tbuckley/cabot-search huggingface dataset:
Abstract 4137107: The Impact of Race in the Evaluation Process for Advanced Heart Failure Therapies
Authors: Dalton Sherwood, Khoula Saleem, Courtney Wills, Mirnela Byku, Randall Watkins, Quefeng Li, Patricia Chang
Journal: Circulation (2024)

Introduction: Racial and socioeconomic disparities in heart failure therapy and heart transplantation have been well described. Potential racial disparities during the evaluation process for advanced heart failure (AHF) therapies is not well understood. We examined whether there were differences by race in the evaluation process for heart transplantation or left ventricular assist device (LVAD) implantation. Methods: Adult patients who underwent heart transplant or LVAD evaluation between May 1, 2014 – Dec 31, 2022 at the University of North Carolina Medical Center were included. Logistic regression models assessed whether approval for heart transplant listing or LVAD implantation differed by race. The multivariate model adjusted for demographic and clinical characteristics, LVEF, RV function, and substance use. Secondary outcomes assessed included the time between critical points in the evaluation process: first clinical encounter with an AHF specialist, evaluation initiation, and final decision. Results: The study cohort included 611 patients (304 non-Hispanic Black patients, 307 non-Hispanic White patients). Black patients were younger than White patients (52.4 vs. 60.7 years), less male-predominant (65.5% vs. 81.4%), with less ischemic cardiomyopathy (16.8% vs. 58.3%, all p&lt;0.05). There was no significant difference in approval for advanced therapies between Black and White patients (unadjusted OR [95% CI]: 1.24 [0.90-1.72]; adjusted OR 0.98 [0.64-1.48]). Male sex was associated with a higher likelihood of approval for AHF therapies (adjusted OR 1.55 [1.02-2.36]). Age (OR 0.98 [0.96-0.99]) and creatinine (OR 0.66 [0.53-0.82]) were associated with a lower likelihood of approval for AHF therapies. Black patients had a significantly longer time interval from the first AHF specialist encounter to the initiation of evaluation for AHF therapies (median 45.5 vs. 14 days, p &lt;0.01), and from the initiation of the evaluation process to the final decision (25.5 vs. 14 days, p &lt;0.01). Conclusions: Male patients had a greater approval rate for advanced heart failure therapies. Black and white patients did not have significantly different approval rates for LVAD implantation or listing for heart transplantation. However, the evaluation process was longer for black patients. Further work is needed to investigate which factors contribute to these racial and sex differences in the evaluation and approval process for advanced heart failure therapies.
Abstract 4137009: Treating Elderly Cardiogenic Shock Patients with a Microaxial Flow Pump; Is It DANGERous?
Authors: Anika Klein, Rasmus Beske, Christian Hassager, Lisette Okkels Jensen, Hans Eiskjaer, Norman Mangner, Amin Polzin, Christian Schulze, Carsten Skurk, Peter Nordbeck, Peter Clemmensen, Vasileios Panoulas, Sebastian Zimmer, Andreas Schaefer, Thomas Engstrom, Lene Holmvang, Anders Junker, henrik Schmidt, Christian Terkelsen, Jacob Moller
Journal: Circulation (2024)

Background: The Danish German Cardiogenic Shock trial (DanGer Shock) recently showed a reduction in all-cause mortality when treating selected patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock with a microaxial flow pump (mAFP). Whether there is an age-related differential survival benefit is unknown. Objective: To assess the influence of age on 180-day all-cause mortality in patients with STEMI and cardiogenic shock randomized in DanGer Shock. Methods: In DanGer Shock (an open-label, international, multicenter trial), 355 adult patients (aged ≥18 years with no upper age limit) with STEMI and cardiogenic shock were included and randomized to a mAFP (Impella CP) plus standard care or standard care alone. Patients were stratified in quartiles according to age, and logistic regression analyses were used to assess mortality according to age quartiles, and to evaluate whether age modified the treatment effect of the mAFP. Results: From lowest to highest quartile, patients’ ages ranged from 31-59, 60-69, 70-76, and 77-92, respectively. There were no differences in blood pressure, lactate level, left ventricular ejection fraction and shock severity across age groups. However, the proportion of females (41%) and the prevalence of hypertension (64%) was higher in patients aged ≥77 years (highest quartile), while more patients aged &lt;60 years (lowest quartile) had been resuscitated before randomization. Mortality increased incrementally from the lowest quartile to the highest (31% vs. 47% vs. 61% vs. 73%, p log-rank &lt;0.001), with an adjusted odds ratio for death at 180 days of 5.50 (95%CI 2.65-11.8, p&lt;0.001) in the highest quartile compared to the lowest. Patients in the three lower quartiles had a lower absolute mortality at 180 days if randomized to the mAFP group, whereas patients in the highest quartile had a higher mortality if randomized to the mAFP group, p=0.028 for interaction, Figure. Conclusion: In patients with STEMI-related cardiogenic shock, the overall mortality increased with advancing age, and treatment benefit of the mAFP appeared to diminish in the eldest patients. (DanGer Shock, NCT01633502)
Abstract 4137145: Aortic Stenosis in Pregnancy: A Multidisciplinary Team Approach
Authors: Alex Caplan, Jordan Jackson, Mohamad kalot, Gregory Yost
Journal: Circulation (2024)

Introduction: The hemodynamic adaptations that occur during pregnancy can have significant effects on patients with aortic stenosis (AS). These changes can lead to structural changes identified on echocardiogram even during uncomplicated pregnancies. While some cases can be managed with medical therapy and activity modification, others may require valve intervention in the gestational period. Case: A 29-year-old female with history of congenital bicuspid aortic valve, G1P0 presented at 42+2 weeks of pregnancy and was admitted to cardiac intensive care unit for continuous hemodynamic monitoring via use of arterial line. Her prior aortic valve disease was treated by valve repair with valvotomy, removal of tissue from pseudo raphe, removal of calcified scar tissue from both commissures, and a mitral valve repair for closure of an iatrogenic tear in her anterior leaflet. She followed closely with maternal fetal medicine and cardiology but became symptomatic at week 28 with lightheadedness, shortness of breath and decreased exercise tolerance (NYHA Class II). By week 33 she noticed lower extremity edema. Despite recommendations for planned delivery, she opted to wait until full term for delivery. Surveillance echoes revealed rising velocities yet stable valve area by planimetry. She ultimately underwent an uncomplicated Cesarean delivery of baby boy in week 42. At 6 months post partum she had successful transcatheter aortic valve replacement. Discussion: As the severity of valvular disease worsens there is a higher risk of complications during pregnancy. In our case, aortic valve velocities were elevated due to the expected hemodynamic changes of pregnancy. Thus, echocardiography monitoring should be used to assess the left ventricle’s ability to tolerate and compensate for these changes, while intervening based on symptoms and NYHA classification. We highlight the importance of multidisciplinary collaboration for safe and successful delivery in patients with AS.
Abstract 4137175: Functional Mitral Regurgitation as a Predictor of Atrial Fibrillation Recurrence Following Catheter Ablation: A Systematic Review and Meta-Analysis
Authors: Lucas Chierici Pereira, Phuuwadith Wattanachayakul, Riley Marotta, Thitiphan Srikulmontri, Andre Carvalho Ferreira, Aman Amanullah
Journal: Circulation (2024)

Background: Recent studies showed that functional mitral valve regurgitation (FMR) was associated with higher long-term mortality in chronic heart failure patients and poorer outcomes in those with atrial fibrillation (AF), including a higher risk of atrial cardiomyopathy. However, the effect of baseline FMR on outcomes post-AF catheter ablation remains unclear due to inconsistent evidence. Methods: We systematically reviewed studies from Medline and EMBASE databases from inception to April 2024. Eligible studies must report the association between baseline FMR and risk of AF recurrence post-AF catheter ablation compared to individuals without FMR. Relative Risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method. Results: Our meta-analysis included 7 cohort studies and found that baseline FMR was associated with a higher risk of AF recurrence compared to those without FMR. The pooled risk ratios (RR) were 1.40 (95% CI 1.11-1.78, I2 = 31%, p = 0.005). No publication bias was identified on the funnel plot. Conclusions: Our pooled analysis found that patients with FMR who underwent AF catheter ablation had a higher risk of AF recurrence compared to those without FMR. Further research is needed to explore the underlying mechanisms and their clinical implications. Keyword: Functional mitral regurgitation, Atrial fibrillation, Catheter ablation, Atrial fibrillation recurrence, Systematic review, Meta-analysis
Abstract 4137144: Return to Cath Lab: Chest Pain Resolution after Right Coronary Artery Chronic Total Occlusion Intervention
Authors: Max Jason, Reid McCallister, Amy Mertens
Journal: Circulation (2024)

Introduction: Subacute stent thrombosis (ST) is related to high rates of cardiac reinfarction. We present a case of reinfarction from ST. The patient’s chest pain (CP) was not alleviated with initial revascularization of his left circumflex (LCx) ST, requiring PCI to his right coronary artery (RCA) chronic total occlusion (CTO). This is a novel approach to CTO PCI which is traditionally a non-urgent procedure. Case: A 53-year-old male with a history of coronary artery disease and surgical turndown presented to the ED with CP. Two weeks prior he had impella guided LM bifurcation PCI with DES and ramus intermedius (RI) angioplasty (PTA) but was nonadherent to clopidogrel. He had a BP of 127/85, HR of 65, and was on room air. Exam was unremarkable. His EKG was in sinus rhythm with S-T depressions ~1mm in leads V1-V4 concerning for posterior infarction. HS-troponin (HST) was 60. Angiography (CA) showed thrombotic occlusion of his LCx DES (Fig 1a) and an RCA CTO (Fig 1c). Optical coherence tomography (OCT) revealed DES struts overlying the ostial LCx concerning for mechanical deformation from carinal shift. OCT guided PTA and laser thrombectomy (LT) of the LCx led to TIMI-3 Flow. LT and kissing balloon inflation (BI) was performed on the LAD and LCx to reshape the carina. HST peaked at 116,012. He had CCS Class IV CP despite medical therapy and returned for re-look CA with TIMI-3 flow in the left-sided circulation without thrombus (Fig 1b). He had PCI to his distal RCA CTO with two DES and TIMI-3 flow in the RCA (Fig 1d). He did not have recurrence of CP. Discussion: Bifurcation PCI leads to challenges from anatomic reconfiguration, metallic DES deformity, and changes in blood flow leading to increased risk of distal ST. This patient’s CA demonstrated LM DES material overlying the LCx from carinal shifting which likely led to interrupted flow dynamics. His LCx ST was partly due to this stasis and his clopidogrel nonadherence. Despite PCI of his LCx his CP remained with poor collateral flow from the left circulation. While CTO procedures are typically done non urgently, emergent intervention on our patient’s RCA CTO led to complete resolution of his CP and clear benefit for symptomatic management.
Abstract 4137198: Cardiac Index At The Time Of Pulmonary Artery Pressure Monitor Implantation And Inotrope Requirement Within 1 Year
Authors: Talha Siddique, Ashley Mitchell, Gregory Panza, Abhishek Jaiswal, Andrew Scatola
Journal: Circulation (2024)

Introduction: Pulmonary artery pressure monitoring with an implantable device (PAPM) improves heart failure hospitalizations (HFH) in patients with symptomatic heart failure. We sought to explore whether cardiac index (CI) predicted need for initiation of inotrope within 1 year of PAPM. Purpose: To examine the association between CI at PAPM implantation and need for inotropes within 1 yr. Methods: We retrospectively analyzed 277 consecutive HF patients who underwent PAPM from 1/1/19 through 10/31/22 with at least 1 yr post-implant follow-up. Demographic and clinical characteristics were compared between those who required inotropes within 1 yr (n=60) vs those who did not (n=217) (Figure 1). Independent samples t-test was used for continuous data and chi-square analysis for categorical data. Logistic regression was used to examine CI as a predictor of inotrope requirement within 1 yr, controlling for age, ejection fraction and glomerular filtration rate. Results: The average age was 69 (12) yr, 54% were male and 60 required inotropes. Patients requiring inotropes had significantly lower CI (2.2±0.6 L/min/m 2 vs 2.6±0.7 L/min/m 2 , p &lt; 0.001). CI was a significant independent predictor of inotrope requirement within 1 yr [odds ratio (OR)=0.3, 0.2-0.6; P&lt;.001). Every increase in CI by 1 L/min/m 2 resulted in 70% lower odds of requiring inotropes (Figure 2). After adjustment, CI remained a significant predictor of inotrope need (OR=0.4, 0.2-0.7; p&lt;0.001); every increase in CI by 1 L/min/m 2 reduced odds of inotrope requirement by 60%. Conclusion: Lower cardiac index at the time of PAPM implantation in symptomatic heart failure patients was associated with an increased need for inotrope within one year. This may identify a cohort of patients at risk of progressing to advanced heart failure. Prospective studies should examine the role of PAPM in management of HF patients with a low presenting cardiac index as well as patients with a PAPM and on inotrope.
Abstract 4137135: Trends in Mechanical Circulatory Support After the New Heart Allocation Policy
Authors: Diala Steitieh, Robert Beale, Ethan Katznelson, Dilan Minutello, Elizabeth Feldman, Daniel Lu, Luke Kim, Udhay Krishnan
Journal: Circulation (2024)

Background: In October 2018 a new heart allocation policy (NHAP) was implemented, which resulted in patients with Intra-aortic balloon pumps (IABP) being upgraded to status-two. We sought to determine practice pattern changes in mechanical circulatory support (MCS) use as a result of the NHAP. Hypothesis: Changes in the new heart allocation policy may lead to shifts in choice of mechanical circulatory support. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) between 2017–2020. Hospitalizations for cardiogenic shock were identified, and stratified based on whether the patients were admitted before or after the NHAP. Baseline characteristics were compared between these cohorts, and the primary outcome of interest was the use of MCS and transplant before and after the NHAP. Subgroup analyses included patients only in transplant centers, non-transplant centers, and those who eventually underwent transplant. Results: A total of 689,935 hospitalizations were included in the final analysis, of which 279,230 (40.5%) were before the NHAP, and 410,705 (59.5%) were after. In allcomers, hospitalizations after the NHAP were less likely to undergo IABP (Adjusted odds ratio [OR] 0.81, p&lt;0.01) and LVAD (Adjusted OR 0.73, p&lt;0.01). These findings were consistent in most subgroup analyses. Patients who underwent transplant after the NHAP however were more than twice as likely to have received a IABP compared to those admitted prior to the NHAP (adjusted OR 2.58; p&lt;0.01). Conclusion: IABP placement after the NHAP increased in patients who underwent transplant, as opposed to allcomers or patients who did not undergo transplant. This change in utilization of MCS may be reflective of perceived benefits and biases in regards to transplantation candidacy.
Abstract 4136804: Effect of Obesity on Arrhythmia Recurrence and Complications following Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation in the REAL-AF Registry
Authors: Gary Peng, Christopher Thorne, Allyson Varley, Jose Osorio, Sandeep Goyal, Paul Zei
Journal: Circulation (2024)

Introduction: Obesity is an important risk factor for atrial fibrillation and its prevalence in the United States is rising. The effect of obesity on outcomes following pulmonary vein isolation in a contemporary setting has not been extensively evaluated. Research Questions: - Is higher body mass index (BMI) associated with increased risk of atrial arrhythmia recurrence following pulmonary vein isolation? - Is higher BMI associated with increased risk of post-procedural complications? Method: - The REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClinicalTrials.gov Identifier: NCT04088071) Registry is a multicenter, prospective observational registry of patients undergoing radiofrequency catheter ablation of atrial fibrillation. We included 2666 patients with paroxysmal atrial fibrillation undergoing index ablation from January 2018 through April 2023. We excluded patients with missing covariates. - The primary outcome was freedom from atrial arrhythmia following ablation. Rhythm monitoring was standardized using patch monitor at 6 month and 1 year. Time-to-event analysis was performed using a 3-month blanking period. Results: - Baseline characteristics are shown in Table 1. The median follow-up was 382 days (IQR: 363-410). - There was a trend toward higher rate of atrial arrhythmia following ablation for patients in the highest BMI group compared with the reference group (BMI&lt;25) ( BMI≥40: HR = 1.41 (0.94-2.12), p= 0.092). There was no difference in the rate of atrial arrhythmia for other BMI groups ( BMI 25 - &lt;30: HR = 0.90 (0.65-1.23), p = 0.5; BMI 30 - &lt;35: HR = 0.89 (0.64-1.23), p = 0.5; BMI 35 - &lt;40: HR = 0.87 (0.57-1.32), p = 0.5). This trend persisted following adjustment for baseline covariates ( BMI 25 - &lt;30: HR = 1.01 (0.77-1.33), p &gt; 0.9; BMI 30 - &lt;35: HR = 0.97 (0.72-1.32), p = 0.9; BMI 35 - &lt;40: HR = 1.01 (0.66-1.55), p &gt; 0.9; BMI≥40: HR = 1.57 (0.96-2.57), p =0.071). - First-pass isolation rates progressively decreased with higher BMI (Table 2). - Complication rates were low across all BMI groups (Table 2). Conclusions: - Severely obese patients with BMI ≥40 experience higher risk of atrial arrhythmia following radiofrequency catheter ablation of paroxysmal atrial fibrillation compared with normal weight individuals. This corresponds with lower rates of first-pass isolation at higher BMI. - Patients across BMI categories experience similarly low rates of procedural complication.
Abstract 4137058: Clinical Characteristics and Outcomes of South Asians Presenting with Acute Coronary Syndrome
Authors: Humail Patel, Kishen Bulsara, Shreya Srivastava, Fahad Hussain, Eric Dulmovits, Shafkat Salam, Mohit Chandi, rajiv jauhar
Journal: Circulation (2024)

Background: Patients of South Asian descent have a higher incidence of atherosclerotic cardiovascular disease and are affected by clinically significant coronary artery disease at an earlier age when compared to the general population. As a result, they have been shown to have a higher rate of cardiovascular events. This at-risk population has not been well studied as it pertains to acute coronary syndrome. Methods: Out of 1610 patients who presented to one of two tertiary care centers between 2021-2022 with a diagnosis of acute coronary syndrome and underwent coronary angiography, 240 patients were identified as being South Asian and were included in the study. 480 non-South Asian patients were randomly selected as controls. A retrospective analysis was conducted to study the demographics, risk factors, clinical presentation, diagnostic features, and outcomes of the two groups. Results: South Asian patients who were diagnosed with acute coronary syndrome and underwent coronary angiography were significantly younger than non-South Asian patients (61 vs 65 years, p &lt; 0.001). Though they were less likely to be smokers, they were significantly more likely to have other known risk factors including hypertension, dyslipidemia, and a history of prior myocardial infarction (p &lt; 0.001). South Asians had mean lower HDL (p = 0.02), higher triglycerides (0.006), and higher Hgb A1C (p &lt; 0.001). Surprisingly, rates of multivessel disease (defined as stenosis of 50% or greater in two or three vessels) were similar between the two groups. South Asians were more likely to be referred for CABG after initial coronary angiography most likely due to diffuse disease (p = 0.014). Clinical outcomes including pre-discharge LVEF, and 2-year mortality were similar between the groups. Conclusions: South Asians are a notoriously high-risk group when it comes to early-onset and more severe coronary artery disease. The pathophysiology behind this disproportionate manifestation of cardiovascular disease is not entirely understood, but several efforts to delineate this are ongoing. Our data demonstrate that this is at least in part, due to a higher prevalence of conventional modifiable and nonmodifiable risk factors in South Asian patients.
Abstract 4136819: Necrotizing Enterocolitis is More Common After Hybrid Stage 1 Palliation Than Norwood Without Clear Risk Factors
Authors: Alyson Pierick, Hillary Liken, Jeffrey Zampi, Jennifer Romano, Courtney Strohacker, Ashley Duimstra, Ray Lowery, Sunkyung Yu, Christopher Sower
Journal: Circulation (2024)

Background: Infants with congenital heart disease are at high risk of developing necrotizing enterocolitis (NEC), with increased morbidity and mortality compared to infants without heart disease who develop NEC. Shunted single ventricle patients are at even higher risk. The hybrid stage 1 palliation (HS1P) is an alternative to the Norwood procedure for high-risk single ventricle patients or as initial palliation for patients with future two ventricle repair, as bridge to transplant, or as destination therapy. Few small studies have shown similar or slightly higher rates of NEC after HS1P compared to after Norwood. Aims: To evaluate the incidence, risk factors, and outcomes of NEC in HS1P versus Norwood patients. Methods: This is a single-center retrospective cohort study of all neonates who underwent HS1P or Norwood procedure from 2011-2022. Demographic data and episodes of NEC (defined using modified Bell’s criteria) were collected. NEC incidences and risk factors were compared between HS1P and Norwood patients using Chi-square test. For HS1P patients, more extensive data were collected including planned and final physiologic outcomes (single ventricle palliation, biventricular repair, transplant, and destination) and primary patient risk factors that led to HS1P. Risk factors and clinical outcomes of HS1P patients with and without NEC were compared using standard univariate tests. Results: The cumulative incidence of NEC in the HS1P group was 53% versus 37% in the Norwood group (p=0.01) and HS1P patients had more NEC episodes than the Norwood group (median 2 vs 1, p=0.03). Suspected NEC (stage 1A/1B) accounted for 70-75% of NEC cases in both groups. Only two infants, both in the HS1P group, had surgical (stage 3B) NEC. We found no differences in baseline demographics between patients with and without NEC in both HS1P and Norwood groups. In the HS1P group, NEC was associated with longer hospital length of stay (LOS), (median 49 days vs 23 days, p&lt;0.0001) and greater need for tube feeds at 1 year (32% of the NEC group exclusively orally fed versus 43% of the non-NEC group, p=0.03). Final physiologic outcome was not associated with development of NEC in the HS1P group (p=0.38). Conclusions: While the exact risk factors or predictors are not clear, NEC is more common after HS1P compared to Norwoods and is associated with longer hospital LOS and late feeding difficulty. Further studies to better understand the physiologic causes of NEC in the HS1P population are needed.