tbuckley/cabot-search huggingface dataset:
Abstract 14303: COVID-19 and the Gender Impact on Sudden Cardiac Death
Authors: Jimmy Saleh, Amer Muhyieddeen, Khaled M Abdullah, Ahmad Harb
Journal: Circulation (2023)

Background: Sudden Cardiac Death (SCD) is an unexpected death attributed to a cardiac cause that occurs within one hour of symptom onset. Males have a higher likelihood of experiencing sudden cardiac arrest compared to females, as evidenced by previous studies indicating a substantial disparity in mortality rates between the genders. The outbreak of the COVID-19 pandemic has had a profound impact on cardiovascular population health patterns. Therefore, our study aimed to assess the influence of the pandemic on the gender-related variation in SCD rates among males and females. Methods: We used the National Inpatient Sample (NIS) to identify all patients admitted to hospitals in 2019 and 2020 with a primary diagnosis of sudden cardiac arrest. To analyze associations, we employed both logistic and linear regression methods, adjusting for potential confounding variables. We set the threshold for statistical significance at a 2-tailed p-value of 0.05. Results: Between 2019 and 2020, a total of 27,430 individuals were admitted to hospitals with a primary diagnosis of sudden cardiac arrest, with 11,705 (42.7%) of these patients being female. When factors such as age, race, hospital bed size, location and teaching status, insurance, and income level, as well as Elixhauser comorbidities and COVID-19 status were considered through multivariate regression analysis, a distinct trend emerged. In the year 2020, which was marked by the COVID-19 pandemic, there was a significant increase in in-hospital mortality among female patients (adjusted Odds Ratio aOR 1.34, 95% Confidence Interval CI 1.04 - 1.79). This trend was not present in the previous year, 2019, prior to the pandemic (aOR 1.03, 95% CI 0.87 - 1.22). Conclusion: Our study revealed a significant increase in mortality among female patients presenting with sudden cardiac arrest during the Covid-19 pandemic. We attribute this increase to the intricate interplay between Covid-19 and the healthcare system. While a direct association between SCD and Covid-19 is possible, it is crucial to acknowledge the indirect ramifications such as the impact of lockdown measures, alterations in behavior, and challenges faced by the healthcare system, all of which may be contributing factors.
Abstract 16504: Hospital Frailty Risk Score (HFRS) Predicts Adverse Events in Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure (LAAC) With WATCHMAN Device
Authors: Shivaraj Patil, Chaitanya Rojulpote, Abhijit Bhattaru, Avica Atri, Sahana Tito, Viha Atri, Ola Khraisha
Journal: Circulation (2023)

Introduction: Frailty and its association with adverse events are well-known in transcatheter aortic valve replacement. However, this association has not been well-studied in patients undergoing Left Atrial Appendage Closure (LAAC). Hypothesis: Frailty predicts adverse events in patients undergoing elective LAAC with WATCHMAN device. Methods: Patients aged ≥65 years who underwent elective LAAC with WATCHMAN device were identified using ICD-10 procedure code 02L73DK from the 2016-2018 HCUP-NIS Database. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS &lt; 5) and frail (HFRS score ≥ 5) groups. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Multivariate regression and receiver operating characteristic (ROC) analyses were used to assess the relationship between the HFRS and MAE. Results: 28,050 patients (Age = 77.3 ± 6.4 years; Female = 42.6%) were included, and 4.7% experienced in-hospital MAE. Frail patients (HFRS score ≥ 5) constituted 12.5% of the cohort. Frail patients were older and had a more significant proportion of women. Rates of MAE were significantly greater in frail patients (4% vs. 9.7%; p&lt;0.001). Increasing Hospital Frailty Risk Score was associated with a greater risk of in-hospital MAE. The AUC - ROC was 0.63 (Figures: A and B). Conclusions: HFRS predicts adverse events after LAAC. HFRS could be implemented in hospital information systems to facilitate the identification of at-risk patients.
Abstract 12486: Predictive Value of Chronotropic Incompetence for Clinical Outcomes in Heart Failure: Findings From the MyoVasc Study
Authors: Noemie Belanger, Silav Zeid, Gregor Buch, Fawad Kazemi-Asrar, David Velmeden, Felix Mueller, Marc W Heidorn, Wilfried Dinh, Karl J Lackner, Tommaso Gori, Thomas Muenzel, Jürgen H Prochaska, Philipp S Wild
Journal: Circulation (2023)

Introduction: Chronotropic incompetence (CI), an important aspect of exercise intolerance, is related to adverse clinical outcomes in heart failure (HF). However, the lack of standardized evaluation of CI results in inconsistent evidence. Aim: To evaluate CI with regard to clinical and medical determinants and relationship to clinical outcomes in HF. Methods: Data from the MyoVasc study (NCT04064450), a prospective cohort on HF, were analyzed. Subjects underwent deep clinical phenotyping, including cardiopulmonary exercise testing on a cycle ergometer. Measures of CI were evaluated, with continuous predicted heart rate reserve (pHRR) emerging as the most clinically relevant definition for operationalizing CI. Clinical and medical determinants of CI were assessed in multivariable linear regression models and outcomes in Cox regression models. Results: The analysis sample included 886 subjects (median age 63 years [interquartile range (IQR) 55; 72]; 29.9% women) who achieved maximal exertion (respiratory exchange ratio&gt;1.0). Symptomatic HF stage C/D was present in 42.8% (379) of the subjects. Sixteen drug groups were identified as CI modulators including β-blockers (β-estimate per SD -0.83 [95% confidence interval -0.95;-0.70], p&lt;0.0001) and antiarrhythmics (β SD -0.93 [-1.30;-0.56], p&lt;0.0001). New York Heart Association functional class, smoking, fatty liver index (FLI), and diabetes mellitus (DM) were the strongest determinants of CI in all subjects independently of sex, age, and previously identified medication. Determinants differed according to left ventricular ejection fraction [LVEF] (≥50 vs &lt;50%), being strongly associated with markers of HF (NT-proBNP) and lung function (FEV1) in HF with reduced EF and more linked to DM or the FLI in HF with preserved EF. In Cox regression analysis adjusted for clinical profile, pHRR independently predicted all-cause death (HR SD 1.86 [1.41;2.45], p&lt;0.0001) and worsening of HF (HR SD 1.37 [1.04;1.81], p=0.025). Conclusions: CI strongly predicted clinical outcomes and revealed relevant differences between HF with preserved and reduced EF. This highlights the relevance of impaired response to exercise in the clinical course of HF with implication for risk stratification and intervention.
Abstract 14263: Comparison of Catheter Ablation versus Antiarrhythmic Therapy in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction
Authors: Marisa DeLuca, Beni R Verma, Yasir Tarabichi, Saima Karim
Journal: Circulation (2023)

Introduction: The differences in outcomes between catheter ablation (CA) versus antiarrhythmic drugs (AAD) for atrial fibrillation (AF) in the setting of heart failure with preserved ejection fraction (HFpEF) are not known. Hypothesis: We hypothesize that patients with AF and HFpEF who undergo CA will have lower morality, stroke/TIA, and acute HF compared to those treated with AAD. Methods: TriNetX, a national retrospective electronic database, was used to identify patients aged 18-80 years with AF and HFpEF from 2017-2023. Patients with a prior diagnosis of systolic HF or cross overs from AAD to CA were excluded. Patients who underwent CA were compared to those treated with AAD (amiodarone, flecainide, dronedarone, dofetilide, propafenone, sotalol). Baseline group comparison was performed using student’s t-test. Age, sex, chronic kidney disease, COPD, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and stroke/TIA were used for 1:1 propensity matching. Kaplan Meier curves were calculated to compare all-cause mortality, stroke/TIA, acute diastolic and systolic HF. Results: Patients who received CA (n=1468) and AAD (n=7426) were propensity matched yielding 1008 patients per cohort. Compared to AAD, CA demonstrated significantly lower all-cause mortality (9.13% vs. 23.7%; HR=2.6; 95% CI [2.038,3.315]; log-rank p&lt;0.0001), lower stroke/TIA risk (5.12% vs. 7.69%; HR=1.6; 95% CI [1.056,2.28]; log-rank p=0.02), and less frequent hospitalization for acute diastolic HF (12.1% vs. 18.8%; HR=1.6; 95% CI [1.185,2.152]; log-rank p=0.0018). Rate of acute systolic HF was similar for both cohorts with 7.76% for CA and 6.90% for AAD (HR=0.88; 95% CI [0.63,1.222]; log-rank p=0.4395). Conclusions: Patients with AF and HFpEF had lower mortality, risk of stroke and acute diastolic HF when they received CA versus AAD. Randomized clinical trials are needed to better understand their short and long-term outcomes.
Abstract 14747: MS Gene: Multistate Modeling of Dynamic Lifetime Risk of Coronary Artery Disease Using Electronic Health Records in the UK Biobank
Authors: Sarah Urbut, Ming Wai Yeung, Art Schuermans, So Mi J Cho, WHITNEY HORNSBY, Akl Fahed, Giovanni Parmigiani, Ludovic Trinquart, Alexander S Gusev, Pradeep Natarajan
Journal: Circulation (2023)

Introduction: Estimated lifetime risk for coronary artery disease (CAD) is an essential goal, yet few tools exist to dynamically update predictions with age-dependent effects. Methods: We considered 221,997 individuals (54% female) followed in the UK Biobank (UKB) Electronic Health Record (EHR) and GP (general practice) since adulthood (median entry age 24, IQR 18-37). We built a multi-state model for dynamic risk, MSGene, comprised of 10 time-dependent states based on cardiometabolic conditions. We report annual state transitions to CAD as age-dependent functions of sex, polygenic score (PRS) and smoking. We evaluate prediction relative to the Pooled Cohort Equations (PCE) for 10-year risk and to empiric values for lifetime risk. We report age-specific absolute risk reduction by integrating yearly relative reduction using imputation from randomized statin trials. Results: MSGene improved accuracy (root mean squared error [RMSE] 0.85% vs 6.56%, P&lt;0.001) compared with PCE for 10-year risk, and has RMSE of 2.6% [SEM 0.0067] for lifetime risk ( Figure 1a ) when compared to empirical rates after validation. The relative effect of PRS on transition from health is greater earlier in life ( Figure 1b ). MSGene reinforced that individuals with low short-term risk are at high lifetime predicted risk: a healthy non-smoking male at the 80 th percentile PRS with a 2.4% (10-year) risk at age 40 has a 23.6% lifetime risk ( Figure 1c ). MSGene nimbly models dynamic transitions ( Figure 1D ): for example, for individuals with hypertension, these increase to 5.6% and 35% (SEM 0.02) respectively. Under statin therapy, predicted absolute risk reduction for those at the highest genetic risk declines from 5.9% [5.85-5.94] at age 40 to 2.8% [2.78-2.92] at age 70. Conclusions: We introduce a novel statistical method, MSGene, which accurately describes the age-dependent risk of developing CAD over the lifespan conditional on PRS and updated health status, for adaptive prevention and screening.
Abstract 14349: Relationship Between Obesity and Youth Athletes’ Physical Activity and Exercise-Related Symptoms
Authors: Grace Qiu, Joshua M Riley, Sean Dikdan, Drew Johnson, David Shipon
Journal: Circulation (2023)

Introduction: Pediatric obesity has significant impacts on the development of many medical comorbidities into adulthood. While studies have identified the negative effects of obesity on exercise performance and cardiovascular health, the effects of obesity on youth athletes are less studied. Hypothesis: Obesity in youth athletes is associated with decreased activity levels and increased exertional cardiac symptoms. Methods: The HeartBytes National Youth Database produced by Simon’s Heart, a nonprofit organization that organizes sports pre-participation examinations (PPEs) of adolescents, was used for this study. This database contains demographic, exercise-related symptoms, and electrocardiogram data obtained during Simon’s Heart PPEs. BMI values were converted to age- and gender-adjusted percentiles, with obesity defined in accordance with CDC definition BMI ≥ 95th percentile. A chi-squared test with odds ratios (OR) and 95% confidence intervals (CI) were used to evaluate obesity outcomes. Results: Of the 7363 patients in the HeartBytes database with BMI data, the majority were male (60.7%) and White (83.3%). The median age was 15.0 years old (interquartile range 13.5-16.5). Youth athletes within the normal weight range (5th-85th percentile) had higher exercise participation rates in comparison to those who were underweight, overweight, or with obesity (p&lt;0.0001 for each). Athletes with obesity were more likely to have exertional symptoms (OR: 1.63 [CI: 1.36-1.96]; p&lt;0.0001), specific symptoms of easily fatigued (OR: 3.00 [CI: 2.38-3.79]; p&lt;0.0001) and dyspnea (OR: 1.69 [CI: 1.37-2.10]; p&lt;0.0001), compared to those without obesity. Athletes with obesity were more likely to have hypertension (OR: 5.35 [CI: 2.00-14.30]; p=0.0002), high cholesterol (OR: 3.84 [CI: 2.51-5.86]; p&lt;0.0001), and ECG T-wave inversion changes (OR: 2.19 [CI: 1.10-4.33]; p=0.022) than those without obesity. No association was found between obesity and diabetes. Conclusions: In this dataset from a national registry of PPEs, obesity in youth athletes is associated with decreased physical activity and exertional symptoms. Further study is needed to elucidate the cause-effect relationship of these findings.
Abstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda
Authors: Chang Yoon Doh, Crystal An, Andrew Y Chang, Joselyn Rwebembera, Tom P Mwambu, Andrea Z Beaton, Doreen Nakagaayi, Pablo Ruda Vega, Craig A Sable, Peter Lwabi, Chris T Longenecker
Journal: Circulation (2023)

Background: There is a considerable gap between those needing and receiving surgery among people with rheumatic heart disease (RHD) in Uganda. Nevertheless, risk factors associated with time to surgery and preoperative mortality among those in need of surgery remain poorly understood. Methods: A cohort of patients with RHD who met criteria for valve surgery was assembled using the Uganda National RHD Registry (Jan. 2009- Aug. 2022). Kaplan-Meier estimates and multivariable Cox proportional hazards models were constructed to estimate time to surgery and death for those awaiting surgery. Results: 1,452 patients met surgical indication for valvular RHD. Median age was 20 years (interquartile range [IQR] 13-36), and 30.4% were male. 29.4% had multiple concurrent valve indications. During a median follow-up of 357 days (IQR 21-1029), 30.6% died while awaiting surgery and 13.5% obtained surgery. Median time to surgery was 9.3 years. Multivariable time to surgery model adjusted for age, socioeconomic factors, and HIV status revealed significantly increased likelihood of surgery in men vs. women (hazard ratio [HR] 1.78; 95% CI 1.21-2.64), college/university vs. none/primary school education (HR 3.60; 95% CI 1.88-6.89), and history of atrial fibrillation (HR 2.78; 95% CI 1.63-4.76), but decreased likelihood of surgery in age ≥18 years (HR 0.49; 95% CI 0.32-0.77) and NYHA class III/IV vs. I/II (HR 0.51; 95% CI 0.32-0.83). Median preoperative time to death was 4.6 years. Following stratification by NYHA class I/II and III/IV and adjustment for age, sex, and socioeconomic class, the following predictors were associated with increased mortality in both models: history of infective endocarditis (HR 2.38; 95% CI 1.05-5.39), RV dysfunction (HR 2.44; 95% CI 1.13-5.27), pericardial effusion (HR 1.68; 95% CI 1.27-2.21), surgical indication for multiple valves (HR 1.77; 95% CI 1.41-2.21), and atrial fibrillation (HR 1.47; 95% CI 1.03-2.10). Conclusions: Our analysis revealed a low rate of surgical intervention and high mortality rate in a high-risk population of Ugandans living with advanced RHD and operative indication. Unsurprisingly, sex and socioeconomic status remain barriers to receipt of surgery that must be addressed to achieve equity in this neglected disease.
Abstract 13716: Implanting an Extravascular ICD in Patients With a Prior Subcutaneous ICD
Authors: Anish Amin, Sarah Cornell, Robert Venditti, Christopher Wiggenhorn, Matthew Cline, Prashanthan Sanders, Venkata Sagi
Journal: Circulation (2023)

Background: The Extravascular Implantable Cardioverter Defibrillator (EV ICD) has been demonstrated as an effective therapy to treat sudden cardiac death using a substernal lead position. Limited data regarding the use of EV ICD in patients with prior subcutaneous ICD (S-ICD) is available. Methods: The EV ICD Pivotal study database was reviewed for subjects with a prior S-ICD. Procedure times were compared using the Wilcoxon rank-sum test. Results: Of the 316 subjects that had an implant attempt in the EV ICD Pivotal study, 9 subjects at 3 sites had history of a prior implanted S-ICD. All were male with a mean age of 59.6 ± 14.4 years. Mean Body Mass Index (BMI) was 29.5 ± 4.7. Five subjects had secondary prevention indication. Mean follow up duration was 1.4 ± 0.7 years. The study protocol required S-ICD explant prior to study enrollment. The mean time between S-ICD explant and EV ICD implant was 35 ± 19 days. Procedure times were similar to denovo EV ICD implant. Median times from first incision to final suture, inclusive of defibrillation testing, for subjects with and without prior S-ICD were 79 (IQR, 69 to 108) and 60.5 (IQR, 52 to 84.5) minutes, respectively (P=0.10). All subjects were defibrillated with 30 J or less at implant. There were no major intraprocedural complications and only 1 major complication during the follow up period, an implant site infection at 18 months. The Florida Patient Acceptance Survey, issued at 6 months post-implant, demonstrated high device acceptance rate with little or no body image concerns. Two subjects each had an appropriately treated episode of spontaneous sustained monomorphic VT, one terminated by ATP and the other terminated by shock following ATP. Conclusions: The EV ICD System can be successfully implanted in patients who previously had an S-ICD. History of S-ICD did not significantly increase procedure time. The EV ICD had a high acceptance in this subgroup and may provide advantage over S-ICD due to its smaller size, and ability to deliver ATP.
Abstract 14809: Macrophages Contribute to Diastolic Dysfunction in Systemic Sclerosis
Authors: Xaviar M Jones, Alessandra Ciullo, Thassio Mesquita, Russell Rogers, Ahmed G Ibrahim, Eugenio Cingolani, Eduardo Marban
Journal: Circulation (2023)

Introduction: Systemic sclerosis (SSc) is an autoimmune disease characterized by aberrant inflammation and internal organ fibrosis, resulting in irreversible scarring and organ failure. In patients with SSc, primary cardiac involvement heralds a poor prognosis, and accounts for one-third of SSc-related deaths. No effective treatments are available for this lethal disorder. However, preclinical investigations are hindered by the scarcity of animal models recapitulating human SSc-associated cardiac disease. Methods: 5-7-week-old C57BL/6J female wild type mice were injected with PBS (control) or 100 μL bleomycin subcutaneously every other day for 4 weeks. Endpoints include body weight, exercise capacity, echocardiography, and histologic quantification of fibrosis in heart (Masson’s trichrome staining). Results: At study endpoint, animals receiving bleomycin exhibited body weight loss (p&lt;0.005) and lower exercise capacity compared to vehicle (p&lt;0.0002). Echocardiographic assessment revealed diastolic dysfunction (measured by E/E’ ratio) in bleomycin exposed mice (38.35 vs 21.38 control; p&lt;0.001), with no changes in systolic function. By Masson’s trichrome staining, cardiac fibrosis was significantly greater in SSc animals compared to controls (p&lt;0.001). Transcriptomic analysis of left ventricular tissue from SSc mice showed enrichment of macrophage signaling pathways. Furthermore, macrophage depletion (for 4 weeks post bleomycin) with clodronate liposomes attenuated diastolic dysfunction (-10.48; p p&lt;0.01) and cardiac fibrosis (p&lt;0.05) in SSc mice compared to vehicle. Conclusions: The bleomycin model of systemic sclerosis also exhibits signs of systemic sclerosis with cardiac involvement, namely diastolic dysfunction and myocardial fibrosis. The clodronate data implicate inflammation and specifically macrophages as drivers of cardiac abnormalities in this preclinical model of SSc.
Abstract 17159: Chronic Corticosteroid Immunosuppression in African American Pediatric Heart Transplant Recipients Does Not Improve Outcomes
Authors: Natalie S Shwaish, Erik L Frandsen, James Kirklin, Ryan S Cantor, Hong Zhao, Jacob Simmonds, Kenneth R Knecht, Sarah Wilkens, Erin V Shea, Warren A Zuckerman
Journal: Circulation (2023)

Introduction: Previous studies consistently demonstrate worse outcomes for African American (AA) pediatric heart transplant (HT) recipients when compared to non-AA counterparts. Medical and social factors have been implicated in this discrepancy. As such, chronic corticosteroid use as maintenance immunosuppression for AA HT patients may be beneficial, though this has not been studied. Hypothesis: Chronic maintenance corticosteroid therapy does not decrease rejection or graft failure in AA pediatric HT recipients. Methods: We performed a retrospective analysis of the Pediatric Heart Transplant Society (PHTS) database for all HT recipients &lt;18 y.o. from January 1 st , 2007 to June 30 th , 2021. Retransplants and multiorgan transplants were excluded. Chronic steroid use was defined as taking oral steroids at one-year post-HT in the absence of rejection past 60 days post-HT to exclude patients who were on steroids for-cause. We used Kaplan-Meier and log-rank analyses for outcome comparisons among cohorts after the first year post-HT. Results: A total of 4099 patients were included, of which 780 (19%) were AA. Of the cohort, 756 (18.4%) were on chronic steroids. Within that group, 157 (20.1%) were AA. Patients on chronic steroids at individual centers ranged 0%-64.7% (median 11.5%, SD 16.9%), with no collective difference between steroid use in AA and non-AA patients. Freedom from rejection was worse in AA compared to non-AA patients, both in steroid and no steroid groups (p&lt;0.01). In the non-AA cohort, freedom from rejection was better in the no steroid group (p&lt;0.01). In the AA cohort, there was no statistical difference in rejection between the steroid and no steroid groups (p=0.20). Analyses of graft survival resulted in the same pattern. Conclusion: Use of Chronic steroids varies widely across pediatric HT centers, with no difference between AA and non-AA patients. AA patients have worse rejection and graft failure, and chronic steroid use did not affect these outcomes.