tbuckley/cabot-search huggingface dataset:
Abstract 4143554: Ventricular Support Use and Mortality Rates in Cardiogenic Shock Between 2018-2023: A Report from the Northern New England Cardiovascular Disease Study Group
Authors: Khaldoon Rashid, Isabelle Lin, Daniel Lutz, James DeVries
Journal: Circulation (2024)

Background: Despite advances in ventricular support devices, increasing awareness and multiple national initiatives to improve survival, mortality from cardiogenic shock remains high. Previous observational studies have shown decreased mortality rates with intra-aortic balloon pump usage over Impella. Relationship between support device use and overall survival in patients with cardiogenic shock remains an area of further investigation. Aims: Our objective was to examine the temporal trends in the mortality and ventricular support in patients with cardiogenic shock undergoing PCI in Northern New England from 2018-2023. Methods: The NNE registry was queried to identify patients presenting for PCI who manifest cardiogenic shock between 2018 and 2023. Shock was defined by the NCDR definition including sustained hypotension requiring inopressor use. Demographics, procedural data, mortality and intraprocedural ventricular support device use was collected. Standard statistical methods were used to calculate outcomes and statistical significance. Results: A total of 842 patients were identified who presented with shock. Overall, in-hospital mortality was 30.9%, and varied from 27.72% in 2018 to 38.3% in 2021 during the height of the COVID-19 pandemic (Figure 1). Mechanical support use remained flat, with an average use of 56% of all cases (Figure 2). The distribution of intra-aortic balloon pumps and Impella devices changed, with Impella use increasing from around 41% in 2018 to 44% by the end of the study in 2023, and intra-aortic balloon pump usage declining from 55% in 2018 to 49% by 2023 (Figure 3). Data was limited to perform a correlation analysis between type of mechanical support device and mortality rates. Conclusions: Despite using ventricular support in nearly 60% of cases, in-hospital mortality for cardiogenic shock remains around 30%. Our data reveals a trend towards higher Impella usage with declining intra-aortic balloon pump usage, interestingly with no change in mortality. This warrants further research to better understand how to optimize care for patients presenting with cardiogenic shock.
Abstract 4143487: Refining Risk Prediction in Systemic Sclerosis Pulmonary Arterial Hypertension
Authors: Ryan Osgueritchian, Hoda Mombeini, Vivek Jani, Abhishek Gami, Steven Hsu, Laura Hummers, Fredrick Wigley, Matthew Lammi, Paul Hassoun, Ami Shah, Stephen Mathai, Monica Mukherjee
Journal: Circulation (2024)

Background: Given the high morbidity and mortality of pulmonary arterial hypertension (PAH), several risk stratification tools have been developed to enhance patient prognostication and management. PAH commonly complicates patients with systemic sclerosis (SSc). However, the disease-specific performance of these scores is unknown. Research Question: To determine the prognostic value of clinical PAH risk scores in SSc and further determine if echocardiographic coupling metrics improve risk score performance. Methods: We included a well-characterized cohort of SSc-PAH patients from Johns Hopkins Medicine with echocardiograms within six months of invasive confirmation of PAH status. Conventional and speckle-tracking echocardiographic analysis was performed. Four scores were calculated: COMPERA 2 4-Risk Strata, REVEAL 2.0, REVEAL Lite 2, and French Criteria. Cox regression with the corresponding C-statistic was used to assess each hazard ratio and predictive power. A new model incorporating coupling parameters with the risk score was generated and compared to the original risk model with Likelihood Ratio (LR) tests. Results: Our cohort consisted of 174 SSc-PAH patients, 63.6 ± 12.7 years, 85.6% female, and 76.4% White, 86% limited SSc, with moderate-severe SSc-PAH on average. Table 1 . Across risk scores, C-statistics ranged from 0.63-0.69 in SSc-PAH, Table 2 . The incorporation of RVGLS/PASP, RVFWS/PASP, and mid-RVFWS/PASP to each risk score model significantly improved mortality prediction (LR test p-value&lt;0.05) with RVGLS/PASP providing the greatest difference in C-statistic across all models. Conclusion: Established risk scores have a modest predictive capacity for mortality in SSc-PAH. Incorporating echocardiographic parameters of right ventricular to pulmonary arterial coupling enhances the performance of these risk scores, aiding in the prognostication of mortality.
Abstract 4143624: The QTc Dilemma in Pediatric DKA: Which correction formula to use?
Authors: Sushmitha Medappa Maruvanda
Journal: Circulation (2024)

Background: In diabetic ketoacidosis (DKA), cardiac complications such as QTc interval prolongation can pose a risk for ventricular tachycardia. The Bazett formula, a standard for QTc correction, may not be the most precise for children due to a higher heart rate variability. Hypothesis: QTc prolongation observed in pediatric DKA is the result of heart rate overcorrection by the Bazett formula. Methods: A retrospective chart review was conducted on pediatric patients admitted to Saint Peter's University Hospital Pediatric Intensive Care Unit for DKA from January 2017 to April 2024. Inclusion criteria encompassed patients under 21 years with two 12-lead ECGs taken during and after DKA resolution. QTc intervals were calculated using the Bazett, Fridericia, Hodges, Framingham, and Rautaharju formulas. Electrolyte levels and pH values were collected during and after DKA resolution. Data analysis was performed using both unpaired and paired data via Stata v18.0. Results: The study included 34 subjects, with 7 subjects having 2 DKA admissions (n=41 ECG pairs). Unpaired analysis indicated QTc prolongation using the Bazett formula in 61% of DKA cases (p=0.015), often due to heart rate overcorrection. The other formulas did not show statistically significant QTc prolongation. Paired analysis revealed a significant QTc increase during DKA compared to the resolved state (p&lt;0.05). Additionally, changes in ionized calcium levels positively correlated with QTc changes in DKA. Conclusion: While the Bazett formula often overcorrects QTc in pediatric DKA, a true QTc interval increase does occur during DKA, albeit less significantly than previously believed. The Rautaharju formula provides a more accurate correction. The Fridericia and Hodges formulas are unreliable. An increase in ionized calcium is also noted in DKA. Current pediatric DKA management guidelines should include routine 12-lead ECGs and venous blood gas analyses with electrolytes to monitor QTc changes and mitigate arrhythmia risks.
Abstract 4143506: Inflammation but not Coronary Atherosclerotic Burden Is Related to Oxygen Uptake On-Kinetics in the 6-Minute Walk Test
Authors: Isadora Rocco, Walter Gomes, Caroline Bublitz, Isis Begot Krainer, Nelson Hossne, Ross Arena, Solange Guizilini
Journal: Circulation (2024)

Background: Anatomic burden of coronary artery disease (CAD) has been considered a consistent prognostic marker. Inflammation also increases the cardiovascular risk and plays a significant role in the evolution of atherosclerosis. The progression of CAD impacts the responses to exercise, reducing functional capacity. Despite this knowledge, the specific interplay between inflammation and atherosclerotic burden in influencing submaximal exercise capacity, particularly oxygen uptake (VO 2 ) kinetics, remains underexplored in CAD. This study aims to investigate how these factors correlate with VO 2 on-kinetics in the Six-minute Walk Test (6MWT) in patients with CAD. METHODS: Patients with obstructive CAD, confirmed by coronary angiography, underwent a 6MWT using a mobile telemetric cardiopulmonary monitoring to assess functional capacity and the VO 2 on-kinetics through the mean response time corrected by work (wMRT). Inflammatory markers were analyzed by dosage of high-sensitivity C-reactive protein, interferon-gama, tumor necrosis factor alpha and interleukins (IL), IL-6, IL-8 and IL-10. Coronary atherosclerotic burden was evaluated by the Grading Scale for Anatomic Burden of Disease from COURAGE Trial. Correlation analyses were performed according to the symmetric distribution of data, using Pearson’s (r) or Spearman’s rank correlation coefficients(r s ). RESULTS: A total of thirty-four patients aged between 60.3±8.0 years were enrolled, presenting body mass index of 26.0±3.7kg/cm 2 , left ventricular ejection fraction of 0.50±0.14, walking distance of 443±66m, VO 2 at steady-state (VO 2SS ) of 896±240ml/min and wMRT of 1.64x10 -3 ± 1.00x10 -3 min 2 /ml. Although correlated with distance and VO 2SS (r=-0.472;p=0.002 and r=-0.434;p=0.015, respectively), atherosclerotic burden was not associated with wMRT (p=0.17). High-sensitivity C-reactive protein and IL-8 were negatively associated with both distance and VO 2SS (r s =-0.428;p=0.001/ r s =-0.543;p=0.001 and r s =-0.438;p=0.014/ r s =-0.407;p=0.019) and positively correlated with wMRT (r s =0.412;p=0.022/ r s =0.505;p=0.003). CONCLUSION: In contrast to anatomic burden, inflammatory markers were associated with both walking intensity and VO 2 kinetics. Therefore, inflammation may be more crucial to exercise response mechanisms than coronary stenosis, suggesting a paradigm shift in our understanding of clinical repercussions of obstructive CAD. Actions able to attenuate the inflammatory profile may improve exercise capacity and prognosis.
Abstract 4143721: Large Sample Size Magnetic Resonance Imaging Measurements to Assess the Relation between Cardiac Function and Structure and White Matter Hyperintensity Volumes.
Authors: Adama Saccoh, Nikhil Paliwal, Carole Sudre, Amand Floriaan Schmidt
Journal: Circulation (2024)

Background: People with established cardiovascular disease (CVD) are at risk of early cognitive decline, and neurodegenerative diseases such as dementia. White matter hyperintensities (WMH) of presumed vascular origin are associated with progressive cerebrovascular disease and risk factors for CVD. The shared risk factors include blood pressure, sedentary lifestyle, genomic risk factors like APOE4 mutations. The extent to which common risk factors explain the co-occurrence of CVD and neurological diseases is unclear. Purpose: To determine the extent of which CMR measurements associated with WMH independent of known cerebrovascular risk factors. Methods: Cardiac and brain MRI images were analysed for 33,198 UK biobank participants. WMH analysis included 5 brain regions (Frontal, Parietal, Temporal, Occipital, Basal Ganglia and Thalami) and total brain WMH volume. Cardiac traits included stroke volumes, atrial volumes, ejection fractions (EF) of right and left chambers, left ventricular (LV) strain, LV wall thickness and aortic areas . Multivariable regression analysis was carried out, where each cardiac trait was regressed on each brain region and adjusted for demographics, cardiac risk factors, family history of disease and socioeconomic factors. Results were evaluated against a multiple testing correct p-value threshold of 0.05, reflecting the number of principle components(n=10) necessary to explain at least 90% of the cardiac trait variability. Results: Higher values of 7 cardiac traits (LV end stroke volume, aortic areas, mid and basal wall thickness) associated with higher WMH volumes for all brain regions. Conversely three traits (LV ejection fraction, descending aorta distensibility and RV ejection fraction) associated positively with lower WMH volumes for all brain regions. LV cardiac output and maximum LAV only associated with frontal lobe WMH volumes. Associations on APOE - ε4 carriership, a known risk factor of Alzheimer’s disease, showed negative association in homozygous carriers between aortic distensibility of the ascending and descending aorta and higher WMH volumes in the frontal and occipital lobes. Conclusions: This study offers insight into WMH burden in a large population of adults. Using cardiac traits as surrogate markers of different cardiac disease could explain how cardiac functionality defines WMH volume distribution and subsequently the wider relationship between cardiovascular and cerebrovascular disease.
Abstract 4143691: Prediction of extent of reverse remodeling and outcome after cardiac resynchronization therapy using a strain-based classification of dyssynchrony
Authors: Jurgen Duchenne, Simon Calle, John Aalen, Elena Galli, Camilla Larsen, Oana Mirea, Alexis Puvrez, Marc de Buyzere, Erik Kongsgard, Gabor Voros, Martin Penicka, Erwan Donal, Otto Smiseth, Frank Timmermans, Jens-Uwe Voigt
Journal: Circulation (2024)

Introduction: Echocardiography-derived septal strain patterns can serve as indicators of the progressive left ventricular (LV) remodeling caused by left bundle branch block (LBBB)-induced dyssynchrony. Research question: What is the prognostic value of these strain patterns in predicting volumetric response and clinical outcome in patients undergoing cardiac resynchronization therapy (CRT)? Methods: In this prospective multicenter study, CRT candidates from 5 centres received pre-implantation echocardiographic assessments with speckle-tracking strain analysis. Dyssynchrony was quantified through the analysis of septal strain curves, categorizing patients into 5 distinct strain patterns, denoted as Stage-0 through Stage-4 (Fig. 1). Extent of reverse remodeling was determined at 1 year. The pre-defined endpoint was death from any cause. Results: A total of 267 patients were included (66±11 years, 69% males, 90% LBBB, LV ejection fraction [EF] 30±7%). CRT yielded a progressive reverse remodeling: minimal in Stage-0 patients (ΔLV end-systolic volume (ESV) -9±21ml; ΔLVEF +4±8%) and substantial in Stage-4 patients (ΔLV ESV -85±54ml; ΔLVEF +20±9%) (ANOVA p&lt;0.001 for both) (Fig. 2). Median follow-up was 49 months. Stage-0 patients showed the least favorable outcome (log rank p=0.002), while subsequent stages exhibited progressively more favorable outcome (log rank p=0.045) (Fig. 3). The occurrence of death decreased incrementally according to the strain stages, with corresponding hazard ratios of Stage-1 through -4: 0.61 (95% CI 0.25-1.50), 0.26 (95% CI 0.10-0.68), 0.29 (95% CI 0.11-0.77), and 0.13 (95% CI 0.04-0.51) compared to Stage-0 (all p&lt;0.001). After adjusting for baseline LVEF, ischemic heart disease, and the presence of an ICD, strain staging maintained a significant association with a reduced risk of adverse outcomes (hazard ratio 0.69 (95% CI 0.51-0.92), p&lt;0.001). Conclusions: Septal strain patterns show a clear association with the extent of reverse remodeling and outcome in CRT-treated patients. The proposed strain staging classification offers valuable insights into the pathophysiology of LBBB-induced LV remodelling and may assist in the identification of candidates who stand to gain the most from CRT implantation.
Abstract 4143552: Prognostic Value of Peak Circulatory Power Versus Peak Oxygen Uptake in Patients with Repaired Tetralogy of Fallot
Authors: Evan Niu, Rachel Sareli, Bibhuti Das, Candice Sareli, Jianli Niu
Journal: Circulation (2024)

Background: Cardiopulmonary exercise testing (CPET) is an essential tool for identifying early signs of clinical deterioration in patients with congenital heart disease (CHD), primarily through the measurement of peak oxygen uptake (VO 2 ). Circulatory power (CircP), a less commonly evaluated variable derived from CPET, has been proposed as a surrogate for cardiac power. However, there is limited direct comparative data on CircP to inform prognostic assessment in these patients. Objective: This study aimed to investigate the prognostic value of peak CircP in individuals with repaired Tetralogy of Fallot (rToF) compared to peak VO 2 . Methods: Forty-seven rToF patients underwent CPET between August 2014 and April 2018 at Memorial Healthcare System, Hollywood, Florida. The Cox proportional hazards model assessed CPET variables associated with major adverse cardiac events (MACEs), adjusting for covariates. Optimal cut-off values for CircP and peak VO 2 were derived from the receiver operating curve (ROC). Kaplan-Meier survival plots illustrated the prognostic significance of CircP and peak VO 2 . Results: Among the 47 patients, 9 experienced MACEs during the follow-up period. Multivariable Cox regression identified that both CircP and peak VO 2 independently predicted MACEs ( p = 0.029 and p = 0.041, respectively). The optimal prognostic threshold value for CircP was 3225 mm Hg mL/kg/min, with an area under the ROC curve (AUC) of 0.93 (95% confidence interval [CI]: 0.84-1.0, p &lt; 0.001), sensitivity of 88.9%, and specificity of 92.1% (Figure 1A). The optimal prognostic threshold value for peak VO 2 was 21.2 mL/kg/min (AUC = 0.91, 95% CI: 0.82-1.0, p &lt; 0.001; sensitivity = 77.8%, specificity = 89.5%) (Figure 1B). AUC values were comparable between CircP and peak VO 2 in predicting MACEs (0.93 vs 0.91, p = 0.777) (Figure 1C). Individuals with CircP &lt; 3225 mm Hg mL/kg/min or peak VO 2 &lt; 21.2 ml/kg/min had a significantly higher MACE risk than those with CircP ≥ 3225 mmHg.ml/kg/min or peak VO 2 ≥ 21.2 ml/kg/min (Figure 2, A and B). Conclusions: The prognostic significance of peak CircP was comparable to peak VO 2 in predicting MACEs in rToF patients. Peak CircP may serve as an independent marker for risk stratification in rTOF patients.
Abstract 4143488: POCUS Guided Diuresis in Acute Decompensated Heart Failure – Quality Improvement in the Cardiac Care Unit
Authors: Sumant Pargaonkar, Sriram Sunil Kumar, Yi-Yun Chen, Pawel Borkowski, Elie Flatow, Vikyath Satish, Donclair Brown, Amrin Kharawala, Maisha Maliha, PANAGIOTIS ZOUMPOURLIS, Anurag Adhikari, Vibhor Garg, Eleonora GAshi, Robert Faillace
Journal: Circulation (2024)

Background: Patients with acute decompensated heart failure (ADHF) often require admission to the Cardiac Care Unit (CCU). Clinical examination alone may be inadequate for management, leading to suboptimal diuretic regimens and prolonged hospital stays. The use of Point-of-care ultrasound (POCUS) to evaluate the lungs for pulmonary edema and inferior vena cava (IVC) for size and collapsibility can enhance volume status evaluation. Aim: Reduce the average duration of IV diuresis by 20% among patients admitted to the CCU for ADHF in 1 year Methods: An algorithm for POCUS guided diuretic regimen escalation was implemented across three Plan-Do-Study-Act (PDSA) cycles. Patients who were intubated, on dialysis, or with isolated RV failure were excluded. PDSA-1 introduced the algorithm and provided training to a team of 5 residents. PDSA-2 included weekly reminders and recruitment of 14 residents to increase buy-in. PDSA-3 focused on incorporating POCUS assessments into nighttime care to facilitate early morning decision-making. Results: Process Measure: Quarterly compliance rates using the number of POCUS orders that were completed- Baseline (0%, n=23), PDSA-1 (0%, n=35), PDSA-2 (19%, n=15), PDSA-3 (31%, n=46). Outcome Measure: The average duration of IV diuresis progressively decreased through the year: Baseline (5 days), PDSA-1 (5.3 days), PDSA-2 (4.4 days), PDSA-3 (3.5 days). There was an increase of 6% in PDSA-1 compared to baseline, but PDSA-2 and 3 showed a progressive reduction of 12% and 30% respectively. Balancing Measure: The mean potassium supplementation showed variation throughout the year: Baseline (63.3 mg), PDSA-1 (141 mg), PDSA-2 (151.7 mg), PDSA-3 (75.7 mg), reflecting no significant negative impact from the intervention. Equity Lens: The duration of IV diuresis, which at baseline ranged from 3 to 8 days across different races, standardized to approximately 5 days for all races by PDSA-3. Conclusion: We progressively reduced the duration of IV diuresis using POCUS-guided lung and IVC assessments with a structured diuretic regimen. This demonstrated improved patient care from early decongestion and symptomatic relief. Additionally, we demonstrate that POCUS plays a crucial role in promoting health equity by providing an objective assessment of volume status across diverse racial groups. This integration promises optimized heart failure management and potential cost reductions from reduced length of stay, highlighting the value of POCUS in clinical practice.
Abstract 4143599: Subpopulation Benefits and Adverse Events of Prophylactic Methylprednisolone for Infant Heart Surgery: An Analysis of the STRESS Trial
Authors: Sudeep Sunthankar, Kevin Hill, Jeffrey Jacobs, Scott Baldwin, Marshall Jacobs, Jennifer Li, Eric Graham, Brian Blasiole, Adil Husain, Mark Bleiweis, Bret Mettler, Alexis Benscoter, Eric Wald, Tara Karamlou, Andrew Van Bergen, Pirooz Eghtesady, John Scott, Brett Anderson, George Alfieris, David Vener M D, Prince Kannankeril
Journal: Circulation (2024)

Background: The Steroids to Reduce Systemic Inflammation after Infant Heart Surgery (STRESS) trial randomized 1200 infants undergoing cardiac surgery with cardiopulmonary bypass to prophylactic intraoperative methylprednisolone (MP) versus placebo. Aims: Evaluate benefits and harms associated with MP in subset populations. Methods: STRESS participants were categorized based on STAT Mortality Category (1-3 and 4-5), age (neonate ≤ 30 days&lt; non-neonate), prematurity (&lt; 37 weeks gestation) and any chromosomal or syndromic diagnoses (CSD). Key postoperative outcomes included any steroid administration (&lt; 72 hours after surgery), peak blood glucose (&lt;72 hours), insulin use (&lt; 24 hours), acute kidney injury (AKI), prolonged mechanical ventilation (&gt;7 days), thrombosis, and infections. Results: The cohort consisted of 30% (364/1200) neonates, 16% (193/1197) premature, and 81% (969/1197) STAT 1-3 operations. Stratified analyses demonstrated notable beneficial effects with MP including reduced use of postoperative hydrocortisone in neonates (OR 0.39 [0.25-0.60]), those following STAT 1-3 (OR 0.65 [0.47-0.91]) and STAT 4-5 operations (OR 0.57 [0.34-0.97]), term infants (OR 0.62 [0.47-0.83]), and those without CSD (OR 0.63 [0.46-0.86]). MP associated with lower thrombosis occurrence among neonates (OR 0.37 [0.16-0.87]) and term infants (OR 0.38 [0.19-0.75]). Notable adverse associations with MP included increased postoperative peak blood glucose levels and insulin use (all subgroups, P&lt;0.01), increased thrombosis events among premature infants (8/100 vs. 0/93, P=0.005), and increased AKI following STAT 1-3 operations (OR 1.35 [1.03-1.77]) and in neonates (OR 1.55 [1.02-2.37]). The AKI association was not significant after adjusting for preoperative renal dysfunction and peak blood glucose. No increase in overall infection or reduction in prolonged mechanical ventilation were detected in any subgroup with MP. Conclusion: Prophylactic intraoperative MP has beneficial and adverse effects in infants undergoing cardiac surgery. The reduction in hydrocortisone, a common treatment for low cardiac output syndrome, and absence of increased infection rates are arguments for prophylactic intraoperative MP. However, MP was associated with increased peak blood glucose levels and a neutral to harmful association with odds of AKI. Though the latter was not significant after adjusting for peak blood glucose, which suggests steroid induced hyperglycemia may contribute to AKI.