tbuckley/cabot-search huggingface dataset:
Abstract 17645: Burden, Disparities, and Predictors of Major Adverse Cardiovascular and Cerebrovascular Events in Cancer Patients Hospitalized With COVID-19 in 2020
Authors: Shobana Krishnamurthy, Sahas Reddy R Jitta, Priyanka Vatsavayi, Chenna reddy Tera, Saisree Reddy Adla Jala, Supriya Maramreddy, Diksha Sanjana Pasnoor, Sridevi Tripuraneni, kavya jammula, Aisha Farooq, Utheja Dasari, Medha Reddy, Rupak Desai
Journal: Circulation (2023)

BACKGROUND: COVID-19 patients are at higher risk of major adverse cardiovascular and cerebrovascular events (MACCE). The underpinning effect of cancer in COVID-19 enhances this risk. Currently, we have limited nationwide data on MACCE events in cancer patients hospitalized with COVID-19. This study aims to identify demographic and clinical predictors of MACCE in this population. METHODS: We identified COVID-19-hospitalized cancer patients using the 2020 National Inpatient Sample. MACCE, inpatient mortality, and baseline demographics and comorbidities were assessed. Predictors of MACCE were calculated using multivariable regression analysis. RESULTS: Of 68,755 cancer patients hospitalized with COVID-19, 24% had MACCE, and 20.4% died in the hospital, with both outcomes being more significant among males, Asian or Pacific Islanders, and those in the fourth income quartile (all p&lt;0.05). Comorbidities exhibited statistically significant associations for MACCE (all p&lt;0.05). Higher adjusted odds of MACCE were found in age groups &gt;65 (OR 4.17; 95% CI 2.94-5.91) and 45-64 (OR 1.77; 95% CI 1.26-2.48) than 18-44 years, self-paying patients (OR 2.15) than Medicare, urban non-teaching (OR 1.25) and urban teaching hospitalizations (OR 1.24) than rural, prior MI (OR 1.36; 95% CI 1.11-1.66), CKD (OR 1.37; 95% CI 1.22-1.54), severe sepsis (OR 2.75; 95% CI 2.42-2.13), respiratory failure (OR 2.67; 95% CI 2.41-2.96), and mechanical ventilation (OR 12.15; 95% CI 10.40-14.21). Compared to the Northeast, hospitals in the Midwest, West, and South had lower odds of MACCE. Obesity, tobacco use, hyperlipidemia, and prior chemotherapy also exhibited lower odds of MACCE (all p&lt;0.05) (Table. 1). CONCLUSION: Our study using contemporary large-scale data found a concerning burden and higher risk of MACCE, particularly in the elderly, patients with CKD, prior MI, severe sepsis, respiratory failure, and mechanical ventilation.
Abstract 14567: Lipid Variability as a Risk Factor of Major Adverse Cardiovascular Outcomes. Meta-Analysis of Observational Studies
Authors: Oscar L Rueda-Ochoa, Laura Valentina V Vega Zambrano, Juan Camilo R Gomez Osma
Journal: Circulation (2023)

Introduction: Serum lipids variability has been described as a risk factor for cardiovascular disease. However, there is no published systematic review in the literature at the moment. The purpose is to evaluate the association between lipid variability and outcomes related to cardiovascular disease. Methods: We made a systematic search in Pubmed, Science Direct, Clinical Key, CINAHL, Lilacs, and Google Scholar using: lipids, variability, death, stroke, myocardial infarction, and cholesterol variability as keywords. Two independent researchers selected and made an extraction of the data. Non-agreement was solved by a third researcher. Non-language limitations were made. Exposure factors were coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) from LDL, HDL, Non-HDL, Total Cholesterol, and Triglycerides. MACE was the outcome of interest. We made a forest plot and heterogeneity analysis using I2. All analyses were made using STATA v. 14.2 Results: Eight papers from the initial 9785 met the inclusion criteria. All papers were cohort studies and a high heterogeneity was identified in the majority of them. The main heterogeneity causes were the difference in the number of participants in the studies, the years following, and the age of the participants included in the studies. In relation to the studies of low heterogeneity (&lt;40%), we found that the high variability of HDL analyzed with CV increases the risk of myocardial infarction (RR=1.39 [95% CI 1.35-1.42, I2 0%]). On the other hand, there were found significative relations between the variability of HDL analyzed with VIM to cardiovascular disease (RR=1.26 [95% CI 1.20-1.33], however, it had a high heterogeneity (I2 68.4%). Conclusions: The comparisons of the studies that analyze lipid variability have a high heterogeneity due to population differences. A relationship was found in the variability of HDL and myocardial infarction.
Abstract 16591: Surgical vs Non-surgical Repair of Aortic Arch in Type A Aortic Dissection: An Inverse Probability Treatment Weighting Propensity Score
Authors: Francesco Nappi, Antonio Salsano, Sanjeet Singh Avtaar Singh, Ivancarmine Gambardella, Antonio Fiore, Fausto Biancari, Francesco Santini, Patrick Mesnildrey, Thibaut Schoell, Nicolas Bonnet, Cristiano Spadaccio
Journal: Circulation (2023)

Introduction: Several surgical techniques are used in acute type A aortic dissection (TAAAD). Most are treated with hemiarch or limited replacement of the ascending aorta with interposition graft while total aortic arch replacement is less frequently performed. The research question/hypothesis: Is total arch replacement justified by the favourable late outcomes despite early complications? Aims: To evaluate if conservative approaches (root-sparing and hemiarch) can improve the early and late outcomes compared to total arch replacement. Methods: From 2005 and 2021, 633 patients underwent TAAAD repair of which 192(30.0%) were women. The ascending aorta replacement with/without root-sparing (group 1) were compared to the partial or total arch replacement cohort (group 2) using propensity score matching. A regression model with inverse probability treatment weighting by propensity score (IPTW) was built to generate a weighted cohort. Results: Patients undergoing aortic arch surgery were significantly younger (mean age 61.0 vs 66.5years; p&lt;0.001), frequently male (70%) or with a family history of aortic dissection or aneurysm (P=0.005). Antegrade cerebral perfusion was preferred when arch surgery was performed (83.5% vs33.8%, P&lt;0.001). Post-IPTW by propensity score analysis revealed that aortic arch surgery was associated with thirty-day mortality (odds ratio 1.60; 95% CI, 1.00-2.55, p=0.05), postoperative stroke (odds ratio 2.19; 95% CI, 1.29-3.73, P=0.004), postoperative sepsis (odds ratio 1.76; 95% CI,1.08-2.87, P=0.02) and mid-term mortality (hazard ratio 1.44, 95% CI, 1.05-1.99, p=0.03). Conclusions: A tailored approach deploying ascending aorta replacement with or without root-sparing in TAAAD prompted to useful outcomes without compromising durability.
Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis
Authors: Chin-Yen Lin, Debra Moser, Jia Rong Wu, Terry Lennie, JungHee Kang, Misook L Chung
Journal: Circulation (2023)

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships. Purpose: To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups. Methods: In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro. Results: Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]). Conclusion: Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.
Abstract 12827: Daylight Savings Time Practice and the Rate of Adverse Cardiovascular Events in the United States: A Probabilistic Assessment in a Large Nationwide Study
Authors: Ozan Dikilitas, Benjamin A Satterfield, Holly Van Houten, Xiaoxi Yao, Bernard J Gersh
Journal: Circulation (2023)

Introduction: Previous studies have shown inconsistent changes in the rates of adverse cardiovascular events after daylight savings time (DST) transitions. In this large-scale, U.S.-based nationwide study, we sought to investigate the association of DST transitions with the rates of adverse cardiovascular events. Methods: The study cohort included 36,116,951 unique individuals from de-identified administrative claims data of the OptumLabs Data Warehouse®. There were 74,722 total adverse cardiovascular events during the week of DST transition and the control weeks (two weeks prior and after) in spring and autumn of 2015-2019. We used Bayesian hierarchical Poisson regression models to estimate the event rate ratios (ERR) representing the ratio of composite adverse cardiovascular event rates (acute myocardial infarction, stroke, cardiogenic shock, cardiac arrest, and sudden death) between DST transition weeks and control weeks. Results: Our results showed an average increase of 3% [95% uncertainty interval; -3% to 10%] and 4% [-2% to 12%] in the rate of adverse cardiovascular events during Monday and Friday of the spring DST transition week, respectively. The probability of spring DST transition being associated with a moderate-to-large increase in the event rates (ERR&gt;1.10) was estimated to be &lt;6% for Monday and Friday, and &lt;1% for the remaining days. During autumn DST transition, the probability of any decrease in adverse cardiovascular event rates was estimated to be &lt;46% and a moderate-to-large decrease in the event rates to be &lt;4% across all days of the week. Conclusions: Spring DST transition week had a suggestive association with a minor increase in adverse cardiovascular event rates on Monday and Friday. The probability of this association to be of clinically meaningful magnitude was estimated to be very low. We did not observe any evidence suggestive of a change in adverse cardiovascular event rates immediately following autumn DST transition. Taken together, our findings, based on a large, diverse cohort from across the United States, suggest that DST transitions are unlikely to significantly impact the rate of cardiovascular events.
Abstract 18210: Renal Denervation in Management of Heart Failure: A Systematic Review and Meta-Analysis
Authors: Steven L Mai, muhammad mushtaq, Chandani Patel, Peter Rasmussen, Alexander Dang, Jeremy C Tomcho, Wissam Khalife
Journal: Circulation (2023)

Introduction: Renal denervation (RDN) is a novel intervention targeting sympathetic nerves along the renal artery. Ablation of this neurohormonal pathway alters the pathophysiology of heart failure (HF) and can lead to improvements in clinical outcomes. We conducted a systematic review and meta-analysis to review the outcome of heart failure patients undergoing RDN. Methods: We performed a comprehensive search on PubMed, Cochrane, and Embase from inceptions through June 2023 using the string “(“renal denervation” OR “renal sympathetic denervation “) AND (“heart failure” OR “congestive heart failure”)”. Exclusion criteria include non-human trials, studies without a baseline and control, and studies without outcomes of interest. We collected the number of patients with HF and the resulting outcomes. Outcomes of interest include left ventricular ejection fraction (LVEF), six minute walk distance (SMWD), NT- proBNP, and systolic and diastolic pressures. The random-effects model was used to calculate the odds ratios (OR), mean differences (MD), and confidence intervals (CI). A p value &lt;0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Nine randomized control trials involving a total of 513 patients were included in our analysis. We found a significant difference when comparing the RDN group to the control groups for LVEF (MD 1.39, 95% CI [0.03,2.75]), SMWD (MD 200.13 m, 95% CI [187.32,212.95]), NT-proBNP (MD -397.16 pg/ml, 95% CI [-438.90, -355.42]), SBP (MD -3.69 mmHg, 95% CI [-7.24, -0.14]) within 12 months. Interestingly, difference in DBP was insignificant (MD -1.13 mmHg, 95% CI [-3.33,1.07]). Our RDN group had a significant decrease in hospital admissions (OR 0.83, 95% CI [0.25,2.77]) for HF exacerbation within 12 month following denervation. When comparing RND to baseline, we found a significant difference in LVEF (MD 1.90, 95% CI [0.64,3.16]) and SMWD (MD 106.56 m, 95% CI [88.72,124.40]). Conclusions: Our analysis demonstrates RDN results in a significant difference in LVEF, SMWD, NT-proBNP, and SBP in patients with HF when compared to control and baseline. However, further research is needed with larger samples to establish the safety and effectiveness of RDN as a viable therapy in HF.
Abstract 15130: Sweat Lactate Sensor for Detecting Anaerobic Threshold in Paitents With Heart Failure: Prospective Clinical Trial (LacS-001)
Authors: Yumiko Kawakubo Ichihara, Kouki Yamaoka, Toshinobu Ryuzaki, Hidehiko Ikura, Daisuke Nakashima, Yasuyuki Shiraishi, Masaki Ieda, Katsumata Yoshinori
Journal: Circulation (2023)

Background: Exercise is essential for good health and prevention of exacerbations in patients with heart failure (HF). To determine ventilatory threshold (VT); a key to detect appropriate exercise intensity, our team developed a small, easy-to-use device for non-invasive, simple, and real-time visualization of sweat lactate dynamics during exercise. Clinical Question: Could our sweat lactate sensor (GI-1) provide a safe and accurate means of detecting VT in patients with HF in a clinical setting? Aim: This prospective clinical trial (clinical trial; jRCT2032220057) was designed to investigate the safety of a sweat lactate sensor (GI-1) and the correlation between the lactate threshold in sweat (sLT), as assessed using our sweat lactate sensor, and the VT. Methods: We recruited 50 patients with HF and New York Heart Association functional classification I-II, with a median age of 63.5 years (interquartile range: 58.0-72.0 years). Incremental exercise tests were conducted and changes in sweat lactate levels were monitored simultaneously. The sLT was defined as the first steep increase in lactate levels from baseline as seen on graphical plots and was evaluated by three independent investigators. The primary outcome measures were a correlation coefficient of 0.6 or greater between sLT and VT, the similarities as assessed by the Bland-Altman analysis, and the standard deviation of the difference between the two within 15 W. Results: Among the 50 patients, a correlation coefficient of 0.651 (95% confidence interval, 0.391-0.815) was achieved in 32 cases. The difference between the sLT and VT was -4.9±15.0 W, and no comparative error was noted in the Bland-Altman plot. No device-related adverse events were reported among the registered patients. Conclusions: Our sweat lactate sensor, GL-1, provides a safe and accurate means of detecting VT in patients with HF in a clinical setting, thereby offering valuable additional information for treatment.
Abstract 13211: Racial Disparities in the Association Between Early Repolarization Pattern and Cardiovascular Mortality
Authors: Simrat Dhaliwal, Mohammed AlSadawi, Faisal Aslam, Paul Kim, Chad Gier, Matthew Henriques, Noelle Mann
Journal: Circulation (2023)

Introduction: The early repolarization (ER) ECG pattern has been associated with increased cardiovascular (CV) mortality, but it is unclear if there are racial differences in risk. Objectives: To evaluate racial differences in East Asian and Caucasian decent and the prognostic significance of ER. Methods: A literature search was conducted for studies reporting the association between ER and CV mortality endpoints. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow up duration was one year. Analysis was performed using odd ratios (OR). Results: A total of 16 studies and 189,422 participants (16,307 with ER vs 173,115 without ER) were included; mean follow-up was one year. ER was associated with increased CV mortality (OR 1.68, 95% CI 1.28-2.20; P&lt;0.01). East Asian patients with ER had higher CV mortality compared to Caucasians (OR 3.94, 95% CI 2.2-7.04 vs. OR 1.32, 95% CI 1.03-1.70; P&lt;0.01). (Figure 1-3) Conclusions: ER pattern is associated with increased CV mortality, particularly in East Asian patients.
Abstract 12703: Hydroxychloroquine Induced Cardiomyopathy: A Case Report and Suggestions for Screening
Authors: Izhan Hamza, Rama Ellauzi, Hamza Malik, Mahammed Mushtaq, Zaid Safdar
Journal: Circulation (2023)

Introduction: Hydroxychloroquine (HCQ) is a commonly used drug for autoimmune diseases. However, it can in rare instances result in life-threatening cardiac consequences. We present a case of HCQ-induced cardiomyopathy in a 61-year-old female. Case presentation: A 61-year-old female with a 15-year history of SLE (Systemic Lupus Erythematosus) presented with new onset heart failure and atrial fibrillation. The patient reported slowly progressive dyspnea on exertion for the last 6 months with worsening bilateral lower extremity swelling. A TTE revealed a moderately dilated left ventricle with an ejection fraction of 20%, with biatrial enlargement. An admission EKG showed new-onset atrial fibrillation. Subsequently, left and right heart catheterization showed normal coronaries, elevated filling pressures with equalization of the wedge, and right atrial pressure suggestive of a restrictive etiology. cMRI was deferred as the patient had multiple abdominal pellets from a prior gunshot wound. An endomyocardial biopsy was obtained which revealed myocardial vacuolization and lipofuscin deposition consistent with HCQ-induced cardiomyopathy. HCQ was discontinued and the patient was discharged on Guideline-directed medical therapy with repeat TTE showing an improved ejection fraction of 40% without the persistence of any symptoms. Discussion: Myocardial toxicity associated with HCQ remains a difficult diagnosis, particularly due to the multiplicity of clinical presentations, echocardiographic and EKG features. The onset of cardiomyopathy in these patients is seen after exposure to a high cumulative dose. Presently there are no guidelines regarding the need for cardiac surveillance in patients using HCQ, unlike the need for Ophthalmic exams. Therefore, it is paramount that patients exposed to high cumulative doses of HCQ be screened in a cost-effective way. Especially since a delayed diagnosis is associated with a poorer prognosis.
Abstract 407: The Efficacy and Frequency of Early Left Heart Catheterization After Out of Hospital Cardiac Arrest Over That Last Decade
Authors: Shobi Mathew, Robert Welch, Robert Swor, Robert Ehrman, Anthony Lagina, Brian J O'Neil
Journal: Circulation (2023)

Background: The efficacy of early coronary intervention after return of spontaneous circulation (ROSC) from out of hospital cardiac arrest, (OHCA) is debated. A recent review of the Wayne County, (Mi) CARES dataset from 2014-18 noted that early LHC maintained the strongest correlation to survival to discharge with good neurological outcome, for all-cause OHCA. Though the overall rate of LHC remained relatively stable, there was a sizable reduction in early LHC and a comparable increase in late LHC in those with CPC 1 and 2 at discharge [ 12 ] Our objective is to utilize the national CARES data to analyze the effect of early LHC on survival with good neurological outcome and to describe the frequency and timing of LHC in OHCA. Methods: This observational study included patients enrolled in the national CARES registry from 2013-21. For the outcome of LHC by year, chi square analysis was performed. Outcome was cerebral performance category, (CPC) (good &lt;3 vs. poor &gt; 3) at hospital discharge. A propensity score (PS) model was constructed using variables predictive of LHC and good outcome to determine probability of LHC. The PS was then used in an inverse weighted random effects logistic regression model to determine the independent effect of early LHC on outcome. Results: 132,758 individual cases were identified. Median age was 60.3 years (s.d. 16.6), 61.8% were male. Early coronary angiography was performed in 26,999 (20.3%) patients. Patients who underwent early angiography often had shockable rhythms (78.% vs 34%), suffered the OHCA in a public location (36.9% vs 26.1%%), and were witnessed cardiac arrests (80% vs 48%). For the full model the odds ratio for a good outcome after early LHC was 2.54 (95% CI 2.36 - 2.73). Only initial shockable rhythm was more predictive of a good outcome with an OR of 3.9. The proportion undergoing early catheterization declined from 27.6 % to 17.3% from 2013 to 2021; p &lt; 0.0001), though the overall catheterization rate remained the same. Conclusion: In patients with OHCA, early left heart catheterization retains a strong association with good neurological outcome at hospital discharge. The use of early left heart catheterization has declined significantly over the last 9 years.