tbuckley/cabot-search huggingface dataset:
Abstract 13644: Management Patterns in Patients With Heart Failure: Insights From iCaReMe Global Registry
Authors: Mikhail N Kosiborod, Carolyn S Lam, Carol Pollock, Kamlesh Khunti, Hiddo Lambers Heerspink, Antonio Nicolucci, Shashank Joshi, Peter Fenici, Susana Goncalves, Hardik Vasnawala, Ahmed HADAOUI
Journal: Circulation (2023)

Introduction: Heart failure (HF) is an increasing major case of morbidity and mortality, including in low and middle income countries (LMIC) due to the rising incidence of HTN, T2D and CKD. Little information is available on the management of HF in LMIC. iCaReMe is a unique ongoing registry collecting data from contemporary routine clinical practice in patients with HF, T2D, HTN and/or CKD. Aims: Describe clinical characteristics, comorbidities and management of HF patients based on data from iCaReMe Registry. Methods: iCaReMe Global Registry (NCT03549754) is a multinational, prospective, observational study to assess the management and quality of care in patients with HF, T2D, HTN and/or CKD. We present baseline descriptive analysis of the HF cohort enrolled from February 2018 to December 2022. Results: A total of 3069 adults (mean age±SD 58.7±12.6 years, 59.2% males, 40.3% obese) with HF from 21 countries were evaluated in this initial report. Of the 2307 (75.2%) patients with available LVEF data; 63.4% had HFrEF, 14.3% HFmrEF, and 22.3% HFpEF. The median (IQR) LVEF was 36(30-47) % and 83% had NYHA class II-IV symptoms. Overall, 27.1% of patients reported history of hospitalization for HF. The comorbidities were common including T2D (60.4%), HTN (57.1%), CAD (45.4%), dyslipidemia (36.0%), and CKD (30.5%). In patients with available data, the mean UACR was 282.5 mg/g [reported in 666 (21.7%) patients] and mean eGFR was 70.3 ml/min/1.73m 2 [reported in 2325 (75.8%) patients]. The medications included ACEi or ARB in 66.6%, ARNI in 15.9%, b-blockers in 65%, MRA in 38.7%, and SGLT2i in 40.3%. Conclusions: iCaReMe Registry provides a unique perspective on the characteristics and management of patients with HF in low and middle income countries and demonstrates substantial burden of multimorbidity. The data highlight gaps between guidelines and routine care and the need to identify and address barriers to the implementation of optimal management and evidence-based therapies.
Abstract 16323: Functional Autoantibody Analysis in Post-Acute Sequela of COVID-19 Patients With and Without Pots: A Case Control Study
Authors: Sameer M Jamal, William T Gunning, John W Spatafore, Zoltan Turi, David Landers, Steven Hollenberg, Taya Glotzer, Jana Tancredi, Blair P Grubb, Joseph E Parrillo
Journal: Circulation (2023)

Introduction: Post-Acute Sequela of COVID-19 (PASC) occurs after recovery from the initial illness. Autonomic dysfunction (AD) may explain these findings. We have previously shown orthostatic intolerance (OI) on standard Italian protocol head-up tilt table in 23 of 24 prospectively studied subjects with PASC and no prior OI. Postural orthostatic tachycardia syndrome (POTS) was noted in 4 of the 23. POTS is associated with elevated levels of autoantibodies. There is a paucity of data evaluating autoantibody presence in subjects with PASC related POTS. Hypothesis: We hypothesized that individuals with PASC related POTS would demonstrate higher levels of certain autoantibodies than controls. Methods: We recruited healthy, COVID-19 PCR negative controls, all previously vaccinated for COVID, who were age and gender matched with the 4 previously identified PASC related POTS patients. Serum was tested for autoantibodies in both groups. Results: Mean ages for the PASC related POTS and control groups were 29 and 31 years, respectively. The PASC related POTS patients had higher levels of functional autoantibodies to several G-protein coupled receptors than controls. The median values for adrenergic A1, adrenergic B2, muscarinic M4, angiotensin 2 and endothelin receptors, comparing controls to PASC related POTS patients, were 10.4 vs 27.5, 14.9 vs 38.5, 7.8 vs 29.0, 12.2 vs 29.5 and 12.6 vs 31.7 Units/ml, respectively. The small size of the 2 groups precludes meaningful statistical testing, but the box plots in Figure 1 show consistent differences in the concentration of antibody receptors seen between the 2 groups. Conclusions: Functional autoantibodies to several G-protein coupled receptors were seen in higher amount in subjects with PASC related POTS compared to healthy controls. While this is a small, case-control study, it suggests a potential autoantibody mediated mechanism that may explain some of the AD seen in PASC patients with POTS.
Abstract 16506: Effect of COVID-19 on Outcomes of Patients Hospitalized With Takotsubo Cardiomyopathy
Authors: Sukhvir Singh, Husam El Sharu, Taha Teaima, Lakshmi Subramanian, Nini Orjonikidze, Amer Muhyieddeen, Omar Khdeir
Journal: Circulation (2023)

Introduction: Takotsubo Cardiomyopathy (TCM), commonly known as stress cardiomyopathy, is a condition characterized by the abrupt occurrence of acute left ventricular dysfunction, triggered by a variety of physical and psychosocial factors. The influence of COVID-19 on the outcomes of TCM hospitalizations remains relatively understudied. Thus, our objective was to investigate the impact of COVID-19 (COVID) on the outcomes of individuals hospitalized with TCM. Methods: The 2019-2020 National Inpatient Sample (NIS) was analyzed to identify adult hospitalizations admitted for TCM with a concurrent diagnosis of COVID-19 using International Classification of Disease 10 Clinical Modification (ICD-10-CM) codes. We compared baseline characteristics using T-test and Chi-square for continuous and categorical variables, respectively and multivariate regression analysis was used to adjust for potential confounders. Results: Out of the 41,324 TCM hospitalizations, 1,665 had a concurrent COVID infection. Hospitalizations with TCM and COVID had statistically significant difference in mortality (adjusted Odds Ratio (aOR) 2.30; Confidence Interval [CI] 1.2-4.5, p = 0.01), longer length of stay (LOS) 4.1 days (CI 2.8-5.5, p &lt; 0.001), and higher mean total hospital charges (THC) of $46,452 (CI 17,711-75203). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities and hospital characteristics. Conclusions: Patients hospitalized for TCM with concurrent COVID 19 infection had increased in-hospital mortality, longer LOS, higher THC and increased odds of cardiogenic shock, cardiac arrest, acute kidney injury (AKI), use of mechanical ventilation and use of vasopressor support.
Abstract 17806: Outcome Prediction Score for Mitral Transcatheter Edge-to-Edge Repair in Patients With Concomitant Significant Tricuspid Regurgitation
Authors: Alon Shechter, Danon Kaewkes, Vivek Patel, Ofir Koren, Keita Koseki, Takashi Nagasaka, Moody Makar, Tarun Chakravarty, Sabah Skaf, Raj R Makkar, Robert J Siegel
Journal: Circulation (2023)

Introduction: Tricuspid regurgitation (TR) adversely affects the post-procedural course following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a clinical risk stratification model for patients undergoing TEER for mitral regurgitation while exhibiting significant TR. Methods: This is a single-center, retrospective study of 217 consecutive individuals referred to an isolated mitral TEER who had above-moderate TR at baseline. The primary outcome of interest was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75% to 25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset. Results: By 1-year, 81 (37.3%) patients died or were hospitalized for heart failure. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-3 scaling system, in which each point represented one of three baseline variables associated with this combined endpoint: serum B-natriuretic peptide (BNP) level &gt;1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and a cardiac implantable electronic device (CIED). C-statistic of the model for the primary outcome was 0.66 (95% CI, 0.58-0.74, p=0.001) and 0.76 (95% CI, 0.62-0.90, p=0.004) in the train and test datasets, respectively - representing a significantly better discrimination ability than the MitraScore and the Society of Thoracic Surgeons score for mitral valve repair. Conclusions: The BNP-RV-CIED (BRC) score is a simple clinical prediction tool that may aid in the triage of mitral TEER candidate with significant pre-existing TR.
Abstract 17080: Subcutaneous Implantable Cardioverter Defibrillator in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis
Authors: Vinicius M Oliveira, Izadora C Oliveira, Antonio da Silva Menezes Junior
Journal: Circulation (2023)

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to transvenous implantable cardioverter-defibrillator (TV-ICD), mitigating the risks associated with transvenous leads. However, the effects of S-ICD in hypertrophic cardiomyopathy (HCM) remains uncertain. Thus, we performed a systematic review and meta-analysis to assess the efficacy and safety of S-ICD in treating patients with HCM. Methods: We systematically searched PubMed, Embase and Scopus on April 2023 for studies comparing S-ICD to TV-ICD in patients with HCM. Key endpoints of interest included incidence of appropriate shocks (AS), inappropriate shocks (IAS), and device-related complications. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed using a random-effects model. Heterogeneity was assessed with I 2 statistics, and a p-value of &lt;0.05 was considered statistically significant. Results: We screened 1070 records. Six studies comprising 3,820 patients were included, of whom 2,497 (65.4%) were male. Mean age ranged from 39.1 to 49.4 years. Our pooled analysis indicated that device-related complications were significantly less frequent in the S-ICD group compared with the TV-ICD group (OR 0.39; 95% CI 0.18 to 0.82; p=0.01; Figure 1A). However, the incidences of AS (OR 0.56; 95% CI 0.20-1.57; p=0.27) and IAS (OR 1.26; 95% CI 0.61 to 2.59; p=0.54; Figure 1B) were not significantly different between the two groups. Conclusions: These findings suggest that S-ICD are associated with fewer device-related complications as compared with TV-ICD, among patients with HCM. Appropriate and inappropriate shocks are not significantly different between the two strategies.
Abstract 12669: Yield of Systematic Screening for Cardiovascular Disease in Young Sports Participants
Authors: Nicholas Roma, Rasha Aurshiya, Bruce Ferraro, Spandan Desai, Maheep Vikram, Sudip Nanda, Jamshid Shirani
Journal: Circulation (2023)

Background: Although rare, sudden cardiac death (SCD) is a tragic event for young athletes. Comprehensive initial pre-participation physical evaluation (CIPPE) is mandated for middle, junior high and senior high school students by Pennsylvania Interscholastic Athletic Association (PIAA) primarily for reducing potential sports injuries and SCD. Those with positive screening for cardiac disease [on 14-element AHA screening questionnaire] are referred for cardiac evaluation. We prospectively evaluated yield of cardiac screening in this age group. Method: From 2015 to 2023, 424 students [age 10-21 (15±2) years, 60% male, 64% Caucasian, 43% overweight) referred for cardiac screening. Evaluation included 12-lead ECG and rhythm strip (100%), transthoracic echo (96.4%), ambulatory monitor (3.8%), exercise ECG (14.5%), stress echo (2.1%), and cardiac MRI (0.9%). Results: Actionable abnormalities were found in 25 (5.9%) and included hypertension (n=8), bicuspid aortic valve (n=4, Figure:A), ascending aortic aneurysm (n=3, Figure:B*), definite or probable hypertrophic cardiomyopathy (n=3, Figure:C), atrial septal defect (n=2), mitral valve prolapse (n=2), aortic insufficiency (n=1), coronary artery anomaly (n=1) and ventricular tachycardia requiring ablation (n=1). Conclusion: Although uncommon, a systematic approach to screening in young sport participants can lead to identification of serious unsuspected cardiovascular disorders in 1 out of 17 students.
Abstract 16070: Prognostic Value of H2FPEF Score Among Symptomatic Patients Referred for Exercise Echocardiography
Authors: Ga Hee Kim, Swiri Konje, Alba Munoz, Kruti Gandhi, Errol C Moras, Christopher Perez Lizardo, Joseph Elias, Arpanjeet Kaur, Alaa M Omar, Edgar Argulian
Journal: Circulation (2023)

Introduction: The H2FPEF score is a recommended tool for estimating the likelihood of heart failure with preserved ejection fraction (HFpEF) in cases of unexplained dyspnea. Limited data is available regarding its prognostic ability. This restrospective study aimed to assess the prognostic value of the H2FPEF score for adverse cardiovascular outcomes. Methods: 532 patients [age 69±6 years, 57% female, and ejection fraction 61±5% (all &gt;50%)] with suspected symptoms of heart failure (HF) referred for exercise echocardiography were included. H2FPEF score was calculated based on: BMI &gt;30 kg/m2 (2 points), atrial fibrillation (3 points), age &gt;60 years (1 point), use of ≥2 hypertension drugs (1 point), E/e’ ratio &gt;9 (1 point), and pulmonary systolic pressure &gt;35 mmHg (1 point). Comparisons were made for death and HF hospitalization. Results: During a median follow-up of 3.8 years, 13 patients died, 35 had HF hospitalizations, and 48 experienced the composite outcome. The score distribution was as follows: 0-1 in 69 (13%) patients, 2-5 in 430 (81%) patients, and ≥6 in 33 (6%) patients. The H2FPEF score averaged 3.2±1.5 and showed a progressive increase in the risk of adverse outcomes. A score of 0-1 was associated with the lowest risk, ≥6 with the highest risk, and 2-5 with an intermediate risk (Figure 1A-C). Compared to a score of 0-1, increased risk for combined outcomes occurred with a score of 2-5 (HR: 3.4, 95% CI: 1.5-8) and ≥6 (HR: 9.6, 95% CI: 3.6-26). Similar risk patterns were observed for death and HF hospitalization. Importantly, during exercise echocardiography, new wall motion abnormalities occurred in 105 (20%) patients and did not differ significantly among the different H2FPEF score groups (p=0.403). A H2FPEF score &gt;1 was associated with an increased risk regardless of the presence or absence of myocardial ischemia (Figure 1D). Conclusions: H2FPEF score is a useful prognostic tool in suspected HFpEF, regardless of echocardiographic presence or absence of ischemia.
Abstract 14588: Comparison of Different Antithrombotic Regimens After Left Atrial Appendage Occlusion: A Systematic Review and Network Meta-Analysis
Authors: Pedro P Carvalho, Douglas Mesadri Gewehr, Isabele A Miyawaki, Alleh Nogueira, Philippe GAROT, Arthur Darmon, Patrizio Mazzone, Alberto Preda, Bruno R Nascimento, Nicole Felix, Luiz F Kubrusly, Rhanderson Cardoso
Journal: Circulation (2023)

Background: The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF) remains uncertain, given the high-risk profile of this population. This network meta-analysis aimed to compare the efficacy and safety of various antithrombotic strategies after LAAO. Methods: We conducted a comprehensive search of MEDLINE, Cochrane, Embase, Lilacs, and ClinicalTrials.gov databases for studies that reported clinical outcomes after LAAO, categorized by the antithrombotic therapies administered at discharge. Direct oral anticoagulants (DOACs), vitamin-K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no therapy were analyzed. We performed a frequentist random-effects network meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CI) for each strategy. The surface under the cumulative ranking curve (SUCRA) P-scores provided a ranking of treatments. Quality assessment and risk of bias were conducted in accordance with Cochrane recommendations. Results: 39 observational studies and 1 clinical trial with a total of 11,111 patients with non-valvular AF were included, totaling 540 cardiovascular events. In the network comparison, DAPT (OR 0.35; 95% CI 0.16-0.76), DOAC (OR 0.35; 95% CI 0.13-0.94), DOAC plus SAPT (OR 0.17; 95% CI 0.04-0.74), and VKA (OR 0.34; 95% CI 0.12-0.97) were superior to no therapy to prevent device-related thrombosis (DRT), whereas SAPT (OR 0.46; 95% CI 0.21-1.03) and VKA plus SAPT (OR 0.43; 95% CI 0.10-0.87) were similar to no antithrombotic therapy. DOAC was associated with a significant reduction of all-cause mortality compared with VKA (OR 0.36; 95% CI 0.15-0.85) and a non-significant trend vs. SAPT (OR 0.49; 95% CI 0.22-1.11). Moreover, DAPT (OR 0.49; 95% CI 0.26-0.91) was superior to SAPT in reducing thromboembolic events, but similar to VKA (OR 0.88; 95% CI 0.37-2.37). There was no significant difference between therapies analyzed in the occurrence of major bleeding. Conclusion: In patients with nonvalvular AF undergoing LAAO, DOAC monotherapy is safe and reduce DRT, all-cause mortality, and thromboembolic events compared with other therapies.
Abstract 17724: Myocardial Extracellular Matrix Proteins Involved in the Overloaded and Unloaded Heart After Myocardial Infarction
Authors: Spyros Archimedes Mavropoulos, Tomoki Sakata, Renata Mazurek, Jonas Marx, Anjali Ravichandran, Kiyotake Ishikawa
Journal: Circulation (2023)

Introduction: The cardiac extracellular matrix (ECM) is a dynamic scaffold that transmits and responds to forces that act on the heart during the cardiac cycle. While acute left ventricle (LV) unloading by catheter-based LV assist device (pLVAD) is now a therapeutic option, its impact on ECM is unknown. Hypothesis: The composition of LV ECM proteins changes in response to wall stress. Methods: Ten Yorkshire pigs underwent the protocol in figure 1. Non-ischemic remote myocardium was processed for ECM specific proteomics. Volcano plots were constructed to determine proteins of interest and differential expression was considered as (-log10(p)&gt;1.3 and |log2(fold-change)| &gt;0.5). Gene ontology (GO) analysis was performed to identify associated molecular processes and biological functions. A group of age-matched pigs (n=6) that did not undergo MI induction served as reference. Immunofluorescence microscopy was performed to validate differential expression. Results: Of the 986 proteins analyzed, 39 were significantly differentially expressed between overloaded and unloaded hearts. GO analysis by molecular function revealed that differences tending towards RNA binding and lipid binding proteins. Analysis by biological process showed that cell differentiation, vesicle transport, and programmed cell death were the processes most favored. Staining for three of the identified differentially expressed proteins (figure 2) had results congruent with proteomic analysis. Conclusions: There were significant differences in the protein composition of the cardiac ECM between acutely unloaded and overloaded myocardium, suggesting that it actively responds to altered LV load.
Abstract 151: The PRINCESS 2 Trial: A Randomized Study to Assess the Impact of Ultrafast Hypothermia on Neurologic Function in Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm
Authors: Emelie Dillenbeck, Jacob Hollenberg, Michael Holzer, Hans-Joerg Busch, Graham Nichol, Peter Radsel, Jan Belohavek, Sune Forsberg, Filippo Annoni, Leif Svensson, Martin Jonsson, Denise Bäckström, Mikael Gellerfors, Akil Awad, Fabio S Taccone, Per Nordberg
Journal: Circulation (2023)

Background: The impact of ultrafast hypothermia, i.e. delivered intra-arrest or immediately after return of spontaneous circulation (ROSC), on functional neurologic outcome after out-of-hospital cardiac arrest (OHCA) is unclear. In two prior trials, prehospital transnasal evaporative intra-arrest cooling was safe, feasible and reduced time to target temperature. Both studies showed trends towards improved neurologic recovery in patients with shockable rhythms. The aim of the PRINCESS2-study is to assess whether cooling, initiated either intra-arrest or immediately after ROSC, followed by in-hospital hypothermia, significantly increases survival with complete neurologic recovery as compared to standard normothermia care, in OHCA patients with shockable rhythms. Methods/Design: This investigator-initiated, randomized, controlled trial will randomize patients at the scene of cardiac arrest to either transnasal cooling within 20 minutes from Emergency Medical System arrival with subsequent hypothermia at 33°C for 24 hours after hospital admission (intervention), or to standard of care with no prehospital or in-hospital cooling (control). Fever (&gt;37,7 o C) will be avoided for the first 72 hours in both groups. All patients will receive post resuscitation care and withdrawal of life support procedures according to current guidelines. Primary outcome is survival with complete neurologic recovery at 90 days, defined as modified Rankin scale (mRS) 0-1. Key secondary outcomes include survival to hospital discharge, survival at 90 days and mRS 0-3 at 90 days. In total, 970 patients are required to detect an absolute difference of 9 % (from 45 to 54 %) in survival with neurologic recovery (80 % power and 2-sided α=0,5). Recruitment starts in Q3 2023 and we expect maximum enrolment to be achieved during 2024 at 20-25 European and US sites. Discussion: This trial will assess the impact of ultrafast hypothermia applied on the scene of cardiac arrest on survival with complete neurologic recovery in patients with OHCA and shockable rhythm