tbuckley/cabot-search huggingface dataset:
Abstract 13033: Usefulness of MR-Derived Left Ventricular Global Longitudinal Strain and Left Atrial Strain to Predict Cardiovascular Events in Patients With HFpEF
Authors: Masataka Katahira, Takatoyo Kiko, Keiichiro Endo, Ryo Yamakuni, Shiro Ishii, Akiomi Yoshihisa, Kenji Fukushima, Hiroshi Ito, Yasuchika Takeishi
Journal: Circulation (2023)

Background: The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LVGLS) and left atrial strain (LAS) obtained from magnetic resonance imaging (MRI) feature tracking in patients with heart failure with preserved ejection fraction (HFpEF). Method: We retrospectively enrolled 150 patients with HFpEF who underwent cardiac MRI from 2015 to 2022. LVGLS and LAS were evaluated from cine mode MRI images. The end point was defined as a composite of all-cause death, myocardial infarction and hospitalization due to decompensated heart failure. Results: At a follow-up of 4.3 ± 2.0 years, 27 events occurred. After dividing the patients into four groups by the median LVGLS and the median LAS, the event-free rate was significantly lowest in the group of LVGLS &gt; -14.3% and LAS &lt; 13.0% than any other groups (P =0.002). In the Cox proportional hazard analysis, LVGLS and LAS were independent predictors of cardiac adverse events in the patients with HFpEF. Conclusion: The assessment of combined LVGLS and LAS was useful to evaluate risk stratification in the patients with heart failure with HFpEF.
Abstract 15495: Serial Measurement of Vascular Endothelial Growth Factor-D in Heart Failure: The PREHOSP-CHF Study
Authors: Moritake Iguchi, Hiromichi Wada, Tsuyoshi Shinozaki, masahiro suzuki, Yoichi Ajiro, Morihiro Matsuda, Akihiro Koike, Tomomi Koizumi, masatoshi shimizu, Yujiro Ono, Takashi Takenaka, Satoru Sakagami, Yukiko Morita, Kazuteru Fujimoto, Kazuya Yonezawa, Kazuro Yoshida, Akiyo Ninomiya, Toshihiro Nakamura, JUNICHI FUNADA, Yutaka Kajikawa, Yoishifumi Oishi, Toru Kato, Kazuhiko Kotani, Mitsuru Abe, Masaharu Akao, Koji Hasegawa
Journal: Circulation (2023)

Background: Vascular endothelial growth factor-D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors. We recently reported that VEGF-D appeared to be a prognostic marker for major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death or heart failure hospitalization (HF), in patients with HF. However, the prognostic value of changes of VEGF-D is unknown. Methods: The PREHOSP-CHF study is a nationwide prospective survey of patients with HF in Japan. Serum VEGF-D levels were measured in 203 patients (mean age, 75 years; male, 62%; mean ejection fraction, 45%) at both baseline and 6-month follow-up. We set the cut-off level of VEGF-D as 366 pg/ml, based on the ROC analysis of the entire cohort of the PREHOSP-CHF study. We defined increased VEGF-D as transition from low VEGF-D to high VEGF-D and decreased VEGF-D as transition from high to low. We investigated the association of changes of VEGF-D levels with the incidence of MACE after 6 months. Results: Mean VEGF-D levels at baseline and 6-month follow-up were 449±199 pg/ml and 519±230 pg/ml, respectively. During the 2-year follow-up, 18 patients developed MACE before 6-month follow-up, and 42 patients developed MACE after 6-month follow up. Based on levels of VEGF-D at baseline, patients with high VEGF-D showed significantly higher incidence of MACE than those without. After excluding the patients developed MACE before 6-month follow-up, 11 of 105 patients with high VEGF-D moved to the low VEGF-D group at 6-month follow-up, and 34 of 78 patients with low VEGF-D moved to the high VEGF-D group. Landmark analysis after 6 months showed that incidence of MACE was significantly higher in patients with increased VEGF-D than those without in the low VEGF-D group, and tended to be lower in patients with deceased VEGF-D than those without in the high VEGF-D group. After adjustment for ejection fraction, N-terminal B-type natriuretic peptide levels, and VEGF-D levels at baseline, increased VEGF-D were also significantly associated with the incidence of MACE after 6 months (hazard ratio per 10 pg/ml increase, 1.02; 95% confidence interval 1.00-1.03; P=0.04). Conclusions: In patients with HF, changes in VEGF-D might serve as a prognostic marker for MACE.
Abstract 13671: A Case of Diffuse Alveolar Hemorrhage While on Systemic Anticoagulation for Impella
Authors: Radhika Ghosalkar, Satoshi Miyashita, Masashi Kawabori, Amanda R Vest
Journal: Circulation (2023)

A 57 year old male with PMH of non-ischemic cardiomyopathy (EF 30%), atrial fibrillation, and VT s/p ICD was admitted to the cardiac intensive care unit for cardiogenic shock. His condition deteriorated necessitating Impella 5.5 implantation as bridge to cardiac transplant. Systemic heparin was started per Impella protocol with a lower anti-Xa goal of 0.2 - 0.3 given post-op bleeding at the R axillary Impella site. Five days post Impella placement he developed bloody secretions from the endotracheal tube requiring multiple blood transfusions and discontinuation of systemic heparin, while maintaining heparin purge. Labs were notable for anti-Xa 0.22, hemoglobin 9.7, and platelets 221. CT Chest demonstrated parenchymal opacities concerning for diffuse alveolar hemorrhage (DAH) which was confirmed via bronchoalveolar lavage; he had no known history of lung disease. High-dose corticosteroids were administered as a high ANA titer (1:128) and low C3 suggested capillaritis. However, decreasing ANA (1: 320) and a negative autoimmune workup decreased the likelihood of a rheumatologic cause for DAH and steroids were discontinued. DAH secondary to acquired von Willebrand syndrome (aVWS) was considered, but factor VIII and vWF activity levels were normal. The bloody secretions improved with inhaled thromboxane and systemic heparin was restarted. Orthotopic heart and kidney transplant was performed with subsequent Impella removal 104 days after Impella placement. Discussion: We present the first documented case of DAH with isolated Impella 5.5 support. Previously reported cases of DAH post-Impella were observed in patients with concurrent ECMO or RVAD. As autoimmune and coagulopathic causes of DAH were excluded, bland DAH secondary to systemic anticoagulation is most likely in this case. This raises a question about how to balance the risk of bleeding with the risk of device thrombosis, stroke and embolic events and when to switch from heparin to sodium bicarbonate purge.
Abstract 13711: Clonal Hematopoiesis Driven by <i>TET2</i> and <i>ASXL1</i> but Not <i>DNMT3A</i> is Associated With Interleukin 6 Levels, Cardiac Biomarkers, Cardiac Remodeling, and Risk of Atrial Fibrillation
Authors: Seyedmohammad Saadatagah, Mohammadreza Naderian, Md Mesbah Uddin, Ozan Dikilitas, Art Schuermans, Abhishek Niroula, Elizabeth Selvin, Ron C Hoogeveen, Kuni Matsushita, VIJAY NAMBI, Bing Yu, Lin Y Chen, Alexander G Bick, Benjamin L Ebert, Michael C Honigberg, Na Li, Amil M Shah, Pradeep Natarajan, Iftikhar J Kullo, Christie M Ballantyne
Journal: Circulation (2023)

Introduction: Aging and inflammation are associated with risk of atrial fibrillation (AF), to which clonal hematopoiesis of indeterminate potential (CHIP) may contribute. We investigated whether CHIP was associated with AF, inflammatory and cardiac biomarkers and cardiac structural changes. Methods: We ascertained CHIP (variant allele frequency, VAF ≥2%) in the Atherosclerosis Risk in Community Study (ARIC visit-5, n = 4,131) and the UK Biobank (UKBB, n = 195,851) participants. Using multivariable Cox regression models, we studied the association of CHIP and the top three implicated genes (i.e., DNMT3A , TET2 , ASXL1 ) with incident AF and conducted a meta-analysis on both cohorts. We also ascertained high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL6), IL18, high-sensitivity troponin T and I (hs-TnT and hs-TnI), NT-proBNP, and echocardiography indices in ARIC. We first standardized the natural log of all markers (st-ln) and used the adjusted quantile regression to compare the median in those with and without CHIP. Results: In ARIC, the mean ± SD age was 75.8 ± 5.2 years, 41% were men, 23% were Black, 25% had CHIP, and 11.6% had large CHIP (VAF ≥10%). These measures in UKBB were 56.4 ± 8.1 years, 45%, 2%, 5.8%, and 2.6%, respectively. In the meta-analysis, compared to those without CHIP, the hazard ratios (95% confidence interval) for AF were 1.12 (1.01 - 1.25, P =0.035), 1.31 (1.07 - 1.60, P =0.009), and 1.48 (1.05 - 2.08, P =0.026) for Large-CHIP, Large- TET2, and Large- ASXL1 , respectively. hs-CRP and IL18 levels were similar in those with and without CHIP as well as gene-specific subgroups. Large- TET2 and ASXL1 were associated with higher IL6, which was separately associated with AF. Additionally, Large- ASXL1 was associated with increased left ventricle mass index and NT-proBNP (coefficients in Figure 1 ). Conclusion: Large TET2 and ASXL1 but not DNMT3A CHIP is associated with higher IL6 levels, indices of cardiac remodeling, and an increased risk of AF.
Abstract 18246: Determining the Most Important Factors for 1-year Health Status Using a Machine-Learning Algorithm in Patients With Peripheral Artery Disease Undergoing Revascularization for Claudication
Authors: Gaelle Romain, Jacob Cleman, Kim G Smolderen, Carlos Mena-Hurtado
Journal: Circulation (2023)

Introduction: Over time, patients with peripheral artery disease (PAD) are at high risk of poor cardiovascular outcomes, but most immediately, their health status is impacted due to lifestyle-limiting symptoms. To improve functioning, peripheral vascular intervention (PVI) may be offered. We aimed to understand which factors predict subsequent health status outcomes following PVI. Methods: We used data from the international ILLUMENATE examining the safety of peripheral angioplasty with vs. without Stellarex drug-coated balloon for femoropopliteal artery disease in randomized trial between 2013 and 2019. Treatment arms were combined for this analysis. EQ-5D 3L Index and Visual Analog Scale (VAS) were assessed at baseline and 1 year. Random forest regression, a base-trees machine-learning algorithm, was built in the training sample (80% of the cohort) and evaluated in the validation sample (20% of the cohort). The importance of 58 included pre-procedural variables was ranked. The most important variables were defined based on visual inspection of the relative importance plots to evaluate the information gained value of each included variable. Results: In the 473 included patients, the mean age was 68.2 ± 9.2 years, 32.1% were female and 4.2% were Black. For the 1-year 3L Index, the most important pre-procedural variables were liver disease and the 3L Index (54.1%). For the 1-year VAS, the most important variables were angioplasty/drug eluting stent following by chronic lung disease (94.9%), mechanical thrombectomy (81.0%), anticoagulant (80.1%) and congestive heart failure (76.5%). (Figure) Conclusions: As part of an effort to develop an individualized health status profile with machine learning, a predictable ranking of pre-procedural variables can inform 1-year health status outcomes in patients with PAD undergoing PVI for claudication. These approaches can inform clinical decision-making and pre-habilitation efforts to maximize treatment success.
Abstract 17841: Early versus Late Anticoagulation for Ischemic Stroke Associated With Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis
Authors: Usman Akbar, Rana Usman Anwar, Talha Shamshad, AHMED ALI, Ahmed Muaaz Umer, Muhammad Waqas, Muhammad Aslam khan, Mounica Vorla, - Muhibullah, Nouman Shafique, Sonia Mukhtar, Muhammad Adnan khan, Munis Raza, Ali haider, Sourbha Dani
Journal: Circulation (2023)

Introduction: The optimal timing for initiating oral anticoagulation in patients who have experienced ischemic stroke is debatable. We conducted an updated systematic review and meta-analysis on the outcomes of patients who received early oral anticoagulation (within &lt;4 days) compared to those who received late oral anticoagulation (within 4-10 days) following the onset of ischemic stroke. Methods: We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “timing of anticoagulation,” “oral anticoagulants,” and “ischemic stroke.” After the screening, We extracted the data from 1980 to May 2023 in a data extraction sheet. We extracted data for three outcomes: Recurrent Ischemic Stroke (IS), Symptomatic Intracranial Hemorrhage (ICH), and all-cause mortality. We used a variance-weighted random-effects model to analyze early vs. late anticoagulation data, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using RevMan software. Results: Our analysis included a total of 08 studies (n= 8119 patients). Early anticoagulation (&lt;4 days) was associated with a lower risk of recurrent ischemic stroke, OR= 0.77(95% CI: 0.60- 0.99, I 2 = 21% ) as compared to late anticoagulation (4-10 days). However, there was no significant difference between the timing for symptomatic ICH, OR=1.27 (95% CI: 0.35- 4.64, I 2 = 0% ). Early anticoagulation was also associated with a reduction in all-cause mortality between the two patient groups. OR=0.63(95% CI: 0.43- 0.93, I 2 = 38% ).(Figure1) Conclusions: Early anticoagulation therapy may significantly reduce the recurrence of ischemic stroke and overall mortality with no significant impact on the risk of symptomatic ICH. More randomized control trials are needed to increase the robustness and reliability of these results.
Abstract 17932: Smoking History is Associated With Worse Outcomes in Patients With Sarcopenia Admitted for Acute Decompensated Heart Failure
Authors: Saeid Mirzai, Ian Persits, Maximilian C Volk, Kunaal Sarnaik, Pieter Martens, Jerry Estep, Po-Hao Chen, Wai Hong W Tang
Journal: Circulation (2023)

Background: Sarcopenia and smoking are independently associated with worse heart failure (HF) outcomes; therefore, their combined effect is likely even more detrimental. Research Questions: We studied the impact of sarcopenia and smoking on outcomes in patients admitted for acute decompensated HF (ADHF). Methods: We conducted a retrospective cohort study of 406 consecutive patients hospitalized at our tertiary care center for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI). To compare survival, patients were divided into four groups: nonsarcopenic nonsmokers (controls, 22.4%), sarcopenic nonsmokers (10.6%), nonsarcopenic smokers (44.3%), and sarcopenic smokers (22.7%). Sarcopenia was the lowest sex-stratified SMI tertile (cutoffs of 29.6 cm 2 /m 2 in males and 25.7 cm 2 /m 2 in females), and smokers were those who had ever smoked. Results: The mean admission age of our cohort was 70±14 years, 44.3% were female, and 67.0% had a smoking history (191 former and 81 active). Compared to nonsmokers, patients with a smoking history had more COPD (53.3% vs. 18.7%, p&lt;0.001) and higher all-cause mortality (HR 1.41, 95%CI 1.05-1.90, p=0.021), but did not differ in SMI. When further stratified by sarcopenia, during a median 22.9 (3.0-33.5) months of follow-up, all groups had higher all-cause mortality when compared to controls (figure 1B); the highest rate was seen in sarcopenic smokers, which remained significant when adjusted for age, male sex, Caucasian race, CAD, and COPD (HR 1.71, 95%CI 1.12-2.60, p=0.013). Sarcopenic smokers also had the highest rate of ICU admissions (50.0%). Conclusions: Sarcopenia and smoking portend worse prognoses in patients admitted for ADHF, with sarcopenic smokers having the worst outcomes, independent of COPD history.
Abstract 17823: Impact of the Type of Tricuspid Annuloplasty Ring Concomitant With Mitral Annuloplasty on Atrial Arrhythmia Behaviour and Pacemaker Implantation Rate, Fact or Fancy
Authors: Mohamed Hassan, Daniel Keller, Berikbol Makhmetov, Zulejha Omerbasic, Dejan Radakovic, Nodir Madrahimov, Rainer Leyh, Constanze Bening
Journal: Circulation (2023)

Background: Tricuspid valve repair has been advocated in patients undergoing mitral valve surgery who have not only preoperative severe TR but also for tricuspid annular dilatation (TAD) of &gt;40 mm. We sought to analyze the impact of the type of tricuspid annuloplasty ring on the atrial arrhythmia behavior and the incidence of permanent pacemaker implantations in patients undergoing mitral valve annuloplasty. Methods: We performed a retrospective review of 408 patients underwent combined tricuspid and mitral valve annuloplasty in our institution between the years 2007 and 2014.Patients were 68,8 ± 10,7 years old, 67% male, 33% female. A total of 325 patients met the inclusion criteria; 201 received three-dimensional (3D) rigid ring (group 1) and 124 received ring annuloplasty with flexible bands (group2). The distribution of the preoperative and perioperative variables was similar. Results: There was no statistical difference in the incidence of high-grade heart conduction disorders lasting more than 3 days postoperatively (13.4% in group 1 and 12.9% in group 2; P = 0.89). Likewise, there was no difference in the incidence of postoperative atrial fibrillation between the two groups (41.2% in group 1 and 37.1% in group 2; P = 0.45). On the other hand, there was statistical difference in the incidence of permanent pacemaker implantation between the two groups (12.9% in group 1 and 25.8% in group 2; P = 0.003). Likewise, there was difference in the incidence of sick sinus syndrome between the two groups (0.01% in group 1 and 16.1% in group 2; P &lt; 0.00001). Conclusion: The need for permanent pacemaker implantation and the incidence of sick sinus syndrom may be increased after the use of flexible tricuspid annuloplasty ring in the setting of mitral valve surgery.Moreover, the present study found no association between the use of Flexible tricuspid annuloplasty ring and a higher incidence of postoperative atrial fibrillation or high-grade heart conduction disorders.Further large-scale randomized controlled studies are needed to elucidate the Impact of the type of tricuspid annuloplasty ring.
Abstract 11613: Hemodynamics in the Exercise Stress Test: Evaluating the Prevalence and Impact of an Abnormal Hemodynamic Response to Exercise in a Modern Population
Authors: Steven C Scherping, Syed C Ahmad, Stephanie Katz, Nisha Hosadurg, James McParland, Katirina Guinto, Jamieson M Bourque
Journal: Circulation (2023)

Background: Adverse hemodynamic responses on exercise stress testing have prognostic impact, but the cumulative effect of multiple abnormalities is not known. These markers include chronotropic incompetence, reduced metabolic equivalents achieved, abnormal hemodynamic gain index, impaired heart rate recovery, and abnormal blood pressure response. Research Questions: In a contemporary population undergoing exercise stress testing, what is the cumulative prevalence and prognostic impact of the number of abnormal stress hemodynamic markers (asHD)? Aims: We measured the prevalence of increasing values of asHD and the associated burden of all-cause mortality and non-fatal myocardial infarction (death/NFMI). Methods: We performed a retrospective, single-center analysis of patients referred for exercise stress myocardial perfusion imaging from 2015-2017. Multivariable Cox proportional hazards modeling was used to explore the relationship between cumulative burden of asHD markers and death/NFMI. Data: The study population included 1,595 patients (mean age 62.1, 36.9% female) with mean follow-up 4.8 years stratified by number of asHD markers (0, 1, 2, or 3+). 60.2% of patients tested had at least one asHD marker. The cumulative burden was 1 asHD in 32%, 2 asHD in 19%, and 3+ asHD in 9.3%. Patients with any asHD were at greater risk for death/NFMI compared to patients with 0 asHD (HR 1.98 [95% CI, 1.39 - 2.83], p&lt;0.001) with a stepwise increase in risk seen with a greater burden of asHD (compared to 0 asHD): 1 asHD: HR 1.70 [95% CI,1.14 - 2.52], p=0.009; 2 asHD: HR 2.02 [95% CI, 1.32-3.10], p=0.001; and 3+ asHD: HR 2.88 [95% CI 1.82-4.56], p&lt;0.001. Conclusion: Contemporary patients referred to exercise stress testing have a substantial burden of abnormal hemodynamic markers. There is an increasing risk of death/NFMI with a greater number of abnormal markers. This data may illuminate cause of symptoms and inform prognosis, supporting the value of functional testing in this group.
Abstract 16342: Age- and Sex-Differences in Accuracy of ICD-10 Codes for Identifying Adults With Pulmonary Embolism: PE-EHR+ Study
Authors: Shiwani Mahajan, Ying-Chih Lo, Antoine Bejjani, Candrika D Khairani, David Jimenez, Stefano Barco, Cesar Caraballo, Eric A Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, HAMID MOJIBIAN, Yuan Lu, Zhenqiu Lin, Sanjay Aneja, Rohan Khera, Samuel Goldhaber, Li Zhou, Manuel Monreal, Gregory Piazza, Harlan M Krumholz, Behnood Bikdeli
Journal: Circulation (2023)

Background Age and sex-differences exist in presentation of adults with pulmonary embolism (PE). However, it remains unclear if these differences influence the accuracy of International Classification of Diseases, Tenth Revision (ICD-10) codes used for identification of PE. Methods: Using multicenter data from Mass General-Brigham Health System (2016-2021), patients were randomly selected from 3 groups: 578 patients with Principal Discharge codes for PE, 578 with Secondary Discharge codes for PE, and 578 without codes for PE. The reference standard for identification of PE was manual chart review by 2 independent physicians. Sensitivity, specificity, and positive and negative predictive values were determined by age (&lt;65 vs ≥65 years) and sex (female vs male). Weighted estimates were obtained by using the total number of hospitalizations. Results: Among 1712 patients included in final analyses, 896 (52.3%) were female and 775 (45.3%) were ≥65 years. Use of Principal-or-Secondary ICD-10 codes had a similar sensitivity by sex (99.5% vs 100% among females vs males) and age (99.8% among both groups) in the study sample. The weighted sensitivity among females was 72.8% (vs 100% for males) and 80.4% among patients ≥65 years (vs 85.2% for &lt;65 years). In the weighted cohort, the positive predictive value was 78.2% among females (vs 80.3% for males) and 78.3% among those ≥65 years (vs 80.0% for &lt;65 years) (Table). Age and sex-differences in the diagnostic accuracy were similarly observed in analyses restricted to Principal, or to Secondary codes. Conclusions: Principal-or-Secondary ICD-10 codes had lower sensitivity and positive predictive value among females and older adults, though the sex-differences in sensitivity may be influenced by limited number of false negatives in this study. Additionally, Secondary codes had higher false positives among older adults. These findings may have important implications for identification of patients with PE using ICD-10 codes.