tbuckley/cabot-search huggingface dataset:
Abstract 4145308: Mechanical Circulatory Support in Cardiogenic Shock Secondary to Acute Myocardial Infarction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Authors: Henrique Alexsander Neves, Gabriela Romaniello, Michelle Collini, Pedro Henrique Reginato, Luana Miyahira Makita, Giovana Schlichta Kojima, Guilherme da Rocha, Victor Galvani Amarilla, Vanio do Livramento Junior Antunes, Gustavo Lenci Marques
Journal: Circulation (2024)

Background: Cardiogenic shock is a leading cause of mortality in acute myocardial infarction. The efficacy of mechanical circulatory support devices in reducing mortality is uncertain. Research Question: Which mechanical circulatory support device is associated with lower mortality and better safety outcomes in patients with cardiogenic shock? Goals/Aims: To compare different mechanical circulatory support devices in patients with cardiogenic shock. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library databases up to April 2024 for randomized controlled trials (RCTs) involving mechanical circulatory support devices (e.g., Impella, ECMO, IABP, percutaneous ventricular assist device) reporting at least 30-day mortality or safety outcomes (bleeding, cerebrovascular events, sepsis). Two reviewers independently extracted data on mortality and safety outcomes. A frequentist network meta-analysis with random-effects models was used, calculating risk ratios (RR) with 95% confidence intervals (CI) and treatment ranking probabilities (P-SCORE). Results: Our systematic review and network meta-analysis included 15 RCTs, involving 1,927 patients, comprised of 77.6% of males with a mean age of 63.1 years, from Europe, North America, and Asia. No device reduced 30-day mortality. IABP had a lower risk of bleeding compared with Impella (RR 0.34; 95% CI 0.17-0.7), while ECMO had a higher bleeding risk compared with no support (RR 1.97; 95% CI 1.18-3.28). Regarding long-term mortality (30 + 180 days), ECMO showed a higher risk compared with Impella (RR 1.22; 95% CI 1.01-1.46). IABP led to fewer cerebrovascular events (RR 0.37; 95% CI 0.15-0.93) and sepsis (RR 0.54; 95% CI 0.35-0.83) compared with Impella. No significant differences were found in other comparisons. Conclusion: No mechanical circulatory support device significantly reduced 30-day mortality in patients with cardiogenic shock. IABP was associated with lower risks of bleeding, cerebrovascular events, and sepsis compared with Impella. ECMO showed a higher risk of bleeding compared with no support and higher long-term mortality compared with Impella. Further research should focus on identifying safer strategies and optimal patient profiles for these devices to improve outcomes.
Abstract 4145254: Effects Of Semaglutide On Safety Outcomes In Patients With Type 2 Diabetes Mellitus And High Cardiovascular Risk: A Meta-Analysis Of Randomized Controlled Trials And Systematic Review
Authors: Maria Antonia Cruz Akabane, Roberto Mazetto, Iury RIBEIRO, Douglas Cavalcante, Imara Barbosa
Journal: Circulation (2024)

Background: The efficacy of semaglutide, a glucagon-like peptide-1 receptor agonist, has been studied in patients with type 2 diabetes mellitus (T2DM) who also have advanced chronic kidney disease (CKD) and/or established cardiovascular disease. These conditions pose a high cardiovascular risk. However, the impact of semaglutide on safety outcomes and the incidence of adverse effects in this population remains unclear. Hypothesis: The use of semaglutide is associated with a higher incidence of gastrointestinal adverse events and specific safety concerns such as severe hypoglycemia and retinopathy. Aims: This study aimed to evaluate the impact of semaglutide on safety outcomes in high-risk cardiovascular patients with T2DM. Methods: PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for randomized controlled trials (RCTs) that compared semaglutide (oral and subcutaneous) to placebo in adult patients with T2DM with CKD and/or established cardiovascular disease and reported the safety outcomes of (1) gastrointestinal disorder; (2) acute pancreatitis; (2) severe hypoglycemia; (3) retinopathy; (4) acute kidney failure and (5) malignant neoplasm. A systematic review and meta-analysis of the findings were performed using RStudio version 2024.04.0. Heterogeneity was examined with the Cochran Q test and I2 statistics. Results: We included 3 RCTs in the final analysis, with a total of 10.013 participants, of whom 5.006 (49.99%) were on semaglutide. Semaglutide was associated with a significant increase in the incidence of gastrointestinal disorders compared with placebo (OR 2.00; 95% CI 1.07-3.77; p= 0.031; figure 1A). Severe hypoglycemia (OR 1.10; 95% CI 0.92-1.31; p=0.31; figure 1B), acute kidney failure (OR 0.93; 95% CI 0.78-1.10; p= 0.402), acute pancreatitis (OR 0.92; 95% CI 0.49-1.71; p= 0.792), retinopathy (OR 1.17; 95% CI 0.91, 1.50; p=0.225) and malignant neoplasm (OR 1.02; 95% CI 0.85-1.24; p=0.809) were not significantly different between groups. Conclusion: In high cardiovascular risk T2DM patients, semaglutide was associated with a higher incidence of gastrointestinal disorders as compared with placebo.
Abstract 4144803: Association of <i>ENTPD-1</i> SNP genotype on inflammatory cell phenotype and ST-elevation myocardial infarction cardiovascular outcomes: a post-hoc analysis of the POPular Genetics
Authors: Wout van den Broek, Samuel Watson, Thomas Bergmeijer, jaouad azzahhafi, Raymond Magorien, Ernest Mazzaferri, Scott Lilly, Talal Attar, Konstantinos Boudoulas, Francesca Madiai, Roman Covarrubias, jurrien ten berg, Richard Gumina
Journal: Circulation (2024)

Background: ST elevation myocardial infarction (STEMI) patients are at increased risk for secondary cardiovascular events. Modulation of purinergic signaling is the mainstay of post-MI antithrombotic therapy. CD39, encoded by the ENTPD1 gene, is a key modulator of vascular homeostasis that hydrolyzes prothrombotic and proinflammatory extracellular nucleotides. The goal of this study was to determine if the ENTPD1 promoter polymorphism rs3814159 genotype associates with inflammatory cell expression of CD39 and with secondary cardiovascular events in patients following STEMI. Approach and Results: FACS analysis of circulating inflammatory cells from volunteers and STEMI patients was conducted. We found that 1) the ENTPD1 promoter polymorphism rs3814159 genotype associates with the level of CD39 expression on T cells, 2) Integrated immunophenotype analysis depicts a temporal expression pattern of increased CD39 on Tregs following myocardial infarction, and 3) Treg phenotype differs by rs3814159 genotype early following STEMI. Next to determine if the rs3814159 genotype associates with STEMI outcomes we analyzed data from the POPular Genetics study. A total of 1964 patients from the original POPular Genetics study cohort had rs3814159 genotype assignment ( Treg CD39 high AA: 517 (24.3%); CD39 int AG: 982 (46.2%); CD39 low GG: 625 (29.4%) consistent with expected frequencies. There were no differences in baseline characteristics by rs3814159 genotype. The primary endpoint of ischemic outcomes (all-cause death, myocardial infarction, target vessel revascularization, and/or stent thrombosis) was significantly higher in those patients homozygous for GG ( Treg CD39 low ) versus AA ( Treg CD39 high ) at rs3814159 by both univariate (HR:1.44; 95% CI:1.04-2.00, p=0.029) and multivariate (HR:1.43; 95% CI:1.03-1.98, p=0.034) analysis using an additive model. No significant differences in bleeding outcomes were observed by genotype using BARC criteria. Kaplan-Meier analysis revealed a significant increase in primary ischemic events in patient homozygous GG ( Treg CD39 low ) versus homozygous AA ( Treg CD39 high ) at rs3814159 (Figure). Conclusions: These data suggest for the first time that ENTPD1 rs3814159 genotype associates with the level of CD39 expression on T-cells and with the incidence of the primary ischemic endpoint of all-cause death, myocardial infarction, target vessel revascularization, and/or stent thrombosis after ST elevation myocardial infarction.
Abstract 4145168: Incidence and Associations of Normal QRS vs Right Bundle Branch Block in Ebstein's Anomaly
Authors: Shisheer Havangi Prakash, Aastha Poddar, Heidi Connolly, Alexander Egbe, Malini Madhavan
Journal: Circulation (2024)

Introduction: Ebstein's anomaly (EA) is associated with ECG signature of right bundle branch block (RBBB). Patients with EA also have high incidence of accessory pathways (AP) and it has been hypothesized that the absence of RBBB on ECG may be associated with a higher prevalence of AP. This study aims to assess the prevalence of RBBB in patients with EA and examine the correlation between its absence and the presence of AP. Methods: Adults (age&gt;18 years) with EA, identified using the Mayo Adult Congenital Heart Disease registry, were divided into 3 groups based on the QRS morphology of their first ECG. Those with prior AP ablation were excluded. The demographic characteristics, baseline ECG data, echocardiographic parameters and EP study data were retrospectively collected and compared between the three groups using Chi-square or ANOVA test as appropriate. Results: Of 596 patients with EA, 358(60.06%) patients had a RBBB, bifascicular block or an incomplete RBBB (group1) ; 18 (3.02%) patients had either a LBBB , ventricular pre-excitation, isolated left anterior or posterior fascicular block (group 2); and 220 (36.92%) patients had normal QRS (group 3). The characteristics of these groups are compared in the table. Patients with RBBB had larger RV size, reduced RV systolic function and higher likelihood of tricuspid valve surgery. EP study was performed in 51 (14%), 3 (17%) and 51 (23%) patients in groups 1, 2,and 3 respectively. One or more APs were noted in 11/51 (22%) and 14/51 (30%) patients with RBBB and normal QRS respectively (p=0.18). Additionally, in patients who did not undergo an EP study, supraventricular tachycardia was documented in 39/307 (13%), 2/15(13%) and 13/169 patients (8%) in group 1,2 and 3 respectively during followup . Conclusion: In a large cohort of adults with EA in a tertiary referral center, greater than one-third of patients had a normal QRS complex without RBBB. However, EP study did not reveal a significant difference in the prevalence of accessory pathways between patients with and without RBBB. In EA, the absence of RBBB may not increase the risk of an underlying accessory pathway.
Abstract 4145313: Efficacy of self-expandable versus balloon-expandable Transcatheter aortic valve replacement in severe aortic stenosis patients: A systematic review and meta-analysis of randomized control trials.
Authors: Pedro Gabriel Scardini, Alonzo Prata, Eric Katsuyama, Ana Carolina Coan, Christian Fukunaga, Wilson Falco Neto, Julia Fernandes, Rafael Petri Santos Pinheiro, Naieli Andrade, Luciana Gioli-Pereira
Journal: Circulation (2024)

Background: Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe aortic stenosis, surpassing surgery in multiple trials. However, there is limited evidence between self-expandable valves (SEV) and balloon-expandable valves (BEV). Therefore, we performed a systematic review and meta-analysis comparing the efficacy of SEV and BEV undergoing TAVR in severe aortic stenosis patients. Methods: We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SEV and BEV in patients with severe aortic stenosis. Our primary endpoint was (1) All-cause mortality. Additionally, we reported the following secondary outcomes:(2) stroke, (3)all-cause mortality within 30 days, and (4) stroke within 30 days. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model. Results: Our meta-analysis included six RCTs comprising 3488 patients, of whom 1617 subjects (46.3%) underwent SEV. The mean age was 81 years, and the mean follow-up was 2 years. In the pooled analysis, our results show no significant difference in all-cause mortality (RR: 0.95; CI 95%: 0.81,1.12; p= 0.56; Fig. 1A ) and stroke (RR:0.97; CI 95%: 0.72,1.32; p= 0.86; Fig. 2A) between SEV and BEV in patients with severe aortic stenosis undergoing TAVR. Our 30 days follow-up analysis also showed no significant change in all-cause mortality (RR: 1.74; CI 95%: 0.88,3.45; p= 0.11; Fig. 1B) and stroke (RR: 0.59; CI 95%: 0.17,1.98; p= 0.39; Fig. 2B). Conclusion: In this meta-analysis comparing SEV versus BEV in patients undergoing TAVR in patients with severe aortic stenosis, there was no significant difference between all-cause mortality and stroke. These findings were consistent in our 30-day follow-up subanalysis.
Abstract 4145153: Heartfelt Headaches: Exploring Cardiac Cephalgia as an Etiology of Headaches
Authors: Sheena Amin, Khaldoon Rashid, Brendan O'Gorman, Daniel Storms
Journal: Circulation (2024)

Introduction: Cardiac cephalgia is an under-recognized type of headache. Description of Case: A 68-year-old female with past medical history of chronic headaches presents with one week of non-radiating central chest pain, exertional dyspnea, palpitations, lightheadedness, and worsening headaches. The headaches were described as a “stabbing and throbbing” pain starting at the vertex and radiating anteriorly. Triggers included stress, and associated symptoms included photophobia and nausea. An electrocardiogram was notable for new T-wave inversions in the inferior leads. An echocardiogram demonstrated an ejection fraction of 44% with regional akinesis of the inferior and inferolateral walls. Patient proceeded for left heart catheterization, which depicted total occlusion of the middle segment of the right coronary artery; a stent was successfully placed and dual antiplatelet therapy was initiated. Following stent placement, she endorsed resolution of her chronic headaches and has not had recurrence. Discussion: This case presents a patient with chronic headaches, initially diagnosed as migraines and occipital neuralgia. She had previously been treated with triptans and botulinum toxin without effect. Resolution of her headaches following revascularization suggest that cardiac cephalgia may be the underlying etiology. Cardiac cephalgia is a secondary headache disorder that is related to cardiac ischemia. It has classically been described as a headache that is triggered by exertion or stress and alleviated by rest or nitrates. Pathophysiology is incompletely understood but current theories include referred pain, simultaneous constriction of cerebral and coronary vessels, reduced cardiac output resulting in increased cardiac pressures and therefore decreased venous return from the brain, and cardiac ischemia-induced neurotransmitter release leading to cerebral vasodilation. The diagnosis of this condition is supported by a temporal relationship between coronary ischemia and headache onset. Interestingly, this patient had a headache onset several months before exhibiting signs of coronary ischemia but had an acute worsening at the time of presentation. It is important to keep cardiac cephalgia on the differential for patients with headaches in order to prevent treatment with agents, such as triptans and ergot derivatives, that are contraindicated in coronary artery disease.
Abstract 4145127: Sex Differences in Everyday Mood States and its Association with Autonomic Physiology
Authors: Amit Shah, Hua She, lisa elon, Qiao Li, Tatum Roberts, Lewam Stefanos, George Haddad, Shishir Gupta, Nitya Tarlapally, Rachel Lampert, Paolo Raggi, Brad Pearce, Arshed Quyyumi, Reza Sameni, Tene Lewis, Samaah Sullivan, J Douglas Bremner, Gari Clifford, Viola Vaccarino
Journal: Circulation (2024)

Background: Although CHD incidence is low amongst young and middle-aged women, those who have premature MI are at a high risk of mortality. Greater psychosocial exposures and mental health comorbidities in women may play a role. We hypothesize that women age ≤ 60 years with recent MI have a higher burden of everyday negative psychological experiences, and that these are associated with greater real-time cardiac autonomic dysfunction compared with men. Methods: We examined real-time mood and autonomic function in 239 participants aged ≤ 60 years with an MI within 8 months. We performed smartphone-based ecological momentary assessments of stressful events and negative mood states (anger, anxiety, distress, loneliness, and sadness) at 3 random points throughout the day for one week. Participants simultaneously wore a Holter monitor to measure autonomic function. Our primary exposure was the average negative mood intensity (rated 0 to 10) throughout the week, and our primary outcome was reduced deceleration capacity of heart rate (DC) during sedentary periods as a measure of lower vagal activity. Other measures of dysautonomia included lower high (HF) and low frequency (LF) heart rate variability (HRV). We used multivariable linear regression models to adjust for potential confounders. Results: The mean age was 52 years, 51% were black, and 36% were women; 76% of women reported at least one stressful event in the week of monitoring, vs. 64% of men (p=0.04). Women reported more negative mood than men by 0.39 units (p=0.02) on average. DC, averaged across the week, was 12% lower, LF HRV was 41% lower, and HF HRV was 34% lower in women than in men. As the weekly average of negative mood increased, the weekly average of DC declined in women only (Figure). After adjusting for age, current smoking, diabetes, and beta-blocker use, each 2-point increase in the negative mood score was associated with a 12% (95% CI: 6.12%-17.88%) lower DC in women only. Similar findings were observed for HF and LF HRV. Conclusions: Young and middle-aged post-MI women reported more real-time negative psychological states, which were associated with worse autonomic function compared to men with early MI. Resting autonomic function was also lower in women. Negative mood in daily life has disproportionate impact on cardiac autonomic regulation among women. Psychophysiological mechanisms are important in the examination of sex-based disparities in CHD pathophysiology and outcome.
Abstract 4145263: A Novel Multivariate Scoring System for Diagnosing Post-Myocardial Infarction Pericarditis Following Percutaneous Coronary Intervention
Authors: Olayiwola Bolaji, Okiemute Omoru, Prakash Upreti, Blanche Echari, Saeed Shoar, Jawad Basit, M Chadi Alraies
Journal: Circulation (2024)

Introduction: Post-myocardial infarction (MI) pericarditis, particularly after percutaneous coronary intervention (PCI), presents with distinct clinical, laboratory, and electrocardiographic features. Despite its unique presentation, no dedicated diagnostic tools exist for this condition in the post-PCI setting, highlighting the need for a tailored approach. This study aims to develop and validate the first comprehensive clinical scoring system specifically designed to accurately diagnose post-MI pericarditis following PCI, utilizing data available at admission. Methods: In this diagnostic case-control study, we compared 60 patients with confirmed post-PCI pericarditis (verified by echocardiography) from our PCI Registry with 120 control patients with various diagnoses from our hospital database. We evaluated 26 potential predictors, including clinical characteristics, chest pain descriptors, and additional diagnostic tests. Independent predictors for the scoring model were identified using stepwise logistic regression. Results: Among the 17 initial variables associated with pericarditis, five independent predictors were identified: age, chest pain exacerbation with thoracic movement, rising troponin levels, diffuse ST-segment elevation, and C-reactive protein levels. These predictors were incorporated into a scoring system based on their regression coefficients. The model demonstrated excellent discrimination, with a C-statistic of 0.97 (95% CI: 0.93-1.0). A score above 6 points yielded a sensitivity of 95% (95% CI: 85-100) and specificity of 86% (95% CI: 78-93), with positive and negative likelihood ratios of 7.2 (95% CI: 4.2-12) and 0.05 (95% CI: 0.01-0.2), respectively, Figure 1. Conclusion: We have developed the first multivariate scoring system specifically designed to identify post-MI pericarditis in patients undergoing PCI. Its promising accuracy has the potential to enhance early recognition, streamline diagnostic processes, and ultimately improve patient outcomes.
Abstract 4145056: A Comparison of Outcomes in Heart Failure Patients with and without Iron Deficiency Anemia: A National Database Analysis
Authors: Olva Bess, Andres Quevedo Ramirez, Abdultawab Shaka, Omotola Oredipe, Jeremiah Bello, Hafeez Shaka
Journal: Circulation (2024)

Introduction: Iron deficiency anemia (IDA) affects millions of people with heart failure (HF) and is of a higher proportion in patients admitted for HF than those seen as an outpatient. The cause of IDA in patients with HF is postulated to be related to the chronic inflammatory process that occurs resulting in decreased erythropoiesis. This could also be a side effect of the extensive treatment. The fate of patients admitted for exacerbation of heart failure, especially those with IDA could be fatal. This study uses the NIS HCUP database to assess the outcome of patients admitted from 2016 to 2019 with heart failure and co-existing iron deficiency anemia. Research question/ hypothesis: Patients with HF and co-existing IDA have worse outcomes than those without. Method: We used the NIS HCUP 2016 to 2019 database for the analysis. The primary outcome was inpatient mortality. Secondary outcomes such as mean length of hospitalization (LOS), mean total hospital charges (THC) adjusted for inflation and proportion of complications were computed. Data was analyzed using regression models adjusted for significant, confounding, sociodemographic and comorbid conditions. Discussion/ Results:: The total population of hospitalizations for HF from 2016 to 2019 was 1270784 with 6.9% having IDA. A higher proportion of hospitalizations with IDA were women. The mortality from the HF admission was 39350 patients. IDA was associated with lower adjusted odds of inpatient mortality (2.5 vs 3.2%, aOR: 0.75, 95% confidence interval (CI) of 0.68-0.84. However, patients with IDA had significantly longer mean LOS and higher THC compared to patients without IDA. Patients with IDA also had increased adjusted odds or requiring pressors, developing acute kidney failure and respiratory failure. Conclusion:: Although IDA did not appear to impact mortality in patients with HF, it was associated with higher inpatient complications and higher healthcare cost utilization. Researchers postulate that limitation of different codes being used when data is recorded could have contributed to the unimpacted mortality. Further studies are needed to decipher other factors. Addressing comorbid IDA in the outpatient setting may significantly decrease the cost associated with hospitalization for HF by decreasing the length of hospitalization and the hospital charges associated with those hospitalizations.