tbuckley/cabot-search huggingface dataset:
Abstract 15763: Increasing Diversity Among Research Participants Through Patient Engagement in the Congenital Heart Initiative
Authors: Mindi Messmer, Scott Leezer, Jamie L Jackson, Shreya Papneja, Areeba Asghar, Ruth Phillippi, aliza marlin, MARK ROEDER, Danielle Hile, Anushree Agarwal, Matthew J Lewis, Arwa Saidi, Ronald J Kanter, Satinder K Sandhu, THOMAS W YOUNG, Roni Jacobsen, Emily Ruckdeschel, Adam M Lubert, Harsimran Singh, Ali N Zaidi, Dan Halpern, anita mathews, Susan Timmons, Thomas Carton, Anitha S John
Journal: Circulation (2023)

Background: The Congenital Heart Initiative (CHI) is the first patient-powered digital registry for adults with congenital heart disease (ACHD). The CHI-Redefining Outcomes and Navigation to Adult-Centered Care (CHI-RON) study is built upon the CHI as a unique collaboration with PCORnet. Goal: Recruitment of populations that are racially diverse, younger, out-of-care, and male has been challenging in ACHD studies. Our goal was to design patient engagement and recruitment strategies to increase these underrepresented populations. Methods: Launched in December 2020, patients across the globe can self-enroll in the CHI registry. The CHI-RON study, initiated in May 2022, recruits ACHD patients at 12 PCORnet centers. Patients are involved in all aspects of the study including recruitment (see Figure 1). Results: As of May 2023, a total of 2,520 participants were recruited by CHI-RON centers while 1,494 self-enrolled in the CHI. Most participants report complex CHD anatomy (n=1,660, 49%). A total of 762 (36%) participants are considered out of care. CHI-RON recruitment methodologies increased representation when compared to self-enrolled CHI participants in terms of ethnicity (10.3 % vs 7.4% Hispanic, p=0.005), race (5.4% vs 2.6%, African American, p&lt;0.001), sex (41% vs 28% male, p&lt;0.001), age (34.8 +/-12.5 years vs 44.5 +/- 14.3 years, p&lt;0.001), and education (33% vs 22% high school equivalent or less, p&lt;0.001). Most patients involved in the study team (n=11, 83%) reported a very to extremely high degree of meaningfulness (average score 85.2) per the Patient Engagement in Research Scale (PEIRS-22). The mean scores of each of the seven subdomains demonstrated significant meaningfulness, especially in the subdomains of convenience, contributions, and benefits. Conclusions: Patient engagement is critical to improving the inclusion of underrepresented populations in clinical research and ensuring alignment with the needs of ACHD patients.
Abstract 14347: Albuminuria, N-Terminal Pro-Brain Natriuretic Peptide and Incident Congestive Heart Failure in High-Risk Adults With Hypertension: A Post Hoc Analysis of the Systolic Blood Pressure Intervention Trial
Authors: Richard Kazibwe, Muhammad Ahmad, Elsayed Z Soliman, Lin Y Chen, Michael D Shapiro, Joseph Yeboah
Journal: Circulation (2023)

Introduction: Abnormal levels of urinary albumin concentration (UAC) and N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) have each been independently associated with an increased risk of congestive heart failure (CHF). It remains unknown whether the concomitant presence of abnormal UAC and NT-proBNP increases an individual’s risk for future CHF beyond that contributed by each biomarker. Objective: To examine the joint association between abnormal UAC and NT-ProBNP with incident CHF in participants from the SPRINT (Systolic Blood Pressure Intervention Trial) study. Methods: This analysis included 8,176 participants from SPRINT with available data on baseline UAC and NT-proBNP. UAC was measured by urine albumin-creatinine ratio (UACR). Albuminuria was defined as UACR ≥30 mg/g. Abnormal NT-proBNP was defined as levels ≥125 pg/ml. Cox proportional hazard models were used to examine the association of UAC and NT-proBNP, as well as albuminuria and abnormal NT-proBNP, with incident CHF. Results: Over a median follow-up of 3.2 years, 179 incident cases of CHF were observed. In adjusted models, the risk of incident CHF (HR 95% CI) associated with each 1 (one) unit standard deviation increase in the levels of UAC and NT-proBNP was 1.10 (1.04-1.16; p &lt;0.001) and 1.13 (1.10-1.16; p &lt;0.0001), respectively. A statistically significant multiplicative interaction between UAC*NT-proBNP was observed in the fully adjusted model (p &lt;0.0001). The risk associated with the presence of abnormal UAC +/- abnormal NT-proBNP in the SPRINT cohort is depicted in the figure. Conclusions: Among SPRINT participants, we found a significant multiplicative interaction between UAC and NT-proBNP as predictors of incident CHF. Also, the risk of future CHF was over six times higher in individuals with abnormal UAC and NT-proBNP, compared with those with normal levels of both biomarkers. More studies are needed to further explore this interaction and the implications on CHF prevention.
Abstract 16850: Suicide Left Ventricle After Transcatheter Aortic Valve Replacement. A Systematic Review
Authors: Diego Barzallo, Juan F Torrado, Cesar J Benites Moya, Amrin Kharawala, Matteo Sturla, Julio Echarte Morales, Andrea Scotti, Juan Terre, jose wiley, Ythan Goldberg
Journal: Circulation (2023)

Introduction: Suicide left ventricle (LV) is an infrequent but severe complication of transcatheter aortic valve replacement (TAVR) that is poorly defined. It is generally referred to as hemodynamic collapse following valve deployment due to acute LV dynamic obstruction. Understanding this complication is essential for its prompt diagnosis and treatment. Methods: We conducted a systematic literature review for studies describing suicide LV (i.e., severe hypotension causing hemodynamic collapse and/or end-organ failure in the setting of a new or worsened dynamic intraventricular gradient after TAVR). Two authors reviewed each study for eligibility, and a third author resolved disagreements. Results: Of 506 studies, 27 publications were considered for the final analysis. Most patients that met the inclusion criteria of suicide LV were women (96%), demonstrating a small ventricle (70%), a hypertrophic septum (81%), and hyperdynamic contractility (50%) on pre-TAVR echocardiographic assessment. An intraventricular gradient pre-TAVR was found in half of the cases. Suicide LV manifested as severe hypotension occurred most often immediately after valve deployment. The LV outflow tract was the most common site of obstruction (85%) (i.e., LVOTO), compared to midventricular obstruction (MVO). Advanced therapies were required in nearly 70% of the cases. The most common advanced therapies were alcohol septal ablation and ventricular pacing. Conclusions: LV suicide after TAVR occurred almost invariably in women. The use of echocardiography before TAVR may be essential to anticipate this complication. Although previous studies report MVO being a more common site of dynamic intraventricular gradient after TAVR, LVOTO appears to carry the highest risk of suicide LV. Further research is required to predict better the risk of suicide LV to improve the ability to perform a bailout strategy in patients with hemodynamic collapse refractory to medical therapy.
Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors
Authors: Mohamed Diab, Nikita Nand, Mohamed M Eid, Muhammad Osama, Deeptanshu Jain, Venkata Satish Pendela, David Corteville, Richard Alweis
Journal: Circulation (2023)

Introduction: Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited. Methods: We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management. Results: The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy. The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction. Conclusion: We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.
Abstract 18594: Symptom Physiology in Postural Tachycardia Syndrome: Prevalence of Dysfunctional Breathing and Preload Insufficiency Using Novel Invasive Cardiopulmonary Exercise Testing
Authors: Bianca Honnekeri, Mohak Gupta, Deborah Paul, Adriano Tonelli, Kenneth A Mayuga
Journal: Circulation (2023)

INTRODUCTION: Dyspnea and lightheadedness are debilitating symptoms experienced by POTS patients, yet there is paucity of data on their pathophysiology. Invasive cardiopulmonary exercise testing (iCPET) is a novel investigation which gathers physiologic data and better characterizes these phenomena. RESEARCH QUESTION: What is the prevalence of dysfunctional breathing (DB) and preload insufficiency (PI) in POTS patients who undergo iCPET? METHODS: We studied hemodynamics in a cohort of 35 POTS patients who underwent iCPET in a sitting bicycle. The protocol augments CPET with continuous data from pulmonary artery catheterization and arterial line. PI is defined as abnormally low right atrial pressure during exercise and reduced peak cardiac output percentage of predicted. DB is characterized by exercise-induced oscillatory ventilation. RESULTS: The study cohort had a mean age of 40.4 years, and 26 of the 35 patients (74.3%) were female. iCPET revealed the prevalence of only DB as 5.7%, only PI as 37.1%, both DB and PI as 37.1%, and neither DB nor PI as 20% (p=0.006). These 4 sub-groups were then compared for analysis. Notably, the cardiac output percentage of predicted at peak exercise was significantly different between the 4 groups (91.6%, 81.1%, 89.5%, 117.4%; p=0.011). The DB alone subgroup had mean PETCO2 at peak exercise of 28.5, mean VE/VCO2 at AT of 37.5, mean respiratory rate of 39.5 cpm and mean maximal ventilation during exercise of 93.7L. DB was more common in older individuals, while PI was more common in younger individuals (p=0.004). Our study suggests that PI and DB are common entities in POTS with distinct hemodynamic characteristics, and may co-occur. CONCLUSION: This study is a first step towards elucidating various physiological abnormalities in POTS, where symptoms are often debilitating. iCPET yields hemodynamic information that may provide avenues for targeted interventions that could significantly improve quality of life.
Abstract 15263: Prognostic Impact of the Hyper-Polypharmacy on the Long-Term Outcomes in Patients With Chronic Heart Failure Following Cardiac Resynchronization Therapy
Authors: Yuma Ono, Taisuke Harada, Hidekazu Kondo, Kunio Yufu, Tetsuji Shinohara, Yasushi Teshima, Naohiko Takahashi
Journal: Circulation (2023)

Introduction: Optimal drug therapy improves long-term prognosis in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, but it exposes patients to the risk of polypharmacy. Hypothesis: This study aimed to determine the association between hyper-polypharmacy and adverse events in patients with CHF after cardiac resynchronization therapy (CRT). Methods: This retrospective study evaluated 134 patients (90 male, mean age 70.6 ± 9.7 years; 31 (23%) old myocardial infarction, 57 (43%) dilated cardiomyopathy, 46 (34%) others) who underwent CRT implantation between 2004 and 2020 and were followed for at least one year after the operation (mean, 1071 ± 649 days). The hyper-polypharmacy group (n = 74) was defined as patients taking total of 10 or more medications at discharge. The primary endpoint was major adverse cardiovascular events (MACE) including cardiovascular death, hospitalization for heart failure (HHF), cerebral infarction, acute myocardial infarction, and cardiac arrest. The secondary endpoints include HHF and all-cause mortality. Results: MACE occurred in 62 (46%), HHF occurred in 55 (41%) and all-cause mortality occurred in 24 (18%) patients. Kaplan-Meier survival analysis demonstrated that hyper-polypharmacy group had a higher incidence of MACE (log-rank 8.29; P = 0.004), HHF (log-rank 8.55; P = 0.0035) and all-cause mortality (log-rank 7.83; P = 0.0051). Cox proportional hazards regression analysis also revealed that the hyper-polypharmacy group had a higher incidence of MACE (HR 2.15; 95% CI:1.28 - 3.75, P = 0.0036), HHF (HR 2.39; 95% CI:1.32 - 4.19, P = 0.0031) and all-cause mortality (HR 3.72; 95% CI:1.49 - 11.2, P = 0.0038). Multiple Cox proportional hazards analysis revealed that hyper-polypharmacy was an independent predictor of MACE (hazard ratio 2.00; 95% CI:1.18 - 3.50, P = 0.01). Conclusions: Hyper-polypharmacy may predict the occurrence of MACE in patients with CHF undergoing CRT implantation.
Abstract 16682: Artificial Intelligence Predicts All-Cause and Cardiovascular Mortalities Using 12-Lead Electrocardiography
Authors: Je W Park, Oh-Seok Kwon, Daehoon Kim, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Chun Hwang, Hui-Nam Pak
Journal: Circulation (2023)

Introduction: Electrocardiography (ECG) can be easily obtained at a low cost and includes voltage and time interval representing heart conditions. We hypothesized that artificial intelligence (AI) detects a subtle abnormality in 12-lead ECG and may predict individual mortality. Methods: Among 502,411 population in UK Biobank, 42,096 individuals had 12-lead ECG from 2013 to 2022. Among 41,572 survival group, after adjusting the following inclusion criteria; normal sinus rhythm, age under 60 years, PR interval 120~200ms, QTc interval 350~460ms, and QRS duration 70~100ms, 4,512 individuals were enrolled in this study. We developed and tested convolutional neural network (CNN) model to predict all cause death, cardiovascular (CV) death, or sudden cardiac arrest (SCA). The study population were divided into train (80%), validation (10%), and test (20%) set. Results: Among 4,512 patients with median 3.7 years [IQR; 2.7-5.1] of follow-up, the rate of all-cause mortality was 11.6% (524). In overall study population, median age was 55.5 years and proportion of male sex was 42.2%. The patients with all-cause death were older (p&lt;0.001) and had more comorbidities (p&lt;0.001). In the train set, CNN model showed 0.93 in AUC for predicting all-cause death. In the test set, CNN model showed consistent good performance power (AUC 0.90) for all-cause death. In subgroup analysis, 102 of 4153 (2.46%) and 57 of 4065 (1.40%) patients experienced CV death and SCA, respectively. The performance power in test set were 0.90 in AUC for CV death and 0.87 in AUC for SCA. Conclusions: AI detects and predicts future all-cause death, CV death, and SCA in median of 2.6 years by analyzing standard 12-lead ECG in generally looking normal sinus rhythm
Abstract 12244: Gender Differences in Leadless Pacemaker Peri-Procedural Adverse Events, Long-Term Device Functions, and Clinical Outcomes
Authors: Jingwen Huang, neal bhatia, Michael S Lloyd, Stacy Westerman, Anand Shah, Miguel A Leal, David B Delurgio, Anshul Patel, Christine Tompkins, Angel R Leon, Mikhael F El-Chami, Faisal M Merchant
Journal: Circulation (2023)

Introduction: Some studies suggested gender differences in procedural complication rates and long-term outcomes for trans-venous pacemakers. Little is known about gender differences associated with leadless pacemaker (LP) implantation. Methods: We reviewed all Medtronic Micra LP implants at our institution from 9/2014 to 9/2022. Device parameters (R wave sensing, impedance, and capture threshold), right ventricular pacing burden (RVP), left ventricular ejection fraction (LVEF), and 30-day adverse events post implant were obtained. Results: Among 489 patients, 50.9% were men. Mean follow-up was 1.7 ± 1.5 years. Women were older than men at the time of LP implant (78.1 ± 14.7 vs 75.5 ± 15.3 years old, p=0.04). There were no significant differences in R wave sensing and RVP between genders. Impedance and LVEF were higher in women and capture thresholds were higher in men at both baseline and last follow up. Despite significant differences in device parameters between genders, differences were small and not clinically relevant in most cases (Figure). Mean number of device deployments required at implant was similar: women 1.3 ± 0.6 vs men 1.4 ± 0.9, p=0.16). Implant related complications were similar between women and men: access site hematoma (5 vs 9, p=0.42), pseudoaneurysm (0 vs 2, p=0.49), cardiac perforation (2 vs 1, p=0.62), 30-day re-hospitalization (16 vs 25, p=0.19) and 30-day mortality (16 vs 17, p=0.99). LVEF decreased over time in both genders (Figure). During follow-up, 4 women and 6 men required transvenous cardiac resynchronization therapy (CRT) implantation (p=0.75) and 4 women vs 2 men required transvenous dual chamber pacemaker implantation (p=0.44). Conclusion: Outcomes of leadless pacemaker implantation are similar between women and men. Long-term device function is excellent in both genders. However, about 3% of all patients required device upgrade, highlighting the need for close electrophysiology follow-up after LP implant in both genders.
Abstract 17918: Provider Care Team Segregation and Ischemic Heart Disease Outcomes by Race
Authors: Hunter Mwansa, Adedoyin Johnson, Shannon Knapp, Janina Q Bisono, Dalancee Trabue, Ryan Yee, Francesca Williamson, Stephen Watty, Natalie Pool, Megan Thomas Hebdon, Wanda Moore, Ekoh Yankah, Nneamaka Ezema, Nia Kimbrough, Johnnie Washington, Karen Lightbourne, Brownsyne Edmonds, Quinn Capers, David Brown, Denee Johnson, Jalynn Evans, Brandi Foree, Anastasia Holman, Courtland Blount, Brahmajee K Nallamothu, John Hollingsworth, Khadijah Breathett
Journal: Circulation (2023)

Background: Black patients have worse ischemic heart disease (IHD) outcomes than White patients. How healthcare provider team segregation, dissimilarity/distinctiveness in the composition of provider teams caring for Black vs White patients within a hospital, contributes to racial inequities in IHD outcomes is unclear. Methods: Using Optum’s de-identified Clinformatics® Data Mart of commercial and Medicare beneficiaries, we identified non-Hispanic Black and White patients with an admission diagnosis of IHD from 2010-2018. We calculated the Segregation Index (SI, 0 - 1; 0 for similarity/complete overlap; 1 for lack of similarity/overlap in the composition of provider teams caring for Black vs White patients). Hospitals were stratified into tertiles with increasing dissimilarity between provider care teams [low (0.16-0.38), medium (≥0.39-0.48), and high (≥0.49-0.97)]. For 30-day readmission, we used generalized linear mixed-effects models including effects of race, SI tertile, race-SI, gender, age-adjusted Charlson Comorbidity Index, and hospital factors including effects of cardiology care, 2-way, and 3-way interactions of race, SI, and cardiology care. Results: Among 183,165 patients with IHD, odds of 30-day readmission were similar by race across SI tertiles in the absence of cardiology care. With cardiology care, Black patients in low and medium SI tertiles had higher odds of 30-day readmission than White patients [low: OR 1.08 (95% CI 1.02 - 1.13); medium: OR 1.12 (95% CI 1.04 - 1.21)] but not the high SI tertile [OR 1.03 (95% CI 0.93 - 1.14)] ( Figure ). Conclusions: Among patients with IHD seen by a cardiologist, for 30-day readmission there was a significant racial disparity in favor of White patients seen at hospitals with lower levels of provider team segregation. Further research is needed to investigate the causes of this disparity, which may be related to preferential selection of cardiologists among commercial and Medicare insured populations.
Abstract 16140: Utility of Cardiovascular Magnetic Resonance Imaging in Clinical Decision Making for Children and Adolescents With Hypertrophic Cardiomyopathy
Authors: Gordon Calhoun, Jean Cavanaugh, Shelley D Miyamoto, Jennifer Romanowicz
Journal: Circulation (2023)

Introduction: Cardiovascular magnetic resonance (CMR) imaging is recommended for surveillance and risk stratification in patients with hypertrophic cardiomyopathy (HCM), but the role of CMR findings in clinical decision making has not been described in a pediatric population. Methods: In this single center retrospective study we identified all patients with HCM who underwent CMR. We then determined if there was a clinical management change based on CMR findings. Results: We identified 136 patients with an HCM diagnosis from 2005-2022. Of these, 55 patients (40%) underwent 76 CMR studies. The HCM etiology was genetic or familial in 31 (56%), idiopathic in 21 (38%), and syndromic in 3 (5%); 34% of patients were female; and the median age (and IQR) of included patients at first CMR was 12 (9-15) years old. Ten patients underwent more than one CMR. Both awake and sedated CMRs were included and there were no complications. Management changes included confirmation of HCM diagnosis in 9 patients (16%), change in medical therapy for 3 (5%), myectomy recommendation in 1 (2%), and implantable cardioverter defibrillator (ICD) placement recommendation in 11 (20%). Of those recommended for ICD placement, 8 were a result of new late gadolinium enhancement and 3 had massive septal hypertrophy (median Z-score 30) discovered or confirmed by CMR. To date, no ICDs have discharged any shocks. Altogether, changes in clinical management were made based on CMR findings for 22 patients (40%), representing a change in management as a result of 29% of the total CMRs performed. Conclusion: CMR is an important contributor to clinical decision making in the management of children and adolescents with HCM. Specifically, CMR in this population was especially useful in defining the diagnosis of HCM in the presence of an equivocal echocardiogram and deciding to place an ICD. Fewer CMRs contributed to decision making regarding medical therapy and septal myectomy.