tbuckley/cabot-search huggingface dataset:
Abstract 14430: The Corcare Heart Function Optimization Protocol: A Structured Quality Improvement Intervention to Improve Goal Directed Targets for Patients With Reduced Ejection Fraction
Authors: Joseph A Ricci, Beverly Bozek, Maria Aprile, Siyam Ibrahim, Stephanie J Frisbee, Jonathan G Howlett, Saleem Kassam, Robert McKelvie, Stephanie Poon, Neville Suskin, Andrew T Yan, Luke Aprile, Shaun G Goodman
Journal: Circulation (2023)

Introduction: Reduced ejection fraction (REF) in patients is prevalent, utilizing substantial health care resources. Goal Directed Therapy (GDT) reduces hospitalization, morbidity, and mortality but use is suboptimal. Care in subspecialty clinics following discharge reduces readmission, but is not scaled for longitudinal care of the larger REF population. Canadian guidelines support integration of primary, specialist, and non-physician care in systems to improve outcomes. Hypothesis: A protocol-guided intervention will achieve high rates of GDT for REF patients in a community health care setting. Goal: To evaluate a pragmatic quality-of-care intervention to achieve GDT for REF patients and assess barriers to GDT. Methods: Patients referred for imaging and cardiology consultation at a community facility (Jan 1/15-Dec 31/22) were screened. Patients with LVEF &lt;41% on echocardiogram were included if their cardiologist consented to study protocol GDT and were enrolled at the next scheduled, usual care cardiologist visit. 2 project nurses confirmed patient status and assisted GDT management using medical directives at 9 protocol-specified visits between usual care visits over 32 weeks. The primary target was achieving GDT or maximally tolerated GDT (&gt;0 mg). A secondary endpoint, clinical inertia, was defined as not achieving GDT due to physician or patient choice. Results: 864 patients (13 cardiologists) participated: median age 71 (28-102) years, diabetes 25%, hypertension 60%, atrial fibrillation 22%. At intake: NYHA class ≥2 (60%), EF &lt;30% (45%), 30-35% (27%), 36-40% (29%), REF etiology ischemic (47%), non-ischemic (43%), mixed (10%). The majority achieved GDT in each class; inertia, not intolerance predominantly accounted for those who did not achieve GDT. Conclusion: This pragmatic community-based intervention achieved high rates of GDT that could improve longitudinal care for REF patients, and is potentially scalable and generalizable.
Abstract 12013: Cardiac Arrhythmia After COVID-19 Vaccination versus Non-COVID-19 Vaccination: A Systematic Review and Meta-Analysis
Authors: Ao Shi, Xiaoyi Tang, Panpan Xia, Meiqi Hao, Yuan Shu, Ryan R Ling, KOLLENGODE RAMANATHAN, Hayato Nakanishi, Karen Karen Smayra, Armin Farzad, Kaibo Hu, Qi Liu, Yue Wu, Peng CAI, Peng Yu, Pengyang Li
Journal: Circulation (2023)

Introduction: Arrhythmia after COVID-19 vaccination is increasingly reported. Whether the risk from COVID-19 vaccines exceeds that of non–COVID-19 vaccines remains controversial. In this study, the incidence of arrhythmia after COVID-19 versus non–COVID-19 vaccination were investigated. Methods: Medline (via PubMed), Scopus, Cochrane Library, and Embase databases were searched for observational studies reporting the incidence of postvaccination arrhythmias from January 1, 1947 to November 27, 2022. Secondary endpoints included tachyarrhythmia incidence and all-cause mortality. Arrhythmia incidence by age, vaccine type, sex, and COVID-19 vaccine dose were analysed, and intrastudy risk for bias and certainty of evidence were evaluated. Results: The overall incidence of arrhythmia (1,528,500,116 vaccine doses, 43 studies) was 561·3 cases per million doses. Arrhythmias were more common after COVID-19 vaccination than non–COVID-19 vaccination (3790·4 vs 13·7 cases per million doses; p&lt;0·001). Compared with COVID-19 vaccines, the influenza, pertussis, and human papillomavirus vaccines were associated with fewer cases of arrhythmia. The overall incidence of tachyarrhythmia was 910·5 cases per million doses; it was higher after COVID-19 vaccination than non-COVID-19 vaccination (6681·8 vs 34·3 cases per million doses; p&lt;0·001). Pooled all-cause mortality postvaccination was 2·4 deaths per million doses. Mortality was comparable between COVID-19 and non–COVID-19 vaccination groups. Conclusions: Although arrhythmia was more frequent after COVID-19 vaccination than after non-COVID-19 vaccination, it was still uncommon. The safety and efficacy of COVID-19 vaccines should be assessed in light of other important factors as well, such as the incidence of regional outbreaks and effects from the COVID-19 infection itself.
Abstract 18857: Association Between Physical Activity and Risk of Incident Cardiovascular Disease in Women With Novel Risk Factors: Evidence From the UK Biobank Cohort
Authors: Zhaleh Ataei, Sergio Ruiz-Carmona, Leah Wright, Erin Howden
Journal: Circulation (2023)

Introduction: Early menopause and complicated pregnancy are associated with a higher risk of cardiovascular diseases (CVD), such as coronary heart disease (CHD) or heart failure (HF). Physical activity (PA) is a modifiable behaviour that typically reduces the risk of CVD; however, it is unclear if this is the case for these novel risk factors. Hypothesis: We hypothesised that PA could moderate the risk of incident CVD in women with novel risk factors. Aims: This study sought to investigate the effect of PA on the risk of incident CVD in women with a history of early menopause and/or complicated pregnancy. Methods: We included 55,930 women (median age 59) with novel risk factors and free from CVD (HF, CHD, arrhythmia, and ischemic stroke) from the UK Biobank Study. Novel risk factors were defined as complicated pregnancy (n=23,627, median age=56), described as a history of any stillbirth or ≥2 miscarriages, gestational diabetes, or hypertensive disorders of pregnancy, and early menopause (n=35,838, median age=60), defined as natural or surgical (bilateral oophorectomy) menopause &lt;47age. Women were categorised into three groups of high (≥1,500 MET-minutes/week), moderate (≥600 MET-minutes/week) and low levels of PA according to their responses to the International Physical Activity Questionnaire (IPAQ). Multivariable Cox proportional hazard models were performed, and the results were adjusted for traditional CVD risk factors such as smoking, alcohol consumption, obesity, diabetes, hypertension, hyperlipidaemia, and cancer. Results: At a median follow-up of 13 years, there were 6636 events. A high level of PA was significantly associated with a lower risk of incident HF (hazard ratio [HR] 0.76, 95% CI[0.63 0.90], n= 1374), arrhythmia (HR 0.79, 95% CI[0.70 0.88], n=2699), and stroke (HR 0.77, 95% CI[0.61 0.97], n=797), compared to low levels of PA. We also observed a significant association between moderate levels of PA and reduced risk of incident arrhythmia (hazard ratio 0.78, 95% CI 0.70 0.87) compared to low levels of PA. Conclusion: High levels of PA can significantly reduce the risk of most incidents of CVD in women with novel risk factors. Thus, higher PA should be strongly encouraged to women with novel risk factors to lower the risk of CVD.
Abstract 14566: Long-Term Efficacy of Evolocumab in Patients With and Without Multivessel Coronary Artery Disease
Authors: Daniel J McClintick, Michelle L O'Donoghue, Gaetano Maria De Ferrari, Jorge M Ferreira, Xinhui Ran, KyungAh Im, J. A Lopez, Mary Elliott-Davey, Bei Wang, Maria Laura Monsalvo, Dan Atar, Anthony Keech, Robert P Giugliano, Marc S Sabatine
Journal: Circulation (2023)

Background: In FOURIER, the magnitude of reduction in risk of major adverse cardiovascular events (MACE) was larger in patients with multivessel disease (MVD) than in those without. However, the median follow-up was only 2.2 yrs. The open-label extension (FOURIER-OLE) allows for a better assessment of the long-term benefit of intensive lipid-lowering in these two subgroups. Methods: Patients with CAD at time of enrollment in the parent FOURIER trial were categorized based on the presence or absence of MVD (≥40% stenosis in ≥2 large vessels). Primary endpoint (PEP; CV death, MI, stroke, hospitalization for UA, or coronary revascularization) and key secondary endpoint (SEP; CV death, MI, or stroke) were assessed through FOURIER and FOURIER-OLE, during which all patients received evolocumab. Results: At enrollment in FOURIER, 23,674 patients had CAD, of whom 25% had MVD (N=6007). In the placebo arm, those with MVD had a higher risk of the PEP (HR 1.45 [95%CI 1.32-1.60], P&lt;0.0001) &amp; SEP (HR 1.37 [1.22-1.56], P&lt;0.0001) than those without MVD. The magnitude of the overall relative risk reduction in those initially randomized to evolocumab tended to be greater in patients with MVD than in those without (RRR 23% vs. 12% for PEP; 30% vs. 15% for SEP; P int 0.07 &amp; 0.04, respectively). The magnitude of benefit tended to grow over the first several years (Fig). This was especially true for CV death, in which for patients with MVD, initial randomization to evolocumab reduced the risk of CV death in the later years (HR 0.70 [0.51-0.97]; Fig bottom). Conclusion: Evolocumab reduced the rate of MACE in patients with and without MVD, with earlier and larger benefit seen in patients with MVD. The magnitude of benefit grew over time, supporting early initiation of intensive LDL-C lowering both in patients with and without MVD.
Abstract 17431: A Rare Cause of Constrictive Pericarditis in a Case of Adult T-cell Lymphoma
Authors: Abdulghani Mounir, Ekow Essien, Faisal Masood, Patrycja Galazka, M F Jan
Journal: Circulation (2023)

Introduction: Adult T-cell lymphoma (ATCL) is a rare T cell lymphoproliferative malignancy that typically presents with lymphadenopathy, hepatosplenomegaly, lytic lesions, hypercalcemia or skin lesions. Cardiac involvement is rare. Case presentation: A 66-year-old male with a history of chronic kidney disease and hypertension presented with dyspnea. Transthoracic echocardiography revealed a moderate pericardial effusion and a left ventricular ejection fraction of 45%. Further workup with MRI and transesophageal echocardiography found extensive circumferential pericardial thickening with enhancement and extensive mediastinal and hilar lymphadenopathy along with a mass along the course of the superior vena cava with extension of disease into the right atrium along the right atrial wall (Figure 1). Endobronchial biopsy of the mediastinal lymph nodes was positive for T-cell lymphoma. Chemotherapy was initiated; however, the patient decided to focus on comfort measures only. Discussion: Cardiac involvement in ATCL is rare and usually detected in postmortem autopsies. Incidence is unknown, and experience is limited to case reports. The largest case series to date found 16 patients who had antemortem diagnosis of symptomatic cardiac involvement of ATCL. The characteristic features included infiltration of the myocardium, pericardial effusion, valvular lesions, and masses in the atrium, similar to what was seen in our patient. To our knowledge, there have been no reported cases of ATCL causing constriction. Prognosis is poor, with median survival of 5 months after development of symptoms (n = 15, range 0-120 months). Conclusion: The incidence of cardiac ATCL is unknown, but it is an extremely rare occurrence. It can present with a wide variety of cardiac involvement, including constriction. The prognosis of cardiac ATCL remains poor.
Abstract 13623: <i>In Silico</i> Comparison of Pressure Head Loss for Outflow Variations of a Novel LVAD Accessory Compared to Generic LVAD Pump Outflow
Authors: Anna Osypka, Florian Meissner, Deniz Ozturk, Heiko Vestner, Michelle Costa Galbas, Martin Czerny, Wolfgang Bothe
Journal: Circulation (2023)

Introduction: Left ventricular assist device (LVAD) implantation is a treatment option for end-stage heart failure, requiring a sternotomy. A novel accessory, redirecting the outflow via the left ventricular apex into the ascending aorta, allows for LVAD implantation via left thoracotomy. Pressure distribution within accessory designs is unknown. Our goal was to compare three different outflow designs with a generic LVAD outflow (Control) to optimize the accessory’s outflow design. Hypothesis: We hypothesize that the LVAD accessory leads to higher pressure head loss than Control and that there are relevant differences among varied designs. Methods: Volume models of the LVAD accessory variations (A–C) and Control were created using computer aided design. Computational fluid dynamics (CFD) was used to simulate blood flow through the accessories and generic outflows. A verification study was performed to optimize numerical parameters. Pressure head loss (mmHg) was calculated for each outflow while changing the LVAD flow rate continuously (2–7 L/min). Pressure loss was compared by mean differences (MD). Results: Pressure head loss increased with higher LVAD flow rate among all groups. Addressing the accessories’ outflow designs, Design B revealed the lowest increase in pressure loss revealing a mean slope of 2.3 mmHg/L/min compared to 4.6 and 3.0 for Design A and C. Referring to a flow rate of 5.5 L/min, a common flow rate among clinical LVAD patients, and comparing pressure head loss with Control, we found an additional pressure loss of 15.5, 6.4 and 8.3 mmHg in Design A, B and C, respectively. Conclusion: There is a trade off between fitting the outflow design to the cardiac geometry and the pressure head loss. Continued optimization of the LVAD accessory could allow minimally invasive LVAD implantation with minimal changes in LVAD performance. Potential compromise between improved design and performance renders CFD an important tool for medical device development.
Abstract 276: Characterization of Chest Dynamics During Out-of-Hospital Manual Cardiopulmonary Resuscitation
Authors: Jose Antonio Urigüen, Koldo Redondo, Jose Julio Gutiérrez, Izaskun Azcarate, James K Russell, Mohamud R Daya, Sofia Ruiz De Gauna
Journal: Circulation (2023)

Introduction: Viscoelastic models are widely accepted in modern literature to explain the non-linear relationship between the force applied by the rescuer and the chest displacement that occurs during chest compressions (CCs). Various studies have shown that applying CCs for prolonged periods of time changes chest properties, but proposed models have mostly been tested under laboratory settings with few patients or during short CPR intervals. Aim: To retrospectively characterize the mechanical dynamics of the chest during manual CCs in pre-hospital cardiopulmonary resuscitation using a simple viscoelastic model. Methods: Force and acceleration signals were extracted from CPR monitors used during pre-hospital resuscitation efforts by TVF&amp;R (OR, USA) on adult patients (≥ 18yo), from which individual CCs and series of CCs between pauses were identified. The model decomposes the measured force as the sum of an elastic term and a damped term, specifically F = k·x + d·v . We characterized each full cycle with a spring coefficient k (N/cm) to measure the stiffness of the chest; and with separated compression and recoil damping coefficients, d c and d r (N·s/cm), to measure its viscosity. Parameters were averaged for sets of 10 CCs. We characterized the variations of the model parameters within each series. We also assessed the chest recovery between consecutive series by comparing the values obtained at the end of each series with the beginning of the next series. Results: A total of 1,156,608 CCs from 615 patients were analysed. From these, 6,073 series of median (IQR) length 190 (119-222) CCs were selected. All parameters decreased within the series, with decreases of the median after 20 sets of 10 CCs of 9.8%, 7.1% and 11.1% for k , d c and d r , respectively (p trend &lt; 0.05). When examining the first 5 series for all cases, k presented a mean recovery of 7%, d c of 5%, and d r of 5%. Conclusion: The proposed model allows the observation of a reduction in stiffness and viscosity of the chest within CC series. It further allows for evaluating the dynamics of the chest around pauses, showing recovery of its properties during the pause. Overall, the model reveals a gradual reduction in chest stiffness and viscosity during CPR.
Abstract 14972: Association Between CEC Measured by Immobilized Liposome-Bound Gel Beads Method and the Size of Lipid-Rich Coronary Artery Plaque
Authors: Tsunehiro Miyakoshi, Yuna Horiuchi, Makoto Araki, Taishi Yonetsu, Mei Watanabe, Motoki Nakamura, Takahiro Kameda, Akira Yoshimoto, Naoya Ichimura, Shuji Tohda, Minoru Tozuka, Tetsuo Sasano, Ryunosuke Ohkawa
Journal: Circulation (2023)

Introduction/Background: High-density lipoprotein (HDL) exerts cholesterol efflux capacity (CEC), and it ameliorates cardiovascular disease (CVD). CEC had been expected as a surrogate biomarker in addition to HDL cholesterol (HDL-C), which has been found not always to reflect the CVD risk. However, the procedures of the conventional CEC assays were too complex to be introduced into clinical practice because of cell-based assay. Given this situation, we invented novel cell-free CEC assay named immobilized liposome-bound gel beads (ILG) method. ILG method utilizes liposomes which contain fluorescence labeled cholesterol instead of lipid loaded foam cells, and has advantage of simplicity of procedure and accuracy. Reserch Question/Hypothesis: Does ILG method show some associations between CEC and HDL subclass, and also reflect the condition of coronary artery plaque? Goals/Aim: We aim to demonstrate CEC by ILG method has clinical significance for assessment of the CVD risk. Methods/Approach: Patients who underwent diagnostic catheterization or percutaneous coronary intervention were enrolled, and 61 patients were examined through CEC analysis by ILG method and assessment of coronary artery plaque by optical coherence tomography (OCT) imaging. Large lipid-rich plaque was defined as a lipid plaque with a lipid arc ≥180°and lipid length ≥5 mm. Serum HDL subclass was analyzed by enzymatic assay (Denka). We defined the ratio apolipoprotein E(apoE)-containing HDL-C to HDL-C as %apoE, and we also calculated the value of HDL 3 -C/HDL 2 -C, and classified HDL 3 - or HDL 2 -rich group. Results/Data: HDL-C was positively associated with %apoE, and CEC of apoE-rich patients was higher than that of apoE-poor patients. This correlation was maintained after classified based on size of HDL. CEC and %apoE in patients with large lipid-rich plaque were significantly lower than in those in without. In contrast, there was no significant difference in HDL-C and LDL-C. Conclusion: In present study, ILG method showed that apoE has some influence on CEC, and CEC was inversely correlated with size of lipid-rich plaque. These results implied that ILG method, suitable CEC assay for clinical site, might be useful to assess the CVD risk.
Abstract 17745: Impact of Acute Limb Ischemia Caused by Femoropopliteal Stent Thrombosis on Clinical Outcomes in Patients With Lower Extremity Artery Disease
Authors: SHO NAKAO, Osamu Iida, Mitsuyoshi Takahara, Nobuhiro Suematsu, Terutoshi Yamaoka, Daisuke Matsuda, Tatsuya Nakama, Masahiko Fujihara, Kazuki Tobita, Takuya Haraguchi, Kenji Ogata, Toshiaki Mano
Journal: Circulation (2023)

Introduction: Although contemporary femoropopliteal (FP)-specific stents have shown durable patency in endovascular therapy (EVT), acute limb ischemia (ALI) caused by stent thrombosis (ST) are substantially experienced in clinical setting. The current study investigated that impact of ALI caused by FP-ST on clinical outcomes in patients with lower extremity artery disease (LEAD). Methods: The current study was multicenter and retrospective study enrolling 498 ALI patients (mean age: 76 years, male: 59%, diabetes mellitus [DM]: 34%, hemodialysis [HD]: 19%). We compared clinical outcomes of 105 ALI caused by FP-ST (ST-ALI) with 347 ALI caused by de novo thrombosis or embolus (de novo-ALI) presenting Rutherford category I or II. Outcome measure was 12-month amputation free survival (AFS), and predictors of AFS were also investigated using multivariate Cox proportional hazard analysis. Results: Frequency of DM (63% vs. 26%) and HD (51% vs. 10%) was higher in ST-ALI, while average age was older (74 years vs. 77 years) and frequency of atrial fibrillation (Af) (18% vs. 49%) was higher in de novo-ALI. In patients presenting with Rutherford category I or II ALI, The 12-month AFS was significantly lower in ST-ALI than in de novo-ALI (52.2±5.1% vs. 75.6±2.5%, p&amp;lt;0.001). Multivariate analysis revealed that ST-ALI (hazard ratio [HR]: 1.77, 95% confidential interval [CI] 1.18-2.65, p=0.006) as well as age (HR: 1.03, 95%CI 1.01-1.05, p=0.008), HD (HR: 2.58, 95%CI 1.64-4.04, p&amp;lt;0.001), Af (HR: 1.77, 95%CI 1.18-2.65, p=0.006), presence of wound (HR: 1.78, 95%CI 1.10-2.88, p=0.018), peak CRP value (HR: 1.05, 95%CI 1.03-1.07, p&amp;lt;0.001) and non-ambulatory status (HR: 2.17, 95%CI 1.41-3.31, p&amp;lt;0.001) were significantly associated with low 12-month AFS. Conclusions: In patients presenting with Rutherford category I or II ALI, ST-ALI, age, hemodialysis, presence of wound, atrial fibrillation, peak CRP value and non-ambulatory status adversely impact on 12-month AFS.
Abstract 15710: Sex-Specific High-Sensitivity Cardiac Troponin Thresholds for Rule-Out of Non-ST-Elevation Myocardial Infarction
Authors: Ingar Ziad Restan, Ole-Thomas Steiro, Hilde L Tjora, Joerund Langoergen, Torbjorn Omland, Paul O Collinson, Rune Bjoerneklett, Kjell Vikenes, Trude Steinsvik, Oyvind Skadberg, Oeistein R Mjelva, Alf Inge Larsen, Vernon V Bonarjee, Kristin Moberg M Aakre
Journal: Circulation (2023)

Introduction: The use of sex-specific cut-offs is recommended when high-sensitivity cardiac troponins (hs-cTn) are used for diagnosing acute myocardial infarction (MI). In this prospective, multi-centre study we evaluated the prognostic performance of sex-specific cut-offs for predicting low risk of MI in the Emergency Department (ED). Methods: 1895 patients (45% female) from two Norwegian centres where evaluated for potential non-ST-elevation myocardial infarction (NSTEMI). Cardiac troponins were tested with hs-cTnT (Roche) and hs-cTnI (Abbott and Siemens). Sex-specific differences in performance for a single-sample NSTEMI rule-out were investigated. Results: NSTEMI was diagnosed in 98 women (11.5%), 135 men (12.9%). Baseline hs-cTn concentrations were consistently lower in women compared to men, though not significantly so in the NSTEMI subgroup (Table 1). ROC curves showed consistent, though non-significantly, smaller AUCs for women compared to men with all three assays (Figure 1). Cut-offs for single sample rule-out aiming at &gt;97% or &gt;99% sensitivity for NSTEMI were evaluated. Women had consistently lower cut-off levels compared with men, with significantly lower (p &lt; 0.001) Youden index for all three assays at &gt;99% sensitivity and for the hs-cTnI assays at &gt;97% sensitivity (Table 2). Conclusions: Sex-specific cut-offs for single sample rule-out should be considered in accelerated diagnostic protocols for evaluation of NSTEMI.