tbuckley/cabot-search huggingface dataset:
Abstract 4146472: 30-day and one-year outcomes of patients with severe aortic stenosis after TAVI using Myval : A Meta-analysis
Authors: Elfatih Hasabo, Amira Abo Ali, Lina Hemmeda, Alaa Salah, Salma S. Alrawa, Ammar Elgadi, Malaz M. Abdalmotalib, Abdullatif Yasir H Eissa, Mohammed Mahmmoud Fadel Allah, Sherif Sultan, OSAMA SOLIMAN
Journal: Circulation (2024)

Introduction: Transcatheter aortic valve implantation (TAVI) has been growing rapidly. The Myval balloon-expandable (BE) valve is a novel valve used for treating patients with severe aortic stenosis. No previous meta-analysis has assessed the different outcomes of TAVR using the Myval. We aim to evaluate the performance and outcomes of the Myval BE valve in patients with aortic stenosis. Methodology: A systematic search was done in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to June 2024. We used the relevant keywords to include studies that reported the outcomes of people who underwent a Myval balloon-expandable procedure for Aortic stenosis. 30-day and one-year outcomes were extracted across the studies. Device success of Myval was identified using Valve Academic Research Consortium (VARC)-2 and VARC-3 criteria. Results: Thirteen studies comprising 1256 patients of aortic valve stenosis were included. Of those, 679/1198 (56.7%) were males. The device success of Myval reached 97% CI [0.95, 0.98] across in included studies (Figure 1). Following TAVI, the procedural death and life-threatening bleeding with Myval were 1.3%, CI [0.6, 2.8], and 0.6%, CI [0.2, 2.5], respectively. Stroke cases following Myval were noticed in 3.6%, CI [2.2, 5.6] of total participants. After following for 30-days, all-cause mortality and moderate or severe aortic regurgitation cases were 1.8%, CI [1.0, 3.2], and 2.3%, CI [1.0, 5.0], respectively. Also, the transvalvular mean pressure gradient was found to be 7.7 mmHg, CI [7.5, 8.0]. One year follow-up showed that all-cause mortality slightly increased, reaching 8.4% CI [6.1, 11.4] and stroke cases were noticed in 5.2%, CI [3.4, 7.9] Conclusion: Myval showed good safety and efficacy outcomes after 30 days and one-year following the TAVI.
Abstract 4146039: Temporal Trends in Hypertension and Malignant neoplasm-related mortality in the United States: Cross-sectional Analysis of a National Database from 1999 to 2020
Authors: Shurjeel Qazi, Huzaifa Ansari, Adam Khan, Syeda Ayesha Ali, Syed Husain Farhan, Mustafa Murtaza, Zaid Zuberi, Ayesha Noman, Jawad Ishtiaq, Muhammad Abdullah Naveed, Rabbia Siddiqi
Journal: Circulation (2024)

Background: While hypertension (HTN) is a major risk factor causing morbidity and mortality following anticancer treatment, the current trends regarding its impact remain unclear.This study utilizes CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to examine HTN and malignancy-related deaths in the US. Methods: CDC WONDER accessed mortality data for adults aged ≥25 from 1999 to 2020, citing HTN and malignant neoplasms as contributing causes of death. Results, presented as age-adjusted mortality rates (AAMRs) per 100,000, underwent Joinpoint regression for trend analysis and annual percentage change (APC) Results: From 1999 to 2020, 1,067,143 deaths occurred in patients with neoplasms and HTN (AAMR = 22.3, 95% CI: 22.3 - 22.4). Males had higher mortality (AAMR = 27.9) than females (AAMR = 18.4). AAMRs varied across racial groups: highest in non-Hispanic blacks (NHB) (35.9), followed by non-Hispanic Whites (NHW) (21.2), Hispanics (17.9), non-Hispanic American Indian/Alaska Native (NH-AIAN) (16.4), and lowest in non-Hispanic Asian/Pacific Islander (NH-API) (15.3). Region-wise analysis showed that mortality rates were highest in the Midwest region (23.2, 95% CI: 23.1 - 23.3) followed closely by the South region at (23.0, 95% CI: 22.9 - 23.0), and then the West region rates of (22.3, 95% CI: 22.2 -22.4) while the Northeast reported the lowest mortality rate (19.8, 95% CI: 19.7 - 19.9). Mortality rates in rural areas were consistently greater throughout the study period compared to urban areas (Rural: 26.0, 95% CI: 25.8 - 26.1; Urban = 22.2, 95% CI: 22.1 - 22.3). Overall AAMR increased sharply from 12.0 in 1999 to 18.1 in 2001, followed by a gradual increase till 2018 (24.4) and then 29.9 in 2020 (APC: 3.9 [95% CI=3.4,4.4]). AAMR rose in men (APC:4.3), and women (APC: 3.4) throughout the study (FigureA). Across races, NH-AIAN showed the largest increase (APC: 5.5), followed by NHW (APC: 4.4), Hispanic (APC: 4.8), NHB (APC: 2.1), and NH-API (APC: 2.0) (FigureB) Conclusion: Despite recent improvements, HTN-malignancy-related mortality is rising. AAMR increased among men, all racial groups, and those in rural areas. Associated risk factors and examining social determinants of health are crucial for better care
Abstract 4146510: Meaningful Clinical Changes Following Endovascular or Surgical Revascularization from the Patients’ Perspective: A Health Status Responder Analysis with BEST-CLI Trial Data
Authors: Kim Smolderen, Alik FARBER, Matthew Menard, Kenneth Rosenfield, Michael Strong, Gheorghe Doros, Gaelle Romain, Jacob Cleman, Lindsey Scierka, Philip Goodney, Carlos Mena-Hurtado
Journal: Circulation (2024)

Background: Chronic limb threatening ischemia (CLTI) is a condition that profoundly impacts individuals’ health status. As attempts are made to improve perfusion and promote limb salvage, the overall goal of CLTI disease management is also to make people feel better as reflected by their health status (symptoms, functioning, quality of life) evaluations. It is unknown how many individuals with CLTI rate their health status as meaningfully changed following endovascular or surgical revascularization 1 year after the procedure. Methods: Secondary data analyses as a pooled cohort of the endovascular and surgical arms for the Best Endovascular versus Best Surgical Therapy in Patients with CLI (BEST-CLI) trial was conducted. Patients were recruited from 150 international sites, during 2014-2019 and completed the generic Short Form-12, EQ-5D, and the peripheral artery disease (PAD)-specific Vascuqol prior randomization and at 1 year following randomization. Using distribution-based thresholds (0.5 standard deviation of baseline health status scores) for determining a minimally clinically important difference, a descriptive analysis was performed to rate 1-year health status responses as improved, remained the same, or worsened. Results: A total of 1,533 patients were included, (71.9% male, mean age 66.9 ± 9.7 years). For patients’ overall physical health status (SF-12 PCS, EQ-5D Index), between 50.1-57.9% rated themselves as improved. For overall mental status (SF-12 MCS), only 39.1-44.8% rated themselves as improved. MCID improvement rates for generic health status did not differ by treatment arm (P-values &gt;.05). When looking at PAD-specific health status, 76.2-76.8% made clinically relevant improvements (endo vs. surgical, P-value 0.823) ( Figure ). Conclusion: The majority of individuals with CLTI achieve clinically meaningful PAD-specific health status improvements at 1 year, regardless of type of revascularization strategy. When it relates to their overall health status, less than ½ experience improvements, especially for their mental health status, 1 in 5 actually experiences worsening. Health status rehabilitation goals following CLTI revascularization may need to be broadened to not only include lower-limb related health status, but also aim to improve overall health status with integrated disease management approaches.
Abstract 4146540: Clinical characteristics and mortality outcomes in a multi-ethnic cohort of Asian patients with myocarditis
Authors: May Li Rolles, Yao Hao Teo, Raymond Wong, Kian Keong Poh, Tiong-Cheng Yeo, Weiqin Lin, William Kong, Ching-Hui Sia
Journal: Circulation (2024)

Background: Myocarditis is an inflammatory disease of the myocardium associated with numerous adverse outcomes such as arrhythmias, heart failure, cardiac arrest as well as death. Clinical characteristics and mortality outcome data in myocarditis specific to Asian patients is limited. Research Question: To evaluate characteristics and mortality outcome amongst a multi-ethnic cohort of Asian patients diagnosed with myocarditis. Methods: This retrospective, single-center cohort study involved consecutive patients diagnosed with myocarditis between 2010 and 2021 in a tertiary academic center. Patient respective clinical profile, diagnostic results and outcomes were detailed. Categorical variables were compared between mortality groups using the chi-squared test, and continuous variables with t-tests or Mann-Whitney U tests. Results: A total of 203 patients (mean age 41.8, 40.9% female) diagnosed with myocarditis were included in the study. The prevalence of fulminant myocarditis, acute non-fulminant myocarditis and chronic inflammatory cardiomyopathy in this cohort was 31%, 67.2% and 5.5% respectively. Over a mean follow up period of 4.7 years (SD 3.5), the all-cause mortality was 17.7% (36 patients) (p=&lt;0.001). The mortality was higher amongst female patients as compared to male patients (21.6% vs 15%; p=0.299) and the mean age was higher amongst patients that suffered from all-cause mortality (48.14 vs 40.43; p=0.036). In terms of aetiology, viral myocarditis constituted the highest proportion overall (n=100; 49%) as well as within the mortality group (n=15; 41%). The overall prevalence of chronic kidney disease, hypertension and diabetes mellitus was 5.4%, 31.5%, and 15.8% respectively. In comparison to the survival group, the mortality group had a higher prevalence of chronic kidney disease (30.6% vs 12.6%; p=0.015), hypertension (47.2% vs 28.1%; p=0.042) and diabetes mellitus (16.7% vs 3.0%; p=0.004). In terms of medication usage, compared to the survival group, the mortality group had higher usage of B-blocker (13.9% vs 5.4%; p=0.144), ACE-i/ARB (13.9% vs 10.8%; p=0.807), statin therapy (22% vs 7.2%; p=0.015), anti-diabetic medications (25% vs 12%; p=0.078),and single/dual anti-platelet therapy (13.9% vs 4.8%; p=0.1). Conclusions: In a multi-ethnic Asian population, increased age, female gender, hypertension, chronic kidney disease, and diabetes mellitus were associated with worse outcomes.
Abstract 4146528: Pre-Heart Transplant Physical Rehabilitation in Patients on Impella Support Improves AMPAC Scores and Functional Status
Authors: Sadhana Jonna, Lekhya Raavi, ivan huespe, Allison Perez Rodriguez, Jatin Passi, Aditya Khanijo, Prasanth Balasubramaniam, Shahin Isha, Gunjan Mundhra, Abby Hanson, Anna Jenkins, Anek Jena, Faiz Saleem, Rachel Hannon, Juan Leoni, Melissa Lyle, Mathew Thomas, Basar Sareyyupoglu, Lydia Sura, Olivia Davis, Jennifer Birst, Si Pham, Greg Worsowicz, Parag Patel, Pablo Moreno Franco, Devang Sanghavi
Journal: Circulation (2024)

Introduction/Background: Patients with heart failure and those waiting for a heart transplant often experience a significant decrease in their ability to perform daily activities and exercise, leading to a lower quality of life. Although exercise-based cardiac rehabilitation (EBCR) is a possible treatment option, its effectiveness has not been well measured, resulting in limited adoption. Research Questions/Hypothesis: Could physical rehabilitation before receiving a heart transplant improve functional status and better outcomes? Goals/Aims: Our objective is to evaluate the effect of pre-transplant physical therapy on the standardized improvement of AM-PAC scores, measured from the earliest pre-transplant assessment to the most recent pre-transplant evaluation. Our second objective is to assess the impact of the latest Pre-Transplant AM-PAC Score on the number of hospital-free days following transplantation. Methods: We conducted a retrospective study on 91 heart transplant patients who received Impella support from January 2019 to April 2023, approved by the Mayo Clinic Institutional Review Board. We collected data on demographics, AMPAC scores, and outcomes at three time points. Continuous variables were compared using the T-test or Mann-Whitney test, and categorical variables using the Chi-square or Fisher's exact test. We used a linear regression model to investigate the relationship between rehabilitation duration and AMPAC scores. Quantile regression was preferred due to the non-normal distribution of the outcome, hospital-free days. Results: We conducted a linear regression analysis and found a statistically significant association between increased hours spent in PT and greater improvement. After one hour of physical therapy, there was an average increase of 1.07 (95% CI 0.1, 2; p=0.03) in AMPAC scoore. We also compared the change in the AMPAC score with hospital-free days, and it was statistically significant in quantile regression analysis, indicating an increase of 0.28 (95% CI 0.2, 0.55; P=0.03) points in the AMPAC Score, corresponding to an additional hospital-free day. Conclusion: Increased hours spent in physical therapy show a significant positive association with greater improvement in standardized AM-PAC Mobility scores and hospital-free days. These findings encourage increasing uptake and support of cardiac rehabilitation programs.
Abstract 4146533: Association of Quantitative Echocardiographic Parameters with Peak VO2, Heart Rate Recovery, and VE/VCO2 from Cardiopulmonary Exercise Testing
Authors: Arundhati Sharma, Anubhuti Sharma, Kalyan Chaliki, Taylor Viggiano, Hari Chaliki, Satyajit Reddy
Journal: Circulation (2024)

Background: Cardiopulmonary Exercise Testing (CPET) analyzes physiologic information with gas exchange during exercise. Peak oxygen volume consumption (absolute peak VO2 and percent predicted peak VO2), minute ventilation divided by carbon dioxide volume (VE/VCO2 slope) and heart rate reduction after 1 minute of recovery (heart rate recovery, HRR) all have well-established prognostic cardiovascular implications. Aim: Given the wider use of echocardiography, we aimed to see if important CPET data could be determined from resting transthoracic echocardiography (TTE). Methods: In this retrospective study, cardiology patients above 18 years who underwent both resting TTE and a max-effort CPET within 3 months of each other (2017-2022) were included. Patients with a history of coronary artery bypass grafting, valve surgery, pacemakers, congenital heart disease, severe valve dysfunction and pulmonary hypertension were excluded before analysis. Univariate analysis with Spearman correlations was used to assess the relationship between 4 CPET measurements {absolute peak VO2 per kg, percent predicted peak VO2/kg (adjusted for age, sex and body surface area), HRR, and VE/VCO2}; and 22 quantitative TTE parameters. Bonferroni correction was applied within each set of correlations, with significance set at p-values &lt;0.025. Multivariate linear regression models were built for all the related TTE measurements to assess relationship with the 4 CPET parameters, adjusting for age and sex. Results: Table 1 shows, out of 1909 patients analyzed, our regression model is strongest for absolute peak VO2/kg (R-squared=0.57), with 3 significantly associated TTE parameters. For percent-predicted peak VO2 per kg, 4 TTE variables were significantly associated. For heart rate recovery, only LV stroke-volume index was correlated. No TTE parameters were associated with VE/VCO2. Conclusion: Notably, echocardiographic stroke volume and tricuspid valve regurgitation peak velocity exhibited a strong correlation with absolute peak VO2/kg and percent predicted peak VO2/kg. LV stroke volume index was correlated with heart rate recovery. VE/VCO2 was not associated with any resting echocardiographic parameters, suggesting this parameter is truly exercise-dependent.
Abstract 4146110: Patient Characteristics In The Enhancing Cardiac Rehabilitation Adherence Through Home-Based Rehabilitation And Behavioral Nudges (ERA-Nudge) Study
Authors: Dana Fletcher, Prerna Gupta, Monica Martinez, josh durfee, amanda hajoglou, Marina Rice, Juan Orendain Valencia, Joy Waughtal, Sheana Bull, Pamela Peterson
Journal: Circulation (2024)

Introduction: Outpatient cardiac rehabilitation (CR) improves outcomes for patients with cardiac disease but has an historically low participation rate. For socioeconomically disadvantaged patients experiencing challenges with access to care, participation can prove especially difficult. The ERA-Nudge trial aimed to evaluate the effect of choice of hospital or home-based CR and the effect of behavioral nudge messaging on participation and adherence in a diverse population of low socioeconomic status. This is the first report of patient characteristics from ERA-Nudge. Methods: ERA-Nudge was a pragmatic, randomized, controlled clinical trial using a 2x2 factorial design conducted at an urban safety net hospital in the US mountain west from 2019 to 2023. Patients were required to be eligible for CR, have a smartphone in order to use a mobile phone app, speak English or Spanish, and provide informed consent to participate in the study. At their baseline visit, patients were randomized to 1) choice of hospital or home-based CR with nudges; 2) choice of hospital or home-based CR alone; 3) hospital-based CR with nudges; 4) hospital-based CR alone. At study-required baseline, 6-week, and 12-week visits, clinical and lifestyle outcomes were assessed. Descriptive analyses were conducted on the characteristics of randomized patients. Results: Among 697 screened patients who were eligible for CR, 517 consented to participate. There were 70 patients who were not randomized (22 no showed for baseline visit; 2 died before randomization; 1 withdrew; 45 could not be re-contacted or did not provide a reason), resulting in 447 patients randomized in the study (Table 1) and 316 that completed the three study-required visits. Conclusions: ERA-Nudge was completed in a diverse, low-income, urban population, supporting the feasibility of evaluating smartphone and mobile app interventions in these patients. Not only did patients enroll, but most completed required study visits. Further analysis of the ERA-Nudge data will provide insight into how these patients responded to nudge-based mobile messaging, and whether having a choice to participate in CR at home impacted their overall CR adherence. Registration Number: NCT03834155
Abstract 4146542: Effect of Beta-Blockers on Mortality in Patients with Tachycardia in the Setting of Sepsis and Septic Shock: A Meta-Analysis of Randomized Controlled Trials
Authors: Giorgi Chilingarashvili, Vibhor Ahluwalia, Avilash Mondal, Vaibhav Ahluwalia, Muhammad Saad Siddique, Duy Chung, Jay Jaiswal, Quang Dat Ha, Reeve DSilva, Gayathri Samudrala, Vien Truong
Journal: Circulation (2024)

Background: Beta blockers have the potential to mitigate the damage caused by adrenergic overdrive in septic shock. However, there is limited data supporting their effectiveness in controlling heart rate in these patients. Recent meta-analyses have demonstrated that beta-blockers can lower mortality rates in patients with sepsis. To evaluate the efficacy of beta-blockers in sepsis and septic shock, we conducted a comprehensive systematic review and meta-analysis. Methods: We performed a systematic review and meta-analysis by thoroughly searching MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews to evaluate the efficacy of beta-blockers in sepsis and septic shock. Random-effects models were utilized to pool effect sizes. The DerSimonian-Laird estimator calculated between-study variance, and the Jackson method was employed to determine a 95% confidence interval (CI). Results: Our analysis included 8 eligible studies with a total of 893 patients (446 in the beta-blocker group, with 64% being female, and 447 in the placebo group, with 59% being female) at 28 days of follow-up. In the beta-blocker cohort, there were 171 deaths (38.3%), whereas the control group had 212 deaths (47.4%) at 28 days of follow-up. The use of beta-blockers did not significantly improve overall 28-day mortality (pooled odds ratio, 0.59; 95% CI, 0.34-1.03; p = 0.07) (Figure). Conclusion: The findings of this systematic review and meta-analysis suggest that beta-blockers do not significantly enhance survival rates among patients with sepsis and septic shock.
Abstract 4146591: Burden of Premature Ventricular Complexes is Unrelated to Prediction of Cardiomyopathy
Authors: Sarah Slaven, Lohit Garg, Christina Healy, Alexis Tumolo, Wendy Tzou, Christopher Barrett, Lukasz Cerbin, Matthew Zipse, Amneet Sandhu, Paul Varosy, Syed Rafay Ali Sabzwari, Michael Rosenberg
Journal: Circulation (2024)

Background: Premature ventricular complexes (PVCs) are commonly seen on cardiac monitoring. Several studies have suggested that frequent PVCs can directly cause cardiomyopathy. Understanding why only certain patients with PVCs develop cardiomyopathy remains a challenge. The current guidelines suggest a cutoff of 10% burden to indicate risk; other studies have suggested thresholds as low as 4% and as high as 24%. In this observational study, we aim to evaluate the association between PVC burden and cardiomyopathy in a larger population than assessed previously. Methods: We performed a cross-sectional analysis of &gt;35K ambulatory monitors obtained on patients seen across the health system from April 22, 2017 and February 20, 2023. Subjects were included if they had ≥24 hours of monitoring, a PVC burden of ≥5%, and a transthoracic echocardiogram (TTE) performed within 3 months before or after monitoring. The presence of cardiomyopathy was defined as left ventricular ejection fraction (LVEF) &lt;50%. Clinical factors including comorbidities and relevant medications were included if they were in the patient’s chart at the time of the monitor. Results: The population included a total of 1451 patients, with age 68.2±14.5 years, female sex in 39.6%, and main indications of PVCs (20.3%), palpitations (15.0%), paroxysmal AF (8.1%), and bradycardia (5.9%). The average PVC burden was 12.4 ±7.4% (5% - 43.4%). Of 746 subjects with a TTE, the mean LVEF was 55.6 ± 9.2% (25% - 76.8%), with 171 subjects (22.9%) having an LVEF &lt;50%. We identified no significant association between PVC burden and LVEF (p = 0.78), nor with PVC burden and depressed LVEF (p = 0.13), with or without adjustment for risk factors. We also failed to identify a significant trend in PVC burden and EF (p=0.75), and a cutoff of 20% was not associated with an increase in depressed LVEF (OR 1.3, 95%CI 0.87 – 2.0, p = 0.20). Conclusions: In this analysis, we found no association between PVC burden and LV function, and could not validate the clinical cutoff of 20% as being a higher risk. These findings suggest that additional patient or PVC characteristics contributing to the development of PVC-induced cardiomyopathy have yet to be fully defined.