tbuckley/cabot-search huggingface dataset:
Abstract 4144485: Gender Disparities in In-Hospital Outcomes After Out-of-Hospital Cardiac Arrest: Insight from the United States National Inpatient Sample
Authors: Sharan Malkani, Andres Quevedo Ramirez, Jeremiah Bello, Hafeez Shaka
Journal: Circulation (2024)

Background: Out-of-hospital cardiac arrest (OHCA) is a critical emergency with a high mortality rate, necessitating immediate intensive medical intervention, which may include advanced therapies such as mechanical circulatory support (MCS). Despite advances and organized protocols, outcomes remain poor due to various factors, including gender. While gender disparities in cardiovascular health well-documented, their impact on OHCA outcomes, particularly in-hospital mortality and MCS use, remains unclear. This study investigates these disparities using the 2019-2020 National Inpatient Sample database, aiming to identify gender differences in outcomes and improve management of OHCA patients. Methods: We conducted a retrospective cohort study based on the 2019-2020 NIS database of the Healthcare Utilization Project. Our population included patients 18 years or older with OHCA as the primary diagnosis, identified using ICD-10 codes. The primary risk factors examined was gender, classified into male and female. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio. Results: During the study period, 26,640 hospitalizations with OHCA were identified, of whom 57.1% were male. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and male patients had lower mean age compared to female patients (64.6 vs 66 years old, p&lt;0.001). A total of 19,425 died (72.9%) and 0.9% needed MCS. Notably, more females died compared to male subset (74.6 vs 71.7%, p&lt;0.001). Although not significant, MCS use was 1.1% in males and 0.67% in females. In the multivariate analysis, we did not find statistical significance among genders regarding in-hospital mortality and MCS use. Conclusion: Our findings reveal a higher in-hospital mortality rate among female patients following OHCA. However, the multivariate analysis did not show statistically significant gender differences regarding in-hospital mortality or the use of MCS. This suggests that factors other than gender are critical in determining these outcomes. Further research is essential to identify these factors and develop targeted interventions to enhance survival rates for all OHCA patients.
Abstract 4144399: Impact of Protein-Calorie Malnutrition on Peri-procedural Outcomes of Transcatheter Aortic Valve Replacement: Latest Insights from National Database
Authors: Mobeen Haider, Krishna Kurpad, Yousra Khalid, Mounica Vorla, ADARSH KATAMREDDY, Sultana Jahan, Issam Moussa, naveed adoni, Sanjay Mehta, sudarshan balla
Journal: Circulation (2024)

Introduction: Transcatheter aortic valve replacement (TAVR) has emerged as an effective and less invasive percutaneous treatment option for select patients with severe aortic stenosis. Nutritional status plays a role in risk stratification for TAVR given its impact on peri-procedural outcomes. We aim to evaluate the impact of protein-calorie malnutrition (PCM) on the outcomes of TAVR. Methods: We queried the national inpatient sample database from year 2016 - 2020 to identify all patients who underwent TAVR. They were classified based on the presence of protein-calorie malnutrition. Statistical significance was assigned at p&lt;05. Results: A total of 303310 patients underwent TAVR. 7430 patients among them had a diagnosis of PCM. Baseline demographics and comorbidities are presented in the table below. Patients with malnutrition had a higher prevalence of chronic lung disease, atrial fibrillation, chronic kidney disease, end-stage renal disease, and chronic liver disease were sicker at baseline as demonstrated by higher Charlson comorbidity index (53.51 vs 69.45, p-value: 0.001). With regards to in-hospital outcomes, the PCM group had a higher incidence of total major bleeding, post-operative deep venous thrombosis/pulmonary embolism, total vascular complications, and in-hospital mortality in patients with PCM as compared to those without. With regards to healthcare resource utilization, TAVR patients with PCM had a longer length of hospital stay and higher total charges. The multivariate analysis reveals that PCM is associated with higher in-hospital mortality (OR: 3.97 with 95% CI: 3.11-5.06). Conclusion: Protein calorie malnutrition is associated with worse outcomes with higher mortality, morbidity, and increased healthcare resource utilization in patients undergoing TAVR. Nutritional optimization should be considered when feasible in this challenging patient population. Studies are needed to understand the mechanisms for worse outcomes in the PCM group
Abstract 4144387: The Prognostic Role of Glucagon-like Peptide-1 Receptor Agonist in Transthyretin Amyloid Cardiomyopathy
Authors: Kuan Yu Chi, Pawel Borkowski, Junmin Song, Yu Chang, Cho Han Chiang, Michele Nanna, MD, FACC, Nikhil Sikand, Cesia Gallegos, Marc Samsky, Michael Nanna
Journal: Circulation (2024)

Background: Guideline-directed medical therapy (GDMTs) for heart failure is often poorly tolerated in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and has unclear efficacy. Contrasting with GDMTs, glucagon-like peptide-1 receptor agonist (GLP1a) does not affect cardiovascular hemodynamics in patients with restrictive physiology. Research Question: What is the association between GLP1a treatment and survival outcomes in patients with ATTR-CM? Aims: To examine the prognostic role of GLP1a in patients with ATTR-CM. Methods: We used the TriNetX Global Collaborative Network database to conduct a retrospective propensity-score matching (PSM) study including adult patients with ATTR-CM, identified through tafamidis records, between September 1, 2019, and January 1, 2024. GLP1a users were defined as those having at least one prescription for GLP1a after the first dispense of tafamidis. GLP1a non-users were those who had no GLP1a prescription in the database but had at least one ambulatory visit after the first tafamidis prescription. The index date for study follow-up was set as the first GLP1a dispense for users and the first ambulatory visit after the first tafamidis prescription for non-users. The primary endpoint was heart failure (HF) hospitalization. The secondary endpoint was all-cause mortality. Incident gastrointestinal bleeding was set as a falsification endpoint. Cox proportional hazard ratios (HR) were calculated to compare study endpoints occurring within two years of the index date between two arms. Results: Of 5,241 ATTR-CM patients treated with tafamidis, 98 GLP1a users were matched to 98 nonusers. Before PSM, the mean BMI (33.4 vs 27.1) and the prevalence of type 2 diabetes (79.0% vs 19.0%) were higher in GLP1a users. After PSM, key covariates were balanced between the two cohorts (Table 1A) . The use of GLP1a was associated with a significant reduction in HF hospitalization (HR, 95% CI, 0.52; 0.28 to 0.96) (Table 1B), compared with non-users. There was no significant difference in all-cause mortality (HR, 95% CI, 0.73; 0.36 to 1.47) and the falsification endpoint between the two groups (Table 1B) . Conclusions: In ATTR-CM, GLP1a use was associated with a significant reduction in HF hospitalization.
Abstract 4144359: Performance of Pooled Cohort Equations and the AHA Predicting Risk of cardiovascular EVENTs Equations Among Multiracial Asian and Pacific Islander People
Authors: Adrian Bacong, Timothy Frankland, Jiang Li, Yihe Daida, Stephen Fortmann, Latha Palaniappan
Journal: Circulation (2024)

Introduction: The AHA Predicting Risk of cardiovascular EVENTs (PREVENT) Equations were introduced as a race-neutral alternative to the Pooled Cohort Equations (PCE) for predicting risk of ASCVD and heart failure. Although the equations have performed well among single-race groups, it is unknown if the PREVENT equations will perform better than PCE for multiracial individuals, a growing demographic population in the United States. Research Question: Do the PREVENT Equations perform better than the PCE among multiracial Asian and Pacific Islander (API) populations in predicting incident ASCVD? Methods: Using electronic health data from the Cardiovascular Disease Among Asians and Pacific Islanders Study, we examined individuals with complete data for all inputs necessary for both PCE and PREVENT from a large healthcare system in Hawaii (n = 27,784). We included individuals without ASCVD prior to entry and examined follow up for 5 years total. We examined 12 race and ethnic groups, including four multiracial groups: “Asian + White”, “Pacific Islander + White”, “Pacific Islander + Asian”, “Pacific Islander + Asian + White”. We evaluated the performance of PCE and PREVENT by calculating C-statistics with 95% Confidence Intervals (CI). Results: The performance of the PCE and PREVENT equations among the full sample was 0.6831 and 0.6813, respectively, reflecting similar moderate performance across both equations. PCE and PREVENT performance was similar among multiracial API groups (Table). However, there was heterogeneity in discriminative performance by group. PCE performance was worst among “Asian + White” individuals (0.65; [95% CI: 0.58, 0.72]) and best among “Pacific Islander + Asian” individuals (0.76; [95% CI: 0.69, 0.8288). Similar trends were seen in PREVENT; performance was worst among “Asian + White” individuals (0.65 [95% CI: 0.58, 0.72]) and was best among “Pacific Islander + Asian” individuals (0.71; [95% CI: 0.64, 0.78]). Conclusions: The base PREVENT Equations had comparable performance to PCE among multiracial Asian and Pacific Islander groups. Additional work is needed to better evaluate the performance of CVD risk equations among multiracial individuals and other emerging populations.
Abstract 4144437: Limited Effect of Circulating Sex Hormones on Cardiac and Vascular Physiology with Healthy Aging
Authors: Tiffany Brazile, Denis Wakeham, Diana De Oliveira Gomes, Christopher Hearon, James Macnamara, Benjamin Levine, Satyam Sarma
Journal: Circulation (2024)

Background: Sex differences in cardiac and vascular aging, including the disparate risk for heart failure with preserved ejection fraction (HFpEF) in women may be mediated by declines in sex hormones. It is unknown if hormone levels affect subclinical cardiovascular changes with aging that predispose women to HFpEF; therefore, we compared hormone levels and afterload, arterial and left ventricular (LV) stiffness across age in healthy men and women. Methods: We studied 194 sedentary normotensive, non-obese adults (55% female; age: 21-88yrs) at rest and maximal exercise. Arterial stiffness was assessed as carotid-femoral pulse wave velocity (PWV). Afterload was assessed at rest with aortic augmentation pressure (aAP), calculated from reconstructed ascending aortic blood pressure (BP) waveforms (SphygmoCor), and at maximal exercise as effective arterial elastance (Ea; systolic BP/stroke volume [derived from C 2 H 2 rebreathe]). Myocardial stiffness was assessed as the slope of individual pressure-volume (right heart catheterization-echocardiography) curves generated by graded LV loading and unloading. Serum Testosterone (T), estradiol, and follicle stimulating hormone (FSH) were measured (TOSOH Bioanalyzer). The effect of age, sex, and hormones were assessed via multivariate linear regression. Results: FSH increased exponentially with age with higher levels in women (Figure A, p&lt;0.001). FSH was associated with Ea (p=0.048, β=0.003) with a small effect size, but not aAP (p=0.078, β=0.017). The effect for FSH was eliminated when adding a sex*hormone level term (Figure B). T declined at &gt;3-fold the rate with age in men (Figure A, p&lt;0.001) and was associated with Ea, also with a small effect size (p=0.041, β=0.001, Figure B). There was no association between FSH or T with arterial or myocardial stiffness (all, p&gt;0.565, β&lt;0.002). Conclusion: Higher exercise afterload with increasing age in women was associated with progressively higher levels of FSH and lower levels of T. In healthy adults, the effects of circulating sex hormones were small relative to the effects of age and sex, and therefore likely do not explain the elevated HFpEF risk in women.
Abstract 4144487: Fully Ungated, Free-Breathing, 3-Dimentional T2* Mapping for Imaging Hemorrhagic Myocardial Infarction
Authors: Xingmin Guan, Hsin-jung Yang, Jane Sykes, Nan Wang, Xinheng Zhang, Richard Tang, Anthony Christodoulou, Behzad Sharif, Debiao Li, Frank Prato, Rohan Dharmakumar
Journal: Circulation (2024)

Introduction: T2* cardiac MRI (CMR) is the standard for detecting hemorrhagic myocardial infarction (MI). However, the conventional T2* CMR (2D breath-held, ECG-gated, multi-gradient-echo T2*) can suffer from limited spatial resolution and multiple motion artifacts. We developed a time-efficient, fully ungated, free breathing, 3D T2* mapping method for detecting and characterizing hemorrhagic MI (hMI). Methods: Our approach, developed using a low-rank tensor framework, was tested in a canine model with reperfused hMI. Animals (n=5) underwent CMR 3 days after reperfusion. Short-axis, conventional 2D and proposed 3D T2*-w images, and the corresponding LGE images were acquired in a 3T CMR system. T2* maps (8 echoes, 1.41-15.44 ms) were constructed using mono-exponential fitting. IMH extent was determined by measuring the weighted sum of the imaging slices with hypointense regions (based on ‘mean-2SD’ criterion) within the LGE positive territories. Image quality was assessed by two CMR experts using a Likert scale (1 – poor; and 5 - excellent). Results: Figure 1 shows representative conventional 2D, proposed 3D T2* images, along with LGE image for reference. T2* image scores were higher with the proposed than the conventional approach: 3.5 ± 0.5 (conventional) vs 3.8 ± 0.3 (proposed), p&lt;0.05. IMH extent measured using the two approaches provided equivalent IMH extent (see Fig. 2) under stable imaging conditions. Conclusions: The proposed 3D T2* mapping can provide much needed improvement in image quality compared to conventional 2D T2* CMR for detection of hemorrhagic MI without the need for breath holding or cardiac gating, both of which are known problems in acute MI patients. Provided imaging conditions are favorable, we also found that the proposed and conventional methods yield equivalent estimates of IMH extent. Additional studies are needed to evaluate the benefits of the proposed approach in clinical setting.
Abstract 4144426: How does intensive blood pressure control reduce the risk of cardiovascular disease events? A biomarker-based mediation analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Matthew Segar, Safi Khan, Khurram Nasir, Tariq Shafi, James Januzzi, Pankaj Arora, Javed Butler, Kershaw Patel
Journal: Circulation (2024)

Introduction: Intensive blood pressure (BP) control is associated with a significant reduction in the risk of heart failure (HF) or all-cause death. However, the extent to which intensive BP control-associated HF risk reduction is mediated by changes in subclinical markers of cardiovascular (CV) disease (CVD) and stage B HF is not well-characterized. Methods: Participants of the Systolic Blood Pressure Intervention Trial (SPRINT) with hypertension and available data on subclinical CVD markers at baseline and follow-up (1- or 2-year visit) were included. The key subclinical markers of CVD analyzed included chronic myocardial injury (assessed by high-sensitivity cardiac troponin I [hs-cTnI]), neurohormonal stress (assessed by N-terminal pro-B-type natriuretic peptide [NT-proBNP]), left ventricular (LV) mass (assessed by electrocardiogram Cornell voltage [CV]), and arterial stiffness (assessed by estimated pulse wave velocity [ePWV]). A counterfactual framework was used to assess the effects of the exposure and mediator on key outcomes, including 1) HF / all-cause death; 2) atherosclerotic CVD (ASCVD), including nonfatal myocardial infarction, nonfatal stroke, or CV death. Results: The present study included 8,872 participants (35% women, 31% Black). Over the 3.3-year median follow-up, there were 333 (3.8%) HF / all-cause death events and 200 (2.3%) ASCVD events. Reductions in neurohormonal stress and LV mass mediated up to 15% of the reduction in risk of HF / all-cause death with intensive BP control ( Table ). In contrast, treatment-related changes in chronic myocardial injury and arterial stiffness did not mediate the benefits of intensive BP reduction on HF / all-cause death risk. Furthermore, changes in any subclinical CVD markers did not mediate the effect of intensive BP control on ASCVD risk ( Table ). Conclusions: In this post-hoc analysis of SPRINT, improvements in neurohormonal stress and LV mass, as identified by surrogate markers of hs-cTnI and CV, were important mediators of the beneficial effects of intensive BP control in reducing the risk of HF / all-cause death. Mediators of the effect of intensive vs. standard BP control for reducing HF / all-cause death differ from those for ASCVD.
Abstract 4144321: Catheter Ablation Outperforms Medical Therapy in Management of Persistent Atrial Fibrillation: Enhanced Cardiac Function, Reduced Mortality, and Lower Hospitalizationion Rates
Authors: Anubhuti Sharma, Arundhati Sharma, Simranpreet Singh Daid, Isha Senthil Velmurugan, Laxmi Priya seelam, Saurav Aryal, Urja Sanghvi, Sahitya Dantuluri, Saif Syed, Binay Panjiyar
Journal: Circulation (2024)

Background: Persistent atrial fibrillation (AF) presents a significant management challenge, particularly in patients with concurrent heart failure. The effectiveness of catheter ablation compared to medical therapy for these patients remains under debate. Aim: This meta-analysis aims to evaluate the outcomes of catheter ablation versus medical therapy for managing persistent AF. Research Question: How does catheter ablation compare to medical therapy in managing persistent AF considering outcomes like arrhythmia recurrence, hospitalizations, cardiac function, exercise capacity, and mortality? Methods: We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with medical therapy in patients with persistent AF. Data sources included PubMed, Embase, Cochrane Library, Clinicaltrial.gov, Google Scholar, and CINAHL/EBSCOHOST, with studies selected based on predefined inclusion criteria. Primary outcomes assessed were recurrence of atrial arrhythmias, hospitalizations, changes in left ventricular ejection fraction (LVEF), changes in 6-minute walk test (6MWT) distance, and all-cause mortality. The data extraction was done using a spreadsheet, and the data analysis was done using RevMan 5.4.1: for meta-analysis Results: A total of 10 RCTs involving 1812 patients were included in the analysis. Compared to medical therapy, catheter ablation significantly reduced the recurrence of atrial arrhythmias (risk ratio [RR] = 0.43, 95% confidence interval [CI]: 0.29-0.63, P &lt; 0.0001). Hospitalization rates due to heart failure were also lower in the ablation group (RR = 0.57, 95% CI: 0.44-0.73, P &lt; 0.001). Improvements in LVEF were observed with a mean difference (MD) of 5.98% (95% CI: 3.81% to 8.15%, P &lt; 0.00001). The performance on the 6MWT was better in the catheter ablation group, with an MD of 28.83 meters (95% CI: 8.61 to 49.05 meters, P = 0.005). Additionally, catheter ablation was associated with a reduction in all-cause mortality (RR = 0.60, 95% CI: 0.45-0.80, P = 0.00006). Conclusion: This meta-analysis demonstrates that catheter ablation is superior to medical therapy in managing persistent atrial fibrillation. Catheter ablation offers significant benefits in reducing atrial arrhythmia recurrence, lowering hospitalization rates, improving cardiac function and exercise capacity, and reducing mortality. These findings support the consideration of catheter ablation as a preferred treatment strategy for patients with persistent AF.
Abstract 4144478: Atrial Fibrillation Recurrence in Patients with Left Atrial Appendage Occlusion with or without Previously Confirmed Left Atrial Appendage Electrical Isolation
Authors: FENGWEI ZOU, Michael Freilich, Giuseppe Ammirati, Nicoletta Ventrella, Juan Cedeno Serna, Jacopo Marazzato, Aung Lin, Xiaodong Zhang, Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Andrea Natale, Luigi Di biase
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias in the general population and imposes significant risk for cerebral vascular events. Catheter ablation is one of the most effective approaches to achieve and maintain sinus rhythm. Left atrial appendage (LAA) is a common arrhythmogenic site for AF and targeting LAA for ablation has been proven to reduce AF recurrence. Nevertheless, LAA electrical isolation (LAAEI) is only performed in certain practices and in patients who have previously received a LAA occlusive (LAAO) device, LAAEI is difficult to achieve after the LAA is occluded. Objective: The aim of this study is to investigate whether confirmed LAAEI prior to LAAO device implantation has an impact on AF recurrence. Methods: Patients who received LAAO were included in this analysis. Demographics, co-morbidities, previous ablations, recurrence of AF or atrial arrhythmias, follow up duration and whether patients had confirmed LAAEI either through LAA ablation or electroanatomical mapping during ablation prior to LAAO implantation were summarized. Kaplan-Meier survival analysis for freedom from atrial arrhythmia recurrence was performed. Results: A total of 613 patients were included in the study period and 63.6% were male. Among them 214 (34.9%) had confirmed LAAEI while 399 (65.1%) did not prior to implantation of LAAO device. Compared to patients without LAAEI, patients in the confirmed LAAEI group were more likely to have persistent and longstanding persistent AF (69.2% vs 46.6%), had higher percentage of diabetes (56.1% vs 40.3%) and heart failure (66.4% vs 33.3%) but were more likely to be male (72.9% vs 58.6%) and younger (70 vs 75 years old). At mean follow up period of 13 +/- 7.3 months, patients in the confirmed LAAEI group had 90.7% freedom from atrial arrhythmia recurrence compared to 81.5% in the no LAAEI group (P&lt;0.001). Conclusion: LAAEI prior to LAAO is associated with significantly reduced risk of AF recurrence after device implantation. LAAEI should be considered before LAAO in patients with LAA substrate given technical difficulty in LAAEI after LAAO.