tbuckley/cabot-search huggingface dataset:
Abstract 17423: The Conundrum of Oxygen Delivery in Redo Cardiac Surgery: Prognostic Implications and Interactions With Major Predictors
Authors: Antonio Pio Montella, Antonino Salvatore Rubino, Caterina Golini Petrarcone, Lucrezia Palmieri, Denise Galbiati, Luca Salvatore De Santo, Marisa De Feo
Journal: Circulation (2023)

Introduction: Nadir oxygen delivery index (DO2i) during cardiopulmonary bypass (CPB) is a known independent predictor of Acute Kidney Injury (AKI) after routine cardiac surgery. Little is known about its prognostic role in the setting of redo procedures. Hypothesis: To define if Nadir DO2i is predictive of renal malperfusion in redo setting. Secondary outcomes were cardiac morbidity (composite of intra-aortic balloon pump or extracorporeal membrane oxygenation, use of continuous high dose inotropic support for at least 24 hours or autopsy evidence of heart failure), stroke and hospital mortality. Methods: All 398 consecutive patients (mean age of 62.1 ± 12.2 years, octogenarians 5.6%, female sex 47.4%, diabetes 20.1%, chronic kidney disease 31.2%, urgent/emergent status 26.2%, third-time sternotomy 9.8%; EuroSCORE II 10.5±11.2%) referred for a redo procedure (January 2011-January 2021) to a single tertiary care, university affiliated center were analyzed. The reliability of NadirDO2i to predict AKI was ascertained with AUC. The best cut-off was determined with the Youden index. The odds to incur in any of the predetermined outcomes was investigated with binary logistic regression. Interaction with known predictors of AKI (preoperative anemia, preoperative chronic kidney disease, older age, emergency status, baseline pathology, EuroSCORE II, need for CPB before sternotomy, blood transfusion during cardiopulmonary bypass) was also investigated. Results: Acute Kidney Injury (any grade) developed in 41.2 % (Risk 17.5%, Injury 8.0%, Failure 15.7%); cardiac morbidity developed in 53.2%, perioperative stroke in 2.8%. In-hospital mortality averaged 17.1%. Best Nadir DO2i predictor of AKI-Failure was 274 ml/min/m2 (AUC 0.644; 68.9% and 60.6% sensitivity and specificity, respectively). Same cut-off predicted cardiac morbidity and hospital mortality (OR 2.200, 95%CI 1.462-3.311 p=0.0002, and OR 4.677, 95%CI 2.577-8.488 p&lt;0.0001, respectively). No interaction of Nadir DO2i emerged with predefined predictors. Conclusions: Nadir DO2i during cardiopulmonary bypass is independently associated with major postoperative morbidity and mortality in redo scenario and is not influenced by other nuances variables.
Abstract 16544: A Multicenter Validation of a Noninvasive Brachial Cuff-ECG System for Estimation of Elevated Left Ventricular End Diastolic Pressure
Authors: David Shavelle, Derek Rinderknecht, Weiwei Jin, W. Brian Chiu, Asia Krupa, Niema M Pahlevan, Kendra Cook, Farrell Mendelsohn, Thomas Cawthon, Ryan Reeves, richard mcnamara, Ryan D Madder, Hoang Nguyen, Sarah Elsayed, John Bahadorani, Daniel Lamont, Tae Y Yang, Steven R Bailey
Journal: Circulation (2023)

Introduction: Measurement of left ventricular end diastolic pressure (LVEDP) is an established diagnostic method to evaluate all types of heart failure (HF). Invasive measurement of LVEDP requires an in-hospital procedure which limits accessibility. A noninvasive technique for detecting elevated LVEDP would significantly improve the diagnosis of HF, particularly in the outpatient setting. Herein we present the results of a multicenter study to validate a noninvasive system to detect elevated LVEDP. Methods: The Vivio System includes a modified blood pressure cuff and single lead ECG to capture brachial artery waveforms to assess preload, afterload and contractility. A model was created to identify patients with elevated LVEDP (&gt; 18mmHg). 728 patients were enrolled from 7 medical centers in the USA. All patients were referred for coronary angiography and left heart catheterization for clinical indications. A group of 321 patients with no known significant health problems were enrolled as a control group. Invasive LVEDP measurements were conducted using Millar catheters. The control group was assumed to have a LVEDP = 10 mmHg. The training dataset (n = 262, mean age 45 ± 19 yrs; 54% male) contained 101 patients with LVEDP measurements (n = 44 with LVEDP &gt; 18 mmHg) and 161 controls. The validation dataset (n = 155, mean age 46 ± 21 yrs; 62% male) contained 75 patients with LVEDP measurements (n = 40 with LVEDP &gt; 18 mmHg) and 80 controls. Results: Leave-one-out cross-validation on the training dataset yielded a sensitivity of 0.84 (95% confidence interval (CI): 0.70 - 0.93) and a specificity of 0.84 (95% CI: 0.79 - 0.89). The validation dataset showed a sensitivity of 0.80 (95% CI: 0.64 - 0.91) and a specificity of 0.83 (95% CI: 0.75 - 0.90). Figure 1 shows the overall classification performance. Conclusion: The Vivio System can accurately detect elevated LVEDP and has the potential to significantly improve early detection of HF in the outpatient setting.
Abstract 16195: Burden of Mental Illness Among Hospitalization for Heart Failure in the United States - Nationwide Study
Authors: Jaspreet Kaur, Aditya Sharma, Francisco Flavio Costa Filho, Ibrahim Zahid, Tushar Mishra
Journal: Circulation (2023)

Introduction: There is limited data regarding the burden of severe mental health illness (SMI) among patients admitted with heart failure (HF) exacerbation. Hypothesis: We sought to determine the characteristics and outcomes of hospitalization for HF among patients with SMI in the United States. Methods: A retrospective analysis of the National Inpatient Sample database from January to December 2019 was done to identify HF hospitalizations. SMI was defined by ICD10-CM codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, and depression. Using logistic regression, we assessed the odds of in-hospital mortality and use of invasive ventricular support device. Results: Out of 1,295,395 hospitalizations with heart failure were identified from January to December 2019, 13.4% had a diagnosis of SMI. Most common SMI was depression (11.6%), followed by bipolar disorder (1.3%), and schizophrenia (0.7%). Patients with SMI were younger (mean age 68 vs 71 years, p&lt;0.05), more likely to be women (58% vs 45%, p&lt;0.05), and more likely to have diabetes, chronic pulmonary disease, hypertension, dyslipidemia, and obesity. The adjusted odds of in-hospital mortality in patients with SMI was 13% lower than those without SMI (OR 0.87, 95% CI, 0.79 - 0.96, P=0.004). Patients with SMI had 26% lower odds (OR 0.74, 95% CI, 0.59 - 0.93, P=0.009) to receive an invasive ventricular support device (IABP, PVAD, LVAD, or ECMO) than those without SMI. Conclusions: Patients with SMI were younger and carried a higher burden of comorbidities. We found a lower short-term risk mortality in patients with SMI and HF exacerbation.
Abstract 14313: A Proteomic Atlas of Human Coronary Artery Reveals the Pathological Progression of Atherosclerosis
Authors: Xinjie Xu, Liang Chen
Journal: Circulation (2023)

Introduction: The key molecular mechanisms associated with human atherosclerotic plaque progression, atherosclerotic lesion initiation and plaque destabilization are not fully understood. Hypothesis: Different stages of atherosclerosis (AS) progression have distinct pathological processes. Some key proteins induce AS progression. Methods: We employed 20 coronary artery samples among 4 explanted hearts from coronary heart disease patients. Each heart contains stages of unaffected control (NC), pathological intimal thickening (PIT), fibroatheroma (FA), transition to thin-cap fibroatheroma (TCFA) and ruptured plaque (RP), which were validated by hematoxylin and eosin (H&amp;E) staining. We performed quantitative proteomics in each of the samples based on tandem-mass-tags and liquid chromatography-tandem mass spectrometry. Furthermore, we measured proteins in human coronary artery tissue via immunofluorescence. Results: Proteomics revealed that extracellular matrix (ECM) organization was the most significantly enriched pathway in PIT. FA exhibited an enrichment of immunologic processes, such as neutrophil degranulation, myeloid leukocyte activation and innate immune response. Molecular profiles of TCFA and RP are similar, with complement and coagulation cascades pathway as a hallmark of these stages. Clustering analysis of DEPs displayed 4 clusters, notably cluster 2 had a precipitous elevation from FA to TCFA. Within this cluster, we identified a high-rank molecule: macrophage-capping protein (CAPG). Immunohistochemistry and immunofluorescence revealed that CAPG is highly elevated in plaque compared to NC and is specifically expressed in the plaque. Conclusions: ECM organization was continuously dysregulated in AS progression. Immune response might initiate the atherosclerotic plaque. Complement and coagulation cascades pathway was a hallmark of TCFA and RP. CAPG might be a therapeutic target for AS progression.
Abstract 14879: Stroll in Style: Rocking the MCS Catwalk!
Authors: Anju Bhardwaj, siavosh saatee
Journal: Circulation (2023)

Introduction: Patients who present with cardiogenic shock may require temporary mechanical circulatory support (tMCS) devices in the ICU. Hypothesis: Physical therapy (PT) and rehabilitation is associated with improved outcomes. But literature investigating the feasibility and safety of mobilization in patients on tMCS is limited. Methods: In this survey-based study, we examined various practice patterns in ambulating patients supported on tMCS globally. We received 93 responses of which 73 (80.22%) were from United States. Results: 82 programs believed that mobilization improved outcomes in these patients. Of these 81 programs (87.1%) ambulate patients supported on tMCS, but only 61 programs (65.59%) have an MCS trained physical therapist ambulating patients on tMCS. 72 programs (77.42%) reported staffing issues as a limiting factor in mobilizing these patients. (Figure 1) 82 programs (88.17%) would change the cannulation site for more convenient patient mobilization. 59 (63.44%) programs reported complications associated with mobilization which included device/cannula dislodgement, pump malfunction, bleeding, hemolysis, etc. (Figure 2) Only 41 programs (44.1%) have a guideline or protocol to ambulate these patients. Conclusions: We conclude that current state of PT in patients on tMCS is suboptimal and needs a uniform standardized protocol. Most programs need an experienced physical therapist to facilitate mobilization of these patients. We also outlined various patient and device related factors which can improve mobilization and outcomes in these patients. More studies are needed to assess impact of mobilization on outcomes and length of stay.
Abstract 18850: Impact of Intravascular Imaging-Guided versus Coronary Angiography-Guided Percutaneous Coronary Intervention on Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Farah Yasmin, Kinza Jawed, Abdul Moeed, Omer Hassan, Saad Ur U Rahman
Journal: Circulation (2023)

Background: Intravascular imaging (IVI) namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), presents as a promising imaging modality for drug-eluting stent (DES) implantation compared to the gold-standard conventional two-dimensional angiography. IVI provides detailed information on vessel lumen, lesion length, and degree of calcification. For this purpose, we conducted a meta-analysis by pooling recently conducted randomized control trials (RCTs) to compare IVI with angiography for DES implantation. Hypothesis: IVI is associated with a significant reduction in CV events for DES implantation. Methods: Fourteen RCTs reporting CV outcomes with IVI versus angiography-guided stent implantation in CAD patients undergoing PCI were included in MEDLINE, and Scopus databases (Inception till May 2023). The primary outcome of interest was target-lesion revascularization (TLR). The outcome measures were summary random effects risk ratio (RR) with 95% confidence intervals. Results: A total of 8,946 patients (IVI 4,751 vs. angiography 4,195; mean age 61.7 years) were included. Over a median follow-up of 15 months (12-24.3), IVI was associated with significantly reduced TLR (RR 0.63 [0.49, 0.79]; Figure 1), target vessel revascularization (RR 0.66 [0.53, 0.83]), and major adverse cardiovascular events (MACE) (RR 0.69 [0.58, 0.78]) vs. conventional angiography for PCI. However, no significant difference was observed in all-cause mortality between the two imaging modalities (RR 0.85 [0.63, 1.15]). Meta-regression analysis showed no significant impact of follow-up duration, baseline comorbidities such as hypertension, smoking status, previous myocardial infarction, and stent length on TLR incidence. Conclusion: IVI was associated with improved CV outcomes in terms of reduced TLR, TVR, and MACE incidence when compared with traditional angiography in CAD patients for stent implantation.
Abstract 16446: The Emergency or Non-Referral Admission Was Associated With the Poor Outcome in Adults Hospitalized for the Treatment of Severe Coronary Sequelae Following Kawasaki Disease: Analysis of the Nationwide Claim-Based Dataset From Japanese Registry of All Cardiac and Vascular Diseases- Diagnosis Procedure Combination
Authors: Yoshihide Mitani, Etsuko Tsuda, Toshihiro Tamura, Yasutsugu Shiono, Michikazu Nakai, Hiroyoshi Yokoi
Journal: Circulation (2023)

Introduction: Kawasaki disease (KD), first reported in 1967, is a risk for ischemic heart disease if complicated by coronary sequelae. However, limited information is available regarding the follow-up status and outcomes of adults hospitalized for severe coronary sequelae resulting from KD. Hypothesis: We hypothesize that emergency or non-referral admission is related to poor outcomes in adults with KD hospitalized for severe coronary sequelae. Methods: Using a nationwide claim-based dataset from Japan, we analyzed adult patients (aged 15 and above) with KD diagnosed according to ICD10 codes, who were hospitalized for the treatment of coronary artery sequelae between April 2013 and March 2020. Treatment groups included acute coronary syndrome (ACS), catheter intervention (PCI), coronary artery bypass grafting (CABG), or the heart failure/arrhythmia group (patients treated for heart failure or arrhythmia, excluding those in the other three groups). ACS was diagnosed based on ICD-10 codes, while other diagnoses were determined using specific procedures. Results: The study comprised 850 patients, predominantly male (74%), with a median age of 34 years (IQR:20-43) and a median body mass index of 22.5 (IQR:20.0-25.4). They were divided into four groups: ACS (n=112), PCI (n=86), CABG (n=92), and the heart failure/arrhythmia group (n=560). The overall patient cohort had emergency admissions (27%) and non-referral admissions (13%), as well as heart failure (46%) and arrhythmia treatment (84%). Outcome measures included intensive care unit care (24%), median hospitalization duration of 4 days (IQR:3-13), total hospital deaths (1%), and median direct medical fees (4932600 Japanese yen). A higher percentage of emergency or non-referral admissions in the ACS or the heart failure/arrhythmia group correlated with unfavorable outcome parameters (p&lt;.05). Conclusions: The present nationwide claim-based dataset study of adults hospitalized for severe coronary sequelae following KD, characterized by young males with normal BMI, showed that emergency or non-referral admission is associated with poor outcomes in the ACS and heart failure/arrhythmia groups. These findings support the importance of healthcare transition for such patients with KD.
Abstract 13609: Racial Disparities and In-Hospital Outcomes of Atrial Fibrillation Ablations in Hypertrophic Cardiomyopathy: A 5-year Nationwide Inpatient Sample Analysis
Authors: Spandan Desai, Nicholas Roma, Kashyap Shah, Shiv Dixit, Michael Durkin
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is a common supraventricular arrhythmia observed in patients with hypertrophic cardiomyopathy (HCM). However, there is a dearth of data regarding racial disparities and in-hospital outcomes specifically among HCM patients undergoing AF ablation. Methods: National Inpatient Sample database from 2016 to 2020 was queried for patients with HCM undergoing AF ablation using appropriate diagnostic and procedural ICD codes. These were further divided into African American (AA) and non-African American (non-AA) groups. Logistic regression was used to compare baseline characteristics and in-hospital outcomes. Results: A total of 610 HCM patients underwent AF ablation between 2016-2020. Out of these, 45 (7.4%) were AA. Compared to non-AA patients, AA patients undergoing AF ablation were younger (mean age: 61-vs-64 years), more often female (56%-vs-54%, p=0.28) and had a higher burden of comorbidities (Table 1). AA patients had lower length of stay (4.1-vs-4.7 days, p=0.008) and total hospital cost ($113,564-vs-158,904, p&lt;0.001). The AA group had a higher prevalence of hypertension (44.4% -vs- 36.3%, p&lt;0.001), obstructive sleep apnea (55.6% -vs- 21.2%, p&lt;0.001), heart failure with reduced ejection fraction (22.2% -vs- 3.5%, p&lt;0.001), alcohol use (11.1% -vs- 0.9%, p&lt;0.001) and class I obesity (11.1% -vs- % 6.2%, p&lt;0.001). This group also had higher in-hospital mortality (11.0% -vs- 0.9%, p&lt;0.001) and worse in-hospital outcomes including acute pericarditis, cardiogenic shock, and requiring mechanical ventilation (Table 1). Conclusions: Despite lower length of stay and hospital cost, AA patients with HCM that underwent AF ablation had higher in-hospital mortality and complications compared to non-AA patients. These observed disparities warrant further research to gain a deeper understanding of the underlying factors contributing to these outcomes.
Abstract 16196: E/e' Predicts Exercise Capacity in Participants Undergoing Exercise Stress Test
Authors: Pooja Patil, Emily Lin, ADAM PURVIS, Kara Harrison, Kevin Toy, Amit Patel, Kenneth Bilchick, Nishaki M Mehta, Khadijah Breathett, Younghoon Kwon, Sula Mazimba
Journal: Circulation (2023)

Introduction: The ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (e’) is a surrogate for left ventricular (LV) filling pressure. Post-stress E/e’ has been shown to predict exercise capacity, but few studies have investigated this correlation with baseline E/e’. Our aim was to evaluate the relationship between baseline E/e’ and exercise capacity during stress test. Methods: All patients undergoing exercise stress testing at University of Virginia from 1/2015 through 9/2015 with the required echo data were included in this study. E/e’ was categorized into quartiles. ANOVA was used to evaluate the relationship between quartiles of E/e’ and exercise duration or METS. Multivariate linear regression was used to adjust for the variables: age, sex, ejection fraction, systolic blood pressure, heart rate, and regional wall motion abnormalities. Results: Baseline characteristics of the 312 participants based on E/e’ quartiles are shown in Table 1; those with higher E/e’, on average, had higher baseline SBP, were older, and had a higher percentage of females. There was a significant difference in exercise duration and METS between E/e’ quartiles (Table 2A) [p &lt; 0.001]. There was an inverse correlation between E/e’ and exercise capacity; the significance was more pronounced with increasing E/e’ (Table 2A) and was present even after adjusting for multiple covariates (Table 2B). Conclusions: Baseline E/e’ correlates with exercise capacity (both duration of exercise and total METS achieved). This suggests that elevated LV filling pressures at rest can predict exercise capacity and may be targeted in future studies to improve exercise tolerance.
Abstract 15954: The Impact of Lipid Rich Plaque on Microvascular Dysfunction Evaluated by Angiography-Derived Index of Microcirculatory Resistance After Percutaneous Coronary Intervention
Authors: Nobuhiro Yamada, Masafumi Ueno, kakehi kazuyoshi, Kyohei Onishi, Gaku Nakazawa
Journal: Circulation (2023)

Introduction: Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction (PMI). Microcirculatory resistance index using pressure wires (invasive IMR) has been used to assess microvascular dysfunction, but recently angiography-derived microcirculatory resistance index (IMRangio) as a noninvasive method has received increasing attention. There have been few reports examining the relationship between noninvasive IMR and LRP assessed by near-infrared spectroscopy (NIRS). The purpose of this study was to investigate the impact of LRP assessed by NIRS on noninvasive IMRangio before and after PCI. Hypothesis: The purpose of this study was to investigate the impact of LRP assessed by NIRS on noninvasive IMRangio before and after PCI. Methods: We retrospectively evaluated consecutive patients admitted for coronary artery disease without ST elevated myocardial infarction (STEMI) who underwent coronary angiography at our hospital from November 2021 to January 2023. We analyzed 50 patients who performed NIRS before and after PCI and IMRangio available. The maximum value of LCBI for any of the 4-mm segments at the culprit lesion (maxLCBI4mm) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit maxLCBI4mm ≥600. On the other hand, the value of IMRangio in culprit vessels was evaluated before and after PCI. The IMRangio values were compared between those two groups. Results: Mean pre-maxLCBI4mm was 529±260 and mean pre and post-PCI IMRangio were 17.5±9.00 and 22.1±10.2, respectively. Mean ΔIMRangio (=IMRangio after PCI–IMRangio before PCI) was 4.63±9.34. ΔIMRangio values were significantly higher in patients with high maxLCBI4mm than in those with low maxLCBI4mm (7.46±1.74 vs 2.23±1.74, P=0.047).The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high maxLCBI4mm group (52.2% vs. 22.2%, p=0.027). Furthermore, patients with elevatedΔIMRangio were significantly more likely to have a maxLCBI4mm ≥ 600 (59.3% vs. 87.0%, P=0.025). Conclusions: IMRangio is a valid alternative to invasive IMR to detect microvascular dysfunction in patients with lipid rich plaque assessed by NIRS.
Abstract 14684: Ambulatory Electrocardiogram for Mortality Risk Stratification in Arrhythmic Mitral Valve Prolapse
Authors: Andrew Cesmat, Abdul Chaudry, Suhani Gupta, Thelsa Weickert, Ross J Simpson, Faisal Syed
Journal: Circulation (2023)

Introduction: Mitral valve prolapse (MVP) has been associated with sudden death. There is little data on whether ambulatory ECG monitoring can be used to better define risk. Hypothesis: Severity of ventricular arrhythmia (VA) on ambulatory ECG is associated with mortality in MVP patients. Methods: We studied patients aged 18 - 90 years with MVP on echocardiography between 2016-19 at our institution who underwent ambulatory ECG monitoring. Ambulatory ECGs were reviewed for PVC burden and rate of non-sustained ventricular tachycardia (NSVT). VA severity was classified as none (PVC&lt;1% and no NSVT), mild (PVC&gt;1% or NSVT&lt;120 beats per minute [bpm]), moderate (NSVT 120-179 bpm) and severe (NSVT≥180 bpm). Kaplan-Meier survival analysis was used to assess whether VA severity is associated with mortality. Results: Holter monitoring was performed in 188 (29.5%) of 637 MVP patients. None, mild, moderate and severe VA was present in 91 (48.4%), 27 (14.4%), 56 (29.8%) and 14 (7.5%), respectively. On multivariate analysis of clinical and echocardiographic features, only bileaflet prolapse was associated with moderate to severe VA (odds ratio [95% CI], 2.10 [1.05-4.16, p=0.03). After a median (IQR) follow-up of 33 (19-46) months, 8 (4.2%) died. VA severity was positively associated with mortality (p=0.0189). Conclusions: Ventricular arrhythmia is frequently present in MVP. Increased severity of ventricular arrhythmia on ambulatory monitoring portends a worse prognosis in MVP patients. Ambulatory ECG monitoring should be considered for risk stratification in MVP patients.