tbuckley/cabot-search huggingface dataset:
Abstract 4146823: Trends and Outcomes in Heart Failure Admissions and Cardiogenic Shock Among Patients with Congenital Heart Disease
Authors: Laith Alhuneafat, Fares Ghanem, Tamas Alexy
Journal: Circulation (2024)

Introduction: This study examines trends in heart failure admissions, cardiogenic shock, mechanical circulatory support (MCS) usage, and cardiac transplant among patients with congenital heart disease (CHD), focusing on double (DV) and single ventricle (SV) CHD. Methods: We analyzed the national inpatient sample from 2016 to 2020 for heart failure admissions, including double and single ventricle CHD, and trends in cardiogenic shock, MCS utilization, cardiac transplants, and mortality. Results: Out of 4,963,884 total admissions, 29,805 were for DV-CHD and 2,415 for SV-CHD. Patients without CHD were older (mean age 71.5 years) than those with DV-CHD (mean age 59.8 years) and SV-CHD (mean age 17.9 years). Non-CHD patients had shorter stays (mean 5.8 days), and lower total charges. CHD admissions remained stable from 2016 to 2020. Cardiogenic shock rates were highest among SV-CHD patients, with significant fluctuations, followed by DV-CHD patients. MCS usage increased, particularly among SV-CHD patients, while DV-CHD patients showed an upward trend and patients without CHD had consistently lower usage. Heart transplant rates were low but increased slightly in 2020 for patients without CHD, with DV and SV CHD patients showing fluctuating rates peaking in 2018 and 2019, then declining in 2020. Inpatient mortality rates were highest among SV-CHD patients, followed by DV-CHD patients, both experiencing significant fluctuations and a general increasing trend, while patients without CHD had the lowest and most stable rates. Conclusion: Our analysis highlights trends in CHD management, including age, length of stay, mortality rates, and healthcare costs. Variations in cardiogenic shock, MCS usage, and cardiac transplants emphasize the need for adaptive clinical practices to optimize patient outcomes.
Abstract 4147668: Impact of New Onset Atrial Fibrillation on In-Hospital Mortality and Other Outcomes Among Patients Admitted for STEMI: A 5-Year Analysis from the National Inpatient Sample
Authors: Abdirahman Wardhere, Nso Nso, Mohammed Nor, Abdilahi Mohamoud, Dimitrios Bampatsias
Journal: Circulation (2024)

Introduction: New onset atrial fibrillation (NOAF) is not a so rare condition among patients hospitalized for ST-segment elevation myocardial infarction (STEMI). However, it’s short-term prognostic value have not yet been studied using a large real-world data. Aim: To evaluate in-hospital mortality and other clinical outcomes of this high-risk subgroup of patients using a large US real-world data. Methods: Between January 2017 and December 2021, 855,400 STEMI patients were identified from the NIS database using ICD-10 codes. The cohort was divided into two groups: those with NOAF and those without (non-NOAF). Outcomes studied included in-hospital mortality and complications such as cardiac arrest, cardiogenic shock requiring pressors or mechanical circulatory support (MCS), acute stroke, and gastrointestinal bleed. Categorical variables were presented as percentages, and continuous variables as median ± interquartile range. Outcomes were analyzed using univariate and multivariate logistic regression to adjust for potential confounders. Results: Of the 855,400 STEMI patients, 51,845 (6%) developed new-onset atrial fibrillation (NOAF) during hospitalization. NOAF patients were generally older (70 vs. 63 years), more likely to be women (32.9% vs. 30%), and more often Caucasian. They also had higher rates of COPD (24.6% vs. 12.3%) and valvular diseases (13.8% vs. 8.2%) compared to non-NOAF patients. Univariate analysis showed NOAF was linked to worse outcomes. Multivariate logistic regression, adjusting for age, gender, race, insurance type and comorbidities, revealed NOAF patients had twice the risk of in-hospital mortality (OR: 2.08, CI: 1.96-2.21, P&lt;0.001) and higher odds of complications: cardiac arrest (OR: 1.9, CI: 1.8-2.19, P&lt;0.001), cardiogenic shock requiring MCS (OR: 2.15, CI: 1.94-2.39, P&lt;0.001), stroke (OR: 1.36, CI: 1.19-1.56, P&lt;0.001), and gastrointestinal bleed (OR: 1.56, CI: 1.4-1.74, P&lt;0.001). Conclusions: In this retrospective study, developing NOAF during index hospitalization for STEMI was associated with higher risk of in-hospital mortality and developing serious complications. Therefore, clinicians should recognize as a sign of worse prognosis and treat NOAF as soon as possible.
Abstract 4147118: Balloon-Expandable versus Self-Expandable Valve for the Management of Bicuspid Aortic Disease: An Updated Meta-Analysis of Clinical Outcomes
Authors: Izadora Oliveira, Andre de Sousa, Arthur Paiva, Vitor Ferreira, Carlos Eduardo Neves de Sá, Joao Victor Alves Alencar, Pedro Lucas Alves Alencar, Ana Paula Duarte Lima, Vinicius Oliveira, Humberto Graner Moreira
Journal: Circulation (2024)

Background: Transcatheter aortic valve implantation (TAVI) has been employed in the management of aortic stenosis (AS) in patients with bicuspid aortic valve (BAV) disease. Nevertheless, the comparative clinical outcomes of different types of valves used in this procedure remain inconclusive. Therefore, we conducted an updated meta-analysis to evaluate the performance of balloon-expandable (BEV) vs self-expandable valves (SEV) in patients with BAV going through TAVI. Methods: We systematically searched PubMed, Embase and Cochrane for studies comparing BEV and SEV in the treatment of AS in patients with BAV undergoing TAVI. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the Cochran Q test and I 2 statistics. Statistical analysis was performed utilizing Review Manager 5.4.1. Results: We included 9 observational studies with a total of 1,666 patients, of whom 974 (58,46%) received a BEV. The follow-up duration ranged from 30 days to 2 years. The pooled analysis revealed no significant differences between the BEV and SEV groups in terms of procedural death (OR 1.05; 95% CI 0.29 – 3.74; P=0.94), 30-day all-cause mortality (OR 0.98; 95% CI 0.55 – 1.72; P=0.93; Figure 1A), 30-day cardiovascular mortality (OR 1.02; 95% CI 0.47 – 2.23; P=0.96), 1 year all-cause mortality (OR 1.06; 95% CI 0.58 – 1.93; P=0.86), annulus rupture (OR 2.67; 95% CI 0.53 – 13.59; P=0.24), coronary obstruction (OR 1.29; 95% CI 0.31 – 5.43; P=0.72), new pacemaker implant (OR 0.76; 95% CI 0.48 – 1.20; P=0.23), moderate or severe aortic regurgitation (OR 0.34; 95% CI 0.11 – 1.00; P=0.05) and stroke (OR 1.18; 95% CI 0.58 – 2.40; P=0.64). However, the requirement of a second valve was significantly less common in patients with BEV compared to those with SEV (OR 0.36; 95% CI 0.17 – 0.76; P&lt;0.01; Figure 1B). Conclusions: This meta-analysis suggests that both types of valves exhibit similar clinical outcomes in patients with BAV undergoing TAVI. Nonetheless, BEV was associated with lower odds of requiring a second valve compared to SEV. Further randomized controlled trials are necessary to confirm these findings.
Abstract 4147548: Usefulness of Baseline NT-proBNP Non-Response Score and Health Status Measures in Assessing Treatment Responses in Heart Failure with Reduced Ejection Fraction
Authors: Thanat Chaikijurajai, Wai Hong Tang
Journal: Circulation (2024)

Background: The NT-proBNP nonresponse score (NNRS) previously derived from the PROTECT and BATTLESCARRED studies was proposed (Gaggin et al, Congest Heart Fail 2013), with the goal to identify patients with chronic heart failure (HF) who would not likely to response to outpatient medical treatment. Hypothesis: The NNRS can be used with health status measures (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OSS]) for assessing treatment response and prognostication in patients with chronic HFrEF. Aims: To validate the prognostic value of NNRS in comparison with KCCQ-OSS. Method: Data on the GUIDE-IT trial were used to derive the NNRS based on 4 predictors and their integeric score (IS) including baseline NT-proBNP (&lt; 1,000, 1,000-5,000, and &gt; 5,000 pg/mL; IS = 0, 2, 3, respectively), heart rate &lt; 60 beats per min (IS = 1), NYHA class III or IV (IS = 1), and history of atrial fibrillation (IS = 1). Multivariable logistic regression analysis was used to determine the predictive value of the NNRS and KCCQ-OSS greater than the median values for NT-proBNP response with adjustment for age, sex, body mass index, comorbidities, baseline creatinine and NT-proBNP levels. Kaplan-Meier curves and log rank test were used to assess survival from CV mortality or HF hospitalization across patients with high and low NNRS and KCCQ-OSS. Results: Among 877 patients (median NNRS=3 [IQR 2-4], and KCCQ-OSS=59 [IQR 40-75]), 252 (28.7%) patients had NT-proBNP &gt;1,000 pg/mL at 12 months, and 321 (36.6%) patients had CV mortality or HF hospitalization during median follow up of 300 days. The NNRS and KCCQ-OSS correlated poorly ( Figure 1A ). After adjusting for covariates, higher NNRS (adjusted OR 1.99, 95% CI 1.02-3.90, P 0.044) and KCCQ-OSS (adjusted OR 2.14, 95% CI 1.33-3.45, P 0.002) were associated with a higher risk of lack of NT-proBNP response at 12 months. Both NNRS and KCCQ-OSS can be used complimentarily for prognostication (log rank P&lt;0.001, Figure 1B ). Conclusions: The NNRS and KCCQ-OSS were associated with persistently elevated NT-proBNP 12 months independently of baseline NT-proBNP levels and can be used complimentarily for prognostication in patients with HFrEF.
Abstract 4147596: Investigating the Role of <i>EMILIN1</i> in Thoracic Aortic Aneurysm Using Vascular Smooth Muscle Cells
Authors: William Schwartzman, Vivian Lee, Aurelie Barry, Emre Bektik, Mark Feinberg, Rajat Gupta
Journal: Circulation (2024)

Background: Thoracic aortic aneurysm and dissection (TAAD) is a rare but devastating disorder that affects more than 13,000 people per year in the United States. Genetic testing can help guide early detection and therapy, but despite identification of numerous causal loci, the genetic architecture of TAAD remains poorly understood. There is a need for further investigation to identify and confirm new causal genes to improve screening for TAAD. We hypothesize that genetic testing of the most phenotypically severe cases in pediatric patients will improve the yield of novel gene identification. Methods: We identified an extreme case of TAA in a 6-month-old patient at Boston Children’s Hospital and performed whole-exome sequencing on DNA samples collected from the proband and unaffected parents. We generated a clonal EMILIN1 knockout (KO) human aortic vascular smooth muscle cell (VSMC) model using CRISPR/Cas9 to assess the effect of complete EMILIN1 loss on gene expression, protein level, and critical VSMC functions including contractility, migration, and proliferation by collagen disk assay, scratch assay, and Ki67 staining respectively. Results: Whole exome sequencing in a pediatric patient with an extreme, progressive TAA phenotype (4.0cm, Z-score +15) identified compound heterozygous nonsense mutations in EMILIN1 , each inherited from one parent, as candidate causal variants. These variants (c.664C&gt;T and c.1606C&gt;T) were validated by Sanger sequencing. The EMILIN1 KO VSMCs demonstrated marked alterations in expression of genes encoding contractile apparatus and extracellular matrix proteins. Functional tests also revealed increased contractility (p=0.0374), decreased proliferation (p&lt;0.0001), and decreased migration (p&lt;0.0001) of EMILIN1 KO cells. Conclusion: Whole exome sequencing in a 6-month-old patient with a severe presentation of TAA identified likely pathogenic compound heterozygous mutations in the EMILIN1 gene. Complete EMILIN1 loss-of-function in VSMCs results in cellular phenotypes comparable to other pathogenic TAA mutations.
Abstract 4147107: Diagnostic and Therapeutic Yield of Routine Esophagogastroduodenoscopy in Patients with Fontan Palliation
Authors: Josue Diaz-Frias, Hari Conjeevaram, Mark Norris, Michael Joynt, Sunkyung Yu, Ashley Duimstra, Ray Lowery, Timothy Cotts
Journal: Circulation (2024)

Introduction: Fontan associated liver disease (FALD) is an important complication of the Fontan Circulation. The presence of esophageal varices is associated with increased morbidity and mortality in patients with underlying cirrhosis. The diagnostic yield of routine esophagogastroduodenoscopy screening (EGD) in Fontan patients with clinical/radiographic suggestion of cirrhosis is unknown with wide practice variation across centers. At our center, the institutional strategy is to refer patients with clinical or radiographic evidence of FALD to the hepatology service. All patients seen by hepatology undergo EGD if they have clinical/radiographic suggestion of cirrhosis and they are clinically stable and without contraindications to the procedure. The purpose of this study was to evaluate the yield of EDG in Fontan patients and inform a strategic surveillance approach. Methods: We performed a single-center retrospective chart review of all patients with Fontan circulation who underwent an EGD from February 1, 2020 to October, 31 2023 at our center. Results: During the study period, a total of 66 patients (51.5% male) with Fontan circulation underwent routine EGD at a median age 30.2 years (range 19.8-60.4 years). The median time from Fontan palliation to initial screening EGD was 27.1 years. Fontan type was lateral tunnel in 41 patients (62.1%), atriopulmonary in 14 (21.2%), and extracardiac in 11 (16.7%). About half (48.5%) of the patients had a systemic left ventricle. At the time of the EGD, 12 (18.2%) patients had a New York Heart Association (NYHA) functional class I, 35 (53.0%) had a functional class II, 19 (28.8%) had a functional class III. The esophageal varices were present in 41 (62.1%) patients, of which 35 (53.0%) had grade I esophageal varices, and 6 (9.1%) had grade II. Additional findings included portal hypertensive gastropathy in 33 (50.0%) patients, erythematous mucosal changes in 16 (24.2%), non-bleeding erosive gastropathy in 4 (6.1%) and gastric vascular ectasia in 1 (1.5%). Conclusion: This study showed a high prevalence of esophageal varices in our Fontan patients, suggesting a role for routine EGD as a screening tool in this population.
Abstract 4147510: A novel methodology for simultaneous analysis of electrical activation parameters and myocardial fibrosis in patients with LBBB and indications to cardiac resynchronization therapy
Authors: Elena Rimskaya, Mikhail Chmelevsky, Olga Aparina, Anastasia Bazhutina, Margarita Budanova, Svyatoslav Khamzin, Olga Stukalova, Sergey Ternovoy, Sergey Golitsyn
Journal: Circulation (2024)

Background: Left ventricular (LV) myocardial fibrosis can be crucial for the electrical wave propagation and thus contribute to left bundle branch block (LBBB) formation. Using a novel specially developed technology we aimed to establish the role of fibrosis in activation parameters in patients with LBBB and indications to cardiac resynchronization therapy (CRT). Materials and Methods: 15 patients (7 male, mean age 59.1±9.8 years) with LBBB underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) and novel AI-based 12-lead ECG non-invasive electrical activation mapping (NIAM) prior to CRT onset. LGE-MRI was performed for the reconstruction of fibrosis 3D geometry and calculation of total fibrosis volume (totLVfvol), and LV transmural index (volFibInLV). In NIAM maps total activation time (totalAT), LV (totalLVAT), total LVAT on epicardial and endocardial surfaces (totLVATepi, totLVATendo) were estimated. LV 3D LGE-MRI and NIAM models were merged for semi-automatic segmentation in each patient followed by calculation in each of 17 segments epicardial segment total AT (ΔSegLVepi), endocardial segment total AT (ΔSegLVendo), total segment fibrosis (SegLVfvol) and transmural index (SegLVtransmInd). Latest activated zone segment (LAZ) location was determined. Results: Mean totLVfvol was 17.4[7.3;53,7] ml and it was not related to totalAT, totalLVAT, totLVATepi and totLVATendo (r=0.18, 0.02, 0.02, 0.52, p&gt;0.05). In segment-by segment analysis fibrosis was variously distributed in LV but its most prominent amount was located in segments 2,3,8,9, 7,and 12. LAZ was typically located in 5 th and 6 th segment in 12 (80%) cases. Its displacement did not depend on the fibrosis in the target segment. Mean SegLVfvol was 3.27[0.53;8.06]ml, SegLVtransmInd was 0.18[0.04;0.42] whereas ΔSegLVepi was 55[42;66], ΔSegLVendo was 44[33;58]. Moderate positive association was revealed between ΔSegLVepi and SegLVfvol (r=0.37, p&lt;0.001), and between SegLVfvol and ΔSegLVendo (r=0.31, p&lt;0.001). Weak positive association between SegLVtransmInd and ΔSeg LVepi (r=0.27, p&lt;0.001), and between SegLVtransmInd and ΔSegLVendo (r=0.211, p&lt;0.001) was detected. Conclusion: Our results based on novel developed technology of simultaneous evaluation of LGE-MRI and NIAM 3D models have showed that in LBBB patients fibrosis being unevenly distributed in myocardium does not determine the totalAT and LVAT but its value can influence of local AT in segment-by-segment analysis
Abstract Sa703: Investigating Racial Disparities in Out-of-Hospital Cardiac Arrest Interventions in Salt Lake City, Utah, USA
Authors: Emad Awad, Jeff Druck, Michael Johnson, Christy Hopkins, Ahmed Z Awad, Dilan Al Kurdi, Scott Youngquist
Journal: Circulation (2024)

Aims: The primary objective of this study was to investigate ethnic disparities in out-of-hospital cardiac arrest (OHCA) interventions, specifically the administration of epinephrine and ant arrythmias. The secondary objective was to explore the association with the provision of bystander CPR (CPR) and the application of Automated External Defibrillator (AED). Methods: This was a retrospective analysis of data from the Salt Lake City Fire Department from 2010 to 2023. The study included adults 18 years or older who experienced OHCA and were treated by EMS. Ethnicity was categorized as Whites, Blacks, Hispanics, Asians, and others. Multivariable regression analysis was used to examine the association between ethnicity and the specified outcomes. Results: Unadjusted analyses revealed no significant differences across ethnic groups in epinephrine and antiarrhythmic medication administration and bystander CPR. However, significant ethnic disparities were observed in AED use: the Asian population had the highest rate (21.8%), while the Black population had the lowest (6.5%). The multivariable analysis found no significant association between ethnicity and any OHCA interventions examined in this study. Conclusions: Our multivariable analysis did not reveal any statistically significant association between ethnicity and various OHCA interventions, including epinephrine administration, antiarrhythmic medication use, bystander CPR, and AED intervention in Salt Lake City. These findings suggest that regional differences in ethnic disparities in OHCA may vary across locations, emphasizing the need for further research into disparities in other regions and the impact of factors such as socioeconomic status and neighborhood conditions.
Abstract 4147560: Interoperable and Scalable Electronic Clinical Quality Measurement for Appropriate Use of Anticoagulation for Atrial Fibrillation in a Multicenter Health System
Authors: Phyllis Thangaraj, Lovedeep Dhingra, Rohan Khera
Journal: Circulation (2024)

Background: Anticoagulation (AC) in patients with atrial fibrillation (AF) at high risk for stroke is strongly recommended in guidelines, but tracking the optimal use of AC at scale and across hospital systems is challenging due to the need to examine both thrombotic and bleeding risks that often factor in clinical decisions. We propose a novel electronic clinical quality measure (eCQM) based on a computable phenotyping algorithm developed for and applied to a common data model (CDM) to enable at-scale assessments of CHA 2 DS 2 VASc and HAS-BLED to patients with AF in a multi-hospital health system. Methods: In patients with AF, we extracted CHA 2 DS 2 VASc and HAS-BLED scores by mapping individual components to standardized concepts from the Observational Medical Outcomes Partnership CDM concept set building tool, ATLAS. Clinician experts pursued manual curation of applicable concepts spanning demographics, conditions, laboratory values, medications, procedures, and vital signs, based on either the presence/absence of conditions in the patient EHR, or the given threshold of lab values or vital signs. We then assessed patients’ AC status across stroke and bleeding risk ranges [A]. Results: Across 5 hospitals and clinic sites, there were 64,632 patients with AF, mean age 74 (SD 14) with 27,846 (43%) female, and 4,060 (8%) Black who interacted with the health system within the past year. The mean CHA 2 DS 2 VASc score was 4.5 (SD 2.0) and HAS-BLED was 3.0 (SD 1.5). For those on AC, the mean CHA 2 DS 2 VASc score was 4.8 (SD 2.0) versus 3.8 (SD 2.1) for those not on AC [B], while the mean HAS-BLED score for those on AC was 3.2 (SD 1.5) vs 2.7 (SD 1.5) for those not on AC [C]. By score, 92% had a stroke risk of 2% or greater, and 66% of these patients were on AC, with a mean HAS-BLED score of 3.2 (SD 1.5). The most common contributors to a HAS-BLED score of 2 or greater were medication exposure predisposing to bleeding (90%), age greater than 65 (85%), prior bleeding event (47%), and uncontrolled hypertension (46%). Across hospital sites, the proportion of patients with AF with a CHA 2 DS 2 VASc score of 2 or more and HAS-BLED score of 4 or less not on AC varied from 58% (Greenwich Hospital) to 72% (Bridgeport Hospital) [D]. Conclusion: We demonstrate the ability of a scalable EHR-native eCQM that accounts for thrombotic and bleeding risk at scale to monitor the quality of care, with gaps in care noted in a large diverse health system.