tbuckley/cabot-search huggingface dataset:
Abstract 4143305: Risk Factors for Adverse Outcomes in a Fontan Population
Authors: Giancarlo Licitra, Lindsey Ivey, Cheryl Raskind-Hood, Fred Rodriguez, Yuting Guo, ABEED SARKER, Wendy Book
Journal: Circulation (2024)

Introduction/Background: Improved survival following Fontan surgery has been tempered by Fontan failure. Heterogenous multi-organ complications varying over time have limited study of Fontan failure. We sought to identify complications associated with hospitalization. Methods/Approach: A retrospective cohort of 735 pediatric and adult Fontan patients were identified from two healthcare systems (median age 7yrs, IQR 14, 57.4% male, 41.0% black). The deduplicated cohort was linked to 2010-2019 encounters from both healthcare systems (one pediatric, one adult) and to death certificates to capture vital status. ICD-9-CM and ICD-10-CM codes were mapped by clinicians to capture variables of interest. Bivariate analyses were conducted to examine select covariates by the composite outcome which includes heart transplant, hepatocellular carcinoma (HCC) and death during the surveillance period; group differences were examined using chi-square, Fisher exact and independent t-tests. Negative binomial regression evaluated the association between select characteristics and hospitalization rates with adjustment. Results/Data: Of 735 Fontan patients,11.6% experienced the primary outcomes (median age 14yrs, IQR 17). Characteristics significantly associated with the composite outcome included older age, dysrhythmia, liver disease, cyanosis and heart failure (Table 1). Modeling showed increased rates of hospitalization for children with dysrhythmia (RR=1.43, 95%CI 1.13-1.80) and cyanosis (RR=2.32, 95%CI 1.78-3.03) adjusting for potential confounders (Table 2). This association remained for adults, however, after adjustment, the association of cyanosis and hospitalization rate was attenuated. Conclusion: Fontan patients with dysrhythmia, liver disease, cyanosis and heart failure are at an increased risk for heart transplant, HCC, and death, and have higher hospitalization rates. Incorporation of these factors into the definition of Fontan failure may help early identification and intervention.
Abstract 4143328: Safety of Direct current cardioversion without pre-cardioversion imaging in patients presenting post percutaneous left atrial appendage occlusion
Authors: Ali Bahbah, Dawn Witt, Susan Casey, Melanie Kapphahn-Bergs, Emily Halvorson, Raed Abdelhadi, Jay Sengupta
Journal: Circulation (2024)

Background: Direct current cardioversion (DCCV) carries a risk of stroke in atrial fibrillation (AF) patients. Hence, published guidelines for mitigating this risk with oral anticoagulation (OAC). There is no consensus agreement on the safest approach when cardioverting patients with left atrial appendage occlusion device in situ. Aims: We aimed to compare association of pre-DCCV imaging with safety and outcomes in patients with WATCHMAN™ undergoing elective DCCV for atrial arrhythmias (AA) Methods: This was a retrospective cohort study of patients who received DCCV for AA during follow up after LAAO procedure from 2016-2024 within a large health care system. Safety endpoint was freedom from stroke, all-cause mortality, device embolism, and systemic embolism within 30-days post DCCV. Significant peri-device leak (PDL) was defined as &gt; 5mm on cardiac imaging. Results: A total of 119 patients were included, more females 70 (59%), with more than half (64 (54%)) receiving a first-generation WATCHMAN™ 2.5, while the rest had WATCHMAN FLX™. Median age at presentation was 77 years (72,82), BMI of 31 kg/m2 (26,37), average CHADSVASC score of 4.5 and HASBLED score of 3. There was a median duration of 10 months (3,21) between LAAO to presentation for DCCV . Forty-four (37%) patients had pre-DCCV imaging, while 75 patients did not receive pre-procedural imaging. Between the two groups, there was no significant difference in OAC (VKA-antagonist/DOAC) usage prior to presentation (8 (18.6%) vs 12 (16.4%), P=0.9), with single antiplatelet therapy was the prevalent anti-thrombotic regimen. There was no significant difference in CHADSVASC, HASBLED, age, LVEF, or timing of presentation relative to the LAAO procedure. Higher percentage of patients were discharged on OAC post DCCV in the imaging cohort (13 (30.2%) vs 14 (19.4%), p=0.27), the difference was not significant. No Device related thrombus (DRT) nor significant PDL was detected on imaging. But non-significant PDL ranging from 2mm-4.7mm was found in 8 (18.1%) out of 44 patients who had imaging prior to DDCV. Safety endpoint was achieved in both cohorts with zero adverse events occurring during the 30 day follow up period post-DCCV. Conclusion: Elective cardioversion for atrial arrhythmias is safe in patients with WATCHMAN™. There were no post-DCCV stroke events in the overall cohort and no DRT identified in the pre-DCCV imaging subgroup. Further studies are needed to determine when pre-DCCV imaging is warranted in this population.
Abstract 4143363: Direct Left Ventricular Unloading Vs Counter Pulsation Support Exhibits Differential miRNA Expression In The Left Ventricle Of Cardiogenic Shock Patients
Authors: Muthu Kumar Krishnamoorthi, Khush Patel, Arvind Bhimaraj
Journal: Circulation (2024)

Background: Various temporary mechanical circulatory support device (t-MCS) options are available for supporting patients in cardiogenic shock. While each device has a different physiological impact on the heart, limited studies compare genetic changes in the heart t-MCS. Here, we compare the impact of a percutaneous left ventricular assist device (pVAD) vs an Intra-aortic balloon pump (IABP) on miRNA expression of the left ventricle in patients being bridged to cardiac replacement. Hypothesis: Difference in genetic signature exists between patients treated with pVAD vs IABP Methods: Myocardial tissue was collected at the time of cardiac surgery from 4 patients bridged with a pVAD (Impella 5.5) and 4 bridged with IABP. Samples from each strategy of support were combined. Bulk sequencing was performed on an Illumina Hiseq 4000. Raw data was processed to identify unique sequences with lengths of 18-26 nucleotides and were mapped to miRBase to identify known and novel microRNAs (miRs). Results: The top upregulated (Fig. 1A) and downregulated (Fig. 1B) miRs had functionality related to endothelial pathology and cell transitions (miR 422,378 &amp;92a, miR-653, miR-144). For example, miR 21 has been shown to represent a pathogenic state in cancer and cardiac disease and was found to be significantly lower in heart failure patients supported with pVAD when compared to patients supported with IABP. Gene set enrichment analysis of all the downregulated miRs was performed using miRNA enrichment analysis and annotation tool (miEAA). UpSet plots (Fig. 1C) of the downregulated miRs exhibited a regulatory role in inflammatory and cancer-based genes. KEGG enrichment analysis of target genes of the differentially expressed miRs exhibited that 1000 genes were associated with metabolic pathways (hsa01100), followed by 500 genes in cancer pathways (hsa05200) (Fig. 1D). Conclusion: Our results suggest that direct cardiac unloading using a p-VAD might have a better improvement of the pathological milieu of heart failure when compared to counter-pulsation unloading. The choice of t-MCS to support myocardial recovery might be important. Our future work will include a prospective study with temporal evaluation of patient’s blood for miRNA profiling.
Abstract 4143193: Integrating Clinical, Genetic, and Electrocardiogram-Based Artificial Intelligence to Estimate Risk of Incident Atrial Fibrillation
Authors: Shinwan Kany, Joel Rämö, Samuel Friedman, Lu-Chen Weng, Min Seo Kim, Akl Fahed, Steven Lubitz, Anthony Philippakis, Mahnaz Maddah, Patrick Ellinor, Shaan Khurshid
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) risk estimation is feasible using clinical factors, inherited predisposition, and artificial intelligence (AI)-enabled electrocardiogram (ECG) analysis. Whether integrating these distinct risk signals improves AF risk estimation is unknown. Methods: In the UK Biobank prospective cohort study, we estimated AF risk using three models derived from external populations: the well-validated Cohorts for Aging in Heart and Aging Research in Genomic Epidemiology AF (CHARGE-AF) clinical score, a published AI-enabled ECG-based AF risk model (ECG-AI), and a 1113667-variant AF polygenic risk score (PRS). We estimated discrimination of 5-year incident AF using time-dependent area under the receiver operating characteristic (AUROC) and average precision (AP). Results: Among 49,293 individuals (mean age 65±8 years, 52% women), 825 (2.4%) developed AF within 5 years. Using single models, discrimination of 5-year incident AF was higher using ECG-AI (AUROC 0.705 [95%CI 0.686-0.724]; AP 0.085 [0.071-0.11]) and CHARGE-AF (AUROC 0.785 [0.769-0.801]; AP 0.053 [0.048-0.061]) versus the PRS (AUROC 0.618, [0.598-0.639]; AP 0.038 [0.028-0.045]). The best performing two component model was CHARGE-AF+ECG-AI (AUROC 0.802 [0.786-0.818]; AP 0.098 [0.081-0.13]), with further improvement observed with inclusion of all components (“Total-AF”, AUROC 0.817 [0.802-0.832]; AP 0.11 [0.091-0.15], p&lt;0.01 vs CHARGE-AF+ECG-AI). Using Total-AF, individuals at high AF risk (i.e., 5-year predicted AF risk &gt;2.5%) had a 5-year cumulative incidence of AF of 5.83% (5.33-6.32). At the same threshold, the 5-year cumulative incidence of AF was progressively higher according to the number of models predicting high risk (zero: 0.67% [0.51-0.84], one: 1.48% [1.28-1.69], two: 4.48% [3.99-4.98]; three: 11.06% [9.48-12.61]. Total-AF achieved favorable net reclassification improvement compared to both CHARGE-AF+ECG-AI (0.039 [0.015-0.066]) and CHARGE-AF+PRS (0.033 [0.0082-0.059]). Conclusions: Integration of clinical, genetic, and AI-derived risk signals improves discrimination of 5-year AF risk over individual components. Models such as Total-AF have potential to improve the prioritization of individuals for AF screening.
Abstract 4143377: Higher Intraoperative Blood Pressure Targets Are Associated with Reduced Delirium After Cardiac Surgery
Authors: Mostafa Abbas, Thomas Morland, ROHIT SHARMA, H Lester Kirchner, Scott LeMaire, Yasser El-Manzalawy
Journal: Circulation (2024)

Background: Intraoperative hypotension has been associated with several adverse outcomes including postoperative delirium (POD). While current guidelines recommend an intraoperative mean arterial pressure (MAP) above 65 mmHg during non-cardiac operations, there is no clear consensus regarding the optimal MAP threshold for cardiac surgery patients. We aim to determine an intraoperative MAP threshold that is associated with a reduced risk of delirium following cardiac surgery. Methods: We established a retrospective observational cohort of adult patients who underwent cardiac surgery within our healthcare system between 2014 and 2021. After excluding patients with preoperative delirium or with no documented Confusion Assessment Method for the ICU (CAM-ICU) result, the final cohort included 4,060 patients. Delirium was defined as a positive CAM-ICU test in a patient with a Richmond Agitation-Sedation Scale (RASS) &gt;= -3. Intraoperative hypotension was defined as the number of MAP measurements below a threshold, k , normalized by the total number of MAP measurements. We experimented with k = 55, 60, 65, …, and 85 mmHg. Separate multivariable logistic regression analyses were conducted for each threshold, k , to investigate its association with POD. Results: POD was documented in 369 patients (9.1%). Patients with POD had higher median age (70 vs 66 years, p&lt;0.001), CHA2DS2VASC score (4 vs 3, p&lt;0.001), and surgery duration time (4.4 vs 3.8 hours, p&lt;0.001). Multivariable regression analysis, summarized in Table 1, showed that intraoperative MAP values below 75 mmHg were consistently associated with increased risk for POD. The number of drops in intraoperative MAP measurements below 75 mmHg was associated with higher risk of POD (adjusted OR=2.17, p=0.010), while the number of drops in intraoperative MAP measurements below 80 mmHg was not significantly associated with higher risk of POD (adjusted OR=1.65, p=0.147). Conclusions: Our results suggest that using a threshold of 75 mmHg for intraoperative MAP during cardiac operations may reduce the incidence of POD. Further research, including prospective clinical studies, is needed to validate and ensure the generalizability of our findings across diverse patient populations.
Abstract 4143356: Validation of a High Bleeding Risk Definition in Cancer Patients Undergoing Percutaneous Coronary Intervention
Authors: Mauro Gitto, Sean Gilhooley, Kenneth Smith, Birgit Vogel, Benjamin Bay, Prakash Krishnan, Joseph Sweeny, ANGELO OLIVA, Pedro Moreno, Pier Pasquale Leone, Francesca Di Muro, Parasuram Krishnamoorthy, Samantha Sartori, Annapoorna Kini, George Dangas, Roxana Mehran, Samin Sharma
Journal: Circulation (2024)

Background: Currently, there are no validated tools to stratify bleeding risk in cancer patients undergoing percutaneous coronary intervention (PCI). The presence of cancer itself is considered a major high bleeding risk (HBR) feature according to the Academic Research Consortium (ARC) definition. However, cancer creates a hypercoagulable state and predisposes patients to thrombotic complications as well as bleeding. Hypothesis: A dedicated HBR definition for cancer patients undergoing PCI could be useful to identify subjects at higher risk of adverse events. Aims: To validate an adapted version of the ARC-HBR criteria in patients with cancer undergoing PCI. Methods: Consecutive patients with a history of cancer undergoing PCI between 2012 and 2022 at a tertiary care center (Mount Sinai Hospital, New York, US) were included. According to our adapted definition, patients were considered at HBR if they met at least one of the major ARC-HBR criteria (other than cancer) or two minor criteria. The primary endpoint was a composite of periprocedural in-hospital or post-discharge bleeding at 1 year. The key secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE) consisting of death, myocardial infarction, or stroke. Results: Of the 2,007 cancer patients included in this study, 1,142 (56.9%) were classified as HBR. Moderate to severe anemia was the most prevalent major HBR criterion ( Figure 1 ). At 1 year, the incidence of bleeding was significantly higher in HBR compared to non-HBR patients (10.9% vs. 3.9%, adj. HR: 2.10, 95% CI: 1.39-3.18, p&lt;0.001), mainly driven by a higher risk of periprocedural bleeding (7.4% vs. 2.4%, p&lt;0.001). Similarly, HBR patients were at higher risk of MACCE (11.0% vs. 3.2%, adj. HR: 2.33, 95% CI: 1.44-3.78, p&lt;0.001) and death (8.8% vs. 2.2%, adj. HR: 2.59, 95% CI: 1.45-4.61, p=0.001) than non-HBR ones. Conclusions: An adapted version of the ARC-HBR definition, in which cancer is not a major criterion, effectively delineates cancer patients undergoing PCI who are at HBR. Cancer patients at HBR, according to this definition, also exhibit a higher risk of thrombotic events and mortality.
Abstract 4143441: Variation in Hypertensive Blood Pressure and Association with Body Mass Index in a Disaggregated Population of Asian and Pacific Islander Adolescents
Authors: Veronica Njuguna, Sherry Zhang, Jeanne Darbinian, Nirmala Ramalingam, Sahar Naderi, Edward Shin, Joan Lo
Journal: Circulation (2024)

INTRODUCTION In the United States, 3 million children have hypertension (HTN), a cardiovascular disease (CVD) risk factor. However, blood pressure (BP) findings in specific Asian ethnic populations remain understudied. This study examines the prevalence of HTN-range BP among subgroups of Asian and Pacific Islander (API) adolescents. Methods: In a cohort of 88,145 API adolescents aged 13-17y with a well child visit in 2013-2019, systolic and diastolic BP and body mass index (BMI) were examined. Those with underweight BMI were excluded. The prevalence of BP ≥130/80 (HTN-range BP) was examined by API ethnicity. Covariates included age, sex, BMI category, and neighborhood deprivation index (NDI). Multivariable logistic regression examined the association of API ethnicity with HTN-range BP, providing adjusted odds ratios (OR) with [95% confidence intervals]. Results: The cohort included 11,694 Chinese, 17,279 Filipino, 5,342 South Asian, 3,495 Southeast Asian, 4,051 Native Hawaiian/Pacific Islander (NHPI) and 46,284 of other/unknown API ethnicity. Mean age was 14.3±1.4y; 50% were female. Prevalence of HTN-range BP was highest for NHPI (11.8%) followed by Filipino (9.6%), and lowest for Southeast Asian (7.0%), Chinese (7.1%), and South Asian (7.6%) adolescents. The proportion with obesity also varied, ranging from 6.5% (Chinese) to 11.3% (South Asian), 12.1% (Southeast Asian), 17.7% (Filipino) and 29.5% (NHPI). Accounting for age, sex, and NDI quartile (Chinese as reference), NHPI (OR 1.54 [1.36-1.74]) and Filipino (OR 1.27 [1.16-1.39]) adolescents had higher odds of HTN-range BP while South Asian (OR 1.10 [0.97-1.24]) and Southeast Asian (OR 0.92 (0.79-1.07]) did not. After adjusting for BMI, the odds of HTN-range BP did not differ for NHPI (OR 1.03 [0.90-1.16]) and Filipino (OR 1.04 [0.95-1.14]) vs Chinese adolescents, but Southeast Asian adolescents had lower odds (OR 0.84 [0.72-0.98]). Sex (OR 1.7 [1.6-1.8]) and BMI (OR ranged from 1.9 [1.8-2.1] to 5.8 [5.3-6.3] in adolescents with overweight and severe obesity) were strongly associated with HTN-range BP. DISCUSSION The higher odds of HTN-range BP among Filipino and NHPI compared Chinese adolescents were largely attributable to higher BMI, suggesting that BMI may be an important factor in elevated BP among these high-risk Asian subgroups during adolescence. Efforts focused on pediatric obesity management, including lifestyle intervention, may be integral to reducing HTN and CVD risk prior to adulthood.
Abstract 4143303: Association of Preeclampsia with Long-Term Coronary Microvascular Dysfunction Utilizing Cardiac Stress Magnetic Resonance Imaging
Authors: Rukmini Roy, Haonan Wang, Sherry Huang, Iva Minga, Shuo Wang, Meaghan O'Hara, Maxine Tang, Jeremy Slivnick, Tamar Polonsky, Sarosh Rana, Roberto Lang, Amit Patel, Sajid Shahul, Hena Patel
Journal: Circulation (2024)

Introduction: Preeclampsia is a hypertensive disorder of pregnancy associated with cardiovascular disease. Systemic peripartum microvascular alternations have been implicated in pregnancies complicated by preeclampsia. Whether coronary microvascular dysfunction is a potential mediator of preeclampsia-associated cardiovascular risk is unknown. We aimed to determine whether individuals with a history of preeclampsia have coronary microvascular dysfunction measured by cardiac magnetic resonance imaging (CMR) at least 5 years postpartum. Methods: Women with singleton pregnancies complicated by preeclampsia and a comparator group with uncomplicated, normotensive deliveries were identified and prospectively enrolled to undergo regadenoson stress perfusion CMR (1.5T Signa Artist GE HealthCare) at least 5 years postpartum. Using the dual sequence technique, fully quantitative perfusion values were determined using Fermi deconvolution. Myocardial perfusion reserve (MPR) was calculated as the ratio of stress to rest myocardial blood flow (MBF). Results: Twenty-three subjects (41.0 ± 6 years, 12.7 ± 5 years post-partum) were included. Women with a history of preeclampsia (n=11) were compared to a control group of women with prior normotensive pregnancy (n=12) ( Figure 1A ). Obesity and diabetes were more common with preeclampsia, but there was no significant difference in the presence of hypertension between the groups (Table 1A). There was no difference in stress MBF. However, preeclampsia was associated with higher rest MBF (1.47 ± 0.54 mL/g/min vs. 1.19 ± 0.29 mL/g/min; p=0.07) and MPR (1.96 ± 0.46 vs 2.66 ± 1.0; p=0.02) compared to normotensive pregnancy ( Figure 1 ). Similarly, corrected MPR remained significantly lower with prior preeclampsia versus uncomplicated pregnancy (2.36 ± 1.0 vs 3.36 ± 1.46; p=0.03). Conclusions: In this study, we observed significantly reduced coronary microvascular function following a pregnancy complicated by preeclampsia at least 5 years postpartum. Heightened cardiovascular risk factors may attenuate this association; however, these observations indicate that systemic microvascular dysfunction in preeclampsia also involves the coronary microcirculation. Further research is needed to better understand the timing and association of these microvascular changes concerning preeclampsia and later heart disease.
Abstract 4143329: Moderate renal dysfunction is independently associated with increased risk of sudden cardiac arrest but only in males
Authors: Thien Tan Tri Tai Truyen, Audrey Uy-Evanado, Harpriya Chugh, Kyndaron Reinier, David Charytan, Sumeet Chugh
Journal: Circulation (2024)

Introduction: Moderate renal dysfunction is independently associated with increased cardiovascular mortality. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) mortality. However, there is a lack of population based studies evaluating a potential association between moderate CKD and SCA. Hypothesis: Moderate CKD is associated with SCA in the general population. Methods: We conducted a case-control study from an ongoing, prospective community-based study of SCA in the US Northwest (catchment population ~1 million; 2002-2020). Cases were individuals who suffered SCA aged 40 to 85 years, who had detailed medical records available, and serum creatinine levels measured before their SCA event. Control participants had no history of SCA and were recruited from the same geographical area. Cases and controls were frequency-matched by age and sex in a 3:1 ratio. Moderate CKD was defined as eGFR 30 to &lt;60 mL/min/1.73 m 2 using the CKD-EPI 2021 formula. Results: We compared 2729 SCA cases and 1097 controls, with mean ages of 65.9 and 66.4 years, and male percentages of 68.6% and 66.1%, respectively. SCA cases had higher proportion of moderate CKD (22.8 vs. 18.0%, p=0.001) and lower eGFR (69.3 [44.8-89.7] vs. 77.6 [63.6-90.7] mL/min/1.73 m 2 , p&lt;0.001) than controls. Multivariable regression analysis adjusted for demographics (age, sex, race) and comorbidities showed that both moderate and severe CKD were independent risk factors for SCA with an odds ratio (OR) of 1.43 (95% confidence interval (CI) 1.16-1.76) and 4.94 (95% CI 3.29-7.39), respectively. Moderate CKD was associated with SCA in male (OR 1.65, 9% CI 1.26-2.166) but not female individuals (OR 1.11, 95%CI 0.78-1.57) whereas SCA risk was similarly increased for men and women with more severe CKD. These findings were consistent across different high-risk populations (Figure). Conclusion: Both moderate and severe CKD are associated with SCA in the general population, but females with moderate CKD appear to be protected. These findings of possible renal involvement in SCA, even during early stages of CKD, warrant further investigation.