). We included patients 18 years or older with a primary diagnosis of AHF. Other covariates of interest included sex, age, race, insurance, income quartile by zip code, comorbidities, hospital location, and size. We used the Charlson Comorbidity Index (CCI) categories to account for comorbidities. Bivariate analyses included Chi-square and Fisher's exact test with categorical variables and mean and median test for LOS to examine possible group differences among patients with AHF. We ran unadjusted and adjusted regression models to test the study hypothesis. Results: We identified a total of 177,811 acute heart failure discharges. Two percent (n= 3542) had VDD. The mean age in a VDD group was 72.8 ±14.06 years while in a non-VDD group was 71.5 years±14.49 (p &amp;lt; 0.001). Among VDD patients, 56.06% were females (p &amp;lt; 0.001); 66.70% were White, 21.70% were black, 6.61% were Hispanic (p &amp;lt; 0.001); 18.66% were in Northeast, 30% in Mid-west, 33.8% in South and 17.5% in West hospital region (p &amp;lt; 0.001). There was a higher proportion of Charlson Comorbidity index of three or more in VDD compared to non-VDD (80.12% vs. 69.41%; p &amp;lt; 0.001) group. VDD status was associated with 31.5% decrease in odds of in-hospital mortality compared to non-VDD status (Adjusted Odds Ratio 0.68, 95% C.I. 0.54- 0.87, p = 0.002). However, there was a small but statistically significant increase in length of stay (β = 0.95, linearized S.E. ± 0.18, 95% C.I. 0.06-0.13, p-value &amp;lt; 0.001) in patients with VDD compared to non-VDD. Conclusions: VDD status is associated with statistically significant increased LOS, but lower in-hospital mortality in patients hospitalized with AHF.
Whole-Exome Sequencing in Multiplex Families to Identify Novel AYA Classical Hodgkin Lymphoma Predisposition Genes
Authors: Keren Xu, Niquelle B Wadé, Amie E. Hwang, David V Conti, Maryam Salehi, Thomas M Mack, Victoria Cortessis, David J Van Den Berg, Adam J. de Smith, Wendy Cozen
Journal: Blood (2021)
Abstract 13758: Right Ventricular Dysfunction Contributes to Left Ventricular Thrombus Formation After Myocardial Infarction
Authors: Peter Nordbeck, Mengjia Chen, Dan Liu, kai hu, Björn Lengenfelder, Georg Ertl, Stefan Frantz
Journal: Circulation (2021)

Introduction: Thromboembolic events such as stroke due to left ventricular thrombus (LVT) formation accompany acute myocardial infarction (MI). Risk factors for the development of LVT after MI have been identified based on limited data, including MI location, severe ventricular wall motion abnormalities or aneurysm, and reduced left ventricular ejection fraction (LVEF). Hypothesis: The purpose of this study was to define additional determinants of LVT formation following acute anterior MI through comparing clinical and echocardiographic characteristics between patients with and without LVT formation during the first 3 months after MI. Methods: This case-control-study comprised acute anterior MI patients with and without LVT, who were selected from a cohort of 1327 consecutive patients with ischemic heart failure in our hospital. The cases and controls were matched for age, sex, and LVEF. LVT was detected by routine/contrast echocardiography or cardiac magnetic resonance imaging during the first 3 months following MI. Results: Formation of apical aneurysm after MI was independently associated with LVT formation (72.0% vs. 43.5%, odds ratio [OR]=5.06, P=0.005). Echocardiographic risk factors associated with LVT formation included reduced mitral annular plane systolic excursion (MAPSE&lt;7mm, OR=4.69), moderate-severe diastolic dysfunction (OR=2.71), and right ventricular (RV) dysfunction [reduced tricuspid annular plane systolic excursion (TAPSE)&lt;17mm (OR=5.48), reduced RV factional area change (RV_FAC)&lt;0.35 (OR=3.32), and enlarged RV diameters (OR=1.62)]. Subgroup analysis showed reduced TAPSE (OR=5.12, P=0.010) associated with increased risk of LVT formation in anterior MI patients without apical aneurysm, independent of clinical and other echocardiographic covariates. Conclusions: RV dysfunction as determined by reduced TAPSE and RV_FAC is independently associated with LVT formation in acute anterior MI patients, especially in the setting of MI patients without the formation of an apical aneurysm. This suggests that besides assessment of left ventricular abnormalities, assessment of concomitant RV dysfunction is of importance in risk stratification of LVT formation in patients with acute anterior MI.