tbuckley/cabot-search huggingface dataset:
Abstract 18587: Factors Associated With Changes in High Sensitivity Troponin and NT-proBNP in Response to Intensive Blood Pressure Lowering in SPRINT
Authors: Thomas T Nguyen, Achsah Varghese, Djhenne Dalmacy, Simon Ascher, Christie M Ballantyne, VIJAY NAMBI, James A de Lemos, Jarett D Berry
Journal: Circulation (2023)

Background We have recently shown that intensive SBP lowering was associated with a modest increase in hscTnT and a decrease in NT-proBNP. In the present study, we sought to compare the independent determinants of changes in biomarkers in intensive vs. standard SBP lowering in SPRINT. Methods: Hs-cTnT and NT- proBNP were measured at baseline, 1-year, and 2-year from stored specimens. Biomarker changes were analyzed according to categories (≥50% increase, ≥50% decrease, and &lt;50% change). The impact of intensive SBP lowering on changes in biomarkers levels was assessed using multivariable-adjusted multinomial logistic regression models in standard and intensive SBP lowering separately. Results: Of 9,361 SPRINT participants, we measured cTnT and NT-proBNP in 8,828 (baseline), 7,887 (year 1), and 7,463 (year 2) free of CVD events. Among individuals with detectable hscTnT at baseline (≥6 ng/L), a 50% increase in hscTnT was observed in 4.5% (year 1) and 6.7% (year 2). Among individuals with baseline NT-proBNP ≥125 pg/mL, a 50% increase in NT-proBNP was observed in 16.7% (year 1) and 21.1% (year 2). Overall, a similar pattern of associations was observed with both biomarkers across treatment groups (see Figure). Several exceptions were noted. Prevalent CVD was associated with an increase in both NT-proBNP and hscTnT in the standard SBP lowering arm but not in the intensive SBP lowering arm. Higher baseline hscTnT was associated with an increase in hscTnT only in the standard arm. Furthermore, we observed biomarker-specific differences. For example, white race, female sex, and blood pressure were consistently associated with an increase in NT-proBNP. In contrast, declining renal function and male sex were associated with increasing hscTnT. Conclusion Factors associated with changes in biomarkers varied by treatment assignment and between biomarkers. These findings highlight the role of noncardiac factors on biomarker changes in the context of intensive SBP lowering.
Abstract 16336: Efficacy and Safety of Saroglitazar in the Management of Atherogenic Dyslipidemia: An Updated Meta-Analysis of Randomized Clinical Trials
Authors: Vinicius M Oliveira, Izadora C Oliveira, Antonio da Silva Menezes Junior
Journal: Circulation (2023)

Background: Saroglitazar is a novel drug used in the treatment of atherogenic dyslipidemia. However, its effect on this condition remains uncertain. Herein, we performed a systematic review and meta-analysis to assess the efficacy and safety of saroglitazar in the management of atherogenic dyslipidemia. Methods: PubMed, Scopus and Embase were systematically searched for randomized controlled trials (RCTs) comparing saroglitazar 4 mg, saroglitazar 2 mg, and placebo in the treatment of atherogenic dyslipidemia. A random-effects model was used to compute the pooled mean difference (MD) for continuous outcomes, with 95% confidence interval (CI). Heterogeneity was assessed with I 2 statistics. Results: We included 7 RCTs with 1,095 patients, of whom 340 (31.0%) were randomized to saroglitazar 2 mg; 513 (46.8%) to the 4 mg dose; and 242 (22.11%) to placebo. Mean age ranged from 40.2 to 62.6 years, and 436 (39.8%) were women. Saroglitazar 4 mg significantly lowered triglycerides (MD -51.18 mg/dL; 95% CI -66.80 to -35.55 mg/dL; p&lt;0.001; figure 1A) and LDL-cholesterol levels (MD -9.15 mg/dL; 95% CI -10.52 to -7.77 mg/dL; p&lt;0.001; figure 1B) when compared with placebo. Moreover, saroglitazar 4 mg minimally increased HDL-cholesterol (MD 2.73 mg/dL; 95% CI 0.49 to 4.97 mg/dL; p=0.02) in comparison with placebo. There were no significant differences between groups in the alanine aminotransferase levels (MD -26.40 U/L; 95% CI -72.15 to 19.36 U/L; p=0.26). There was a slight increase in body weight in the saroglitazar 4 mg group when compared with placebo (MD 0.90 Kg; 95% CI 0.31 to 1.48 Kg; p=0.003). In the comparison of saroglitazar 4 mg vs. 2 mg, the higher dose significantly outperformed the lower dose with regards to reduction in triglycerides (MD -32.38 mg/dL; 95% CI -53.62 to -11.14 mg/dL; p=0.003). Conclusion: Our findings suggest that saroglitazar 4 mg is effective for the reduction of triglycerides and LDL-C, with a small increase in body weight relative to placebo.
Abstract 19022: Is Peritoneal Dialysis Superior to Hemodialysis Regarding Outcomes in End-Stage Renal Disease Patients With ST-Segment Elevation Myocardial Infarction? Insights From the National Inpatient Sample Database (2016-2020)
Authors: Rohan Gajjar, Aniesh Bobba, Sami J. Shoura, Ufuk Vardar, Taha Teaima, Karthik Gangu, Siri Vummaneni, Vij Aviral, Neha Yadav
Journal: Circulation (2023)

Introduction: ST-segment elevation myocardial infarction (STEMI) in end-stage renal disease (ESRD) is associated with worse outcomes. Peritoneal dialysis (PD) has shown better hemodynamic tolerability and quality of life. We analyzed outcomes comparing PD to HD in ESRD patients with STEMI using the National Inpatient Sample (NIS) database. Methods: NIS (2016-2020) was queried to identify adult STEMI admissions with co-morbid dialysis-dependent ESRD using ICD-10-CM codes, then stratified to HD-ESRD and PD-ESRD using ICD-10-PCS codes. Propensity score matched HD-ESRD controls were derived based on demographics and baseline co-morbidities. Multivariate logistic/linear regression were used to analyze the outcomes, such as inpatient mortality and complications, length of stay (LOS) and total hospital charge (THC). Results: Of the ESRD patients with STEMI, 1225 underwent PD, and 10675 underwent HD. Trend analysis showed declining in-patient mortality despite increasing STEMI burden in HD group, with up-trending mean LOS and THC. In contrast, PD group showed unchanging trends. Upon propensity score matching, PD patients showed similar adjusted odds of inpatient mortality and mean LOS but significantly lower mean THC. Further, PD patients had lower adjusted odds of inpatient complications, mainly ischemic strokes, pulmonary embolism, and hemopericardium. Conclusions: Our analysis showed a declining trend in inpatient mortality with STEMI in HD group. Although propensity-matching showed similar inpatient mortality, our research deemed PD superior to HD in STEMI patients, given lower financial burden and better outcomes with lower odds of inpatient complications.
Abstract 14776: Myopericarditis Mimicking Myocardial Infarction With Non-Obstructive Coronary Arteries
Authors: Mohammad M Akhtar, Hanad Bashir, Santosh Menon
Journal: Circulation (2023)

This is a case of a 76-year-old female with a past medical history of recurrent paroxysmal symptomatic supraventricular tachycardia (SVT), atherosclerotic heart disease, mild aortic and mitral valve regurgitation, mild-moderate tricuspid regurgitation, right bundle branch block, hypothyroidism and bronchiectasis who presented to her dermatology appointment with palpitations and dizziness. She visited the cardiologist's office and was found to have SVT on electrocardiogram which did not terminate with Valsalva maneuvers. She arrived at the emergency department with chest pain and converted to sinus rhythm after 6 mg of intravenous adenosine was administered. Her troponin peaked to 0.21 and she was admitted with concerns for non-ST segment elevation myocardial infarction. Transthoracic echocardiogram showed left ventricular ejection fractions of 61 percent with no wall motion abnormalities and left atrial and inferior vena cava dilation. She underwent left heart catheterization which only showed mild calcification and minimal luminal irregularities of the left anterior descending artery. Cardiac MRI showed myopericarditis and she was discharged with 0.6 mg of colchicine twice daily with plans for outpatient follow up. Discussion Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discovered to have myocarditis on cardiac MRI 25-30% of time. However, this case uniquely demonstrates myopericarditis as the cause for MINOCA which may not have been previously specified. In addition, it is important to emphasize the utility of Cardiac MRI as a non-invasive modality to diagnose MINOCA “mimics”, especially in the female population.
Abstract 13632: Predictors of Death and/or Readmission in Extremely Elderly Patients Hospitalized for Decompensated Heart Failure
Authors: Larissa M Targino, Douglas L Medeiros, Eduardo S Darzé, Queila B Oliveira, Karina C Cordeiro, Luiz Eduardo F Ritt
Journal: Circulation (2023)

Introduction: Heart Failure (HF) is the final stage of cardiac illness, and it has become highly prevalent with the aging population. The extremely elderly population is underrepresented in HF clinical studies. This study aims to identify predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure. Research Question: What are the predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure? Methods: Retrospective cohort study in the model of a single-center registry including data from 2019 to 2022. The study was conducted at a private tertiary institution located in Salvador-BA, Brazil and included patients ≥ 80 years old admitted with a diagnosis of HF. Data was collected from electronic medical records and through follow-up performed 30 days after discharge, analyzed using descriptive statistics and compared by parametric or non-parametric tests, as appropriate. Multivariate analysis with logistic regression was performed to evaluate independent predictors of readmission and death from HF. Results: A total of 221 extremely elderly patients hospitalized for decompensated HF were included. There was a higher prevalence of females (57.4%), mean age of 87.6 ± 4.9 years, and mean Left Ventricular Ejection Fraction (LVEF) of 49.5 ± 17.1%. After 30 days, it was found that 14.9% of this sample had a death outcome and 16.7% were readmitted, totaling 28.1% of combined outcome (death and/or rehospitalization). The outcome group had older age (88.7 ± 4.6 years vs. 87.2 ± 4.9; p = 0.039), lower diastolic blood pressure (DBP) (74.8 ± 18.4 mmHg vs. 81.5 ± 15.6 mmHg; p = 0.007), higher rate of past ischemic stroke (30.6% vs. 13.2%; p = 0.002), and higher palliative care rate (27.4% vs. 3.2%; p = 0.001). In logistic regression, history of ischemic stroke [OR: 3.43 (CI: 1.30 - 9.05); p = 0.013], DBP [OR: 0.96 (CI: 0.93 - 0.99); p = 0.010], and palliative care [OR: 66.71 (CI: 8.18 - 543.66); p &lt; 0.001] were independent risk factors for the combined outcome at 30 days. Conclusion: In extremely elderly patients admitted for heart failure, death or hospitalization at 30 days demonstrated an independent association with a history of ischemic stroke, DBP and palliative care.
Abstract 16165: Implicit Bias and Unintentional Harm in Vascular Care: The Case for Intervention
Authors: Corey A Kalbaugh, Kerry Howard, Erika Beidelman, Brian Witrick, Katharine McGinigle, Samantha Minc, Olamide Alabi, Caitlin W Hicks, Andrew A Gonzalez, Samuel Cykert
Journal: Circulation (2023)

Introduction. Unconscious, or implicit, bias may influence physician treatment decisions and contribute to healthcare disparities. Research Questions. Is implicit bias associated with inappropriate care for claudication and 1-year major amputation? Methods: All vascular interventionists of the Society for Vascular Surgery Vascular Quality Initiative (VQI) were invited to take the race Implicit Association Test (IAT). The IAT asks participants to classify sequential images of African American (Black) and European American (White) faces to positive and negative attributes and groups them by racial preference based on reaction time. IAT results were weighted and linked to VQI peripheral revascularization data to test the association between implicit bias with patient race and performance of below-knee procedures for claudication, a measure of inappropriate care. We assessed the association of below-knee procedures and patient race with odds of 1-yr amputation, using physician implicit bias as a moderator. Results: Among the 218 physicians that completed the IAT, physicians with White preference (70%) were more likely to perform a below-knee procedure on Black patients ( Fig A ) and their Black patients had increased odds of 1-yr amputation compared to White patients (OR: 3.0, 95%CI: 1.7-5.4). Physicians with no preference (20%) had no variability in below-knee procedures by patient race and fewer 1-yr amputations. A below knee procedure for claudication (ref: above-knee) was associated with increased odds of 1-year amputation, but the effect was greater among physicians with White bias (OR: 8.2;4.7-14.5) compared to no bias (OR: 3.6;1.4-9.7) ( Fig B ). Conclusions: Implicit bias is associated with inappropriate treatment selection, especially for Black patients. These results suggest the need for system level interventions that transparently identify procedures that are not aligned with best practices to reduce the negative effect of implicit bias.
Abstract 16553: Effects of Digital Yoga on Physical and Psychological Outcomes in Patients With Heart Failure: A Randomised Controlled Trial
Authors: Anna Stromberg, Leonie Klompstra, Joanna-Maria Papageorgiou, Towe Hedbom, Marie Lundberg, Lotti Orwelius, Ingela Thylen, Tiny Jaarsma
Journal: Circulation (2023)

Objectives: To determine effects of digitally delivered yoga on exercise capacity and patient-reported outcome measures. Methods: Two-arm randomised controlled study including participants with heart failure or conditions in need of intensive care from four hospitals in Sweden. Participants were randomised to a control group receiving individual exercise advice or to the intervention group (tele-yoga). The intervention lasted for 3 months and included live-streamed group-yoga via Zoom for 60 minutes twice/week and individual yoga for a minimum of 10 minutes/day using an app. The primary endpoint of the study was a combined endpoint consisting of change in functional capacity measured by 6 minute walk test (6MWT), health-related quality of life (EQ-5D index/VAS) and symptoms of anxiety and depression (hospital anxiety and depression scale - HADS). The primary end-point analysis after 3 months follow-up compared the change in the combined endpoint between the participants in the tele-yoga and control group. Secondary endpoints included separate analysis of functional capacity, health-related quality of life and symptoms of anxiety/depression. Results: 311 participants were randomized to tele-yoga (n=156) and control (n=155), mean age 66 years, 30% women, 80% diagnosed with heart failure. There was a significant improvement in favor of the tele-yoga group in the combined primary endpoint consisting of physical function, quality of life and anxiety and depression (p=.006). When analysing them separately, there was a significant improvement in 6MWT (p=.008) and quality of life in EQ-5D VAS (p=.014), but not in EQ-5D index (p=.12), and a significant difference between the groups in symptoms of anxiety and depression (p=.03). Median attendance to yoga-sessions was 20 sessions (maximum 24) and 69% of the study participants were adherent to &gt;18 tele-yoga sessions. There were no adverse events reported during yoga sessions or app usage. Conclusion: Digitally delivered mind-body training such as tele-yoga showed a significant improvement in the combined end-point consisting of physical function, health-related quality of life and mental health. Tele-yoga may be a promising new form of rehabilitation for patients with heart failure.
Abstract 15114: Enhanced External Counter Pulsation for Treatment of Angina With No Obstructive Coronary Artery Disease (ANOCA)
Authors: Namrita D Ashokprabhu, Jessie Fox, Sachin Shah, Yulith Roca Alvarez, Christian Schmidt, DARLENE TIERNEY, Lauren Thompson, Timothy D Henry, Odayme Quesada
Journal: Circulation (2023)

Background: Angina and no obstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a non-invasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole (diastolic augmentation and increased preload), followed by deflation during systole (decreased afterload). Although EECP is indicated in refractory angina patients, its effectiveness in treating refractory angina in ANOCA patients is relatively unknown and limited to small case series. Objective: Assess the efficacy of EECP treatment in ANOCA patients using Canadian Cardiovascular Society (CCS) angina class, 6-minute walk test (6MWT), Duke Activity Status Index (DASI), Seattle Angina Questionnaire (SAQ), and weekly anginal episodes. Methods: We examined ANOCA patients (defined as £50% stenosis in any major epicardial vessels) with CCS class 3 or 4 angina that completed EECP treatment at 2 large centers. CCS class, 6MWT, DASI, SAQ, and weekly anginal episodes were evaluated pre- and post- EECP treatment, as data was available. A paired Student’s t-test, Wilcoxon signed-rank test, and McNemar’s test were utilized as appropriate. Results: 65 ANOCA patients (63% female; 60±11 years) that completed 35±2 EECP sessions were included. Patients were on 4±2 cardiac medications pre-EECP (78% statin, 52% ACEI/ARB, 62% BBs, 34% CCBs, 48% nitrates, and 53% ranolazine). Post-EECP, 42 patients (65%) had an improvement of 3 1 CCS angina class with 16 (25%) improving by 3 2 classes. Significant improvements in CCS angina severity, 6MWT, DASI, SAQ, and weekly anginal episodes were evident post-EECP ( Table ). Conclusion: In ANOCA patients, EECP therapy reduces CCS angina class and improves exercise tolerance. EECP should be considered in ANOCA patients with refractory angina CCS class 3 or 4 as a part of optimal medical therapy.
Abstract 14927: Transcatheter Aortic Valve Implantation Bailout for Severe Aortic Insufficiency Due to Aortic Root Dissection Following Ascending Aortic Aneurysm Repair
Authors: Alejandro Sanchez-Nadales, muftawu deen iddrisu, Mileydis Alonso, Abdullah Sarkar, David Lopez, Craig R Asher, Emad Hakemi
Journal: Circulation (2023)

Case Presentation: 75-year-old female with history of conservatively managed ascending aortic aneurysm with mild Aortic Insufficiency (AI) and a chronic Type B aortic dissection. Due to rapid aneurysmal expansion she underwent surgical ascending aortic aneurysm repair with a 32-mm Gelweave graft, aortic valve commissuroplasty, and 1-vessel aorta-to-right coronary artery bypass graft. She was discharged 15 days post-op in stable condition. However presented 2 weeks later with new onset dyspnea with minimal exertion, orthopnea, peripheral edema, wide arterial pulse pressure (150/50 mmHg), jugular venous distention. Transthoracic and transesophageal echocardiography showed a new and severe AI, with preserved left ventricular ejection fraction. A computed tomography angiogram (CTA) of the chest showed an acute aortic dissection at the proximal and distal segments of the aortic graft (Figure 1). She underwent a transcatheter aortic valve implantation (TAVI) with a self-expanding bioprosthesis: 27 mm Portico TM valve (St. Jude Medical, St. Paul, MN, USA) anchored at the annular level (annular area 370 mm 2 , perimeter 69 mm with calculated over sizing of 30%) and at the 32 mm Gelweave graft level (42 mm bioprosthesis aortic outflow dimension) without acute complications (Figure 2). She was discharged and remained clinically well without recent readmission for CHF exacerbation. Conclusions: Patient was deemed a poor surgical candidate due to frailty and recent sternotomy. This case demonstrates TAVI as off-label treatment option for severe AI due to aortic root dissection in poor surgical candidates.
Abstract 12816: Changes in Self-Care and Quality of Life After Hospitalization for Coronary Heart Disease
Authors: Brynja Ingadottir, Margret H Svavarsdottir, Corrine Y Jurgens, Christopher S Lee
Journal: Circulation (2023)

Background: Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we know little about how CHD self-care influences quality-of-life (QOL) over time. Hypothesis: Changes in CHD self-care would be associated with changes in QOL. Aims: Identify distinct trajectories of change in self-care following a hospitalization for CHD that were associated with significant differences in QOL over time. Methods: Longitudinal study (Iceland). Patients completed surveys at hospital discharge and 6 months later. Self-care was measured with the Self-Care of CHD Inventory (maintenance and management scores = 0-100, higher=better) and QOL was measured with the SF-12 (physical and mental QOL = 0-100, higher=better). Growth mixture modeling was used to identify trajectories of CHD self-care behaviors. Results: A total of 373 patients (mean age 64.3±8.9, 79% male) completed the study. Two trajectories of CHD self-care were identified. The first one (57.2% of the sample - solid line - “Inadequate and Worsening”) had comparatively worse self-care at both timepoints; maintenance improved but management got significantly worse over time (-6.3±24.4 points, p=0.005). The second trajectory (42.8% of the sample - dashed line - “Adequate and Maintaining”) had comparatively better self-care at both timepoints; maintenance improved significantly (+5.0±16.2 points, p&lt;0.001), and management was unchanged over time (+0.8±21.9 points, p=0.713). Participants in both trajectories had significant improvements in their physical and mental QOL (both p&lt;0.001) over time ( Fig. 1 ). Participants in the first trajectory had comparatively worse physical and mental QOL at both timepoints (all p&lt;0.05). Conclusion: Two distinct trajectories of self-care were identified and linked to significant differences in QOL following a hospitalization for CHD. Care models that focus on improving self-care skills might also improve QOL of patients with CHD.