tbuckley/cabot-search huggingface dataset:
Abstract 16703: ST Elevation Myocardial Infarction and Chronic Total Occlusion: Trends and In-Hospital Outcomes in the United States
Authors: Revanth Reddy Bandaru, Avilash Mondal, Sanjana Aggarwal, Pratiksha Shankarlal Nathani, Kesavan Sankaramangalam, Rupak Desai
Journal: Circulation (2023)

Introduction: Acute ST-segment elevation myocardial infarction (STEMI) occurs due to sudden thrombotic complete occlusion of one or more coronary arteries resulting in transmural ischemia and eventually necrosis. Chronic total occlusions (CTO) are incidentally found in a minority of patients and have been implicated in poor outcomes in STEMI patients. There is a paucity of data analyzing the trends and outcomes of STEMI patients with a CTO (STEMI-CTO). Methods: We used the National Inpatient Sample to identify elderly (&gt;65 years) STEMI patients with vs. without CTO. We compared the prevalence trends of STEMI, baseline characteristics, in-hospital mortality, and complications, including cardiogenic shock, in these two groups from 2016 to 2019. Chi-square test was used to determine the statistical significance of these variables. Results: Of 317,105 STEMI hospitalizations, 21,115 had concomitant CTO. Patients with CTO were more likely to be young (median age 73 vs. 74, p &lt;0.001), obese (13.8% vs. 12.8%), males (67.5% vs. 60.5%), with peripheral vascular disease (13.4% vs. 10.8%), hyperlipidemia (67.5% vs. 65.5%), and prior history of MI (15.2% vs. 12.3%), PCI (14.1% vs. 13.0%) and CABG (9.4% vs. 6.1%) (p&lt;0.001). In-hospital mortality was more frequent in CTO-STEMI compared to non-CTO-STEMI patients (12.5% vs. 11.8%, p=0.003). From 2016-2019, the prevalence of CTO kept decreasing (10.7% vs. 6.5%, P&lt;0.001); however, increasing mortality trends in CTO patients (14.4% vs. 12.2%) compared to decreasing mortality trends in non-CTO patients (11.2% vs. 12.5%) was concerning. [Fig. 1]. Also, the frequency of in-hospital deaths was on a uptrend and peaked in 2019 amongst all CTO patients. Conclusions: The prevalence of CTO in STEMI patients is decreasing, while in-hospital mortality, cardiogenic shock and hospital expenses continue to rise. Future prospective studies are necessary to understand the trends among CTO-STEMI patients to avoid poor outcomes.
Abstract 13952: Neurodevelopmental Outcomes in Early Adolescence: The Pediatric Heart Network’s Single Ventricle Reconstruction Trial
Authors: Thomas Miller, Felicia Trachtenberg, Binu Sharma, Caren S Goldberg, Jane W Newburger, Ashok Panigrahy, Russell Gongwer, J W Gaynor, Mary Kral, Renee Sananes, Amee Shah, Rocky Tsang, Kathryn Gustafson, Linda M Lambert, Jodie Votava-Smith, Kimberley Heinrich, dawn ilardi
Journal: Circulation (2023)

Introduction: Neurodevelopmental (ND) and functional impairments for survivors of palliated hypoplastic left heart syndrome (HLHS) are among the most consequential morbidities, resulting in an increased risk of poor school performance and lower reported quality of life. Longitudinal follow-up of those enrolled in the Single Ventricle Reconstruction (SVR) III study provides opportunity to measure important outcomes such as ND, and understand associated risk factors. Goals/Aims: Describe and identify predictors of ND outcomes at 10-12 years of age in participants enrolled in SVR. Methods: Transplant-free survivors from the SVR III trial were invited to complete in-person ND assessments, including the Wechsler Intelligence Scale for Children-V, Wechsler Individual Achievement Test-III, and the Behavior Rating Inventory of Executive Function (BRIEF). Descriptive and regression analyses were performed. Results: Of the 237 enrolled in SVR III, 200 (84%) received a ND assessment. Participants who did vs did not undergo assessment were more likely to be male (63% vs 51%), white (87% vs 76%) and have a higher Child Opportunity Index (61 ±26 vs 46 ±39). Mean Full Scale IQ for the cohort was almost 1 standard deviation (SD) below the normative mean (88 ±18), with 39% &gt;1 and 15% &gt;2 SD below the normative mean. Similar patterns were seen for Reading (38% &gt;1 SD and 16% &gt; 2SD) and Math Composites (38% &gt;1 SD, 19% &gt; 2SD). Executive functions measured with the BRIEF were similarly affected, with 25% to 45% of individuals showing clinically significant (T score &gt;65) Plan/Organization problems on parent and teacher forms, respectively. Measures of socioeconomic status, number of complications, and requirement for a gastrostomy-tube were all independent predictors for multiple ND outcomes. Conclusions: In early adolescence, transplant-free survivors of surgical palliation for HLHS show clinically significant ND concerns across multiple domains of functioning. The distribution of outcomes is broad. Our findings support the American Heart Association recommendations for screening and evaluation in middle school to inform interventions that promote academic success and quality of life.
Abstract 181: Adiponectin Alleviates Acute Murine Pulmonary Injury Post Cardiopulmonary Resuscitation
Authors: Yarong He, Yaowen Jiang, Shiyuan Tang, Haifang Yu, Yu Cao
Journal: Circulation (2023)

Objective: Patients with cardiac arrest (CA) are often suffering from pulmonary ischemia-reperfusion injury after active cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC). In recent years, previous studies have found that acute lung injury (ALI) after ROSC could be an independent risk factor for the prognosis of out of hospital cardiac arrest (OHCA). However, there is still a lack of effective therapy for pulmonary injury caused by CA-CPR-ROSC with no side effects. Methods: C57BL/6 male mice, aged from 8 to 10 weeks were purchased from Dossy Experimental Animals Co. Ltd (Chengdu, China). All the mice were feeding and drinking freely in the animal room of Sichuan University West China Science and Technology Park for one week. The experiments involving mice were approved by the Ethics Committee from West China Hospital of Sichuan University (approval No.2017071A). At the day before experiment, mice were given fasting treatment but allowed to drink water freely. CA-CPR-ROSC could cause global cerebral ischemia injury in vivo. APN (10μg/0.05ml per mice) was intravenously injected to mice at 10 min after restoration of spontaneous circulation (ROSC). Computed tomography (CT) scan of the lungs was performed before executing the animals. We used the Opal Color Manual IHC staining Kit for multiplex immunofluorescence staining measurement. Western blot detected the expression of Nrf2, OCLN, and CLDN5 in murine pulmonary tissues. Results: The results of CT scanning and routine histological measurements showed that APN could protect mice against murine pulmonary injury caused by CA-CPR-ROSC, compared to that of mice in CA-CPR-ROSC group. The results of western blot suggested that the expression of Nrf2 significantly increased in mice pulmonary tissues in CA-CPR-ROSC, whereas the expression of OCLN and CLDN5 obviously decreased in murine pulmonary tissues in CA-CPR-ROSC. Conclusion: Current study indicated the protect role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC. The protective role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC might be associated to the Nrf2 signaling pathway.
Abstract 14256: Examining the Efficacy of Inferior Vena Cava Filters in the Direct Oral Anticoagulant Era
Authors: Toru Takase, Yohei Funauchi, Yugo Yamashita, Kazuhisa Kaneda, Ryuki Chatani, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Ryusuke Nishikawa, Gaku Nakazawa
Journal: Circulation (2023)

Introduction: No previous reports have adequately demonstrated whether inferior vena cava filters prevent pulmonary embolism, and reports of disadvantages, such as worsening venous thrombosis, have led to a decrease in the frequency of their use. However, in actual clinical practice, patients often encounter situations in which they expect to benefit from inferior vena cava filters; hence, exploratory studies examining their efficacy continue. Hypothesis &amp; Methods: We analyzed data from the COMMAND VTE Registry-2, a multi center, retrospective, observational study of symptomatic venous thrombosis in the DOAC era, for cases using inferior vena cava filters. Results: A total of 5197 cases of venous thrombosis were enrolled, among whom 483 (9%) had inferior vena cava filters implanted. The inferior vena cava filter was implanted long-term and removed in 6% and 3% of cases, respectively. Inferior vena cava filters tended to be implanted in patients with active cancer patients, with more patients with terminal cancer, on anticancer therapy, and with distant metastases having long-term filter implantation (P = 0.001). After inferior vena cava filter implantation, the inferior vena cava filter implantation group showed a significantly lower incidence of pulmonary embolism within 30 days after the onset of initial venous thrombosis (P = 0.011). However, Kaplan-Meier analysis during a median follow-up of 854 days showed that long-term implantation of inferior vena cava filters significantly increased incidence of deep vein thrombosis (P = 0.001), whereas multivariate analysis found that long-term implantation of inferior vena cava filters was an independent risk factor for deep vein thrombosis (HR: 2.096, 95% CI: 1.254-3.508, P = 0.005). Conclusions: Inferior vena cava filters may be effective in preventing pulmonary emboli in the short term; however, even in the DOAC era, long-term filter implantations were associated with an increased incidence of deep vein thrombosis.
Abstract 13067: Conduction System Pacing to Achieve Cardiac Resynchronization Therapy: Is There a Sex Difference in Response Rates?
Authors: Nikola Kocovic, Brady Houtz, Behzad B Pavri
Journal: Circulation (2023)

Background: It is well established that in patients with dyssynchronous heart failure related to left bundle branch block (LBBB) and reduced left ventricular ejection fraction (LVEF), females show higher response rates than males when cardiac resynchronization (CRT) is achieved by conventional biventricular (BiV) pacing. Whether this sex difference is also true when CRT is achieved via conduction system pacing is unknown. Hypothesis: There is no difference between women and men in response rates when CRT is achieved by conduction system pacing (CSP), either by His bundle pacing (HBP) or by left bundle area pacing (LBAP). Methods: Patients who underwent CSP with a baseline LVEF ≤40% and a QRS duration ≥140 milliseconds (ms) were retrospectively selected from a CSP database maintained at our institution. 52 patients were included: 17 females and 35 males. Baseline clinical, electrocardiographic, echocardiographic, and follow up data were gathered and analyzed. Electrocardiograms and echocardiograms closest to the dates of implant and at last known follow up were used. Super-response was defined as absolute EF improvement ≥15%. Results: At baseline, there were no statistically significant differences in clinical, electrocardiographic, and echocardiographic characteristics between females and males except for higher prevalence of coronary disease in men, and higher percentage use of guideline directed medical therapy in men (Table 1). At median follow up of 113 days, there were no differences in electrocardiographic or echocardiographic response, number of super-responders, and mortality between females and males (Table 1). Conclusions: Unlike conventional CRT where females show superior response rates, CRT with CSP seems to provide comparable benefits in females and males. If confirmed in larger data sets, this may represent an important advantage of CSP over conventional CRT.
Abstract 18855: Comparison of Hospital Outcomes in Sick Sinus Syndrome Patients With and Without Pacemaker- A Nationwide Inpatient Sample Analysis
Authors: Ayesha Abbasi, Aneeza Jamshed, IMRAN AZIZ, SMRITI KHANAL, Mahir Yilmaz, Sami Shoura, Ramtej Atluri
Journal: Circulation (2023)

Introduction: Sick sinus syndrome refers to degenerative fibrosis of the sinoatrial node, leading to bradyarrhythmias with or without tachyarrhythmias. Pacemaker implantation is a common therapeutic intervention in patients with symptomatic sick sinus syndrome (SSS). We aimed to analyze the periprocedural outcomes for patients with SSS who undergo pacemaker implantation. Hypothesis: Pacemaker implantation is associated with lower odds of mortality in patients with sick sinus syndome. Methods: Retrospective cohort study with data from 2016-18 combined National Inpatient Sample database. ICD-10 codes used to include admissions with SSS and dichotomized based on permanent dual chamber pacemaker implantation. The primary and secondary outcomes were studies between the two cohorts. Multivariate linear and logistic regression were used to adjust for confounders Results: Out of 190,625 sick sinus syndrome, admissions in 2016-18 NIS database, 115,195 (60%) received a permanent pacemaker. Permanent pacemaker implantation in SSS patients was associated with lower adjusted odds of inpatient mortality (aOR 0.22, 95% CI 0.17-0.29, p&lt;0.001), decrease in mean LOS by 0.31 days (5.55 vs 5.86, p&lt;0.001) and higher adjusted THC by a difference of 35,489 USD (116,474 USD vs 80,985 USD, p&lt; 0.001). Secondary outcomes are shown in Fig. Conclusions: Pacemaker implantation in sick sinus syndrome patients is associated with 80% decrease in mortality, shorter length of stay, and significantly lower odds of inpatient complications including sepsis, pulmonary embolism, ventricular fibrillation, acute kidney injury when compared to patients without a pacemaker.
Abstract 16259: Sex Related Differences in Clinical Presentation and Outcomes in Left Ventricular Thrombus
Authors: Adam J Russell, Murrium I Sadaf, Jonathan Misch, Jagdeep Kaur, Tushar Tarun, SENTHIL KUMAR, Srikanth Vallurupalli
Journal: Circulation (2023)

Introduction: Sex related differences in the etiology, clinical characteristics and outcomes in patients with left ventricular thrombus (LVT) are not well understood. Methods: We developed a multi-center registry of patients diagnosed with LV thrombus by echocardiography between 1/1/2014-12/30/2020. Cases were retrospectively identified and baseline clinical characteristics, thrombus features, treatment, resolution and long-term outcomes were studied. Results: Women constituted 27% of all patients (n=271, 29% African American). Compared to men, there were no significant differences in age at presentation (median age 60 years) or median LVEF at presentation (25%). Women were more likely to have nonischemic cardiomyopathy (52.6% vs 32.2%, p=0.02) and presented with thromboembolic event at time of diagnosis of LVT (27.3% vs 13.6%, p=0.008). There was no difference in use of vitamin K antagonists during the study period. During a median follow-up of 72 months, there was no significant difference in all-cause mortality or risk of stroke or arterial thromboembolism (figure 1A-B). In Cox regression analysis, age and LVEF at presentation, chronic kidney disease, malignancy and LVEF at presentation were significant predictors of long-term mortality. Conclusions: There was no significant difference in all-cause mortality or risk of stroke or thromboembolism between men and women after diagnosis of LV thrombus.
Abstract 13771: Left Atrial Size and Frailty Indexes Predict Poor Prognosis in Hospitalized Elderly Patients With Heart Failure
Authors: Masakazu Miura, Shinichi Okuda, Kazuhiro Murata, Yasuhiro Ikeda
Journal: Circulation (2023)

Background: Left ventricular ejection fraction (LVEF) is a cardiac index used to diagnose and determine heart failure (HF) treatment strategy. However, in elderly patients with HF, LVEF is not a good predictor of prognosis. We have previously found that patient outcomes are associated with left atrial (LA) size and noncardiac factors such as malnutrition, muscle weakness, and cognitive dysfunction. This study examined whether a combination of LA function and noncardiac indicators related to frailty can predict an accurate prognosis in hospitalized elderly patients. Methods: Hospitalized HF patients over 65 years of age from January 2019 to December 2022 were consequently enrolled in the Yamaguchi Prefectural Grand Medical (YPGM) Center. We divided three categories: sinus rhythm (SR) with normal LA, SR with LA enlargement (LAE), and persistent or chronic atrial fibrillation (AFib) with LAE. Cox proportional hazard analyses were employed to determine the prognosis factors, i.e., the primary outcome as all-cause death or HF readmission and the secondary outcome as major adverse cardiac and cerebrovascular events (MACCE). Results: Overall, 676 HF patients were admitted to YPGM Center. Of those, 462 (median age 84.0, 47% female) met the study criteria. During the follow-up of 204.0 days, 46 patients reached all-cause death (10%), 82 experienced HF readmission (18%), and 116 developed MACCE (25%). LA volume index (LAVI) (Hazard ratio [HR]: 1.012; 95% confidence interval [CI]: 1.003-1.022; p = 0.013) and handgrip strength (HR: 0.917; 95%CI: 0.868-0.970; p = 0.002) were associated with the primary outcome. Nutritional status assessed by geriatric nutritional risk index (GNRI) was associated with the primary and secondary outcome (HR: 0.956; 95%CI: 0.927-0.985; p = 0.003, and HR: 0.937; 95%CI: 0.909-0.966; p &lt; 0.001, respectively), but neither AFib nor LVEF. The adverse events were lower in SR with the normal LA group than in other groups. Furthermore, a multiple logistic regression model, including LAVI, AFib, GNRI, and handgrip strength, most accurately predicted the primary outcome than those with the AFib or LVEF. Conclusion: The value of benefits as a prognosis lies more in LAVI and frailty indexes than in the presence of AFib and LVEF in elderly HF patients.
Abstract 14150: Glycolysis and Cardial Fibrosis
Authors: Zhaowei Zhu, Bing Han, Zheng Zhang, Shenghua Zhou
Journal: Circulation (2023)

Introduction: Cardiac fibrosis is a significant global issue, which however has limited therapeutic options. 6 - phosphofructo - 2 - kinase/fructose - 2,6 - biphosphatase 3 (PFKFB3) is established to play a critical role in the process of glycolysis. However, its specific role in the pathogenesis of cardiac fibrosis is still not well understood. Hypothesis: PFKFB3 plays a critical role in cardial fibrosis. Methods: To determine the role of PFKFB3 in cardiac fibroblast (CF) activation and fibrosis, single - cell RNA sequencing analysis was applied to identify the metabolic changes of fibroblast subclusters in cardiomyopathy. PFKFB3 inhibition with genetic ( Pfkfb3 +/- ) mice or pharmacological (3PO) approach was used to demonstrate the role of PFKFB3 in cardiac fibrosis with animal models, induced by isoproterenol (ISO) or left coronary ligation. The role of PFKFB3 in primary CFs activation was confirmed by gene inhibition or overexpression. Recombinant PFKFB3 was used to test its extracellular role in CFs activation and inflammation. Serum PFKFB3 level was also tested from patients with cardiomyopathy. Results: We found that glycolysis changes most in cardiac myofibroblasts (myoCFs) in cardiomyopathy. PFKFB3 increased significantly in both cardiac fibrotic regions and myoCFs induced by TGF-β1. Inhibition of glycolysis, via several approaches, blunted TGF-β1-induced activation, proliferation and migration ability of myofibroblasts and demonstrated therapeutic benefit in cardiac fibrosis in mice. PFKFB3 released from myoCFs facilitated the activation of CFs and promoted the inflammatory response. Mechanistically, HIF-1α is required in TGF-β1 induced glycolysis. Plasm PFKFB3 was also found to be a biomarker for cardiac fibrosis in patients with cardiomyopathy. Conclusions: PFKFB3 is a candidate target for cardiac fibrosis.
Abstract 16540: Left Ventricular Longitudinal Strain Analysis Using Four-Dimensional Computed Tomography for the Detection of Apical Sparing in Cardiac Amyloidosis
Authors: Kinoshita Makiko, Hiroyuki Takaoka, Joji Ota, Shuhei Aoki, Katsuya Suzuki, Satomi Yashima, Kazuki Yoshida, Haruka Sasaki, Noriko Eguchi, Yoshio Kobayashi
Journal: Circulation (2023)

Introduction: Cardiac computed tomography (CT) not only allows for coronary artery evaluation but also enables myocardial assessment, including left ventricular (LV) ejection fraction (LVEF) and extracellular volume fraction. Advanced software makes it possible to analyze LV longitudinal strain (LS) on CT (Figures A and B). Hypothesis: LS analysis using four-dimensional cardiac CT is helpful for the differential diagnosis of LV hypertrophied myocardial diseases and detect cardiac amyloidosis (CA). Methods: We analyzed 45 patients with LV hypertrophied myocardial diseases who underwent cardiac CT using 256-detector row or 320-detector row CT in our institutions since 2009. Fifteen patients of them were diagnosed with CA (69 ± 9 years, 12 males), the other 15 patients were diagnosed with hypertrophic cardiomyopathy (HCM) (63 ± 16 years, nine males), and the rest of the 15 patients were diagnosed with aortic valve stenosis (AS) (83 ± 8 years, seven males). We analyzed LV global LS (GLS) and segmental LS using specific software and four-dimensional CT data. We evaluated relative apical LS as the value dividing the average LS of apical segments by the sum of the average LS of basal segments and mid-ventricular segments (Figure C). If the value was ≥ 1, apical sparing was defined as present. We compared the LS data and the percentage of apical sparing among those three myocardial diseases. Results: There was no significant difference in LVEF among the three groups (54 ± 12%, 58 ± 13%, and 50 ± 18%, respectively; P = 0.39). There was no significant difference in LV global LS among the three groups (-12.2 ± 3.2%, -11.2 ± 5.0%, and -11.0 ± 5.4%, respectively; P = 0.75). Apical sparing was observed in 6 cases (40%) of CA, which was significantly higher than in one case (7%) of HCM or AS (P = 0.02). Conclusions: Advanced image analysis software has made LVLS analysis by cardiac CT possible. It is considered helpful in detecting apical sparing, specifically in CA.