tbuckley/cabot-search huggingface dataset:
Abstract 16308: Comparison of Myocardial Mechanics Post Mitral Valve Repair With Leaflet Preservation vs. Leaflet Resection: A Sub-Analysis of the Randomized CAMRA CardioLink-2 Trial
Authors: Rawan K Rumman, Subodh Verma, Vincent Chan, Alexandra Fottinger, Adrian Quan, Makoto Hibino, Benoit E de Varennes, Michael W Chu, Hwee Teoh, bobby Yanagawa, Gianluigi Bisleri, Howard Leong-Poi, David Mazer, Kim Connelly
Journal: Circulation (2023)

Introduction: Prior studies comparing leaflet resection vs. leaflet preservation for surgical repair of mitral regurgitation (MR) caused by prolapse focus predominantly on measurement of left ventricular ejection fraction. This study aims to evaluate subclinical differences in myocardial mechanics pre- mitral valve (MV) repair, immediately after, and 1-year post-repair, as well as compare differences between leaflet resection and preservation strategies. Methods: 104 patients were randomly assigned to the resection or preservation group for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Speckle-tracking echocardiography was performed at baseline (pre-repair), immediately post-repair, and 1 year post-repair. Global longitudinal strain (GLS) was compared at the three timepoints, as well as between leaflet preservation and resection groups using descriptive statistics. Results: The mean age of the participants was 65 ± 10 years, and 83% were male. The mean GLS pre-MV repair was -19.6 ± 5.4, and did not differ between the leaflet resection and leaflet preservation groups. The mean GLS dropped to -12.8 ± 4.7 immediately post-repair (p= 0.001 compared to pre-repair). The GLS immediately post-repair was slightly lower in the leaflet resection vs. preservation group (-11.8 ± 4.9 vs. -14.2 ± 3.3, p=0.04). At 1 year post-repair, the mean GLS improved to -16 ± 4, but remained below pre-repair values (p=0.001 compared to immediate post-repair, p=0.03 compared to pre-repair values). At 1-year follow-up, there were no differences in GLS between the leaflet resection and preservation groups. Conclusion: The leaflet preservation and resection techniques for surgical repair of MR have similar effects on myocardial mechanics 1-year post-repair. MV repair is associated with an immediate reduction in myocardial strain, with only partial recovery in the first year post-MV repair. Further studies are needed to determine whether myocardial strain continues to improve beyond the first year post-repair to baseline levels.
Abstract 15111: The Combination of Vagal Nerve Stimulation and Intra-Aortic Balloon Pumping Rapidly Modulates Heart Rate and Cardiac Load While Maintaining Hemodynamics in a Dog Model of Acute Heart Failure
Authors: Hidetaka Morita, Midori Kakuuchi, Shohei Yokota, yoshida yuki, sato kei, Kazuo Sakamoto, Eiko Ishida, Takeshi Tohyama, Hiroki Matsushita, Koji Todaka, Keita Saku
Journal: Circulation (2023)

Background: In acute heart failure (AHF) condition, excessive tachycardia increases myocardial oxygen consumption (MVO 2 ). Recently, we have developed an intravenous vagal nerve stimulation (iVNS) catheter which can stimulate right vagal nerve and induce HR reduction (Fig. 1). Since inappropriate bradycardia in AHF condition leads to hemodynamic instability, the use of intra-aortic balloon pumping (IABP) may serve as a beneficial adjunctive therapy for iVNS. Methods: We induced AHF by the direct ethanol injection (0.5-2 ml/kg) to myocardium. The specialized basket catheter was inserted through the right femoral vein and placed in the superior vena cava. The IABP with 20-cc balloon was inserted through left femoral artery. We also calculated MVO 2 by the product of coronary flow and the difference of oxygen saturation between coronary artery and coronary sinus. We compared HR, MVO 2 , and hemodynamics between baseline and 3-min after iVNS (n=11). In addition, we examined the impact of IABP on hemodynamics during iVNS in AHF condition (n=8). Results: The direct ethanol injection increased LAP (+3.6±7.2 mmHg) and decreased left ventricular ejection fraction (-28±9.8%). The iVNS (20Hz, 10-22 V) rapidly reduced HR (-13±6.9%, P&lt;0.01) and MVO2 (-11±8.1%, P&lt;0.05), while slightly decreased CO (-10±7.3%) and increased LAP (+2.0±3.5 mmHg) (Fig. 2). An adding of IABP during iVNS increased CO (1.2±0.24 vs. 1.3±0.30 l/min, P&lt;0.05) and decreased LAP (14±8.6 vs. 13±8.2 mmHg, P&lt;0.05) . Conclusion: The combination of iVNS and IABP shows clinical potential as a novel therapy for effectively modulating excessive cardiac load in cases of unstable hemodynamics.
Abstract 17446: Trends, Disparities, and Outcomes in Patients With Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock
Authors: Samuel Tan, Wenchy Siu, Shasawat Kumar, Paulus Adinugraha
Journal: Circulation (2023)

Introduction: Cardiogenic shock (CS), a highly fatal complication, is estimated to be seen in up to 20% of patients with Takotsubo cardiomyopathy (TC). Previous studies have found patients with TC to have similar mortality rates as those with acute myocardial infarction, highlighting the potential importance of therapeutic intervention. However, the existing literature on TC is limited. Hypothesis: Minority patients with TC-CS are associated with increased mortality. Methods: All adult admissions with a diagnosis of Takotsubo Cardiomyopathy and cardiogenic shock (TC-CS) were analyzed using the National Inpatient Sample Database between January 2016 and December 2019. Outcomes included in-hospital mortality, in-hospital complications, and resource use. We used multivariate logistics and Elixhauser co-morbidities to adjust for clinical comorbidities. Results: Our study population included 37,902 patients with a diagnosis of Takotsubo cardiomyopathy. Of the sampled population, 2,455 (6.48%) experienced cardiogenic shock. Over the study time period, there was a significant increase in prevalence with TC-CS (p&lt;0.001). Compared to patients with TC, patients with TC-CS were significantly associated with acute kidney injury (OR: 2.463, p&lt;0.001). Controlling for baseline characteristics and Elixhauser comorbidities, Asians were at significantly higher odds of developing cardiogenic shock (OR: 1.859, p&lt;0.001) and mortality, while Whites were at significantly decreased odds of developing cardiogenic shock (OR: 0.690, p&lt;0.001). In addition, Asians who self-pay were at significantly higher odds (OR: 4.836, p=0.005) of developing cardiogenic shock compared with Asians holding insurance. Conclusions: Our study offers insights into the disparities connected with TC-CS. There is a statistically significant increase in the trend of incidence of CS among patients with TC, and CS is associated with significantly higher odds of mortality. Notably, Asian individuals with TC face significantly higher odds of developing CS. However, there were no significant differences in hospitalization costs between races in patients with TC-CS.
Abstract 11900: Potassium Magnesium Citrate is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone
Authors: Wanpen Vongpatanasin, John M Giacona, Danielle Pittman, Ashley Murillo, Ghazi Khan, Jijia Wang, Jimin Ren, Orson W Moe, Charles Pak
Journal: Circulation (2023)

Thiazide-type diuretics (TD) are the first-line treatment of hypertension in many guidelines because of its consistent benefit in lowering BP and cardiovascular risk. TD is also known to cause excess risk of diabetes mellitus (DM), which may limit its long-term use. Although hypokalemia was thought to be the main mechanism of TD-induced dysglycemia, potassium (K) supplementation alone does not consistently prevent TD-induced elevation in fasting plasma glucose (FPG). In addition to reducing serum K, TD triggers magnesium (Mg) depletion. However, it is unknown if Mg supplementation attenuates metabolic side effects of TD. Accordingly, we conducted a randomized double-blinded clinical trial in 60 hypertensive patients without DM to compare effects of KCl (40 meq daily) vs. KMgCitrate (Cit) powder containing identical amount of K, 20 meq of Mg, and 74 meq of Cit daily during chlorthalidone (CTD) treatment. Each patient received CTD alone (25 mg/day) for 3 weeks prior to randomization. The primary endpoint was the change in FPG after 4-month of treatment from baseline (CTD alone) after adjusting for baseline FPG as a covariate. The mean age of subjects was 59±11 years (45% Female, 30% Black participants). We found that CTD induced a significant rise in FPG, insulin, and a significant fall in serum K and 24-h urinary citrate excretion (all p &lt; 0.05). We found that KMgCit significantly increased serum K, 24-hour urinary Mg, and 24-hour urinary Cit excretion; and attenuated the rise in FPG which was not observed with KCl (Figure 1 A-C). There were no significant differences in liver fat by MRI or fasting plasma insulin between the 2 groups. In conclusion, our study showed beneficial effects of magnesium supplementation in maintaining serum K and reversing effects CTD on plasma glucose, which may improve safety profile and optimize long-term cardiovascular outcomes in hypertensive patients.
Abstract 18182: Inappropriate Shocks After Mitraclip™ Placement: Should Reassessment of Post-Procedural ICD Sensitivity Be Routine Practice?
Authors: Unnati Bhatia, Ivan D Hanson, Nishaki M Mehta
Journal: Circulation (2023)

Case Description: A 53 year old African American woman with non-ischemic cardiomyopathy (EF 10%) with intolerance to GDMT (allergies) and severe secondary MR. An ICD was placed years ago. Given LBBB and QRS 146ms, she underwent a BiV(biventricular pacing)-ICD upgrade with symptomatic improvement, but persisting exertional intolerance. TEE showed a favorable anatomic profile for transcatheter edge-to-edge MV repair and a MitraClip™ was placed. Post-procedure, the severity of MR decreased significantly (from severe to mild), however there was no sizable improvement in LV EF. Also, there were no significant EKG changes. Three months later, she experienced multiple inappropriate shocks (IAS). Device interrogation revealed T-wave oversensing (TWOS). TWOS was noted on multiple vectors with LV only pacing, but was solely associated with fusion complexes on BiV pacing. R wave sensing threshold was increased. Patient was switched to BiV only pacing and AV delay(paced and sensed) was decreased to avoid fusion beats. Patient did well and no further IAS were noted at 4 months follow-up. Discussion: ICDs (+/- CRT) are vital in preventing SCD in advanced CHF. Currently, transvenous technology is excellent at avoiding TWOS, however our case represents a challenging dilemma where repolarization may have changed post-operatively after MitraClip™ placement. T wave amplitude is dynamic and real time monitoring of sensing threshold is needed. This becomes especially important after structural heart procedures like MV TEER that can induce subclinical electroanatomic changes. While MitraClip™ can reduce ventricular arrhythmias with favorable remodeling, inappropriate sensing of devices is a small but real risk. Consequently, there are no established guidelines on routine post-procedural device interrogation. Preemptive reassessment of T wave safety margin and monitoring of sensing thresholds and lead placement may be useful following structural heart interventions.
Abstract 14700: Associations of Left Ventricular Structure With Cumulative Systolic Blood Pressure Load: A Report From Women’s Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction Study
Authors: Sachini Ranasinghe, Yujie Cui, Okezi Obrutu, Michael D Nelson, C Noel Bairey Merz, Janet Wei
Journal: Circulation (2023)

Background: Recent studies have identified cumulative systolic blood pressure load to be associated with increased risk of adverse cardiovascular disease (CVD) outcomes. Similarly, associations between left ventricular (LV) structure and CVD events have long been recognized. Purpose: The purpose of this study was to assess the association between cumulative systolic blood pressure (CuSBP) load and LV structure in women with suspected ischemia with no obstructive coronary arteries (INOCA). Methods: Women enrolled in the Women’s Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction (WISE-CVD) study (NCT00832702) underwent cardiac magnetic resonance imaging (CMRI) for LV structure and those (n= 225) who had at least 2 blood pressure (BP) measures recorded at a single site before their baseline CMRI were included in this analysis. Cumulative systolic BP (CuSBP) was defined as systolic BP (SBP) ≥ 130 divided by all SBP readings and each mean value multiplied by the years. LV remodeling index was defined as the ratio between LV mass and LV end diastolic volume (LVEDV). Results: The mean age was 55±10 years, body mass index (BMI) 26.3 ± 5.5 kg/m 2 , 36% had a history of hypertension, number of BP medications was mean 2.7 ± 1.6 [median 2 (range 0, 8)], and SBP and DBP were 126 ± 15 and 66 ± 10 mmHg respectively. Age, BMI and history of hypertension were significantly associated with higher CuSBP load. In univariate analyses, LV end diastolic volume and LV end systolic volume decreased, and LV remodeling index increased across CuSBP quartiles while LV mass index did not significantly differ among the quartiles (Figure 1) . In multivariable regression analysis, the association between CuSBP and LV mass index and LV remodeling index remained significant. Conclusions: Among women with suspected INOCA, higher CuSBP load was associated with greater LV mass index and concentric LV remodeling independent of age. Changes in LV volumes may represent age-related changes in LV structure.
Abstract 15773: The Forgotten Ventricle: Insight Into Dynamic Effects of Left Ventricular Assist Device Ramp on Right Ventricle Function
Authors: Armin Garmany, John M Stulak, Alfredo L CLAVELL, Atta Behfar, Andrew Rosenbaum
Journal: Circulation (2023)

Introduction: Left ventricular assist devices (LVAD) with magnetically levitated impellers have become standard due to hemocompatibility and survival profile. To optimize LVAD speeds, we previously introduced simultaneous right and left heart (RH/LH) catheterization during ramp studies. Here, we report pairing of this approach with pressure-volume (PV) assessment in a patient with a HeartMate 3 LVAD with mitral regurgitation (MR). The combined approach evaluated left ventricular (LV) hemodynamics and right ventricular (RV) PV-relationships during ramp testing. Methods: A 68-year-old male with ischemic cardiomyopathy, two years following HeartMate3 implantation, presented with NYHA class III symptoms. To evaluate for dyspnea, he underwent a RH/LH catheterization ramp study. RV PV-loops were created by use of a conductance catheter system, allowing creation of PV loops. Results: At the baseline LVAD speed of 5300 rotations per minute (RPM), right atrial pressure was elevated at 16 mmHg and pulmonary artery (PA) pressure of 26 mmHg. Left-end diastolic pressure (LVEDP) was elevated (16mmHg). Baseline cardiac index (CI) was 2.01 L/min/m 2 . Ramp testing was performed, increasing speeds from 5300 to 5800 RPM. Progressive LV unloading was observed with a 5 mmHg drop in LVEDP and a 3 mmHg drop in PA pressure. However, RV PV loop monitoring revealed a negative impact on RV contractility with the maximal elastance (Emax) slope demonstrating a 22% reduction. Furthermore, a 17% reduction in RV stroke volume was documented, while diastolic function remained unchanged. Thus, despite excellent LV offloading and diminishment of RV afterload, the significant negative impact on Emax resulted in no net increase in CI (+0.04 L/min/m 2 ) during the ramp evaluation. Inotrope therapy was initiated for RV function with increased LVAD RPM to outcompete MR. Conclusions: While RH/LH catheterization provides a real-time perspective of the interventricular relationship during ramp, the impact of increasing LVAD speeds on RV function has yet to be directly measured. Here, the RV PV loop relationship during LVAD ramp showed that although LVAD speed increases in the setting of MR may facilitate LV unloading, a drop in RV afterload did not compensate for reduction in RV contractility.
Abstract 12470: Sacubitril/Valsartan in Patients With Heart Failure and Deterioration of Kidney Function to Estimated Glomerular Filtration Rate Less Than 30ml/min/1.73m <sup>2</sup> : Insights From PARAGON-HF and PARADIGM-HF
Authors: Safia Chatur, Muthiah Vaduganathan, Brian L Claggett, Finnian McCausland, Akshay S Desai, Iris Beldhuis, Jean L Rouleau, Michael R Zile, Milton Packer, Marc A Pfeffer, Martin P Lefkowitz, John J McMurray, Scott D Solomon
Journal: Circulation (2023)

Background: Sacubitril/valsartan is a foundational therapy for patients with heart failure (HF). Although current US FDA labeling does not identify threshold kidney function below which initiation or continuation of sacubitril/valsartan is precluded, guidelines generally identify eGFR&lt;30mL/min/1.73m 2 as a contraindication to therapy. Methods: The RCTs PARAGON-HF and PARADIGM-HF assessed sacubitril/valsartan versus valsartan or enalapril in patients with HF. Patients with eGFR &lt;30 (PARADIGM) or &lt;25 mL/min/1.73 m 2 (PARAGON) at randomization were excluded. Discontinuation below this eGFR during follow-up was not mandated. We examined the effects of sacubitril/valsartan on efficacy and safety in patients experiencing progression of CKD to eGFR&lt;30mL/min/1.73m 2 in follow-up. Results: Among 4,746 patients in PARAGON-HF and 8,346 patients in PARADIGM-HF (with eGFR&gt;30ml/min/1.73m 2 at randomization), 613 (12.9%) and 691 (8.3%), respectively, had an eGFR&lt;30mL/min/1.73m 2 at least once in follow-up. Patients with CKD progression had higher rates of study drug discontinuation and hyperkalemia (&gt;5.5 mmol/L); however, rates remained similar between treatment groups. Patients with deterioration in kidney function to eGFR&lt;30ml/min/1.73m 2 were at a higher risk of the primary composite outcome in both PARAGON-HF (RR 2.08; 95% CI: 1.72-2.52) and PARADIGM-HF (HR 2.32; 95% CI: 1.94-2.76). The incidence of the primary composite outcome was lower in patients treated with sacubitril/valsartan irrespective of deterioration in kidney function to eGFR&lt;30mL/min/1.73m 2 in both PARAGON-HF (P int =0.74) and PARADIGM-HF (P int =0.50); Figure 1 . Conclusion: HF patients with progression of CKD to eGFR&lt;30ml/min/1.73m 2 experience high risk of CV outcomes and continuation of sacubitril/valsartan was associated with persistent benefit. These data support potential continuation of sacubitril/valsartan, even among patients experiencing progression to advanced CKD.
Abstract 317: Development of a Swine Model of Rapidly-Induced Septic Shock Using Single Lipopolysaccharide Infusion and Titratable Inhaled Nitric Oxide to Prevent Severe Pulmonary Vasoconstriction
Authors: Moaz B Saeed, Azib Shahid, Armin Razi, Iyad Ayoub, Alvin Baetiong, Regent Laporte, Martin Pelletier, Raul J Gazmuri
Journal: Circulation (2023)

Objective: A serious limitation of LPS-induced swine models of septic shock is severe pulmonary vasoconstriction triggered, in part, by the pulmonary release of thromboxane A2. Efforts to overcome this limitation have included a stepwise increase in LPS dosing, intravenous aspirin derivatives, and inhaled nitric oxide (NO). We studied the effects of titrated inhaled NO given coincident with rapid LPS-infusion aimed at inducing the key features of septic shock over a shorter time period. Methods: We developed a LabVIEW-controlled system for inhaled NO delivery and monitoring. Exploratory studies showed that an NO concentration of up to 300 ppm sufficed to prevent significant pulmonary vasoconstriction despite delivery of a full LPS dose (12.6 μg/kg) in 30 minutes. We used this approach in 6 male domestic pigs (39.2 - 41.1 kg) and assessed hemodynamic and metabolic effects over 6 hours. NO and LPS infusion were started concurrently. Fluid resuscitation and vasopressor therapy were guided by macrohemodynamic measurements using custom-developed LabVIEW-controlled closed-loop algorithms. Results: Shown are medians with IQ25 and IQ75. LPS infusion increased pulmonary vascular resistance from 112 [72, 127] at baseline to 213 [120, 313] dynes-sec/cm 5 after 20 minutes. NO (139 [131, 166] ml/min) rapidly blunted the effect preventing the mean pulmonary artery pressure from exceeding 30 mmHg, avoiding detrimental effects on right ventricular function throughout the experiment. NO was rapidly de-escalated over 30 minutes using a closed-loop algorithm developed to prevent the mean pulmonary artery pressure from exceeding 30 mmHg. Within 60 minutes of LPS infusion start, animals began to develop key features of septic shock including tachycardia, hypotension, and systemic vasodilation triggering fluid resuscitation and norepinephrine administration. Additionally, blood lactate increased from 1.06 [0.90, 1.45] at baseline to 4.14 [2.43, 8.78] mmol/l after 3 hours remaining stable for an additional hour and subsequently decreasing in 3 and increasing in the other 3 animals, with half of the animals surviving the 6-h period. Conclusion: We developed a swine model of rapidly-induced key features of septic shock useful to explore early septic shock management.
Abstract 13028: Estimating Cardiovascular Event Rates in US Veterans Using the SMART Risk Score
Authors: Milan Ravishankar, Patrick Strickland, Nicole Minniefield, Helene DiGregorio, Rick Weideman, David Jacob, David Fernandez Vazquez, Bert Little, Subhash Banerjee
Journal: Circulation (2023)

Background: There is limited data on racial differences in long term cardiovascular (CV) outcomes amongst U.S. veterans. Methods: Utilizing the VA Informatics and Computing Infrastructure and the Corporate Data Warehouse we compared 10-year predicted major adverse CV events [MACE, a composite of all-cause death and non-fatal myocardial infarction] in patients referred for cardiovascular consultation between 2003 and 2009 using the SMART risk score with observed rates across racial groups. The SMART risk score classified patients into low 0-9.9%, intermediate 10-19.9%, high 20-29.9%, and very high &gt;=30% risk groups. Results: 473,136 patients including white (74.7%), African American (15.5%), and other (9.8%) made the study cohort. Observed event rates were significantly higher in African Americans compared with Whites across all SMART risk groups [p&lt;0.001], and highest in the other races, inclusive of Hispanics. These results are depicted in Figure 1 . Conclusion: There is a significantly higher observed 10-year MACE rate in African American veterans compared with their white counterparts across all predicted SMART risk score groups.