tbuckley/cabot-search huggingface dataset:
Abstract 18140: Is Socioeconomic Status Associated With a Novel Clinical Risk Prediction Score for Sudden Cardiac Death?
Authors: Kyndaron Reinier, Harpriya Chugh, Audrey Uy-Evanado, Sumeet S Chugh
Journal: Circulation (2023)

Introduction: Lower socioeconomic status (SES) is associated with higher risk of sudden cardiac death (SCD), but SES has not been used for SCD risk stratification. We have recently developed a novel risk score (VFRisk) for avertable SCD (8 clinical factors, 4 ECG markers, and 1 echocardiographic marker). We evaluated the association of the clinical components of the VFRisk score with SES. Hypothesis: Higher VFRisk scores will associate with lower SES. Methods: Individuals with SCD (2002-2019), were identified from a large ongoing study in a northwest US metro area (pop ~1 million). For each SCD case, a partial VFRisk score was calculated limited to the 8 clinical components (VFRisk-clinical; diabetes, HF, stroke, atrial fibrillation, COPD, history of MI, seizure, and syncope). The VFRisk-clinical score was categorized as low (&lt;25 th percentile), moderate (25 th -75 th ), and high (&gt;75 th percentile). SES was defined for each SCD case by residential census tract median household income and categorized into quintiles. Results: Among 4,412 SCD cases, data for SES and VFRisk-clinical was available for 3,606 (82%) with a median VFRisk of 2.8 (min 0 - max 13.4). There was a weak negative linear correlation between median household income quintile and VFRisk-clinical score (r = -0.05, p=0.002) and mean VFRisk-clinical score was slightly lower with higher SES quintile (Figure). However, there was no significant trend in the proportion of SCD cases with a high VFRisk-clinical score (&gt;75 th percentile) by median income quintile (p=0.13). In a logistic regression model, income quintile was not significantly associated with a high VFRisk-clinical score (p=0.60). Conclusions: No clear association was observed between the VFRisk-clinical score and SES, possibly due to involvement of SES early in the causal pathway of these clinical conditions, or due to effects of SES on risk pathways for SCD separate from the components of the VFRisk score.
Abstract 12373: Clinical Outcomes in Patients With Left Ventricular Assist Device on Guideline Directed Medical Therapy: A Propensity Score Matched Analysis
Authors: Bharat Rawlley, Andres Cordova Sanchez, Kartik Gupta, Matthew Ramm, Debanik Chaudhuri
Journal: Circulation (2023)

Introduction: We investigate the benefit of Guideline Directed Medical Therapy [GDMT] in patients with Left Ventricular Assist Device (LVAD) using an insurance claims database. Methods: We queried Trinetx US collaborative network for patients with LVAD and created two groups; those who received ≥2 prescriptions of any GDMT medication and who did not receive any GDMT after implantation. These were matched by Propensity Score Matching (PSM) for age, race, sex, BMI, LVEF, SBP, DBP, ischemic heart disease, hypertension, disorder of pulmonary circulation, chronic kidney disease (CKD) and acute kidney injury (AKI). All diagnosis were identified using ICD codes. Patient demographics, LVEF, BMI, SBP and DBP were recorded as reported by TriNetX. We looked at primary and secondary outcome measures starting 90 days until 10 years post implantation, primary being all cause mortality and secondary being risk of decompensated heart failure, hypotension, AKI, odds of receiving heart transplant and LVAD explant. Results: We had 4514 patients with LVAD on GDMT and 687 without GDMT. After PSM, we had 651 patients in each group. Both were matched by PSM with Standardized mean difference (SMD) &lt; 0.1 for all variables. Those with LVAD on GDMT had lower risk of all-cause mortality [233 (37.28%)] compared to those not on GDMT [157 (56.29%)] (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.24-0.37, P &lt; 0.0001) [Figure 1] but at a higher risk of decompensation (RR 2.74, 95% CI 2.19-3.42), hypotension (RR 3.58, 95% CI 2.73 - 4.69) and AKI (RR 2.64, 95% CI 2.23-3.18). Patients receiving heart transplant and LVAD explant had higher odds of being on GDMT [Odds Ratio [OR], 95% CI: 2.86, 1.87 - 4.37; 4.29, 2.13 - 8.63, respectively). Conclusions: LVAD patients on GDMT have lower all-cause mortality, higher odds of receiving heart transplant and LVAD explant starting 90 days post implant. However, for reasons not clear to us, they are also at higher risk of decompensation, hypotension and AKI.
Abstract 18084: Coagulopathy and Hospital Outcome in Patients With Covid-19: An Insight From National Inpatient Sample
Authors: Majd Al Ahmad, Laith Alhuneafat, Anas Al-Ahmad, Mohammad Hamza, Bharadwaj Satyavolu, Hafiza Hareem Waqar, ahmad jabri, Ahmad Al-Abdouh
Journal: Circulation (2023)

Introduction: SARS-CoV-2 infection has been linked to thrombosis and bleeding. In this study we aim to investigate coagulopathy rates, predictors and in-hospital outcomes in a nationally representative sample of COVID-19 patients. Methods: Using the 2020 National Inpatient Sample. We identified adult patients who were admitted with a principal diagnosis of COVID-19. Mortality difference, LOS, and COC were evaluated as indicators of healthcare resource usage. Regression analysis adjusted for baseline variables and comorbidities compared individuals who developed coagulopathy to those who did not. Logistic regression analysis was used to identify COVID-19 coagulopathy facrtors. p-value &lt;0.05 indicated statistical significance. Results: Among 1,050,045 COVID-19 admissions, 12% (126,225 patients) developed coagulopathy. Those with coagulopathy group had higher rates of in-hospital mortality (aOR 1.31, CI 1.23-1.39, p &lt;0.001), prolonged LOS (aMD 2.29 days, 95% CI 2.12-2.46, p&lt;0.001), and increased COC (aMD 142615$, 95% CI 32905-41299, p&lt;0.001) compared to those that did not develop coagulopathy. Factors associated with coagulopathy included male gender, black race, higher Charleston comorbidity index, and lowest income quartile Conclusion: Approximately 12% of patients developed coagulopathy, which was associated with increased in-hospital mortality, longer length of stay, and higher cost of care. These findings emphasize the importance of identifying and managing coagulation disorders in COVID-19 patients to improve outcomes and allocate healthcare resources effectively. Further research is needed to explore interventions and strategies for mitigating the impact of coagulopathy in this population
Abstract 15344: LVAD Recipients and Caregivers Understanding of Associated Complications
Authors: Aroosa Malik, Matthew Mignery, Supriya Shore
Journal: Circulation (2023)

Introduction: Shared decision-making centers around accurate patient understanding of risk-benefits associated with a therapy. This study evaluates (i) patient and caregiver estimated risks for LVAD complications and (ii) describes how patients and caregivers rationalize estimated risks. Methods: We conducted a qualitative study using semi-structured interviews with 18 LVAD recipients and 9 caregivers between 1/13/2023 - 6/4/2023. Interviews were transcribed and coded, with themes identified using rapid qualitative analysis. Results: Included patients had a median age (range) of 60.5 (28-83) years, 12 (67%) were men, 12 (67%) were White and 10 (56%) received their LVAD as destination therapy (DT). Participating caregivers included 8 (89%) women supporting 5 (56%) DT LVAD recipients. Using the Penn Columbia Risk Score, 22% of the participants were high risk, 33% moderate risk, and 44% were low risk for mortality. When asked about patient physician communication participants ranked their interactions highly. Of all LVAD risks, both patients and caregivers demonstrated good understanding of risks of stroke and heart failure hospitalization after LVAD (89% and 72% respectively). However, both patients and caregivers described poor understanding of risks of GI bleeding and LVAD associated infections (63% patients and 25% caregivers for GI bleeding and 55% patients and 37% caregivers for infection). We identified three themes explaining how patients and caregivers rationalized under-estimation of LVAD risks (i) lack of awareness (ii) survivor bias (iii) minimization. Exemplary quotes highlighting these themes are provided in the Table below. Conclusion: Our qualitative study highlights the poor understanding patients have with regards to LVAD complications. This highlights the need to improve LVAD recipient and caregiver education on associated risks.
Abstract 13333: Review of Simultaneous Kidney and Heart Transplant After 2018: UNOS Data
Authors: Het Patel, Arpita Pawa, Surabhi Maheshwari, Kathryn Gayle
Journal: Circulation (2023)

Introduction: In October 2018, the Organ Procurement and Transplant Network (OPTN) adopted a 6-tier system for organ allocation where priority was given to critically ill patients, especially those on Extra Corporeal Membrane Oxygenation (ECMO) support. The guideline lacks information about multiorgan transplant due to weak evidence on Simultaneous Kidney and Heart transplant (SKHT) data. Hence with this study, we aim to review outcomes of patients on ECMO at the time of SKHT. Method: This was a retrospective study of adult SKHT recipients between 2018-2022 from the OPTN database. The study excluded individuals who underwent simultaneous multiple organ transplants, isolated heart transplants, as well as those with incomplete outcome information. The cohort was stratified by ECMO need at the time of transplant. Univariate cox regression analysis was performed for predictors of worse outcomes. Patient survival was compared using Kaplan Meier (KM) curve and log rank test. Results: A total of 1383 patients were included in this study, of which 72 (5.2%) were on ECMO bridge. On review of baseline characteristics, patients on ECMO had mean wait time of 65 (± 190) days with higher mortality rate post-transplant and a lower mean survival time as compared to the non-ECMO counterparts (398 (± 404) vs 545 (± 462) days, p= 0.008). On analysis of KM curve, SKHT recipients on ECMO bridge had higher mortality within the first 10 months of transplant and plateaued after that. The only predictors associated with worst outcomes among ECMO recipients were dialysis requirement and development of stroke post-transplant. On the contrary, Left Ventricular assisted device (LVAD) use prior to transplant was associated with 70% reduction in mortality in non-ECMO group (HR: 0.30 (95% CI: 0.11 - 0.83, p=0.02)) in this cohort. Conclusion: Following the change in guidelines, around 5.2% of the total SKHT recipients were on the ECMO bridge. Dialysis requirement and development of stroke post-transplant was independently associated with higher mortality compared to non ECMO group. On the contrary, patients on LVAD support at the time of transplant have had better outcomes.Figure 1:
Abstract 16852: Pathological ECG Findings in 24-h-Holter-ECGs in Patients With Ischemic Stroke
Authors: Tobias Uhe, Katrin Wasser, Wolf Schaebitz, Martin Koehrmann, Johannes Brachmann, Ulrich Laufs, Martin Dichgans, Götz Gelbrich, David Petroff, Klaus Groeschel, Rolf Wachter
Journal: Circulation (2023)

Introduction: ECG-monitoring covering several days is recommended by current guidelines to detect atrial fibrillation (AF) and other arrhythmias in stroke patients. In practice, the extent of rhythm monitoring varies. Here, we use data from the 24-hour screening-Holter-ECGs of the ongoing randomized multicenter trial Find-AF 2 to assess the rate of AF and other arrhythmias. Methods and Results: Find-AF 2 (NCT04371055) is a randomized and controlled open-label parallel multicenter trial with central AF adjudication (intervention arm) and blinded endpoint assessment. Patients ≥60 years with recent (≤30 days) ischemic strokes according to the AHA/ASA definition of any etiology are screened for eligibility. All eligible patients receive a 24-hour Holter-ECG prior to randomization. Holter ECG data are analyzed by the core laboratory using dedicated analysis software and following a predefined standard operation procedure. In this analysis, we included all 24-hour Holter-ECGs up to June 1, 2023. We analyzed 3742 24-hour-Holter-ECGs from 51 different centers and found new arrhythmias in 120 patients (3.2%). AF was detected in 61 patients (1.6%) with a median duration of the longest episode of 730 minutes [interquartile range (IQR) 220;1180] (see Figure 1). This led to the initiation of anticoagulation in all 61 patients (100%). In 47 patients (1.3%), pauses &gt;2.5 s (mean 3.1s±0.5s; longest pause 4.8s) or relevant bradycardias &lt;40 bpm were diagnosed. This resulted in the implantation of pacemakers in six patients. Finally, we found regular supraventricular tachycardias in 25 patients (0.7%; median duration 7.0 min [IQR 1.0;21.3]) - 24 of them had focal atrial tachycardias and one an AVNRT. Conclusion: Overall, 3.2% of ischemic stroke patients had pathological ECG findings, leading to a therapeutic change in 56%, most commonly anticoagulation for AF detection The number needed to screen for a change in medical management was 56.
Abstract 16785: Hypertension Induces Metabolite Content Alterations in Hypoperfused Mouse Brain Cortex
Authors: Lorenzo Carnevale, Marialuisa Perrotta, Francesco Mastroiacovo, Raimondo Carnevale, Jacopo Pacella, Daniela Carnevale, Giuseppe Lembo
Journal: Circulation (2023)

Introduction and aims: Hypertension is one of the main risk factors for dementias. To understand the link between vasculature and neuronal dysfunction in hypertension-induced cognitive impairment we leverage MRI, a translational imaging tool that let us concomitantly analyze cerebral structure, function and metabolism. Methods: Transverse aortic constriction (TAC) was performed in C57Bl/6J mice to induce cerebral hypertension. The brain was characterized by structural MRI, cerebral blood flow (CBF) was analyzed by perfusion MRI and cortical cerebral metabolism was characterized by point-resolved spectroscopy performed on a small-animal dedicated 7T MRI. Finally, we characterized the microvascular structure in regions impacted by hypertension by immunofluorescence. Results: TAC mice shown hemodynamic alterations in cortical CBF compared to sham mice (A). Macroscopic volumetric analyses of the cortex shown no significant alterations, however hypoperfused cortical regions shown local cortical thickening, suggesting a local swelling due to inflammatory processes (B). The histological microvascular analysis evidenced capillary Blood-Brain Barrier loss of integrity (C). Finally, this cortical region shown alterations in glucose and glutamine metabolite concentration measured by MR spectroscopy (D). Conclusions: Leveraging MRI we have concomitantly characterized the cortical structure, function and metabolism in TAC-hypertensive mice. These alterations in cerebral blood flow and metabolism of glucose/glutamine are biomarkers of ongoing cerebral injury and are potential targets of further investigation to shed light on the interplay between vascular and neuronal injury in hypertension.
Abstract 15034: Characteristics of Sudden Cardiac Death According to BMI Group: The FinGesture Study
Authors: Lassi Mantyniemi, Lasse Pakanen, Lauri Holmstrom, Jani T Tikkanen, Juha Vahatalo, Anette Eskuri, Juha Perkiomaki, Heikki Huikuri, Juhani Junttila
Journal: Circulation (2023)

Background: The prevalence of obesity has increased significantly in Western Societies. Obesity increases the risk of sudden cardiac death (SCD), but the etiology and mechanisms of obesity-related SCD are unclear. Hypothesis: We hypothesized that obesity is associated with specific SCD characteristics which may explain the increased risk of SCD in obesity. Aims: We aimed to investigate the characteristics of SCD according to the BMI group. Methods: This study is derived from the FinGesture study, which has prospectively collected all out-of-hospital SCD cases from Northern Finland since 1998 (population ~700,000). As required by Finnish law, all sudden deaths undergo medicolegal autopsy, and the Fingesture study has included all sudden deaths from Northern Finland with autopsy-verified cardiac etiology (i.e., SCD). The determination of the cause of death was based on a combination of autopsy findings, medical records, and police and emergency medical service reports. Results: The study population consisted of a total of 5,869 autopsy-verified SCD victims. Mean age was 64.9±12.4 and 78.9 % were male. The mean age decreased along with increasing BMI class (Table) (p &lt; 0.001). The proportion of non-ischemic cardiac disease (p &lt; 0.001, Figure) and the mean heart weight at autopsy (p &lt; 0,001, Table) increased along with increasing BMI. Conclusions: Obesity-related SCD is associated with younger age and a higher proportion of non-ischemic cardiac disease with hypertrophy. These results suggest that early development of non-ischemic cardiac disease may contribute to obesity-related SCD.
Abstract 14695: Artificial Intelligence Applied to the Electrocardiogram Predicts Outcomes in Patients With Severe Aortic Stenosis and Potential Cardiac Amyloidosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Milagros Pereyra, JUAN FARINA, Ahmed K. Mahmoud, Isabel G Scalia, Francesca Galasso, Michael E Killian, Mustafa Suppah, Chieh-Ju Chao, John P Sweeney, Floyd D Fortuin, Julie Rosenthal, Reza Arsanjani, Chadi Ayoub
Journal: Circulation (2023)

Introduction: Cardiac amyloidosis (CA) has been suggested to be common (up to 16%) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). CA has poorer outcomes and its assessment in all TAVR patients may be costly and challenging. Hypothesis: CA may be screened for with an artificial intelligence (AI) clinical predictive model applied to pre-TAVR ECGs, and high probability (&gt;50%) for CA may be associated with worse clinical outcomes. Methods: In this retrospective analysis of the Mayo institutional National Cardiovascular Disease Registry (NCDR)-TAVR, patients undergoing a TAVR between Jan-2012 and Dec-2017 were included. Pre-TAVR ECGs were analyzed by the AI predictive model for CA embedded in the EMR. EMRs were reviewed to assess for a clinical diagnosis of CA in those identified as high probability (&gt;50%) by the AI tool. Clinical outcomes on 1 year follow-up were extracted from the NCDR-TAVR database and Kaplan-Meier curves were created to compare patients with high CA probability (≥50%) versus those with low probability (&lt;50%). Results: Of 1070 patients who underwent TAVR (mean age 81.1± 8.5 years, 58.2% male), 263 (24.6%) had ≥50% probability for CA on pre-procedure ECG. Only 18 (1.7%) of these had clinical diagnosis of CA. In the survival analysis, high probability of CA by AI tool was associated with higher all-cause mortality (HR 1.60, 95%CI 1.09-2.34, p=0.01) and greater HF admissions (HR 1.59, 95%CI 1.08-2.35, p&lt;0.01). Neither TIA/stroke nor myocardial infarction were statistically significant. MACE (TIA/stroke, myocardial infarction, heart failure admissions) was higher in the ≥50% CA probability group (HR 1.68, 95%CI 1.17-2.40, p&lt;0.01), (Figure) . Conclusion: CA is clinically underdiagnosed in patients undergoing TAVR. AI applied to pre-TAVR ECGs suggesting higher probability for CA identifies a subgroup at higher risk of clinical events, who may benefit from further diagnostic evaluation for CA.
Abstract 15499: Biochemical and Genetic Newborn Screening for Familial Hypercholesterolemia
Authors: Amy L Peterson, Xiangqiang Shao, Xiao Zhang, Michael Lasarev, Megan Benoy, Patrice Held, Vanessa Horner
Journal: Circulation (2023)

Introduction: Familial Hypercholesterolemia (FH) causes elevated low-density lipoprotein cholesterol (LDL-C) and premature atherosclerosis. Despite guidelines, universal screening rates remain low. Newborn screening could increase FH diagnostic rates. Hypothesis: FH can be diagnosed from newborn dried blood spots for LDL-C, total cholesterol (TC), and apolipoprotein B (apoB), followed by selective genetic testing to identify pathogenic and likely pathogenic variants causing FH. Methods: De-identified, residual newborn screening dried blood spots were analyzed for LDL-C, TC, and apoB with results expressed as multiples of the median (MoM). Mahalanobis distance (measuring MoM different from 1) was computed and the top 8% of distances selected for genetic testing (panel including LDLR , APOB , PCSK9 , LDLRAP1 , APOE , LIPA , ABCG5 , and ABCG8 ). Results: A total of 10,004 specimens had biochemical testing, with 768 specimens selected for genetic testing. In total 15 variants were identified, 11 pathogenic and 4 likely pathogenic (Table 1). Composite Mahalanobis distance from LDL-C and apoB identified the most variants, followed by apoB alone and then LDL-C alone. TC alone identified the fewest number of variants (Table 2). Conclusions: Testing newborn dried blood spots with biochemical and reflex genetic testing is feasible to detect FH. Genetic testing of about 8% of samples identified 1 in 667 newborns with FH, but more extensive genetic testing would likely detect more variants. Prospective studies are needed to correlate newborn results with LDL-C levels later in childhood.
Abstract 17687: Left Ventricular Unloading in Pulmonary Hypertension With Impella 5.5 as a Bridge to Heart Transplantation
Authors: Moses Lee, Samuel Jackson, Andrew D Watson
Journal: Circulation (2023)

A 59 year-old male with a history of triple-vessel coronary artery bypass graft surgery, ischemic cardiomyopathy with an implantable cardioverter defibrillator, pre- and post-capillary pulmonary hypertension, severe mitral regurgitation, paroxysmal atrial fibrillation, diabetes mellitus, hypertension was referred for transplant evaluation in the setting of cardiogenic shock despite inotropic support. His initial right heart catheterization showed RAP 21 mmHg, RVP 91/9 mmHg, PAP 88/31 mmHg with a mean of 50 mmHg, PCWP 22 mmHg, PVR 6.6 Wood units, SVR 857 dynes, and CO 4.85 l/min/CI 2.59 l/min/m 2 by thermodilution. His hospital course was complicated by acute renal failure requiring continuous renal replacement therapy. Inotropic support could not be weaned on multiple attempts, and pulmonary and wedge pressures remained significantly elevated despite a trial of inhaled nitric oxide. The patient underwent Impella 5.5 placement to assess the hemodynamic response of unloading the left ventricle. A repeat right heart catheterization showed a RAP 1 mmHg, RVP 42/1 mmHg, PAP 48/13 mmHg with a mean of 26 mmHg, PVR 2.3 Wood units, SVR 829 dynes, and CO 6.75 l/min/CI 3.74 l/min/m 2 by thermodilution. Measurements were obtained with Impella 5.5 at P-8 level, milrinone 0.2 mcg/kg/min, treprostinil 4 ng/kg/min, epoprostenol 1 mg every 6 hours, and sildenafil 10 mg in morning and afternoon and 15 mg in evening. The patient underwent successful heart and kidney transplantation. Post-transplantation right heart catheterization showed persistent pre-capillary pulmonary hypertension with normal filling pressures and CI. His pulmonary hypertension was managed with sildenafil 40 mg three times daily and ambrisentan 10 mg daily. This case demonstrates favorable hemodynamic effects of left ventricular unloading using Impella support with significant reduction in pulmonary vascular pressure to reach candidacy for heart transplantation.