tbuckley/cabot-search huggingface dataset:
Abstract 13678: Initial Decline in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: Insights From DELIVER
Authors: Finnian R Mc Causland, Brian Claggett, Muthiah Vaduganathan, Akshay S Desai, Pardeep S Jhund, Orly Vardeny, James C Fang, Rudolf A de Boer, Kieran Docherty, Adrian F Hernandez, Silvio E Inzucchi, Mikhail N Kosiborod, Carolyn S Lam, Felipe Martinez, Jose F Saraiva, Martina McGrath, Sanjiv J Shah, Subodh Verma, Anna Maria Langkilde, Magnus Petersson, John J McMurray, Scott Solomon
Journal: Circulation (2023)

Introduction: Among patients with heart failure with reduced ejection fraction, an initial eGFR decline &gt;10% with dapagliflozin was associated with a lower risk of cardiovascular (CV) outcomes and slowing of kidney function decline, compared with a similar decline among those on placebo. We examined these associations in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Methods: In this prespecified analysis of DELIVER, the frequency of initial eGFR decline (baseline to month 1) was compared between dapagliflozin vs. placebo. Cox models (adjusted for baseline eGFR, age, sex, race, BMI, hypertension, left ventricular ejection fraction, log-transformed NT-proBNP, systolic blood pressure (SBP), ACEi or ARB use, MRA use, and change in SBP from baseline to month 1) were fit to estimate the association of initial &gt;10% eGFR decline with CV (CV death or heart failure event) and kidney (≥50% eGFR decline, eGFR &lt;15 ml/min/1.73m 2 or dialysis, death from renal causes) outcomes, landmarked at month 1, stratified by baseline diabetes. Results: The median [IQR] initial change in eGFR was -1 [-6, +5] and -4 [-9, +1] ml/min/1.73m 2 with placebo and dapagliflozin, respectively (difference 3 ml/min/1.73m 2 ; P&lt;0.001). Patients randomized to dapagliflozin were more likely to develop an initial eGFR decline &gt;10%, vs. placebo (odds ratio 1.9; 95%CI 1.7, 2.1). An initial eGFR decline &gt;10% was associated with a higher risk of the CV outcome among those randomized to placebo (adjusted hazard ratio [aHR] 1.31; 95%CI 1.08, 1.59), but not to dapagliflozin (aHR 0.93; 95%CI 0.77, 1.13; P interaction =0.01; Fig. 1 ). In the dapagliflozin group, an initial eGFR decline &gt;10% was not associated with adverse kidney outcomes (aHR 0.94; 95%CI 0.49, 1.82). Conclusions: Among patients with HFmrEF/HFpEF in DELIVER, an initial eGFR decline &gt;10% (vs. ≤10%) was not associated with a higher risk of cardiovascular or kidney events, among those assigned to dapagliflozin.
Abstract 11979: Cardiac MRI Adds Value in Discerning Pediatric Heart Transplant Rejection and Its Management
Authors: Laura Olivieri, Nicolle Ceneri, Karin Hamann, John T Berger, Yue-Hin Loke, Ravi Vegulla, Tacy E Downing, Joshua Kanter, Steven Staffa, David Zurakowski, Russell Cross
Journal: Circulation (2023)

Introduction: Endomyocardial biopsy (EMB) drives rejection diagnosis in pediatric heart transplant patients but is subject to false negatives and carries risk. Cardiac MRI can detect and quantify myocardial fibrosis and edema with T1 and T2 mapping. Hypothesis: Cardiac MRI may improve discernment of acute rejection in pediatric transplant patients. Methods: Pediatric heart transplant patients referred for clinically indicated EMB underwent noncontrast MRI with T1 +T2 mapping prior to EMB. Segmental T1 and T2 values were measured for base/mid/apex segments. Mean and peak T1+ T2 were quantified per encounter. Rejection treatment was per institutional protocol, and categorized as (A) no changes, (B) oral therapy initiated, or (C) IV therapy initiated. Treatment decisions were blinded to MRI results. Treatment category and T1+T2 were compared with Fisher’s exact test and logistic regression. Results: 89 encounters in 34 patients (median age 13.2y (IQR 8.3-16.8), BSA 1.39 m2 (1.09-1.65), 44.1% female) were successfully completed, with treatment groups A 11%, B 8%, C 81%. Median T1 mean and T1 peak values were (1022 ms (994-1040) and 1077 ms (1056, 1113)), respectively. Median T2 mean and T2 peak values were (50.4 ms (48.4-53.2) and 57.4 ms (53.1-60.8)), respectively. Higher T2 mean and T2 peak predict need for IV therapy; the strongest discriminator was T2 mean &gt; 54.5 (AUC = 0.801, 95% CI: 0.630, 0.972) Table 1. T1 mean and T1 peak were not significant in predicting rejection requiring IV therapy. Adding T1 mean to T2 mean did not improve the AUC (0.804 (95% CI: 0.637, 0.971), DeLong p=0.74). Finally, the odds ratio of new IV rejection therapy for T2 mean values &gt; 54.5 ms is 16.1 (95% confidence interval: 3.6 - 72.6, p&lt;0.001). Conclusions: Average T2 values (cutoff &gt; 54.5 ms) were efficacious at identifying need for IV treatment for rejection in pediatric heart transplant patients, regardless of T1 values. MRI is a promising noninvasive test to identify children at risk of rejection.
Abstract 109: Nitric Oxide Added to the ECMO Circuit Improves Neuroprotection and Cardiac Function After Cardiac Arrest
Authors: Daniele Linardi, Romel Mani, Sara Martinazzi, Venanzio Di Nicola, Sissi Dolci, Loris Mannino, Ilaria Decimo, Leonardo Gottin, Giovanni Battista Luciani, Alessio Rungatscher
Journal: Circulation (2023)

Background: Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest. Nitric Oxide (NO) has shown potential for exerting a protective role in ischemia/reperfusion damage in different organs. Aim: This study aims to investigate the cardio and neuroprotective effects of NO administered in the extracorporeal membrane oxygenation (ECMO) circuit after cardiac arrest. Methods: Thirty male SD rats were subjected to 10 minutes of cardiac arrest. They were randomly assigned to receive ECMO or ECMO plus NO (20 ppm) administered in the oxygenator (ECMO+NO). After 1 hour, the animals were weaned from ECMO, hemodynamic analysis using pressure-volume miniaturized catheter, and cardiac and brain samples were collected after two hours. Results: Analysis of cardiac function showed improved systolic cardiac function in the ECMO+NO group compared to standard ECMO (stroke volume: 55 ± 8 vs. 26 ± 9 μl, cardiac index: 9.05 ± 1.41 vs. 4.70 ± 0.81 ml/min/100g, dP/dt max : 6870 ± 290 vs. 5124 ± 205 mmHg/s; p&lt;0.01). The ECMO+NO group also exhibited reduced systemic resistance (total peripheral resistance: 2.14 ± 0.42 vs. 2.95 ± 0.35 mmHg/ml/min/100g; p&lt;0.05) and improved ventricular-arterial coupling (Ees/Ea: 0.96 ± 0.15 vs. 0.53 ± 0.15; p&lt;0.001). Neuroinflammation, assessed by the expression of Iba1, a microglia activation marker, was attenuated in the ECMO+NO group (8.37 ± 0.41% vs. 12.58 ± 0.48%; p &lt; 0.001). The extent of hypoxic brain areas, analyzed by thiol oxidation, was lower in the ECMO+NO group (4.07 ± 0.45% vs. 11.72 ± 1.03%; p&lt;0.01). Conclusions: NO administration in the oxygenator during ECMO after cardiac arrest improves cardiac function and ventricular-arterial coupling and enhances neuroprotection decreasing neuroinflammation and hypoxic areas. NO administration in the ECMO circuit might be a promising therapeutic adjunct during ECLS.
Abstract 13908: Racial Disparities in Surgical Approach for Patients With Atherosclerotic Chronic Limb Threatening Ischemia
Authors: William E Allen, Joshua D Greendyk, Syed F Haider, Afif Hossain, Abhishek Sharma
Journal: Circulation (2023)

Background: Over 8 million individuals in the US have been diagnosed with peripheral artery disease (PAD) with a cumulative annual cost exceeding $21 billion dollars. Chronic limb-threatening ischemia (CLTI) is the most severe form of this group, with a 2-year mortality as high as 40%. This study aims to identify racial disparities in the different approaches to treatment of CLTI. Methods: This IRB-approved retrospective study utilized data from the ACS-NSQIP. All recorded cases of surgical bypass, endovascular revascularization, or amputation below the knee for the treatment of CLTI between 2012 and 2021 were isolated. Propensity score matching and univariate analysis was performed to assess the independent effect of black self-identified race on access and outcomes. Results: 50,184 cases of CLTI were identified. Using propensity and logistic regression, we identified that black self-reported race is an independent predictor of both endovascular revascularization and amputation rather than open bypass (OR = 1.542, 95% CI=1.451-1.639, p&lt;.001; OR = 1.977, 95% CI=1.797-2.174, p&lt;0.001). Additionally, black patients were significantly less likely to experience any postoperative complications (OR=0.928, CI=0.865-0.996, p=0.037). Conclusion: Our analysis revealed a significant racial disparity in access to open bypass surgery. Our results also showed lower incidence of post-operative complications amongst CLTI black patients receiving endovascular revascularization or amputation. Our findings herein warrant further investigation to address racial disparities and barriers in the treatment of CLTI.
Abstract 11882: Acute Cardiac Events Among Older Adults Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus
Authors: Rebecca C Woodruff, Michael Melgar, Huong Pham, Fleetwood V Loustalot, Pam Daily Kirley, Isaac Armistead, Daewi Kim, Kyle Openo, Patricia Ryan, Chloe Brown, Erica Bye, Sarah Shrum Davis, Grant Barney, Kevin Popham, Ann Thomas, H Keipp Talbot, Mary Hill, Laurence Sperling, Fiona Havers
Journal: Circulation (2023)

Introduction: Respiratory syncytial virus (RSV) can cause severe illness among older adults, but potential cardiac complications have not been comprehensively described. We evaluated the frequency and severity of acute cardiac events among older adults hospitalized with laboratory-confirmed RSV to inform recommendations for RSV vaccine candidates in development. Methods: The RSV-Associated Hospitalization Surveillance Network (RSV-NET) abstracted medical record data among all hospitalized patients identified with laboratory-confirmed RSV infection (clinician-ordered testing) in a population-based catchment area of 38 counties in 9 states. Among adults aged ≥50 years hospitalized with RSV during the 2015-16 to 2017-18 RSV seasons, we estimated the period prevalence and 95% confidence interval (CI) of acute cardiac events, identified from the patient’s discharge diagnoses and ICD-10 codes. Multivariable generalized estimating equation models estimated the adjusted risk ratio (aRR) of intensive care unit (ICU) admission and in-hospital death by acute cardiac event status. Results: Among 3959 adults aged ≥50 years hospitalized with RSV (mean age 73 years), 20.8% (CI, 19.5-22.1) experienced an acute cardiac event during hospitalization, most frequently acute heart failure (14.3%; CI, 13.2-15.4; Table). Acute cardiac events were common among adults aged ≥75 years (25.0%; CI, 23.1-27.0) and among those with underlying cardiac disease (30.4%; CI: 28.5-32.3). Compared to patients without an acute cardiac event, those with an acute cardiac event were more likely to experience ICU admission (16.8% vs 27.0%; aRR: 1.7, CI: 1.5-1.9) and in-hospital death (4.1% vs 8.8%; aRR: 2.0, CI: 1.6-2.5). Conclusions: One in 5 older adults hospitalized with RSV experienced an acute cardiac event, which was associated with approximately double the risk of severe outcomes. Adults at greater risk of cardiac complications from RSV may benefit from vaccines when available.
Abstract 12328: Impact of Female Sex on Cardiogenic Shock Outcomes - A Cardiogenic Shock Working Group Report
Authors: Van-Khue Ton, Manreet Kanwar, BORUI LI, Vanessa Blumer, Song Li, Elric Zweck, Shashank Sinha, Maryjane Farr, Shelley Hall, Rachna Kataria, maya guglin, Esther Vorovich, Jaime Hernandez-Montfort, Arthur Reshad Garan, Mohit Pahuja, Saraschandra Vallabhajosyula, Sandeep Nathan, Jacob Abraham, Neil Harwani, Gavin W Hickey, Detlef Wencker, Andrew Schwartzman, Wissam Khalife, Claudius Mahr, Ju H Kim, Arvind Bhimaraj, Paavni Sangal, Yijing Zhang, Daniel Burkhoff, Navin K Kapur
Journal: Circulation (2023)

Introduction: Studies reporting cardiogenic shock (CS) outcomes in women are scarce. Hypothesis: Among patients with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS), women have worse survival at discharge and more vascular complications than men. Methods: We analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed using baseline characteristics. Logistic regression was performed for log odds of survival. Results: Among 5,083 patients, 1,522 were women (30%) with a mean age of 66.5±13.2 years. There were 30% women and 29.1% men with AMI-CS (p=0.03). More women presented with de novo HF-CS compared to men (26.2% vs. 19.3%, p&lt;0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%, p=0.009) (Figure A) and higher maximum SCAI stage E (26% vs. 21%, p=0.04) in women than men (Figure B). Women were less likely to receive pulmonary artery catheters (52.9% vs. 54.6%, p&lt;0.001), heart transplant (6.5% vs. 10.3%, p&lt;0.001) or left ventricular assist device (7.8% vs. 10%, p=0.01). Differences in AMI-CS cohort were less discrepant. Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%, p&lt;0.001), bleeding (7.1% vs. 5.2%, p=0.01), and limb ischemia (6.8% vs. 4.5%, p=0.001) (Figure C). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men, p=0.06). Conclusions: Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications and improve outcomes of women with CS.
Abstract 13995: Remote, Smart Device Based Cardiac Rehabilitation After Myocardial Infarction - Smart Rehab Study
Authors: Peter Wohlfahrt, Dominik Jenca, Jolana Mrazkova, Pavel Suchánek, Martin Kotrc, Marek Sramko, Vojtech Melenovsky, Michael Zelizko, Jan Pitha, Vera Adamkova, Josef Kautzner
Journal: Circulation (2023)

Introduction: After myocardial infarction (MI), increasing functional capacity is an important goal of cardiac rehabilitation, that improves prognosis. However, standard cardiac rehabilitation is not accessible to many patients. Telemedicine programs are emerging as promising alternatives to in-person programs, but evidence confirming its benefits is lacking. Hypothesis: Smart device based remote cardiac rehabilitation can improve functional capacity assessed by VO2peak after MI. Methods: Patients were offered participation at the time of hospitalization for MI. One month after MI, patients underwent a cardiopulmonary exercise test, 6-minute walking test (6MWT) and were randomized 1:1. In the intervention group, patients received a smart watch to track the recommended number of steps, that was derived from the 6MWT. Adherence to the recommendations was telemonitored by a study nurse, with an over the phone motivation talk if compliance was unsatisfactory. In the control group, patients were recommended 150 minutes/week of moderate intensity exercise. Exercise stress tests were repeated after 3 months. Results: In total, 59 patients (mean age 51.5±10.4 years, 10.2% women, 67.8% STEMI, 96.6% PCI, mean discharge EF 48±10%) were included in the study. At baseline, there was no difference in clinical characteristics and functional capacity between the intervention (n=29) and control (n=30) groups. After 3 months of the intervention, VO2peak improved in the intervention arm with between group difference of 1.56 ml/kg/min (95%CI 0.06-3.05, p=0.041), with no difference in 6-minute walking distance (p=0.11). The effect of intervention differed by baseline functional capacity (p for interaction &lt;0.01). Among patients with VO2peak at baseline ≤95% predicted, the between-group VO2peak difference after 3 months was 2.46 ml/kg/min (95% CI 0.78-4.13, p=0.005), and also oxygen uptake efficiency slope (between group difference 235, 95% CI 43-428, p=0.02) and 6-minute walking distance improved (between group difference 60m, 95% CI 1.5-119, p=0.045). Conclusions: Smart device based remote cardiac rehabilitation improves functional capacity after myocardial infarction, particularly in those with decreased functional capacity. NCT03926312
Abstract 12259: Gas6 Binding With Sav1 to Restore Yap Transcriptional Activity in a Specialized Cardiomyocytes Population Contributes to Heart Regeneration
Authors: Yi Fan, Yu Liu, Zehao Zhang, Wenfeng Zhou, Chengqi Lin, Wei Xie, Genshan Ma
Journal: Circulation (2023)

Introduction: The neonatal mammalian heart possesses transient regeneration capacity following injury, during which certain cardiomyocytes (CMs) undergo self-proliferation and establish specific communication networks within the microenvironment. However, the characteristic of these CMs has not been elucidated. Hypothesis: Analyzing communication networks of CMs involved in the microenvironment of neonatal heart regeneration will help identify heterogeneous populations of CMs and functional genes for regenerative treatment of adult myocardial infarction. Methods: CellChat was used to analyze communication networks in sc(n)RNA-seq datasets of postnatal mouse heart development and post-injury regeneration processes. Transcriptomic analysis was performed on Gas6-enriched CMs. Single-type cell isolation was used to assess Gas6 expression. CM-specific Gas6 loss- or gain-mice were generated using Cre-loxP system and Adeno-associated virus system. Adenoviral gene transfection, mass spectrometry, co-immunoprecipitation, domain truncation constructs, and dual-luciferase reporter gene assay were used to investigate the effect and mechanism of Gas6 in vitro. Results: The Gas pathway was identified among 2021 cell-cell pathways as contributing to the development and regeneration of CMs, with Gas6 being the functional gene involved. Gas6-enriched CMs exhibit heterogeneity in relation to proliferation and are abundant in neonatal hearts but disappear in adult hearts. CM-specific Gas6 gene knockout hindered myocardial proliferation in neonatal mice after apex resection. CM-specific Gas6 gene overexpression increased CM proliferation and protected cardiac function during postnatal heart growth and in injured adult hearts. In vitro studies revealed that the α-helical domain of Gas6 interacted with Sav1, inhibiting its recruitment to MST and subsequent phosphorylation cascade. Overexpression of Gas6 promoted Yap translocation into the nucleus and restored the transcription of genes involved proliferation and regeneration. Conclusions: Gas6-enriched CMs constitute a specialized population necessary for heart regeneration, in which Gas6 acts as a promoter of Yap transcriptional activity to enhance CM proliferation.
Abstract 12166: Social Determinants of Health and Acute Interstage Outcomes: An NPC-QIC Analysis
Authors: Benjamin Zielonka, Emily M Bucholz, Minmin Lu, Katherine Bates, Garick D Hill, Nelangi M Pinto, Lynn A Sleeper, David W Brown
Journal: Circulation (2023)

Introduction: The interstage period after Stage 1 palliation (S1P) carries high morbidity and mortality. The impact of social determinants of health (SDOH) on acute interstage outcomes has not been well described. Question: How do SDOH affect interstage outcomes? Methods: Infants discharged after S1P in the National Pediatric Cardiology Quality Improvement Collaborative Phase 2 registry were analyzed. ZIP code-level Childhood Opportunity Index (COI), a composite metric incorporating 29 indicators, was used to classify patients into 5 COI levels. Birth and S1P characteristics were compared. The association between COI level and binary acute interstage outcomes was assessed using log-rank test and logistic regression with and without adjustment for race/ethnicity, interstage risk factors, and interstage duration. Results: There were 1837 patients from 68 centers. There were differences across COI levels in birthweight, proximity to a surgical center, area of residence, age and weight at S1P, S1P length of stay (LOS), and feeding mode at discharge ( Table ). Over 98% of patients in all COI levels had home monitoring. Death or transplant occurred in 101 (5%) patients with unplanned readmission in 987 (53%), ICU admission in 448 (24%), unplanned catheterizations in 345 (19%), and reoperation in 83 (5%). COI level was not associated with differences in interstage outcomes on logistic regression or log-rank test ( Figure) . Conclusions: COI level is associated with differences in pre-operative status, feeding mode, and S1P LOS, but not acute interstage outcomes. The role of home monitoring programs in protecting against interstage disparities merits further investigation.
Abstract 13676: Characteristics and Outcomes of Patients With Clinically Significant Valvular Heart Disease and Cardiogenic Shock Admitted to Cardiac Intensive Care Units
Authors: Anthony P Carnicelli, Elliott Miller, Meshe Chonde, David Berg, Michael Palazzolo, Nijat Aliyev, Erin A Bohula, Madeleine Hamilton, Ryan Keane, Jonathan Kusner, Daniel Loriaux, L Kristin K Newby, Harsh Patolia, Jacob Pierce, Sean Van Diepen, Jason N Katz, David Morrow
Journal: Circulation (2023)

Introduction: Little is known about the characteristics &amp; outcomes of patients (pts) with significant valvular heart disease (VHD) and cardiogenic shock (CS). In addition, differences between pts with CS due to VHD vs VHD as “bystander” to CS have not been described. Methods: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America coordinated by the TIMI Study Group. Participating centers capture all CICU admissions for 2 months annually. Pts with CS and significant VHD were classified as having CS due to VHD or CS with concomitant VHD not felt to be the cause of CS. Admissions from 2017 - 2021 were analyzed. Results: Of 3,974 CICU admissions with CS, 165 (4.2%) had CS due to VHD and 769 (19.4%) had CS with concomitant VHD. Pts with CS due to VHD were older (71 vs 67 y), less commonly had a hx of HF (47.3% vs 73.1%), &amp; more commonly had LVEF&gt;50% on admission (51.5% vs 16.8%); p&lt;0.001 for all. Resource use varied significantly (Fig). Nearly 1/3 of pts (30.3%) with CS due to VHD underwent surgical/transcatheter valve procedures during CICU admission, contrasting with those with CS and concomitant VHD (13.5%; p&lt;0.001). In-hospital mortality was similar between the 2 VHD groups (39.4% vs 33.8%, p=0.17). In-hospital mortality for allcomers with CS and VHD (concomitant or causative) was higher than in those with CS and no VHD (34.8% vs 29.7%; p=0.003), including adjusted for age, sex, SOFA score, and pre-CICU cardiac arrest (aOR 1.23; 1.03-1.47). Mortality was numerically lower in pts undergoing a valve procedure (23.4% died; 16% with CS due to VHD, 26.9% with CS and concomitant VHD; p=0.13), compared to pts who did not (37.1% overall; 49.6% &amp; 34.9%, respectively; p=0.003). Conclusions: Although VHD is the primary cause of CS in a minority of pts, the presence of significant VHD is associated with higher mortality. In contemporary CICUs, procedural intervention is undertaken in ~1/3 of cases and mortality was numerically lower in pts who underwent valve procedures.