tbuckley/cabot-search huggingface dataset:
Abstract 15795: Outcomes After Cardiac Implantable Electronic Devices Among People With and Without HIV
Authors: Sophia Y Xiao, Anjali Thakkar, Yifei Ma, Matthew S Durstenfeld, Priscilla Y Hsue
Journal: Circulation (2023)

Introduction: The long-term outcomes of cardiovascular implantable electronic devices (CIED) in people with HIV (PWH) is unknown despite higher rates of sudden cardiac death and heart failure in HIV. Objective To compare outcomes between PWH and the general population who have CIEDs. Methods: Retrospective cohort study of patients receiving care at two academic hospitals in San Francisco who got CIEDs (pacemaker, implantable cardioverter defibrillator, cardiac resynchronization therapy ± defibrillator) from 2000-2018. Since CIEDs were rarer in PWH than in those without HIV, we also did a nested case-control study. Case and controls were matched by age, sex, and CIED type. Death data was obtained from the National Death Index. Results: We identified 3,268 patients who got CIEDs; 1% was PWH. In PWH at CIED implantation, mean HIV duration was 19 years, mean CD4 count was 449 cells/uL, 78% had undetectable viral loads, and all were on antiretroviral therapy. PWH were younger than the control (mean age 62 vs. 69 years, p &lt; 0.01). Both groups had similar rates of hypertension, diabetes, CAD, smoking, and drug use, but more PWH had hepatitis C than the control (25% vs. 3.0%, p &lt; 0.01). Both groups had a similar number of pacemakers (56% vs. 58%, p = 0.86) and defibrillators (44% vs. 39%, p = 0.56). Post-procedure, five (16%) PWH had lead failure or infection while nine (14%) controls had lead failure. One PWH with site infection reported IV drug use. Post CIED placement, median survival in years was 5.3 in PWH vs. 6.4 in controls. No strong association between HIV status and survival (HR 1.9 [95% CI 0.7 to 5.0]) was seen ( F igure ). Conclusions: To our knowledge, this is the first study looking at survival post CIED between PWH and the general population. Our findings suggest that the number of PWH getting CIEDs remains low despite no definitive evidence of procedural complications; and that PWH have similar survival to those without HIV. More studies exploring barriers to CIED placement in PWH are needed.
Abstract 17584: Tricuspid Valve Infective Endocarditis: A Catastrophic Complication of Preterm Rupture of Membranes
Authors: Geethika Earthineni, Somshukla Ghosh, Divya R Verma, Kishore Harjai, Roland Njoh, Hanumanth K Reddy
Journal: Circulation (2023)

Background: Few cases of post-partum complication of Group B Streptococcus (GBS) tricuspid valve (TV) infective endocarditis (IE) after live vaginal birth have been reported. We present the same, further complicated by septic emboli tospleen through patent foramen ovale (PFO). Case: 33-year-old 4 weeks post-partum female (G7P6) in septic shock was diagnosed with GBS TV IE with 41mm X 21mm vegetation(F1) with septic emboli to lungs and spleen. Echocardiogram showed PFO with right to left shunt. Ceftriaxone and Gentamycin were started. Her pregnancy was complicated with preterm premature rupture of membrane (PPROM); she had received no antenatal care. Vegetation was debulked with AngioVac procedure (AVP) while PFO was occluded with trans-septal compliant balloon(F2). After recovery from acute illness TV was replaced with bioprosthetic valve. Decision-Making: IE was most likely a post-partum complication in absence of IV drug use, intravascular device, right sided cardiac anomaly. Large size of vegetation with embolization warranted use of AVP to debulk the vegetation as a bridge to valve surgery. PFO occlusion with balloon during AVP prevented potential catastrophic embolization to the brain. Conclusion: Mothers colonized with GBS routinely get antibiotics to prevent transmission to the newborn; this case highlights the need for GBS screening and treatment to reduce maternal morbidity as well. Minimally invasive AVP can debulk vegetations thus decreasing infectious burden and risk of septic embolization before surgery.
Abstract 158: Exploring the Potential for Kidney Donation in Out-of-Hospital Cardiac Arrest Cases With No Chance of Survival
Authors: Richard Chocron, Thomas Laurenceau, Frankie BEGANTON, Florence Dumas, Xavier Jouven
Journal: Circulation (2023)

Introduction: The global kidney shortage can potentially be addressed through the implementation of the uncontrolled donation after circulatory death (uDCD) pathway. However, the current Termination-of-Resuscitation (TOR) rules, although effective in identifying futile resuscitation, do not consider the potential benefits of organ donation. Objective: This study aims to assess the potential pool of uDCD kidney donors among patients with resuscitation attempts by Emergency Medical Services (EMS) who meet TOR criteria. Methods: Retrospective analysis was conducted using data from the Paris Sudden Death Expertise Center (SDEC) registry spanning from 2011 to 2020. TOR criteria evaluation and identification of potential organ donors were performed using established selection criteria from previous protocols on TOR rules and uDCD. Incidence rates (per patient-years) were calculated using data from the National Institute of Statistics and Economic Studies. Results: Out of 19,976 cases of Out-of-Hospital-Cardiac Arrest (OHCA) with resuscitation attempts by EMS, 12,890 (64.5%) did not achieve sustained Return of Spontaneous Circulation (ROSC). Among patients with no successful ROSC, the annual number and incidence of patients with no chance of survival varied across different TOR rules, ranging from 626 to 1081 cases and from 8.14 to 10.04 per 100,000 patient-years. The proportion of OHCA patients meeting both TOR criteria and extended kidney criteria ranged from 67.8% to 73.6% of total cases of OHCA who did not achieve sustained ROSC. Conclusion: Our findings demonstrate that the implementation of a uDCD program, in cases where TOR rules indicate no chance of survival, has the potential to significantly increase the pool of potential organ donors.
Abstract 17418: Daily Intake of Fruits and Vegetables Moderates the Effect of a Nutrition Intervention on Symptom Burden in Patients With Heart Failure
Authors: JungHee Kang, Terry Lennie, Martha J Biddle, Misook L Chung, Chin-Yen Lin, Jia Rong Wu
Journal: Circulation (2023)

Introduction: Patients with heart failure (HF) often remain symptomatic after optimization of medical treatment. Complementary interventions may reduce symptom burden. We conducted a 6-month randomized controlled trial of a nutrition intervention (NIHFT) to reduce fluid overload, oxidative stress, and inflammation, which are major pathologic pathways underlying HF symptoms.Aims: 1) To examine the effects of NIHFT on HF symptom burden (i.e., shortness of breath, edema, and fatigue); and 2) to determine if intake of fruits and vegetables, primary sources of antioxidants and anti-inflammatories, moderated the effect of the NIHFT on HF symptom burden. Methods: Patients with HF (n=116) with complete baseline data were included (61% male, 63±12 years old, 64% NYHA III/IV). Intervention group received 1) individualized educational intervention for sodium reduction that included promoting fruit and vegetable intake, 2) daily low sodium tomato or vegetable juice, and 3) omega-3 supplementation (1050 mg EPA, 150 mg DHA/capsule/day) for 6 months. Symptom burden was measured by the Memorial Symptom Assessment Scale-HF at baseline and 3 and 6-month. Daily intake of fruits and vegetables at baseline was dichotomized (≤1 vs ≥2 servings/day). A linear mixed-effect model was used. Results: There was no direct effect of the NIHFT on symptom burden. However, baseline intake of fruits and vegetables moderated the effect of the intervention on overall symptom burden scores (beta estimate= -4.67, SE=1.89, P=0.015). Reduction in symptom burden was greater among patients with lower baseline fruit and vegetable intake compared to those with higher intake. Among the subscales (i.e., frequency, severity, and distress) of overall symptom burden, frequency (beta estimate= -1.63, SE=0.66, P=0.014) and severity (beta estimate= -1.81, SE=0.61, P=0.004) were significantly moderated by the intake of fruits and vegetables. Conclusions: The findings indicate that the nutrition intervention was more effective in reducing symptom burden for patients with lower baseline intake of fruits and vegetables. This suggests that increased fruit and vegetable intake may further reduce HF symptom burden in patients on optimal medication therapy.
Abstract 17620: Progressive Volume Retention Requiring an Increase in Loop Diuretic Use After Watchman Implant: A Retrospective Case Control Study
Authors: Clifton Parrott, Nisha Patel, Harry Hicklin, Edward Hodges, Prashant Bhave, S. Patrick Whalen, David X Zhao, karl richardson
Journal: Circulation (2023)

Introduction: Some patients with atrial fibrillation and high stroke risk cannot be anticoagulated. Percutaneous left atrial appendage occlusion (LAAO) is a potential alternative stroke risk reduction strategy. The LAA secretes ANP which has neurohormonal effects on fluid balance, but the effects of LAAO on clinical volume status remains uncertain. Goals: We expanded upon our prior data reporting a rise in diuretic use after LAAO by including a control cohort of patients without LAAO. Methods: Retrospective clinical data from patients who underwent LAAO at our institution from 2015-2020 with Watchman 2.5 (n=151, 38% female) and Watchman FLX patients from 2020-2022 (n=80, 31% female) were analyzed. A control group consisting of patients with atrial fibrillation who have not had LAAO were included (n=186, 38% female). Data extracted included demographics, loop diuretic dose, LVEF, and presence of HTN, CAD, PAD, DM, CKD, TIA/CVA. Progressive volume retention was defined as initiation or increase in loop diuretic dose within 12 months of LAAO, or within last 12 months from most recent cardiology visit for controls. Results: There was no significant difference in clinical variables between the two groups except for a significantly high proportion of TIA/CVA in LAAO group (p=0.003) and CKD and HF in the control group (p=0.031 and 0.004, respectively). Specifically, 49/231 (21.2%) of the LAAO cohort showed a rise in loop diuretic requirements compared to 27/186 (14.5%) of the controls (p = 0.078). There were 17/231 (7.4%) new loop diuretic prescriptions in the LAAO group compared to 6/186 (3.2%) for the controls (p = 0.066). In multivariable analyses controlling for age, sex, BMI, preimplant LVEF, prior HF, CKD, and LAAO, only age, prior HF, and LAAO predicted a rise in loop diuretic in subsequent year after implant. The strongest predictors were the presence of prior HF, OR 2.32 (95% CI 1.28-4.21, p = 0.005) and LAAO, OR 1.9 (95% CI 1.09-3.27, p = 0.023). Conclusions: These results suggest that LAAO is associated with an almost two-fold increased risk of clinically relevant volume retention. This risk appears to be highest among patients with a clinical history of HF. These findings may inform preimplantation discussions and post-LAAO expectations and clinical management.
Abstract 17594: The Impact of Socioeconomic Status on Anthracycline Cardiotoxicity in a Diverse Population
Authors: Justin J Song, Waqas Hanif, Rachel Clark, Magued Haroun, Carol Fernandez Hazim, Caroline McNaughton, Leandro Slipczuk, Mario J Garcia, Min Pu, Carlos Gongora, Tomas G Neilan, Della Makower, Roberto Alejandro Sica, Earle Chambers, Carlos J Rodriguez, Lili Zhang
Journal: Circulation (2023)

Introduction: There are sparse data on the impact of socioeconomic status (SES) on the incidence of anthracycline cardiotoxicity. Aims: To examine the association of neighborhood-level SES factors with anthracycline cardiotoxicity. Methods: We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer in the Montefiore Health System. The endpoint was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction [LVEF]≥10% to LVEF&lt;53%). We analyzed neighborhood-level SES measures (median household income [MHI], high school graduate rate, employment rate), and composite indices of neighborhood-level social disadvantage (the Social Vulnerability Index [SVI] and Area Deprivation Index [ADI]), with higher scores indicating worse neighborhood-level SES. Results: A total of 925 patients (22% Non-Hispanic White (NHW), 25% Non-Hispanic Black (NHB), 31% Hispanic, and 2% Non-Hispanic Asian) were included. During a median follow-up of 21 months, 116 patients (13%) developed cardiotoxicity. Patients who developed cardiotoxicity had significantly lower MHI, lower high school graduation rates, lower employment rates, higher SVI and ADI compared with patients who did not develop cardiotoxicity (all p&lt;0.01). In multivariable adjusted Cox Proportional-Hazards models, MHI (1 st quartile vs 4 th quartile HR 2.1, p=0.024), SVI (HR 3.66, p=0.014) and ADI (HR 1.01, p=0.018) were significantly associated with a higher risk of cardiotoxicity development after adjusting for age, sex, cardiovascular risk factors, baseline LVEF, and anthracycline dose. ADI remained significantly associated with cardiotoxicity after adjustment for race/ethnicity (HR 1.01, p=0.046). Conclusions: In a large, socioeconomically diverse cohort of cancer survivors treated with anthracycline-based chemotherapy, SES indices were associated with the development of cardiotoxicity. ADI may be a better predictor of cardiotoxicity independent of race/ethnicity.
Abstract 17577: Cardiomyopathy With Positive ATTR Mutation but Negative Tc-PYP Scan: A Conundrum
Authors: Charoo Iyer, Syed Faiz F Abbas, Chengu Niu, Elizabeth Lee
Journal: Circulation (2023)

Background: Cardiac amyloidosis (CA) is a Hypertrophic Cardiomyopathy (HCM) mimic. Technetium labeled pyrophosphate (Tc-PYP) scan provides a rapid &amp; non-invasive means for identifying ATTR-type CA with 99% sensitivity and specificity. We present 2 patients who were referred to HCM clinic but were found to have genetic testing positive for hTTR. In both cases, Tc-PYP scan was negative. Case Presentation: Outlined in Figure 1. Discussion: Both cases present a diagnostic and management dilemma. Neither of these two patients can be strictly considered asymptomatic carriers of the ATTR gene as both had phenotypic expression in the form of cardiomyopathy &amp; massive LVH on imaging. Yet, in both Tc-PYP scan was negative. Neither had the ATTR mutations (Phe64Leu and Val30Met) that have reported association with negative Tc-PYP scan. Another possibility is early CA, which maybe rarely associated with negative Tc-PYP scan. Patient 1 refused endomyocardial biopsy, so early CA remains on the differential for her. Patient 2 had a negative endomyocardial biopsy. Her case is unique due to history of liver transplant 20 years prior to presentation making phenotypic CA less likely, but not impossible as there have been prior reports of cardiac disease progressing even after liver transplantation in familial ATTR. She also had tacrolimus exposure, which is known to cause LVH in rare cases. Both patients had hypertension, which could have also contributed to LVH. This case series serves to highlight the importance of maintaining a broad differential diagnosis in patients undergoing evaluation for HFpEF and severe LVH, particularly in cases of positive genetic testing but negative PYP scan for CA. From a management standpoint, it is unclear if early initiation of tafamidis might have a role in preventing cardiomyopathy progression in such patients with diagnostic uncertainty &amp; ongoing concern for early CA.
Abstract 14162: Long-Term Outcomes for Contemporary Mechanical versus Bioprosthetic Surgical Mitral Valve Replacement in Patients Aged 50 to 70 Years
Authors: Ayman R Fath, Amro Aglan, Abdullah Eldaly, Abdulbaril Olagunju, Ahmed Almomani
Journal: Circulation (2023)

Background: Guidelines are still unclear regarding whether mechanical or bioprosthetic valves should be selected for mitral valve replacement (MVR) in patients aged 50-70 years. Aims: To assess long-term outcomes in patients aged 50-70 years undergoing MVR using contemporary mechanical and bioprosthetic valves. Methods: We performed a retrospective study using the TriNetX global database to identify patients aged 50 to 70 years who had primary isolated surgical MVR from 2014 to 2020. Patients who had concomitant or prior cardiac surgeries were excluded. Patients were stratified into 2 groups: mechanical and bioprosthetic, and a 1:1 propensity-score matching to control for baseline differences between the two groups was performed. The primary endpoint was all-cause mortality and secondary endpoints were stroke, major bleeding, and reoperation over a follow-up period of 8 years. Results: Propensity-score matching yielded 1,130 patients in each group. There were significantly higher rates of all-cause mortality, stroke, and major bleeding events in the mechanical group compared to the bioprosthetic valve. There was no significant difference between the two groups regarding reoperation (Table 1 and Figure 1). Conclusion: At an 8-year follow-up, the use of contemporary bioprosthetic valves for MVR in patients aged 50-70 years shows favorable all-cause mortality and lower rates of strokes and major bleeding with similar reoperation rates compared to mechanical valves.
Abstract 13344: Differential Impact of Self-Care Behaviour on Mortality Between Patients With Stable and Recent Worsening Chronic Heart Failure
Authors: Taro Koya, Toshiyuki Nagai, Atsushi Tada, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Aoyagi Hiroyuki, Shogo Imagawa, Tokuda Yusuke, Yoshiya Kato, Masashige Takahashi, Sakai Hiroto, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Hiroshi Okamoto, Toshihisa Anzai
Journal: Circulation (2023)

Backgrounds: Although self-care is crucial to maintain health and recommended in the guidelines in patients with chronic heart failure (CHF), its prognostic significance is controversial. We hypothesized that self-care is more effective in vulnerable patients with recent hospitalization due to worsening HF (WHF). The aim of this study was to investigate the prognostic significance of self-care behaviour on mortality between patients with stable and recent worsening CHF. Methods: We prospectively examined consecutive 1,873 CHF patients from a Japanese multicenter registry and assessed the European Heart Failure Self-care Behaviour Scale (EHFScBS) at enrollment. The patients were divided into inpatient due to WHF (WHF group) and outpatient stable CHF (stable CHF group). The optimal EHFScBS was defined as more than 70 based on previous reports. The primary outcome was all-cause death. Results: Of studied patients (1,102 male, mean age 72 ± 13 years), 625 (33%) and 1,165 (67%) were classified into WHF and stable CHF groups, respectively. During a median follow-up period of 427 (IQR 273 - 642) days, the primary outcome occurred in 50 patients. In stable CHF group, there was no significant difference on primary outcome between optimal and suboptimal EHFScBS (P = 0.65) (Figure A). On the other hand, patients with suboptimal EHFScBS showed a higher incidence of death than those with optimal score in WHF group (P = 0.01) (Figure B). In WHF group, Cox regressions showed that the EHFScBS score was independently associated with mortality (HR 0.51, 95% CI 0.26-0.99) adjusted for significant covariates including hemoglobin, estimated glomerular filtration rate, serum sodium, log NT-proBNP, and the Meta-Analysis Global Group in Chronic Heart Failure risk score. Conclusions: In patients with recent worsening, not stable CHF, the EHFScBS was associated with subsequent mortality, indicating that the self-care education might be more effective for patients with recent worsening CHF.
Abstract 17570: Combining Genomic Profiling and Clinical Data Through Machine Learning Modeling for the Prediction of Coronary Artery Disease Severity: Insights From the Genetic SYNTAX Score (GESS) Trial
Authors: Fani Chatzopoulou, Nikolaos Mittas, EFSTRATIOS KARAGIANNIDIS, Andreas S Papazoglou, NIKOLAOS STALIKAS, Dimitrios V Moysidis, Alexandros Giannopoulos-Dimitriou, Aikaterini Saiti, Maria Ganopoulou, Anna Papa, Dimitrios Chatzidimitriou, George Giannakoulas, Georgios Sianos, Lefteris Angelis, Ioannis S Vizirianakis
Journal: Circulation (2023)

Background: Genomic profiling emerges as a powerful partner in the prediction of CAD development. Hypothesis: Machine learning (ML) algorithms integrating genomic profiling and clinical data could improve patient outcomes by contributing to earlier non-invasive diagnosis of obstructive CAD. Aims: The Genetic Syntax Score (GESS) prospective cohort study aimed to create a ML-algorithm able to predict the severity of CAD based on the analysis of 228 single nucleotide polymorphisms (SNPs) and relevant clinical and demographic data. Ultimate goal of this analysis was to compare the predictive capacity of a SNP-including model with that of a clinical model without SNPs. Methods: Patients with suspected CAD (n=919, mean age: 64±12 years) underwent invasive coronary angiography (from 2019 to 2021), and, thereby, their SYNTAX score was determined. Peripheral blood samples were drawn for genomic profiling (next generation sequencing analysis of a custom-made panel consisting of 228 SNPs) under standardized methods. After the ML-based selection of the most important subset of features (clinical/SNPs), two competing meta-learners were fitted, called Model A (including clinical/demographic predictors) and Model B (Model A plus SNPs predictors). The difference in their predictive capacities for the precise assessment of CAD risk (whether a patient presents with SYNTAX score &gt;0 or =0) and CAD severity (whether a patient presents with higher SYNTAX score) was investigated via Delong’s test and Wilcoxon signed-rank test, respectively. Results: Our ML-algorithm identified a total of 8 SNPs (rs11984041, rs41291556, rs2023938, rs2107595, rs216172, rs1800562, rs3732379, and rs964184) as significant predictors of CAD risk, and 7 SNPs (rs4845625, rs6689306, rs2046934, rs1332844, rs6801273, rs663129, and rs870142) as significant predictors of CAD severity. Model B demonstrated superior performance compared to Model A (Z=2.451, p=0.014 for CAD risk assessment, and V=16731, p=0.002 for CAD severity assessment). Conclusion(s): The combined use of clinical/demographic parameters and genomic profiling might be deployed to improve the prediction of CAD risk and severity under the guidance of ML-techniques. Registration: NCT03150680