tbuckley/cabot-search huggingface dataset:
Abstract 12163: Initiation of Guideline Directed Medical Therapy at Hospital Discharge Improves Outcomes in Heart Failure With Reduced Ejection Fraction
Authors: Chi-Cheng Huang, Yen-Wen Wu
Journal: Circulation (2023)

Background: HFrEF is associated with high morbidity and mortality. Current guidelines recommend early initiation of all GDMT, but critical gap exists in daily practice. Research Questions: We aimed to demonstrate the benefits of initiating all GDMT at hospital discharge. We also investigated factors that caused the suboptimal prescription of GDMT. Methods: This retrospective cohort study extracted data of all HFrEF patients admitted to a tertiary hospital in Taiwan from Jan. 2018 to Dec. 2019. Variables such as the date of mortality were collected by electronic medical records or by phone calls. Physicians would select a reason when patients were not given individual GDMT. Outcomes were analyzed according to the use of GDMT (0/1, 2, or 3-pillars). Results: A total of 343 patients were included in the analysis. We found that patients receiving 3-pillars GDMT had significantly better outcomes; they had the lowest risk of 1-year cardiovascular death (3%) or 6-month heart failure hospitalization (5%), but they only accounts for 60 - 80% of patients in every quarter. The main factors that limited the proportion of patients receiving 3-pillars GDMT were the lower prescription rate of ACEIs/ARBs (80.8%) and MRAs (84.0%). In patients not using ACEIs/ARBs, most physicians were worried about renal impairment (71.2%) or hypotension (24.2%). Meanwhile, patients were not given MRAs due to renal impairment (69.1%) or because they were considered asymptomatic (27.8%). Analysis on the eGFR of patients not receiving optimal GDMT revealed that 60.9% of them had stage 3-4 CKD; only the addition of ACEIs/ARBs resulted in a nonsignificant eGFR drop of 3.5 ml/min/1.73m 2 after 3 months. Conclusions: This study confirmed the advantage of starting 3-pillars GDMT early in HFrEF patients. It also revealed the underutilization of GDMT due to concerns of worsening renal function. Efforts should be made to address this disparity to improve the care of HFrEF patients in Taiwan
Abstract 16866: Complete Revascularization for Left Main Acute Myocardial Infarction
Authors: Sun Oh Kim, Yu Jung Jung, Jun Chang Jeong, Byung Ju Son, Jong-Il Park, Kang-Un Choi, Jong-Ho Nam, Jang-Won Son, Ung Kim, Jong-Seon Park
Journal: Circulation (2023)

Background: In patients presenting with acute myocardial infarction (AMI) with left main (LM) culprit lesion and multivessel disease, percutaneous coronary intervention (PCI) of non-culprit lesions in LM culprit AMI is challenging and whether it reduces mortality and adverse events is unclear. Hypothesis: Complete revascularization will show better outcome than culprit-only revascularization in multi-vessel LM AMI PCI. Methods: We reviewed total of 16831 patients among from July 2016 to June 2020 Korean Acute Myocardial Infarction Registry (KAMIR) and 395 patients were enrolled with LM culprit multi-vessel AMI treated by PCI. We excluded in-hospital death 35 cases then categorized patients whether treated with complete revascularization (n=198) or culprit-only revascularization (n=162). Study outcome was a composite of major cardiac adverse events (MACE) including cardiac death, myocardial infarction, re-PCI, stent thrombosis and rehospitalization due to heart failure. We used propensity score (PS) matching method and cumulative event-free survival and MACE were analyzed over 3 years follow-up. Results: After PS matching, baseline and angiographic characteristics were similar between two groups (Complete group, n=142 versus Culprit-only group, n=142). Killip classification (Class IV : n=13 (9.2%) versus n=14 (9.9%), p -value=0.762) and initial diagnosis (STEMI : n=47 (33.1%) versus n=52 (36.6%), p- value=0.618) at admission were also not different between two groups. There was no difference in MACE between two groups (n=27 (19%) versus n=28 (19.7%), log-rank test p- value = 0.64). Conclusion: Although, other studies had shown better outcome of complete revascularization in multi-vessel AMI, in multi-vessel LM AMI PCI, complete revascularization should be carefully decided depending on the patient's condition.
Abstract 16854: Successful Retention of Vulnerable Populations in New York City: The BETTER-BP Randomized Trial
Authors: Erika Clarke, Yasmin Gutierrez, Stefany de Brito, Yuchen Meng, Samrachana Adhikari, John A Dodson, Antoinette Schoenthaler
Journal: Circulation (2023)

Introduction: Clinical trial retention in safety-net practices is challenging. To better understand reasons for loss to follow-up, we analyzed data from an ongoing clinical trial in the NYC public hospital system. Methods: We analyzed the first 185 participants enrolled in the BETTER-BP study, an ongoing randomized trial of wireless antihypertensive medication adherence monitoring with a financial incentive lottery to promote medication taking behavior. BETTER-BP enrolls participants from two NYC public hospitals (Bellevue and Gouverneur) and follow-up lasts 12 months. We reported the rate of loss to follow-up at 12 months and assessed baseline characteristics (age, sex, race, ethnicity, insurance status, BMI, blood pressure, comorbidities, and substance use) of those lost vs. retained. ANOVA was used for continuous variables, and the Chi-squared test for categorical variables. Results: Median age was 55.0 (47.5, 62.5) years, 59% were female, 59% Hispanic, and 26% Non-Hispanic Black. Three quarters were Medicaid-insured or uninsured. There were 155 participants retained at 12 months (83.8% retention rate). Characteristics of those retained vs. lost to follow-up are shown in the Table. Participants who were lost to follow-up were more likely to report current alcohol use (43.3% vs. 36.8%, p &lt; 0.001) and illicit substance use (16.7% vs. 3.9%, p &lt; 0.001). Notably, missingness in alcohol use and illicit substance use was also higher among those lost to follow up. Other baseline characteristics were similar between the two groups. Conclusion: Overall retention was high (&gt;80%). Alcohol and illicit drug use were associated with loss to follow up and may serve as markers for future strategies to mitigate attrition.
Abstract 18201: Intracoronary Optical Coherence Tomography versus Intravascular Ultrasound in ST and Non-ST Elevation Myocardial Infarction: A Nation-Wide Analysis
Authors: Ruth ann Mathew Kalathil, Suma Pusapati, Akshay Machanahalli Balakrishna, Dua Noor Dutt, Ahmed Aboeata
Journal: Circulation (2023)

Introduction: Intravascular ultrasound (IVUS) and intracoronary optical coherence tomography (OCT) are the 2 techniques of intracoronary imaging that are currently accessible modalities to precisely measure coronary diameters and characterize morphology of lesions. We aimed to compare the impact of IVUS and OCT on outcomes and 30-day readmission rates following STEMI and NSTEMI. Methods: We queried the National Readmission database (2010-2019) to identify patients with STEMI and NSTEMI, undergoing PCI and compared outcomes and 30-day readmission rates between patients undergoing IVUS-guided PCI and OCT-guided PCI. Multivariable logistic regression was performed to evaluate the odds ratios (OR) of adverse outcomes in the 2 groups Results: Of 67,479 STEMI admissions undergoing ICI-guided PCI, 65,137 underwent IVUS and 2,342 underwent OCT. Patients undergoing OCT compared to IVUS had lower Length of stay (LOS) (OR 0.98 [0.96-0.99], P&lt;0.05). However, there was no significant difference in in-hospital mortality, 30-day readmission rate and 90-day readmission rate. Of 103,901 NSTEMI admissions undergoing ICI-guided PCI, 100,127 underwent IVUS and 3774 underwent OCT. Patients undergoing OCT compared to IVUS had lower LOS (OR 0.95 [0.93-0.98], P&lt;0.001) and 30-day readmission rates (OR 0.84 [0.71-0.99], P&lt;0.05), but no significant differences were found in in-hospital mortality and 90-day readmission rates Conclusions: In acute MI patients undergoing ICI-guided PCI, OCT-guided PCI during index hospitalization is associated with similar outcomes compared to IVUS-guided PCI (except better LOS and 30-day readmission rates in NSTEMI).
Abstract 16249: A Case of Myocarditis and Pneumonitis Associated With Pembrolizumab Therapy
Authors: Sheetal R Maragiri, Wissam Abdallah, Tyler Kemnic, David Fermin, Sherilyn Munoz, Richard Koubek, Laura Franey
Journal: Circulation (2023)

Introduction: Immune checkpoint inhibitors (ICI) are a novel therapy that activates antitumor immunity but can have varied immune-related adverse effects. As ICI therapy is used to treat malignancy, cases of autoimmune myocarditis and heart failure increase, thought to be due to PD-1 inhibition, which may be potentially fatal. Case presentation: A 37 yo female with history of autoimmune hepatitis and stage III melanoma on Pembrolizumab (ninth cycle 1.5 months prior) presented with chest pain, tachycardia, fatigue, dyspnea, and fever. Lab studies were notable for elevated troponin, lactic acidosis, and disseminated intravascular coagulation (DIC). CT thorax showed asymmetric ground glass opacities, concerning for ICI pneumonitis. Echocardiogram showed an LVEF of 15% with global hypokinesis. She was treated for severe sepsis, DIC, and respiratory failure, temporarily requiring intra-aortic balloon pump. Heart failure guideline-directed medical therapy (GDMT) was started. Clinical presentation was concerning for acute myocarditis related to ICI therapy as a cause for new cardiomyopathy. A cardiac MRI (CMR) revealed subepicardial late gadolinium enhancement (LGE) along the basal inferior/inferolateral wall segments concerning for myocarditis. Corticosteroids with a prolonged taper were started. Endomyocardial biopsy of the septum (EMB) was negative. Her clinical status improved and repeat echo showed LVEF recovery up to 45%. Discussion: Endomyocardial biopsy (EMB) provides definitive diagnosis of myocarditis and is recommended (Class I) for new-onset heart failure with hemodynamic compromise and/or arrhythmias. Although our patient’s EMB was negative (likely due to limitation of sample location), she met the 2013 ESC guideline diagnostic criteria for myocarditis with elevated troponin, functional and structural abnormalities on cardiac imaging. With increased utilization of ICI therapy in the management of aggressive malignancies, it is important to monitor for potentially adverse effects such as autoimmune myocarditis. Standard treatment is prompt initiation of corticosteroids, though newer studies report successful treatment with immunomodulators, such as abatacept and ruxolitinib, if steroids are unsuccessful.
Abstract 13105: Applying Proteomic CV and Kidney Prognosis Risk in T2D Patients to Identify High-Risk Patients
Authors: Michael Hinterberg, Missy Simpson, Clare Paterson, Jessica Chadwick, Jessica Kuzma, Stephen A Williams
Journal: Circulation (2023)

Background: The interdependence of cardiovascular and kidney health in T2D requires understanding the combination of disease risk. Proteomic surrogate models for cardiovascular risk and kidney prognosis have been developed and validated, but not in a combined manner in T2D patients. Hypothesis: Combining the results of independent proteomic risk models for 4-year cardiovascular risk and kidney prognosis will identify patients at highest risk for MACE, better than eGFR. Methods: Plasma from 1,220 participants with T2D from the Atherosclerosis Risk in Communities (ARIC) study visit 5 were assayed for &gt;5,000 proteins using the SomaScan® assay; 34.2% had incident MACE (MI, stroke, HF hospitalization, or death). Predictions from a validated proteomic CV risk model were calculated, as well as a de novo kidney prognosis model developed and validated in the Chronic Renal Insufficiency Cohort and Fenland cohort. Patients were stratified by predefined CV risk bins and sub-stratified by 2x kidney prognosis risk, and compared to eGFR stratification. Log-odds of Kaplan-Meier (KM) event rates were compared between strata. Results: Proteomic kidney risk predictions did not sub-stratify patients at low/medium CV risk (p &gt; 0.05), but did stratify high-risk CV patients, with highest CV and kidney risk patients (5.6% of patients; p &lt; 0.05) having a KM-estimated 63.4% 4-year MACE rate, more than 8 times the low CV risk group. Conversely, stratification using a corresponding eGFR threshold did not significantly stratify high-risk CV patients. High CV risk MACE types were different depending on proteomic kidney risk sub-stratification (chi-square p &lt; 0.015), and participants with increased kidney risk had more HF hospitalizations (39.7% of MACE). Conclusions: Among patients with T2D and elevated proteomic markers for CV risk, an independent proteomic risk model for kidney prognosis can be applied to identify a significantly larger proportion of patients at risk for MACE.
Abstract 296: Comparison of Prognostic Performance Using Quantitative Analysis of Head Computed Tomography and Apparent Diffusion Coefficient Imaging Before Target Temperature Management in Out-of-Hospital Cardiac Arrest Survivors
Authors: Jung A A Yoon, Jung Soo Park, You Yeonho, Kang Changshin, Min Jin Hong, Yong Nam In
Journal: Circulation (2023)

Aim: We compared head computed tomography (HCT) and diffusion-weighted magnetic resonance imaging (DW-MRI) findings before target temperature management (TTM) to predict neurological outcomes in out-of-hospital cardiac arrest survivors. Methods: Using prospectively collected data from a TTM registry, we included patients who underwent HCT and DW-MRI within 6 h of return of spontaneous circulation (ROSC). We examined the gray-to-white matter ratio (GWR) on HCT and apparent diffusion coefficient (ADC) values obtained through voxel-based analysis of DW-MRI. We analyzed the mean ADC value and the % voxels of ADC thresholds (percentage of voxels below ADC thresholds per total voxel) at 50-step intervals ranging from 200 to 1200 х 10 -6 mm/s, identifying thresholds that differentiate between good and poor neurological outcomes. Additionally, we analyzed the combination of pupillary light reflex (PLR) and neuron-specific enolase (NSE) values acquired at the same time points to predict the neurological outcomes. The primary outcome measure was the dichotomized cerebral performance category (CPC) at six months, defined as good (CPC 1-2) or poor (CPC 3-5). Results: Of 131 patients (26% female), 74 (57%) had poor outcomes. The time from ROSC to HCT and DW-MRI scans was 1.7h and 3.2h, respectively. The group with a good outcome had higher GWR (1.26 vs. 1.20) and mean ADC (787.10 vs. 697.49) values, but lower values in all ranges (250-1150) of ADC values (all P&lt;0.001). Mean ADC and ADC values in the range of 350-650 demonstrated better predictive performance for poor outcomes than the GWR (P &lt; 0.05). The mean ADC value had the highest sensitivity of 51.3% (95% CI 39.4-63.1; cutoff value ≤ 739.2 х 10 –6 mm 2 /s) when the false positive rate (FPR) was 0%. Furthermore, when combined with PLR and NSE values, the prognostic performance was significantly improved compared to using Mean ADC alone (0.83 vs 0.92; P&lt;0.01). Conclusions: In this cohort study, early voxel-based quantitative ADC analysis after ROSC (i.e., before TTM) was associated with poor neurological outcomes 6 months after cardiac arrest. We found that the Mean ADC value showed the highest sensitivity when the FPR was 0% and that combining the NSE and PLR values resulted in an even better prognostic performance.
Abstract 12471: Use of Traditional Heart Failure Medications in Patients With Cardiac Amyloidosis and Heart Failure is Safe but Does Not Improve Mortality or Hospitalization
Authors: Crystal L Yan, Ryan A Gallo, Moises Vasquez, Beatriz Rivera Rodriguez, Luis Trujillo, Nina Rivera, james hoffman
Journal: Circulation (2023)

Background: Randomized controlled trials have demonstrated mortality benefit for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction. However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. Objective: The aim of this study was to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced ejection fraction (HFrEF) or HF with mid-range ejection fraction (HFmrEF). Methods: We conducted a single-center retrospective study. Patients were included if they were diagnosed with cardiac amyloidosis and HFrEF or HFmrEF between January 2012 and 2022. The primary outcomes of interest were medication use patterns (for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA)); potential medication side effects (symptomatic bradycardia, fatigue, hypotension, lightheadedness, and syncope); hospitalization; and death. The associations of BB, ACEI/ARB/ARNI, and MRA use with clinical outcomes were evaluated using Kaplan Meir and Cox proportional hazards regression. Results: 82 patients met study criteria. At time of cardiac amyloidosis diagnosis, 63.4% were on a BB, 51.2% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. At last follow up, 51.2% were on a BB, 35.4% were on an ACEI/ARB/ARNI, and 43.9% were on a MRA. There were no statistically significant differences in rates of potential medication side effects in patients on the medication class compared to those who were not. There was no association with mortality for baseline or follow-up BB, ACEI/ARB/ARNI, or MRA use. There was an association with hospitalization for baseline and follow-up MRA use, but this effect was lost after controlling for pre-specified covariates. Conclusions: BB, ACEI/ARB/ARNI, and MRA use is not infrequent in patients with concomitant cardiac amyloidosis and HFrEF or HFmrEF. These traditional HF therapies may be safely used in this population. However, their use does not appear to improve mortality or hospitalization.
Abstract 13798: Change Patterns of Nightly Sleep Duration as Well as Sleep Quality and Risk of Cardiovascular Disease: A Chinese Nationwide Cohort Study
Authors: Xiangming Hu, Haojian Dong, Yanqiu Ou, Yingling Zhou, Jieliang Liu, Junguo Jin, Lujing Jiang, Mingqin Liu
Journal: Circulation (2023)

Introduction: Sleep has been included by the American Heart Association as a new component of Life's Essential 8, as the adverse effects of too much or low nighttime sleep and bad sleep quality on cardiovascular disease (CVD) are well established. Hypothesis: Different change patterns of nightly sleep duration and sleep quality have different CVD risks. Methods: A total of 7,905 adults without CVD history were enrolled in 2011, and the incidence of CVD was tracked until 2018. Nightly sleep duration was categorized as good (6-8 hours) and bad (less than 6 or more than 8 hours), and sleep quality was also categorized as good (1-2 scores) and bad (more than 3 scores). Participants were divided into four groups according to categories of the nightly sleep duration change patterns as well as the sleep quality change patterns in 2011 and in 2015. Logistic regressions and restricted cubic splines were performed to assess the association between change patterns of nightly sleep duration as well as sleep quality and CVD risk. Results: Over a median of 7 years of follow-up, 873 participants (11.0 %) developed CVD. The nightly sleep duration change patterns of good-bad, bad-good and bad-bad were associated with an increased risk of incident CVD, compared to the good-good group. The sleep quality change patterns of good-bad and bad-bad were associated with an increased risk of incident CVD, compared to the good-good group, while the effect in bad-good sleep quality group was not significant. Changes in nighttime sleep duration had a U-shaped relationship with new-onset CVD in subjects with sleep deprivation, and an increase of less than 4 hours was associated with reduced CVD risk in this population. Sleep quality change linearly related with the incidence of CVD. Conclusions: Suboptimal change patterns of nightly sleep duration and sleep quality were both associated with increased CVD risk. For sleep deprived people, supplementing with a certain amount of sleep could reduce the risk of CVD.
Abstract 14435: Psoas Muscle Index as a Tool to Predict Outcomes in a Pulmonary Hypertension Population Undergoing Pulmonary Thromboendarterectomy
Authors: Steven Hopkins, Jillian Hall, Madeline Lee, Anjali Vaidya, Paul R Forfia, Estefania Oliveros
Journal: Circulation (2023)

Introduction: Sarcopenia is defined as an overall decline in skeletal muscle mass and has been associated with a range of cardiac pathologies. Psoas Muscle Index (PMI) has emerged as a metric of sarcopenia. We investigated the prognostic value of PMI on six-minute walk distance (6MWD), and length of stay (LOS) in pulmonary hypertension patients following Pulmonary Thromboendarterectomy (PTE). Hypothesis: Sarcopenic patients will have lower 6MWD meters and increased LOS compared to non-sarcopenic patients. Methods: Retrospective chart review of 65 patients with CTEPH who had undergone PTE with CT scans of the abdomen between 2017-2022. Psoas muscle area was measured at the L3 level on CT scan. PMI was calculated using the formula (left psoas area + right psoas area)/height 2 . Patients in the 1 st quartile PMI for their gender were classified as sarcopenic. 1 st quartile PMI values were calculated as 5.34 cm 2 /m 2 for males, and 3.30 cm 2 /m 2 for females. Results: 17 (26%) patients were classified as sarcopenic. There were no significant differences between sarcopenic and non-sarcopenic groups comparing hemodynamics (mean PA 45 vs 42 mmHg, PVR 9 vs 8 WU, CI 2 vs 2.1-l/min/m 3 ), age (61.2 vs 59.7-years), female sex (52.9 vs 55.3%), ethnicity or comorbidities. Regarding 6 minute walk distance (6MWD), the sarcopenic group had significantly lower meters walked than the non-sarcopenic group pre-PTE (220 vs. 322-meters, p=0.049). Following PTE, there was less distinction between groups in 6MWD (347.1 meters vs 345.1, p=0.970). The sarcopenic group increased their 6MWD more than the non-sarcopenic group (137.3 meters vs 43.7, p=0.055). The sarcopenic group had significantly longer overall length of stay (LOS) (27 vs 14-days, p=0.001), and intensive care unit stay (19 days vs. 6-days, p=0.002) than the non-sarcopenic group. Conclusions: Sarcopenia is prevalent in patient with CTEPH. Sarcopenic patients with CTEPH had lower pre-PTE 6MWD, longer ICU stays and overall hospital LOS.