tbuckley/cabot-search huggingface dataset:
Abstract 12861: Steroidal Mineralocorticoid Receptor Antagonist Treatment Patterns and Predictors of Discontinuation
Authors: Emma Richard, Nihar R Desai, Vincent Willey, Alain Gay, Charlie Scott, Kerstin Folkerts, Elena Pessina, Chia-Chen Teng, Nikolaus G Oberprieler
Journal: Circulation (2023)

Introduction: Steroidal mineralocorticoid receptor antagonists (sMRA), spironolactone and eplerenone, are indicated for several cardiovascular (CV) conditions, including heart failure and hypertension. However, adverse drug reactions may lead to discontinuation. This study aimed to explore sMRA treatment patterns and predictors of discontinuation. Methods: This retrospective observational study used administrative claims from the Healthcare Integrated Research Database® to identify naïve adult users of sMRAs between 01 Jan 2016 and 31 May 2021 with at least 12 months of continuous health plan enrollment before initiation. Five subgroups were identified based on comorbidities before sMRA initiation - heart failure with preserved or reduced ejection fraction (HFpEF/HFrEF), undetermined heart failure (undHF), chronic kidney disease (CKD) and type 2 diabetes (T2D), and nondiabetic-CKD (ndCKD). sMRA treatment patterns and discontinuation (i.e., no refill within two prescription cycles) were described. Multivariate logistic regression modeling was used to explore predictors (i.e., demographics, comorbidity burden, specialist prescribing, CV disease, and medications) of discontinuation in all sMRA users and subgroups separately. Results: We identified 224,100 sMRAs users (99% spironolactone), including 8,553 HFpEF, 19,636 HFrEF, 20,336 undHF, 11,336 CKD and T2D, and 10,134 ndCKD, patients. Over a median of 655 days, a dose change was observed in 23% of patients. A dose increase was more common than a decrease (16% vs. 7%), a trend that was observed across all subgroups. Overall, 73% of sMRA users discontinued treatment after a median of 90 days. Discontinuation in subgroups was lower; 62% in HFpEF, 58% in HFrEF, 61% in undHF, and 66% in both CKD subgroups. No specific factors were consistently associated with increased odds of sMRA discontinuation. However, increased comorbidity burden, use of other CV medications, and cardiologist prescribers significantly decreased the odds of discontinuation across most subgroups. Conclusions: Most naïve sMRA users discontinue therapy within six months of initiation. No demographic or clinical factors were consistently associated with increased odds of sMRA discontinuation.
Abstract 15688: Association of Cytochrome P450 2C19 Polymorphism With Ischemic and Bleeding Risk in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
Authors: Diona Gjermeni, Sofia Szabo, Viktoria Anfang, Hannah Vetter, David Hesselbarth, Stefan Leggewie, Dietmar Trenk, Daniel Duerschmied, Dirk Westermann, Christoph B Olivier
Journal: Circulation (2023)

Introduction: CYP2C19 isoenzymes of cytochrome P450 impact the effect of clopidogrel. Guidelines recommend clopidogrel in addition to oral anticoagulation (OAC) in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). This study aimed to evaluate the association of CYP2C19 polymorphism with ischemic and bleeding risk in patients with AF undergoing PCI. Methods: Patients with AF and an indication for OAC were included in this two-center prospective cohort study up to 3 days after PCI. Carriers of ≥1 loss of function (LOF) allele CYP2C19*2 were classified as poor metabolisers (PM). Carriers of ≥1 gain of function allele (GOF) were defined as rapid metabolisers (RM). Normal metabolisers (NM) were defined as absence of LOF and GOF alleles. Primary outcome was defined as death, myocardial infarction, or stroke (MACE) at 6 months ±2 weeks. Secondary outcome was defined as non-major clinically relevant (NMCR) or major bleedings. Results: 283 patients were included in the study. Median age was 78 (interquartile range, IQR 72-82) years old and 204 (72%) were males. All patients received treatment with clopidogrel and OAC. 73 (26%) were PM, 108 (38%) were NM and 102 (36%) RM. The primary ischemic outcome occurred in 22 (8%) and the secondary outcome in 38 (13%) patients. PM status did not significantly associate with primary ischemic outcome (PM: 6 [8.2%] vs. NM+RM: 16 [7.6%]; odds ratio, OR 1.09 [95% confidence interval 0.41-2.89], p=0.805). RM status did not significantly associate with bleeding (RM: 14 [13.7%] vs. PM+NM: 24 [13.3%]; OR 1.04 [0.51-2.12], p=1.00). Bleeding rates tended to be lower for patients with PM status (major, NMCR, or minor bleeding: PM 12 [28.7%] vs. NM+RM 84 [40.0%]; 0.61 [0.34-1.07], p=0.09). Conclusions: This pilot study of patients with oral anticoagulation for atrial fibrillation and clopidogrel after PCI ruled out, with 95% confidence, a ≥3-fold increase of ischemic risk for carriers of ≥1 loss of function allele CYP2C19*2 compared with non-carriers. This study was underpowered to detect less pronounced associations. LOF-carrier status might protect from bleeding.
Abstract 18328: A National Survey to Identify the Inequality in the Career Development Between Male and Female Cardiologists in Japan
Authors: Mai Shimbo, Fumie Nishizaki, Noriko Fukue, Chisa Matsumoto, Satsuki Noma, Satoko Ohno-Urabe, Chizuko A Kamiya, Sachiko Kanki, Tomomi Ide, Hideo Izawa, Tatsunori Taniguchi, Atsuko Nakayama, Yoshio Kobayashi
Journal: Circulation (2023)

Background: Equality of training opportunities and job satisfaction are not well studied among Japanese cardiologists, especially among female cardiologists in the invasive subspecialties. Methods: We investigated the career development of cardiologists using a questionnaire sent by e-mail to 14,798 cardiologists belonging to the JCS in September 2022. Feelings of equality in training opportunities and job satisfaction were assessed by examining cardiologists' age, gender and subspecialty. These feelings were compared between male and female cardiologists. Invasive treatment subspecialties included ischemia, arrhythmia, surgery, structural heart disease and emergency. Results: Responses were received from 2,566 cardiologists (17.3%). Female cardiologists (n = 624) were underrepresented in ischemia, cardiac surgery and emergency compared to male cardiologists (n = 1,942) (13.0% vs 29.5%, 2.4% vs 6.2%, 1.0% vs 3.2%, 1.4% vs 2.6%, respectively). Female cardiologists perceived more inequality in training opportunities than male cardiologists (44.1 vs. 33.9%, p=0.0001) and were less satisfied with their work than male cardiologists (71.3 vs 80.8%, p=0.0001). In the invasive subspecialties, female cardiologists felt more inequality than male cardiologists (50.0 vs 36.2%, p&lt;0.001) and were less satisfied with their work than male cardiologists (74.0 vs 81.7%, p=0.001). Although male cardiologists in invasive subspecialties did not feel significantly more unequal and dissatisfied than those in non-invasive subspecialties (p=0.063, p=0.758, respectively), female cardiologists in invasive subspecialties felt more unequal and dissatisfied than those in non-invasive subspecialties (p=0.015, p=0.040, respectively). In invasive subspecialties, cardiologists with family care responsibilities were less satisfied with their work than cardiologists without those responsibilities (84.0% vs. 79.0%, p=0.039). Conclusions: Female cardiologists felt more inequality and dissatisfaction in career development than male cardiologists, especially in invasive subspecialties. Diverse workplaces can promote equality in training opportunities and job satisfaction for both female and male cardiologists.
Abstract 12851: Severe Right and Left-Sided Multi-Valvular Carcinoid Heart Disease Associated With Ovarian Carcinoid Tumor
Authors: Jordan Y Troy, Sana Rashid, Ronak Bharucha, Thomas R Cimato, Stanley F Fernandez
Journal: Circulation (2023)

Carcinoid tumors are neuroendocrine neoplasms that secrete vasoactive substances, primarily serotonin, and have an incidence of approximately 2 in 100,000 people. Up to 60% of carcinoid tumors result in carcinoid heart disease (CHD), and unlike other carcinoid tumors, ovarian carcinoid tumors can involve the heart without liver metastasis. By bypassing the liver, ovarian carcinoid tumors can result in CHD in the absence of liver metastasis. We present a rare case of a 40-year-old female who presented in cardiogenic shock requiring inotropic support with echocardiographic evidence of preserved left ventricular systolic function (LVEF 50-55%) and multiple retracted leaflets that exhibited poor coaptation resulting in severe mitral regurgitation, torrential tricuspid regurgitation, and moderate-to-severe aortic regurgitation. Her left heart catheterization revealed non-obstructive coronary artery disease. A non-contrast CT torso revealed an isolated large septated left ovarian cystic mass (7.1x5.2 x7.1cm) without any other mass or lesion. In the setting of an elevated CA-125 (536units/mL, normal 0-35units/mL) and 24-hour urinary 5-HIAA (12.1mg, normal 2-9mg) with a normal CEA, CHD was suspected as the most likely diagnosis given the isolated ovarian mass and severe valvular disease. She underwent triple valve surgery in which valvular pathology revealed myxoid degeneration. Her post-operative course was complicated by multi-organ failure requiring multiple inotropes and V-A ECMO shortly thereafter, but the patient unfortunately passed away. While there are a few documented cases of CHD from ovarian carcinoid (less than 0.5% of cases) and left-sided CHD (less than 10% of cases), this is the first documented case, to our knowledge, describing severe right and left-sided CHD associated with a suspected ovarian carcinoid tumor.
Abstract 15517: Physician-Patient Engagement to Improve Ambulatory Systolic Blood Pressure
Authors: Kyle Kapcin, Aaisha Shah, Lauren Mathos, Alexandra Johnston, Mrudula Gadani
Journal: Circulation (2023)

Introduction: Hypertension is a leading cause of death and disability-adjusted life-years globally. Using implementation science of the 2017 ACC/AHA Guideline for High Blood Pressure (BP) in Adults, we posited a quality improvement (QI) project targeting physician education and multidisciplinary patient engagement in two large urban ambulatory clinics to improve patient blood pressures. Hypothesis: We hypothesize that direct physician and patient education and engagement improves achievement of hypertension goals within ambulatory clinics. Methods: A QI initiative consisting of a half-day of resident hypertension education, patient access to home BP monitors, and direct patient engagement via physician outreach was conducted. Patients not at BP goal defined as systolic blood pressure (SBP) &gt;130 mmHg were followed over 8 months via multidisciplinary approach to ensure adequate follow-up appointments. Data was collected after 8-months and compared descriptively. BP ranges at month 0: Group A &lt;130 mmHg, Group B 130-139 mmHg, Group C 140-159 mmHg, Group D &gt;=160 mmHg. Emphasis was placed on Groups C and D. Results: A total of 6,030 patients had follow-up visits in the 8-month study window. At month 0, 874 patients fell within Group C and 301 within Group D. Of those in Group C, 29.5% achieved SBP goal (&lt;130 mmHg), 27.5% improved BP to 130-139 mmHg, and 34.4% remained within 140-159 mmHg at month 8. In Group D, 20.9% achieved goal SBP &lt;130 mmHg, 17.6% reached 130-139 mmHg, and 34.6% improved to 140-159 mmHg. (Figure 1). Limitations included patients without access to BP cuff during telehealth visits. Conclusions: Direct physician engagement and multidisciplinary approach to hypertension management led to decreased SBP readings. Further investigation is warranted to determine how these interventions affect long-term cardiovascular outcomes.
Abstract 16189: Using Vectorcardiography to Predict Prognosis in Patients With STEMI and Heart Failure
Authors: Sidney Perkins, Demetri Monovoukas, Zoey Chopra, Corey Powell, Anuush Vejalla, Vishwaratn Asthana
Journal: Circulation (2023)

Introduction: There is an unmet need for a non-invasive and cost-effective surveillance tool for characterizing the severity and progression of heart failure (HF) to guide evidence-based therapies. We hypothesize that changes over time in unique parameters extracted using vectorcardiography (VKG) have the potential to predict clinical outcomes in patients with HF. The pathophysiology of HF involves abnormal remodeling and a loss of cardiomyocytes, which may alter the strength and direction of the net depolarization signal. These subtle changes can be elucidated using VKG and correlated with prognosis. We hypothesize a similar approach can be utilized for patients post-STEMI as the underlying pathophysiology - loss of myocardium - is comparable and could serve as an initial proof-of-concept. Methods: We identified 209 patients discharged from Michigan Medicine between 2016 and 2021 with a diagnosis of acute STEMI. For each patient, a single 12-lead EKG pre-STEMI and &gt;1-week post-STEMI were collected. A set of 60 VKG parameters were derived by analyzing features of the QRS complex. We used LASSO regression analysis incorporating clinical variables and VKG parameters to create a predictive model for the composite outcome of mortality or HF at 90 days post-STEMI. Model accuracy was determined by randomly partitioning the data into five folds and running the logistic regression model on all folds but one. Results: Comorbid diabetes (OR = 3.04, p = 0.06), QTc post-STEMI (OR = 2.44, p &lt;0.05), and P wave onset pre-STEMI (OR = 0.41, p &lt; 0.05) were consistently predictive. A logistic regression with just these variables has a raw accuracy of 80.3% and cross-fold validation accuracy of 79.4%. Future work aims to create one of the largest pre-/post-STEMI ECG databases, with over 1,200 patients, which will be used to corroborate the above results and serve as a tool for other investigators to explore. Conclusions: ECG changes before and after a STEMI event can be used to assess the risk of mortality or HF and help guide management. The composite outcome appears to be dominated by variables that are primarily associated with arrhythmogenic death. Future work will focus on pump failure alone and determine VKG parameter predictiveness in HF specifically.
Abstract 16503: C-X-C Motif Chemokine Ligand 12 is a Primary Determinant of Coronary Artery Dominance
Authors: Pam Rios, Daniela Zanetti, Austin Hilliard, Jeffrey Naftaly, Pratima Prabala, Pik Fang Kho, Kyong-Mi Chang, Meg E Plomondon, Stephen Waldo, Philip S Tsao, Shoa L CLARKE, Kristy Horse, Themistocles L Assimes
Journal: Circulation (2023)

Introduction: Left coronary dominance is associated with worse clinical outcomes in the setting of coronary artery disease (CAD). Little is known about the determinants of dominance, including whether it is solidified in utero or sometime after birth. Hypothesis: Investigating the genetic determinants of dominance will identify new arteriogenesis pathways targetable for enhancing coronary artery growth and collateralization in humans. Methods: We conducted a stratified multi-population genome-wide association study of dominance using REGENIE and TopMed-imputed genotypes available in 43813 White, 9532 Black, and 3550 Hispanic participants of the Million Veteran Program (MVP) who had undergone a cardiac catheterization. We modelled left and co-dominant combined vs. right, as well as left vs. right dominance, adjusting for sex and 10 genetic principal components. We also explored whether dominance and CAD were genetically correlated using LD score regression. Lastly, we sought to validate compelling population genetic signals in mice using whole organ imaging of the heart, which allows for the quantification of coronary anatomy and variation. Results: Thirteen loci reached genome wide significance (GWS). The most intriguing was a top hit located downstream of C-X-C Motif Chemokine Ligand 12 (CXCL12) which, remarkably, reached GWS in both White and Black Veterans. While the CXCL12 signal robustly colocalized with the signal in this region for CAD (COLOC PPH4: 87.1%), the genome wide genetic correlation of dominance with CAD was otherwise modest in both MVP (rg=-0.18, p=0.007) and CardiogramplusC4D (rg=-0.16, p=0.018). To gain evidence for causality, we modeled dominance in Cxcl12-deficient mice (n=64 wildtype; n=62 heterozygous). Murine coronary arteries develop in a field of Cxcl12 expression and choose right or left dominance during embryogenesis, a time when we found human dominance to also be evident. Reminiscent of our human GWAS, dominance was skewed away from the common phenotype in Cxcl12 heterozygous mice (p=0.038). Conclusions: CXCL12 is a primary determinant of coronary artery dominance in humans and mice. The modest negative genetic correlation between CAD and dominance supports a developmental component to CAD susceptibility.
Abstract 16047: Quantifying the Cardiovascular Burden of Extreme Heat: A Meta-Analysis of Over 400 Laboratory-Based Heat Exposure Studies
Authors: Robert D Meade, Ashley P Akerman, Sean R Notley, Gregory W McGarr, Emma R McCourt, Nathalie V Kirby, Joseph T Costello, James D Cotter, Craig G CRANDALL, Antonella Zanobetti, Glen P Kenny
Journal: Circulation (2023)

Background: Heat waves are associated with increased fatalities from cardiovascular events, which has been attributed to increased cardiac strain secondary to the effects of heat on cardiac function. However, our understanding of these adjustments has come primarily from laboratory research employing insulated/encapsulated heating modalities (hot water perfusion suits). We evaluated whether the cardiac responses seen in this work reflect those experienced in studies exposing participants to high ambient temperatures. Methods: We systematically reviewed studies published up to January 2023 examining cardiac outcomes in adults rendered hyperthermic with water perfusion suits or unencapsulated exposure in a climate chamber. Mixed effects meta-analyses were conducted to evaluate whether changes in each outcome with increasing core temperature were modified by heating modality. We also estimated associations (natural spline) between ambient heat index and thermal and cardiac responses in the climate chamber studies. Results: 584 effect estimates of the heat-induced increase in heart rate (primary outcome) from 406 studies were included (~6800 participant exposures). Heart rate was 7 beats/min [95% CI: 3, 13] greater in the perfusion suit vs. climate chamber studies for similar increases in core temperature (P&lt;0.001). Likewise, there were greater elevations in cardiac output (slope difference: 1.2 L/min/°C [0.1, 2.3]), systolic pressure (14 mm Hg/°C [3, 24]), and rate pressure product (2923 mm Hg·beats/min/°C [1027, 4808]) with rises in core temperature in the perfusion suit compared to climate chambers studies (P≤0.036). In the climate chamber studies, core temperature and heart rate increased as much as 1.0°C [0.8, 1.3] and 31 beats/min [16, 37] (P&lt;0.001) in conditions reflective of deadly North American heat waves (heat index: 50-67°C). Conclusions: Our understanding of the effect of heat on cardiovascular responses primarily comes from encapsulated heating modalities, which we show overestimate heat-induced cardiac burden. To support public health research on extreme heat, we provide the first empirical estimates demonstrating considerable thermal and cardiac strain is experienced in conditions reflective of deadly heat waves.
Abstract 14299: Low Left Atrial Motion Automatically Calculated is Indicator of Atrial Cardiomyopathy and High Risk of Cardioembolic Stroke
Authors: SATOKO RYUZAKI, Yusuke Kondo, Miyo Nakano, Masahiro Nakano, Takatsugu Kajiyama, Ryo Ito, Toshinori Chiba, Yutaka Yoshino, Yuya Komai, Yukiko Takanashi, Yoshio Kobayashi
Journal: Circulation (2023)

Background: Atrial cardiomyopathy is considered to be an important risk factor for cardioembolic stroke. However, little is known how to evaluate the degree of atrial cardiomyopathy. Hypothesis: Left atrial ejection fractions (LAEF) are useful and more sensitive predictors of cardioembolic stroke. Aim; To identify the relationship between LAEF and clinical events such as cardioembolic stroke. Methods: The left atrial appendage closure (LAAC) database of our institution from February 2020 to April 2023 was retrospectively analyzed. The LAEF was calculated from cardiovascular computed tomography (CT) imaging data using the automatic 3-dimensional chamber analysis software. We examined the relationship between the risk of cardioembolic stroke and LAEF. Results: We enrolled 52 consecutive patients who underwent cardiovascular CT before LAAC (age, 75.3±1.1 years; female gender, 26.9%; BMI, 23.3±0.5 kg/m 2 ; CHA 2 DS 2 -VASc score, 4.8±0.2; HAS-BLED score, 3.3±0.1). Of those, 22 (42.3%) patients had histories of cardioembolic stroke. Comparison between patients with and without cardioembolic stroke were shown in Table1. Receiver-operating characteristic curve analysis confirmed that 16.32% was the best cut-off value of LAEF for the history of cardioembolic stroke (AUC = 0.81). In the multivariate analysis, LAEF ≤ 16.32% is the independent predictor for cardioembolic stroke (p-value = 0.0362, respectively) (Table2). Conclusions: Low left atrial motion was potential risk factor for cardioembolic stroke in this population. This result could have a relevant impact on the antithrombotic management of patients and, moreover, LAAC could be the best option for these patients.
Abstract 16392: Arrhythmias in Acute Care Cardiology: Prevalence, Therapies, and Outcomes- An Analysis of the Pediatric Acute Care Cardiology Collaborative (PAC <sup>3</sup> ) Database
Authors: Dustin Nash, Sonali Patel, Aarti Dalal, Amy Schiller, Heather Giacone, Scott J Weinreb, Andrew Headrick, Lindsey Malloy-Walton, Caitlin Brateng, Ronn E Tanel
Journal: Circulation (2023)

Introduction: Arrhythmias are common in pediatric cardiology patients, yet prevalence during hospitalizations and treatments are poorly defined. This descriptive study reports arrhythmia prevalence and medical management from Pediatric Acute Care Cardiology Collaborative (PAC 3 ) centers. Aims Our primary aim is to describe prevalence and outcomes of treated arrhythmias among acute care cardiology units (ACCU). Secondary aims include comparison of medical vs. post-operative admissions and selection of antiarrhythmics. Methods: We performed a multi-center retrospective review of the PAC 3 registry limited to hospitalized patients with an arrhythmia treated from 2/2019-2/2023 among 33 centers. Arrhythmias are classified in the registry as Atrial Tachycardia/Supraventricular Tachycardia (AT/SVT), Junctional Tachycardia (JT), or Ventricular Tachycardia (VT). Descriptive statistics, Wilcoxon-Mann-Whitney, and χ2 testing were used. Results: Prevalence of treated arrhythmia in the cohort (n=38,396) was 5.4% (n=2,090 patients) over 2291 hospitalizations. AT /SVT (68.3%) were more frequent than VT (21.5%) or JT (2.8%) (p&lt;0.01). Bradyarrhythmias (7.5%) were infrequent. Of 8,733 CICU transfers, 513 (5.9 %) transfers of 257 patients (2.0 transfers/patient) were due to arrhythmia. Medical and Surgical patients varied in demographics and outcomes (Table). For AT/SVT, propranolol was the most prescribed antiarrhythmic, followed by sotalol. (Figure). Conclusions: Treated arrhythmias are prevalent in ACCU patients and are a relatively frequent cause of ICU transfers. Arrhythmia treatment patterns warrant further investigation and could be the subject of QI.