tbuckley/cabot-search huggingface dataset:
Abstract 13072: Safety and Efficacy of Lead Extraction at Time of Device Upgrade
Authors: John R Power, Kavisha Patel, Kathleen Jacobs, Travis Pollema, Gordon Ho, Ulrika Birgersdotter-Green
Journal: Circulation (2023)

Introduction: Patients with permanent pacemakers may require upgrade to ICD or CRT but there is no consensus on whether unused leads should be abandoned or extracted. Transvenous lead extraction (TLE) adds potential risk and can be complex in cases of complete venous occlusion. The safety and efficacy of TLE as a strategy to upgrade pacemakers has not been systematically explored and the impact of venous occlusion is unknown. Aims: 1) Characterize the success and safety of TLE for the indication of pacemaker upgrade to ICD or CRT 2) Assess the effect of complete venous occlusion on outcomes Methods: A total of 50 patients underwent TLE for the sole indication of pacemaker upgrade at UCSD from January 2018 to January 2023. All patients completed preoperative cardiac TLE CT. In-hospital outcomes and procedural variables were collected by chart review. Association with venous occlusion was analyzed using McNemar and t-tests. Results: All 50/50 (100%) patients had successful TLE and successful device upgrade with CRT-D in 44/50 (88%) patients and DC-ICD in 6/50 (12%) patients. No complications occurred (conversion to open extraction, injury, tamponade). Preoperative CT showed complete venous occlusion in 14/50 (28.0%) patients. Median lead extraction fluoroscopy time was 6.0 minutes (IQR: 3.7-8.5). Laser extraction was required in 48/50 patients (96%), laser sheath upsizing in 4/50 (8.0%), conversion to mechanical sheath in 7/50 (14.0%), and telescoping sheaths in 1/50 (2.0%). Venous occlusion was not associated with different baseline characteristics, TLE techniques, or fluoroscopy time (Table 1). Conclusions: TLE in combination with pacemaker upgrade had excellent procedural success. Preoperative CT identified complete venous occlusion in 28% of patients, but this was not associated with technical difficulty, procedural success, or clinical outcomes. Further studies are required to assess the long-term impact of this lead management strategy.
Abstract 17044: Normal Ranges of Right Atrial Strain by Contemporary Echocardiography Software: A Prospective Comparative Cohort Study
Authors: Ankit Agrawal, Joseph El Dahdah, Aro Daniela Arockiam, Tiffany Dong, Muhammad Majid, L L Rodriguez, Richard A Grimm, Brian P Griffin, Zoran B Popovic, Tom Kai Ming K Wang
Journal: Circulation (2023)

Introduction: Right atrial strain (reservoir RASr, conduit RAScd and contractile RASct) are increasingly utilized in the clinical and research setting such as for diastology grading, heart failure and valvular heart disease. However, the feasibility and reference ranges of right atrial strain measurements by contemporary strain software on different vendor scanners are not well established. We evaluated and compared two-dimensional right atrial strain values, reference ranges and associated factors across three strain software vendors in healthy subjects. Methods: Healthy subjects (n=100) undergoing echocardiography during January-April 2023 were prospectively studied, with equal number by age-groups, gender and GE versus Philips scans. Right atrial strains were quantified using TomTec version 51.02 (Autostrain LA), EchoPAC version 206 (AFI-LA) and VVI software for statistical analyses. Results: The table shows the right atrial strain means (and lower limits of normal defined as 95 th percentile) ± standard error by strain software, including RASr of 41.2±0.9% (29.6±1.6%) by TomTec, 35.9±0.7% (27.0±1.3%) by EchoPAC (which could only measure on GE scans), and 44.8±1.3% (27.6±2.2%) by VVI. EchoPAC measurements of right atrial strain were significantly less negative than TomTec or VVI (P&lt;0.01), while TomTec has slightly less negative measurements than VVI for RASr only but similar for RAScd and RASct. Multivariable linear regression showed systolic blood pressure to be significantly associated with RASr measured by VVI with beta coefficient (95%CI) per 1 mmHg of 0.23 (0.08-0.38), why no factors were significantly associated with RASr measured by TomTec or EchoPAC. Conclusions: TomTec and VVI were vendor neutral for measuring right atrial strains, while EchoPAC can only measure this on GE scans. Normal means, lower limits of normal and associated factors of right atrial strain measurements by strain vendor were established for clinical applications.
Abstract 17074: Development and Multinational Validation of a Machine Learning-Based Optimization for Efficient Screening for Elevated Lipoprotein(a)
Authors: Arya Aminorroaya, Lovedeep S Dhingra, Seyedmohammad Saadatagah, Erica S Spatz, Evangelos K Oikonomou, Rohan Khera
Journal: Circulation (2023)

Background: Lipoprotein(a) [Lp(a)] is associated with an increased risk of major adverse CV events even among those receiving optimal lipid-lowering therapy. However, &lt;1% of patients with or without ASCVD undergo Lp(a) testing. We developed a machine learning model to optimize screening for high Lp(a) using structured clinical elements. Methods: We included 456,815 participants of UK Biobank (UKB), the largest cohort of people who underwent protocolized Lp(a) testing regardless of indication. Potential features spanned demographics, medication history, diagnoses, procedures, vital signs, and lab values from UKB and linked EHR to predict high Lp(a) (≥150 nmol/L). The dataset was split into train and test sets (80:20). We trained multiple extreme gradient boosting models using all available features and selected the best model by prioritizing high AUROC while minimizing the number of features using cross-validation. Pooled cohort equation (PCE) was used as a comparator to predict high Lp(a). We externally validated the model in well-established CV cohorts of ARIC, CARDIA, and MESA (Fig A). Results: The best model used features of LDL-C, statin use, triglycerides, HDL-C, ASCVD, and antihypertensive medication use, and outperformed the PCE score for predicting high Lp(a) (AUROC 0.66 vs 0.52, P&lt;0.001). The model performed comparably across ARIC, CARDIA, and MESA cohorts (Fig B). To find 1 person with high Lp(a), the model reduces the number needed to test (NNT) by up to 62% depending on the probability threshold, which can be tailored to different use cases (Fig C). The relative reduction in NNT is higher among those without vs with ASCVD (49% vs 26%, for optimized specificity with a threshold of 0.2). Conclusions: Our model optimizes Lp(a) testing strategies using commonly available clinical features, which can be leveraged in EHR and other settings for efficient Lp(a) screening. The model can encourage greater Lp(a) testing and optimize case finding for future studies.
Abstract 16193: Differences in Mortality Between Patients With Left Ventricular Assist Devices and End-Stage Renal Disease on Peritoneal Dialysis versus Hemodialysis
Authors: Ahmed K Saleh, Gina Josey, Vibhu Parcha, Javier Neyra
Journal: Circulation (2023)

Introduction: End-stage renal disease (ESRD) patients with concomitant heart failure often require left ventricular assist devices (LVADs), but the impact on mortality in peritoneal dialysis (PD) versus hemodialysis (HD) is unclear. This study aims to compare mortality rates in prevalent and incident ESRD patients with LVADs on PD versus HD. Hypothesis: We hypothesize differences in mortality rates and heart transplantation rates between LVAD patients on PD versus HD. Methods: A retrospective cohort analysis used data from the TriNetX Research Network database. Propensity score matching compared two cohorts: LVAD with HD (Cohort 1) and LVAD with PD (Cohort 2). Demographic data, comorbidities, and baseline laboratory values were collected. Mortality rates were assessed using risk analyses over a 3-year period following LVAD placement. Results: The study cohorts included 252 patients each after propensity score matching, with mean ages of 63.8 ± 14.3 years (Cohort 1) and 62.87 ± 15.4 years (Cohort 2). No significant differences were observed in demographic data including gender, race, or ethnicity between the two cohorts. The mortality rate did not significantly differ between Cohort 1 (HD) and Cohort 2 (PD) (0.563 vs. 0.603), with a risk difference of -0.04 (95% CI: -0.126, 0.046, p = 0.366). The risk ratio and odds ratio for mortality also showed no significant differences. Conclusion: ESRD patients with LVADs receiving PD demonstrated similar mortality rates compared to those receiving HD. These findings suggest that dialysis modality does not seem to influence mortality outcomes in patients with LVAD. Further research is needed to better understand the differences between these complex patient populations.
Abstract 15671: Research Participants Are Hesitant About the NIH’s New Data Sharing Policy and Its Implications for Cardiac Research
Authors: Stephanie Nino de Rivera, Shalom Omollo, Annie Myers, Yihong Zhao, Ruth M Masterson Creber
Journal: Circulation (2023)

Objective: To evaluate participant preferences for the NIH’s Data Sharing (DMS) Policy and its implications for cardiac research. Introduction: The recent NIH DMS Policy went into effect in January 2023, yet it is unclear how the intended expansion to study data by the public will impact participant willingness to participate in research. Minoritized communities are already underrepresented in research and this could create distrust and increase hesitancy to participate in research. Giving participants options about future use of data, how it is stored and shared all requires further research. Methods: A representative sample of adults in the US (n=610) were surveyed using an online platform (Prolific). Questions assessed participants’ agreeability with the new policy, change in willingness to participate in research, and preferences for consenting to future data sharing. Descriptive statistics and bivariate analyses were conducted using Pearson’s chi-squared test and Fisher’s exact test for categorical variables. Results: Participants' mean age was 45 (19-93) years, 49.7% were female, 12.8% were Black/African American, 5.9% Asian, and 77.9% White, with the remainder identifying with another race (3.4%). Notably, fewer Black/African Americans (50%) agreed to the new NIH data sharing policy compared to White (67%), Asian (72%), and other races (86%). The results for additional questions relating to the new NIH policy and preferences for sharing clinical data are presented in Figure 1. Conclusion: The new NIH DMS policy can increase hesitancy towards participating in research, especially in minoritized communities. Future work should focus on methods to increase representation in cardiac research by ensuring patient preferences for data sharing are upheld.
Abstract 15234: Greater Statin Interruption Rates and Lower Adherence for Women versus Men With HIV in the United States
Authors: Thibaut Davy-Mendez, Alan C Kinlaw, Nwora Okeke, Michelle Floris-Moore, Joseph J Eron, Stephen A Berry, Heidi M Crane, Carol E Golin, Sonia Napravnik, Ross J Simpson
Journal: Circulation (2023)

Introduction: People with HIV, particularly women, have an elevated CVD risk, and a recent trial showed they can benefit from statin initiation even at low/moderate predicted CVD risk. Yet &lt;50% of patients with HIV on statins experience adequate lipid reductions. To inform efforts to reduce CVD risk and gender disparities in this population, we examined statin persistence and adherence by gender in a nationwide sample of privately insured people with HIV. Methods: Among people with HIV ≥18 in MarketScan Commercial Claims who initiated a statin in 2015-2020, we used outpatient pharmacy claims to estimate 1) time to statin interruption (first gap &gt;30 days) and 2) monthly proportion of days covered (PDC) by a statin. PDC analyses censored people if they were off statins ≥6 months. We estimated gender differences in interruption rates using hazard ratios (HR) and in having low adherence (PDC&lt;80%) using risk ratios (RR) adjusted for age, calendar year, US census region, and employment status. Results: There were 7809 statin initiators (17% women; 60% in the South; median age 52 years, IQR 47-57). Two years after statin initiation, 81.0% (95% CI 78.1%-83.8%) of women and 69.8% (68.4%-71.3%) of men had ≥1 statin interruption (adjusted HR women vs. men 1.35 [1.25-1.46]) (Fig. 1A). Monthly PDC decreased in the first 6 months of statin use to 61% for women and 68% for men, then increased to 73% and 80%, respectively, after 2 years (Fig. 1B). Over all months, women more commonly had PDC&lt;80%, with an adjusted RR of 1.27 (1.20-1.34). Conclusions: People with HIV had high statin interruption rates and adherence &lt;80% at most time points, with disparities for women versus men. It is possible that, despite having insurance, women with HIV in this sample are more affected than men with HIV by socioeconomic and other barriers to statin adherence. Gender-specific efforts in people with HIV should address these barriers to promote adherence to CVD preventative pharmacotherapy in this population at high risk.
Abstract 12053: Diagnostic Utility of SGLT2 Inhibitors to Facilitate Myocardial Glucose Suppression During Evaluation of Myocardial Inflammation
Authors: Senthil Selvaraj, Mahesh K Vidula, Chaitanya Rojulpote, Caitlin Clancy, Milton Rossman, Lee R Goldberg, Daniel A Pryma, Paco E Bravo
Journal: Circulation (2023)

Background: The non-invasive cornerstone for evaluating cardiac sarcoidosis (CS) remains 18 F-FDG-PET. However, FDG-PET requires suppressing physiologic glucose uptake to highlight pathologic uptake. Short term ketogenic diet (KD) is standard-of-care, yet inadequate suppression occurs in 10-20% which can mimic CS patterns. Ketone metabolic markers strongly predict appropriate glucose suppression, and therefore the ketogenic-SGLT2i may facilitate suppression. Methods: We prospectively evaluated 494 scans from 388 unique patients undergoing evaluation for CS. FDG-PET images were classified as diagnostic (negative or positive for CS-related inflammation) or non-diagnostic (diffuse or non-specific uptake). We used mixed effect linear regression (accounting for clustering at the participant level), adjusting for age, race, sex, days of KD, heart failure (HF), and diabetes mellitus. Results: Mean age was 59.0±10.1 years, 63% were male, 29% were Black, 21% were repeat scans, and 14% were on SGLT2i. SGLT2i use was associated with male sex, features/treatment for HF and diabetes, and higher hemoglobin and ketone levels ( Table , p&lt;0.05 for all comparisons). Diagnostic scans were more frequently achieved in the SGLT2i group (98.6%) vs. non-SGLT2i group (92.0%) (unadjusted beta-coefficient 6.6%, 95%CI 0.0-13.1%, p=0.049; multivariable-adjusted 8.0%, 1.3-14.6%, p=0.019). Adjusting for log-transformed BHB eliminated this relationship (beta-coefficient 4.7%, p=0.17), though hemoglobin adjustment did not (beta-coefficient 7.9%, p=0.038). There were no interactions by days of KD, HF, sex, race, or diabetes (p-interaction&gt;0.05 for all comparisons). Conclusions: SGLT2i facilitated diagnostic FDG-PET scans (number needed-to-treat 13-15), which was nearly universally achieved (99%), and may be mediated by their ketogenic effects. We demonstrate a novel diagnostic niche which may decrease inappropriate treatment, costs, and radiation.
Abstract 13944: The Efficacy and Safety of New Potassium Binders on RASSi Optimization in Hyperkalemic Patients With Heart Failure: A Systematic-Review and Meta-Analysis of Randomized Controlled Trials
Authors: Mohamed T Abuelazm, amr T badr, Mostafa Atef, Mustafa Turkmani, Ahmed Mazen Amin, AYA Aboutaleb, Ibrahim Gowaily, Basel Abdelazeem
Journal: Circulation (2023)

Introduction: Guideline-directed medical therapy (GDMT) has improved outcomes in patients with heart failure (HF), including the use of renin-angiotensin-aldosterone system inhibitors (RAASi); angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), angiotensin receptor/neprilysin inhibitor (ANRi), and mineralocorticoid receptor antagonists (MRAs). RAASi can hinder the excretion of potassium, resulting in hyperkalemia. New potassium binders (NPB) (patiromer and sodium zirconium cyclosilicate) can prevent this adverse effect; however, the efficacy and safety of NPB for this indication have not been fully established. Methods: We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through April 26th, 2023. We used the fixed-effect model to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI). Results: We included five RCTs with a total of 1,399 patients. BPB was significantly associated with successful MRA optimization (RR: 1.13 with 95% CI [1.02, 1.25], P=0.02), decreased patients with MRA at less than target dose (RR: 0.72 with 95% CI [0.57, 0.90], P=0.004), and decreased hyperkalemic episodes (RR: 0.50 with 95% CI [0.32, 0.79], P=0.003). However, there was no difference between NPB and placebo regarding ACEi/ARB/ANRi optimization (RR: 1.02 with 95% CI [0.89, 1.17], P=0.76) and serum potassium change (MD: -0.31 with 95% CI [-0.61, 0.00], P=0.05). Conclusion: NPB can successfully improve GDMT outcomes by enhancing MRA optimization and decreasing hyperkalemic episodes. However, data regarding the NPB effect on ACEi/ARB/ANRi optimization remain scarce. Therefore, future RCTs should investigate it and conduct a head-to-head comparison of NPB.
Abstract 13086: National Trends in Timely Ambulatory Follow-Up After Acute Myocardial Infarction and Congestive Heart Failure Cospitalizations Among Medicare Beneficiaries
Authors: Timothy S Anderson, Robert W Yeh, Shoshana Herzig, Edward R Marcantonio, Bruce Landon
Journal: Circulation (2023)

Introduction: Following hospitalization for acute myocardial infarction (AMI) or congestive heart failure (CHF), close outpatient follow-up is warranted for symptom monitoring and initiation or titration of evidence-based therapies. Objective: To describe temporal trends in ambulatory care following CHF and AMI hospitalizations, between 2010 and 2019. Methods: We examined a 100% sample of Medicare fee-for-service beneficiaries discharged to the community after an AMI or CHF hospitalization. We assessed quarterly rates of timely post-discharge cardiology and primary care follow-up, defined as receipt of an ambulatory visit within 14 days of discharge. We assessed trends for five subgroups based upon known disparities in cardiovascular outcomes: sex, race/ethnicity, Medicaid dual-eligibility, county-level social deprivation index, and rurality. Results: The AMI cohort included 1,680,916 hospitalizations (54.9% male, 9.4% Black, 81.7% White) and the CHF cohort included 4,256,405 hospitalizations (47.7% male, 16.2% Black, 75.0% White). Timely cardiology follow-up after AMI increased from 26.8% in 2010 to 39.4% in 2019 (absolute change 12.6%) while follow-up after CHF increased from 22.0% to 33.4% (absolute change 11.5%). The proportion of patients without cardiology or primary care follow-up after AMI decreased to 36.1% in 2019 and to 41.6% for CHF. Though rates of timely follow-up increased for all demographic groups, female, Black, Hispanic, Medicaid dual-eligible patients, patients residing in rural areas, and patients residing in counties with high social deprivation were less likely to receive follow-up throughout the study. Conclusions: Rates of timely ambulatory care after AMI and CHF hospitalization have improved, but the majority of patients do not receive follow-up within 14 days of discharge. Efforts to improve post-hospital cardiology and primary care follow-up have the potential to improve clinical outcomes and reduce disparities.
Abstract 12590: Association of Iron Deficiency With the Recurrence of Atrial Fibrillation After Pharmacological Cardioversion
Authors: Marat Valeev, Dilyara Khastieva, Natalia Tarasova, Niiaz Khasanov
Journal: Circulation (2023)

Introduction: Anemia and iron deficiency (ID) are common conditions in patients with atrial fibrillation (AF). The presence of anemia may be associated with worse outcome in patients with AF. The potential role of ID in the development of AF has been discussed recently, however the issue is considered only in the context of anemia. Thus, information on the direct impact of ID on AF development and on the sinus rhythm maintenance remains limited. Methods: The purpose of this article is to study the effects of ID on the frequency of recurrence of AF within 12 months in patients with paroxysmal AF after pharmacological cardioversion with amiodarone.198 patients (120 men) with nonvalvular paroxysmal AF with successful pharmacological cardioversion were included in the study between 2019-2021 years. The Me of the patients age is 71 (63,2–77) year. ID is assumed to be present when serum ferritin &lt;100 ng/mL or 100 ng/mL ≤ serum ferritin ≤299 ng/mL with transferrin saturation (TSAT) &lt;20%. The primary outcome was AF recurrence within 12 months after pharmacological cardioversion. AF recurrence is statistically tested by the Kaplan-Meier test. Results: The patients were divided into 2 groups: group 1 - 116 patients with ID, group 2 - 82 patients without ID. The groups did not differ in the main clinical parameters, comorbidities and medications. After cardioversion, all patients received treatment according to the current guidelines. The significant difference in AF recurrence was observed between groups. Within 12 months of observation, AF recurrence was developed in 49 (42.2%) patients in group 1 and in 16 (19.5%) patients in group 2 (p=0.0008). The RR of the recurrence of AF in patients with ID is 2.64 [95% CI: 1.5-4.65] (p=0.0003). Conclusion: ID is associated with the higher chances of AF recurrence within 12 months after pharmacological cardioversion. ID increases the risk of AF recurrence by 2,64 times within 12 months after pharmacological cardioversion.
Abstract 17888: Apixaban versus Vitamin K Antagonists for Left Ventricular Thrombus: A Systematic Review and Meta-Analysis
Authors: Eric Pasqualotto, Douglas Mesadri Gewehr, Rafael Oliva Morgado Ferreira, Matheus chavez, Fernando Pessoa, Francisco Cezar A de Moraes, RAFAEL PEREIRA, Luiz F Kubrusly
Journal: Circulation (2023)

Introduction: Left ventricular thrombus (LVT), a major complication following acute myocardial infarction, significantly contributes to the increased risk of stroke and systemic embolism. Although vitamin K antagonists (VKAs) are the first-line treatment for LVT, direct oral anticoagulants (DOACs) have emerged as a potential alternative. However, the comparative effectiveness and safety of DOACs and VKAs for LVT treatment remain uncertain. Research question: Is apixaban therapy more effective and safer than VKA therapy for LVT? Aim: To assess the efficacy and safety of apixaban compared with VKAs therapy in patients with LVT. Methods: We systematically searched PubMed, Embase, and Cochrane databases for studies comparing the efficacy and safety of apixaban versus VKAs. We applied the random-effects model to calculate odds ratios (OR) and the corresponding 95% confidence interval. Heterogeneity was assessed using I 2 statistics. All calculations and graphics were performed using R (version 4.2.3). Results: Three randomized clinical trials (RCTs) were included, with 109 patients assigned to either apixaban (56 patients) or VKAs (53 patients). Compared to VKAs, apixaban showed no significant impact on thrombus resolution (OR 0.69; 95% CI 0.11-4.50; p=0.70; I 2 =0%), stroke reduction (OR 0.91; 95% CI 0.09-9.38; p=0.93; I 2 =1%), clinically relevant bleeding (OR 0.21; 95% CI 0.02-1.99; p=0.17; I 2 =0%), or all-cause mortality (OR 0.65; 95% CI 0.11-3.78; p=0.63; I 2 =8%). Conclusions: Apixaban therapy showed similar efficacy and safety to VKAs for LVT. These findings support the use of apixaban as an alternative to VKAs in LVT treatment.