tbuckley/cabot-search huggingface dataset:
Abstract 4144618: Mitral regurgitation quantification by Cardiac Magnetic Resonance; Does the approach matter?
Authors: Saed Alnaimat, Mark Doyle, Anita Radhakrishnan, Moneal Shah, Victor Farah, Amresh raina, Robert Biederman
Journal: Circulation (2024)

Introduction/Background: Quantification of mitral regurgitation (MR) by CMR is performed indirectly by subtracting the aortic forward flow (measured by phase velocity mapping) from the left ventricular stroke volume (LVSV, measured by 3D EDV-ESV). However, 3D volumetric analysis of the LV can be performed by either including papillary muscles in the blood pool “Contour Method” or as part of myocardium “Blood Volume Method”. While both methods are considered acceptable to the Society for Cardiovascular Magnetic Resonance 2020 Guideline, using either method has a significant impact on the calculated LVSV, which in turn affects the calculated mitral regurgitant fraction (MRfr). Moreover, no universal cutoff for MR grading by CMR has been established yet. Research Questions/Hypothesis: We sought to validate which method (Blood Volume or Contour) should be used to quantify MR by comparing the calculated MR grade by CMR (assessed by MRfr) to MR grade by echocardiography (none, trace, mild, moderate, or severe). Methods/Approach: This is a single-center retrospective analysis. CMR studies were analyzed using Medis Suite (Version 4.0.50.2) Software. Each patient was analyzed twice; initially using Contour Method then Blood Volume Method. Results/Data: A total of 100 patients with various grades of MR were included. 83% of patients had a transthoracic echocardiogram (TTE) while 17% had a transesophageal echocardiogram (TEE). 94% of patients had their echocardiogram performed within 6 months of CMR, and 80% performed within 3 months of CMR. We found that the Contour Method tends to over-estimate the severity of MR, especially in patients with small ventricles (Figure 1) and in patients with milder grades of MR (less than moderate). This is because Contour Method yields a higher SV than Blood Volume Method. When compared to echocardiographic grades of MR, Blood Volume Method has a much better performance in quantifying MR severity (Kappa 0.89) than Contour Method (Kappa 0.44, Figure 2 ). Based on Blood Volume method, we suggest cutoffs of MR grading by CMR as listed in Table 1 . Conclusions: In this study, we present evidence that papillary muscles and trabeculations should be excluded from the blood pool in routine volumetric analysis for accurate assessment of LV stroke volume. This practice is not firmly established by current guidelines. We also present evidence-based reference ranges of mitral regurgitation grades according to the mitral regurgitant fraction calculated by CMR.
Abstract 4144428: Gender Differences In Leadless Pacemaker Placement Clinical Outcomes: Analysis Of Nationwide Readmission Database
Authors: Hira Akhlaq, Ndausung Udongwo, Adeyinka Adeniyi, Haroon Alam, Mariam Ahmed, Anne Marie Arcidiacono, Lauren Klei, Jalal Ghali, Joseph Heaton
Journal: Circulation (2024)

Background: Leadless pacemaker implantation (LPI) is common among patients with sick sinus syndrome (SSS) or atrioventricular block (AVB). Our study explores 30-day readmission rates (30-dr) following LPI for SSS and AVB, comparing outcomes between male and female patients. Methods: Using the Nationwide Readmissions Database, we conducted a retrospective analysis of patients who underwent LPI for SSS, and second or third-degree AVB between 2017 and 2021. Our study cohort was stratified by gender. The primary outcome was 30-dr, while secondary outcomes included inpatient mortality, length of stay (LOS), complications, and total hospital charge (THC). Results: Among the 17,759 patients meeting the inclusion criteria, 54.1% (n = 9,613) were males and 45.9% (n = 8,146) were females, with a mean age of 76.4 ± 12.6 years. The mean age was 75.5 ± 12.4 years for males and 77.4 ± 12.6 years for females (adjusted Wald test, p &lt; 0.01). Logistic regression analysis revealed that females had higher odds of readmission (OR 1.21, 95% CI 1.06 - 1.39, p &lt; 0.01) compared to males. However, inpatient mortality and LOS did not differ significantly between the two groups (p &gt; 0.05, all). In addition, males had a higher rate of complications leading to hemodialysis and the use of mechanical ventilators (p &lt; 0.05, all), while women had higher complications in pericardial effusions and tamponade (p &lt; 0.05, all). The mean THC was higher in males ($50,589 vs 47,681), compared to females (adjusted Wald test, p = 0.02). Conclusion: Our study revealed that female patients have a higher risk for 30-dr after LPI for SSS and AVB,. While the difference between two groups was not significant for inpatient mortality and LOS, the males had higher THC. Moreover, the nature of complications differed between males and females as well. This highlights the need for tailored interventions to minimize readmissions in this patient population.
Abstract 4144631: Angiographic and Clinical Outcomes with Drug-Coated Balloon Versus Drug-Eluting Stents for In-Stent Restenosis: A Meta-Analysis
Authors: Hritvik Jain, Ramez Odat, Neha Pervez, Aman Goyal, Jyoti Jain, Nandan Patel, Ashish Yadav, Janhvi Shah, Jagriti Jha, Siddhant Passey
Journal: Circulation (2024)

Background: The rate of in-stent restenosis (ISR) in clinical practice is approximately 5-10% after 5 years of percutaneous coronary intervention for coronary artery disease. ISR is associated with a high risk of adverse events. The current literature comparing drug-eluting stents (DES) to drug-eluting balloons (DEB) for ISR has yielded divergent results, prompting this meta-analysis. Methods: A comprehensive systematic literature review was conducted across major electronic databases, from inception to May 20, 2024. The search was aimed at identifying studies that compared DCB with DES for ISR. Using an inverse-variance random-effects model, we pooled odds ratios (OR) and mean differences (MD) with their respective 95% confidence intervals (CI). Statistical significance was set at p&lt;0.05. Results: Twelve studies encompassing 2362 patients with CAD (1250: DCB and 1112: DES) were included. Pooled analysis demonstrated that DCB was associated with a significantly lower mean lumen diameter at follow-up [MD: -0.17; 95% CI: -0.27, -0.07; p&lt;0.001] than DES. However, there was no statistically significant difference in mean in-stent late lumen loss [MD: -0.06; 95% CI: -0.16, 0.04], cardiovascular mortality [OR: 0.74; 95% CI: 0.36, 1.51], all-cause mortality [OR: 0.78; 95% CI: 0.45, 1.35], myocardial infarction [OR: 0.75; 95% CI: 0.48, 1.18], major adverse cardiovascular events [OR: 1.16; 95% CI: 0.85, 1.58], target lesion revascularization [OR: 1.52; 95% CI: 0.99, 2.32], and stent thrombosis [OR: 0.84; 95% CI: 0.27, 2.58]. Conclusion: ISR treatment with DCB was associated with a lower minimum lumen diameter at follow-up than DES. No significant differences were noted in the other outcomes. Additional appropriately powered trials with larger patient populations are necessary to confirm our findings.
Abstract 4144671: Safety and Efficacy of Aortic Cross-Clamp for Thrombosed Acute Type A Aortic Dissection
Authors: Yoshinori Nakahara, Tomohiro Iwakura, Akira Marui
Journal: Circulation (2024)

Introduction/Background: Clamping the ascending aorta in acute type A aortic dissection (aTAAD) surgery is an important technique that facilitates proximal procedures such as reinforcement and root replacement during systemic cooling and reduces extracorporeal circulation time. However, in case of aTAAD with thrombosed false lumen, clamping the aorta may lead to serious thromboembolism such as ischemic stroke Research Questions/Hypothesis: We sought to compare the safety and the efficacy of cross-clamp of the ascending aorta with thrombosed and patent false lumen of aTAAD. Methods/Approach: From January 2004 to December 2023, a total of 1550 patients with aTAAD underwent emergent surgery at our institution. Among them, 1404 (91%) patients underwent aortic cross-clamp during systemic cooling. The completeness of the cross-cramp was 99.9%. They were divided into 2 groups based on the false lumen status in the ascending aorta: thrombosed (group T, n=399 [28%]) and patent (group P, n=1005 [72%]). After propensity score matching, 389 patients in each group were matched. Results/Data: After matching, there were no significant differences in age and male gender ratio between the groups. (Table 1A) Preoperative shock state and malperfusion were also similar. The cannulation site did not differ between the groups (Femoral artery: 79% vs. 84% for group T vs. P, P = 0.11; Subclavian artery: 12% vs. 8.0%, P = 0.12). There were no significant differences in the incidence of ischemic stroke (5.4% vs. 6.2% for group T vs. P, P = 0.65), 30-day mortality ( 2.1 vs. 4.1% for group T vs. P, P = 0.10 ), and spinal cord injury (1.3 vs. 1.0% for group T vs, P, P = 1.00), respectively. (Table 1 B）Logistic regression model revealed that thrombosed type dissection was not an independent risk factor for ischemic stroke (odds ratio 1.13, 95% confidence interval 0.66–1.92; P = 0.66). Conclusions: Cross-clamp of the ascending aorta in aTAAD surgery was very useful in that the proximal procedures could be performed during systemic cooling. Notably, in patients with thrombosed false lumen, the procedure could be performed safely without increasing the risk of cerebral complications.
Abstract 4144646: Assessing the Impact of Remote Consultation Strategies on Optimizing Guideline-Directed Medical Therapy in Heart Failure Patients: A Meta-Analysis
Authors: Alhasan Saleh Alzubi, Mohammed S. Beshr, Abdelrahman Farag Abdelwahed, Maram Abuajamieh, Abdulmoez Fauzi Elmesherghi, Moad Ekreer, Zahra Sayed Jalal Alawi, Muhab Azlitni, MOSTAFA EL AWAMI, Mohamed barakat mohamed mohamed, Ahmed Elfaituri, Muhammed Elhadi
Journal: Circulation (2024)

Background: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves outcomes and quality of life. It includes renin-angiotensin system inhibitors (ACE inhibitors, ARBs, ARNi, MRAs), beta-blockers, and SGLT2 inhibitors, which reduce deaths and hospitalizations. Many patients are undertreated, with non-optimized regimens. Few studies compare virtual versus in-office visits for GDMT management. This study aims to assess the efficacy of a virtual multidisciplinary GDMT team in optimizing therapy for HFrEF patients. Methodology: On March 19, 2024, we conducted searches in PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Virtual Health Library (VHL) to identify relevant clinical trials. We included trials comparing virtual consultations with in-office consultations to optimize GDMT, focusing on changes in the usage of GDMT medications (ACEI/ARBs/ARNIs, MRA, BB, and SGLT2) and cardiac hospitalization rates. We used STATA 18 with a DerSimonian random effects model to calculate effect size. Analyses were performed on pre- and post-data of both groups using odds ratios, and we compared cardiovascular hospitalization rates in the post-data using odds ratios (OR). Result: The database search yielded 2,401 studies, of which 8 studies with a total of 15,758 participants were included. There was no statistically significant difference in GDMT usage between in-office and virtual consultations for all drugs. For in-office visits, the OR were: SGLT2, OR 1.30 (95% CI: 0.85 - 1.99); beta blockers, OR 1.13 (95% CI: 0.92 - 1.40); MRA, OR 1.12 (95% CI: 1.05 - 1.19); and ACE, ARB, or ARN inhibitors, OR 1.06 (95% CI: 0.96 - 1.17). For virtual consultations, the OR were: SGLT2, OR 1.72 (95% CI: 0.87 - 3.38); beta blockers, OR 1.61 (95% CI: 0.96 - 2.73); MRA, OR 1.17 (95% CI: 0.98 - 1.40); and ACE, ARB, and ARN inhibitors, OR 1.24 (95% CI: 0.85 - 1.80). There was no statistically significant difference in cardiovascular hospitalization events between virtual and in-office visits, with an OR of 0.74 (95% CI: 0.45 - 1.21). Conclusion: There were no differences between the two groups in optimizing GDMT usage. However, GDMT medications remain underutilized in heart failure patients despite their proven benefits in reducing morbidity and mortality. More policies and innovative strategies are needed to optimize their usage. Further investigation is crucial for refining clinical approaches and enhancing patient care.
Abstract 4144742: Outcomes of a modified Frozen Elephant Trunk technique with debranch first in acute and chronic aortic arch disease
Authors: Antonio Pio Montella, veronica d'oria, Mario Miele, Paolo Masiello, Generoso Mastrogiovanni, Antonino Salvatore Rubino, luca de santo, Marisa De Feo, Severino Iesu
Journal: Circulation (2024)

Introduction: Although Frozen Elephant Trunk has emerged as a valuable technique in aortic arch pathology it is still burdened by a high mortality and morbidity rate due to the technical complexity and clinical and anatomical substrates. Research Questions: Evaluation of early hard outcomes in a surgical approach encompassing the following : 1) central cannulation of the right subclavian artery or the right axillary artery; 2) debranch-first approach (selective cannulation of left common carotid artery with single 8-mm dacron graft and the left subclavian artery for cerebral perfusion with single 10-mm dacron graft); 3) central venous cannulation of right atrium; 4) use of a home-made 4-branched perfusion circuit for extracorporeal circulation; 5) brachiocephalic artery clamping at 26–28°C and beginning of selective antegrade perfusion. The aortic arch is opened and the distal stent graft of the hybrid prosthesis is released into the descending thoracic aorta. The strengthened collar of the prosthesis is sutured to the aorta, and, after cannulation of the fourth lateral branch, systemic perfusion is resumed. The anastomosis between the hybrid prosthesis and sino-tubular junction is then completed and the cross-clamp is released. The prosthesis-elongated supra-aortic vessels are then termino-terminally re-anastomosed to the corresponding branches of the hybrid prosthesis. Methods: Retrospective analysis of a prospectively collected database including 167 patients referred for FET (55 %acute aortic dissections, 14.5% chronic aortic dissections, and 30.5% extended aneurysms, 67% males, 9.2% diabetes mellitus, 72% arterial hypertension, 8.2% chronic renal failure, 12% peripheral vasculopathy, 3% bicuspid aortic valve, 11.9% redo) Results: The average cardio-pulmonary bypass time, crossclamp time, cerebral and visceral perfusion time is 192, 102, 29 and 12 minutes, respectively. In-hospital mortality occurred in 16% (44% due to respiratory failure), spinal cord injury in 2.8% and stroke in 3.5% of patients. Conclusion: Debranch-first technique and cerebral protection through the trivascular perfusion strategy appear safe and effective in the treatment of complex arch pathology.
Abstract 4144705: Risk of Cardiovascular Disease in Giant Cell Arteritis: Systematic Review and Meta-analysis
Authors: Sawai Singh Rathore, Sanjana Allam, Bijay Jeswani, Swetha Manoj, Tirath Patel, Saif Syed, Aman Goyal
Journal: Circulation (2024)

Background: Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies show that there may be an increased risk of cardiovascular disease in GCA, but the results are inconsistent. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA. Methods: A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism. Results: The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55 to 2.15), MI (OR = 1.63, 95% CI = 1.34 to 1.97), CAD (OR = 1.51, 95% CI = 1.09 to 2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55 to 2.46), PAD (OR = 2.02, 95% CI = 1.69 to 2.41), stroke (OR = 1.52, 95% CI = 1.25 to 1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73 to 2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50 to 2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38 to 4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis. Conclusion: The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.
Abstract 4144267: Time Trends in Major Adverse Cardiovascular Events-Related Outcomes After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis on Sex Differences
Authors: Shayan Shojaei, Asma Mousavi, Hamidreza Soleimani, Fatemeh Takaloo, Peyvand Parhizkar Roudsari, Dorsa Salabat, Amirreza Shahmohamady, Mehdi Mehrani, Parisa Seilani, Haleh Ashraf, John Nelson, Rosy Thachil, Fady Iskander, Safi Khan, Khurram Nasir, Kaveh Hosseini
Journal: Circulation (2024)

Background: Percutaneous coronary intervention (PCI) is considered procedure of choice in patients with acute coronary syndrome (ACS). However, whether outcomes of PCI differ by sex remains uncertain. Hypothesis: This systematic review and meta-analysis aims to evaluate potential sex-related differences in major adverse cardiovascular events (MACE) after PCI among ACS patients in different timeframes. Methods: We conducted a systematic search of Pubmed, Embase, Cochrane, and ClinicalTrials databases to identify relevant randomized controlled trials with ACS patients undergoing PCI. The primary outcome of our article was study defined MACE components (all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and need for revascularization). We evaluated Our outcomes in different timeframes, short-term (within 1 month after PCI), mid-term (1 month to 1 year), and long-term (&gt;1 year). We used a random-effects model to estimate risk ratios (RR) and 95% confidence intervals (CI). Egger’s test and funnel plots were used to assess publication bias. Results: Among 32 trials (78,846 patients; 59,491 men and 19,355 women), at short-term, PCI was associated with higher risk of all-cause mortality (RR=2.51, 95% CI 1.70; 3.71), MI (RR=1.33, 95% CI 1.00; 1.77), and stroke (RR=4.35, 95% CI 1.35; 14.04) in women compared with men. Concerning mid-term outcomes, the male group exhibited significantly lower risk of all-cause mortality, cardiovascular mortality, MI, and stroke compared to women group (RR=1.44, 95% CI 1.21; 1.72), (RR=1.29, 95% CI 1.00; 1.66), (RR=1.16, 95% CI 1.04; 1.28), and (RR=1.49, 95% CI 1.15; 1.93), respectively. Eventually, In the long-term, women were found to have a higher risk of both all-cause mortality (RR=1.27, 95% CI 1.16; 1.40) and cardiovascular mortality (RR=1.26, 95% CI 1.08; 1.48) compared to men. However, in terms of the need for revascularization, men had a higher risk compared to women (RR=0.87, 95% CI 0.77; 0.98). Conclusion: In the meta-analysis of PCI related trials in ACS patients, women have a higher risk of cardiovascular events compared to men in different timeframes.
Abstract 4144721: The role of Na <sup>+</sup> /K <sup>+</sup> ATPase alpha 1 subunit in the sex-difference-associated high risk of thrombosis
Authors: Angela Li, Hong Yue, Hannah Wise, Wei Li
Journal: Circulation (2024)

Background: Significant sex differences in the risk of thrombosis-related diseases such as myocardial infarction, stroke, and venous thromboembolism have been well documented in clinical studies. However, the mechanism for these differences is unknown. The sodium/potassium ATPase (NKA), comprising α and β subunits, is crucial in maintaining the sodium and potassium gradient across the cell membrane. It is known that estrogen upregulates the expression of the NKA α1 subunit, encoded by the Atp1a1 gene, NKA α1 also acts as the receptor for androgen. We hypothesize that NKA α1 is responsible for the sex difference in the risk of thrombosis. Methods: Wild-type (WT) and α1 heterozygous ( α1 +/- ) mice of both sexes, aged 8-12 weeks, were subjected to the FeCl 3 -induced carotid artery injury thrombosis model. WT and α1 +/- mice that underwent orchiectomy (ORX) or ovariectomy (OVX) were subjected to the thrombosis study in vivo 8 weeks later. Western blot of platelet lysates was used for mechanistic molecular studies. Results: WT female mice had a significantly shorter time to form occlusive thrombosis than males. Atp1a1 haplodeficiency significantly inhibited 7.5% FeCl 3 -induced thrombosis in male but not in female mice ( Figure 1 ). ATP1A1 heterozygosity significantly reduced platelet ATP1A1 expression in male mice without affecting intracellular sodium concentration. Female mice platelets expressed more α1 than males. OVX or ORX significantly reduced plasma estrogen (17-beta-estradiol) and testosterone levels, with gonadectomy-induced hormone changes being more dramatic in males ( Figure 2 ). OVX did not affect thrombosis in female mice, either WT or α1 +/- mice. ORX did not affect thrombosis in WT mice; however, it significantly enhanced thrombosis in male α1 +/- mice ( Figure 3 ). The expression of platelet ATP1A1 was significantly increased in mice that underwent ORX for 8 weeks or under ovariectomy for 8 weeks followed by treating them with estrogen for 1 week. Conclusion: ATP1A1 plays an essential role in platelet activation and thrombosis. Both ORX and estrogen treatment significantly increased platelet ATP1A1 expression, consequently diminishing the anti-thrombotic phenotype in the male α1 +/- mice. These data suggest that the interaction between NKA α1 and sex hormones plays a pivotal role in thrombosis. Targeting ATP1A1 could be a novel strategy for addressing the sex difference-associated high risk of thrombosis.