tbuckley/cabot-search huggingface dataset:
Abstract 17249: Epidemiology of Wolff-Parkinson-White Syndrome Among Acute Care Recipients in California
Authors: Justin T Teraoka, Janet J Tang, Jean Jacques Noubiap, Thomas A Dewland, Gregory M Marcus
Journal: Circulation (2023)

Introduction: Wolff-Parkinson-White syndrome (WPW) is a congenital heart disease associated with life-threatening arrhythmias. However, little is known about the epidemiology of WPW in the general population. Goals: To describe the frequency, predictors, and management associated with WPW among California residents. Methods: We used Ambulatory Surgery, Emergency Department, and Inpatient data from the California Department of Health Care Access and Information to identify California residents receiving hospital care between January 1, 2005 to December 31, 2020. Demographics were ascertained from the database. Rurality was determined using the CDC Urban-Rural Classification. Diagnoses and procedures were identified using clinical diagnostic codes. Two multivariable logistic regression models were used to 1) assess the association between patient characteristics and WPW in the entire cohort and 2) examine the odds of undergoing an electrophysiology study (EPS)/ablation among those with WPW. All models were adjusted for sex, rurality, race/ethnicity, and median income. Results: Among 31,414,813 individuals (53% female, 53% non-White, 3% rural), 19,866 (0.06%) had WPW. After multivariable adjustment, those who were female, non-White, or residing in a lower income county had lower odds of having a diagnosis of WPW. Among those with WPW, those who were female, Black, Native Hawaiian/Pacific Islander, or residing in a lower income county were less likely to undergo EPS/ablation. Hispanics and Asians with WPW were more likely to undergo an EPS/ablation than non-Hispanic Whites (Figure). Conclusions: There are substantial differences in both the diagnosis and treatment of WPW by patient characteristics. Whether, or to what degree, these are due to biological differences, the clinical presentation, access to care, or willingness to undergo interventions is deserving of future research.
Abstract 196: Splenic Red Blood Cell Mobilization During Cardiac Arrest in Swine
Authors: Tyler J Rolland, Daniel Cucinotta, Sumbule Zahra, Brian R Weil
Journal: Circulation (2023)

Objective: The spleen can rapidly mobilize red blood cells (RBCs) to increase blood O 2 carrying capacity in response to a variety of stressors. However, the contribution of splenic RBC mobilization to blood oxygenation during cardiac arrest (CA) and its impact on resuscitation efforts have not been directly studied. Accordingly, we subjected splenectomized swine to CA to test the hypothesis that splenic RBC mobilization meaningfully affects blood O 2 content during CPR. Methods: Swine (n=18) were randomized to splenectomy (SPLX; n=9) or sham surgery (SHAM; n=9) 1-week before undergoing 8-minutes of electrically-induced VF CA followed by CPR with defibrillation and epinephrine (EPI; 0.015 mg/kg iv). Serial blood sampling was performed to assess hemoglobin, hematocrit, and blood O 2 content before CA, during CPR, and following return of spontaneous circulation (ROSC). Results: Compared to baseline, SHAM animals exhibited a significant 41±5% increase in hemoglobin and hematocrit and 30±4% rise in O 2 carrying capacity during CA that was absent after SPLX ( Figure ). Although this did not significantly affect the rate of ROSC between SPLX (44%) and SHAM (56%) groups, time to ROSC (779±196 vs. 455±37 sec; p=0.02) and EPI needed to achieve ROSC (3.3±1.3 vs. 1.4±0.2 boluses, p=0.04) were significantly higher after SPLX. Among animals that achieved ROSC (n=4/group), between-group differences in hemoglobin, hematocrit, and O 2 carrying capacity persisted for up to 90 min post-ROSC alongside a significant reduction in RBC count in SPLX (6.4±0.1 x 10 6 /μL) vs. SHAM (7.3±0.2 x 10 6 /μL) animals (p=0.01). Conclusion: Splenic RBC mobilization during CA contributes to a significant rise in blood O 2 carrying capacity that is evident during CPR and throughout the early post-ROSC period. The absence of this response is associated with a prolonged time to ROSC and additional hemodynamic support, suggesting that impaired splenic RBC mobilization may adversely affect outcomes after CA.
Abstract 17134: Mycn is a Regulator of Cardiomyocyte Proliferation and Regeneration in the Mammalian Heart
Authors: Thijs A Larson, Javier E Sierra-Pagan, Satyabrata Das, Tamas Alexy, qinglu li, Xiao Ma, Wuming Gong, Jianyi J Zhang, Mary G Garry, Daniel J Garry
Journal: Circulation (2023)

The adult mammalian heart has limited regeneration in response to injury. Therefore, we focused on defining new factors and mechanisms that could enhance repair and regeneration in the adult mouse heart. MYCN is a protooncogene that regulates embryonic heart development. We identified MYCN as a downstream effector of the sonic hedgehog (SHH) signaling cascade during cardiomyocyte proliferation. However, its role in heart regeneration is unknown and warrants further investigation. Here, we describe a novel role for MYCN as a regulator of cardiomyocyte (CM) proliferation and regeneration using genetic mouse models and in vivo modified RNA (modRNA) delivery. By crossing Mycn floxed mice with the Myh6 -MerCreMer mice ( Mycn CKO), we conditionally deleted Mycn in the neonatal heart following administration of 4-hydroxy-tamoxifen (4-OHT) starting at P0. Successful deletion of Mycn was demonstrated by qPCR analysis of P2 isolated CMs. Immunohistochemical (IHC) analyses of P3 neonatal hearts in the absence of MYCN demonstrated a significant decrease in Ki67 expression and pH3 detection. This observation was validated in isolated P7 CMs and hearts pulsed with EdU which demonstrated a significant decrease in EdU+ CMs in the absence of MYCN compared to control. We then performed LAD coronary artery ligation surgeries in control and Mycn CKO P2 neonatal mice. Echocardiography one month following LAD coronary artery ligations demonstrated that the Mycn CKO failed to recover baseline cardiac function compared to their control counterparts who achieved complete recovery measured by ejection fraction (EF) and fractional shortening (FS). RNAseq analysis of control and Mycn CKO hearts one month following LAD ligations demonstrated that muscle developmental pathways were significantly downregulated in the Mycn CKO group compared to the control. We then delivered either GFP (control) or Mycn modRNA intramuscularly into the border zone following LAD coronary artery ligation injuries in adult (2-6 month old) mice. We observed that the Mycn modRNA treated mice had significantly improved cardiac function at one month and two months following injury/delivery compared to controls. These results identify MYCN as a regulator of CM proliferation and heart regeneration.
Abstract 17185: Percutaneous Intervention in Chronic Total Coronary Occlusion: Impact on Ventricular Arrhythmia and Mortality Compared to Medical Therapy
Authors: ahmad jabri, Laith Alhuneafat, Anas Alameh, Mohammad Alqarqaz, Enrique Soltero, Mir B Basir, Adnan Yousaf, Saima Karim, Aisha Siraj
Journal: Circulation (2023)

Background: The incidence of ventricular arrhythmias (VA) in patients with chronic total coronary occlusions (CTO) in the absence of advanced left ventricular dysfunction is not well described. Moreover, little is known about how revascularization may impact VA in this population compared to medical therapy alone. Methods: In this single-center retrospective cohort study from January 2010 to January 2019. We identified 100 patients with CTO on cardiac catheterization with a left ventricular ejection fraction (LVEF) &gt;35% who did not undergo coronary artery bypass surgery following CTO diagnosis. Percutaneous revascularization was performed for 44 patients. The primary outcomes evaluated were VA and mortality rates at end of the study period. Secondarily, cardiovascular outcomes were compared between the intervention and optimal medical therapy (OMT) groups at the end of the study period. Survival analysis was performed via Kaplan Meier calculation for VA and mortality. Statistical analysis was performed using STATA 15 and R-studio. Results: Mean age was 59.91(± 13.05) and BMI was 31.8(± 7.41). Patients were 66% male, 64% White, and 23% Black. Baseline characteristics, use of antiarrhythmic therapy, baseline LVEF, and the number of CTOs and locations of CTOs were not significantly different between groups. During a median follow-up of 4.1(± 2.54) years, the OMT group experienced higher rates of VA (21.4% vs 7.7 %, p = 0.011), and mortality (37.5% vs 15.9%, p=0.031). Conclusion: CTO in the absence of severe LV systolic dysfunction (LVEF &lt;35%) is associated with a high rate of VA and all-cause mortality, suggesting the need for further study on the impact of CTOs and their revascularization on VA and mortality in patients with LVEF &gt;35%.
Abstract 17064: Reversible Myocardial Depression and Dilatation in COVID-19 Shock Patients
Authors: Matthew J Fata, Steven M Hollenberg, Brent Klinkhammer, Taya Glotzer, Sameer Jamal, David Landers, George Rockett, Jana Tancredi, Zoltan Turi, Joseph E Parrillo
Journal: Circulation (2023)

Introduction: A characteristic pattern of bacterial and fungal septic shock is decreased left ventricular ejection fraction (LVEF) and modest dilatation of the left ventricle. In survivors, the myocardial depression and dilatation are reversible within several days. Using echocardiography, we have previously reported a cohort of COVID-19 shock patients with reduced LVEF. We now report serial studies of COVID-19 shock patients. Hypothesis: Myocardial dysfunction and dilatation associated with COVID-19 are reversible. Methods: In COVID-19 patients with shock requiring vasopressors who underwent echocardiography, left ventricular ejection fraction (LVEF) by Simpson’s rule and stroke volume by doppler were analyzed. Based on the LVEF and CI, patients were categorized into groups with low or normal values using EF 45% and CI 2.2 liters/minute/meter as the respective thresholds. A subset of 18 patients underwent serial echocardiography which were performed at a median of 13(9,39) days after the initial. The LVEF and LV volumes recorded during initial and follow-up echo were analyzed retrospectively using paired t-testing. Results: Comparing initial with follow-up values, the mean LVEF was 34.7(2.0) vs 43.8(3.47), p=0.01, indexed stroke volume 29.6(1.9) ml vs 31.7(2.3) ml, p=0.52, LV end-diastolic volume 182(14.1) ml vs 152.1(12.9) ml, p=0.03 and LV end-systolic volume 120.2(13.1) ml vs 90.1(12.1) ml, p=0.03 respectively (see Figure). Conclusions: Serial echocardiographic studies of COVID-19 shock patients with reduced LVEF and ventricular dilatation demonstrate reversibility of myocardial depression and dilation with no change in stroke volume, a finding strikingly similar to that seen in bacterial and fungal induced septic shock. Thus, COVID-19 (viral) induced septic shock may have a similar pathogenetic mechanism of myocardial dysfunction to that seen with bacterial or fungal sepsis.
Abstract 18958: Management of Patients With Suspected Left-Sided Prosthetic Valve Endocarditis According to Myocardial FDG-PET CT Results
Authors: Juan Caceres, Mark Edwards, Andrew Harris
Journal: Circulation (2023)

Introduction: Accurate diagnosis of prosthetic valve endocarditis (PVE) is challenging because echocardiography (Echo) can be limited by artifact from prosthetic material. Myocardial FDG-PET (PET) can improve diagnostic accuracy; however, little is known about its effect on patient management. Research Question: Does PET affect management of patients with suspected left-sided PVE? Methods: A retrospective, single-center study was conducted on all admitted patients with a history of aortic valve replacement (AVR) or mitral valve replacement (MVR) or repair who underwent a myocardial PET for suspected endocarditis between April 2016 to December 2022. PET was defined as positive, negative, or indeterminate based on signal intensity/pattern at valve prosthesis. For this analysis, patients with indeterminate results were included with negative results, resulting in four groups PET+, PET-, Echo+ and Echo-. Patients were followed up to twelve months. Data were obtained from chart review and supplemented with national death index data. Results: Of a total of 146 included patients, 68% had a surgical AVR, 14% had a transcatheter AVR and 21% had an MVR. Median age was 63 years and 30% of patients were female. Most patients had positive blood cultures on admission (66%). The Echo+/PET+ group had a high rate of definite PVE (95%). PVE was rejected in 58% of those in the Echo-/PET- group. PET+ patients were more likely to undergo surgery in both the Echo- (24% for PET+ vs. 12% for PET-) and Echo+ (62% for PET+ vs. 20% for PET-) groups. High rates of prolonged antibiotic courses (73%) were seen across all groups; PET- groups had lower rates of prolonged antibiotics. Conclusions: Although most patients with suspected PVE underwent initial conservative management, PET+ patients had higher rates of surgical management. Negative PET results may help to identify patients with suspected PVE that may not require prolonged antibiotics.
Abstract 18575: Impact of Mechanical Circulatory Support on In-Hospital Mortality in Ventricular Tachycardia Ablation: A United States Nationwide Analysis
Authors: Abdul Rahman Akkawi, Omar Chehab, Alexandros Briasoulis
Journal: Circulation (2023)

Background: Mechanical circulatory support (MCS) devices have emerged as a valuable tool in ventricular tachycardia (VT) ablation procedures, offering potential benefits such as improved hemodynamic stability, preserved organ perfusion, and optimized coronary perfusion during prolonged VT induction and mapping. However, the impact of different MCS modalities on in-hospital mortality following VT ablation remains unclear. Objective: This study aimed to investigate the impact of various MCS modalities on in-hospital mortality in those undergoing VT ablation during hospitalization. Method: We analyzed data from the National Inpatient Sample to identify patients who underwent VT ablation and received transient mechanical cardiac support between 2019 and 2020. The primary endpoint was in-hospital mortality, stratified by different MCS modalities. Additionally, we explored independent predictors of in-hospital mortality. Result: A total of 850 patients underwent VT ablation and required MCS from January 2019 to December 2020. Among these patients, extracorporeal membrane oxygenation (ECMO), percutaneous left ventricular assist device (PLVAD), intra-aortic balloon pump (IABP), and a combination of more than one MCS modality were utilized in 5.8%, 64.7%, 18.8%, and 10.5% of cases, respectively. The in-hospital mortality rates for these groups were 40%, 16%, 22%, and 61%, respectively (p&lt;0.01). Notably, the use of multiple MCS modalities, female sex, other races, and self-payment were independent predictors of mortality, with adjusted odds ratios (aOR) of 21.9 (p=0.008; 95% confidence interval [CI]: 2.2-217.1), 9.27 (p=0.045; 95% CI: 1.1-82.1), 27 (p=0.038; 95% CI: 1.1-29.4), and 27.6 (p=0.041; 95% CI: 1.2-660.8), respectively. Conclusion: Our study highlights that the use of multiple MCS modalities, female sex, other races, and self-payment are independent predictors of in-hospital mortality, highlighting the need for careful consideration and selection of MCS for VT ablation patients.
Abstract 18817: Dysregulation of Key Calcium Cycling Genes Does Not Drive Right Heart Maladaptation in a Porcine PH Model
Authors: Anjali J Ravichandran, Renata Mazurek, Spyros Mavropoulos, Tomoki Sakata, Kiyotake Ishikawa, Jonas Marx
Journal: Circulation (2023)

Introduction: Pulmonary hypertension (PH), a complex disease characterized by an elevated pulmonary artery pressure, causes maladaptation in patients. Maladaptation, or the hemodynamic and functional changes involved in RV/PA uncoupling, leads to poorer outcomes in patients. Dysregulation of calcium cycling controlled by SERCA2a and modulators, PLN and SUMO1, has been shown to cause left heart failure (HF), however its role in right heart maladaptation is unclear. Hypothesis: The dysregulation of the key calcium cycling genes, SERCA2a, PLN, and SUMO1 contributes to the maladaptation in PH. Methods: In this retrospective study, tissues of a porcine Yorkshire model of post-capillary PH were analyzed to understand molecular differences in right ventricular (RV) remodeling resulting in refractory symptom presentation (maladaptive group, n =6) or symptom absence (adaptive group, n =5). Pulmonary and cardiac hemodynamics, functional assessment, echocardiography, and pressure-volume relationship data were collected. Sham control group, ( n =5) received left thoracotomy only. Results: Calcium cycling genes known to be dysregulated in left HF did not display significant differences in group or spatial expression across RV, septal, and LV tissues (Figure). Other significant findings include increases in RV hypertrophy (p&lt;0.001) and stroke work (p=0.0036) when comparing maladaptive and sham group ( n =5) with RV dilation only in maladaptive group (p=0.0004). Conclusions: Dysregulation of calcium cycling genes in the RV does not explain symptom presentation in the maladaptive group and suggests different processes underlie left and right HF. RV dilation is likely a key driver of maladaptive symptom presentation in a porcine model of PH.
Abstract 18797: Use of Convolutional Neural Networks to Detect Overweight and Obesity and Estimate Body Mass Index
Authors: Grace Greason, Kathryn Mangold, Betsy Medina-Inojosa, Jwan Naser, Francisco Lopez-Jimenez, Zachi Attia
Journal: Circulation (2023)

Background: Our team has previously developed convolutional neural networks (CNNs) to estimate age and sex from a 10-second, 12-lead ECG as indicators of patient wellness. Here, we develop an additional wellness network to estimate body mass index (BMI) from the ECG input signal. Aims: To evaluate the performance of neural networks trained to classify and directly estimate BMI. Methods: We identified all adult patients in the Mayo Clinic system who had a 10-second, 12-lead ECG within 15 days of a BMI measurement. Of the&amp;nbsp;174,863 patients in the cohort, 2,895 were underweight (BMI &lt; 18.5), 42,387 were of normal weight (BMI 18.5-24.9), and 57,939 were overweight only (BMI 25.0-29.9). Among patients categorized as obese, 39,788 had class I obesity (BMI 30.0-34.9), 18,978 had class II obesity (BMI 35.0-39.9), and 12,876 had class III obesity (BMI ≥ 40.0). The cohort was split into training, validation, and testing datasets in an 8:1:1 ratio to develop networks for BMI classification and a direct&amp;nbsp;estimation of BMI. Results: In detecting overweight in the testing set, the model achieved an AUC of 0.86 (95% CI 0.85, 0.87). In detecting class I, class II, and class III obesity, the model yielded AUCs of 0.84 (95% CI 0.83, 0.85), 0.84 (95% CI 0.83, 0.85), and 0.85 (95% CI 0.85, 0.86), respectively. The model to estimate BMI achieved a mean absolute error of 3.70. Conclusions: AI-enabled ECGs demonstrate efficient detection of overweight patients and all classes of obesity. Further research is needed to determine if discrepancies between the traditionally measured BMI and the AI-ECG BMI reflect the presence or lack of metabolic abnormalities.
Abstract 17274: Frequency of Cardiology Follow-Up in Childhood Cancer Patients
Authors: Bhavya Talwar, Rittal Mehta, Niti Dham
Journal: Circulation (2023)

Background: Childhood cancer survivors (CCS) are at risk of early or late-stage cardiotoxicity, the third leading cause of death in CCS. American Heart Association Scientific statement stresses the importance of timely follow-up of CCS. Children's Oncology Group (COG) has also recommended serial cardiac testing based on therapy doses. However, compliance of cardiac follow-up is not known. Hypothesis: Cardiology follow-up in CCS is poor and needs improvement. Goal: Our goal is to identify factors that limit timely cardiology follow-up. Methods: We retrospectively cross-referenced patients from the oncology clinic with our echocardiogram database, focusing on solid tumor survivors from 1996-2018 that received anthracyclines or cardiac field radiation. Excluding patients not requiring cardiac monitoring, we collected demographic, oncology history and treatment, and cardiac evaluation related data. Based on COG guidelines, we determined if each patient maintained their expected cardiology follow up. We then assessed whether follow up was associated with median household income, medical insurance type, gender, and age at diagnosis using chi square or t-test. Results: A total of 49 patients (24F/25M) met inclusion criteria included. Timely cardiology follow up was only seen in 50% of the patients, regardless of how far out the patients were from treatment. There was no correlation between follow up and median household income, medical insurance, gender, or age of diagnosis (p values &gt;0.05). Conclusions: This data demonstrates there is a major gap in providing key cardiac care to CCS, as 50% of patients did not maintain expected follow up. This finding was irrespective of socioeconomic status or age at diagnosis. This suggests a greater emphasis must be placed on educating families about potential cardiac risks and the need for appropriate follow up care. This can be established through a stronger collaboration between cardiology and oncology programs.
Abstract 16890: Postoperative Atrial Fibrillation Following Coronary Artery Bypass Surgery in Severe Obesity: Impact of Waist Circumference
Authors: Jeanne Roberge, Amelie Paquin, Sarah Oconnor, Paul Poirier, Pierre Voisine, Marie Eve E Piche
Journal: Circulation (2023)

Introduction: Obesity (body mass index (BMI) ≥ 30 kg/m 2 ) is an independent risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) surgery. The incidence of POAF in patients with severe obesity (BMI ≥ 35 kg/m 2 ) is less studied. For a given BMI, higher waist circumference (WC) predicts adverse cardiovascular outcomes. Whether WC predicts POAF independently of BMI among patients with severe obesity remains unknown. Aim: To evaluate the risk of POAF after isolated CABG in patients with severe obesity, and the role of WC in predicting POAF in this population. Methods: Our cohort included 7,995 patients undergoing isolated CABG (2006-19). Patients with atrial fibrillation were excluded. POAF risk was compared across BMI and WC categories. In patients with severe obesity, the association of a 10 cm incremental in WC with POAF risk was assessed. We used a log-binomial regression model. Results are presented as adjusted relative risks (aRR) with 95% confidence intervals (CI). Results: 763 (9.5%) patients had a BMI ≥ 35 kg/m 2 . Mean BMI was 38.5 ± 3.6 kg/m 2 and WC was 123.4 ± 10.8 cm. The severe obesity group was younger (63 ± 9 vs. 67 ± 9 years, p &lt;0.01) and had a higher proportion of females (28 vs. 21%, p &lt;0.01) compared to normal BMI. More patients with severe obesity developed POAF (37 vs. 29%, aRR: 1.52 [95%CI 1.36-1.72], p &lt;0.01). aRRs of POAF according to BMI and WC categories are presented in Table 1. Independently of BMI, every 10 cm increment in WC among patients with severe obesity was associated with an increased risk of POAF (aRR: 1.17 [95%CI 1.09-1.25], p &lt;0.01). Conclusions: POAF after CABG is prevalent in patients with severe obesity. Our results showed a gradient of increasing POAF risk with increasing BMI and WC. In patients with severe obesity, WC independently provided additional prognostic value beyond BMI. Since POAF is associated with adverse long-term outcomes, WC could be targeted for the development of preventive strategies.