tbuckley/cabot-search huggingface dataset:
Abstract 4138301: Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data
Authors: Hoang Nhat Pham, Enkhtsogt Sainbayar, Ibrahim Ramzi, April Olson, Abdulla Alabagi, Sabrina Soin, Danny Aiti, Phillip Tran, Justin Lee, Mohammed Khanji, Anwar Chahal, Mamas Mamas
Journal: Circulation (2024)

Background: Hyperlipidemia (HLD) is a major risk factor for cardiovascular disease (CVD). Little is known regarding temporal variation in CVD mortality related to HLD. The COVID-19 pandemic added complexity to factors influencing CVD mortality. Question: What are the yearly trends and impact of the COVID-19 pandemic on HLD-related CVD mortality in the United States? Methods: Mortality and demographic data for adults were obtained from CDC repository from 1999-2020, using ICD-10 codes HLD (E78.0-E78.5) and CVD (I00-I99). Age adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models evaluated mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to calculate projected AAMR in 2020, subsequently compared to actual 2020 death rates to estimate pandemic-attributed excess deaths. Results: A total of 483,155 HLD-related CVD deaths were recorded between 1999-2020. Despite the CVD mortality decline in general population, HLD-related CVD AAMR rose from 36.33 [95% CI, 35.52-37.13] in 1999 to 99.77 [98.67-100.87] in 2019. Ischemic heart diseases (AAMR 49.39) were the most common causes of death while hypertension had the highest annual mortality increase (AAPC +10.23%) in populations with HLD. Higher HLD-related CVD mortality was observed in males (AAMR 104.87) than females (AAMR 61.93), in those ≥75 years (AAMR 646.45) than 35-75 years (AAMR 54.11), in non-Hispanic (NH) (AAMR 82.49) than Hispanic (AAMR 58.98) populations, and in rural (AAMR 89.98) than urban (AAMR 78.94) regions. NH Black populations (AAMR 84.35) and Western US regions (AAMR 96.88) had the highest HLD-related CVD. The first year of COVID-19 pandemic resulted in 10.55% excess HLD-related CVD death, with the most prominent increase in the 35-75 years age group (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) populations. Conclusions: Our study revealed an increase in HLD-related CVD mortality which was exacerbated by the COVID-19 pandemic. Higher CVD mortality disproportionately affected males, Black, elderly (≥75 years), and rural populations with HLD. Further research is needed to validate our findings and identify contributing factors.
Abstract 4138282: Effect of cardiopulmonary exercise testing parameters and global longitudinal strain on survival after surgery for severe primary mitral regurgitation
Authors: Jonathan Afoke, Chieh-Mei Tsai, Hartzell Schaff, Richard Daly, Joseph Dearani, Juan Crestanello, Malakh Shrestha, Gabor Bagameri, Phillip Rowse, Trevor Chopko, Casey Briggs, myriam martinez aguilar, Austin Todd, Hector Michelena, Vuyisile Nkomo, Thomas Allison
Journal: Circulation (2024)

Background: Optimum timing of surgery for severe primary mitral regurgitation (MR) particularly in the absence of significant symptoms or echo evidence of LV impairment remains unclear. Other modalities of assessment include cardiopulmonary exercise testing (CPET) and novel echo measurements, such as LV global longitudinal strain (LVGLS). We sought to evaluate whether pre-op CPET or LVGLS are associated with survival after surgery. Methods: We identified consecutive patients who had surgery for severe primary MR between 2007 and 2017 and had pre-op CPET. Clinical and mortality data were collected from chart review and our institutional database. LVGLS was retrospectively collected by a single person blinded to patient outcomes. Primary outcome was post surgery all cause death, and we used univariable analysis to identify variables associated with all cause death. Results: We included 176 patients with median age 63 (IQR 51, 71) years, 63 patients (35.8%) were female and 31 patients (14.8%) had a history of atrial fibrillation. 165 patients (93.8%) had mitral repair, 18 (10.2%) had concomitant CABG, 22 (12.5%) had concomitant ablation procedure and 14 (8.0%) had concomitant tricuspid procedure. 114 patients (64.8%) were in NYHA Class I and 56 (31.8%) were in NYHA Class II. There was no operative mortality. Median % predicted peak VO2 (ppVO2) was 89 (74, 101), median ventilatory equivalent of carbon dioxide (VE/VCO2) was 28.0 (25.7, 31.0) l/min/l/min and median respiratory exchange ratio was 1.2 (1.1, 1.2). 73 patients (41.5%) had abnormal CPET (defined as ppVO2&lt;85%). Median LVEF was 65 (60, 68) %, median LVESD was 35 (32, 38) mm and median LVGLS was 18.5 (16.6, 20.3) %. 45 patients (25.9%) had abnormal LVEF (defined as ≤ 60%), 11 patients (6.7%) had abnormal LVESD (defined as ≥45mm) and 35 patients (20.8%) had abnormal LVGLS (defined as &lt;16%). At a median follow up of 10.2 (6.8, 13.2) years, there were 19 (10.8%) deaths. In the univariate analysis, age at surgery (HR 1.12, p&lt;0.001), LVESD (HR 1.11, p=0.009), LVGLS (HR 1.11, p=0.013) and VE/VCO2 (HR 1.08, p=0.044) were associated with all cause mortality. Conclusion: A significant proportion of patients with no or mild symptoms exhibit echocardiographic evidence of LV impairment when having surgery for severe primary MR. CPET parameters such as VE/VCO2 and novel echocardiographic measurements such as LVGLS may predict risk of long term mortality and potentially inform timing of surgery in these patients.
Abstract 4138426: Geographic Disparities in Cardiometabolic Health Widened Across US States Between 2011 and 2021
Authors: Rachel Gardner, Archana Pravin Tale, Rishi Wadhera
Journal: Circulation (2024)

Background: Geographic inequities in cardiovascular mortality are pervasive in the US. Pandemic-related delays in screening and treatment, economic loss, and worsening social determinants may have widened geographic disparities in cardiometabolic health, particularly in states that were hardest hit by these spillover effects. Understanding changes in state-based inequities could inform targeted public health efforts to advance cardiovascular health. Questions: Did the prevalence of cardiometabolic risk factors (diabetes, hypertension, hyperlipidemia, obesity) and lifestyle factors (alcohol consumption, physical inactivity, tobacco use) change between 2011 and 2021? How did between-state differences change over this period? Methods: We included adults from the CDC’s Behavioral Risk Factor Surveillance System. Survey-weighted logistic regressions models were used to calculate age and sex-adjusted risk difference between states with the highest and lowest adjusted prevalence rates of each risk factor in 2011 and 2011, respectively. An interaction term for state and year was included to assess for differential changes in between-state disparities. Results: From 2011 to 2021, there were increases in the age- and sex-adjusted prevalence of diabetes (10.9% [95% CI, 10.7,11.0] to 12.4% [12.2,12.6]), hypertension (32.4% [32.1,32.7] to 33.7% [33.4,34.0]), and obesity (27.5% [27.2,27.7] to 33.1% [32.8,33.5]). Geographic inequities widened, with increases in the difference between states with the highest vs lowest prevalence of diabetes (5.7% [5.3,6.1] to 7.8% [7.3,8.3]), hypertension (14.2% [13.6,14.8] to 17.2% [16.4,17.9]) and obesity (14.3% [13.6,15.0] to (15.7% [14.7,16.7]) (Table). The prevalence of alcohol consumption (18.0% [17.7,18.2] to 15.6% [15.3,15.8]), physical inactivity (25.7% [25.4,27.4] to 24.0% [23.6,23.7]), and tobacco use (44.9% [44.5,45.3] to 36.3% [35.8,36.8]) decreased, and between-state differences did not widen. Conclusion: In this national study, the prevalence of hypertension, obesity, and diabetes increased from 2011 to 2021, and state-based inequities widened. Our findings highlight the urgent need for public health interventions to address widening state-based disparities in cardiometabolic health.
Abstract 4138275: Demographic, Regional, and State-level Trends of Mortality in patients with Atrial fibrillation in the United States, 1999 to 2020
Authors: Vikash Jaiswal, Fakhar Latif, Yusra Mashkoor, FNU Danisha, Akash Jaiswal, Muhammad Hanif, Richard Amara, Timm Dickfeld, Monodeep Biswas
Journal: Circulation (2024)

Background: There exists a paucity of data regarding mortality trends among individuals with atrial fibrillation (AF) based on age, gender, race and ethnicity, and geographic regions. Objective: To investigate the trends in mortality in the United States (US) associated with AF among individuals aged ≥45 years. Methods: We reviewed the death certificate data from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database to examine atrial fibrillation–related mortality trends from 1999 to 2020 in individuals ≥45 years of age. We calculated crude and age adjusted mortality rates (AAMRs) per 100 000 patients and annual percentage change (APC) with 95% CIs. Results: Between 1999 and 2020, 2,576,839 AF-related deaths were identified among US adults over 45 years of age. The age adjusted mortality rate (AAMR) for AF-related deaths rose significantly from 70.6 in 1999 to 149.1 in 2020. Initially, the AAMR remained stable from 1999 to 2009 (APC): 2.31; 95% CI: -0.57 to 5.84), then increased significantly from 2009 to 2018 (APC: 3.60; 95% CI: 2.12 to 4.75), and saw a sharp rise from 2018 to 2020 (APC: 8.46; 95% CI: 4.76 to 10.44). There were notable disparities among demographic groups. Men consistently had higher AAMRs than women from 1999 (men: 79.9, women: 64.4) to 2020 (men: 180.5, women: 125.3). Non-Hispanic (NH) White adults had the highest AAMR (108.6), followed by NH American Indian/Alaska Native (73.4), NH Black (66.7), Hispanic or Latino (55.5), and NH Asian or Pacific Islander adults (51.2). The age group 85+ consistently showed the highest mortality rates throughout the study period. Regional differences were also evident, with the residents of western region (109.5) and nonmetropolitan areas (109.6) having the higher AAMRs when compared to other regions (Midwest: 104.3, Northeast: 95.1, and South: 95.0) and metropolitan areas (98.3), respectively. State-level variations were also significant. Conclusion: Our study found a rise in AF-related mortality in the US from 1999 to 2020, with significant disparities among demographic and geographic subgroups. Higher AAMRs were noted in males, non-Hispanic Whites, adults over 85, and residents of the western and nonmetropolitan US. Addressing disparities in access to quality care, timely diagnosis, insurance maintenance, and implementing targeted health policies can help reduce AF-related mortality.
Abstract 4138242: Association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes from left atrial appendage occlusion (LAAO) device implantation in elderly (&gt;80 yrs) patients with atrial fibrillation (AF)
Authors: asmaa Ahmed, Muhammad Osama, Nauman Naeem, DMITRY CHUPRUN, Mohan Rao
Journal: Circulation (2024)

Background: LAAO has been used as an alternative strategy for stroke prevention in selected patients with AF, however there is very limited data about the outcomes in elderly patients with kidney disease. Methods: The National Inpatient Sample was queried for LAAO in the US between 2015–2020. Hospital outcomes were assessed for elderly patients undergoing LAAO in three cohorts; no CKD, CKD and ESRD. Results: A total of 31,360 elderly patients undergoing LAAO were identified in the study period; 23,250 (74.1%) had no CKD, 7,610 (24.2%) had CKD, and 500 (1.5%) had ESRD. CKD and ESRD were independently associated with higher odds of in-hospital mortality [aOR 3.06, 95 % CI (1.805-5.207), p &lt;0.001)] &amp; [ aOR 9.69 ,95% CI (3.52-26.64), p &lt;0.001], cardiovascular complications [ aOR 1.43 ,95% CI (1.208-1.696), p &lt;0.001] &amp;[ aOR 3.41 ,95% CI (2.12-5.48), p &lt;0.001], p &lt;0.001], neurological complications [aOR 1.2 ,95% CI (1.05-1.36), p=0.006] &amp;[aOR 1.58 ,95% CI (1.07-2.33), p=0.019], gastrointestinal and hematological complications [aOR 1.22 ,95% CI (1.06-1.39), p=0.003] &amp;[ aOR 1.71 ,95% CI (1.16-2.52), p &lt;0.001] respectively when compared to patients with no CKD. CKD was independently associated with higher odds of renal complications compared to patients with no CKD [aOR 5.34 ,95% CI (4.532-6.303), p &lt;0.001]. In comparison to patients with ESRD, patients with CKD had significantly higher odds of renal complications [aOR 8.01 ,95% CI (3.28-19.57), p &lt;0.001] with no significant difference in the odds of in-hospital mortality [aOR 0.4 ,95% CI (0.14-1.12), p=0.08]. In terms of resource utilization, length of stay didn’t differ with different kidney functions (1(1-1) for the three cohorts). However the ESRD cohort had the highest hospitalization costs compared to the CKD and no CKD cohorts ($26.113 ($19.728 -$34.362) vs. $25.799 ($20.231-$32.943) vs. $24.894 ($19.641-$31.373), p &lt;0.001). Conclusion: The prevalence of CKD and ESRD was around 25.7% in elderly patients with AF undergoing LAOO. CKD and ESRD were independently associated with higher odds of in-hospital mortality compared to patients with no CKD while CKD was independently associated with higher odds of renal complications after LAAO.
Abstract 4138248: Outcomes of Patients with Radiation-Associated Cardiac Disease Undergoing Cardiothoracic Surgery: Development of a Disease Specific Risk Score
Authors: Andrew Gaballa, Shada Jadam, Tom Kai Ming Wang, Shinya Unai, Marijan Koprivanic, Eric Roselli, Samantha Xu, Susan Ospina, Patrick Collier, Brian Griffin, Milind Desai
Journal: Circulation (2024)

Background: Radiation-associated cardiac disease (RACD) has significant long-term mortality and morbidity, often requiring cardiac surgery(CS). Hypothesis: We sought to study factors associated with longer-term survival in RACD patients and develop a specific risk score associated with 5-year survival following CS. Methods: This was an observational cohort study of 351 patients with documented RACD (252 [72%] had mantle radiation for lymphoma at a mean of 18 years prior), who underwent CS at a tertiary care center between 1991-2018. Clinical characteristics were collected, and Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Multivariable analysis for 5-year mortality was performed using age, sex, history of lymphoma, New York Heart Association class, prior cardiac surgery, atrial fibrillation, constriction, chronic pulmonary disease, serum creatinine, left ventricular ejection fraction, right ventricular systolic pressure and valvular surgery(aortic, mitral or tricuspid). Results: Clinical characteristics are shown in Figure 1. Mean follow-up was 6.2±4.6 years&amp;5-year mortality occurred in 123 (35%) patients (7 [2%] in-hospital deaths). Cox 5-year survival analysis results are shown in Figure 2A. A receiver operator curve analysis for 5-year mortality showed an area under curve of 0.70 (95% confidence interval 0.64-76, p&lt;0.001). Subsequently, a 5-year risk score (0-7 points) was generated (Figure 2 A); with an increasing risk of mortality at 5 years, based on increasing risk score (Figure 2C). Cardiac reoperation was not associated with worse outcomes. Conclusion: RACD patients undergoing CTS have a high rate of 5-year mortality, despite a low baseline STS score&amp;perioperative mortality. A novel RACD-specific risk score (incorporating higher age, abnormal renal/pulmonary, constrictive pericarditis&amp;need for concomitant mitral valve surgery) provides good discrimination for 5-year survival&amp;could be used for shared-decision making.
Abstract 4138212: Efficacy of Left Atrial Appendage Occlusion in Reducing Mortality and Major Bleeding Events in Cancer Patients with Atrial Fibrillation
Authors: Rochell Issa, Zoha Majeed, Ryan Issa, Rohan Prasad, Patrick Collier, Arianne Agdamag, David Kaelber, Diego Sadler, Alok Khorana, Mohamed Kanj, Rohit Moudgil
Journal: Circulation (2024)

Introduction: Atrial fibrillation (AF) is a common comorbidity in cancer patients, increasing their risk of stroke and mortality. Cancer patients are often excluded from anticoagulation and AF intervention trials due to the nature of their disease, and risk scores such as HAS-BLED, CHADS2/CHADS2-VASc often underpredict the high risk of AF and related complications for these patients. Research Question: Does left atrial appendage occlusion (LAAO) reduce mortality, major bleeding events (MBE), and stroke in cancer patients with AF? Methods: Using TriNetX, an international health research network with data from over 100 million patients, cancer patients with AF, with and without LAAO were identified between 2015 and 2022. Equal cohorts of 147 patients were created after propensity score matching for demographics, diabetes, hypertension, and heart failure. Measures of Association and Survival Analysis were conducted between 3-months and 5-years. The primary outcome was mortality. The secondary outcomes were MBE and stroke. Results: The study included 294 cancer patients with AF, with 147 having received LAAO. The risk of mortality at 3 months was 6.8% in the LAAO+ group compared to 15% in the LAAO- group (p-value= 0.025). At 6 months, the mortality risk was 8.8% in the LAAO+ group and 18.4% in the LAAO- group (p-value= 0.017). At 1 year, the mortality risk was 12.2% in the LAAO+ group and 23.8% in the LAAO- group (p-value=0.010). At 5 years, the mortality risk was 28.6% in the LAAO+ group and 49.7% in the LAAO- group (p-value&lt;0.0001). The MBE risk was 20.4% for the LAAO+ group and 32% for the LAAO- group at 3 months (p-value= 0.024). At 6 months, the MBE risk was 25.9% in the LAAO+ group and 40.1% in the LAAO- group (p-value=0.009). Although there was no significant difference in risk of MBE at 1 year and 5 years, survival was higher among the LAAO+ group than the LAAO- group (64.92% vs 52.76%; p-value= 0.038 at 1 year and 52.67% vs 39.23%; p-value=0.029 at 5 years). However, there was no difference between stroke risk or survival probability across all measured time points. Conclusion: LAAO in cancer patients with AF was associated with significantly reduced mortality and major bleeding events over a 5-year period compared to those without LAAO. These findings suggest that LAAO may be a beneficial intervention for improving survival and reducing bleeding complications in cancer patients with AF.
Abstract 4138230: Incidence of Worsening Tricuspid Regurgitation Following Implantation of Leadless versus Dual-Chamber Pacemakers
Authors: Omar Aldaas, Jesus Gil, Gordon Ho, Ulrika Birgersdotter-Green
Journal: Circulation (2024)

Introduction: Cardiac implantable electronic devices (CIED) may result in or worsen tricuspid regurgitation (TR), which is associated with a higher risk of morbidity and mortality ( Figure 1 ). However, the incidence of TR following implantation of leadless pacemakers versus dual-chamber pacemakers (DC-PPM) is not well described. Hypothesis: Micra leadless pacemakers will have a lower incidence of worsening TR relative to standard DC-PPMs. Aims: To evaluate the incidence of worsening TR after implantation of leadless and DC-PPMs. Methods: We performed a retrospective study of all patients who underwent Micra leadless pacemaker or DC-PPM implantation at the University of California, San Diego from 2/2019-2/2024. The primary outcome was incidence of worsening TR. Results: A total of 476 patients underwent CIED implantation with both pre- and post-echocardiograms completed, of which 26.9% (n=128) had a Micra leadless pacemaker implanted and 73.1% (n=348) had a DC-PPM implanted. The average time to first post-implantation echocardiogram was 359 days in the Micra group and 510 days in the DC-PPM group (p=0.004). Worsening TR post-CIED implantation occurred in 21.9% (n=28) of patients who had a Micra and 25.9% (n=90) of patients who had a DC-PPM (p=0.192). The TR worsened by an average of 0.88 ± 0.32 grades in the Micra group versus 0.98 ± 0.33 grades in the DC-PPM group (p=0.08). Conclusion: In this analysis, leadless pacemaker implantation was associated with a statistically insignificant trend towards less TR. However, the degree of worsening TR following leadless pacemaker or DC-PPM implantation is relatively mild and of unclear clinical significance.
Abstract 4138238: A Tense Race: Correlation of Liver Stiffness with Ultrasound Elastography and Hemodynamics in Fontan Patients.
Authors: Yuen Lo Yau, Matthew Purlee, Lindsey Brinkle, Dipankar Gupta, Dalia Lopez-Colon, David Saulino, John Anthony Coppola, Himesh Vyas
Journal: Circulation (2024)

Background: Ultrasound elastography (USE) is a non-invasive tool to diagnose and monitor liver fibrosis. Patients with Fontan physiology are predisposed to congestive hepatopathy, progressive liver fibrosis, and end-stage liver disease. We sought to determine whether hemodynamics pre- and post-Fontan are associated with increased liver stiffness on USE. Methods: A single-center retrospective study included Fontan patients who had one or more USE between 06/2008-03/2024. Liver stiffness was reported as shear wave elastography (SWE) in m/s. Hemodynamic data pre- and post-Fontan and recent echocardiographic data were collected. Data was analyzed as continuous (linear regression model) and as a dichotomous variable (t-test). Results: A total of 78 post-Fontan USE results in 56 patients were analyzed. Table 1 describes the demographics of our patient population. The spectrum of fibrosis based on USE was normal (3.8%), mild (10.3%), moderate (55.1%) and severe (30.8%). In patients with more than one USE, the average increase in SWE was 0.04m/s per month. Pre-Fontan median Glenn pressure was 12mmHg [IQR 13, 15] (p=0.83). On post-Fontan catheterization, median Fontan pressure was 18mmHg [16, 21] (p=0.86). We did not find a significant correlation between hemodynamics and severity of liver stiffness on USE (Tables 2&amp;3). No correlation was seen between USE and severity of ventricular function or atrioventricular valve regurgitation. SWE as a function of time from Fontan operation (&lt;5 yr, 5-10 yrs, &gt;10 yrs) did not vary significantly. Conclusions: USE as a marker of liver congestion does not correlate with hemodynamics pre- or post-Fontan. Further studies are necessary to determine the clinical utility of USE in Fontan patients.