tbuckley/cabot-search huggingface dataset:
Abstract 4145617: Racial Disparities in Management and Outcomes of Acute Myocardial Infarction and Non-Acute Myocardial Infarction Related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database
Authors: Anushka Desai, Anum Minhas, Faisal Rahman
Journal: Circulation (2024)

Background: Cardiogenic shock (CS) has high morbidity and mortality rates. There is limited understanding of race differences in the management and outcomes of CS. Methods: We queried the US National Inpatient Sample database (years 2016-2021) for CS hospitalizations in adults and categorized them by presence of acute myocardial infarction (AMI) on admission. Using multivariable logistic regression modeling, we adjusted for age, sex, income, insurance, comorbidities, and prior cardiac interventions and compared racial differences in use of and time to interventions, inpatient mortality, and cardiac arrest during hospitalization for AMI-CS and non-MI-CS. Results: Out of a total 1,012,050 weighted hospitalizations for CS, 60% involved non-MI-CS, while 40% were AMI-CS. Among AMI-CS hospitalizations, Black patients were less likely to receive IABP (aOR: 0.87, 95%CI: 0.82-0.93), pLVAD (aOR: 0.79, 95%CI: 0.72-0.86), PCI (aOR: 0.79, 95%CI: 0.75-0.84), and CABG (aOR: 0.77, 95%CI: 0.71-0.83), than White patients (all p&lt;0.001). For non-MI-CS hospitalizations, Black patients were less likely to receive PCI (aOR: 0.58, 95%CI: 0.50-0.67), CABG (aOR: 0.55, 95%CI: 0.50-0.60), and invasive mechanical ventilation (aOR: 0.91, 95%CI: 0.87-0.94) and were more likely to receive right heart catheterization (aOR: 1.27, 95%CI: 1.21-1.33) and LVAD (aOR: 1.39, 95%CI: 1.25-1.54) when compared to White patients (all p&lt;0.001). In both types of CS, treatment of Hispanic, Asian, and Native American patients was largely comparable to that of White patients. Regardless of CS type, Black patients were more likely to have cardiac arrest during hospitalization. Race was not seen to impact likelihood of inpatient mortality or early treatment within 24 hours in either non-MI-CS or AMI-CS hospitalizations. Conclusions: Differential management of CS by race is most notable between Black and White patients with Black patients being less likely to receive most treatments. Inpatient mortality rates remain comparable across race and ethnicity groups. Future studies should further investigate the clinical impact of racial differences in management and assess survival based on time to procedure and length of stay.
Abstract 4145615: Impact of Acute Coronary Syndrome on Hospitalization Outcomes in Young Adults with Substance Use Disorder: A Nationwide Analysis (2016-2020)
Authors: Lakshmi Subramanian, Sashwath Srikanth, Nikitha Devaprasad, Jinye Liu, Pavan Vihar Reddy Podduturi, Zoofi Shan, Urmi Jindal, Divyank Patel, Rupak Desai
Journal: Circulation (2024)

Background: Substance use disorder (SUD) is increasingly prevalent among young adults, often leading to severe cardiovascular complications. The specific impact of acute coronary syndrome (ACS) on young adults with SUD is not well-documented. We aimed to investigate the impact of ACS on young adults with SUD by comparing demographics, comorbidities, and in-hospital outcomes between those with and without ACS. Methods: We used the 2020 National Inpatient Sample (NIS) database to identify hospitalizations of young adults (18-44 years) with SUD and categorized them into those with and without ACS using ICD-10 codes. We compared demographics, comorbidities, all-cause mortality (ACM), and cardiogenic shock between the two groups. Multivariable regression analysis was performed to compare outcomes. Results: A total of 4,132,379 weighted hospitalizations of young adults with SUD were included in our study, of which 0.7% (n=30,955) had ACS. The population in the ACS group was older (median age 37 years vs. 32 years), more often had males (71.5% vs. 52.2%) and blacks (26.3% vs. 20.6%), and less often consisted of whites (56.7% vs 64.5%) compared to the no-ACS group. The ACS group had higher rates of hyperlipidemia, hypertension, diabetes, obesity, and peripheral vascular disease compared to the no-ACS group. Interestingly, tobacco and alcohol use disorders were more common in the no-ACS group (Table 1). The ACS group was also associated with higher hospital costs. Patients with ACS suffered significantly higher odds of ACM (aOR 10.16, 95% CI 8.96-11.53) as compared to those without ACS. Over the five years from 2016 to 2020, the rates of ACS admissions among young adults with SUD remained largely unchanged. (all p&lt;0.001). Conclusion: In this large nationwide analysis, ACS was associated with a significantly higher risk of ACM in young adults with SUD. Further research is essential to validate this data and develop effective strategies to improve outcomes for this vulnerable population.
Abstract 4145497: Pump-Assisted Vein Dilation for Arteriovenous Fistula Creation – Translation of the Amplifi Vein Dilation System from Bench to Bedside
Authors: Rebecca Treffalls, Surendra Shenoy, Adrian Ebner, Mark Macedo, Erdie De Peralta, Scott Richardson, Mimi Fritterer, Krishnil Mani, michael brown, Geoffrey Douglas Tansley, Nicholas Franano, Paul Muller, Jonathan Morrison
Journal: Circulation (2024)

Background: Autologous arteriovenous fistulas (AVF) are the preferred choice for hemodialysis access due to their longevity, lower complication rates, and mortality benefit. Their use is limited by vein size and necessary maturation period, excluding up to a third of patients. A novel solution to this problem is pump-assisted vein dilation (PAVD), where the vein is “pre-matured” using a miniatured centrifugal pump that draws blood from a central vein, delivering it into the recipient vein (e.g., cephalic) under pressure. The aim of this study is to report the initial safety studies in sheep and a first-in-human (FIH) pilot study as a prelude to a phase 2 clinical study. Methods: Preclinical Study: Three anesthetized male sheep (50-70 kg) underwent cephalic PAVD using the Amplifi Vein Dilation System for 7 days (mean). These subjects and two control animals (no-PAVD) underwent brachiocephalic AVF creation and observation for 6 weeks, with weekly surveillance fistulagrams and duplex ultrasound (U/S). AVFs were then explanted for histological analysis. Clinical Study: Ten patients were recruited for a phase 1 study. They underwent cephalic PAVD for 7 days (mean), followed by brachiocephalic AVF creation and surveillance at 2 and 6 wks. Data on vein diameter and flow rates of the AVF were collected, as well as safety data on complications such as bleeding, infection, and embolism. Results: Preclinical Study: PAVD increased mean±SD vein diameter (mm) from 4.5±1.0 to 8.4±1.0 (p=0.005); leading to greater cephalic vein diameter at the time of AVF creation in the PAVD group vs no-PAVD (8.2±1.3 vs. 3.3±0.7; p&lt;0.05). After 6 wks of maturation, mean vein diameter was still greater in the PAVD group compared to no-PAVD (12.8±2.8 vs. 8.4±0.7; p&lt;0.05). Mean flow increased at 41 mL/min/day versus control animals at 5.2 mL/min/day. Clinical Study: All subjects saw an increase in vein diameter with PAVD at baseline vs. at 6 wks (2.3±0.5 vs. 5.2±0.7; p&lt;0.05), as well as mean flows (mL/min) (285±30 vs. 724±149). There were no Amplifi-related or procedure-related serious adverse events. Conclusion: The translation of PAVD for AVF creation from bench-to-bedside provides safety and efficacy data on a novel solution that can increase the availability of autologous AVFs in patients excluded due to size criteria. The Amplifi vein dilation system can effectively and rapidly dilate peripheral veins without stimulating neointimal hyperplasia. PAVD should be explored in a phase 2 clinical study.
Abstract 4145554: Obstructive Sleep Apnea Increases the Risk of Cardiovascular Disease and Stroke Among Persons with Cancer: Analyses from a Multi-center Electronic Healthcare Records-Based Database.
Authors: Ehimen Aneni, Omair Ahmed, Fadar Otite
Journal: Circulation (2024)

Background: Cancer and obstructive sleep apnea (OSA) individually elevate cardiovascular diseases (CVD) and stroke risk. However, it is unclear whether OSA contributes additional CVD risk in persons with pre-existing cancer. Methods: Using the TriNetX, an electronic healthcare records-based database from large healthcare organizations, we compared adverse CVD outcomes and ischemic stroke incidence between patients with and without OSA diagnosed with cancer between 01/2012 and 06/2023. Adverse CVD outcomes was defined as a composite of incident heart failure, incident atrial fibrillation / flutter, incident myocardial infarction or all-cause mortality. Patients were eligible to enter the cohort on the day of cancer diagnosis. The follow-up period for outcome events began one year after patients entered the cohort and patients contributed follow-up time till the outcome event occurred or till the end of the study period. After propensity risk score matching on demographics and comorbidities we conducted a time-to-event analyses. Results: A total of 509,477 patients with both cancer and OSA were propensity score matched to 509,477 patients with cancer but without OSA. The table shows the demographic and comorbidities of the matched groups. Among persons with cancer, OSA diagnosis was associated with increased risk of adverse CVD outcomes (HR: 1.37, 95% CI: 1.36 – 1.38). OSA in persons with cancer increased the risk of heart failure, atrial fibrillation / flutter and myocardial infarction. OSA also increased the risk of ischemic stroke. However, total mortality risk was reduced among those with OSA. See the table for details. Conclusion: OSA increases the risk of adverse CVD outcomes and ischemic stroke in persons with cancer. These analyses suggest that persons with cancer should be screened and treated for OSA. Future studies will need to determine the impact of OSA treatment e.g., positive airway pressure (PAP) therapy on CVD related outcomes in persons with cancer. Further investigation into the paradoxical reduction in all-cause mortality with OSA is warranted.
Abstract 4145507: Impact of Angiotensin-I-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Carotid Plaque Composition Assessed By MRI
Authors: Karlo Wiley, Allison Anker, Ana Martinez Torres, Guliz Kozdag Gold, Alejandro Vivoni, Cristina Sanina
Journal: Circulation (2024)

Background: Carotid artery stenosis is a well-established risk factor for ischemic stroke, contributing to 10-20% of strokes or transient ischemic attacks. Currently, MRI is the gold standard in carotid plaque imaging due to its high resolution and high sensitivity for identifying intraplaque hemorrhage, ulceration, lipid-rich necrotic core, and inflammation. The purpose of the study is to determine the effects of Angiotensin-I-converting enzyme inhibitors(ACEIs) and Angiotensin receptor blockers (ARBs) on carotid plaque characteristics. Methods: Before elective carotid revascularization 30 patients (mean age 72±8 years; 16 males, 14 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. 16 patients were on ACEIs or ARBs. Results: MRI demonstrated that although 25% of patients who were on ACEIs or ARBs had lipid-rich necrotic core, 71% of patients who were not on ACEIs or ARBs had lipid-rich necrotic core. While 9 (90%) males who were not on ACEIs or ARBs had lipid rich necrotic core, 1 (25%) female who was not on ACEIs or ARBs had lipid rich necrotic core, p=0.015. There was no gender difference for lipid rich necrotic core in patients who were on ACEIs or ARB. Conclusion: This study demonstrated that patients receiving ACEIs or ARBs had less lipid rich necrotic core in the carotid plaques compared to patients not receiving ACEIs or ARBs. Additionally, patients with lipid-rich necrotic core who were not on ACEIs or ARBs were mostly males.
Abstract 4145582: Implications of a “Smart” Resuscitation Strategy to Identify Rhythm and Physiologic Phenotype During CPR
Authors: Heemun Kwok, Jason Coult, Jennifer Blackwood, Julia King, Peter Kudenchuk, Thomas Rea
Journal: Circulation (2024)

Background: Previously described algorithms evaluated defibrillator biosignals during ongoing CPR to characterize the underlying rhythm and its physiologic phenotype. We hypothesized that a “smart” resuscitation strategy incorporating these algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology. Methods: In a cohort study of ventricular fibrillation OHCA from 2017-2019, rescuer actions (rhythm analysis, shock delivery, pulse check and medication administration) were extracted from EMS, audio, and defibrillator recordings. Previously validated algorithms were combined to assess both cardiac rhythm and physiologic measures. The combined smart algorithm was compared to observed clinical practice with respect to rhythm accuracy and CPR interruption. The frequency of potentially misdirected drug therapy, defined as epinephrine use with &gt;50% probability of spontaneous pulse or antiarrhythmic use with a predicted rhythm of asystole or bradycardia, was determined. Low vitality physiologic phenotype was defined as a shockable rhythm with low probability of post-shock ROSC or a non-shockable rhythm with low probability of a pulse during a clinical pulse check. Vitality phenotypes were compared with respect to post-shock ROSC following shock delivery and pulse prevalence during pulse checks. Results: : Of 390 VF-OHCA cases, median age was 64, and 46% survived to hospital discharge. There were a median of 5 rhythm analyses, 3 shocks, and 2 pulse checks per case. The smart strategy achieved comparable shock accuracy (95% sensitivity, 98% specificity) to observed care while decreasing the median CPR interruption from 12 to 6 seconds. Of 597 epinephrine doses, the algorithm identified 17% (n=99) with predicted probability of ROSC over 50%. Of 248 antiarrhythmic doses, the algorithm predicted the rhythm was asystole or bradycardic organized in 9% (n=23). Following 1334 VF shocks, post-shock ROSC differed by phenotype: 4% (9/217) with low vitality versus 22% (244/1117) with high vitality (p&lt;0.01). During 1088 pulse checks, a pulse was present in 9/171 (5%) with low vitality compared to 325/917 (35%) with high vitality (p&lt;0.01). Conclusion : A smart resuscitation strategy that assesses the specific rhythm and physiologic phenotype could positively affect hands-on time, medication administration, shock delivery, and pulse checks. It has the promise to improve OHCA survival but requires rigorous comparison to current protocols.
Abstract 4145340: Health System Variability in Lipid Management for Patients with Atherosclerotic Cardiovascular Disease: An Analysis from Cv-MOBIUS
Authors: Nishant Shah, Peter Shrader, Satoshi Shoji, Seth Martin, Soledad Fernandez, Alanna Chamberlain, Jonathan Arnold, Michael Shapiro, Mark Effron, Elizabeth Chrischilles, Clint Allred, Elisa Priest, Mahanaz Syed, H Lester Kirchner, Monika Leja, Zahid Ahmad, Bethany Kalich, Nafeesa Dhalwani, Laney Jones, Cezary Wojcik, Eric Peterson, Ann Marie Navar
Journal: Circulation (2024)

Background: Nationally, many ASCVD patients fail to achieve an LDL-C &lt;70 mg/dL, and uptake of both statin and non-statin therapies is low. The degree to which this varies across health systems is less clear. Methods: A cross sectional analysis was performed where lipid levels and lipid lowering therapies (LLT) were assessed using electronic health record data in patients with a previous diagnosis of ASCVD. The data was obtained across 14 US healthcare systems between 1/1/2021-12/31/2022. Proportions of patients with an active prescription of any statin, high intensity statin, ezetimibe, PCSK9i, and combination therapy (two or more agents) within 395 days of the most recent LDL-C value (index date) was evaluated overall and by participating site. Additionally, the proportion of patients with an LDL-C &lt;70 mg/dL at the index date was also assessed. Results: Across 14 health systems, 1,118,623 patients with ASCVD were identified (median 61,840 per health system, range 8,161-182,315). Overall, 675,776 (60.4%) had an LDL-C level in the past year (range 39.1% - 70.8%). Of those with a lipid level, achievement of LDL-C &lt;70 mg/dL ranged from 34.6-47.2%. In total, 42.6% were on any statin, 20.1% were on a high intensity statin, 4.3% on ezetimibe, and 1.2% on a PCSK9i. Only 2.9% were on combination therapy of a statin with ezetimibe or a PCSK9i. Variability was seen across health systems in utilization of each of these therapies, however even in the highest performing health systems, LLT uptake and achievement of LDL-C &lt; 70mg/dL remained low ( Figure). Conclusion: Variability in utilization of LLT in ASCVD patients between health systems suggests that system-level factors may impact achieving guideline-based LDL-C goals. Despite the variability, the highest proportion of patients achieving an LDL-C &lt;70mg/dL remained under 50% indicating the need for aggressive implementation efforts.
Abstract 4145387: Cardiac Myosin inhibitors in patients with Symptomatic Hypertrophic Cardiomyopathy: An updated Systematic review and Meta-analysis of randomized trials.
Authors: Alonzo Prata, Eric Katsuyama, Ana Carolina Coan, Julia Fernandes, Pedro Gabriel Scardini, Christian Fukunaga, Wilson Falco Neto, Rafael Petri Santos Pinheiro, Naieli Andrade, Alexandra Regia Dantas Brígido
Journal: Circulation (2024)

Background: Current therapeutic options for relieving symptoms in hypertrophic cardiomyopathy (HCM) predominantly involve invasive interventions. In contrast, cardiac myosin inhibitors (CMI), such as aficamten and mavacamten, represent a promising pharmacological alternative to alleviate left ventricular outflow tract obstruction. However, there is limited data regarding the efficacy of this therapy. Methods: We searched Pubmed, Cochrane, and Embase databases for randomized controlled trials (RCT) comparing CMI with placebo among symptomatic HCM patients. Key outcomes assessed included: (1) improvement in at least one New York Heart Association (NYHA) functional class, (2) enhancement in the Kansas City Cardiomyopathy Questionnaire - Clinical Summary Score (KCCQ-CSS), and (3) change in N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels. Statistical analyses were performed using R Studio 4.3.2. Results: Six RCTs were included, involving 826 patients, of whom 443 (53.6%) were assigned to the CMI group. The majority of participants were male (57%), with a mean age of 57.9 years and a mean follow-up duration of 21 weeks. In the pooled analysis, CMI was associated with a significant improvement of at least one NYHA functional class (RR 2.21; 95% CI 1.75, 2.80; p&lt;0.001; Fig 1) and KCCQ-CSS (MD 7.18; 95% CI 4.64, 9.72; p&lt;0.01; Fig 2A). Moreover, CMI also reduced NT-proBNP levels (MR 0.22; 95% CI 0.17, 0.29; p&lt;0.01, Fig 2B). Conclusion: This meta-analysis highlights the potential of CMI as a promising pharmacological therapy for managing symptomatic HCM, with significant improvements in NYHA functional class, quality of life and NT-proBNP levels.
Abstract 4146135: NOX2-generated oxidative stress in the epicardial adipose tissue promotes left atrial electrical remodeling in a canine model of atrial fibrillation
Authors: Anna Pfenniger, Aleksei Mikhailov, Shin Yoo, Wenwei Zhang, Lauren Benson, Ashita Bhatnagar, David Johnson, William Marszalec, Asish Ghosh, Bradley Knight, Rod Passman, Rishi Arora
Journal: Circulation (2024)

Background: Epicardial adipose tissue (EAT) is increasingly recognized as a key factor in the development of atrial fibrillation (AF). In addition to direct myocardial infiltration by adipocytes affecting conduction properties, EAT may also promote an arrhythmogenic substrate through paracrine and endocrine effects. EAT was shown to preferentially generate oxidase-dependent reactive oxygen species (ROS) when compared to subcutaneous fat. While a role for myocardial ROS in the development of AF is well established, a separate role for EAT oxidative stress remains unexplored. Hypothesis: Oxidative stress in the EAT contributes to atrial electrical remodeling and development of AF. Aims: Determine the effect of EAT-restricted gene therapy with NOX2 shRNA on atrial electrical remodeling in the short-term canine atrial tachypacing (ATP) model of AF. Methods: A single-chamber pacemaker was inserted for the ATP model. Animals developed persistent AF after 4-6 weeks, after which the atria were harvested. Unpaced animals were used as controls. Expression of NOX2 in the EAT was assessed by qPCR. EAT oxidative stress was determined by IHC for 8-OHdG, a marker of DNA oxidative damage. A subset of animals underwent an open-chest gene injection procedure restricted to the EAT (with a plasmid expressing NOX2 shRNA or a scrambled sequence) prior to initiation of ATP for 9 days. A terminal EP study determined regional atrial ERP and AF inducibility. Results: NOX2 expression was significantly increased in the EAT of animals with ATP-induced AF when compared to unpaced controls (Panel A, p&lt;0.05 by t-test). IHC for 8-OHdG showed that in addition to the atrial myocardium, DNA oxidative damage was also extensively present in the EAT (Panel B, 8-OHdG+ nuclei marked with arrows). Animals having received NOX2 shRNA-expressing plasmids in the EAT had attenuated AF inducibility after short-term ATP when compared to controls (Panel C, p&lt;0.001 by Chi-squared test). This was associated with an attenuation of ERP shortening (panel D, two-way ANOVA p&lt;0.001). Importantly, this effect was not only observed in the posterior left atrium (PLA) but also in the left atrial appendage (LAA), which is devoid of EAT. Conclusion: Expression of NOX2 is increased in the EAT of the canine ATP-model of AF. EAT-restricted NOX2 inhibition globally attenuates left atrial electrical remodeling, consistent with an at-a-distance effect of EAT oxidative stress on the formation of an atrial arrhythmogenic substrate.