tbuckley/cabot-search huggingface dataset:
Abstract 4145454: Clinical and Hemodynamic Predictors of Stabilization and Associated Complications in Patients with Cardiogenic Shock Supported with Impella 5.5
Authors: Vanessa Blumer, Jacob Abraham, Borui Li, Manreet Kanwar, Reshad Garan, Shashank Sinha, Jaime Hernandez-Montfort, Daniel Burkhoff, Navin Kapur
Journal: Circulation (2024)

Background: Despite widespread use of the Impella 5.5 to support patients with cardiogenic shock (CS), the identification of patient profiles that benefit the most from this intervention remains a challenge. Understanding the clinical and hemodynamic characteristics associated with successful outcomes is crucial for optimizing patient selection and management. Methods: Using data from a comprehensive registry of 508 patients, we evaluated clinical stabilization among those receiving Impella 5.5 for CS. Clinical stabilization was defined as weaning from the Impella 5.5 without escalation to additional mechanical circulatory support and discharge from the hospital alive, or bridging to durable heart replacement therapy (HT or LVAD) without further escalation of support. Results: Of the 508 patients analyzed, 30.7%(N=156) achieved clinical stabilization. The mean age of the cohort was 58.4±12.6 years, with 83.7% being male. Heart failure-related cardiogenic shock (HF-CS) was present in 69.5% of the patients. No significant demographic differences were observed between the stabilization and deterioration groups (p&gt;0.05). Patients who stabilized were more likely to have HF-CS (p&lt;0.001) and lower incidence of out-of-hospital cardiac arrest (OHCA)(p&lt;0.001). Higher pulmonary artery pressure (mPAP, p=0.02) and pulmonary capillary wedge pressure (PCWP, p&lt;0.001) were significant predictors of stabilization. The presence of implantable cardioverter-defibrillators (ICDs) was more common in stabilized patients (p=0.01). Major complications such as stroke (stabilization:3.8%, deterioration:6.1%, p=0.3), limb ischemia (stabilization:1.9%, deterioration:7.4%, p=0.02), and bleeding requiring surgery (stabilization:7.7%, deterioration:12.8%, p=0.09) were observed. Notably, bleeding requiring transfusion was significantly higher in the deterioration group (41.5% vs. 30.1%,p=0.02). The median duration from Impella 5.5 insertion to heart recovery or discharge was 15.1 days (IQR:7.7-29.1 days). Conclusions: Among patients with CS supported with the Impella 5.5, those with HF-CS, higher pulmonary pressures, and the presence of ICDs are more likely to achieve clinical stabilization. Significant complications, including bleeding and limb ischemia, remain a concern and require careful management. This study highlights the importance of detailed pre-implant hemodynamic assessment and suggests that targeted management strategies based on these predictors could improve patient outcomes.
Abstract 4145577: Barriers to the Brain: Unveiling the Impact and Disparities of Sentinel Cerebral Protection in TAVR Patients
Authors: Samuel Tan, Lucy Zheng, Wenchy Siu, Robert Trenschel, Marlon Rivera Boadla, SAKSHI KHURANA, AMIT GULATI
Journal: Circulation (2024)

Background: The Sentinel Cerebral Protection System (SCPS) was initially demonstrated to lower stroke risk during transcatheter aortic valve replacement (TAVR). However, recent trials have failed to confirm these benefits and have excluded patients with specific risk factors that increase stroke risk. Research Question: What are the outcomes, utilization trends, and disparities in the use of the SCPS during TAVR procedures, and how do these outcomes vary by race, ethnicity, and income levels? Objective: To evaluate the impact of the SCPS on in-hospital mortality, complications, hospital costs, and length of stay in patients undergoing TAVR, and to identify trends and disparities in SCPS utilization across different racial, ethnic, and income groups. Methods: This retrospective study utilized the National Inpatient Sample to identify patients undergoing TAVR and SCPS from 2017 to 2020. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included complications, hospital costs, and length of stay. Weighted multivariable logistic regression and chi-square tests were used to analyze outcomes, controlling for comorbidities, age, gender, and, when appropriate, race/ethnicity. Results: The study included 67,670 TAVR patients, with 4,410 using SCPS. SCPS prevalence increased from 180 to 2,790 over the study period without significant differences in mortality, length of stay, or cost compared to those without SCPS. Patients using SCPS had lower odds of stroke (OR: 0.48; p &lt; 0.040) and post-procedural hemorrhage (OR: 0.682; p &lt; 0.039). Hispanic patients utilizing SCPS had higher hospital costs ($55,983; p &lt; 0.010) without a difference in length of stay. SCPS was less likely to be used in Black (OR: 0.49; p &lt; 0.001) and Hispanic (OR: 0.36; p = 0.013) patients. Compared to White patients in the lowest income quartile, SCPS was more likely to be used in the second (OR: 1.28; p &lt; 0.017), third (OR: 1.67; p &lt; 0.001), and fourth (OR: 1.74; p &lt; 0.001) quartiles. No similar income-based trend was observed for other racial or ethnic groups. Conclusion: No significant difference in in-hospital mortality was observed among patients using SCPS during TAVR. However, SCPS use was associated with lower odds of complications without changes in length of stay or cost. Despite these associated benefits and the absence of significant contraindications, disparities in SCPS utilization were observed across racial, ethnic, and income groups.
Abstract 4145520: Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft for Left Main Coronary Artery Disease in Patients with Prior Cerebrovascular Disease: A Systematic Review and Meta-analysis
Authors: Shurjeel Qazi, Muhammad Majid, Syed Hassaan Ali, Huzaifa Ansari, Sana Qazi, Muhammad Sohaib Asghar, Jaideep Singh Bhalla, Ezra Amsterdam, Allan Klein
Journal: Circulation (2024)

Background: The previous literature reports similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD) in such patients. Thus, our aim is to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG. Methods: A comprehensive search of electronic databases, PubMed, SCOPUS, and Cochrane Central was conducted from their inception till May 2024. Outcomes of interest included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), Myocardial Infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data were pooled and analyzed using a random effects model and presented as hazard ratios (HR) along with their 95% confidence intervals (CI). Heterogeneity was quantified using the I(2) index. Results: We included three studies in our analysis (n = 5,732). Our analysis demonstrated that in patients with prior CEVD, PCI lead to significantly increased risk of MACCE (HR = 2.56, 95% CI:[1.23, 5.37], p = 0.01] and MI (HR = 2.97, 95% CI: [1.72, 5.13], p&lt; 0.01). While an elevated risk of all-cause mortality (HR: 1.35, 95% CI: [0.92, 1.98]; p = 0.12) and repeat stroke (HR: 1.67, 95% CI: [0.81, 3.42], p = 0.16) was observed, these were comparable across procedures. Similarly, an elevated but comparable risk of repeat revascularization was observed between the two procedures (HR: 3.44, 95% CI: [0.50, 23.60]; p = 0.21). Conclusion: Our results show that PCI significantly elevates the risk of MACCE and MI in patients with prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were comparable. The increased risk of adverse CV events in CEVD patients may be due to co-morbidities like hypertension, smoking, diabetes, peripheral vascular disease, renal insufficiency, inflammation, and hypercoagulability. We recommend including prior CEVD in pre-operative assessments for revascularization and developing novel strategies for patients with LMCAD and prior CEVD.
Abstract 4145440: Simultaneous Percutaneous Ventricular Septal Closure and Mitral Valve Repair in Postinfarction Ventricular Septal Rupture and Papillary Muscle Rupture Complicated by Cardiogenic Shock
Authors: Ilya Giverts, Azka Naeem, VIJAY SHETTY, Benjamin Youdelman
Journal: Circulation (2024)

Introduction: Post-infarction (post-MI) ventricular septal rupture (VSR) and papillary muscle rupture (PMR) are usually lethal complications of acute STEMI that have decreased in the fibrinolytic era and with rapid STEMI response teams. Delayed correction is preferred for recovery from MI and healing of the edges of the VSD but like emergent repair, delayed treatment is also associated with high mortality. We present a case of concomitant post-MI VSR and PMR successfully corrected by simultaneous percutaneous intervention. Case presentation: A 76-yo female with hypertension, obesity and asthma presented with progressively worsening dyspnea and mild substernal chest pain for 4 days. She appeared pale, diaphoretic, and hypoxic, with troponin of 22ng/mL and lactate of 9mmol/L. ECG showed Q waves with STE&lt;1 mm in the inferior leads. A bedside EchoCG suggested possible VSR with a L-to-R shunt. Emergent angiography showed a 100% thrombotic occlusion of LCA and chronic 100% RCA occlusion. Right heart catheterization indicated elevated right-sided pressures with a stepwise increase in SaO2 from 45% the RA to 70% in the RV. She remained hemodynamically unstable requiring mechanical ventilatory and circulatory support with intra-aortic balloon pump (IABP) and vasopressors. Transthoracic EchoCG showed LVEF of 30% with akinetic inferior wall and RV, irregularly shaped 1 cm VSD in the mid-inferoseptum with a predominant L-to-R shunt, along with intramyocardial dissection, partially torn papillary muscle with severe MR. The patient was kept in ICU for 25 days with IAPM to allow for scarring of the VSD followed by percutaneous VSD closure with an Amplatzer device and mitral valve repair with a MitraClip. IABP was removed subsequently but the patient failed weaning process and ended up requiring tracheostomy. She was successfully discharged to a skilled nursing facility two months after admission. Discussion: Post-MI VSR and PMR usually fail conservative management while open heart surgery carries high risk. In our case VSR and PMR were corrected with a one-time percutaneous procedure. Conclusion: Percutaneous intervention seems a promising alternative even for combined post-MI mechanical complications.
Abstract 4145601: Prevalence and Distribution of Retinal and Deep Learning-Based Versus Actual Coronary Artery Calcium Scores: A Large South Korean Population Aged 21-90 Years
Authors: Yunnie Cho, Tyler Hyungtaek Rim, Beom-hee Choi, Gyouchul Jung, Chan Joo Lee, Sung Ha Park, Hyeonmin Kim, Chanyang Seo, Sahil Thakur, Yong Yu Tan, Tien Wong, Ching-Yu Cheng, Giuliano Generoso, Ronaldo Correa Fabiano, Isabela Bensenor, Marcio Bittencourt, Jun Hwan Cho
Journal: Circulation (2024)

Introduction: Reti-CVD, a novel cardiovascular risk stratification tool derived from deep learning and retinal photography, offers a promising alternative to CT scan-measured Coronary Artery Calcium (CAC) scores in predicting cardiovascular events. This study investigates the profile of Reti-CVD scores using data from three medical centers in South Korea: GC iMED Gangbuk&amp;Gangnam branches and Philip Medical Center. Hypothesis: Reti-CVD scores can effectively stratify cardiovascular risk across different age groups and genders and correlate with actual CAC scores, demonstrating their utility as predictive markers for cardiovascular risk. Methods: Data from 598,831 retinal images from Philip Medical Center and 74,859 from GC iMED Gangbuk&amp;Gangnam branches were analyzed for Reti-CVD. The overall dataset consists of 45,858 individuals aged 21-90 years. The distribution of Reti-CVD and CAC scores across various age groups, segmented into ten-year increments, was examined. For 4,685 individuals with available follow-up data, longitudinal changes in Reti-CVD scores over an approximate two-year period were assessed using Pearson’s correlation analysis. Results: In both Reti-CVD and CAC distributions, each age group exhibited distinct score ranges, with increasing cardiovascular risk as age increased, as shown in Figures 1 and 2. Men had consistently higher scores, indicating gender differences. The longitudinal study further revealed a significant positive correlation between baseline and follow-up Reti-CVD scores (Correlation Coefficient: 0.158, p-value &lt; 2.2e-16). Discussion: Reti-CVD score analysis in relation to age and gender exhibited similar trends to CAC scores, offering insights into cardiovascular risk profiles and enabling percentile assessments within specific gender and age groups. The correlation between baseline and follow-up scores emphasizes Reti-CVD's potential as a longitudinal cardiovascular risk marker, suggesting the need for closer monitoring and intervention strategies for those with higher initial scores.
Abstract 4145449: Heart in Overdrive: Poly-supplementation leading to myopericarditis
Authors: Mahmoud Abdalla, Vipul Reddy, Mahnoor Anjum, Oliver Abela, Aftab Ahmad
Journal: Circulation (2024)

Introduction: Performance-enhancing supplements have been linked to several detrimental cardiovascular events including demand ischemia, tachyarrhythmias, and sudden cardiac death. However, cases of myopericarditis have seldom been reported. We present a case of a previously healthy young male with myopericarditis secondary to performance-enhancing supplements. Case presentation: Patient is a 33-year-old athletic male with no significant medical history who presented with severe retrosternal chest pain and exertional dyspnea. The patient was athletic and used multiple performance-enhancing supplements including SERMs, TRT, thermogenic fat burner, Cardarine, and a caffeinated pre-workout. Labs were notable for a peak hs-cTn of 391. An EKG showed sinus rhythm with new onset incomplete RBBB, nonspecific T wave inversions, and ST deviations. A TTE revealed an EF of 45-50% and diffuse hypokinesia. He was subsequently admitted as a case of NSTEMI. The patient underwent left heart catheterization which revealed no evidence of CAD. Myopericarditis was confirmed by CMR which demonstrated late enhancement and increased T1 and T2 mapping. Biventricular systolic dysfunction was also noted with a left and right ventricular EF of 43% and 34% respectively. The patient was diagnosed with HFmrEF and discharged on GDMT; metoprolol succinate and lisinopril. Discussion: Despite the widespread use and accessibility of performance-enhancing supplements, the body of literature regarding their cardiovascular effects remains insubstantial. Their suspected cardiotoxic effects are not solely attributed to their inherent adverse properties but also from frequent product contamination with other cardiotoxic agents, such as heavy metals, introduced through substandard manufacturing practices. Furthermore, these supplements are frequently used in combination, further potentiating their adverse effects. A significant consideration is the lack of FDA testing to verify label accuracy leaving consumers without vital information on ingredients, dosages, and possible interactions thus subjecting them to undisclosed hazards. A thorough examination of regulatory testing in the supplement industry could yield a positive impact on public health and facilitate the establishment of guidelines for safe and effective usage. We hope that as the body of evidence continues to grow, we can better evaluate the effects of individual supplements and their potential interactions when used concomitantly.
Abstract 4145384: Incidence of Necrotizing Enterocolitis (NEC) in Infants with Congenital Heart Disease on the Acute Care Cardiology Unit (ACCU): A Report from the Pediatric Acute Care Cardiology Collaborative (PAC3)
Authors: Rachel Duncan, Sonali Patel, Elisa Marcuccio, Ashraf Harahsheh, Emmanuelle Favilla, Kaitlin L'italien, Eyal Sagiv, Courtney Strohacker, Amy Schiller, Jenifer Tierney, Suzanne Williams, Jeffrey Weiner
Journal: Circulation (2024)

Introduction: Necrotizing enterocolitis (NEC) is a life-threatening condition of compromised gastrointestinal mucosa with risk of progression to ischemia, necrosis and perforation. The incidence and outcomes of NEC in infants with congenital heart disease (CHD) are incompletely understood. Hypothesis: Patients who develop NEC in the acute care cardiology unit (ACCU) are likely to have different patient characteristics and worse clinical outcomes than those who do not develop NEC. Aims: Describe differences in baseline characteristics and clinical outcomes in infants &lt; 6 months of age with CHD in the ACCU who suffered NEC compared to those who did not. Methods: Data were analyzed from the Pediatric Acute Care Cardiology Collaborative (PAC 3 ) database. All patients &lt; 6 months were included. Patients who had NEC (Bell’s stage ≥2) on the ACCU were compared to those who did not. Results: In 29041 patient encounters from 16770 unique patients across 33 centers, the incidence of NEC was 1.5%. Patients with NEC were more likely to have extracardiac abnormalities, antenatal diagnosis and have undergone procedural intervention (Table 1). Patients who developed NEC had longer lengths of stay and higher rates of mortality, CICU transfer and readmission (Table 2). In addition, patients who developed NEC had lower rates of oral feeding at encounter end. Of 14823 patients in their post-surgical encounter, those who developed NEC were significantly more likely to have undergone a more complex index procedure and to be younger, lower weight and on prostaglandin at the time of surgery. Patients who developed NEC were more likely to be on anticoagulation, ACE-inhibitors, anti-reflux medications, milrinone, diuretics and anticonvulsants. Conclusion: In this original multicenter analysis, patients who developed NEC on the ACCU had different characteristics and significantly worse clinical outcomes. Further study is warranted to identify risk factors for NEC in this vulnerable population.
Abstract 4145413: Factors Associated with Long Term Adverse Limb Events after Endovascular Revascularization: The Boston Femoral Artery Endovascular Revascularization Outcomes (FAROUT) study
Authors: Edwin Mandieka, Ramael Ohiomoba, Piotr Sobieszczyk, Andrew Eisenhauer, Thomas Todoran, SCOTT KINLAY
Journal: Circulation (2024)

Background: Patient, lesion, and procedural characteristics may impact the long-term risks of adverse limb outcomes differently after successful endovascular revascularization for lower extremity peripheral artery disease. Objective: To assess the relationships of patient, lesion, and procedural characteristics to the subsequent risk of major and minor adverse limb events over the decade after successful endovascular revascularization of the superficial femoral artery for chronic limb threatening ischemia (CLTI) or lifestyle limiting claudication. Methods : A retrospective cohort of patients who underwent endovascular revascularization between 2003-2011 were followed for a median of 9.3 (25-75%: 6.8, 11.1) years. Hazard ratios and 95% confidence intervals (HR, 95% CI) from Cox proportional hazards models assessed the risk of major adverse limb events (MALE) or minor revascularization, MALE alone, and minor revascularization alone. Results: There were 232 index limb revascularizations in 185 patients. Longer lesion length was associated with a higher risk of MALE or minor revascularization (HR=2.09, 95% CI=1.22, 3.60) and minor revascularization alone (HR=2.53, 95% CI=1.39, 4.61). Current smoking was linked with minor revascularization (HR=3.83, 95% CI=1.54, 9.56). CLTI was associated with MALE or minor revascularization (HR=1.89, 95% CI=1.09, 3.29), and MALE alone (HR=7.43, 95% CI=3.11, 17.79). Black race/ethnicity (HR=4.74, 95% CI=1.51, 14.9) and low density lipoprotein (LDL) &gt;100 mg/dL (HR=2.76, 95% CI=1.20, 6.35) were linked to MALE alone. Conclusion Factors related to MALE differed from those related to minor revascularization. Lesion length and smoking were linked to minor revascularization, whereas CLTI, Black race/ethnicity and elevated LDL were linked to MALE.
Abstract 4145402: The Role of Extracorporeal Membrane Oxygenation in Advanced Peripartum Cardiomyopathy Requiring Heart Transplant: A Case Report
Authors: Renata Toledo-Elias, Regina Aguilar, Rodrigo Figueroa Méndez, Daniel Manzur-Sandoval, Gustavo Rojas-Velasco
Journal: Circulation (2024)

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure, which occurs late in pregnancy or within the first 5 months postpartum and it is the most common cause of death related to heart failure in pregnant women. To establish the diagnosis, other causes of heart failure must be ruled out and a left ventricular ejection fraction (LVEF) &lt;45% must be present. Prognosis can range from complete recovery of the heart function to progressive deterioration with the need for mechanical circulatory support and heart transplant. DESCRIPTION OF CASE: We present the case of a 33-year-old woman with a 5-year history of PPCM. She was enrolled in the heart transplant program for progressive deterioration of cardiac function with an LVEF of 31%. The patient was admitted to the emergency department due to progressive dyspnoea and signs of low cardiac output and treatment for decompensated heart failure was established. Initially, she remained stable, however, on the fifth day of hospitalization the patient presented an event of monomorphic ventricular tachycardia and sudden hemodynamic deterioration. The diagnosis of cardiogenic shock was established, which was refractory to medical treatment, therefore an intra-aortic balloon pump was implanted and an extracorporeal membrane oxygenation (ECMO) system with veno-arterial configuration was placed. After 4 days of ECMO assistance, the patient showed hemodynamic improvement, therefore vasopressor and inotropic support were gradually reduced and she was weaned off mechanical support. Afterwards, given the availability of an organ, a bicaval orthotopic heart transplant was performed without complications. DISCUSSION: Recovery rates of PPCM are typically high, however, there is an important percentage of patients who progress to cardiogenic shock with a mortality rate up to 50%. This highlights the importance of recognition and adequate treatment of PPCM and the early use of mechanical circulatory support if required as a bridge to recovery or heart transplantation.