tbuckley/cabot-search huggingface dataset:
Abstract 15819: The Outcome of Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation: A Updated Systematic Review and Meta-Analysis
Authors: Bo Peng, Apurva O Badheka
Journal: Circulation (2023)

INTRODUCTION: Although the current treatment of choice of severe pure aortic regurgitation (AR) is surgical aortic valve replacement, increasing evidence has shown the potential of transcatheter aortic valve replacement (TAVR) in the management of patients who have high surgical risk profiles. AIMS: To conduct a systematic review and meta-analysis in evaluating the outcome of TAVR for pure AR based on current emerging evidence. Methods: Articles on MEDLINE, CINAHL, Web of Science, Embase, and Cochrane that studied the outcome of TAVR for the management of pure native AR were extracted. Device success rates, post-procedure moderate to severe AR rates as well as in-hospital, 30-day, and 1-year all-cause mortality rates were pooled for meta-analysis. Subgroup analyses of the above outcome comparing early-generation devices (EGD) and new-generation devices (NGD) were performed. Data were presented with incidences and 95% confidence intervals (CI), and I 2 was used to analyze heterogeneity. Results: Twenty-four studies involving 4435 patients were included. The pooled device success rate was 89.6% (95% CI 81.7% to 92.2%, I 2 = 91.63%), and 88.2% (95% CI 83.4% to 92.9%, I 2 =86.0%) of device placement was achieved by single implantation. Compare to EGD (72.2%, 95% CI 58.3% to 86.1%, I 2 =94.1%), NGD (91.6%, 95% CI 87.4% to 95.8%, I 2 =83.8%) has a higher device success rate. The overall in-hospital, 30-day, and 1-year all-cause mortality of TAVR for AR was 3.7% (95% CI 2.1% to 5.2%, I 2 =70.2%), 6.9% (95% CI 4.8% to 9.0%, I 2 =79.5%), and 13.9% (95% CI 8.5% to 19.2%, I 2 =89.1%), respectively. A higher 30-day all-cause mortality rate was observed in patients who received EGD implantations (12.6%, 95% CI 7.7% to 17.5%, I 2 =61.4%) than those have NGD placements (6.3%, 95% CI 3.9% to 8.7%, I 2 =51.0%). About 6.9% (95% CI 4.6% to 9.3%, I 2 =72.4%) and 4.6% (95% CI 1.5% to 7.7%, I 2 =86.2%) of patients continue to have moderate to severe AR post-procedure and at 30 days, respectively. CONCLUSION: Our current systematic review and meta-analysis suggests that TAVR may be a feasible option for patients with pure AR who have high surgical risks. NGD is superior to EGD in AR management due to its higher device success rate and favorable mortality outcome.
Abstract 12082: Dermatomyositis Associated Pulmonary Fibrosis Masquerading as Severe Aortic Insufficiency
Authors: Umar Farooq, Humail Patel, Tashina Dussie, karen mrejen, Robert Kalimi, Azhar Supariwala
Journal: Circulation (2023)

Description of Case: A 56-year-old female with asthma and hypertension presented for two weeks of dyspnea, cough, and fevers. Initial workup revealed bilateral ground glass opacities. TTE revealed severe aortic insufficiency, early mitral valve closure, and a LVEF of 65%. The patient underwent SAVR and was started on diuresis but continued to have significant respiratory distress over the next few months, leading to recurrent hospitalizations and requiring home oxygen therapy. Serial imaging revealed worsening of her pulmonary opacities. Due to persistent musculoskeletal and cutaneous symptoms with an elevated CPK, an alternative diagnosis was considered: dermatomyositis associated pulmonary fibrosis. The patient was started on steroids and immunomodulatory therapy with improvement in her symptoms. Discussion: Dermatomyositis (DM) is an inflammatory myopathy characterized by proximal muscle weakness, rash, and other manifestations including ILD and esophageal dysmotility. Mortality in patients with DM is associated with rapid progression of ILD. Patients may also have myocardial involvement and heart failure. Patients with presumed cardiogenic respiratory failure that does not improve with HF optimization should undergo further workup and consideration of a broader differential diagnosis. Unexplained elevated CPK disproportionate to troponins, and persistent hypoxia in patients with multisystem involvement should trigger an autoimmune work up. If such a process is identified, patients may have a rapid improvement in their symptomatology and excellent prognosis following immunomodulatory therapy. If left undiagnosed, it can cause multi-system failure, including significant myocarditis and heart failure.
Abstract 15975: Cardiogenic Shock Teams Are Associated With Lower Mortality, Bleeding and Vascular Complications: A Systematic Review and Meta-Analysis
Authors: Carlos L Alviar, Muhammad H Maqsood, Behnam N Tehrani, Shashank Sinha, Sean Van Diepen, Jason N Katz, Samuel Bernard, Mireia Padilla-Lopez, Norma Keller, Sripal Bangalore
Journal: Circulation (2023)

Introduction: Short-term mortality and morbidity associated with cardiogenic shock (CS) remains high. However, observational studies suggest that CS teams improve outcomes. Our aim is to systematically evaluate the outcomes associated with CS team use by performing a meta-analysis of the published literature. Methods: A comprehensive literature search of the PubMed/EMBASE, Cochrane databases and published abstracts was performed from inception to 06/01/2023 including studies comparing CS outcomes before and after the implementation of CS teams (excluding case reports and pediatric studies). Outcomes included in-hospital mortality, bleeding, vascular complications, use of temporary mechanical circulatory support (tMCS), and renal replacement therapy (RRT). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using DerSimonian-Laird method. The Eggers test was used to assess publication bias; significant heterogeneity was considered if I 2 &gt; 75%. Results: Of 524 studies screened, 5 met inclusion criteria. This included 2,331 subjects (1091 managed with a CS team and 1270 without, mean age 62.5 years, 72.1% male, 41% non-white). The implementation of CS teams was associated with lower risk of in-hospital mortality ([OR] = 0.63 [95% CI 0.49 - 0.81]; I 2 =19%; p &lt; 0.001) (Fig), major bleeding (OR = 0.69 [95% CI 0.48 - 0.99]; I 2 =0%; p = 0.042), and vascular complications (OR = 0.61 [95% CI 0.40 - 0.93]; I 2 =0%; p = 0.021) compared to management without CS teams. There were no differences in tMCS (OR = 0.81 [95% CI 0.56 - 1.17]; I 2 =52%; p = 0.26) or RRT use (OR = 0.74 [95% CI 0.44 - 1.25]; I 2 =78%; p = 0.26). There was no evidence of publication bias (p &gt; 0.05). Conclusions: In this meta-analysis, CS team implementation was associated with lower in-hospital mortality, major bleeding, and vascular complications, but no difference in the use of tMCS or RRT. These findings support further prospective studies to assess the impact of CS teams in improving outcomes.
Abstract 13355: Acute Type A Aortic Dissection Surgical Repair in Octogenarians, Meta Analysis
Authors: Ahmed K. Awad, Mohammed Tarek Hasan, Hazem Salah Rezq, Heba Aboeldahab, Mohamed K. Elkhashab, Salah Mahmoud Hamouda, Hassan Elkersh, Ayman K. Awad, Ambreen Nabeel, Syed Karam Gardezi, Rehmat Ullah Awan
Journal: Circulation (2023)

Aortic dissection is a serious medical condition that can lead to life-threatening complications. Type A aortic dissection (TAAD) is a subtype that occurs in the ascending aorta and is associated with increased morbidity and mortality rates. Surgical intervention is the standard of care for TAAD, but the optimal surgical approach for octogenarians remains a topic of debate. This meta-analysis aimed to investigate the long-term surgical outcomes of TAAD in octogenarians. Electronic databases were searched from inception to September 20, 2022, to include any randomized clinical trials (RCT) and observational studies that compare TAAD in octogenarians versus TAAD in septuagenarians. The Mantel-Haenszel method was used to pool study estimates and calculate odds ratios (OR) with 95% confidence intervals (CI). Twenty-seven observational studies comprising 18,057 participants were included in the meta-analysis. Surgical repair for TAAD in octogenarians had a lower risk of re-exploration (RR = 0.08), stroke (RR = 0.09), renal failure (RR = 0.09), respiratory failure (RR = 0.18), neurological complications (RR = 0.09), and bleeding (RR = 0.08), compared to septuagenarians. On the other hand, antegrade cerebral perfusion (RR = 0.39) and tracheostomy (RR = 0.11) were less likely to be used in octogenarians than in septuagenarians. In terms of surgical parameters, octogenarians had a significantly shorter cardiopulmonary bypass surgery time and systemic cardiac arrest time than septuagenarians (MD = -13.84 and -2.46), respectively. Even though postoperative mortality rose dramatically with age, surgical care was associated with a significantly reduced inpatient mortality rate when compared to medical management. Octogenarians undergoing surgical repair for type A aortic dissection have a statistically significant difference in cardiopulmonary bypass surgery time, systemic cardiac arrest time, and 5-year survival rate when compared to septuagenarians.
Abstract 17344: Risk Factors for Disease Severity in Cardiac Laminopathy
Authors: Ramin Garmany, Raquel Neves, Martina Gluscevic, Konstantinos Siontis, Naveen L Pereira, Michael J Ackerman, John Giudicessi
Journal: Circulation (2023)

Introduction: Disease-causative variants in LMNA -encoded lamin A/C cause a penetrant dilated cardiomyopathy associated with conduction disease (CD) and ventricular arrhythmias (VA). Prior studies show conflicting results regarding the effect of sex, variant type, and CD on severity and sudden death risk in cardiac laminopathy. Methods: In this retrospective study, we utilized a single-center genetic arrhythmogenic cardiomyopathy registry (N=432) to identify patients with ultra-rare LMNA variants and ascertain the effect of sex, mutation type, and clinical presentation on disease severity. Advanced heart failure (AHF) events were defined as ventricular assist device placement or cardiac transplantation whereas VA events were defined as sudden cardiac arrest, sustained ventricular arrhythmia, or appropriate implantable cardioverter-defibrillator shock. Results: The LMNA variant-positive cohort (N=83) had an age of diagnosis of 36 ± 10 years with 80% showing a cardiac phenotype. No difference in the age at diagnosis (37 vs. 34 years; p=0.3) or prevalence of AHF events (14% vs. 18%; p=0.8) and VA events (34% vs. 36%; p=0.9) was observed between females (N=50) and males (N=33). Furthermore, there was no difference in age of diagnosis (37 vs. 33 years; p=0.1) or prevalence of AHF (14% vs. 12%; p=0.9) and VA events (33% vs. 34%; p=0.9) between individuals with missense (N=42) or frameshift (N=32) variants. Interestingly, in comparison to individuals that presented with isolated CD (N=11) those that first presented with left ventricular dysfunction or arrhythmias (atrial or ventricular) (N=41) were more likely to have VA events (9% vs. 53%; p=0.01) and AHF events (0% vs 29%; p=0.05). In addition, those with structural/arrhythmic presentation had earlier time to VA events (15 years vs. 22 years; p=0.04) and AHF events (23 vs undefined; p=0.09) than those with CD. Conclusions: Contrary to prior studies, in this large single-center cardiac laminopathy study, sex and mutation type were not associated with increased risk of AHF or VA events. However, patients presenting with isolated CD had a lower risk of AHF and VA events. Contemporary multi-center studies are needed to better ascertain risk factors associated with AHF and VA events in cardiac laminopathy.
Abstract 13622: Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Joshua A Jacobs, Catherine G Derington, Alexander R Zheutlin, Jordan B King, Jordana B Cohen, John Bucheit, Ian M Kronish, Daniel K Addo, Donald E Morisky, Tom H Greene, Adam P Bress
Journal: Circulation (2023)

Introduction: Therapeutic inertia (TI), the failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains highly prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI when targeting intensive BP goals remains unclear. Methods: Cross-sectional analysis of the 12-month visit of participants randomized to the intensive systolic BP (SBP) arm of the SBP Intervention Trial (SPRINT), which randomized adults at high cardiovascular disease risk to an intensive (&lt;120 mm Hg) vs. standard (&lt;140 mm Hg) SBP treatment group. TI was defined as no change in the antihypertensive medication regimen intensity score, which incorporates the medication number and dose, when the SBP &gt;120 mm Hg. Self-reported medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (&lt;6), medium (6 to &lt;8), and high (8). Poisson regression models with robust error variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for TI associated with MMAS-8 category. Results: Among 1,009 intensive arm participants with SBP &gt;120 mm Hg at the 12-month visit (mean age 69.6 years, 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low self-reported adherence (vs. high) were younger and more likely to be non-Hispanic Black or current smokers. The prevalence of TI among low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (vs. high) were associated with TI (PR 1.11; 95% CI 0.87,1.42, PR 1.08; 95% CI 0.84,1.38, respectively). Conclusion: Although clinician uncertainty about medication adherence is often cited as a reason for why antihypertensive intensification is withheld when the BP is above goal, we observed no evidence of an association between self-reported adherence to antihypertensive medication and TI.
Abstract 15078: Atrial and Brain Natriuretic Peptides Expression and Release in Pulmonary Hypertension
Authors: Jessie Van Wezenbeek, Aida Llucia-Valldeperas, rowan Smal, Fjodor Bekedam, Frances S De Man
Journal: Circulation (2023)

Introduction: Precapillary pulmonary hypertension (PH) is characterized by progressive overload for the right ventricle and right heart failure (RHF). N-terminal Brain Natriuretic Peptides (NTproBNP) and Atrial Natriuretic Peptides (ANP) are secreted from cardiomyocytes upon stretch. NTproBNP is used as biomarker for RHF. Aim: To study the association between ANP and NTproBNP and pressure overload in blood, right heart tissue and induced pluripotent stem cell derived cardiomyocytes (iPSC-CMs) from PH-patients. Methods: We analyzed NTproBNP in 344 PH-patients, 9 controls, and in 9 PH-patients before and 6-months after pulmonary endarterectomy (PEA). We measured NPPA and NPPB gene expression on end-stage human right ventricular (RV) and right atrial (RA) samples from 8 PH-patients and 5 controls. In addition, we performed immunofluoresence staining for ANP and BNP on RA tissue (N=4) and RV tissue (N=10) in PH and controls (N=5). iPSC-CMs from 1 male and 1 female PH-patients were stretched for 24h at 1Hz and 10% on the Flexcell FX-6000 system, and NTproBNP release was measured on static and stretched iPSC-CMs. NTproBNP levels were measured through ECLIA. Results: NTproBNP serum levels were elevated in PH-patients versus controls (918 vs 25 pg/mL, Fig1A). Pressure unloading in CTEPH patients did not result in a decrease in NTproBNP (Fig1B). In RV tissue of PH-patients NPPA expression was upregulated, but NPPB was not (Fig1C). ANP and BNP content was higher in RA and RV tissue of PH-patients (Fig1D-E). Finally, ~5x higher NTproBNP was released from male vs female iPSC-CMs under static conditions and after mechanical stretch (Fig1F). Conclusions: ANP and BNP showed important differences at gene and protein levels in relation to pressure overload. To confirm current results, further analyses on atrial and ventricular iPSC-CMs will be performed, in addition to mid-range proANP measurements in patients’ blood and iPSC-CMs conditioned medium.
Abstract 15559: Mortality Risk Stratification Using Artificial Intelligence Augmented Prediction of Serum Potassium in Cardiac Intensive Care Unit Patients
Authors: Christopher Heinrich, David Harmon, John J Dillon, Kianoush Kashani, Zachi Attia, Paul Friedman, Jacob C Jentzer
Journal: Circulation (2023)

Introduction: Hyperkalemia has been associated with increased mortality in cardiac intensive care unit (CICU) patients. An artificial intelligence (AI) augmented electrocardiogram (ECG) can predict hyperkalemia, and other AI-ECG algorithms have predicted mortality in CICU patients. Hypothesis: We hypothesized that the AI-ECG hyperkalemia algorithm could stratify mortality risk beyond the serum potassium measurement. Methods: We included 11 234 unique Mayo Clinic CICU patients admitted from 2007 to 2018 who had both a 12 lead ECG and blood potassium (K) level obtained at admission with K&gt;=5 mEq/L defining hyperkalemia. ECGs underwent AI evaluation for probability of hyperkalemia (probability &gt;=0.5 defined as positive). Hospital mortality was analyzed using logistic regression and survival to one year was estimated using Kaplan-Meier and Cox analysis. Results: The mean age was 70 years, 37.8% were females, and 92.4% were white. Chronic kidney disease was present in 20%. The mean K value was 4.2 mEq/L, and 13% (n=1460) had hyperkalemia. AI-ECG predicted hyperkalemia in 34% (n=3820). In-hospital mortality was higher in patients with laboratory and/or AI-ECG hyperkalemia, and these patients had lower survival out to 1 year. Mortality was lowest in patients with normal K and negative AI-ECG and highest in patients with both laboratory-confirmed hyperkalemia and AI-ECG predicted hyperkalemia. Patients with isolated laboratory hyperkalemia (false-negative AI-ECG) had higher mortality than those with isolated AI-ECG hyperkalemia (false-positive AI-ECG). Conclusions: AI-ECG probability of hyperkalemia, even with a normal laboratory K, was associated with higher short-term and long-term mortality in CICU patients. The laboratory K value and AI-ECG probability of hyperkalemia are complementary risk factors. The AI algorithm can detect prognostically important ECG abnormalities which may reflect the effects of K levels on the myocardium.
Abstract 17955: Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock
Authors: Joseph Taleb, Theodoros Giannouchos, Christos Kyriakopoulos, Antoine Clawson, Erin Davis, Konstantinos Sideris, Kevin S Shah, Joseph Tonna, Elizabeth Dranow, Tara Jones, Spencer Carter, James C Fang, Josef Stehlik, Robert Ohsfeldt, Craig Selzman, Thomas Hanff, Stavros G Drakos
Journal: Circulation (2023)

Background: Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock (CS), but their implementation costs have not been studied. Objectives: To compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared to standard of care (SoC). Methods: We examined patients with refractory CS, treated with or without a Shock Team at a tertiary academic hospital from 2009-2018. Real-world hospital data was used to compare costs and outcomes, including survival at discharge, 1-year survival, and quality adjusted life years (QALYs) gained at 1 year. Incremental cost-effectiveness ratios (ICER) were calculated over a 1-year time horizon, with parameter uncertainty evaluated through probabilistic sensitivity analysis using (PSA) 1000 second-order Monte Carlo simulations. Results: The study involved 244 patients, with 123 treated by the Shock Team and 121 receiving SoC. Patients were predominantly male (77.5%), with a mean age of 58 years (18-92). The Shock Team approach improved survival rates at hospital discharge and 1-year follow-up (61.0% vs 47.9%; p=0.04 &amp; 55.0% vs 40.5%; p=0.03, respectively). The ICER for increases in survival probability at discharge for the multidisciplinary Shock Team compared to SoC was $102,088. The ICER for increases in survival probability at 1-year was estimated at $96,152 and at $127,862 per one QALY gained. PSA estimates showed that the Shock Team was cost-effective in the majority of simulations using a willingness-to-pay threshold of $150,000, while it was also dominant in almost one-third of the simulations. Conclusion: The Shock Team approach for treating refractory CS may be a cost-effective alternative to traditional SoC. These findings can help prioritize the implementation of Shock Team initiatives to further improve cardiogenic shock outcomes.
Abstract 18921: Obstructive Sleep Apnea in the Presence of Heart Failure With Preserved Ejection Fraction is Associated With Low Arousal Threshold and Increased Sleep Fragmentation
Authors: Thomas M Tolbert, Sumeet S Mitter, stamatios lerakis, Ayham Adawi, Daphne Valencia, Anna Mullins, Ankit Parekh, Ricardo Miguel S Osorio Suarez, Indu Ayappa, David M Rapoport
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is often accompanied by obstructive sleep apnea (OSA). The effects of HFpEF on OSA pathophysiology remain relatively unexplored. Pulmonary congestion and sympathetic nervous activity (SNA) may drive ventilatory control instability (high loop gain [LG]). Elevated SNA also theoretically predisposes sleep to easier interruption by breathing events of OSA, reflected by low arousal threshold (ArTH). Hypothesis: In comparison to patients with OSA alone, patients with both OSA and HFpEF have higher LG and lower ArTH. Methods: We reviewed records to include patients with 1) transthoracic echocardiography with EF&gt;40% and left ventricular diastolic dysfunction by decreased age-adjusted e’ and/or left atrial volume index &gt;28 mL/m 2 ; 2) OSA by apnea-hypopnea index (AHI3A) ≥15 events/hour; and 3) raw polysomnography (PSG) data available for advanced signal analysis. LG and ArTH were estimated by Phenotyping Using Polysomnography (PUP), a MATLAB algorithm that quantifies pathophysiologic mechanisms of OSA using PSG data. Values in HFpEF+OSA patients were compared to values from research volunteers with OSA alone. Results: The HFpEF+OSA group included 21 patients. The OSA alone group included 43 research volunteers. LG was lower for HFpEF+OSA (0.63±18) compared to OSA alone (0.69±18), but the difference was not statistically significant. ArTH was significantly lower for HFpEF+OSA (117.0±15.9 %eupnea) compared to OSA alone (152.8±54.8 %eupnea, p = &lt;0.001) and remained significant after adjustment for age, sex, and body mass index. ArTH was correlated with sleep efficiency (R = 0.43, p = &lt;0.001) and negatively correlated with wake after sleep onset (R = -0.35, p =0.005). Conclusions: HFpEF is associated with low arousal threshold, which may contribute to sleep fragmentation. Our data did not confirm the hypothesis of greater breathing instability in patients with HFpEF and OSA compared to OSA alone.