tbuckley/cabot-search huggingface dataset:
Abstract 4144319: Socioeconomic and Geographic Factors Associated with Reduced Prenatal Diagnosis of Significant Congenital Heart Disease at a Single Regional Institution
Authors: Benjamin Ittleman, Waylon Howard, Kathryn Virk, Nicholas Brown, Aarti Bhat, Elizabeth Caris, Jeff Conwell, Lindsay Edwards, Mark Lewin, Nelangi Pinto, Matthew Studer, Luciana Young, Bhawna Arya
Journal: Circulation (2024)

Background: Prenatal diagnosis (PND) of congenital heart disease (CHD) is associated with lower preoperative mortality and improved perinatal outcomes. Socioeconomic (SE) and geographic disparities impact PND of CHD in the United States. However, the relationship of these disparities and PND along with postnatal outcomes have not been previously studied in the Northwestern United States, a large geographic catchment area with significant SE and access-to-care variability. Hypothesis: Greater SE disadvantage, defined by higher Area Deprivation Index (ADI), as well as non-white race, Hispanic ethnicity and increased distance from our regional surgical center are associated with lower rates of PND of CHD. Aims: To evaluate the association of SE and geographic variables and PND of CHD in a cardiac center with a unique catchment area. Also to compared post-operative outcomes between those diagnosed prenatally and postnatally. Methods: A Retrospective cross-sectional study of all patients with CHD requiring surgical intervention &lt;6 months of age between 2014-202 at a single institution, serving 6 states, in the Northwestern United States was performed. Medical records, prenatal, and surgical databases provided demographic, diagnosis, and outcomes data. Race, ethnicity, ADI and address data were collected from first hospitalization or prenatal record depending on timing of diagnosis. Results: 705 patients met inclusion criteria; 511 prenatally diagnosed and 194 postnatally. Higher (more disadvantaged) State ADI (p&lt;0.001), non-white race (p=0.03), Hispanic ethnicity (p&lt;0.002) and increased distance from surgical center (p&lt;0.001) were associated with lower rates of prenatal diagnosis. No significant difference in post-surgical variables between prenatally and postnatally diagnosed patients was found. Conclusion: In a large regional catchment area serviced by a single surgical center, non-white race, Hispanic ethnicity, higher state ADI and distance from regional surgical center were associated with decreased rates of PND of significant CHD. This study provides a framework for developing strategies to improve accessibility to comprehensive prenatal care for underserved communities.
Abstract 4144657: Is Changing Climate Affecting the Risk of Acute Coronary Syndrome-related Hospitalizations and Outcomes of Young Adults During Summer Months in the United States?
Authors: Sachin Singh, Ali Danish, Lovekumar Vala, Riya Dhadhal, Neha Kanthala, Maneeth Mylavarapu, Adil Mohammed, Hafeezuddin Ahmed, Joanne Mathew, Hassaan Imtiaz, Ankit Vyas, Rupak Desai
Journal: Circulation (2024)

Introduction: Seasonal variations, particularly cold weather, can increase the risk of acute coronary syndrome, as evidenced by various studies over the years. On the other hand, hot weather can cause dehydration, electrolyte imbalances, and thermoregulatory strain on the heart, leading to adverse cardiac events. In recent years with rising concerns about global warming, we aim to study the impact of climate changes during the summer on outcomes among people hospitalized with ACS. Methods: We used the National Inpatient Sample from 2016 to 2020 to identify young adults hospitalized with ACS using appropriate ICD-10 codes. Patients were categorized into two cohorts: summer (hospitalizations during June, July, and August) and non-summer (hospitalizations during other months). The outcomes studied were ACS hospitalizations and in-hospital mortality. Pearson chi-square tests and the Mann-Whitney U test were used for cohort comparisons. Results: Of 230,555 ACS hospitalizations, 26.2% (n=60,340) occurred during the summer months, with a median age of 40 years. White individuals had higher hospitalization rates compared to others (57.8% vs. 58%), and those from lower socioeconomic statuses had higher ACS hospitalizations in both cohorts (37.5% vs. 38.1%). Comorbidities like hypertension, diabetes, and hyperlipidemia were lower in the summer cohort (all p&lt;0.001). The rates of in-hospital death were higher in the summer cohort compared to the non-summer cohort (4.7% vs. 4.5%, p=0.019). However, logistic analysis showed no significant association between summer climate and ACS hospitalizations (OR 1.02, 95% CI 0.99-1.04, p=0.178) or all-cause mortality (OR 1.04, 95% CI 0.94-1.06, p=0.446), irrespective of region or gender. Conclusion: While in-hospital mortality rates were higher during the summer months, there was no significant association between summer climate and the incidence of ACS or all-cause mortality, regardless of region or gender, when adjusted for confounding factors.
Abstract 4144651: Association Between Pre-Existing Chronic Total Occlusion and Post-TAVR Pacemaker Implantation: A Retrospective Propensity Matched Analysis
Authors: Shahan Haseeb, Umair Ansari, Shafia Munir, Sang Lee, Marvyn Chan, Seth Goldbarg
Journal: Circulation (2024)

Introduction: Post-transcatheter aortic valve replacement (TAVR) pacemaker (PPM) implantation is a known complication. Chronic total occlusion (CTO) of coronary arteries is common in TAVR patients and is a marker of advanced coronary calcification. Its influence on the requirement for PPM post-TAVR remains unclear. We investigated the association between pre-existing CTO and the incidence of PPM post-TAVR. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2018-2020 with 205,565 patients who underwent TAVR. Propensity score matching was utilized to create a matched cohort of patients with and without CTO, balancing key variables such as age, sex, elective procedure status, and comorbid conditions (heart failure, arrhythmias, pulmonary circulation disorders, peripheral vascular disorders, and complicated diabetes). Outcomes measured included the requirement for PPM implantation post-TAVR, in-hospital mortality, and major adverse cardiac events (MACE). Weighted samples were utilized and p-value &lt;0.05 was considered significant. Results: The unmatched analysis included 3,495 patients with CTO and 202,070 without CTO. Patients with CTO were likely to have comorbidities such as heart failure, arrhythmias, and complicated diabetes (Table 1). Unmatched results showed a higher incidence of PPM implantation in patients with CTO (9.2%) compared to those without CTO (7.1%) (p&lt;0.05). Propensity score matching yielded a cohort of 6,930 patients. In the matched analysis, the incidence of PPM implantation was 9.2% in patients with CTO and 6.5% in those without CTO (p=0.06). Logistic regression analysis in the matched cohort demonstrated that CTO was associated with increased odds of PPM implantation post-TAVR (OR 1.47, 95% CI 0.99-2.18, p=0.06). In-hospital mortality and MACE did not differ significantly between the two groups. Conclusion: We conclude that pre-existing CTO may be associated with a higher incidence of PPM implantation after TAVR, although the difference was not statistically significant. Further research is needed to validate these findings and explore the mechanisms involved.
Abstract 4144377: L-2-hydroxyglutarate Attenuates the Accumulation of Long Chain Acylcarnitines in Myocardial Ischemia
Authors: Niv Vigder, Huamei He, Sergey Tumanov, Georgia Watermeyer, Ryan Mulhern, Stuart Cordwell, Joseph Loscalzo
Journal: Circulation (2024)

Mammalian cells have several adaptive mechanisms to counteract the adverse effects of metabolic and redox stress induced by ischemia. Hypoxia, a hallmark of ischemia, results in the selective reduction of the tricarboxylic acid cycle metabolite, α-ketoglutarate, to the L -( S )-enantiomer of 2-hydroxyglutarate (L2HG) in several cell types. L2HG protects hypoxic cells by buffering increases in the NADH/NAD + redox couple and inhibiting mitochondrial electron transport. In addition, the accumulation of L2HG induced by genetic knockout of L2HG dehydrogenase (L2HGDH), the only known enzyme capable of oxidizing L2HG back to α-ketoglutarate, protects mice against myocardial injury during ischemia. This protection by L2HG manifests as decreased myocardial infarct size and improved cardiac function, owing partly to a metabolic shift in carbon flux from glycolysis towards the pentose phosphate pathway. However, myocardial ischemia also leads to perturbations in fatty acid metabolism as manifest by accumulation of acylcarnitines and acyl-CoA’s. It remains unclear as to whether or not L2HG accumulation affects fatty acid metabolic homeostasis during myocardial ischemia. Here, we induced L2HG accumulation by homozygous deletion of the l2hgdh gene in male mice ( l2hgdh -/- ; n=12). Hearts isolated from these mice and their wild-type littermates ( l2hgdh +/+ ; n=13) were subjected to ex vivo Langendorff perfusion at coronary perfusion pressure of 80 mmHg for 30 min with (ischemic group) or without (control group) subsequent perfusion at ~10% pressure for 90 min. Using liquid chromatography tandem mass spectrometry (LC-MS/MS)-based nontargeted lipidomics, we identified several species of long chain acylcarnitines that accumulated by ischemia in hearts obtained from L2HGDH +/+ mice [linoleoyl carnitine, palmitoyl carnitine, and hydroxy-linoleoyl carnitine increased by 13.2-fold (p=4.2 x 10 -6 ), 10.7-fold (p=1.7 x 10 -6 ), and 10.0-fold (p=5.8 x 10 -6 ), respectively]. Interestingly, however, this accumulation was attenuated substantially in ischemic hearts obtained from L2HGDH -/- mice [hydroxy-linoleoyl carnitine, palmitoyl carnitine, and linoleoyl carnitine were downregulated by 62.6% (p=0.034), 54.2% (p=0.018), and 35.4% (p=0.054) in ischemic hearts from L2HGDH -/- mice when compared to L2HGD +/+ littermates]. Overall, these findings highlight a novel and potentially important role for L2HG in restoring the perturbations in fatty acid metabolism induced by myocardial ischemia.
Abstract 4144636: Novel Technique for Impella Sheath Explantation Through Antegrade Wiring via Contralateral Access: A Gateway to Preventing Clot Embolization
Authors: Liyan Obeidat, Asem Ayyad, Anas Al-suraimi, Ahmad jabri, Pedro Villablanca, Mohammad Alqarqaz
Journal: Circulation (2024)

Introduction: Mechanical Circulatory Support (MCS) is increasingly used in patients with cardiogenic shock (CS) or compromised hemodynamics during high-risk percutaneous coronary or structural interventions. Safe removal of large-bore MCS devices and closure of arteriotomy sites are crucial to prevent bleeding and vascular complications. Clot formation within intra-arterial sheaths post-MCS implantation poses a risk of thromboembolic complications, necessitating innovative approaches for safe removal. Case presentation: We present a 69-year-old male with a history of multivessel coronary artery disease (CAD), who was admitted with CS due to non-ST-segment elevation myocardial infarction (NSTEMI) requiring Impella CP device implantation. He later demonstrated hemodynamic stability with a heart rate ranging from 70 to 80 beats per minute and a mean arterial pressure (MAP) ranging from 75 to 80 mmHg, with the Impella set at power level 8 (P8). He underwent successful weaning from Impella support per protocol and was subsequently brought to the cardiac catheterization laboratory (CCL) for device explantation. The procedure began with the standard technique; however, upon inspection of the sheath following device removal, a sizable clot was visualized. To prevent embolization, we avoided standard retrograde wiring and instead, a Glide Advantage wire was threaded to the Impella sheath in an antegrade fashion via a contralateral access. A balloon was inflated within the sheath for dry field closure. Subsequently, the balloon and sheath were pulled together, extracting the clot in the process. Discussion: MCS utilization has risen, necessitating meticulous approaches to arterial access and device removal to mitigate bleeding and vascular complications. In our case, our primary concern revolved around the risk of embolization stemming from the sizable clot observed within the Impella sheath post-device removal when using the standard retrograde technique. This situation posed the potential for serious consequences, including acute limb ischemia, organ ischemia, or cerebrovascular accidents. Consequently, we needed to devise a novel technique for sheath explantation that would ensure safety and effectiveness. Our approach, employing the contralateral access and advancing the wire antegradely, provided a secure alternative, averting the severe consequences associated with clot embolization.
Abstract 4144730: Combining novel lipid biomarkers with deep learning algorithms to develop an initial non-invasive screening approach for ruling out obstructive coronary artery disease
Authors: EFSTRATIOS KARAGIANNIDIS, Andreas Papazoglou, Thomai Mouskeftara, Olga Deda, Theodoros Liapikos, Eleftherios Panteris, Barbara Fyntanidou, Nikolaos Fragakis, George Theodoridis, Helen Gika, George Giannakoulas
Journal: Circulation (2024)

Background: A personalized, non-invasive assessment approach for evaluating the risk of obstructive coronary artery disease (CAD) is crucial for patients with an intermediate or low clinical likelihood of CAD before undergoing invasive coronary angiography (ICA). This method allows clinicians to effectively rule out the presence of obstructive CAD without the need for ICA or to determine if a referral for ICA is warranted. Emerging lipidomics biomarkers may be valuable in this process. However, technological challenges in detecting structurally similar lipids and the requirement for advanced computational tools have so far impeded the clinical application of lipidomics research. Hypothesis: Our study aims to develop an innovative non-invasive diagnostic test utilizing novel lipidomics biomarkers, potentially revolutionizing current risk classification schemes for CAD. Methods: In this post-hoc analysis of the CorLipid trial (NCT04580173), we employed extreme gradient boosting (XGBoost) machine learning to assess the predictive power of a lipidomics panel for obstructive CAD risk. Liquid chromatography-mass spectrometry analyzed lipid profiles from 146 individuals undergoing ICA. SYNTAX Score (SS) was used to define obstructive CAD as SS&gt;0 versus non-obstructive CAD (SS=0). Results: Of the 146 participants (25% female, mean age: 61 ±11 years old), 55% had obstructive CAD (SS&gt;0). Lipidome changes [phosphatidylinositols, (lyso-)phosphatidylethanolamine, (lyso-)phosphatidylcholine, triglycerides, diglycerides, and sphingomyelins] were investigated to identify lipids potentially associated with the phenotype and complexity of CAD. Using this information, 290 quantified serum lipid species were utilized to develop an XGBoost algorithm with 17 serum biomarkers ( consisting of sphingolipids, glycerophospholipids, triacylglycerols, galectin-3, glucose, low-density lipoprotein, and lactate dehydrogenase) with very good discriminative ability [ROC AUC: 0.875 (95%CI: 0.867-0.883)], excellent sensitivity (100%) but moderate specificity (62.1%) for the prediction of obstructive CAD. Conclusions: These findings indicate that a deep-learning-based non-invasive diagnostic test, using lipidomics serum biomarkers, could reliably rule-out obstructive CAD without necessitating ICA. To enhance generalizability, these results should be validated in larger and similar cohorts. Further research, particularly leveraging machine learning, is promising for refining risk stratification.
Abstract 4144337: Temporal Trends of Permanent Pacemaker Implantation With Transcatheter Aortic Valve Replacement in the United States 2016 - 2023
Authors: Chirag Mehta, Mohamed Bhargout, Khansa Ahmad, Ahmed Elkaryoni, Hafiz Imran, Jinnette Abbott, Barry Sharaf, Paul Gordon, Marwan Saad
Journal: Circulation (2024)

Background: Permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR) is associated with adverse outcomes and cost. Whether the incidence and timing of PPMI has changed with the advent of newer device iterations and implantation techniques is unknown. Methods: This contemporary analysis queried the Vizient Database to identify patients who underwent TAVR from January 2016 to November 2023. The primary outcome was the trend of PPMI within 30 days of TAVR (i.e., during index admission, or readmission for PPMI within 30 days) over the study years. Linear trend test was used for trend analyses. Results: Of 253,100 TAVR patients, 24,797 (9.8%) received a PPMI within 30 days. Compared to the non-PPMI group, patients in the PPMI group were of similar age, but were more likely male and White, and had a higher burden of comorbidities. Over the study period, the rate of 30-day post-TAVR PPMI ranged from a low of 13.6% in 2017 to a high of 16.6% in 2023, with an overall increase in trend (p=0.04). With respect to timing of PPMI, the rate of PPMI during index TAVR admission remained similar (p=0.19), while the rate of 30-day readmission for PPMI increased (p&lt;0.001). In tandem, there was a significant trend of shorter hospital length of stay (p&lt; 0.001) across the study period. Conclusion: Despite advancements in TAVR and expansion to lower risk patients during the time period examined, the rate of PPMI within 30 days of TAVR increased, mainly driven by an increase in PPMI after the index hospitalization. Further study is needed to understand the reasons for the observed trends.
Abstract 4144717: SGLT2 Inhibitors and Diabetic Retinopathy: Reducing Surgical Interventions and Vision Loss
Authors: Usman Akbar, Ahmed Muaaz Umer, Nouman Shafique, Fnu Muhibullah, Ayesha Akbar, Muhammad Abdullah Naveed, Faizan Ahmed, Muhammad Aslam Khan, Hadia Sohail, Michael Cheshire
Journal: Circulation (2024)

Background: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors extend their utility beyond glycemic control in type 2 diabetes mellitus (T2DM) by demonstrating cardiovascular risk reduction, heart failure protection, and attenuation of chronic kidney disease progression. Additionally, SGLT-2 inhibitors may confer ancillary benefits in reducing the risk of diabetic retinopathy (DR). This study evaluates the impact of SGLT2 inhibitors on DR outcomes in a matched cohort of T2DM patients. Methods: Utilizing data from the US Collaborative Network, we assessed the effects of SGLT2 inhibitors on DR in 97,495 propensity score-matched pairs using the TriNetX analytics platform. Comparative analyses between treated and untreated cohorts were conducted, including risk differences, odds ratios (OR), risk ratios (RR), and p-values. Evaluated outcomes encompassed surgical interventions requiring laser photocoagulation, anti-VEGF injection utilization, and incidence of vision loss. Results: In terms of surgical interventions (retinal excision and repair, and vitreous drainage), the SGLT2 inhibitor cohort exhibited a significant risk reduction, evidenced by a risk difference of -0.000 (95% CI: -0.001 to -0.000, p=0.027), RR of 0.790 (95% CI: 0.640 to 0.974), and OR of 0.789 (95% CI: 0.640 to 0.974). No significant difference was observed for laser photocoagulation (Risk Difference: 0.000, 95% CI: -0.000 to 0.000, p=1.000). Similarly, anti-VEGF injection outcomes did not differ significantly despite a risk difference of -0.002 (95% CI: -0.003 to -0.001, p=0.002). The analysis revealed a substantial protective effect against vision loss in the SGLT2-treated patients, with a risk difference of -0.010 (95% CI: -0.012 to -0.008, p&lt;0.000), RR of 0.793 (95% CI: 0.759 to 0.829), and OR of 0.785 (95% CI: 0.750 to 0.822). Conclusion: Our findings indicate that SGLT2 inhibitors significantly decrease the necessity for surgical interventions and the risk of vision loss in patients with DR. The lack of significant differences in laser photocoagulation and anti-VEGF injection outcomes suggests targeted benefits of SGLT2 inhibitors. These results underscore the potential role of SGLT2 inhibitors as a valuable component in the management strategy for diabetic retinopathy.
Abstract 4144532: Bivalirudin Reduces Major Bleeding And Cardiovascular Mortality in MI patients Undergoing PCI Compared to Unfractionated Heparin.
Authors: Anubhuti Sharma, Arundhati Sharma, Simranpreet Singh Daid, Urja Sanghvi, Sahitya Dantuluri, Saif Syed, Isha Senthil Velmurugan, Laxmi Priya seelam, Saurav Aryal, Binay Panjiyar
Journal: Circulation (2024)

Background: Antithrombotic regimens play a pivotal role in averting complications and ischemic incidents post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients. Bivalirudin stands as a viable alternative to unfractionated heparin in this cohort, demonstrating the efficacy and safety profiles. Aim: We aimed to compare the efficacy and safety of bivalirudin versus unfractionated heparin in post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients. Research Question : What is the efficacy and safety of Bivalirudin compared to unfractionated heparin in patients with MI undergoing PCI, specifically in terms of major bleeding, cardiovascular mortality, and other major adverse cardiovascular events? Methods: We systematically searched PubMed, including MEDLINE, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, and EBSCOhost/CINAHL, from January 1, 2000, through May 29, 2024, for randomized controlled trials (RCTs) that evaluated Bivalirudin versus unfractionated heparin and with a study population of patients with MI undergoing PCI. Data extraction was done using a spreadsheet, and data analysis was done using RevMan 5.4.1 for meta-analysis. The primary efficacy and safety endpoints were major bleeding, major cardiovascular events, cardiovascular mortality, all-cause mortality, myocardial infarction, stent thrombosis, and stroke. Results: Our analysis included 11 RCTs, encompassing a total of 40,919 participants. When compared with unfractionated heparin, bivalirudin was associated with a significant reduction in major bleeding events (RR 0.66 [0.55 to 0.80]; p &lt; 0.0001) and cardiovascular mortality (RR 0.79 [0.67 to 0.92]; p &lt; 0.003). However, there were no significant differences between Bivalirudin and unfractionated heparin in terms of major adverse cardiovascular events (RR 1.02 [0.91 to 1.13]; p = 0.76), all-cause mortality (RR 0.89 [0.78 to 1.01]; p = 0.08), MI (RR 0.99 [0.85 to 1.15]; p = 0.90), stent thrombosis (RR 1.12 [0.53 to 2.40]; p = 0.76), or stroke (RR 0.96 [0.73 to 1.26]; p = 0.75). Conclusion: Our meta-analysis indicates that in patients with MI undergoing PCI, Bivalirudin is associated with lower rates of major bleeding and cardiovascular mortality compared to unfractionated heparin. However, there were no significant differences observed in major adverse cardiovascular events, all-cause mortality, MI, stroke, or stent thrombosis between the two treatment groups.