tbuckley/cabot-search huggingface dataset:
Abstract 4139079: Procedural Volume and Outcomes After Septal Reduction Therapies in Hypertrophic Obstructive Cardiomyopathy
Authors: Nirav Patel, Naman Shetty, Mokshad Gaonkar, Abdulla Shahid, Girija Divekar, Akhil Pampana, Nehal Vekariya, Li Peng, Mustafa Ahmed, Garima Arora, Pankaj Arora
Journal: Circulation (2024)

Background: Septal myectomy (SM) and alcohol septal ablation (ASA) are preferred modalities for individuals with symptomatic obstructive hypertrophic cardiomyopathy (HCM). Apart from patient-level factors, operator and hospital volume play a role in determining clinical outcomes in patients undergoing septal reduction therapies. However, contemporary data on the influence of operator and hospital volume on clinical outcomes are lacking. Methods: This retrospective study used nationwide data from the Vizient ® from 2016-2022. The appropriate ICD-10 diagnosis/procedure codes were used to identify patients with HCM who underwent SM and ASA. Based on operator and hospital volumes, the cohort was stratified into low-, medium-, and high-volume based on tertiles of annualized procedures. The outcomes of interest were 30-day mortality and 90-day readmissions. Multivariable-adjusted logistic and Cox models were used to assess the association of outcomes with operator and hospital volumes. Results: Among 5,725 HCM patients included in this study, 3,990(69.7%) and 1,735(31.3%) underwent SM and ASA, respectively. Among those who underwent SM, low-(OR adj :1.86;95%CI:1.11–3.15) and medium-(OR adj :1.93;95%CI:1.05–3.55) volume operators were associated with higher odds of mortality compared with high-volume operators.( Table ) Similarly, medium-volume hospitals had higher odds of mortality post-SM compared with high-volume hospitals (OR adj :2.29;95%CI:1.32–3.99).( Table ) Moreover, low-volume operators (HR adj :1.51;95%CI:1.22-1.88) and hospitals (HR adj :1.60;95%CI:1.14-2.23) were associated with greater risk for readmission compared with their high-volume counterparts for SM.( Figure ) Among those who underwent ASA, low-(OR adj :2.99;95%CI:1.15-7.75) and medium-(OR adj :3.86;95%CI:1.30–11.46) operator volume was associated with higher odds for mortality compared with high-volume operators.( Table ) Compared with high-volume operators, the risk of readmission was similar to low-volume operators (HR adj :1.31;95%CI:0.96-1.77).( Figure ) However, hospital volume was not associated with mortality and readmission for ASA. Conclusions: Low operator and hospital volumes for septal reduction therapies were associated with higher postoperative morbidity and mortality compared with their high-volume counterparts. The current study highlights the need to refer HCM patients requiring septal reduction therapies to high-volume centers with experienced operators who have expertise in performing these procedures.
Abstract 4139665: Effects of Various Caffeine Drinks on the Cardiovascular Health of Youth Athletes
Authors: Grace Qiu, Seong Kyu Kim, Douglas Corsi, Imran Masood, Alexander Hajduczok, Brian Osler, Drew Johnson, Renee Langstaff, David Shipon
Journal: Circulation (2024)

Introduction: Caffeine has been associated with both positive and negative impacts on adult athletes. However, the effects of caffeine on youth athletes have not been clearly established. Hypothesis: Cardiac screening findings will vary by caffeine intake. Aims: To assess the impact of different types of caffeinated drinks on youth athletes. Methods: The HeartBytes National Youth Database produced by Simon’s Heart was used for this study. The database contains demographics, exercise-related symptoms, ECG data obtained during Simon’s Heart PPEs, and self-reported data on caffeine intake for soda, energy drinks, tea, and coffee. To investigate the effects of specific caffeinated drinks, we excluded those consuming multiple caffeine drink types from the data set and used propensity score matching to control for confounding variables of race, sex, and exercise intensity. An odds ratio statistic and p-value of 5% criterion were used to evaluate the correlation between caffeine and cardiovascular risk factors. Results: Of the 7425 athletes in the database, the majority were male (60.6%) and White (83.1%). The mean BMI was 21.4 (SD 4.6). The median age was 15.0 years old (IQR 13.5-16.5). Of 1864 athletes taking caffeine drinks, 685, 43, 617, 246 drank only soda, energy drinks, tea, and coffee respectively. Athletes drinking soda had higher odds of diabetes (p=0.041), ADHD (p&lt;0.0001), anxiety or depression (p=0.004) and obesity (p=0.018), but lower odds of asthma (p=0.011) if exercising more than 10 hours/week. Athletes drinking energy drinks had higher odds of hypercholesterolemia (p=0.021) if exercising less than 5 hours/week, and higher odds of murmur if exercising more than 10 hours/week. Athletes drinking tea had higher odds of hypertension (p=0.043), exertional dyspnea (p=0.019), ECG right ventricle hypertrophy (p=0.021), and higher odds of ECG nonspecific ST wave abnormality (p=0.04) if exercising more than 10 hours/week. Athletes drinking coffee had higher odds of exertional syncope (p=0.001), and higher odds of ECG T wave inversion (p=0.038) if exercising more than 10 hours/week. Conclusion: Overall, both tea and coffee drinkers were at higher risk of ECG abnormalities, with higher risk of hypertension and exertional dyspnea in tea drinkers. Coffee drinkers also had higher risk of exertional syncope. Soda drinkers were at higher risk of diabetes and obesity. Further studies are needed to delineate long-term effects of caffeine consumption on youth athletes.
Abstract 4139108: Identifying Predictors of Durable Treatment Response among Patients with Claudication; A Secondary Analysis of the CLEVER Trial
Authors: Firas Hentati, Eric Secemsky
Journal: Circulation (2024)

Background: Symptomatic peripheral artery disease (PAD) is prevalent and targeted therapies include optimal medical care (OMC), supervised exercise therapy (SET) and revascularization (ST). Although most PAD trials focus on objective outcomes, improvement in quality of life is important to the patient. The Supervised Exercise, Stent Revascularization, or Medical Therapy for Claudication (CLEVER) Trial examined longitudinal patient-reported outcomes to assess response to OMC, SET and ST. The predictors of symptomatic improvement have not been fully assessed. Research Question: What are the predictors of symptomatic response to therapy for patients with PAD? Aims: To assess how demographics, comorbidities, and treatment modality predict improvement in patient-reported outcomes as measured by the Peripheral Artery Questionnaire (PAQ). Methods: This is a secondary analysis of the CLEVER trial, which randomized patients with claudication to OMC alone, SET or ST. The primary outcome measure was PAQ at 18 months. Response was defined as a change in the PAQ Summary Score by the minimal clinically important difference (MCID) of ≥10 points compared with baseline. Multivariable logistic regression was used to identify predictors of response. Results: Of the 103 participants (66 male, median age 63 years) included in this analysis, 22 were randomized to OMC, 40 to SET, and 41 to ST. Sixty-five (63%) participants had a decrease in PAQ Summary score of 10 or more points at 6 months. Of 98 participants who completed the 18-month PAQ, 52 (55%) had a response to therapy. Compared to those randomized to OMC, on univariate analyses, participants randomized to SET had a 4.5 (95%CI:1.5-13.6) increased odds of response at 6 months and a 4.2 (95%CI:1.2-15.1) increased odds at 18 months. Those randomized ST had a 6.6 (95% CI:2.1-20.9) and 10.9 (95% CI:2.9-40.6) increased odds of response at 6 and 18 months respectively. When controlling for demographics, comorbidities, and ABI, SET (18-month OR 3.9; 95%CI:1.1-14.7) and ST (18-month OR11.5 95%CI 2.9-45.7) remained associated with symptomatic response at 6 and 18 months. Treatment group was the only independent predictor of clinically meaningful symptomatic improvement. Conclusion: Among randomized patients in the CLEVER trial, treatment with either SET or ST was most predictive of quality life improvement at 6 and 18 months. These interventions, with a prioritization of SET, should be more widely available and offered to symptomatic PAD patients.
Abstract 4139575: Feasibility and safety of left bundle branch area pacing in amyloid light chain cardiac amyloidosis
Authors: Jiaqi Yu, Deyan Yang, Jiaqi Wang, Jingbo Fan, Yongtai Liu, Peng Gao, Hua Deng, Taibo Chen, Zhongwei Cheng, Lihua Zhang, Jinzhi Lai, Xiaohan Qin, Kangan Cheng, Jian Li, Quan Fang
Journal: Circulation (2024)

Background: Left bundle branch area pacing (LBBAP) has been persuasively adopted in clinical practice to achieve electrical and mechanical synchrony of the left ventricle. However, LBBAP in amyloid light chain cardiac amyloidosis (AL-CA) patients has not been studied in detail. Hypothesis: LBBAP could be a feasible and safe approach to rectify the conduction system diseases of AL-CA patients. Aim: To study the feasibility and safety of LBBAP in AL-CA patients. Methods: Consecutive patients with AL-CA and newly implanted pacemaker in our centre between 1st January 2022 and 31st December 2023 were retrospectively included. The diagnosis of AL-CA was confirmed according to the current ESC position statement. Indications for pacemaker fulfilled the current ESC guideline. All patients underwent attempts of LBBAP or right ventricular pacing (RVP) based on operators’ preference. Results: A total of 10 patients were included. RVP was chosen initially in 1 patient and LBBAP was attempted in 9 patients. LBBAP were successfully performed in 6 patients (66.7%, 6/9). Three patients crossed over to RVP group because LBBAP was failed to achieve (Fig.1) . Baseline clinical characteristics and pacing parameters was compared between LBBAP group and RVP group ( Table.1 ). Duration of intrinsic QRS was similar and paced QRS was wider in RVP group ( P =0.029). During follow-up, one patient in LBBAP group died from sudden death 15 days after implantation, while 2 patients in RVP group died from sudden death and pneumonia 55 days and 17 days after implantation, respectively. Seven patients visited our centre at three-month follow-up without adverse events and interrogation reports were summarized in Fig.1 . Conclusion: LBBAP appears to be a reasonable method for physiological pacing for patients with AL-CA and bradycardia, but its impact on long-term prognosis needs further investigation.
Abstract 4139438: Prognostic Value of Cardiopulmonary Exercise Testing in a Contemporary Pediatric Fontan Cohort
Authors: Alan Wang, Garett Griffith, Kendra Ward
Journal: Circulation (2024)

Background: Peak exercise capacity via cardiopulmonary exercise testing (CPET) has been shown to have prognostic significance in adult Fontan patients. Aims: The aim of this study was to determine the role of CPET in predicting death or need for transplantation in pediatric Fontan patients. Hypothesis: We hypothesize that patients with lower baseline exercise capacity would have worse outcomes. Methods: We performed a retrospective review of pediatric patients ≤ 18 years of age who had a lateral tunnel or extracardiac Fontan and underwent a CPET (respiratory exchange ratio ≥ 1.0) and spirometry between 2004 and 2022. Serial analysis was performed for patients with CPETs ≥ 2 years apart. Restrictive lung pattern was categorized as forced vital capacity (FVC) ≤ 80% predicted with a normal or increased forced expiratory volume in 1s (FEV1)/FVC, obstructive pattern as FEV1/FVC ≤ 80% predicted, and mixed pattern as FVC ≤ 80% predicted and FEV1/FVC ≤ 80%. Cardiovascular adverse events (CAE) included mortality or cardiac transplantation. Univariate regression analysis was performed. Results: A total of 114 patients were included. The mean age at baseline CPET was 12.9 ± 2.9 years and average age at Fontan operation was 3.3 ± 1.7 years. The baseline peak oxygen consumption (VO2peak) was 31.7 ± 7.7mL/kg/min (83.5 ± 10.9% predicted) (Table 1). A total of 80/114 patients had reproducible spirometry with 51 (63.8%) being normal, 22 (27.5%) restrictive pattern, 6 (7.5%) obstructive pattern, and 1 (1.3%) mixed pattern. Serial CPETs were performed in 51 of 114 (44.7%) patients with a mean duration between CPETs of 3.5 ± 2.5 years. The percent predicted VO2peak changed by -0.73 ± 5.88% per year. A total of 15 out of 114 patients (13.2%) had CAE over a mean follow up of 7.8 ± 4.7 years. Each 1-minute increase in exercise duration achieved at baseline resulted in a 28.1% risk reduction in CAE. Conclusion: Exercise capacity is maintained during the adolescent years in a contemporary cohort of pediatric Fontan patients. A higher baseline exercise duration is associated with a lower risk for future CAE. A majority of pediatric Fontan patients had normal spirometry.
Abstract 4139474: Safety of Sodium-Glucose Cotransporter-2 Inhibitors Peri-Percutaneous Coronary Intervention: A National Experience
Authors: Alaa Rahhal, Hashim Mohammad, Sham AlKodmani, Firas Hamsho, Wael Hamam, Nawras Al-Tikrety, Noor Moustafa, Yamane Chawa, Barakat Aladwan, Mohamad Wajeh Dulli, Dana Alomari, Mohanad Shehadeh, Ahmed Mahfouz, Sumaya Alyafei, Abdulrahman Arabi, Khaled Mohamed
Journal: Circulation (2024)

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have cardio-renal protection benefits regardless of diabetes status. However, the outcomes of uninterrupted SGLT2i use peri-percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remain uncertain. Therefore, this study aimed to evaluate the safety of SGLT2i use peri-PCI. Methods: We conducted a retrospective observational cohort study that included all patients admitted with ACS who underwent revascularization with PCI at Qatar's main tertiary cardiology center between 1/01/2018 and 31/12/2020. The use of SGLT2i peri-PCI was defined as the established use of SGLT2i before the index admission or early initiation of SGLT2i during the index admission within 24 hours of contrast exposure. The study population was divided into two groups; (1) SGLT2i users; (2) SGLT2i non-users. The primary outcome was the risk of contrast-induced nephropathy (CIN) with SGLLT2i use, defined as an increase in serum creatinine by more than 0.3mg/dL or more than 50% of the baseline value within 48 hours of contrast exposure. A propensity score–matched model (1:1) was used to adjust for baseline characteristics between the study groups. Logistic regression analysis was used with a P-value &lt;0.05, indicating statistical significance. Results: We included 3421 ACS patients who met the eligibility criteria (88% male, mean age 54±10 years, and 59% Asian), with 95 patients classified as SGLT2i users and 3326 as SGLT2i non-users. Using 1:1 propensity score matching, 95 patients were included per arm with an absolute standardized difference &lt;0.1 for all baseline characteristics. The use SGLT2i peri-PCI was not associated with an increased risk of CIN [ before propensity score matching: 4 (4.2%) versus 146 (4.4%), aOR= 1.31 (0.45-3.78), P-value 0.622; after propensity score matching: 4 (4.2%) versus 5 (5.3%), OR= 0.79 (0.21-3.04), P-value 0.733]. Conclusion: Our findings suggest that the uninterrupted use of SGLT2i among patients with ACS undergoing PCI is safe without increasing the risk of CIN, warranting continuation of SGLT2i use or early initiation during ACS.
Abstract 4139663: Impact of Catheter Ablation for Atrial Fibrillation on Clinical Outcomes in Hypertrophic Cardiomyopathy: Findings from the REVEAL-HCM Study
Authors: Kentaro Koyama, Yukichi Tokita, Kakeru Ishihara, Junya Matsuda, Yoshiaki Kubota, yoichi imori, Yuki Iwasaki, Wataru Shimizu, Hiroaki Kitaoka, Yasushi Sakata, Kaoru Dohi, Takao Kato, Shouji Matsushima, Hitoshi Takano, Kuniya Asai, Chisato Izumi
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is the most common arrhythmia associated with hypertrophic cardiomyopathy (HCM), and patients with HCM complicated by AF are known to have a poor prognosis. Although many studies have reported the efficacy of catheter ablation (CA) for AF in various events, a few have shown its efficacy in HCM patients. Moreover, no large-scale, long-term follow-up studies have been conducted. Therefore, we performed a subgroup analysis of the REVEAL-HCM study to evaluate the long-term efficacy of CA for AF in HCM patients. Methods: The REVEAL-HCM study was a retrospective, multicenter, observational longitudinal cohort study that enrolled 3611 consecutive HCM patients aged ≥ 16 years at 23 centers in Japan between January 2006 and December 2018. Of these, patients who either had a medical history of AF or developed AF during the study period were included, excluding those previously treated with CA for AF. Patients were divided into two groups based on whether they received CA post-enrollment. The primary outcome measured was a composite of all-cause death, heart failure hospitalization, and thromboembolism, while the secondary outcomes assessed each of these events individually. Results: Among 1131 HCM patients with AF (67±12 years, 472 females), CA was performed in 284 patients (25%). During a median follow-up of 4.4 years, 455 composite events were observed. Univariate Cox regression analysis showed significantly fewer composite events in the CA group compared to the No-CA group (hazard ratio [HR]: 0.30; 95% confidence interval [CI]: 0.23-0.41; P &lt; 0.001) (Figure). Multivariate Cox regression analysis also demonstrated a significant reduction in composite events (HR: 0.35; 95% CI: 0.25-0.49; P &lt; 0.001). Multivariate Cox regression analysis of the secondary outcomes also revealed significantly fewer events in the CA group for all-cause death (HR: 0.58; 95% CI: 0.34-0.99; P = 0.044), heart failure hospitalization (HR: 0.33; 95% CI: 0.21-0.50; P &lt; 0.001) and thromboembolism (HR: 0.23; 95% CI: 0.10-0.49; P &lt; 0.001). Conclusion: Our study suggests that CA for AF may reduce major clinical events in HCM patients.
Abstract 4139207: Supraselective Administration of Very Low-dose Intracoronary Epinephrine as a Rescue and First-line Drug for the Management of No-reflow in Conjunction With the IIB-IIIA Inhibitor Tirofiban.
Authors: Roberto Correa Bastidas, Roberto Correa Soto
Journal: Circulation (2024)

Background: Occurring in 0.6% to 10% of percutaneous coronary interventions (PCI), no-reflow is a complication associated with poor outcomes like myocardial infarction extension and death. The mechanism behind no-reflow is complex and likely multifactorial, and several drugs have been described for its management including intracoronary epinephrine (ICE) at doses ranging from 50 to 400 µg. Hypothesis: We hypothesize that supraselective administration of ICE at very low doses could be effective in the successful management of no-reflow. Methods: This single-center case series from Bucaramanga, Colombia (August 2021-October 2023) reports on 9 patients with/without ST-segment elevation myocardial infarction who underwent PCI and developed no-reflow. As first-line therapy for no-reflow management, supraselective administration of 5 to 50 µg of ICE was performed through an ad hoc fenestrated angioplasty balloon with a two-way drug perfusion technique (proximal to distal, and distal to proximal) at an approximate rate of 2 µg/min. All patients received a 1000 µg intracoronary bolus of Tirofiban during the procedure, and an IV infusion of 0.15 µg/kg/min was continued up to 24 hours postangioplasty. Results: The mean age of patients was 72.7±10.6 years, and 8 out of 9 patients were male. The mean LVEF was 34±11.3% before PCI. Patients received varying doses of ICE (5, 10, 20, 40 and 50 µg), 7 received it as the first-line treatment, while 2 received it as a second-line option after 360 µg of intracoronary adenosine failed to improve blood flow. TIMI 2 flow (4 patients) and TIMI 3 flow (5 patients) were achieved with no consistent association between higher ICE doses and achieving TIMI 3 flow. All 9 patients were discharged alive from the Cath Lab. However, one patient with LVEF 20% died of pulmonary edema 7 hours postangioplasty. The mean heart rate before and after the procedure was 78±20.8 bpm and 84±18.3 bpm respectively. No severe cardiac arrhythmias were observed. Transient inotropic support with a norepinephrine infusion was needed by 2 patients. Conclusion: The supraselective administration of ICE at very low doses (5-50 µg) resolved no-reflow in 100% of patients with acute coronary syndrome. We propose the use of this drug at very low doses as a first-line therapy for the management of coronary no-reflow, as well as the development of future randomized control trials to evaluate its effectiveness, and compare it to current therapies, in a larger population.
Abstract 4139275: Degree of rurality moderates the association of sedentary behavior with cognitive function in patients with cardiac diseases
Authors: Chin-Yen Lin, Jia-Rong Wu, Geunyeong Cha, Martha Biddle, Misook Chung, Frances Feltner, Mary Kay Rayens, Debra Moser
Journal: Circulation (2024)

Background: Whether there are disparities in cognitive function in individuals living in rural areas compared to urban areas is unknown. Some investigators have found that rural residents have better cognitive function, while others report the opposite. Sedentary behavior is a major risk factor for cognitive health in patients with cardiac diseases; however, little is known about the impact of sedentary behavior on cognitive function at different degrees of rurality. Purpose: The aim of the study was to determine whether degree of rurality moderates the relationship between sedentary lifestyle and cognitive function among rural patients with coronary heart disease or heart failure. Methods: This study includes 135 coronary heart disease or heart failure patients residing in Appalachia (aged 59 ± 12 years, 53% female). Sedentary behavior was measured by the average daily sedentary time (in minutes) using accelerometry (ActiGraph). Cognitive function was assessed using the Montreal Cognitive Assessment-Blind. Rurality was determined by Rural-Urban Commuting Area (RUCA) codes. Participants were categorized into two groups based on degree of rurality: 1) 89 participants were included in a less rural group (RUCA codes 2−3 within Appalachia and RUCA codes 4−6 for micropolitan areas &lt; 50,000 population); and 2) 46 participants were included in a more rural group (RUCA codes 7−10 for small towns &lt; 9,999 population). Data were analyzed using the PROCESS macro in SPSS to test the proposed moderating effect controlling for age, gender, and depressive symptoms. Results: The time spent in sedentary behavior ranged from 3.2 to 13.3 hours per day, with an average of 7.9 ± 2.1 and a median of 7.8 hours per day. Sedentary behavior predicted cognitive function (B = −0.006, p = 0.012), but this relationship was moderated by rurality group (coefficient of rurality group*secondary behavior interaction term = 0.006, p = 0.029). Patients living in more rural areas had significantly worse cognitive function if they were sedentary for longer periods (p = 0.012), but this relationship was not observed in those living in less rural areas (p = 0.986). Conclusions: Although being sedentary is associated with worse cognitive function, degree of rurality significantly interacts with sedentary behavior in this association. Testing the impact of promoting physical activity on cognitive function is warranted in this population, particularly for those living in highly rural areas.