tbuckley/cabot-search huggingface dataset:
Abstract 15589: Impact of Preprocedural Anemia on In-Hospital and Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Athanasios Rempakos, Spyridon Kostantinis, Bahadir Simsek, Judit A Karacsonyi, Michaella Alexandrou, Deniz Mutlu, James Choi, Paul Poommipanit, Jaikirshan Khatri, Laura Young, Rhian Davies, Stewart Benton, Farouc A Jaffer, Raj Chandwaney, Lorenzo Azzalini, Khaldoon Alaswad, brian jefferson, Jarrod D Frizzell, Nidal Abi Rafeh, MD, FACC, Ahmed El Guindy, OMER GOKTEKIN, Bavana V Rangan, Olga Mastrodemos, Ahmed Al-ogaili, Salman S Allana, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis, sevket gorgulu
Journal: Circulation (2023)

Background: The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 8,633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of &lt;13 g/dL for men and &lt;12 g/dL for women. Results: Anemia was present in 1,652 (19%) patients undergoing CTO PCI. These patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p&lt;0.001) and fluoroscopy (45 vs. 40 min; p&lt;0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted HR: 1.63; 95% CI: 1.07-2.49; p=0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p=0.004). Conclusions: Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI.
Abstract 15387: Outpatient Intravenous Diuresis for Acute Exacerbation of Heart Failure: A Claims-Based Analysis
Authors: Pierantonio Russo, Michael Sicilia, Daniel Pfeifer, Ryan Rumantir, Kevin Mc Dermott
Journal: Circulation (2023)

Introduction There is evidence that selected patients with HF exacerbation can be treated with outpatient IV diuresis (OIVD), delaying or avoiding subsequent acute care services and reducing cost. Hypothesis In selected HF patients, OIVD reduces or delays hospitalization and lowers medical cost. Methods Retrospective claims analysis using the Truven Market Scan database of medical and pharmacy claims (200 million USA lives). We identified all patients with claims for HF (Oct 2015- Sept 2022) receiving OIVD within 12 months after HF diagnosis.OIVD was administered as single day or multiple days events (OIVD over 10-day window). Care episodes and cost within 12 months after initiation of OIVD were defined by location of care: Hospital, ER, Observation, Skilled Nursing Facilities (SNFS) Outpatient Clinics. Results Out of 924,174 patients (age 63.4; SD 14.8) with an ICD 10 for HF, 42,132 received OIVD in hospital clinics, other clinics, physician's offices andER/Observation. One OVID episode was documented in 37,178; multipe in 4,954 (1.4-1.5 episodes per patient). After initiation of OVID, 33,172 patients required care for HF in ER, Observation, Hospital and SNFS (average of 5.9 events per patient). Hospitalization and SNFS were delayed by a mean of 4.60 months from OIVD. The remaing 8,960 patients did not require subsequent acute care or SNFS services for HF. The cost per OIVD episode was higher for ER and Observation (range $952 -$1730) than for outpatient clinics (range $190 -$ 786). The cost of hospitalization ranged $14,500-$57,488. Conclusions In selected patients with HF, OIVD is effective in delaying or preventing use of acute care services and it is associated with cost avoidance. New care protocols are needed to expand the use of OIVD in outpatient clinics and even in the home as an alternative to ER/Observation/Inpatient.
Abstract 17819: Latent Class Analysis of Heart Health in a Marginalized Black Community
Authors: Linda D Oakley, Wan-Chin Kuo, Rick P Voland, Hannah Olson-Williams, Fatih Kunkul, Roger L Brown
Journal: Circulation (2023)

BACKGROUND Mounting evidence associates Black American’s experiences of chronic stress with younger age hypertension (HTN) onset, higher prevalence rates, and poorer treatment outcomes. Epigenetic research findings attribute these trends to DNA methylation, commonly referred to as stress related premature biological aging. Guided by the current American Heart Association (AHA) Science Statement on heart health, this health equity study aims to examine positive Black identity as a measure of positive psychological health in Black adults. METHODS Our community-engagement survey measured self-reports of: (1) environmental wellbeing, positive self-regard, spirituality, chronic stress, Black identity, anxiety, depression, anger, and five AHA essential cardiovascular health (CVH) factors: (2) physical activity, fruit, vegetables, smoking tobacco, and sleep. Multivariable linear regressions examined psychological health and CVH as predictors of systolic blood pressure. Latent class analysis (LCA), using ordinal indicators, assessed for latent sample profiles as statistical probabilities of similar responses and sample heterogeneity. RESULTS In a community sample (N=201) of Black adults (age M=46.7, SD=15.9), primarily female (N=141, 69.5%), increases in systolic blood pressure (Mean=134, SD=20.9) were associated with more chronic stress and less environment wellbeing; decreases were associated with less expressed anger. The LCA results show a four-class statistical solution with greater heterogeneity in spirituality, anger, anxiety, and depression. Among the four profiles, two theoretical latent classes for high and low systolic blood pressure were distinct. Low systolic blood pressure is associated with higher levels of environmental wellbeing, physical activity, and self-regard, both more and less spirituality, more positive Black identity, moderate anger, anxiety, and depression, and checking your BP. CONCLUSION In addition to emotion regulation, physical activity, and self-care, our findings support CVH promotion strategies in marginalized communities of Black Americans designed to reduce chronic stress, improve environmental wellbeing, and support positive Black identity.
Abstract 15659: Bupropion Overdose Requiring Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Stephanie Golob, Peter Ting, Kyle Pires, Vanessa Soetanto, Benjamin Pagano, Kah-Loon Wan, Sylvie Hall, Lauren Bianco, Joseph Hawkins, Hannah Schimmer, Victoria Yunaev, William Howe, Jessica Landau, Allison Greco, Radu Postelnicu, Rafael Harari, Silas Smith, James Horowitz, David Park, Norma Keller, Sripal Bangalore, Stuart Katz, Carlos Alviar
Journal: Circulation (2023)

Introduction: Bupropion is a monocyclic antidepressant that inhibits dopamine and norepinephrine reuptake, with significant risk cardiotoxicity in overdose cases. Case: A 32-year-old transgender man with a history of Human Immunodeficiency Virus (on anti-retroviral therapy), poly-substance use disorder, and depression presented with an intentional bupropion overdose. On arrival the patient was noted to have seizures and a decreased mental status. He was intubated and treated with anti-epileptic medication. Initial EKG was sinus tachycardia with a QTc of 456 milliseconds. Transthoracic echocardiogram (TTE) showed severely reduced left ventricular ejection fraction (LVEF) that worsened over a 6 hour period from 40% of 25%. Serial EKGs showed progressive QTc prolongation to 635 milliseconds. Cardiac catheterization demonstrated angiographically normal coronary arteries and a Cardiac Index of 2.5 L/min/m 2 . Due to the rapidly prolonging QTc and the significant risk of ventricular tachycardia (VT), the decision was to proceed with Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) cannulation after a multidisciplinary shock team discussion. A few hours after cannulation, patient suffered hemodynamically unstable VT, requiring electrical cardioversion (DCCV) with brief return to sinus rhythm (SR) and with subsequent VT recurrence, that responded to lidocaine and repeat DCCV. ECG normalized and the patient was decannulated from VA ECMO on hospital day 4. Repeat TTE showed recovery of LVEF to 60%. The patient was extubated and discharged to psychiatric rehabilitation. Conclusion: Cardiogenic shock and ventricular arrhythmias are well recognized complications from bupropion toxicity likely due to gap junction inhibition. VA ECMO cannulation should be considered as part of multidisciplinary team assessment for patients at high risk for hemodynamic or electrical collapse in toxidromes with marked cardiotoxicity.
Abstract 14902: Prevalence and Characteristics of Myocarditis-Related Sudden Death in the General Population
Authors: Lauri Holmstrom, Lassi Mäntyniemi, Anette Eskuri, Ida Hookana, Harri Silvola, Lasse Pakanen, Heikki Huikuri, Juhani Junttila
Journal: Circulation (2023)

Introduction: Myocarditis is a frequent cause of sudden cardiac death (SCD) in young individuals (&lt;35 years), but the frequency of myocarditis in middle-aged (35-65 years) and older SCD victims (&gt;65 years) is unclear. Objective: We aimed to investigate the prevalence and characteristics of myocarditis-related sudden death in the general population. Methods: Our study population is drawn from the Fingesture study, which has prospectively collected all out-of-hospital SCD cases from Northern Finland (population ~700,000) since 1998. As required by Finnish law, all sudden deaths undergo a medicolegal autopsy. All out-of-hospital sudden death cases in the community with a verified cardiac cause of death at autopsy are included in the Fingesture study. By 2017, the Fingesture study had collected data on 5,869 SCD victims. Results: In total, 60 SCD victims had evidence of acute myocarditis at autopsy (1.0% of all SCD cases). The mean age of SCD victims with myocarditis was 55.9±18.2, which was significantly lower than among the rest SCD victims (65.0±12.3; p&lt;0.001). Myocarditis cases were also more often female in comparison to the rest SCD cases (33.3% vs. 21.0%; p=0.02). The proportion of myocarditis was highest among young (&lt;35 years) SCD cases (n=6/73; 8.2%), and the proportion decreased in middle aged (35-65 years) (n=34/2,948; 1.2%) and older (&gt;65 years) SCD cases (n=20/2,848; 0.7%) (p&lt;0.001), although the absolute number was higher. The most common diagnosis was undetermined acute myocarditis (n=42/60; 70%) followed by infective myocarditis (n=10/60; 16.7%) and pericarditis (n=5/60; 8.3%). In addition, two SCD cases had sarcoidosis and one had giant cell myocarditis. Five SCD cases due to myocarditis (8.3%) occurred during physical exercise. Conclusions: Myocarditis is a rare cause of SCD in the general population. Although the relative proportion of myocarditis was highest among young SCD victims, the absolute number was highest among middle-aged SCD victims.
Abstract 16791: Conduction System Response to Cardiac Resynchronization Therapy
Authors: Jiyoung J Lee, Raj Bhatt, Mikael Yilmaz, Noel G Boyle, Duc H Do
Journal: Circulation (2023)

Background: Cardiac resynchronization therapy (CRT) can be an effective treatment for cardiomyopathy patients with intraventricular conduction delay. However, significant controversy remains over the effect of QRS duration shortening on CRT outcomes. We hypothesize that reduction in QRS duration following CRT implantation is associated with echocardiographic outcomes. Methods: We included all adult patients with structural heart disease and CRT followed at UCLA. We reviewed all available electrocardiograms (ECG) and echocardiograms. We excluded patients with CRT for complete heart block, congenital heart disease, and those without intrinsic QRS ECGs prior to CRT. Patients were categorized as left bundle branch block (LBBB) if Strauss criteria were met prior to CRT implantation. Other patterns (including right bundle branch block with QRS duration ≥150ms) were classified as IVCD. We evaluated QRS duration before and immediately after CRT implantation. Changes in QRS duration post-CRT implant were calculated in percentage change. Echocardiograms were evaluated for changes in left ventricular end diastolic dimension (LVIDD) and ejection fraction (LVEF) following CRT implantation. Results: We included 108 patients (mean age of implant 66.1±12.8 years, 65% male, 63% nonischemic cardiomyopathy). Of these, 44 patients (41%) had LBBB. After CRT, patients with LBBB had significant decrease in QRS duration (-9.3±17.0% vs +16.9±30.9%, p &lt; 0.001), improvement in LVEF (12.1±10.5% vs 1.85±10.7%, p &lt; 0.001) and reduction in LVIDD (-0.6±0.7cm vs 0.1±0.7cm, p &lt; 0.001) compared to patients with IVCD. Decrease in QRS duration was significantly correlated with both improvement in LVEF (Pearson r = 0.21, p = 0.037) and reduction in LVIDD (Pearson r = 0.28, p = 0.006). Conclusion: CRT resulted in significantly larger decrease in QRS duration amongst patients with LBBB compared to IVCD. QRS duration reduction was, in turn, significantly correlated with improvements in LVIDD and LVEF. This likely reflects the proximal nature of true LBBB, and the ability of CRT to utilize the remaining distal Purkinje system for impulse propagation. Further research on the electrical and mechanical response to CRT can help guide optimization of target populations.
Abstract 16318: Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal
Authors: Khawaja M Talha, John G Winscott, Vishal Patel, Kellan E Ashley, Michael McMullan, Alejandro Lemor, William Campbell, Gabriel A Hernandez
Journal: Circulation (2023)

Background: The use of Impella assist device for high-risk percutaneous coronary interventions (HR-PCI) and cardiogenic shock (CS) has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Objective: To describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. Methods: A descriptive, retrospective review of electronic medical records in all patients that underwent LBA closure using this novel method from July 1, 2018, to June 30, 2022, was performed at the University of Mississippi Medical Center. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate or delayed (&gt;6 hours) bleeding, and access site hematoma/pseudoaneurysm were included. Results: Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with the arterial recoil method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 + 16 years. The most common indication for Impella placement was HR-PCI (40%), followed by non-acute myocardial infarction (AMI) CS (35%), and AMI-CS (25%). After downsizing of the femoral sheath to 6 Fr, 14 patients (70%) underwent manual compression, 3 patients had a 6 Fr sheath left in place to maintain access, 2 patients underwent placement of a Perclose device, and 1 patient underwent placement of a Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. A total of 5 patients (25%) died inpatient, including one patient who had palliative removal of the Impella device; the deaths were unrelated to complications of Impella removal. Conclusions: LBA closure post-Impella removal with this novel method is safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.
Abstract 17465: Analysis of Intra-Operative Heart Rates Reveals a Novel Sub-Phenotype in Coronary Artery Bypass Grafting Patients
Authors: Mostafa Abbas, Thomas Morland, H Lester Kirchner, Eric S Hall, Jeffrey Shuhaiber, Yasser El-Manzalawy
Journal: Circulation (2023)

Background: We aim to investigate the use of intra-operative heart rate (HR) trajectories to develop and characterize sub-phenotypes of coronary artery bypass grafting (CABG) patients with distinct risk and outcome profiles. Methods: We used a retrospective cohort including 4194 CABG patients admitted to a large rural healthcare system between 2012 and 2021. Functional data analysis (FDA) was applied to patients’ intra-operative HR trajectories to identify distinct sub-phenotypes. Results: The elbow method suggested that the optimal number of clusters is four. Fig. 1 shows the mean HR trajectory curve (top) and Kaplan-Meier survival curve (bottom) for each of the four identified groups. G1 (Low HR) includes 35.2% of the patients with median age 68 years. Patients in G1 had the lowest ICU after CABG length of stay (LoS) of 76.1 hours and the longest CABG median procedure duration of 4.6 hours. Assignment to G1 was significantly associated with shorter ICU LoS (p= 2.2E-6). G2 (Intermediate HR) includes 35.4% of the patients with median age of 67 years. Patients in G2 had the highest prevalence of urgent admissions, 25.5%. Assignment to G2 was significantly associated with shorter ICU LoS (p=0.016). G3 (Increasing HR) includes 15.6% of the patients with median age 67. Patients in G3 had the shortest median procedure duration of 3.68 hours. Those patients were found to be significantly at risk of prolonged ICU stays (p=0.0002). Finally, G4 (High HR) includes 16.2% with the lowest observed median age of 65 years. Patients in G4 have the highest prevalence of in-hospital mortality (5.2%), 30-day readmission (4.3%), and 1-year mortality (4.8%). Assignment to G4 was significantly associated with the following outcomes: prolonged ICU stays (p=2.62e-9); in-hospital mortality (p=8.03e-5); 30-day readmission (p=0.017); and 1-year mortality (p=0.02). Conclusions: CABG sub-phenotypes based on intra-operative HR trajectories had distinct clinical characteristics and outcomes.
Abstract 13555: Effect of Calcium Channel Blockers on Clinical Outcomes in Patients After Percutaneous Coronary Intervention With Left Ventricular Dysfunction
Authors: Manabu Uematsu, Takamitsu Nakamura, Takeo Horikoshi, Tsuyoshi Kobayashi, Toru Yoshizaki, Jun Nakamura, Aritaka Makino, Yukio Saito, Jun-ei Obata, Takao Sawanobori, Hajime Takano, ken umetani, Tetsuya Asakawa, Akira Sato
Journal: Circulation (2023)

Although calcium channel blockers (CCBs) are effective in hypertension and IHD, short-acting CCBs are not recommended for heart failure due to have negative inotropic effects. On the other hand, long-acting CCBs have been reported to be safe for use in patients with cardiac dysfunction, but details are still unclear. In this study, we investigated the relationship between the effects of CCBs on CAD patients and left LV function. Methods: We enrolled 7173 consecutive CAD patients (Age; 69 [61-76] years and male; 78%) who underwent successful PCI for AP or ACS between April 2008 and March 2020 from prospective, multicenter registry (FUJISUN registry). Of the enrolled patients, 5307 analyzable patients were divided by LVEF &lt;40 or ≥40%. Patients were prospectively followed for a maximum of 8 years or until the occurrence of the cardiac events (CEs): cardiac death, nonfatal MI. Results: During the follow-up period (3.6 [1.4-6.7] years), 230 (4%) CEs occurred (109 Cardiac death, 121 MI). Both patients with LVEF &lt;40% and ≥40% had higher prevalence of HT and lower levels of BNP in CCB group than in non-CCB group. Propensity match analysis was performed to reduced selection bias for CCB use in each group. In patients with LVEF &lt;40%, Kaplan-Meier analysis showed that CCB group had significantly lower probability of CEs than non-CCB group, whereas in those with LVEF ≥40%, the probability of CE was similar in both groups. Multivariate Cox proportional hazards analysis showed that CCB group had significantly lower probabilities of CEs compared with non-CCB group in patients with LVEF&lt;40%, (HR 0.25; 95% CI 0.09-0.71, p &lt;0.01), but not in those with LVEF≥40% (HR 1.13; 95% CI 0.80-1.60, p = 0.50). Conclusions: Long-acting CCBs may improve clinical outcomes in post-PCI CAD patients with LV dysfunction.
Abstract 12776: Sustained Impact of Peripartum Cardiomyopathy on Mental Health Disorders and Quality of Life
Authors: Sarah Thordsen, Madeline Smith, Sara Matloub, Joan Briller, Zoltan Arany, Jennifer Lewey
Journal: Circulation (2023)

Introduction: Mental health diagnoses such as depression, post-traumatic stress disorder (PTSD), and anxiety are common after acute cardiovascular events. Peripartum cardiomyopathy (PPCM) affects women near the end of pregnancy or in the near post-partum period and occurs during a period of heightened psychosocial stress. There is limited data on the prevalence of mental health diagnoses after the acute PPCM event. Methods: Patients with self-identified PPCM enrolled in the online PPCM Registry (PPCM-R at ppcmr.org) and completed validated surveys for depression (Patient Health Questionnaire - 9, PHQ-9), anxiety (Generalized Anxiety Disorder -7, GAD-7), PTSD ( Posttraumatic Stress Disorder Checklist- Civilian, PCL-C) and quality of life (Rand SF-36). Patients were recruited on PPCM support groups, social media, and physician referral. Results: After 4 months, 103 patients enrolled and 55 (54%) completed the mental health and QOL surveys. Mean age was 32.3 (SD 4.7) and median time since diagnosis was 4.2 years (IQR 1.7, 10.4 years). Mean (SD) PHQ-9 score was 8.1 (7.3) and 27% had a score (≥10) indicating moderate or severe depressive symptoms. Mean (SD) GAD-7 score was 7.3 (6.7) and 36% of participants had scores (≥10) consistent with moderate or severe anxiety symptoms. Mean (SD) PCL-C score was 20.7 (19.3) and 33% screened positive for PTSD. Overall, 30% of participants reported that QOL was ‘fair’ or ‘poor’ with lower domain scores for physical function, emotional function, energy/fatigue and general health compared to the general population. Characteristics of participants stratified by mental health symptom severity and QOL scores are presented in the Table. Conclusions: Half (51%) of participants had at least one mental health screening tool which indicated current moderate or severe symptoms of depression, anxiety or PTSD. These findings confirm a significant burden of mental health symptoms in this PPCM survivor cohort.