tbuckley/cabot-search huggingface dataset:
Abstract 12360: Association of Coagulation Factor XI Levels With Cardiac Function and Cardiovascular Events: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yuekai Ji, Michael J Zhang, Wendy Wang, Faye L Norby, Jeremy R Van't Hof, ANNE EATON, Alvaro Alonso, Scott Solomon, Amil M Shah, Lin Y Chen
Journal: Circulation (2023)

Introduction: Coagulation Factor XI (FXI) inhibitors are a promising and novel class of anticoagulants, but a recent animal study showed that FXI has an anti-fibrotic role that ameliorated diastolic dysfunction and heart failure (HF). Whether FXI levels are associated with cardiac function and cardiovascular (CV) events in humans is unknown. Hypothesis: We hypothesize that lower FXI levels are associated with worse cardiac function and higher risk of CV events (HF and atrial fibrillation [AF]). Methods: We included 4,471 participants (mean age 75 years, 57% female, 17% Black) who attended ARIC Visit 5 (2011-2013) with plasma FXI measured by Somalogic and cardiac function measured by echocardiography. HF and AF events were ascertained through 2019. Linear regression was used to assess the association between FXI and cardiac function measures. Logistic regression and Cox proportional hazard model were used to examine the association of FXI levels with prevalent and incident HF and AF, respectively. Result: At baseline, there were 665 and 419 participants with prevalent HF and AF; over a median follow-up of 7 years, there were 643 and 415 incident HF and AF events. Among cardiac function measures, we found significant associations between FXI level and E/A ratio, left atrial (LA) volume index, LA reservoir strain, and LA contractile strain, but not E/e’ ratio, LA conduit strain, left ventricular (LV) ejection fraction or LV global longitudinal strain (Table). Lower FXI levels was associated with a higher odds of prevalent AF but not prevalent HF (Table). No significant associations were found between FXI levels and incident HF or AF. Conclusion: Lower FXI levels are associated with worse diastolic function, LA function and size, and prevalent AF, but not LV systolic function, prevalent HF, or incident HF or AF. More research is needed to assess unwanted effects of FXI inhibition on cardiac function and risk of CV events.
Abstract 12237: All-Cause and Cause-Specific 30-day Readmission After Left Ventricular Assist Device Implantation: Comparing the HeartMate 3 vs Pre-HeartMate 3 Eras
Authors: Muhammad U Almani, Nijat Aliyev, Muhammad Qudrat Ullah, Mohammad S Khan, Stephen J Greene
Journal: Circulation (2023)

Introduction: In recent years, the HeartMate 3 (HM3) has become the most commonly implanted left ventricular assist device (LVAD) for patients with end-stage HF in the United States. We assessed 30-day readmission rates and leading causes of readmission for patients newly receiving an LVAD in the pre-HM3 era compared to the HM3 era. Methods: Using the Nationwide Readmission Database (NRD), all adult admissions (age ≥18) with LVAD implantation from October 2015 - December 2020 were identified. Admissions were excluded if the patient had: died while inpatient, missing data for age, sex, or mortality, transferred to another acute care facility or December admission. Multivariable Cox regression analysis with all-cause and cause-specific readmission within 30 days as the ‘failure event’ and time from index hospitalization discharge to failure event as the ‘time to failure event’ was analyzed. Based on the timing of initial FDA approval of HM3, the study period was divided into two eras: 2015-2017 was defined as the pre-HM3 era and 2019-2020 as the HM3 era. The year 2018 was deemed the transition period and excluded from the analysis. Results: Among 13,867 hospitalizations for LVAD implantations, 57.6% of index hospitalizations were during the pre-HM3 era (mean age= 56 years, men= 77.2%), and 42.4% were during the HM3 era (mean age= 56 years, men= 76.6%). Hazards of 30-day all-cause readmissions were similar in the two eras (Figure 1 Panel A) . LVAD implantation in the HM3 era was associated with lower risks of 30-day readmission with a gastrointestinal (GI) bleed or pump thrombosis and a higher risk of 30-day readmission with an acute kidney injury (AKI) compared to the pre-HM3 era ( Figure 1 Panel B). Conclusion: There was no significant difference in risk of 30-day all-cause readmission after LVAD implantation in the HM 3 and Pre-HM 3 eras. However, implant in the HM3 era was associated with lower risk of readmission with GI bleed and pump thrombosis and higher risk of readmission with AKI.
Abstract 12398: Prognostic Impact of Early Ablation in Patients With Decompensated Heart Failure Accompanied by Atrial Fibrillation
Authors: Arihide Okahara, Shunsuke kawai, Masaki Tokutome, Hirohide Matsuura, kosuke okabe, Masashi Sada, Junpei Itonaga, Eiichi Koga, Hiroshi Kisanuki, Ayano Hara, Kiyohiro Ogawa, Ryuichi Matsukawa, Yasushi Mukai
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, which leads to worse clinical outcomes. Catheter ablation (CA) of AF in younger patients with HF with reduced EF (HFrEF) has become an established treatment option. However, clinical impact of early CA of AF in patients hospitalized for acute decompensated heart failure (ADHF) is uncertain. Hypothesis: This study aims to investigate the prognostic impact of early CA of AF in patients who were hospitalized for ADHF. Methods: Consecutive 234 patients with ADHF requiring in-hospital care accompanying with AF were retrospectively analyzed 2 years after discharge. Patients who underwent CA within 3 months after HF admission (CA group; n=51) and those who did not (optimal medical therapy [OMT] group; n=183) were compared with regards to clinical outcomes. Results: The median age of the studied population was 83 year-old; 72±12 in the CA group and 84±9 in the OMT group. Persistent AF was observed in 92.2% in the CA group and 63.9% in the OMT group. During 2 years after admission, recurrence of AF was observed in 19.6% in the CA group and 82.0% in the OMT group. In the crude study, all-cause mortality and HF mortality were significantly lower in the CA group than in the OMT group (all-cause: hazard ratio (HR) [95%CI]: 0.07 [0.01-0.53], p=0.00074; HF: HR 0.19 [0.07-0.48], p=0.000078; respectively) (Figure A and Figure B). Since the OMT group had severer characteristics including age, sex or NYHA class, a propensity-matched analysis was performed (n=33, each group). All-cause mortality tended to be lower in the CA group (HR 0.19 [0.02-1.67], p=0.13) (Figure C), however, it did not reach to a statistical significance. On the other hand, HF readmission rate was still significantly lower in the CA group even after the propensity-matched analysis (HR 0.17 [0.04-0.59], p=0.0054) (Figure D). Conclusions: CA of AF early after ADHF admission was associated with a better long-term prognosis in patients with HF and AF.
Abstract 12424: Left Atrial Strain and Incident Heart Failure in Older Adults
Authors: Carlo Mannina, Kazato Ito, Zhezhen Jin, Yuriko Yoshida, Cesare Russo, Koki Nakanishi, Mitchell Elkind, Tatjana Rundek, Shunichi Homma, Marco Di Tullio
Journal: Circulation (2023)

Introduction: The prevalence of heart failure (HF) is rising, particularly in older adults. Left atrial (LA) dysfunction is commonly seen in HF, but it is unclear if it predicts onset or contributes to its development. Hypothesis: LA strain reduction is associated with incident HF in the general elderly population, independent of other risk factors and even in the presence of normal LA volume. Aims: We aimed to investigate the association between reduced LA strain (LAε) and strain rate (LASR) and incident HF in older adults without history of HF or atrial fibrillation (AF), adjusting for HF risk factors and echocardiographic parameters. Methods: We examined 795 participants aged ≥55 from the Cardiovascular Abnormalities and Brain Lesions (CABL) study with no history of HF or AF. LAε pos , LASR pos , LASR early-neg , and LASR late-neg were assessed using speckle-tracking echocardiography for global, reservoir, conduit and pump function, respectively. Incident HF was detected through standardized interviews, in-person visits, active hospital surveillance of admission and discharge ICD-9 codes. LA strain's association with incident HF was assessed using a cause-specific hazards regression model, adjusting for HF risk factors, including incident AF. Results: Mean age was 70.9±9.2 years (297 men, 498 women). During a mean follow-up of 11.4 years, 215 participants (27.0%) developed new-onset HF; incident AF occurred in 98 (12.3%). Left ventricular ejection fraction and global longitudinal strain were not associated with new-onset HF (p=0.06 and p=0.23, respectively). All LA strain measures at baseline were significantly associated with new-onset HF (all p&lt;0.01). In multivariable analysis, only LASR late-neg (adjusted HR per SD decrease 2.31, 95% CI 1.12-4.43) remained independently associated with new-onset HF, after adjusting for LA volumes, left ventricular systolic function, and incident AF. LASR late-neg was especially associated with incident HF in participants with normal LA size (HR 8.64, CI 3.10-24.08). Conclusion: Reduced LA strain during atrial contraction is independently associated with new-onset HF in older adults. LA strain measurement may improve HF risk stratification in older adults, even in the presence of normal LA volume.
Abstract 13786: Early Mortality Following Transcatheter Edge-to-Edge Repair of Mitral Regurgitation
Authors: Yong Hao Yeo, Min Choon Tan, Qi Xuan Ang, Boon Jian San, Jia Yean Thong, Justin Lee, Kwan S Lee
Journal: Circulation (2023)

Background: While transcatheter edge-to-edge repair (TEER) is increasingly used, data on risk stratification for predicting early mortality after TEER are scarce. Objective: This study aimed to assess early mortality and analyze the predicting factor of early mortality among patients who underwent TEER. Methods: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the predictors of early mortality. Results: 15,931 patients who had TEER were included in this study; 292 (1.8%) with early mortality and 15,639 (98.2%) without. There was a decreasing trend in early mortality from 1.9% in 2017 to 1.7% in 2020, but it was insignificant (p=0.18). In multivariable analysis, the independent predictors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95% confidence interval [CI]: 1.11-2.22, p=0.01), end-stage renal disease (aOR: 2.34; CI: 1.44-3.79, p&lt;0.01), chronic liver disease (aOR: 4.90; CI: 3.29-7.29, p&lt;0.01), coagulation disorder (aOR: 3.42; CI: 2.32-5.03, p&lt;0.01) and heart failure (aOR: 2.90; CI: 1.39-6.03, p=0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2%) and infection (26.6%), respectively. Conclusion: The early mortality following TEER was low at 1.8%. The independent predictors of early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure. Figure Hazard Curves for Early Mortality after TEER Stratified by Clinical Predictors of Early Mortality.
Abstract 12401: Multidimensional Representativeness of Older Adults With Atrial Fibrillation in Randomized Controlled Trials: Comparing Participants of 12 Oral Anticoagulant RCTs to a Nationally Representative US Cohort
Authors: Sachin J Shah, Timothy Anderson, David Cheng, Joseph S Ross, Richard Hobbs, Stuart Connolly, Michael D Ezekowitz, Carl van Walraven, Daniel E Singer
Journal: Circulation (2023)

Background: Anticoagulant RCTs are thought to have enrolled younger and less comorbid patients with atrial fibrillation (AF) compared to the general population. We developed a representation score summarizing patient characteristics to describe how well RCT participants with AF reflect a nationally representative cohort. Methods: We studied adults &gt;=65 years old with AF by harmonizing two data sources: (1) patient-level data from 12 landmark RCTs testing anticoagulants vs. placebo or antiplatelets from the Atrial Fibrillation Investigators (AFI) consortium and (2) the Health and Retirement Study AF cohort (HRS-AF), a representative cohort of older adults with AF in the U.S. We fit a logistic regression model to estimate the probability of inclusion in the HRS-AF cohort in the pooled sample using age, height, weight, gender, heart failure, hypertension, diabetes, prior stroke, and prior myocardial infarction. This estimate, the Trial Benchmark Score, reflected the probability of belonging to the HRS-AF cohort and ranged from 0 to 1, with higher scores reflecting a greater likelihood of belonging to the HRS-AF cohort. We plotted the distribution of scores for HRS-AF and AFI participants and compared the mean scores using a t-test. Results: Compared to the HRS-AF cohort (n=3542), AFI participants (n=7933) were younger (72 vs. 76yrs, standardized mean difference [SMD] -0.7), more frequently male (64% vs. 46%, SMD 0.3), and had a lower likelihood of prior stroke (19% vs. 23%, SMD -0.4). The mean Trial Benchmark Score differed significantly between the two cohorts (HRS-AF mean 0.47 vs. AFI mean 0.23, p&lt;0.001) ( Figure ). 52% of HRS-AF participants and 12% of AFI participants had a score &gt;0.47 (the HRS-AF mean score). Conclusion: Differences in the Trial Benchmark Scores distributions indicate a substantial difference in the distribution of observable characteristics and that RCT participants were not fully representative of the benchmark population.
Abstract 12481: Comparative Outcomes of Catheter Directed Thrombolysis Plus Systemic Anticoagulation versus Systemic Anticoagulation Alone in the Management of Intermediate-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis
Authors: Akshay Machanahalli Balakrishna, Ruth Ann Mathew Kalathil, SUMA PUSAPATI, Auras R Atreya, Aryan Mehta, Mridul Bansal, Vikas Aggarwal, Mir B Basir, Ajar Kochar, Alexander G Truesdell, Saraschandra Vallabhajosyula
Journal: Circulation (2023)

Introduction: There are limited and conflicting data on the initial management of intermediate-risk (or submassive) pulmonary embolism (PE). Hypothesis: This study sought to compare outcomes of catheter directed thrombolysis (CDT) in combination with systemic anticoagulation (SA) to SA alone. Methods: A systematic search was conducted in MEDLINE, EMBASE, PubMed, and the Cochrane databases from inception to March 1, 2023 for studies comparing outcomes of CDT+SA versus SA alone in intermediate-risk PE. The major outcomes were in-hospital, 30-day, 90-day, and 1 year mortality, minor and major bleeding, and blood transfusion, right ventricular (RV) recovery, and length of stay (LOS). We used random-effects models to aggregate data and to calculate pooled incidence and risk ratios (RR) with 95% confidence intervals (CIs). Results: A total of 15 (two randomized, 13 observational) studies with 10,549 (2,310 CDT+SA and 8,239 SA alone) patients were included. Compared with SA, CDT+SA was associated with significantly lower in-hospital mortality (RR 0.41, 95% CI 0.30 to 0.56, p &lt;0.001), 30-day mortality (RR 0.34, 95% CI 0.18 to 0.67, p =0.002), 90-day mortality (RR 0.34, 95% CI 0.17 to 0.67, p =0.002), and 1-year mortality (RR 0.58, 95% CI 0.34 to 0.97, p =0.04). There were no significant differences between the two cohorts in rates of major bleeding (RR 1.39, 95% CI 0.72 to 2.68, p =0.56), minor bleeding (RR 1.83, 95% CI 0.97 to 3.46, p =0.06), and blood transfusion (RR 0.34, 95% CI 0.10 to 1.15, p =0.08). Conclusions: CDT+SA is associated with significantly lower short-term and long-term all-cause mortality without any differences in major/minor bleeding, in patients with intermediate-risk PE.
Abstract 12439: Abdominal Visceral Fat Area and Density Are Associated With Coronary Artery Calcification: A Cross-Sectional Analysis of the Multi-Ethnic Study of Atherosclerosis
Authors: Amier Haidar, Preethi Srikanthan, Karol E Watson, Matthew A Allison, Richard Kronmal, Tamara B Horwich
Journal: Circulation (2023)

Introduction: The associations of body composition components, including muscle and adipose tissue, and markers of subclinical coronary artery disease are unclear. We examined the relationship between abdominal CT-derived measures of the area and density of fat and muscle with coronary artery calcification (CAC), using data from the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: A randomly selected total of 1,974 MESA participants free of coronary heart disease underwent abdominal CT scans at exams 2 or 3, with the resulting images interrogated for abdominal body composition. Using six cross-sectional slices spanning L2-L5, Medical Imaging Processing Analysis and Visualization (MIPAV) software was used to determine abdominal muscle and fat composition by utilizing appropriate Hounsfield units (HU) ranges. CT chest scans obtained during the exam 1 were used to obtain CAC scores, calculated using the Agatston method and spatially weighted calcium score (SWCS). Multivariable linear regression analysis was performed to assess the relationship between both abdominal visceral fat and muscle area and density to prevalent CAC. Results: A total of 1,089 participants had a CAC&gt;0, with an average CAC score of 310. In the fully adjusted model, for every 10 cm 2 increase in visceral fat area, the likelihood of having a CAC &gt;0 increased by 0.60% (p&lt;0.001). In the minimally adjusted model, abdominal muscle area was significantly associated with CAC&gt;0, which became non-significant in the fully adjusted model. For density of visceral fat , every 1 HU increase (less lipid dense fat tissue), the likelihood of having a CAC score&gt;0 decreased by 0.29% (p&lt;0.05). No significant relationship was observed between density of abdominal muscle and CAC&gt;0. Conclusion: Greater area and higher lipid density of abdominal visceral fat was associated with an increased likelihood of having CAC, while there was no significant relationship between abdominal muscle area or density and CAC. Both the quantity and the quality of fat have associations with an important marker of subclinical atherosclerosis, CAC, and their significance with respect to cardiovascular outcomes requires further evaluation.
Abstract 12344: Effect of Valved versus Non-Valved Conduits in Norwood Procedure on Ventricular Size and Function in Stage I Palliation for Hypoplastic Left Heart Syndrome
Authors: Alexandra N Linder, Halil Beqaj, Nimrod Goldshtrom, Amee Shah, Andrew B Goldstone, David Kalfa, Michael P DiLorenzo
Journal: Circulation (2023)

Background: Mortality in the interstage period remains high in hypoplastic left heart syndrome (HLHS) after introduction of the right ventricle (RV) to pulmonary artery conduit to the Norwood procedure. Prior studies have not shown long term survival benefit with conduits, possibly due to regurgitation and volume load, which may cause decreased RV function. Valved conduits (VC) were introduced more recently to address these limitations. Hypothesis: The goal of the study was to assess differences in RV size and function during the interstage period between patients undergoing Norwood procedure with valved versus non-valved conduits (NVC). We hypothesized that patients with VC would have smaller increases in RV size and improved function compared to those with NVC. Methods: Twenty-five consecutive neonates with HLHS who underwent Norwood procedure with VC were compared to 25 consecutive neonates who underwent Norwood with NVC from 2013 and 2022. Primary outcomes were RV size measured by end diastolic area (EDA) on 4-chamber images and function measured by RV fractional area change and global longitudinal strain. Results: Most patients with VC (96%) did not develop more than mild conduit regurgitation. There was no difference in EDA increase one month post op between groups, but there was a significantly smaller increase in EDA pre-Glenn compared to baseline in the VC group (Table 1). Functional measures were not significantly different during follow up. There was no difference in interstage cardiac events or mortality. Conclusions: Patients with VC at time of Norwood had smaller increases in ventricular size compared to those with NVC, but there were no differences in functional parameters during follow up. It is possible decreased volume load will have a beneficial long term effect on the immature myocardium of infants with HLHS. Larger studies are needed to further examine the hemodynamic benefits of VC in the interstage period and throughout the stages of palliation.
Abstract 13784: Impact of the Variation of Aortomitral Positional Anatomy for the Atrioventricular Conduction Disorder in the Mitral Valve Surgery
Authors: Kazuma Handa, Masashi Kawamura, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Yusuke Misumi, Masaki Taira, Kazuo Shimamura, Shigeru Miyagawa
Journal: Circulation (2023)

Introduction: Advances in cardiac imaging have provided detailed anatomical information, including the variation of the aortic root rotation. This variation affected the distance between membranous septum and right fibrous trigone, that might be synonymous with variation of the conduction system location. However, clinical significance has been unknown. We aimed to analyze the variation of the aorto-mitral position and its relationship of conduction disorder in the mitral valve surgery. Methods: This study included 180 patients underwent simple mitral valve surgery (valve repair: n=159, replacement: n=21). The anatomical variations were classified by preoperative three-dimensional transesophageal echocardiography (3D-TEE), and postoperative occurrence of new conduction disorder was analyzed. Results: As in the image, the variations in the aorto-mitral position were classified into Lateral (14%) or Center appearance (86%) groups, which was further classified to Center (83%), Lateral (14%), or Medial rotation (3%) groups. Atrioventricular conduction disorder was observed as first-degree block (n=24 (13%)) including complete right bundle branch block (n=1 (0.6%)). This disorder newly occurred more in the Lateral appearance compared to the Center (36% vs 10%, p=0.0003). The prolongation of the PR interval (msec) between the pre and postoperative period (ΔPR) was greater in the Lateral appearance than the Center (+17 vs +14, p=0.02). Regarding the aortic root rotation, the conduction disorder occurred in 6%, 27% and 20% patients, and each ΔPR was +2, +16 and +22 of the Center , Lateral , and Medial rotation respectively. Conduction disorder occurred more in the Lateral rotation than the Center (p=0.0017), persisting one year after the surgery (19% vs 2%, p=0.0059). Conclusion: The variation of the aorto-mitral position could be classified by 3D-TEE. The Lateral rotation would be a risk of atrioventricular conduction disorder in the mitral valve surgery.