tbuckley/cabot-search huggingface dataset:
Abstract 4138277: Protamine Administration and Bleeding Risk Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis
Authors: Arwi Omar Kara, Mohammed S. Beshr, Alhasan Saleh Alzubi, Arowa hassan abdulrahman Alansari, Esraa Arhaym, Dania Mukhtar Aburawi, MOSTAFA EL AWAMI, Hatim Shahin, Abdelrahman Farag Abdelwahed, Anas Atiyah Abdulsalam, HEYAM ALMEZGHWI, Muhammed Elhadi
Journal: Circulation (2024)

Background: Bleeding risk is a major concern for patients receiving transcatheter aortic valve implantation (TAVI) due to heparin use. In recent studies, Heparin antagonists, such as protamine, have shown potential in mitigating this complication. We aim to evaluate its potential role in reducing the risk of bleeding in patients post-TAVI. Methods On March 18, 2024, related articles were searched in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion criteria consisted of studies that reported the use of protamine in patients who underwent TAVI, with the aim of reducing bleeding risk compared to administering a placebo or no treatment. Our primary outcomes included major bleeding, life-threatening bleeding, the need for blood transfusion, the 30-day mortality rate, and any events of stroke or transient ischemic attack (TIA). The effect size was calculated using the odds ratio with a 95% confidence interval. Meta-analysis was conducted based on random-effect model using Revman. Results Out of the 14,705 articles we obtained, only 5 papers were included. One was a randomized controlled trial; the remaining 4 were observational cohorts with control groups. These studies comprised a total of 3,502 patients. Protamine significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p = 0.0003, I 2 = 37%), especially with full-dose administration (1 mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH) (OR 0.38, 95% CI 0.25-0.58, p &lt; 0.00001, I 2 = 0%). Similarly, protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI 0.20-0.67, p = 0.001, I 2 = 4%), particularly with full-dose usage compared to partial-dose (OR 0.37, 95% CI 0.18-0.73, p = 0.004, I 2 = 0%). However, no significant difference was observed in the need for blood transfusion (OR 0.75, 95% CI 0.46-1.24, p = 0.27, I 2 = 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p = 0.56, I 2 = 49%), or 30-day mortality (OR 0.93, 95% CI 0.62-1.39, p = 0.73, I 2 = 0%). Conclusions The use of protamine appears to significantly reduce major and life-threatening bleeding. The need for blood transfusion, risk of stroke or TIA, and 30-day mortality did not show significant differences. These findings suggest that protamine may be an effective intervention for reducing bleeding complications post-TAVI. However, large randomized controlled trials are needed to validate these findings.
Abstract 4138237: Clinical Utility of T2 Mapping for the Assessment of Myocardial Inflammation in Patients With Cardiac Sarcoidosis
Authors: Mio Uno, Hisanori Kosuge, Yasuhiro Fujita, Satoshi Hida, Kazuhiro Satomi
Journal: Circulation (2024)

Introduction: 18 F-FDG PET has been used for the evaluation of active inflammatory lesions in cardiac sarcoidosis (CS), but it is burdensome for patients to perform as a routine follow-up. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) that can detect myocardial fibrosis is limited in its ability to assess active inflammation. T2 mapping has been shown to detect myocardial inflammation in myocardial diseases without radiation exposure and contrast agents (Figure). However, the ability of T2 mapping for discriminating inflammatory myocardium has not been fully clarified in patients with CS. Hypothesis: We assessed the hypothesis that T2 mapping has potential for the discrimination of inflammatory myocardium in patients with CS. Methods: Twenty-seven subjects who underwent CMR at 3T and 18 F-FDG PET to diagnose CS were enrolled. Fourteen subjects were diagnosed as CS due to LGE and myocardial FDG uptake on 18 F-FDG PET (PET-positive group). Thirteen subjects showed no myocardial FDG uptake (PET-negative group). NativeT1, T2, and extracellular volume fraction (ECV) were measured using a 16-segment model. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate T1 and T2 mapping in discriminating between active and inactive inflammatory segments in the PET-positive group. Results: Mean native T1, native T2 and ECV showed no significant differences between the PET-positive and the PET-negative groups. However, maximum T2 values, which were highest ones in the 16 segments, were significantly higher in the PET-positive group than the PET-negative group (51.3 ± 7.7 ms vs 45.7 ± 3.6 ms, p = 0.014). In the PET-positive group, ROC analysis showed AUC of 0.72 in native T2, 0.61 in native T1, and 0.68 in ECV for discriminating inflammatory myocardium. The optimal cutoff value of native T2 was 45.7 ms, and the diagnostic performance had a sensitivity of 44.4 %, specificity of 93.3 % , positive predictive value of 88.1 %, and negative predictive value of 60.1 %. Conclusion: T2 mapping is a promising approach for the discrimination of inflammatory myocardium without radiation exposure and contrast agents in patients with cardiac sarcoidosis.
Abstract 4138281: Relationship of Collagen Metabolism Biomarkers, Left Atrial Fibrosis and Ablation Outcome in Atrial Fibrillation
Authors: Waddah Malas, Nicholas Poellinger, Gabriel Diaz, Mashaal Ikram, Cara Joyce, Debra Hoppensteadt, Jawed Fareed, Smit Vasaiwala, David Wilber, Mushabbar Syed
Journal: Circulation (2024)

Introduction: Inflammation and fibrinogenesis in the left atrium are hypothesized to play a major role in the development of atrial fibrillation (AF). We previously showed that collagen metabolism biomarkers (CMB) are significantly elevated in patients with AF compared to healthy controls. Objective: We sought to investigate the relationship between CMB, Left Atrial Fibrosis (LAF) and AF recurrence after ablation. Methods: Patients with AF undergoing ablation evaluation (N= 96) were prospectively enrolled between 2015 – 2020. Plasma samples were collected prior to ablation and analyzed for CMB using commercially available ELISA kits. Sixty-four patients underwent AF ablation and were followed for 6 months for AF recurrence. CMR was performed in 48 patients using cine and 3D high resolution, late gadolinium enhancement imaging on 3T MRI to measure LAF. Patients were classified into 2 groups dichotomized by the median LAF value. Results: Mean age was 60.3 ± 10.3 years, mean BMI 29.7 ± 4.9 kg/m2, mean CHA2DS2-VASc score 1.9 ± 1.4 and 27% were women. Paroxysmal AF was present in 52.5%. The median LAF score was 13.6% (IQR 9.8 – 21.7). High PINP, high CITP and low TIMP-2 were associated with high LAF score (Table 1). High CITP was also associated with recurrence of AF after ablation {4.26 ng/ml (IQR 3.22 - 4.65) vs 3.26 ng/ml (IQR1.92 - 4.25), P = 0.02}. Conclusion: Higher levels of PINP and CITP were significantly associated with higher LAF score in AF patients. TIMP-2 was associated with low LAF. Higher CITP was also associated with AF recurrence after ablation. Further larger studies are needed to better understand the relationship between collagen biomarkers, LA fibrosis and their clinical impact on rhythm control in AF.
Abstract 4138269: The Association Between Automatically Assessed Broad P-wave and Cardiovascular Events in Patients with Cardiovascular Risks
Authors: Ayako Yokota, Tomoyuki Kabutoya, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2024)

Background: A broad P wave in electrocardiography reflects atrial remodeling and is associated with cardiovascular events. Although there are several reports on the association between a broad P wave and cardiovascular events, the association between automatically assessed P-wave duration and cardiovascular events in cardiovascular high-risk patients has not been clarified. Hypothesis: We hypothesized that a greater automatically assessed P-wave duration would be associated with cardiovascular events in patients with cardiovascular risk factors. Methods: We included 4,654 patients with access to automated electrocardiography (ECG) analysis of those in the Cardiovascular Prognostic Coupling Study in Japan (a registry of subjects with one or more cardiovascular risk factors, excluding patients with atrial fibrillation). Twelve-lead ECG was conducted, and the P-wave duration in each lead was analyzed automatically using the 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). We selected the maximum P wave duration (Pmax) among the 12 leads. The primary endpoint was a composite endpoint (cardiovascular death, nonfatal myocardial infarction/stroke), and the secondary endpoint was heart failure hospitalization. We assessed two P-wave cut-offs (Pmax ≥ 140, 150 msec) in relation to cardiovascular events. Results: There were 218 patients with Pmax ≥140 ms and 123 patients with Pmax ≥150 ms. N-Terminal pro brain natriuretic peptide (NT-proBNP) was significantly higher in patients with Pmax ≥140 ms than in those with Pmax &lt;140 ms (median 134.0 vs. 65.7 pg/mL, p&lt;0.001). NT-ProBNP was also higher in patients with Pmax ≥150 ms than in those with Pmax &lt;150 ms (median 192.0 vs. 66.9 pg/mL, p&lt;0.001). The mean follow-up period was 53 ± 17 months. The primary endpoint occurred in 180 cases and the secondary endpoint in 73 cases. A broad P-wave defined as Pmax ≥140 ms was independently associated with the primary endpoint (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.04–2.70, p=0.034) but not with the secondary endpoint (HR 1.96, 95% CI 0.99–3.90, p=0.055) after adjustment for covariates including NT-proBNP. A broad P-wave defined as Pmax ≥150 ms was independently associated with both the primary endpoint (HR 2.08, 95% CI 1.06–4.09, p=0.034) and the secondary endpoint (HR 3.22, 95% CI 1.38–7.52, p=0.007). Conclusions: Automatically assessed P-wave duration of Pmax ≥ 150 ms was a significant predictor of cardiovascular events and heart failure.
Abstract 4138397: Gender Difference in Prevalence and Survival of Pulmonary Hypertension: A Prospective Cohort Study of 502,173 UK Biobank Participants
Authors: Fang Zhu, Qian Zhang
Journal: Circulation (2024)

Background: Research into pulmonary hypertension (PH) reveals significant sex-based disparities in long-term survival rates. Notably, women, despite being more susceptible to PH, often experience better survival outcomes than men—a phenomenon possibly linked to the "estrogen paradox." This study leverages the comprehensive UK Biobank to examine the role of sex in influencing these outcomes. By exploring differences in PH incidence and survival rates across genders, our research aims to provide a deeper understanding of the mechanisms at play and inform more effective, gender-specific analysis. Methods: This prospective cohort study utilized data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow-up until November 30, 2023, for England and Scotland, and May 31, 2022, for Wales. Through diagnostic codes, medical records, and imaging studies, 3,296 PH cases and 497,580 cases without PH were identified . We followed them for the mortality rates over a period of 10 years. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards models to assess sex-specific survival differences, adjusting for confounders like age, BMI, ethnic, menopause, smoking status, and comorbidities. Results: During 7,978,349 person-years of follow-up, of 502,173 participants in this prospective cohort, 3,296 were diagnosed with PH, while 497,580 did not receive the PH diagnosis. The prevalence of PH in the male cohort and the female cohort were 0.76% (1743 of 228,991 men) and 0.57% (1553 of 273,182 women), respectively, with significant difference between the two groups (p&lt;0.001). In the PH cohort, the mortality rates of patients were 47.06%. In the male patients with PH, the mortality rate was significantly higher than the female PH patients (51.78% vs. 41.53%, p&lt;0.001). After stratifying women into menopause and no-menopause group, Kaplan-Meier curves showed that even the age of male group was significantly younger than the menopause group (p&lt;0.001), the male still had worse survival situation. Conclusion: To conclude, the prevalence of PH in the male participants was significantly higher than the female participants. While the mortality rate in the male participants was also significantly higher than the female participants.
Abstract 4138332: Lipoprotein (a), Triglyceride-Glucose Index and Incident Atherosclerotic Cardiovascular Disease (ASCVD): Analysis of the UK Biobank
Authors: Richard Kazibwe, Christopher Schaich, Parag Chevli, Jeffrey Kingsley, Rishi Rikhi, Muhammad Ahmad, Saeid Mirzai, Juliana Namutebi, Anurag Mehta, Harpreet Bhatia, Erin Michos, Michael Shapiro
Journal: Circulation (2024)

Background: The triglyceride-glucose index (TyG), an inexpensive novel surrogate marker for insulin resistance, and lipoprotein (a) [Lp(a)] are both risk factors for atherosclerotic cardiovascular disease (ASCVD). However, it is uncertain whether TyG modifies the relationship of Lp(a) with incident ASCVD. Objective: To investigate the relationship of Lp(a) and TyG with the risk of incident ASCVD. Methods: We included UK Biobank participants without ASCVD at enrollment. Baseline TyG was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. We classified TyG values as high (≥75th percentile) or low (&lt;75th percentile), and Lp(a) levels, in nmol/L, as &lt;125 or ≥125. Participants were then stratified into four groups: Group-1: Low TyG with Lp(a), &lt;125, Group-2: Low TyG with Lp(a) ≥125, Group-3: High TyG with Lp(a) &lt;125, and Group-4: High TyG with Lp(a) ≥125. We used multivariable Cox regression to estimate the risk of ASCVD (a composite of peripheral arterial disease, coronary artery disease, myocardial infarction, ischemic stroke, and cardiovascular mortality) of TyG and Lp(a) adjusted for the other, and in the four combination groups. Results: Eligible participants (N=254,377) had a mean (SD) age of 56.0 (8.1) years, and 53.2% were female. The median follow-up was 14.6 years. In separate models additionally adjusted for cardiovascular risk factors (see Figure legend), the hazard ratio (HR [95% CI]) for ASCVD was 1.18(1.13–1.23) for Lp(a) ≥125 nmol/L (vs. &lt;125 nmol/L), adjusted for TyG, and 1.09(1.05–1.13) for high TyG (vs. low), adjusted for Lp(a). A statistically significant interaction between TyG and Lp(a) was observed in the fully adjusted model (p &lt;0.001). Compared to Group-1 (low TyG with Lp(a) &lt;125nmol/L), the adjusted HR (95% CI) of incident ASCVD in Group-2, -3 and -4 were: 1.07(1.04–1.13), 1.15 (1.09–1.21) and 1.34(1.25–1.44), respectively (Figure). Conclusions: These findings demonstrate that TyG and Lp(a) are associated with incident ASCVD risk independently of each other. Moreover, TyG modified the effect of Lp(a) on ASCVD, suggesting that insulin resistance may amplify the atherogenic, inflammatory, and/or thrombotic effects of Lp(a), thereby further increasing ASCVD risk.
Abstract 4138252: Association between Pressure-Adjusted Heart Rate and Mortality in Cardiogenic Shock
Authors: Curtis Ginder, Jacob Jentzer, Jianping Guo, Sean Van Diepen, Jason Katz, David Morrow, David Berg
Journal: Circulation (2024)

Introduction: Among patients with cardiogenic shock (CS), high right atrial pressure (RAP) and low mean arterial pressure (MAP) are associated with in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate * RAP-to-MAP ratio (HR * [RAP/MAP]), integrates these parameters and has been used to identify cardiovascular dysfunction in critical illness. Higher PAHR values associate with higher surgical ICU mortality, but the prognostic significance of PAHR has not been assessed in cardiac intensive care unit (CICU) patients with CS. Hypothesis: We hypothesized that higher PAHR values are associated with higher risk of in-hospital mortality in patients with CS. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multinational registry of CICUs coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24h of CICU admission, we calculated PAHR (in bpm) and assessed its relationship with in-hospital mortality. Patients on temporary mechanical circulatory support were excluded. Odds ratios were adjusted for age, sex, vasoactive-inotropic score (VIS), SCAI stage, and preceding cardiac arrest. Subgroup analyses stratifying by CS subtype were performed. Results: Among the 1411 CS admissions in the analysis cohort (mean age 61 years, 31% women), 18% had AMI-CS, 75% had HF-CS, and 7% had secondary CS. At the time of assessment (median 1.4h after CICU admission), 75% were on vasoactive support (median VIS 3.8). Median HR was 92 (Q1-Q3 77-109) bpm, RAP 15 (Q1-Q3 10-19) mmHg, MAP 75 (Q1-Q3 67-87) mmHg, and PAHR 17 (Q1-Q3 11-24) bpm. A stepwise gradient of higher in-hospital mortality with increasing PAHR values (p-trend &lt;0.001; Fig ) was observed. In adjusted models, a higher PAHR was associated with higher in-hospital mortality (aOR per 10-bpm, 1.35 [95% CI, 1.15-1.58]), and had stronger prognostic associations with mortality than its individual hemodynamic components (Fig) . Conclusion: Higher PAHR is strongly associated with in-hospital mortality in CS patients. PAHR, a simple parameter which is readily calculable without needing a pulmonary artery catheter, may aid in identifying CS patients at higher risk of death.
Abstract 4138386: Deep Learning-Enabled Assessment of Right Ventricular Function Using 2D Echocardiograms Improves 1-Year Mortality Prediction in Patients with Severe Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
Authors: Mark Lachmann, Vera Fortmeier, Lukas Stolz, Marton Tokodi, Shinsuke Yuasa, N. Patrick Mayr, Michael Joner, Erion Xhepa, Karl-Ludwig Laugwitz, jorg hausleiter, Volker Rudolph, Teresa Trenkwalder
Journal: Circulation (2024)

Background: Right ventricular (RV) function has a well-established prognostic role in patients with severe mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) and is typically assessed using echocardiography-measured tricuspid annular plane systolic excursion (TAPSE). Recently, a deep learning model has been proposed that accurately predicts RV ejection fraction (RVEF) from 2D echocardiographic videos, with similar diagnostic accuracy as 3D imaging. Aims: This study aimed to evaluate the prognostic utility of the deep learning-predicted RVEF values in patients with severe MR undergoing TEER. Methods: This multicenter registry study analyzed the associations between the predicted RVEF values and 1-year mortality in patients with severe MR undergoing TEER. To predict RVEF, 2D apical four-chamber view videos from preprocedural transthoracic echocardiographic studies were exported and processed by a rigorously validated deep learning model. Results: From 1,366 patients undergoing TEER between 2017 and 2023, good-quality 2D apical four-chamber view videos could be retrieved for 1,154 patients (84.5%). Survival at one year after TEER was 84.7%. The predicted RVEF values ranged from 26.6% to 64.0% and correlated only modestly with TAPSE (Pearson correlation coefficient R: 0.33; p -value: &lt;0.001). Importantly, predicted RVEF levels were superior to TAPSE levels in predicting 1-year mortality after TEER (area under the curve: 0.687 vs. 0.625; p -value: 0.029). Furthermore, Kaplan-Meier survival analysis revealed that patients with preserved RV function (defined as a predicted RVEF of ≥45%) had significantly better 1-year survival rates than patients with reduced RV function (92.1% [95% CI: 89.5-94.7%] vs. 80.3% [95% CI: 77.4-83.3%], respectively, hazard ratio for 1-year mortality: 2.67, p -value: &lt;0.001). Conclusion: Deep learning-enabled assessment of RV function using standard 2D echocardiographic videos can refine the prognostication of patients with severe MR undergoing TEER. Thus, it can be used to screen for patients with RV dysfunction who might benefit from intensified follow-up care.
Abstract 4138420: Impact of the American Heart Association Get-With-The-Guidelines Heart Failure A.S.I.A. Program in Taiwanese hospitals
Authors: Chien-Yi Hsu, Chia-Te Liao, Yen-Wen Wu, Chi-Cheng Huang, Tao-Wei Chang, Hung-Yu Chang
Journal: Circulation (2024)

Introduction: The American Heart Association (AHA) Get With the Guidelines – Heart Failure program has been implemented for years in the United States with extensive literature supporting its benefits. In 2022, the AHA Heart Failure Adherence to Science Implementation in Asia (HF A.S.I.A.) powered by Get With The Guidelines program was first introduced in five Asian countries. Research Question: This study aims to explore the impact of this program's implementation in Taiwanese hospitals. Methods: Data were sourced from the Taiwan Society of Cardiology-HF-Registry 2020, a prospective registry that tracks HF cases from 27 hospitals in Taiwan between 2020 and 2024. Among these, four hospitals began participating in the HF A.S.I.A. program in January 2022. This study compared patients from hospitals that participated and did not participate in the HF A.S.I.A. program. Results: A total of 1,933 HF patients with a left ventricular ejection fraction ≤ 40% were included, comprising 460 participants from the HF A.S.I.A. program and 1,473 non-participants. The HF A.S.I.A. group was younger, had significantly lower systolic blood pressure, larger left ventricular diameter, and experienced more frequent prior hospitalizations for HF. However, there were no significant differences between the two groups in terms of baseline heart rate, estimated glomerular filtration rate, blood potassium levels, and most comorbidities. During the study period, due to changes in payment policies, the use of angiotensin receptor neprilysin inhibitor (ARNI) decreased in the non-participant group, while the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) increased. Conversely, the use of ARNI in the HF A.S.I.A. group continued to rise in line with guideline recommendations and the usage of SGLT2i was higher than in the non-participant group. After adjustment, one-year lost to follow-up rate was significantly lower (3.0% vs. 5.6%, p =0.032) and all-cause mortality rate trended non-significantly lower (7.6% vs. 11.4%, p =0.096) among the HF A.S.I.A. group. Conclusion: Despite enrolling sicker patients, participation in HF A.S.I.A. program was associated with higher quality of HF care.