tbuckley/cabot-search huggingface dataset:
Abstract 14181: Subclinical Left Ventricular Dysfunction in COVID-19 Recovered Patients Using Speckle Tracking Echocardiography
Authors: Shekhar Kunal, Sudhanshu Mahajan, Bhushan Shah, MP Girish, ANKIT BANSAL, Vishal Batra, Jamal Yusuf, Saibal Mukhopadhyay, Anubha Gupta, Mohit Gupta
Journal: Circulation (2021)

Introduction: Myocardial injury during active coronavirus disease-2019 (COVID-19) infection is well described however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients and studied its correlation with various parameters. Methods: A total of 134 subjects within 30-45 days post recovery from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all subjects. Results: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID-19 illness and were categorized into mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID-19 illness groups. Asymptomatic COVID-19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21 ± 3.4%; moderate: -18.1 ± 6.9%; severe: -15.5 ± 3.1%; P &lt; 0.0001). Subjects with reduced LVGLS had significantly high interleukin-6 (P &lt; 0.0001), C-reactive protein (P = 0.001), lactate dehydrogenase (P = 0.009) and serum ferritin (P = 0.03) levels during index admission. Conclusions: Subclinical LV dysfunction was seen in nearly a third of recovered COVID-19 patients while 10.5% had RV dysfunction. Our study suggests a need of close follow-up among COVID-19 recovered subjects to elucidate long-term cardiovascular outcomes.
Abstract 11299: Ablation of Persistent Atrial Fibrillation Abolishes Fibrotic Substrate for Rotors Perpetuation but Creates Substrate for Macro-Reentrant Flutter: Insights from Patient-Specific Computational Modeling
Authors: Savannah Bifulco, Fima Macheret, Griffin Scott, Nazem W Akoum, Patrick M Boyle
Journal: Circulation (2021)

Introduction: Arrhythmia recurrence after ablation in persistent AF (PsAF) is common, often presenting as atrial flutter (AFL). Fibrotic remodeling is known to exacerbate arrhythmic activity in PsAF and can play a key role in sustaining rotors, but the synergy between non-conductive ablation-induced scar and native fibrosis is poorly understood. Hypothesis: We used computational simulations in left atrial models reconstructed from late gadolinium enhanced (LGE)-MRI to test the hypothesis that ablation in PsAF abolishes fibrotic substrate for rotor perpetuation, but also creates new substrate conducive to macro-reentrant AFL (MRs). Methods: LGE-MRI was performed on 24 PsAF patients pre- and 3-6 months post-ablation. Post-ablation scar was mapped into pre-ablation models (Fig A). A standardized approach was used to test inducibility. Arrhythmia episodes were classified as MR (i.e., conduction around vein, lesion, or mitral valve) or rotor-driven (i.e., rotational sources localized to compact areas of fibrotic substrate). Summary data are presented as median[IQR]. Results: For many 13/24 pre-ablation models in which induced arrhythmias were predominantly rotor-driven, activity in the corresponding post-ablation models was primarily sustained by MR (Fig B; left and right panels, respectively). There were significantly more unique rotor sites in pre- vs. post-ablation models (Fig C, P&lt;0.05; 1[2] vs. 0[1]) in contrast, we saw significantly more episodes of MR in post- vs. pre-ablation models (Fig D, P&lt;0.01; 1[0.5] vs. 1[1]). Conclusions: In this modeling study, pre-ablation arrhythmias sustained by native fibrosis alone were more likely to be rotor-driven. In contrast, MRs were more common in models incorporating both scar from ablation and residual fibrosis. This suggests PsAF ablation may transform substrate that favors rotor perpetuation into one that is more conducive to AFL. Comparing these findings to recurrence outcomes is a crucial next step.
Abstract 11246: Racial Distribution and Regional Comparison in Hospital Outcomes Among Patients with Peripartum Cardiomyopathy in the United States
Authors: Michael Fatuyi, Leanne Pereira, Emmanuel Akuna, Awfa Zain elabidin, Vahid Namdarizandi, Mubarak Yusuf, LORETTA AKPALA, Rukayat Otulana, Asimul H Ansari
Journal: Circulation (2021)

Introduction: Peripartum cardiomyopathy (PPCM) is a rare entity, first described over two centuries ago, associated with left ventricular systolic dysfunction in the last month of pregnancy and up to 5 months postpartum, in the absence of another identifiable etiology for heart failure. Black women are disproportionately affected by this condition. Our study sought to evaluate the racial distribution of each region and regional differences in-hospital outcomes among patients with PPCM in the United States. Methods: Data were obtained from the nationwide inpatient sample database (NIS) for 2016 and 2017. We included data on all adult females (aged 18 - 49 years) hospitalized with a principal diagnosis of PPCM using ICD-10 codes. Our primary outcome was in-hospital mortality. Secondary outcomes included: length of stay, cardiac arrest, and cardiogenic shock. Multivariable logistic and linear regression models were constructed to evaluate the relationship between PPCM and regional in-hospital clinical outcomes. A p-value &lt;0.05 was considered statistically significant. Results: A total of 3,030 hospitalizations for PPCM were included. Regional distribution for the northeast, midwest, south, and west were 12.0%, 20.8%, 50.0%, and 17.2%, respectively with a mean age of 31 years (CI of 28-34, P &lt; 0.01) across all regions. Inpatient mortality was 0.82% overall. Using northeast as the reference of comparison, there was no statistically significant difference in mortality across the regions. There was white predominant in the midwest and west compare to black predominant in the south and northeast (Table 1). In addition, we found no differences in the average length of stay, rates of cardiac arrest, or cardiogenic shock. Conclusion: There were no regional differences in hospital outcomes among patients admitted with PPCM in the US
Abstract 13566: Blood Volume Analysis Phenotypes in Heart Failure Patients Supported With Left Ventricular Assist Device
Authors: Dmitry Yaranov, Marc Silver, Soren Thompson, John Strobeck, John L Jefferies
Journal: Circulation (2021)

Introduction: Left ventricular assist device (LVAD) offers advanced heart failure (HF) patients increased survival, life quality and functional status however little information is available regarding the underlying deranged circulatory physiology of LVAD patients. In patients with HF, wide variations in intravascular volumes (total blood volume (TBV), plasma volume (PV) and red blood cell volume (RBCV)) have been measured with blood volume analysis (BVA) and distinct phenotypes have emerged. Methods: BVA used in a single center to evaluate 22 LVAD patients (17M/5W), aged 32-70yrs, BMI 37.5(avg), LVADs implanted 42-1912 days before BVA. All patients had successful completion of BVA. Results: Only 4/23(17%) had normal TBV and RBCV. Graph1. Eleven patients (50%) were anemic, 3 (14%) with hypovolemia. Overall, 6 patients (27%) were hypervolemic with variances reaching +80%, including 2 patients (9%) with significant hypervolemia and polycythemia indicating heightened risk of thrombosis. Three patients (14%) presented with hypovolemia indicating increased risk for organ failure. Figure 1. shows these variances in more recently implanted LVAD patients as more extreme compared to more remotely. Conclusions: As in patients with advanced HF, wide TBV derangements are seen in LVAD patients up to 64 months post LVAD placement. Anemia persists in 50% and polycythemia is present in 9%, both of which are prognostic in HF patients. An early signal is some lesser variances over long time periods, indicating that long-term survival may be associated with lesser volume derangements. These variances, not suspected clinically, inform clinicians of additional therapeutic approaches that may improve host and device outcomes including recovery, safety, and device durability. Patient and clinician acceptance and adoption of BVA was excellent and BVA phenotypes add significant value to centers implanting LVADs.
Abstract 11989: Cardiac Muscle-Specific Disruption of the Exocyst Trafficking Complex Results in Heart Failure
Authors: Herena Y Ha, Briana K Shimada, Nicole K Nakamura, Lamar T Carter, Emi Lin Luo, Darcy S Tokunaga, Janna Zoll, Noemi Polgar
Journal: Circulation (2021)

Increased myocardial glycolysis is protective against ischemic injury. Glucose uptake via glucose transporter GLUT4 is the rate-limiting step of glycolysis in cardiomyocytes. GLUT4 delivery to the cardiomyocyte membrane can be triggered by insulin or by increased ATP-demand (i.e. during ischemia) via the AMP-activated protein kinase (AMPK). Previous studies of adipocytes and our recent study in skeletal muscle demonstrated that the exocyst trafficking complex is critical for GLUT4 exocytosis in response to insulin. But it is not known if the insulin-insulin receptor-exocyst-GLUT4 signaling axis is conserved in the cardiomyocytes, or if the exocyst also regulates cardiac glucose uptake via AMPK-induced GLUT4 translocation. Investigating glucose transporter trafficking in cardiomyocytes will be key to better understanding the mechanism of cardiac glucose metabolism under normal and disease conditions. We hypothesized that the exocyst is necessary for myocardial glucose uptake and metabolism and its activity protects the heart from ischemic injury. We have generated tamoxifen-inducible cardiac muscle-specific knockout mice of the central exocyst subunit Exoc5 (Exoc5-CMKO) to evaluate the role of the exocyst in cardiac fuel metabolism in vivo . Unexpectedly we found that cardiac muscle-specific Exoc5 knockout shortened the lifespan of Exoc5-CMKO mice (median survival after tamoxifen treatment was 60.5 days). Echocardiography showed cardiac dysfunction in Exoc5-CMKO mice, with reduced ejection fraction (Ctrl: 0.77; CMKO: 0.43; p&lt;0.0001) and fractional shortening (Ctrl: 45.57; CMKO:21.62; p&lt;0.0001), and increased systolic and diastolic LV diameters (LVID s (mm): Ctrl: 1.81; CMKO: 3.32; LVID d (mm): Ctrl: 3.47; CMKO:4.2; p&lt;0.0001) compared to controls. Histological analysis revealed increased fibrosis in Exoc5-CMKO hearts, while isolated knockout primary cardiomyocytes showed decreased contractility and altered calcium handling. Our findings suggest that the exocyst is necessary for proper cardiac muscle function. Future studies will investigate how impaired exocyst-mediated membrane trafficking leads to heart failure in our Exoc5-CMKO mice.
Criterion-Based Measurements of Patient Experience in Health Care
Authors: Thom Mayer, Arjun Venkatesh, Donald M. Berwick
Journal: JAMA (2021)

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Abstract 11587: Absent Ductus Arteriosus is Relatively Common in Neonates with Symptomatic Tetralogy of Fallot, and Rarely Associated with Critically Deficient Pulmonary Blood Flow at Birth
Authors: Shiraz A Maskatia, Andrew C Glatz, Bryan H Goldstein, Athar M Qureshi, Jeffrey Zampi, Courtney McCracken, Michael Kelleman, George Nicholson, Jeffery J Meadows, Shabana Shahanavaz, Mark A Law, Sarosh P Batlivala, Joelle Pettus, Christopher Mascio, Paul Chai, Jennifer Romano, Ivor Asztalos, Amy Pajk, Asaad Beshish, Christopher J Petit
Journal: Circulation (2021)

Introduction: Absent ductus arteriosus (ADA) is a poorly described feature associated with tetralogy of Fallot (TOF). We compare characteristics and outcomes of neonates with symptomatic TOF (sTOF) with ADA to those with a ductus arteriosus (DA). Hypothesis: We hypothesized: neonates with sTOF and ADA would have similar outcomes to those born with a DA, and a small portion of the ADA cohort would have critically-deficient pulmonary blood flow (CDPBF). Methods: Consecutive neonates with sTOF who underwent intervention during the neonatal period from 2005—2017 were identified from the Congenital Cardiac Research Collaborative. Those with DA on echocardiogram performed on the first day of life or on fetal echocardiogram were identified and compared to those with ADA. ADA neonates who required ECMO or intervention to augment PBF on the first day of life were defined as having CDPBF. Patient characteristics and outcomes were compared between DA and ADA groups. Results: Among 519 neonates, 460 (89%) had a DA and 59 (11%) had ADA. ADA neonates were more likely to carry a genetic or syndromic diagnosis, had smaller branch PA sizes, and were more likely to receive a transannular patch compared to those with a DA. Despite this, reintervention rates were similar (data not shown), and there was only a small difference in mortality that did not reach statistical significance. Of ADA neonates, 7/59 (12%) had CDPBF. Compared to ADA neonates without CDPBF, those with CDPBF had lower baseline oxygen saturation (58 vs 87%, p=0.031) and smaller pulmonary valve (PV) annular z-score (-2.9 vs -2.5, p=0.015) with similar reintervention rates and mortality. Conclusion: ADA is relatively common in sTOF. Despite higher rates of comorbidities, mid-term reintervention rates and mortality are similar to those with DA. CDPBF is a rare, high-risk feature of infants with sTOF and ADA. Smaller PV size may be a marker of CDPBF. Future work should focus on prenatal factors to identify fetuses with TOF, ADA and CDPBF.
Abstract 11387: Four-Dimensional Spatiotemporal Characterization of Cardiomyopathy in Duchenne Muscular Dystrophy Using Cardiac Magnetic Resonance Imaging
Authors: Conner C Earl, Victoria I Pyle, Frederick Damen, Larry W Markham, Jonathan Soslow, Craig J Goergen
Journal: Circulation (2021)

Introduction: Cardiomyopathy (CM) is the most common cause of mortality in Duchenne muscular dystrophy (DMD). Because CM progression is variable, there is a critical need for biomarkers to detect early onset or rapid progression. Our objective was to evaluate localized kinematic parameters that correlate with function utilizing spatiotemporal analysis of 4D (3D plus time) cardiac magnetic resonance (CMR). We hypothesized that novel regional strain metrics would correlate with left ventricular ejection fraction (LVEF), providing insight for future DMD CM characterization studies . Methods: Sequential short axis cine CMR images of DMD patients (n=10) with a range of CM severity were compiled into 4D sequences. Epi- and endocardial borders were then segmented across one cardiac cycle for kinematic analysis. We evaluated Green-Lagrange circumferential strain (ε cc ) at 60 equally spaced short axis slices and across 60 time points to generate a spatiotemporal map. We also evaluated a novel “hybrid strain index” combining basal ε cc with posterior free-wall longitudinal strain. Spearman’s rho was used to determine statistical correlation. Results: DMD subjects had a median age of 11 years (8-24); 3 had LVEF&lt;55% and 7 had late gadolinium enhancement. Regional peak averages of ε cc decreased with LVEF for basal ( rho =-0.94, p &lt;.001) and mid-LV ( rho =-0.84, p =.004) but not at the apex ( rho =-0.55, p =.106). The hybrid strain index also decreased with LVEF ( rho =0.89, p &lt;.001). Qualitative spatiotemporal ε cc maps of mild, moderate, and severe DMD cases demonstrate stark differences in regional wall motion (Figure 1). Conclusion: 4D spatiotemporal analysis of CMR images in DMD patients allows for robust comparison of regional kinematic parameters that correlate with LVEF. Figure 1: 4D CMR spatiotemporal analysis of DMD cardiomyopathy. A,B) Schematic of circumferential strain (ε cc ). C,D,E) Example mild, moderate, and severe patient spatiotemporal ε cc maps.
Abstract 10404: The Role of Patient, Community and Healthcare System Factors in the Variability of Heart Failure Hospital Readmissions
Authors: Joshua Saef, Arshneel S Kochar, Michael T Martyn, Robert A Montgomery, Paul Cremer, Yuli Y Kim, Venu Menon, Wai Hong Tang
Journal: Circulation (2021)

Introduction: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals by reducing Medicare (CMS) reimbursement for those institutions with higher rates of readmissions following hospitalizations for heart failure (HF). Understanding the contributors to readmission following HF hospitalization can identify meaningful areas for intervention. We examine whether community and patient or healthcare system factors contribute more to variability in HF readmissions. Methods: We compiled CMS hospital data on HF readmissions, CMS physician reimbursement data, and 2020-21 County Health Rankings (Credit: University of Wisconsin). The outcome was the ratio of a hospital’s HF readmissions to HF discharges. Physician/healthcare system factors included total number of cardiac subspecialists, presence of all subspecialties, and the mean proportion of reimbursed charges. Patient/community factors included mean Hierarchical Condition Category (HCC) risk score (quantifies expected healthcare costs for CMS beneficiaries based on ICD-10 coding), median household income, the proportion of residents reporting no physical activity, and access to food stores. Models were created using linear regression. Model of best fit was determined using R 2 , AIC, BIC in model training data and mean absolute prediction error (MAPE) and root mean square prediction error (RMSE) in test data. Results: The linear regression model incorporating community and patient factors explained greater variability in HF readmission rates and performed with greater accuracy in the test data (R 2 0.177; AIC -6879.1; BIC -6840.542; MAPE 0.030; RMSE 0.039) than the model incorporating physician/healthcare system factors (R 2 0.021; AIC -6566.7; BIC -6539.191; MAPE 0.032; RMSE 0.041). HCC score and level of physical activity were associated with the greatest effect sizes on the outcome. Conclusions: At a county level, community/patient factors appear to contribute more to variability in hospitals’ HF readmission rates than physician/healthcare system factors. Further analyses should explore other community, patient, and provider factors that contribute. The HRRP does not account for community or patient factors, indicating its limitations.
Abstract 11430: Etripamil Nasal Spray Reduces Heart Rate in Patients with Paroxysmal Supraventricular Tachycardia Prior to Conversion to Sinus Rhythm
Authors: James E Ip, Bruce S Stambler, Philip T Sager, Silvia Shardonofsky, Benoit Coutu, A Shekhar Pandey, Blandine Mondesrt, Atul Verma, Francis Plat, Michael Chen, Alan J Camm
Journal: Circulation (2021)

Introduction: Etripamil (E) is a rapidly and short acting, nasally administered calcium channel blocker being developed to terminate AV nodal-dependent PSVT. The NODE-301 first in class, multicenter study, evaluated self-administration of E nasal spray 70 mg outside a healthcare environment for acute termination of PSVT. This post-hoc analysis addresses the effect of E on heart rate (HR) during PSVT prior to conversion to sinus rhythm (SR). Methods: In NODE-301, 156 subjects experienced a vagal-maneuver refractory, symptomatic episode of confirmed PSVT, 107 subjects self-administered E and 49 placebo (P) (2:1 randomization) during PSVT. Each PSVT was documented by an ambulatory cardiac monitoring system that was placed on the chest after symptoms began. Baseline (average of four values before drug administration), and every minute of HR data were captured from baseline until one minute before the PSVT was converted to SR. Adequate HR data were available for 150 subjects, 102 on E and 48 on P. Six subjects were not included in this analysis, 4 converted before one minute (3 E and 1 P) and 2 E subjects experienced an early defect of recording. Results: Baseline mean (±SE) HR were 179 (±2.8) and 174 (±4.0) bpm for E and P respectively. Mean change in HR from baseline was greater in the E group than P group ( p &lt;0.0001). This decrease appeared within the first minute (-5 bpm ±0.9), 3 min (-10 bpm ±1.2), 10 min (-16 bpm ±2.1), 30 min (-14 bpm ±3.4) and 40 min (-13 bpm ±2.9) after E administration. The notable decrease in the E group was sustained through the 60minute observation period. A statistically significant difference in HR was reached between E and P notably at 3 ( p &lt;0.03), 10 ( p &lt;0.0001), 30 ( p &lt;0.0002), and 40 min ( p &lt;0.004). Conclusion: Etripamil significantly decreases the HR in PSVT prior to conversion to SR and is sustained over the 60 min observation. This finding may provide clinical benefits to patients for self-management of PSVT.
Management of ischaemia with non-obstructive coronary arteries (INOCA)
Authors: John F Beltrame, Rosanna Tavella, Dione Jones, Chris Zeitz
Journal: BMJ (2021)

Abstract Up to half of patients undergoing elective coronary angiography for the investigation of chest pain do not present with evidence of obstructive coronary artery disease. These patients are often discharged with a diagnosis of non-cardiac chest pain, yet many could have an ischaemic basis for their symptoms. This type of ischaemic chest pain in the absence of obstructive coronary artery disease is referred to as INOCA (ischaemia with non-obstructive coronary arteries). This comprehensive review of INOCA management looks at why these patients require treatment, who requires treatment based on diagnostic evaluation, what clinical treatment targets should be considered, how to treat patients using a personalised medicine approach, when to initiate treatment, and where future research is progressing.