tbuckley/cabot-search huggingface dataset:
Abstract 17005: Racial Differences in Mortality in Patients With Severe Aortic Stenosis After Aortic Valve Replacement
Authors: Khendi T White Solaru, Zoran Popovic, Vidyasagar Kalahasti, Eric Roselli, Benico Barzilai
Journal: Circulation (2018)

Introduction: Aortic valve replacement (AVR) improves survival in patients with aortic stenosis (AS) or congenital bicuspid AV (BAV). To the authors’ knowledge, there are no studies that have examined racial differences in mortality after AVR for patients with severe AS or BAV. It is unknown whether AA patients undergoing AVR have worse outcomes and if they are impacted by confounding variables such as socioeconomic status. Hypothesis: We sought to identify clinical characteristics in African Americans (AAs) and Whites who had AVR for severe AS. We hypothesized that there would be significantly higher mortality in AAs that would diminish after adjusting for differences in socioeconomic status and prevalence of other clinical characteristics such as hypertension and LV hypertrophy. Methods: Retrospective analysis was performed on 10,299 AA or Caucasian patients with severe AS or BAV treated at Cleveland Clinic with primary AVR from 1/1/2000 to 1/1/2017. Short- and long-term survival was assessed non-parametrically by the Kaplan-Meier method in both the unadjusted and matched groups. We used a propensity score strategy to match the two groups on a multitude of clinical and socioeconomic variables which yielded 201 matched pairs. Results: Median follow-up for death was 3.86 years. AAs had significantly higher short- and long- term mortality in the unadjusted analysis (p&lt;0.001). After rigorous propensity matching, there was no significant differences between the groups (p=0.19). AAs were significantly more likely to have hypertension, diabetes, renal failure, CVA, and LVH. The biggest contributors to mortality in AAs according to our saturated model (C-statistic=0.93) were unemployment rate, poverty level, posterior wall thickness, degree of heart failure, LV mass, diabetes, preoperative creatinine, and hypertension, respectively. Conclusions: Our study is the largest of its kind and unique in its finding that African Americans have significantly higher mortality after AVR as compared to Caucasians but no significant differences after propensity matching. This suggests that the differences in mortality outcomes are largely driven by differences in socioeconomic status.
Abstract 16772: Gender Differences in the Presentation and Prognosis of Patients With Danon Disease
Authors: Michela Brambatti, Alessandro Maolo, Elliott Koshi, Matthew Taylor, Eric Adler
Journal: Circulation (2018)

Background: Danon Disease (DD) is a rare X-linked disorder with high morbidity and mortality. Clinical features include skeletal myopathy, hypertrophic cardiomyopathy (HCM), and neurologic symptoms. The first cases were described in 1981; however, gender differences are still poorly understood. Methods: From 773 manuscripts published from 2000-2017 in MEDLINE and EMBASE, we identified 180 cases. We included in the principal analysis 146 patients diagnosed with a genetic test (if index case) or muscle biopsy (if a relative of the index case). Results: Symptoms first occurred in males significantly earlier than females (median age 9 years vs. 23 p&lt;0.001). Cardiomyopathy occurred in 91% of patients, the majority of whom had HCM. Thirty-seven (25.3%) patients received automated cardiac defibrillators, as primary prevention in 64.9% of cases. Males with hypertrophy were twice as likely to develop advanced heart failure at a median age of 21 years. Conversely, dilated cardiomyopathy (DCM) was 4 times more prevalent in females (n=12, 75%) compared to males (n=3, 19%). Intellectual disability was significantly more frequent in males (53.9% males vs. 9% females with a median age of onset of 6 and 19, respectively, p=0.829). Abnormalities in the laboratory tests, such as AST, ALT or CK were described in 62.5 % of the population (83.3% of males and 15.6% female). Muscle myopathy was described in 64 (49%) cases - 57 (63.3%) males and 7 (12.7%) females- at a median age of 13 years and 19, respectively (p=0.826). Overall, 51 patients (34.9 %) died or required a left ventricular assist device (LVAD) or heart transplant (HTx). Median age at the time of death/HTx/LVAD was 26 years and 52 years in males and females, respectively (p &lt;0.001 by the log-rank test) (fig 1). Although not statistically significant, males were more likely to experience temporary complications after HTx compared to females (25% vs. 0%, p=0.136). Conclusions: Despite being an X linked disease, females with Danon have significant morbidity and a shortened lifespan. DCM is more prevalent in females, while HCM and post-Htx complications were more prevalent in males. Both genders had a prolonged survival as compared to prior studies, possibly reflecting increased awareness and earlier diagnosis.
Abstract 16721: Cardiovascular and Metabolic Risk Profile of Nonalcoholic Fatty Liver Disease Patients and Liver Transplant Recipients
Authors: Kyungeh An, Jeanne Salyer, Shadab Siddiqui
Journal: Circulation (2018)

Introduction: Cardiovascular disease (CVD) mortality is a growing concern in chronic liver disease (CLD) patients. Although prevention of CVD should target the whole spectrum of CLD, earlier CLD such as nonalcoholic fatty liver disease (NAFLD) vs. advanced CLD such as liver transplant recipients (LTR) may have different risk profiles. Yet, the differences in CVD and metabolic risk profiles between NAFLD and LTR patients have not been investigated. Hypothesis: We hypothesize that, between NAFLD and LTR patients, there are differences in (1) global CVD risk measured by Framingham Risk Score (FRS), (2) systemic inflammatory biomarker of hsCRP, and (3) metabolic risk factors, such as blood pressure (BP), glucose, lipid profile, and anthropometric indices including body mass index (BMI) and waist circumference. Methods: 27 adult LTR who exhibited no history or current CVD or rejection of transplantation were compared to 23 biopsy-confirmed NAFLD patients. Global CVD risk was calculated using the FRS equation. Plasma level of hsCRP, fasting glucose, lipid profile including total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), and triglycerides(TG) were analyzed using ELISA. Anthropometric analysis was conducted to assess obesity. Results: LTR compared to NAFLD patients had (1) lower FRS (7.15±6.15 vs. 15.88±11.39%, p&lt;0.001), (2) higher level of hsCRP (36.85±40.60 vs. 4.38±4.73 mg/L, p&lt;0.001), (3) higher systolic BP (132.48±15.18 vs. 123.30±11.24mmHg, p&lt;0.05) and diastolic BP (80.41±9.30 vs. 72.52±6.90 mmHg, p&lt;0.01), higher HDL in both men (46.20±14.72 vs. 38.50±3.62 mg/dl, p=0.044) and women (61.57±11.20 vs. 49.76±11.63mg/dl, p=.042). There were no differences between groups in metabolic dysfunction indices such as fasting glucose, TC, LDL, or waist circumference. Conclusion: The liver transplantation does not increase the global CVD risk or the metabolic risks. However, systemic inflammation and suboptimal BP indicate LTR at risk of CVD. Reducing obesity is critical target to both LTR and NAFLD patients. Maintaining BP at optimal level should be the target in LTR whereas improving lipid profile is critical in NAFLD to prevent CVD. Large scale study will inform clinicians with the specific targets of CVD prevention for patients in diverse phases on CLD spectrum.
Abstract 16729: Pressure Adjusted Heart Rate as a Predictor Ofadverse Outcomesafter Left Ventricular Assist Device Implantation
Authors: Bradley Ternus, Atta Behfar, John Schirger, Simon Maltais, Gregory Barsness, John Stulak, Jacob Jentzer
Journal: Circulation (2018)

Introduction: Baseline hemodynamic parameters have been shown to predict postoperative outcomes such as right ventricular failure (RVF) in LVAD patients. The pressure adjusted heart rate (PaHR) is a hemodynamic parameter that has not been reported in LVAD recipients. Hypothesis: Patients with an elevated PaHR at baseline will have an increased risk of adverse outcomes following LVAD implantation. Methods: Historical cohort study of 273 patients with preoperative invasive hemodynamic assessment before durable LVAD implantation from January 1 st , 2007 to April 10 th 2017. Baseline patient characteristics and hemodynamic parameters were assessed. The primary endpoint was a composite of 30 day mortality, stage 3 acute kidney injury (AKI), and postoperative RVF. Univariate analysis was used to identify predictors of the composite endpoint, which were entered into stepwise backwards multivariate logistic regression to determine independent predictors of the composite outcome. Results: The mean age was 59 and 79% of the patients were male. The median INTERMACS profile was 4 and 166 (60%) of LVADs placed were as destination therapy. The primary composite endpoint was reached by 74 (27%) patient, including 30-day mortality in 13 (5%), severe AKI in 48 (18%) and RVF in 53 (19%). Univariate predictors of the composite endpoint (p &lt;0.05) included atrial fibrillation, INTERMACS profile, home inotropes, preoperative IABP, admission creatinine, baseline Vasoactive-Inotropic Score, mean right atrial pressure (mRAP), mRAP/wedge, mean arterial pressure/mRAP, mean pulmonary artery pressure/mRAP, right ventricular stroke work index (RVSWi), pulmonary artery pulsatility index, and the PaHR. Logistic regression identified PaHR (OR 0.96, 95% CI 0.93-0.99, p=.026), RVSWi (OR 1.002, 95% CI 1.001-1.004, p=.002), home inotropes (OR 0.46, 95% CI 0.22-0.94, p=.034), atrial fibrillation (OR 0.48, 95% CI 0.26-0.88, p=.019) and admission creatinine (OR 0.51, 95% CI 0.34-0.77, p=0.002) as predictors of the composite endpoint. Conclusions: The PaHR is a readily available, novel hemodynamic parameter, that when elevated on baseline hemodynamic assessment can predict those patients at increased risk of postoperative adverse outcomes after durable LVAD implantation.
Abstract 16893: The Effect of a Nurse-Driven Program Utilizing Implantable Pulmonary Artery Pressure Monitoring to Reduce Hospitalizations in Low-Socioeconomic Urban Patients With Heart Failure
Authors: Charina F Alcain, Rahmana Aziz-Smith, Rhys Chua, Corey Tabit, Kirk Spencer
Journal: Circulation (2018)

Background: The hospitalization rate in patients with heart failure (HF) remains high despite advances in HF treatment. This is especially true in low-socioeconomic urban patients. While implantable pulmonary artery pressure monitors (such as the Abbott CardioMEMS) have been shown to reduce readmissions in highly-selected, overwhelmingly white and male cohorts, their efficacy in low-socioeconomic, urban, minority populations is not known. We hypothesized that a nurse-driven program utilizing the CardioMEMS device in addition to guideline-directed medical therapy could reduce hospitalizations in such patients with heart failure. Methods: At the University of Chicago Medical Center, 18 high-utilizing patients (84% non-white, 44% female) with NYHA Class III HF were implanted with a CardioMEMS following a hospital admission for HF. Data obtained from the CardioMEMS guided a specially-trained nurse in adjusting medications in order to relieve or prevent congestion. Enrolled patients were matched using 30 clinical and demographic variables with contemporaneous control patients with HF who received usual care. All patients had been followed at our center for at least 6 months and continued to receive well-established HF management including education, discharge phone calls, close clinic follow up, and use of evidence-based HF medications throughout the study period. Each patient’s hospitalizations were recorded and compared using Fisher’s exact test. Results: Among the 18 patients who received a CardioMEMS, there were 33 HF-related hospital admissions during the 6 months prior to CardioMEMS implantation. In comparison, there were 5 HF-related hospital admissions in the 6 months post-implantation, representing an 85% decrease in HF-related hospital readmission (p&lt;0.01). Additionally, 14 out of the 18 patients did not have any HF-related hospital admissions after device implant. Similarly, there were 35 all-cause admissions in the 6 months prior to implantation and only 18 admissions in the 6 months after implantation, a decrease of 49% (p&lt;0.01). Control patients had no significant change in HF-related or all-cause hospitalization. Conclusion: A nurse-driven CardioMEMS program significantly reduces HF-related and all-cause hospitalization rates among high-risk, low-socioeconomic, urban patients. Such a program can be used as an effective adjunct to other multidisciplinary interventions in this highly-vulnerable patient population.
Abstract 16878: Preoperative Risk Factors for Delayed Discharge Post Carotid End Arterectomy and Carotid Artery Stenting: Is There Variability Among Centers?
Authors: Anupama Vasudevan, Rosha Nodine, Kristyn Mannoia, William P Shutze
Journal: Circulation (2018)

Introduction: Patient and procedure related factors contribute to prolonged post-procedural length of stay (PLOS) in patients undergoing Carotid End Arterectomy (CEA) or Carotid Artery Stenting (CAS). Objective: Identify pre-procedural risk factors for a discharge later than the day following the procedure. We also explored if there was variability in the patient population and PLOS between the centers. Methods: Regional VQI data (SoVONet) from the Society for Vascular Surgery Patient Safety Organization was obtained; outlier centers were those with higher median PLOS than the rest. The independent risk factors were identified by logistic regression analysis. Results: A total of 4867 CEA subjects (14 centers, 2012-2017) were included. Median age was 71 (22-90), 59.6% were male, median PLOS (days) was 1 (0-38) for 12 centers and 2 (1-94) for centers 5 &amp;14 (outlier centers). Including all centers, 72.0% of subjects were discharged within one day while 28% stayed longer than a day post procedure. Differences in the independent risk factors were noted with and without including outlier centers (Table 1). Patients who underwent CEA at outlier centers were younger with higher proportion of non-whites and transferred from other hospitals. Burden of pre procedural dialysis and prior neuro events was higher, while COPD was lower among outlier centers. A total of 801 CAS patients (11 centers, 2012-2016) were included. Median age was 70 (22-90), 61.3% were male, median PLOS was 1 (0-16) day. Preop ambulation, hemoglobin levels prior CEA/CAS, transfer from another hospital were independent risk factors. However, “transfer from another hospital” was marginally significant when adjusted for centers, indicating a center influence. Conclusion: The risk factors for a delayed discharge were different for CEA and CAS. In addition, the patient population differed between the centers for CEA and this is to be taken into consideration when exploring for risk factors for delayed discharge.
Abstract 16689: Simultaneous Assessment of Cardiac Metabolism and Function Using PET/MR With Continuous FDG Infusion
Authors: Mary Grace Francheska Razalan, Ryan Centanni, Gregory P Barton, Alan B McMillan, Kara N Goss
Journal: Circulation (2018)

Background: We recently demonstrated the feasibility of simultaneous assessment of cardiac contractile function and metabolism in an animal model via positron emission tomography/magnetic resonance imaging (PET/MRI) with continuous 18 F-fluorodeoxyglucose ( 18 F-FDG) infusion. The aim of this study is to determine feasibility of utilizing continuous FDG infusion in human subjects to assess real-time response to cardiac stressors. Methods: Subjects underwent standard cardiac MRI while receiving continuous FDG infusion for 60 minutes, with the first 15 minutes in normoxia (FiO2 = 0.209) followed by 45 minutes in hypoxia (FiO2=0.12). Contractile response was measured via MRI analysis. For PET analysis, 3D regions of interest (ROIs) were drawn over the left ventricle, paraspinal muscles, right hepatic lobe, and blood pool. Average ROI values were extracted to develop time-activity curves, which were used to quantify the uptake (Ki) in each tissue of interest using Patlak Analysis (Figure 1). A paired t-test was used to compare changes from normoxia to hypoxia. Results: Hypoxia resulted in expected nonsignificant hemodynamic changes (Table 1). While skeletal muscle and liver showed significant decreases in glucose uptake during hypoxia, the myocardium did not demonstrate a significant shift in activity in this small sample size. Conclusion: Simultaneous PET/MR with continuous FDG infusion captures real time cardiac contractile activity and metabolism. Further investigation to refine this novel, noninvasive modality will be useful to study early shifts in cardiac metabolism and reserve, which may precede development of overt heart failure.
Abstract 16896: Risk Factors and Outcomes of Acute Limb Ischemia in Infants With Congenital Heart Disease
Authors: Robert A Swendiman, Jon G Quatromoni, Willian Quarshie, Heather Griffis, Scott M Damrauer, Maryam Y Naim
Journal: Circulation (2018)

Introduction: Acute limb ischemia (ALI) has been observed in infants with congenital heart disease (CHD). However, little is known about the demographics, clinical characteristics, and outcomes amongst these patients. Hypothesis: Infants with CHD with ALI are at significantly increased risk for adverse outcomes. Methods: We performed a retrospective cohort study of infants (&lt;1 year of age) admissions for CHD using the 2003-2012 KID databases from the Healthcare Cost and Utilization Project. ALI and associated risk factors, treatments, and outcomes were defined using ICD-9 codes. Survey weights were utilized to estimate U.S. population-based estimates. Chi-square tests were used to compare groups. P &lt; 0.05 indicated statistical significance. Results: We identified 368,398 observations of infants with CHD in the combined KID data, yielding an estimated average of 134,866 infant admissions per year for CHD in the U.S. Of these, 0.18% were diagnosed with ALI. The development of ALI was significantly associated with male sex (p = 0.0003) and single-ventricle CHD (p &lt; 0.0001). Arterial line placement (RR 1.9 [1.67, 2.23]), cardiac catheterization (RR 14.7 [12.88, 16.87]), extracorporeal membrane oxygenation (RR 6.0 [5.24, 6.86]), and cardiac surgery (RR 8.5 [7.46, 9.73]) each increased the risk of ALI (p &lt; 0.0001 for all). At least one of these procedures occurred in 73% of admissions with ALI as compared to 25% in admissions without ALI (p &lt; 0.0001). Therapy for ALI (other than anticoagulation) varied, with a total of 174 admissions (18.1%) undergoing thrombolysis (4.0%), endovascular (4.0%), or an open surgical (9.3%) procedure. Admissions with ALI had a longer median length of stay (25.8 vs. 6.1 days, (p &lt; 0.0001), and greater mortality (11.1% vs. 3.4%, p &lt; 0.0001). Conclusions: Risk of ALI in infant visits with CHD significantly increases with procedural interventions and is associated with a prolonged hospital course and a 3.2-fold risk of mortality.
Abstract 16675: Association Between Cardiovascular Risk Factors and Sedentary Behavior Prevalence: A Cross-Sectional Analysis of the National Health Survey-2013
Authors: Lucas Helal, Marlos R Domingues, Daniel Umpierre
Journal: Circulation (2018)

Introduction: Sedentary behavior (SB) independently increases the risk of CV disease, as well as of CV and all-cause mortality. However, it is still unknown how the prevalence of the detrimental amounts of SB is affected by CV risk factors prevalences. To do so, we aimed to estimate the association between the prevalences of traditional CV risk factors and television watching time ≥ 4 hours/day (TV4) in adults (≥ 18 years old). Hypothesis: We hypothesized that CV risk factors prevalences would be independently associated with the prevalence of TV4. Methods: This is an analysis of the 2013’s Brazilian National Health Survey. We sought to estimate how the prevalence of age ≥ 35 years old, obesity (BMI ≥ 30 kg/m 2 ), sleep disturbance episodes (SD) in the last two weeks, major depression (MD), hypertension (HYP) and diabetes mellitus (DM) diagnosis could be independently associated with TV4. A Poisson’s regression was carried out in 36,714 adults within a three-step level of predictors and TV4 to achieve the final model, as follows: age (1); BMI, SD and MD (2); HYP and DM (3). All the risk factors remained at the final. Also, a model with and without SD was also conducted to address its potential confounding role with the other risk factors. Prevalence ratios (PR) with 95% confidence intervals (95%CI - α=0.05). Whenever necessary, variables were dichotomized from their original categories. Age was originally collected as a continuous variable. Results: We found a TV4 prevalence of 15.65% (95%CI 15.37-15.95%). In our final model, all CV risk factors prevalences remained independently associated with TV4 prevalence. More specifically, age ≥ 35 years old was associated with a decrease in TV4 prevalence (PR 0.82, 95%CI 0.78-0.87), whereas obesity (PR 1.25, 95%CI 1.17-1.32), SD (PR 1.36, 95%CI 1.28-1.45), MD (PR 1.09, 95%CI 1.01-1.19), HYP (PR 1.16, 95%CI 1.09-1.24 and DM (PR 1.17, 95%CI 1.12-1.22) were associated with increasing. Moreover, when removing SD from the final model, the association between MD and TV4 was the only modified and increased (1.19, 95%CI 1.09-1.29). Conclusions: The prevalences of CV risk factors were independently associated with the detrimental amounts of SB. SD attenuated the RP between MD and TV4, leading us to speculate a potential role of SD in the attributable TV4 prevalence for MD. Our findings disclaim a potential risk factor loop scenario and reinforce the need to test whether the reduction of SB could reduce CV risk factors or not, including a special attention on SD, to better clarify any potential causal relationship among our studied risk factors.