tbuckley/cabot-search huggingface dataset:
Abstract 4144990: Relationships Between Degree of Obesity, Transthoracic Impedance, and Cardioversion Efficacy
Authors: Alexandra Sanchez, Barret Murphy, Joshua Aymond, Michael Bernard, Aimee Hiltbold, Sammy Khatib, GLENN POLIN, PAUL ROGERS, Michael Castine, Daniel Morin
Journal: Circulation (2024)

Background: In our recent multicenter randomized clinical trial comparing the efficacy of single versus dual direct current cardioversion (DCCV) in patients with significant obesity (body mass index [BMI] ≥35 kg/m 2 ) undergoing DCCV for atrial fibrillation (AF), we found higher success rates using dual-DCCV. In addition to total energy applied, another important parameter is transthoracic impedance (TTI), as it impacts myocardial current density. Higher TTI is associated with DCCV failure. Previous studies found a positive correlation between BMI and TTI among normal-BMI patients (B=1.9 Ω/[kg/m 2 ]). Whether there is a significant relationship between BMI and TTI in obese patients is unknown. Objective: In this post-hoc analysis of the dual-DCCV study, we investigated whether further increase in BMI above 35 kg/m 2 correlates with increasing TTI, and whether TTI impacts procedural success in obese patients. Methods: Of the 200 patients included in the primary study, impedance data were available for 112. The relationship between BMI and TTI was compared using linear regression, and t-tests were used to assess whether DCCV efficacy varied significantly with BMI or TTI. Results: Among these 112 patients (age 65±11 years, BMI 41±7 kg/m 2 , 36 [32%] female, 17 [15%] Black), increasing BMI was weakly associated with a small, though statistically significant, increase in TTI (R 2 =0.04, B=0.53, p=0.03). There was no difference between patients with successful cardioversion (n=101) vs. failure (n=11) in terms of BMI (41±6 vs. 44±14 kg/m 2 , p=0.16) or TTI (96±19 vs. 98±18 Ω, p=0.81). These relationships were also true when the analysis was limited to participants receiving single-DCCV (n=57; with success in 48 [84%]): 41±6 vs. 45±15 kg/m 2 , p=0.21; and 98±15 vs. 102±17 Ω, p=0.48. Conclusion: In patients with Class 2 or higher obesity undergoing DCCV, there is a weaker association between further increase in BMI and TTI than previously found among patients with BMI &lt;35 kg/m 2 . Further, in this high BMI population, there is no difference in TTI or BMI based on success or failure of DCCV.
Abstract 4145234: <u>Trends in 30-Day Readmission Rate, Mortality Outcome and Resources Utilization Among Patient who underwent Leadless Pacemaker Revision and Removal.</u>
Authors: Michael Fatuyi, Ndausung Udongwo, Temidayo Abe, Oluwasegun Akinti, John Stacy, Joseph Amoah, Akinwale IYEKU, Aria Kenarsary, Zachary Goldberger, Daniel Modaff, Matthew Kalscheur, Sunil Vasireddi
Journal: Circulation (2024)

Background: Leadless pacemakers (LPM) utilization has grown significantly, yet data on LPM removal and/or revision (LPM-RR) remains limited. This study aims to evaluate trends in 30-day readmission rate (30-dRr), mortality, and resource utilization associated with LPM-RR Method: We analyzed data from the Nationwide Readmission Database from 2016 to 2021. Patients ≥ 18 years who underwent LPM-RR were identified using ICD-10 codes. The primary outcome was the trend on 30-dRr following LPM-RR. Secondary outcomes included mortality, resource utilization (Length of stay {LOS}&amp;inflation-adjusted mean hospital cost),&amp;most common readmission diagnosis. Predictive marginal effects over the years&amp;regression analyses were conducted. Results: LPMs placement increased from 350 in 2016 to 16,225 in 2021 (p-trend &lt; 0.001), while the rate of revisions and removals declined from 6.2% to 1.2% (p-trend &lt; 0.001). The mean age at index admission was 70.9 years with 51.6% females, compared to 71.6 years and 60.8% males among readmitted patients. The 30-dRr increased slightly from 13.8% in 2016 to 16% in 2021 (p trend = 0.1). Index admission mortality trends were non-significant, decreasing from 7.4% in 2017 to 4.2% in 2021 (p-trend = 0.4). Readmission mortality trends also remained non-significant, from 8.3% in 2016 to 8.4% in 2021 (p-trend = 0.3). The index admission mean LOS was 12.1 days in 2016 to 10.2 days in 2021 (p trend = 0.09), while readmission mean LOS was 4.1 days to 3.8 days (p trend = 0.9). The inflation-adjusted mean hospital cost for index admissions decreased from $76,432.5 in 2016 to $61,501 in 2021 (p trend = 0.08), whereas readmission costs increased from $6,773 to $9,358 (p-trend = 0.7). The most common reason for readmission was hypertensive heart disease with heart failure. Conclusion: From 2016 to 2021, LPM implantation grew rapidly with a significant decline in revision and removal rates. During this period, 30-dRr&amp;resource utilization have remained relatively stable, with a trend toward decreasing mortality within 30 days after LPM implantation, likely owing to technology/technique advancements, increased experience, as well as patient selection. Further research is needed to assess outcomes for the rapidly evolving use of LPM in an increasingly broader range of patient populations.
Abstract 4144883: Management of Iron Deficiency in Heart Population Treated in Heart Failure Unit and the Outlier Setting, A Comparison Study.
Authors: Sorayya Kakhi, Muminah Baig, Muminah Ali Abdullah, Mohammed Alalawi, Aya Eltahir, Laura Bijman, Mark Peterzan, Robin Ray, Nesan Shanmugam, Lisa Anderson, Heba Ghazal, Fadi Jouhra
Journal: Circulation (2024)

Background: Iron deficiency (ID) is common amongst patients with heart failure (HF). The European Society of Cardiology (ESC) guidelines recommends intravenous (IV) Iron supplementation in symptomatic HF patients with reduced left ventricular ejection fraction (LVEF) and ID to alleviate HF symptoms and improve quality of life. The current study aims to assess adherence to the latest ESC guidelines in treatment of ID in HF patients admitted to non-cardiac (outlier) wards at St. George's University Hospital (SGH), London. The results were compared to standard practice at a dedicated heart failure unit (HFU) at SGH. Methods: Retrospective data was collected on consecutive HF patients, admitted to SGH between September 2022 and September 2023. 386 patients met the inclusion criteria, defined as HF with LVEF &lt; 50% and ID according to ESC guidelines. Of total population, 190/386 patients were admitted to the outlier wards and 196/386 to the HFU. Patients considered ineligible for administration of IV Iron therapy, were those not meeting the guideline thresholds for treatment of ID, patients with active cancer or bleeding and patients on oral Iron supplementation. Results: The mean age of patients admitted to HFU was 71 +/- 13 SD, 66% male. 72% (141/196) of the patients were tested for ID, of which 51% (72/141) had ID as per inclusion criteria. 57% (41/72) of those with ID were prescribed IV Iron, whilst 43% (31/72) were not treated. The reason for not treating patients identified as Iron deficient was presence of active infection (19/31) or bleeding (3/31). In 9/31 of untreated patients with ID, the reason for not being prescribed with IV Iron was not identifiable through review of medical notes. It is important to note that 28% (55/196) were not tested for ID during their hospitalisation and missed the opportunity for treatment. (Figure 1) In outlier wards, mean age was 77 +/- 14 SD, 66% male. 46% (87/190) patients were tested for ID, of which 16% (14/87) were identified as Iron deficient and were prescribed IV Iron. 4% (12/87) were not treated for no obvious reason and 18% (16/87) met the criteria for ID, but due to presence of contraindication did not receive IV Iron. Missed opportunity was 54% in outlier population. (Figure 2) Conclusion: This study demonstrated that patients admitted to HFU, were more likely to be tested for ID and receive IV Iron, compared to patients admitted to outlier wards but there is still room for considerable improvement in both settings.
Abstract 4144828: Increased Testosterone and Reduced Myofibroblast-like Smooth Muscle Cells are associated with Carotid Atherosclerotic Plaque Instability
Authors: Jae Hyun Byun, Karina Gasbarrino, Ioanna Gianopoulos, Helena Papacostas Quintanilla, Huaien Zheng, Styliani Daskalopoulou
Journal: Circulation (2024)

Background: Cardiovascular disease remains the leading cause of death worldwide. Unstable atherosclerotic plaques that reside in the carotid arteries are major etiological factors known to increase the incidence of ischemic strokes. Moreover, sex differences exist in plaque morphology and composition; males are more prone to develop unstable plaques and subsequent rupture, while females tend to develop more stable plaques but exhibit worse outcomes post-stroke. Despite these differences however, there is currently a lack of sex-specific guidelines for carotid atherosclerotic disease management. Objective: To investigate the association between endogenous sex hormones and the sex-specific cellular and genetic signatures linked to plaque instability. Methods: Carotid plaque specimens and pre-operative fasted blood samples were collected and analyzed (n=460; mean age of 71.0±9.0; 68.9% male) from recruited males and post-menopausal females who underwent carotid endarterectomy at McGill University-affiliated hospitals. Distribution and relative expression of sex hormones in plaques were evaluated using liquid chromatography mass spectrometry (LC-MS/MS)-based methods by quantifying levels of 17ß-estradiol (E 2 ) and testosterone (T). Plaque single-cell suspensions (n=10) underwent single-cell RNA sequencing (scRNA-seq) to characterize differences in plaque cell expression phenotypes by identifying distinct cell subpopulation clusters. Results: Males with unstable plaques had significantly higher circulating T levels and T to E 2 ratio compared to males with stable plaques, with no significant differences in E 2 levels within all groups. Furthermore, scRNA-seq analysis of plaque samples revealed 15 subpopulations of cells; 6 non-immune cell clusters (smooth muscle cells [SMCs], myofibroblasts, and endothelial cells) and 9 immune cell clusters (macrophages, T-lymphocytes, B-lymphocytes, natural killer cells, and dendritic cells). In both sexes, stable plaques exhibited the highest abundance of myofibroblast-like SMCs and pro-fibrotic genes compared to unstable plaques. Similarly, female stable plaques exhibited significantly reduced number of myofibroblast-like SMCs compared to male stable atherosclerotic plaques. Conclusions: Our findings demonstrate that taken together, increased circulating testosterone levels and reduced myofibroblast-like SMCs expressing pro-fibrotic genes in the plaque may be associated with increased carotid atherosclerotic plaque instability.
Abstract 4144947: Invasive Hemodynamic Validation of a Novel Echocardiographic Artificial Intelligence Screening Tool for HFpEF
Authors: Ryan Sachar, Maria Latz, John Blair, Tess Allan, Gene Kim, Jonathan Grinstein, gary woodward, Roberto Lang, Mark Belkin
Journal: Circulation (2024)

Background: Right heart catheterization (RHC) is the gold standard for diagnosing heart failure with preserved ejection fraction (HFpEF). An FDA-approved artificial intelligence (AI) technology uses a four-chamber transthoracic echocardiogram (TTE) image to screen patients for HFpEF. Methods: We compared invasive hemodynamic data between patients screened for HFpEF by this TTE AI algorithm. We retrospectively collected data from two cohorts of patients with an ejection fraction (EF) ≥ 50% undergoing RHC for the evaluation of HFpEF. The most recent TTE was screened using the AI tool and reported as either suggestive or non-suggestive for HFpEF – labeled as “positive” or “negative,” respectively. Invasive hemodynamic parameters at rest and during exercise were collected. Positive and negative groups were compared using Student’s t-test and Mann-Whitney U test. Results: A total of 47 patients (82% women, 79% Black, average EF 62%) had a previous RHC, with 23 undergoing subsequent exercise RHC. There were 18 patients (38%) with a positive AI result and 29 (62%) negative. Positive patients had significantly higher rates of atrial fibrillation (38% vs 11%, p=.03), NT-proBNP levels (median 451 vs 117 ug/mL, p=.001), and H2FPEF (median 6 vs 4, p&lt;.001) and HFA-PEFF scores (median 5 vs 2, p=.005). Of 18 positive patients, 16 (89%) had a resting pulmonary capillary wedge pressure (PCWP) &gt; 15 mmHg, consistent with HFpEF, compared to only 14 of 28 (50%) negative patients. With exercise 6 of 7 (86%) positive patients had PCWP ≥ 25 mmHg, consistent with HFpEF, compared to 11 of 20 (55%) negative patients. At rest, positive patients had significantly higher PCWP, mean pulmonary arterial pressure (mPAP), and pulmonary vascular resistance (PVR). After exercise, there were no significant differences in PCWP or mPAP between the two groups, but thermodilution cardiac output was significantly lower in the positive patients. Conclusion: Patients identified as HFpEF positive by a validated TTE-guided AI tool were more likely to have HFpEF confirmed invasively, indicating its potential for risk stratification. However, the negative predictive value for HFpEF confirmed by invasive hemodynamics was low in this population.
Abstract 4144868: Optimizing the Care of Patients with Cardiac Amyloidosis in a Safety Net Hospital: A Multidisciplinary Heart Team Approach
Authors: Joshua Stephens, Oreoluwa Olakunle, Kaylyn Crawford, Nicole Guynn, Dimitri Ford, MATTHEW BROWN, FAITH WORKS, Deborah Taylor, Mary Katherine Cheeley, Carlos Lopez, ifeoma Onuorah, Raghuveer Halkar, Sagar Amin, Briana Gibson, Leon Bernal-Mizrachi, Modele Ogunniyi
Journal: Circulation (2024)

Introduction Cardiac Amyloidosis is often underdiagnosed due to the heterogeneity of clinical presentation, disease rarity, and clinician unfamiliarity with diagnosis and management. Studies have shown that timely diagnosis and effective treatment can prolong median survival in patients with cardiac amyloidosis. By optimizing cardiovascular care, multidisciplinary heart teams play a significant role in cardiovascular disease management. We describe a multidisciplinary heart team (MDHT) based approach to the diagnosis and management of suspected cases of cardiac amyloidosis in a safety net hospital. Methods: A MDHT working group of cardiologists, hematologists/oncologists, nuclear medicine physicians, radiologists, pathologists, nephrologists, advanced practice practitioners, and pharmacists was established to optimize the clinical care of patients with amyloidosis. Virtual monthly interdisciplinary meetings were held from January 2022 to May 2024 to review clinical cases, discuss diagnostic and treatment plans, review cardiac imaging, and implement best clinical practices to improve patient outcomes. Cases were identified based on referrals and consultations.The clinical case presentation was led by cardiology and hematology/oncology fellows. The ACC Cardiac Amyloidosis Expert Consensus Decision Pathway was used to guide management. Results: Of the 95 patients who were suspected to have amyloidosis, 44.2% (n=42) were female, and 91.6% self-identified as Black, the median age was 70.5 years. For diagnostic testing, 32.6% (n=31) underwent a PYP scan after light chain AL amyloidosis was rulled out, and 15 patients(15.8%) underwent either cardiac or bone marrow biopsy for concerns of AL amyloidosis. Of the total cohort, 26.32% (n=25) had hereditary transthyretin amyloidosis (hATTR), and 3.16% (n = 3) had AL amyloidosis. Of the patients with confirmed amyloidosis (29.47%, n=28), 67.9% (n=19) received medical therapy [53.57% (n=15) received Tafamidis for hATTR cadiomyopathy and 7.1% (n=2) received chemotherapy for light chain AL amyloidosis. Conclusion: A multidisciplinary heart team approach resulted in the diagnosis of cardiac amyloidosis in 26% of our cohort with 68% of the cohort receiving medical treatment. This collaboration has facilitated patient-centered care, comprehensive evaluation and personalized treatment plans for patients with suspected cardiac amyloidosis and also provided educational opportunities for trainees.
Abstract 4144928: Association between Congenital Heart Disease and the Risk of Cancer and its subtypes.
Authors: Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, FNU Sundas, Alessia Gimelli, Kendra Grubb
Journal: Circulation (2024)

Background: Relationship between congenital heart disease and the risk of cancer and its subtypes is not well understood. Objective: This study aim to investigate the association between CHD and risk of cancer and its subtypes among adult patients. Method: The TriNeTX research database was used to identify patients aged ≥18 years of age from January 2000 to January 2021. Patients were categorized into two groups, one with CHD and another without CHD group of patients. Patients were followed for 1 and 3 years respectively. Propensity score-matched analysis (PSM) (1:1) was performed on demographics and comorbidities such as hypertension and diabetes mellitus. The primary outcome was cancer risk, while secondary outcomes were breast cancer, thyroid cancer, skin cancer, gastrointestinal tract cancer (GI), lung cancer, and brain tumors. Results:: After 1:1 propensity score matching, the study cohort comprised 33,581 CHD patients and 33,581 non CHD patients. CHD patients were having a significantly higher risk of cancer after 1 year of follow-up (RR, 2.10 (95% CI: 1.764-2.515, P&lt;0.001). A similar trend of higher risk of cancer was observed after 3 years of follow-up (RR, 1.63 (95% CI 1.436-1.851, P&lt;0.001) when compared with the non CHD group of patients. The risk of lung cancer was significantly higher among CHD groups of patients after 1 year of follow-up (RR, 1.44 (95% CI: 1.024-2.049), P=0.035), and after 3 year of follow-up (RR, 1.28 (95% CI: 1.018-1.630, P=0.034). Skin cancer were found significantly higher in CHD patients after 1 year of follow-up (RR, 1.42 (95% CI: 1.171-1.741), P&lt;0.001), however, this became non-significant after 3 years of follow-up (RR, 1.05 (95% CI: 0.926-1.203, P=0.416). On the other hand, the risk of brain tumors was comparable in both groups after 1 year of follow-up (RR, 1.60 (95%CI: 0.727-3.530), P=238). However, after 3 years of follow-up, the risk of brain tumor became significantly higher in CHD patients (RR, 2.73 (95% CI: 1.369, 5.449), P=0.003) when compared with non CHD group of patients. In contrast, the risk of breast cancer, GI tumor, and thyroid cancers were comparable both after 1 year follow-up, and after 3 years of follow-up among both groups of patients. Conclusion: These findings suggest that CHD patients are at higher risk of having Cancer, specifically lung cancer, dermatological cancer, and brain tumors.
Abstract 4144890: Efficacy and Safety of Pressure-controlled Intermittent Coronary Sinus Occlusion in ST-Elevation Myocardial Infarction (STEMI) Patients
Authors: Bijay Jeswani, Tirath Patel, Sawai Singh Rathore, Saif Syed, Sanjana Allam, Akshat Banga
Journal: Circulation (2024)

Background: Pressure-controlled intermittent coronary sinus occlusion (PiCSO) is an innovative therapeutic approach that enhances myocardial perfusion and minimizes reperfusion injury by intermittently occluding the coronary sinus, thereby increasing retrograde coronary perfusion. To date, no meta-analysis has comprehensively evaluated the efficacy and safety of PiCSO in this setting. This meta-analysis aimed to evaluate the addition of PiCSO to primary percutaneous coronary intervention (pPCI) in patients with STEMI, providing a comprehensive assessment of its potential benefits and risks in the clinical setting. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using the inverse variance method, random-effect models were used to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was set at p &lt; 0.05. The primary endpoints were the mean infarct size (% LV mass), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), and microvascular obstruction extent (MVO) (%LV) at follow-up (2-5 days). Results: Six studies, encompassing 467 STEMI patients, were included in the analysis. PiCSO in addition to pPCI did not significantly alter infarct size (SMD = 0.16; 95% CI -0.31 to 0.63; p= 0.51), LVEF (SMD = 0.07; 95% CI - 0.14 to 0.28; p= 0.51), LVESV (SMD = -0.13; 95% CI -0.34 to 0.08, p= 0.21) and LVEDV (SMD = -0.11; 95% CI -0.32 to 0.10; p=0.31) compared with conventional treatment with pPCI alone. There was no significant difference in the extent of microvascular obstruction (MVO) between the two groups (SMD = -0.12; 95% CI -0.39 to 0.16; p = 0.37). Conclusion: Our meta-analysis suggests that PiCSO as an adjunct to pPCI does not significantly improve myocardial protection or ventricular function in STEMI patients. Future research should investigate whether specific patient subgroups might benefit from this intervention.
Abstract 4145002: Bowel Inflammation leads to Heart Transplantation
Authors: Vincent Mack, Jenna Mahoney, Mark Vanderland, Nathaniel Tanner, Zaid Ammari, Jessica Cushing
Journal: Circulation (2024)

Introduction: The ATTACH trial in 2003 demonstrated that Anti-tumor necrosis factor alpha therapy was associated with the evolution and progression of heart failure in patients with moderate to severe chronic heart failure. The United States FDA also reports that in rare cases, it is implicated in new onset heart failure in those under the age of 50. We present a case of new onset biventricular failure with cardiogenic shock in the setting of anti-TNF therapy, resulting in orthotopic heart transplantation. Case: A 22-year-old male with history of Crohn’s disease, on infliximab, presented to the ED with dyspnea. He was recently hospitalized for right middle cerebral artery CVA, during which he was diagnosed with new onset nonischemic cardiomyopathy with an LVEF 26% on cardiac MRI. Extensive workup was unrevealing for etiology of cardiomyopathy. He had a negative 3 generation family history to suggest familial or inherited cardiomyopathy. In the ED, he was hypotensive at 62/41 mmHg, tachycardic to 104 bpm. Laboratory data demonstrated a lactate 11.5 mmol/L, creatinine 1.96 mg/dL, AST 454, ALT 670, total bilirubin 1.3, and NT Pro-BNP 6607 pg/mL. A pulmonary artery catheter was placed, which revealed RAP 28 mmHg, PCWP 26 mmHg, PAPI 0.7, Fick CI 1.1 L/min/m 2 and CPO 0.41 W. A shock alert was called, and the patient was emergently cannulated for V-A ECMO with an IABP for LV venting. He was transferred to a transplant center, where he underwent OHT. Discussion: Anti-TNF therapy has been implicated in the worsening of chronic heart failure; however, the development of new-onset heart failure is rare, and the literature is limited. Kwon et al reported a case series from the FDA MedWatch list, which included 47 patients who experienced new or worsening heart failure after starting Infliximab or Etanercept for ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis. Of these 47 patients, 38 (81%) developed new onset heart failure. The pathogenesis of heart failure in patients on TNF alpha therapy is thought to be related to a dose-dependent activation of the Death-promoting pathway mediated by TNF Receptor 1 and a relative decrease in activation of the Survivor Activating Factor Enhancement pathway mediated by TNF Receptor 2. We add this case to the growing body of literature regarding the risks of TNF-alpha inhibitors in patients with established heart failure and propose using TNF-alpha inhibitors as the etiology of this patient’s new onset cardiomyopathy.