tbuckley/cabot-search huggingface dataset:
Abstract 4138611: Impact of SGLT-2 Inhibitor Use on Atrial Fibrillation Incidence Following Heart Failure Hospitalization
Authors: Thomas Fretz, Tanyanan Tanawuttiwat, Onyedika Ilonze, Mithilesh Das
Journal: Circulation (2024)

Introduction: The development of atrial fibrillation (AF) in patients with heart failure (HF) is associated with increased morbidity and mortality. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated cardiovascular benefit in patients with both preserved and reduced ejection fractions. Meta analysis of prospective trials suggest reduced incidence and burden of atrial fibrillation in patients taking SGLT-2 inhibitors, though this has not been specifically addressed in prospective trials. Hypothesis: SGLT-2 inhibitors reduce the incidence of atrial fibrillation in patients with heart failure. Aim: The goal of the study is to assess the impact of SGLT-2 inhibitor on the incidence of atrial fibrillation following heart failure hospitalization. Methods: The study included consecutive patients who were admitted to an academic tertiary care center over a 3 year time period with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was development of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiographic data, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new-onset AF after HF hospitalization. Results: Among the 3,953 patients included in our study, 704 (17.8%) patients were prescribed SGLT-2 inhibitors. Of those taking SGLT-2 inhibitors, 559 (79.4%) patients had diabetes. SGLT-2 inhibitor use is associated with significant reduction of AF at one year ( p&lt;0.001; RR 0.65; 95% CI: 0.51-.81 ). This finding was consistent across patients with reduced ejection fractions (EF&lt;50%) ( p=0.001; RR 0.56; 95% CI: 0.40-.80 ) and preserved ejection fraction (EF&gt;50%)( p=0.001; RR 0.58; 95% CI: 0.42-0.80 ). Conclusion: In patients with reduced ejection fraction and preserved ejection fraction heart failure, use of an SGLT-2 inhibitor is associated with a statistically significant lower risk of new-onset atrial fibrillation at one year following HF hospitalization.
Abstract 4138477: Small Vessels, Big Challenges: Clinical and Demographic Correlates of Failure to Respond to Optimal Medical Therapy in Patients with Microvascular Angina
Authors: Diya Karwa, Avraj Virdi, Tim Kinnaird, Sean Gallagher, Omar Aldalati, Rhodri Davies, Abbas Zaidi, Richard Wheeler, Peter OCallaghan, Zaheer Yousef, Vasim Farooq
Journal: Circulation (2024)

Background: Microvascular angina (MVA), resulting from coronary microvascular dysfunction, affects 40-50% of patients with exertional chest pain or dyspnea and a normal coronary angiogram. This condition significantly impairs quality of life and elevates the risk of major cardiac events, including myocardial infarction, stroke and death. MVA is classified as 'structural' (coronary flow reserve [CFR] &lt;2.5&amp;index of microcirculatory resistance [IMR] &gt;25) or 'functional' (CFR &lt;2.5&amp;IMR &lt;25). Current treatments are empirical, necessitating further investigation. Methods: This single-centre, retrospective study conducted in South Wales from 2019-24 examined MVA cases confirmed via national electronic health records. The Canadian Cardiovascular Society (CCS) angina grade was assessed at diagnosis and post optimal medical therapy (OMT) during clinic visits. Ordinal logistic regression was used to identify independent correlates of higher CCS grade, considering baseline LDL, age, diffuse epicardial disease, sex, hypertension, kidney function, smoking status and HbA1c levels as covariates. Results: Among 64 identified MVA cases (median age 69 yrs, IQR 61.3-77.8; 68.8% male), 81.3% had structural MVA, 6.3% functional MVA and 12.5% mixed disease. Coronary vessel testing was performed on 1, 2 or 3 vessels in 29.7% (n=19), 53.1% (n=34; 21 positive [+ve] in 2 vessels, 13 +ve in 1 vessel) and 17.2% (n=11; 5 +ve in 3 vessels, 5 +ve in 2 vessels, 1 +ve in 1 vessel) of cases, respectively. The LAD was most commonly affected vessel (82.8%). At diagnosis, 79.7% had CCS grade III or higher (Fig 1). Post OMT, 45.3% achieved CCS grade 0-I, 31.8% CCS grade II and 15.6% remained at CCS grade III (refractory angina). Medications included ranolazine (84.4%), beta-blockers (70.3%) and calcium channel blockers (28.1%). Ordinal logistic regression analysis (X 2 =0.27, p=0.033) identified baseline LDL (95% CI [0.16, 1.26]; p=0.011), age (95% CI [-0.12, -0.001]; p=0.045), diffuse epicardial disease (95% CI [0.016, 2.13]; p=0.047) and male sex (95% CI [0.066, 2.36]; p=0.038) as independent correlates of higher CCS grade, signifying poor response to OMT. Conclusion: MVA manifests regionally, underscoring the need for multi-territory testing. Although tailored OMT proved effective for many, 15.6% of patients continued to experience refractory symptoms (CCS grade III). This highlights the necessity for alternative therapeutic strategies to improve patient outcomes in this challenging condition.
Abstract 4138483: Outcomes of Hypoplastic Left Heart Syndrome by Subtype and Presence of Ventriculocoronary Connections: A Fetal Heart Society Multi-Center Retrospective study
Authors: David Barris, Lindsay Freud, Patrick Day, Shaine MORRIS, Keila Lopez, Ann Kavanaugh-Mchugh, Stacy Killen, Shabnam Peyvandi, Flora Nunez Gallegos, Anita Moon-Grady, Erik Michelfelder, Angela Mcbrien, Lisa Hornberger, Caroline Lee, Whitnee Hogan, Anjali Chelliah, Lisa Howley, Bhawna Arya, Sam Keller, Anita Krishnan, Mary Donofrio, carolyn taylor, Nazia Husain, Bethan Lemley, Christina Ronai, Wayne Tworetzky, Catherine Ikemba, Clarelle Gonsalves, Miwa Geiger, Son Duong, Jennifer Cohen
Journal: Circulation (2024)

Background: Hypoplastic left heart syndrome (HLHS) is classified by subtype: mitral atresia and aortic atresia (MA-AA), mitral stenosis and aortic atresia (MS-AA), and mitral stenosis and aortic stenosis (MS-AS). It is controversial whether specific HLHS subtypes and presence of ventriculocoronary connections (VCC) are associated with transplant-free survival. We aimed to determine whether there is an increased risk of mortality associated with specific HLHS subtypes, whether this risk is stratified by the presence of VCC, and if a specific type of stage I palliation in patients with VCC improves survival. We also aimed to determine practice variation in the evaluation of HLHS patients with VCC. Methods: We performed a multicenter retrospective cohort study of fetuses and infants &lt; 2 months of age with HLHS admitted between 1/2012-12/2016 to participating Fetal Heart Society institutions. Patients with HLHS variants were excluded. We collected patient specific data and surveyed participating centers for practice variation. Kaplan-Meier curves with log-rank test were used to assess transplant-free survival and cox proportional hazard analysis was performed with adjustment for center as a random intercept. Results: 341 patients from nine centers were included. MA-AA was the most common subtype (177, 52%), followed by MS-AA (102, 30%), and MS-AS (62, 18%). VCC were diagnosed or suspected in 65 patients (19%). A total of 287 patients were live born with intention to treat. HLHS subtype was not associated with transplant-free survival (Figure 1A). Presence of VCC was associated with a lower transplant-free survival (p=0.026, Figure 1B). In the subset of patients diagnosed with VCC, there was not a significant difference in survival based on type of stage I palliation (Figure 1C). Cox proportional hazard modeling adjusted for center demonstrates that presence of VCC has a hazard ratio of 1.74 (CI 1.02-2.98), p =0.04. Survey data regarding practice variation for patients with VCC (Figure 2) demonstrates 33% of centers modify the type of stage I palliation based on presence of VCC. Conclusions: In a multicenter cohort of HLHS patients, patients with VCC had lower transplant-free survival compared to those without VCC, while subtype and type of stage I palliation did not have a statistical difference. There is considerable practice variation in the management of HLHS patients with VCC that may warrant further investigation.
Abstract 4138672: Blood Pressure and Cardiovascular Outcomes in Adults with Diabetes and Chronic Kidney Disease
Authors: Hyeok-Hee Lee, Jong Hyun Jhee, Eun Jin Kim, Hyeon Chang Kim, Daichi Shimbo, Hokyou Lee
Journal: Circulation (2024)

Background: Most international guidelines recommend intensive blood pressure (BP) targets (e.g., &lt;130/80 mm Hg) for patients with chronic kidney disease (CKD). However, the data supporting these recommendations are limited, particularly for those with concomitant diabetes. Hypothesis: Systolic BP (SBP) &lt;130 mm Hg and diastolic BP (DBP) &lt;80 mm Hg are associated with a reduced risk of cardiovascular disease (CVD) in adults with diabetes and CKD. Aims: To determine the association of BP with incident CVD risk among adults with diabetes and CKD. Methods: From a Korean nationwide health screening database, we identified 373,966 adults aged 20-79 with both diabetes and CKD who: (1) underwent baseline health examinations in 2009-2013; (2) had ≥3 BP measurements; and (3) did not have CVD at baseline. The associations of baseline average SBP and DBP with CVD risk were assessed using multivariable-adjusted cause-specific Cox models. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD. Results: The median (Q1-Q3) age of the participants was 62 (53-70) years; 40.8% were female. Over a median follow-up of 10.2 years, a total of 40,781 incident CVD events occurred. Compared with SBP 130 to &lt;140 mm Hg as the referent group, the multivariable-adjusted HRs (95% CIs) for CVD event in the SBP ≥150 mm Hg, 140 to &lt;150 mm Hg, 120 to &lt;130 mm Hg, and &lt;120 mm Hg groups were 1.34 (1.29-1.39), 1.11 (1.08-1.14), 0.89 (0.87-0.91), and 0.77 (0.74-0.80), respectively. Compared with DBP 80 to &lt;90 mm Hg as the referent group, the HRs (95% CIs) in the DBP ≥100 mm Hg, 90 to &lt;100 mm Hg, 70 to &lt;80 mm Hg, and &lt;70 mm Hg groups were 1.70 (1.56-1.85), 1.19 (1.15-1.24), 0.88 (0.86-0.90), and 0.83 (0.80-0.87), respectively (Figure A). SBP &lt;130 mm Hg and DBP &lt;80 mm Hg were each associated with a reduced CVD risk in a log-linear manner (Figure B, Figure C). The findings were consistent when examining kidney instead of cardiovascular outcomes. Conclusion: Among patients with diabetes and CKD, SBP below 130 mm Hg and DBP below 80 mm Hg were associated with a reduced risk of CVD.
Abstract 4138487: A Novel Technique in Managing Equipment Entrapment: A Complicated Case of Aortic Valvuloplasty Balloon Rupture and Detachment
Authors: MAHMOUD ABDELSALAM, Shady Ezaldin, Shadi Abu-Halimah, Richard Han
Journal: Circulation (2024)

Introduction: A 79-year-old male patient with a history of surgical AVR presented with severe bioprosthetic aortic stenosis requiring valve-in-valve TAVR. The plan was to place an Evolut CoreValve after intentionally fracturing the basal ring of his surgical valve. Through an 18F sheath, a 25mm x 4.5cm True balloon was advanced to the surgical valve over a Lunderquist wire. However, the balloon ruptured immediately after fracturing the valve ring. Decision making: Efforts were made to remove the ruptured True balloon while maintaining the position of the wire, but attempts to withdraw it through the 18F sheath were unsuccessful due to resistance at the distal tip of the sheath. Subsequently, the proximal portion of the balloon catheter was partially detached and removed. An exchange was made to a 22F Gore DrySeal sheath, but again, efforts to withdraw the ruptured balloon were unsuccessful (Figure 1). Various snares were employed, but all attempts to manipulate the balloon into the sheath were ineffective. The ruptured balloon remained in the abdominal aorta and eventually detached from the hypotube. The 22F sheath was then exchanged for a 20F Inari Protrieve sheath. Two Supracore wires were then inserted through the sheath, with one designated for snare delivery and the other for maintaining vessel access. A Tulip snare was guided over one Supracore wire to the descending thoracic aorta, where the snare was opened and the Lunderquist wire was captured at the junction between the stiff and soft parts of the wire (Figure 2). The snared wire and ruptured balloon were retracted into the exposed Nitinol cone of the Inari sheath, successfully engulfing the balloon and compressing it (Figure 3). The sheath, wire, balloon, and snare were then removed as a unit while the wire access was maintained. A new 22F Gore DrySeal sheath was inserted. Inspection confirmed the complete removal of all components of the ruptured True balloon and the catheter. The procedure concluded with the successful deployment of a 29mm Evolut pro CoreValve. The patient made an uneventful recovery and was discharged home the following day. Conclusion: The Inari Protrieve sheath proved valuable in this case of complicated intravascular equipment entrapment. The soft, funnel-shaped nitinol cone aided in capturing and compressing the bulky ruptured balloon, obviating the need for a surgical cutdown.
Abstract 4138475: Comparative Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Patients with Right Heart Failure: Insights from Nationwide Readmission Database
Authors: Sajog Kansakar, Dhan Shrestha, Jurgen Shtembari, Nava Sharma, Kailash Pant, Norbert Moskovits, VIJAY SHETTY, Khagendra Dahal, Jishanth Mattumpuram, Daniel Katz
Journal: Circulation (2024)

Background: The annual number of transcatheter aortic valve implantation (TAVI) performed has surpassed that of surgical aortic valve replacement (SAVR) as its use expands to patient populations not included in initial clinical trials. However, in patients with Right Heart Failure (RHF), the outcomes of TAVI and SAVR remain unclear. Methods: We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2021. Using ICD-10 codes, we identified all adult admissions for TAVI and SAVR with the presence of RHF. The primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications, 30-day readmission rate, length of stay, and total hospitalization charges. Results: The study included 3,712 adult patients with RHF, of which 1,386 (37.3%) underwent TAVI and 2,326 (62.7%) underwent SAVR. Compared to SAVR patients, TAVI patients were older (63 years vs. 76 years, p&lt;0.01) and had a higher burden of peripheral vascular disease, chronic liver disease, and coagulopathy, while SAVR patients had a higher burden of hypertension, diabetes mellitus, coronary artery disease, left heart failure, chronic lung disease, smoking, malignancy, and anemia. On multivariable analysis, compared to TAVI, SAVR was associated with higher odds of mortality (26.6% vs. 9.3%, p&lt;0.01), mechanical circulatory support use (41.5% vs. 9.22%, p&lt;0.01), respiratory failure (34.2% vs. 10.2%, p&lt;0.01), acute kidney injury (58.1% vs. 37.7%, p&lt;0.01), and need for blood transfusion (31.4% vs. 11.0%, p&lt;0.01). There was no difference in 30-day readmission (13.8% vs. 14.3%, p=0.51) and permanent pacemaker implantation (7.0% vs. 8.7%, p=0.33). SAVR was associated with a longer median hospital stay (14 days vs. 8 days, p&lt;0.01) and higher hospitalization charges ($406,826 vs $265,303, p&lt;0.01). When compared to patients wihout RHF, the presence of RHF predicted higher in-hospital mortality for both TAVI (9.3% vs. 1.2%, p&lt;0.01) as well as SAVR (26.6% vs. 3.7%, p&lt;0.01). Conclusions: From 2018 to 2021, more RHF patients underwent SAVR (62.7%) than TAVI (37.3%), but SAVR was associated with worse short-term outcomes, including higher in-hospital mortality, in-hospital complications, and healthcare resource utilization.
Abstract 4138484: Exploring medical students’ clinical preparedness to provide cardiovascular care for sexual and gender minorities
Authors: Andreas Koehler, Rebecca Beyer, Timo Nieder, Peer Briken, Sidney Smith, Ross Simpson
Journal: Circulation (2024)

Sexual and gender minorities (SGM) have unique risk factors for cardiovascular disease (CVD). A higher likelihood of tobacco use, inadequate exercise, diabetes, dyslipidemia, hypertension, and obesity have been found, driven by increased psychosocial stressors across the lifespan. Specific treatments, especially gender-affirming hormone therapy, can also increase the CVD risk. Even though SGM-related issues have been introduced into medical education, students’ expertise regarding cardiovascular care for SGM populations has not been studied. The present study examines the clinical preparedness, attitudes, and basic knowledge of medical students regarding cardiovascular care for SGM populations. Medical students from Germany were recruited to take part in an online survey. Additionally, medical students from the UK and the USA will be recruited in the future. We used a variety of channels for recruitment (e.g., mailing lists of student councils, social medical groups). The LGBT-DOCSS was used to assess SGM-related clinical competency. Based on prior work of our research group, we developed items to assess the knowledge of SGM-related cardiovascular care and educational needs. We calculated descriptive statistics to describe the outcomes of interest. Currently, 217 medical students (20% final-year) from 5 German medical schools participated in the study. Regarding general SGM-related clinical competency, participants scored below average on clinical preparedness (3.4/7.0), above average on basic knowledge about SGM-specific healthcare (5.1/7.0), and low on explicit bias and prejudice towards SGM individuals (6.4/7.0). 84 % of the participants reported not feeling appropriately prepared to deliver cardiovascular care for SGM populations. Most participants (72 %) only knew about one or two SGM-specific CVD risk factors. There was a high interest in learning about cardiovascular care for SGM populations (96%) and a preference to implement the issue in medical school curricula (93%). Additional data from Germany, the USA, and the UK will be presented at the time of the conference presentation. The present study provides insights into the clinical preparedness of medical students regarding cardiovascular care for SGM populations. Despite showing a high interest in learning about SGM-specific cardiovascular care, most medical students feel underprepared on the issue. Implementing SGM-specific cardiovascular health into medical school curricula could close this gap.
Abstract 4138546: From Nature’s Remedy to Cardiac Emergency: A Case of Takotsubo Cardiomyopathy Induced by High-Dose Berberine Supplementation
Authors: Aakriti Jain, Lara Almeidinha, Zachary Teibel, Andrew Takla, Hina Ukrani, Nikita Nand, Nevin Anderson, Mohan Rao, Mallory Balmer-Swain
Journal: Circulation (2024)

Introduction: Takotsubo cardiomyopathy (TCM) is a reversible cardiac condition often precipitated by emotional or physical stress. Certain medications have also been implicated. While prognosis is generally favorable, associated QTc prolongation and ventricular arrhythmias can be life threatening, necessitating identification of potential triggers. This report highlights TCM in a patient using high-dose berberine, a plant alkaloid known for its hypoglycemic properties. Case description: A 69-year-old female with a history of type 2 diabetes mellitus, and hyperlipidemia presented after a syncopal event. It was preceded by sudden onset of dizziness, nausea, and vomiting. She had been using berberine for a year to lower her blood sugar and had recently switched to a higher dose of a more potent formulation. Vitals were unremarkable. Initial evaluation revealed a prolonged QTc interval of 659 ms (Figure 1A) and elevated troponin-I levels. She was treated with intravenous magnesium, which improved her QTc to 540 ms and revealed new T-wave inversions in the precordial leads. Echocardiogram showed an ejection fraction (EF) of 35%, with LV apical akinesia and hypercontractile basal segments. Cardiac catheterization ruled out significant coronary artery disease, leading to a diagnosis of TCM. Berberine was discontinued, and guideline-directed medical therapy was initiated. Given the presentation with syncope and high suspicion of aborted sudden cardiac death (SCD), she was discharged with a wearable cardioverter-defibrillator (WCD) as a precaution due to the risk of ventricular arrhythmias during recovery. At her 8-week follow-up, QTc and EF had normalized (Figure 1B), prompting WCD removal. Conclusion: The pathophysiology of berberine-induced cardiomyopathy remains uncertain and requires further research. This case underscores the importance of recognizing the potential cardiotoxic effects of berberine, particularly when used in high doses. A thorough medication and supplement history is crucial in patients presenting with unexplained cardiac symptoms. The reversible nature of TCM, when promptly recognized and treated, highlights the need for comprehensive follow-up to ensure recovery of cardiac function.
Abstract 4138494: Remote Blood Pressure Monitoring and Intervention as a better and cost-effective method of Hypertension control compared to Usual care: A Systematic Review
Authors: Venkata Sai Abhilash Meda, Ashok Adhikari, Chandana Tadigotla, Ashwith Reddy Gaddam, Yogeshkumar Vaghamashi, Umang Gupta, Binay Panjiyar
Journal: Circulation (2024)

Introduction/Background: Hypertension is a leading cause of morbidity and mortality. Despite treatment recommendations and encouragement of lifestyle changes, the actual rate of blood pressure control is still not at par. Remote intervention methods have been shown to achieve better rates of blood pressure control utilising lesser resources and lower healthcare costs. We conducted a systematic review by qualitatively evaluating the potential impact of remote monitoring and interventions compared to usual care in controlling Hypertension. Research Question: Are remote monitoring techniques and interventions better than usual in-person blood pressure checks for hypertension control? Methods: We did a comprehensive literature search of Pubmed/MEDLINE, Google scholar, Cochrane central Library, PLOS ONE, ScienceDirect and Clinicaltrials.gov to identify eligible randomised control trials and clinical trials published between July 2013 and May 2025. A Risk of Bias assessment was conducted using Cochrane Risk of Bias tools such as ROB-2 for randomised control trials and ROBINS-1 for cohort studies. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 5,185 records analysed, 10 randomised control trials, 1 cohort study and 1 implementation study satisfied our inclusion criteria. Compared to usual care, remote monitoring methods showed significant difference in systolic blood pressure control at 6-12 months in 9 out of 12 studies, while 3 studies did not show any significant difference. Quality of life, physical health, mental health and drug compliance have also shown a significant positive difference in patients. Remote self monitoring interventions were found to be more cost-effective than usual care. They also reduced the load of patients seeking appointments for hypertension control thereby improving the quality of patient care. Conclusion: The management of clinical hypertension is a challenging entity. Conventional methods of regular in-office blood pressure checks are both tedious and resource consuming. Using remote monitoring methods have shown to significantly improve blood pressure control compared to routine methods. It also eliminates white-coat hypertension during follow-up blood pressure checks which leads to more appropriate interventions. Remote monitoring and intervention for hypertension control is time-effective, cost-effective and improves quality of life.