tbuckley/cabot-search huggingface dataset:
Abstract 4135525: Bridging the Gap: How a Specialized Heart Failure Program Improves Guideline-Directed Medical Therapy Optimization for Rural Patients
Authors: Claudia Mae Velasco, Gladys Baksh, Heather Reesor, Michele Haydo, Omaima Ali
Journal: Circulation (2024)

Background: Previous research has shown that patients with heart failure with reduced ejection fraction (HFrEF) living in rural areas have suboptimal utilization of guideline-directed medical therapy (GDMT). Considering the associated increased mortality risk, this highlights the need for novel approaches to improve GDMT optimization for rural patients. The aim of this study was to evaluate how rural residence influences outcomes in a multidisciplinary, telehealth-based HF-GDMT optimization program implemented at our institution. Methods: We studied 322 patients who participated in a HF-GDMT optimization program led by a HF nurse practitioner and clinical pharmacist at Penn State Hershey Medical Center. We categorized residence at the time of enrollment using the Rural-Urban Commuting Area (RUCA) classification system. Differences in patient characteristics and program outcomes between the two groups were analyzed. P &lt; 0.05 indicated statistical significance. Results: Among the 322 patients enrolled, 56 (17.4%) resided in rural areas and 266 (82.6%) in urban areas. Rural patients were younger (mean age 61.1 vs. 65.1; p=0.04) and the two groups differed significantly in racial demographics (p=0.006). The rural group had a higher proportion of patients with chronic HF (55.4% vs. 39.8%; p=0.038) and fewer patients with a recent HF hospitalization (30.4% vs. 49.2%; p=0.012). As far as outcomes, program completion rates were similar between rural and urban patients (83.9% vs. 83.1%; p=1). Those who received target doses of the four GDMT drug classes versus the maximum tolerated dose were also similar between the rural and urban groups (21.4% vs. 15.8%; p=0.32). Conclusions: Patients from rural areas were more likely to present with chronic HF and less likely to have recent HF hospitalizations compared to their urban counterparts, suggesting potential disparities in access to HF care. Despite these differences, program outcomes, measured by completion rates and GDMT medication titration, were comparable between the two groups. Our findings emphasize the crucial role of specialized HF programs in advancing GDMT use for rural patients, which may ultimately improve HF outcomes and bridge the healthcare gap.
Abstract 4136694: Impact of left ventricular support devices on myocardial and pulmonary recovery in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation
Authors: Ishida Masaru, MASAAKI RYOMOTO, Toshihiro Funatsu
Journal: Circulation (2024)

Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is used to treat cardiogenic shock. However, retrograde arterial perfusion from the femoral artery can increase left ventricular (LV) afterload, resulting in LV distention which may hamper myocardial recovery and worsen pulmonary congestion. An intra-aortic balloon pump (IABP) can mitigate LV afterload, and Impella (Abiomed, Danvers, MA) can directly unload LV pressure. This study aimed to evaluate the efficacy of LV support devices during VA-ECMO in patients with cardiogenic shock. Methods: We retrospectively collected data from 213 consecutive patients treated with VA-ECMO due to cariogenic shock at our institution between January 2013 and December 2023. Patients were categorized as either receiving VA-ECMO alone or VA-ECMO with an LV support device. The LV support device was characterized as VA-ECMO with IABP or Impella. Data were analyzed for mortality, weaning from VA-ECMO, and changes in pulmonary congestion using the congestion score index (CSI), which is a semi-quantitative approach to pulmonary congestion based on a 6-zone evaluation of chest radiography, scoring each zone from 0 (no congestion) to 3 (intense pulmonary edema). Results: In this study, 95 patients received VA-ECMO alone, whereas 118 patients received an LV support device (101 VA-ECMO with IABP and 17 VA-ECMO with Impella). LV support devices improved weaning from VA-ECMO (odds ratio, 3.09 [95% confidence interval (CI), 1.75–5.55]; p&lt;0.0001) whereas there was no difference in IABP versus Impella cohorts. Compared with VA-ECMO alone, patients with VA-ECMO with an LV support device had better survival at 30 days (OR, 3.04 [95% CI, 1.73–5.43]; p&lt;0.0001). The rate of survival to discharge was better in VA-ECMO with an LV support device versus VA-ECMO alone (hazard ratio, 2.51 [95% CI, 1.72–3.65]; p&lt;0.0001). The evaluation of pulmonary congestion using the CSI revealed that congestion significantly improved in VA-ECMO with Impella (changes of CSI: 1.86 to 1.36) but not in VA-ECMO with IABP (1.80 to 1.96) and VA-ECMO alone (1.94 to 2.14). Conclusion: An LV support device may be associated with reduced mortality and increased success in weaning off VA-ECMO in patients with cardiogenic shock. Impella may be particularly effective in reducing pulmonary congestion.
Abstract 4136767: Racial/Ethnic and Sex Disparities in the Outcomes and Treatment of In-Hospital Cardiac Arrest: A Nationwide Analysis From the United States
Authors: Abdilahi Mohamoud, nadhem abdallah, Mahmoud Ismayl, Mark Linzer, Rehan Karim, Abdirahman Wardhere, Dawn Johnson, Andrew Goldsweig
Journal: Circulation (2024)

Background: In-hospital cardiac arrest (IHCA) is associated with significant morbidity and mortality. The relationships of race/ethnicity and sex to outcomes and treatment patterns among patients with IHCA remain poorly understood. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020 to identify adult patients with IHCA and compare in-hospital outcomes stratified by race/ethnicity (White, Black, Hispanic) and sex. The primary outcome was in-hospital mortality. Secondary outcomes included rates of in-hospital procedures. Multivariable logistic regression was used to adjust for potential confounders. Results: Among 207,770 patients with IHCA, 26.6% had ventricular tachycardia/fibrillation (VT/VF) and 73.4% had pulseless electrical activity (PEA)/asystole. In the VT/VF subgroup, Black males (aOR 1.42, 95% CI 1.21-1.66), Black females (aOR 1.25, 95% CI 1.05-1.50), and Hispanic females (aOR 1.30, 95% CI 1.01-1.66) had higher odds of mortality compared to White males (Figure 1). In the PEA/asystole subgroup, Black males (aOR 1.25, 95% CI 1.11-1.39) and Hispanic males (aOR 1.22, 95% CI 1.07-1.40) had higher odds of mortality, while White females had lower odds (aOR 0.88, 95% CI 0.82-0.94) compared to White males (Figure 2). Black patients were less likely to receive percutaneous coronary intervention (aOR 0.53, 95% CI 0.43-0.66 for males; aOR 0.54, 95% CI 0.42-0.69 for females) and coronary artery bypass grafting (aOR 0.50, 95% CI 0.30-0.82 for males; aOR 0.47, 95% CI 0.27-0.81 for females) compared to White males in VT/VF arrests. Additionally, Black males had the highest adjusted odds of renal replacement therapy in VT/VF arrests (aOR 1.47, 95% CI 1.21-1.80), while Hispanic males had the highest adjusted odds in PEA/asystole arrests (aOR 1.49, 95% CI 1.27-1.74) compared to White males. The remaining outcomes of interest in both VT/VF and PEA/asystole arrests are shown in Figure 1 and Figure 2 respectively. Conclusion: Significant racial/ethnic and sex disparities exist in outcomes and treatment patterns among patients with IHCA, with differences observed in both VT/VF and PEA/asystole subgroups. Targeted efforts and further studies are needed to better understand and address these disparities and improve outcomes in these severely ill patients.
Abstract 4135723: Efficacy and Safety of Ticagrelor with Aspirin vs Ticagrelor Monotherapy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Abdul Moeed, Adam Khan, Abdul Basit Jawed Memon, Muhammad Ali Mushtaq, Anfal Munir, Aira Mughal, Ume Habiba Ashfaq, Asharib Munir Chaudhary, Arisha Mahfooz, Susheel Kumar, Aliyan Abdul Rahman, Maryam Khan, Vishal Reddy Bejugam, Abdul Hannan Siddiqui, Hala Najeeb, mahboob alam
Journal: Circulation (2024)

Background: Dual antiplatelet therapy (DAPT) consisting of ticagrelor, a P2Y 12 inhibitor, and aspirin, is the recommended treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). However, recently ticagrelor monotherapy has been shown to preserve ischemic protection while reducing bleeding risk in ACS patients. We aimed to compare the clinical outcomes of DAPT and ticagrelor monotherapy in ACS patients undergoing PCI. Methods: MEDLINE, Scopus, and EMBASE were queried up to May 2024 for randomized controlled trials (RCTs) comparing ticagrelor monotherapy after 1 to 3 months of DAPT versus continued DAPT for 12 months in ACS patients. The primary outcomes were all-cause death, net adverse clinical events (NACE) and Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. Key secondary endpoints included BARC 3 or 5 bleeding, myocardial infarction (MI), hemorrhagic and ischemic stroke, and target vessel revascularization (TVR). A random-effects meta-analysis was performed to derive risk ratios (RR) and corresponding 95% confidence intervals (CI). Results: Six RCTs including 28,526 patients, with a mean age of 63.5 years, were included. DAPT was associated with a significantly higher risk of all-cause death (RR: 1.32, 95% CI: 1.05-1.64, P=0.02), NACE (RR: 1.20, 95% CI: 1.01-1.42, P=0.04), and BARC 2, 3, or 5 bleeding (RR: 1.96, 95% CI: 1.71-2.26, P&lt;0.00001) compared to monotherapy. DAPT significantly increased the risk of BARC 3 or 5 bleeding (RR: 2.06, 95% CI: 1.69-2.51, P&lt;0.00001) however, no association was seen in myocardial infarction (RR: 1.01, 95% CI: 0.84-1.20, P=0.94). Conversely, DAPT resulted in a non-significant reduction in ischemic (RR: 0.94, 95% CI: 0.63-1.41, P=0.77) and hemorrhagic stroke (RR: 0.83, 95% CI: 0.36-1.95, P=0.67). Additionally, no significant association could be ascertained in TVR (RR: 1.18, 95% CI: 0.94-1.48, P=0.15). Conclusion: Our analysis highlights the elevated risks of all-cause death, NACE, and major bleeding with DAPT compared to monotherapy in ACS patients post-PCI, favoring the latter for safety. Future investigations should refine antiplatelet therapy durations and identify specific patient subsets for optimal DAPT utilization.
Abstract 4136721: Reducing the Use of Transesophageal Echocardiogram Prior to Cardioversion Using Machine Learning
Authors: Emily Meisel, Reece Frechette, Ethan Kramer, Chen Bai, Ali Nassereddin, Madeline Smoot, Emily Edwards, Varsha Kurup, Gerald Naccarelli, Dhaval Naik, Mamoun Mardini, Mohammed Ruzieh
Journal: Circulation (2024)

Introduction/Background: Direct current cardioversion (DCC) is used to terminate atrial fibrillation and atrial flutter. Due to increased stroke risk post DCC, a transesophageal echocardiogram (TEE) is performed in selected patients to rule out left atrial appendage thrombus (LAAT) prior to DCC. The prevalence of LAAT is around 2.5% in the era of direct oral anticoagulants. This is a large proportion of patients with no LAAT on TEE and calls for strategies to improve patient selections for TEE before DCC. Research Questions/Hypothesis: In this study we aimed to determine if the use of machine learning could accurately predict the presence of LAAT among patients with nonvalvular atrial fibrillation and atrial flutter. Methods/Approach: We collected demographic, comorbid, and transthoracic echocardiographic data on 795 patients who underwent TEE prior to DCC for nonvalvular atrial fibrillation and atrial flutter. We developed and validated an explainable machine learning model using the eXtreme Gradient Boosting algorithm with 5x5 nested cross-validation. The algorithm used 37 variables to predict the probability of LAAT. Results/Data: The prevalence of LAAT in our cohort was 11.3%. Our model achieved an area under the curve (AUC) of 0.79 in predicting LAAT, figure 1A. In comparison, CHA2DS2-VASc score performed poorly in our cohort with an AUC of 0.48, figure 1B. The ranking of variables most strongly predictive of LAAT is shown in figure 1C, with left ventricle ejection fraction as the most instrumental. Patients were categorized into 10 groups based on the percentile of their predicted probability of having a thrombus. A lower percentile (e.g., 10%) indicates a lower probability of having a thrombus. By utilizing a cutoff point of 0.16, which includes 10.0% of the patients, we can exclude the presence of thrombus with 100% certainty. Conclusion: Machine learning, compared to traditional risk scores, offers enhanced predictive model for identifying LAAT and provides better guidance for TEE and anticoagulation therapy before DCC.
Abstract 4135861: Lipoprotein(a) and Its Impact on Left Ventricular Remodeling Over a Decade: The Multi-Ethnic Study of Atherosclerosis
Authors: Ashkan Abdollahi, Omar Chehab, Bruna Scarpa, Seamus Whelton, Bharath Ambale-Venkatesh, Colin Wu, Wendy Post, David Bluemke, Michael Tsai, Sotirios Tsimikas, Joao AC Lima
Journal: Circulation (2024)

Background: Lipoprotein (a) (Lp[a]) is associated with an increased risk of cardiovascular disease and mortality, as well as heart failure and myocardial fibrosis. However, the link between Lp(a) and cardiac remodeling as a pathway to adverse cardiac outcomes remains unknown. Objectives: This study investigated the relationship between Lp(a) levels and longitudinal changes in the left ventricular (LV) remodeling over a decade among individuals without a previous history of cardiovascular disease. Methods: 2,366 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac MRI at Visit 1 (2000-02) and Visit 5 (2010-12) and had available Lp(a) at baseline were examined. Lp(a) was analyzed as a continuous and a categorical variable based on quartiles (Q1[&lt;7.6 mg/dL], Q2[7.6-16.7 mg/dL], Q3[16.8-38.8 mg/dL], Q4[&gt;38.8 mg/dL]). Multivariable linear regression analysis was used to examine the association of Lp(a) with changes in cardiac MRI measures of LV remodeling ( Table ). Results: Participants had a mean age 60±9 years and 53% were women. Over 10-year follow-up, LV indexed volumes decreased, while LV indexed mass and mass to volume ratio increased across all the Lp(a) quartiles. However, LV ejection fraction only decreased in the third and fourth Lp(a) quartiles. Lp(a) examined as a continuous variable was associated with an increase in LV end-systolic indexed volume (per log-unit Lp[a]; β 0.32 mL/m 2 ; P = 0.01), LV indexed mass (per log-unit Lp[a]; β 0.38 g/m 2 ; P = 0.02), and a decrease in LV ejection fraction (per log-unit Lp[a]; β -0.29 %; P = 0.02) over 10 years after adjusting for sociodemographic and traditional cardiovascular risk factors ( Table ). Similarly, the fourth Lp(a) quartile was associated with an increase in LV end-systolic indexed volume (β 1.07 mL/m 2 ; P = 0.01), LV indexed mass (β 1.17 g/m 2 ; P = 0.02) and a decrease in LV ejection fraction (β -1.01 %; P = 0.01) compared to the first Lp(a) quartile after controlling for risk factors. The observed associations remained significant after further adjusting for aortic valve calcium score at Visit 1 ( Table - Model 3), and baseline coronary artery calcium score and interim myocardial infarction ( Table - Model 4). Conclusions: In a multi-ethnic cohort of participants free of cardiovascular disease at baseline, higher Lp(a) levels were independently associated with an increase in LV end-systolic volume and LV mass as well as a decrease in LV ejection fraction over the span of a decade.
Abstract 4136755: Associations of Pulmonary Hypertension and Lung Cancer: A Prospective Cohort Study of Half a Million UK Biobank Participants
Authors: Fang Zhu, Qian Zhang, Qingquan Luo
Journal: Circulation (2024)

Background: Pulmonary hypertension (PH) and lung cancer (LC) are both significant public health issues with substantial morbidity and mortality. Recent studies suggest potential associations between pulmonary vascular diseases and LC due to shared risk factors and pathophysiological mechanisms, yet comprehensive research in large populations is scarce. Methods: This prospective cohort study utilized data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow-up until November 30, 2023, for England and Scotland, and May 31, 2022, for Wales. We included 6,425 participants with LC, identified using linked cancer registry data, and followed them for the incidence of PH over a period of 10 years. We adjusted for potential confounders including age, ethnics, sex, smoking status, BMI, and histologic subtypes of LC. Statistical analyses were performed using Time-dependent Cox proportional hazards models to estimate the associations between PH and LC. Results: Of 502,173 participants in this prospective cohort, 6,425 were diagnosed with LC, while 494,451 did not receive the LC diagnosis. The prevalence of PH in the LC cohort and the no-LC cohort were 0.64% (1,494 of 3,142 women [47.55%]) and 2.40% (59 of 154 women [38.31%]), respectively, with significant difference between the two groups (p&lt;0.001). In the LC cohort, the mortality rates of patients without PH and with PH were 69.18% and 77.92% (p=0.020). Among the patients diagnosed with LC and PH, 33.12% were diagnosed with LC after PH (PH-LC), while 66.88% were diagnosed with LC before PH (LC-PH). And the mortality rates of the PH-LC group and the LC-PH group were 78.43% and 77.67%, respectively, with no significant difference between the two groups (p=0.915). Time-dependent Cox regression analysis showed that PH shows an increasing trend in risk (5th year HR: 3.22, 95% CI: 2.09-4.99, p-value &lt; 0.001), highlighting its significant impact on LC long-term prognosis. Conclusion: To conclude, the presence of PH significantly increased the risk of mortality in participants with LC, especially for the long-term LC survivors. And certain percentage of patients were diagnosed with LC before PH, but they had no significant difference between the patients with LC after PH.
Abstract 4136847: Administration of the Recombinant Activated Protein C Rescues the Cardiac Vulnerability to Ischemic Insults in Aging through Modulating Inflammatory Response during Ischemia and Reperfusion
Authors: Lily Slotabec, Nadiyeh Rouhi, Blaise Seale, Hao Wang, Fernanda Filho, Michael Adenawoola, Ji Li
Journal: Circulation (2024)

Introduction: Activated protein C (APC) is an endogenous vitamin-K-dependent serine protease and exhibits therapeutic potential for ischemic heart disease. The APC derivatives with anticoagulant and/or cytoprotective properties were produced through chemical engineering to characterize the functional domain of APC for limiting ischemia/reperfusion (I/R) injury. Hypothesis: The thromboinflammatory regulation by APC ameliorates ischemic insults caused by I/R through the receptor EPCR/PAR1. Methods: Young (3 months)/aged (24 months) wild type C57BL/6J mice and PAR1 R46Q/R46Q (block cleavage by APC) knock in mutant (3 months, C57BL/6J) mice were subjected to ligation of left anterior descending coronary artery with 45 min of ischemia. 5 min prior to reperfusion, wild type APC, cytoprotective selective APC-2Cys, or anticoagulant selective APC-E170A (0.2 μg/kg i.v.) was administered followed by 24 hr of reperfusion. The left ventricles of hearts were used for immunoblotting and flow cytometry analysis. Results: APC and APC-2Cys but not APC-E170A reduced I/R-induced myocardial infarction. Echocardiography showed that APC and APC-2Cys but not APC-E170A can rescue systolic dysfunction by I/R in young/aged WT but not in PAR1 R46Q/R46Q mice. Biochemical analysis showed that administration of APC and APC-2Cys inhibited activation of inflammation signaling c-Jun N-terminal protein kinase (JNK) and NF-κB by I/R and reduced mRNA levels of the proinflammatory cytokines TNFα and IL-6 in young/aged WT but not in PAR1 R46Q/R46Q hearts. The plasma cytokine array demonstrated that APC and APC2-Cys reduced potency of pro-inflammatory cytokines and apoptotic signaling cytokines during I/R. Moreover, I/R-triggered inflammasome NLRP3 was reduced by APC and APC-2Cys in young/aged WT but not in PAR1 R46Q/R46Q hearts. The flow cytometry showed that APC and APC-2Cys increased lymphocyte and decreased myeloid cell abundance and increased the recruitment of inflammation-mediating CD8a + T-cells during I/R in young/aged WT but not PAR1 R46Q/R46Q hearts, indicating that the APC/EPCR/PAR1 axis mediates APC's immune regulation under I/R. Moreover, APC and APC-2Cys reduced I/R-triggered macrophage abundance in young/aged WT hearts, although the proportion of M1 and M2 macrophages was unchanged. Conclusions: The cytoprotective domain of APC is critical for its cardioprotection against ischemic insults. EPCR/PAR1 receptor complex mediates APC's immune regulation in aging during I/R conditions.
Abstract 4135869: Local Ethanol Infusion after Pulsed Field Ablation Enhances Acute Efficacy of In Vivo Ventricular Electroporation
Authors: Taro Koya, Naoto Otsuka, Jason Tri, yang ying, William Sauer, Samuel Asirvatham, Duy Nguyen
Journal: Circulation (2024)

Background: Pulsed field ablation (PFA) has emerged as an innovative technology for treating cardiac arrhythmias. PFA increases cell permeability, which can lead to apoptosis. Greater PFA energy may be necessary to ablate ventricular myocardium for ventricular tachycardia circuits, but this carries risks of side effects such as gaseous formation (microbubbles) and hemolysis. Ethanol (EtOH) infusion has been used to ablate pathologic myocardial tissues in hypertrophic cardiomyopathy and for refractory arrhythmias. Hypothesis: We hypothesize that PFA in the ventricle can increase EtOH uptake through PFA-generated pores, thereby enhancing ablation efficacy, even at low powers, by utilizing the cell permeability effects of PFA. Aim: The aim of this study is to investigate the effect of local EtOH infusion after PFA on lesion size in porcine ventricles. Methods: The ventricles of five porcine subjects were ablated in vivo with a PFA low power setting (750 V, at 20 μs for 50 pulses separated by 200 ms) using a focal bipolar irrigated ablation catheter and BTX 830 electroporation generator (Harvard Apparatus). After PFA was performed, 2 ml of 90 % EtOH vs. saline (control) was infused through the catheter tip to the site of ablation. We compared the electrograms voltage amplitude reduction before and after PFA, and the ablation lesion characteristics. Results: A total of 10 lesions in the control group and 9 lesions in the EtOH group were analyzed. For the controls, the voltage after PFA was not reduced. In contrast, for the EtOH group, the voltage after PFA was significantly reduced ( Figure 1A ). On gross pathology, there were significant differences in ablation lesion depths and volumes between the 2 lesion sets ( Figure 1A-B ). Conclusion: Local EtOH infusion after ventricular PFA enhanced acute efficacy of electroporation. Concurrent PFA with local EtOH infusion has the potential to improve efficacy without requiring higher energy parameters, thereby reducing PFA risks. Future studies on chronic efficacy are warranted.