tbuckley/cabot-search huggingface dataset:
Abstract 13181: Tricuspid Regurgitation Impact on Outcomes (TRIO) Score in Patients With Tricuspid Regurgitation and Severe Pulmonary Hypertension
Authors: Mohamad Saleh Alabdaljabar, Jwan Naser, Conor Kane, Kyla Lara-Breitinger, Vidhu Anand, Cristina Pislaru, Mackram F Eleid, Mohamad Alkhouli, Garvan Kane, Patricia A Pellikka, Grace Lin, Vuyisile T Nkomo, Sorin Pislaru
Journal: Circulation (2023)

Background: Clinically significant tricuspid regurgitation (TR) is an important contributor to morbidity and mortality. The Tricuspid Regurgitation Impact on Outcomes (TRIO) score based on 8 parameters (age, gender, chronic heart failure, chronic lung disease, heart rate, creatinine, aspartate transaminase level, and TR severity) is used for risk stratification. The performance of the TRIO score in patients with TR secondary to severe pulmonary hypertension (PH) is unknown. Research Questions: To evaluate whether the TRIO score can be applied in patients with TR and pulmonary hypertension (PH), and to identify other predictors of mortality. Methods: Retrospective study including patients with TR ≥ moderate. Severe PH was defined as right ventricular systolic pressure (RVSP) ≥50 mmHg. The impact of clinical, echocardiographic and laboratory variables on mortality was evaluated with the Cox proportional hazard method. Results: A total of 13,482 patients from the TRIO population were included; severe PH was present in 6,530 (48.4%); mean age 73.4 + 13.3, 55.7% females. TRIO score performance was modest (AUC 0.62) in risk stratification (Figure A). PH patients had significantly higher mortality than those without PH at all levels of TRIO score (Figure B); differences were progressively lower with increasing TRIO scores. At multivariate analysis, only TRIO score [HR = 1.54 (1.35-1.77) per unit change], presence of an elevated NT-proBNP [HR = 1.02 (1.02-1.03) per 1000 pg/ml change], RVSP (HR = 1.08 (1.02-1.16) per 10 mmHg change], presence of RV dysfunction [HR = 1.15, (1.05-1.26)] and pulmonary artery pulsatility index (PAPi) ≤ 4 [HR = 1.34 (1.07-1.67)] were significant predictors of mortality (model AUC 0.65). Conclusions: TRIO score allows risk stratification in PH patients, but performance is modest; incorporating additional factors marginally increased model performance. PH patients have higher mortality at all levels of TRIO score, more so at low scores.
Abstract 16330: Aspirin Dosing by Body Mass Index: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness
Authors: Nishant P Shah, Cara Hoke, Grace Rhodes, Amanda Stebbins, Lisa M Wruck, Kamal gupta, Sunil Kripalani, Daniel Munoz, Jeffrey Whittle, Catherine Benziger, Saket Girotra, Kirk U Knowlton, Tamar S Polonsky, Russell Rothman, Robert A Harrington, Adrian F Hernandez, William S Jones
Journal: Circulation (2023)

Introduction: Elevated body mass index (BMI) is a risk factor for cardiovascular (CV) events. It remains unclear if the effectiveness and safety of aspirin dose (81mg vs 325mg) is modified by baseline BMI. Research Question: To determine differences in CV event rates and major bleeding between aspirin dose and BMI in patients with coronary artery disease (CAD). Methods: Participants from the ADAPTABLE trial were stratified by BMI categories defined as normal weight (BMI &lt;25 kg/m 2 ), overweight (BMI ≥25 to &lt;30 kg/m 2 ), and obese (≥30 kg/m 2 ). The primary outcome was a composite of all cause death, hospitalization for myocardial infarction (MI), or hospitalization for stroke, assessed in a time-to-event analysis. The event rate represented events per 100 patient years of follow up. The primary safety outcome was hospitalization for major bleeding with blood product transfusion. Cox proportional hazards models were used to evaluate the primary outcome by aspirin dose and BMI category. Results: A total of 12,715 participants (n=1,822 normal weight, n=4,485 overweight, and n=6,408 obese) had data available for BMI and analysis. The event rate for the primary outcome in those at normal weight was similar across aspirin dose (5.38 for 81mg vs 5.43 for 325 mg, adjusted HR 1.06 [95% CI 0.81-1.39]). This relationship was also seen in both overweight (3.53 for 81mg vs. 3.27 for 325mg, 1.10 [0.88-1.36]), and obese (3.50 for 81mg vs 3.45 for 325 mg, 1.04 [0.87-1.25]) BMI (figure). There was no difference in the primary safety outcome by aspirin dose [normal weight 0.92 (0.41-2.08), overweight 1.65 (0.77-3.55), obese 1.17 (0.62-2.20)]. The overall event rate for the primary outcome was lower in overweight (0.68 [0.57-0.81]) and obese (0.65 [0.55-0.78]) groups compared to normal weight. Conclusion: In ADAPTABLE, no difference was seen in CV event rates and major bleeding across BMI by aspirin dose. However, the overall event rates were lower in elevated BMI groups suggesting an obesity paradox.
Abstract 16565: Machine Learning Model for Predicting Mortality in Acute Myocardial Infarction Patients Managed With or Without Beta-Blocker
Authors: Jinah Cha, Woo Jin Ahn, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Sujin Hyun, Soohyung Park, Dong Oh Kang, Eun Jin Park, Cheol Ung Choi, Yung-Kyun Noh, Myung ho Jeong
Journal: Circulation (2023)

Introduction: Optimal personalized medical therapy is crucial for reducing the mortality risk of acute myocardial infarction (AMI). But, assessing the potential individual benefits of beta-blockers (BB) remains challenging despite the consensus of current guidelines. Hypothesis: The hypothesis is that machine learning (ML) models can predict the mortality benefit of BB for individual AMI patients, thus helping to identify subgroups with the highest clinical benefit. Methods: A total 13,104 AMI patients registered in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH) were included in the study. After exclusion of in-hospital death (N = 505), datasets were randomly allocated to the training (N = 8467) and test datasets (N = 4132) by 2:1 ratio. Binary GLM Logistic Regression, Subspace Discriminant, Kernel Naive Bayes, Boosted Trees and KNN were used to train the ML model. Patients were stratified into quartiles (Q1, Q2, Q3, Q4) based on the estimated risk.The low-risk group comprised Q1 and Q2, while the high-risk group consisted of Q3 and Q4. Results: Binary GLM Logistic Regression outperformed other models in the 5-fold cross validation test (area under the curve = 0.85, sensitivity = 98.6%). Errors of estimated mortality were within 0.3% for all quartile groups. High-risk group identified by the ML model demonstrated significant reduction in mortality with the usage of BB, whereas no such benefit was observed in the low-risk group. Additionally, subgroups of chronic kidney disease (CKD), anemia, and old age (&gt;65) displayed notable reduction in mortality when managed with BB, in the high-risk group. Conclusions: With the successful performance of ML model predicting mortality, we identified subpopulations within AMI patients who are highly likely to benefit from the usage of BB. Clinical decision-making could be potentially optimized for individual AMI patients by application of the ML model, through personalized risk scoring and identification.
Abstract 16107: Post-Cardioversion Device-Related Thrombus in a Patient With Left Atrial Appendage Occlusion Device on Apixaban
Authors: Hasaan Ahmed, Mahmoud Ismayl, Anirudh Palicherla, Miranda Heppler, Terezia Petraskova, Omar Kousa, Eric Van De Graaff
Journal: Circulation (2023)

Introduction and Importance: Current guidelines recommend against pre-procedural transesophageal echocardiogram (TEE) prior to cardioversion in atrial fibrillation patients compliant with oral anticoagulants for at least 3 weeks. The relevance of these guidelines remain unclear in those undergoing repeat cardioversion. Case Presentation: 66-year-old male with a history of atrial fibrillation and an implanted left atrial appendage occlusion device(LAAO), compliant with apixaban, presented with dyspnea and lightheadedness. He was cardioverted into sinus rhythm 10 days prior to symptom onset with TEE unremarkable for thrombus. Vitals were remarkable for tachycardia and electrocardiogram revealed that the patient converted back into atrial fibrillation. Patient was then scheduled for cardioversion. At the patient’s request, a TEE was obtained which revealed a new thrombus in the left atrium located on his WATCHMAN device. Cardioversion was canceled and patient was admitted for coumadin initiation with lovenox bridge along with neurological monitoring due to increased stroke risk. Clinical Discussion: Restoration of sinus rhythm after cardioversion can lead to thrombus formation due to atrial stunning, a transitory dysfunction of the atrial appendage and atrium.Atrial stunning occurs immediately after cardioversion and can persist for several weeks. Time-span of preceding atrial fibrillation, presence of structural cardiovascular disease, and atrial size impact severity of atrial stunning and duration of anticoagulation needed.While anticoagulation decreases the risk of thrombus formation, it does not completely eliminate it, especially in those with increased stroke risk factors. Conclusion: Atrial fibrillation patients are susceptible to thrombus formation after cardioversion.Further studies should be done to assess the need for routine TEE after cardioversion in those with increased risk for stroke on anticoagulants or who have LAAO.
Abstract 16801: Effect of Cyclosporine A on Infarct Size in Rat Hearts Donated After Circulatory Death
Authors: Zachary Kiernan, Qun Chen, Edward J Lesnefsky, Mohammed Quader
Journal: Circulation (2023)

Introduction: Ischemia-reperfusion injury (IRI) is inherent in heart donation after circulatory death (DCD), hence only hearts with &lt;30 minutes of ischemia are used for transplantation. Mitochondrial permeability-transition pore (MPTP) opening has been implicated in IRI. Cyclosporine A (CyA) is known to inhibit MPTP opening. No data on infarct size reduction with CyA exists in a DCD heart. Hypothesis: CyA given during reperfusion will reduce infarct size in DCD hearts. Methods: Male Sprague-Dawley rats were assigned to either DCD + CyA, DCD + vehicle, or control-beating heart donors (CBD) (n=10 per group). Rats were anesthetized with pentobarbital, intubated and ventilated. Vecuronium and heparin were given for muscle paralysis and anticoagulation respectively. For DCD group, ventilation was terminated (start of anoxia/ischemia time), and hearts procured after 5, 10, 15, 20, 25 minutes. CBD hearts were procured without ischemia. Hearts were then perfused on a Langendorff setup for 90 minutes. Vehicle and CyA groups received DMSO and CyA (2μM) in KH buffer, respectively, for first 15 minutes followed by 75 minutes of KH buffer. Developed pressure (DP) was measured via a balloon tip catheter placed in the left ventricle. Infarct size was measured using triphenyltetrazolium chloride staining. CBD hearts perfused with KH buffer only served as controls. Results: Percent infarct size following 5, 10, 15, 20, and 25 minutes of ischemia was 17.7 ± 4, 19.3 ± 6, 25 ± 4, 27.3 ± 3, and 25.4 ± 11 respectively. CyA given to 25 minutes ischemia group reduced infarct size to 14.7%, corresponding to 6 minutes of ischemia. At 60 minutes CyA treated hearts had higher DP (mmHg) compared to vehicle group (34 ± 13 vs. 51 ± 17, p=0.017 ). Conclusions: CyA given during reperfusion to DCD hearts significantly reduced infarct size and preserved function. CyA use may allow for longer ischemia times during DCD heart procurement.
Abstract 18506: Echocardiographic Hemodynamic Assessment in Patients Undergoing Aortic Balloon Valvuloplasty: A Longitudinal Case Series
Authors: Joseph E Karpenos, Marija Petrovic, Juan Arango Morales, Joseph Elias, Hannah Hart, Samantha Shetty, Soumya Gupta, James Choi, Sara Diaz Saravia, Kristen Carter, Nnedindu Asogwa, Eyadeh Mdanat, Ga Hee kim, Robert Leber, Alaa M Omar, Edgar Argulian
Journal: Circulation (2023)

Introduction: We studied the anatomical and hemodynamic impact of balloon aortic valvuloplasty (BAV) using echocardiography in patients undergoing transcatheter aortic valve replacement (TAVR) or not. Methods: Retrospectively 22 patients referred for BAV were included [84±7 years, 63% women, ejection fraction (EF): 55±15%; EF≥50% in 16]. Echocardiography was done at 3 time points: baseline, immediately after BAV, and either after TAVR or during follow-up if TAVR was not performed. Results: BAV indications were: 2 urgent non-cardiac surgery, 7 cardiogenic shock, 1 for palliation, and 13 bridged to TAVR. At baseline, the aortic valve area (AVA) was 0.7±0.1 cm2, mean transaortic pressure gradient (PG) was 41±11 mmHg, stroke volume index (SVi) was 33±10 ml/m2, transvalvular flow rate (FR) was 197±44 ml/s, and transvalvular resistance (TVR) was 118±41 dyn.s.cm-5. Immediately after BAV, AVA significantly increased (0.9±0.2 cm2, p=0.002) and PG decreased (32±8.7 mmHg, p=0.019), indicating favorable anatomic outcomes. Interestingly, SVi (36±13, p=0.372), FR (209±60 ml/s, p=0.112), and TVR (95±49 dyn.s.cm-5, p=0.112) did not change immediately after BAV (Figure 1). During follow-up, TAVR patients exhibited near normalization of all valvular profiles, while non-TAVR did not show significant changes compared to post-BAV (Figure 1). After a median follow-up of 28 months, 7 patients died, 9 had cardiac hospitalizations, 2 had strokes, and 3 had acute coronary syndromes. As expected, TAVR had a significantly lower incidence of non-fatal composite outcomes compared to non-TAVR (1 vs. 9, p=0.007). Conclusions: Our findings indicate that BAV did not lead to substantial hemodynamic improvement in terms of transvalvular flow, flow rate, or valvular resistance, which appeared to improve only with TAVR. The modest anatomical effect of BAV did not seem to justify the high clinical risk associated with the procedure.
Abstract 16898: Myocardial Recovery Associated Gene Cdcp1 Expression Attenuates Cardiac Fibrosis in a Pressure Over-Load Mouse Model
Authors: Min Wang, Hridyanshu Vyas, Carolyn Roos, Runqing Huang, Duan Liu, Jyotan Sahni, Dennis M McNamara, Simona Barlera, Silvana Pileggi, Luisa Mestroni, Marco Merlo, Gianfranco Sinagra, Florence Pinet, Anna Chaloupka, Jan Krejci, Pascal de GROOTE, Richard Weinshilboum, Jordan D Miller, Naveen L Pereira
Journal: Circulation (2023)

Background: We have previously demonstrated by performing a genome-wide association study that a genetic locus resulting in ↓CDCP1 expression was associated with myocardial recovery in patients with dilated cardiomyopathy (DCM). We have subsequently shown that ↓CDCP1 decreases human cardiac fibroblast proliferation in vitro , however, its potential role in modulating cardiac fibrosis and function in vivo is unknown. Methods: A Cdcp1 knock-out (KO) mouse was generated on FVB/NJ background. Angiotensin II/Phenylephrine (AngII/PE) or saline was infused by an osmotic pump into mice ( Cdcp1 KO n=20; wild type/wt n=18) for 4 weeks. Echocardiography was performed at 0 and 4 weeks. Picrosirius red (PSR) staining was performed on cross-sectional heart tissue to identify cardiac fibrosis, which was quantified, using ImageJ software, as a percentage of left ventricular (LV) area stained by PSR. Results: LV mass index (LVMI) significantly increased in AngII/PE wt mice as compared to saline wt (figure a. 3.65±0.15 mg/g vs 3.05±0.17mg/g, p=0.01), however, AngII/PE Cdcp1 KO mice had significantly decreased LVMI as compared to AngII/PE wt mice (figure a. 3.17±0.09 mg/g vs 3.65±0.15 mg/g, p=0.01). In addition, fractional shortening trended higher in AngII/PE Cdcp1 KO mice as compared to AngII/PE wt mice (figure b. 50.36±2.06% vs 45.48±1.43%, p=0.07). Extent of cardiac fibrosis was significantly higher in AngII/PE wt mice as compared to saline wt (figure c. 15.79±0.49% vs 7.93±0.39%, p&lt;0.0001), however AngII/PE Cdcp1 KO mice had significantly reduced cardiac fibrosis as compared to AngII/PE wt mice (figure c. 9.41±0.43%, p&lt;0.0001). Conclusions: CDCP1 KO significantly reduces pressure over-load induced LV hypertrophy and cardiac fibrosis. Its role as a novel therapeutic target in attenuating fibrosis and improving cardiac function in DCM needs to be further explored.
Abstract 16394: Increasing Prevalence of Cardiovascular Comorbidities Among Patients With Primary Biliary Cirrhosis: 2012-2020
Authors: Mina Iskander, Ankoor Patel, Joel Mintz, Juan Uribe, Moises Vasquez, Juan Quintero Martinez, Jose Luna Alvarez Amezquita, mohammed mustafa, Vinod K Rustgi
Journal: Circulation (2023)

Background: Primary Biliary Cirrhosis (PBC) is an autoimmune cholestatic liver disease characterized by progressive damage to the small bile ducts within the liver. PBC is a chronic inflammatory condition frequently associated with cardiac complications in practice, including hyperlipidemia, cardiac arrythmias, and cardiomyopathy. However, data regarding the cardiovascular disease trends and complications in patients with PBC is limited. Aims: To demonstrate the trends of cardiac complications including atrial fibrillation (AF), congestive heart failure (CHF), cardiac arrythmias, myocardial infarction (MI), coronary artery disease (CAD), and valvular disorders in patients with PBC. Methods: A retrospective cohort study using The National Inpatient Database was used to identify patients with PBC from 2012 to 2020. Results: A total of 22,136 patients inpatients with PBC were identified. Prevalence increased from 2,374 in 2012 (mean [SD] age 63.9 [14.2] years; 85.3% female) to 2,470 in 2020 (mean [SD] age 65.3 [13.9] years; 84.0% female). There was a statistically significant marked increase in MI (4.6% to 8.1%; P&lt;0.001), CHF (14.2% to 21.6%; P&lt;0.001), CAD (14.9% to 17.3%; P&lt;0.001), and AF (12.3% to 16.2%; P&lt;0.001) from 2012 to 2020. There was no significant increase in valvular disorders (8.2% to 9.3%; P=.286) and a significant decrease in cardiac arrythmias (24.2% to 23.4%; P=0.011) found from 2012 to 2020. Conclusion: In an inpatient population with PBC, with there was a significant uptrend in MI, AF, CAD, and CHF between 2012 to 2020. There was no change found in valvular disorders and a downtrend in cardiac arrythmias over the same time frame. Further data assessing the cardiovascular outcomes in PBC and its etiology are needed to optimize strategies for long term management of these patients from a cardiovascular standpoint.
Abstract 15351: Characteristics of Veterans Enrolled in a Nationwide Home Telemonitoring Blood Pressure (BP) Program
Authors: AREEF Ishani, David Nelson, Sean Nugent, Brent Taylor, Karen L Margolis, Oliva Taylor, Jacob McPherson, Srihari Raju, Hanna Ibrahim, Nayanjot K Rai, Paul Drawz
Journal: Circulation (2023)

Background: Guidelines recommend home BP monitoring for the diagnosis and management of hypertension. The Veterans Affairs (VA) has a robust nationwide home BP monitoring telehealth (HT) program. Aims: We aimed to determine factors associated with being enrolled in the VA’s HT program using a nationwide cohort. Methods: Veterans with hypertension and a primary care (PC) visit between 4/2013 and 9/2015 were identified and classified as telehealth if they enrolled in the HT program and were issued a home-telehealth BP monitor. Control patients were not enrolled. Patient characteristics including the care assessment needs (CAN) score (validated probability for mortality or hospitalization in the following year) were extracted from the electronic health record (EHR). Results: Over 33 months, 29,927 (2.5%) veterans were enrolled in the HT program and 1,160,506 (97.5%) veterans with hypertension were not enrolled. Compared to controls, HT patients were of similar age (median 66 years), were more likely to be female (5.6% vs 4.6%), be of Black race (28.7% vs 20.1%), have a higher index median systolic BP (158.4 vs 153 mmHg), have a greater number of PC visits in the 2 years prior (11 vs 7 visits), have a higher median probability of a mortality or hospitalization event within 1 year (13% vs 7%) and were on a greater number of antihypertensive medications than those not enrolled (Table). These veterans were seen by 9,301 PC providers, who enrolled the following percentages of their hypertensive patients (% of patients by % of providers): 0% by 22%, &lt;2% by 24.1%, 2-5% by 28.9%, 5-10% by 16.4%, 10-20% by 6.9% and &gt;20% by 1.7%. Conclusion: The VA’s HT program is used by a limited number of Veterans. Those enrolled are sicker and have a greater burden of hypertension than those not enrolled. Most providers have a small percentage of their panel of patients enrolled. This preliminary report comes from a study evaluating the effect of HT on BP control, cardiovascular events, and non-cancer mortality.
Abstract 13492: Optimal Fluoroscopy Views and Catheter Selection for Coronary Angiography in Porcine Models
Authors: Swaiman Singh, Skylar Rizzo, Tyra A Witt, Mary Nagel, Paul Stalboerger, Atta Behfar
Journal: Circulation (2023)

Coronary angiography is the gold standard for the diagnosis and treatment of epicardial coronary artery disease. Further, it is an essential tool for conduction of translational cardiac research on large animal models, in the development of novel cardiac therapies. While in humans coronary angiography has an exceedingly low mortality rate; in pigs, procedural mortality has been reported as high as 15%, likely due to unsuitable variations in angiographic techniques. Porcine models are used due to the resemblance of cardiac function and anatomy to humans. However, procedural guidelines delineating proper equipment to be used for angiography in this model has yet to be systematically assessed. Aims: To evaluate clinically common catheters for their utility in the safe engagement of the coronary vessels in pigs. Establish optimal workflow and fluoroscopy views for safe coronary artery engagement and angiography. Method/Results: Percutaneous superficial femoral artery access was acquired via ultrasound guidance and subsequent cardiac catheterization was performed in sus domesticus weighing 35-50 kg. Catheters that were tested included the JL 2.5, JL3.0, JR 3.0, AR1, AL1, MPA1, Champ1, 3DRC, hockey stick and RCB (5-7 french) operated over a standard .035 J tip wire. AP views were optimum to engage both the left and right coronary vessels. Only AR1, 3DRC, and hockey stick catheters successfully engaged the RCA, while all catheters tested could successfully engage the LCA. AR1 was noted to be the best for RCA engagement and AL1 for Left system engagement. AR1 was also the most succesful in engagement of both LM and RCA in same pig. AL1 provided the most stable engagement for Left coronary system. AR1/JL were better for LAD intervensions. AL1 is best for LCX intervensions Conclusion: We present a systematic description of percutaneous coronary angiographic procedures highlighting that AL for the LCA and AR for the RCA are the best choice of catheters for fastest and safest engagement of the coronary arteries limiting both radiation time and contrast use. While variations in anatomy can mandate changes in angiographic angles and catheter techniques, AP visualization and use of AL and AR catheters provided the most consistent and effective approach for porcine angiography.