tbuckley/cabot-search huggingface dataset:
Abstract 15493: Coronary Artery Revascularization Strategies for Angiographically Inconclusive Lesions: A Network Meta-Analysis of Randomized Controlled Trials
Authors: Thanakit Suebsaicharoen, Wiphut Dejprasert, Pawin Numthavaj, Amarit Tansawet, Thinnakrit Sasiprapha, Ammarin Thakkinstian
Journal: Circulation (2023)

Background: There has been no head-to-head comparison among coronary artery revascularization strategies including different guiding modalities for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Aim: To compare the cardiovascular outcome of all available coronary artery revascularization strategies Method: Systematic search of randomized controlled trials and study selection were performed in accordance with PRISMA guidelines. Coronary artery disease with angiographically inconclusive lesions was the domain of interest. Trials were excluded if they involved patients with left main disease, chronic total occlusion, or primary PCI for acute myocardial infarction (MI). The outcome of interest was a primary endpoint of all-cause death, non-fatal MI, or unplanned revascularization. Patient-level data was constructed from Kaplan-Meier (KM)-extracted data and combined across studies. A mixed-effect Weibull regression with accelerated failure time was used, and hazard ratios (HR) with 95% confidence intervals (CI) were then estimated. Result: A network map of 7 interventions including 15 trials of 17286 patients and cumulative probability curves are shown in Figure 1A and 1B respectively. CABG is the most effective strategy with 42% risk reduction in primary endpoint compared to angiography-guided PCI (HR 0.58, 95% CI 0.50-0.67), followed by quantitative flow ratio (QFR)-guided PCI (HR 0.64, 95% CI 0.50-0.82), intravascular ultrasound (IVUS)-guided PCI (HR 0.70, 95% CI 0.53-0.93) and fractional flow reserve (FFR)-guided PCI (HR 0.79, 95% CI 0.66-0.96). PCI guided by instantaneous flow ratio (iFR) and optical coherence tomography (OCT) is also superior to angiography but not statistically significant as shown in Figure 1C. Conclusion: CABG remains the most effective strategy in reducing the primary endpoint while QFR is superior to OCT, IVUS, FFR, iFR, and angiography in guiding PCI accordingly.
Abstract 18094: Supersaturated Oxygen Therapy Benefits Late Presenters With Anterior ST-Segment Elevation Myocardial Infarction
Authors: Jay H Traverse, M Nicholas Burke, Yader Sandoval, Yale Wang, Ivan Chavez, Emmanouil S Brilakis, Joao Cavalcante
Journal: Circulation (2023)

Introduction: Patients with late-presentation ST-Segment Elevation Myocardial Infarction (STEMI) are at increased risk of mortality and development of heart failure and have limited therapeutic options besides percutaneous coronary intervention (PCI). Hypothesis: Intracoronary supersaturated oxygen therapy (SSO2) (Zoll / Therox) is approved as an adjunctive therapy to PCI in STEMI patients and may reduce infarct size in patients with less than 6 hours of ischemia. However, in pre-clinical studies, the delivery of SSO2 reduces infarct size even when delivered 24 hours following coronary occlusion. We hypothesized that late-presenting anterior STEMI patients may benefit from SSO2 therapy following PCI. Methods: We studied 12 patients (7M, 5F; 60 ± 9 years) with ongoing anterior STEMIs and prolonged ischemic times (12.2 ± 7.6 hrs). Ten of the 12 patients had an occluded LAD on presentation with TIMI 0 flow and 11 patients had anterior q-waves in at least 2 consecutive leads on the presenting EKG. All patients underwent successful PCI of the LAD with DES followed by 60 minutes of SSO2 therapy delivered through a catheter placed in the left main coronary artery. Cardiac MRI measurement of LV function and infarct size was performed in all patients 1 to 3 days later. Results: Mean infarct size was 32 ± 10 % of LV mass. Baseline left-ventricular ejection fraction (LVEF) measured within 24 hours of PCI was 37.8 ± 10.0 %. LVEF improved to 50.2 ± 11.2 % on follow-up imaging performed at a mean of 2 months following PCI (p &lt; 0.01). To date, all patients remain alive and no patients have been admitted for heart failure. One patient underwent LVAD placement during his baseline hospitalization for persistent cardiac shock and another patient underwent bypass surgery 7 months later after having developed in-stent restenosis and progressive CAD. Conclusions: SSO2 therapy can be safely performed in high-risk STEMI patients with prolonged ischemic times who undergo successful PCI and is associated with a significant recovery of LV function when measured several months later.
Abstract 16521: Using Electronic Health Record Data to Identify and Prioritize Patients With Heart Failure With Reduced Ejection Fraction for a Remote Medication Optimization Program
Authors: Ozan Unlu, Alexander J Blood, John W Ostrominski, Hunter J Nichols, Samantha Subramaniam, Daniel Gabovitch, Jacqueline Chasse, Christopher P Cannon, Akshay S Desai, Benjamin Scirica, Kavishwar Wagholikar
Journal: Circulation (2023)

Introduction: Remote medication management programs (RMMP) might be effective in optimizing guideline directed medical therapy (GDMT) for HFrEF. Identification of patients that can be safely managed remotely and prioritization of those with the highest need for medication optimization is crucial, especially in the setting of constrained resources. Methods: We analyzed records from our institutional enterprise data warehouse to identify patients with HFrEF in whom GDMT can be safely optimized by an RMMP within the Mass General Brigham health system between May 2021 and May 2023. After identifying a population with HFrEF, we excluded patients with contraindications to GDMT and with higher risk of adverse medication reactions. Next, we identified active and past medications by using medication discontinuation data (Figure). We performed chart review on a random sample of 100 patients to validate our analysis. Results: We have identified 1771 patients with HFrEF who are actively receiving care and are eligible for remote medication optimization. Only 7% (129/1771) of patients were prescribed all four GDMT, however in 4% (78/1771) at least one of these prescriptions was discontinued. Of all patients, 45% (801/1771) had stopped at least one GDMT, including 50% of SGLT2i, 30% of MRA, and 46% of ARNI. Patients who were never prescribed GDMT were identified as top priority for the RMMP. Conclusion: EHR data can effectively identify and prioritize HFrEF patients for medication optimization. Similar to prior HFrEF registries, our study showed poor utilization of GDMT. However, it also revealed a significant number of patients who had their GDMT prescriptions discontinued. Investigating the reasons for discontinuations may elucidate barriers to GDMT optimization. This study can be expanded to patients with HFpEF and HFmEF, and refined further by using natural language processing, machine learning, and by incorporating data for medication refill, claims, and dosages.
Abstract 14145: The Zinc Transporter ZIP7 Plays a Critical Role in Ferrotposis Induced by Ischemia/Reperfusion in Mouse Hearts
Authors: Hualu Zhang, Shuya Zhang, Zhelong Xu
Journal: Circulation (2023)

Background: Although ferroptosis has been proposed to play a role in myocardial ischemia/reperfusion (I/R) injury, the exact molecular mechanism by which ferroptosis is induced by I/R remains unclear. Hypothesis: We tested the hypothesis that upregulation of the zinc transporter ZIP7 at reperfusion triggers ferroptosis by downregulating the mitochondrial GPX4 (mtGPX4) via the guanine-rich sequence-binding factor 1 (GRSF1) and increasing mitochondrial iron accumulation through inhibition of the mitochondrial iron importer degradation. Aims: To determine if ZIP7 plays a role in I/R-induced ferroptosis and to investigate the underlying molecular mechanism. Methods: Mouse hearts were subjected to I/R in vivo . The cardiac-specific Slc39a7 conditional knockout mice (ZIP7 cKO) were generated by adopting the CRISPR/Cas9 system. Adult mouse cardiomyocytes were isolated enzymatically. Ferroptosis was evaluated by detecting PTGS2, MDA, and BODIPY C11. Mitochondrial Fe 2+ was determined with Mito-FerroGreen fluorescent probe. Results: I/R upregulated ZIP7 expression and induced ferroptosis as indicated by the increases in PTGS2 mRNA expression (290.90 ± 52.78 % of control), MDA (152.10 ± 15.07 % of control) and BODIPY C11 (130.68 ± 5.52 % of control) levels, which was prevented by ZIP7 cKO. ZIP7 cKO also mitigated doxorubicin-induced ferroptosis. ZIP7 cKO upregulated mtGPX4 expression (123.40±3.26 % of I/R) and increased mitochondrial GRSF1 expression (150.90±8.51 % of I/R) at reperfusion. In addition, knockout of GRSF1 inhibited GPX4 expression (54.73±5.44 % of control). Moreover, ZIP7 cKO prevented the accumulation of Fe 2+ within mitochondria (44.15±2.46 % of I/R) and promoted the degradation of SLC25A37 (62.57±8.03% of I/R) and SLC25A28 (69.82±3.10 % of I/R) at reperfusion. Conclusions: Upregulation of ZIP7 contributes to the induction of ferroptosis at reperfusion presumably by reducing mtGPX4 expression via GRSF1and increasing Fe 2+ accumulation within mitochondria through inhibition of SLC25A37 and SLC25A28 degradation.
Abstract 16707: Clinical Validation of a Chest-Worn Personal ECG Device for the Detection of Atrial Fibrillation
Authors: Satish Reddy, Alan Kennedy, Kirthi Vidyasagar, Peter Doggart, Peter Joseph, Rebecca C Funston, Manav Bhushan
Journal: Circulation (2023)

Introduction: Novel consumer-focused personal ECG devices have the potential to revolutionise the way that cardiac arrhythmias are diagnosed and managed. These devices can be used remotely to monitor patients for arrhythmias, which could lead to earlier detection and treatment. In this study, we aimed to compare the cardiologist's interpretation of clinical 12-lead ECG recordings to a consumer-focused dry-electrode ECG chest strap device (Fourth Frontier FX+). Methods: We included patients seen in an outpatient cardiology clinic at the Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, India. A total of 163 paired ECG recordings were captured from 85 adult patients (50% female, median age 54 years, AF present at the time of recording in 38%). Patients with critical cardiac problems or life support systems were excluded. ECG data from the Fourth Frontier FX+ (Fourth Frontier, Bangalore, India) and a standard 12-lead ECG were obtained simultaneously in the supine position. PDF reports for both devices were then generated, and the cardiologist's interpretation of the Fourth Frontier FX+ ECG was compared to the cardiologist's interpreted 12L ECG. Results: The cardiologist's interpretation of the Fourth Frontier FX+ data matched the cardiologist-interpreted 12L data for all patients. One FX+ ECG was excluded from the analysis due to not enough data being captured by the device. A total of 33 patients were correctly identified as having atrial fibrillation. Conclusion: The results of this study demonstrate that the Fourth Frontier FX+ ECG monitor is comparable to a 12-lead ECG for cardiac rhythm monitoring and that it can be used remotely to monitor patients for cardiac arrhythmias. This has the potential to change the way that arrhythmias are diagnosed and managed and lead to earlier detection and treatment at scale.
Abstract 13673: Effects of Bariatric Surgery on Blood Pressure Management in Type 2 Diabetes: Analysis From a Thirteen-Year Cohort Study
Authors: Fahmida Mannan, Ryan Wiltshire, Adrian Heald
Journal: Circulation (2023)

Introduction: Bariatric surgery (BS) is an effective intervention for both weight loss and improved metabolic health in those with Type 2 diabetes (T2D), yet there is limited data on its long-term effect on blood pressure (BP) control. Aim: This prospective cohort study aims to evaluate the long-term effect of BS on BP and metabolic health in T2D patients in a tertiary centre in North-West England. Methods: Patients who underwent BS (gastric bypass/sleeve gastrectomy) between 2009 - 2012 at a single tertiary surgical centre in North-West England were followed for up to 13 years. Preoperative and follow-up data including BP readings, HbA1c, BMI and antihypertensive medication use was obtained from electronic patient records at regular intervals to ascertain longitudinal outcomes in BP, BMI and HbA1c. Results: 119 patients were included in the study. Optimal metabolic health state was achieved at 12 months post-surgery for BMI (-14.78kg/m 2 (95%CI: 13.37-16.20, p&lt;0.001)), systolic BP (sBP) (-15.02mmHg 95%CI: 8.23-21.81mmHg, p&lt;0.001)), diastolic BP (dBP) (-8.1mmHg, 95%CI: 4.26-11.91, p&lt;0.001)) and HbA1c (-24.41mmol/mol, 95%CI: 18.25-30.58, p&lt;0.001). A sustained reduction in both sBP and dBP was maintained for up to 5 years, mirroring a reduction in concurrent use of antihypertensive medications (164 prescriptions v 66 at 5 years). However, at latest follow-up, there was an observed increase in antihypertensive prescription (95 v 66) yet there was no statistically significant change in mean BP. Furthermore, the number of patients with clinically diagnosed hypertension (BP 140/90 or more was lowest at 5 years (n=53 v 86 pre-op) before rising at the latest follow-up (n=57). Conclusions: Our study demonstrates that BS has a sustained benefit on BP as reflected by both absolute measurements and reduction in antihypertensive medication use. It remains an effective strategy not only for weight loss but also for the comprehensive management of metabolic comorbidities in T2D patients as evidenced by reductions in antihypertensive use, HbA1c, BMI and BP. However, more research is needed to explore the longer-term effects of these benefits at ≥ 10 years given the increases in antihypertensive use, BMI and HbA1c after this period.
Abstract 12453: Racial Disparities in Long-Term Survival Among Patients With Moderate and More Severe Tricuspid Regurgitation
Authors: Hilal Olgun Kucuk, Kyla Lara-Breitinger, Christopher Scott, Mohamad S Alabdaljabar, Vidhu Anand, LaPrincess C Brewer, Cristina Pislaru, Brian P Shapiro, Hari P Chaliki, Vuyisile T Nkomo, Mackram F Eleid, Patricia A Pellikka, Sorin V Pislaru
Journal: Circulation (2023)

Introduction: Tricuspid regurgitation is a common echocardiographic finding leading to excess morbidity and mortality in adult population. Hypothesis: Racial and ethnic disparities have been observed in various cardiovascular disorders’ prevalence and natural course, including valvular lesions. However, little is known about the epidemiology and clinical correlations of TR among non-Hispanic Black adults. Methods: To examine risk factors and clinical outcomes in non-Hispanic Black adults with moderate or more severe TR, 685 patients (7%) self-identified as non-Hispanic Black and 9127 (93%) self-identified as non-Hispanic White with a first echocardiographic report of moderate or more severe TR between 2005-2016 were studied. Results: Non-Hispanic Black patients had more severe TR when compared to white patients (25% vs. 20%, p&lt;0.001). After adjusting for age and sex, non-Hispanic Black patients had significantly higher 10-year all-cause mortality (HR=1.34 (1.18, 1.52), p&lt;0.001). Black race remained a risk factor for all-cause mortality even after adjustment for comorbidities like CHF, COPD, DM, CKD, hypertension, and ischemic heart disease (HR=1.23 (1.08, 1.40), p=0.002). Conclusions: Significant racial disparities exist in demographic, clinical and echocardiographic characteristics between non-Hispanic Black and White patients with moderate or more severe TR. Black race is a potential disease modifier leading to excess mortality.
Abstract 14106: Predicting Persistently Elevated Pulmonary Artery Diastolic Pressure Despite Adequate Diuresis
Authors: Francis Allinson, Daniel Ng, Leah Puglisi, Ajay Srivastava
Journal: Circulation (2023)

Introduction: Patients with chronic HF can be challenging to manage via ambulatory hemodynamic monitoring due to persistent elevations in pulmonary artery diastolic pressure (PADP) despite appropriate diuresis. Knowing what factors predict persistently elevated PADP on CardioMEMS can help guide patient selection and management. Hypothesis: We propose that underlying heart failure phenotypes exist that are less likely to respond to hemodynamic guided management. Methods: This was a single-center, retrospective analysis of Scripps Clinic patients who underwent CardioMEMS implantation from June 2015 to September 2022. A total of 115 patients were included and divided into two cohorts based off their average PADP calculated using their last 4 transmissions. The normal PADP cohort included patients with an average PADP ≤ 20 mmHg while the persistently elevated PADP cohort included patients with a PADP &gt; 20 mmHg. Results: Of the 115 patients analyzed, 62 patients were in the normal PADP cohort while 53 patients were in the persistently elevated PADP cohort. There was no significant difference between baseline demographic data, except for renal function, as shown in Table 1. There was a significant difference between the two groups when comparing pulmonary pressures and PVR via right heart catheterization prior to CardioMEMS implantation, but not when comparing pulmonary artery pressure obtained via echocardiogram (Table 1). The persistently elevated PADP cohort had a significantly lower GFR and were on higher doses of loop diuretics than the normal PADP cohort. Conclusions: Our analysis shows that renal function, baseline invasive hemodynamic data consistent with pulmonary vascular remodeling and decreased cardiac index can help predict patients with persistent elevations in their PADP on ambulatory hemodynamic monitoring and highlights the importance of early HF management before vascular remodeling complicates hemodynamic guided management.
Abstract 14220: Establishing Dosing Parameters for the Use of Maternal Hyperoxygenation to Affect Fetal Cardiovascular Physiology
Authors: Michelle Kaplinski, Megha D Tandel, Yingjie Weng, Aaron Phillips, Kelly Thorson, Katie Jo Stauffer, Theresa Tacy, Shiraz A Maskatia
Journal: Circulation (2023)

Introduction: Maternal hyperoxygenation (MH) has been used to aid in the prognosis of fetal abnormalities. No data exist on the dose-response relationship or washout time of short-term MH administration related to fetal cardiovascular effects. Hypothesis: There may be a dose-response to MH with effect on pulmonary vascular resistance as measured by pulmonary artery pulsatility index (PAPI) and combined cardiac output (CCO). Aims: The aims of this study were: to determine the appropriate MH dose to obtain a physiologic response (i.e. decrease in PAPI), to evaluate the change in CCO, and to identify the washout period. Methods: Expectant mothers with normal fetal echocardiograms were prospectively recruited from 3/2019 to 6/2023. A research echocardiogram with MH was performed after 31 weeks gestation. Fetal cardiac abnormalities and other comorbidities were excluded. Patients were randomly assigned to either; 2 liters (L) nasal cannula (NC), 4L NC or 8L facemask, all at 100% Fi0 2 . Measurements of PAPI and CCO were performed at baseline, at 1 minute (min) and at 5 min intervals to 20 mins. The same time points were repeated off oxygen. Differences in PAPI were compared between doses and between time points using a mixed effects model. Results: We recruited 29 patients at a mean gestational age of 32.9 (± 0.9 weeks). On oxygen, there was a statistically significant decrease in the PAPI at 8L (-0.18 per min, 95% CI -0.32, -0.05), with the largest decrease occurring between baseline and 5 mins, and PAPI stabilizing after 10 mins (figure). During the washout period, starting at 1 min off oxygen, PAPI values normalized, with no statistically significant changes with 2L, 4L or 8L compared to baseline. No effect on CCO was seen from MH administration. Conclusions: An oxygen dose of 8L is needed for an appropriate PAPI response, with the largest effect occurring before 10 mins. After oxygen is removed, PAPI values normalize by one min. Changes in CCO were not seen with MH in this normal population.
Abstract 12772: In Hospital Outcomes With Extracorporeal Membrane Oxygenation Alone vs Combined With Percutaneous Left Ventricular Assist Device
Authors: Fatima Lakhani, Bertrand Ebner, Sukhpreet Kaur, Rosario Colombo, Mrudula Munagala
Journal: Circulation (2023)

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used to support patients with cardiogenic shock. However, it is associated with an increase in systemic afterload which can lead to worsening cardiac function. The use of a percutaneous left ventricular assist device (pLVAD) plus ECMO has emerged as a strategy to offload the left ventricle, with some studies showing improved outcomes. Hypothesis: The use of ECMO plus pLVAD is associated with improved outcomes compared to the use of EMCO alone. Methods: The National Inpatient Sample was queried from 2011-2018 for relevant ICD-9 and ICD-10 codes to identify patients with cardiogenic shock supported with ECMO or ECMO plus a pLVAD (Ecpella) during the same admission. Baseline characteristics and in-hospital outcomes between groups were compared. Logistic regression was performed to adjust for pre-specified co-variates for outcomes. p-value was considered significant if &lt;0.001. Results: Of 20,171 patients with cardiogenic shock supported with ECMO, 16,064 (79.6%) were treated with only ECMO and 4,107 (20.4%) were treated with ECMO plus pLVAD. Patients in the Ecpella group were more likely to be male (72% vs 66%), have a history of hypertension (50% vs 47%), diabetes (21% vs 15%), chronic kidney disease (27% vs 22%), coronary artery disease (54% vs 44%), myocardial infarction (6% vs 4%, p&lt;0.001 for all). Age (55.6 vs 55.2 years (p = 0.09) and rate of atrial fibrillation and flutter were not significantly different. After adjusting for significant variables, patients in the Ecpella group, had higher rates of mortality (OR 1.2; CI [1.1-1.3]), stroke (OR 1.3; CI [1.2-1.5]), and major bleeding (OR 1.5; CI [1.4-1.7], p &lt; 0.001 for all). The rate of inpatient dialysis was lower in the Ecpella group (OR 0.7; CI 0.7-0.8; p &lt; 0.001). Conclusions: Cardiogenic shock patients treated with ECMO plus pLVAD had worse outcomes compared to patients treated with ECMO alone. Although it is possible that patients treated with ECMO plus pLVAD had a more critical presentation, further studies are needed to evaluate these findings.