tbuckley/cabot-search huggingface dataset:
Abstract 12037: Impact of Age on Hospital Outcomes After Catheter Ablation for Ventricular Tachycardia
Authors: Min Choon Tan, Chrystina Kiwan, Yong Hao Yeo, Qi Xuan Ang, Olubadewa Fatunde, Justin Z Lee, Aneesh Tolat, Dan Sorajja
Journal: Circulation (2023)

Background: Catheter ablation for ventricular tachycardia (VT) has been increasingly performed over the past decades. However, the real-world data on the safety profile of this procedure among elderly patients is limited. Objective: This study aimed to evaluate the procedural outcomes and 30-day readmission among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these groups. Results: Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Following the procedure, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days) (35.5% vs 29.3%, p&lt;0.01), non-home discharge (13.4% vs 6.0%, p&lt;0.01), 30-day readmission (17.0% vs 11.4%, p&lt;0.01), and early mortality (5.5% v 2.4%, p&lt;0.01). The median cumulative cost of hospitalization was significantly higher in the elder groups ($40,230 vs. $37,612, p ≤0.01). There was no significant difference in the procedural complications between the two groups. Through multivariable analysis, the elderly group was associated with significantly higher odds of early mortality (OR: 7.50; CI 1.86 - 30.31, p=0.01), non-home discharge (OR: 2.41; CI: 1.93 - 3.00, p&lt;0.01) and 30-day readmissions (OR: 1.58; CI 1.32 - 1.89, p&lt;0.01). Conclusion: Our study suggests that elderly patients have poorer in-hospital outcome in early mortality, non-home discharge and 30-day readmissions following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications.
Abstract 13325: Novel Heterozygous <i>EFEMP2</i> Variant Detected in a Patient With Bilateral Internal Carotid Artery Dissection and Oligodontia
Authors: Olivia Millay, Mary B Sheppard, Liisa Bergmann, James Hartsfield
Journal: Circulation (2023)

Cutis laxa is a rare connective tissue disorder characterized by sagging or inelastic skin. This phenotype is caused by multiple genotype variants. Biallelic variants in the EFEMP2 gene cause cutis laxa subtype IB characterized by aortic aneurysm, arterial tortuosity, arterial stenosis, joint laxity, arachnodactyly, emphysema, and retrognathia. EFEMP2 encodes fibulin-4, an extracellular matrix protein involved in elastogenesis and modulation of TGF-beta signaling. To date, monoallelic variants in EFEMP2 have not been described as pathogenic. Furthermore, oligodontia has not been associated previously with variants in EFEMP2 . We describe a 67-year-old male with a past medical history of left distal internal carotid artery (ICA) pseudoaneurysm and dissection, right distal ICA dissection, arterial tortuosity, and oligodontia who was found to have a heterozygous variant of uncertain significance in EFEMP2: c.1279_1289del11, p.Arg427CysfsX27. The variant has not been observed previously in large population cohorts and causes a shift in reading frame that substitutes the carboxyl terminal 17 amino acids with 26 alternative amino acids. This carboxyl terminal variant of EFEMP2 has been predicted to interact with PITX2 in yeast two-hybrid analyses. Furthermore, variants in PITX2 have been associated with dental agenesis, including oligodontia. We hypothesize that heterozygous variants in EFEMP2 represent a new syndrome characterized by arteriopathy and dental agenesis.
Abstract 16885: Progression of Aortic Valve Stenosis in Atrial Fibrillation versus Sinus Rhythm: Implications for Clinical Practice and Severe Aortic Stenosis Diagnosis
Authors: Katarina L Fabre, Vuyisile T Nkomo, Saki Ito, Bradley R Lewis, Sorin V Pislaru, William R Miranda, Jae K Oh
Journal: Circulation (2023)

Introduction: Rate of aortic stenosis (AS) progression in patients with concurrent atrial fibrillation (AF) has not been previously described. Objectives: To describe changes over time in aortic valve area (AVA) and associated hemodynamics during AS progression in patients in AF versus sinus rhythm (SR). Methods: Patients with AVA ≤ 1 cm 2 and preserved left ventricular ejection fraction ≥50% were identified from the Mayo Clinic Echocardiographic Laboratory Database. Serial echocardiograms prior to the development of AVA ≤ 1 cm 2 (Time 0) were examined. Inverse probability weighting was used for statistical analysis. Results: A total of 166 patients were included (SR=79 and AF=87), mean age 78.1 ± 7.8 years, females 31%. The rates of AVA reduction (-0.14±0.01 vs -0.12±0.01 cm2/year, p=0.31) and increase in trans-aortic peak velocity (+0.23 ± 0.02 vs +0.22 ± 0.02 m/sec, p=0.55) and mean gradient (MG) (3.9 ± 0.3 vs 3.8 ± 0.4 mmHg, p=0.83) did not differ between AF and SR (Figure 1). However, AF was associated with systematically lower forward stroke volume index (SVi), peak velocity and MG for the same AVA compared to SR (p&lt;0.04 for all) throughout AS progression. When AVA reached 1 cm 2 , SVi (38.8±6.6 vs 45.7 ±8.9, p=0.02), peak velocity (3.9 ± 0.6 vs 4.1 ± 0.6 m/sec, p=0.04) and MG (36.6±10.9 vs 41±12.8 mmHg, p=0.03) were lower in AF compared to SR. Conclusions: The rate of AS progression was not different in AF versus SR. However, forward flow was systematically lower in AF resulting in discordant AS during AS progression and when AVA reached 1 cm 2 . Doppler velocity and MG criteria for severe AS appear to be lower in AF versus SR which has implications for timely diagnosis of severe AS and patient management.
Abstract 129: Gender Differences and Receipt of Telephone Cardiopulmonary Resuscitation of Suspected Out-of-Hospital Cardiac Arrests
Authors: Audrey L Blewer, Monique A Starks, Heather King, Lauren Hart, Lee Van Vleet, Charlotte Patterson, Pedro Altamirano, Fahad Siddiqui, Truls Ostbye, Janet A Prvu, Anjni Joiner
Journal: Circulation (2023)

Introduction: Women receive bystander cardiopulmonary resuscitation (CPR) less frequently in public. The gender of the person calling 911 and gender of the telecommunicator may influence receipt of telephone CPR for women with suspected out-of-hospital cardiac arrests (OHCA). Objectives: We sought to assess whether gender of the caller was associated with women’s receipt of CPR for suspected OHCA. Secondarily, we examined gender of the telecommunicator and the receipt of CPR by women with suspected OHCA. We hypothesized that receipt of CPR for women patients will be less when the caller is a woman compared to when a caller is a man, while gender of the telecommunicator will not affect the receipt of CPR by patient gender. Methods: We conducted a retrospective study of 911 calls of suspected OHCAs in Durham, NC (08/1/2021-10/31/2021). Calls were professionally transcribed. A database was created of the calls including gender of the caller, telecommunicator, and patient (assigned by coder as woman/man/other), as well as characteristics of initiation and receipt of CPR. Gender of the caller and gender of the telecommunicator were examined for their association with gender of the patient. Data were analyzed descriptively. Results: Eighty-eight calls were examined, representing 82 patients. Excluding pediatric arrests (&lt;18 years old) and healthcare facility arrests, 79 were included. Of those, 36% of patients were women, mean age was 58±20, and 39% received bystander CPR (33% of women, 46% of men). Sixty percent of the callers were women and 70% of the calls were conducted by a women telecommunicator. Of the calls made by women, 25% of women patients received CPR compared to 48% of men. In contrast, of the calls made by men, 40% of women patients and 40% of men patients received CPR. Similarly, of the telecommunicators that were men, 40% of women patients and 40% of men patients received CPR. Of the telecommunicators that were women, 30% of the women patient’s received CPR compared to 47% of the men patients. Conclusion: Gender of the caller and telecommunicator may influence the likelihood of women’s versus men’s receipt of CPR. Further research is needed to understand whether gender bias impacts these interactions and what types of interventions could improve equity.
Abstract 18683: Prevalence of Obesity in Transgender Adults and Its Impact on Major Adverse Cardiac and Cerebrovascular Events and Pulmonary Embolism: A Population-Based Analysis
Authors: Adhvithi Pingili, Praveena Sunkara, Roopeessh vempati, Hasmitha J Madhavaram, Madhusha Vemula, Mohit Lakkimsetti, Ishita Vasudev, Jyotsna Gummadi, Gurbina Sagoo, Mounica Majooju, Athmananda Nanjundappa, Sandeep Singh, Rupak Desai
Journal: Circulation (2023)

Introduction: Although obesity and its impact on major adverse cardiac and cerebrovascular events (MACCE) and pulmonary embolism(PE) have been extensively studied, little is known about obesity’s impact on MACCE and PE in the transgender population. Through this study, we sought to establish the prevalence of obesity and its impact on MACCE outcomes and PE in this population subset. Methods: Using the National Inpatient Sample 2020 database, we identified admissions of transgender patients or patients with prior sex reassignment surgery using ICD-10 CM Codes. Later, all these patients were divided into obesity and non-obesity cohorts. Multivariate regression analysis was then performed for in-hospital MACCE and PE to calculate the odds ratio (OR). Predictors for MACCE were also identified in transgender patients with obesity. Results: In 2020, 19,345 transgender patients or patients who had sex reassignment surgery were admitted to the hospital; 16,390 (84.7%) had no obesity, and 2,955 (15.3%) had obesity. In the obesity cohort, 64.5% of patients had a mean age between 18-44 years, 66.5% were white, 47.9% were transgender males, and 52.1% were transgender females. The most common comorbidities include hypertension (43.5%), diabetes (32.5%), and chronic pulmonary disease. (27.7%). Among the transgender patients with obesity, 5.4% had MACCE events, and 1.2% had cardiac arrest. A statistically significant association was observed in MACCE [OR 2.1, 95% confidence interval (CI) 1.24-3.55, p=0.006] and cardiac arrest (OR 3.92, 95% CI 1.11-12.63, p=0.022 among obesity cohort, with age being the important predictor of MACCE. However, no statistically significant association was observed in acute myocardial infarction (OR 1.82, 95% CI 0.8503.93, p=0.125), acute ischemic stroke (1.34, 95% CI 0.39-4.62, p=0.638) and PE (2.18, 95% CI 0.83-5.72, p=0.113). Conclusion: We observed increased odds of MACCE and cardiac arrest in transgender patients with obesity in our large population-based analysis. This observation could be a result of hormonal treatment that transgender adults receive or associated disparities with transgender care. Further large-scale studies are needed to understand the impact of obesity and MACCE events, and PE in this population.
Abstract 15270: Macrophage ADAR1 Regulates Atherosclerosis Development Through Editing-Independent Degradation of PPAR-γ
Authors: Dunpeng Cai, Takashi Murashita, John Markley, Shiyou Chen, Ken Fujise, Douglas K Bowles
Journal: Circulation (2023)

Background: Macrophage activation and vascular inflammation play important roles in atherosclerosis. Non-editing functions of adenosine deaminase acting on RNA (ADAR1) in macrophage activation and atherosclerosis remain elusive. Methods: Nonvascular ADAR1 in atherosclerosis progression was investigated via aortic transplantation and bone marrow transplantation. ApoE-/- mice combined with macrophage-specific ADAR1 deficiency were used to determine macrophage-specific roles of ADAR1 in atherosclerosis. Human coronary atherosclerotic specimens were utilized to establish the relevance to human atherosclerosis. Moreover, a humanized atherosclerosis model was created to examine the influence of human macrophages in human arteries. Results: ADAR1+/– attenuates atherosclerosis. Allograft transplantation of wild-type abdominal aorta into ADAR1+/– recipient mice promoted atherosclerosis. Likewise, bone marrow transplantation from wild-type mice to ADAR1+/– recipient mice negated the protective effects of ADAR1+/–, suggesting that nonvascular ADAR1 is instrumental for atherosclerosis progression. ADAR1 deficiency in hematopoietic cells lessened the prevalence and severity of atherosclerosis, and impeded macrophage infiltration, foam cell formation, and aortic wall inflammation. Mechanistically, ADAR1 deletion deterred classical macrophage activation and foam cell formation via downregulation of PPAR-γ, which was mediated by enhancing ubiquitination and further degradation of PPAR-γ. Importantly, ADAR1 was upregulated in macrophages in human atherosclerotic lesions. Transplantation of ADAR1-deficient human monocytes, rather than their wild-type counterparts, into hyperlipidemic immunodeficient mice suppressed the formation of atherosclerosis in transplanted arteries from patients undergoing coronary artery bypass grafting surgery due to coronary artery blockade by atherosclerotic plagues. Interestingly, ADAR1 suppression in macrophages noticeably augmented the anti-atherosclerotic effect of the PPAR-γ agonist rosiglitazone. Conclusions: These results demonstrate that noncanonical ADAR1 plays an essential role in the regulation of macrophage activation and atherosclerosis development.
Abstract 15728: Incidence and Impact of Right Ventricular Dysfunction in the Outcomes of Septic Shock
Authors: Lekhya Raavi, Sadhana Jonna, Shahin Isha, Anna Jenkins, Abby Hanson, Arvind Balavenkataraman, Aysun Tekin, Vikas Bansal, sean M caples, Syed Khan, Nitesh K Jain, Rodrigo Cartin-Ceba, Bhavesh M Patel, Ricardo Diaz Milian, Carla P Venegas, Anna B Shapiro, Anirban Bhattacharyya, Sanjay Chaudhary, Sean P Kiley, Quintin J Quinones, Neal M Patel, Pramod K Guru, Pablo M Franco, Archana Roy, Devang Sanghavi
Journal: Circulation (2023)

Introduction: Sepsis and its associated systemic inflammatory response syndrome in the heart can lead to septic cardiomyopathy. We aim to explore new onset cardiac dysfunction in septic shock patients and its association of right heart dysfunction with hospital outcomes. Hypothesis: Early development of correct ventricular abnormalities due to septic shock may lead to worse hospital outcomes. Methods: We conducted a retrospective study of 102 patients who were hospitalized at the Mayo Clinic between August 2018 and September 2022 with septic shock and had at least one pre-sepsis echo (within one year before admission) and one post-sepsis echo (within seven days of access). Information on patient demographics, comorbidities, echo parameters, and outcomes was collected from our sepsis database and retrospective chart review. Categorical variables were described as percentages and compared by Chi-square test, and continuous variables as medians and compared using an independent sample t-test. Statistical analysis was performed using BlueSky Statistics v10.3.1. Results: Our study included 102 patients with a median age of 68 (55, 78) years, the majority being men (68%) and Caucasians (80%). Between pre- and post-sepsis echos, there was a noticeable decrease in LVEF (60% vs 50.5 %; p=0.002). Moreover, there was an increase in reduced RV function (31.6% vs. 62.6%, p&lt;0.001), reduced LV function (56.5% vs. 85.2%, p=0.048), and RV dilatation (35.8% vs. 51.5%, p=0.03). There was also a noticeable decrease in IVC collapsibility of more than 50% (65.9% vs 22.9%, p&lt;0.001). There was no significance in terms of demographics, comorbidities, and baseline vitals and labs among patients with RV dysfunction and without RV dysfunction except for a lower LVEF (49% vs 62 %, p= 0.004) and decreased &gt;50 % IVC collapsibility (14.5% vs 48%, p=0.005) in RV dysfunction group. We found no differences in hospital mortality, ICU and hospital LOS, or mechanical ventilation requirements amongst patients with RV abnormalities in function and size. Conclusions: Our retrospective study shows that abnormalities in RV function and RV size are commonly observed in the initial week of septic shock. However, such RV abnormalities did not translate into worse hospital outcomes.
Abstract 12127: Diagnostic Performance of Fractional Flow Reserve, Instantaneous Wave-Free Ratio and Quantitative Flow Ratio, on the Same Patient and Procedure
Authors: Cesar Alejandro Rodriguez Salinas, Allan Mendez Rodriguez, ENRIQUE PONCE DE LEON, Emma Puron Gonzalez, Jose R Azpiri
Journal: Circulation (2023)

Introduction: Contemporary percutaneous coronary intervention (PCI) seeks precision and physiological assessment of coronary artery stenosis. Fractional Flow Reserve (FFR) is currently the gold standard for lesion physiology assessment; however, it's invasive and expensive. Other modalities, such as Quantitative Flow Ratio (QFR) and Instantaneous Wave-Free Ratio (iFR), can also determine the functional repercussion of coronary stenosis less invasively. Hypothesis: The results of FFR, iFR, and QFR of the same lesion, obtained during the same PCI, demonstrate the significant diagnostic capability of iFR and QFR, compared with FFR. Methods: Retrospective and unicentric study with stable chronic heart disease patients who underwent PCI. For every angiographic lesion, FFR, iFR and QFR were realized during the PCI. QFR was performed by an X-ray technician, blinded to the FFR and iFR results. A descriptive analysis was performed, as well as a correlation between the three measurements with Pearson’s r, chi-square, and ROC curve; and Bland-Altman plot for the results of FFR and QFR. Results: Thirty-six lesions of 27 patients were analyzed. For FFR, stenosis was considered significant when the result was &lt;0.80, obtaining 17 lesions (52%) as significant; for iFR, it was &lt;0.89, obtaining 14 significant lesions (38%); and for QFR, it was &lt;0.85, resulting in 19 (52%) significant lesions. Considering that FFR is the actual gold standard, a ROC curve was used to analyze QFR, were the best cutoff value was 0.88 with a sensitivity of 88% and specificity of 64% (AUC of 0.86, 95% CI 0.736- 0.991, p&lt;0.001), while for iFR the best cutoff value was 0.90 with a sensitivity of 82% and specificity of 74% (AUC of 0.85, 95% CI 0.722-0.984, p&lt;0.001). Pearson’s r revealed a significant correlation between FFR-iFR (r=0.6, p&lt;0.001), FFR-QFR (r=0.58, p&lt;0.001), and QFR-iFR (r=0.62, p&lt;0.001). Bland-Altman plot showed no significant difference between the data obtained with FFR and QFR. Chi-square test determined (p&lt;0.001) that the three angiographic methods had a good correlation in determining whether a lesion was significant. Conclusion: The study demonstrated the significant diagnostic capability that the QFR and iFR methods have, when compared against the current gold standard FFR.
Abstract 15896: Disparities in Awareness and Treatment Among Women With Hypertension: Insights From the American Heart Association Research Goes Red Registry
Authors: Megan M McLaughlin, Alexis Beatty
Journal: Circulation (2023)

Introduction: Hypertension is a significant modifiable risk factor for cardiovascular disease among women in the United States. We sought to evaluate whether health concerns, awareness, and treatment of hypertension differed by race/ethnicity and other demographic characteristics in a national cohort of women. Methods: We used data from participants with self-reported hypertension enrolled in the AHA Research Goes Red registry, an online platform powered by Verily, who responded to the Research Goes Red questionnaire. We analyzed differences in health concerns, awareness of blood pressure (BP) and cholesterol levels, and treatment using Chi-squared tests. Results: Of 6,170 women who responded as of February 2023, 1,835 (30%) reported a history of hypertension. The top health concerns reported among women with hypertension were weight (17%), access to care / paying for healthcare (16%), and hypertension (13%). Health concerns varied significantly by age and race/ethnicity; younger women and Black and Hispanic women were more likely to report hypertension as their top concern (p-value &lt;0.001). Among women with hypertension, 77% reported knowing their BP, 33% reported knowing their cholesterol levels, and 90% reported being on an anti-hypertensive. Black and Hispanic women were less likely to know their BP (p-value 0.003) and cholesterol (p-value 0.001) compared to White women. Treatment for hypertension did not vary significantly by race/ethnicity, income, or education (Table 1). However, younger women were less likely to be treated (p-value &lt;0.001); only 58% of women 18-29 years old were on anti-hypertensives. There were also disparities in treatment by employment status (p-value 0.002) and among uninsured women (p-value 0.046). Conclusions: In this national cohort of women with hypertension, gaps and disparities exist in awareness and treatment of hypertension. This analysis highlights targets for quality improvement in hypertension care for women.
Abstract 17669: Prevailing Racial, Regional, and Income-Based Disparities in Cardiovascular Outcomes in Postmenopausal Women Hospitalized With SARS-CoV-2 in 2020
Authors: Shaylika Chauhan, Dhayashri Dhavapalani, Sidhartha G Senapati, Manoj R Allala, Viraj R Shah, Kamya U Thakkar, Pavan Vihar Reddy Podduturi, Hem Shah, Abhiram Rao Damera, Ananth V Guddeti, Rupak Desai
Journal: Circulation (2023)

Introduction: Racial, regional, and income disparities have been shown to impact cardiovascular outcomes in postmenopausal women with SARS-CoV-2. Addressing these disparities can improve healthcare equity and outcomes for this vulnerable population. Methods: A retrospective cohort study utilized data from the National Inpatient Sample (NIS)-2020 to examine female patients aged over 55 years who were admitted to hospitals in 2020. The study focused on primary endpoints, specifically major cardiac and cerebrovascular events (MACCE) including all-cause mortality, AMI, cardiac arrest, and stroke. Multivariable logistic regression was used to evaluate the association between demographic factors and cardiovascular outcomes, after controlling for confounding variables. Results: Of the total 547,225 postmenopausal women hospitalized with SARS-CoV-2, 19.8% had MACCE. Racial disparities were significant, as Native American, Hispanic, Asian and African American women exhibited higher rates of MACCE compared to Caucasian women, with odds ratios (OR) of 1.63 (95% CI: 1.33-1.98, p&lt;0.001), 1.25 (95% CI: 1.18-1.32, p&lt;0.001), 1.17 (95% CI: 1.07-1.28, p&lt;0.001), and 1.11 (95% CI: 1.06-1.17, p&lt;0.001), respectively. Regional variations were also observed, with the Northeast region demonstrating a higher prevalence of cardiovascular complications compared to the West (OR: 1.22, 95% CI: 1.14-1.32, p&lt;0.001). Additionally, income level played a significant role, as women from the first- and second-income quartiles had higher MACCE rates compared to those in the fourth quartile (OR: 1.19, 95% CI: 1.12-1.26, p&lt;0.001; OR: 1.09, 95% CI: 1.03-1.15, p&lt;0.001). Conclusions: This study reveals significant racial, regional, and income disparities in cardiovascular outcomes among postmenopausal women with SARS-CoV-2. Targeted interventions and further research are necessary to improve healthcare equity and outcomes in vulnerable populations.