tbuckley/cabot-search huggingface dataset:
Abstract 13680: Assessing the Role of Phosphodiesterase-5 Inhibitors in the Management of Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis
Authors: Muhammed K Elfaituri, Alhasan Saleh Alzubi, Ala Khaled, Ahmed BenGhatnsh, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: The advent of left ventricular assist device (LVAD) therapy revolutionized the management of severe heart failure. Right ventricular failure (RVF) remains a principal cause of mortality among these patients. Previous reports suggest phosphodiesterase-5 inhibitors (PDE-5is) can decrease pulmonary pressure, enhance ventricular function, and lower the risk of thrombosis and stroke. Nonetheless, certain studies present conflicting data, indicating potential increases in bleeding and mortality among patients using PDE-5is. Hypothesis: This study aimed to assess the outcomes of LVAD patients who were administered PDE-5is. Methods: A comprehensive search of PubMed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature was conducted until January 2022. We included studies that directly compared outcomes of LVAD patients who used PDE-5is versus those who did not. Primary outcomes focused on postoperative RVF and all-cause mortality, while secondary outcomes included stroke, gastrointestinal bleeding, and pump thrombosis. The statistical analysis was performed using "R" statistical computing software (version 4), utilizing the metafor and meta packages. Results: Eight studies encompassing 3035 PDE-5i users and 3023 non-users were included in our analysis. PDE-5i use was not significantly associated with postoperative RVF (RR: 0.84; 95% CI 0.58-1.21, P=0.35; I2 = 83.2%). Similarly, there was no significant correlation between PDE-5i use and all-cause mortality (RR: 0.99; 95% CI 0.96-1.02, P=0.75; I2 = 0%), pump thrombosis (RR: 0.66; 95% CI 0.61-0.72, P=0.45; I2 = 0%), stroke (RR: 0.96; 95% CI 0.84-1.08, P=0.58; I2 = 0%), or gastrointestinal bleeding (RR: 1.13; 95% CI 0.77-1.67, P=0.65; I2 = 0%). Conclusions: Our analysis suggests that PDE-5i use is not associated with increased adverse outcomes such as bleeding, stroke, thrombosis, or all-cause mortality in LVAD patients. However, given the heterogeneity of the included studies and a lack of robust evidence supporting PDE-5i use, high-quality randomized controlled trials are needed to assess the potential benefits, efficacy, and safety of PDE-5is in reducing RVF, thrombosis, and all-cause mortality in LVAD patients.
Abstract 12011: A Case of Emphysematous Pyelonephritis With Use of Empagliflozin
Authors: ARISH MAKNOJIA
Journal: Circulation (2023)

Background: SGLT2i improve cardiovascular (CV) outcome in patients with HFrEF with or without diabetes (DM). Although recent trials and metanalysis have showed improve renal outcomes with SGLT-2i, one should be aware of the potential serious adverse effects with this group of medications including life threatening UTI. Case: 50-year-old female with history of type 2 DM presented with septic shock due to bilateral (B/L) pyelonephritis, with no associated renal calculi. CT of the abdomen also revealed emphysematous pyelonephritis of the left kidney. Few days later, patient went into PEA requiring intubation with return of spontaneous circulation within 4 minutes of advanced cardiac life support. Patient was extubated subsequently later on during her hospitalization. Work up for PEA revealed depressed left ventricular systolic function with an EF of 25-29% with no wall motion abnormality. Patient also developed decompensated HFrEF with development of b/l pleural effusion and generalized anasarca. Cardiology was consulted for management of her cardiomyopathy. She was recommended coronary angiography but she declined. Therefore, Patient was started on guideline direct medical therapy for HF with metoprolol succinate, lisinopril and spironolactone. Due to recent evidence of SGLT-2i improving CV outcomes in patients with HFrEF, it was also recommended to start SGLT-2i. Discussion: On further reviewing regarding use of SGLT-2i and association with UTI, we found a case report causing emphysematous pyelonephritis with use of canagliflozin. Medication reconciliation done at the time of discharge revealed that patient was recently initiated on empagliflozin three months prior to her admission. Therefore, it was speculated that her emphysematous pyelonephritis could be one of the rare complications of SGLT-2i since no other etiologies was noted per urological workup and we decided not to continue SGLT-2i. A search of FAERS from March 2013 through October 2014 identified 19 cases of urosepsis reported with the SGLT2 inhibitors (canagliflozin [n=10] and dapagliflozin [n=9]). All cases resulted in hospitalization. No deaths were reported. Clinicians should be aware of potential life-threatening UTI which may occur with SGLT-2i use.
Abstract 12681: Sex-Specific Predictors of Pacemaker Implantation After Transcatheter Aortic Valve Implantation
Authors: ANA C IRIBARREN, Galen Cook-Wiens, Eugenio Cingolani, Ashkan Ehdaie, Michael M Shehata, Xunzhang Wang, Tarun Chakravarty, Raj Makkar, C Noel N Bairey Merz, Roopinder Sandhu
Journal: Circulation (2023)

Introduction: Permanent pacemaker (PPM) remains a common complication after transcatheter aortic valve implantation (TAVI). Despite recognition of sex-specific differences in the electrophysiological structure of the heart, there is a paucity of data examining whether predictors for PPM after TAVI differs among women and men to facilitate a precision medicine approach. Hypothesis: To examine incidence rates and predictors of PPM after TAVI according to sex. Methods: We retrospectively examined incidence rates and characteristics of women and men requiring PPM within 30-days after TAVI between 2012 to 2021. Predictors of PPM were identified using logistic regression. Results: A total of 3323 patients underwent TAVI, of which 407 (12.3%) required PPM within 30-days after TAVI. A PPM was required in 12.3% (170/1377) of women and in 12.2% (237/1946) of men (p=0.89). Baseline characteristics are shown in the Table. Compared to women, men requiring a PPM were more likely to have a history of myocardial infarction (MI), prior bypass surgery, reduced systolic function, first degree atrioventricular block (1 st AVB), normal renal function, balloon expandable prosthesis, and larger prosthesis size. In multivariable analysis, right bundle branch block and self-expandable prosthesis were significant predictors for both sexes (Figure). Men had relatively more exclusive predictors (age, prior MI, atrial fibrillation, 1 st AVB, left bundle branch block, prosthesis size) compared to women (Figure). Conclusions: PPM incidence rates after TAVI are similar for women and men however, sex-specific predictors for PPM exist and may be used guide pre- and post-procedural management.
Abstract 12736: Prevalence, Characteristics, and Outcomes of Infective Endocarditis in Patients With Liver Disease in the United States
Authors: Mohamed Khayata, Richard A Grimm, Brian P Griffin, Bo Xu
Journal: Circulation (2023)

Introduction: Infective endocarditis (IE) is common in patients with liver disease. Data regarding IE in liver disease are limited. Hypothesis: We analyzed IE admissions to determine inpatient outcomes among patients with liver disease in the United States. Methods: We used the 2017 National Readmission Database to identify index admission of adults with IE, based on the International Classification of Disease, 10th revision codes. The primary outcome was 30-day readmission. Secondary outcomes were mortality and predictors of hospitalization readmission. Results: We identified 40,413 IE admissions. Figure 1 presents prevalence of variables associated with liver disease in this cohort. Patients who were readmitted were more likely to have a history of hepatitis C virus (19.4% vs 12.3%, p &lt; 0.001), hyponatremia (25% vs 21%, p &lt; 0.001), and thrombocytopenia (20.3% vs 16.3%, p &lt;0.001). After adjusting for age, hypertension, heart failure, diabetes mellitus, and end stage renal disease, hyponatremia (odds ratio (OR): 1.25; 95% confidence intervals [CI]: 1.17 to 1.35; p &lt; 0.001) and thrombocytopenia (OR: 1.16; 95% CI: 1.08 to 1.24; p &lt; 0.001) correlated with higher odds of 30-day readmission. Mortality was higher among patients with hyponatremia (29% vs 22%, p &lt; 0.001), thrombocytopenia (29% vs 17%, p &lt; 0.001), coagulopathy (12% vs 5%, p &lt; 0.001), cirrhosis (6% vs 4%, p &lt; 0.001), ascites (7% vs 3%, p &lt;0.001), liver failure (18% vs 3%, p &lt; 0.001), and portal hypertension (3% vs 1.5%, p &lt; 0.001) (Figure 2). Conclusions: Important liver disease related variables correlate with higher risks of hospital readmission and mortality in patients with IE. Targeting such variables may improve outcomes in this patient population.
Abstract 13737: Two Episodes of Intermittent Complete Heart Block Following Elective Procedures
Authors: Mariana Garcia-Arango, Dejan Vrtikapa, Adam Gepner
Journal: Circulation (2023)

Background: Iatrogenic bradycardia and complete heart block can occur with medications commonly administered during general anesthesia. Case: A 79-year-old male with past medical history of coronary artery disease, hypertension, paroxysmal atrial fibrillation and a left bundle branch block, underwent elective lithotripsy procedure, baseline ECG demonstrated in Figure A. Post-operatively, he developed asymptomatic complete heart block approximately 3 minutes after receiving sugammadex, a paralytic reversal agent (see Figure B). He was admitted for monitoring and spontaneously converted to sinus rhythm after 10 hours. The patient was discharged home with a 30-day event monitor; no pauses or high-grade atrioventricular block was noted during the monitoring period. Three months later, he underwent ureteroscopy stent exchange; during the induction with propofol he developed asystole followed by cardiac arrest. CPR was initiated and had return to spontaneous circulation after 3 minutes. The patient was transferred to the ICU, however, once again complete heart block was observed. Clinical decision-making: This case highlights recurrent episodes of transient complete heart block in the setting of an underlying left bundle branch and first-degree AV block that were exacerbated by medications during general anesthesia. Because of his underlying conduction disease and recurrent complete heart block and subsequent cardiac arrest, he ultimately underwent insertion of permanent dual chamber pacemaker. Conclusion: Iatrogenic transient complete heart block is a rare but potentially fatal complication. Prompt diagnosis and clinical suspicion of reversible causes are warranted. Significant underlying conduction disease should be considered to decide the ideal therapeutic option.
Abstract 13706: Determinants of Right Ventricular Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial Experience
Authors: Henri Lu, Riccardo M Inciardi, Martin Abanda, Amil M Shah, Maja Cikes, Brian Claggett, Narayana Prasad, Carolyn S Lam, Margaret M Redfield, John J McMurray, Scott Solomon, Sheila Hegde, Hicham Skali
Journal: Circulation (2023)

Introduction: Right ventricular dysfunction (RVD) is a major prognostic factor in patients with heart failure with preserved ejection fraction (HFpEF), however determinants of RVD in HFpEF are not well described. Although sex-specific mechanisms have been incriminated in the development of HFpEF, it is unclear whether this is also true for RVD. Goals: (1) Assess the prevalence of RVD (defined as a tricuspid annular plane systolic excursion [TAPSE] &lt;1.7 cm, a fractional area change [FAC] &lt;35% or a RV free wall longitudinal strain [RVFWLS] &lt;20%, absolute value) in patients with HFpEF; (2) identify determinants of RVD, overall and according to sex, in patients with HFpEF. Methods: We used data from patients enrolled in the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality (N=809, 53% women, mean age 74±8 years). Determinants of RVD, in the whole study population and according to sex, were identified using a multivariable logistic regression model. Results: There were 461 patients (57%) with RVD. After multivariable adjustment, RVD was cross-sectionally associated with a history of atrial fibrillation of flutter (AFF), older age, higher heart rate, greater LV mean wall thickness and higher NT-proBNP values. Systolic blood pressure and LV global longitudinal strain (absolute value) showed an inverse association ( Figure ). These results were consistent between men and women, except for AFF and LV mean wall thickness, which were associated with a greater likelihood of RVD in men (OR 2.46, 95%CI 1.33-4.56, OR 1.61, 95%CI 1.18-2.21 respectively) but not in women (OR 0.99, 95%CI 0.58-1.68, OR 0.90 95%CI 0.69-1.17 respectively, p-values for interaction=0.028 and 0.006). Conclusions: RVD was highly prevalent in our study population. Determinants of RVD included AFF, LV remodeling and systolic impairment, and increased NT-proBNP levels. Differences between men and women suggest gender-specific mechanisms in the development of RVD in HFpEF.
Abstract 13736: Whole Body versus Small Muscle Mass Exercise Training in Patients With Heart Failure With Preserved Ejection Fraction: Impact on Peripheral Responses to Exercise
Authors: Rachel Skow, Christopher Hearon, Satyam Sarma, James MacNamara, Mitchel Samels, Paul J Fadel, Benjamin D Levine, Mark J Haykowsky
Journal: Circulation (2023)

Background: Patients with heart failure with preserved ejection fraction (HFpEF) have reduced peak aerobic power (VO 2 ) during whole body exercise due in part to smaller increases in blood flow (BF) and arterial-to-venous oxygen difference (Δa-vO 2 ). We recently demonstrated that 8wks of single leg knee extension (SLKE) exercise training was effective in improving whole body VO 2 by increasing Δa-vO 2 in HFpEF; whether SLKE training induces greater peripheral adaptations compared to traditionally prescribed whole-body (i.e., cycle) training is unknown. Hypothesis: SLKE training will result in larger improvements in peak leg VO 2 , leg BF, and Δa-vO 2 during a SLKE peak exercise test vs cycle training. Methods: We recruited 16 patients with HFpEF (71 ± 6yr, 5 males) and randomized them to cycle or SLKE training 3-4 days/wk for 16wk. Before and after the intervention we quantified leg BF (ultrasound), femoral venous O 2 partial pressure (PvO 2 ) and saturation (IV catheter) during incremental SLKE peak exercise to determine peak leg VO 2, Δa-vO 2, and skeletal muscle diffusive conductance (DMO 2 ; leg VO 2 /[2x leg PvO 2 ]). Results: SLKE (n=9) and cycle (n=7) groups were matched for age and sex. Both groups increased peak workload during the SLKE exercise test (34±8%; mean ± SE; p=0.005). There was a main effect of training such that peak DMO 2 improved in both groups (cycle: 45±19%; SLKE: 12±3%; see Figure 1 ). Peak Δa-vO 2 also improved (main effect of training, p=0.002); however, this was greater in response to cycle compared to SLKE training (12±3% vs 3±2%; interaction effect, p=0.035). Conclusion: These preliminary data indicate that both types of training improve leg DMO 2 ; however, greater improvements in O 2 extraction occurred with cycle training. The differences in the peripheral adaptations may be attributed to a larger exercise “dose” in the cycle trained group. This data highlights that both modalities are effective components of exercise prescription for patients with HFpEF.
Abstract 12267: Timing and Mode of Death Following Treatment of Neonatal Symptomatic Tetralogy of Fallot
Authors: Sara M Trucco, Yun Zhang, Courtney McCracken, Andrew C Glatz, Christopher J Petit, Athar Mahmood Qureshi, Jeffrey Zampi, Shabana Shahanavaz, George Nicholson, Nathalie Abejero, Allen Ligon, Jay Patel, Christopher Mascio, Shiraz A Maskatia, Jennifer Romano, Michael L Obyrne, Kathryn Stack, Jeannette Wong-Siegel, Asaad Beshish, Mark Law, Kristal Hock, Sarosh P Batlivala, Sarah Speed, Jeffery J Meadows, Disha Goel, Hala Khan, Bryan H Goldstein
Journal: Circulation (2023)

Introduction: Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, using a staged (SR) or primary repair (PR) strategy. Independent of management, the risk of post-procedural mortality is considerable. Although risk factors for late mortality after TOF repair have been established, the modes of death and associated factors have not been defined in early childhood following treatment of sTOF. Methods: Neonates with sTOF who had an initial intervention from 2005-2017 at 9 centers of the Congenital Cardiac Research Collaborative were reviewed. Among the patients who died, additional details related to timing and cause of death, and last clinical follow-up, were obtained and described. Comparisons of patient characteristics between survivors and non-survivors were performed. Results: Of 572 sTOF patients (230 PR, 342 SR), there were 52 (9%) deaths at a median age of 82 (25 th - 75 th %ile: 28, 246) days . Timing of mortality included: inpatient post-palliation (n=9), interstage in SR pathway (n=11), inpatient post complete repair (CR) (SR, n=5; PR, n=11) and post-CR following hospital discharge (n=16). Death occurred within 30 days of palliation or repair in 52% of cases. Most deaths were due to cardiac etiologies, with only 6 including ≥1 non-cardiac cause of death (NEC (n=2), sepsis (n=1), CNS bleed (n=2), trauma (n=1)). Risk factors for mortality included presence of genetic syndrome, non-cardiac anomaly, prematurity, low birth weight, and need for ventilation prior to initial intervention (p&lt;0.05 for all). Modes and timing of death in the 16 patients who died after CR discharge are shown (Figure). In these, RV dysfunction at last echo was present in 50%. Conclusions: When death occurs after interventions for sTOF, it frequently occurs early, and relates to traditional risk factors. Amongst patients with childhood mortality following discharge from CR, sudden death and reintervention-related events predominate known causes.
Abstract 11914: Diagnostic and Prognostic Role of Left Ventricular Strain Imaging in Adults With Coarctation of Aorta
Authors: Sriharsha Kandlakunta, Marwan Ahmed, Snigdha Karnakoti, Omar Abozied, Ahmed Younis, Alexander C Egbe
Journal: Circulation (2023)

Introduction: The relative diagnostic and prognostic performance of left ventricular global longitudinal strain (LVGLS) as compared to LV ejection fraction (LVEF), and the role of LVGLS for detecting early stages of LV systolic dysfunction in adults with repaired coarctation of aorta (COA) is unknown. Objective: The purpose of this study was to address these knowledge gaps. Methods: Retrospective cohort study of adults with repaired COA that underwent transthoracic echocardiogram (2003-2020). LV systolic function was assessed using LVEF (derived from volumetric analysis) and LVGLS (derived from speckle-tracking echocardiography). Results: Of the 795 patients (age 36±14 years), mean LVEF and LVGLS were 62±11%, and 21±4%, respectively. The prevalence of LV systolic dysfunction was higher when assessed using LVGLS as compared to LVEF (20% versus 6%, p&lt;0.001). Of 795 patients, 94 (12%) patients died, of which 75 (9%) died from cardiovascular causes. LVGLS provided more robust prognostic power in predicting all-cause mortality as compared to LVEF as evidenced by a higher C -statistic (0.743, 95%CI 0.730-0.755 versus 0.782, 95% CI 0.771-0.792, p&lt;0.001). Furthermore, patients with normal LVEF in the setting of reduced LVGLS had a higher risk of all-cause mortality (as compared to patients with normal LVGLS and LVEF) and were at risk for temporal decline in LVEF during follow-up. Conclusions: These findings suggest that the use of LVGLS for risk stratification can help identify high-risk patients, and provide opportunities for interventions, which would, in turn, improve clinical outcomes. Further studies are required to empirically test these postulates.
Abstract 11995: Contemporary Guideline-Directed Medical Therapy (GDMT) for Heart Failure is Associated With A Reduced Incidence of New-Onset Atrial Fibrillation
Authors: Masaki Tokutome, Ryuichi Matsukawa, Junpei Itonaga, Eiichi Koga, Ayano Hara, Hiroshi Kisanuki, Masashi Sada, Kosuke Okabe, Arihide Okahara, Shunsuke kawai, Kiyohiro Ogawa, Hirohide Matsuura, Yasushi Mukai
Journal: Circulation (2023)

Backgrounds: Heart Failure (HF) is a risk factor for new-onset atrial fibrillation (AF), and the new-onset AF is associated with a worse prognosis in HF patients. It has been reported that renin-angiotensin system inhibitor (RASi), β-blocker, mineral-corticoid receptor antagonist (MRA) and Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the new-onset AF in HF patients. However, significance of contemporary guideline-directed medical therapy (GDMT) for HF (RASi/ARNI + β-blocker + MRA + SGLT2i) on new-onset AF is unknown. We investigated the impact of GDMT for HF on new-onset AF. Methods and Results: We retrospectively studied the long-term (The mean follow-up was 603 ± 410 days) incidence of new-onset AF in HFrEF and HFmrEF patients without episode of AF (n=410) admitted to our hospital due to decompensated HF between 2015 and 2022. Patients were divided into 2 groups; patients treated with ≦2 HF drugs (n=192) and patients with ≧3 HF drugs (n=218) after discharge. The incidence of new-onset AF was significantly fewer in the ≧3 HF drugs group (HR 0.36, 95%CI 0.16-0.82). A multivariate analysis revealed that ≧3 HF drugs use was an independent negative predictor of new-onset AF (HR 0.38, 95%CI 0.15-0.98, P=0.04). Even after a propensity score matching of clinical variables, the incidence of new-onset AF was consistently fewer in the ≧3 HF drugs group (HR 0.39, 95%CI 0.15-1.00, P=0.04). Finally, comparing between patients with and without new-onset AF, new-onset AF was significantly associated with re-hospitalization for HF (HR 5.41, 95%CI 3.32-8.89, P&lt;0.001) and all-cause death (HR 2.36, 95%CI 0.98-5.68, P=0.047) in the studied population. Conclusion: The contemporary GDMT is associated with a reducing of new-onset AF in HF patients, which may be involved in the better outcomes with it.
Abstract 12016: Rare Variants in <i>APOE</i> Gene Are Associated With Disease-Onset and Outcomes of Hypertrophic Cardiomyopathy
Authors: Qiya Huang, Channa Zhang, Minjie Lu, Xiaochen Bo, Jizheng Wang, lei song
Journal: Circulation (2023)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and may lead to tragic outcomes such as sudden cardiac death and heart failure. Previous studies have shown that HCM patients undergo significant lipid-related metabolic reprogramming. But whether lipid gene variants affect the diagnosis and prognosis of HCM patients remains unclear. Methods and Results: Whole-exome sequencing was performed in 985 patients with HCM and 759 non-HCM controls to search for lipid gene variants. The APOE rare variants were more prevalent in patients with HCM than controls (odds ratio, 4.91, P &lt; 0.001). Patients with APOE rare variants have higher left ventricular outflow tract gradient (LVOTG) (71.0 VS 38.0 mmHg, P = 0.035), higher triglycerides (1.59 VS 1.32 mmol/L, P = 0.051) and lower lipoprotein a (65.5 vs 113 mg/L, P = 0.076) in peripheral blood. APOE carriers also had elevated free fatty acids in 290 surgically resected myocardial tissue lipidomics data (P = 0.008). With a median follow-up time of 5.10 years, HCM patients with APOE rare variants were more likely to experience cardiovascular death (adjusted HR 4.8, P = 0.001) and all-cause death (adjusted HR 3.5, P = 0.008). Conclusion: Our cohort data indicated that rare variants of APOE are associated with altered lipid metabolism in peripheral blood as well as myocardial tissue, increased LVOTG, and greater risk of HCM disease-onset as well as poor prognosis. We proposed that APOE might be associated with HCM and that its contribution to myocardial hypertrophy through lipotoxicity may be an emerging mechanism for HCM pathogenesis and progression.