tbuckley/cabot-search huggingface dataset:
Abstract 12782: Predicting One-Year Survival in LVAD Patients Using Different Predictive Models
Authors: Nicholas J Fabry, Mirnela Byku, Paul B Tessmann, Quefeng Li, Randall Watkins, Patricia Chang
Journal: Circulation (2021)

Introduction: Left ventricular assist device (LVAD) support improves quality of life and survival in patients with end-stage heart failure (HF), but predicting which patients benefit most remains a challenge. The Penn Columbia Risk Score (PCR) and pretransplant risk stratification score (RSS) have predicted 1-year mortality in LVAD and transplant patients, respectively. We sought to compare the PCR and RSS in our single center’s LVAD population and evaluate additional predictors of survival at 1 year. Methods: Perioperative data were collected from 202 patients who received an LVAD (HVAD, Heartmate II, or Heartmate III) from 2014-2020. The logistic regression model assessed goodness-of-fit of the PCR and RSS in our population. The PCR model is based on age, creatinine, total bilirubin (tbili), body mass index, right ventricular dysfunction, aortic insufficiency while the RSS score is based on age, prior sternotomy, HF etiology, eGFR, tbili, and mechanical support. Logistic regression models were used to identify additional predictors of 1-year mortality. Results: In our 202 patients, the RSS was more predictive of 1-year mortality (R 2 =0.14) than PCR (R 2 =0.02). In addition to age, tbili, inotrope score, pulmonary artery pulsatility index (PAPi), right ventricular dysfunction, mechanical support (defined as intra-aortic balloon pump, ECMO, or temporary LVAD), and albumin were each associated with 1-year mortality (p &lt;0.05). A multivariate model including age, tbili, PAPi, right ventricular dysfunction, and albumin, had higher correlation with 1-year mortality than the RSS (R 2 =0.21). The addition of inotrope score and mechanical support to this model did not significantly change the association (R 2 =0.20). Discussion: In our patient population, the PCR and RSS were poorly predictive of 1-year survival showing almost no association. Our novel model showed higher association, while still being suboptimal. Further research is needed to refine which clinical characteristics will best predict success and survival in LVAD patients.
Abstract 9023: Post-Operative Ectopic Atrial Tachycardia in Congenital Heart Disease
Authors: Jonathan Uniat, Allison Hill, Mark James, Mark Shwayder, Michael J Silka, Yaniv Bar-cohen
Journal: Circulation (2021)

Introduction: Ectopic atrial tachycardia (EAT) is relatively common in infants following surgery for congenital heart disease (CHD). There is limited data regarding this arrhythmia. Hypothesis: Operative factors, including CHD diagnosis, can identify risk factors for post-operative EAT. Methods: This was a retrospective analysis of patients undergoing CHD surgery in the first year of life between January 2007 and July 2020. Patients and surgeries with EAT were compared to those without EAT. Results: Out of 5,792 infant CHD surgeries, 129 (2.2%) developed postoperative EAT. The onset of EAT occurred at a median of 9 days (IQR 5-14 days) after CHD surgery. Compared to controls, the EAT cohort was younger (median 7 vs 85 days, p &lt;0.01) and had lower weight (3.3 vs 4.3 kg, p &lt;0.01) with no gender difference. EAT occurred following 24/265 (9%) total anomalous pulmonary venous connection (TAPVC) repairs (relative risk of 4.7, p&lt;0.001), 22/351 (6%) arterial switch operations (RR 3.2, p&lt;0.001), 6/90 (7%) interrupted arch repair (RR 3.1, p=0.004), and 23/460 (5%) Norwood operations (RR 2.5, p&lt;0.001). EAT patients had longer cardiopulmonary bypass (median 64 vs 58 min, p=0.008) and deep hypothermic circulatory arrest times (15 vs 0 min, p&lt;0.001) but no statistically significant difference in cross clamp times (25 vs 31 min). Antiarrhythmics were given to 109 patients (84%), but treated patients were more likely to be identified for study inclusion potentially biasing this percent-treated value. Propranolol (60%), amiodarone (22%), and flecainide (4%) were the most frequently used antiarrhythmics during hospitalization. On discharge, 60% of EAT patients were on antiarrhythmics, most commonly propranolol (55%), amiodarone (4%), and flecainide (4%). Although 15 patients did not survive to hospital discharge, EAT was not directly implicated in any deaths. Conclusions: In this study of a large cohort of postoperative EAT patients, the arrhythmia occurred in 2.2% of cases with a median onset of 9 days after surgery. TAPVC repair carried the highest risk of postoperative EAT, followed by arterial switch, interrupted aortic arch repair, and Norwood operations. Patients with EAT were younger, smaller, and had longer bypass and circulatory arrest times than controls.
Abstract 10091: Fine Fibrillatory Wave as a Risk Factor for Heart Failure Event in Atrial Fibrillation Patients: The Fushimi Af Registry
Authors: Tetsuma Kawaji, Hisashi Ogawa, Yasuhiro Hamatani, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2021)

Introduction: The clinical significance of fibrillatory (F) wave on electrocardiogram during atrial fibrillation (AF) is poorly understood. Hypothesis: We assessed the hypothesis that fine F wave was associated with heart failure (HF) event in AF patients. Methods: The current study enrolled 2442 AF patients whose baseline electrocardiogram during AF rhythm was available from a Japanese community-based prospective survey, the Fushimi AF Registry. The impact of fine F wave, defined as the amplitude of F waves less than 0.1mV, on the primary composite HF endpoint (a composite of hospitalization due to HF and cardiac death) was examined. Results: Fine F wave was observed in 589 patients (24.1%). Patients with fine F wave were older, and had higher prevalence of sustained AF, pre-existing HF and larger left atrial diameter than those with coarse F wave. During the median follow-up duration of 5.9 years, the cumulative incidence of a composite of hospitalization due to HF and cardiac death was significantly higher in patients with fine F wave than in those with coarse F wave (33.3%, and 23.9% at 8 years, log-rank P&lt;0.001: Figure). The higher risk associated with fine F wave was consistent even for individual components of the primary composite HF endpoint. By multivariable analysis with 11 clinically relevant variables, fine F wave became an independent predictor for the primary composite HF endpoint (hazard ratio 1.31, 95% confidence interval 1.07-1.61, P=0.01). Conclusions: Compared with coarse F wave, fine F wave was more prevalent in patients with larger left atrial diameter or those with sustained AF, and was independently associated with higher risk for HF events.
Abstract 9778: Insertable Cardiac Monitoring in Unexplained Syncope Patients is Cost-Saving Compared to External ECG Monitoring Followed by Insertable Cardiac Monitor
Authors: Klaus K Witte, Matthew R Reynolds, Sarah C Rosemas, Paul D Ziegler, Laura M Sawyer
Journal: Circulation (2021)

Background: Insertable cardiac monitors (ICMs) are recommended early in the evaluation of unexplained syncope patients after a non-diagnostic initial evaluation, and have been demonstrated as cost-effective for arrhythmia detection in this population. However, pathways frequently include short-term external cardiac monitors (ECM) prior to ICM. Objective: We aimed to evaluate the cost-effectiveness of immediate ICM versus a delayed ICM approach (30-day ECM followed by ICM in patients remaining undiagnosed), in unexplained syncope patients in the U.S. Methods: A discrete state Markov model assessed the cost-effectiveness of immediate vs. delayed ICM, from a U.S. payer perspective. Cohort characteristics were informed using the 2008-2016 Optum ® Clinformatics ® U.S. claims database. Syncope recurrence was modeled based on the EasyAs trial, with risks of mortality, injury, and quality of life consequences identified from the literature. ICM data capture was based on data for Reveal LINQ™ ICM. Diagnostic success with ECM was simulated based on the likelihood of monitoring occurring simultaneously to syncopal recurrence and patient adherence. Cost inputs were derived from claims and national average payment data. All diagnostic and arrhythmia-related treatment costs and benefits were modeled over a lifetime horizon, and future costs/effects were discounted at 3% per annum. Results: Immediate ICM was associated with lower lifetime per-patient costs compared to delayed ICM ($36,348 vs.$36,826), and a gain of 0.013 quality-adjusted life-years. This was largely driven by the cost of ECMs in the delayed ICM strategy, totaling $616,600 per 1,000 patients but with a small diagnostic yield such that 92.8%of patients required an ICM. The immediate ICM approach remained the dominant strategy when the assumed patient adherence to prescribed ECM was increased to 100%, and regardless of the choice of initial ECM (1, 2, 14, or 30-day monitor). Cost savings with immediate ICM increased further in scenarios assuming some delayed ICM patients are loss to follow-up after the initial ECM. Conclusions: A strategy of immediate ICM was cost-saving compared to delayed ICM, due to the cost and low diagnostic yield of ECM and the delay in arrhythmia detection and treatment.
Abstract 14432: Cardiac Arrest Death in the United States, 1999 to 2009
Authors: Nithin F Venepally, Thao Dang, Nithin R Venepally, Juan G Sierra, Govind Jha, Bibek Bakhati, Rangesh Modi
Journal: Circulation (2021)

Introduction: Cardiac arrest (CA) remains an important health issue in the United States. Mortality trends of CA death from 1999 to 2018 has been previously published by the American Heart Association. We aim to update the age-specific mortality rates for 2019 and temporal trend in mortality of any-mention cause of CA death from 1999 to 2019. Additionally, we sought to describe the temporal trends of gender and race. Methods: The United States statistics mortality data from 1999 to 2019 were analyzed. A retrospective population-based study was conducted through a search within the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. This was performed using the ICD-10 Codes: I46.0, I46, I46.9 and I49.0. Mortality rate was calculated for all the group of ages. Age-adjusted rate was reported for gender and race, crude rate was stated for age group. Poisson regression was used to calculate incidence rate ratio and analyze the temporal trend. Negative binomial regression was used for over dispersed data. Results: We identified 7 435 677 subjects with any-mention of cardiac arrest death from 1999 to 2019. The age-adjusted mortality rate for 1999 was 91.2 compared to 94.7 in 1998. Furthermore, from 1999 to 2019, the trend continues to decrease in CA-related deaths depicted by a gradual decline in the age adjusted mortality rate per year (IRR 0.97 95 % CI 0.95 to 0.99]). Gender age-adjusted mortality rate was higher in males compared to females (126.7 vs 91.3 [IRR 1.39 95 % CI 1.27 to 1.52]). The black/African American population had higher death rates for CA than white (156.9 vs 101.5 [IRR 1.57 95% CI 1.43 to 1.73]) followed by Asian/Pacific Islander (100.5) and American Indian/Alaska Native (80.5). Conclusions: In the period between 1999 and 2019, CA age adjusted mortality rate showed a significant gender and racial disparity. The significant difference in death rates among different racial groups warrants additional investigation. The present surveillance data demonstrates a gradual 10-year decline of CA-related mortality. The increased awareness of CA through public health education, social media and bystanders trained, are thought to play an important factor in the decline of CA deaths.
Abstract 11978: Increased Early Prothrombotic Potential of Transcatheter Aortic Valve Implantation Compared With Percutaneous Coronary Intervention Identified With Viscoelastic Hemostatic Assessment of Coagulation
Authors: Jonathon P Fanning, Shaun Roberts, Sarvesh Natani, Karl Poon, Alexander Incani, Christopher Anstey, John F Fraser
Journal: Circulation (2021)

Introduction: Antithrombotic guidelines for transcatheter aortic valve implantation (TAVI) are extrapolated from percutaneous coronary intervention (PCI). Comparison of the thrombotic profiles of the procedures is necessary to determine the validity of this supposition. Hypothesis: TAVI has higher thrombogenic potential than PCI due to greater endothelial damage, artificial surface exposure and altered rheology. Methods: Patients undergoing transfemoral TAVI with Edwards SAPIEN-3 (n=16) or elective PCI (n=12), were prospectively recruited. Blood was sampled at 4 timepoints, following: T1-sedation/anesthesia; T2-heparin (100 IU/kg) and TAVI/PCI deployment; T3-protamine (1mg/100IU heparin); and, T4-6h post procedure. Analysis included: 1) viscoelastic hemostatic profiling with thromboelastometry (ROTEM Sigma ), thromboelastography (TEG6s) and activated clotting time; 2) platelet function (Multiplate analyzer); and, 3) routine coagulation panel (PT/INR, aPTT, thrombin clotting time, anti-Xa, platelet count and direct/Claus fibrinogen). Results: There were no difference in baseline characteristics except for older age in the TAVI cohort (83±2 vs 73±4; p=0.028). A relative prothrombotic effect was demonstrated early post TAVI for all components of the coagulation pathway measured by rotational thromboelastometry (Figure), including: intrinsic (INTEM), extrinsic (EXTEM), fibrinogen (FIBTEM) and despite heparin neutralisation (HEPTEM). Heparin effect limited thromboelastography analysis and resulted in significant rises between T1 and T2 for all variables in the routine laboratory coagulation panel (except direct fibrinogen), which normalised by T4. Conclusions: Coagulation profiles differ between the two procedures with TAVI relatively more prothrombotic than PCI. While the clinical significance of this is unclear further investigation to determine optimal periprocedural antithrombotic prophylaxis is mandated.
Abstract 10536: Adenosine Triphosphate - Sensitive Potassium Channel Opener Diazoxide Reduces Myocardial Stunning in a Porcine Lad Occlusion Model
Authors: Ana K Velez, Eric Etchill, Katherine Giuliano, Sean Kearney, Melissa Jones, Jie Wang, Brian Cho, Mary Beth Brady, Jeffrey M DODD-O, Rosmi Thomas, Jennifer S Lawton
Journal: Circulation (2021)

Introduction: Adenosine triphosphate - sensitive potassium (K ATP ) channels provide endogenous myocardial protection by coupling cell membrane potential to metabolism, as they are inhibited by ATP and open during times of metabolic stress. Pharmacologic opening of K ATP channels mimics ischemic preconditioning, and diazoxide (DZX) preserves myocardial function following prolonged global ischemia. Hypothesis: We hypothesized that DZX would reduce myocardial stunning after left anterior descending coronary artery (LAD) occlusion followed by global ischemia, similar to a clinical situation of acute myocardial infarction followed by coronary revascularization. Methods: Twelve swine underwent LAD occlusion (30 min), followed by 120 min global ischemia protected with hyperkalemic cardioplegia (CPG) +/- DZX (N=6 each), followed by intermittent CPG (q 20 min), then 60 min reperfusion (RF). Cardiac output (CO), mean time to wean from cardiopulmonary bypass (CPB), left ventricular ejection fraction (LVEF), left ventricular developed pressure (LVDP), caspase - 3 (apoptosis), and infarct size were compared. Results: All 6 animals in the DZX group separated from CPB by 30 min RF whereas only 1 and 4 animals in the CPG group had separated at 15 and 30 min, respectively (Figure). DZX was associated with shorter average time to wean from CPB (17.5 vs 27.0 min, p=0.13) and higher CO at all time points during reperfusion (2.9 vs 1.5 L/min at 30 min RF, p=0.05), however, these were not significantly different. DZX was associated with higher LVEF after 30 minutes of reperfusion (42.5 vs 15.8%, p=0.009; Figure). There were no differences between groups in vasopressor use, infarct size, caspase - 3, or LVDP. Conclusions: DZX reduces myocardial stunning and facilitates separation from CPB following LAD occlusion and subsequent global ischemia in a porcine model. The addition of DZX to hyperkalemic cardioplegia has the potential to reduce myocardial stunning in the clinical setting.
SURG-10. DEVELOPMENT OF NOVEL TOPICAL FLUORESCENT PROBE FOR INTRAOPERATIVE RAPID DETECTION OF GLIOMA
Authors: Shota Tanaka, Yosuke Kitagawa, Mako Kamiya, Yugo Kuriki, Kyoko Yamamoto, Takenori Shimizu, Takahide Nejo, Taijun Hana, Tsukasa Koike, Erika Yamazawa, Yoshihiro Kushihara, Satoshi Takahashi, Masashi Nomura, Hirokazu Takami, Shunsaku Takayanagi, Akitake Mukasa, Yasuteru Urano, Nobuhito Saito
Journal: Neuro-Oncology (2021)

Abstract PURPOSE Fluorescence imaging is an important surgical adjunct in malignant glioma surgery. 5-aminolevulinic acid (5-ALA) has been proven effective for radical tumor resection and extended progression-free survival in a phase III randomized trial and therefore integrated into surgery for malignant glioma. Importantly, however, some limitations still exist in its use, which include false positivity and false negativity as well as inability of re-administration. In this study, we aimed to develop a novel, spray-type fluorescent probe using hydroxymethyl rhodamine green (HMRG) as a fluorescent scaffold. METHODS We have previously established a fluorescent probe library comprised of more than 320 kinds of HMRG probes. They have HMRG as a fluorescent scaffold with various types of dipeptides attached to it. Primary probe screening was performed using the homogenized tumor samples from patients with glioblastoma operated at our institution. Secondary screening followed using the selected probes and fresh tumor samples obtained from patients with glioblastoma operated from 2016 until 2018. Diced electrophoresis gel (DEG) assay, two-dimensional gel electrophoresis followed by a multi-well plate-based fluorometric assay, was performed to identify responsible enzymes for the selected probe. Further experiments with inhibitors, real-time PCR, immunohistochemistry, and western blotting were performed for confirmation. RESULTS Proline-arginine-HMRG (PR-HMRG) was selected as a candidate probe based upon the above two-step screenings. It achieved 79.4% accuracy in receiver operating characteristic curve analysis. Calpain-1 was found to be responsible to cleave PR-HMRG probe by DEG-proteome analysis. Calpain-1 protein was expressed at significantly higher level in tumors that were fluoresced by PR-HMRG than in those that were not. CONCLUSIONS Our innovative screening method was able to find PR-HMRG as a novel fluorescent probe effective for rapid detection of glioblastoma. A preclinical study is planned to assess the efficacy and safety of the selected probe.
Abstract 13928: Asymmetric Dimethylarginine (ADMA) Mediates the Effect of miRNA-762 on All-Cause Mortality in Patients With Coronary Artery Disease
Authors: Natalia Jarzebska, Sergey Tselmin, Marcus Kleber, Winfried Maerz, Hong Jin, Bornstein Stefan, Arduino A Mangoni, Norbert Weiss, Roman Rodionov
Journal: Circulation (2021)

Introduction: Plasma concentrations of the endogenous L-arginine homologue asymmetric dimethylarginine (ADMA) independently predict cardiovascular and all-cause mortality. We sought to identify miRNAs that mediate the effects of ADMA on mortality or influence mortality through regulation of ADMA concentrations. Methods: In 993 participants of the Ludwigshafen Risk and Cardiovascular Health study (age 63.0±10.5 years, 31.4% females and 74.7% with coronary artery disease (CAD)) we measured ADMA and miRNAs concentrations in citrate plasma and investigated associations between them and with all-cause mortality. Results: miRNA-762 was positively and significantly correlated with ADMA concentrations (p=0.0013) and with all-cause mortality after adjusting for age and sex (HR (95%CI: 1.51(1.26-1.81); p=7.37E-06). The association remained significant after additionally adjusting for body mass index, CAD, arterial hypertension, diabetes, smoking, lipids, C-reactive protein, fibrinogen, renal function, homocysteine and medication (p=0.04). Mediation analyses showed that ADMA mediated 67% of the effect of miRNA-762 on mortality while miRNA-762 only mediated 8% of the effect of ADMA. Conclusions: miRNA-762 is an independent predictor of all-cause mortality in patients with CAD. The effects of miRNA-762 on mortality might be at least partially mediated by ADMA. miRNA-762 has been recently shown to regulate apoptosis in cardiomyocytes in myocardial infarction. We are currently investigating the effects of miRNA-762 on ADMA metabolism and stress responses in cultured cardiomyocytes and endothelial cells.
Abstract 11178: Non-Invasive Identification of Fibrotic Atrial Cardiomyopathy with Neural Networks Based on 642,400 12-Lead Ecgs from an Extensive Cohort Simulation Study
Authors: Claudia Nagel, Olaf Doessel, Axel Loewe
Journal: Circulation (2021)

The clinical picture of fibrotic atrial cardiomyopathy is caused by a partial replacement of atrial myocardial tissue with fibrotic substrate. Being subject to electrical and structural remodeling processes, the substrate provides the necessary properties for the maintenance of atrial fibrillation and could thus be a good risk marker. We hypothesize that the P waves in the 12-lead ECG present a non-invasive and cost-effective tool to quantify the extent of atrial fibrosis as an alternative to state-of-the-art approaches. Our virtual patient cohort comprised a combination of 80 atrial, 25 thoracic geometries and 27 rotation angle variations of the atria. For each atrial model, 10 stages of fibrosis were defined by replacing different fractions of the myocardial volume with fibrotic tissue patches exhibiting remodeled ionic and conduction velocity properties. Conducting electrophysiological simulations in sinus rhythm on each model combination with one to three different healthy baseline conduction velocities yielded 642,400 synthetic ECGs. P wave duration, dispersion, peak-to-peak amplitudes and terminal force in V1 were calculated and served, together with atrial volumes and torso sizes, as an input for a regression neural network to estimate the volume fraction of atrial fibrosis. The root mean square error between the ground truth and the estimated extent of fibrosis was 8.74% left atrial fibrotic volume. Based on the regression results, a distinction between the healthy and the diseased cohorts was possible with an accuracy of 99.01%, a sensitivity of 99.57% and a specificity of 62.38%. In conclusion, we have gauged the potential of the 12-lead ECG for estimating fibrotic atrial volume fractions in an extensive cohort simulation study comprising both, functional and anatomical inter-subject variability. As a next step, the methods need to be validated with clinical data for which robust feature extraction algorithms are required.