tbuckley/cabot-search huggingface dataset:
Abstract 4146993: Anthracycline-based Chemotherapy in A Patient with Breast Cancer and Left-Ventricular Hypertrabeculation
Authors: Serena Joseph Rahme, Elizabeth Cathcart-Rake, John Giudicessi, Joerg Herrmann
Journal: Circulation (2024)

Introduction: Anthracyclines (AC), a class of chemotherapeutic drugs, are used to treat various cancers, including breast cancer (BC). However, AC cause dose-dependent cardiac toxicity. Practice guidelines list pre-existing cardiomyopathy as a risk factor for cancer therapy-related cardiac dysfunction (CTRCD), but there is a lack of data on cardiotoxicity risk in patients with left ventricular (LV) hypertrabeculation without LV hypertrophy/dilation. We present a patient with LV hypertrabeculation who developed LV dysfunction after AC chemotherapy for BC. Description of Case: A 55-year-old woman diagnosed with multicentric invasive ductal carcinoma (IDC) of the right breast, stage IIA (cT3 cN1 cM0), grade 2, ER+/PR+/HER2-, was treated with neoadjuvant Paclitaxel for 3 months. Before AC-based chemotherapy, stress cardiac MRI due to residual post-COVID-19 dyspnea showed LV hypertrabeculation with a non-compacted/compacted ratio of 2.3, LVEF 56%, and no delayed enhancement. Transthoracic echocardiography (TTE) reported an LVEF of 52% with GLS of -17%. The patient's electrocardiogram (ECG) showed normal sinus rhythm, and NT-pro BNP levels were &lt;20 pg/mL. Genetic testing identified a rare variant in MYH7-encoded myosin heavy chain 7 (p.Arg941Leu-MYH7). She had no cardiovascular (CV) risk factors or family history of CV disease. She then underwent 4 cycles of Doxorubicin (cumulative dose 232.2 mg/m2) and Cyclophosphamide, followed by bilateral mastectomy and adjuvant radiotherapy (5000 cGy in 25 fractions). One year after chemotherapy, follow-up TTE showed LVEF decreased to 45% with GLS of -17%. The patient’s ECG remained normal, and NT-pro BNP levels were &lt;36 pg/mL. Despite an LVEF decline, not all criteria for CTRCD were met, suggesting a gene-environment interplay between her chemotherapy and pre-existing MYH7-mediated non-dilated LV cardiomyopathy (NDLVC) with hypertrabeculation. The patient has remained without symptoms of heart failure and is currently taking Letrozole 2.5 mg daily. Discussion: This case offers a unique perspective on a BC patient treated with AC chemotherapy, who has a possible MYH7-mediated NDLVC with hypertrabeculation, and who experienced an LVEF decline of indeterminate significance. While the association of her possible NDLVC with hypertrabeculation is uncertain, the safety of AC in patients with isolated hypertrabeculation or NDLVC with hypertrabeculation, as introduced by the 2023 ESC cardiomyopathy guidelines, remains to be defined.
Abstract 4147497: Post Cardiac Arrest Temperature Management: Therapeutic Normothermia and Hypothermia Effect on Cardiac Function
Authors: Armando Pichs Diez, Bharat Rawlley, Ngonack Ngembus, Anderson Anuforo, Debanik Chaudhuri
Journal: Circulation (2024)

Background: There is strong data about the neuroprotective effects of targeted temperature management (TTM) in patients post cardiac arrest, however, there is limited literature on the cardiac effects. We evaluate the impact of targeted normothermia (TN) vs targeted hypothermia (TH) on left ventricular ejection fraction (LVEF). We hypothesized that targeted hypothermia would be more cardioprotective than targeted normothermia, thus manifesting in improved LVEF and/or reduced incidence of new heart failure at various points in time. Method: We queried the TriNetX Global collaborative network for adult (≥18 years) patients with LVEF &gt;50% who suffered a Cardiac arrest (CA) and Coma within one day of CA, and we created two groups: therapeutic hypothermia and therapeutic normothermia. TTM was identified with International Classification of Diseases 10th edition (ICD-10) Procedure codes 6A4Z0ZZ, 6A4Z1ZZ, and SNOMED code 308693008 and the TN group excluded patients with documented temperature ≥ 99.6 °F or ≤ 97.6 °F within 1 day of CA. Similarly, the TH group was identified using the same ICD codes and excluded patients with documented temperatures ≥96.7°F or ≤ 91.3°F within 1 day of CA being excluded. Propensity Score Matching (PSM) done for age, race, sex, and multiple cardiovascular comorbidities. Outcomes were measured at 3-, 12-, and 36 months post-CA included the risk of LVEF ≤ 50%, new onset heart failure, and new prescription of loop diuretic. Results: After PSM 510 patients were analyzed, with 255 well-matched subjects in each group. At 3 months there were no significant odds of TH causing a decrease in cardiac ejection fraction to 50% or less (Odds Ratio [OR] 0.90, 95% CI: 0.37 – 2.18) compared to TN. No significant difference was seen at 12 months (OR 0.897, 95% CI: 0.37 – 2.18) or 36 months (OR 0.71, 95% CI: 0.32 – 1.60). Other outcomes at 3 months without significant difference include new HF (OR 0.97, 95% CI: 0.39 – 2.43), and new loop diuretic (OR 0.77, 95% CI: 0.33 – 1.80). These odds were similarly not significant at 12 and 36 months. Conclusions: In post-CA patients who received TTM, no cardioprotective effects were appreciated between hypothermia compared to normothermia at 3-, 12-, and 36 month follow up. There was no difference in new diagnosis of HF post-CA or new loop diuretic prescription. With the understanding that TN has fewer side effects than TH then the results reinforce the use of TN post cardiac arrest.
Abstract Su1010: The Effect of Varying Constriction Rate and Duty Cycle Combinations on Hemodynamics in Circumferential Thoracoabdominal Cardiopulmonary Resuscitation
Authors: Aidan Paradis, David Gaddy, Karen Moodie, Timothy Mader, Alexandre Dufresne, Christine Couturier, Simon Dufresne, Daniel Davis, Christopher Sims, Norman Paradis
Journal: Circulation (2024)

Introduction: Circumferential constriction thoracoabdominal CPR (CCTA-CPR) may have enhanced hemodynamics and safety, but its optimal parameters have not been studied. We have found that higher constriction rates and longer duty cycles (DC) are each associated independently with improved indicators of hemodynamics in CCTA-CPR. It is possible that a particular combination of these two CCTR-CPR parameters is optimal. Hypothesis: In CCTA-CPR, there may be a rate and DC combination that is best-associated with improved indicators of hemodynamics. Methods: Ventricular fibrillation was induced in female Yorkshire swine (n = 6, ~30 kg). CPR was provided by a prototype pneumatic CCTA-CPR system. CCTA-CPR constriction parameters were alternated in 45-second epochs among rates of 80, 100 and 120 per minute and DCs of 30% and 50%. Aortic ( Ao ) and right atrial ( RA ) pressures were measured using micromanometer catheters. Coronary perfusion pressure ( CPP ) was derived as the difference between the Ao and RA pressures. The change in CPP ( Δ-CPP ) from the beginning to the end of each treatment epoch was the principal indicator of hemodynamic efficacy. Results from among all experiments were grouped by treatment type and subjected to Analysis of Variance. Results: Five rate/DC combinations were tested: 80/min at 30% DC, 80/min at 50% DC, 100/min at 30% DC, 100/min at 50% DC, and 120/min at 50% DC. Final Ao pressures for these treatments were 24, 27, 25, 31, and 28 mmHg, respectively. Final RA pressures were 6.7, 6.3, 6.6, 6.9, and 6.9 mmHg. This yields CPPs of 18, 20, 18, 24, and 21 mmHg. The Δ-CPPs were 2.3, 5.3, 2.3, 5.7, and 6.0, respectively. There was a trend toward higher Δ-CPPs with higher rates and with the greater duty cycle (p &lt; 0.10). Conclusion: There was an association, and possibly interaction, between higher rates of constriction and longer duty cycles with improved indicators of hemodynamics. Overall, a rate of 120/min with a 50% DC appeared optimal. If correct, these findings indicate that previous clinical trials of semi-circumferential automated CPR devices may have read-out incorrectly because of suboptimal device parameters.
Abstract 4147018: Predictors of Clinically Meaningful 1-Year Health Status Improvements Following Endovascular or Surgical Revascularization: Insights from the BEST-CLI Trial
Authors: Kim Smolderen, Matthew Menard, Alik FARBER, Kenneth Rosenfield, Michael Strong, Gheorghe Doros, Philip Goodney, Gaelle Romain, Jacob Cleman, Lindsey Scierka, Carlos Mena-Hurtado
Journal: Circulation (2024)

Background: Understanding patient factors associated with successful clinically meaningful health status results after undergoing endovascular or surgical revascularization for chronic limb threatening ischemia (CLTI), will enable targeted allocation of care resources. We examined predictors of meaningful improvements in 1-year health status following endovascular or surgical revascularization 1 year after the procedure. Methods: We applied distribution-based (0.5 standard deviation of baseline health status scores) minimally clinically important difference (MCID) thresholds to 1-year health status change scores derived from a pooled cohort of the endovascular and surgical arms for the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. The trial was conducted during 2014-2019 and enrolled patients with CLTI from 150 international sites. Patients completed the peripheral artery disease (PAD)-specific VascuQol prior randomization and 1 year following randomization. Multivariable logistic regression models (improved vs. remained the same/worsened) for 1-year VascuQol changes were constructed, including demographic and clinical factors. Cubic splines were explored for presenting baseline VascuQol health status scores. Results: A total of 1,533 patients were included, (71.9% male, mean age 66.9 ± 9.7 years). Absence of diabetes, history of claudication, and lower Wifi stage was more likely to be associated with successful health status response at 1 year (R 2 =0.77). Baseline presenting health status was associated with the odds of achieving a successful health status response, with those presenting with lower baseline scores (VascuQol score &lt;3), having a higher odds of a successful PAD-specific health status response. Type of revascularization (endo vs. surgery) was not associated with successful health status response ( Figure ). Conclusion: Diabetes status, claudication history, and Wifi staging are important factors to evaluate when discussing the potential for a successful health status response following endovascular or surgical revascularization. Overall, those who present with more impacted health status, stand to benefit the most, regardless of revascularization type.
Abstract Sa1204: Implementing Family-Centered CPR and AED Education for Hispanic and Black Americans in Churches
Authors: Ruth Pobee, Pavitra Kotini-Shah, Bhumi Patel, Courtney Schwerin O'Reilly, Marina Del
Journal: Circulation (2024)

Background: Despite the high rates of cardiac arrest incidence among minoritized groups, access to bystander cardiopulmonary resuscitation (CPR) training and automated external defibrillator (AED) use is limited. Research Question: How can we implement a program to provide CPR and AED education to Black and Hispanic American families within churches? Methods: An implementation study was conducted to provide CPR and AED education to individuals, parents, and children from Black and Hispanic churches in Will and DuPage counties, Illinois. In this process, the research team coordinated with church leaders to promote and register participants for CPR and AED education. Field observations, participant numbers, training environments, questions from participants, and recruitment challenges were documented. Weekly meetings were held by the research team to discuss field experiences and address challenges. Results: Out of 17 churches contacted, 6 leaders signed permission letters; responses from the remaining 11 are currently pending. Training has been conducted in 4 churches thus far. In these 4 churches, 65 participants registered, and 53 attended, including 27 families (6 couples and 21 families with children) and 26 individuals. Challenges encountered in implementing the trainings in the churches included religious concerns about science, immigration issues requiring confidentiality, and older participants needing approval from their adult children. Many participants dropped out due to scheduling conflicts or job responsibilities. Some parents couldn't attend with their children, though most couples participated. Despite these challenges, church leaders actively participated and connected the research team with other churches, broadening the study's reach. One participant, having experienced their child's cardiac arrest, expressed a strong desire to improve their CPR skills. Conclusion: Family-centered CPR and AED education was successfully implemented in churches which attracted families, hence providing an avenue to increase access to CPR and AED education for minoritized groups in a comfortable setting. Overall, participants appreciated the opportunity and once engaged, were eager to acquire or practice these skills. Venues such as churches are feasible implementation settings to promote time-sensitive, life-saving skills of bystander CPR among minority groups.
Abstract Sa803: Duration of cardiopulmonary resuscitation and survival for pediatric patients with out-of-hospital cardiac arrest
Authors: Masashi Okubo, Sho Komukai, Junichi Izawa, Sriram Ramgopal, Clifton Callaway, Robert Berg
Journal: Circulation (2024)

Background: Prior studies have reported that a longer duration of prehospital cardiopulmonary resuscitation (CPR) before return of spontaneous circulation (ROSC) is associated with poor patient outcomes for adults with out-of-hospital cardiac arrest (OHCA). The association of CPR duration with survival has not been fully investigated for pediatric patients. Aim: To quantify the time-dependent probability of survival as a function of CPR duration among pediatric patients with OHCA. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective multicenter OHCA registry at 10 sites in the US and Canada from 2011 through 2015. We included pediatric patients (&lt;18 years) with emergency medical services (EMS)-treated OHCA. We estimated the time-dependent probability of subsequently surviving to hospital discharge if patients without prehospital ROSC at each minute of CPR duration received further CPR beyond the time point. The numerator was the number of patients without ROSC at each minute and subsequently survived to hospital discharge. The denominator was the number of patients without ROSC at each minute, excluding those who had termination of resuscitation before or at each minute. Results: Of 1,313 eligible pediatric patients (median [IQR] age, 1 [0-9] year; 773 [58.9%] were male), 236 (18.0%) achieved prehospital ROSC. The median interval from initiation of CPR by EMS clinicians to ROSC was 10 minutes (IQR 5-16 minutes). The time-dependent probabilities (95% CIs) of survival to hospital discharge among patients without ROSC were 7.9% (6.4%-9.4%) at 1 minute, 5.6% (4.3%-6.9%) at 5 minutes, 2.6% (1.6%-3.5%) at 10 minutes, 1.1% (0.4%-1.8%) at 15 minutes, and 0.6% (0.02%-1.3%) at 20 minutes of CPR duration. The point estimate of the probability became less than 1% at 17 minutes of CPR duration. Conclusions: In this analysis of a large multicenter OHCA registry, we quantified the time-dependent probability of survival to hospital discharge in each minute of CPR duration for pediatric OHCA. These findings provide EMS clinicians, patients, and their surrogates with insights into the likelihood of survival if pediatric patients without ROSC continue to receive further CPR.
Abstract 4147416: Racial Disparities in Periprocedural Outcomes and Mortality in Catheter Ablation of Atrial Fibrillation Among Congestive Heart Failure Patients in the United States: An Analysis from the National Inpatient Sample Database
Authors: Hitesh Bhatia, Adishwar Rao, Siddharth Agrawal, Muhammad Khan, Akriti Agrawal, Rakendu Jayasree Rajendran, Asna Aafreen, . Parul, Shraddha Bhattarai, Saurabh Sharma
Journal: Circulation (2024)

Background: Atrial Fibrillation (AF) and congestive heart failure (CHF) are intertwined disorders that contribute to cardiovascular morbidity and mortality. Arrhythmia burden is a key prognostic factor in patients with AF and CHF. Numerous studies have suggested that catheter ablation outperforms conventional therapies in improving clinical outcomes for these patients. This study aims to evaluate the racial disparities affecting periprocedural outcomes and mortality in CHF patients undergoing AF ablation. Methods: We searched the National Inpatient Sample (NIS) data from 2016 to 2021 using ICD-10 and ICD-10-PCS9 codes to look for patients with CHF who underwent ablation for AF and stratified the data on the basis of race, particularly African American(AA) and White American (WA) population. We used the Pearson Chi-Square test to analyze categorical variables and the Wilcoxon Rank Sum test for continuous variables to evaluate racial disparities in the periprocedural outcomes in patients undergoing ablation. Additionally, we also used a multivariate logistic regression analysis to compute adjusted odds ratios (aORs) for outcomes. Results: After analyzing NIS data from 2016 to 2021, among 7,803,487 patients admitted for AF and CHF, only 94,245 underwent ablation. Among those who underwent ablation, AA were admitted and received ablation at a younger age compared to WA (63.89 years versus 71.48 years). We found that AA patients experienced higher rates of HF exacerbation (91% vs 88.9%, p:0.006, ), cardiogenic shock (7.8% vs 5.6%, p&lt;0.001), acute kidney injury (AKI) (38.7% vs 28.2%, p&lt;0.001 ), and major adverse cardiovascular and cerebrovascular events (MACCE) (12.6% vs 9.9%, p&lt;0.001 ) than WA patients. Additionally, multivariate analysis revealed AA had increased odds of HF exacerbation (aOR 1.40, 95% CI 1.16-1.70, p&lt;0.001) and AKI (aOR 1.67, 95% CI 1.49-1.88, p&lt;0.001) [Table 1]. Also, AA patients also had a longer length of stay (LOS) (&gt; 7 days for 50.5% of AA versus 39.1% of WA p&lt;0.001), utilized Medicaid more frequently (13.7% versus 4.3%, p&lt;0.001), and incurred higher total charges (median charge of $174,604 versus $161,210, P: &lt;0.01) compared to WA [Table 2]. Conclusion: Racial disparities are evident in the periprocedural outcomes and mortality in CHF patients undergoing ablation for AF. More studies are needed to investigate these findings further and potentially help resolve the disparities.
Abstract 4146827: Abnormal Liver Stiffness as a Risk Factor for Elevated Hemoglobin A1c in Patients with Fontan Physiology
Authors: Priya Tumuluru, Elli Lockhart, Michael Carr, Alyssa Kriegermeier, Christina Laternser, sheetal patel
Journal: Circulation (2024)

Background: Staged surgical palliation resulting in the Fontan operation increases survival in patients born with single ventricle congenital heart disease. Fontan survivors are at higher risk for dysfunction in multiple organ systems. Recent studies have shown higher prevalence of elevated hemoglobin A1c (HbA1c) as a marker of abnormal glucose metabolism in Fontan patients with modifiable associated factors such as obesity and hypertriglyceridemia. However, other risk factors associated with abnormal HbA1c in this population remain unclear. In adults with structurally normal hearts, liver fibrosis and cirrhosis are associated with insulin resistance and elevated HbA1c. One of the known complications of Fontan physiology is elevated systemic venous pressure and resultant liver congestion and fibrosis; however, it is unclear if there is a relationship between liver congestion and abnormal glucose metabolism or insulin resistance in this population. Ultrasound shear wave elastography (SWE) is a non-invasive imaging technique that can quantify the extent of liver fibrosis in patients with structurally normal hearts. Our study aimed to discern a relationship between liver stiffness measured via ultrasound SWE and elevated HbA1c in Fontan patients. Methods: Single-center retrospective cross-sectional cohort study including Fontan patients with documented HbA1c testing and liver stiffness measurement (kilopascals, kPa) measured via SWE. Linear correlation and variable comparisons were examined. Results: Of 414 Fontan patients evaluated at our center, 190 had at least one HbA1c. Abnormal HbA1c ( &gt;5.6%) was found in 36% (n=70). Additionally, 141 patients had at least one ultrasound SWE and were included in our study. 82 (58%) were male, mean age at time of elastography was 19.46 ± 9.70 years, and 59 (42%) were Caucasian. Patients with abnormal HbA1c had a statistically significant higher median liver stiffness as compared to those with normal HbA1c (13.9± 21.0 kPa vs. 8.9 ±3.04 kPa, p=0.024). Conclusion: More than one third of Fontan survivors have abnormal glucose metabolism demonstrated by an elevated HbA1c. Hepatic congestion and fibrosis are known complications of Fontan physiology and increasing liver stiffness by ultrasound elastography may be associated with worsening glucose metabolism. Further investigation is needed to understand how elevated HbA1c and liver stiffness are related and how they affect long-term clinical outcomes in Fontan survivors.
Abstract 4146947: Obese adolescents supported with VADs have inferior post-transplant outcomes
Authors: Justin Berger, Erika Mejia, Rachel Sanderlin, Xuemei zhang, Constantine Mavroudis, Matthew O'Connor, Aaron DeWitt, Humera Ahmed, Joseph Rossano, Carol Wittlieb-Weber, Jonathan Edwards, Kimberly Lin, Anna Joong, Katsuhide Maeda, Jonathan Edelson
Journal: Circulation (2024)

Background: The prevalence of both obesity and the use of left ventricular assist devices (LVAD) is increasing in pediatrics, but what impact obesity has on post-heart transplant (HT) outcomes when using an LVAD as a bridge to transplant (BTT) is unknown. Methods: Retrospective cohort study of patients 12-18 years old in the UNOS database with a durable LVAD and listed for heart transplant (HT) between 7/1/2004-12/31/2021. Demographic and clinical variables were assessed. Patients were classified as overweight (BMI ≥ 85-&lt;95% percentile), Class I obesity (BMI ≥ 95-&lt;120% of the 95 th %), and Class II/III obesity ( ≥ 120% of the 95 th % or BMI ≥ 35) at time of listing and transplant. The primary outcome was 1-year post-HT survival; additional outcomes included post-HT length of stay (LOS), rejection, and waitlist removal. A multivariable analysis was performed to identify the independent association of morbid obesity with 1-year post HT survival. Results: Of 539 adolescent BTT patients, 41% had a BMI ≥ 85 th percentile at time of listing: 76 were overweight, 84 were Class I, and 60 were Class II/III. Class II/III patients, compared to overweight, demonstrated a decrease in BMI between listing and transplant (△BMI -0.2, IQR -2.6–0.5 vs 0.0, IQR -0.5–2.6, p= 0.003) with similar improvement in functional status (27% vs 32-36%, p=0.37) and equivalent post-HT LOS (17 vs 15-17 days, p =0.09). However, these patients were more frequently inactivated (13% vs 4-7%, p=0.04). In adjusted analysis, the highest BMI cohort had lower likelihood of reaching HT (OR 0.65, 95% CI 0.48-0.88) and increased 1-year post-HT graft failure (OR 4.47, 95% CI 1.22-14.78) (Fig. 1A). The 5-year mortality of these patients was nearly twice that of other adolescents (29% vs 18%, p=0.06) (Fig. 1B). Conclusions: Class II/III obese adolescent VAD patients have an increased risk of waitlist inactivation and 1-year graft failure. Use of VADs and HT in obese adolescents may be reasonable (71% 5-year survival) if the team, patient, and family are aware of the higher risk profile. Given the socioeconomic contributions to obesity in children, further studies examining if obesity can be a modifiable risk factor in VAD and HT is critical.