tbuckley/cabot-search huggingface dataset:
Abstract 14662: What Factors Contribute to the Presence of Coronary Microvascular Dysfunction in Patients With Non-Obstructive Coronary Artery Disease?
Authors: Hiroki Teragawa, Chikage Oshita, Yuko Uchimura, Yu Hashimoto, Shuichi Nomura
Journal: Circulation (2023)

Introduction: In recent years, there has been growing interest in coronary microvascular dysfunction (CMD). Several risk factors have been discussed as causes of CMD, but there are still many unknowns. Hypothesis: In this study, we evaluated clinical risk factors for CMD in patients with chest pain with non-obstructive coronary artery disease (INOCA). Methods: Sixty-two patients who were able to undergo comprehensive coronary angiography at the time of chest pain screening were included in the study. Patients with a history of heart failure were excluded. Comprehensive angiography excluded patients with organic coronary artery stenosis (%stenosis&gt;50%) and was performed with the spasm provocation test using acetylcholine (ACh) to induce coronary spasm and with a pressure wire to evaluate CMD. Positive coronary spasm was defined as the presence of usual chest pain or electrocardiographic changes and &gt;90% coronary artery constriction on angiograms in response to ACh provocation. In addition, a coronary spasm within one section of the American Heart Association’s classification was defined as a focal spasm. CMD was defined as the presence of coronary flow reserve (CFR) &lt; 2.0 or an index of microcirculatory resistance (IMR) ≥ 25 obtained from a pressure wire. The clinical background leading to CMD was investigated and evaluated by logistic analysis. Results: Of 62 patients with INOCA, 26 (42%) had CMD. The results are shown in the table. Conclusions: These results suggested that factors contributing to CMD in INOCA patients were diverse: women, smoking, focal spasm, and elevated NTproBNP level. It is necessary to identify the cause of CMD before treatment in such patients.
Abstract 15265: Rilonacept for Refractory Pericarditis Following Immune Checkpoint Inhibitor Therapy: A Case Report
Authors: Mohanad Hamandi, Janelle Gooch, Joshua E Levenson
Journal: Circulation (2023)

Background: Immune checkpoint inhibitor (ICI)-mediated cardiotoxicities are rare but potentially fatal. Myocarditis, with clinical presentations ranging from asymptomatic to cardiogenic shock, and pericarditis, have been reported in clinical trials and as post-marketing experience with immunotherapy. It is estimated to occur in less than 1% of individuals receiving single immune checkpoint inhibitor therapy, with a median time to onset of 30 days. Herein, we report a case of late-onset ICI-mediated myopericarditis presenting with cardiogenic shock, followed by recurrent pericarditis refractory to steroid taper. Case Presentation: A 44-year-old woman with triple-negative breast cancer underwent chemotherapy, immune checkpoint inhibitor therapy with Pembrolizumab, lumpectomy, and radiation therapy. After the treatment, the patient developed symptoms consistent with myopericarditis, complicated by pericardial effusion with tamponade and cardiogenic shock. The patient underwent emergent pericardiocentesis and, due to refractory shock, was initiated on high-dose steroid therapy with complete resolution. However, during the tapering of steroids, the patient experienced a recurrence of pericarditis, characterized by chest pain, recurrent pericardial effusion, and elevated inflammatory markers. NSAIDs and colchicine were initiated early in the management but failed to achieve symptom control. Given the refractory nature of the recurrent pericarditis, the decision was made to reintroduce prednisone therapy, which led to substantial symptomatic improvement. To avoid further flares with steroid taper, the patient was started on rilonacept. It led to sustained pain control, and steroids were successfully tapered. Conclusion: Pericarditis is a rare complication of pembrolizumab. There are no specific guidelines on the management of ICI-related recurrent pericarditis. Rilonacept was added due to the refractory nature of her symptoms with steroid taper. It led to sustained improvement in pain, and steroids were successfully tapered.
Abstract 13406: Surveillance Bias: Inpatient Outcomes of Heart Failure in Substance Users as an Example
Authors: Mohamad Alhoda Mohamad Alahmad, Cheryl A Gibson
Journal: Circulation (2023)

Introduction: Substance use (SU), including opioid, methamphetamine, and cocaine use, is not infrequent among those with heart failure (HF). We aimed to characterize substance use among patients with heart failure and its association with inpatient outcomes. Methods: We used the Nationwide Readmission Database (NRD) for 2019 for our retrospective study. First, we extracted all cases older than 18 years that included a primary diagnosis of HF. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results: We identified 1,318,006 discharges with a primary diagnosis of HF. SU was present in 5% of the study cohort (n= 57,395 cases). Patients with SU were younger than those without SU (mean age 55 years vs. 72 years, p&lt;0.001) and fewer women (29% vs. 49%, p&lt;0.001). Patients with SU had a higher prevalence of underlying hypertension, acquired immunodeficiency syndrome, and chronic lung and liver disease, but a lower prevalence of malignancy, dementia, end-stage renal disease, diabetes, and cerebrovascular disease (p&lt;0.001). Substance users had significantly lower inpatient mortality (1.4% vs. 2.9%, p&lt;0.001), but higher leaving against medical advice (AMA) (8% vs. 1%, p&lt;0.001), length of stay (mean 9 days vs. 8 days, p&lt;0.001), and all-cause 30-day readmission rates (58% vs. 46%, p&lt;0.001). Even after adjusting for age, gender, and comorbidities, the presence of SU continued to be associated with lower inpatient mortality compared to those without SU (OR 0.81 [0.73-0.90]). In this case, mortality rates are calculated based on discharge-level records rather than patient-level records. This leads to a dilution of the inpatient mortality rate because drug users who have multiple readmissions contribute more to the denominator. After excluding patients who left AMA or had readmission in the same year, SU was not associated with any favorable outcome (OR 1 [0.90-1.12]). Conclusions: While administrative data offers opportunities to study clinical outcomes, understanding how data is created and analyzed is key. Because the NRD database is built based on discharge-level rather than patient-level records, this is an example of how these calculations can introduce bias.
Abstract 16467: The Prevalence, Racial Distribution, and In Hospital Outcome of Percutaneous Coronary Intervention in Non ST Elevation Myocardial Infarction With Patients With Wild Type Transthyretin Cardiac Amyloidosis
Authors: Faizal Ouedraogo, Olayiwola Bolaji, Olanrewaju Adabale, Saeed Shoar, Ambica V Nair, Endurance O Evbayekha, Akanimo Antia, Bede N Nriagu, Arnaud Yanogo, Abiodun Idowu, Stanley O Oghoghorie, Saeed Graham
Journal: Circulation (2023)

Introduction: Epicardial coronary arteries are also a target for intramural amyloid deposits in cardiac amyloidosis beyond the myocardium. For patients with restrictive cardiomyopathy and some degree of stable chronic angina, the role of coronary revascularization has not been clearly shown to have additional benefits over medical management. In unstable angina and Non-ST-elevation acute coronary syndrome (NSTE-ACS) population, isolated observations have painted a grimmer prognosis. Hypothesis: We hypothesized that wild-type ATTR-CA patients with NSTEMI undergoing Percutaneous coronary interventions (PCI) had poor outcomes. We sought to establish their prevalence and uncover the determinants of these outcomes. Methods: A five-year retrospective inquiry of the National Inpatient Sample (NIS) database from 2016 to 2020 on all the patients admitted with a matching diagnosis to the ICD-10 code of interest. Results: Over the five-year span of our observation, about 1,116,170 patients were admitted to the hospital in the US with an NSTE-ACS diagnosis, of which 99% underwent PCI during the same hospitalization (1,116,065). Among the latter 1,505 patients (1%) had ATTR-CA. The most represented demographics in that subpopulation were men (69%), elderly about 74 years old on average (80%), and Whites (60%). The cumulative mortality rate among the ATTR-CA PCI group was higher (18%) than the general NSTE-ACS PCI (14%). Factors associated with survival at hospital discharge were female sex (p-value 0.008), and black race (p-value 0.019). Meanwhile, Asian race (p-value 0.0001), being in a teaching hospital (p-value 0.0001), medium to large size hospital (p-value 0.0001) were harbingers of poor outcomes including death (18%), prolonged hospitalization (about 9.5 days), and higher healthcare costs (about $127,319). Conclusions: PCI has mortality benefits in STEMI and unstable CAD. However, in the ATTR-CA with unstable CAD, this might not be the case as seen with the staggering 28% risk increase in mortality rates in our study. Percutaneous revascularization in wild-type ATTR-CA deserves its own category when clinicians are weighing the benefits and a multidisciplinary approach should be preferred.
Abstract 14449: Long-Term Colchicine for Cardiovascular and Limb Risk Reduction in Peripheral Artery Disease
Authors: Patrick Heindel, James J Fitzgibbon, Eric A Secemsky, Deepak Bhatt, Mohammed Alomran, Subodh Verma, Ibrahim A Almaghlouth, Arin Madenci, Mohamad A Hussain
Journal: Circulation (2023)

Introduction: Evidence from randomized trials suggests colchicine may reduce major adverse cardiovascular events (MACE) in patients with coronary artery disease. Colchicine's effect in lower extremity peripheral artery disease (PAD) is not known. Methods: To make inferences about the real-world effectiveness of colchicine in PAD, we emulated a pragmatic target trial, leveraging variable prescription durations when adding colchicine to urate lowering therapy in patients with gout and PAD. Eligible patients received care at a multicenter academic health system between July 2007 and December 2019. Electronic health records were linked to Medicare claims data. Patients received either colchicine indefinitely (long-term) or for 3 months (short-term) and the observational analog of the per-protocol effect was estimated. Inverse probability weighted marginal structural models were used to adjust for potential confounding, immortal-time, and collider-stratification biases. The primary outcome was a 2-year composite of major adverse limb events (MALE), MACE, and all-cause mortality. Results: A total of 1,025 patients were enrolled; mean age was 77 years (SD 7), 32% were female, and 9% were non-white race. The risk of the primary composite outcome at 2 years was 31.2% (95% CI 26.9, 35.2) in the long-term colchicine group and 32.7% (29.6, 36.4) in the short-term group (Figure), with a risk difference of -1.6% (-6.3, 3.4) and risk ratio of 0.95 (0.82, 1.11). Beyond 2 years, risk estimates of secondary outcomes in each group diverged, but confidence intervals also widened (Figure). Conclusions: In a real-world sample of high-risk patients with PAD and gout, estimates of the effect of colchicine provided no conclusive evidence that colchicine decreased the risk of adverse cardiovascular or limb events and death. The cardiovascular and limb benefits of colchicine in older comorbid populations with PAD and advanced systematic atherosclerosis remain uncertain.
Abstract 15929: Safety Profile of Ultrasound Enhancing Agents in Echocardiography Across Yale New Haven Health System
Authors: Md Mashiul Alam, Gini P Jeyashanmugaraja, Robert L McNamara, Evgeny Shkolnik
Journal: Circulation (2023)

Background: Ultrasound Enhancing Agents (UEAs) are increasingly used in echocardiography for delineation of endocardial border and detection of left ventricular (LV) thrombus with reported rate of serious adverse reactions from 0 to 0.029%. Contemporary utilization and safety data of UEA in echocardiography are scarce. Aims: We aimed to obtain contemporary data on comparative safety of UEA Lumason and Definity in inpatient and outpatient settings across large academic healthcare system. Methods: A retrospective database analysis of all echocardiograms performed within Yale New Haven Health System (YNHHS) between January 1, 2019 to December 31, 2022 was done. Echocardiography reporting software captured type of UEA as well as any observed adverse reaction. All reported adverse events were manually chart reviewed through electronic medical record for confirmation and grading severity. American College of Radiology (ACR) criteria for contrast agent reaction were used for grading to mild, moderate, or severe reaction. Adverse reactions differences were analyzed with Pearson’s chi-square and predictors were identified by Logistic regression. Results: Out of 305,749 echocardiograms 91,215 (29.83%) required UEAs. In total, 430 (0.47%) adverse events were reported. Lumason (49216, 54.42%) and Definity (41077, 45.42%) were mainly used agents with 158 (0.32%) and 270 (0.66%) reactions recorded, respectively (p&lt;0.001). There were more mild reactions with Definity (245, 0.6%) Vs Lumason (124, 0.25%) (p &lt;0.001), and more severe reaction with Lumason (13, 0.026%) Vs Definity (3, 0.007%) (p=0.0322). Females had higher chance of having any form of contrast reaction (OR 1.707; 95% CI: 1.412-2.065). Older age (OR 0.984 per 1 year; p &lt;0.0001) and higher heart rate (OR 0.993 per 1 bpm; P = 0.050) were associated with a decreased chance of reaction. Ejection fraction and body mass index were not associated with adverse events. Conclusion: UEAs are frequently used in routine echocardiography studies. Adverse reactions to UEA were rare and mostly mild. Severe reactions were more frequent with Lumason than Definity. Female sex, younger age and lower heart rate were associated with increased incidence of adverse reactions.
Abstract 13074: Incremental Value of Abnormal Quantitative Myocardial Perfusion and Myocardial Infarction Using Cardiovascular Magnetic Resonance as Prognostic Markers in Type 2 Diabetes Mellitus
Authors: Noor Sharrack, Kristopher D Knott, Jian L Yeo, Tushar Kotecha, Louise A Brown, Aldostefano Porcari, Robert D Adam, Gaurav Gulsin, Sharmaine Thirunavukarasu, Amrit Chowdhary, Eylem Levelt, James Moon, Gerry McCann, Marianna Fontana, Peter Kellman, Theresa Munyombwe, Chris P Gale, David L Buckley, Peter P Swoboda, John GREENWOOD, Sven Plein
Journal: Circulation (2023)

Introduction: Abnormal myocardial perfusion and MI are each associated with cardiovascular events in individuals with diabetes mellitus (DM). Hypothesis: We hypothesised that, in patients with T2DM, CMR determined quantitative myocardial perfusion and MI are independent predictors of major adverse cardiovascular and cerebrovascular events (MACCE) and that the presence of both offers incremental prognostic value. Methods: A prospective multicentre cohort of individuals with T2DM and healthy controls underwent stress CMR with inline quantitative myocardial perfusion and late gadolinium enhancement (LGE). Adjusted cox proportional hazard models (adjusted for age, sex, LVEF, LV end diastolic volume (LVEDV) and LV mass quantified associations between quantitative myocardial perfusion and MI with MACCE (composite of all-cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation). Results: A total of 572 participants with T2DM from four centres and 52 healthy controls were followed for a median of 851 (IQR 765-935) days, during which 82 (14%) participants accrued at least one MACCE, including 25 (4%) deaths. Presence of either CMR pathology was associated with increased MACCE (normal quantitative myocardial perfusion and no MI: 7% MACCE; abnormal quantitative myocardial perfusion or MI: 13% MACCE (adjusted HR compared with normal 2.06 (95% CI 1.07-3.97, p=0.03)); and both abnormal quantitative myocardial perfusion and MI was associated with the highest event rate: 28% MACCE (adjusted HR compared with normal quantitative myocardial perfusion and no MI 4.55 (95% CI 2.32-8.90, p&lt;0.001)). Conclusion: In individuals with T2DM, the presence of either abnormal quantitative myocardial perfusion or MI is associated with MACCE and the presence of both offers strong incremental prognostic value.
Abstract 15195: Utility of a Polygenic Risk Score for Dilated Cardiomyopathy in the General Population
Authors: Alessia Paldino, Marta Figueiral, Hridyanshu Vyas, Gregory Jenkins, Christopher Scott, Eric Klee, Richard J Rodeheffer, Jose R Medina-Inojosa, Margaret M Redfield, John C Burnett, Francisco Lopez-Jimenez, Gianfranco sinagra, Marco Merlo, Naveen L Pereira
Journal: Circulation (2023)

Introduction: Common genetic variation has been linked to an increased risk of developing dilated cardiomyopathy (DCM). However, the phenotypic profile, outcomes, and biological mechanisms by which such genetic background may predispose individuals to DCM are still unknown. Hypothesis: The primary objectives of this study were to develop a DCM polygenic risk score (PRS) based on prior case control-DCM GWAS and to apply this PRS to a well clinical characterized general population. Methods: The DCM-PRS was derived from 13 DCM risk alleles that were assayed in an unselected cohort (n=1897) of unrelated Olmsted County residents age &gt;45 years who did not have a history of heart failure (HF) or CM and underwent physical examination, echocardiography, and blood analyses. Results: The entire population was equally divided into quartiles based on the DCM-PRS. No significant differences were present in terms of age (median 62 years) and sex (48% male). However, a significant correlation was detected between the DCM-PRS and left ventricle ejection fraction (LVEF) (Beta: -2.68, p&lt;0.001), LV end-systolic diameter (Beta: 0.22, p&lt;0.001), and LV end-diastolic diameter (Beta: 0.14, p=0.01). During a follow-up of 16 years (IQR: 15-17), 47 subjects developed DCM. Using a 3:1 non-DCM vs DCM matched cohort, a logistic regression analysis, found a significant correlation between median DCM-PRS and DCM development [OR=2.27 (1.06, 4.85), p=0.03]. However, there was no association between the DCM-PRS and HF biomarkers (aldosterone, natriuretic peptides, ST2, Galectin-3). Conclusions: DCM-PRS correlates with decreased LVEF, increased LV dimensions, and DCM development in a general population without significant differences in baseline clinical features. The absence of correlation between the DCM-PRS and available HF biomarkers suggests that this genetic background affects LV traits and DCM development independent of these biological mechanisms.
Abstract 17788: Long-Term Impact of Previous Severe Preeclampsia on Heart and Large Artery Structure and Function
Authors: Luiz Bortolotto, Renata Verardino, Thiago A Andrade De Macedo, Sara Rodrigues, Valeria Costa-Hong, Fernanda Baptista, Rossana Francisco, Maria Bortolotto
Journal: Circulation (2023)

Introduction: Women with previous history of preeclampsia (PE) are at risk of cardiovascular events. Hypothesis: To evaluate subclinical cardiovascular repercussions by noninvasive methods in women with previous severe PE. Methods: Cross-sectional study was carried out in a tertiary hospital. Women evaluated 2 to 5 years after delivery and divided into 3 groups: isolated preeclampsia (IPE=30), superimposed preeclampsia and/or chronic hypertension (Sup/HC)=60 and normal gestation (NG) =30. Variables analyzed: age, body mass index (BMI), systolic blood pressure (SBP) and diastolic BP (DBP) by ambulatory blood pressure monitoring (ABPM-24h) and office, central pressure (BPc) by Sphigmocor®; pulse wave velocity-PWV by Complior® e echocardiogram (ViviDI-GE®). Results: Clinical : Age (years): (Sup/HC=38 vs NG=34,6 vs IPE= 31, p &lt;0,001). BMI (kg/m2): Sup/HC=32,6 vs NG=27,1 vs IPE=28,4, p&lt; 0,001); SBP (mmHg): ABPM-24h (awake): (Sup/HC=128,4 vs NG=117,5, p&lt;0,004); office: (IPE=124,8, Sup/HC=133,6 vs NG=114,6, p &lt;0,001). DBP (mmHg) : office (IPE=80,4;Sup/HC=87,8 vs NG= 73,3) and (Sup/HC=87,8 vs IPEH= 80,4), (p&lt;0,001); SBPc (IPE=115,4, Sup/HC=124,4 vs NG 105,8, p &lt; 0,001). DBPc: (Sup/HC=88,8 vs NG= 75; Sup/HC=88,8 vs IPEH=81,8, p&lt;0,001); Vascular : PWV (m/s) (Sup/HC=8,1 vs NG=6,8, IPE=7,0, p&lt;0,012); Echocardiogram : Septum wall thickness (mm) (IPE=9,2 vs Sup/HC=9,7, NG=8,4, p&lt;0,004); left atrium (mm) (Sup/HC=38 vs IPE=36 vs 34, p&lt;0,005); left ventricle mass index (g/m2) (Sup/HC=81 vs IPE=80 vs. NG=66, p&lt;0,002), Conclusions: Women with previous IPE had elevated BP values and cardiac repercussions compared to previous normal gestation while previous superimposed or chronic hypertension had also elevated BP, vascular and cardiac impairment compared to other previous gestational conditions.
Abstract 17169: Beyond CHA2DS2-VASc: Independent Predictors of Ischemic Stroke in Patients With Atrial Fibrillation
Authors: Josephine Harrington, Kelly Arps, Angie Wu, Karen Chiswell, Heidi T May, Ghanshyam Palamaner Subash Shantha, Jeffrey VanWormer, Thomas Viethen, Hardi Mundl, Rosa Coppolecchia, Eren Elci, Tatsiana Vaitsiakhovich, Larry R Jackson, Kevin L Thomas, Jonathan P Piccini, Manesh R Patel
Journal: Circulation (2023)

Introduction: Factors outside of the CHA 2 DS 2 -VASc score also contribute to stroke risk, and patients prescribed anticoagulants still face a residual stroke risk. Methods: A multivariable model to predict stroke risk was built using data from patients treated for atrial fibrillation (AF) at Duke between 2009 and 2018. The model was then refined in patients presenting with incident AF at 7 hospitals within the larger PCORnet database. Results: Of 43,896 patients with AF included in our multivariable model creation data set, median age was 71.6 years, 44.2% of patients were female, 17.4% were black, and median CHA 2 DS 2 -VASc was 3. DOAC was prescribed in 24.2%, warfarin in 28.7%, and 50.4% were not prescribed either anticoagulant. The 5-year incidence of ischemic stroke was 3.5%. In a multivariable model, patients who were black, had prior major bleeding, or who were prescribed aspirin or an SSRI were at increased risk for ischemic stroke regardless of type of anticoagulation, whereas lower eGFR did not increase the risk. The model was refined in the PCORnet database using 244,213 patients with incident AF, with additional identification of lower risk for patients with BMI &gt;30 or recent cardiac surgery, and use of P2Y12 as a risk factor. Multivariable models showed substantial improvement in stroke prediction within both the Duke and PCORnet treatment cohorts, with improvement in C-indices to 69.6-75.7%, from baseline C-indices of 63.5%-68.7% for CHA 2 DS 2 -VASc alone among patients on DOAC, warfarin, or who were untreated. Conclusions: Lower BMI, prior major bleeding, antiplatelet (ASA or P2Y12) use, and black race were significantly associated with increased risk for ischemic stroke, independent of the commonly used CHA 2 DS 2 -VASc score. Future AF research should attempt to integrate these emerging risk factors with the existing CHA 2 DS 2 -VASc framework to improve the identification of patients at high risk of stroke and in greatest need of anticoagulation.