tbuckley/cabot-search huggingface dataset:
Abstract 17055: Underweight and Obesity Among Asian Children at Age 3 to 5 Years: Implications for Counseling to Promote Cardiometabolic Health Across the Lifecourse
Authors: Adrian M Bacong, Louise Greenspan, Malini Chandra, Latha Palaniappan, Joan C Lo
Journal: Circulation (2023)

Background: Body mass index (BMI) is an important pediatric measurement that supports nutrition/weight counseling in children, especially for obesity. However, children with low BMI (&lt;5 th percentile or “underweight”) should be considered, as Asian children are at risk for adverse cardiometabolic health at lower BMI as adults. Mehods: Using electronic record data from well-child visits from 5361 Chinese, 6215 Filipino, 5775 South Asian, and 48,666 Non-Hispanic White (NHW) children with BMI at age 3 and 5 years in a US healthcare system, we examined BMI distribution, underweight (&lt;5th percentile), obesity (≥95th percentile), and changes in BMI from age 3 to 5 years. Results: Underweight was higher in Asian vs NHW (highest for South Asian, 15.0%, age 3, p&lt;0.01). Obesity was highest for Filipino (11.3%, age 5) and lowest for Chinese (3.6%) vs NHW (p&lt;0.01). At age 3, trends in greater proportion with underweight vs obesity for Chinese (6.3% vs 3.0%) and South Asian (15.0% vs 6.5%) children were seen, but not Filipino (5.0% vs 9.7%) and NHW (4.0 vs 7.8%) children (Table), similar to age 5. Most children with underweight had height &lt;25th percentile. By age 5, large proportions shifted out of underweight, with modest obesity increases (Table). Obesity transition was greatest for South Asian children. Conclusions: Among major Asian groups and NHW children, underweight was most prevalent in South Asian (1 in 7, age 3) and obesity most prevalent in Filipino (1 in 10, age 5) children. High obesity prevalence in Filipino children and greater BMI transition in South Asian children highlight ethnic differences in BMI that support targeted lifestyle counseling to improve future cardiometabolic health.
Abstract 16285: Persistent or Worsening Depression is Associated With Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease (CAD)
Authors: Nishant Vatsa, Josiah Bennett, Sonika Vatsa, vardhmaan jain, Daniel Gold, Matthew Gold, Shivang Desai, Kiran Ejaz, Alireza Rahbar, Joy D Hartsfield, Yi-An Ko, Laurence Sperling, Puja K Mehta, Arshed A Quyyumi
Journal: Circulation (2023)

Introduction: Depression has been associated with a higher risk of major adverse cardiovascular events (MACE). Whether a longitudinal change in depressive symptoms is associated with MACE in patients remains unknown. Hypothesis: We hypothesized that increasing or persistent depression increases the risk of MACE in patients with CAD. Methods: 5,479 participants with CAD enrolled in the Emory Cardiovascular Biobank (mean age 63.8 years, 39.9% female) were evaluated for baseline depression symptoms with the patient health questionnaire 9 (PHQ9). Depression was defined as PHQ9 &gt;4. At one year, 1,286 participants completed follow-up PHQ9, and the PHQ9 change (1 year minus baseline score) was calculated. Cox models, adjusted for demographics, cardiovascular risk factors, medications, ejection fraction, CAD severity, and high sensitivity C-reactive protein levels, were performed to assess associations between PHQ9 and five-year MACE - a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, and nonfatal stroke. Results: During five-year follow-up, there were 1067 (19.5%) MACE, with a 7.2% MACE rate after one year in the subset with follow-up depression data. Of the total, 38.8% were depressed at baseline and 23.6% at one year. Of participants with baseline depression, 34.8% had persistent depression at one year, whereas depression improved in the remaining. Among patients without baseline depression, 15.9% developed new depression at one year. A higher baseline PHQ9 score was associated with higher MACE rates (adjusted hazard ratio (HR): 1.02 [CI 1.00, 1.03], p=0.03). Overall, PHQ9 change independently predicted MACE (adjusted HR: 1.12 [1.05, 1.2], p=0.001); thus, participants with no change or increase in PHQ9 score were 96% (p=0.04) more likely to have MACE compared to those with a decrease in PHQ9 score after one year. Similarly, participants with new or persistent depression (PHQ9&gt;4) at one year had a 59% (p=0.006) higher risk of MACE compared to those with absent or improved depression. Conclusions: An increase or persistence of depressive symptoms predicts MACE in CAD. Whether treatment of depression will improve cardiovascular outcomes in this high-risk population needs further investigation.
Abstract 17466: Impact of the Covid-19 Pandemic on Pediatric Cholesterol Screening Rates
Authors: Jessica Schwartz, Xiao Zhang, Amy L Peterson
Journal: Circulation (2023)

Introduction: Universal cholesterol screening during childhood has been recommended by the American Academy of Pediatrics since 2011, but most children remain unscreened. We hypothesized that the COVID-19 pandemic and subsequent disruptions in routine healthcare impacted pediatric cholesterol screening rates and may have disproportionately affected children based on race, ethnicity, socioeconomic status (SES), or rural/urban status. Hypothesis: The COVID-19 pandemic impacted pediatric lipid screening rates based on race, ethnicity, SES, and rural/urban status. Methods: The provider order placement rate (OPR) for a screening cholesterol panel was calculated for established patients 9-21 years old at a single institution pre-pandemic (3/18/2019-3/17/2020), mid-pandemic (3/18/2020-3/17/2021), late-pandemic (3/18/2021-3/17/2022), and post-pandemic (3/18/2022-12/31/2022). OPR was analyzed, including a chi-squared test, based on race, ethnicity, SES, rural/urban status, and the department of the visit. Results: Overall OPR fell over time and in both pediatric and family medicine specialties. There was a decrease in OPR across all race and ethnicity groups, though most did not reach statistical significance. Urban advantaged, urban, and rural underserved had a disproportionately larger decrease in OPR, though all groups had a lower OPR at the end of the study. Conclusions: The OPR decrease in late- and post-pandemic stages may be due to the pandemic. Though OPR differences existed between some rural/urban statuses and the ordering department pre-pandemic, these factors may have worsened these gaps. Future studies are needed to identify and address barriers to pediatric cholesterol screening.
Abstract 15092: Projected Cost Saving With Optimal Medication Adherence in Cardiovascular Disease Patients Requiring Lipid Lowering Agents in Mexico and Thailand
Authors: Jeong-Yeon Cho, Fernando A. Wilson, Usa Chaikledkaew, Arintaya Phrommintikul, Kyoo Kim, Nathorn Chaiyakunapruk
Journal: Circulation (2023)

Background: Adherence to chronic cardiovascular treatments is less than 50% in developing countries, which impedes achieving targeted clinical outcomes. This study aims to estimate potential benefits of improving adherence in CVD patients requiring secondary prevention. Methods: We performed state-transition Markov model simulation for secondary CVD prevention in Mexico and Thailand. Stakeholders were engaged based on CHEERS II guideline. The analyses were performed upon a healthcare system perspective for a lifetime horizon. Two scenarios were compared: (1)optimal adherence (which is simulated based on mean adherence from a meta-analysis of 51 RCTs), and (2) status quo. The association of adherence and CVD outcomes (MI and stroke) is based on a dose-response meta-analysis of observational studies of 4,051,338 patients. Direct medical costs are obtained from literature review. Outcomes are accumulated number of CVD events and associated costs in 2022 USD, life-year, and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of our findings. Results: Status quo in both countries were expected to have a higher risk of CVD than optimal adherence (Mexico: RR 1.22, 95% CI 1.17-1.28; Thailand: RR 1.21, 95% CI 1.16-1.26). The number needed to treat to prevent one additional CV event was 25.02 and 29.37, respectively. Consequently, achieving optimal adherence can increase life-year by 0.60, 0.84 and QALYs by 0.59 and 0.68 in Mexico and Thailand, respectively. Moreover, this could avert CV event-related medical costs of $614 and $313. When lipid lowering therapy costs are included, the optimal adherence scenario results in cost saving with $418 in Mexico and $293 in Thailand. Cost saving findings are robust across all sensitivity analyses. Conclusion: In developing countries, patients requiring lipid lowering agents for secondary CVD prevention suffer from preventable outcomes due to their suboptimal medication adherence. It is recommended to consider various methods of improving adherence that could result in cost savings and achieving therapeutic goals.
Abstract 16146: A Scoping Review of Adverse Outcomes Associated With Cardiac Resynchronization Therapy Device Implantation: Implications for Informed Consent
Authors: John Mancini, Aanand Naik, Parag Goyal
Journal: Circulation (2023)

Background/Objectives: Cardiac Resynchronization Therapy (CRT) is a treatment option for many adults with heart failure with reduced ejection fraction (HFrEF). While the benefits of CRT are well-established, the downstream implications of adverse events are not well-characterized. We sought to better understand the ramifications of CRT-related adverse events on length of hospital stay (LOS) and mortality—information relevant for patients and clinicians to make informed decisions about pursuing CRT. Design: Scoping Review Methods: We conducted an initial PubMed search using terms including “Congestive Heart Failure” or “Heart Failure” and "Cardiac resynchronization" or "Cardiac re-synchronization" or "Biventricular pacing.” We reviewed resulting articles that were written in English, studied CRT devices, and outlined adverse events related to CRT device placement. We separately searched PubMed for additional articles outlining individual adverse events identified using search terms “event name,” “mortality,” and “hospital stay.” We read articles and summarized data regarding the impact of reported adverse events on hospital LOS and mortality. Results: Our search identified 18 full length articles with relevant data. The most common adverse events included device implant failure/non-response, lead dislodgment, coronary sinus dissection, and pocket hematoma. The LOS and mortality rates of each event are shown in Table 1. Of note, LOS for implantation in the ambulatory setting is up to 1 day; LOS for uncomplicated implantation during hospitalization is 4.6 days. Implantation during hospitalization with complication is mean 13.6 days. Conclusion: While absolute risks for adverse events associated with CRT implantation are low, several have important implications on hospital LOS and mortality. These findings warrant inclusion in discussion regarding the risks of CRT when clinicians and patients engage in informed decision making related to CRT.
Abstract 18853: Rescue of Pulmonary Hypertension-Induced Right Ventricular Failure by Silencing Snai1 Induces Alterations in Methylation Status of Critical Genes Regulating Endothelial-to-Mesenchymal-Transition and Fibrosis
Authors: Somanshu Banerjee, Varina R Clark, Sandra Martineau, Jason Hong, Asif Razee, Steeve Provencher, Sandra Breuils Bonnet, Sebastien Bonnet, Soban Umar
Journal: Circulation (2023)

Introduction: Pulmonary hypertension (PH)-induced RV failure (PH-RVF), a significant prognostic determinant, is characterized by RV endothelial-to-mesenchymal transition (EndMT), fibrosis, and remodeling. However, the regulatory control of RV EndMT and fibrosis remains unclear. Hypothesis: TGFβ1-Snai1-LOXL2 axis regulates RV EndMT and fibrosis in PH-RVF. Key gatekeeper transcription factor (TF) Snai1 mediates RV EndMT and fibrosis via differential methylation changes in EndMT and fibrotic genes and may serve as a novel therapeutic target. Methods: Male rats received s.c. Monocrotaline (MCT, 60mg/kg, n=9; 30-days), Sugen (20mg/kg, n=9; 3-wk hypoxia+2-wk normoxia; SuHx) or PBS (CTRL, n=9). For Snai1-knockdown (KD), MCT rats received siSnai1 (n=6; 5nM every 3-4d, IV) or scramble (n=7) from day 14-30. Echo, cath, RV-RNASeq, qPCR, WB, IF validation, and RV-DNA methylome RRBS-Seq were performed. Differentially methylated sites (DMS) and regions (DMR) were assessed. Secondary RNASeq analysis was performed on human decompensated-RVF vs Control (dRVF; GSE198618) and human RVs were assessed for EndMT, fibrosis, myofibroblast (MFB) transition, and Snai1+LOXL2. Snai1-KD was performed on human coronary artery endothelial cells (HCAECs) and human cardiac fibroblasts (HCFs) under hypoxia+TGFβ1. Results: MCT and SuHx had increased RVSP and Fulton index and decreased RVFAC (all p&lt;0.001). RNASeq showed EndMT and Snai1 as the top-upregulated pathway and TF respectively in MCT and SuHx and human dRVF. RV EndMT, fibrosis, MFB transition, TGFβ1-Snai1-LOXL2, and peri-nuclear colocalization of Snai1+LOXL2 were increased in MCT, SuHx and dRVF patients. Snai1-KD rescued PH-RVF via significantly reducing Snai1+LOXL2. RV-RNASeq demonstrated EndMT as the top-downregulated pathway and decreased fibrotic DEGs. RV RRBS-Seq showed significant DMS and DMR remodeling of Dnmt3a, Kdm1a, Snai1, TGFβ1/2, and other critical EndMT and fibrotic genes. Snai1-KD inhibited hypoxia+TGFβ1-induced EndMT in HCAEC and MFB transition in HCF by decreasing Snai1+LOXL2 expression and reversing EndMT and fibrotic DEGs respectively. Conclusions: Rescue of PH-RVF by silencing Snai1 induces alterations in methylation status of critical genes regulating EndMT and fibrosis.
Abstract 18796: Predictors of Repeat Ablation in DECAAF-II Patients
Authors: Nour Chouman, Ala' Assaf, Hadi Younes, Mario Mekhael, Charbel Noujaim, Noor Makan, Chanho Lim, Han Feng, eoin donnellan, Omar Kreidieh, Amitabh C Pandey, Nassir Marrouche
Journal: Circulation (2023)

Introduction: Post-ablation arrhythmia recurrences are common, yet the incidence of Repeat Ablation (RA) in patients with Persistent Atrial Fibrillation (PeAF) is under-investigated and it remains unclear whether RA can be predicted. Hypothesis: We looked for associations between certain patient/disease characteristics, and RA incidence. Methods: Using the DECAAF-II trial database, we divided PeAF patients into 2 groups: with or without RA. We compared them for: demographics &amp; comorbidities, baseline left atrial (LA) myopathy (reflected by LGE-MRI-detected LA fibrosis %, &amp; LA volume), the duration in days between AF diagnosis &amp; ablation, and ablation type (PVI Vs PVI + fibrosis-guided). The smart AF burden “Smurden” during the 3 months blanking period, defined by the % of days with detected AF over the total ECG monitoring duration, was also analyzed. Using a p-value cut-off of 0.3, variables were retained then included in a multivariate logistic regression model. Results: 732 patients were included. Demographics, comorbidities, &amp; other parameters are reported in Table1. Bivariate associations with p&lt;0.3 were found: LA volume in mm 3 was significantly higher in patients with RA: 139.41 vs 129.54, p = 0.012; history of stroke and CABG were more common in RA with ORs respectively: 1.661, p = 0.111; 2.891, p = 0.096; RA incidence was higher in the PVI only group: OR = 0.77, p = 0.2; the Smurden was higher in RA patients: 33.68 % vs 12.55 %, p &lt;0.001. The multivariate analysis showed one significant predictor of RA: Smurden OR: 9.413, CI 4.831- 18.343, p&lt;0.001(Figure1). Conclusions: High AF burden during the blanking period was a significant predictor of RA in PeAF patients.
Abstract 16717: Managing Myxedema Coma: A Challenging Case of Cardiogenic Shock Culminating in Orthotopic Heart Transplantation
Authors: Allan Lin, Saimanoj Guntaka, Michael Vaysblat, Suhwoo Bae, Jason Ng, Matthew Pierce
Journal: Circulation (2023)

Background: Myxedema coma (MC) is a rare manifestation of severe hypothyroidism often seen in elderly female patients. While the sequelae of MC can lead to multi-organ involvement and eventual failure, irreversible Heart Failure (HF) is rarely seen. This case culminated in orthotopic heart transplant (OHT) for definitive treatment. Case Presentation: A 23-year-old male presented with worsening RUQ abdominal pain for 2 weeks. In the ED, he had PEA arrest and with ROSC, he was admitted to the CCU for presumed cardiogenic shock, with labs remarkable for lactate 7.5 mmol/L, pro-BNP 6104 pg/mL, and markedly elevated serum creatinine and LFTs. The patient exhibited HF symptoms for 9 months before admission, manifesting as worsening LE edema, fatigue, and weight gain. He was also noted to have untreated hypothyroidism with repeat TSH of 857 μIU/mL on admission, indicating MC as a potential trigger for worsening HF. TTE revealed severe biventricular dysfunction with global hypokinesis and LVEF of 10-15%. Inotropic support was initiated with dobutamine, with RHC showing CVP 11 mmHg, RV 23/11 mmHg, PA 32/22 mmHg, PCWP 25 mmHg, and CI 2.3 LPM/m 2 . Subsequent deterioration in CI and MVO2 necessitated IABP placement and vasopressor support, and later rescue VA-ECMO with atrial septostomy, aiming for OHT. Endocrine evaluation confirmed primary hypothyroidism, and the patient received high-dose levothyroxine, T3, and stress-dosed steroids. While there have been instances where cardiac consequences of myxedema HF were reversed by thyroid administration, his significantly dilated left ventricular internal dimension at end diastole, as well as complications of ECMO (bleeding) expedited his transplant evaluation. OHT was successfully performed on hospital day 14. Continuous improvement in thyroid function studies was observed throughout the treatment course with levothyroxine therapy. Discussion: Worsening HF in the setting of MC, particularly in a male patient, is an uncommon presentation that requires prompt action. This patient required mechanical support as an eventual bridge to OHT with simultaneous treatment for hypothyroidism, illustrating the complexity of the case and the interventions necessary for a positive outcome in an uncommon clinical scenario.
Abstract 16653: Assessment of Price Variation for TAVR and SAVR Procedures Across US Hospitals
Authors: Pranav Sharma, Chen Wei, Ishan Paranjpe, Paul A Heidenreich, Kevin Schulman, Alexander T Sandhu
Journal: Circulation (2023)

Introduction Transcatheter Aortic Valve Replacement (TAVR) has become a mainstay of aortic stenosis treatment, alongside Surgical Aortic Valve Replacement (SAVR). Despite their widespread use, little is known about their commercial cost burden as this data was confidential prior to the 2021 Federal Price Transparency Final Rule. Using newly available pricing data, we aimed to compare hospital variation in TAVR and SAVR prices and describe factors predictive of prices. Methods Prices for DRG 267 (TAVR) and 220 (SAVR) were extracted from the Turquoise Health database and linked to hospital characteristics using Medicare IDs. Price variation within and across hospitals was assessed by calculating the ratio between the 90th and 10th percentile commercial or hospital rates, respectively. The Kruskal-Wallis test was used to test for associations between price and categorical factors. Results 1116 hospitals reported prices for TAVR and 1215 hospitals reported prices for SAVR. Commercial prices for TAVR ($70,482) and SAVR ($66,629) were 1.83 and 1.77x the Medicare price. Within hospitals, the 90th percentile payer-negotiated TAVR price was 1.80x the 10th percentile price, while across hospitals, the 90th percentile hospital by median commercial price was 3.40x the 10th percentile price. This was similar for SAVR. Several factors were associated with higher prices, including major teaching status (TAVR $17,736 and SAVR $19,057 vs non-teaching). For-profit status and investor-ownership were associated with lower prices. While higher hospital-wide readmission rates and higher hospital ratings were associated with higher prices, there was no significant association with hospital-wide mortality. Conclusion This analysis demonstrates substantial markups for TAVR and SAVR commercial prices and significant variation both within and between hospitals associated with teaching status, hospital ratings, and readmissions but not hospital mortality.
Abstract 13419: Transient Coronary Artery to Left Ventricular Fistula With Diastolic Mitral Regurgitation
Authors: Ikuo Misumi, Kei Miyanaka, Iwaho Hazekawa, Koji Sato, Akihisa Tabira
Journal: Circulation (2023)

Introduction: A fistula from a coronary artery to the cardiac chamber is incidentally found in 0.08% to 0.3% of patients undergoing coronary angiography. Case Presentation: A 73-year-old woman with hypertension, diabetes mellitus, chronic renal failure, and nephrosis visited our department due to dyspnea. The patient’s physical examination revealed a blood pressure of 191/109 mmHg and a pulse rate of 77 beats per min. The blood sampling results revealed a plasma brain natriuretic peptide level of 2,001 pg/mL. A 12-lead electrocardiogram showed poor R wave progression in leads V1 to V4. Chest radiography revealed left pleural effusion. Parasternal transthoracic echocardiography showed left ventricular hypertrophy. Left ventricular (LV) ejection fraction was 41%. A pulsed-wave Doppler echocardiography at the mitral inflow showed diastolic mitral regurgitation and a fusion of E and A waves. An unusual myocardial flow was noted in the apical myocardium. It was directed toward the apical surface during systole (Fig. 1a), and directed toward the LV lumen during diastole (Fig. 1b), suggesting coronary artery to LV fistula through sinusoid. Global strain obtained from apical long axis imaging showed myocardial shortening continued to diastole, suggesting post-systolic shortening (PSS). After treatment for hypertension, both of myocardial flow and diastolic MR disappeared. A longitudinal global strain imaging revealed disappearance of PSS. Conclusion: This is a rare case of diastolic MR due to PSS at the fistula from the coronary artery to the left ventricle.