tbuckley/cabot-search huggingface dataset:
Abstract 13378: Identifiable Differences in Comorbidities and Surgical History Among Asian, Native Hawaiian, and Pacific Islander Stroke Patients With Carotid Artery Disease
Authors: Anson Y Lee, Julia R Jahansooz, Kirra Borrello, Michelle Trinh, Edward J Weldon, Kyle M Ishikawa, Hyeong Jun Ahn, Enrique Carrazana, Jason C Viereck
Journal: Circulation (2023)

Introduction: A detailed characterization of comorbidity prevalence among carotid artery disease patients has not been thoroughly explored in Asian, as well as Native Hawaiian and Pacific Islander (NHPI) populations. Research Question: This study investigated the types of comorbidities and surgical procedures associated with carotid artery disease in Asian and NHPI populations. Methods: This retrospective study utilized data from a stroke treatment center in Hawaii between the years 2020-21. Patients were identified with ICD-10 codes for stroke and only those ≥18 years old with either a completed carotid artery Doppler ultrasound or carotid angiography were included in the study. Collected data included demographics, location of stroke, degree and location of carotid stenosis, comorbidities, and previous surgical history. Wilcoxon rank sum test and Fisher's exact test were used as appropriate. Results: Overall, 117 patients were included with 74 of identifiable race (45% NHPI, 32% Asian, and 23% White). The average age at the time of stroke was 69 years and 40.0% (47/117) of patients were female. Amongst all races, there were no differences in the greatest degree of carotid stenosis (p=.15) or location of stenosis along the right carotid artery (p=.16), but there was a difference in the location of left carotid stenosis (p=.04). Endocrine conditions were the only comorbidity identified at significantly different rates between all racial groups (p=.02). Prior cardiac (p=.03), otolaryngological (0=.007), and orthopedic (p=.01) procedures differed significantly by race among the cohort. The majority of these differences were present when comparing NHPI or Asian patients against White patients, with no significant differences found between Asian and NHPI patients. Conclusions: Asian and NHPI stroke patients were found to have significantly different rates of left carotid stenosis, endocrine conditions, and prior cardiac, otolaryngological, or orthopedic surgeries when compared to White patients. Due to these race-specific differences in patient demographics and history, the implementation and investigation of carotid artery disease risk assessments should be pursued to best improve stroke outcomes among all patients.
Abstract 14577: Electrocardiogram Parameters for Predicting the Severity of Coronary Artery Disease in Non-ST Segment Elevation Acute Coronary Syndrome
Authors: Rahul Choudhary, Sourabh Goswami
Journal: Circulation (2023)

Background: Quantitative electrocardiogram (ECG) parameters have been found to correlate with severity of coronary artery disease (CAD). Thus, it may serve the purpose of risk stratifying patients with non-ST segment elevation acute coronary syndrome (NSTEACS). But little is known about the accuracy of each parameter.So, this study was done to assess the correlation of ECG parameters with severity of CAD in patients with NSTEACS and to compare the diagnostic accuracy among them. Methods: 178 patients with NSTEACS with left ventricular ejection fraction &gt;50% were selected for the study after excluding patients with heart failure, arrhythmia, prior myocardial infarction or revascularisation. P wave peak time (PWPT), corrected QT dispersion (cQTd) and QT dispersion ratio (QTDR) was calculated in all patients. CAD severity was assessed visually by coronary angiography and calculating the syntax score. Results: PWPT, cQTd and QTDR were increased significantly in patients with left main (LM) or triple vessel disease (TVD) than others. These parameters also showed a strong positive correlation with the syntax score ( P&lt;.001 ). Among these parameters, cQTd showed the best diagnostic accuracy (76% sensitivity and 64% specificity) to detect LM or TVD with a cut-ff value of 74 ms. Conclusion: PWPT, cQTd and QTDR may help to identify high risk patients with NSTEACS and early invasive procedure can be done to salvage a large area of myocardium at jeopardy. These may be particularly helpful to the physicians in periphery who have limited resources. Keywords: coronary artery disease, non-ST segment elevation acute coronary syndrome, P wave peak time, corrected QT dispersion, QT dispersion ratio
Abstract 17192: Characterization and Localization of Focal Atrial Tachycardia in Adult Congenital Heart Disease
Authors: Christine OConnell, Kelly Arps, Matthew A Carlisle, Hannah Schwennesen, Salim F Idriss, Ronald Kanter, Jonathan P Piccini
Journal: Circulation (2023)

Introduction: Patients with adult congenital heart disease (ACHD) often develop atrial arrhythmias, including focal atrial tachycardia (FAT). In non-ACHD patients, algorithms using surface ECG P-wave morphology are helpful to predict FAT location to assist in planning targeted ablation procedures, but similar algorithms have not been fully developed for ACHD patients with complex anatomy, including prior surgical correction and other anatomic differences. Methods: In this single-center retrospective cohort study, 29 patients with ACHD who underwent catheter ablation for FAT were included. FAT P-waves from 12-lead electrocardiograms obtained in clinic or the electrophysiology laboratory were classified as 1) positive, 2) negative, 3) isoelectric, or 4) biphasic. FAT ablation sites identified by electroanatomic mapping were grouped by region: right atrium (RA), paraseptal (PS), and left atrium (LA). Accuracy of P-wave classification criteria to predict FAT region were determined. Results: Thirty FATs were assessed in 29 patients (mean age 47 +/- 16 yrs, female 55%). RA FAT sites: crista terminalis (14), Fontan baffle (3) non-septal tricuspid annulus (1). PS FAT sites: PS tricuspid annulus (2), coronary sinus ostium (3), foramen ovale (1). LA FAT sites: mitral annulus (2), right superior pulmonary vein (1), left atrial appendage (3). Based on previously reported P-wave morphology localization criteria in normal hearts, sensitivities and specificities were analyzed in these ACHD patients and are shown in the Table. Additional algorithms were also tested. We determined that a biphasic (+/-) or negative P-wave in lead V1 was associated with a 100% specificity for the RA compared to PS or LA. Conclusions: P-wave morphology may be useful in predicting atrial location of FAT in ACHD patients. Similar to patients with normal hearts, lead V1 P-wave morphology in ACHD patients provides the most useful information for localizing FAT with a high degree of specificity.
Abstract 12705: Identification and Characterization of Solbinsiran, a GalNAc Conjugated siRNA Targeting Angiopoietin-Like 3
Authors: Hank Dudek, Marc Abrams, Utsav Saxena, Anton Turanov, Bob Brown, Giacomo Ruotolo, Laura Michael
Journal: Circulation (2023)

Introduction: While statins play an important role in reducing LDL-C levels and the risk of ASCVD events, residual risk from apolipoprotein B (apoB)-containing lipoprotein particles persists among patients with or at high risk of ASCVD. Hypothesis: Blocking ANGPTL3 activity or preventing its expression is a therapeutic approach to reduce apoB-containing lipoprotein particles. Solbinsiran (LY3561774), a novel Dicer-substrate small interfering RNA oligonucleotide, was designed to reduce the levels of ANGPTL3 protein expression. Methods: Nucleotide base sequences of a library of anti-ANGPTL3 siRNAs were selected using an in silico RNAi prediction algorithm on ANGPTL3 mRNA sequences conserved in humans and cynomolgus monkeys. Through a large-scale in vitro screen of the anti-ANGPTL3 library in human cells, the candidate solbinsiran sequence was identified as an efficacious siRNA. Solbinsiran in vivo efficacy was measured by RT-qPCR of liver from CD-1 female mice overexpressing human ANGPTL3 . The degree and durability of ANGPTL3 mRNA knockdown and circulating protein level reduction by solbinsiran was evaluated in cynomolgus monkeys administered single dose subcutaneous injections of either PBS or 3 mg/kg solbinsiran. Blood samples to measure ANGPTL3 protein were collected on Study Days -8, -5, and 0, and weekly after dosing until Day 113. Ultrasound-guided core needle liver biopsies were collected on Study Days 5, 28, 56, 84, and 113. Total RNA derived from the liver biopsy samples to measure ANGPTL3 mRNA was subjected to RT-qPCR analysis. Results: When given a single dose at 1 mg/kg subcutaneously, solbinsiran reduced human ANGPTL3 mRNA by 65% in hepatocytes as compared to vehicle-treated mice. A single dose of solbinsiran reduced liver ANGPTL3 mRNA expression by up to 72.9% (p&lt;0.0001) and serum ANGPTL3 protein expression by 68.6% (p&lt;0.001). Solbinsiran also displayed a long duration of activity, as indicated by a greater than 50% mRNA knockdown remaining 12 weeks after a single dose. Conclusions: These data supported the advancement of solbinsiran to Phase 1 clinical testing in participants with mixed dyslipidemia (ClinicalTrials.gov Identifier: NCT04644809).
Abstract 12877: Giant Pericardial Cyst Causing Syncope
Authors: Shane Miller, Cali Clark, Ashley Broce
Journal: Circulation (2023)

A 30 year old male presented with episodes of near syncope with dizziness, palpitations, chest tightness, and left arm paresthesias. Upon presentation, his vitals were normal. Initial imaging of a chest radiograph showed an enlarged cardiac silhouette and a follow-up chest CT demonstrated a 10 cm cystic mass in the anterior mediastinum concerning for a giant pericardial cyst. Echocardiogram was performed which showed a normal ejection fraction, no valvular abnormalities, and a trivial pericardial effusion. A CT-guided drainage was performed with 440mL of fluid removed and shrinkage of the cyst to 27x63mm. The aspirate was loaded with leukocytes without organisms identified. The following day, the cyst recollected to 85x69mm. Repeat CT-guided drainage was attempted however was unsuccessful due to right pneumothorax. After resolution of the pneumothorax, he was asymptomatic prompting discharge with close outpatient follow-up. Outpatient imaging demonstrated increased size of the pericardial cyst to 11 cm in diameter. A third drainage via CT-guidance was attempted however only minimal fluid was able to be drained. As the patient remained asymptomatic, it was recommended the patient have repeat imaging in 6 months and monitor for symptoms. Pericardial cysts are relatively rare and comprise 7% of mediastinal masses. They originate from failed fusion of the mesenchymal lacunae that form the pericardial coelom. Pericardial cysts typically range from 1 to 5 cm in diameter, with those over 10cm being termed 'giant pericardial cysts'. Most cysts are asymptomatic, although if symptoms do occur they are generally in response to mass effect and compression of local structures, such as shortness of breath and chest discomfort. If a patient remains asymptomatic, conservative management with serial imaging is recommended. However, if a patient becomes symptomatic or develops complications, surgical management via a pericardectomy or percutaneous aspiration is recommended.
Abstract 15700: What Role Does Physical Activity Play in Health-Related Quality of Life (HRQoL) of Children With Hypertrophic Cardiomyopathy (HCM)?
Authors: Jennifer Conway, Tara Pidborochynski, Samuel Lemaire-Paquette, Michael Khoury, Chentel Cunningham, Santokh S DHILLON, Nassiba Laroussi, Laurence Vaujois, Frederic Dallaire, Daryl Schantz, Kathryn Armstrong, Wadi Mawad, Timothy J Bradley, Aamir Jeewa
Journal: Circulation (2023)

Introduction: Higher levels of physical activity (PA) have been associated with better health-related quality of life (HRQoL). Whether this is true for patients counselled to restrict PA is unknown. Our aim was to examine the relationship between objective measures of PA and HRQoL in children with hypertrophic cardiomyopathy (HCM). Methods: A cross-sectional study of children with HCM, aged 10-18 yrs, enrolled from 10 Canadian sites (2016-23), who underwent cardiovascular screening including the PedsQL Quality of Life Inventory to measure HRQoL. PA measured via Fitbit occurred over 2 weeks. PA parameters included average daily heart rate, step-count, distance covered (Kms), stair flights, activity and sedentary time. Multiple linear regressions were performed to assess the relationship between PA and HRQoL. Covariate adjustments included: age/sex/BMI class at enrollment, cardiac arrest history, previous ICD implant and PA restriction. Correlation matrix was calculated for PA parameters. Results: Fifty-six patients were enrolled [71.4% male; median age 15.5 yrs (IQR 13.8-16.8), median BMI 23.3 Kg/m 2 (IQR 19.5-27.7)], including 11% with a cardiac arrest, 30.4% with an ICD implant and 75% PA restricted. The Fitbit was worn for a median of 14 days (IQR 13.3-14). Average daily steps were 7586 (IQR 5333-10324]) and median sedentary time 893 mins (IQR 735-1141). After adjustment, the average daily steps were associated with Physical HRQoL scores [mean difference (MD) of 2.0 [95% CI 0.3-3.0] per each 1000 steps increase (p=0.02)]. Similar effect sizes were seen for Physical HRQoL with average daily Kms, active time and stairs flights. These outcomes were highly correlated with daily steps (Spearman's ρ; 0.97, 0.81 and 0.6). Conversely, 100 mins of sedentary time decreased mean Physical HRQoL scores by 2 (MD = -2 [-4--0.4]; p=0.02). Only average daily stair flights (MD = 0.6 [0.1-1.1]; p=0.02) was associated with a higher Total HRQoL. Conclusions: Increasing PA in children with HCM, especially with flights of stairs, was associated with higher Physical/Total HRQoL, whereas sedentary time had a determinantal effect on Physical HRQoL. Efforts to decrease sedentary time and improve PA may improve the overall physical and total HRQoL of children with HCM.
Abstract 17294: Dynamic Change Patterns of Visceral Adiposity Index and Risk of Cardiovascular Disease: A Chinese Nationwide Cohort Study
Authors: Xiangming Hu, Yanqiu Ou, Haojian Dong, Yingling Zhou, Junguo Jin, Jieliang Liu, Lujing Jiang, Mingqin Liu
Journal: Circulation (2023)

Introduction: Visceral adiposity index (VAI), as a reliable marker for visceral adiposity accumulation and dysfunction, is an independent risk factor for cardiovascular disease (CVD). However, the influence of VAI transition on CVD has never been revealed. Hypothesis: Different VAI dynamic change patterns have different impacts on the risk of CVD. Methods: There were 5,395 participants aged equal or more than 45 years recruited in 2011 and followed up until 2018, with VAI information and free of a diagnosis of CVD at baseline. New-onset CVD including heart disease and stroke was defined by medical diagnosis. A receiver-operating characteristic curve was employed to divide individuals into high and low VAI categories. Participants were divided into four groups based on VAI change patterns during follow-up period (2011—2015): low-low group, low-high group, high-low group, and high-high group. The probabilities of CVD-free survival were estimated by Kaplan-Meier analysis. A Cox proportional hazards model was used to evaluate the association between different change patterns of VAI and CVD. Results: During a median follow-up period of 7 years, 969 participants (17.9%) developed CVD. The high-high group (hazard ratio (HR): 1.65, 95% confidence interval (CI): 1.39—1.97) and the low-high group (HR: 1.29, 95% CI:1.04—1.61) were associated with a higher risk of CVD after adjusting for demographic characteristics and traditional risk factors compared to the low-low group, while the effect in high-low group was not significant. Conclusions: Changes in VAI were significantly associated with CVD risk. Monitoring the dynamics of the VAI in public health practice would help prevent CVD.
Abstract 15645: Budget Impact Analysis of PrecisionCHD, an Artificial Intelligence Guided, Integrated Genetic-Epigenetic Test for Assessing CHD, Demonstrates Extensive Cost Savings Compared to Conventional Methods
Authors: Meeshanthini Dogan, David Frisvold, Khullani Abdullahi, Tim Dogan, Robert Philibert
Journal: Circulation (2023)

Coronary heart disease (CHD) costs the United States healthcare system at least $216 Billion in treatment cost and $147 billion in lost productivity annually. Therefore, there is an urgent need for cost-effective solutions to reduce both the human and economic burden of CHD. Because the initial CHD diagnostic approach has a large impact on subsequent costs and healthcare outcomes, risk bearing entities are keen to determine the optimal algorithmic approach for guiding the use of CHD diagnostic tools. In order to better understand the economic and clinical impact of a newly developed Precision Epigenetic test for assessing CHD status, PrecisionCHD, we conducted a budget impact analysis comparing the use of PrecisionCHD to the use of conventional exercise ECG and coronary computed tomographic angiography (CCTA) (in a 75:25 ratio) as the initial diagnostic assessment of CHD using nationally published cost estimates, generally accepted side effects, sensitivity and specificity metrics for each test, with all positive tests resulting in the initiation of moderate to high dose statin therapy as per treatment guidelines. Our analysis showed that for an insurance plan with 1 million covered individuals, a $20 co-pay for office visits and 10% co-insurance, the use of PrecisionCHD over exercise ECG and CCTA would result in $92 million in annual cost savings with a significant portion of those savings being secondary to the inferior performance of exercise ECG. Increasing the number of CCTA test performed increases the number of CHD cases detected, but also results in greater costs including costs secondary to contrast dye induced kidney damage. We conclude that the use of PrecisionCHD for CHD detection can improve healthcare outcomes and decrease CHD related costs. Given current trends in the developments in epigenetics-based approaches, it is likely that this advantage will increase further.
Abstract 16676: Risk Assesment of Sudden Cardiac Death With RR Interval Fluctuations
Authors: Esa Rasanen, Teemu Pukkila, Matti Molkkari, Kjell Nikus, Leo-Pekka Lyytikainen, Terho Lehtimaki, Jari Viik, Mika Kahonen, Jussi Hernesniemi
Journal: Circulation (2023)

Introduction: Changes in conventional measures for short-term heart rate variability (HRV) have been associated with heart failure, coronary artery disease and even sudden cardiac death (SCD). However, the predictive value of HRV in clinical settings has been limited. Secondly, the current HRV methods have not discriminated SCDs from other causes of death, which would be relevant for proper prevention and treatment. In this study we utilize novel time series analysis methods for RR intervals in ultra-short-term measurements to distinguish SCD from other causes of death. Methods: We apply second-order detrended fluctuation analysis (DFA) with maximally overlapping windows to assess the correlations in RR intervals as a function of the scale, i.e., the range of consecutive RR intervals in one-minute resting ECG. The analysis is based on the baseline ECG recordings from the prospective FINCAVAS study of cardiac patients with a median follow-up time of 8.3 years, during which 378 deaths were recorded including 76 SCDs in the total population of 2794 subjects. Results: Our DFA method can discriminate between incident SCD cases and patients dying to other causes. The discrimination is maximized on scale 9, with an univariate hazard ratio of 0.71 and 95% confidence intervals (CI) (0.55-0.91). Excluding other cardiac deaths from the control group we are left with 279 deaths resulting to univariate hazard ratio of 0.62 (0.47-0.82 CI) on scale 8. Conclusions: The ability to distinguish SCD from other causes of death shows that the scale-dependent DFA method is a superior alternative to the conventional HRV methods. The utilization of one-minute RR interval measurements for risk assessment provides new non-invasive tools for clinical inspections, as well as promising prospects to health monitoring with wearable devices.
Abstract 16616: Automatic Measurement of Short-Term Variability of Repolarization Captures Modulation by Pacing on Human Intracardiac Electrograms
Authors: Vera Loen, Alfonso Aranda, Agnieszka Smoczynska, David Sprenkeler, Anton E Tuinenburg, Coert O Scheerder, Paul J DeGroot, Marc A Vos, Mathias Meine
Journal: Circulation (2023)

Introduction: Short-term variability of repolarization (STV) increases prior to ventricular arrhythmias (VA) both in humans and in animal models of VA, and is therefore a promising tool for real-time monitoring of arrhythmic risk. To integrate this concept in cardiac devices, a method to automatically determine STV on intracardiac electrograms (EGM) was developed. This STV algorithm demonstrated high efficacy in predicting life-threatening VA in animal studies, but still needs to be evaluated on human signals. Objective: To assess the performance of the novel automatic method of STV measurement on human EGMs during sinus rhythm (SR) and pacing. Methods: ECG and EGM signals with a 1 kHz sampling frequency were recorded in 14 dual chamber implantable cardioverter-defibrillator (ICD) patients during implantation (n=4) or replacement (n=10) procedures. Recordings were obtained in SR, atrial pacing at 80 beats per minute (AAI80) and atrioventricular pacing at the same frequency (DDD80). STV was calculated over 31 consecutive beats as Σ
Abstract 15164: The Different Prognostic Values of T1 Mapping in Patients With Hypertrophic Cardiomyopathy
Authors: JIE Wang, Jinquan Zhang, Lutong Pu, Weitang Qi, Yuanwei Xu, Yuchi Han, Yucheng Chen
Journal: Circulation (2023)

Objectives: This study aimed to determine the impact of T1 mapping on cardiovascular magnetic resonance (CMR) on long-term adverse outcomes in patients with hypertrophic cardiomyopathy (HCM). Background: In patients with HCM, the prognostic value of native T1 and extracellular volume fraction (ECV) for sudden cardiac death (SCD) has not been well defined. Methods: Consecutive 663 participants with HCM who underwent CMR were recruited. The follow-up endpoints included heart failure (HF)-related death and SCD or aborted SCD. Results: During the median follow-up time of 44 months (interquartile range [IQR]: 23 to 65.5 months), 55 (8.3%) participants reached the endpoint including 37 (5.6%) with SCD or aborted SCD and 18 (2.7%) with HF-related death. On Cox proportional hazards regression multivariable analyses, native T1 but not ECV was independently associated with CD (hazard ratio [HR]: 1.00; 95% confidence interval[CI] : 1.00 to 1.01; P = 0.02), while native T1 (HR: 1.01; 95%CI: 1.00 to 1.01; P = 0.008) and ECV (HR:1.15 for every 1% increase; 95%CI: 1.05 to 1.26; P = 0.003) were both independently associated with HF-related death after the adjustment for left ventricular ejection fraction (LVEF) and LV late gadolinium enhancement (LGE) extent. Conversely, native T1(HR: 1.00; 95% CI: 1.00 to 1.01; P = 0.40) and ECV (HR: 1.01; 95% CI: 0.94 to 1.08; P = 0.81) were not associated with SCD after the adjustment for non-sustained ventricular tachycardia, history of syncope and LV LGE extent. Conclusions: In this study of patients with HCM, T1 mapping had distinct prognostic associations; native T1 and ECV were both independently associated with HF-related death, whereas T1 mapping was not independently associated with SCD or aborted SCD. These findings may indicate distinct implications for the management of left ventricular fibrosis in HCM.