tbuckley/cabot-search huggingface dataset:
Abstract 18115: A Multidisciplinary Approach to Critical Cardiac Illness Survivorship: Cardiac Intensive Care Unit Recovery Clinic
Authors: Alexander Hoffman, Gustav J Smith, Brianne Thornton, Dustin Hillerson
Journal: Circulation (2023)

Introduction: Cardiac intensive care unit (CICU) survivors have a high burden of morbidity and debility. Patients discharged from the CICU with a diagnosis of cardiogenic or septic shock, coma after cardiac arrest, or receive mechanical ventilation or mechanical circulatory support are referred by the CICU team to the Cardiac Intensive Care Unit Recovery Clinic (CICURC), a multidisciplinary clinic aimed at identifying barriers to return to function and optimizing medical and rehabilitation therapies. Aims: To define the cardiac profile and symptom burden of CICURC patients and compare outcomes to those referred but never attended. Methods: The medical records of sequential patients referred to the CICURC at our institution were retrospectively reviewed for clinical and outcome variables. Surveys were used to assess for cognitive, physical, or mental health impairment, findings of post-intensive care syndrome (PICS). Chi-squared test was performed to compare outcomes between groups. Results: From CICURC opening July 1, 2022, through May 27, 2023, 27 patients were referred, of whom 15 (56%) were seen in CICURC. The median age of patients seen in clinic was 61 years (IQR 47-74), 14 (93%) were male, 11 (73%) had an out-of-hospital cardiac arrest, 9 (60%) recovered from cardiogenic shock, of whom 5 (33%) were on mechanical circulatory support, and 12 received mechanical ventilation (80%). The median EF was 40% (IQR 25-50). From surveys, 5 patients screened positive for PICS (33%) and 6 were at risk for malnutrition (43%). Compared to those who did not attend clinic, only 1 (7%) CICURC attendee was readmitted within 30 days (vs. 3 [25%], p=0.18) and later died (vs. 4 [40%], p=0.04). Conclusions: CICU survivors have a high burden of disability after discharge. Multidisciplinary clinics focused on CICU recovery may reduce 30-day readmissions and mortality. Further research is needed on diagnosing PICS and therapies for recovery from critical cardiac illness.
Abstract 18762: Pacemaker Pocket Erosion - An Undesired Complication of Leuprolide Therapy
Authors: Ibragim Al-Seykal, Akil A Sherif, Ajay K Mishra, Ashwini Bhat, Nitish Sharma, Robert Harizi, Luigi Pacifico
Journal: Circulation (2023)

Introduction: Pacemaker pocket erosion is an uncommon delayed complication of the cardiac implantable electronic device (CIED) implantation that most frequently occurs in frail and elderly patients. We present a case of such a patient who developed pacemaker pocket erosion after being initiated on hormonal therapy for advanced prostate cancer. Case presentation: The patient is a ninety-three-year-old male with a history of persistent atrial fibrillation and dual chamber pacemaker in situ with last generator change two years prior presented with a two-week history of pacemaker wound dehiscence and exposed pacemaker. Six months earlier, the patient was diagnosed with advanced prostate cancer, was initiated on gonadotropin-releasing hormone agonist, leuprolide, and subsequently developed unintentional weight loss of 30 pounds. For two months prior to the current presentation, the patient noticed subjective discomfort at the site of the pacemaker pocket which he did not report to his cardiologist and eventually developed an erosive wound overlying the pacemaker pocket exposing the device (Image 1). He was admitted to the hospital and found to be hemodynamically stable, without leukocytosis and, negative blood cultures. Transthoracic and transesophageal echocardiograms showed no evidence of vegetation. He was empirically treated with daptomycin and was referred for pacing system extraction. He underwent pacing system replacement with leads and device extraction followed by leadless Micra VR (Medtronic, Minneapolis, MN) pacemaker implantation. Following a 4-week antibiotic course post pacemaker system extraction, the pacemaker pocket wound was fully healed. Conclusions: Aging and weight loss are known major risk factors for device-pocket erosion and externalization of the CIED. It highlights the importance of improving awareness of this entity and that initiation of hormonal therapy can be a contributing factor to such complications.
Abstract 13534: A Systematic Review and Network Meta-Analysis of Non-Metastatic Castrate Resistant Prostate Cancer Therapy Cardiotoxicity
Authors: Moez K Aziz, Donald Molony, Catrin Smith, Travis Holder, Neal Mody-Bailey, Oliver Brunckhorst, Jerry Roland, Christopher Owen, Jeffrey Song, Alexander Samuel Iacobucci, Jacob Galan, Lily Choi, Mariya Fatakdawala, Darren Sanchez, Emma Thames, Jared Imber, Justin Swaby, Daniel Xiao, Andrew Zarker, Gabriela Kostrzanowska, Resa Magill, Giorgio Gandaglia, Skyler Howell, Efstratios Koutroumpakis, Ali Ziaolhagh, Juan C Plana, Abdelrahman Ali, Wamique Yusuf, Cezar Iliescu, Steven E Canfield
Journal: Circulation (2023)

Introduction: For non-metastatic castrate resistant prostate cancer (M0CRPC) with a prostate-specific antigen doubling time of &lt; 10 months, European Association of Urology (EAU) guidelines recommend androgen deprivation therapy (ADT) plus either enzalutamide, apalutamide, or darolutamide as first-line therapy. However, this recommendation does not account for potential cardiotoxicity of treatments. Hypothesis: We expect differences among first-line therapies for the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias. Methods: We searched Ovid Medline, Elsevier Embase, and the Cochrane Library for randomized clinical trials (RCTs) from inception until August 2022. Studies with clearly stratified M0CRPC reporting at least one first-line therapy and cardiotoxicity domain were included. RCTs were grouped into mid- (&lt; 24 months) and long-term (&gt; 24 months) studies based on median duration of follow-up. Frequentist fixed-effect network meta-analysis was performed to estimate risk ratio (RR) and 95% confidence intervals (CI). Results: For hypertension and vascular toxicity, 3 mid- and 3 long-term studies were found. Two mid- and 3 long-term studies assessed arrhythmias. For heart failure, 2 mid- and 2 long-term studies were found. All studies had a similar placebo population treated with ADT alone. Median follow-up times for mid- and long-term studies are shown in Figure 1. We did not find any RCTs assessing myocarditis. However, compared to other first line therapies, ADT plus enzalutamide was associated with increased risk of hypertension in the mid- and long-term. Increased risk of vascular toxicity was also detected but only in the long-term (Figure 1). Conclusions: Enzalutamide is associated with higher risk of cardiotoxicity compared to other first-line androgen receptor targeted antagonists.
Abstract 17764: Clinical Outcomes and Predictors of Vasoplegia in Patients Undergoing Orthotopic Cardiac Transplantation at a High-Volume Single-Center
Authors: Jameson G Wilbur, Jonathan Wright, Yasaman Navari, Mahmoud Abdel-Rasoul, Sujal Modi, Nevin Britto, Nkongho Binda, Bryan Whitson, Asvin Ganapathi, Sakima A Smith
Journal: Circulation (2023)

Background: Patients undergoing heart transplantation are at significant risk of the developing post-operative vasoplegia, which is associated with poor outcomes. Despite significant burden to these patients, risk factors for development of vasoplegia are poorly understood. We assess these risk factors and outcomes in patients undergoing orthotopic heart transplant at our high-volume academic center. Methods: 173 patients underwent cardiac transplantation between January 1 st , 2015 and February 28 th 2022 at the Ohio State University Wexner Medical Center. Baseline demographics, operative characteristics, peri-operative management, and long-term follow-up data were obtained. Vasoplegia was defined as provider documentation of vasoplegia for patients with persistent hypotension requiring the use of one or more vasopressors to maintain mean arterial pressures &gt;65 mmHg in the absence of other explainable causes (cardiogenic shock, sepsis, etc.) The two primary endpoints assessed were development of vasoplegia in the 48 hours post-transplant and all-cause mortality. Statistical significance was assessed using Chi-squared, analysis of variance, or Kruskal-Wallis where appropriate. Results: In total, 173 patients underwent cardiac transplantation. 89 (51.4%) developed vasoplegia in the post-operative period. 130 (75.1%) were males. The average age at transplant was 56 years. Patients with vasoplegia were more likely to have history of atrial fibrillation (p=0.01) and had higher BMI (p&lt;0.01) compared to those without. There were otherwise no significant differences in demographic data such as past medical history and medication history in those with and without vasoplegia. Patients with vasoplegia had significantly higher cardiopulmonary bypass times (p=0.01), aortic cross-clamp times (p&lt;0.01) and need for red blood cell transfusion peri-operatively (p=0.02). Patients with vasoplegia had higher 30-day mortality (p=0.03), however there was no significant difference in 1-year mortality for those with and without vasoplegia. Conclusions: Vasoplegia is common following orthotopic heart transplant, and short-term mortality is high. Appropriate risk-stratification is paramount in caring for these high-risk patients.
Abstract 16570: Benchmarking Risk-Adjusted Outcomes in Congenital Heart Surgery
Authors: Ram Kumar Subramanyan, Dylan Thibault, Sean OBrien, J W Gaynor, David M Shahian, Emile Bacha, Vinay Badhwar, Chris Caldarone, Joseph A Dearani, Felix Fernandez, Jeffrey P Jacobs, David M Overman, Sara K Pasquali, Tabitha Rainey, Jennifer Romano, Subhadra Shashidharan, James Tweddell, John E Mayer
Journal: Circulation (2023)

Background: Robust models exist to predict risk-adjusted mortality following congenital heart surgery. It is known that underlying diagnosis modifies predicted risk of operations, and institution-level outcomes vary based on their unique case mix. We therefore evaluated risk-adjusted outcomes for a subset of diagnosis-procedure (D-P) combinations within the Society of Thoracic Surgeons' (STS) congenital heart surgery database (CHSD). Methods: A clinician panel identified the most frequently encountered D-P combinations in CHSD between 07/2017 and 06/2021. Candidate modeling techniques were compared in a random 80% development cohort. Model performance was assessed using internal and cross-validation calibration, discrimination plots and optimism adjusted C-statistics. The final selected model was evaluated in the 20% validation sample. Results: The chosen subset of D-P combinations represented 45,384 of 87,589 (52%) unique episodes of surgical care in CHSD during this time-period. The development cohort (36,350 episodes) had 1.8% mortality (667 deaths). All candidate models had excellent discrimination with C-statistics ranging from 0.862 to 0.876. The model with the best combination of discrimination, calibration, and clinical face validity was a modified version of the current STS mortality risk model. This version included all current risk model variables with the addition of indicator variables for D-P combinations. In the 20% validation sample (9,034 episodes), this model was well calibrated (Figure) and had excellent discrimination (C = 0.879). Conclusion: We describe a cohort of D-P combinations widely encountered in the STS CHSD. Further, we refined the existing STS CHSD risk model for application to these D-P dyads to derive empirical risk-adjusted benchmark outcomes. This approach will benefit quality improvement efforts at an institutional level and may have implications for publicly reporting congenital heart surgery outcomes.
Abstract 16842: Progression of Myocardial Fibrosis in Hypertrophic Cardiomyopathy
Authors: Shiro Nakamori, Ethan J Rowin, Narjes Jaafar, Jennifer Rodriguez, Long H Ngo, Warren J Manning, Martin Maron, Reza Nezafat
Journal: Circulation (2023)

Background: There is limited data on the progression of the scar on LGE in patients with hypertrophic cardiomyopathy (HCM) stratified by age and its relationship with sudden cardiac death (SCD). Objectives: We compared LGE progression as stratified by age and examined the relationship of this risk to SCD. Methods: A total of 102 HCM patients (age &lt;60 years; n=75, age ≥60 years; n=27) undergoing two consecutive cardiovascular magnetic resonance (CMR) at an interval of 4.3 ± 3.3 years from two medical centers were evaluated. LGE was quantified semi-automatically using a 6-SD threshold followed by manual adjustment. Median follow-up from study entry to the most recent evaluation was 7.3 years. The primary endpoint was the composite of resuscitated cardiac arrest and SCD. Results: At the first CMR, LGE was detected in 61 (60%) patients. At the follow-up, 25 patients developed a new LGE; thus, 86 (84%) patients had LGE by the follow-up CMR. Overall, the progression rate was 0.7 ± 1.0%/year, including 21 patients (21%) with LGE progression ≥1% /year and 5 (5%) with LGE &gt;15% at follow-up. The risk of LGE progression ≥1%/year was significantly higher in patients &lt;60 years (25% vs. 7%, p=0.02). There was a trend for the highest risk of LGE progression ≥1%/year in patients &lt;60 years with LGE &gt;10% at baseline scan. LGE progression ≥1%/year was a strong predictor of the primary outcomes (HR 1.88 [95% CI; 1.08-3.26], p=0.03). LGE progression moderately correlated with changes in LV mass, indexed LV mass index, and maximal LV end-diastolic wall thickness (p&lt;0.001 for all). Conclusions: Progressive fibrosis occurs more frequently in young to middle-aged HCM patients and identifies a cohort at high risk of SCD. One-quarter of young to middle-aged patients exhibit LGE progression ≥1%/year, underscoring the importance of repeating CMR to re-evaluate for potential LGE progression in this age group.
Abstract 15388: Atrial Fibrillation Burden Reduction From Antiarrhythmic Drugs in Patients With Cardiac Implantable Electronic Devices
Authors: Sarah M Schwartz, Graham Peigh, Kasen Culler, Daniel Mathew, Rhea Verma, Betelehem Lemma, Rod S Passman
Journal: Circulation (2023)

Introduction: Efficacy of rhythm control treatments for atrial fibrillation (AF) is usually measured by time to recurrent AF, however reduction in AF burden is a more clinically relevant endpoint. Cardiac implantable electronic devices (CIEDs) provide continuous rhythm monitoring that allows for highly accurate measures of AF burden. Ablation has been shown to reduce AF burden by &gt; 99% in CIED patients, but there are limited data on the impact of antiarrhythmic drug (AAD) therapy on AF burden. Methods: A single-center retrospective study of all CIED patients with new AAD initiation for AF between 4/2018-3/2022 was conducted. Patients with CIED-detected AF burden within 6 months pre- and 12 months post-AAD initiation were eligible for inclusion. CIED-detected AF burden was compared pre- and post-AAD initiation. Results: Of the 214 patients included in analysis (73.6 ± 11.8 yrs, 63% male, CHA 2 DS 2 -VASc 3.8 ± 1.6), there was a statistically significant reduction in AF burden following AAD initiation (pre-AAD 4.5% [IQR: 1.0%, 27.9%]; post-AAD 0.1% [IQR: 0%, 3.2%], p&lt;0.001). Of patients prescribed amiodarone (n=148, 69%), the median AF burden decreased from 3.6% [IQR: 1.0%, 28.0%] to 0.1% [IQR: 0.0%, 2.5%] (p&lt;0.001). Among patients on other AADs (flecainide n=22, 10%; sotolol n=21, 10%; dronedarone n=12, 6%; dofetilide n=8, 4%; propafenone n=3, 1%) the median AF burden decreased from 6.6% [IQR: 1.7%, 25.5%] to 0.2% [IQR: 0%, 3.5%] (p=0.028) (Figure). There was no significant difference in AF burden reduction between amiodarone and non-amiodarone AADs (amiodarone 90.9% [IQR: 0.0%, 100.0%], non-amiodarone AADs 74.0% [IQR: 0.0%, 99.9%], p=0.686). Conclusions: AADs significantly reduce CIED-measured AF burden, but this burden reduction is less than what is reported with ablation. There was no significant difference in AF burden reduction between cohorts of patients on amiodarone and non-amiodarone AADs.
Abstract 15716: Meta-Analysis of Randomized Controlled Trials Comparing Ablation Targets Beyond Pulmonary Vein Isolation versus Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation
Authors: Arpanjeet Kaur, Arshdeep Dhaliwal, Nebojsa Markovic, Subrat Das, Darren Kong, Dhruv Kansal, Mason Marcus, Serdar Farhan, Ranjit Suri
Journal: Circulation (2023)

Introduction: Catheter ablation for persistent atrial fibrillation (PeAF) is challenging and pulmonary vein isolation(PVI) alone has limited success. Adjunctive ablation strategies like posterior wall isolation (PWI), linear ablation, substrate modification utilizing complex fractionated atrial electrograms (CFAE) or MRI guided fibrosis ablations have demonstrated variable results beyond PVI alone. We performed a meta analysis of randomized controlled trials (RCTs) comparing efficacy, safety and procedural outcomes of PVI plus adjunctive ablation strategies versus PVI alone. Methods: We performed a comprehensive search of electronic databases from inception to April 2023 searching RCTs comparing PVI alone versus PVI+adjunctive strategies(linear ablations, CFAE, PWI, low voltage area ablation and MRI-guided atrial fibrosis ablation). Primary efficacy outcome was recurrence of atrial arrhythmias &gt; 30s after a single ablation procedure, with or without antiarrhythmics. Secondary safety outcome was composite of access site complications, tamponade, hemopericardium, pericardial effusion, pericarditis, stroke/TIA, pulmonary vein stenosis, atrioesophageal fistula or phrenic nerve palsy. Procedural characteristics included mean procedural time and mean ablation time. Pooled risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were calculated. Statistical analysis was performed using RevMan5.4.1 Results: 10 RCTs with a total of 3042 patients (PVI plus adjunctive n= 1717; PVI alone n= 1325) were included. The mean age was 61.6 ± 0.14 years. The mean follow-up was 16.5 months. There was no significant difference in primary efficacy outcome (RR: 0.99; CI: 0.88-1.12; p&gt; 0.05; I2 = 28%) or secondary safety outcome (RR: 1.46; CI: 0.97-2.18; p&gt; 0.05; I2 = 16%), between two groups. Procedural characteristics including mean procedural time in minutes (MD: 31.84; CI: 4.92-58.75; p&lt; 0.05; I2 = 95%) and mean ablation time in minutes (MD: 20.30; CI: 8.16-32.43; p&lt; 0.05; I2 = 95%) were significantly shorter for PVI alone group. Conclusions: Adjunctive ablation strategies provide no additional benefit over PVI alone in PeAF, but are associated with significantly longer procedural and ablation time.
Abstract 13233: Disparities in Speed of Diagnosis of Hypertrophic Cardiomyopathy in the United States
Authors: Ahmad Masri, Warren Stevens, Marric Buessing, Eric Zuk, Jenny Lam, Yuanhui Zhang, Ervant J Maksabedian Hernandez, Seth A Seabury
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is a cardiac disease that can be genetic in cause. Early diagnosis, risk stratification, and pharmacological management can reduce the disease burden, yet several studies have highlighted disparities in early diagnosis by gender and race. Goals: This study compares age, severity at diagnosis, and time-to-diagnosis, by gender, race, and county-level poverty rate in a nationally representative population of over 65-year-olds. Methods: We used Medicare claims data from 2016-2020 to construct a sample who had at least two HCM claims and continuous enrollment for at least 2 years prior to their first HCM claim. We measured age and severity of heart disease at diagnosis, as well as time from the first observed indication of heart disease to HCM diagnosis. Results: We identified 48,857 patients with an HCM diagnosis in the study period, of which 60% were women and 81% were Non-Hispanic White. Comparing relative rates, Black and Hispanic patients at the time of HCM diagnosis had a 16% higher prior rate of heart failure (HF), and a 11% higher rate of prior major adverse cardiovascular events (MACE). In addition, in Black HCM patients, the share of atrial and non-atrial arrhythmias that were clinically diagnosed before HCM diagnosis was 28% lower than among White patients (p&lt;0.001). Importantly our multi-attribute approach highlighted the composite roles of race and county-level poverty: at the time of HCM diagnosis, Black men in the poorest quartile of counties had a 26% higher rate of HF, 22% higher rate of MACE and a 53% lower rate of clinically diagnosed arrhythmia (all p&lt;0.001) than White men in the wealthiest quartile of counties. Additionally, the median time from the first indication of heart disease until the diagnosis of HCM in Black and Hispanic patients from the poorest quartile of counties was 347 days longer than for Non-Hispanic White patients from the wealthiest quartile of counties (p&lt;0.001). Conclusions: This study shows evidence of disparities in diagnosis of older patients with HCM in the United States, particularly in terms of race and county-level poverty. New approaches are needed to address these disparities and improve access to care for patients in underserved and vulnerable communities.
Abstract 12784: Ischemic Cardiac Autophagy/Mitophagy is Regulated by TRPML1 and Mitochondrial Reactive Oxygen Species
Authors: An Xie, Gyeoung-Jin Kang, Eun Ji Kim, Feng Feng, Samuel C Dudley
Journal: Circulation (2023)

Introduction: In myocardial infarction (MI), activated autophagy/mitophagy helps degrade cytoplasmic macromolecules/proteins/ organelles (especially damaged mitochondria), recycle breakdown products, and prevent oxidative damage and cell death. It had reported that reactive oxygen species (ROS) activates the transcription factor EB (TFEB) via a lysosomal transient receptor potential mucolipin 1 (TRPML1) Ca 2+ efflux. TFEB is thought to be the master regulator of lysosome biogenesis. Hypothesis: We investigated whether lysosomal TRPML1 was activated by ROS and contributed to ischemic cardiac autophagy/mitophagy. Methods: MI was induced in wild type C57BL/6J mice by ligated left anterior descending coronary artery. Mice were studied at three weeks after MI surgery. Results: The lysosomal-restricted TRPML1 Ca 2+ release channel was significantly upregulated by 84.8% in cardiac border zone (BZ) and 55.4% in a remote zone after MI. As expected, dephosphorylated TFEB (i.e., active TFEB), mitophagy marker Parkin, autophagy marker LC3II, and lysosome marker LAMP1 increased substantially after MI. Autophagy degradation was upregulated as measured by SQSTM1/p62. TRPML1 protein expression was reduced in a dose-dependent manner by TRPML1 shRNA AAV9 (AAV9 was injected 1 week after MI for two weeks). The protein levels of LC3II and LAMP1 significantly decreased in MI BZ after AAV9 transfection. Mitochondrial ROS scavenger (mitoTEMPO, 1 mg/kg/day, i.p.) treatment for two weeks (starting at 1 week after MI) significantly inhibited TRPML1, LAMP1, LC3II and Parkin expression in the MI BZ. Conversely, when TRPML1 was overexpressed in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), the protein levels of LC3II/Parkin were increased. Speaking to human relevance, TRPML1 was significantly increased in human patients with ischemic cardiomyopathy. Conclusion: Autophagy and mitophagy after MI are regulated by TRPML1 and mitochondrial ROS.