tbuckley/cabot-search huggingface dataset:
Abstract 12840: Left Atrial Enlargement is a Useful Predictor for Incident Heart Failure in Atrial Fibrillation Patients Without Pre-Existing Heart Failure
Authors: Yasuhiro Hamatani, Moritake Iguchi, Kenjiro Ishigami, Syuhei Ikeda, KOSUKE DOI, Takashi Yoshizawa, Yuya Ide, Akiko Fujino, Mitsuru Ishii, Nobutoyo Masunaga, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the risk stratification for HF in AF patients. Hypothesis: Left atrial diameter (LAD) is a simple prognostic parameter in patients with HF. We hypothesized that LAD is a useful predictor for incident HF in AF patients even without pre-existing HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%), we investigated 2,464 patients with the data of LAD at enrollment. We divided the patients into 4 groups stratified by LAD (&lt;40 mm, 40-44 mm, 45-49 mm, and ≥50 mm), and compared the backgrounds and incidence of HF hospitalization between the groups. Results: Of 2,464 patients (mean age: 72±11 years, female: 919 [37%], paroxysmal AF: 1,405 [57%], and mean CHA2DS2-VASc score: 3.0±1.6), the mean LAD was 42±8 mm (&lt;40 mm: 1007 [41%], 40-44 mm: 650 [26%], 45-49 mm: 467 [19%] and ≥50 mm: 340 [14%], respectively). Patients with larger LAD had a higher prevalence of elderly and non-paroxysmal AF, and had a higher CHA2DS2-VASc score (all P&lt;0.001). During the median follow-up of 6.0 years, 260 patients (11%) were hospitalized for HF (annual incidence: 1.8% per person-year). Kaplan-Meier curves revealed that LAD was able to stratify the incidence of HF hospitalization in AF patients without HF (Figure). Multivariable Cox regression analysis demonstrated that larger LAD were independently associated with the risk of HF after adjustment by age, sex, AF type, and CHA2DS2-VASc score (Figure). Conclusion: Larger LAD was significantly associated with the higher incidence of HF hospitalization in AF without pre-existing HF, suggesting the utility of LAD regarding the risk stratification for HF in these patients.
Abstract 12273: Circulating Monocyte Mitochondrial Function Reflects Myocardial Oxidative Metabolism in Humans With Heart Failure
Authors: Vandana Revathi Venkateswaran, Otto Muzik, Ramesh C Gupta, Ruicong She, Vinita S Gupta, Kristina Castle, L. Keoki Williams, Hani N Sabbah, David E Lanfear
Journal: Circulation (2023)

Introduction: We previously showed that mitochondrial function in circulating monocytes is abnormal in humans with heart failure (HF) compared to normal controls, and that it correlates to cardiomyocyte mitochondrial function in dogs with HF. But, there is no data in humans supporting a relationship between monocyte mitochondrial function and cardiac energy metabolism. Hypothesis: To test the association of circulating monocyte mitochondrial function metrics with myocardial energy metabolism in patients with HF and reduced left ventricular (LV) ejection fraction (HFrEF) quantified using C 11 acetate PET imaging. Methods: We studied 10 patients with stable HFrEF that underwent the PET imaging. Region of interest analysis was used to yield time-activity curves that represent multiple LV myocardial regions. The early phase of tracer washout curves were fitted mono-exponentially to obtain the constant Kmono (a measure of oxidative metabolism). Peripheral blood monocytes were isolated and mitochondrial function was quantified using SEAHORSE. We tested the correlation of mitochondrial metrics with Kmono, adjusted for mechanical energetic output of the heart (calculated as stroke volume index*mean BP*heartrate). Results: Among the 10 patients (aged 57-74), 3 were women, 4 self-identified as Black, and 4 had ischemic etiology. Mean EF was 35% (range 18-45%), mean systolic BP was 126 (range 100-147), and mean Kmono was 0.054 (range 0.038-0.102). Results are summarized in the table. After accounting for variation in mechanical cardiac work, we found significant positive correlations of each mitochondrial metric with Kmono. Conclusions: We find that mitochondrial function in circulating blood monocytes may be a biomarker of cardiac oxidative metabolism and cardiomyocyte mitochondrial function. If validated as a non-invasive measure of cardiac energetics, this could accelerate research in cardiac energy deprivation and its relationship to HF progression.
Abstract 12978: Real-World Treatment Patterns in Hispanic and White Patients With Pulmonary Arterial Hypertension (PAH) in the United States
Authors: Lana Melendres-Groves, Wenze Tang, Hayley D Germack, Zhiwen Liu, Kay Sadik
Journal: Circulation (2023)

Introduction: ESC/ERS guidelines recommend initial double oral combination therapy (endothelin-receptor antagonist plus phosphodiesterase 5 inhibitor) in low or intermediate risk PAH patients without cardiopulmonary comorbidities. Upfront use of prostacyclin pathway analogue (PPA) is recommended for patients with high risk of 1-year mortality. Few studies have evaluated treatment patterns/adherence in PAH patients across ethnic groups. Aims: To describe demographic/clinical characteristics and treatment patterns in US Hispanic and White PAH patients. Methods: A retrospective, observational, analysis using Optum’s de-identified Clinformatics ® Data Mart database identified patients aged ≥18 years with pulmonary hypertension (PH) diagnosis (excluding chronic thromboembolic PH) and were new users of PAH medications. Index date was the 31 st day after first PAH-specific medication use (1 Jan 2016-30 Jun 2022); the 30-day window between first PAH medication use and index date was used to identify the initial PAH regimen. Patient characteristics and PAH treatment patterns were analyzed descriptively, with standardized mean differences (SMD) between cohorts assessed (SMD &gt;0.1 indicated significant difference). Results: Hispanic patients were younger, with lower income, lower education level, and higher comorbidity burden than White patients (Table). Few patients received initial combination PAH treatment with similar use of combination therapy in the two cohorts (~14% in each). Hispanic patients were less likely to receive a PPA-containing index treatment regimen and had lower index treatment adherence (Table). Conclusions: In Hispanic and White patients, index combination PAH therapy use was low. Hispanic patients were less likely to receive a PPA-containing index treatment and had lower index treatment adherence. Further research and awareness of the influence of ethnicity on treatment management is needed to improve PAH care.
Abstract 14028: Stroke Location, White Matter Disconnections, and Neurodevelopmental Outcomes in Infants With Congenital Heart Disease
Authors: Thiviya Selvanathan, Ting Guo, Shabnam Peyvandi, Anne Synnes, Vann Chau, Linh Ly, ANTHONY J BARKOVICH, Mike Seed, Patrick S McQuillen, Steven P Miller
Journal: Circulation (2023)

Objectives: Infants with congenital heart disease (CHD) are at risk for stroke, although associations with neurodevelopmental outcomes have varied. In adults with stroke, location and altered structural connectivity (disconnections) have been linked to neurologic symptoms. We assessed whether stroke (1) location and (2) white matter disconnections are related to neurodevelopment in infants with CHD. Methods: Infants underwent pre- and post-operative brain MRI in prospective studies at 3 centres (UBC, UCSF, SickKids) and completed 18-month neurodevelopmental assessments using Bayley Scales with separate motor and cognitive composites. Adverse outcomes were defined as composite score &lt;85. Strokes were manually segmented. Voxel-wise lesion symptoms maps (VLSM) were used to assess relationships between lesion location and neurodevelopment. Disconnectomes were generated using stroke segmentations as seeds for tractography and diffusion MRI from healthy controls. Voxel-wise disconnectome-symptoms maps (VDSM) of associations between structural disconnections and neurodevelopment were developed. Results: 50 infants with strokes had neurodevelopmental outcomes data. Most strokes were small (&lt;1/3 of arterial territory; n= 33) and in the left MCA territory (Fig 1A). However, strokes in the right basal ganglia and adjacent central white matter were most strongly associated with adverse motor and cognitive outcomes (Fig 1B). White matter disconnections extended beyond areas of injury (Fig 1C); these were extensive even in small strokes. Disconnections of tracts passing through the right basal ganglia were most strongly associated with adverse motor and cognitive outcomes (Fig 1D). Conclusions: Strokes involving the basal ganglia, particularly in the right hemisphere, were associated with worse motor and cognitive outcomes in infants with CHD. These data draw increasing attention to the right hemisphere in early-life stroke and neurodevelopment.
Abstract 12452: Risk Stratification in Cardiogenic Shock Patients With Venoarterial Extracorporeal Membrane Oxygenation Using Lung Computed Tomography Density and Model for Endstage Liver Disease Score
Authors: Tasuku Hada, Osamu Seguchi, Kitahata Nana, SHOTARO KOMEYAMA, Hiroki Mochizuki, Naoki Tadokoro, Satoshi Kainuma, Takuya Watanabe, Satsuki Fukushima, Yasumasa Tsukamoto
Journal: Circulation (2023)

Background: End-organ dysfunction often occur in patients receiving femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) and it has been reported to be associated with poor prognosis. This study aimed to elucidate the ability to risk stratification in patients with cardiogenic shock (CS) who received VA ECMO using lung computed tomography (CT) density and Model for End-stage Liver Disease exclude INR (MELD-XI) score. Methods: This is a single-center retrospective observational study targeted 65 CS patients who has had available chest CT images on VA ECMO support followed by MCS escalation from 2012 to 2021. The average density of lung CT images in the lung field at the level of tracheal bifurcation was measured using region-of-interest methods. MELD-XI scores were also calculated. The primary endpoint was 180-day all cause death after MCS escalation. Results: Twenty-two patients (34%) died within 180 days during the follow-up period [659 (78-1,544) days]. According to the Cox regression analysis higher MELD-XI scores (≥ 18) (HR; 2.68; 95% CI, 1.05-6.86; p=0.039), and higher lung CT density [≥ -481 Hounsfield unit (HU)] (HR, 5.64; 95% CI, 1.95-16.28; p=0.001) were independently associated with all cause death. Moreover, combination of both lung CT density and MELD-XI score further refine risk stratification in current patient population : group A, high lung CT density (≥-481 HU) and high MELD-XI score (≥18); group B, high lung CT density (≥-481 HU) or high MELD-XI score (≥18); and group C, low lung CT density (&lt;-481 HU) and low MELD-XI score (&lt;18) (group A:31.3% vs. group B:65.2% vs. group C:88.5%, log-rank p&lt;0.001). Conclusions: Combination of higher lung CT density and higher MELD-XI score is a useful predictor of prognosis in patients with VA ECMO requiring escalation of MCS.
Abstract 12974: Sex Differences in Invasive Coronary Angiography at a Large Urban US Hospital
Authors: Sarah Chiu, Shuanglang Yao, Dinesh Kadariya
Journal: Circulation (2023)

Introduction: Invasive coronary angiography (ICA) is a common procedure to evaluate for ischemic heart disease. Significant sex differences in referral for invasive coronary angiography as well as intervention have been reported. The aim of the current study was to evaluate the impact of male and female sex on patterns of ICA at a large urban hospital. Methods: We retrospectively reviewed hospital procedures performed at UF Health Jacksonville between 2014 and 2018. The electronic health record was queried. Total number of cases and number of cases who did not undergo percutaneous coronary intervention (PCI) or coronary artery bypass graft at the same encounter were retrieved. Chi-square was used to compare groups and odds ratio with 95% confidence interval calculated, and a p-value &lt;0.05 was considered statistically significant. Results: A total of 5556 patients underwent ICA with a men (n=3307) to women (n=2249) ratio of 1.47. Similarly, the ratios of fractional flow reserve (FFR) and intravascular ultrasound (IVUS) were lower in women as compared to men. The mean age for male patients was 61±12 years and &lt;3% were &lt;40 years old. The mean age for female patients was 62±13 years and &lt;3% were &lt;40 years old. Female gender was significantly associated with lower likelihood of having intervention with a male versus female odds ratio (OR) of 1.5 [95% CI 1.4-1.7, p &lt;0.001]. However, those females who underwent PCI had the same ratio of receiving balloon angioplasty, stents or atherectomy as compared to males. Conclusion: In a large urban US clinical center with a diverse and underserved population, being a woman significantly decreases the likelihood of referral for ICA as well as PCI. Our study aligns with prior investigations and underscores the need for further studies to clarify the underlying causes of these differences.
Abstract 12925: MICU Overflow Patients in the Cardiac Intensive Care Unit: Insights From the Critical Care Cardiology Trials Network Registry
Authors: Ameesh Isath, Atul Bali, Uzair Mahmood, FNU Namrata, David Berg, Erin A Bohula, David Morrow, Howard A Cooper
Journal: Circulation (2023)

Background: The cardiac intensive care unit (CICU) is designed to manage critically ill patients (pts) with acute cardiovascular (CV) conditions, but may be the site of care for pts with non-CV critical illness when medical ICU (MICU) beds are unavailable. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of consecutive admissions to CICUs in North America coordinated by the TIMI Study Group. Pts with no acute or major cardiac issues were designated as MICU overflow and were compared to those admitted with acute CV illness. A generalized mixed-effect regression model was used to adjust for age, sex, Sequential Organ Failure Assessment (SOFA) score and cardiac arrest while accounting for variability among centers. Results: Among 18,006 CICU admissions, 778 (4.3%) were MICU overflow, with a range of 0% to 26% among centers. MICU overflow rates trended lower over time (Fig-A) . In comparison to admissions with acute CV illness, MICU overflow patients were younger (60.0 vs 67.0 y, p&lt;0.001) and more likely to be female (45.6 vs 36.7%, p&lt;0.001). Comorbidities differed markedly between the 2 groups (Fig-B) . Presentation with cardiac arrest was more common among admissions with acute CV illness (12.9% vs 4.5%, p&lt;0.001). MICU overflow admissions had higher SOFA scores than those with acute CV illness (5.0 vs 3.0, p&lt;0.001). Resource utilization is shown in Fig-C . ICU LOS was similar (2.0 vs 2.2d, p=0.4). MICU overflow status was associated with a trend in CICU mortality (adj-OR 1.19, 95% CI 0.93-1.53, p=0.16) and significantly higher hospital mortality (adj-OR 1.69, 95% CI 1.36-1.73, p&lt;0.001) (Fig-D) . Conclusions: MICU overflow pts constitute a meaningful number of admissions to CICUs. These pts have more multi-system disease, greater baseline organ dysfunction, and higher hospital mortality than pts with acute CV illness. These findings reinforce the need for multidisciplinary CICU teams with expertise in all facets of critical care.
Abstract 12969: Role of Elevated High-Sensitivity Cardiac Troponin T in Determining the Clinical and Angiographic Outcomes in Patients With Chronic Total Occlusion Undergoing Percutaneous Intervention: A Meta-Analysis
Authors: Nanush Damarlapally, Aanchal Sawhney, Jyoti Verma, Harroop Singh S Klair, Dhanush Kolli, Birimroz SINGH SIBIA, Vardhan Chalasani, Rasya Reddy, Jithin Teja Kolli, Rupak Desai, Rajesh Sachdeva, Gautam Kumar, Timir K Paul
Journal: Circulation (2023)

Background: Percutaneous Coronary Intervention of Chronic Total Occlusion (CTO-PCI) leads to higher periprocedural myocardial injury (PMI); however, the prognostic value of high-sensitive-Cardiac Troponin T (Hs-cTnT) in CTO-PCI outcomes is not well studied. This review evaluated the association of Hs-cTnT with major adverse cardiovascular events (MACE) following CTO-PCI. Methods: We conducted a thorough literature search in PubMed, Scopus, Embase, and Google Scholar, using relevant keywords, to identify studies up to 2022. The primary outcome of interest was MACE, which included all-cause mortality, PMI, target vessel revascularization (TVR), and target vessel re-occlusion (TVRO). Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using binary random-effects models. Heterogeneity was assessed using I 2 statistics. Results: Our analysis included four studies investigating 1499 post-CTO-PCI patients (mean age 66.77±10.09 years, 81.5% male). Patients with multivessel disease, retrograde approach, and previous PCI or coronary artery bypass graft procedures were more likely to present with elevated Hs-cTnT levels due to the complexity of the procedure. No difference in baseline comorbidities was noted in patients with and without elevated Hs-cTnT, including diabetes and hypertension. There was no significant association between Hs-cTnT levels and MACE (OR:1.56 p=0.25), TVR (OR:2.03, p=0.22), PMI (OR:3.45, p=0.07), and mortality (OR:2.35, p=0.14) ( Figure 1) . However, a significant association was found between Hs-cTnT levels and TVRO [OR:8.78 (95% C.I. 3.64-21.17) p&lt;0.01, I2 0%]. Conclusion: Patients with elevated Hs-cTnT levels have a nine-fold higher risk of TVRO than those with normal levels in CTO-PCI. Periprocedural Hs-cTnT measurement can be utilized for risk stratification of TVRO after CTO-PCI with no association with MACE. Overall smaller sample size warrants more randomized studies to substantiate the results.
Abstract 12716: Left Ventricular Hypertrophy Phenotype to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis
Authors: Lili Wang, Jiayi Yi, Xin Zheng
Journal: Circulation (2023)

Introduction: Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, due to the heterogeneous nature of LVH, the predictive value of the LVH phenotype for incident AF remains uncertain. Methods: We utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, participants who underwent cardiac magnetic resonance imaging examination were included for analysis. LVH was defined as LV mass index ≥ 85.3 g/m 2 for females and ≥ 107.8 g/m 2 for males. Isolated LVH was determined as LVH without elevated cardiac biomarkers, and malignant LVH was determined as LVH with elevated hs-TnT level of ≥14 ng/L, or/and NT Pro-BNP level of ≥125 pg/mL. Results: A total of 4983 participants were included in the final analysis, with a mean age of 61.5 years. 272 (5.6%) had isolated LVH, and 222 (4.5%) had malignant LVH. During a median follow-up of 8.5 years, 272 cases of AF were observed. Compared to participants without LVH or elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95% CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95% CI, 2.77-6.16) had higher AF risks after adjusted for age, sex, race, body mass index, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes. Malignant LVH carried a 1.5-fold increased risk (HR: 2.48, 95% CI: 1.30-4.73) of AF compared to isolated LVH (Panel A). Kaplan-Meier cumulative AF incidence curves showed that malignant LVH had a significantly higher incidence of AF than those in other phenotypes (Panel B). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (areas under the curves[AUC] increase: 0.03, p&lt;0.001) (Panel C). Conclusions: The risks of AF incidence varied across LVH phenotypes, showing that malignant LVH carried a higher risk compared to other LVH phenotypes. LVH phenotype could provide additional predictive power for AF occurrence above the CHARGE-AF model.
Abstract 13723: Waitlist Outcomes for Pediatric Heart Transplantation in the Current Era: An Analysis of the PHTS Database
Authors: Ryan J Butts, Leah Toombs, James K Kirklin, Kurt Schumacher, Jennifer Conway, Shawn C West, Scott R Auerbach, Neha Bansal, Hong Zhao, Ryan S Cantor, Deipanjan Nandi, David M Peng
Journal: Circulation (2023)

Introduction: Waitlist mortality (WM) remains high in pediatric heart transplantation (HT). Allocation policy is a potential tool to help improve WM. This study aims to identify patients listed status 1A at highest risk for WM to potentially inform future allocation policy changes. Hypothesis: Significant variation in WM will exist even within highest urgency waiting status (1A). Methods: The pediatric heart transplant society database was queried for all patients &lt;18 years of age listed for HT between January 1, 2010 to December 31, 2021. WM was defined by death while awaiting transplant or being removed from the waitlist due to clinical deterioration. Kaplan-Meier analysis, log-rank testing, and Cox-proportional hazard models were created to determine association with WM. Subgroup analysis was performed in 1A patients based upon body surface area (BSA) at time of listing, cardiac diagnosis, and presence of mechanical circulatory support. Results: Among 5,974 children listed, 3928 (65.8%) were status 1A. Patients listed 1A had a higher burden of WM (p&lt;0.01) compared to patients listed status 1B or status 2. Among 1A patients, BSA&lt;0.3m 2 , congenital heart disease (CHD), and lower eGFR was associated with higher WM. VAD support at listing was associated with lower WM (figure, all p-values&lt;0.01) except in the single ventricle cohort (CHD-SV) (HR 2.13, p&lt;0.01). For BSA&lt;0.3m 2 listings, diagnosis other than dilated cardiomyopathy was associated with increased risk of WM . Prior cardiac surgery was associated with WM in the BSA 0.3-0.7m 2 and &gt;0.7m 2 groups. ECMO was associated with increased risk of WM in all cohorts (HR 2.26, p&lt;0.01). Conclusions: Significant variability exists in WM in patients listed 1A. Future changes to the pediatric allocation system should factor in the increased risk of WM in patients supported by ECMO, CHD-SV on VAD support, and small children with CHD, RCM or HCM.