tbuckley/cabot-search huggingface dataset:
Abstract 18005: Underrepresentation of Women in Clinical Trials of Heart Failure With Reduced Ejection Fraction
Authors: Eson J Ekpo, Sujana Balla, Summer Ngo, Celeste Witting, Ashish Sarraju, Fatima Rodriguez
Journal: Circulation (2023)

Background: There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), and influence current guidelines for therapy. Objectives: To evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF. Methods: We queried Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). PPR was calculated based on the proportion of women with HFrEF in the Framingham cohort (40%). A PPR of 0.8 to 1.2 was considered representative. Results: The final analysis included 33 RCTs. All trials except two were mentioned in the 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guidelines for the Management of Heart Failure. Women represented 23.2% of enrolled participants (n = 24,363/ 104,972), ranging from 11.4% to 40.1% per-trial. Overall PPR was 0.58, with per-trial estimates ranging from 0.29 - 1.00. Five trials (15.2%) had a PPR of women representative of the disease population. Representation didn’t change significantly by the decade examined. The proportion of women in North American and Multiregional trials was significantly greater than in trials conducted in Europe (p = 0.04). The proportion of women was greater in industry trials compared to government-funded trials (p = 0.05). Conclusions: Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits, which may affect the sex-specific generalizability of major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.
Abstract 17163: The Relationship Between TIMI Frame Count, Microvascular Resistance, and Coronary Flow Reserve in Patients With Ischemia and Nonobstructive Coronary Arteries
Authors: Ethan Loftspring, Kenneth Harkin, Amanda Joa, Claudia Serrano-Gomez, Ayman Farid, Harmony Reynolds, Nathaniel R Smilowitz
Journal: Circulation (2023)

Introduction: Ischemia and nonobstructive coronary artery disease (INOCA) may be caused by coronary microvascular dysfunction (CMD), but coronary function testing for CMD is not routinely performed. Consensus statements include coronary flow reserve (CFR), an index of microcirculatory resistance (IMR), or coronary slow flow by corrected TIMI frame count (cTFC) &gt;25 as diagnostic for CMD. However, correlations between cTFC and invasive parameters of CMD are uncertain. Methods: Adults age ≥ 18 with INOCA (&lt;50% stenosis by invasive coronary angiography in all major epicardial coronary arteries) were prospectively enrolled. cTFC was measured from baseline angiography of the left anterior descending artery. Invasive coronary function testing using thermodilution techniques was performed to identify CMD, defined by IMR≥25 and/or CFR&lt;2.5. Relationships between cTFC and invasively derived CMD were evaluated. Results: Ninety-seven patients (mean age 60.4 ± 11 years; 80% female) underwent assessment; coronary slow flow was present in 46%. Coronary slow flow (cTFC&gt;25) had a sensitivity of 50%, a specificity of 57%, a positive predictive value of 53%, and a negative predictive value of 54% to identify CMD defined by IMR and/or CFR. cTFC weakly correlated with IMR (r=0.40, p&lt;0.001) and was not correlated with CFR (Pearson r=-0.03, p=0.73). Areas under the receiver operating characteristic curves were calculated for cTFC to identify abnormal IMR (AUC = 0.64), CFR (AUC = 0.55), CMD (AUC = 0.59), and CMD endotypes of abnormal IMR with normal CFR (AUC = 0.65), abnormal CFR with normal IMR (AUC = 0.58), abnormal IMR and CFR (AUC = 0.54). Conclusions: Coronary slow flow by angiography was not a reliable indicator of CMD defined by abnormal IMR and/or CFR. Correlations between cTFC and IMR were poor and no correlation with CFR was observed. These findings raise questions regarding the relevance of coronary slow flow at baseline to assess microvascular pathology causing INOCA.
Abstract 16670: Significance of Cardio-Ankle Vascular Index as an Indicator of Renal Function Decline: A Systematic Review and Meta-Analysis
Authors: Hamed Tavolinejad, Julio A Chirinos
Journal: Circulation (2023)

Introduction: Large artery stiffness leads to increased pulsatile energy transmission to the microvasculature, resulting in microvascular damage in high-flow low-resistance organs, including the kidneys. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that is less blood pressure dependent. However, its association with renal function remains understudied. Hypothesis: To determine if baseline CAVI is associated with renal function decline. Methods: The databases PubMed, Scopus, and Web of Science were systematically searched until June 2023 for original longitudinal studies. The study outcome was defined as renal function decline or incidence/progression of chronic kidney disease. The “Methodological Index for Non-Randomized Studies” (MINORS) was used for quality assessment. Pooled effect measures were calculated with random-effects models that were stratified based on CAVI cutoffs and the reported effect measure. Results: Among 7 studies (66,595 subjects; 45% male) the ranges of average age, eGFR, and follow-up duration were 46-69 years, 51-87 mL/min/1.73m2, and 1-7 years, respectively. All but one study (Kusunose et al.) reported adjusted models. The meta-analyses showed significant associations between high baseline CAVI and worsening renal function outcomes among studies reporting hazard ratios for a categorical exposure (HR=1.30; 95% CI [1.18-1.43]; P&lt;0.001; I 2 =38%), continuous exposure (HR [per SD] =1.14 [1.04-1.25]; P=004; I 2 =23%), and for odds ratios (OR [categorical exposure] =1.67 [1.01-2.76]; P=0.046; I 2 =71%). Conclusions: We observed a significant association between higher baseline CAVI and renal function decline over time. These results suggest that CAVI is a marker of kidney disease risk. Further research is warranted to investigate the role of CAVI as an indicator of risk of end-organ damage, and to investigate interventions targeting arterial stiffness to mitigate the burden of chronic kidney disease.
Abstract 13250: Establishing Partition Values and Clinical Phenotype for Heart Failure Patients With Abnormal Left Atrial Function Index: A Cross-Sectional Analytical Study
Authors: Anthony Kweki, Henry Aiwuyo, Endurance O Evbayekha, Oluwaseye Oladimeji, Ugoeze Iloeje, Oluwasegun Akinti, Osarenkhoe John, Michael Fatuyi, Ejiroghene Umuerri, Fredrick Aigbe, Austine Obasohan
Journal: Circulation (2023)

Introduction: Left atrial function index (LAFI) has recently been validated for global estimation of left atrial (LA) function. LA dysfunction is critical to developing overt heart failure (HF), and getting the best tool for assessing its function is critical to HF prevention. This study attempts to establish cut-off values for LAFI among HF patients and identify which HF phenotype is associated with abnormal LAFI. Hypothesis: Is there any association between abnormal LAFI and changes in LV function? Methods: This cross-sectional study was conducted at the Delta State University Teaching Hospital, Nigeria. We recruited 80 hypertensive HF patients and 40 healthy normotensive controls. LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOT-VTI = left ventricular outflow tract velocity time integral). Relationships between variables were determined using an independent student’s t-test, and a P-value of &lt;0.05 was significant. Results: In the control arm, the LAFI reference range was estimated to be 24.07-76.24. Abnormal LAFI was defined as LAFI &lt; 24 and 77.5% of the individuals with HF were found to have abnormal LAFI. There was no difference in age (61.83±7.48 vs. 63.22±6.75, p=0.46), BMI (28.27±4.47 vs. 29.52±5.91, p=0.33) and systolic BP (127.34±19.28 vs. 120.94±19.94, p=0.22) of hypertensive HF patients with LAFI &lt;24 and LAFI ≥24. Those with abnormal LAFI had lower EF (45.04±11.06 vs. 63.73±14.73, p&lt;0.0001), FS (25.75±8.26 vs 32.49±8.64, p=0.003) and SV (57.16±13.30 vs. 64.99±16.94, p=0.02). However, E/E’ (15.62±5.61 vs. 9.2±3.22, p&lt;0.0001) and LAVI (37.22±5.80 vs. 16.48±5.65, p&lt;0.0001) were higher among patients with lower LAFI. Contrarily, E/A (1.87±0.97 vs. 1.87±0.83, p=0.98) and TAPSE (17.87±3.67 vs. 19.54±2.47, p=0.06) did not show any difference among the groups. Conclusions: This study shows that abnormal LAFI was associated with impaired LV function and it is crucial to deploy this non-invasive modality of cardiac assessment in hypertensive patients. Early identification of abnormal left atrial mechanics is pertinent to preventing overt HF, especially in parts of the world where access to advanced cardiovascular care is limited.
Abstract 14494: National Trends in Emergency Department Discharges for Acute Pulmonary Embolism, 2006-2015
Authors: Nathan W Watson, Brett Carroll, Anna Krawisz, Alec A Schmaier, Eric A Secemsky
Journal: Circulation (2023)

Introduction: Outpatient management for selected low-risk patients with acute pulmonary embolism (PE) has emerged as a safe and feasible approach that is currently supported by clinical practice guidelines. However, recent evidence suggests that many patients are still managed with hospital admission. Few studies have assessed recent real-world, national trends in discharge rates for acute PE from the emergency department (ED). Methods: We conducted an observational study leveraging data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between the years 2006-2020. NHAMCS is a nationally representative probability sample which reflects ED visits within the US. All patients with a primary diagnosis of acute PE were included. Subgroup analysis was performed on patients who were hemodynamically stable (heart rate&lt;110 and systolic blood pressure&gt;100) and those with a PESI risk class I or II. Results: Between 2006-2020, there were an estimated 2,519,606 ED visits for acute PE. Among the whole cohort, the mean age was 58.2 (SE: 1.53) and 59.1% were female. Overall, 22.1% of patients with acute PE were discharged from the ED, which increased from 7.8% between 2006-2008 to 32.1% between 2018-2020. A total of 67.9% of patients were hospitalized, which decreased from 83.7% between 2006-2008 to 61.9% between 2018-2020. When stratified by hemodynamic stability or low PESI risk class, similar trends were observed (Figure). Since 2012, 33.0% of patients with PESI class I or II were discharged and 57.8% were hospitalized. Conclusion: In a representative nationwide sample, rates of discharge from the ED for acute PE have increased over the past fifteen years with the largest increase occurring between 2009-2014. However, since 2012, only one-third of low-risk patients presenting to the ED were discharged for outpatient management and rates appear to have stabilized. We speculate that outpatient management for low-risk acute PE is still underutilized in the US.
Abstract 16265: Precipitants of Acute Hemodynamic Instability in Patients With Hypertrophic Cardiomyopathy Admitted to the Cardiac Intensive Care Unit
Authors: Raunak M Nair, Sanchit Chawla, Andrew Higgins, Ran Lee, Wael A Jaber, Penelope Rampersad, Paul C Cremer, Venu Menon
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease in the United States which can infrequently present with acute hemodynamic instability. Our study aimed to identify the precipitants of acute cardiovascular decompensation resulting in Cardiac Intensive Care Unit (CICU) admission in patients with HCM. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of CS and co-existing HCM were identified through electronic medical charts. Only those with previously uncorrected HCM in the form of no prior myectomy/alcohol septal ablation and not on mavacamten were included in our study. Chart review was performed by physician investigators to identify the etiology precipitating hemodynamic instability in these patients. Results: Overall, 2754 patients were admitted to our CICU with CS during the study period, of which 21 patients (1%) had coexisting uncorrected HCM. The median age of patients with HCM admitted to our CICU was 61 years, 52% (n=11) were females, and 86% (n=18) were White Americans. The in-hospital mortality of patients with HCM-CS was around 24% (n=5). Retrospective chart review to identify the precipitating agent revealed atrial fibrillation with rapid ventricular response (Afib-RVR) to be the most common precipitant (33%, n=7), followed by severe MR in the setting of dynamic outflow obstruction (19%, n=4) and non-obstructive heart failure (19%, n=4). Conclusion: Identification of the precipitating mechanisms is critical to manage HCM patients presenting with hemodynamic instability. Rapid atrial fibrillation appears to be the most common precipitant leading to hemodynamic instability in this population.
Abstract 18088: Survival After Ventricular Tachycardia Onset in Left Ventricular Assist Device Recipients
Authors: Patrick T Lynch, Alexandra Maloof, Abdi Rasekh, Ajith Nair, Ilyas Colombowala, Joanna Esther Molina Razavi, Anish Badjatiya, Mihail G Chelu
Journal: Circulation (2023)

Introduction: Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with heart failure. However, the burden of ventricular tachycardia (VT) increases after LVAD insertion. The role of ablation in treating VT in LVAD recipients is unclear. Hypothesis: The incidence of VT following LVAD insertion is associated with worse survival, but this association is ameliorated by VT ablation. Methods: This is a single-center retrospective review of 549 LVAD recipients. LVADs implanted elsewhere, LVADs prior to 2011, and patients with inadequate follow up were excluded. Endpoints were transplantation, explantation, and last date of follow up. Event failure was defined as patient death. Cox and Kaplan-Meier survival analysis was performed with STATA and reported as hazard ratio with 95% confidence interval (HR [95% CI]). Results: Pre-LVAD VT was seen in 52% of patients: 33% had a prior ICD shock and 12% had a prior VT ablation. At study conclusion, 57% had died, 22% were transplanted, 9% were explanted, and 12% remained alive. Regardless of VT incidence, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). While post-LVAD VT overall was not associated with worse survival (HR 1.1 [0.8-1.3]), VT within 1 year of LVAD insertion demonstrated worse survival (HR 1.9 [1.3-2.6]; Figure 1). Incremental years between LVAD insertion and VT onset improved survival (HR 0.8 [0.7-0.9]). Among those with post-LVAD VT, ablation was not associated with a survival difference (IRR 0.9 [0.6-1.4]) regardless of the timing of ablation or VT onset. Conclusions: The incidence of VT within 1 year of LVAD insertion is associated with worse survival. However, mortality was not improved by VT ablation. This study is limited by its retrospective design, and further prospective studies would better determine the impact of VT ablation on survival in LVAD recipients.
Abstract 14338: The Impact of Medication-Assisted Treatment for Opioid Use Disorder on Congestive Heart Failure Outcomes
Authors: Peter Rasmussen, Yong-Fang Kuo, Biai Dominique Elmir Digbeu, Wissam Harmouch, Steven Mai, Mukaila Raji
Journal: Circulation (2023)

Introduction: Congestive heart failure (CHF) and opioid use disorder (OUD) are leading contributors to healthcare utilization in the United States. Little is known about how OUD treatment impacts clinical outcomes in patients with both CHF and OUD. We examined the impact of medication assisted treatment (MAT—buprenorphine and methadone) on outcomes for patients diagnosed with OUD and CHF, and which MAT medication is associated with the fewest cardiac toxicities. Hypothesis: The use of MAT in patients with both CHF and OUD will improve clinical outcomes related to CHF including hospitalizations, emergency room (ER) visits, and mortality. Methods: A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum’s de-identified Clinformatics® Data Mart Database. Using a multivariate logistic regression model, patients who were prescribed MAT were compared to those who were not. The primary outcomes were CHF hospitalizations, CHF ER visits, all-cause hospitalizations, and mortality. Results: No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. A subgroup analysis demonstrated that buprenorphine had a lower risk of mortality compared to methadone (HR 0.72, 95% CI 0.52-1.00, p=0.0482). Conclusions: No significant differences in CHF hospitalizations, CHF ER visits, and all-cause hospitalizations were observed between the MAT and non-MAT cohorts. Buprenorphine was associated with a lower risk of mortality when compared to methadone.
Abstract 16963: A Nation-Wide Study on Incidence, Mortality and Case Fatality of Acute Coronary Syndrome Reveals Levelling Off of the Incidence Decrease Among Young Women Aged 35-54 Years in 1996-2021 in Finland
Authors: Atte Kallstroem, Ida Holopainen, Oleg Kambur, Markus Perola, Veikko V Salomaa, Aki S Havulinna, Markus Räsänen, Juha Sinisalo
Journal: Circulation (2023)

Introduction/background: Incidence and case fatality (CF) of acute coronary syndrome (ACS) have declined in the last decades, but cardiovascular disease remains one of the leading causes of death in the Western world. The knowledge of the current trends in incidence, mortality, and CF of ACS from Finland and even worldwide is sparse, though some studies have suggested slowed incidence decrease and even increase in younger age groups. Thus, we set out to investigate the changes in these event rates in Finland from 1996 to 2021. Research questions/hypothesis: To examine how the ACS burden has evolved in Finland from 1996 to 2021, especially after 2010. Methods/approach: We used Finnish country-wide registers, i.e., Hospital Discharges Register (HDR, from Care register for health care) and the National Causes of Death Register with complete coverage of non-fatal and fatal ACS events. We analyzed incidence and mortality rates, and CF, as well as the significance of their trends using negative binomial and logistic regression adjusting for age and sex. Results/data: Altogether, 186 489 non-fatal and 72 907 fatal incidents of ACS events were included in the analysis. ACS incidence decreased in men (Annual percentage change (APC) -2.0% [95% CI -2.2 to -1.8]) and in the older age groups of women (APC of 55-64-year-old -1.5% [-1.7 to -1.2] and 65-74-year-old -3.3% [-3.5 to -3.1]), but the decrease in incidence slowed down over the last decade. Importantly, in 35-54-year-old women ACS incidence decrease halted (APC of 35-44-year-old 0.4% [-0.3 to 1.0] and 45-54-year-old 0.2% [-0.1 to 0.5]). ACS mortality and case-fatality declined steadily in both sexes and all age groups throughout the study period (APC of the mortality in men -4.5% [-4.7 to -4.3] and in women -5.1% [-5.3 to -4.7]. APC of the CF in men -2.7% [-2.9 to -2.6] and in women -3.4% [-3.6 to -3.2]). Conclusions: In concordance with other recent reports, we showed that the ACS mortality in both men and women was steadily decreasing. However, we observed that ACS incidence decline slowed down in older age groups and even halted in women aged 35-54. These alerting results emphasize the need for cardiovascular prevention, particularly in young and middle-aged women.
Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study
Authors: Naveed Sattar, James A de Lemos, Bruno Linetzky, Palash Sharma, Raleigh Malik, Mathijs Bunck, Nadia Ahmad, Adam Stefanski
Journal: Circulation (2023)

Background: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention. Aim: To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect. Methods: Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction. Results: Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively). Conclusions: Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.