tbuckley/cabot-search huggingface dataset:
Abstract 11518: Patient Reported Outcomes Measures Are Infrequently Used in Clinical Studies of Heart Transplant Recipients
Authors: Melissa A Austin, Nosheen Reza
Journal: Circulation (2023)

Introduction / Background: The goals of heart transplantation (HT) are to improve symptoms, restore quality of life, and extend survival. Clinical trials in HT recipients have largely focused on objective outcomes such as measures of cardiac function and survival; however, a paucity of data exists regarding the use of patient reported outcome measures (PROMs) as outcomes in these studies. Aims: We aimed to characterize the use of PROMs in registered clinical trials of HT recipients. Methods: All clinical studies of adult HT recipients were queried from ClinicalTrials.gov, and studies were stratified by inclusion of PROMs. Studies reporting PROMs were identified via specific search terms using the “outcomes measures” field. Summary statistics compared characteristics of studies that did versus did not report PROMs. Results/Data: Between November 1999 and August 2022, 227 studies of HT recipients were registered on ClinicalTrials.gov. At least one PROM was reported in 11% (n=24/227) of registered studies. Studies reporting PROMs were more likely to be conducted outside of the United States (91.7% vs 54.2%, p&lt;0.001) and report a greater number of total primary/secondary outcomes (PROMs: median 7 [IQR: 4, 9] vs. No PROMs: median 3 [IQR: 2, 6]; p&lt;0.001). The majority of studies reporting PROMs (58.3%) were initiated after 2020. Twenty-one distinct PROM tools/domains were reported as outcome measures, with the Short Form Health Survey 36 being most frequently used (n=10/24). Thirteen of the 21 PROMs included questions assessing mental health, whereas only three PROM tools were cardiac-specific (Figure). Conclusions: Only about one in ten registered clinical trials of HT recipients include PROMs, and mental health was the most commonly assessed domain when a PROM was included. Development and validation of PROM tools is needed to assess the multifaceted nature of health-related quality of life in HT recipients.
Abstract 12362: High Rates of Mortality in Uganda Following Acute Rheumatic Fever: Findings From a Community-Based Prospective Cohort Study
Authors: Scott H Wirth, Jafesi Pulle, Jang Dong Seo, Doreen Nakagaayi, Craig Sable, Asha C Bowen, Tom Parks, Jonathan Carapetis, Emmy Okello, Andrea Z Beaton, Emma Ndagire
Journal: Circulation (2023)

Introduction: Rheumatic heart disease (RHD) is the largest contributor to cardiac mortality in children worldwide. Little contemporary data exist on its antecedent illness, acute rheumatic fever (ARF). There is an urgent need to understand outcomes following ARF in RHD-endemic settings. We aimed to describe medium-term mortality, disease recurrence, and change in carditis among Ugandan children following ARF diagnosis, and to identify correlates of mortality. Methods: We conducted a prospective cohort study of children diagnosed with definite ARF in 2017-2020 during a community-based incidence study. Patients were enrolled in a national registry and followed with annual review, most recently in August 2022. Kaplan-Meier (KM) survival analysis was used to describe all-cause mortality and individual Cox proportional hazards regression models were used to identify correlates of death. Descriptive statistics were used to characterize changes in carditis. Results: Among 135 children with definite ARF, 22/135 (16.3%) experienced death, 19/135 (14.1%) cardiac death, 5/135 (3.7%) ARF recurrence, and 5/135 (3.7%) surgery over a median (interquartile range) of 4.25 (3.4, 5.1) years. KM analysis saw 14/22 (63.6%) of deaths occur by one year, 16/22 (72.7%) by two years, and 20/22 (90.9%) by three years. The presence of moderate/severe carditis (HR 14.1, 95% CI 4.2, 47.7) and PR prolongation (HR 3.9, 95% CI 1.5, 9.9) at diagnosis was associated with increased cardiac mortality. Among 107 survivors included in echocardiographic sub-analysis, 27/107 (25.2%) had improvement in carditis, 70/107 (65.4%) no change, and 10/107 (9.4%) progression. Conclusions: These are the first contemporary data from sub-Saharan Africa reviewing medium-term outcomes following ARF. Adverse outcome rates exceeded those reported elsewhere. Most decedents already had advanced cardiac involvement upon first ARF diagnosis, as evidenced by PR prolongation and high-grade carditis, suggesting a history of prior undiagnosed ARF recurrences that had already compounded into RHD. These data indicate that a high burden of ARF exists in the community that is undetected by current methods, emphasizing the need for better point-of-care diagnostics to improve early ARF detection.
Abstract 11817: Calculating Aortic Root Z- Scores With Ideal Body Weight Reclassifies Risk in Overweight and Obese Patients
Authors: Radhika Ghosalkar, Kevin John, Jing Li, Rachael Steinhauer, Benjamin S Wessler, Ayan R Patel, Brian C Downey
Journal: Circulation (2023)

Introduction: Indexing transthoracic echocardiography (TTE) aortic root diameter (AoR diam) measurements using body surface area (BSA) is important in children and small adults in whom non-indexed values may under detect dilation. However, the commonly used formula for expected AoR diam uses actual body weight, which may bias results in obese adults as AoR diam does not increase with body weight. Z-scores compare a patient’s AoR diam relative to an age, size, and sex specific population mean such that z- score = (observed AoR diam - expected AoR diam) /0.261. A normal AoR diam z-score is -2 ≤ z-score ≤2. Hypothesis: We hypothesize that using ideal body weight (IBW) in place of actual weight when calculating z-score reclassifies a significant proportion of overweight and obese patients with z-score &lt; 2 to z-score ≥2. Methods: We performed a retrospective review of all patients with a TTE at Tufts Medical Center in 2022 and Ao root diam ≥ 4 cm. We excluded patients &lt; 20 years old and those with inadequate TTE images or missing aortic measurements. Expected AoR diam and z-scores were calculated using both actual weight and IBW. A z-score difference, z diff = z actual weight - z ideal weight , was calculated. Results: 485 patients met our study criteria with a subset of 352 patients with BMI ≥ 25. The z diff was significantly different from zero across all BMI groups (p = 0.0003) and in the subset with BMI ≥ 25 (p&lt;0.001). 17.9% of patients with BMI ≥ 25 with z actual weight &lt; 2 were reclassified to z ideal weight ≥ 2 (p&lt;0.001) compared with 2.2% of patients with BMI &lt; 25 (p&lt;0.001). Among AoR diam subgroups of 4 - 4.5 cm, &gt; 4.5 - 5 cm, and &gt; 5 cm, all reclassification occurred in the 4 - 4.5 cm group. Within the 4 - 4.5 cm group, 24.1% of patients with z actual weight &lt; 2 reclassified to z ideal weight ≥ 2. Conclusions: Compared to current methods using actual weight, the use of IBW to calculate Ao root z-scores reclassifies nearly 2 in 10 patients with BMI ≥ 25 to Ao root dilation. Among patients with Ao root diam of 4 - 4.5 cm, nearly 1 in 4 are reclassified as dilated by z-scores calculated with IBW. Such reclassification would impact clinical decisions about increased surveillance and/or treatment. Further studies are needed to determine the optimal approach to indexing Ao root size and the implications for management.
Abstract 12712: Safety of Latex Containing Swan-Ganz Catheters in Patients With Cutaneous Hypersensitivity to Latex
Authors: Brady Houtz, Kellen J Round, Paul J Slota, Michael L Scharf, Megan K Ford, David L Fischman, mahek shah, Nicholas J Ruggiero, Alec Vishnevsky, Jordan Price, Michael P Savage
Journal: Circulation (2023)

Introduction: Hypersensitivity to latex is common. Balloon-tipped right heart catheters are typically made from latex. Latex-free catheters while available have limitations including the need for large sized vascular sheaths. It is unknown if latex balloon catheters can be safely used in patients who have cutaneous reactions to latex. Goals: The goal of this study was to assess the safety of using latex-containing catheters for right heart catheterization (RHC) in patients with a prior history of cutaneous allergy to latex. Methods: Electronic medical records and cardiac catheterization procedure database identified 127 consecutive patients with a history of cutaneous hypersensitivity (rash, urticaria) to latex who underwent RHC with balloon-tipped catheters. Patients with known anaphylaxis to latex were excluded. The primary outcome was the occurrence of periprocedural hypersensitivity reactions. Outcomes of patients with latex-containing catheters (LC Group, n=99) were compared to patients with latex-free catheters (LF Group, n=28). Results: The study population consisted of 28 men and 99 women, aged 65 + 14 years. Indications for RHC were heart failure in 48 (38%), pulmonary hypertension in 25 (20%), cardiomyopathy in 19 (15%), valvular heart disease in 19 (15%), unexplained dyspnea in 13 (10%), and heart transplant in 2 (2%). LC and LF patients had comparable demographics, cardiac risk factors, and indications for RHC. In-body catheter exposure times in the LC and LF groups were 8.6 + 5.0 and 9.7 + 6.1 minutes, respectively (p=ns). Venous sheath sizes were smaller in the LC group; sheaths &lt; 5 Fr were used in 52/99 (53%) of the LC group vs. 0/28 in the LF group (p&lt;0.001). Antecubital vein access was used in 42/99 (42%) of the LC group but in none of the LF group (p&lt;0.001). There were no procedural hypersensitivity reactions in either the LC or LF groups. Repeat procedures were common; in total, 149 RHC were performed using latex catheters with no reactions. Conclusions: In patients with a history of non-anaphylactic cutaneous hypersensitivity to latex, the use of latex balloon-tipped catheters was not associated with allergic reactions. Latex catheters offer technical advantages including smaller sized vascular sheaths and more options for venous access.
Abstract 12367: Sex-Specific Differences in Quality of Life and Atrial Fibrillation Recurrence Following Ablation of Persistent Atrial Fibrillation: Insights From the DECAAF II Trial
Authors: Hadi Younes, Han Feng, Christian Sohns, Mathias Forkmann, Charbel Noujaim, Mario Mekhael, Ala' Assaf, Nour Chouman, Omar Kreidieh, chao huang, Chanho Lim, Abdel Hadi El Hajjar, eoin donnellan, Amitabh C Pandey, Nassir Marrouche, christian mahnkopf
Journal: Circulation (2023)

Introduction: Sex-specific differences have been observed in the literature in outcomes of catheter ablation of atrial fibrillation. Objective: We sought to evaluate sex-specific differences in persistent atrial fibrillation(PeAF) particularly in relation to quality of life and AF recurrence after ablation. Methods: We examined all PeAF patients in the DECAAF II trial and divided them into 2 groups, women and men. We evaluated sex-based differences in quality of life based on the SF-36 quality of life score. We assessed each component of the score before and after ablation as well as the total score. The Mann-Whitney U test was used. A time-to-event analysis was conducted to assess for AF recurrence. Results: We included 815 patients(21% women, 79% men). Women experienced more PeAF recurrence(53.3%) after 90 days of the blanking period than men(40.2%) [HR= 1.4311 (1.132, 1.809), p&lt;0.01](Figure 1). SF36 Quality of Life scores showed significant differences between women and men in 9 out of 9 categories both before and after ablation at 12 months. Women consistently reported lower scores than men in physical functioning (p&lt;0.01), physical health(p&lt;0.01), emotional problems(p&lt;0.01), energy and fatigue(p&lt;0.01), emotional wellbeing(p&lt;0.01), social functioning (p&lt;0.01), pain(p&lt;0.01), general health(p&lt;0.01), and health change(p&lt;0.01). Total scores for women remained lower both pre- and post-ablation(p&lt;0.01)(Figure 2). Conclusion: Female patients with PeAF demonstrated more AF recurrence and consistently poorer quality of life compared to males before and after ablation, indicating the need for further investigation and targeted interventions.
Abstract 11820: Importance of Resting Heart Rate Assessment in Autonomic Dysfunction Evaluation in Congestive Heart Failure Patients
Authors: George Tawfellos, Daniel Gulko, Gregory Petrossian, Jacqueline Kenitz, Christina Beegle, Jeanwoo Yoo, Mikhail Torosoff
Journal: Circulation (2023)

Background: Novel treatments in congestive heart failure (CHF) aim at ameliorating autonomic dysfunction. Autonomic dysfunction typically manifests with resting tachycardia and blunted baroreceptor reflex response and been classically described in CHF with reduced LV ejection fraction (EF) but baroreflex function in CHF with preserved EF has not been well investigated. Methods: A single center prospective study was conducted by measuring resting and lowest heart rates (HR) during voluntary breath holding in 118 CHF patients, 68 ± 14 years old, 50 females (42.3%), BMI 30.1 ± 8.5 kg/m 2 , HTN in 97 (82.2%), CAD in 64 (54.2%), diabetes in 49 (41.5%), and chronic lung disease in 39 patients (33.1%). HFrEF less than 40% was found in 41 (34.7%) patients; for the purposes of analysis HRmrEF and HFpEF groups were combined. Beta-blockers were used in 92 (78%) and non-dihydropyridine calcium channel blockers were used in 7 (5.9%) patients. Results: The majority of HFpEF or HFmrEF patients had resting HR less than 80 bpm (55/77 patients, 71.4%), while the majority of HFrEF patients had resting HR more than 70 bpm (32/41 patients, 78%, p=0.015). Furthermore, HFpEF and HFmrEF patients had lower breath holding HR (69.7 ± 14.7 bpm in HFpEF and HFmrEF patients vs. 77.6 ± 13.9 bpm in HFrEF patients, p=0.005). There was a trend of increased resting HR in patients with Class IV CHF (p=0.179). Furthermore, class IV CHF patients manifested with increased breath holding HR (68.9 ± 15.3 bpm in combined NYHA class I-II, 69.9 ± 12.2 bpm in NYHA class III, 79.9 ± 16.1 bpm in NYHA class IV, p=0.02). Regardless of the CHF class (p=0.060) and/or LV EF (p=0.913), increased resting HR was associated with higher breath holding HR. Patients with baseline HR &lt;60 bpm had breath holding HR of 54.6 ± 6.2 bpm, as compared to 94.9 ± 9.0 bpm in patients with baseline HR &gt;90 bpm, p&lt;0.001. Conclusion: In CHF patients, increased resting HR is a strong indicator of abnormal baroreceptor function. HRmrEF and HFpEF patients have lower resting and breath holding HR, suggesting less pronounced autonomic dysfunction, as compared to more pronounced autonomic dysfunction in HFrEF patients. Additional studies are needed to investigate whether autonomic modulation treatment is equally beneficial in patients across the LVEF spectrum.
Abstract 12754: The Forgotten Circulation: Lymphovascular Malformation Presenting as a Complex Mediastinal Mass in a Young Adult
Authors: Giselle A Suero-Abreu, Anushri Parakh, Lily L Sung, Brian Ghoshhajra, Tomas G Neilan, Doreen Defaria Yeh, Yin P Hung, Danielle B Cameron, Jordan P Bloom
Journal: Circulation (2023)

A 20-year-old transgender male presented with one week of intermittent shortness of breath and chest pain. He reported dizziness and increasing pain when playing the trumpet. His exam was unremarkable, but chest X-ray showed mediastinal widening and opacification of the retrosternal space (Fig. 1A). Chest CT showed a well-defined centrally enhancing prevascular mediastinal mass abutting the superior vena cava (SVC) and right heart (Fig. 1B). He was referred to a thoracic surgeon for evaluation. Subsequent chest CT venography and MRI demonstrated a progressively enhancing, part-solid and cystic mass with dilated veins draining into the SVC and a phlebolith. Due to imaging and clinical features, including a low probability of malignancy given negative tumor markers, lymphovascular malformation was favored over other possibilities such as thymoma, germ cell tumor, sarcoma, or Kaposiform hemangioendothelioma. After multidisciplinary discussions between cardiology, radiology, cardiothoracic and pediatric surgery, and a review at a dedicated vascular anomalies center, the consensus was for close surveillance. A 6-week follow-up MRI showed no significant change, but given increased dyspnea and chest pain, the decision was made to proceed with surgical resection via median sternotomy. The tumor was densely adherent to the right phrenic nerve, pericardium, and SVC but was excised completely without complications (Fig. 1C). Pathology confirmed a benign vascular malformation with lymphatic and venous components (Fig 1D). This diagnosis is more common in the pediatric population but a rare cause of dyspnea and chest pain in a young adult. This case illustrates the value of multimodality imaging and multidisciplinary collaboration among adult and pediatric subspecialists in the diagnosis and treatment of a rare, complex mediastinal mass in a young adult patient.
Abstract 11821: Association of Hemoglobin With Mortality Outcomes in the Critical Care Cardiology Trials Network (CCCTN) Registry
Authors: Rasheed Durowoju, Christine Chow, Erin A Bohula, David Berg, Jeong-Gun Park, David Morrow, Younghoon Kwon
Journal: Circulation (2023)

Introduction: Anemia is common in critically ill patients and is a known risk indicator for poor outcomes. Little is known about the impact of anemia on short term outcomes in the setting of cardiac critical illness. We examined the association of varying degrees of anemia with in-hospital outcomes in cardiac intensive care unit (CICU) admissions. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in North America coordinated by the TIMI Study Group. During annual campaigns, each center contributes at least 2-mo of all consecutive medical CICU admissions. Admissions were stratified according to baseline hemoglobin (Hgb). The association of Hgb and in-hospital mortality, CICU length of stay and hospital length of stay was examined by logistic regression with multivariable adjustment. Results: Among 17,759 admissions, the median baseline Hgb was 12.0 g/dL (IQR 10.0, 13.8). Patients with lower Hgb tended to be older and female with lower body weight and a greater burden of comorbidities. After adjusting for sex and other relevant covariates, a lower baseline Hgb was associated with higher odds of in-hospital death (p-trend &lt;0.0001), and longer CICU and hospital length of stay (p-trend &lt;0.0001). Conclusions: Anemia is prevalent in half of patients admitted to the CICU. Lower Hgb level, even well above standard transfusion thresholds, is independently associated with higher in-hospital mortality and longer length of stay in cardiac critical illness.
Abstract 13757: Suppression of Ischemia-Hypoxia Reperfusion Injury in Human iPS Cell-Derived Cardiomyocytes Through Downregulation of EGR1 Mediated by miR-124-3p
Authors: Qiaoke Yang, Kozue Murata, Tadashi Ikeda, Kenji Minatoya, Hidetoshi Masumoto
Journal: Circulation (2023)

Background: Ischemic heart diseases are one of the leading causes of death globally. Although timely revascularization is performed, some cases may still result in heart failure due to ischemia-hypoxia reperfusion (IH/R) injury. Early growth response 1 (EGR1) was reported to involved in reperfusion injury, but its specific role in IH/R-induced apoptosis in human cardiomyocytes (CMs) remains unexplored. Hypothesis: EGR1 is involved in the exacerbation of the IH/R-mediated apoptosis in human CMs, and miR-124-3p acts as an antagonist of EGR1. Methods: Human induced pluripotent stem cell (hiPSC)-derived CMs were cultured in serum-free low-glucose medium with a hypoxic chamber. EGR1 expression and the extent of apoptosis were evaluated by qRT-PCR, Western blotting (WB), and immunofluorescent assay (IFA). RNA-seq was conducted to identify specific pathways. SiRNA targeting EGR1 and miR-124-3p mimic were used to downregulate EGR1 under IH/R. Results: qRT-PCR (Control vs IH/R: 1.000 ± 0.000 vs 5.749 ± 2.947; P&lt;0.01) and WB (0.037 ±0.038 vs 0.953 ± 0.306; P&lt;0.0001) analyses revealed higher expression of EGR1 in IH/R group. IFA demonstrated a higher ratio of cleaved Caspase-3-positive apoptotic cells in IH/R group (0.202 ±0.206 vs 0.377 ± 0.252; P&lt;0.001). RNA-seq analysis indicated significant downregulation of pathways related to cell survival in IH/R. The siRNA downregulated EGR1 successfully, as confirmed by qRT-PCR, WB, and IFA (IH/R Water vs IH/R siRNA: 0.612 ±0.307 vs 0.257 ±0.122; P&lt;0.01), which led to the suppression of apoptosis (0.288 ±0.143 vs 0.142 ±0.049; P&lt;0.05). miR-124-3p mimic downregulated EGR1 under IH/R conditions, as shown by PCR (IH/R Water vs IH/R miRNA mimic: 3.731 ±1.126 vs 2.568 ±0.959; P&lt;0.0001) and WB (0.947 ±0.438 vs 0.478 ±0.277; P&lt;0.05). IFA proved the suppression of EGR1 by miR-124-3p mimic (0.414 ±0.101 vs 0.062 ±0.064; P&lt;0.0001), which subsequently reduced CM apoptosis (0.234 ±0.127 vs 0.092 ±0.047; P&lt;0.001). Conclusion: EGR1 participate in exacerbating apoptosis mediated by IH/R in human CMs. The downregulation of EGR1 suppresses IH/R-induced apoptosis. Treatment with miR-124-3p targeting EGR1 may potentially serve as a novel therapeutic approach for cardioprotection in the future.
Abstract 12022: Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T)
Authors: Rafael N Miranda, Feng Qiu, Ragavie Manoragavan, Peter Austin, David Naimark, Stephen E Fremes, Dennis T Ko, Mina Madan, Mamas Mamas, Maneesh Sud, Derrick Tam, Harindra C Wijeysundera
Journal: Circulation (2023)

Introduction: Transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis has seen indication expansion and exponential growth in demand over the last decade. In many jurisdictions the growing demand outpaced capacity, increasing wait-times and pre-procedural adverse events. Objective: To derive prediction models that estimate the risk of adverse events on the waitlist that would inform the development of a triage tool for use by clinicians to identify patients who should be prioritized for TAVI. Methods: We conducted an observational retrospective cohort study using population-based administrative data from Ontario, Canada. Adult patients referred for TAVI from April 1 st , 2012 to March 31 st , 2020 were included and followed-up to the first of: death, TAVI procedure, removal from waitlist, or end of the observation period. We used competing risk subdistributions hazards models to find significant predictors for each of the following outcomes: (1) all-cause death while on the waitlist, (2) all-cause hospitalization while on the waitlist, (3) receipt of urgent TAVI, and (4) a composite of outcomes 1-3. The median predicted risk in our population at 12 weeks was chosen as a threshold for a maximum acceptable risk while on the waitlist, and was incorporated in the triage tool to recommend individualized wait-times. Results: We included 13,128 patients in the analyses. 586 (4.46%) patients died on the waitlist, and 4,343 (33.08%) had at least one all-cause hospitalization. 6,854 TAVIs were completed, of which 1,135 (16.56%) were urgent procedures. We were able to create parsimonious models for each outcome that included clinically relevant predictors. Optimism-corrected C-statistics varied from 0.63 to 0.75, optimism-corrected Brier scores from 0.03 to 0.19, and the calibration slopes from 0.79 to 0.99. Conclusions: We developed the Canadian TAVI Triage Tool (CAN3T), a triage tool to assist clinicians in the prioritization of patients who should have timely access to TAVI. We anticipate that the CAN3T will be a valuable support tool for patients and clinicians, with the potential of bringing meaningful changes to the health system as it may improve equity in access to care, reduce preventable adverse events and improve system efficiency.