tbuckley/cabot-search huggingface dataset:
Abstract 4141252: Transcatheter versus Surgical Tricuspid Repair among Medicare Beneficiaries: One-Year Results
Authors: Tomonari Shimoda, Hiroki Ueyama, Yoshihisa Miyamoto, Atsuyuki Watanabe, Hiroshi Gotanda, Yusuke Tsugawa, Toshiki Kuno
Journal: Circulation (2024)

Background: Mid-term comparative evidence on transcatheter versus surgical tricuspid valve repair is limited at the national level. Objective: We aimed to evaluate the in-hospital and 1-year outcomes of transcatheter edge-to-edge repair (TV-TEER) versus surgical repair among Medicare beneficiaries. Methods: We analyzed the national data on Medicare beneficiaries aged ≥65 who underwent TV-TEER or isolated surgical tricuspid repair between January 2016 and December 2021. The outcomes of interest included in-hospital mortality, permanent pacemaker implantation rates, and 1-year all-cause mortality and major adverse cardiovascular events (MACE). MACE comprised all-cause mortality, heart failure hospitalization, stroke, and tricuspid reinterventions. We computed propensity scores for undergoing TV-TEER or surgical repair and a matching weight analysis was conducted to compare the two groups. Results: A total of 2,257 patients were included (TV-TEER= 1,063 patients, surgical repair = 1,194 patients). The annual volume of TV-TEER cases increased from 20 in 2016 to 307 in 2021 while the annual volume of surgical cases decreased from 233 cases to 156 cases (Figure A). In the unadjusted cohort, TV-TEER was associated with lower in-hospital and 1-year mortality rates (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.70-0.99; P=0.03). Adjusted in-hospital mortality was also significantly lower in the TV-TEER group compared to the surgical repair group (2.2% vs. 14.2%, P&lt;0.001). Additionally, TV-TEER was associated with lower 1-year all-cause mortality compared to surgical repair (adjusted HR, 0.75; 95% CI, 0.61-0.92; P=0.007) (Figure B). MACE was also lower in the TV-TEER group at 1 year (adjusted HR, 0.73; 95% CI, 0.60-0.88; P&lt;0.001). TV-TEER also resulted in fewer post-treatment permanent pacemaker implantations (0.5% vs. 14.0%, P&lt;0.001) after adjustment. Conclusions: Among Medicare beneficiaries undergoing TV-TEER or surgical repair, TV-TEER was associated with more favorable in-hospital and 1-year outcomes compared to surgical repair. While a rapid increase in TV-TEER cases was observed, further validation of mid-term outcomes is essential to ensure proper patient selection.
Abstract 4140882: Peak Stroke Incidence Following Left Atrial Appendage Closure
Authors: Chayce Weaver
Journal: Circulation (2024)

Introduction: Atrial fibrillation (A fib) is the most common arrhythmia affecting 1-2% of the general population. A fib is a well-established risk factor for ischemic strokes. In patients with nonvalvular A fib, the majority of embolic strokes are caused by thrombi development in the left atrial appendage. Systemic anticoagulation (AC) is effective in reducing stroke risk in patients with A fib. However, bleeding complications and medication nonadherence are barriers to effective AC. In these patients, left atrial appendage occlusion (LAAO) act as a form of nonpharmacologic treatment. Methods: We completed a retrospective descriptive study evaluating patients with a fib undergoing either open left atrial appendage closure or percutaneous occlusion. Patients were selected from the HCA database (Jan 2021-Jul 2023). ICD 10 codes were used to identify patients with documented a fib. Procedure ICD codes were used to identify patients that underwent percutaneous LAAO. Patients with documented STEMI, left ventricular thrombus, mechanical mitral or aortic valve replacement were excluded. 5,661 underwent percutaneous closure. Stroke readmissions were evaluated at 45, 90, and 180 days. Chi-square was used to evaluate for statistically significant differences. Results: Of the 5,661 patients 40 developed a stroke within 45 days, 38 within 90 days, and 26 within 180 days (P=.19) The average patient age was 76.1 years with STD 7.86. There were 2438 females and 3223 males. Discussion: Stroke occurrence was similar by day 90 as day 45. There was no statistical difference in stroke by day 180; however, the trend suggests a larger drop off in stroke readmission rates after day 90. Perhaps with a larger study, a significant effect may be detected. Currently AC is only recommended for 60 days post procedure. With clinical significance, future studies may be warranted to evaluate bleeding incidence during post procedure AC and the utility of extending therapy to 90 days.
Abstract 4141241: Pulmonary dynamic hyperinflation augments pulmonary capillary wedge pressure during exercise in patients with heart failure with preserved ejection fraction
Authors: Michael Leahy, James MacNamara, Tiffany Brazile, Denis Wakeham, Mitchel Samels, Christopher Hearon, Andrew Tomlinson, Bryce Balmain, Tony Babb, Benjamin Levine, Satyam Sarma
Journal: Circulation (2024)

Introduction: Adults with heart failure with preserved ejection fraction (HFpEF) have an exaggerated rise in pulmonary capillary wedge pressure (PCWP) with exercise. Pulmonary function in patients with HFpEF is often flow limited, thereby perpetuating dynamic hyperinflation (DH) and breathing at a mechanically unfavorable percentage of total lung volume. We therefore sought to characterize the impact of DH on PCWP in adults with HFpEF during exercise. Methods: Twenty-seven patients with HFpEF were evaluated (Age: 70 ± 7 years, Female: 70 %, BMI: 38.1±6.3 kg/m 2 ). PCWP and central venous pressure (CVP, right heart catheterization), oxygen uptake (breath by breath), cardiac output (direct Fick), and ventilation were measured upright at rest, 20 W, and peak exercise (73 ± 27 W) on a semi-recumbent cycle ergometer. End-expiratory lung volume was determined by having patients complete inspiratory capacity maneuvers during rest and exercise. DH was defined as an increase in end-expiratory lung volume of &gt;150ml from rest. Results: End-expiratory PCWP was greater in patients with DH at 20 W (DH: 24 ± 6 mmHg vs. Normal: 18 ± 6, p=0.033) and peak exercise (DH: 44 ± 9 vs. Normal: 31 ± 6 mmHg, Panel A, p=0.002). The effect of DH occurred despite similar change in stroke volume (DH: 29 ± 15 vs. Normal: 37 ± 11 mL, p=0.164) and cardiac output (DH: 10.4 ± 1.7 vs. Normal: 11.1 ± 2.7 L/min, p=0.420) at peak exercise; however, BMI was greater in patients with DH (40.1 ± 6.0 vs. 34.4 ± 5.4 kg/m 2 , p=0.020). The degree of dynamic inflation was significantly associated with end-expiratory PCWP during exercise (slope= 0.531, R 2 = 0.281, p= 0.005, Panel B). Conclusion: Patients with HFpEF who dynamically hyperinflate during exercise have greater PCWP than those who do not. DH was associated with obesity and the severity of hyperinflation scaled proportionally to higher exercise PCWP. These findings indicate the augmented exercise PCWP in patients with HFpEF may not be entirely attributed to ventricular stiffness, but also a consequence of increased intrathoracic pressure from dysfunctional ventilatory mechanics.
Abstract 4140936: Global, Regional, and National Trends in Atrial Fibrillation/Flutter Among Overweight and Obese Individuals: A Comparative Analysis of Gender, Age, and Risk Factors (1990-2019)
Authors: Yichao Xiao, Yujie Kang, Zehao Lan, Zhaohua Lv, Qiming Liu, Shenghua Zhou
Journal: Circulation (2024)

Background: Atrial fibrillation/flutter (AF/AFL) significantly contributes to global cardiac morbidity and mortality. Understanding its epidemiological trends is crucial for devising effective health interventions. Objective: This study aimed to elucidate the global burden of AF/AFL among overweight and obese individuals from 1990 to 2019, exploring variations in mortality, disability-adjusted life years (DALYs), and risk factor prevalence across 204 countries, as per the Global Burden of Disease Study 2019 (GBD 2019). Methods: Utilizing GBD 2019 data, this observational study assessed age-standardized mortality and DALY rates for AF/AFL. The analysis emphasized demographic variations (age, sex), socioeconomic disparities (as indexed by the sociodemographic index, SDI), and major modifiable risk factors such as hypertension, obesity, and lifestyle choices. Results: This study revealed a significant global increase in AF/AFL-related mortality, exceeding 63,000 deaths in 2019—an increase of 2.42% since 1990. DALYs exhibited a parallel upward trajectory. Notably, the AF/AFL burden increase was more pronounced in regions with lower SDIs, indicating marked health outcome disparities. A high body mass index (BMI) was identified as a predominant modifiable risk factor, highlighting the increasing impact of lifestyle-related health challenges. Moreover, mortality rate disparities were evident across different sex and age groups, with the highest rates among women and individuals aged 85-89 years. Conclusion: The increasing global burden of AF/AFL, especially associated with higher BMI, necessitates immediate public health interventions. These findings underscore the urgency for targeted preventive strategies focusing on lifestyle modifications and enhanced healthcare access, particularly in lower-SDI regions and among vulnerable populations.
Abstract 4140698: <u>CA</u> SE <u>M</u> ANAGERS AND <u>P</u> EER <u>S</u> UPPORT GROUPS (CAMPS) FOR PROPHYLAXIS ADHERENCE IN RHEUMATIC HEART DISEASE
Authors: Sarah De Loizaga, Jafesi Pulle, Atanas Okumu, Juliet Alepere, Jane-Liz Nambogo, Emma Ndagire, Gloria Kaudha, Nicholas Ollberding, Emmy Okello, Joselyn Rwebembera, Andrea Beaton
Journal: Circulation (2024)

Background: Secondary antibiotic prophylaxis (SAP) is the only intervention known to prevent rheumatic heart disease (RHD) progression, but non-adherence to SAP undermines most global RHD programs. RESEARCH QUESTION: We sought to determine whether enhanced SAP support administered through the public health system was feasible and a scalable model. AIMS: Determine the difference in 1-year SAP adherence rates of children with RHD in Uganda randomized to either Usual Care or Enhanced Support. Explore differences in patient-reported outcomes including treatment satisfaction and health-related quality of life (HRQoL). Methods: We conducted a pragmatic randomized trial of two support strategies for SAP integrated into routine care in Eastern Uganda. Children ages 5 to 17 years with RHD were randomized to either Usual Care or Enhanced Support . Outcome measures at the end of 12 months included SAP adherence, health related quality of life, and treatment satisfaction. See Figure 1. Results: In total, 208 participants were included in the analysis (103 from Usual Care and 105 from Enhanced Support) from 11 participating health centers. Mean age between the groups was the same (13.2 years), with 62.1% and 54.3% female participants in Usual Care and Enhanced Support, respectively. Most participants had only mild disease, with only 11.7% in Usual Care and 8.6% in Enhanced Support having moderate/severe disease. Mean WAMI scores between the two groups were the same, 0.49. After 12 months, mean adherence was 80.0% for those receiving Usual Care, compared to 98.2% for those receiving Enhanced Support (estimated mean difference 18.2% days of coverage; 95% CI 14.4; 22.1, p&lt;0.001). Treatment satisfaction and HRQoL scores were not statistically significantly different between the groups. Conclusion: Although further research is needed to understand the minimum elements needed to achieve ideal SAP adherence and to understand implementation and dissemination at scale, the integration of community health workers into RHD supports may provide an effective and scalable model to improve outcomes for children with RHD in low-resource settings.
Abstract 4141580: Prognostic value of blood cellular indices for 30-day mortality in patients with acute pulmonary embolism. Study from the RIETE Registry.
Authors: Fakiha Siddiqui, Alfonso Tafur, Bulent Kantarcioglu, Alberto García-Ortega, Maurizio Maria CIAMMAICHELLA, Pablo Javier MARCHENA, Olga Gavin, Adriana MUNERA, Jawed Fareed, Manuel Monreal, RIETE Group
Journal: Circulation (2024)

Introduction: Diagnostic and prognostic value of blood cellular indices (CI) has been reported to predict the adverse outcome in various diseases including pulmonary embolism (PE). We have recently reported neutrophil to lymphocyte ratio (NLR) as the best predictive marker for short-term mortality in acute PE patients compared to platetet to lymphocyte ratio (PLR) and systemic immune inflammation index (SII). This study was designed to compare the prognostic value of NLR with other cellular indices such as neutrophil to monocyte ratio (NMR) and monocyte to lymphocyte ratio (MLR) predicting 30-day mortality outcome in patients with acute PE. Methods: This study include 5084 patients from the RIETE Registry to evaluate the association between NLR, NMR and MLR with the 30-day mortality in PE patients. Receiver operating curve (ROC) analysis was used to define the optimal cutoff values for the ratio’s. Degree of association were analyzed by univariate chi-square and multivariate logistic regression model with all the clinically relevant variables , however, to avoid multicollinearity, ratios were modeled separately. Result: In the cohort of 5084 patients, 49 % were male and 51% were female with the median age 71-years. Thirty-day mortality rate was 4.5%. Following ROC analysis, NLR &gt;7.0, NMR &gt;11.0 and MLR &gt;0.5 were considered as the optimal cutoff for 30-day mortality. Degree of association between cellular indices and 30-day mortality were presented in table 1, elevated level of NLR, NMR, and MLR at baseline were associated with risk of death at 30-day. In both the adjusted (with clinically relevant variables) and unadjusted model, patients with elevated NLR &gt;7.0 showed the finest association with mortality compared to NMR and MLR (figure 1). Conclusion: Blood cellular indices is considered as a reliable and measurable prognostic marker for 30-day mortality in PE patients, however, elevated NLR at baseline supercede NMR and MLR. Further studies are obligatory to investigate the potential mechanisms by which the NLR, NMR, and MLR relates with PE outcomes to improve patient management.
Abstract 4141571: Association of Ambient Air Pollution with Pulmonary Hemodynamics and Long-term Survival in Patients with Pulmonary Arterial Hypertension: A Multi-center Cohort Study in China
Authors: sicheng zhang, Luyang Gao, Sicong Li, Manqing Luo, Qunying Xi, Ping Lin, Zhihui Zhao, qing zhao, Tao Yang, Qixian Zeng, Zhihua Huang, Xin Li, Anqi Duan, Yijia Wang, Qin Luo, Yan-Song Guo, Zhihong Liu
Journal: Circulation (2024)

Background: Although ambient air pollution exposure has been linked with increased mortality in many cardiovascular or pulmonary diseases, its relationship with pulmonary arterial hypertension (PAH) is still unknown. The present study aims to investigate the association of ambient particulate matter (PM) exposure with pulmonary hemodynamics and long-term survival in patients with PAH in China. Methods: This retrospective multi-center cohort study included 1511 participants who underwent invasive right heart catheterization and were eventually diagnosed with PAH from January 2014 to December 2020. The primary outcome was transplant-free survival from the time of diagnosis. The association of PM 2.5 and PM 10 with all-cause death or lung transplantation was assessed by fitting Cox proportional risk models. Generalized linear models were used to examine the relationship between PM exposure and pulmonary hemodynamic severity at baseline. Restricted cubic splines were used to describe exposure-response curves. Mediation analysis with bootstrap method was used to explore whether potential variables mediated the associations. Results: During a median follow-up of 36.7 months, all-cause death or lung transplantation occurred in 149 patients. Per 10 µg/m 3 increase of PM 2.5 and PM 10 were associated with 14.5% and 7.9% increased risk of primary outcomes adjusting for potential confounding variables, respectively. PM 2.5 and PM 10 were associated with European Society of Cardiology risk stratification and with pulmonary hemodynamics at baseline, in particular pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), cardiac index, and mixed venous oxygen saturation (S V O 2 ). Effect of PM may be mediated in part by impaired glucolipid metabolism and inflammation-associated lymphocyte. Conclusions: Particulate matter exposure was associated with disease severity and pulmonary hemodynamics at baseline in patients with PAH, and higher chronic exposure to PM 2.5 and PM 10 independently predicted shorter transplant-free survival.
Abstract 4141380: The relationships between circulating biomarkers of iron deficiency and outcomes in patients with heart failure and reduced ejection fraction: insights from DAPA-HF.
Authors: Kieran Docherty, Alice Brennan, Shivasankar Sukumar, Paul Welsh, Piotr Ponikowski, Mark Petrie, John Cleland, Scott Solomon, Pardeep Jhund, John McMurray
Journal: Circulation (2024)

Background: In patients with HFrEF, the guideline definition of iron deficiency (ID) uses both ferritin and transferrin saturation (TSAT) levels. However, observational studies and subgroup analyses of randomized controlled trials show that TSAT alone, or alternative biomarkers of ID, may better predict mortality and response to intravenous (iv) iron. Goal: Examine the relationships between circulating biomarkers and alternative ID definitions and outcomes in patients with HFrEF in DAPA-HF. Methods: Key inclusion criteria were: 1) NYHA class II-IV, 2) LVEF ≤40%, 3) elevated plasma NT-proBNP and 4) eGFR ≥30 ml/min/1.73m 2 . The primary outcome was a composite of a worsening HF event (HF hospitalization or an urgent HF visit requiring iv therapy) or cardiovascular death. Iron biomarkers were measured before randomization. The current guideline-recommended definition of ID is ferritin &lt;100ng/mL or TSAT &lt;20% and ferritin 100–299ng/mL. Alternative definitions examined were: iron ≤13umol/L, TSAT&lt;20% (regardless of ferritin), and serum transferrin receptor (sTFR) &gt;4.70mg/L (males) and &gt;4.59mg/L (females). Results: Of the 4744 patients randomized, 2840 (60%) had ferritin, TSAT, iron and sTFR measured at baseline. Of these, 1228 (43%) had guideline-defined ID (374 [30%] based on ferritin &lt;100ng/mL alone); 857 (70%) had ferritin &lt;100ng/mL, 854 (70%) TSAT &lt;20%, 853 (69%) iron ≤13umol/L, and 312 (25%) elevated sTFR. The lowest event rates were in iron replete patients with TSAT ≥20% and ferritin ≥100ng/mL (primary outcome=10.1/100 person-years [PY]) - Table. Event rates in iron replete patients with TSAT &lt;20% and ferritin ≥300ng/mL were higher (17.5/100PY) and comparable to guideline-defined ID with TSAT &lt;20% (19.3/100PY). Event rates were intermediary in guideline-defined ID patients with TSAT ≥20% and ferritin &lt;100ng/mL (12.5/100 PY). The risk of the primary composite outcome per log-unit increase was: ferritin=HR 0.88, 95%CI 0.80-0.97; TSAT=0.75, 0.65-0.88; iron=0.79, 0.64-0.97 (and per log-unit decrease in sTFR=0.61, 0.48-0.76). Conclusion: Low transferrin saturation is a predictor of adverse outcomes in HFrEF, irrespective of ferritin level.
Abstract 4140902: Association Between the Severity of Coronary Artery Stenosis with the Minimum Responsive Dose of Intracoronary Ergonovine Provocation Test
Authors: Seung-Woon Rha, Woo Jin Ahn, sujin hyun, Jinah Cha, Se Yeon Choi, Byoung Geol Choi, Markz Sinurat, Soohyung Park, Cheol Ung Choi, Chang Gyu Park, Dong Oh
Journal: Circulation (2024)

BACKGROUND: Coronary artery spasm (CAS) is a cause of variant angina and is typically diagnosed by intracoronary provocation test. Investigations regarding association between the burden of coronary artery stenosis and the minimum responsive dose of ergonovine (ERG) required for provocation is limited. METHODS: In this study, 356 patients who underwent the ergonovine (ERG) provocation test and showed CAS between October 2004 and December 2022 were enrolled. Significant CAS was defined as temporary narrowing of ≥70% during the ERG test. Patients were divided into three groups, based on the minimum responsive dose of ERG: E1 group (20ug, n=13), E2 group (40ug, n=53) and E3 group (80ug, n=290). RESULTS: In patients who were documented with positive intracoronary ERG provocation test, 3.7% responded at the lowest dose (20ug), 14.9% responded at the medium dose (40ug) and 81.5% responded only at the highest dose of ERG (80ug). The baseline characteristics of the patients among the 3 groups were similar, demonstrating no significant difference in the prevalence of hypertension, diabetes mellitus, and dyslipidemia. However, patients who responded at E2 dose showed higher proportion of smokers than E3 dose (E2 34.0% vs. E3 25.9%, p=0.043). E1 group demonstrated the highest proportion of severe stenosis (92.3%), followed by E2 group (90.6%) and E3 group (71.4%) (Figure 1). In addition, incidence of focal CAS and multi-vessel CAS were higher among those who responded to lower doses (focal CAS: 23.1% vs. 20.8% vs. 10.0%; multi-vessel CAS: 61.5% vs.50.9% vs. 36.6%). CONCLUSION: In patients with chest pain with positive intracoronary ERG provocation test, higher burden of stenotic lesions was found to be more frequent and more susceptible in patients who responded at lower doses of ERG.
Abstract 4141212: Cardiovascular And Obstetrical Outcomes In Women With Premature Coronary Artery Disease
Authors: Meryem MIKOU, Niki PROCOPI, Pierre CHARLEUX, Ghilas Rahoual, Mathieu Kerneis, Johanne Silvain, Lise Legrand, Jacky Nizard, Gilles Montalescot, Michel Zeitouni
Journal: Circulation (2024)

Background: Premature coronary artery disease (CAD) is increasing, especially in young women. There is currently no data regarding the cardiovascular and obstetrical risk of pregnancy in patients with premature CAD. Objective: This study aims to describe the cardiovascular, obstetrical and fetal outcomes in pregnant patients with premature CAD. Methods: Using the AFIJI cohort of individuals with premature CAD (Appraisal of risk Factors in young Ischemic patients Justifying aggressive Intervention), we compared the cardiovascular outcomes of women aged &lt; 40 years-old who experienced pregnancy versus those who did not. Major adverse cardiovascular events (MACE) including death, myocardial infarction, ischemic stroke, or unplanned revascularization were analyzed using a Cox model with pregnancy as a time-dependent variable. A secondary analysis described obstetrical and fetal outcomes in pregnant women with premature CAD vs. pregnant women of the French National maternal and fetal cohort (n=11992). Results: Among women with premature CAD in the AFIJI cohort (N = 120), 50 were aged &lt; 40 years among whom 24 experienced pregnancy. Aspirin was the only treatment continued during pregnancy. We observed an association between pregnancy and an increased risk of cardiovascular events (aHR 3.87, IC95% 1.41-10.63, p &lt; 0.01) adjusted for age and tobacco use. When comparing with the French National database, pregnant women with premature CAD had higher rates of preeclampsia (20.8% vs. 2.3%), pregnancy-induced hypertension (37.5% vs. 2%), threat of premature birth (20.8% vs. 4.8%), postpartum hemorrhage (12.5% vs. 3%) and fetal death (8.7% vs. 0.8%). Conclusion: Pregnancy in women with premature coronary artery disease is associated with a higher risk of major adverse cardiovascular events and significant more obstetrical complications. These findings highlight the need for careful monitoring and management of pregnant patients with a prior history of CAD to mitigate these risks.