tbuckley/cabot-search huggingface dataset:
Abstract 12042: Elevated Levels of Bicarbonate Predict Adverse Outcomes in Patients With Chronic Heart Failure
Authors: Tomofumi Misaka, Yu Sato, Yukiko Sugawara, Ryo Ogawara, Shohei Ichimura, Yusuke Tomita, Fumiya Anzai, Tetsuro Yokokawa, Akihiko Sato, Takeshi Shimizu, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Akiomi Yoshihisa, Yasuchika Takeishi
Journal: Circulation (2023)

Background: The bicarbonate (HCO3 - ) buffer system plays a crucial role in maintaining acid-base homeostasis, and HCO3 - levels are affected by multiple factors in heart failure. Recently, a sub-analysis of the ADVOR trial for acute heart failure revealed that patients with elevated serum HCO3 - levels experienced beneficial effects of decongestion by acetazolamide. However, the significance of HCO3 - levels in chronic heart failure has not been fully understood. Aim: We sought to clarify whether HCO3 - levels have clinical relevance or prognostic impact in patients with chronic heart failure. Methods and Results: We conducted a prospective study involving hospitalized patients with stage C/D heart failure and measured HCO3 - levels in arterial blood gas samples prior to discharge. We enrolled a total of 718 patients (mean 68.3 years old and 62.1% male), with neutral pH ranging from 7.35 to 7.45, and found that 132 (18.4%) had HCO3 - levels exceeding 26 mmol/L. Patients with HCO3 - &gt; 26 mmol/L were more likely to be male and to use loop diuretics, and had higher serum sodium, as well as lower potassium levels, compared to those with HCO3 - &lt; 26 mmol/L, whereas there were no differences in B-type natriuretic peptide levels or left ventricular ejection fraction between the two groups. In a Kaplan-Meier analysis, patients with HCO3 - &gt; 26 mmol/L had lower event-free survival rates from cardiac deaths and decompensated heart failure as well as the composite of the cardiac events over a median follow-up period of 1540 days ( Figure ). In a multivariable Cox proportional hazard model after adjusting confounding variables, the presence of HCO3 - &gt; 26 mmol/L was independently associated with increased risks of the composite of cardiac events (hazard ratio, 1.64; P &lt; 0.01). Conclusion: Elevated HCO3 - levels may indicate enhanced proximal nephron activation and resistance to loop diuretics, which predicted adverse outcomes in patients with chronic heart failure, even within a normal pH range.
Abstract 11813: Ten-year Risk of Atherosclerotic Cardiovascular Disease Predicts Long-Term Mortality in Lipid-Lowering Therapy
Authors: Zhiyuan Ma, Lynn N Moran, Jamshid Shirani
Journal: Circulation (2023)

Background: The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) can be effectively estimated by the ASCVD Risk Score derived from the pooled cohort equations. Current guidelines, thus, recommend primary prevention statin therapy based on ASCVD Risk Score while assessing effectiveness of statin therapy by targeting low-density lipoprotein cholesterol levels. It is unclear whether ASCVD Risk Score can also predict impact of statin therapy on mortality. Methods: A retrospective analysis of National Health and Nutrition Examination Survey (NHANES) (III and 1999-2008) linked to the National Death Index was conducted with propensity score matching. The study included 6647 adults without lipid-lowering therapy and 2484 with lipid-lowering therapy. Follow up was truncated at 10 years. Cox regression models and C statistics were used to assess the association between ASCVD Risk Score and mortality. Results: In the matched cohort with 4802 individuals with similar ASCVD risk profiles, ASCVD Risk Score was comparably predictive of all-cause mortality in the lipid-lowering therapy [area under curve (AUC)=0.75 ;95% confidence interval (CI)=0.73-0.77) and non-therapy (AUC=0.74; 95% CI=0.71-0.77) groups ( p =0.5). Similarly, the ASCVD Risk Score was comparably predictive of cardiovascular mortality in both groups (AUC=0.75; 95% CI=0.70-0.79 versus AUC=0.77; 95% CI=0.73-0.80; p =0.5). Lipid-lowering therapy was significantly associated with reduced all-cause mortality [adjusted hazard ratio (HR)=0.70; 95% CI=0.61-0.82; p &lt;0.01) and cardiovascular mortality (adjusted HR=0.65; 95% CI=0.51-0.83; p &lt; 0.01), particularly in those with an ASCVD Risk Score of ≥7.5%. Conclusions: ASCVD Risk Score comparably predicts mortality in individuals with and without lipid-lowering therapy. Individuals on lipid-lowering therapy had lower all-cause and cardiovascular mortality, compared to those without lipid-lowering therapy despite similar ASCVD Scores at baseline. These findings suggest that statin therapy may predictably reduce mortality in patients initiated on lipid lowering therapy for primary prevention based on the ASCVD Risk Score.
Abstract 11805: Hidden Hazards: Unraveling Risk Factors for New-Onset Acute Heart Failure in Liver Transplant Recipients
Authors: Hussein Al Sudani, James Boris, Bruce Adrian Casipit, Christine Adekayode, Margaret Staniszewski, Sally Hannoodee, Kevin Bryan U Lo, Raphael bonita
Journal: Circulation (2023)

Introduction: Heart failure with reduced ejection fraction (HFrEF) following liver transplantation (LT) is associated with increased morbidity and mortality. Early identification and optimization of risk factors associated with development of heart failure in LT recipients could improve cardiac and liver transplant outcomes. Hypothesis: The study's primary objectives were to ascertain the incidence of new-onset HFrEF post-liver transplant, identify the associated risk factors and understand their clinical outcomes. We hypothesized that certain demographic and clinical factors may predispose liver transplant recipients to develop new-onset HFrEF. Methods: Our retrospective cohort study included 568 liver transplant recipients at our center. Patients were categorized based on whether or not they developed new-onset HFrEF post LT We utilized descriptive statistics, chi-square tests, and logistic regression analyses to investigate potential associations between patient demographics, clinical risk factors and the development of new HFrEF . Results: The incidence of acute heart failure post-transplant was 8% (n=43). Within this group, 51% had HFrEF (LVEF&lt;40%), 37% HFmrEF (LVEF 40-49%),12% HF with preserved EF. LVEF was significantly lower in the new-onset HF group [40(30-45) vs 60(55-65), p&lt;0.001]. Median time to HF onset was 25 days. Coronary artery disease (OR 2.53, 95% CI 1.01-6.35, p=0.04) and malignancy history (OR 2.35, 95% CI 1.15-4.81, p=0.02) were significant predictors of new onset HFrEF. New onset HFrEF was associated with higher 180-day mortality (14% vs 6%, OR 2.57, 95% CI 1.00-6.56, p=0.048). Conclusions: Coronary artery disease and history of malignancy were identified as risk factors for new-onset HFrEF post-LT. Additional research is needed to better understand the impact of CAD and malignancy on cardiac and liver transplant outcomes that may result in improved patient care.
Abstract 11697: Combined-Energy Pulmonary Vein Isolation and Posterior Wall Isolation for Persistent Atrial Fibrillation: Results of a 3-year Follow-Up
Authors: Michael N Jiang, Heajung L Nguyen, Aron Bender, Carlos Macias, Jason Bradfield, Houman Khakpour, Marmar Vaseghi, Yuliya Krokhaleva, Eric F Buch
Journal: Circulation (2023)

Introduction: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for paroxysmal atrial fibrillation (AF), but the optimal ablation strategy for persistent AF (PsAF) remains controversial. Hypothesis: The purpose of this study was to investigate whether combined-energy cryoballoon (CB) PVI and radiofrequency (RF) left atrial posterior wall isolation (LAPWI) at index ablation of PsAF yields higher success than PVI alone. Methods: Patients with persistent AF (n = 186) who underwent catheter ablation between 2016 and 2019 at a single large academic medical center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Combined-energy ablation (n=92) consisted of CB antral PVI followed by RF roof and floor lines to achieve LAPWI, along with isolation inside the box as needed. The control group had PVI only (n=94) with either CB (n=57) or RF (n=37). The primary endpoint was 12-, 24-, and 36-month freedom from any documented atrial tachyarrhythmia over 30 seconds after a 90-day blanking period following catheter ablation, compared by Kaplan-Meier analysis. Secondary endpoints included AF burden, procedural parameters, and complications. Results: The primary endpoint of 12-month freedom from any atrial tachyarrhythmia was higher for the combined-energy group vs the control group (79.1% vs 58.2%, p = 0.009). This improvement was sustained at 24 months (63.0% vs 45.8%) and at 36 months (60.3% vs 43.1%) and remained significant after adjustment for clinical covariates (adjusted HR 0.45, 95% confidence interval 0.22-0.95; p = 0.03). There was no significant difference in procedure time or complication rates, however fluoroscopy time was shorter with combined-energy ablation (p&lt;.001). Conclusions: In this single center experience, combined-energy CB-PVI and RF-LAPWI was associated with reduced AF recurrence compared to PVI with a single energy source.
Abstract 11720: Logistic and Economic Burden of Non-Obstructive Hypertrophic Cardiomyopathy - Results From Medical and Pharmacy Claims Data
Authors: Sanika Amonkar, Meiling Chen, Eros Papademetriou, Ravi Potluri, David Rotter, Michael Butzner, Theodore Abraham
Journal: Circulation (2023)

Introduction: Data are limited on the complication burden of non-obstructive hypertrophic cardiomyopathy (nHCM). Hypothesis: Symptoms and complications increase the logistic and economic burden of nHCM. Aim: To assess pre vs post complication resource use and charges (per person per year [PPPY], in USD) for patients with nHCM. Methods: We used Symphony medical and pharmacy claims data from 2016-2021 to identify (by ICD-10 code) 18,011 adult patients in the United States with symptomatic (SYMP) or asymptomatic (ASYMP) nHCM. SYMP was defined as fatigue, chest pain, syncope, dyspnea, heart failure (HF), or palpitations within 3 months of index date; and complications as atrial fibrillation (AF)/flutter, ventricular fibrillation/tachycardia (VF/VT), supraventricular tachycardia, stress cardiomyopathy, HF, or heart transplant. Results: In SYMP vs ASYMP nHCM (n=9600 vs 8411), mean age was 63±14 vs 62±16 years ( p &lt;0.001), 49% vs 45% were female ( p &lt;0.001), and incidence of complications was 0.96 vs 0.39 per 1000 patient years ( p &lt;0.001; HR 0.44, 95% CI 0.40-0.48). For both groups, the most frequent complications were HF, AF and VT. In SYMP nHCM, complications increased inpatient (IP) admissions ( p &lt;0.001 ) and all-cause charges ($59,070 to $73,630 PPPY; p =0.006), without altering outpatient (OP) visits ( p =0.438) (Fig.). In ASYMP nHCM, complications increased IP admissions, OP visits (both p &lt;0.001), and all-cause charges ($22,711 to $66,053 PPPY; p &lt;0.001) (Fig.). For patients with SYMP vs ASYMP nHCM, incremental post complication charges were $14,560 vs $43,343 PPPY, p =0.007. Conclusions: In this study, patients with SYMP vs ASYMP nHCM were older, predominantly female, and had higher rates of complications. Irrespective of symptoms, complications were associated with increased IP admissions and charges. Our data highlight the value of complication prevention, especially for patients with ASYMP nHCM, for whom complications may steeply increase charges.
Abstract 11656: Relation Between Method of Indexation for Normal Chamber Dimensions and Association With Functional Measures: The Multi-Ethnic Study of Atherosclerosis
Authors: Jordan B Strom, Monica Mukherjee, Lauren Nelson, Benjamin H Freed, Julius Gardin, Jonathan Afilalo, Sanjiv J Shah
Journal: Circulation (2023)

Background: Normalization of echocardiographic chamber measurements for body surface area (BSA) may result in biased estimation of dimensions in obese or sarcopenic individuals. While alternative scaling systems that circumvent this issue have been proposed, there remains a dearth of information on normal values indexed to scaling parameters other than BSA and whether they vary by sex or race/ethnicity. Methods: Of 3032 individuals who underwent echocardiography at Exam 6 in the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 608 without apparent cardiopulmonary or cardiometabolic disease (69.5 ± 7.0 years, 46.2% male, 47.5% White). Normal values for left and right heart variables across a variety of ratiometric (BSA, body mass index [BMI], height) and allometric (height 1.6 , and height 2.7 ) scaling systems were defined as the mean value ± 1.96 standard deviations and compared across sex and race/ethnicity categories. In the broader cohort (N = 3032), we evaluated the correlation of indexed parameters and functional measures (NT-proBNP, 6-minute walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire [KCCQ]). Results: Height 2.7 had the best overall mean correlation with functional measures (mean correlation -0.12 ± 0.04 with KCCQ; mean correlation -0.15 ± 0.08 with 6MWD) and was superior to BSA for KCCQ and 6MWD (both p &lt; 0.001) but not NT-proBNP (both p &gt; 0.05). Mean correlations for allometric scaling were greater than ratiometric scaling for KCCQ and 6MWD (both p &lt; 0.001) but not NT-proBNP (both p &gt; 0.05). For 6MWD, mean correlations for allometric scaling (p = 0.001) but not ratiometric scaling (p = 0.8) were more negative (suggestive of impaired function) than unindexed measures. Conclusions: In this a multi-ethnic cohort of community-dwelling older adults free from apparent cardiopulmonary or cardiometabolic diseases, we provide normative indexed values for commonly measured echocardiographic parameters across a variety of indexation methods and show that they differ across sex and race/ethnicity categories. Allometric height 2.7 correlated best with functional measures and was superior to BSA. Current chamber quantification guidelines should be updated to reflect normative data on scaled parameters.
Abstract 11663: T Wave Alternans: A Clue in Plain Sight
Authors: Mohamed Gabr, Shaunak Mangeshkar, Luis Cerna, Kusha Rahgozar, Mustafa H Al-Taei, michael grushko
Journal: Circulation (2023)

Introduction: T-wave alternans (TWA) refers to the beat-to-beat variability in T-wave amplitudes or polarity on surface ECGs, and can signify susceptibility to malignant ventricular arrhythmias (VA). Aims: We present a case to emphasize the pathophysiology and clinical significance of this ECG finding. Case description: A 52 year-old female with history of HIV presents with shortness of breath and is treated for heart failure. In the ED, she has witnessed syncope and is found to have VT that progresses to VF. Resuscitation efforts are successful and include amiodarone loading. Figure 1A demonstrates baseline ECG on admission with a QTc of 495 ms. A few days later, an ECG reveals QTc of 696 ms with TWA (figure 1B). Shortly after, she develops polymorphic VT in the setting of long-short sequences and an R on T trigger (figure 1C) that is terminated with cardioversion. Review of pre-admission ECGs reveals that QTc prolongation occurred after initiation of a retroviral regimen that included rilpivirine and worsened with amiodarone. Both medications are discontinued, and she is eventually discharged with a QTc of 450 ms. Early theories for TWA's mechanism hypothesized that dispersion of refractoriness resulted in depolarization through alternating pathways and thus this phenomenon. Recent understanding further suggests that TWA occurs as a result of cellular alternans and variation in action potential duration due to dysregulation of repolarization. If discordant repolarization alternans ensues, whereby neighboring cells repolarize in opposite phases (long-short, short-long), the resultant repolarization gradient and heterogeneity in cellular repolarization serves as the substrate for VA; if a premature beat encounters refractory myocardium and unidirectional block occurs, a re-entrant excitation tachycardia can be initiated. Conclusions: TWA on ECG suggests myocardial electrical instability as a result of cellular repolarization inhomogeneity.
Abstract 11893: Efficacy and Safety of Ongericimab in Chinese Patients With Primary Hypercholesterolemia and Mixed Dyslipidemia
Authors: Xiaozeng Wang, Qiu Miaohan, Zhifeng Cheng, Xianyou Ji, Jiyan Chen, Hong Zhu, Yida Tang, Zhouqing Huang, Guohai Su, Gaopin Wang, Zhijun Huang, Zhuhua Yao, Jinxiu Lin, Yihong Sun, Shunhui Li, Cong Shao, Hui Yan, Yi Zhao, Xuelian Bai, shi wang, Han Yaling
Journal: Circulation (2023)

Background: Ongericimab, a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9), significantly reduced low-density lipoprotein cholesterol (LDL-C) levels in the phase 2 trial. A phase 3 trial was conducted to evaluate the efficacy and safety of ongericimab in Chinese patients with primary hypercholesterolemia and mixed dyslipidemia on background lipid-lowering therapy (LLT). Methods: This was a randomized, double-blind, placebo-controlled, 52-week trial conducted in China (NCT02662569). Eligible patients receiving stable statin (±ezetimibe) therapy but not achieving LDL-C goals were enrolled. Patients were randomly assigned in a 2:1:2:1 ratio to receive either ongericimab 150 mg or placebo subcutaneously every 2 weeks (Q2W), or ongericimab 300 mg or placebo subcutaneously every 4 weeks (Q4W) for 52 weeks. The primary endpoint was percent change in LDL-C from baseline to week 24. Results: A total of 806 patients were randomized, 802 patients received at least one dose of ongericimab or placebo. The least-squares (LS) mean difference between ongericimab and placebo in LDL-C from baseline to week 24 was -67.7% (95% CI: -72.49%, -62.99%; p &lt; 0.0001) in Q2W group and -61.2% (95% CI: -67.09%, -55.21%; p &lt; 0.0001) in Q4W group. LDL-C reductions were maintained to Week 52. Ongericimab also favorably altered other lipid parameters (Table 1). The overall incidence of adverse events was similar between ongericimab and placebo. Conclusion: Ongericimab on stable background LLT significantly reduced LDL-C and was well tolerated in Chinese patients with primary hypercholesterolemia and mixed dyslipidemia.
Abstract 12040: Acute-to-Chronic Assessment of Trajectory of Left Ventricular Ejection Fraction is Useful to Predict Long-Term Clinical Outcomes After Acute Myocardial Infarction
Authors: Goro Yoshioka, Atsushi Tanaka, Koichi Node
Journal: Circulation (2023)

Aims: To determine the prognostic impact of left ventricular ejection fraction (LVEF) trajectories from acute to chronic phase of acute myocardial infarction (AMI). Materials and methods: Among 2,266 consecutive patients admitted for AMI from February 2008 to January 2016, 1,330 survivors with LV ejection fraction (LVEF) ≥40% during hospitalization who had LVEF data at 6 months after AMI were analyzed. Patients were divided into three subgroups based on LVEF at 6 months: reduced-LVEF (&lt;40%), mildly-reduced-LVEF (≥40% and &lt;50%) and preserved-LVEF (≥50%). Occurrence of a composite of hospitalization for heart failure or cardiovascular death after 6 months of AMI was the primary endpoint. The prognostic impact of LVEF at 6 months on primary endpoint was analyzed with a multivariate-adjusted Cox proportional hazards regression model. Results: Overall, the mean age was 67.5 ± 11.9 years, and LVEF during index hospitalization was 59.4 ± 9.1%. The individual trajectories of LVEF from index hospitalization to 6 months was dynamically changed. The median (interquartile range) duration of follow-up was 3.0 (1.5-4.8) years, and the primary endpoint occurred in 35/1,330 (2.6%) patients (13/69 [18.8%] in the reduced-LVEF, 9/265 [3.4%] in the mildly-reduced-LVEF, and 13/996 [1.3%] in the preserved-LVEF categories). The adjusted hazard ratio for the primary endpoint in the reduced-LVEF vs. mildly-reduced-LVEF categories and in the reduced-LVEF vs. preserved-LVEF categories was 4.71 (95% confidence interval [CI], 1.83 to 12.13; p &lt;0.001) and 14.37 (95% CI, 5.38 to 38.36; p &lt;0.001), respectively (Figure). Conclusion: Late-onset LV systolic dysfunction was significantly associated with long-term outcomes after AMI. Our findings suggest that, even in AMI survivors without LV systolic dysfunction at the acute phase of AMI, reassessment of LVEF and careful monitoring of its trajectories is useful to predict long-term clinical outcomes.
Abstract 11930: Using Implementation Science to Develop a Familial Hypercholesterolemia Screening Program in Primary Care: The CARE-FH Study
Authors: Laney K Jones, Katrina M Romagnoli, Tyler J Schubert, Katarina Clegg, H Lester Kirchner, Yirui Hu, Dylan Cawley, Victoria Norelli, Marc S Williams, Sam S Gidding, Alanna Kulchak Rahm
Journal: Circulation (2023)

Introduction: Cholesterol screening in primary care is necessary to identify children and young adults with familial hypercholesterolemia (FH). Research question: What is the current state of FH screening and what barriers exist to screening? What implementation strategies informed by human centered design can be utilized to improve FH screening in primary care? Aim: We partnered with key stakeholders to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically usable strategies to be deployed as a package in the CARE-FH clinical trial. Methods: Data on the perspectives of primary care clinicians to implement an FH screening program were collected. Methods informed by implementation science and human centered design for data collections included: contextual inquiries, surveys, and deliberative engagement sessions. Results: Current screening for FH occurred rarely, and then only after a cardiovascular event or sometimes in primary care due to a family history of high cholesterol or early heart attack. Surveys of primary care clinicians suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers and facilitators to screening identified where improvement in FH screening and diagnosis could occur. Data from the current state and perspectives on FH screening were used to identify multilevel implementation strategies that were presented to and modified by clinician and healthcare stakeholders. This package of strategies was pilot tested in one primary care clinic and further refined to a final implementation strategy package to be tested in a geographical cluster randomized stepped wedge trial. Conclusion: We created an implementation strategy package to be deployed and evaluated in the CARE-FH clinical trial to improve FH awareness, identification, and initiate guideline-based care.