tbuckley/cabot-search huggingface dataset:
Abstract 4146123: Exercise intolerance in HFpEF patients is related to skeletal muscle glycolytic ATP generation during exercise
Authors: Joseph Goldenberg, T Samuel, Sabra Lewsy, Michael Schar, Gary Gerstenblith, Robert Weiss
Journal: Circulation (2024)

Introduction: Exercise intolerance (EI) and early fatigue limit daily activities in patients with heart failure with preserved ejection fraction (HFpEF). Impaired skeletal muscle (SM) energy metabolism is associated with EI in HFpEF but the metabolic pathways that contribute to SM ATP production have not been studied. Given the importance of SM to whole-body glucose utilization, and the prevalence of insulin resistance and obesity in HFpEF, we examined glycolytic ATP production and its potential contribution to EI in HFpEF. Hypothesis: Previously unmeasured SM glycolysis limits ATP energy metabolism during exercise and is related to EI in HFpEF patients. Methods: We exploited non-invasive 31 P magnetic resonance spectroscopy to assess SM energy metabolism and glycolytic rates and their impact on EI in 62 HFpEF patients. Dynamic 31 P spectra of exercising calf muscle were acquired during graded plantar flexion exercise (PFE) until fatigue to measure high-energy phosphates, phosphocreatine (PCr) and ATP, and inorganic phosphate for determination of pH changes to quantify total glycolytic ATP during exercise. Results: Subjects were a mean age of 65 years, 53% were women, mean BMI of 39 kg/m2, 48% had diabetes and 48% were NYHA class III. Greater leg SM total glycolysis during exercise was closely associated with longer sustained exercise assessed by six-minute walk distance (Spearman r = 0.35; p=0.004), peak CPET VO 2 (Spearman r = 0.51; p&lt;0.001), and PFE time to fatigue (Spearman r = 0.42; p&lt;0.001). In contrast, mitochondrial oxidative ATP capacity was not related to exercise capacity. The rate of PCr decline was slower in those with longer six-minute walk (Pearson r = -0.42; p&lt;0.001) and PFE (Spearman r = -0.95; p&lt;0.001) durations and was closely related to greater glycolytic energy production (Spearman r = -0.3; p=0.017). This suggests that greater glycolytic ATP production during exercise in HFpEF patients is associated with slower SM high-energy phosphate decline and is itself closely associated with better physical performance inside and outside the MRI. Conclusion: Reduced SM glycolytic flux during exercise in HFpEF patients is associated with rapid SM high-energy phosphate decline during exercise and, importantly, closely tied to severe exercise intolerance in HFpEF measured by six-minute walk distance and peak CPET VO 2 . Impaired SM glycolytic capacity may offer a new metabolic target to treat HFpEF-associated disability.
Abstract 4146514: Safety and Contemporary Trends of Left Atrial Appendage Occlusion in Patients 85 Years and Older versus Less Than 85 Years
Authors: Nelson I Barrera, Salomon Chamay, Katerina Jou, Roberto Cerrud-Rodriguez, Francisco Gallegos Koyner, Luigi Di biase
Journal: Circulation (2024)

Background: There is a relative lack of comparative effectiveness research on the safety profile of left atrial appendage occlusion devices (LAAO) in patients ≥ over 85 years of age. Hypothesis: We hypothesize that patients who underwent LAAO older than 85 years will have similar odds of mortality and post-procedure complications when compared with younger patients. Aim: We aim to examine the safety of the in-hospital mortality and immediate complications of patients ≥85 years who underwent LAAO compared to those &lt; 85 years. Methods: Patients undergoing LAAO from 2016-2021 were queried from the National Inpatient Sample. Using propensity score matching, patients were matched into two cohorts based on age ( ≥85 years and &lt;85 years) in a 1:1 fashion using the ≥85 cohort as the dependent variable. In-patient mortality, post-procedure complications, and LAAO placement trends were compared using logistic regression models. The total complication outcome summarizes pericardial, cardiac, pulmonary, vascular, renal, neurologic, and infectious complications. Results: 136,075 patients underwent LAAO; each group included 19,015 patients. The overall mean age for the older group was 87.2 ± 1.0 years vs. 74.2 ± 5.1 years for the younger cohort. There were no associations between the two cohorts in in-patient mortality and total complications (aOR 1.40; 95% CI 0.44-4.42; p= 0.57) and (aOR 0.89; 95% CI: 0.79-1.01; p= 0.07). There was no significant difference in major circulatory events (aOR 0.85; 95% CI 0.75-1.01), but the odds of bleeding requiring transfusion were higher in the older cohort compared to the younger cohort (aOR 2.19; 95% CI 1.10-4.37). Overall, total complications and major cardiac, vascular, circulatory, renal, and neurologic complications were not statistically significantly different between cohorts. There was a significant increase in LAAO placement from 2016 to 2021 in both cohorts [&gt;85 (p= 0.04);&lt;85 (p= 0.02)] Conclusion: In the 2016-2021 National Inpatient Sample, patients who underwent LAAO aged ≥85 had comparable inpatient mortality and post-procedure complications to younger patients. These results contribute to the growing body of evidence supporting the safety of LAAO in elderly patients aged 85 and above.
Abstract 4145528: Right Atrial Pressure Respiratory Variation as a Predictor of Right Heart Failure After Left Ventricular Assist Device
Authors: Cole Buchanan, Melissa Lamicq, Miriam Atteya, Azalfa Lateef, Jacob Read, Vishal N. Rao, Samuel Friedman, Alec Biscopink, Arman Kilic, Jennifer Hajj, Ramsey Wehbe, Brian Houston, Ryan Tedford
Journal: Circulation (2024)

Introduction: Right heart failure (RHF) is a significant contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Lack of respiratory variation in the right atrial pressure (RAP) waveform, perhaps a marker of RV reserve capacity, has been associated with RHF and worse outcomes in patients with left heart failure and precapillary pulmonary hypertension. It is unknown if RAP respiratory variation may predict early RHF post-LVAD implantation. Hypothesis: We hypothesized that lack of RAP respiratory variation pre-implant would be predictive of early post-LVAD RHF. Methods: In this single center retrospective analysis, pre-LVAD right heart catheterizations for 183 patients who underwent HeartMate 3 LVAD implantation between November 2016 and December 2023 were reviewed. RAP and pulmonary artery wedge pressure (PAWP) respiratory variation were independently quantified by two investigators. Lack of RAP respiratory variation was defined as ≤ 2 mmHg between inspiration and expiration. To account for differences in respiratory effort and pulmonary vascular compliance, the difference between PAWP and RAP respiratory variation was assessed. The 2020 Academic Research Consortium definition was used to define early RHF. Groups were compared using Mann-Whitney U test and Fisher’s exact test. Results: Sixty-two of 183 patients (34%) developed early RHF post-LVAD. RAP was similar between the no RHF and RHF groups (10.4±6.4 vs. 10.5±6.8, p=0.98). There was no significant difference in RAP respiratory variation between the no RHF and RHF groups (3.2±2.4 vs. 3.0±2.0, p= 0.55). There was no difference in RHF rates between those that lacked and maintained RAP respiratory variation (35% vs. 32%, OR = 0.86, 95% CI [0.47, 1.60]). The difference between PAWP and RAP respiratory variation was not significantly different between no RHF and RHF groups (4.3±2.8 vs. 4.7±3.2, p = 0.41). Conclusion: Despite the prognostic significance in heart failure and precapillary pulmonary hypertension populations, RAP respiratory variation was not associated with post-LVAD RHF in our study. Ongoing efforts are needed to improve prediction of RHF in patients undergoing durable LVAD implantation.
Abstract 4145605: Disease-Causing Variants in Genes Associated with RASopathy and Aortopathy in Advanced Dilated Cardiomyopathy
Authors: Louie Cao, Joshua Rushakoff, Ian Williamson, Anja Karlstaedt, Michelle Kittleson, Lawrence Czer, Evan Kransdorf
Journal: Circulation (2024)

Introduction: Genetic testing reveals the presence of disease-causing (American College of Genetics and Genomics [ACMG] likely pathogenic [LP] or pathogenic [P]) variants in about 20% of patients with dilated cardiomyopathy (DCM). Exome sequencing can identify variants in novel genes that may be associated with DCM. Research Question: Do patients with advanced DCM harbor LP/P variants in genes associated with non-dilated cardiac, muscular, or vascular phenotypes? Goals: We determined the prevalence of LP/P variants in genes associated with 3 non-dilated cardiac, 1 muscular, and 1 vascular phenotype in 60 patients with advanced DCM requiring heart transplant. Methods: We conducted a retrospective study of patients who received a heart transplant between 2017 and 2023 at Cedars Sinai and who provided informed consent to participate. All subjects had DCM defined by LVEF ≤ 50% and LVEDD ≥ 95 th percentile for sex and height. Whole exome sequencing was performed on explanted heart tissue. We assessed for rare variants in genes classified as having definite, strong, or moderate association with DCM, hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), RASopathy, muscular dystrophy (MD), and thoracic aortic aneurysm (TAA) by ClinGen Gene-Disease Validity Curation Expert Panels. Variant pathogenicity was determined using ACMG criteria. Results: We identified 13 patients (22%) with LP/P variants in DCM genes. For non-DCM genes, we identified 12 LP/P variants in a total of 11 patients (18%) (FIGURE). There were no variants in HCM or ARVC genes. We identified 5 patients each with 1 LP/P variant in RASopathy genes; of these, 2 were in conjunction with DCM variants. We identified 2 patients each with 1 LP/P variant in MD genes. We identified 5 patients with LP/P variants in TAA genes; of these, 2 were in conjunction with a single DCM variant. No patients carrying RASopathy, MD, or TAA LP/P variants exhibited non-cardiac phenotypic manifestations of these conditions. Conclusion: In patients with advanced DCM requiring heart transplant, we found that 18% of patients harbored LP/P variants in genes associated with RASopathy, MD, or TAA, without exhibiting non-cardiac phenotypic manifestations of these conditions. Further research is needed to validate these gene variants as primary or secondary causes of DCM. If validated, more expansive genetic testing may be indicated in patients with advanced DCM.
Abstract 4145565: A comparison of the efficacy of initial high energy versus initial low energy biphasic shocks for cardioversion of atrial fibrillation and atrial flutter – a real-life experience
Authors: Sai Vikram Alampoondi Venkataramanan, Ramarao Vunnam, Dinesh Voruganti, Shane Tsai
Journal: Circulation (2024)

Background: In patients with atrial fibrillation (AF), biphasic energy is superior to monophasic energy for cardioversion (CV). However, the optimal initial biphasic energy for CV is unknown. There are no studies in the US comparing the different biphasic energy levels. Objective: To compare the efficacy of initial high energy (IHE, 300-360J) versus initial low energy (ILE, ≤200J) biphasic shocks for CV of AF. Methods: Patients who received CVs at our institution for AF over a year were identified using the ICD-10 code. Patients who received internal CV, CV during other procedures, or CV for hemodynamic instability were excluded. Shocks were delivered using Lifepak® 20 through self-adhesive electrodes placed in an anteroposterior direction. Statistical analysis was performed using IBM® SPSS® Statistics software. The primary endpoint was conversion to sinus rhythm after the first shock (CSRF) and the secondary endpoint was conversion to sinus rhythm (SR) using multiple shocks. Results: A total of 594 patients were screened and 409 patients were included for final analysis. Results are shown in the table. Patients in the ILE group had lower BMI and lower rates of prior ablation. Patients in the IHE group had higher rates of CSRF (95.5% vs 87.6%, p=0.018). On subgroup analysis, higher rates of CSRF were observed with IHE even in patients with BMI&gt;30 (97.4% vs 84.2%, p=0.019). More patients in the ILE group required multiple shocks. Even when multiple shocks were used, there was a higher rate of conversion to SR in IHE vs ILE (95.5% vs 92%, p=0.24). On multivariate analysis, the odds of CSRF were 6-fold higher with IHE after adjusting for sex, ejection fraction, prior ablation, obesity, and history of heart failure. Conclusion: Our study shows that IHE is better than ILE at converting AF into SR with the first shock. Even though the latest AF guidelines recommend 200J for initial cardioversion, select patients may benefit from &gt;300J to avoid multiple shock attempts.
Abstract 4145545: Mortality and Ventricular Support Use in Cardiogenic Shock between 2018-2023: A Report from the Northern New England Cardiovascular Disease Study Group
Authors: James Devries, Tanush Gupta, Cathy Ross, Khaldoon Rashid, Ansar Hassan, Hannah Chaudry, Rony LAHOUD, Isabelle Lin, Eric Rothstein, Michael Young
Journal: Circulation (2024)

Background: Mortality from cardiogenic shock remains high, despite increasing awareness and multiple national initiatives to improve survival. Little is known about the relationship between support device use and overall survival in patients with cardiogenic shock. We sought to examine the temporal trends in mortality and ventricular support in patients with cardiogenic shock undergoing PCI in Northern New England. 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 ionopressor 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: At total of 842 patients were identified who presented with shock. Overall in-hospital mortality was 30.9%, and varied from 27.4% in 2018 to 38.3% in 2021 during the height of the COVID-19 pandemic (Image 1). Mechanical support use remained flat, with an average use of 57% of all cases (Image 2). The distribution of intra-aortic balloon pumps and Impella devices changed, with Impella use increasing from around 41% in 2018 to 44%and IABP use decreasing from 55% to around 49% by the end of the study in 2023 (Image 3). There was no correlation between survival and type of mechanical support device used. Conclusions: Despite using ventricular support in nearly 60% of cases, in-hospital mortality for cardiogenic shock remains high at around 30%. A trend towards less IABP use and higher Impella use has not changed overall mortality. More study is needed to better understand how to optimize care for patients presenting with cardiogenic shock.
Abstract 4145557: Principal Strain Analysis by 3D Echocardiography Provides Novel Insights into Function and Prognostication in Single Left Ventricles.
Authors: Ryusuke Numata, Daisuke Matsubara, Tomoyuki Sato, Renzo Calderon-Anyosa, Yan Wang, Dario Collia, Gianni Pedrizzetti, Anirban Banerjee
Journal: Circulation (2024)

Background: Progressive systolic dysfunction is considered an important risk factor for Fontan failure. Previously we have shown that principal strain (PS) is a novel 3D concept that provides insights into 3D deformation of single right ventricle (SRV). In this study, we plan to apply the concept of PS in patients with single left ventricle (SLV). Hypothesis: PS may predict the risk of composite outcomes in post-Fontan patient with SLV. Methods: We prospectively enrolled 48 post-Fontan patients with SLV (median age: 12.4 years), 64 with SRV, and 102 age-matched controls (12.4 years). We performed 3D speckle-tracking echocardiography (3D-STE) to measure magnitude and direction of PS (PS angle), magnitude of secondary strain (SS), other conventional strains, which were described as absolute values, and LV volumetric indices. PS depicts both magnitude and direction of principal myocardial contraction, whereas SS defines a lower intensity strain in the perpendicular direction. SLV group included tricuspid atresia (41.7%), double inlet left ventricle (37.5%), and pulmonary atresia with intact ventricular septum (20.8%). A composite outcome, experienced by 10 patients in SLV group, comprised of any of the following: Fontan failure, take-down of the Fontan, and clinically significant arrhythmia. Results: In the SLV group, the magnitudes of PS and SS were reduced in most walls, except for the lateral wall compared to controls (global PS (GPS): 30.5 ± 3.2 vs. 34.6 ± 2.8%, global SS (GSS): 12.1 ± 3.0 vs. 15.7 ± 2.9 %, p &lt; 0.001, respectively). All PS angles in SLV group had a significantly oblique orientation, except for lateral walls and were similar to those of SRV (global PS angle: 31.4 ± 6.7 vs. 33.0 ± 6.5 vs. 27.6 ± 5.6 degrees in SLV vs. SRV vs. controls, p&lt;0.001, Figure 1). Among the 3D-STE indices, the magnitude of PS in the anterior wall was the best predictor of composite outcomes in SLV group (AUC: 0.734, cut off: 27.1%, Figure 2). There was an increased risk of the composite outcomes, even after adjusting for age and SpO 2 (OR: 0.69 [95% CI: 0.48 – 0.98]; P &lt; 0.04, Table 1). Conclusion: PS analysis is a newly described method in children that provides not only the magnitude but also the angles of cardiac deformation. It may offer incremental value in predicting risk of composite outcomes in post-Fontan patients.
Abstract 4145595: Relationship status is associated with sex differences in social and health-seeking behaviors among heart failure patients
Authors: Katarina Leyba, David Kao
Journal: Circulation (2024)

Background: Evidence from observational cohort studies suggests that lifelong unmarried status is associated with worse outcomes in men but not women. The reasons for these sex differences is poorly understood. Purpose: Identify sex differences in health-seeking behaviors according to relationship status that correspond to sex differences in clinical outcomes Methods: Data from study visits reporting multiple social and health-seeking behaviors were obtained from the Atherosclerosis Risk in Communities (ARIC, year 23) study, Multiethnic Study of Atherosclerosis (MESA, year 10) and Framingham Heart Study Offspring (FHS, year 40) were pooled and harmonized. Behaviors including recent doctor visits, medication compliance, activity and caloric intake were summarized by relationship status and sex. Behaviors found to be different between relationship groups were then analyzed for association with all-cause mortality using Cox proportional hazards analysis. Results: There were 2653 subjects with incident HF, of whom 1479 were married, 208 were divorced, 78 were never married, 33 were separated, and 784 were widowed. Never-married status was associated significantly higher risk of all-cause mortality in men (HR 1.83 [1.11-3.04, p=0.019]), but not women (HR 0.75 [95% CI 0.44-1.27]). Compared with unmarried men, married men had significantly better medication adherence (Morisky score, 44% vs. 25%, p=0.003), emotional support (ESSI5 16.7±3.8 vs. 13.8±4.3, p&lt;0.001), and social support (Berkman Social Network Questionnaire 26.6±6.3 vs. 22.9±6.4, p&lt;0.001), whereas there were no differences in these metrics between married and unmarried women. Of these, the higher ESSI and BSNQ indices were both associated with reduced all-cause mortality, whereas the Morisky score was not. Conclusion: Married men experience significantly more social and emotional support than unmarried men, whereas women do not. Personal support systems may be an important contributor to the relationship between unmarried status and HF outcomes in men.
Abstract 4145578: Clinical and Angiographic Outcomes of Paclitaxel-Coated versus Limus-Coated Balloons for Coronary In-Sent Restenosis: A Systematic Review and Meta-analysis
Authors: Esteban Rodriguez, Maria Agustina Callizo Bedoya, Jesslyn Hariyanto, Gharira Batool, Maria Vargas, Jesse Medina, Bertrand Ebner, Raul Torres Heisecke, Rosario Colombo
Journal: Circulation (2024)

Background: Drug-coated balloon (DCB) angioplasty with paclitaxel-eluting devices is an established treatment for coronary in-stent restenosis (ISR). Limus-coated balloons have emerged as an alternative. We aimed to perform a meta-analysis comparing clinical and angiographic outcomes between limus-coated balloons (LCB) and paclitaxel-coated balloons (PCB) in coronary ISR. Methods: Databases were searched for randomized and non-randomized studies comparing LCB with PCB in patients with coronary ISR. Angiographic outcomes included percent diameter stenosis and in-segment late lumen loss (mm) as assessed by quantitative coronary angiography (QCA). Clinical outcomes included a composite of cardiac death, target lesion myocardial infarction (MI), and target lesion revascularization (TLR). Statistical analysis was performed using Review Manager (Cochrane Collaboration). Results: A total of 1,224 patients from 7 studies were included, 5 of which were randomized controlled trials. PCBs were used to treat coronary ISR in 577 (47%) patients. The mean follow-up was 13.7±4.5 months. The mean age was 66±10 years, with 76.3% being male. Type 2 diabetes mellitus was present in 44.4% of the patients, and 31.5% had a prior MI. There were no significant differences between PCB and LCB in terms of percent diameter stenosis (mean difference: -4.58%, 95% CI: -10.79 to 1.62, P = 0.15) or in in-segment late lumen loss (mean difference: 0.02 mm, 95% CI: -0.07 to 0.11, P = 0.72) at follow-up QCA. At 12 months, there were no significant differences in the composite outcome of cardiac death, target lesion MI, and TLR (RR: 1.01, 95% CI: 0.77 to 1.32, P = 0.97) between groups. LCB showed similar TLR rates compared to PCBs (RR: 0.64, 95% CI: 0.30 to 1.34, P = 0.23) at 12 months (Figures 1A and 1B). Conclusion: For patients with coronary in-stent restenosis, both paclitaxel-coated and limus-coated balloons offer effective treatment options with comparable clinical and angiographic outcomes. This provides reassurance and flexibility in treatment choices. The trend favoring PCBs in percent diameter stenosis warrants further investigation in larger, well-powered studies to compare these DCB types in similar populations.