tbuckley/cabot-search huggingface dataset:
Abstract 4147601: Associations between Accelerated Aging Phenotypes with Cancer-Specific and Cardiovascular-Specific Mortality in Long-Term Cancer Survivorship
Authors: Britton Scheuermann, Carl Ade
Journal: Circulation (2024)

Background: The consequences of cancer and anti-cancer treatments are often described as representing an “accelerated aging” phenotype. However, little is known about how the “accelerated aging” phenotype affects mortality risks in long-term cancer survivors. Purpose: To investigate the association between accelerated aging phenotype and cause-specific mortality in a sample of long-term cancer survivors Methods: Data for cancer survivors (CS) were extracted from the National Health and Nutrition Examination Survey between the years 1999-2010. Participants missing vital data and those diagnosed with multiple cancers, childhood cancers, cancer within the previous 5 years, or skin cancer were excluded. Mortality outcomes were collected from the National Death Index through December 2019. The Phenotype Age score was derived from blood biochemistry measures such as albumin, creatinine, and c-reactive protein. Accelerated Aging (AA) was defined as a Phenotype Age greater than the participants’ chronological age. CS were grouped by time since diagnosis: 5-10, 10-15, 15-20, and ≥20 years. Within each group, hazard ratios (HR) were derived from competing-risk hazard regression for the AA phenotype association with cancer-specific and cardiovascular-specific mortality. Regressions were modeled with participant age as the time-scale to account for the predictive nature of chronological age. Results: A total of 875 CS (65.6±12.9 years, 62% female, 31% non-white, 15.6±9.4 years from cancer diagnosis) were included. The most common cancer types were prostate (16%) and breast (21%) cancer. There were 107 cancer and 113 cardiovascular deaths over a 10.8±4.6 year follow-up. The AA phenotype was significantly associated with cardiovascular-specific mortality in each survivor group (all p&lt;0.05). Conversely, the AA phenotype was only significantly associated with cancer-specific mortality in the 5-10 years of survivorship group (p=0.01). Results are displayed in Figure 1, along with cubic splines fit to the HR of each survivorship group. Conclusions: Present results suggest that the AA phenotype may demonstrate time-dependent associations with cancer-specific and cardiovascular-specific risks, two leading causes of death in CS.
Abstract 4140140: Cardiology Follow-Up as a Determinant of LDL-C Management Success in Secondary Cardiovascular Prevention
Authors: Surik Sedrakyan, William Laband, Bilawal Nadeem, Uyen Lam
Journal: Circulation (2024)

Managing low-density lipoprotein (LDL) cholesterol is crucial for secondary cardiovascular prevention. Despite ACC/AHA recommendations for maintaining LDL below 70 mg/dL, achieving this target remains suboptimal. This study investigates the impact of consistent cardiologist involvement on LDL cholesterol management. Methods: We conducted a multicenter, cross-sectional cohort study within the Steward Healthcare System in Massachusetts, analyzing data from 10,211 patients hospitalized from January 2019 to March 2024. This study offers a detailed snapshot of data across the study period, capturing both recent and long-standing cases identified through ICD codes for conditions like NSTEMI, CAD, STEMI, or CABG, specifically as markers for secondary cardiovascular prevention. We utilized the most recent LDL cholesterol measurements for our analysis and compared the distribution of lipid-lowering medications across groups. Notably, follow-ups with cardiologists outside our network were not tracked, potentially omitting relevant data. Statistical analysis employed the Chi-square test for categorical variables and binary logistic regression to adjust for confounders. Results: showed that patients with regular cardiology visits more often achieved LDL levels below 70 mg/dL (57.45% vs. 46.67%; OR 1.54, 95% CI: 1.42-1.68; P&lt;0.0001). These patients also had lower mean LDL levels (68.72 ± 27.02) compared to those without cardiology follow-up (75.82 ± 30.27; P&lt;0.0001). Higher usage of PCSK9 inhibitors and non-statin medications was noted among the visiting group, with an adjusted OR of 1.43 (95% CI: 1.29-1.59; P&lt;0.0001). Conclusion: Our study shows that cardiologist involvement significantly enhances cholesterol management in CAD patients, as evidenced by a higher proportion achieving optimal LDL levels and more aggressive use of lipid-lowering medications. Despite these benefits, some patients discontinue their follow-ups with cardiologists after coronary events, shifting cholesterol management to primary care providers (PCPs). This transition often results in less aggressive treatment strategies, evidenced by elevated LDL levels in patients lacking recent cardiology care. To sustain effective cholesterol management and stringent LDL targets, long-term follow-up with a cardiologist is crucial. Furthermore, equipping PCPs with the necessary tools and protocols to adopt more aggressive treatment approaches could bridge the care gap when specialist visits are infrequent.
Abstract 4144597: Cardiovascular Health Among Youth with Neurodevelopmental Disability: Analysis of National Survey of Children's Health (NSCH) – 2021
Authors: Carissa Baker-Smith, Zugui Zhang, Shannon Robson, Freda Patterson, Benjamin Brewer, Jung-Mei Tsai, Anjana Bhat
Journal: Circulation (2024)

Introduction: The National Survey of Children's Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD). Hypothesis: Youth with NDD are more likely to have poor CVH status compared to non-NDD youth. Methods: We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD. Results: 12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3, p &lt;0.0001 ), smoking/exposure (94.5 vs. 90.7, p&lt;0.0001 ), diabetes mellitus (95.2 vs. 90.2, p &lt;0.0001 ), obesity (80.0 vs. 73.2, p &lt;0.0001 ), a heart condition (95.4 vs. 93.8, p=0.021 ), or dyslipidemia (98.1 vs. 95, p&lt;0.0001 ). Overall CVH status was (93.9 vs. 91.0, p&lt;0.0001 ) among non-NDD vs NDD participants. NDD participants had a greater odds of having a heart condition (OR=1.91, 95% CI: 1.51-2.42) and poor CVH status (OR=1.53, 95% CI: 1.45-1.62). Propensity score matching showed similar results. Conclusions: Neurodevelopmental disability is associated with poorer CVH status in youth. Efforts to improve CVH status in youth should include greater focus on youth with NDD.
Abstract 4148089: Comparative Efficacy of Carvedilol versus Metoprolol in Patients with Implantable Cardioverter Defibrillators and Ventricular Arrhythmias: A Systematic Review and Meta-Analysis
Authors: Ahmed Ali, Marwan Ahmed, Karim Ali, Mohamed Awad
Journal: Circulation (2024)

Background: Ventricular arrhythmias are major causes of morbidity and mortality in patients with cardiovascular disease. Implantable cardioverter-defibrillators (ICDs) are commonly used to prevent sudden cardiac death in these patients. However, patients with ICDs frequently experience recurrent arrhythmias and inappropriate shocks, which can impact their quality of life. Beta-blockers, specifically carvedilol and metoprolol, are commonly prescribed to manage these arrhythmias. This meta-analysis aims to compare the impact of both medications in this patient population. Methods: A comprehensive literature search was conducted to identify relevant studies comparing carvedilol to metoprolol in patients with ventricular arrhythmias or ICDs. Study outcomes included all-cause mortality, recurrent ventricular arrhythmia, and inappropriate ICD shocks. Effect estimates are presented as hazard ratios (HR) with 95% confidence intervals (CI). Results: 1,453 studies were identified through database search. After full-text screening, a total of 5 studies involving 9,292 patients were included. We found no significant difference in the incidence of recurrent ventricular arrhythmias between carvedilol and metoprolol (HR = 0.99, 95% CI [0.75, 1.32], P = 0.97). Additionally, Carvedilol showed a trend toward reduction of all-cause mortality (HR = 0.83, 95% CI [0.68, 1.03], P = 0.09). On the other hand, Carvedilol was associated with a statistically significant reduction of inappropriate ICD shocks (HR = 0.61, 95% CI [0.48, 0.78], P &lt; 0.001). Conclusion: Carvedilol may offer additional benefits over metoprolol in managing patients with ventricular arrhythmias or ICDs, particularly in minimizing the incidence of inappropriate ICD shocks. However, no significant difference was found in terms of all-cause mortality and recurrent ventricular arrhythmia incidence. Further research is needed to confirm these findings and guide clinical decision-making.
Abstract 4119517: Association of Systemic Inflammatory Response Syndrome with Cardiovascular Events after Mitral Transcatheter Edge-to-edge Repair
Authors: Carlo Mannina, Akarsh Sharma, Andreina Carbone, Eduardo Bossone, Antonino Tuttolomondo, Edgar Argulian, Eric Neibart, Jonathan Halperin, George Dangas, Samin Sharma, Annapoorna Kini, stamatios lerakis
Journal: Circulation (2024)

Background: Systemic inflammatory response syndrome (SIRS) following cardiovascular interventions is associated with adverse events during hospitalization and follow-up. Mitral transcatheter edge-to-edge repair (M-TEER) is increasingly utilized for treatment of mitral regurgitation (MR). Hypothesis: It is unknown whether SIRS following M-TEER may occur and be associated with adverse clinical outcomes. Goals: to investigate the frequency and impact of SIRS following M-TEER on major cardiovascular events (MACE) and MR recurrence. Methods: A total of 158 consecutive patients with severe MR undergoing M-TEER were studied. SIRS was defined by leukocytosis (≥12×10 9 /L) and fever (T≥38 °C) within 48 hours after intervention. Baseline inflammation was measured by absolute neutrophil and lymphocyte counts and neutrophil: lymphocyte ratio (NLR). The primary endpoint of MACE was the composite of non-fatal myocardial infarction (MI), non-fatal stroke, and all-cause death. Recurrent MR at follow-up was also recorded. Results: The mean patient age was 80.8±8.8 years. 44 (27.9%) developed SIRS. NLR correlated with onset of leukocytosis and fever (p=0.04). During a median follow-up of 12.5±8.2 months, the primary endpoint occurred in 27 (17.1%) patients (6 MI, 5 strokes and 16 deaths). Patients with SIRS more often had severe MR (79.5% vs. 62.7%, p=0.02) and adverse left ventricular (LV) remodeling indicated by lack of reduction in end-diastolic diameter (LVEDD) at follow-up (p=0.12 for SIRS-patients vs. p=0.0012 for non-SIRS patients). After adjustment for pertinent variables, SIRS (HR 3.24, CI 1.13-9.31, p=0.03) was independently associated with MACE. Conclusion: SIRS after M-TEER is a strong independent predictor of MACE. Closer follow-up is warranted as patients with SIRS have more severe MR and unfavorable LV remodeling at follow-up.
Abstract 4140168: Association of left and right branch blocks with clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF)
Authors: Sukhila Reddy, Vishwajeet Singh, Alok Dwivedi, Debabrata Mukherjee, abhizith deoker
Journal: Circulation (2024)

Background: Although left (LBBB) and right (RBBB) bundle branch blocks play a critical role in cardiovascular pathogenesis, the associations of LBBB and RBBB with cardiovascular (CV) outcomes, especially in patients with HFpEF is understudied compared with normal QRS. Aim: We assessed clinical outcomes of LBBB and RBBB in patients with HFpEF who were admitted for acute decompensated heart failure compared with those without bundle branch blocks. Method: A cross-sectional study was conducted using the National Inpatient Sample (NIS) database from 2019. We only included adult hospitalizations with HFpEF admitted for acute decompensated heart failure in the study. Hospitalized records were categorized into three groups (LBBB, or RBBB, and those with normal QRS). Clinical outcomes included atrial fibrillation (AF), ventricular fibrillation (VF), complete heart block (CHB), sick sinus rhythm (SSR), cardiac arrest (CA), length of stay (LOS) and in-hospital mortality. Propensity score (PS) inverse probability of treatment weighting and matching were applied to determine the association between BBB types and CV outcomes and validated associations in sensitivity analyses. Results: A total of 334511 hospitalizations with HFpEF included LBBB (6818, 2%) and RBBB (7948, 2.4%) were analyzed. Compared to normal QRS, LBBB was associated with VF (odds ratio [OR]=2.47, p&lt;0.001), SSR (OR=1.72, p&lt;0.001), CHB (OR=2.77, p&lt;0.001) and longer LOS (relative risk [RR]=1.15, p&lt;0.001) after adjusting for covariates in PS analysis. Similarly, RBBB was associated with AF (OR=1.30, p&lt;0.001), VF (OR=1.59, p=0.033), SSR (OR=1.72, p&lt;0.001), CHB (OR=2.81, p&lt;0.001), CA (OR=1.19, p&lt;0.001), and longer LOS (RR=1.08, p&lt;0.001) [Table 1]. These associations remained consistent in multiple validation analyses including after additionally adjusting for obesity, hypertension and diabetes. Conclusion: In hospitalized records with acute decompensated HFpEF, BBB was associated with increased risk of CV outcomes and longer hospital length of stay. The extent of association with multiple CV outcomes varied according to RBBB and LBBB.
Abstract 4139177: Five-Year Clinical Outcomes of Balloon-Expandable versus Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Small Aortic Annulus
Authors: Shubhadarshini Pawar, Vivek Patel, TAKASHI NAGASAKA, Jair Basantes, Prateek Madaan, Justin Markel, Ofir Koren, Dhairya Patel, Tarun Chakravarty, Mamoo Nakamura, Wen Cheng, Sabah Skaf, Hasan Al-Jilaihawi, Raj Makkar, Aakriti Gupta
Journal: Circulation (2024)

Introduction: Self-expanding transcatheter aortic valves (SEV) have reportedly better hemodynamic outcomes, and similar clinical outcomes compared to balloon-expanding valves (BEV) at 1 year in patients with a small aortic annulus based on results from the SMART trial. Head-to-head comparison of long-term clinical outcomes, however, is lacking. Objectives: To compare the long-term (5 years) echocardiographic and cardiovascular outcomes in BEV versus SEV in patients with small aortic annulus undergoing transcatheter aortic valve replacement (TAVR). Methodology: The RESOLVE registry included consecutive patients who underwent TAVR and survived up to 30 days at Cedars-Sinai Medical Center with either BEV or SEV from 2015 to 2020, with clinical variables obtained from the STS/TVT registry. CT core lab analysis identified patients with a small aortic annulus (&lt;430 mm 2 ), who were systematically followed up with clinical exams and echocardiography until December 2023. The primary outcome was a composite of all-cause mortality, stroke or transient ischemic attack, or heart failure hospitalization at 5 years. Results: Out of 1392 patients, a total of 423 met criteria for small aortic annulus (345 BEV, 78 SEV), with a median follow-up of 5 years (4-6 years). There were no significant differences in baseline sociodemographic and clinical characteristics between the BEV and SEV groups. (Figure 1) The post-TAVR invasive aortic valve mean gradient were similar in both groups [Median (IQR): BEV:3(1-5.8), SEV: 3.4(0.4-6.6), p 0.58], while echocardiographic gradients were higher in BEV group [Median (IQR): BEV:12 (9-15), SEV:8(6-11), p&lt;0.001)].There was no significant difference in primary outcome at 5 years in Cox multivariable regression analysis (HR:1.21, 95% CI 0.81-1.82, p 0.33) (Figure 2). There were no significant differences in other clinical endpoints at 5 years, although patients with SEV had lower echocardiographic gradients and higher indexed effective orifice area. (Figure 2-3) Conclusion: Post-TAVR invasive aortic valve gradients were similar between BEV and SEV, despite higher echocardiographic transaortic gradients in BEV patients. We found no significant difference in 5-year clinical outcomes between patients who received TAVR with BEV or SEV.
Abstract 4139144: "Comparative Analysis of Inpatient Outcomes: Decompensated Systolic Heart Failure (HFrEF) with and without Iron Deficiency Anemia, Propensity-Matched Nationwide Study (2017-2021)."
Authors: Aravind Dilli Babu, Mirza Baig, Ram Bhutani, Krunalkumar Patel, Nivedita Kharkongor Chengappa, Clinton Tang, Lekshmi Narayan Raghavakurup, David Snipelisky
Journal: Circulation (2024)

Background: Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF). Methods: Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts. Results: Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000). Conclusion: HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.
Abstract 4144508: Efficacy and Safety of Intravenous Hydralazine vs Intravenous Labetalol in Management of Gestational Hypertension: A Meta-analysis of Randomized Controlled Trials
Authors: Prakash Upreti, Jawad Basit, Muhammad Moiz Nasir, Mushood Ahmed, Maurish Fatima, Aman Goyal, Mohammad Hamza, Saher Ashraf, M Chadi Alraies
Journal: Circulation (2024)

Background: Hypertension in pregnancy affects around 15% of all pregnant women and is one of the leading causes of maternal and fetal, mortality and morbidity. Hydralazine and labetalol are administered intravenously to control hypertension in pregnant women. However, data regarding their comparative efficacy and safety is limited. Considering the paucity of data, we conducted a systematic review and meta-analysis to pool all the studies published on this subject and provide robust evidence. Methods: We followed PRISMA guidelines for conducting this systematic review and meta-analysis. Two investigators searched PubMed/MEDLINE, Scopus, the Cochrane Library, and Google Scholar from inception until May 2024. The randomized controlled trials (RCTs) which compared the effects of intravenous labetalol versus hydralazine in pregnant women with hypertensive disorder of pregnancy were included in our pooled analysis. A random-effects model was used to calculate the weighted mean differences (MD) for continuous outcomes and odds ratio (OR) for the discrete outcomes along with the corresponding 95% confidence intervals (CIs). We considered a p-value of less than 0.05 statistically significant in all cases. Results: A total of 8 RCTs with total population of 1138 patients were pooled. The pooled analysis showed that the final systolic blood pressure (MD = -4.74, 95% CI: -12.09 to 2.62, p = 0.21) and diastolic pressure (MD = -0.86, 95% CI: -9.22 to 7.49, p = 0.84) remained comparable. The incidence of maternal hypotension (OR = 0.13, 95% CI: 0.06 to 0.29, p&lt;0.001) was significantly lower with labetalol administration compared to hydralazine. However, we found no statistically significant difference between two groups for persistent hypertension (OR = 0.86, 95% CI: 0.37 to 1.97, p = 0.72), neonatal death (OR = 2.97, 95% CI: 0.58 to 15.25, p = 0.19), stillbirth (OR = 0.73, 95% CI: 0.25 to 2.17, p = 0.57), fetal arrhythmia (OR = 0.56, 95% CI: 0.30 to 1.07, p = 0.08), APGAR score &lt; 7 at 5 min (OR = 2.44, 95% CI: 0.69 to 8.65, p = 0.17), cesarean section (OR = 0.97, 95% CI: 0.53 to 1.80, p = 0.93), and the number of mean doses required for successful blood pressure control (MD = -0.37, 95% CI: -1.07 to 0.34, p = 0.31). Conclusion: Intravenous labetalol and hydralazine have similar efficacy and safety profiles for blood pressure control in pregnant women. However, the risk of maternal hypotension is significantly lower with labetalol administration as compared to hydralazine.