tbuckley/cabot-search huggingface dataset:
Abstract 4139565: Association of transcatheter edge-to-edge repair with clinical outcomes in atrial functional mitral regurgitation
Authors: Jwan Naser, Faysal Massad, Christopher Scott, Barry Borlaug, Patricia Pellikka, Austin Kennedy, Trevor Simard, Maurice Enriquez-Sarano, Vuyisile Nkomo, Hector Michelena, Sorin Pislaru
Journal: Circulation (2024)

Background: Atrial functional mitral regurgitation (AFMR) constitutes ~25% of ≥moderate MR and has been associated with a high prevalence and incidence of HFpEF. Transcatheter edge-to-edge repair (TEER) has shown effectiveness in improving symptoms in AFMR, but its impact on mortality and HF hospitalizations is unknown. Objective: Evaluate rates of mortality and HF hospitalizations in patients with ≥moderate AFMR treated with TEER and compare them to conservative management. Methods: Consecutive adults with ≥moderate AFMR (functional MR with left atrial enlargement, ejection fraction≥50%, and absent &gt;mild left ventricular enlargement) were identified retrospectively. Ecxlusion criteria were previous cardiac surgery, ≥moderate aortic regurgitation/stenosis, infiltrative/hypertrophic cardiomyopathy, regional wall motion abnormalities or malignancy. Propensity score matching was performed (1:1 ratio) between patients treated with TEER and patients treated conservatively based on age, sex, EuroScore II, effective regurgitant orifice area, and the integrative MR severity. To ensure similar technique in evaluation in the 2 groups, variables were obtained from the closest transthoracic echocardiogram before TEER in the TEER group [median 65 (IQR 29-111) days]. Results: Overall, 46 patients with ≥moderate AFMR treated by TEER and 46 treated conservatively were included, Table 1 . Patients undergoing TEER had more frequent atrial fibrillation and NYHA class ≥III. MR improved to ≤moderate in 93% of patients undergoing TEER on procedural transesophageal echocardiography, Figure 1 . On 1–3-month post-TEER follow-up, 64% had NYHA class I/II (vs 33% pre-TEER), Figure 1 . Over median 2.2 (IQR 1.2-3.1) years, 32 patients died (rate 13%/year in each group, log-rank p=0.85), Figure 2 . When adjusted for baseline NYHA, rates of HF hospitalizations were not different between the groups (Wald-test p-value=0.48). Residual ≥moderate AFMR in the TEER group was not associated with mortality (log-rank p=0.83), but ≥1 class improvement of NYHA in patients with baseline NYHA &gt;1 was associated with decreased mortality, Figure 2 . Conclusion: MR severity and NYHA class improved with TEER for AFMR, and improved NYHA class was associated with decreased mortality. However, the association of TEER with decreased risk of mortality or HF hospitalization remains unproven, and larger randomized studies are needed to evaluate the potential role of TEER on these outcomes in AFMR.
Abstract 4139227: Exercise Right Ventricular-Pulmonary Arterial Coupling predicts long-term Functional Outcome in Patients undergoing Surgery for Secondary Ischemic Mitral Regurgitation.
Authors: Carlo Fino, DIEGO BELLAVIA, Michele D'Alonzo, Maurizio Merlo, Vito Domenico Bruno, Massimo Caputo, Julien Magne, amedeo terzi, MICHELE SENNI, Samuele Bichi, Caterina Simon, Edoardo Sciatti, Agnese Maccarana, Giovanni Marchetto, attilio iacovoni, Philippe Pibarot
Journal: Circulation (2024)

Background: The treatment of secondary ischemic mitral regurgitation is challenging and predictors of functional and clinical outcome are pivotal in order to define the best therapeutic strategy. In these patients there is growing evidence that assessing the right ventricular (RV)-pulmonary arterial (PA) coupling during exercise has additive diagnostic and prognostic value. To date, no data are available as regard the exercise assessment of the RV- PA coupling in patients undergoing surgery for ischemic mitral regurgitation Research Question: in patients with ischemic mitral regurgitation the evaluation of the exercise RV-PA coupling could play a crucial role for patients selection and prognosis Aim: to test resting and exercise echocardiographic predictors of functional capacity and clinical outcome in patients referred to surgery Methods: A 6-minute walking test and exercise stress echo performed at preoperative baseline, at 1 year and at median FU of 6 years (IQR: 3.70; range: 4.5– 8) on 50 patients (age: 67 ± 8 year; EF: 35 ± 5%), undergoing surgery by valve replacement or repair. Generalized linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6-MWT. Results: Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/ pulmonary artery systolic pressure (PASP) ratio showed the strongest correlation with long-term six-minute walking test (r=0.81, p&lt; 0.01) (Figure 1).The receiver operating characteristic analysis found that a preoperative exercise TAPSE/PASP &lt; 0.34 predicted the lowest quartile of six-minute walking test at long-term (sensitivity: 79%; specificity: 100%) (Figure 2) and a composite clinical outcome of heart failure and death for any cause (PPV 91.3%, NPV 100%). On multivariable analysis TAPSE (Estimates:4.05; SE:0.90; p &lt; 0.01) and TAPSE/PASP ratio (Estimates:106.9; SE: 31.54, p &lt;0.01) were significantly associated with better long-term six-minute walking test (Table 1) Conclusions: A preoperative exercise TAPSE/PAPS &lt; 0.34 predicts a poor six-minute walking test performance and an higher likelihood of clinical adverse events over time. In patients with secondary ischemic mitral regurgitation the exercise RV-PA coupling could add value in order to improve risk stratification. These findings need to be comfirmed by larger studies
Abstract 4138965: The Triglyceride-Glucose Index and Type 2 Diabetes are Mutually Independent Predictors of Major Cardiovascular Events in Patients With Established Cardiovascular Disease
Authors: Thomas Plattner, Barbara Larcher, Arthur Mader, Alexander Vonbank, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2024)

The triglyceride-glucose index (TyG) is a validated biomarker of insulin resistance. Its power to predict major cardiovascular events (MACE) in patients with established cardiovascular disease is unclear and is addressed in the present study. We enrolled 1790 consecutive patients, 1481 with angiographically proven CAD and 309 with sonographically proven PAD. Prospectively, MACE were recorded over a mean follow-up period of 10.7±5.0 years. At baseline, the TyG index was significantly higher in patients with T2DM (n=586) than in non-diabetic subjects (9.2±0.7 vs. 8.7±0.5; p&lt;0.001). During follow-up, 916 of our patients suffered MACE. The event rate was significantly higher in patients with T2DM than in non-diabetic subjects (60.2 vs. 47.7%; p&lt;0.001). The TyG index in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index, and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.21 [1.12-1.30], p&lt;0.001); HRs in patients without T2DM and in diabetic subjects were 1.08 [0.95-1.25], p=0.272 and 1.16 [1.03-1.31], p=0.013, respectively, with no evidence of an interaction between TyG and T2DM (p=0.093). With T2DM additionally entered into the regression model, TyG in the total study population predicted cardiovascular events independently from the presence of T2DM (HR 1.12 [1.03- 1.23], p=0.008), while T2DM remained independently predictive of MACE after adjustment for TyG (HR 1.42 [1.19-1.67]; p&lt;0.001). From our data we conclude that the TyG index and T2DM are mutually independent predictors of MACE in patients with CAD.
Abstract 4138835: Efficacy and Safety of Sodium-glucose Transporter 2 Inhibitors in Acute Decompensated Heart Failure Patients Concomitant with Physical or Cognitive Frailty: Finding from the WET-HF Registry
Authors: Ayami Naito, Yuji Nagatomo, Midori Iwashita, Akane Kawai, Yukinori Ikegami, Makoto Takei, Ayumi Goda, Takashi Kohno, Atsushi Mizuno, Shintaro Nakano, Munehisa Sakamoto, Mitsunobu Kitamura, Yasuyuki Shiraishi, Shun Kohsaka, Takeshi Adachi, Tsutomu Yoshikawa
Journal: Circulation (2024)

Background: Recent evidence suggests the efficacy and safety of sodium-glucose transporter 2 inhibitors (SGLT-2is) in heart failure (HF) patients. However, there still remain concerns in their use among patients with physical or cognitive frailty. Methods: West Tokyo Heart Failure (WET-HF) Registry is an ongoing prospective multicenter registry in Japan enrolling all patients who were hospitalized for acute decompensated heart failure. We retrospectively analyzed the impact of physical or cognitive frailty-related factors (FF) on the association of SGLT-2i prescription with long-term outcomes using the data of WET-HF (2018-23, n=5106). Patients without data of SGLT-2i prescription at discharge were excluded. Primary endpoint (PE) was defined as the composite of cardiac death and HF rehospitalization during 2 years after discharge. Results: At baseline 3208 of 4845 patients (66%) had FF defined by any of following 5 factors: BMI &lt;18.5 kg/m 2 , Barthel index ≤85, clinical frailty scale ≥4, geriatric nutritional risk index (GNRI) &lt;82, and a history of dementia. The study population was divided by prescription of SGLT-2is at discharge. SGLT-2i users (n=737) showed younger age (73 vs 80 years, P&lt;0.001), higher number of male sex (67% vs. 57%, P&lt;0.001), higher prevalence of HF with reduced ejection fraction (55% vs. 40%, P&lt;0.001), and diabetes mellitus (63% vs. 26%, P&lt;0.001) compared to SGLT-2i non-users. This trend was similarly seen in FF subgroup. SGLT-2i users showed significantly lower rate of PE compared to non-users (19% vs 23%, P=0.008, log-rank test). The results were directionally similar in the patients with FF (20% vs. 26%, P=0.006), but in those without FF there was no difference in PE between SGLT-2i users and non-users (17% vs. 16%, P=0.96). These associations persisted even after adjusting for patient background with a propensity score-based inverse probability of treatment weighting for SGLT-2i prescription (FF, HR 0.59 [0.39 – 0.91], P=0.016; No FF, HR 0.75 [0.47 – 1.20], P=0.23, P for interaction 0.48). At 1 year after discharge (follow up rate 61%), there was no difference in SGLT-2i continuation rate between FF and No FF groups (81% vs. 85%, P=0.14). The patients with FF who continued SGLT-2i showed no significant temporal changes in BMI, GNRI, or eGFR, whereas those without SGLT-2i showed significant decline in eGFR (P&lt;0.001). Conclusions: SGLT-2is was safe and efficacious even for HF patients with FF in our retrospective analysis.
Abstract 4139545: Impact of Catheter Ablation(CA) in patients with Heart failure with preserved ejection fraction(HFpEF) : A meta-analysis of RCTs
Authors: Basilio Addo, Sammudeen Ibrahim, Walter Agyeman, Desmond Boakye Tanoh, Richard Amoateng, Abdul-Fatawu Osman
Journal: Circulation (2024)

Introduction: CA has been shown to be superior to medical management in improving mortality and hospitalization in patients with heart failure with reduced ejection fraction. However, literature concerning the benefit of CA in patients with HFpEF are scarce. There have been some non-randomized clinical trials which have attempted to bridge the gap. Therefore, we conducted a systematic review and meta-analysis of RCTs focusing on the impact of catheter ablation in patients with HFpEF. Objective: To systematically review and perform a meta-analysis by comparing the outcomes of CA versus medical therapy in patients with HFpEF, focusing on all-cause mortality, cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations. Methods: We conducted a systematic search on PubMed, Cochrane library, Scopus database, and Web of Science using the appropriate search strategy through to April 2024. Only English original RCTs that compared CA with medical management were included for data extraction. The outcomes of interest were as follows- All-cause mortality, Cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations. Results: Four RCTs which included a total of 1620 patients (796 in the intervention group and 824 patients in the medical management group). Follow up duration ranged between (24 – 72 months). Improvement in Heart failure hospitalizations or events was seen in the CA group as compared with the medical management group (OR: 0.57, 95% CI 0.43-0.77, P= 0.0002). There was also a reduction in All- cause hospitalizations in the CA group with an OR of 0.67, 95% CI 0.44-0.82, p=0.005. With regards to cardiovascular mortality and all cause mortality in the CA group the OR was 0.74, 95% CI 0.40-1.35, P= 0.59 and 0.68, 95% CI 0.46-1.03, P= 0.07 respectively. These were found not to be statistically significant. Conclusion: Using CA in patients with atrial fibrillation and HFpEF showed a statistically significant reduction of heart failure hospitalizations and all cause hospitalizations. Despite the trend towards CA, cardiovascular mortality and all cause mortality were found not to be statistically significant when comparing catheter ablation and medical management. This is the largest meta-analysis in this sub-population till date. With the advent of pulsed field ablation, it will also be intriguing to see how those results contrast CA in atrial fibrillation management in patients with HFpEF.
Abstract 4138949: Type 2 Diabetes is Not a Coronary Artery Disease Risk Equivalent: Longterm Results from a Prospective Cohort Study on Patients Who Underwent Coronary Angiography
Authors: Thomas Plattner, Barbara Larcher, Arthur Mader, Alexander Vonbank, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2024)

Type 2 Diabetes (T2DM) and pre-existing coronary artery disease (CAD) are strong and independent risk factors for cardiovascular events, and data from large cohort studies suggest that the cardiovascular risk conferred by T2DM in the absence of CAD is equivalent to that conferred by CAD in the absence of T2DM. However, because the presence of CAD in these studies was defined clinically rather than by visualization, unrecognized subclinical CAD in T2DM patients may have biased results. We therefore prospectively investigated patients with T2DM and non-diabetic subjects in whom the baseline CAD state was diagnosed angiographically. We recorded cardiovascular events over a follow-up period of 22 years in a large cohort of 1819 patients undergoing coronary angiography for the evaluation of established or suspected stable CAD. From our patients, 595 had neither significant CAD nor T2DM (CAD-/T2DM-), 171 had T2DM but not significant CAD (CAD-/T2DM+), 701 had significant CAD but not T2DM (CAD+/T2DM-) and 352 had both T2DM and significant CAD (CAD+/T2DM+). The incidence of cardiovascular events was lowest in CAD-/T2DM- patients (24.7%). Compared to this group it was significantly higher in CAD-/T2DM+ patients (36.1%; p&lt;0.001) and in CAD+/T2DM- patients (50.8%; p&lt;0.001) and highest (p=0.001) in CAD+/T2DM+ patients, in whom it was higher than in CAD-/T2DM+ (p&lt;0.001) or CAD+/T2DM- (p=0.001) patients. Importantly, CAD+/T2DM- patients were at a significantly higher risk of cardiovascular events than CAD-/T2DM+ patients (p&lt;0.001). In Cox regression analysis the risk increase conferred by CAD was higher (adjusted (HR 2.35 [1.92-2.89]; p&lt;0.001) than that conferred by T2DM (adjusted HR 1.54 [1.33-1.78]; p&lt; 0.001). From our long term results we conclude that angiographically diagnosed CAD is a stronger predictor of future cardiovascular events than T2DM. T2DM is not a CAD risk equivalent.
Abstract 4139380: A Report of <u>2000</u> Consecutive Patients Undergoing Imaging with Pacemakers and ICDs in the MRI Environment; the Additive Value of a Large, Prospective ~20-Year Observational Study
Authors: Robert Biederman, Moneal Shah, Mark Boltralik, Ronald Williams, Richard Lombardi, Francesco Mangini, Mark Doyle
Journal: Circulation (2024)

Background: Imaging of conventional PM’s and ICDs are infrequently performed via MRI. While many studies, including the MagnaSafe Trial have unequivocally supported MRI safety in patients with such devices, the added clinical value has rarely been considered. Accordingly, we performed an observational, IRB-approved, prospective study to determine the 'Additive Value' beyond safety for patients with conventional PM/ICD's undergoing clinical MRI. We hypothesize that MRI in PM/ICD patients is critical to an existing diagnosis and often markedly alters diagnosis and subsequent downstream patient management. Methods: An MRI Device exam (GE 1.5T,WI) pioneered by cardiologists (&gt;90% over 10 yrs; 100% over 20 years) was performed. Subsequently, a series of prospective defining questions using Boolean Logic Construct were answered within 1 week of MRI by both MRI technologist and MRI physicians. Questions : 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did subsequent patient management change? If 'Yes' was answered to any of the above questions, it was considered that MRI was of value to pt diagnosis and/or impending therapy. Results: Average MRI: 25±14min for 2,008 consecutive patients of which 1,526 (76%) were neuro/neurosurgery, 141 (7%) were musculoskeletal and 341(17%) were CV cases. Upon review: of the N euro/neurosurgery MRIs, 1,376 (89%) provided additional information. The diagnosis changed in 1018 (74%), while medical therapy changed in 977 (71%). In only 124 (9%) did MRI simply confirm original diagnosis. For Cardiac patients, MRI changed the original diagnosis in 235 (69%). MRI did not contribute in 42 (12%) as it was uninterpretable (ICD artifact), while in 64 pts, the diagnosis did not change. Finally, in 146 Orthopedic pts, MRI provided additional information in 143 (98%) and in 130 (89%), changed pt care, and in 4 pts (3%), simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any patient all with tracking for &gt;1 year. Conclusion: Via a dedicated program of MRI in PM/ICD patients adds substantial clinical value to diagnosis and subsequent management justifying ant inherent risk(s). Herein, we propose that yet another impediment to the advancement of CMR-PM/ICD strategies can become routine and often life-changing.
Abstract 4139585: Differences in Health Care Utilization Prior to Cardiac Arrest Among Patients with Shockable versus Non-Shockable Rhythms
Authors: Elizabeth Burden, Marc Deyell, Nathaniel Hawkins, Meijiao Guan, Jennie Helmer, Brian Grunau, Christopher Fordyce
Journal: Circulation (2024)

Background: Health care utilization has been shown to be high prior to out-of-hospital cardiac arrest (OHCA). However, differences in patterns of health care utilization between OHCA presenting with shockable and non-shockable rhythms have not been explored. Hypothesis: Health care interactions prior to cardiac arrest are more common among those presenting with non-shockable rhythms, a large proportion of which may be a manifestation of chronic disease progression. Aim: To examine health care utilization prior to OHCA and the differences between patients presenting with shockable and non-shockable rhythms, in comparison to population controls. Methods: This was a matched case-control study. Cardiac arrests from 2009-2019 were identified in the British Columbia Cardiac Arrest Registry. Age, sex and geographic population controls were identified. We examined health care utilization in the 3 years prior to cardiac arrest. Results: A total of 3,461 shockable and 11,470 non-shockable OHCA patients were identified and matched 4:1 to 45,871 controls. The rate of hospitalization in the 3 years prior was 57% in the shockable group (39.5% in controls, OR 1.66, 95% CI 1.53-1.79) and 61.5% in the non-shockable group (39.5% in controls, OR 2.67, 95% CI 2.55-2.79). Overall hospitalizations were more common in both OHCA compared to controls, while non-cardiovascular (CV) admissions were greater for the non-shockable versus shockable groups ( Figure ). When examining bi-weekly rates of hospital and ER visits leading up to OHCA, both groups had increased CV encounters arising at 10 weeks prior to arrest, whereas the non-shockable group had greater non-CV encounters as compared to the shockable group. Conclusion: Shockable and non-shockable OHCA show high rates of health care utilization leading up to cardiac arrest, which may provide opportunities for intervention. Differences between the shockable and non-shockable groups may reflect underlying pathophysiology, which has implications for prevention of OHCA.
Abstract 4139530: Leveraging Natural Language Processing for Echocardiographic Data Extraction in Hypoplastic Left Heart Syndrome
Authors: Zachary Girvin, Srushti Gangireddy, Andersen Coleman, Henry Ong, Wei-Qi Wei, Prince Kannankeril, Sudeep Sunthankar
Journal: Circulation (2024)

Background: Automated data mining performs well with discrete data, and efforts are underway to use natural language processing (NLP) for textual data collection. This method has yet to be proven generalizable to echocardiographic data in congenital heart disease. Aim: Assess the accuracy of an NLP algorithm relative to manual record abstraction (MRA) in collecting echocardiographic data in a cohort of patients with hypoplastic left heart syndrome (HLHS). Methods: Patients with HLHS at our institution between 2007 and 2022 were identified. MRA collected serial echocardiographic data at 5 predefined points between birth and stage II palliation, focused on right ventricle wall motion (RVWM) and tricuspid regurgitation (TR). Separately, an NLP algorithm was created to abstract the same data. We used our institution’s identified clinical research database, the Research Derivative (RD), which follows the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Echocardiogram reports were identified by report type and matching titles. Regular expression matched phrases for RVWM and TR with qualifier phrases of function. Qualifier phrases were mapped to severity scales: 0 (normal) to 6 (severely depressed) for RVWM; 0 (normal) to 5 (severe regurgitation) for TR. The results of the MRA and NLP collection methods were compared using Cohen’s kappa test. Results: A total of 707 echocardiograms from 180 patients were compared. The NLP model correctly identified RVWM in 93.9% (664/707) and TR in 82.6% (584/707). There was a high degree of agreement for both features (RVWM: k=0.84 [0.88-0.98]; TR: k=0.93 [0.80-0.89]). The most common reason for a no-match scenario was an absence of descriptive text available in the RD that was available in the electronic health record (EHR); 19% (8/43) and 66% (81/123) of no-match in RVWM and TR respectively. Misidentification by NLP algorithm accounted for 37% (16/43) of RVWM and 15% (19/123) of TR no-matches. These represent the algorithm assigning an incorrect score due to misinterpretation of echocardiogram report language, most commonly those with complex verbose descriptions of features. Conclusion: The NLP algorithm demonstrates high proficiency in collecting echocardiogram data when text is available for extraction. Its use is limited in reports containing complex descriptive language. These data suggest its utility as an accompaniment for data abstraction to increase data collection efficiency and reduce MRA errors.