tbuckley/cabot-search huggingface dataset:
Abstract 426: The Rural Experience of Cardiac Arrest in Maine: Geography, EMS Access, and Social Determinants of Health
Authors: Teresa L May, Henry Stoddard, Alison Daley, Matthew Sholl, Jason Oko, Sergey V Ryzhov, Joanne T deKay, David Gagnon, Richard R Riker, David B Seder
Journal: Circulation (2023)

Introduction: Resuscitation resources and outcomes differ between rural and urban areas, largely due to patient risk factors and limited emergency medical service (EMS) resources. The current definitions of rural areas are inconsistent and do not encompass all the factors that may affect post-resuscitation care, such as healthcare access, and social determinants of health (SDOH). Hypothesis: In addition to rurality category, measures of healthcare access and SDOH further explain variability in cardiac arrest outcomes across the state of Maine. Goals: Evaluate the difference in model performance in determining survival at three months, using EMS-data, measures of geographic rurality, healthcare access, and SDOH. Approach: We utilized Maine EMS &amp; Fire Information Systems to identify non-traumatic out-of-hospital cardiac arrests in Maine from 2018-2021. We merged this data with state Center for Disease Control data to determine 30-day survival. Risk adjusted models were developed and measures of healthcare access and SDOH were added for all patients and for a cohort of patients who were transported to an Emergency Department (ED). We measured model performance and compared models using likelihood ratio tests. Results: Inclusion criteria was met in 4,277 patients and 1,167 (27%) patients were transported to an ED. After risk adjustment, the best performing model included Rural Urban Commuting Area (p=0.083), time from arrest to highest level of EMS provider (p&lt;0.001) and Area Deprivation Index (p=0.01). For patients transported to EDs, the best performing model included population per square mile (p=0.001), time from arrest to highest level of EMS provider (p=0.041) and census tract with high school education or greater (p&lt;0.001). In both cohorts, the model with all three factors and other risk adjustment was superior to the baseline and models with any individual factor (likelihood ratio test p&lt;0.05). Conclusions: The addition of rurality measures to cardiac arrest characteristics improves model association with good outcome and the addition of markers of EMS response and SDOH explained additional variability. These factors should be considered in combination when evaluating outcome disparities among patients with cardiac arrest.
Abstract 18463: Direct Oral Anticoagulants versus Vitamin K Antagonists in Morbidly Obese Patients (BMI ≥ 40): An Updated Systematic Review and Meta-Analysis
Authors: Usman Akbar, Saad U Malik, Abdul Qadeer, Nouman Shafique, Bisher Mustafa
Journal: Circulation (2023)

Introduction: The safety and efficacy of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) remain unknown in patients with BMI ≥ 40 kg/m 2 . We aim to evaluate the risk of recurrent VTE and major bleeding in patients with a BMI ≥ 40 when started on DOACs versus VKAs. Methods: We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “venous thromboembolism”, “Vitamin K antagonists” and “direct oral anticoagulants”. After the screening, We extracted the data till May 2023 in a data extraction sheet. Our inclusion criteria were: adult patients, morbidly obese (BMI ≥ 40 kg/m 2 ), who were on DOACs or VKAs for VTE or atrial fibrillation. We used a variance-weighted random-effects model to analyze data on DOACs vs. VKAs, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using the ‘meta’ package in R. Results: Our analysis included a total of 16 studies (n= 62704 patients). Obese patients on DOACs had a significant reduction in the risk of recurrent VTEs compared to VKAs OR 0.72 (95% CI: 0.59 - 0.88, I2 :19%). Also, DOACs were associated with a lower risk of major bleeding compared to VKAs in morbidly obese patients (OR = 0.65, 95% CI: 0.58 - 0.74, I2 :0%). For non-major bleeding, although the statistical significance was not reached, a consistent trend favoring DOACs was observed (OR = 0.76, 95% CI: 0.47-1.21). (Figure1) Conclusions: Among morbidly obese patients (BMI ≥ 40), DOACs are associated with a significantly lower risk of recurrent VTEs, and major bleeding compared to VKA. For non-major bleeding, there was a trend favoring DOACs over VKA. Increased recruitment of obese patients in clinical trials is needed to provide us with robust data for informed clinical decision-making.
Abstract 18352: Impact of Approach Site on Conduction Defect in Right Ventricular Biopsy
Authors: Shohei Yoshida, Hayato Tada, Akihiro Nomura, Shinichiro Takashima, Soichiro Usui, Kenji Sakata, Kenshi Hayashi, Noboru Fujino, Masayuki Takamura
Journal: Circulation (2023)

Introduction: Myocardial biopsy is a fundamental procedure for diagnosing myocarditis and cardiomyopathy. Complete right bundle branch block (CRBBB) is a potential complication of right ventricular biopsy (RV-EMB) that occurs at a certain rate. Consequently, patients with complete left bundle branch block (CLBBB) often exhibit reluctance to undergo RV-EMB due to the risk of complete atrioventricular block. However, it is precisely in such cases that the diagnosis of CLBBB through myocardial biopsy becomes crucial and concerns clinicians.Although there are two approaches to RV-EMB, namely the transfemoral vein and transjuglar vein approaches, and each institution has its preferred method, no study has investigated the variation in complication rates, particularly the occurrence of CRBBB, based on the different approach sites for RV-EMB. AIMS:This study aims to analyze the disparity in complication rates, primarily CRBBB, attributable to differences in the approach site during the RV-EMB procedure. METHODS/RESULTS: Over all 266 cases who underwent RV-EMB at Kanazawa University between January 2017 and December 2022 including 87 cases with transfemoral venous approach (Group TF) and 179 cases with transjugular venous approach (Group TJ) were enrolled in this retrospective single-center study. Group TF exhibited a higher usage of warfarin (15.1% vs. 3.4%, p=0.001) and obtained fewer specimens compared to Group TJ (2.97±0.98 vs. 3.90±0.65 pieces, p&lt;0.001).Transient CRBBB was observed in 26 (29.9%) patients in Group TF and 13 (7.3%) patients in Group TJ (p&lt;0.001); CRBBB persisted beyond 24 hours in 8 (9.1%) and 2 (1.1%) patients(p=0.004), respectively. One case of cardiac tamponade occurred in Group TF, and two cases of VF were reported in Group TJ, with no instances of stroke, permanent pacemaker implantation, or mortality.Multivariate logistic regression analysis identified approach cite (Group TF/TJ) as an independent predictor of CRBBB (p&lt;0.001, odds ratio 0.43). CONCLUSIONS: The transjugular venous approach in RV-EMB demonstrates potential in reducing the occurrence of CRBBB as a complication. In cases where complete atrioventricular block is a concern, such as those with CLBBB, the transjugular vein approach may be preferable.
Abstract 18514: A Simulation Study on the Inducibility of Atrial Fibrillation Drivers From Intra-Atrial Electrode Catheters Using Personalized Computational Models Based on LGE-MRI
Authors: Kensuke Sakata, Carolyna Yamamoto Alves Pinto, Syed Yusuf Ali, Shane Loeffler, Brock Tice, Ryan P Bradley, Adityo Prakosa, Eugene G Kholmovski, Natalia A Trayanova
Journal: Circulation (2023)

Introduction: Although non-inducibility of atrial fibrillation (AF) drivers just after pulmonary vein isolation (PVI) with or without substrate ablation for persistent AF (PsAF) has been proposed as an acute outcome suggesting a successful long-term outcome, recent studies have found no association with long-term freedom from atrial tachyarrhythmias. It is unclear whether the latter finding is due to complete elimination of all AF drivers or the inadequacy of an AF induction test. Recently, patient-specific computer simulation based on late gadolinium enhancement (LGE)-MRI has been proposed to be useful for detecting rotors as PsAF drivers. Hypothesis: By investigating the accuracy of an induction test following PsAF ablation from the sites commonly used in clinical practice, particularly coronary sinus (CS), we might establish the promising method to confirm non-inducibility during ablation procedure. Methods: Thirty-five consecutive PsAF patients underwent LGE-MRI tests for fibrosis-based computational models. Rotors were induced by rapid pacing from 40 bi-atrial sites near fibrosis after PVI then ablated, repeated until obtaining non-inducibility of rotors. Each induced rotor was investigated for whether it was induced by pacing at lateral right atrium (RA), high RA or CS where electrode catheters were typically placed and used for induction test (Figure). Results: Except for 9 patients having poor LGE-MRI images or low fibrosis burden, 21 patients had a total of 136 locations capable of sustaining extra-PVI rotors. Of the total amount of rotors induced, 24% were induced by pacing at lateral RA, 11% at high RA and 45% at CS, respectively. The capture of all arrhythmogenic locations capable of sustaining rotors improved to 59% by performing induction test from all 3 pacing sites instead of a single one (p&lt;0.01). Conclusions: Although CS is the reasonable pacing site for induction test, that from RA should be also conducted for the optimal rotor detection.
Abstract 18372: Peripheral Intravascular Lithotripsy to Facilitate Transfemoral Transcatheter Aortic Valve Replacement - Updated Outcomes
Authors: Stephanie Tom, Andy Tully, Chandan Devireddy, Kendra Grubb
Journal: Circulation (2023)

Background: Transfemoral transcatheter aortic valve replacement (TF-TAVR) approach has proven to be superior to alternative access[1]. However, a subset of patients being evaluated for TF-TAVR are deemed unfit secondary to peripheral arterial disease. Despite reduction of delivery system profiles to 14 - 18 Fr, current systems still pose an increased risk of access vessel injury. For patients anatomically unfit for standard transfemoral access, peripheral intravascular lithotripsy (IVL) has emerged to facilitate femoral access for TAVR. Methods: Single center, retrospective analysis of an institutional patient database, queried from 1/2018 through 12/2022 for all patients undergoing TAVR. All patients undergoing IVL facilitated lithotripsy for transfemoral access were analyzed. Results: A total 2,209 TAVR cases were identified, with 75 (3.78%) having undergone lithotripsy: 14 in 2018, 15 in 2019, 16 in 2020, 13 in 2021, and 17 in 2022. The lithotripsy cohort consisted of 45% female with mean age of 78±9.8 years. Average length of stay was 3 days. Common and external iliac lesions were the most common target (n=41/75), followed by common iliac alone (n=25/75). Majority of IVL was performed with 7-mm lithotripsy catheter (n=55/75). Procedural success was 98.7% (n=74/75). Average fluoroscopy time 31 minutes, and average total contrast infusion 87cc. Average number of pulses per lesion was 260 ±52. Mean target lesion diameter on the right 5.0 ±1.2mm and left 5.3 ±1.3mm. Average aortic valve calcium score was 2405.6 ±1260.4. Total complication rate was 28%. Complications requiring secondary vascular procedure occurred in 5.3% (n=4/75) with femoral stenosis requiring balloon dilation, external iliac pseudoaneurysm and retroperitoneal bleed secondary to common femoral pseudoaneurysm primarily repaired, and CFA occlusion required open endarterectomy. Mortality at 30-days 1.3% (n=1/75). Conclusions: This abstract aims to provide an updated report of a single institution experience for the use of IVL to facilitate transfemoral TAVR. The IVL facilitated TF-TAVR is feasible, safe, and effective at preserving the transfemoral TAVR route in patients with severe peripheral artery disease. [1] Holmes. et al. J Am Coll Cardiol, 2015. 66(25): p. 2813-2823
Abstract 18211: Does Frailty Matter in High Risk PCI
Authors: Ajar Kochar, Benjamin Peterson, Rebecca Young, Michael Nanna, Jennifer A Rymer, Abdulla Damluji, Karen P Alexander, Balimkiz Senman, Nadia R Sutton, Ariela Orkaby, Deepak Bhatt
Journal: Circulation (2023)

Background: There are limited data depicting the relationship between frailty and in-hospital outcomes for high-risk PCI. Methods: The Cath-PCI registry (2018 - 2020) was used to examine the association of frailty as defined by the Canadian Study of Health and Aging (CSHA) frailty index and in-hospital complications for patients undergoing PCI. We conducted a logistic regression analysis for in-hospital mortality. Results: The sample size was 1,316,390 individuals aged ≥ 65 years undergoing PCI. The frailty distribution was: 78,921 not frail (6.0%), 892,695 pre-frail (67.8%), 284,444 frail (21.6%), and 60,330 severely frail (2.2%). The median age of patients who were frail was 76 years, 39.4% were female, and 87.2% were white. In-hospital rates for any bleeding stratified by frailty status were: not frail: 1.0%, pre-frail: 1.5%, frail 3.3%, severely frail 8.9%. The adjusted odds ratio (aOR) regarding in-hospital mortality among PCI patients at high bedside mortality risk for pre-frail, 2.58 (95% CI: 1.42 - 1.80) for frail, and 5.14 (95% CI: 4.56 - 5.80) for severely frail. The adjusted association for in-hospital mortality across sub-groups stratified by frailty status was: left main PCI ~ pre-frail aOR 1.44 (95% CI: 1.01 - 2.05), frail aOR 2.18 (95% CI: 1.53 - 3.11) and severely frail aOR 3.98 (95% CI: 2.79 - 5.70). While the aORs for chronic total occlusion were ~ pre-frail 1.57 (95% CI: 0.97 - 2.52), frail 2.31 (95% CI: 1.43 - 3.75) and severely frail 6.04 (5.40 - 6.75) and cardiogenic shock ~ pre-frail 1.33 (95% CI: 1.08 - 1.64), frail 1.54 (95% CI: 1.25 - 1.90) and severely frail 2.44 (1.99 - 3.00). Conclusions: Contemporary PCI is commonly performed on frail patients. Frailty is associated with higher risk of mortality across high-risk PCI categories; however, severe frailty depicts a distinct and exceptionally high-risk cohort.
Abstract 18395: Urinary Metals as Novel Risk Factors for Incident Heart Failure and Subtypes in Indigenous Communities in the US: Evidence From the Strong Heart Study
Authors: Irene Martinez-Morata, Arce Domingo, Gernot Pichler, Jose Manuel Garcia Pinilla, Jason G Umans, Maria Tellez-Plaza, Richard B Devereux, Daichi Shimbo, Ana Navas-Acien
Journal: Circulation (2023)

Introduction: Chronic exposure to metals is an independent risk factor for CVD, yet the role of metal exposure on heart failure (HF) and HF subtypes remains understudied. Indigenous communities in the US suffer a high burden of CVD and have been historically exposed to moderate and high levels of environmental metals. In this study we evaluate the prospective association between urinary metal levels and incident HF and HF subtypes in the Strong Heart Study, the largest US cohort of American Indian adults. Hypothesis: We hypothesize that urinary metals are prospectively associated with increased HF risk, and the associations will be different for ejection fraction (EF) &lt;50% and EF &gt;50%. Methods: A total of 2,706 participants (mean (SD) age 56.4(8.1) years, 58% female) with urinary metals available at baseline (1989-1991) were included. Incident HF events were ascertained through 2019 by a physician panel, including classification of HF subtypes (EF50% and EF&lt;50%). Progressively adjusted Cox proportional hazards models were used to identify the risk of incident HF and HF subtypes by an interquartile range (IQR) change in urine metals (Table 1). Results: A total of 444 participants developed HF (90 EF &gt;50%, 127 EF&lt;50%, 227 unclassified). Baseline levels of all metals were higher among participants who developed HF. In fully adjusted models (Model 2), higher levels of urinary cadmium, molybdenum and zinc were significantly associated with HF risk. The associations varied by HF subtype. While no significant associations were identified for those EF≥50%, higher levels of urinary tungsten, molybdenum, and zinc were significantly associated with HF EF&lt;50% risk. Conclusions: We identified an association between baseline urine levels of several essential and non-essential metals and incident HF risk in the Strong Heart Study, with strongest associations for those with EF&lt;50%. These findings can help identify novel modifiable risk factors of HF and inform prevention strategies.
Abstract 18447: Comparative Seasonal Variation in Outcomes Among Patients Hospitalized for Heart Failure in Cold- and Warm-Climate States
Authors: Ellen K Brinza, David P Kao
Journal: Circulation (2023)

Background: Despite emerging evidence that extreme heat and air pollution exposure are linked to adverse cardiovascular disease outcomes, paradoxical seasonal trends in heart failure hospitalizations and deaths have been observed, with peaks occurring in winter months. This study aimed to explore how seasonal variations in heart failure admissions differ among individuals hospitalized in cold-climate and warm-climate states. Methods: Population-level, state-wide data were used to explore outcomes among all individuals hospitalized for heart failure in Texas (1999-2016) and New York (1994-2007). Seasonal variation was assessed using time of discharge (January-March, April-June, July-September, October-December). Multivariable logistic and linear regression were used to explore the relationship between time of discharge and the primary outcomes of interest: mortality and length of stay (LOS). Analyses were adjusted for age, sex, race, ethnicity, and comorbidities (hypertension, hyperlipidemia, diabetes, CAD, arrhythmias, anemia, COPD, tobacco use). Results: Among individuals hospitalized for heart failure in both Texas and New York, mortality and LOS were significantly increased during winter months compared to spring, summer, and early fall (Table). While similar seasonal trends were observed across states, the observed effect sizes were smaller in the Texas population. Conclusions: Among patients hospitalized for heart failure in Texas and New York, there is an increase in mortality and LOS during winter months. However, the differences in effect sizes after controlling for traditional risk factors suggests that other variables (i.e., temperature fluctuations) may affect these seasonal trends and warrants further exploration.
Abstract 15409: Analysis of Discrimination and Calibration of Two Cardiovascular Risk Scores in Patients With Non-Alcoholic Steatohepatitis Shows a Need for Improved Accuracy of These Models
Authors: Jesse Fishman, Andrea R Mospan, Heather L Morris, Derek Gazis, Arun Sanyal, Philip Newsome, Rohit Loomba
Journal: Circulation (2023)

Background: CV risk can be estimated by risk scores such as the Framingham and the Pooled Cohort Equations (PCE). The applicability of these tools in present day NASH (non-alcoholic steatohepatitis) cohorts, individuals with increased morbidity and mortality from CVD, was evaluated to assess their relevance. Hypothesis: The Null Hypothesis is that there is no difference between the predicted CV risk as estimated by the Framingham or PCE risk scores, and the actual CV events that occur in a NAFLD (non-alcoholic fatty liver disease)/ NASH cohort. Aim: To assess the prognostic performance of the Framingham and PCE risk scores in a NAFLD/NASH cohort. Methods: The study population were US patients in the observational TARGET-NASH study with NAFLD/NASH aged 18 years or older. Patients with any CV history at or prior to index were excluded. Patients’ five-year CV risk was estimated using recalibrated Framingham and PCE models and compared with observed CV events. Model discrimination and calibration were assessed using the area under the receiver operator curve (AUROC) and Hosmer-Lemeshow test statistic, respectively. Results: 980 and 587 patients in the Framingham and PCE cohorts, respectively, had all data needed for calculation of CV risk, of which 274 and 169 had at least five years of follow-up. Framingham five-year predicted CV risk was significantly greater among patients who did vs did not experience a CV event (13.7% [SD 9.0] vs 10.5% [SD 8.8]; p=0.02). No statistically significant difference was observed in the PCE analysis. The AUROC was 0.62 (95% CI 0.51, 0.73) for Framingham and 0.58 (95% CI 0.44, 0.72) for PCE at five years, with worst predictive performance among the subgroup of cirrhotic NASH patients for both risk equations. Analyses of model calibration revealed a statistically significant lack of calibration for both tools at five years (Framingham: χ 2 =25.58, p=0.001; PCE: χ 2 =33.86, p&lt;0.001). Conclusion: Framingham and PCE may have poor predictive accuracy for CVD risk in NAFLD/NASH cohorts. This tended to be most apparent among the upper decile of predicted risk, with predicted values far exceeding the observed. Lack of ten-year follow-up and unmeasured risk factors may also explain some of the residual overestimation not accounted for in our models.
Abstract 17987: The Added Value of Radiomics Texture Features on Late Gadolinium Enhancement Cardiac Magnetic Resonance to Detect Myocardial Inflammation in Patients With Cardiac Sarcoidosis
Authors: Avanti V Gulhane, Peter Muzi, Murat Sadic, Mohamed Abdelmotleb, Hamid Chalian, Mehrzad Shaiefi, Matthew J Nyflot, Hubert Vesselle, Ganesh Raghu, Karen G Ordovas
Journal: Circulation (2023)

Introduction: Radiomics analysis provides quantitative pixel-signal-intensity information on cardiac magnetic resonance (CMR). Hypothesis: Can radiomics improve performance of CMR for detection of myocardial inflammation in cardiac sarcoidosis (CS)? We aim to assess the added value of CMR radiomics to standard CMR image analysis for the diagnosis of active CS. Methods: We retrospectively analyzed CS patients referred for both CMR and F18-FDG-PET/CT(PET) within 90 days of each other. Myocardium was segmented on a dedicated semi-automated workflow by MIM encore software and features extracted by pyradiomics. PET were reviewed for the presence of myocardial FDG uptake, defining segments with inflammation. CMR-segments were reviewed for the presence of late gadolinium enhancement(LGE) and increased T2 signal by 2 experienced radiologists. Analysis was performed to assess for differences in radiomics features in segments with/without inflammation. ROC analysis was conducted to define the added value of radiomics for diagnosis of myocardial inflammation. Results: In 80 patients with 1360 AHA-CMR segments (mean age 58 years, 62.5% male) with CS, 276(20.3%) segments had FDG uptake on PET/CT, 252(18.5%) segments showed LGE and 54(3.9%) segments had increased signal on T2W images. Significant quantitative differences for LGE-derived radiomics features were highest for Entropy and Gray Level Cooccurrence Matrix Autocorrelation between segments with and without inflammation on PET (Table1). The presence of LGE was the best independent predictor for inflammation on PET. T2W abnormality alone was not an independent predictor from the presence of LGE. Significant improvement was seen in area under the curve when radiomics features were combined with standard CMR predictors (LGE/T2W) vs standard CMR predictors alone. Conclusions: Quantitative radiomics features on LGE-CMR have the potential to improve the ability of CMR for assessment of inflammation in CS.