tbuckley/cabot-search huggingface dataset:
Abstract 13463: Effect of an Intervention to Reduce Sedentary Behavior on Blood Pressure in Desk Workers: The RESET BP Randomized Clinical Trial (RCT)
Authors: Bethany Barone Gibbs, Subashan Perera, Kimberly Huber, Joshua Paley, Margaret B Conroy, John Jakicic, Matthew F Muldoon
Journal: Circulation (2023)

Introduction: High sedentary behavior (SB) is associated with cardiovascular (CV) risk in cohort studies, yet definitive data from RCTs of SB reduction on CV risk factors is lacking. Hypothesis: A 3-month SB reduction intervention would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. Methods: We recruited desk workers with systolic BP (SBP) 120-159 mmHg or diastolic BP (DBP) 80-99 mmHg, not on antihypertensives, and reporting low physical activity. Participants were randomized 1:1 to a 3-month SB reduction intervention or control. The intervention targeted replacing sitting with standing and stepping via health coaching, a wrist-worn activity prompter, and a height-adjustable workstation. All day and work-specific SB, standing, stepping, and steps were measured by a thigh-worn triaxial accelerometer. Protocolized office SBP (primary outcome), DBP, and HR were measured in duplicate on two occasions at each baseline and 3 months; 24-hr ambulatory BP and carotid-femoral PWV via tonometry were also measured. Changes in outcomes were compared across groups using analysis of covariance and mixed models. Results: Participants (n=271) had mean age 45 y and BP 129/83 mmHg; 60% were female and 82% were non-Hispanic White. Retention was 97%. Intervention participants reduced SB during work (-1.3 hr/day) and across all waking hours (-1.1 hr/day) compared to controls (both p&lt;0.001). Intervention participants increased work-specific standing (1.2 hr/day), stepping (5 min/day) and steps (398/day) and all day standing (1.0 hr/day), stepping (7 min/day) and steps (528/day) compared to control (all p&lt;0.05). Yet, the intervention did not yield a greater reduction in BP or PWV vs. controls (all p&gt;0.05). Differences in changes were office SBP -0.24 mmHg (p=0.793), DBP 0.08 mmHg (p=0.894), and heart rate -2.75 (p=0.190). Findings were similar for 24-hr, daytime, and nighttime ambulatory BP averages (all &lt;1.2 mmHg; p&gt;0.05). Differences in PWV were higher (opposite from the hypothesized direction) in intervention vs. control and approached significance (0.18 m/s, p=0.07). Conclusions: In sedentary desk workers with mild-moderate untreated BP, this 3-month intervention reduced daily SB by about one hour but did not improve BP or PWV.
Abstract 15454: Socioeconomic Disparities and Healthcare Utilization Differ Significantly Among Cardiovascular Diseases in Medicare Patients: Medicare Current Beneficiary Survey (MCBS), 2020
Authors: Daniel Won, James Walker, Connor Workman, Ashvita Ramesh, Tom Liu, Donald M Lloyd-Jones, S C Malaisrie
Journal: Circulation (2023)

Introduction: Socioeconomic factors impact access to healthcare and patient care, particularly for patients with cardiovascular diseases (CVD). Understanding the differences in healthcare utilization and financial burden among patients with CVD is essential for developing targeted interventions and policies to improve patient care and reduce the financial burden of CVD. Methods: This cross-sectional study used the 2020 Medicare Current Beneficiary Survey (MCBS) to analyze disparities in socioeconomic factors among Medicare beneficiaries with various CVD. A survey-weighted logistic model was used to compare the proportion of socioeconomic factors between patients with and without hypertension (HTN), atherosclerosis (ASVD), angina, myocardial infarction (MI), heart failure (HF), and valvular disease or arrhythmias. Results: A significantly higher proportion of Medicare patients with HTN, ASVD, angina, HF and valvular disease/arrythmias attended &gt;10 office visits per year (p&lt;0.001) than those without (Figure 1A). Medicare patients with CVD reported greater difficulty paying medical bills (p&lt;0.001), and those with MI and HF were significantly more likely to delay care due to cost (p&lt;0.05). However, &lt;4% of Medicare patients reported skipping or having difficulty affording blood pressure medications due to cost (Figure 1B, 1C). Conclusions: Medicare beneficiaries with CVD have significantly more office visits and difficulty paying medical bills, which imposes a substantial financial burden. However, reducing blood pressure medication costs is unlikely to substantially reduce the financial burden of CVD for Medicare patients with hypertension.
Abstract 13212: Prevention of Delayed Coronary Obstruction Following Transcatheter Aortic Valve Replacement Using Intravascular Ultrasound and "Modified" Snorkeling Stent Technique
Authors: Nobuyasu Ito, Shunsuke Mizutani, Daichi Hato, Masashi Okamoto, Akiko Goda, Tomoko Fujimoto, Tsutomu Wada, Yoshitaka Ichikawa, Takahiro Tokuda, Masahiro Yano, Takafumi Yamane, Ryosuke Kiyama, Hiroshi Fujita, Kazunori Yoshida, Tohru Masuyama
Journal: Circulation (2023)

Introduction: Coronary obstruction (CO) is a potentially fatal complication that can occur after transcatheter aortic valve replacement (TAVR). Here we report a successful management of a TAVR patient at risk of delayed CO using intravascular ultrasound (IVUS) and a "modified" snorkeling stent technique. Case presentation: An 88-year-old woman presented with severe symptomatic aortic stenosis. Despite the left coronary artery (LCA) being not low, a Multidetector Computed Tomography scan identified a relatively long leaflet of the left coronary cusp (LCC) and a calcified nodule on the cusp (Figure 1A), indicating a high CO risk. A transfemoral TAVR was conducted using a 26mm Evolut FX (Medtronic, IL, USA) protecting the LCA with a 6-F Judkins left (JL) 4.0 guiding catheter, a 0.014 inch coronary guide wire, and a guide-extension catheter. Upon reaching the point of no recapture, LCA blood flow was maintained, and hemodynamics was stable. However, IVUS revealed the calcified nodule on the LCC was close to the left main (LM) ostium (Figure 1B), indicating a high risk of delayed CO.We continued and completed the prosthesis deployment protecting the LCA. Following the deployment, We introduced another guiding catheter (6-F JL3.5) into the prosthesis and engaged it with the LCA via the prosthesis frame, utilizing a double-guiding catheter technique. Subsequently, we placed a coronary stent from the LM to the prosthesis (Figure 1C). After the TAVR procedure, we verified that a JL3.5 catheter could easily engage the implanted coronary stent (Figure 1F). This "modified" snorkeling stent technique appears feasible and provides easier coronary access compared to the "Chimney" snorkeling stent technique.
Abstract 15121: Bioresorbable Molybdenum Electrodes: Towards a Novel Generation of Temporary Epicardial Pacing Wires
Authors: Maria Elisa Prieto Jarabo, Christian Redlich, Antje Schauer, Celine Guder, Georg Poehle, Thomas Weissgaerber, Volker Adams, Utz Kappert, Ali El-Armouche, Axel Linke, Michael Wagner
Journal: Circulation (2023)

Introduction: Cardiac pacing with temporary epicardial pacing wires (TEPW) is used to treat rhythm disturbances after cardiac surgery. Removal is recommended on day 4-7. Occasionally, TEPW cannot be mechanically extracted, have to stay in the thorax and may rarely cause serious complications like migration and infection. We aim to develop novel, bioresorbable TEPW that will dissolve over time even if postoperative removal is unsuccessful. Methods and Results: We manufactured prototypical braided molybdenum (Mo) leads (16 Mo wires of 40 μM diameter each, length 18 cm for ex-vivo, 7.5 cm for in-vivo trials) coated with the biodegradable polymers poly(lactide-co-glycolic acid) (PLGA, inner coating) and polycaprolactone (PCL, outer coating) for shaping and electrical insulation. Mo electrodes showed similar pacing and sensing properties to conventional steel electrodes (Osypka) in Langendorff-perfused rat hearts, even with somewhat lower stimulation thresholds. In artificial body fluid at 37°C, polymer-coated Mo electrodes dissolved at a rate of 1.6 ± 0.3 μg/cm 2 ·d (n=5) compared to uncoated electrodes with 30.3 ± 0.8 μg/cm 2 ·d (n = 4, p &lt; 0.001). Assessing apoptosis and necrosis in human cardiomyocytes and cardiac fibroblasts, we detected no toxicity at Mo concentrations up to 0.52 mM. To test Mo TEPW in vivo, we sutured them epicardially onto the anterior wall of hearts of female Wistar rats, led them out of the thorax and placed them in a subcutaneous pocket. We tested electrophysiological properties directly after implantation, after two weeks and one month. Mo electrodes showed similar pacing and sensing properties directly upon implantation and after two weeks. After one month, all but one pair of Mo electrodes were mechanically broken at their exit from the thorax, the site of assumedly highest mechanical stress. Conventional steel TEPW had similar electrical properties following implantation, after two weeks and one month with no signs of breakage. Conclusion: We demonstrate that Mo TEPW can feasibly be used for epicardial pacing in vivo for up to two weeks. These findings represent an important step in the development of bioresorbable TEPW as a novel and even safer approach to temporary epicardial pacing.
Abstract 18185: A Multicenter Prospective Trial of Therapeutic Angiogenesis Using Bone Marrow-Derived Mononuclear for Patients With Critical Limb-Threatening Ischemia Caused by Thromboangiitis Obliterans
Authors: Kenji Yanishi, Ayumu Fujioka, Arito Yukawa, Jun Yoshimura, Takaaki Ozawa, Daiki Goto, Hirofumi Kawamata, Satoaki Matoba
Journal: Circulation (2023)

Background: Thromboangiitis obliterans (TAO) can develop critical limb-threatening ischemia (CLTI). Despite conventional treatments, such as smoking cessation or revascularization, young patients require limb amputation. Therapeutic angiogenesis using bone marrow-derived mononuclear cell (BM-MNC) implantation has demonstrated long-term efficacy and safety in patients with CLTI, particularly those with TAO. To expand BM-MNC implantation in clinical practice, further evidence is required in CLTI patients with TAO. We aimed to determine the efficacy of BM-MNC implantation in a prospective trial. Methods: This multicenter, prospective, interventional trial was performed under an advanced medical care program. We enrolled 22 patients with CLTI and skin perfusion pressure (SPP) &lt;30 mmHg; they underwent BM-MNC implantation within 28 days (Figure.1). The follow-up period was 180 days, and the primary endpoint was an improvement in the SPP value in the affected target limb 180 days after the implantation. One patient dropped out from the follow-up. Results: The mean age was 47.6 years (male: 90.5%, Fontaine classification IV: 57.1%). The SPP value significantly improved on day 180 (p&lt;0.001) (Figure. 2). The secondary endpoints, i.e., numerical rating scale scores and transcutaneous oxygen pressure values significantly improved within day 180. The 3-year major amputation-free and overall survival probability in the safety analysis set were 95.5% and 89.5%, respectively (Figure. 3). No severe adverse events occurred. Conclusions: We believe that the BM-MNC implantation will likely become a feasible and safe therapy for CLTI patients caused by TAO.
Abstract 13542: Electrical Delay, LA Electromechanical Delay, and LA Volume Contribute to Increased LA Stiffness in Relatively Elderly Patients With Pulmonary Vein Isolation for Atrial Fibrillation
Authors: Takuya Sasaki, Shinichi Okuda, Hitoshi Nagai, Takeshi Ueyama, Yasuhiro Ikeda
Journal: Circulation (2023)

Background: Atrial dysfunction occurs after pulmonary vein isolation (PVI) for atrial fibrillation (AF), and some reports suggest that electrical conduction delay (ECD) via the Bachmann bundle could be a contributing factor. However, the relationship between ECD in the atria and LA function after PVI remains unclear. The LA reservoir strain (LARS) by speckle-tracking echocardiography (STE) is used to assess LA booster function, with a decrease indicating increased LA stiffness. Purpose: We aim to investigate ECD, LA electromechanical delay (LAEMD), and LA function in patients after PVI for AF. Methods: This single-center retrospective study included 74 patients (Mean age at 70.4 ± 9.1 years, 44 males, left ventricular ejection fraction (LVEF): 62.9 ± 6.8 %, LA volume index: LAVI 39.0 ± 10.8 ml/m 2 ) who were in sinus rhythm at the echocardiographic examination. ECD on the ECG was defined as the presence of biphasic P waves, which were classified into those not observed (group A; n=42), those observed only in III lead (group B; n=23), and those observed in all lower wall leads (II, III, aVF) (group C; n=9). LAEMD was defined as the time interval between the top of the R wave on the ECG and the start of the late diastolic wave (a') on the tissue doppler imaging, and the lateral (a' lateral) and septum (a' septum) time differences (a’ sep-lat time) were calculated. To evaluate the LA function, two-dimensional STE was analyzed. Results: Mean observation period was 19.2 months after PVI. Groups B and C showed significant differences in a' sep-lat time compared to group A. LARS was markedly reduced in all groups (average: 19.0 ± 6.3). LARS and LAVI showed a significant difference between groups A and C. Multivariate analysis of factors leading to LARS showed correlations with a', E/e'. Conclusion: These results suggest that in relatively elderly post-PVI AF patients with preserved LVEF, the ECD and LAEMD as well as LAVI may affect LA function long after PVI and contribute to increased LA stiffness.
Abstract 16822: Short Term Outcomes of Endovascular and Surgical Therapies for Critical Limb Ischemia: A Nationwide Analysis
Authors: Ahmad Naser, ISRAEL SAFIRIYU, Harriet Akunor, Michael Fatuyi, Sanjana Nagraj, Elie Flatow, Eleonora Gashi, Seth I Sokol
Journal: Circulation (2023)

Background: Endovascular therapy (EVT) and peripheral arterial bypass surgery (PABS) are established revascularization modalities in patients with critical limb ischemia (CLI). However, there is limited data regarding the short term outcomes of both procedures. Research question: Is there a difference between the in-hospital outcomes of EVT and PABS for patients with CLI? Methods: Patients with a diagnosis of CLI in the National Inpatient Sample database were reviewed from 2018 to 2020, and stratified into EVT and PABS groups. The primary outcome was in-hospital mortality and secondary outcomes included in-hospital complications. Multivariate logistic regression was used to adjust for confounders. Results: A total of 14,015 adult patients with CLI were identified (EVT:11,970; PABS: 2045). There was no significant difference in the in-hospital mortality between the two groups (adjusted odds ratio [aOR] 0.43, 95%CI 0.10-1.89 p=0.264). Furthermore, there was no significant difference in the rates of in-hospital complications: septic shock (aOR 0.67, 95%CI 0.18-2.36, p=0.529), acute stroke (aOR 0.54, 95%CI 0.12-2.36, p=0.413), cardiogenic shock (aOR 0.89, 95%CI 0.14-7.84, p=0.973), vascular complications, (aOR 1.66, 95%CI 0.67-4.11, p=0.278), compartment syndrome (aOR 0.24, 95%CI 0.03-1.90, p=0.177), and acute kidney injury (aOR 1.30, 95%CI 0.88-1.90, p=0.184) between the two groups fig 1 . In addition, the mean length of stay was comparable between the groups 5.95 vs 6.14 days (adjusted mean difference[aMD] 0.23, 95%CI -0.31-0.78, p=0.298. However, the mean hospital costs were significantly lower for the PABS group compared to the EVT group ($24,463 vs $29,400, aMD 0.87 $-3,684, 95%CI $-5,813-$-1,554, p=0.001). Conclusion: Endovascular therapy and bypass surgery for CLI had comparable in-hospital mortality and in-hospital complications, although, the hospital cost was significantly higher with endovascular therapy.
Abstract 18141: Outcomes of Prospective Computational 12-Lead ECG Mapping to Guide Ablation of Unstable Ventricular Tachycardia
Authors: Gordon Ho, Kevin Sung, Frederick Han, Jonathan Hsu, Kurt Hoffmayer, farshad raissi, Gregory K Feld, David E Krummen
Journal: Circulation (2023)

Background: Unstable ventricular tachycardia is difficult to map and ablate, with high recurrence rates. We developed a 12-lead ECG mapping algorithm based on computational models to localize VT to help guide ablation of unstable VT. Hypothesis: We hypothesized that prospective ECG-mapping can facilitate invasive activation mapping and improve the success of unstable VT ablation. Aims: To compare the time to ICD shock + death in patients undergoing ECG-mapping guided ablation of unstable VT compared to standard ablation controls. Methods: Consecutive patients from 2 centers with unstable VT undergoing ECG-mapping guided VT ablation were prospectively enrolled. Using the ECG, computational mapping localized the VT onto a 3D model. A multielectrode catheter was placed at the predicted site and activation mapping was performed during VT reinduction. Ablation was performed per standard protocol. Time to ICD shock or death was compared using Cox regression (adjusting for age, EF and ICM) between ECG-mapping guided ablation vs standard VT ablation controls with a minimum 3 month f/u. Accuracy of ECG mapping was compared with activation mapping. Results: Out of 32 consecutive patients who underwent ECG-mapping guided VT ablation, 26 had unstable VT (age 66±10 yr, EF 34±17%). All 26 (100%) patients with unstable VT (median VT CL: 326±81ms) underwent successful activation mapping, Fig 1A. Using Cox regression adjusting for covariates, ECG-mapping guided VT ablation had a significant reduction in ICD shock or death compared to standard ablation controls (p=0.01, HR=0.23 [CI 0.07-0.70], Fig 1B). There was a 99% reduction in total ICD shocks during mean 7.5 month f/u. For all 32 patients, the mean accuracy of ECG mapping was 1.3±0.7cm when compared to invasive activation±entrainment mapping. Conclusions: Use of computational 12-lead ECG mapping to guide ablation of unstable VT significantly improved freedom from ICD shocks and death resulting in excellent accuracy.
Abstract 14399: Development of Heart Failure in High-Risk Post-Myocardial Infarction Patients: An Analysis of the Paradise-MI Trial
Authors: Peter VanDer Meer, Eugene Braunwald, Marc A Pfeffer, Christopher Granger, Lars Kober, Eldrin F Lewis, Aldo Pietro P Maggioni, Douglas L Mann, John J McMurray, Jean L Rouleau, Scott Solomon, Philippe G Steg, Karola Jering, Gerald A Berry, Alberto Fernandez, Brian Claggett
Journal: Circulation (2023)

Objectives: The aims of this study were i) to examine the incidence, risk factors and subsequent mortality after high-risk acute myocardial infarction (AMI) and ii) compare the effects of sacubitril/valsartan with the ACE inhibitor ramipril across heart failure (HF) risk categories. Background: The contemporary risk of developing HF following AMI in the coronary reperfusion era is not well documented. Methods: We analyzed the 5661 patients enrolled in the PARADISE-MI trial which compared sacubitril-valsartan to ramipril after AMI. Patients were required to have acute pulmonary congestion and/or left ventricular systolic dysfunction at the time of AMI, but no history of HF. We analyzed a composite outcome of first occurrence of investigator-reported HF hospitalization or outpatient development of HF. Results: During a median follow up of 22 months, 734 patients (13%) developed a first episode of HF, of which 496 (68%) were a hospitalization and 238 (32%) an outpatient HF episode. Only 74 patients (10%) experienced another AMI prior to developing HF. Independent predictors for the development of HF were a lower baseline left ventricular ejection fraction (LVEF), pulmonary congestion, diabetes, older age, higher heart rate, previous MI, and renal dysfunction. A risk-score showed an exponential increased risk of developing HF with a higher score (Figure 1). The relative effect of sacubitril/valsartan compared to ramipril was similar across the HF risk spectrum (p-value for interaction=0.14). The hazard ratio for cardiovascular mortality after outpatient development of HF (in comparison to no event) was 3.9 (95% CI 2.5-6.2) and after an HF hospitalization was 10.0 (95% CI 7.8-12.8). Conclusion: New onset HF after high-risk AMI was common and resulted in a 10-fold higher cardiovascular mortality than no HF. Sacubitril/valsartan, compared to ramipril, showed similar efficacy across the HF risk spectrum.
Abstract 18693: Effect of Mechanical Unloading on Cardiogenic Shock Severity in Venoarterial Extracorporeal Membrane Oxygenation Patients
Authors: sana ahmad, Dimitrios Varrias, Rebecca Smoller, Moein Bayat Mokhtari, Kayla Floyd, Kylie Roslin, Tikal Kansara, Gerin R Stevens, Simon Maybaum, Miguel Alvarez Villela
Journal: Circulation (2023)

Introduction: Mechanical unloading (MU) with Intra-aortic balloon pump (IABP) or Impella is commonly used to prevent left ventricular (LV) distension in VA-ECMO patients, but its impact on shock severity is not well described. Methods: Patients treated with VA-ECMO in our hospital between 2016-2022 for cardiogenic shock (CS) due to LV failure not related to cardiac surgery were included if no MU was used or it was instituted within 24h of ECMO cannulation. Patients were grouped according to MU: ECMO alone, ECMO + IABP or ECMO + Impella. Linear mixed effects models adjusting for age, sex, hypertension, acute myocardial infarction (AMI) etiology of shock and pre-ECMO cardiac arrest (CA) were used to assess the impact of MU on hemodynamic and perfusion markers. R version 4 was used for analysis. Results: Among 68 patients included, 18 received ECMO alone, 17 ECMO + IABP, and 33 ECMO + Impella. Age and CA were similar across groups. The Impella group had a higher proportion of men and patients with AMI. Pulmonary artery diastolic pressure was unchanged in all groups. Compared to ECMO alone, MU did not enhance lactate clearance (interaction: IABP p=0.7, Impella p=0.22), but it did improve the vasopressor-inotropic score (IABP p=0.03, Impella p=0.01), serum creatinine (IABP p=0.03, Impella p=0.04), and alanine transaminase (IABP only p=0.02). Survival to decannulation was similar in patients with ECMO alone (50%), Impella (64%) and IABP (65%) (p=0.68). Conclusions: In adults treated with VA-ECMO for CS unrelated to cardiac surgery, LV MU can lead to improvements in CS severity.