tbuckley/cabot-search huggingface dataset:
Abstract 12182: Importance of Comorbidities in 24-month AF-Free Survival After Catheter Ablation
Authors: Jonas Leavitt, Dimitrios Varrias, Kristie Coleman, Elliot Wolf, Stefanos Zafeiropoulos, Christopher Gasparis, Ari Zimmer, Rajat Goyal, Laurence Epstein, Stavros Mountantonakis
Journal: Circulation (2023)

Background: Presence of cardiac and non-cardiac comorbidities is reported to affect success of catheter ablation (CA) of atrial fibrillation (AF), however their predictive value in 1 and 2 year AF free survival is not reported. Research Questions: Which cardiac and non-cardiac comorbidities are most useful in predicting AF free survival after a single CA for paroxysmal and persistent AF. Goals: Create a model to identify potential risk factors that may reduce the long term success of catheter ablation for patients with AF to allow for risk modification Methods: We included 1435 patients with symptomatic AF undergoing first time CA in 1 of 8 Hospitals of Northwell Health and follow ups for at least 24 months ablation. Baseline echocardiographic and laboratory data were extracted from our common EMR, and clinical outcomes were determined after manual review of the 6, 12 and 24 month visit. Baseline patient characteristics included age, gender, BMI, diagnoses, laboratory and echocardiographic measures used in a stepwise estimation logistic regression model using STATA /IC 16.1. Results: From our patient cohort (age 67.1±10.4, 565 female, 645 persistent), 28% of patients had AF recurrence within the 1st year, and 32.5% within 2 years. Multivariate analysis identified persistent AF as the only independent risk factor for AF recurrence within 12 months (P=.001). For 24-month recurrence the independent predictors were LVEF (p=.014), Diabetes Mellitus (p=.045), cardioversions prior to ablation (DCCV) (p=.001), and pulmonary disease (p=.001). Energy modality was not a significant predictor of AF recurrence. Hypertension (p=.008) was found to be negatively associated with AF recurrence. Our prediction model (Figure 1) for AF recurrence 24 months post-CA produced an ROC curve of 0.8048 and was 77% accurate. Conclusion: The presence of baseline comorbidities implies that such comorbidities, rather than procedural failure, are mostly related with AF recurrence after 1 year.
Abstract 11709: High Rates of Hyperkalemia Recurrence After Medical Nutrition Therapy in Patients With Heart Failure: REVOLUTIONIZE I Real-World Evidence Study
Authors: Abiy Agiro, Christopher G Rowan, Pooja Desai, K. Arnold Chan, Ellen Colman, Katie White, Jamie P Dwyer
Journal: Circulation (2023)

Introduction: Medical nutrition therapy (MNT) slows chronic kidney disease (CKD) progression but its effect on serum potassium (K + ) and hyperkalemia (HK) recurrence in patients with heart failure (HF) and comorbid CKD is unclear. REVOLUTIONIZE I is a real-world study of HK recurrence in patients who received MNT after experiencing HK. Aims: This analysis aims to describe HK recurrence in a subgroup of patients with HF and comorbid CKD in the REVOLUTIONIZE I study. Methods: Patients aged ≥18 years with HF and stage 3/4 CKD who received MNT within 30 days after a serum K + value of &gt;5.0 mEq (1/1/2019 to 10/31/22) were identified from TriNetX Dataworks de-identified electronic health records data. Patients were excluded if they received outpatient K + binder therapy within 6 months before the index date (MNT date + 7 days). Patients were censored at the first of: 6 months post-index, outpatient K + binder therapy initiation, death, or 10/31/22. HK recurrence was calculated for 1-6-month intervals post-index and compared with the estimated a priori HK recurrence rate (50%) by Chi-square test. Results: The HF subgroup included 1179 patients. Of 861 patients with ≥6 months’ follow-up, 485 (56.3%) had ≥1 HK recurrence ( Figure ), with a mean ± SD of 2.6 ± 2.2 recurrences (range 1-14). Time between HK recurrences decreased with each recurrence, from a mean of 42 days for the first recurrence to 35 days for the second and &lt;30 days for additional recurrences. Conclusions: This real-world study showed that HK is a chronic, recurrent condition for the majority of patients with HF and comorbid CKD, despite the use of medical nutrition therapy. There is unmet need to consider long-term anti-HK therapy with newer K + binders to reduce HK recurrence in this patient population.
Abstract 12149: Vericiguat May Improve Conduit Vessel Function and Exercise Functional Capacity in Heart Failure With Reduced Ejection Fraction
Authors: Toru Takase, Koichiro Matsumura, Gaku Nakazawa
Journal: Circulation (2023)

Background: The treatment of heart failure with reduced ejection fraction (HFrEF) has advanced considerably in recent years with the advent of novel agents; however, limitations, such as blood pressure and renal dysfunction, limit the number of patients who can benefit from this treatment in practice. Vericiguat, a novel heart failure treatment, has been found to be efficacious in patients with HFrEF while maintaining a good safety profile. Unfortunately, its mechanisms remain largely unknown. Objective and Methods: A total of 11 patients with HFrEF who were determined to be inadequately treated underwent right heart catheterization, echocardiography, flow-mediated dilatation (FMD) testing, 6-min walking distance (6MWD) test, and blood sampling at a median interval of 70 ± 13 days before and after vericiguat treatment. Results: Participating patients were 73 ± 9.3 years old with a mean of 2.5 repeated heart failure hospitalizations, ejection fraction (EF) of 31.2% ± 8.7%, BNP of 328.7 ± 282, and New York Heart Association classification of mostly II. No significant changes in systolic blood pressure or pulse rate were observed before and after vericiguat introduction (115 ± 64 vs. 105 ± 52 mmHg and 70 ± 5 vs. 75 ± 12 bpm; P = 0.533 and 0.960, respectively). No significant changes in the mean pulmonary artery pressure and pulmonary artery wedge pressure were also observed before or after drug administration (19 ± 5 vs. 17 ± 10 mmHg and 7 ± 5 vs. 9 ± 3 bpm; P = 0.177 and 0.240 respectively). However, cardiac output was significantly increased and vascular resistance was significantly decreased after vericiguat treatment (4.0 ± 1.0 vs. 4.3 ± 1.1 L/min and 1719 ± 462 vs. 1467 ± 377 dynes·sec·cm-5; P = 0.016 and 0.002, respectively). FMD test results improved significantly after treatment (4.5 ± 5% vs. 8.1± 8%: P = 0.027), with the 6MWD increasing significantly by 42 m (311 ± 100 vs. 353 ± 50 m; P = 0.035). BNP also decreased significantly, whereas eGFR remained unchanged (317 ± 274 vs. 221.5 ± 200 pg/mL and 51.7 ± 21 vs. 51.5 ± 25.3 mL/min/1.73 m 2 ; P = 0.015 and 0.967, respectively). Conclusion: Vericiguat may improve exercise tolerance by improving vascular endothelial function and cardiac output.
Abstract 11916: An Elusive and Unusual Diagnosis of Cardiac Sarcoidosis
Authors: Kyle Kapcin, Alexandra Johnston
Journal: Circulation (2023)

Introduction: Cardiac sarcoidosis (CS) can present heterogeneously; presentations are often related to conduction system abnormalities in the form of AV block or ventricular arrhythmia, or heart failure. There are not yet widely accepted diagnostic guidelines for CS although diagnostic pathways such as the Japanese Ministry of Health and Welfare and the Heart Rhythm Society criteria exist. Methods: A 65 year old female with a history of hypertension, HFpEF, CAD with remote DES to RCA, CKD3a, Obesity and biopsy proven pulmonary sarcoidosis presented with 3 days of sudden onset dyspnea and hypoxia. Labs included aa pro-BNP of 16,754 pg/mL (0-299) and high-sensitivity troponin of 35 ng/L (0-14). EKG showed sinus rhythm with left axis and QTc of 499 ms. Chest Xray revealed pulmonary edema consistent with heart failure exacerbation Echocardiogram revealed EF 60-64%, normal LV and RV wall motion and thickness, and GLS of-17.2%. Left heart catheterization revealed patent RCA stent and non-obstructive CAD. She was diuresed to euvolemic state. Inpatient cardiac monitoring, repeat EKGs, and an 8 day holter monitor showed no arrhythmia or conduction abnormality. Although clinical suspicion for CS was low due lack of arrhythmia, preserved EF and several independent risk factors for HFpEF. FDG-PET was performed to rule out CS and revealed defects in basal anteroseptal and apical lateral regions consistent with sarcoid related fibrosis (Figure 1). Disseminated disease was seen in mediastinal and splenic regions. The patient was started on prednisone and methotrexate therapy for immunosuppressive treatment of CS. Conclusions: In patients with known sarcoidosis, a high index of suspicion for CS is required due to lack of clear diagnostic guidelines. Although diagnostic criteria frequently highlight systolic heart failure and arrhythmias, CS can present in patients with HFpEF, and the presence of other risk factors for diastolic heart failure should not preclude CS investigation.
Abstract 12085: Emergency Heart Failure Mortality Risk Grade (EHMRG) Score Quintiles Correlate With Short and Long-Term Healthcare Costs
Authors: Harsh Parikh, Ava John-Baptiste, Steven Chu, Maria Santiago, Jiming Fang, Peter C Austin, Joan Porter, Heather J Ross, Douglas S Lee
Journal: Circulation (2023)

Introduction: The use of the EHMRG model in the emergency department (ED) has been demonstrated to improve outcomes for patients presenting with acute heart failure (HF). It is unknown if the EHMRG model also correlates with healthcare costs, which has not been examined in other HF risk models. Hypothesis: We hypothesized that patients with higher EHMRG risk scores, i.e., sicker, would have higher costs of care in short-term (30-day) and longer-term (up to 2 year) time horizons. Methods: We examined direct costs of care from a health payer perspective using the original EHMRG derivation cohort of 11,857 patients hospitalized with acute HF in Ontario, Canada (from 2004) and linking to population-based case-costing databases. Costs were stratified by the quintiles of the EHMRG risk score (Q1 = lowest risk, Q5 = highest risk). Costs (in 2021 Canadian dollars) were categorized into hospital, physician, drug, home care, long term care (LTC), and other costs. Results: Patients in the lowest EHMRG risk quintile (Q1), compared to higher quintiles (Q2-Q5) had lower total cost of care in both the short-term ($8,113 vs $9,442, $10,557, $12,078 and $15,005, p &lt;0.001) and long-term ($46,661 vs $55,904, $58,904, $63,286 and $64,229, p&lt;0.001). This positive correlation between EHMRG risk quintile and cost of care was also observed for hospital costs ($26,388 [Q1] vs $35,659 [Q5], p&lt;.0001) and LTC costs ($1,236 [Q1] vs $6,316 [Q5], p&lt;.0001) at all time intervals, including at 2 years shown here. Physician costs and drug costs were positively correlated with EHMRG risk quintiles at 30 days (physician: $1,241 [Q1] vs $1,762 [Q5], p&lt;0.0001; drug: $219 [Q1] vs $282 [Q5], p&lt;.0001), and negatively correlated at 2 years (physician: $7,943 [Q1] vs $7,175 [Q5], p&lt;.0001; drug: $4,539 [Q1] vs $4,377 [Q5], p&lt;.0001). There was an increasing trend of costs irrespective of the formulation of the EHMRG risk score as 7-day risk quintile, 30-day risk quintile, or 30-day risk tertile. Conclusion: The EHMRG7 risk score was positively correlated with healthcare costs from 30 days to 2 years after initial ED presentation. This novel correlational study demonstrated that in the absence of an associated intervention, higher mortality risk in HF patients portends higher costs in short and long-term follow-up.
Abstract 11760: Prevalence of Atherosclerosis, Heart Failure, and Chronic Kidney Disease Among Patients With Type 2 Diabetes and Management With Diabetes Pharmacotherapy
Authors: Jeff Mohl, Cori R Rattelman, Balmatee Bidassie, Carey Robar, Jigar R Rajpura
Journal: Circulation (2023)

Introduction: Individuals with type 2 diabetes (T2D) are at increased risk for cardiovascular disease (CVD), the leading cause of mortality in these patients, and chronic kidney disease (CKD). Recent clinical guidelines recommend the use of diabetes pharmacotherapy with cardiovascular or renal benefits in patients with T2D and CVD or CKD. Aims: The aims of this study were to 1) assess the prevalence of established CVD, including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), and CKD, and 2) determine the proportion of patients prescribed CVD/CKD-protective diabetes pharmacotherapy (SGLT-2i and GLP1-RA) among individuals with T2D receiving primary care in the US. Data: Data for this retrospective, cross-sectional study were obtained from Optum Labs Data Warehouse, which contains de-identified administrative claims and electronic health record data representing a diversity of age, race, and ethnicity across the US. Eligible individuals were aged ≥18 years, had established T2D and were required to have ≥1 outpatient visit with a primary care provider in 2019. Results: This study included 843,119 individuals with T2D receiving care in 2019. Among these patients, the prevalence of CVD was 44.1%, with 41.5% having evidence of ASCVD and 14.4% having evidence of HF, and the prevalence of CKD was 34.6%. The prevalence of these comorbidities increased with age. For individuals who had T2D and ASCVD, HF, or CKD, 14.0%, 11.7% and 15.1%, respectively, were prescribed SGLT-2i or GLP1-RA, relative to 16.8% of patients with T2D without these comorbidities. Additionally, compared with younger patients, comorbid patients older than 65 years were prescribed these therapies at much lower rates. Conclusions: Among patients with T2D and established CVD, 9 of 10 patients had ASCVD: a 3-fold higher prevalence than HF. Less than 17% of individuals with T2D were prescribed a guideline-recommended glucose-lowering treatment with cardiovascular and renal benefits. The data from this study suggest that patients with T2D and CVD/CKD were prescribed less SGLT-2i or GLP1-RA compared to patients with T2D without these comorbidities. This trend was concerning among older patients, who had both higher rates of these comorbidities and lower prescribing trends.
Abstract 12151: Impact of Psychosocial Risk Factors on the Outcomes of Patients Undergoing Cather Ablation for Atrial Fibrillation
Authors: Siddharth Agarwal, Bilal Munir, Amna Mohyud Din Chaudhary, Vagisha Sharma, Satyam Krishan, Christopher V Desimone, Abhishek Deshmukh, Stavros Stavrakis, Sunny S Po, Sadeer Al-Kindi, Zain Ul Abideen U Asad
Journal: Circulation (2023)

Introduction: There is limited data on how psychosocial risk factors (PSRFs) affect the outcomes of patients undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of PSRFs affects the outcomes of AF ablation and tested this hypothesis using a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were divided into two cohorts based on the presence or absence of ≥1 PSRF. PSRFs were divided into 5 domains including limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, and uninsured status. A multivariable logistic regression model was utilized to adjust for confounders. Results: Our cohort included 50,623 AF ablation procedures, of which 21,363 (42.2%) had ≥ 1 PSRF. On multivariable analysis, the presence of ≥ 1 PSRF was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI]: 1.02-1.22; p=0.02), peripheral vascular complications (aOR:1.18; 95% CI: 1.01-1.38; p=0.04), pulmonary complications (aOR:1.16; 95% CI: 1.05-1.29; p&lt;0.01) and neurological complications (aOR:1.42; 95% CI: 1.12-1.78; p&lt;0.01), along with higher odds of 30-day all-cause readmissions (aOR:1.30; 95% CI: 1.19-1.43; p&lt;0.01) and atrial fibrillation/flutter related readmissions (aOR:1.27; 95% CI: 1.08-1.50; p&lt;0.01), 90-day all-cause readmissions (aOR:1.30; 95% CI: 1.20-1.40; p&lt;0.01) and atrial fibrillation/flutter related readmissions (aOR:1.22; 95% CI: 1.06-1.41; p&lt;0.01), and 180-day all-cause readmissions (aOR:1.35; 95% CI: 1.24-1.45; p&lt;0.01) (Figure 1). Conclusion: In conclusion, our data suggest an association between PSRFs and worse in-hospital outcomes along with increased all-cause and arrhythmia-related readmissions in patients undergoing AF ablation.
Abstract 12144: The Association Between High Cardiac Index and Mortality
Authors: Katarina Zeder, Shelsey W Johnson, Laurel Y Lee, Wei Qi, William M Oldham, Gabor Kovacs, Alexander Opotowsky, Ryan J Tedford, Evan L Brittain, Bradley A Maron
Journal: Circulation (2023)

Background: Elevated cardiac index (CI) is implicated in the pathophysiology of heart failure. However, data on the CI hemodynamic spectrum that is associated with adverse outcome are lacking. We hypothesized that elevated CI is associated with increased mortality in patients referred for right heart catheterization (RHC). Methods and Results: We retrospectively assembled data for patients undergoing RHC at Vanderbilt University (1998-2013) with ≥ 1 yr follow-up, excluding patients with low CI (&lt;2.2 L/min/m 2 ) which is known to be associated with increased mortality (N=2,548; age median 60 IQR [50-69] yrs; male, 50%; body mass index [BMI], 29 [25-35] kg/m 2 ). Univariate Cox-regression was used to assess the association between CI (measured by thermodilution) octile and all-cause mortality (N=925 [36%] events, time to event 4.7 [3.1-8.8] yrs). All-cause mortality was 31% higher in the highest CI octile (N=317; 4.1 [3.9-4.7] L/min/m 2 ; HR=1.31 [95%CI: 1.01-1.71], P=0.046) compared to the CI octile with lowest mortality risk (N=311; 3.1 [3.0-3.2] L/min/m 2 ). Patients with CI &gt;4.1 L/min/m 2 were younger (54 [46-63] vs. 60 [49-67] yrs, P&lt;0.001) and had lower BMI (28 [24-34] vs. 31 [26-36] kg/m 2 , P&lt;0.001), pulmonary vascular resistance (1.4 [0.9-2.4] vs. 1.8 [1.3-2.7] WU, P&lt;0.001), and hemoglobin (11.9 [10.3-13.7] vs. 12.7 [11.1-13.8] g/dL, P=0.003); similar mean pulmonary arterial pressure (27 [19-35] vs. 26 [20-36] mmHg, P=0.556), pulmonary arterial wedge pressure (13 [8-18] vs. 13 [9-18] mmHg, P=0.352), frequency of hemodialysis (11% vs. 9%, P=0.259) and hyperthyroidism (2% vs. 1%, P=0.491); but significantly higher frequency of liver cirrhosis (18% vs. 7%, P&lt;0.001) compared to the low risk CI group. The mortality association for CI &gt;4.1 L/min/m 2 remained significant after adjusting for age, sex, liver cirrhosis and hemodialysis (HR 1.34 [95%CI 1.03-1.76], p=0.032). Conclusion: Cardiac index &gt;4.1 L/min/m 2 is associated with a significant increase in all-cause mortality among patients referred for RHC, even after adjusting for established risk factors for high-output heart failure. These data expand the mortality continuum related to CI and support further studies that clarify the clinical phenotype of at-risk patients.
Abstract 11755: Efferocytic Regulator Rab11FIP1 Alleviates Inflammation and Cardiac Remodeling After Myocardial Infarction
Authors: lingfang zhuang, Ruiyan Zhang, Kang Chen, Xiaoxiang Yan
Journal: Circulation (2023)

Introduction: Defective efferocytosis drives cardiac dysfunction after myocardial infarction (MI); however, the underlying molecular mechanisms and regulators of macrophage efferocytosis remain unknown. Hypothesis: This study aimed to explore the modulator and its mechanisms of the continued clearance and degradation of phagolysosomal cargo during MI. Methods: Leveraging macrophage RAB11FIP1 knockout model, flow cytometry and PET-CT technologies, we examined the functional significance of RAB11FIP1 after MI. Moreover, a nanoliposome-linked ssDNA aptamer contained modified RAB11FIP1 mRNA was designed. Results: By comparing the transcriptomic signatures of our scRNA-seq data, we identified RAB11FIP1 was the most sensitively efferocytic gene among all phagosome-related signatures. RAB11FIP1 deficiency resulted in a considerable exacerbation in cardiac function, the accumulation of apoptotic cardiomyocytes and a reduced efferocytosis. RAB11FIP1-loss also led to increased infiltration of CCR2+ macrophages and neutrophils with upregulation of proinflammatory mediators, IL-1β, TNF-α, Ccl2 after MI. In mechanistic studies, RAB11FIP1 defect disabled the recycling of efferocytic receptor, Mertk, further impaired continued macrophages efferocytosis. Moreover, the scRNA-seq data revealed that the regulon activity of XBP1, which acted as the key ER-stress executor, was significantly activated in RAB11FIP1-null hearts, then, the activated XBP1 governed the transcriptional expression of pro-inflammatory mediators after MI. Finally, we constructed a nanoliposome-linked ssDNA aptamer to specifically target macrophages. RAB11FIP1-expressing phagocytes display a striking increase in efferocytosis and decline in inflammation, cardiac remodeling after MI. Conclusions: Collectively, these findings advance the relationship of RAB11FIP1 between macrophage efferocytosis, ER-stress response and the cardiac inflammation.
Abstract 11752: Correlation of Myocardial Work Parameters With Left Ventricular Ejection Fraction in Patients With Chagas Disease From a Quaternary Hospital in Brazil
Authors: Alex dos Santos Felix, Rodolfo De Paula Lustosa, Daniel A Kasal, Helena C Rey, PEDRO P SPINETI, Marcelo I Bittencourt, Felipe N Neves de Albuquerque, Ana Luiza F Sales, Marcia B Castier, RICARDO M MOURILHE ROCHA
Journal: Circulation (2023)

Introduction: Although left ventricular ejection fraction (LVEF) is one important parameter for management of pts with heart diseases and a major prognostic factor in Chagas cardiomyopathy (CC), it has great variability. Myocardial Work (MW) is a new promising technique which integrates afterload to longitudinal strain analysis using noninvasive blood pressure (NIBP) values, calculating pressure x strain loops (PSL). Correlation of MW with LVEF in pts with CC is unknown. Hypothesis: LV MW may have good correlation with LVEF in pts with Chagas Disease (CD). Methods: We included 39 consecutive pts(74,4% women, median age 68,8±9,7) followed in a quaternary Brazilian hospital with diagnosis of CD, dividing them into groups based on the stages of heart disease: Group 1: normal Echocardiography (Echo) and ECG, Group 2: pts with alterations in ECG and/or Echo with preserved LVEF, Group 3: pts with reduced LVEF with or without heart failure. A comprehensive Echo was performed in all pts, and LVEF was measured by 2D biplane Simpson. LV MW was measured using speckle-tracking echo, using NIBP as an afterload index for generation of PSL by a specific software. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were classified in group 1, 14 (35,9%) in group 2, and 14 (35,9%) in group 3. There was a very strong correlation of LVEF with GWI (p&lt;0,001; r=0,781), GCW (p&lt;0,001; r=0,813), a strong correlation pf LVEF with GWE (p&lt;0,001; r=0,661) and a weak correlation of LVEF with GWW (p=0,046; r=-0,332). All MW parameters, except from GWW had good sensitivity and specificity to detect pts with reduced LVEF, with best cutoff for GWI = 1501mmHg% (AUC=0,980) and GCW=1719,5mmHg% (AUC=0,986). Conclusions: MW parameters, except from GWW, had strong correlation with LVEF in this subset of pts with CD, with good performance for the detection of LVEF≤52%, with high sensitivity and specificity.