tbuckley/cabot-search huggingface dataset:
Abstract 4147717: Sodium Glucose Cotransporter 2 Inhibitors on Chronic Heart Failure with Reduced Ejection Fraction in Adult Congenital Heart Disease Patients: A Systematic Review and Meta-analysis
Authors: Bibhuti Das, Jianli Niu
Journal: Circulation (2024)

Background: SGLT2 inhibitors have demonstrated efficacy in reducing cardiovascular death and hospitalization and are recommended as first-line therapy for hear failure (HF) in adults due to acquired heart diseases. Our study aimed to assess the safety, tolerability, and outcomes of HF patients with adult congenital heart disease (ACHD) treated with SGLT2 inhibitors. Methods: We conducted a comprehensive search of three major databases—PubMed, Scopus, and Embase—and collected articles on the use of SGLT2 inhibitors for HF in ACHD patients who were already receiving angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers (BB), and mineralocorticoid antagonists (MRA). We excluded articles related to acute decompensated HF and HF with preserved ejection fraction. The primary outcome was the change in NYHA functional class (FC). Secondary outcomes included changes in B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels, as well as body weight. Additionally, we evaluated the safety and tolerability of SGLT2 inhibitors in ACHD HF patients. A pooled effect size was calculated based on mean differences (MD) or log odds ratio (LogOR). Results: Our meta-analysis included 9 studies with a total of 287 patients aged 19 to 67 (median 37.5 years) (Table). When SGLT2 inhibitors were added to combined therapies, they significantly improved NYHA FC (LogOR: 1.3, 95% CI: 0.37–2.23, p=0.01) (Figure 1A), decreased NT-proBNP (MD -0.43, 95% CI -0.70 to -0.16, p=0.00) (Figure 1B), were associated with a reduction in systolic blood pressure (MD = -0.32, 95% CI: -0.51 to 0.14, p=0.00) (Figure 1C), and led to an elevation of creatinine (Cr) levels (MD = 0.18, 95% CI -0.0 to 0.36, p=0.06) (Figure 1D). Only 4 patients experienced urinary tract infections (UTIs), and none had hypoglycemia or ketoacidosis. Conclusion: Our meta-analysis demonstrates that SGLT2 inhibitors improve NYHA FC, decrease NT-proBNP, and are well-tolerated with safety features similar to adult HF clinical trials when added to combination HF therapies including ACEI/ARB/ARNI, BB and MRA. Future prospective studies are needed to assess long-term clinical outcomes in ACHD patients with HF.
Abstract 4147790: Comparison of Clinical Efficacy and Safety of Different Advanced Treatment Strategies for Acute Pulmonary Embolism: A Bayesian Network Meta-analysis
Authors: Prakash Oli, Sagun Dawadi, Dhan Shrestha, Jurgen Shtembari, Jishanth Mattumpuram, Daniel Katz
Journal: Circulation (2024)

Background: Anticoagulation therapy (ACT) remains the cornerstone of acute pulmonary embolism (PE) management and reduces the mortality risk to &lt;1% in low-risk PE. However, AC is inadequate in intermediate and high-risk acute PE, thus requiring additional therapies. So, there has been a search for better advancement in therapeutic approaches, including catheter-directed thrombolysis (CDT) or thrombectomy, surgical embolectomy (SE), or mechanical thrombectomy (MT). We performed this network meta-analysis to analyze the outcome of different therapeutic approaches for acute intermediate and high-risk PE. Method: We conducted a Bayesian network meta-analysis to synthesize direct and indirect evidence from pertinent studies published until May 2024 using PubMed, Embase, and Scopus databases comparing different therapies for intermediate and high-risk PE patients. This study is registered with PROSPERO, and data analysis was performed using the “BUGSnet” package in R. Result: This analysis included 1,639,413 patients with intermediate or high-risk PE from 72 studies. The probability of CDT being ranked highest was for short-term mortality (catheter-directed intervention: 93), long-term mortality (Ultrasound-assisted Thrombolysis (USAT): 86.17), major bleeding (USAT: 85.58), and intracranial hemorrhage (USAT: 86.06) whereas surgical embolectomy for any and gastro-intestinal bleedings (93.76 and 78.7) respectively. The risk of short-term mortality and intracranial hemorrhage were lower among the patients treated with USAT [(OR: 0.38, CrI: 0.17 to 0.81) and (OR: 0.27, CrI: 0.10 to 0.69)] than those treated with AC only and MT in a random effects model. Conclusion: Based on the findings of this network meta-analysis, compared to other advanced PE management modalities, catheter-based interventions, especially ultrasound-assisted thrombolysis, could potentially reduce short and long-term mortality risk without increasing bleeding risk.
Abstract 4148151: Device Extraction Improves Survival in ESRD Patients with CIED Infections
Authors: Stefano Byer, Ashraf Alzahrani, Peter Farjo, Edward Powers, xPaarix xDominicx
Journal: Circulation (2024)

Introduction: Patients with end-stage renal disease (ESRD) are prone to cardiovascular implantable electronic device (CIED) infections with a reported 12-month infection rate of 1%, portending an all-cause mortality rate up to 35%. Complete device extraction reduces reinfection and mortality, but is complex and carries high risks, especially for ESRD patients. Here we compare outcomes in infected CIED extraction in the ESRD population. Methods: This study utilized data from the TriNetX research network. We included adults with a history of ESRD and CIED infection. Patients were stratified by device extraction, and those with a history of renal transplant were excluded. Propensity score matching was performed, with outcomes of interest: mortality, all-cause admission, sepsis or bacteremia, and 30-day complications. Results: In the ESRD population, we identified 271 patients who underwent extraction for infected CIED and 623 who did not undergo extraction. CIED extraction was associated with improved survival at one year (65.7% vs 57.3%, p=0.047). The survival benefit was evident at 30 days (91.6% vs 85.8%, p=0.03). No appreciable difference in freedom from admission (30.6% vs. 32.1%, p=0.875) or from sepsis or bacteremia (44.9 vs. 44.8%, p=0.130) at one year. At 30 days, there was no difference in development of pericardial effusion or tamponade (95.7% in vs. 98%, p=0.069), respiratory failure (75.9% vs. 73.4%, p=0.529), or red blood cell transfusion (94% vs. 90.1%, p=0.153). In the extraction group, freedom from cardiac surgery at 30 days was 88.1%, with 11.6% of patients requiring open lead extraction. Conclusion: In ESRD patients with CIED infections, device extraction is associated with a significant reduction in all-cause mortality at one year without increasing the risk of all-cause admission, sepsis or bacteremia, or 30-day complications. These findings support considering device extraction in this high-risk population to improve survival outcomes. Further research is needed to optimize management strategies and address the challenges specific to ESRD patients with CIED infections.
Abstract Sa1001: Epinephrine for In-hospital Cardiac Arrest: Effect and Time to Return of Spontaneous Circulation
Authors: Anders Norvik, Eirik Unneland, Jan Terje Kvaloy, Daniel Bergum, Jan Pål Loennechen, ELISABETE ARAMENDI, Jon Urteaga, Eirik Skogvoll
Journal: Circulation (2024)

Introduction: Epinephrine is the mainstay of drug treatment during cardiac arrest and it is firmly established that it promotes Return of Spontaneous Circulation (ROSC). In this study we aimed to describe the effect and occurrence of ROSC after administering epinephrine to hospitalized patients with primary pulseless electrical activity (PEA), i.e., administered during PEA as the first recorded arrest rhythm. Method: We investigated 78 episodes of primary PEA registered between Aug. 2018 and Oct. 2022 at St. Olav University Hospital (Trondheim, Norway). In 36 episodes, the first dose of epinephrine was administered during primary PEA and registered with minute precision. We created different time dependent covariate profiles for the effect of epinephrine, starting at 0 (time of administration), rising linearly to 1 (presumed maximum effect) and decreasing to 0 immediately thereafter. Time to presumed maximum effect started at 5 seconds (s) after administration and increased in steps of 5s until 300s. We entered each of these different covariate profiles into separate Cox regression models using time to ROSC as outcome obtaining in total 60 Hazard ratios (HR) from all the models. Results: Median time to epinephrine administration was 185s (range 80 to 310) after start of resuscitation. In total, 23 patients obtained ROSC after the administration of epinephrine and 15 patients obtained ROSC without epinephrine. The different hazard ratios (y-axis) were plotted against the location of the maximum point of the covariate profile (x-axis) in Fig. 1. HR peaked twice, at 70 and 155s, 11.4(p&lt; 0.001) and 4.1(p= 0.013), respectively. Discussion: This study indicates a strong effect of epinephrine during primary PEA 1-2 min after administration. This information may provide the treating team with useful insight on what to expect after administering epinephrine. In addition, the actual effect may be even larger, as the sickest patients (expected to respond less well to epinephrine) are more often monitored and thus recieve epinephrine earlier.
Abstract Sa105: Comparing of the pre-hospital advanced airway managements in cardiac arrest : Supraglottic airway vs. Direct laryngoscope vs. Video Laryngoscope
Authors: MINWOO KIM, Jeong Ho Park, Sang Do Shin, Kyoung Song, Young Sun Ro, Kijeong Hong, Joo Jeong, Tae Han Kim, Ki Hong Kim, Yoonjic Kim, Yeongho Choi, Stephen Gyung Won LEE, Seulki Choi
Journal: Circulation (2024)

After the implemetation of special emergency services, advanced airway management(AAM) in cardiac arrest has been tried actively. We aim to compare the success rates and patient outcomes of supraglottic airway(SGA), endotracheal intubation with direct laryngoscope(ETI with DL), and endotracheal intubation with video laryngoscope(ETI with VL) in patients with sudden cardiac arrest, and evaluate the effectiveness of the video laryngoscope in the pre-hospital stage. This study was conducted on cardiac arrest patients who transferred to ED by EMS from July 2019 to December 2021. Using the Korean OHCA registry, EMS ambulance runsheet, and cardiac arrest in-depth registry, patients with sudden cardiac arrest over 18 years old, caused by medical cause, and who were treated by the special EMS team at the site and got AAM were enrolled. Cases with unknown information on AAM success or time of arrival/death were excluded. Pre-hospital ROSC, 72 hr survival, survival to discharge, good neurological outcome were compared among SGA, ETI with DL and ETI with VL using multivariable logistic regression. Initial AAM success and final success rates were also compared. 10,587 cases were enrolled in the study, of which 9379 cases got SGA, 493 ETI with DL, and 985 ETI with VL. In the first attempt, the insertion success rate is higher with SGA, but the overall success is higher with VL. For any prehospital ROSC, compared to SGA, ETI with DL was 1.33 (1.00-1.75), and ETI with VL was 1.92 (1.57-2.34). Compared to SGA, aOR for survival within 72 hours was 1.13 (0.81-1.56), 1.34 (1.06-1.70), survival to discharge was 1.05 (0.64-1.65), 1.06 (0.74-1.49), and good neurological outcome was 0.64 (0.31-1.25), 1.17(0.71-1.86) in ETI with DL or ETI with VL respectively. Compared to the SGA, aOR of the initial success was 0.44 (0.32-0.61) and 0.48 (0.38-0.62) in the ETI with DL and ETI with VL groups, respectively, and the final success rate was 0.78 (0.45-1.44), 1.14 (0.72-1.94). Endotracheal intubation in EMS showed the lower initial success rate than SGA, but when using a video-laryngoscope, the final success rate rises to a sufficiently similar level, and the pre-hospital ROSC success rate is higher than that of SGA.
Abstract 4147941: Impact of a fractional flow reserve-guided invasive versus conservative management strategy on outcomes in the ISCHEMIA trial
Authors: Joshua Zuniga, Ayesha Singh, John Rodman, David Brown
Journal: Circulation (2024)

Introduction: Fractional flow reserve (FFR) is an invasive, lesion-specific surrogate for myocardial ischemia. However, the impact of an FFR-guided invasive strategy on outcomes in chronic coronary disease (CCD) when compared to a conservative strategy is unclear. Purpose: To compare the outcomes of patients with CCD enrolled in the ISCHEMIA trial randomized to the invasive (INV) arm who underwent FFR during initial angiography with those randomized to a conservative (CON) strategy with optimal medical therapy alone. Methods: The ISCHEMIA data set was obtained from the NHLBI. Patients randomized to the INV arm who underwent FFR at initial angiography were compared to those who were treated with a CON strategy using optimal medical therapy. Unadjusted cumulative event probabilities were estimated using the Kaplan-Meier method. The co-primary endpoints of interest were cardiovascular death (CV) death and myocardial infarction (MI). Secondary outcomes included all-cause mortality and health status as determined by the Seattle Angina Questionnaire (SAQ) angina frequency (AF), quality of life (QoL) and summary scores (SS). Results: Of the 5,179 patients with CCD and at least moderate ischemia on stress testing, 2,322 were randomized to the CON strategy and 2,475 were randomized to the INV strategy. Of these, 428 underwent angiography with FFR (INV-FFR). CON patients were younger than INV-FFR patients (64.3 [9.6] years vs. 65.5 [8.7] years, P=0.013). The incidence of hypertension, diabetes, smoking, BMI, or prior MI did not differ between groups. SAQ AF, QoL, and SS scores did not differ between groups at baseline. CON patients had more vessels with greater than 70% stenosis (1.49 [0.9] vs. 1.24 [1.0], P&lt;0.001). Of CON patients, 87% had moderate or severe ischemia vs 83% of INV-FFR patients (P=0.009). The SAQ AF, QoL, and SS scores did not differ between groups at 1, 3 or 5 years. After 5 years of follow-up, there was no difference in freedom from CV death (94% vs 97%, P=0.11) or all-cause mortality (92% vs 93%, P=0.44) in CON compared to INV-FFR groups. However, 5-year freedom from MI was lower in CON patients (87.0% vs 92%, P=0.039). Conclusion: Despite selecting for patients with less extensive coronary disease and less severe ischemia, an FFR-guided INV approach did not result in reductions in CV or all-cause mortality at 5 years or improvements in health status at 1, 3 or 5 years. However, INV-FFR was associated with a reduction in MI at 5 years.
Abstract 4147854: Cardiac Involvement is Prevalent in Patients with Pediatric Mitochondrial Disease and is Associated with Higher Likelihood of Hospital Admission
Authors: Robyn Lottes, Morgan Kinsinger, Anna Joong, Gregory Webster, Divakar Mithal
Journal: Circulation (2024)

Background: Mitochondrial disease has an estimated incidence of 1.6 per 5,000 live births and can affect nearly any organ system; however, the cardiac presentations and clinical implications of mitochondrial disease remain poorly understood. The purpose of this study was to describe the prevalence of cardiac disease in a cohort of patients with known mitochondrial disease and compare outcomes between patients with and without cardiac disease. Methods: This retrospective study performed at a single pediatric tertiary-care hospital included patients with a clinical and genetic diagnosis of mitochondrial disease that had at least one encounter with our hospital system between 2019 and 2024. Available echo and ECG data and cardiology documentation was reviewed. Clinical characteristics including hospital admissions and number of subspecialties involved in care were retrieved from the electronic medical record from 2007-2024. Analysis of clinical findings was performed using chi-squared analysis, and comparison of hospitalized days, ICU days, and number of subspecialties involved in care was performed using Student’s T test analysis. Cardiac abnormalities that were identified at the time of death or arrest unrelated to a primary cardiac etiology were not included as cardiac disease. Results: Cardiac disease was present in 31/94 patients. More than one cardiac diagnosis was present in 5 patients thus 37 unique cardiac diagnoses were made. Cardiomyopathy was most common (17/95), with hypertrophic cardiomyopathy in 9/17. Electrophysiology disease was present in 9/94 patients with 5/9 having antegrade ventricular pre-excitation. Two patients recieved heart transplant. Patients with cardiac disease were more likely to be hospitalized than those without disease (83% vs 59%, p=0.02), and more likely to require admission to an ICU (61% vs 37%, p=0.02). Hospital and ICU days varied widely within groups and there was no significant difference between those with vs those without cardiac disease. There was no statistical difference in mortality. Conclusions: Cardiac disease is present in a third of children with genotype positive, phenotype positive mitochondrial disease. No current guidelines exist to determine cardiac screening in most forms of mitochondrial disease, despite a higher prevalence of severe cardiac abnormalities than in many other populations where screening is vocally advocated, such as athletes and patients with a positive family history of cardiac disease.
Abstract 4147899: Clinical Usefulness of Pulmonary Embolism Response Team (PERT) among Pulmonary Embolism Patients: A Systematic Review and Meta-analysis
Authors: Prakash Oli, Sagun Dawadi, Dhan Shrestha, Jurgen Shtembari, Amit Bhandari, Daniel Katz
Journal: Circulation (2024)

Background: Despite the advancement in management, pulmonary embolism has challenges in its early diagnosis and initiation of the therapies. To counter this situation, the concept of a Pulmonary Embolism Response Team (PERT), a multidisciplinary team comprised of different healthcare providers, emerged in 2012 as an initiative to optimize care for pulmonary embolism patients. This approach shown to be effective in improving the early and effective management of PE patients, thus improving the clinical recovery in some studies yet remain inclusive in other studies. Given the trending PERT acceptance situation in PE management, we performed this systematic review and meta-analysis to analyze the clinical impact of the PERT approach on PE patient management. Methods: We conducted a systematic review and meta-analysis from pertinent studies published until May 2024 using PubMed, Embase, and Scopus databases comparing PERT vs standard approach for PE management. This study is registered with PROSPERO and data analysis was performed using the RevMan Web. Results: In this analysis, 15,621 PE patients who managed via the PERT or standard approach were included in 23 studies. The use of PERT was associated with significantly lower odds of short-term mortality (OR: 0.76, CI 0.59 to 0.99), and higher odds of utilization of advanced treatment strategy (OR: 3.45, CI 1.95 to 6.09). Additionally, PERT was associated with favorably lower odds of major bleeding (OR: 0.60, CI 0.34 to 1.05) and early achievement of therapeutic anticoagulation (MD: -1.39, CI -5.32 to 2.54). Despite higher odds of ICU admission, the length of stay in ICU was significantly lower in the PERT group (MD: -0.67, CI -1.28 to -0.05). Conclusion: Based on this meta-analysis, the PERT approach for PE management significantly increases the chances of utilization of advanced PE management strategies, thus shortening the ICU stays, and reducing mortality risk. Additionally, it could potentially reduce the major bleeding risk. PERT should be in the focus as one of the standards of care for area PE management.
Abstract Sa107: Course and Outcomes of Prehospital Advanced Airway Management Efforts in the Pragmatic Airway Resuscitation Trial (PART)
Authors: Kim Moeller, Jonathan Powell, Christopher Gage, Ashish Panchal, Henry Wang
Journal: Circulation (2024)

Background: Prehospital advanced airway management may be associated with important complications, such as failed insertion attempts or the need to replace a successfully inserted airway. Only limited data describe the course and outcomes of these efforts. Objective: Describe the reasons for abandoning or replacing advanced airway management devices in the Pragmatic Airway Resuscitation Trial (PART). Methods: Secondary analysis of PART, a multicenter trial comparing airway management in adult out-of-hospital cardiac arrests (OHCA). Paramedics performed laryngeal tube (LT) and endotracheal intubation (ETI) per study protocol. For unsuccessful advanced airway management, paramedics reported the reasons for abandoning further airway insertion attempts. For successful advanced airway events, paramedics reported the reasons for removing the device. We further determined the reasons for the emergency department (ED) removal of successfully placed prehospital airway devices. We analyzed the data using descriptive techniques, including frequency (%). Results: Of 3,004 patients, first airway techniques were LT 1,423, ETI 1,227, and BVM 354. First-effort success rates in advanced airways were LT 90.3% and ETI 51.6%. For the second effort, airway switches were LT to ETI [62 (45.0)] and ETI to LT [454 (76.4)]. Of 1,317 total ETI efforts, reasons for abandoning airway insertions were difficulty visualizing vocal cords [243 (18.5)], view obstructed by blood/vomit [(51 (3.9)], and difficult anatomy [50 (3.8)]. Of 1,928 total LT efforts, reasons for abandoning airway insertion were ventilation/device difficulties [39 (2.0)], uncertain placement [27 (1.4)], and obstruction by blood/vomit [20 (1.0)]. Reasons for removing successfully placed airways were ventilation/device difficulties [LT 37 (1.9); ETI 7 (0.5)], displacement [LT 19 (1.0); ETI 26 (2.0)], obstruction by blood/vomit [LT 20 (1.0); ETI 7 (0.5)], and uncertain placement [LT 17 (0.9); ETI 11 (0.8)]. Among 684 LTs transported to the ED, reasons for LT removal were unknown [416 (60.8)], physician discretion [194 (28.4)], and local protocol requirements [47 (6.9)]. Conclusion: Abandonment of airway insertion was more common with ETI, mainly due to poor vocal cord visualization. Successfully placed airways were replaced infrequently. EDs replaced a large portion of prehospital LTs. These data highlight the challenges of placing and maintaining advanced airway devices.