tbuckley/cabot-search huggingface dataset:
Abstract 4147438: Use of Impella RP Flex for Right Ventricular Failure (RVF): A Single Center Review
Authors: Marissa Heyer, Patricia Walters, Scott Stewart, Kanika Mody, David Landers, George Batsides, Yuriy Dudiy, Mark Anderson
Journal: Circulation (2024)

Introduction/Background: Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS). Research Questions/Hypotheses: The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients. Methods/Approach: Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures. Research/Data: Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days. Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%). Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes. Conclusions: The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.
Abstract 4147410: Impact of HIV on In-Hospital Outcomes in STEMI Patients: A Propensity-Matched Analysis from the NIS Database
Authors: Alexandr Ceban, Hafiz Muhammad Waqar Younas, Amro Taha, Fadi Khir, Hafiz Khizer Mubeen, Hafiz Muhammad Umair Younas, Uzair Nisar, Muhammad Naqib Ullah, Nawal Asif, Ammar Mahmoud, Racovita Alexei, Maja Boshkovska Spaseski
Journal: Circulation (2024)

Introduction: Advancements in antiretroviral therapy (ART) have significantly increased the lifespan of patients living with HIV over the past decade. Studies have shown higher mortality and morbidity rates following acute coronary syndrome (ACS) in HIV patients, attributed to traditional cardiac risk factors, psychosomatic illness, metabolic effects of ART, and chronic immune activation caused by HIV. Hypothesis: We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV. Aims: We hypothesized that HIV patients presenting with ACS in the form of STEMI would have poorer in-hospital clinical outcomes compared to patients without HIV. Methods: We queried the National Inpatient Sample (NIS) Database from 2015-2019 using ICD-10 codes to identify STEMI patients with and without HIV. Propensity matching adjusted for confounders. The primary outcome was in-hospital mortality; secondary outcomes included major bleeding, the need for mechanical circulatory support (MCS), and net adverse clinical events (NACE). STATA was used for statistical analysis. Results: A total of 581,859 patients were included in the analysis. Baseline comorbidities are listed in Table 1. STEMI patients with HIV were younger (54±12 vs 63±18 years) and had higher rates of liver disease, renal failure, depression, polysubstance abuse, and a history of MI. After propensity matching, in-hospital mortality was similar between both subgroups (Table 2). No significant differences were found between the subgroups in NACE, need for MCS, and major bleeding. Conclusion: Despite being a strong risk factor for CAD, the presence of HIV did not influence in-hospital clinical outcomes in patients presenting with STEMI. This may reflect improved ACS protocols, advancements in ART, and a younger patient cohort. Additional studies are needed to further validate these findings.
Abstract 4147108: Assessment of Myocardial Strain with Cardiac Magnetic Resonance Imaging in Patients at Genetic Risk of Dilated Cardiomyopathy
Authors: Virimchi Pillutla, Alice Zheng, Vencel Juhasz, Sean Jurgens, Saketh Challa, Joel Ramo, Daria Kramarenko, Mark Daly, Connie Bezzina, Patrick Ellinor, Tomas Neilan, Krishna Aragam
Journal: Circulation (2024)

Background: Genetic risk and myocardial strain have emerged as early indicators of susceptibility to dilated cardiomyopathy (DCM). However, it remains unclear whether these markers are associated with one another and enhance the prediction of incident disease. Aim: We evaluated the interplay between measures of myocardial strain by cardiac magnetic resonance imaging (CMR) and genetic (monogenic and polygenic) risk for DCM, and their capabilities for predicting incident disease. Methods: We performed a retrospective analysis of 39,217 participants in the UK Biobank without cardiomyopathy, heart failure, or valvular heart disease at enrollment. Genetic risk was determined by the presence of a high confidence rare variant across 12 ClinGen-prioritized DCM genes and/or a high DCM polygenic risk score (PRS). CMR-derived measures of left ventricular (LV) myocardial strain, size, and function were obtained. Myocardial strain assessments included LV global longitudinal (GLS), global circumferential (GCS) and global radial strain (GRS). Results: Both monogenic and polygenic risk for DCM were most strongly correlated with LV GCS as compared to LVGLS or LVGRS. Specifically, compared to non-carriers of DCM-rare variants, TTN rare variant carriers (n=139) demonstrated worse LVGCS (-19.79 vs. -22.40, p=1.51e-21). Participants with high DCM polygenic risk also had worse mean LVGCS (top 10% vs. middle 50% of the DCM PRS, -21.43 vs. -22.39, p = 8.06e-53) (Figure 1). In addition, those with a significant relative interval decline in LVGCS (≥ 12%, n=45) had a higher median PRS (0.43 vs. -0.05, p=0.0097) compared to those without (n=177); this relationship was not evident for LV GLS or GRS. Multivariable Cox regression models adjusted for baseline LVEF, age, sex and body mass index showed that both LVGCS (HR=1.56 [1.13–2.14] per standard deviation (SD) of LVGCS, p=0.0065) and DCM PRS (HR=1.52 per SD of PRS [1.19–1.95], p=0.00072) were associated with an increased risk of incident non-ischemic cardiomyopathy (n=67). Conclusion: High genetic risk for DCM is strongly associated with worse LVGCS, and both genetic risk and LVGCS may have value for incident disease prediction.
Abstract 4147328: Adverse Social Determinants of Health in a Low-Income Population Hospitalized with Heart Failure
Authors: Syed Kazim Rizvi, Nidhish Lokesh, Ritika Dhruve, James Miller, Neil Keshvani, Ambarish Pandey
Journal: Circulation (2024)

Background: Heart failure (HF) is a leading cause of hospitalization and readmission. Understanding the burden and impact of social determinants of health (SDOH) among HF patients at safety-net hospitals is critical for improving outcomes. Methods: We conducted a prospective, cross-sectional study to identify the prevalence of adverse SDOH among patients hospitalized with acute HF at an urban, safety-net hospital. English or Spanish-speaking patients hospitalized for HF were enrolled between 11/2022-6/2023. We collected data across 5 SDOH domains based on the Healthy People 2030 SDOH Model from the U.S. Department of Health and Human Services. The overall burden of adverse SDOH parameters and their association with hospitalization or emergency room (ER) visits at 90 days was assessed. Multivariate logistic regression models adjusted for selected covariates from the total pool of demographic, clinical, and social covariates using stepwise regression. Results: 174 individuals were included (mean age 55 y, 73.6% male, 61.5% Black, 20.7% Hispanic). A high adverse SDOH burden was noted, with 60% of patients unemployed, 65% living below 130% of the federal poverty limit, 53% with food insecurity, 49% with low social support, and 40% with housing instability (28% homeless). In multivariate logistic regression (area under the curve (AUC) = 0.80, F1 score = 0.71), increasing comorbidity burden (aOR 4.84, 95% CI 2.04-12.5, p&lt;0.01), being uninsured (aOR 3.57, 95% CI 1.59-8.50, p&lt;0.01), having low social support (aOR 3.06, 95% CI 1.48-6.53, p&lt;0.01), and having dependents (aOR 2.98, 95% CI 1.13-8.38, p=0.03) were associated with increased odds of 90-day readmission or ER visit ( see Table ). Conversely, being employed (aOR 0.22, 95% CI 0.09 – 0.52, p&lt;0.01) and having difficulty paying bills (aOR 0.43, 95% CI 0.20-0.88, p=0.02) were associated with decreased odds of 90-day readmission or ER visit. Conclusions: Hospitalized patients with HF at a safety-net hospital have a high burden of adverse SDOH. Adjusted analysis revealed significant associations of SDOH parameters with 90-day readmission or ER visits, highlighting the need for targeted interventions to recognize and improve adverse SDOH.
Abstract 4146750: Bundle Payment Reimbursements and Atrial Fibrillation Ablation Outcomes: Analysis of Real-World Data
Authors: Cole Howie, Stefano Byer, Ryan Cochran, xPaarix xDominicx
Journal: Circulation (2024)

Background: Bundled payments represent a shift in reimbursement models, promoting value-based care by providing providers a predetermined payment per episode of care rather than fee-for-service. This model incentivizes optimizing patient care while reducing spending on unnecessary tests, treatments, and days hospitalized. Atrial fibrillation (AF) ablation procedures transitioned to bundled payment reimbursements starting January 1, 2022. Research Question: What impact has value-based care made on patient care treatments and outcomes? Methods: This retrospective study utilized the TriNetX Global Research Network to review and compare patient outcomes for AF ablation patients (CPT code 93656) the year leading up to (Jan 1 – Dec 30, 2021) and year subsequent (Jan 1 – Dec 30, 2022) initiation of bundle payments. Propensity score matching was applied to balance cohorts based on demographic characteristics and comorbidities. One-year post-ablation complication rates were analyzed. Results: Propensity score matching of the pre-bundle (N = 14,690) and post-bundle cohorts (N = 16,734) resulted in 14,687 patients from 91 U.S. healthcare organizations. The post-bundle cohort suffered a lower prevalence of circulatory system diseases (ICD-10 code I00-I99) compared to the pre-bundle cohort (91.2% vs 92.4%, p&lt;0.001). The post-bundle cohort was less likely to undergo ablations for subsequent tachyarrhythmias (1.9% vs 2.5%, p=0.006) and lower stroke rates one-year post-ablation (3.3% vs 3.8%, p=0.013). Conclusion: The transition to bundle payment reimbursements for AF ablation procedures was associated with a significant reduction in post-ablation stroke rates and a reduced likelihood of undergoing additional ablations for tachyarrhythmias. Future studies should focus on financial analyses of the AF ablation bundles to further optimize care under this reimbursement model.
Abstract 4146968: The Impact of Weight Loss Following Bariatric Surgery on Regression in Cardiovascular-Kidney-Metabolic Syndrome
Authors: Ebenezer Aryee, Bige Ozkan, Peter Benotti, Xin Chu, G Craig Wood, Radhika Rajgopal Singh, Ron Hoogeveen, Gary Gerstenblith, Elizabeth Selvin, Josef Coresh, Chiadi Ndumele
Journal: Circulation (2024)

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome reflects the interrelatedness of cardiovascular, kidney, and metabolic disease, with excess/dysfunctional adiposity as the predominant etiology. The CKM staging framework facilitates assessment of progression, as well as regression, of CKM syndrome stages. However, the impact of intentional weight loss on CKM stage regression has not been quantified. Methods: We prospectively evaluated 360 bariatric surgery patients in the Geisinger Obesity Institute Registry free of cardiovascular disease. Data were collected pre-operatively, and 6-18 months post-operatively. CKM syndrome stage was defined as Stage 0: no CKM risk factors; Stage 1: excess/dysfunctional adiposity (body mass index &gt;= 25kg/m 2 or fasting blood glucose [FBG] 100-125mg/dL); Stage 2: metabolic risk factors (high blood pressure [&gt;= 130/80mmHg], diabetes [FBG &gt;= 126mg/dL], hypertriglyceridemia [&gt;= 135mg/dL]), or chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] 30 - &lt;60mL/min/1.73m 2 ); and Stage 3: moderate-to-severely elevated high-sensitivity cardiac troponin I levels (&gt;= 4 ng/L in women or &gt;= 6 ng/L in men) or very high-risk CKD (eGFR &lt; 30 mL/min/1.73m 2 ). We compared the distribution of CKM stages pre- and post-surgery, and used logistic regression and cubic splines to assess the association of weight loss with odds of regressing to a lower CKM syndrome stage over time. Results: The mean age was 46 years (83% women, 95% White, mean BMI 46 kg/m 2 ). On average, participants lost 28% of their baseline weight. During follow-up, there was a decrease in the proportion with CKM stage 3 (20% to 12%) and stage 2 (65% to 41%), with an increase in stage 1 (15% to 42%). CKM Stage 0, non-existent pre-surgery, was seen in 5% of participants post-surgery. Overall, 45% regressed in CKM syndrome stage (Panel A). In logistic regression, there was a linear relationship between weight loss and odds of CKM stage regression (Panel B), with each 10% greater weight loss associated with an OR of 1.91 (95% CI 1.45-2.50) for CKM stage regression. Conclusion: Weight loss is strongly linked to CKM stage regression, underscoring the role of intentional weight loss in improving CKM health.
Abstract 4147434: Efficacy and Safety of Tirofiban for the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)
Authors: Muhammad Ayyan, Adeel Ahmad, Samratul Fuadah, wasid bin showkat, Dorothy Bullecer, Thahsin Taikadan, Sarika Mutyala, Cara Mohammed, Abimbola Hussein, Julie Anne de Lima Loiola, Mary Gabrielle Te Chy
Journal: Circulation (2024)

Background: Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used after ischemic episodes like stroke or acute coronary syndromes. We are assessing the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke. Methods: A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 yielded randomized controlled trials (RCTs) comparing Tirofiban and control in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure. Results: A total of eight RCTs with 3678 patients were included in our meta-analysis. According to our meta-analysis, the Tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.14; CI = 1.05-1.25; I 2 = 38%). We found no difference between the two groups regarding excellent outcome (mRS score 0-1) at 90 days (RR 1.15; CI = 0.99-1.33; I 2 = 51%) and mortality (RR 0.86; CI = 0.50-1.46; I 2 = 56%). The tirofiban group did not increase the incidence of both intracranial hemorrhage (ICH) (RR 1.23; CI = 1.04-1.46; I 2 = 0%) and symptomatic ICH (RR 1.41; CI = 0.93-2.14; I 2 = 0%). Conclusion: According to our analysis of acute ischemic stroke patients, Tirofiban increased the number of patients with functional independence with no increase in adverse events as compared to the control group. Large-scale RCTs are needed to better ascertain the role of Tirofiban in acute ischemic stroke.
Abstract Sa304: Breaking New Ground in Prehospital Medicine: The Impact of Prehospital ECPR in Japan - A 14-Patient Case Study
Authors: KENSUKE FUJITA, Yoshihiro Hagiwara, Takayuki Ogura
Journal: Circulation (2024)

Background: Since January 2022, our emergency medical center has operated a prehospital extracorporeal cardiopulmonary resuscitation (ECPR) system. The ECPR team is dispatched for suspected CPA cases. Criteria for ECPR on the scene include patients aged 65 or younger with an initial rhythm of shockable or PEA. Additionally, witness presence, bystander CPR, and blood gas analysis are considered. Due to the difficulty in obtaining accurate on-scene information, the Sign of Life (SOL) is crucial. Cannulation is performed in a mobile ICU under mechanical CPR, with ultrasound-guided cannulation as the first choice. Once ECMO is established, systemic O2/CO2 optimization using a gas blender and rapid initiation of targeted temperature management (TTM) at 34°C are performed. This is the only system in Japan systematically performing prehospital ECPR for all OHCA cases, known as the "Utsunomiya model." Objective: To evaluate the outcomes and feasibility of prehospital ECPR at our facility in Japan. Methods: This retrospective case series included patients who underwent prehospital ECPR between January 2022 and May 2024. The primary outcome was favorable neurological outcome, and secondary outcomes included 28-day survival and complications. Results: The prehospital ECPR system responded to 113 calls, resulting in 14 cases where ECPR was performed (11 identified as CPA by dispatchers, and 3 as non-CPA). The average patient age was 59 years, 85.7% were male, 64.3% had witnessed arrests, and bystander CPR was performed in 71.4% of cases. SOL was present in 57.1%, with initial rhythms: shockable in 28.6%, PEA in 50%, and asystole in 21.4%. ECMO-related metrics included a no-flow time of 2.5 minutes and a low-flow time of 33 minutes. Cannulation was performed percutaneously under ultrasound guidance, with an average cannulation time of 9.5 minutes. Favorable neurological outcomes were achieved in 28.6% of cases, with a 28-day survival rate of 64.3% and a complication rate of 0%. Among cases with SOL, the 28-day survival rate was 87.5%, and favorable neurological outcomes were 50%. Of the four cases with favorable outcomes, one had a shockable rhythm, two had PEA, and one had asystole, all with SOL. Conclusion: Prehospital ECPR is a feasible intervention within the Japanese emergency medical system, demonstrating promising outcomes. Further studies are required to optimize patient selection and procedural protocols to improve results.
Abstract 4147456: Serum and Glucocorticoid Regulated Kinase 1 (SGK1) Inhibition Induces Anti-Fibrotic and Anti-Inflammatory Responses: Relevance to Cardiac Fibrosis
Authors: Delphine Labit, Maroua Khalifa, Shannon Hewgill, Marc Vidal, Dinesh Srinivasan, Debra Odink, Saumya Das, Eric Campeau
Journal: Circulation (2024)

Background: Cardiac fibrosis is a condition characterized by deposition of extracellular matrix proteins and myofibroblasts, leading to scar formation, cardiac dysfunction and arrhythmogenesis. Various cardiometabolic stressors can promote fibrosis and scarring, including MI, hypertension, diabetes and obesity. Targeted therapy to prevent cardiac fibrosis is therefore an important unmet medical need. In a mouse model of obesity-related atrial fibrillation (AF), inhibition of SGK1 reduced markers of inflammation and fibrosis, suggesting SGK1 as a novel target. Several SGK1 inhibitors are being evaluated in clinical studies for the treatment of long QT syndrome, paroxysmal AF, and heart failure. Hypothesis: SGK1 activation is a significant driver of inflammation and fibrosis, and its inhibition may offer a new therapeutic strategy for treating fibrotic diseases, including those of the cardiovascular system. Methods: Primary hepatic stellate cells, lung fibroblasts, and proximal tubule cells were treated with TGFβ for 24-48 hours to induce fibrosis and measure the effects of SGK1 inhibition on markers of fibrosis (alpha SMA and collagen 1). Three, selective and potent, SGK1 inhibitors (SGK1-I 1,2,3) were tested in a BioMAP fibrosis panel at concentrations ranging from 0.3 to 10 µM. The fibrosis panel includes three systems that model TGFβ and TNFα driven myofibroblast differentiation during chronic inflammation and wound healing. Markers of fibrosis, tissue remodeling, myofibroblast activation, and inflammation were measured quantitatively. IC50s were determined using GraphPad Prism. Results: In primary human stellate cells, SGK1-I,1,2,3 inhibited αSMA and collagen 1 mRNAs with IC50s ranging from 0.1- 0.8 µM and 1.0-3.0 µM, respectively. In primary lung fibroblasts, treatment with SGK1-I reduced the mRNA and protein expression of αSMA. Treatment of cells from different tissues with TGFβ resulted in a 1.5-to-3.0-fold increase in SGK1 mRNA and protein and this was blocked by the TGFβ receptor inhibitor SB525334. SGK1 inhibitors displayed anti-inflammatory and anti-fibrotic properties in the BioMAP panel, with inhibition of IL-6, IL-8, MCP-1, and αSMA, collagen 1, and TIMP1 respectively. Conclusion: SGK1 is an important effector of TGFβ signaling. The development of SGK1 inhibitors may represent a new therapeutic strategy for treating fibrotic diseases. Additional studies are warranted to further evaluate novel SGK1 inhibitors in cardiac fibrosis