tbuckley/cabot-search huggingface dataset:
Abstract 18420: Appropriateness and Cost Analysis of Adult Inpatient Transthoracic Echocardiograms in a Community Hospital
Authors: Swecha Goel, Kevin Bliden, Sahib Singh, Aravind Dilli Babu, Nivedita Kharkongor Chengappa, Chiranjeevi Sainatham, Lekshminarayan Raghavakurup, Damian Sidorski, Paul Gurbel
Journal: Circulation (2023)

Introduction: Although inpatient transthoracic echocardiograms (TTEs) are important for guiding patient management, their overuse could be a concern leading to delayed discharges, unnecessary burden on hospital staff, and increased hospital costs. We analyzed the appropriateness, benefits, cost expenditure and unnecessary burden of TTE testing. Methods: A retrospective cohort analysis of a subset of patients undergoing TTEs in 2022 from a community hospital was performed. Appropriateness of use criteria (AUC) in accordance with American Society of Echocardiography and alteration in medical management was evaluated by 3 independent reviewers. Hospital cost analysis was performed based on median TTE cost ($682), yearly total adult TTEs performed (n=4,636), AUC criteria, and alteration in management under Maryland all-payer insurance model. Results: In 234 TTEs matched by age, gender, and race, AUC was not met in 32.5% of patients. Most TTEs were indicated for LV function assessment and ACS (Figure). Change in management was significantly higher in patients who met vs. not meeting AUC (54 vs. 11%, p&lt;0.001). In patients meeting AUC, men had a higher change in management compared to women (61 vs. 46%, p = 0.05). No significant differences were found in the percentage of patients who benefitted from inpatient TTE by subgroups based on indications, except for cardiac trauma. Inappropriate TTE testing led to a yearly loss of approximately $313,000 in hospital revenue and an additional loss of $150,000/year for every 5% of patients who meet AUC with no alteration in medical management. Conclusion: In this community hospital analysis, nearly one-third of adult inpatient TTEs were obtained outside the recommendations of established guidelines. Strategies to improve adherence to ASE guidelines and patient selection for TTE testing are warranted to reduce unnecessary resource utilization and healthcare costs.
Abstract 15665: Lack of Association Between Inpatient Percutaneous Coronary Intervention Volume and Thirty-Day Readmissions After Acute Myocardial Infarction- Cardiogenic Shock
Authors: Kannu Bansal, Mohak Gupta, Mohil Garg, Neel Patel, Saraschandra Vallabhajosyula
Journal: Circulation (2023)

Introduction: Volume-outcome relationship data is limited for acute myocardial infarction-cardiogenic shock (AMI-CS). Revascularization is mainstay of therapy in AMI-CS. Objectives: Authors sought to examine relation between hospital inpatient percutaneous coronary intervention (PCI) volume and 30-day readmissions after an AMI-CS admission. Methods: Nationwide Readmissions Database (NRD) 2016-2019 was analyzed. Hospitals were categorized into quartiles (Q1, lowest to Q4, highest) based on annual inpatient PCI volume. Primary outcome of interest was 30-day unplanned all-cause readmissions. Secondary outcomes included cardiac, non-cardiac and heart-failure (HF) readmissions at 30-days. Results: A total of 49,558 index AMI-CS admissions were present in 3,954 PCI performing hospitals. Median hospital PCI volume was 174 (inter-quartile range 70-316). 59% admissions for AMI-CS were present in quartile Q4. Overall, 30-day readmission rate was 18.5% (n=9,179); of which 56.2% were cardiac, 43.8% were non-cardiac and 25.8% were related to HF. We did not find any difference in 30-day all-cause readmissions (Q1 = 17.6% vs. Q2 = 18.4% vs. Q3 = 18.2% vs. Q4 = 18.7%, p=0.55). Similarly, cardiac (Q1 = 10.9% vs. Q2 = 11.0% vs. Q3 = 10.6% vs. Q4 = 10.2%, p=0.29), and HF (Q1 = 5.0% vs. Q2 = 4.8% vs. Q3 = 4.8% vs. Q4 = 4.8%, p=0.99) readmissions were not different across quartiles. Non-cardiac readmissions were more-commonly observed in higher quartiles (Q1 = 6.7% vs. Q2 = 7.4% vs. Q3 = 7.7% vs. Q4 = 8.5%, p=0.001). However, no significance was noted with any outcome after multivariable adjustment. Similarly, no relationship was observed between hospital PCI volume as continuous variable and all-cause or cause-specific readmissions on restricted cubic spline analysis. Conclusions: In a national representative sample of 3,954 hospitals with 49,558 AMI-CS admissions, we found lack of an association between hospital PCI volume and 30-day all cause or cause-specific readmissions.
Abstract 12216: A Novel Designed Atrial Postero-Septum Linear Ablation Method (Icho Line) for Non-Pulmonary Vein Triggers of Atrial Fibrillation (AF)
Authors: Yasushi Mukai, Shunsuke Kawai, Arihide Okahara, Masaki Tokutome, Hirohide Matsuura, kosuke okabe, Masashi Sada, Junpei Itonaga, Koga Eiichi, Hara Ayano, Hiroshi Kisanuki, Ryuichi Matsukawa
Journal: Circulation (2023)

Introduction: Therapeutic strategy for non-pulmonary vein (PV) triggers of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-pulmonary vein (PV) trigger sites of atrial fibrillation (AF). For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line” covering the non-PV triggers from this area. Methods: Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers were detected in 104 patients (12.7%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers of AF from postero-septum or CT. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation was continuously ablated toward the CT like the shape of a ginkgo leaf (Figure). Results: Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure). Recurrence with atrial tachycardia was very rare in the Icho line group. Conclusions: A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.
Abstract 13526: Palliative Care Service Utilization in End-Stage Heart Failure: A Propensity Matched Nationwide Analysis
Authors: ISRAEL SAFIRIYU, Sanjana Nagraj, Mayowa Adefuye, Michael Fatuyi, Amrin Kharawala, Majd Al Deen Alhuarrat, Dimitrios Varrias, Ahmad Naser, Rosy Thachil
Journal: Circulation (2023)

Background: Palliative care services (PCS) is crucial in the care of end-stage heart failure (ESHF) patients. However, there is limited data on the utilization rates and the predictors PCS in ESHF patients. Research question: What is the frequency of PCS utilization, and what are the predictors of PCS use in ESHF patients? Methods: ESHF admissions were identified from the National Inpatient Sample database from 2018 – 2020. The identified admissions were stratified based on the use of PCS. The primary outcomes were the rate of utilization, and the predictors of PCS use in ESHF patients. Multivariate logistic regression and propensity matching were used to adjust for confounders. Results: In total, 147,140 ESHF admissions were identified, of which only 6.2% (9170) had PCS use. Patients with PCS were older(71.66 years vs 63.78 years; p&lt;0.001), and were less likely to be of African American race (13.7% vs 17%; p&lt;0.001). They were more likely to have a do-not-resuscitate (DNR) status (66.1% vs 10.2%; p&lt;0.001), be frail (42.4% vs 18.3%), and have had a cardiac arrest event(2.5% vs 0.8%;p&lt;0.001). The major predictors of PCS use were DNR status (adjusted odds ratio[aOR]:13.38, 95%CI: 11.73 – 15.27; p&lt;0.001), cardiogenic shock (aOR: 3.54, 95%CI: 3.02 – 4.15; p&lt;0.001), cardiac arrest during the current admission (aOR: 1.57, 95%CI: 1.01 – 2.44; p&lt;0.001), &amp; urban teaching hospital status (aOR: 1.69, 95%CI: 1.36 – 2.09; p&lt;0.001) Fig 1 . A matched pair of 8255 patients were identified in both groups. The ESHF patients with PCS had a higher in-hospital mortality (aOR: 3.30; 95%CI: 2.73 – 3.99; p&lt;0.001), and were less likely to receive a heart transplant (aOR: 0.25; 95%CI: 0.12 – 0.50; p&lt;0.001) Tab 1. Conclusion: Palliative care services are significant underutilized in the United States. DNR status, cardiogenic shock, respiratory failure, cardiac arrest, and admission to an urban teaching hospital were the major predictors of PCS use in ESHF.
Abstract 16049: Hydrogen Sulfide Attenuates Duchenne Cardiomyopathy via Suppression of Sterile Inflammation
Authors: Taylor I Roy, Chad Cain, Adolfo G Mauro, Frank J Raucci, Fadi N Salloum
Journal: Circulation (2023)

Background: Duchenne muscular dystrophy (DMD) is a lethal, X-linked recessive disease caused by mutations in dystrophin. There is currently no cure for DMD, and the main cause of death is dilated cardiomyopathy. Hydrogen sulfide (H 2 S) is a gaseous molecule produced endogenously, and disruptions in basal H 2 S levels have been associated with various pathophysiological conditions, including heart failure. In this study, we investigated whether H 2 S could prevent cardiac dysfunction in a mouse model of DMD. Methods: Male mdx 4cv /mTR KO mice received early treatment (ET) with the H 2 S donor, SG1002 (40 mg/kg/day in chow starting at the time of weaning) or no treatment (NT), and wildtype C57BL (WT) mice were used as control. Left ventricular ejection fraction (LVEF) was assessed by transthoracic echocardiography. Skeletal and cardiac fibrosis was determined by picrosirius red staining. NLRP3 inflammasome activity was measured through apoptosis speck like protein (ASC) staining in cardiac muscle tissue. Results: NT mice exhibited significant LVEF decline by 4 months compared to ET and WT mice and declined further by 12 months (n=15-17, NT: 45.2% ± 7.9 vs ET: 57.1% ± 8.9% and WT: 56.5% ± 7.0%, P&lt;0.001). In addition, ET mice showed significantly reduced fibrosis compared to NT mice in the myocardium (n=5-8, 2.62% ± 0.87% vs 11.32% ± 4.70%, respectively, P=0.002), diaphragm (n=11-14, 15.84% ± 9.0% vs 31.14% ± 7.1%, respectively, P&lt;0.001), and gastrocnemius (n=12-17, 7.60% ± 3.14% vs 13.48% ± 5.97%, respectively, P=0.004) at 12 months. ASC aggregation score was significantly higher in cardiac tissue samples (Fig 1) from NT mice at 12 months compared with WT mice. ET attenuated the increase in cardiac ASC aggregation at 12 months compared with NT mice (P&lt;0.001). Conclusions: Our results demonstrate that early treatment with SG1002 preserves cardiac function in a mouse model of DMD and suggest a potential therapeutic role of NLRP3 inflammasome suppression as a protective strategy in DMD.
Abstract 16289: Functional Status Improves Following Heart Transplantation for Most Patients and Functional Status at One Year Predicts Five-Year Survival
Authors: Rachel E Wittenberg, Elizabeth Mostofsky, Murray A Mittleman
Journal: Circulation (2023)

Introduction: Heart transplantation is a critical treatment for end-stage heart disease, with the goal of improving both length and quality of life. We investigated predictors of functional status improvement following transplant and the impact of functional status at 1 year on survival. Methods: We used data from the Scientific Registry of Transplant Recipients on 34,649 U.S. adults who received a heart transplant from Jan. 2006 - Jul. 2020. Functional status was measured using the Karnofsky Performance Scale (KPS; 0-100%). Linear regression with stepwise selection was used to identify predictors of change in KPS from listing to transplant, and from transplant to 1 and 5 years post-transplant. Kaplan Meier curves with log-rank testing was used to compare 5-year survival between patients with poor (≤50%) versus non-poor (&gt;50%) KPS at 1 year. Results: Mean KPS was low at listing (47.9%, SD 22.4%) and discharge following transplant (45.6%, SD 24.1%). At 1-year post-transplant, the mean KPS increased to 85.8% (SD 17.7%), which was stable at 5 years (Figure). There was a small difference in KPS at 1 and 5 years based upon KPS at listing (p&lt;0.0001). After adjusting for KPS at transplant and transplant center, predictors of the magnitude of KPS change from transplant to 1 year included insurance type, diabetes, hypertension, prior cardiac surgery, smoking, “1A” waitlist priority, and hospitalization status. Predictors of KPS change from transplant to 5 years included insurance type, diabetes, ventricular assist device use, prior cardiac surgery, sex, and age. Only 5.5% of patients had poor KPS (≤50%) at 1 year. Of these patients, 5-year survival was significantly lower at 72.9% compared to 88.3% among patients with KPS&gt;50% at 1 year (p&lt;0.0001). Conclusions: Functional status is an important outcome following heart transplant and impacts survival. Most patients alive at 1 year have excellent KPS but clinical and social interventions may help optimize KPS among at-risk patients.
Abstract 13620: Highlights From National Inpatient Sample 2016-2020: Temporal Trends in Septal Reduction Therapy in Hypertrophic Cardiomyopathy
Authors: Spandan Desai, Nicholas Roma, Kashyap Shah, Leyla Gasimli-Gamache, Jamshid Shirani
Journal: Circulation (2023)

Introduction: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are used for septal reduction therapy (SRT) in obstructive hypertrophic cardiomyopathy (oHCM). Selection criteria, local expertise, and reported outcomes for choice of SM versus ASA have evolved in recent years. We aimed to compare recent temporal trends of SM and ASA. Methods: National Inpatient Sample 2016-2020 was queried to identify adults with oHCM using appropriate ICD codes along with procedure codes for ASA and SM. oHCM patients were divided into two groups- SM and ASA. Logistic regression was used to compare in-hospital outcomes. Results: Between 2016 and 2020, there were 5445 cases of SM and 1955 cases with ASA. Cases with ASA were older (67.5 -vs- 59.7 years), more likely to be females (67.3% -vs- 56.3%, p&lt;0.001), and had higher proportion of African Americans (12% -vs- 7%, p&lt;0.001). An overall downward trend in number of SM procedures and an increase in ASA procedures from 2016 to 2020 was observed as listed in Table 1. There were lower number of SM procedures compared to ASA in 2020. While total number of SRT remained relatively stable, proportion of ASA increased in all regions (West, South, Northeast) except Midwest. Urban teaching hospitals continued to perform &gt;90% of SRTs each year and mortality was significantly higher in non-teaching compared to urban teaching hospitals for both SM (8.9% -vs- 2.3%, p&lt;0.01) and ASA (5.6%-vs-1.9%, p&lt;0.01). Major complications were uncommon and did not change during the study period for both procedures. Conclusions: This retrospective database of hospital admissions for SRT indicates that there was a decline in proportion of patients that underwent SM for oHCM between 2016 and 2020 in most regions of the United States. Further studies are needed to determine the impact of this trend on long-term outcomes of patients with oHCM.
Abstract 13371: Left Bundle Branch Area Pacing: Experiences From the First Two Years Implanting in an Academic Training Program
Authors: Carmel Ashur, Francis Zirelle, Ryan Aleong, Paul D Varosy, John West, Amneet Sandhu, Alexis Tumolo, Michael Rosenberg, Syed Rafay Ali Sabzwari, Christopher Barrett, Lukasz Cerbin, Bilal Saqi, Daniel Varela, Matthew Zipse, Wendy Tzou, Lohit Garg
Journal: Circulation (2023)

Background: Left bundle branch area pacing (LBBAP) has emerged as a more durable physiologic pacing strategy to His bundle pacing and a promising alternative to cardiac resynchronization therapy. Integration of this procedural technique within an academic training program has not yet been described. Objective: Highlight the procedural learning curve of implanting LBBAP leads within a fellowship program. Methods: Retrospective analysis of consecutive patients who underwent placement of a Medtronic 3830 lead for LBBAP at our institution from 1/2021-12/2022. Results: A total of 180 patients underwent LBBAP lead placement over the study time period. Overall, total procedure time was 133.7±58.2min, lead placement time 30.7±20.0min, fluoroscopy time 22.5±21.2 min, left bundle branch (LBB) capture rate 70% and paced QRS duration 128.6±19.3 ms. When dividing the study period by 6-month intervals, there was a rise in procedural volume (21, 28, 62 and 59 cases, respectively), a trend towards less fluoroscopy use (20.2±12.2, 16.7±9.1, 16.2±12.6 and 16.6±14.4 min), less total radiation (345.2±323.3, 317.2±630.9, 214.9±271.2 and 171.7±253.9 mGy), decreased LBBAP lead placement time (37.8±24.3, 30.7±16.3, 28.2±21.5, 30.6±18.7 min), decreased delivery system exchanges (19%, 11%, 8% and 2%*, *p≤0.01 from first six months) and improved LBB capture rates (50%, 69%, 83%*, 64%, *p≤0.01 from first six months). Both fellowship classes showed significant improvements in LBB capture rates (40% to 94% and 38% to 84%, p≤0.01 for both) and paced-QRS duration (140.0±27.2ms to 120.2±16.5ms and 136.2±21.8ms to 121.7±17.2ms, p≤0.05 for both) after 12 months of experience. Conclusion: Over the first two years of performing LBBAP in an academic training program, there was a rise in procedural volume with trends towards less fluoroscopy use, decreased LBBAP lead placement time with significantly decreased delivery system exchanges and improved LBB capture rates. Significant improvements in LBB capture rates and paced-QRS duration were seen by fellows after 12 months of experience. LBBAP is an increasingly popular pacing technique that can be effectively integrated within a training program, with early introduction important to accommodate the initial learning curve.
Abstract 15200: Impact of Nocturnal Blood Pressure Fall on Long-Term Outcome for Recurrence of Atrial Fibrillation After Catheter Ablation
Authors: Tomonori Watanabe, Satoshi Hoshide, Hitoshi Hachiya, Hiroaki Watanabe, Takafumi Okuyama, Ayako Yokota, Masashi Kamioka, Takahiro Komori, Hisaki Makimoto, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
Journal: Circulation (2023)

Introduction: Hypertension is known as a risk factor to progress the etiology of atrial fibrillation (AF). However, influence of non-dipper on AF recurrence after pulmonary vein isolation (PVI) remains unknown. Methods: We investigated the clinical impact of non-dipper evaluated by 24-hour ambulatory BP monitoring on the long-term outcome for AF recurrence in 76 AF patients underwent the PVI. Results: All of 76 patients (mean age:66±9 years, hypertension:78%, non-paroxysmal AF:24%) had procedural success of PVI. Twenty patients had AF recurrence during follow-up of median of 1158 days post-PVI. There was no difference in BP level between the AF recurrence and non-recurrence groups (average 24h-systolic BP:126±17 vs. 125±14mmHg, P=0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs. 15.0%, P=0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF, and average 24h-systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI: 1.05-7.34], P=0.039). The patients with non-dipper had a larger left atrial (LA) volume index than those with dipper (45.9±17.3 vs. 38.3±10.2ml, P=0.037). In 58 patients underwent the high-density voltage mapping in LA, 11 patients had low voltage area (LVA) defined as an area with a bipolar voltage &lt; 0.5mV. There was no difference in existence of LVA between patients with non-dipper and those with dipper (22.2% vs. 16.1%, P=0.555). Conclusions: Non-dipper is an independent predictor of AF recurrence after PVI. Management for abnormal diurnal BP variation may be important in patients after PVI.
Abstract 13582: Interferon Regulatory Factor 8 Promotes Abdominal Aortic Aneurysm via Inducing Type I Conventional Dendritic Cell Differentiation
Authors: Zhen Yuan, Li Shu, Yidong Wang, Zhejun Cai
Journal: Circulation (2023)

Introduction: Abdominal aortic aneurysm (AAA) remains to be the most common true aneurysm worldwide. Previous studies identified the participation of dendritic cells (DC) in the pathogenesis of AAA. However, the detailed subtypes involved and mechanisms remain unknown. Our previous RNA-Seq data determined dramatically increased Irf8 in AAA samples, which drives DC differentiating to Type I conventional dendritic cells (cDC1). Aim: The aim of the work is to determine the role of interferon regulatory factor 8 (IRF8) in the development of AAA. Methods and Results: Murine AAA were induced via elastase infusion. The single-cell transcriptomic sequencing of CD45+ cells in murine AAA samples identified the dramatically increased cDC1. By flow cytometry, we found that the ratio of CD103 + cDC1s reached maximum at day 7. Compared with the control group, Irf8 CAG-LSL Itgax Cre mice ( Irf8 overexpression in DC) suffered significantly more severe aneurysm expansion, elastin degradation and apoptosis of smooth muscle cells, while the AAA development in Irf8 flox/flox Itgax Cre mice ( Irf8 deletion in DC) was less sharp. Batf3 -/- mice which were cDC1 depleted, showed similar characteristic in AAA expansion with Irf8 flox/flox Itgax Cre mice. The effective CD8 + T cells increased significantly in Irf8 CAG-LSL Itgax Cre mice than the control group, while decreased in Irf8 flox/flox Itgax Cre ones. Deletion of Clec9a which blocks cross-present dead-cell-associated antigens to the CD8 + T cells, also attenuated AAA development, in accordance with Irf8 flox/flox Itgax Cre mice in gross anatomy and pathology changes. Conclusion: Our findings suggest that the activation of IRF8 promotes cDC1 differentiation, which subsequently activate CD8 + T cells and contribute to destruction of the aortic-wall and AAA formation.