tbuckley/cabot-search huggingface dataset:
Abstract 18920: Left Atrial Function is Associated With Left Ventricular Mass in Women With Preserved Left Ventricular Ejection Fraction and Late Gadolinium Enhancement on Cardiac MRI
Authors: Alda Bregasi, patita sitticharoenchai, Ben A Lin, Hien Pham, Nina Kukar, Jose R Concepcion, Benjamin A. Zalta, Adam H Jacobi
Journal: Circulation (2023)

Introduction: Myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac MRI may be related to conditions with increased left ventricular (LV) mass and diastolic dysfunction. Women have an increased incidence of LV diastolic dysfunction and poorer clinical outcomes compared to men. Aim: To examine gender-based associations between LV mass and left atrial total emptying fraction (LATEF), a surrogate for diastolic function, in patients with LGE on cardiac MRI. Methods: We analyzed 134 consecutive patients undergoing cardiac MRI and LGE sequences on a 1.5T GE scanner. LV mass and LV/LA volumes (indexed by BSA) were measured offline from cine SSFP images using Precession software. Presence of LGE was reported. Nonparametric analyses were performed. Results: 40 patients with more than mild mitral regurgitation, pericardial disease, or LVEF &lt;50% were excluded. 94 patients studied (49% women) had a median age of 51 years [IQR 38-67] with no gender-based difference. Median LV mass index (LVMi) for all patients was 69.5 g/m2 [IQR 57-82] and was higher in LGE vs no-LGE patients (p&lt;0.001) and higher in men vs women (p&lt;0.05). Median LATEF for all patients was 0.50 [IQR 0.41-0.54] and was lower in LGE vs no-LGE patients (p&lt;0.001) with no gender-based difference. LVMi had a strong inverse correlation with LATEF for all patients and for the LGE group (r=-0.58, p&lt;0.001 and r=-0.51, p&lt;0.001 respectively). LVMi had a very strong inverse correlation with LATEF (r=-0.74, p&lt;&lt;0.001) in women with LGE and moderate inverse correlation in women with no-LGE (r=-0.45, p=0.02). LVMi had a moderate inverse correlation with LATEF in men with LGE (r=-0.48, p. &lt;0.01) and no correlation in men with no-LGE (Figure). Conclusions: LA function inversely correlates with indexed LV mass, most strongly in women with LV LGE. Further exploration of these parameters may allow earlier detection of LV diastolic dysfunction and improved risk stratification.
Abstract 13508: Baseline Lipid Profile and Risk of Atrial Fibrillation Recurrence After Atrial Fibrillation Ablation
Authors: Jack Tiahnybik, Hisaki Makimoto, Masashi Kamioka, Tanyanan Tanawuttiwat, Tomonori Watanabe, Mithilesh Das, Yasushi Imai, John Miller, Masashi Kamioka, Kazuomi Kario, Takeki Suzuki
Journal: Circulation (2023)

Introduction: Dyslipidemia is a modifiable cardiovascular risk factor. However, it is unclear if baseline lipid levels prior to atrial fibrillation (AF) ablation are associated with AF recurrence. Hypothesis: This study aimed to examine if there was an association between baseline lipid profiles and AF recurrence after AF ablation. Methods: We retrospectively studied patients who underwent AF ablation from January 2016 to September 2021 at two high-volume international centers. Patients with a lipid profile in the previous 24 months prior to AF ablation and a one-year post-ablation follow-up with electrocardiogram were included. AF recurrence was defined as having a 12-lead electrocardiographic evidence of AF or atrial tachycardia within one year after a 3-month blanking period. Logistic regression analysis was performed to examine association of lipid profiles (low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglycerides) with AF recurrence. Lipid profiles were evaluated both as continuous and categorical variables. Well-established cut-points were used for LDL, and tertiles were used for HDL, TC, and triglycerides. Results: A total of 287 patients were included in the study (mean age (SD), 63.6 (10.5), 36% female). Patients with LDL&lt;70 mg/dL or TC &lt; 141 mg/dL had a decreased risk of AF recurrence in unadjusted analysis. These associations remained significant after adjustment by traditional AF risk factors and statin use (odds ratios (ORs) (95% confidence interval): 0.27 (0.09 - 0.79) and 0.28 (0.09 - 0.84), respectively. TC analyzed as a continuous variable was associated with increased risk of AF recurrence (1.012 (1.002 - 1.022) per 1 mg/dL increase). (Table). Conclusions: In our international registry, patients with LDL &lt;70 mg/dL or TC &lt;141 mg/dL were associated with a reduced risk of AF recurrence, suggesting a beneficial effect of low LDL and TC in patients with AF undergoing catheter ablation.
Abstract 16440: Gender Differences of In-Hospital Outcomes in Acute Myocardial Infarction and Cardiogenic Shock Patients Using Impella: From the Nation Inpatient Sample 2016-2019
Authors: Shizhe FU, Wang Kairu, Guangzhi CONG, Xueping Ma, Hui HUANG, Shaobin JIA
Journal: Circulation (2023)

Background: There is a lack of independent studies on gender differences in hospital outcomes with Impella in patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS). Our study aims to provide evidence on the impact of gender differences on AMI-CS patients receiving Impella with a nationally representative sample. Methods: Data were obtained from the National Inpatient Sample (NIS) from 2016 to 2019. Patients with AMI and CS were searched in the NIS using ICD-10 CM codes, and those with Impella were screened using ICD-10PCS codes. Patients treated with Impella were then stratified by gender. We used multivariate regression analysis with inverse probability weighting(IPTW) based on propensity scores to compare the risk of in-hospital death after Impella among patients of different genders. Results: From 2016-2019, a total of 2,953 inpatients with AMI combined with CS using Impella were identified. Of these, 28.5% were women. Women treated with Impella were older (mean age 68.42 versus 64.68 years, P&lt;0.0001). Male inpatients on Impella had a higher proportion of NSTEMI, and were more likely to have smoking, congestive heart failure, cardiac arrhythmias, and acute renal failure. Female inpatients were more likely to have STEMI and were more likely to have Chronic pulmonary disease, uncomplicated hypertension, hypothyroidism, and valvular disease. After IPTW-adjusted baseline clinical covariates, women using Impella had a higher risk of in-hospital death than men, while length of stay and total hospital cost did not differ significantly between genders (OR, 1.33 [95%CI, 1.10-1.60]; Beta, -0.05 [95%CI, -0.80-0.71]; and Beta, 8105.24 [95%CI, -25376.84-9166.35]; respectively). Conclusions: Impella use was lower in women. However, in-hospital mortality was significantly higher in women among AMI-CS patients using Impella. Further studies are needed to explore the reasons for higher mortality in female patients using Impella.
Abstract 13309: Severe Cardiomyopathy as Harbinger of Multisystem Inflammatory Syndrome From Epstein Barr Infection
Authors: Phuong Uyen Vo, Daljeet Singh, Kenneth D Varian, Gabriela Orasanu
Journal: Circulation (2023)

Introduction: Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition characterized by multiple organ injury after a viral infection. Features include fever, elevated inflammatory markers, evidence of acute viral infection, and at least three of the following clinical criteria: peri/myocarditis or acute ventricular dysfunction, rash, encephalopathy, shock, and gastrointestinal symptoms. This is a case of nonischemic cardiomyopathy (NICMP) as a MIS-A manifestation after an Epstein-Barr viral (EBV) infection. Description of Case: A 38 year-old female, with a recent pneumonia, presented with two weeks of fever, dyspnea, hemoptysis, fatigue, and right leg swelling. Initial ECG showed sinus tachycardia. Laboratory testing showed leukocytosis 15.5k/uL, NT pro BNP 6470 pg/mL, C-reactive protein 234 mg/L, lactic acid 3.7 mmol/L, creatinine 1.5 mg/dL (baseline 0.7 mg/dL), AST 372 U/L, ALT 658 U/L. RSV, influenza, COVID-19, HIV, hepatitis B/C, and urine antigens were undetected. Imaging showed deep vein thrombosis in right leg veins and bilateral pulmonary emboli with infarcts. Heparin infusion was started. A transthoracic echocardiogram showed biventricular systolic failure with an ejection fraction of 20%. Coronary angiography showed no coronary artery disease. Cardiac MRI showed dilated NICMP with minimal late gadolinium enhancement. The nadir of her cardiac index was 1.2 L/min/m 2. She was started on nitroprusside infusion for early-stage cardiogenic shock. Extensive workup for thrombophilia, autoimmune, amyloidosis, infectious causes were all normal except for an elevated EBV early antigen IgG which indicated past infection within a few months, aligning with patient’s reported pneumonia symptoms before presentation. She clinically improved and was bridged to heart failure guideline directed medical therapy and apixaban on discharge. Discussion: Though MIS-A has been reportedly associated with COVID-19, EBV can cause MIS, with severe cardiomyopathy, nephropathy, hepatopathy, and pulmonary infarcts requiring intensive cardiac care, in a normal young adult.
Abstract 14678: Racial/Ethnic Disparities in Low-Density Lipoprotein Cholesterol Testing Following Myocardial Infarction Hospitalization Among Medicare Beneficiaries in the United States, by State
Authors: Jenna Jones, Lisandro D Colantonio, Zhixin Wang, Vera A Bittner, Robert S Rosenson, Bethany Kalich, Nafeesa Dhalwani
Journal: Circulation (2023)

Introduction: Low-density lipoprotein cholesterol (LDL-C) is used to guide lipid-lowering treatment following hospitalization for myocardial infarction (MI). Recent analyses illustrate a lack of short-term LDL-C testing across the United States, but it is unclear whether race/ethnicity differences exist in all states. Lack of LDL-C testing following an MI may represent a missed opportunity to identify groups of patients with low response to lipid-lowering therapy. Research Question: Does use of LDL-C testing at 90 days post-MI differ by race in each state and across states? Methods: We conducted a retrospective cohort study of Medicare beneficiaries with fee-for-service coverage, pharmacy benefits, and ≥66 years of age with an MI hospitalization between 2016 and 2020 and estimated the cumulative incidence of LDL-C testing at 90 days post-MI overall, by state, and by race. Results: Of the 532,767 MI hospitalizations, 84.4% and 8.4% were among non-Hispanic White and non-Hispanic Black beneficiaries, respectively, with Asian and Hispanic beneficiaries each representing 2.0% of the hospitalizations. The cumulative incidence of LDL-C testing in the US was 29.9%. Hawaii had the highest overall cumulative incidence of LDL-C testing (43%) while Arkansas had the lowest (17%). Cumulative incidence of LDL-C testing was lowest among non-Hispanic Blacks (26.0%) compared to all other racial groups with testing rates between 30-33%. In most states, cumulative incidence of LDL-C testing among Non-Hispanic Blacks was lower than the state average, whereas among Whites it was higher than the state average (see Table 1). Conclusions: LDL-C testing was low in the 90 days after hospital discharge for MI among Medicare beneficiaries, with substantial geographic and race disparities. In many states, our data suggests testing for Black Americans was lower than the state average. Funding: Amgen Inc.
Abstract 15962: Validation of the Senescence-Associated Secretome to Predict Mortality in Patients With Degenerative Aortic Valve Stenosis
Authors: Silvia Mas-Peiro, Lukas Zanders, Tina Rasper, Alexander Berkowitsch, Stefanie Dimmeler, Andreas M Zeiher
Journal: Circulation (2023)

Introduction: The senescence-associated secretory phenotype (SASP) is a potential driver of age-related risk reflecting advanced biological aging. Circulating SASP components include pro-inflammatory cytokines, growth modulators and matrix remodelling proteases. Aortic valve stenosis (AVS) is the prototypical inflammatory age-associated cardiovascular disease. Hypothesis: To identify circulating SASP components with an impact on prognosis in elderly pts with AVS. Methods: In a derivation cohort (n=120), circulating levels of 24 SASP components were measured using Luminex Multiplex ELISA, before undergoing TAVR. ROC curves and Youden-index derived optimal cut-off values were used to assess the predictive power of each SASP for long-term mortality. In a validation cohort (n=198), the significant predictors of mortality identified in the derivation cohort, as well as a panel of 3 independent predictors in multivariate analyses, were prospectively validated. Results: In the derivation cohort, 9 out of 24 SASP components significantly predicted mortality in univariate analyses with AUC&gt;0.62; only 3 (GDF-15, ICAM-1, and osteoprotegerin) remained independent predictors in multivariate analyses (all p&lt;0.03). All 3 were confirmed as significant independent predictors of mortality in the validation cohort (see AUC curves). After adjustment for clinical parameters, a score based on the cumulative number of these 3 SASP components showed a substantial increase in long-term mortality after TAVR for each additional positive marker (see KM-curves). Conclusions: This study validates high levels of 3 SASP components reflecting different pathophysiological pathways of senescence as independent predictors of long-term mortality in AVS. Their cumulative occurrence provides a deeply improved discrimination power and, may serve as a much needed risk stratification tool in elderly patients with AVS undergoing TAVR.
Abstract 17145: Impact of Preoperative Levosimendan in Patients With Severe Heart Failure Undergoing Left Ventricular Assist Device Support: A Meta-Analysis
Authors: Pedro Luciano, Nicole Felix, Lara Melo Soares Pinho de Carvalho, Alleh Nogueira, Clara Siqueira, Rhanderson Cardoso, Giuliano Generoso
Journal: Circulation (2023)

Introduction: Left ventricular assist devices (LVADs) are frequently employed as a bridge to transplant or destination therapy. The implementation of preventive preoperative measures can have a beneficial impact on the prognosis of patients undergoing LVAD implantation. However, the role of levosimendan in this context remains uncertain. Goals: To evaluate the efficacy of preoperative levosimendan in reducing complications after LVAD implantation. Methods: We systematically searched PubMed, Scopus, and Cochrane Library for studies comparing the use of levosimendan before LVAD implantation vs. standard of care alone in May 2023. Statistical analyses were performed using Review Manager 5.4.1. Heterogeneity was assessed with I2 statistics. Results: Four studies comprising 4032 patients who underwent LVAD implantation were included, of whom 15,2% were on preoperative levosimendan. There was no significant difference between groups in 30-day mortality (OR, 0.95 [95% CI, 0.70-1.28], I2=0%, p=0.73 - Fig. 1A), right ventricular failure (OR, 0.92 [95% CI, 0.47-1.80], I2=69%, p=0.81 - Fig. 1B), or length of intensive care unit (ICU) stay (mean difference, 2.63 [95% CI, -2.07-7.33], I2=92%, p=0.27 - Fig. 1C). Conclusions: In this meta-analysis, the preoperative use of levosimendan was not associated with reduced mortality, right ventricular failure, or length of ICU stay in patients undergoing LVAD implantation.
Abstract 16120: Efficacy of an Electronic Medical Record Alert System in Identifying Cardiac Implantable Electronic Device Infection
Authors: Edward R Horton, Richard L Saporito, David Fleece, John T Enevoldsen, Joshua M Cooper, Edmond M Cronin, Isaac R Whitman, Chethan Gangireddy
Journal: Circulation (2023)

Introduction: Cardiac Implantable Electronic Device infection (CIED-I) is common, morbid, and frequently under recognized. Electronic Medical Record (EMR) based alerts have been proposed as a solution to improve detection of CIED-I. Hypothesis: Development of a real-time EMR algorithm to identify CIED-I can improve recognition of patients with CIED-I. Methods: An EMR (Epic, Verona, WI) alert system to identify inpatients with CIED-I was developed based on the presence of CIED and positive blood cultures. The presence of CIED was determined using patient problem list, structured data elements describing device implantation, and prior device interrogation. Alerts were generated each time a patient with CIED had a positive blood culture. We examined patients admitted between January 2020 - March 2023. Identified patients were adjudicated manually to confirm: (1) the presence of CIED and (2) true bacteremia versus contaminant based on patient and microbiological characteristics. Results: The algorithm generated 255 alerts, corresponding to 100 unique patients over 142 hospitalizations. Of these alerts, 213 appropriately identified 88 unique patients with positive blood cultures and CIEDs, resulting in an alert specificity of 84% and patient specificity of 88%. The remaining 42 (16.6%) alerts occurred in 10 patients who no longer had CIED due to prior CIED extraction (6 at the time of heart transplant and 4 with extraction without reimplantation) as well as 2 patients with erroneous blood culture identification (one positive syphilis antibody test and one lab documentation error). In patients with appropriate alerts, 27 patients had 4/4 positive blood culture bottles, 5 patients had 3/4, 10 patients had 2/4, 41 patients had 1/4, 2 patients had 2/2, and 1 patient had 1/2. The positive predictive value of the algorithm to identify true bacteremia was 0.65 (138/213). Conclusions: The algorithm has high specificity to identify patients with possible CIED infection. Improving the accuracy of device detection, by incorporating radiology imaging or history of extraction, could further improve specificity. Positive predictive value and alert fatigue could be improved by stratifying alerts by blood culture species and total number of positive blood cultures.
Abstract 14501: Process Evaluation of a Double Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra-Low-Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA)
Authors: Olutobi A Sanuade, Tyler A Jacobson, Adriana Quintana, Fallon Flowers, Danielle Lazar, My Vu, Jairo Mejia, Jody Ciolino, Mark D Huffman, Namratha Kandula
Journal: Circulation (2023)

Introduction: This explanatory sequential mixed-methods process evaluation of the QUARTET USA clinical trial (NCT03640312) explores patient and health professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management. Methods: Sixty-two patients took part in the trial. Survey data were collected from patients to understand their beliefs about blood pressure medications and treatment satisfaction with LDQT. A sub-sample of 13 English and Spanish patients and 11 health professionals, recruited via purposive sampling, took part in semi-structured qualitative interviews. Data collection took place between August 2019 and July 2022. Quantitative data were analyzed using descriptive statistics and cross-tabulations, and the qualitative data were analyzed using thematic analysis. Common themes from the two sets of findings were integrated. Results: 54.3% of patients believed in the necessity of their blood pressure medicines and 40.6% were concerned about the side effects and long-term effects of their medications. At trial completion, 80.4% of the patients were satisfied with the LDQT, 96.4% were certain the benefits of taking LDQT outweighed the disadvantages, and all participants reported that it was convenient to take. Both patients and health professionals found LDQT acceptable because it facilitated patients’ blood pressure control and medication adherence, and reduced patients’ perceived pill burden and adverse reactions. Health professionals stated that a limitation of LDQT was the inability to titrate the dose and that health insurance coverage and inclusion of LDQT in national hypertension guidelines could increase its widespread use. Conclusions: The LDQT strategy was acceptable to patients and health professionals for hypertension treatment. While LDQT therapy generally improved and maintained patients’ blood pressure control, medication adherence, and had a good safety profile, the limitation of its titration inflexibility and medication cost were raised by health professionals. Making LDQT therapy flexible by introducing stepped care combinations and ensuring health insurance coverage could increase its widespread implementation and scale-up.
Abstract 15274: STEMI as Initial Manifestation of Essential Thrombocythemia
Authors: Christy Sanchez, Marissa A Donatelle, Everett Rogers, Karthik Vedantam, Esteban Escolar
Journal: Circulation (2023)

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm of myeloid cell expansion, mainly excessive platelet production, associated with thrombotic complications. Myocardial infarction (MI) in the setting of ET can result from thrombosis in the absence of coronary atherosclerosis. Here we present a case of ST elevation MI in the setting of previously undiagnosed ET. Case Report: A 59-year-old male with hypertension presented to the ED with left upper extremity weakness which started upon waking. On exam, he was in acute distress and diaphoretic. EKG revealed sinus rhythm with ST elevation in II, III, aVF, V5, and V6 suggesting inferolateral STEMI (Figure 1A). Labs were notable for Hgb 8.5g/dL, white blood cell count 33k/μL, and platelets 1.9million/μL. Decision Making: He was loaded with aspirin and clopidogrel (dual antiplatelet therapy-DAPT) and taken for coronary angiogram which revealed 80-90% thrombotic occlusion of the left circumflex artery (Figure 1b). Thrombectomy was performed and a drug-eluting stent was placed. A bone marrow biopsy showed JAK2 positive ET with myelofibrosis. He was immediately started on hydroxyurea. Platelets remained elevated, thus pegylated IFN alpha-2a was started which normalized platelet count. He remained on DAPT through discharge with no recurrent ischemic events or in-stent thrombosis during the 45-day hospitalization post stent placement. Conclusion: Patients with ET are at high risk for arterial thrombosis regardless of the presence of traditional atherosclerotic risk factors. High-risk patients, which includes those age over 60 with JAK2 mutation or history of arterial thrombosis, should be treated prophylactically with aspirin and hydroxyurea for cytoreduction. MI may be the first clinical manifestation of ET, even in patients without atherosclerotic risk factors. Initial management in patients with ET presenting with STEMI includes PCI with DAPT and early cytoreductive therapy.