tbuckley/cabot-search huggingface dataset:
Abstract 12984: Impact of Cardio-Ankle Vascular Index on New Cancer Diagnosis in Patients With Coronary Artery Disease
Authors: Takeshi Shimizu, Yuya Sakuma, Yuki Muto, Yu Sato, Yusuke Kimishima, Akihiko Sato, Tomofumi Misaka, Akiomi Yoshihisa, Takayoshi Yamaki, Kazuhiko Nakazato, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2023)

Introduction: Cardiovascular risk factors are associated with increased risk of future cancer. However, the relationship between quantitative parameters of atherosclerosis and the risk of future cancer is unclear. Here we investigated the association between cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and future new cancer diagnosis in patients with coronary artery disease. Methods: This was a prospective observational study which enrolled consecutive 1122 patients with coronary artery disease, excluding patients with atrial fibrillation or dialysis. According to the receiver operating characteristic curve analysis, the cut-off value of CAVI in predicting new cancer diagnosis was 8.70. We divided patients into two groups: the high-CAVI group (CAVI ≥ 8.70, n = 578, 51.6%) and the low-CAVI group (CAVI &lt; 8.70, n = 544, 48.4%). We compared the patients’ characteristics and followed the incidence of new cancer diagnosis. Results: The high-CAVI group, as compared with the low-CAVI group, were older (72.3 vs. 64.0 years, P &lt; 0.001) and had higher prevalence of diabetes mellitus (53.8 vs. 45.6%, P = 0.006), chronic kidney disease (47.1 vs. 32.5%, P &lt; 0.001) and anemia (46.0 vs. 32.9%, P &lt; 0.001). In contrast, there was no difference in the prevalence of smoking, hypertension, dyslipidemia, heart failure and history of malignancies between two groups. In the follow up period (mean of 2182 days), there were 141 new cancer diagnosis. The cumulative incidence of new cancer diagnosis was significantly higher in the high-CAVI group than in the low-CAVI group ( P = 0.007). In the multivariable Cox proportional hazard analysis after adjusting for confounding factors, CAVI was found to be an independent predictor of new cancer diagnosis (hazard ratio 1.51, 95% confidence interval 1.05-2.17, P = 0.022). Conclusions: High CAVI is associated with the risk of future cancer in patients with coronary artery disease.
Abstract 242: Assessment of Biomarkers After Standard Cardiopulmonary Resuscitation versus Extracorporeal Cardiopulmonary Resuscitation
Authors: Helena Brodska, Petra Kavalkova, Dani R Lavage, Jana Smalcova, Milan Dusík, Jan Belohlavek, Tomas Drabek
Journal: Circulation (2023)

Background: Multiple biomarkers have been used in prognostication of outcome after out-of-hospital cardiac arrest (OHCA) and standard cardiopulmonary resuscitation (CPR). Limited evidence exists for patients resuscitated with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers will differ between CPR and ECPR. Methods: This is a pre-planned sub-analysis of Prague-OHCA study. Patients were randomized to either CPR or ECPR. The primary outcome was poor neurologic outcome at 180 days, defined as a cerebral performance category (CPC) of 3-5. Secondary outcomes included assessment of biomarkers of neurologic injury (NSE), inflammation (procalcitonin - PCT, C-reactive protein - CRP, neutrophil-lymphocyte ratio - NLR) and hematology (platelets - Plt, D-dimers - D-dim, and fibrinogen - Fg) using Mann-Whitney test with Bonferroni correction, and ROC analysis of data at 24-72 h. Results: In as-treated analysis, ECPR was used in 92 patients. The primary outcome was not different between groups: CPR, CPC 1-2 48 (29.3%) vs CPC 3-5 116 (70.7%); ECPR, CPC 1-2 20 (21.7%) vs CPC 3-5 72 (78.3%); p= 0.191. In general, individual biomarkers exhibited similar trajectories over 72 h, with worse values in patients with CPC 3-5 in both CPR and ECPR groups. PCT was higher in ECPR group at 24-72 h (all p&lt;0.01). NSE, CRP and NLR did not differ between groups. Plt, D-dim and Fg were lower in ECPR vs CPR groups at 24-72 h (all p&lt;0.001). ROC analysis showed the best performance of NSE in both CPR and ECPR groups (AUC 24 h: 0.89 vs 0.78; 48 h: 0.9 vs 0.9; 72 h: 0.91 vs 0.9). PCT showed good performance specifically in ECPR (AUC 24 h: 0.72 vs 0.84; 48 h 0.73 vs 0.87; 72 h: 0.73 vs 0.86). Optimal cutoff points were higher in ECPR vs CPR in NSE (24 h: 60 vs 84; 48 h: 65 vs 61; 72 h: 39 vs 57) and PCT (24 h: 1.8 vs 11, 48 h: 1.0 vs 5.3, 72 h: 0.9 vs 5.6). Conclusions: Biomarkers have similar trajectories after OHCA rescued with either CPR or ECPR although absolute values were higher in ECPR. NSE had superior prognostic value in both groups while PCT showed a good prognostic performance specifically in the ECPR group. Additional studied biomarkers may have modest incremental value. Prognostication algorithms using biomarkers should reflect a mode of resuscitation.
Abstract 14088: Impact of Social Determinants of Health on Blood Pressure and Cholesterol Control in a Smartphone-Based Cardiovascular Risk Self-Management Program
Authors: Vedant S Pargaonkar, Brian Roach, Edo E Paz
Journal: Circulation (2023)

Background: Social determinants of health (SDOH) are environmental factors that have an impact on one's health, outcome, and quality of life. SDOH like language, income, healthcare access, race/ethnicity, and neighborhood characteristics can manifest in inequalities in cardiovascular disease (CVD) and its risk factor burden, resulting in inequitable CVD related morbidity and mortality. Limited data are available on effects of SDOH on CVD risk factor control among users of digital health technology. Aim: To study the impact of SDOH like primary language, household income, access to healthcare and urban/rural residential type on blood pressure (BP) and total cholesterol (TC) control in participants of a smartphone-based cardiovascular risk self-management program with AI-based digital coaching. Methods: Participants’ data were matched with Agency for Healthcare Research and Quality’s 2020 SDOH database by ZIP code. Changes in systolic BP (SBP), diastolic BP (DBP) and TC were evaluated from baseline to 6 months follow up. The SDOH variables- primary language, median household income, distance to healthcare facility and urban/rural residential type - were used to predict changes in BP and TC via regression models adjusted for age, gender, and baseline BP/TC. Results: In 27,553 participants (age 55 ± 0.1 y, 48.5% women), overall reduction in BP and TC were observed (p&lt;0.001). Of those with baseline stage 2 hypertension, 80.5% reduced SBP at follow up, and 82.9% of those with baseline high TC (≥240 mg/dL) reduced TC at follow up. Median household income was associated with change in SBP (β -1.6E-5, p &lt; 0.001) and DBP (β -4.8E-6, p &lt; 0.001), but not TC. This association was not clinically significant as each $62,535 increase in the median household income was associated with an additional 1 mm Hg in BP reduction. No difference in BP or TC change was found based on primary language, distance to healthcare facility, and urban/rural residential type (p &gt; 0.05). Conclusion: In a smartphone-based cardiovascular risk self-management program, the majority (&gt;80%) of high-risk participants reduce BP and TC across various SDOH factors. These results highlight the potential use of this technology to bridge health inequity gaps in prevention and control of CVD risk.
Abstract 17712: The Discrimination Ability of the CHA2DS2-VASc Score for Predicting Ischemic Stroke in Patients With and Without Atrial Fibrillation: An Updated Meta-Analysis
Authors: Jawad Basit, Zaofashan Zaheer, Farah Yasmin, Aleena Ahmed, Mohammad Hamza, Huzaifa Ahmad Cheema, Usman A Akbar, Muhammad Aamir, kuldeep dhama, Sajeel Saeed, Mohammad E Rehman, Jahanzeb Malik, Sardar Muhammad Alamzaib, yasar sattar, Gary Tse, M Chadi C Alraies
Journal: Circulation (2023)

BACKGROUND: The CHA2DS2-VASc score guides anticoagulation therapy for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. A previous meta-analysis showed a moderate discrimination ability of CHA2DS2-VASc score to detect stroke in patients with &amp; without NVAF. In the presence of newly published data over the past three years, there is a need to recalibrate the existing statistical evidence. METHODS: A comprehensive literature search was conducted across PubMed, Embase, CENTRAL (the Cochrane Library), &amp; Google Scholar from inception till May 2023. All studies evaluating the discrimination ability of the CHA2DS2-VASc score, as measured by the C statistic, for short (&lt;2 years), intermediate (2-5 years), &amp; long-term (&gt;5 years) follow-ups in patients with &amp; without NVAF were included. The generic inverse variance weighted random effects method was used to pool C-statistic &amp; corresponding standard errors (SEs) from each study. RESULTS: A total of 28 studies with a population of 639450 patients were included. Seventeen studies (n=500555) reported the discrimination ability of CHA2DS2-VASc score for NVAF patients, &amp; 11 studies (n=138895) for patients without NVAF. The summary C statistic for short-term follow up was 0.66 (0.62-0.70) for NVAF subgroup. For mid-term follow-up, the pooled C statistic was 0.65 (0.63-0.67), while being 0.63 (0.60-0.66) &amp; 0.68 (0.66-0.70) for the subgroup with NVAF &amp; without NVAF respectively. The CHA2DS2-VASC score showed moderate discrimination [0.66 (0.62-0.70)] at long-term follow up (NVAF [0.58 (0.55-0.61)]; without NVAF [0.67 (0.64-0.70]). CONCLUSION: CHA2DS2-VASc score has moderate &amp; similar discrimination ability for detecting stroke in both NVAF &amp; non-NVAF patients.
Abstract 15445: Extracorporeal Membrane Oxygenation and Reperfusion Strategies in High-Risk Pulmonary Embolism Hospitalizations
Authors: Ioannis T Farmakis, Ingo Sagoschen, Stefano Barco, Karsten Keller, Luca Valerio, Johannes Wild, George Giannakoulas, Gregory Piazza, Lukas Hobohm, Stavros V Konstantinides
Journal: Circulation (2023)

Introduction: Extracorporeal membrane oxygenation (ECMO) offers potentially life-saving circulatory support in patients with high-risk pulmonary embolism (PE) and refractory hemodynamic instability. Optimal reperfusion strategies in combination are unclear. Hypothesis: To investigate the contemporary use of ECMO in conjunction with reperfusion strategies in high-risk PE. Methods: We identified high-risk PE hospitalizations in the Nationwide Inpatient Sample (years 2016-2020) and investigated the use of ECMO in conjunction with thrombolysis-based (systemic thrombolysis or catheter-directed thrombolysis) and mechanical (surgical embolectomy or catheter-based thrombectomy) reperfusion strategies with regards to in-hospital mortality and major bleeding. Results: Among 122,735 hospitalizations for high-risk PE ECMO was used in 2,805 (2.3%); stand-alone in 1.4%, with thrombolysis-based reperfusion in 0.4%, and with mechanical reperfusion in 0.5%. Compared to neither reperfusion nor ECMO, ECMO plus thrombolysis-based reperfusion was associated with reduced in-hospital mortality (adjusted OR, 0.60; 95% CI, 0.38-0.97), whereas no difference was found with ECMO plus mechanical reperfusion (1.02; 0.66-1.59), and ECMO stand-alone was associated with increased in-hospital mortality (1.59; 1.21-2.09). In the cardiac arrest subgroup, ECMO was associated with reduced in-hospital mortality (0.71; 0.53-0.93). Among all patients on ECMO, thrombolysis-based reperfusion was significantly associated (0.54; 0.32-0.90), and mechanical reperfusion showed a trend (0.74; 0.47-1.18) towards reduced in-hospital mortality compared to no reperfusion, without increases in major bleeding. Conclusions: In patients with high-risk PE and refractory hemodynamic instability, ECMO may be a valuable supportive treatment in conjunction with reperfusion treatment but not as stand-alone treatment especially for patients suffering from cardiac arrest.
Abstract 16858: QRS/T Ratio With Progression of Left Bundle Branch Block From New to Old: Is Voltage-Time-Integral Better Than Amplitude in Discriminating of Chronicity of Block?
Authors: Nicholas Kettelkamp, Charles Kircher, Christopher Harvey, Seth Sheldon, Madhu Reddy, Rhea C Pimentel, Amit Noheria
Journal: Circulation (2023)

Introduction: Discriminating acute versus chronic left bundle branch block (LBBB) has well known and important clinical implications. QRS/T vector magnitude ratio, and ratio of deepest S to tallest T in precordial leads, have been shown to discriminate new vs old LBBB. We sought to evaluate how QRS/T voltage-time-integral (VTI) ratio, as opposed to QRS/T amplitude ratio changes with progression of LBBB from new to old. Hypothesis: We proposed that QRS/T VTI ratio would be equivalent to QRS/T amplitude ratio in distinguishing new from old LBBB. Methods: We analyzed ECGs of patients with known chronic LBBB (n=385, 53.5% female, age 70.6±12) against ECGs of patients with acute LBBB (n=79, 53.6% female, age 77.7±9.5) one day post transcatheter aortic valve replacement (TAVR) and at 1 month post TAVR utilizing VTI of 3D QRS and 3D T-wave ratio. Orthogonal X, Y, Z leads were reconstructed from 12-lead ECG using Kors’s matrix. VTI X, Y ,Z and VTI 3D were obtained from temporal integration of voltage in X, Y, Z and root-mean-squared (3D) ECGs respectively. We compared changes in QRS/T amplitude, VTI ratios, and maximum precordial S/T magnitude ratio 1 month after versus day 1 of new LBBB using pairwise t-tests. Results: We found acute post-TAVR LBBB was best distinguished utilizing VTI of 3D QRS (3.37±1.27, p &lt;0.0005) compared to 3D T-wave ratio (2.90±1.00, p &lt;0.003). We also found LBBB post TAVR at one month is best distinguished by the 3D QRS/T-wave VTI ratio (1.53±0.32, p &lt; 0.0001) and less so by the 3D amplitude ratio (3.27±1.37, p 0.003) Acute max precordial S/T magnitude was not able to differentiate chronic from acute LBBB ( p 0.1). At one month follow up, acute LBBB TAVR QRS-T amplitude ratios were found to return to their baseline values (3.37±1.27 for acute and 3.27±1.37 with p 0.5). Conclusions: Between VTI of 3D QRS and 3D T wave ratio, VTI 3D QRS proved to be more reliable for distinguishing acute versus chronic LBBB. Chronicity of LBBB was not predicted by maximum precordial S/T magnitude.
Abstract 15491: Have Heart Transplant Allocation Policy Changes Brought Improvements in Mortality for Children and Adults With Congenital Heart Disease? A UNOS Database Analysis
Authors: Jonathan B Edelson, Xuemei zhang, Steve Ampah, Constantine D Mavroudis, Katsuhide Maeda, Jonathan J Edwards, Kimberly Y Lin, Joseph Rossano, Carol Wittlieb-Weber, Matthew O'Connor
Journal: Circulation (2023)

Introduction: The United Network of Organ Sharing (UNOS) made changes to the priority for allocation of hearts for transplantation (HT) in 2016 for pediatric patients and 2018 for adult patients. There are limited data describing the association of these changes with waitlist outcomes in patients with congenital heart disease (CHD). Methods: The United Network for Organ Sharing (UNOS) database was queried for pediatric (&lt;18 y/o, PCHD), and adult (18yo-50yo, ACHD), patients with a CHD diagnosis listed for HT. Cohorts were grouped into pre and post-allocation change eras: PCHD 1/1/11-3/21/15 and 1/1/17-12/31/21, ACHD 1/1/15-10/17/18 and 1/1/19 to 12/31/21. Differences in era for survival from the time of listing for HT were compared using competing risk models. Results: We identified 3,646 patients listed for HT during the study period including 1,520 PCHD and 432 ACHD pre-allocation change and 1,443 and 251 post. More PCHD patients in the post cohort were supported with ventricular assist devices (7.6% vs 3.2%) while fewer were on inotropes (41% vs 47%), intubated (18% vs 21%) or on ECMO (5.3% vs 7.9%) (p for all &lt;0.01 ). For ACHD, ECMO (4.8% vs 1.9%) and intra-aortic balloon pump (6.8% vs 1.9%) use was more prevalent in the post era (p&lt;0.05 for both). In a competing risk model adjusting for illness severity, the HR for death or waitlist removal within 1 year of HT listing was higher in the pre-allocation era compared to post for PCHD (HR 1.27 [95% CI 1.06-1.52]) but unchanged for ACHD (HR 1.36 [95% CI 0.77-2.41]). Figure 1 Conclusions: ACHD patients did not have the mortality benefit from policy changes which other groups, including PCHD, have experienced. Incorporating measures into the allocation system which more completely capture the illness severity that comes with ACHD are warranted, as are strategies to improve long term survival in this growing population.
Abstract 279: Sustained Inflation and Chest Compression versus 3:1 Chest Compression to Ventilation Ratio During Cardiopulmonary Resuscitation of Asphyxiated Newborns A Cluster Randomized Controlled Trial
Authors: Georg Schmolzer, Gerhard Pichler, Anne Lee Solevag, Brenda law, Souvik Mitra, Michael Wagner, Daniel Pfurtscheller, Maryna Yaskina, Po-yin Cheung
Journal: Circulation (2023)

Background: Neonatal resuscitation guidelines recommend 3:1 compression to ventilation ratio (C:V) ratio during chest compression (CC). In piglets, continuous CC superimposed by sustained inflation (CC+SI) resulted in faster time to return of spontaneous circulation (ROSC), lower mortality, improved hemodynamics and ventilation compared to 3:1 C:V. Similar a pilot trial in preterm infants reported significant faster ROSC with CC+SI compared to 3:1 C:V. Objective: To test the hypothesis that in newborn infants receiving chest compression with CC+SI compared with 3:1 C:V time to ROSC will be reduced or increased. Design/Methods: Multicenter cluster randomized trial of CC+SI vs. 3:1 C:V in newborn infants receiving CC. Hospitals were randomized to CC+SI or 3:1 C:V for 12 months then switched to 2 nd intervention for another 12 months. Infants were eligible if bradycardic with heart rate &lt;60/min or asystolic. Primary outcome was time to ROSC (heart rate &gt;60 for one minute). Analysis was performed according to intention-to-treat. The trial was stopped to slow enrolment, Covid-19 pandemic, and funding constrains. Results: Four sites (Edmonton, Graz, Halifax, and Vienna) included infants, which were randomized to either CC+SI (n=11) and 3:1 C:V (n=14). The groups were balanced in relation to demographics and delivery room interventions.The median (IQR) time to ROSC with CC+SI was 90 (60-270)sec and with 3:1 C:V was 615 (174-780)sec (p=0.0502 - log rank, and 0.16 cox proportional hazards regression) (Figure).Survival was 9/11 (82%) with CC+SI and 7/14 (50%) with 3:1 C:V [relative risk (RR) 0.36, 95% Confidence interval (CI) 0.094 to 1.42]. There were no differences in secondary outcomes between groups. Conclusion: CC+SI resulted in a reduction in time to ROSC. There was a trend towards higher survival rates with CC+SI.
Abstract 14093: Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the MyPACE Randomized Clinical Trial
Authors: Kramer J Wahlberg, Margaret Infeld, Tim B Plante, Alexandra E Novelli, Nicole Habel, Trace Barrett, Markus Meyer
Journal: Circulation (2023)

Introduction: Heart failure with a preserved ejection fraction of 50% or higher (HFpEF) is prevalent and has few evidence-based therapies. In a trial of HFpEF patients with specialized pacemakers, treatment with an accelerated personalized pacing rate averaging 75 bpm (myPACE) markedly improved quality of life, NT-proBNP, physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60bpm (usual care). Methods: Provider-initiated echocardiographic studies obtained before and after the trial were assessed for changes in left ventricular (LV) structure and function amongst participants who continued their pacing assignment. The analytic approach aimed to detect differences in standard and advanced echocardiographic parameters within and between study arms. Results: Of the 100 trial participants, 16 patients in the myPACE arm and 20 in the usual care arm had a qualifying set of echocardiograms with a mean±SD time of 3.7±2.0 years apart. Heart rates were expectedly higher among myPACE patients after the trial (in bpm: myPACE 75±6 vs. usual care 65±7, p&lt;0.001). Sustained exposure to moderately accelerated pacing resulted in a reduced septal wall thickness (myPACE 1.07±0.05mm vs usual care 1.23±0.04, p=0.008) and a lower LV mass to systolic volume ratio (myPACE 1.52±0.09 vs. usual care 1.84±0.05, p=0.038) accompanied by a small reduction in LV ejection fraction (in %: myPACE 55±1 vs usual care 60±1, p=0.015). These changes were paralleled by marked improvements in heart failure-related quality of life (MLHFQ points: myPACE 17±21 vs usual care 28±22, p&lt;0.001). Markers of diastolic function and LV performance were not affected. Conclusions: Exposure to continuous accelerated pacing in HFpEF is associated with a reduced LV wall thickness and a lower mass to systolic volume ratio and ejection fraction that remained within normal limits.
Abstract 15642: Discrimination Against Physicians in Interventional Cardiology
Authors: Athanasios Rempakos, Michaella Alexandrou, Bahadir Simsek, Spyridon Kostantinis, Judit A Karacsonyi, Deniz Mutlu, Allison Hall, Arnold Seto, Barbara A Danek, Binita Shah, Courtney Baechler, Delaine Thomas, James Choi, Jeremy Rier, Kathleen Kearney, Ki Park, Mosi Bennett, Santiago A Garcia, Thao Duong, Jimmy Kerrigan, Ahmed Al-ogaili, Bavana V Rangan, Olga Mastrodemos, Salman S Allana, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis
Journal: Circulation (2023)

Background: Data on discrimination against physicians in the field of interventional cardiology are limited. Methods: We performed an online, anonymous, international survey of interventional cardiologists. Results: A total of 445 interventional cardiologists participated in the survey. Median age was 46-50 years and most (61%) practice in the United States. Among the participants, 13% were women and 13% belonged to underrepresented minority groups. Participants were asked to discern which characteristics contribute to discrimination against physicians in their workplace. Several characteristics were identified (Figure): language accent (48%), race/ethnicity (44%), age (44%), gender (43%), and appearance/clothing (40%). Women were more likely to have experienced discrimination by patients and families (81% vs 54%; p&lt;0.001), peers (81% vs 45%; p&lt;0.001), supervisors (73% vs 43%; p&lt;0.001), support staff (64% vs 36%; p&lt;0.001), and nursing staff (63% vs 37%; p=0.001), compared with men. Similarly, among participants who practice in the US, UK, Canada, and Australia (n=296), physicians whose first language was not English were more likely to have experienced discrimination from patients and families (73% vs 46%; p&lt;0.001), peers (63% vs 35%; p&lt;0.001), supervisors (56% vs 33%; p&lt;0.001), support staff (51% vs 28%; p&lt;0. 001), and nursing staff (52% vs 31%; p=0.001), compared with native English speakers. Both women (60% vs 7%; p&lt;0.001) and underrepresented minority groups (28% vs 12%; p=0.003) were more likely to be mistaken for a non-physician employee, compared with men and non-underrepresented minority groups respectively. While 9% (n=42) of the total participants reported incidents of discrimination to their respective organizations, only 19% of those (n=8) expressed satisfaction with the response received. Conclusions: Our survey provides a snapshot of the current status of discrimination faced by interventional cardiologists.