tbuckley/cabot-search huggingface dataset:
Abstract 13715: Efficacy of Implantable Cardioverter-Defibrillators/Cardiac Resynchronization Therapy Defibrillator Remote Monitoring in Patients With Heart Failure: A Bayesian Meta-Analysis of Randomized Controlled Trials
Authors: Ahmad Al-abdouh, Mohammed Mhanna, mahmoud Barbarawi, Mohammad As Sayaideh, Waiel Abusnina, Ahmad Jabri, Hossam Alzu’bi, Anan Abu Rmilah, Ikram-Ul Haq, Erin Michos, Abhishek Deshmukh
Journal: Circulation (2021)

Introduction: Remote monitoring using implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillator (CRT-D) can be used as an adjunctive diagnostic tool to traditional hospital and clinic visits to monitor the volume status of patients with heart failure (HF). Methods: We searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception through February 4th, 2021) for randomized controlled trials (RCTs) evaluating ICDs/CRT-D remote monitoring versus standard of care in patients with HF. Of 642 articles retrieved after removing duplicate items, we included 11 RCTs encompassing 5,965 patients. Absolute risk difference (ARD) with 95% credible interval (CrI) was estimated. Pooled (posterior) risk difference was computed using Bayesian hierarchical methods, random effects model and weakly informative prior. Results: The ARD for mortality was centered at -0.01 (95%CrI: -0.03; 0.01, Tau: 0.02), with 82% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for cardiovascular mortality was centered at -0.03 (95%CrI: -0.11; 0.05, Tau: 0.10), with 84% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for HF admissions was centered at -0.00 (95%CrI: -0.07; 0.06, Tau: 0.08), with 57% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0 [Figure]. Conclusions: This meta-analysis suggests that ICD/CRT-D remote monitoring in patients with HF is associated with a higher probability of reduced all-cause mortality, and cardiovascular mortality compared with standard care. However, ICD-CRT/D remote monitoring was associated with minimal probability of difference in HF hospitalizations.
Abstract 12248: Dosing of Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation and Renal Dysfunction
Authors: Jennifer A Rymer, Laura E Webb, Tracy Y Wang
Journal: Circulation (2021)

Introduction: Reduced doses of direct oral anticoagulants (DOACs) are approved to prevent bleeding complications in specified populations of patients with non-valvular atrial fibrillation (NVAF). Little is known about the accuracy of DOAC dosing in patients with renal dysfunction. Hypothesis: We hypothesized that NVAF patients with renal dysfunction would be more likely to receive an inappropriate dose of a DOAC compared with patients with normal renal function. Methods: We examined all patients who had at least two claims for NVAF between 2015 and 2017 in the Symphony Health claims dataset. We defined under-dosing as patients treated with a reduced dose without meeting label specified criteria for dose reduction, and excess dosing as patients treated with a full dose despite meeting criteria for dose reduction. We performed a logistic regression model to measure the effect of CrCl on DOAC dosing. Results: Among 86,919 patients with NVAF and CHA 2 DS 2 -VASc &gt; 2, 12.3% were underdosed and 5.0% were excess dosed. Patients who received excess-dosed or under-dosed DOACs were older and more likely to have comorbidities such as heart failure or history of prior stroke (all p&lt;0.001), compared with patients who were appropriately dosed. Among patients with CrCl &gt; 60 ml/min, under-dosing occurred in 9% of patients, highest among patients treated with edoxaban (18%) and rivaroxaban (10.4%). Under-dosing rates were higher among patients with CrCl 30-59 ml/min, especially for apixaban and dabigatran ( Table) . Excess dosing occurred in approximately 1 in 5 patients with CrCl &lt;30 ml/min. For every 10 unit decrease in CrCl, the odds of the patient receiving an inappropriately dosed DOAC increased by 27%. Conclusions: Incorrect DOAC dosing was observed in a substantial number of patients with NVAF in this large national study. Dosing errors occurred more frequently in patients with lower renal function, suggesting the need for efforts to improve effective and safe dosing of DOACs.
NCOG-30. AWAKE CRANIOTOMY FOR MENINGIOMA RESECTION: A STUDY ON THE SAFETY AND TOLERABILITY
Authors: Saqib Kamran Bakhshi, Noyan Jawed, Faraz Shafiq, Syed Ather Enam
Journal: Neuro-Oncology (2021)

Abstract Resection of intra-axial brain tumors under scalp block improves safety of surgery, permitting preservation of neurological function and early recovery. However, limited data is available on employing this anesthesia technique for extra-axial tumors particularly meningioma, raising concerns that it may not be feasible due to dural attachment of tumor causing intractable pain and discomfort. We retrospectively analyzed 17 patients who underwent AC for resection of meningioma at our hospital during last 5 years, employing non-probability consecutive sampling. Variables for demographics, and details of diagnosis and surgical procedure were recorded. Eleven of these cases had grade I meningioma, and 6 had grade II meningioma. The mean age of these patients was 45.8 ± 10.5 years. Seizures were the most common presenting complain (n = 7; 41.2%). Eleven patients (58.3%) had convexity meningioma, 4 (33.3%) had parasagittal meningioma and 1 each had a parafalcine and anterior skull-base meningioma. The mean duration of surgery was 180.8 ± 36.2 minutes and the median estimated blood loss was 450 ml (IQR: 225 ml – 737.5 ml). The mean length of stay in the hospital was 3.1 ± 1.3 days. Only 1 patient had a prolonged hospital stay of 7 days because of post-operative seizures. Simpson grade I resection was performed in 6 (41.7%) patients, and grade II resection in 10 (50%) patients. Deterioration in pre-operative neurological exam was not seen in any patient, and no one required emergency intubation, conversion of surgery to general anesthesia, or re-operations. We propose that AC does not pose any significant risk of intra-operative or post-operative pain during meningioma resection, particularly convexity and parasagittal meningioma, and can make surgery possible for patients who are high risk for, or are not willing to undergo general anesthesia.
Abstract 11886: Total Root Remodeling by Sleeve Technique for Severe Aortic Regurgitation in Patient With Mild or Moderate Root Dilatation
Authors: Kikuko Obase, Shun Nakaji, Ichiro Matsumaru, Takashi Miura, Kiyoyuki Eishi
Journal: Circulation (2021)

Introduction: Cusp repair in combination with root repair is a central strategy for aortic regurgitation (AR). However, aortic root replacement in patient without significant root dilatation is controversial. Hypothesis: Sleeve procedure can be an alternative to root replacement in such clinical settings. Methods: 27 tricuspid aortic valve patients (Body surface area: 1.64±0.16 m2) without significant root dilatation who underwent aortic valve repair with Sleeve procedure during January, 2017-April 2020 were studied. Of the 81 cusps, 34 cusps underwent central plication. Neo-chord technique was prophylactically applied in 12 cusps to prevent future leaflet prolapse. Selected Valsalva graft size was 26.1±1.4 mm. Pre- and post-operative diastolic valve geometry was evaluated by 3D cardiac computed tomography. Results: Geometric change in aortic valve by Sleeve is summarized in the Table. Postoperative increase in commissure height was noted and effective height of non-plicated cusp kept more than 8.5 mm in average postoperatively despite of the nearly 10 mm reduction in STJ diameter. There was no recurrence of AR more than grade II in one year follow-up. Conclusions: Preserved or increased commissure height by Sleeve procedure may contribute to sufficient cusp coaptation with preventing an iatrogenic cusp prolapse. Because of the external covering with the graft, neo-chord technique could be stably performed under Sleeve procedure. Sleeve procedure offers valve-sparing and total root remodeling without root replacement/coronary reconstruction in repairing AR, which may be beneficial for patients with mild or moderate root dilatation.
Abstract 10152: ST-Elevation Myocardial Infarction Induced by Acute Occlusion of an Ostial Left Intermammary Artery Graft Occurring 13 Years After Coronary Artery Bypass Graft Surgery
Authors: Taketo Sonoda, Hideki Wada, Manabu Ogita, Satoru SUWA, Tohru Minamino
Journal: Circulation (2021)

The left intermammary artery (LIMA) graft is commonly used in coronary artery bypass grafting (CABG) to left anterior descending (LAD) because of its superior long-term patency. Acute occlusion of the LIMA causing ST-elevation myocardial infarction (STEMI) in the late postoperative period is rare, and its pathological mechanism is unclear. We present a case of acute occlusion of the LIMA in a 87-year-old woman who underwent CABG surgery 13 years previously. She was transferred to our hospital because of acute chest pain. Electrocardiography showed ST-elevation in anterior leads. Emergency coronary angiography revealed total occlusion of proximal LAD segment and the ostial LIMA (Figure). Therefore, we judged that the LIMA occlusion was causing anterior STEMI, and performed emergency percutaneous intervention. We successfully implanted a drug eluting stent at the culprit lesion and final angiography showed good reperfusion. Although the LIMA graft is expected long-term patency, early recognition of the possibility of LIMA occlusion might be necessary in patients with AMI after CABG surgery.
Abstract 12758: Dissecting Heart Age Using Cardiac Magnetic Resonance Videos, Electrocardiograms, Biobanks, and Deep Learning
Authors: Alan Le Goallec, Jean-Baptiste Prost, sasha collin, Samuel Diai, Theo Vincent, Chirag Patel
Journal: Circulation (2021)

Introduction: Heart disease is the first cause of death after age 65 and, with the world population aging, its prevalence is expected to starkly increase. Methods: We used deep learning to build a heart age predictor on 45,000 heart magnetic resonance videos [MRI] and electrocardiograms [ECG] from the UK Biobank cohort (age range 45-81 years). (Figure 1) Results: We predicted age with a root mean squared error [RMSE] of 2.81±0.02 years (R-Squared=85.6±0.2%) and found that accelerated heart aging is heritable at more than 35%. MRI-based anatomical features predicted age better than ECG-based electro-physiological features (RMSE=2.89±0.02 years vs. 6.09±.0.02 years), and heart anatomical and electrical aging are weakly correlated (Pearson correlation=.249±.002). Our attention maps highlighted the aorta, the mitral valve, and the interventricular septum as key anatomical features driving heart age prediction (Figure 2). We identified genetic (e.g titin gene) and non-genetic correlates (e.g smoking) of accelerated heart aging. Conclusions: We built the first accurate heart age predictor, and showed that different dimensions of the heart can age at different rates. We identified genetic and non-genetic factors associated with accelerated heart aging. Our predictor can be used the assess the effect of rejuvenating therapies on cardiovascular health.
Abstract 10355: Puzzling St Elevations After Cardiac Shock Wave Therapy
Authors: Karsh Gaurav, Zachary Morrow, Adam Gershon, Varinder Singh
Journal: Circulation (2021)

Background: The differential diagnosis of ST elevation is broad, including ischemia, hyperkalemia, benign repolarization, and others. Here we present a case of ST elevations immediately post cardiac shock wave therapy, a non-invasive modality based on the lithotripsy method using low-intensity shock waves to stimulate angiogenesis, reduce angina, and improve myocardial perfusion. Case: 84-year-old male with a history of coronary artery disease, type 2 diabetes mellitus, hypertension, was admitted to the hospital with unstable angina. He received laser atherectomy, cardiac shock wave therapy, as well as a drug eluting stent to the mid left anterior descending artery. Patient was brought to the coronary care unit (CCU) for post-catheterization monitoring and was immediately noted to have prominent ST elevations in leads V2-V6 (Fig 1), however remained stable and asymptomatic. Bedside echocardiogram showed no new segmental wall motion abnormalities or pericardial effusion. He was taken back to the catheterization lab for a second look revealing the newly placed patent stents. Serial EKGs in the CCU showed resolving ST elevations, without the formation of new q waves, and he was discharged the next morning. Discussion: Shock wave therapy was introduced in 1980 as a treatment for ureteral stones. Now, shock wave therapy is delivered to areas of ischemic myocardium to stimulate angiogenesis and reduce refractory anginal symptoms. Electrocardiographic changes after shock wave therapy have not been studied and more importantly, their clinical implications remain unclear. New ST elevations after revascularization is often an ominous sign, indicating continuing ischemia or aneurysm. We postulate that in the setting of cardiac shock wave therapy, ST elevations may represent stunned myocardium as a consequence of the high-voltage discharges. Further studies and case reports are needed to evaluate the clinical implications of ST elevations after shock wave therapy
Abstract 10835: Inflammatory Heart Disease After COVID-19 Vaccination: A Preliminary Cardiac MRI Perspective
Authors: J Ronald Mikolich, Sathwika Thodeti, Anthony Lattanzio, Sanjay Vallabhaneni, Muhammad Khalid, Balakrishna Brahmandam, brandon mikolich
Journal: Circulation (2021)

Introduction: On June 2, 2021, 6 case reports of myocarditis after the Pfizer COVID-19 vaccine surfaced. Each case had a cardiac MRI (CMR) study using T2 weighted and delayed gadolinium imaging. CMR was performed for post-vaccine symptoms. Although valuable, these data do not shed light on the prevalence of this post-vaccine occurrence. This study was designed to assess the prevalence of inflammatory heart disease(IHD) in a group of patients who had a CMR after receiving a COVID-19 vaccine. Hypothesis: Evidence of myocarditis may occur on cardiac MRI after all types of COVID-19 vaccine. Methods: From January 1 to June 8, 2021 303 patients underwent a CMR at Sharon Regional Medical Center. The date of vaccination, type of vaccine and COVID testing results and date for each of these patients were ascertained. All patients who were vaccinated prior to the CMR exam constituted the study population. IHD by CMR was defined as abnormality of 2 or more pulse sequences of the Modified Lake Louise Criteria(MLLC) of 2018: T2 STIR, Delayed enhancement after gadolinium, and prolongation of myocardial or pericardial T1 or T2 relaxation times. The number of patients with CMR evidence of IHD was tabulated for Pfizer, Moderna and Johnson&amp;Johnson(J&amp;J) vaccines. Results: Of 303 patients with a CMR during the study period, 77 were vaccinated prior to CMR. The mean time between vaccination and CMR was 41 days. 42 patients had a Pfizer vaccine, 30 had Moderna and 5 received J&amp;J. 10 Pfizer receipants had IHD findings on CMR(24%), as did 7 of Moderna(23%) and 2 of J&amp;J(40%). 13 patients had a positive COVID test prior to vaccination and IHD was present on CMR in 9 patients(69%) in this subgroup, while only 8 of 63(13%) without a positive COVID-19 test before vaccination showed evidence of IHD. Conclusions: Although retrospective, these data provide valuable information about the occurrence of IHD after COVID-19 vaccination using CMR imaging. A similar percentage of patients vaccinated with any of the 3 vaccines appear to subsequently show evidence of IHD on CMR, more so if previously COVID positive. However, evidence of IHD on post-vaccine CMR does not definitively establish causality. CMR exams before and after COVID-19 vaccination using MLLC will be required to prove a cause-effect relationship.
Abstract 12571: Predictors of Successful Ablation of Premature Ventricular Contractions in Structurally Normal Heart
Authors: Javid Mahmoodi, Hannah Bernstein, Roshni Khatiwala, Laura Potter, Uma N Srivatsa
Journal: Circulation (2021)

Background: Long term exposure of premature ventricular contractions (PVCs) may lead to development of cardiomyopathy. Catheter ablation has been reported to effectively reduce PVC burden. Objective: To determine factors that may predict acute and long-term success with catheter ablation in the following locations: left ventricular outflow tract (LVOT), right ventricular outflow tract (RVOT), left ventricular summit (LVS), and papillary muscle (PM). Methods: All PVC ablations in structurally normal hearts from 6/2010 to 6/2017 were included. Acute and long-term success was assessed. Long-term success was defined as &gt;80% PVC reduction. Results: A total of 149 patients were included. Mean age of subjects was 57.7 ± 13.1, 55.0% were female. Mean PVC per hour prior to procedure was 900.5 ± 716.8. Distribution of PVC location was: 46.3% RVOT, 21.5% LVOT, 20.1% LVS, 20.5% PM. 8.2% of patients had more than one location of ablation. Acute success was 93.3%. Mean PVC/hour reduction for all locations was 79.5%, RVOT 77.3%, LVOT 89.5%, LVS 77.2%, PM 82.6%, and 67.8% for multiple locations. There was statistically significant reduction in mean PVC/hour when comparing baseline and follow-up PVC burden for each anatomic location except when multiple locations were ablated (Paired t test, p = values shown in Graph 1). Long-term success was 70.5%, measured by rhythm monitor with median follow up of 69 days (IQR 20-323). To assess predictors for ablation failure, logistic regression was performed for the following variables: age, sex, ethnicity, method (robotic magnetic navigation (RMN) vs manual), location, and reduced EF. The only statistically significant predictor of long-term failure was reduced EF (OR = 2.67, p = .048). Conclusion: Acute success was high with PVC ablation regardless of location of origin. Deep sites requiring ablation at multiple locations were less effective.
Abstract 12866: Ischemic Heart Disease Selectively Modifies The Right Atrial Appendage Transcriptome
Authors: Severi Mulari, Arda Eskin, Milla Lampinen, Annu Nummi, Tuomo Nieminen, Kari Teittinen, Teija Ojala, Matti Kankainen, Antti Vento, Jari Laurikka, Markku Kupari, Ari Harjula, Nurcan Tunçbag, Esko Kankuri
Journal: Circulation (2021)

Introduction: Although many pathological changes have been associated with ischemic heart disease (IHD), molecular-level alterations specific to the ischemic myocardium and their potential to reflect disease severity or therapeutic outcome remain unclear. Currently, diagnosis occurs relatively late and evaluating disease severity is largely based on clinical symptoms, various imaging modalities, or the determination of risk factors. Objectives: This study aims to identify IHD-associated signature RNAs from the atrial myocardium and evaluate their ability to reflect disease severity or cardiac surgery outcomes. Methods: We collected right atrial appendage (RAA) biopsies from 40 patients with invasive coronary angiography (ICA)-positive IHD undergoing coronary artery bypass surgery and from 8 patients ICA-negative for IHD (non-IHD) undergoing valvular surgery. Following RNA sequencing, RAA transcriptomes were analyzed against those 429 donors from the GTEx project without cardiac background. Results: The IHD transcriptome was characterized using repressed RNA expressions in pathways for cell-cell contacts and mitochondrial dysfunction. Specifically, we identified the increased expressions of the CSRNP3 , FUT10 , SHD , NAV2-AS4 , and hsa-mir-181 genes to correlate with the complexity of coronary artery obstructions or with a functional cardiac benefit from bypass surgery. Conclusions: Our results provide an atrial myocardium-focused insight into IHD signature RNAs. The specific gene expression changes we characterized here pave the way for disease mechanism-based identification of biomarkers allowing for the early detection and treatment of IHD.
Abstract 13575: Conversion of a Face-to-Face Educational Intervention to Electronic Delivery Offers Increased Access to Women With a History of Acute Coronary Syndrome
Authors: Leslie L Davis, Chiao-hsin Teng, Kathyrn Tippey
Journal: Circulation (2021)

We previously tested a face-to-face individualized educational intervention designed to improve symptom recognition in women who had recently experienced an acute coronary syndrome event. To increase accessibility to women in rural communities we converted the face-to-face intervention to a digital format including a responsive symptom monitoring diary. We implemented user experience tools to optimize the design, functionality, and aesthetics of the final product including personas, user stories, feature association, and a priority-feasibility matrix to determine the initial website structure of the website that applied this structure. We iterated mockup designs by conducting online focus groups with women with a history of ACS. Participants provided feedback on preferences for the device they would use; website settings, icons, and language; timing of reminders to complete daily symptom diaries; and understanding of the action plan and visual displays of symptom feedback to share with their provider. Eleven women (18% black; mean age 62.1) with varied digital literacy (36.4% never used ZOOM) from suburban (63.6%) or rural (36.4%) settings were included from 3 online focus groups. Participants determined website settings, icon, and language; initial symptom survey format; and language in the action plan and final visual display of symptom feedback data, respectively. A final focus group with 5 clinicians (2 cardiologists/3 nurse practitioners) provided input for modifications to the content, features, and scientific rationale for design decisions prior to finalizing the product. By delivering the intervention in an online acceptable format, we can reach women from rural settings who otherwise may not have completed a structured educational program post-ACS.