tbuckley/cabot-search huggingface dataset:
Abstract 16337: Guideline-Directed Medical Therapy Use and Association With Outcomes Among Hospitalized Heart Failure With Reduced Ejection Fraction Patients During COVID-19
Authors: Pratyaksh K Srivastava, Alexandra Klomhaus, Asim Rafique, Pooja S Desai, Lori Daniels, Clyde W Yancy, Eric H Yang, Gregg C Fonarow, Rushi Parikh
Journal: Circulation (2023)

Background: The association of prior to admission guideline-directed medical therapy (GDMT) with outcomes among patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF) and COVID-19, as well as overall GDMT prescription patterns during the pandemic, is not well known. Methods: HFrEF patients (left ventricular ejection fraction ≤40%) admitted with acute decompensated heart failure (ADHF) were identified from the American Heart Association’s Get With The Guidelines Heart Failure Registry. We analyzed the association of prior to admission GDMT use with odds of in-hospital mortality, and with odds of severe COVID-19, using adjusted logistic regression models. GDMT was defined as prescription of angiotensin converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI), beta blocker (BB), or mineralocorticoid receptor antagonist (MRA). We further evaluated GDMT prescription trends during the pandemic. Results: We identified 23,899 HFrEF patients admitted with ADHF (2/16/20-3/24/21) during the pandemic, of which 333 had a diagnosis of COVID-19. We also identified 26,459 HFrEF patients admitted with ADHF in the year prior to the pandemic (2/16/19-2/15/20). Prior to admission ACEI/ARB/ARNI, BB, or MRA use was not associated with odds of in-hospital mortality or severe COVID-19. Among all HFrEF patients, prior to admission ACEI/ARB/ARNI and BB use was lower during the pandemic compared to the year prior (Figure 1, Panel A). Prior to discharge prescription of ACEI/ARB/ARNI, MRA, and triple therapy (ACEI + BB + MRA) was higher during the pandemic compared to the year prior (Figure 1, Panel B). Conclusion: Among patients with HFrEF admitted with ADHF and COVID-19, prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19. GDMT prescription rates at discharge were similar to or improved during the pandemic compared with the preceding year.
Abstract 14498: Predictive Value and Optimal Cut-Off High-Sensitivity Troponin T Levels in Patients With Acute Pulmonary Embolism
Authors: Moojun Kim, Chang-Ok Seo, Hangyul Kim, Hye Ree Kim, Kyehwan Kim, Jin-sin Koh, Seok-Jae Hwang, Jinyong Hwang, Jeong Rang Park
Journal: Circulation (2023)

Introduction: An elevated troponin level serves as a sign of myocardial injury in cases of acute pulmonary embolism (PE) and is considered one of the factors used to assess risk and determine thrombolytic therapy. Nonetheless, high-sensitivity troponin (hsTnT) has not been extensively researched among patients with acute PE. Hypothesis: The elevation of hsTnT levels could predict adverse outcomes in acute PE. Methods: A retrospective chart review of 307 patients who were diagnosed with acute PE from July 2020 to April 2023 was conducted. All patients were confirmed by computed tomography pulmonary angiography. The 30-day adverse outcome was defined as a composite of PE-related mortality, cardiac arrest, hemodynamic collapse, and vasopressor use. Youden-index quantification was used to identify the optimal hsTnT cut-off value. The echocardiographic right ventricular dysfunction signs and electrocardiographic findings were collected at baseline examinations. Results: HsTnT values ranged from 3 to 1152 ng/L [median 33 (25 th -75 th percentile 15-78) ng/L]. Receiver operating characteristic curve analysis for the 30-day adverse outcome showed moderate significance (AUC 0.68 (95% CI 0.60-0.81) (Fig. 1). The optimal hsTnT cut-off value was 33 ng/L. Patients with hsTnT ≥ 33 ng/L were characterized by advanced age, lower blood pressure, higher creatinine, and exhibited signs of right ventricular dysfunction. The hazard ratio of hsTnT ≥ 33 ng/L for adverse outcomes was 3.69 (95% CI 1.62-8.40) (Table 1). Conclusion: We refined the predictive value of troponin in acute PE, and suggest the level hsTnT ≥ 33 ng/L as an optimal cut-off value for the prediction of the 30-day adverse outcomes.
Abstract 15242: The Flipside of Flecainide: A Case of Flecainide Induced Loss of Capture
Authors: Zeba Hashmath, Sara Samaan, Aditi Naniwadekar
Journal: Circulation (2023)

Introduction: Flecainide is a class 1c anti-arrhythmic agent that slows phase 0 of the fast inward sodium (Na) channels in a rate-dependent fashion leading to decreased conduction velocity in the His-Purkinje and ventricular myocardium. Its high affinity and slow unbinding prolong QRS duration on electrocardiogram (EKG). Partial renal excretion and a narrow therapeutic index of 0.2-1mcg/mL can cause drug toxicity. Case: A 72-year-old woman presented with palpitations and weakness. She had a history of non-ischemic cardiomyopathy, biventricular (BiV) implantable cardioverter defibrillator, frequent premature ventricular contractions on flecainide 100 mg twice a day, and chronic kidney disease. She was hypotensive and with acute kidney injury. EKG showed wide complex ventricular rhythm, QRS duration of 305 ms and intermittent ventricular pacing (Fig.1A), changed since EKG 6 months ago (Fig.1B). Device interrogation revealed normal sensing and impedances but failure to capture from all 3 leads. She had stable lead parameters and appropriate BiV pacing 6 months ago. Chest X ray showed stable lead positions. Flecainide toxicity was suspected, and Na bicarbonate infusion was started. Flecainide level was 2.4mcg/mL (normal &lt;1mcg/mL). She went into an idioventricular rhythm which terminated spontaneously (Fig.1C). After 48 hours of Na bicarbonate infusion, lead capture was noted with narrower QRS (198 ms) (Fig.1D) and on day 6, EKG was back to effective BiV pacing with QRS duration 127 ms (Fig.1E). Discussion: This case highlights the EKG manifestations of flecainide toxicity including QRS widening, sine-wave pattern and loss of pacing capture due to prolonged ventricular refractoriness. It also underscores the reversibility of this condition with prompt treatment using Na bicarbonate. Conclusion: Early recognition and rapid treatment of the cardiac effects of flecainide toxicity is critical in managing a life threatening but reversible medical condition.
Abstract 17495: Protein Kinase A Activity in Heart Failure Spectrums
Authors: Tarun W Dasari, Jennifer Myers, Stavros Stavrakis, Madeleine W Cunningham
Journal: Circulation (2023)

Introduction: Protein Kinase A (PKA) signaling is activated by β-adrenergic receptor (BAR) stimulation and regulates myocardial contraction and cellular functions. Chronic PKA overactivation can lead to apoptosis, structural dysfunction and arrhythmias. Heart failure (HF) is associated with increased BAR stimulation and downstream detrimental cellular effects likely mediated by increased PKA activation, but it remains unclear whether PKA is uniformly increased across HF spectrums. We aimed to determine the extent of PKA activity in HF phenotypes. Methods: Serum from HF patients (age 18-89, 66% male) (acute systolic HF, n=19, HF with reduced ejection fraction HFrEF (n=58) and HF with preserved ejection fraction-HFpEF (n=10) were collected. PKA assay: H9c2 rat heart cells (ATCC) were plated overnight and serum samples (1:100 dilution) were incubated with cells for 1 hour. Specific activity of the enzyme in pmol/min/ng was calculated (% above the basal PKA rate). For comparison, healthy controls (n=35, age 18-69, 59% male) were tested. In 3 HFrEF subjects, serum PKA signaling was inhibited by anti-IgG beads, specific antigens or Propranolol. Mann Whitney U test was performed to determine differences between groups. Results: Median PKA activation was 76% (acute HF), 49% in HFrEF, 39% in HFpEF and 9% in healthy controls. Compared to controls, PKA activity was significantly higher across all HF phenotypes (p&lt;0.05). No statistical difference was noted between HF phenotypes although acute HF sera demonstrated numerically higher PKA activation in the heart cells. PKA activity was attenuated with anti-IgG beads or Propranolol in HFrEF, which suggests circulating IgG autoantibodies lead to induction of PKA signaling via BAR pathway in HF. Conclusion: PKA activity is increased across HF spectrums compared with healthy controls. Acute systolic HF appears to be associated with highest PKA activation. Further studies are underway to corroborate these findings.
Abstract 17772: The Relationship Between Renin-Angiotensin System Inhibition and Coronary Artery Calcification Evaluated by Intravascular Ultrasound
Authors: Daisuke Kanda, Kenta Ohmure, Daichi Fukumoto, Hirokazu Shimono, Hiroyuki Tabata, Nobuhiro Ito, Yoshiyuki Ikeda, Mitsuru Ohishi
Journal: Circulation (2023)

Introduction: Coronary artery calcification is significantly associated with major adverse cardiac events in patients with coronary artery disease (CAD), and severely calcified lesions are significantly associated with poor outcomes after percutaneous coronary intervention (PCI). Hypothesis: The relationship between renin-angiotensin system inhibition and coronary artery calcification is unknown. Methods: Five hundred stable CAD patients undergoing PCI were divided into none/mild and moderate/severe calcification groups according to the grade of calcification in the target lesion evaluated by intravascular ultrasound (IVUS). Calcification with a calcium arch &amp;gt;180° and calcium length &amp;gt;5 mm in the target lesion was defined as moderate/severe calcification. We examined the association between patient’s characteristics and morphology in target lesions assessed by IVUS. Results: One hundred ninety of the 500 patients (38%) showed moderate/severe calcification of the culprit lesion. In the moderate/severe calcification group, the survival rate was significantly lower, and cumulative incidence of major cardiovascular and cerebrovascular events (MACCE) was higher than in the none/mild calcification group after PCI (p=0.015 and p=0.003, respectively). Age, body mass index, hypertension, use of angiotensin-converting enzyme inhibitor (ACEI), hemodialysis, high-sensitivity C-reactive protein levels, low-density lipoprotein cholesterol levels, serum albumin levels were associated with moderate/severe calcification lesion in univariate logistic analysis, but the use of angiotensin II receptor blocker was not. Multivariate logistic analysis identified age [odds ratio (OR); 1.05, 95% confidence interval (CI): 1.02-1.08, p&amp;lt;0.001], use of ACEI (OR; 0.46, 95% CI: 0.23-0.91, p=0.025), and hemodialysis (OR; 6.07, 95% CI: 2.39-15.42, p&amp;lt;0.001) as independent factors of moderate/severe calcification lesions. A comparison of P-value for interaction of use of ACEI and hemodialysis was p=0.51. Conclusions: Using of ACEI was negatively associated with moderate/severe calcification in target lesions assessed by IVUS. ACEI may have a potential for inhibitory effect on coronary artery calcification.
Abstract 14128: Walking Exercise for Peripheral Artery Disease: Effects in Women and Black Americans
Authors: Mary O Whipple, Dongxue Zhang, Lu Tian, Lihui Zhao, Diane Treat-Jacobson, Mary M McDermott
Journal: Circulation (2023)

Introduction: In people with lower extremity peripheral artery disease (PAD), rates of participation in supervised exercise therapy are lower in women and Black Americans, compared to men and White Americans, respectively. This study used data from randomized clinical trials in participants with PAD to assess whether walking exercise improved walking performance in women and Black Americans. Methods: Data were combined from three randomized clinical trials that compared supervised treadmill exercise (3 sessions/week) for six months to a non-exercise control group. Data were also combined from two randomized clinical trials that compared home-based walking exercise for six months to a non-exercise control group. The six-minute walk (6MW), treadmill walking performance, and the Walking Impairment Questionnaire (WIQ) were measured at baseline and six-month follow-up. In meta-analyses, the effects of supervised and home-based exercise were each compared to a non-exercise control group. The effects of supervised and home-based exercise were compared directly. Tests for interaction were used to compare effects of exercise in Black, compared to White participants and in women, compared to men. Results: A total of 370 participants (n=159 [43%] women, n=228 [62%] Black) completed a supervised exercise trial; 349 participants (n=175 [50%] women, n=187 [54%] Black) completed a home-based exercise trial. Supervised and home-based exercise significantly improved 6MW in Black Americans and women (Table). Compared to home-based exercise, supervised exercise was associated with greater improvements in treadmill outcomes, while home-based walking improved 6MW more than supervised exercise. There was no significant interaction of sex or race on exercise outcomes. Conclusions: Supervised and home-based exercise significantly improved 6MW and treadmill walking distance in women and Black Americans with PAD, respectively, compared to a non-exercise control.
Abstract 14513: A Bayesian Analysis of Circadian Variation in Sudden Death in Wake County, North Carolina
Authors: Sydra Siddiqui, David C Elzinga, Leigh B Pearcy, Connor James, Susan Keen, Ross J Simpson
Journal: Circulation (2023)

Introduction: Sudden death is often attributed to coronary artery disease. Demonstrating that sudden death exhibits a different circadian profile than coronary artery disease would support the emerging concept that sudden death is a syndrome, with multiple etiologies. Hypothesis: Sudden death will demonstrate a circadian peak with deaths more frequent in the morning hours. Methods: The study analyzed 399 sudden death victims aged 18-64 attended by Wake County Emergency Medical Services (EMS) from 2013 to 2015. Time of death was determined using EMS records and medical examiner reports. When time of death could not be reliably determined for a victim, the victim was removed from the study. Only 169 deaths (42.3%) where time of death was reliably known to within one hour were included in the final analysis. Bayesian hierarchical modeling identified the location and/or absence of peak times for sudden death victims overall and subgroups with heart failure (19), coronary artery disease (40), hypertension (89), and respiratory disorders (48). Results: Time of death for all-cause sudden death victims spanned from 6:30 AM to noon, with no evidence of a specific, circadian peak. However, sudden death victims with underlying chronic heart failure displayed a strong circadian peak around 7:00 AM, while respiratory disorder cases showed a limited peak in the mid to late morning. Victims with coronary artery disease and hypertension exhibited no peak (Figure 1). Conclusions: Sudden death victims lack a distinct overall pattern for time of death. However, individuals with underlying heart failure and possibly respiratory diseases demonstrate a circadian pattern. These findings support the notion that sudden death has multiple causes beyond coronary artery disease. Future preventive interventions should consider the diverse etiologies of sudden death.
Abstract 17266: Associations of Life’s Essential 8 With Phenotypic Age in a Nationally Representative Cohort of US Adults
Authors: Rahul Hosalli, Vanessa Dinh, Nour Makarem
Journal: Circulation (2023)

Introduction: Phenotypic age (PhenoAge), a new biomarker-based biological aging measure, captures morbidity and mortality risk in the general population. Associations of cardiovascular health (CVH), based on the enhanced Life’s Essential 8 (LE8) framework, with PhenoAge and phenotypic age acceleration (PhenoAgeAccel) have not been evaluated. Hypothesis: Higher CVH will be associated with lower PhenoAge and PhenoAgeAccel in US adults. Methods: Participants were 6,593 men and women from the 2015-2018 NHANES (mean age: 47y, 50% female, 6% Asian, 10% Black, 16% Hispanic, 64% White). The overall and component CVH scores were calculated using the LE8 framework. PhenoAge was computed from nine biomarkers and chronological age. PhenoAgeAccel was the difference between PhenoAge and chronological age, with higher positive values indicating faster biological aging. Survey-weighted multivariable linear models were used to evaluate the overall and component CVH scores in relation to PhenoAge and PhenoAgeAccel. Results: Participants with high CVH had negative PhenoAgeAccel, while those with low CVH had positive PhenoAgeAccel (-4.20 vs. 2.36; p&lt;0.01). Each 10-unit increase in the LE8 score was associated with lower PhenoAge (β(95%CI): -4.82 (-5.28, -4.36)) and PhenoAgeAccel (β(95%CI): -1.80 (-1.98, -1.62)). Those with high vs. low CVH had lower PhenoAge (β(95%CI): -17.15 (-18.98, -15.33)) and PhenoAgeAccel (β(95%CI): -6.08 (-6.76, -5.41)) (p-trend&lt;0.001). Being in the highest vs. lowest tertile of all LE8 metrics was associated with negative PhenoAgeAccel (p-trend&lt;0.01) (Table). Further, being in the highest vs. lowest tertile of the physical activity, BMI, glucose, blood lipids, and blood pressure scores was related to having lower PhenoAge (p-trend&lt;0.05). Conclusions: CVH is inversely associated with PhenoAge and PhenoAgeAccel with evidence of a dose-response relation. Improving CVH may decelerate biological aging and reduce associated morbidity.
Abstract 16671: Supraventricular Ectopic Activity Predicts Postoperative Atrial Fibrillation, New-Onset Atrial Fibrillation, and Worse Survival in Hypertrophic Cardiomyopathy
Authors: Changrong Nie, Changsheng Zhu, Zhengyang Lu, Shuiyun Wang
Journal: Circulation (2023)

Introduction: Supraventricular ectopic activity (SEA), in the form of frequent premature atrial contractions (PACs) and runs of PACs, has been considered a marker of foci that are capable of firing rapidly to initiate atrial fibrillation (AF), but the cut-off value has not been determined. Therefore, we aimed to examine the association between SEA and postoperative AF (POAF) and clinical outcomes and to investigate the cut-off value in patients with hypertrophic cardiomyopathy. Methods: This cohort included 1491 consecutively recruited patients, of which 530 were excluded for various reasons, leaving 961 patients for final analysis. All patients received 24-hour Holter ECG monitoring 2-5 days before surgery. Results: The mean age of the study population was 48.4 (SD,12.3) years and 397 patients (41.3%) were female. The incidence of POAF was 20.7% and increased with PACs severity. Multivariable logistic regression analysis showed that supraventricular tachycardia (SVT) was independently associated with higher incidence of POAF and the model including SVT had the largest area under the curve (AUC) [AUC=0.710] among all the multivariable models. Furthermore, Kaplan-Meier survival curves demonstrated that patients in the tertile 3 (upper tertile of the total numbers of PACs), PACs&gt;100, PACs &gt;200, ESVEA (top decile of PACs plus top decile length of short atrial runs), and ESVEA3 (PACs&gt;100 plus top decile length of short atrial runs) group had significantly higher cumulative rates of new-onset AF and composite endpoints compared to their counterparts. On multivariable Cox regression analysis, PACs&gt; 100, PACs&gt;200, ESVEA, and ESVEA3 were independent indicators for higher incidence of new-onset AF and composite endpoints. Among those multivariate models, PACs &gt;200 had the higher effect size for predicting new-onset AF [Hazard ratio (HR) 3.13, 95% confidence interval (CI) 1.74-5.62] and composite endpoints [HR =2.00, 95%CI 1.30-3.06]. Conclusions: The incidence of POAF was 20.7% increasing with the severity of the PACs burden. Moreover, among supraventricular arrhythmias, SVT was the best indicator for predicting POAF. Likewise, PACs&gt;200 may consider as the best candidate for predicting a higher incidence of new-onset AF and composite endpoints.
Abstract 16217: Characteristics and Short-Term Outcomes of Patients With Cardiogenic Shock Secondary to Myocarditis
Authors: Raunak M Nair, Abhishek Ramgir R Giri, Sanchit Chawla, Ankit Agrawal, Shashank Shekhar, Andrew Higgins, Ran Lee, Wael A Jaber, Penelope Rampersad, Paul C Cremer, Venu Menon
Journal: Circulation (2023)

Background: The clinical profile and short-term prognosis of patients with cardiogenic shock (CS) secondary to myocarditis remains poorly defined. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records. Patients were further categorized into those with CS secondary to myocarditis (myocarditis-CS) or other etiologies (non-myocarditis-CS). Only patients with confirmed myocarditis with an endomyocardial biopsy or cardiac MRI were included. Descriptive characteristics and short-term outcomes of this group were explored. Results: A total of 2775 patients were admitted to our CICU with CS of which, 26 patients (1%) had CS secondary to confirmed myocarditis. Compared to patients with non-myocarditis CS, patients with myocarditis-CS were significantly younger (median age of 49 vs 65, p&lt;0.001), had lower prevalence of known coronary artery disease (23% vs 62%, p&lt;0.001), and significantly lower prevalence of other comorbidities (diabetes- 12% vs 42%, dyslipidemia- 23% vs 49%, and hypertension- 31% vs 62, all p&lt;0.05). Amongst patients with myocarditis-CS, 23% (n=6) patients received a heart transplant during the same admission whereas 8% (n=2) were discharged on an LVAD. Viral myocarditis was the most common etiology (35%, n=9), followed by idiopathic myocarditis (23%, n=6), and lymphocytic (15%, n=4). The 30-day all-cause mortality of patients with CS-myocarditis was 8% compared to 22% for those with non-myocarditis CS (p=0.1). Conclusion: Myocarditis continues to remain an infrequent cause of CS in the contemporary era accounting for around 1% of all CS admissions. A third of these patients would require advanced therapies and so early consideration of a destination mechanical therapy or transplant is vital to ensure optimal care of these patients.