tbuckley/cabot-search huggingface dataset:
Abstract 4138901: Estimated Plasma Volume Status Reflected Changes In Hemodynamic Parameters On Echocardiogram After Treatment In Patients With Heart Failure With Preserved Ejection Fraction.
Authors: Katsuomi Iwakura, Nobuaki Tanaka, Masato Okada, ATSUNORI OKAMURA, Watanabe Heitaro, Masahiro Seo, Takaharu Hayashi, Takahisa Yamada, Yasumura Yoshio, Shungo Hikoso, Katsuki Okada, Daisaku Nakatani, Yohei Sotomi, Yasushi Sakata
Journal: Circulation (2024)

Introduction: Estimated plasma volume status (ePVS) is an index of changes in plasma volume and may play a significant role in the management of heart failure (HF). Research questions: Whether does ePVS reflect the hemodynamic changes after treatment in patients with HF? Aims: The aim of this study was to investigate the relationship between ePVS and changes in echocardiographic parameters after treatment in patients with HF with preserved ejection fraction (HFpEF). Methods: We retrospectively analyzed data from 1226 patients (81±9 years, 55.2 % female) registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, a multicenter registry of patients hospitalized for acute decompensated HFpEF. We collected blood samples and performed echocardiography on admission and shortly before discharge. We calculated ePVS based on the Strauss formula using hemoglobin (Hb) and hematocrit (Hct) values as 100 x [(Hb(discharge)/Hb(admission) x (1 - Hct(admission)) / (1 – Hct(discharge))] – 100 (%), and investigated the correlations between ePVS and changes in echocardiographic parameters. Patients were followed for median of 708 days (IQR 365, 1086 days) to observe all-cause death and major adverse cardiovascular events (MACE; death, HF hospitalization and stroke). Results: The median value of ePVS was -0.97 (IQR -1.10, -0.86), indicating successful volume reduction during hospitalization. The decrease of inferior vena cava (IVC) diameter was correlated with ePVS (p&lt;0.0001). Whereas ePVS was not correlated with left ventricular (LV) end-systolic diameter, it was correlated with decreases in LV diastolic diameter (p=0.007), LV ejection fraction (p=0.01), time-velocity integral of LV outflow (TVI LVO , p&lt;0.0001), LV mass (p=0.01) and left atrial diameter (p=0.0002). Among diastolic parameters, ePVS was correlated with decrease in E velocity (p&lt;0.0001) and e’ velocity (p=0.002) but not with E/e’ ratio. Change in tricuspid regurgitation pressure gradient was inversely correlated with ePVS. A stepwise multivariate regression analysis revealed that ePVS was associated with changes in IVC diameter, E velocity and TVI LVO . A Cox proportional hazard model showed that ePVs was a predictor for both all-cause death and MACE. Conclusion: EPVs was correlated with changes in echocardiographic parameters relevant to hemodynamics after HF treatment and predicted prognosis in patients with HFpEF.
Abstract 4139576: Trends in Incidence, Therapies Utilized and Clinical Outcomes after Cardiac Medication Exposures in the Pediatric Population
Authors: Nicholas Borkey, Shan Yin, Sarah Worley, Peter Aziz, Iqbal El Assaad, Akash Patel
Journal: Circulation (2024)

Background: Approximately 2 million exposures are reported to US poison centers annually with 56% &lt;20yrs of age in 2022. Adverse events due to cardiac medication ingestions are well-known, but limited data exists on national trends and outcomes in pediatrics. Aims: This study describes the trends in incidence, therapies used, and outcomes after cardiac med exposure over the last decade in the pediatric population. Methods: A retrospective cohort study was conducted from the National Poison Data System from 2012-2022 for patients ≤ 19 yrs exposed to cardiac meds: anti-arrhythmics, β-blockers, calcium channel antagonists, and cardiac glycosides. Analyses were stratified by med class and age group for trends in incidence, therapies, and outcomes. Results: A total of 100223 cases of cardiac med exposures were reviewed: 74% (0-5 yr), 8% (6-12 yr), and 18% (13-19 yr). From 2012-2022, the annual incidence of exposures decreased by 6%; however, it increased by 82% in the 13-19 yr group. In 6-19 yr olds, there was an increase in exposures for all med classes except cardiac glycosides. There was a difference in the therapies used across med classes, and 2.2% of all cases required selected cardiorespiratory therapies (p&lt;.001, Table 1). The outcomes also varied by med class (p&lt;.001, Table 1). 11819 (11.8%) cases resulted in ICU admission, of which 64% were in the 13-19 yr group, and 1355 (1.4%) cases resulted in a major/fatal outcome. For all age groups, exposure to &gt;1 med type had a higher proportion resulting in ICU admission (p&lt;.001). Of those with a major/fatal outcome, 82% were in the age 13-19 yr group. For this age group, exposure to &gt;1 med type had a higher proportion resulting in major/fatal outcome compared to any single med class except for anti-arrhythmics (p&lt;.001). Chronic exposure was more likely to result in major/fatal outcome compared to acute exposures in followed cases (4.7% vs 1.6%, p&lt;.001). Conclusions: Teenagers showed the largest increase in cardiac med exposures from 2012-2022 and the highest rates of ICU admissions and major/fatal outcomes. These findings underscore the need for heightened awareness when prescribing cardiac mediations and the importance of mental health screening in older children.
Abstract 4139025: The Impact of Diastolic Function on Cardiac Outcomes in Patients with Cirrhosis after Liver Transplantation
Authors: Mark Wadid, Aram Bedrosian, Candace Lessey, Jui Shah, Sourbha Dani, Maurizio Diaco, Gautam Gadey, Amir Qamar, Raza Malik, Ethan Rowin
Journal: Circulation (2024)

Introduction: Diastolic dysfunction may prognosticate adverse cardiovascular outcomes post-liver transplantation (LT). However, the impact of diastolic dysfunction on post-transplant outcomes has not been thoroughly investigated. We sought to determine the prognostic utility of baseline echocardiographic abnormalities on post-LT outcomes. Methods: A retrospective cohort study was conducted on adult patients who underwent LT at Lahey Hospital (2015-2020), followed until 2023 for major adverse cardiovascular events (MACE) and mortality. Diastolic dysfunction was assessed per 2016 ASE guidelines: septal e' &lt; 7 cm/s; lateral e' &lt; 10 cm/s; E/e' ≥ 15; Left atrial volume index &gt; 34 ml/m 2 ; Tricuspid Regurgitation velocity &gt; 2.8 m/s. with 0 or 1 abnormal parameter considered normal, 2 abnormal parameters were categorized as indeterminate, and ≥3 as diastolic dysfunction. Results: LT was performed in 423 patients (mean age 56.4 ± 9.62; 67.4% male), mainly for alcohol cirrhosis (36%), metabolic dysfunction-associated steatotic liver disease (16%), and liver malignancy (15%). Pre-operative echocardiography was conducted a median of 3 days before LT evaluation. Ejection fraction (EF) was 65 ± 4.5%; no patient had EF &lt; 50%. Diastolic dysfunction was noted in 17 patients. 363 had normal diastolic function and 44 indeterminate diastolic function. Over 3 years post-LT, 70 patients died (5 cardiovascular deaths), and 48 experienced MACE: 21 hospitalizations for acute heart failure, 8 nonfatal myocardial infarctions, 14 cerebrovascular events, and 5 cardiovascular deaths. Mortality and MACE rates did not differ significantly between patients with normal diastolic function (16.8% and 13.2%), indeterminate (13.6% and 9.1%), or diastolic dysfunction (18.8% and 18.8%, p=0.84 and p=0.58 respectively). However, a higher proportion of patients who experienced MACE had a history of atrial fibrillation (AF) (33% vs. 14%, p &lt; 0.001) and CAD before LT listing (31% vs. 9%, p &lt; 0.001), despite 60% of patients with MACE and CAD undergoing revascularization. Conclusion: In this cohort, diastolic dysfunction did not appear predictive of all-cause mortality or adverse cardiac events post-LT, suggesting it may not be a sensitive marker for post-LT cardiovascular complications. In contrast, patients with prior AF and CAD history are at higher risk, indicating a need for further studies to evaluate if these conditions should preclude LT.
Abstract 4139327: Life-Saving Synchrony: Treating Leadless Pacemaker-Induced Cardiogenic Shock with Cardiac Resynchronization Therapy
Authors: Chinwe Mbisike, Ndausung Udongwo, Anthony Lyonga Ngonge, Adeyinka Adeniyi, Theodora Esomonye, MO ALKUBEYSI, David Zhuo
Journal: Circulation (2024)

Leadless pacemakers (LPMs) represent a significant advancement in cardiac pacing technology, offering several advantages over traditional transvenous systems. However, they are not without complications such as leadless pacemaker-induced cardiomyopathy (LPM-CMP). We present a case of cardiogenic shock from LPM-CMP requiring cardiac resynchronization therapy (CRT) as a rescue strategy. A 77-year-old female with a history of heart failure with reduced ejection fraction, coronary artery disease status post recent percutaneous coronary intervention to the proximal-to-mid left anterior descending artery, complete heart block status post LPM implantation, and chronic kidney disease stage 3b, presented to the emergency department after a syncopal event. Initial vital signs were blood pressure 96/64 mmHg and heart rate 62 bpm, while LPM interrogation showed 100% right ventricular pacing burden. Physical exam revealed congestion with jugular venous distension and 2+ pitting bilateral lower extremity edema. Initial labs (BNP 4792 pg/mL, hs-troponin 202 ng/L, lactate 5.5 mmol/L, AST/ALT 68/30 U/L, and creatinine 3.3 mg/dL (baseline 1.5 mg/dL)) were consistent with SCAI Stage B cardiogenic shock. She was transferred to the cardiovascular intensive care unit for inotropic and vasopressor support. By hospital day 10, she was on 10 mcg/kg/min of dobutamine, 3 mcg/min of epinephrine, and 14 mcg/min of norepinephrine. Despite this and extensive diuresis, she continued to deteriorate. After ruling out acute coronary syndrome, LPM-CMP was suspected as the etiology, and CRT-D was implanted on day 14. Echocardiography-assessed stroke volume correspondingly improved from 25 mL on pressors to 30 mL after CRT-D and off pressors. She was subsequently optimized on heart failure guideline-directed medical therapy, and discharged home on day 19. LPM-CMP is a rare but potentially serious complication of LPM implantation. Early recognition and appropriate management are essential for optimizing patient outcomes. In this case, CRT-D implantation proved to be a successful intervention, resulting in significant clinical improvement and symptom resolution. This underscores the importance of individualized patient management and the role of advanced device therapies in the treatment of LPM-induced complications. Further research is needed to better understand the risk factors, pathophysiology, and optimal management strategies for LPM-CMP, especially as a rescue strategy in cardiogenic shock.
Abstract 4139285: Awareness of Myocardial Infarction and Stroke Symptoms Among Asian American Adults: Insights from the National Health Interview Survey 2014 and 2017
Authors: Sunita Dodani, Nehal P. Patel, Austin D. Le, Yanal B. Kawaleet
Journal: Circulation (2024)

Introduction: Stroke and Myocardial Infarction (MI) are the leading causes of death in the United States. Awareness of symptoms is vital for early recognition and prompt treatment, which can significantly improve health outcomes. This study examines MI and stroke symptom awareness among Asian American adults, a group with limited prevalence estimates on this critical health metric. Hypothesis: There is variability in MI and stroke symptom awareness among Asian American subgroups, influenced by sociodemographic factors such as age, nativity, education, and income. Methods: We conducted a secondary analysis using data from the 2014 and 2017 National Health Interview Survey. Our sample included 2,832 Asian adults, categorized into self-identified ethnic groups: Asian Indian, Chinese, Filipino, and "Other Asian" (an aggregate category including Japanese, Korean, Vietnamese, and others due to low sample sizes). We assessed awareness of MI and stroke symptoms and the prevalence of recognizing 9-1-1 as the appropriate subsequent action using the Rao-Scott chi-square test to account for the complex survey design. Results: The study sample consisted of 2,832 adults (46.7 % male, 53.3% female, mean age 44.6 years [SD: 16.5 years]). Ethnic distribution was 22.0% Asian Indian, 22.5% Chinese, 20.8% Filipino, and 34.7% Other Asians. Significant disparities in symptom awareness were found among subgroups. Filipino adults exhibited the highest awareness of all five stroke symptoms (68%, 95% CI: 63%-73%) compared to Chinese (62%, 95% CI: 57%-67%), Asian Indian (53%, 95% CI: 48%-58%), and Other Asian adults (59%, 95% CI: 57%-61%). Similarly, Filipino adults also had the highest awareness of MI symptoms (51%, 95% CI: 45%-56%), compared to Asian Indian (37%, 95% CI: 32%-42%), Chinese (30%, 95% CI: 25%-34%), and Other Asian adults (30%, 95% CI: 27%-34%) ( Figure). Conclusion: There is significant heterogeneity in MI and stroke symptom awareness among Asian American adults. Filipino adults demonstrated the highest levels of knowledge regarding subsequent actions. The study underscores the need for targeted public health interventions to enhance MI and stroke symptom awareness, particularly focusing on subgroups with lower awareness.
Abstract 4138992: Beta blockers and calcium channel blockers in pre-symptomatic patients with hypertrophic cardiomyopathy: prevalence, discontinuation, and effectiveness
Authors: William Bradlow, Kevin Elgui, Quentin Klopfenstein, Felix Balazard, Paul Trichelair, Maxime TOUZOT, Mariann Micsinai Balan, Paul Van Haelst, Belinda Sandler, Amy Sehnert, Arnaud Bastien, Perry Blizard, TOMAS RIPOLL-VERA, Pau Pericas, Marat Fudim, Suresh Balu, Bradley Hintze, Husam Salah, Manesh Patel, Aurelie Foucher, Philippe Charron
Journal: Circulation (2024)

Background: Beta-blockers (BB) and non-dihydropyridine calcium channel blockers (CCB) are first-line therapies for hypertrophic cardiomyopathy (HCM) used both upon symptom onset and for pre-symptomatic patients. However, there is limited evidence supporting their efficacy, particularly from randomized controlled trials. Aims: In this study we assessed the prevalence, discontinuation rates, and effectiveness of BB/CCB for NYHA class I HCM patients. Methods: Utilizing data from a real world cohort spanning 4 centers, we evaluated BB/CCB effectiveness in NYHA class I patients with HCM. The effectiveness analysis for a composite endpoint (NYHA class worsening and cardiovascular-related hospitalization) was performed independently at each center and an aggregated analysis was performed. NT-proBNP level analysis was performed where longitudinal data was available. Patients initiating therapy during follow-up were compared to untreated controls, adjusting for confounders (duration since HCM diagnosis, left atrial volume index (LAVi), E/e' lateral ratio, medical history, NT-ProBNP levels) using inverse probability weighting and Stürmer trimming. The association between treatment and the risk of composite endpoint was assessed through Cox regression, while mixed models for repeated measures were used for NT-proBNP levels. Results: Among the 735 patients, 64% initiated BB/CCB therapy with a 33% discontinuation rate at 4 years. A total of 222 patients with extreme propensity scores were excluded. As shown in Table 1., no benefit from BB/CCB in reducing the composite endpoint risk (HR=1.08, p=0.79) was observed. This was consistent across the different components of the endpoint. Additionally, no benefit in reducing NT-proBNP levels after 1 year was detected (Least Means Square difference=0.02, p=0.79). Conclusion: Initiation of BB/CCB for NYHA I HCM patients did not appear to reduce the risk of progression measured by the functional capacity, CV hospitalization and NT-proBNP. Despite the inherent limitation of observational studies, these findings together with the high discontinuation rate of the therapy, underscore the need for further research to validate optimal treatment strategies for pre-symptomatic HCM patients.
Abstract 4139510: Nighttime home blood pressure was a crucial indicator in predicting adverse outcomes for patients with stage B heart failure
Authors: Takahiro Komori, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2024)

Background: Stage B heart failure (HF) was associated with increased cardiovascular and HF events. Hypertension is a risk factor for these events in Stage B HF. Nighttime blood pressure (BP) is more strongly associated with cardiovascular events than daytime BP, but nighttime home BP measurement is not widely used. Method: We analyzed 573 stage B HF patients with at least one cardiovascular risk factor who underwent home BP monitoring. Stage B HF was defined as BNP ≥35pg/ml, or NT-proBNP ≥125pg/ml, Troponin T &gt;0.014ng/ml, LVEF &lt;50%, enlarged left ventricular dimensions in diastole (≥60mm in men and ≥54mm in women), enlarged left atrium (&gt;40mm), or increased left ventricular mass (&gt;115g/m 2 in men and &gt;95g/m 2 in women). Morning, evening, and nighttime home BP were measured by home BP devices, and cardiovascular events were followed up. Results: During a mean follow-up of 7.6 ± 3.6 years, 65 cardiovascular events occurred. Morning, evening, and nighttime home SBP were higher in the event group than in the non-event group (146±19 vs 140±14 mmHg, p=0.01, 137±17 vs 131±14 mmHg, p&lt;0.01, 129±16 vs 123±14 mmHg, p&lt;0.01, respectively). Kaplan Meier analysis showed that the high BP cut-off group defined by HT guidelines had significantly higher incidents of events in office, morning, and nighttime home SBP (p=0.03, p=0.02, p&lt;0.01, respectively)(Figure). In multivariate Cox regression analysis adjusting for significant variables, nighttime home SBP &gt;120mmHg was a significant predictor of the outcome (Hazard Ratio 2.03, 95% Confidence Interval: 1.13-3.65, p=0.02). Conclusions: Elevated nighttime home BP was a significant predictor for cardiovascular outcomes in stage B HF patients.
Abstract 4139724: Heart Transplant in Geriatric Population from 2000 to 2023: UNOS Database Study
Authors: Thomas Yoo, Juan David Linares Velandia, Ahmed Seliem
Journal: Circulation (2024)

Background: Advancements in heart transplant has expanded boundaries to greater range of patients to receive transplant. Despite concerns of increased morbidity and mortality, data from previous studies showed selected patients 70 years or older who underwent heart transplant had similar morbidity and mortality compared to younger patients. With growing population age and increase in technology, transplant candidacy is expanded to selected robust geriatric patients. Objective(s): Determine change in the number of transplant cases and the percent from total yearly cardiac transplant in geriatric population Method: Heart transplant recipients of all ages from 2000 to 2023 were identified in the United Network for Organ Sharing (UNOS) database and stratified into different age groups. Primary outcomes of interest included number of heart transplant cases and percentage from total yearly transplant. Results: In total, we identified 66,079 heart transplant recipients from 2000 to 2023. Among these patients, 9,964 (12.40%) were patients aged 65 above and 28,554 (45.50%) were 50-64 years old (figure 1A). There was an overall increase in the number of heart transplants from 2000 to 2023, 2,199 to 4,545 cases per year, respectively. There was an increase in the number of heart transplants in the geriatric population from 216 to 841 (figure 1B). From 2000 to 2013, there was an increase in the percent of transplant recipients in patients 65 years and older from 9.80% to 17.60%, after which remained stable (figure 1C). There was a relative decrease in proportion of patients 50-64 years from 2000 to 2014, from 51.10% to 42.80%, respectively. The number of cardiac transplants among 50-64 year old group from 2000 to 2008 decreased from 1,123 to 920 then increased again by 2014. Conclusion: There has been a significant increase in the total number of heart transplants from 2000 to 2023. Currently, heart transplants in geriatric population consist of a significant portion of total heart transplants close to 1 of 5 transplants that occur per year (18% to 19%). This number has grown from 9.80% (2000) to 18.50% (2023) among all heart transplants per year.
Abstract 4139311: Comparative Effects of Education and Income Levels and Cardiovascular Risk Factors for the Risk of Ischemic Heart Disease, Ischemic Stroke, or Peripheral Artery Disease Associated Mortality
Authors: David Fueller, Chang Liu, David Boten, Oliver Ritter, Gesine Doerr, Vardhmaan Jain, Shivang Desai, Laurence Sperling, Yan Sun, Arshed Quyyumi
Journal: Circulation (2024)

Background: Low educational attainment and income are associated with a higher risk of adverse cardiovascular (cv) outcomes. Research Question: The impact of lower education and income levels on the risk of cv death defined as ischemic heart disease, ischemic stroke, or peripheral artery disease associated mortality, and how this compares to traditional cv risk factors including overweight/obesity, hypertension, type 2 diabetes, smoking history, frequent alcohol consumption, physical activity, and family history for heart disease. Methods: In this prospective study involving 396,614 participants of the United Kingdom Biobank (UKB) with no history of ischemic heart disease, ischemic stroke, or peripheral artery disease at enrollment, we divided participants into five groups according to annual household income as defined in UKB, and six groups of educational attainment created using the International Standard Classification of Education. Five BMI (kg/m 2 ) categories were created (&lt;25; 25-29.9; 30-34.9; 35-39.9, ≥40). The association of education and income with cv death was assessed using Fine-Gray sub-distribution hazard models including covariate adjustment for age, sex, race, number of people in the household, spatial socioeconomic deprivation, plasma lipids, and traditional cv risk factors. Results: Mean age was 55.8 years, 46% were men, and mean time of follow-up was 14.3 years. There were 3,930 cv deaths. One level lower in income was associated with a higher risk for cv death (aHR 1.28, 95% CI 1.22-1.34, p &lt;0.0001). One level lower in education was non-significantly associated with cv death (aHR 1.02, 95% CI 1.00-1.04, p=0.06). One level lower in income was associated with a higher risk for cv death compared to one group higher in BMI categories (aHR 1.15, 95% CI 1.10-1.21, p &lt;0.0001) and was comparable to the risk associated with having a father, mother, or sibling with heart disease. Conclusion: The risk for cv death associated with one level lower in income as assessed in the UKB is higher than the risk associated with one group higher in BMI categories and comparable with a family history for heart disease, highlighting the importance to assess socioeconomic factors in cardiovascular risk assessments.