tbuckley/cabot-search huggingface dataset:
Abstract 17807: Rapid Progression of CAD After Stopping Statin and Starting a Ketogenic Diet in a Phenotypic Lean Mass Hyper-Responder
Authors: Laura Kukuc, Matthew Proute, Tiffany Haynes, Robert Fishberg, Nosagie Ohonba, Loba Alam
Journal: Circulation (2023)

Introduction: Ketogenic diet (KD) has been a popular diet method for weight loss and described as an alternative to pharmacotherapy on social media. KD is thought to improve some risk factors of ASCVD, such as type 2 DM, obesity, and decrease LDL. Recent studies have described lean mass hyper-responders (LMHR), a specific phenotype with lower BMI, total cholesterol &gt;200 mg/dL, HDL &gt;80, and TG &lt;70. LMHR is thought to be protective against ASCVD. While on carbohydrate restricted diet, LMHR may have significant rise in LDL. We present a patient with known CAD and similar phenotype to LMHR that developed rapid progression of CAD after stopping statin and initiating strict KD. Hypothesis: KD may accelerate disease in those with known CAD, despite being LMHR phenotype. Methods: 51-year-old male with BMI 23, CAD with previous PCI to proximal LAD, HTN, HLD, family history of early CAD, presented with inferior STEMI. He underwent emergent catheterization revealing 95% stenosis of the mid RCA and 99% occlusion of the distal RCA treated with two drug eluting stents. Previous catheterization showed only moderate disease of the distal RCA. He had discontinued atorvastatin about 2 years after his first coronary intervention due to myalgias. Prior to starting it, his total cholesterol was 207, LDL 131, HDL 43, and TG 67 with a normal BMI- similar traits to LMHR phenotype. Atorvastatin 80 mg was started, and his LDL decreased to 44. After he discontinued the statin, he started a KD to try to manage his cholesterol and CAD. Results: When he presented with STEMI, his total cholesterol was 388, LDL 301, HDL 73, TG 71, and Lp(a) 155 nmol/L. He resumed atorvastatin 80 mg and started alirocumab at discharge with subsequent LDL of 14. Conclusions: Social media has influenced many to try ketogenic diet to manage metabolic health. Some influencers have questioned high-LDL association with ASCVD and have recommended avoiding pharmacotherapy. Despite popular opinion that high-LDL in this phenotype does not have clinical implication, our patient with a similar profile had rapid progression of CAD while on a KD and was untreated for HLD. Patients with known CAD and LMHR should be very cautious when starting popular diets and should discuss the possible implications with their provider.
Abstract 17534: Safety and Feasibility of Adenosine Stress CMR for CAV Detection in Orthotopic Heart Transplant Recipients
Authors: Giandomenico Bisaccia, Roberto Licordari, Isabella Leo, Giulia La Vecchia, Maria Perotto, Maria Cristina Procopio, Sabina Gallina, Joyce Wong, Chiara Bucciarelli-Ducci
Journal: Circulation (2023)

Background: Stress perfusion cardiac magnetic resonance (CMR) imaging is recommended in international guidelines in class I in patients with known or suspected CAD. Patients undergoing cardiac transplantation (OHT) are at risk of developing cardiac allograft vasculopathy (CAV). Adenosine is relatively contraindicated after transplantation because of a presumed risk of atrioventricular block in denervated hearts. We sought to evaluate the safety and feasibility of adenosine stress CMR in patients with OHT and suspected CAV. Methods: In an outpatient cohort study, we measured the incidence of adverse effects of adenosine stress CMR in consecutive OHT recipients undergoing quantitative stress perfusion CMR for suspected CAV. We additionally stratified patients based on presence of significant CAV (grades 2-3 versus 0-1) on either invasive or computed tomography coronary angiography to evaluate potential CMR biomarkers of significant coronary disease in this population. Results: We identified 50 adenosine stress CMR studies performed in 45 individual patients at a median of 19 years after transplantation (IQR 4.7-24.4); 9% of studies were conducted within the first year post-transplantation. No life-threatening adverse events, brief or prolonged atrioventricular block or other arrythmias occurred after adenosine infusion. Significant myocardial ischemia (≥ 1.5 segments) was reported in 17% of patients. When stratified by CAV severity, stress MBF index, but not inducible ischemia on visual inspection, was found to significantly differentiate patients with severe CAV from those without significant coronary disease (ANOVA p = 0.028). Conclusion: Adenosine stress perfusion CMR is safe and feasible in OHT recipients. Quantitative measurement of stress MBF index may represent a promising marker of coronary disease with incremental value over qualitative assessment of ischemia, and should be evaluated in future studies.
Abstract 18888: Demographic and Racial Trends of Ischemic Heart Disease Related Mortality in Patients With Cancer
Authors: Sarath Lal Mannumbeth Renjithlal, Mohamed M Eid, Dinesh Abhijeeth Shanker, Fahad Eid, Kirolos Barssoum, Nikhil Cordeiro, PILLAI NISHA
Journal: Circulation (2023)

Introduction: We aim to assess the demographic and racial trends of mortality associated with Ischemic heart disease in patients diagnosed with neoplasia, between 1999 and 2020. Methods: A cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for the Epidemiological Research database (CDC-WONDER) was conducted to investigate the trends in mortality associated with Ischemic heart disease (ICDcodes - I20-I25) in patients with diagnosis of neoplasm or cancer during the time of death (ICD codes C00-D48). The study calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals, using jointpoint regression analysis. Demographic and racial trends were evaluated. Results: 359,383 Ischemic heart disease-related deaths occurred in cancer patients from 1999 to2020. Annual trends show that the AAMR decreased from 8.3 (95% CI 8.2-8.4) in 1999 to 3.3(95% CI 3.3-3.4) in 2020. The overall AAMR from 1999-2020 had an Annual PercentageChange (APC) decrease of -5 (95% CI: -5.3 to -4.7). When stratified by sex, males had a worseAAMR at 7.6 (95% CI: 0.6-0.6), and females were found to have an AAMR of 3.1 (95% CI: 0.5-0.5). When stratified by ethnicity, AAMR was highest among African Americans at 5.4 (95% CI:5.3-5.4), followed by white at 4.9 (95% CI 4.9-5.0), followed by American Indian or Alaskan Native at 2.7 (95% CI 2.6-2.9), followed by Asian or PacificIslander at 2.5 (95 % CI 2.5-2.6). Conclusions: In the United States, there has been a general decrease in IHD-associated Mortality in cancer patients from 1999 to 2020. Similar to the IHD-related mortality in the general population. Our data shows that the AAMR is worse in men, black population. In the setting of worse AAMR in specific populations, further research is needed to identify the causes and potential strategies to improve AAMR in cancer patients.
Abstract 13953: A Genome-Wide European Ancestry Study Identifies Coronary Artery Disease-Associated Loci Through Gene-Sex Hormone Interaction
Authors: vardhmaan jain, Amonae Dabbs-Brown, Chang Liu, Qin Hui, Anurag Mehta, Peter Wilson, Arshed A Quyyumi, Yan Sun
Journal: Circulation (2023)

Background: Genome-wide association studies (GWAS) have improved our understanding of the genetic basis of coronary artery disease (CAD). While sex-differences in CAD have been observed, little is known about the role of sex hormones in CAD genetics. Accounting for sex hormone levels may help identify CAD-risk loci and extend our knowledge of its genetic architecture. Methods: We performed a GWAS to identify CAD risk loci by incorporating gene-sex hormone interactions in 365,662 individuals of European ancestry enrolled in the UK Biobank (UKB). Genetic interactions of total testosterone (TT), bioavailable testosterone (BAT) and sex-hormone binding globulin (SHBG) were evaluated. GEM software was used to conduct sex-stratified genome-wide interaction analysis with prevalent CAD. Enrollment age and principal components 1-10 were model covariates. The online post-GWAS tool FUMA was used to annotate the biological functions of marginal, interaction, and joint effects summary statistics. Results: We identified 64 loci in males and 8 loci in females that reached genome-wide significance (p &lt; 5х10 -8 ) for CAD ( Table 1 ). Among males, 3 significant loci were identified for BAT, one for TT and one for SHBG using joint effect model that did not overlap with those identified with marginal effect. Among females, 5 significant loci were identified, all for TT using joint effect that that did not overlap with those identified with marginal effect. Of these 5 loci, two loci were independently identified with significant SNP-TT interaction. These loci were mapped close to the TRDN and THADA genes that have been implicated in congenital ventricular tachycardia and polycystic ovarian syndrome, respectively. Conclusion: This Genome-wide gene-sex hormone interaction study identified genomic-risk loci that may contribute to the differential CAD risk between men and women, which would otherwise not have been discovered in traditional GWAS only including marginal genetic effect.
Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy
Authors: Guido Claessen, Ruben De Bosscher, Kristel Janssens, Paul Young, Christophe Dausin, Mathias Claeys, Piet Claus, Kaatje Goetschalckx, Jan Bogaert, Amy M Mitchell, Michael D Flannery, Adrian D Elliott, Chenglong Yu, Olivier Ghekiere, Tomas Robyns, Caroline M Van De Heyning, Prashanthan Sanders, Jonathan M Kalman, Monique Ohanian, Magdalena Soka, Emma Rath, Eleni Giannoulatou, Renee Johnson, Paul Lacaze, Lieven Herbots, Rik Willems, Diane Fatkin, Hein Heidbuchel, André La Gerche
Journal: Circulation (2024)

BACKGROUND: Exercise-induced cardiac remodeling can be profound, resulting in clinical overlap with dilated cardiomyopathy, yet the significance of reduced ejection fraction (EF) in athletes is unclear. The aim is to assess the prevalence, clinical consequences, and genetic predisposition of reduced EF in athletes. METHODS: Young endurance athletes were recruited from elite training programs and underwent comprehensive cardiac phenotyping and genetic testing. Those with reduced EF using cardiac magnetic resonance imaging (defined as left ventricular EF &lt;50%, or right ventricular EF &lt;45%, or both) were compared with athletes with normal EF. A validated polygenic risk score for indexed left ventricular end-systolic volume (LVESVi-PRS), previously associated with dilated cardiomyopathy, was assessed. Clinical events were recorded over a mean of 4.4 years. RESULTS: Of the 281 elite endurance athletes (22±8 years, 79.7% male) undergoing comprehensive assessment, 44 of 281 (15.7%) had reduced left ventricular EF (N=12; 4.3%), right ventricular EF (N=14; 5.0%), or both (N=18; 6.4%). Reduced EF was associated with a higher burden of ventricular premature beats (13.6% versus 3.8% with &gt;100 ventricular premature beats/24 h; P =0.008) and lower left ventricular global longitudinal strain (–17%±2% versus –19%±2%; P &lt;0.001). Athletes with reduced EF had a higher mean LVESVi-PRS (0.57±0.13 versus 0.51±0.14; P =0.009) with athletes in the top decile of LVESVi-PRS having an 11-fold increase in the likelihood of reduced EF compared with those in the bottom decile ( P =0.034). Male sex and higher LVESVi-PRS were the only significant predictors of reduced EF in a multivariate analysis that included age and fitness. During follow-up, no athletes developed symptomatic heart failure or arrhythmias. Two athletes died, 1 from trauma and 1 from sudden cardiac death, the latter having a reduced right ventricular EF and a LVESVi-PRS &gt;95%. CONCLUSIONS: Reduced EF occurs in approximately 1 in 6 elite endurance athletes and is related to genetic predisposition in addition to exercise training. Genetic and imaging markers may help identify endurance athletes in whom scrutiny about long-term clinical outcomes may be appropriate. REGISTRATION: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374976&amp;isReview=true ; Unique identifier: ACTRN12618000716268.
Abstract 15799: Frequency and Etiology of Post-Operative Leukocytosis After Heart Transplantation
Authors: Ian R Sigal, Maria Molina, Teresa Wang, Pavan Atluri, Marisa Cevasco, Emily Blumberg, Arwin Thomasson, Rhondalyn C McLean, Lee R Goldberg, Luise L Holzhauser, Michael V Genuardi
Journal: Circulation (2023)

Introduction: Many factors contribute to post-operative leukocytosis after heart transplantation; it may be challenging to determine whether post-operative leukocytosis is caused by infection. Objective: To describe the frequency and causes of leukocytosis after heart transplantation. Methods: A representative sample of 207 of 308 patients who underwent heart transplant at our institution between 1/1/17 and 12/31/22 was examined. Leukocytosis was defined as a white blood cell (WBC) count peak &gt;11 th/μL or a 30% increase in WBC if pre-transplant baseline was &gt;11 th/μL. Leukocytosis was classified as early (post operative day [POD] 0-3), delayed (POD 4-7), or late (POD 8-60). Culture, biopsy, and other clinical data were used to adjudicate etiology. Groups were compared using χ 2 , Fisher’s, or t-test as indicated. Results: The sample was 27% female with a mean age of 51.2 (±12.6) years. A total of 404 leukocytosis episodes were identified affecting 204 patients. Common etiologies included: post-transplant surgery (47.0%), true infection (27.2%), corticosteroid bolus (4.0%), subsequent surgery (3.5%), rejection (3.0%), and thrombus (3.0%). Delayed (24/47) and late (59/146) leukocytosis were more likely to be associated with infection than early leukocytosis (27/211, p&lt;0.0001 for both comparisons). Common causes of infection were: pneumonia (33%), bloodstream infection (20%), skin and soft tissue (12%), unknown (9%), urinary (5%), and colitis (3%). Post-operative infection was associated with increased hospital length of stay after transplantation (17 vs 46 days, p&lt;0.0001), and increased in-hospital mortality (9.6% vs 2.7%, p=0.040). ECMO (p=0.08), non-ECMO temporary mechanical circulatory support (p=0.70), prior cardiac surgery (p=0.08), and donor bloodstream infection (p=0.40) were not associated with post-operative infection. There was no significant difference in cross clamp time (p=0.42), ischemic time (p=0.27), or age (p=0.07) in patients with vs without infection. Conclusion: Leukocytosis after transplant is nearly universal. Patients developing leukocytosis on POD ≥4 have a high rate of concurrent infection compared to those with early leukocytosis, which is in turn associated with increased LOS and in-hospital mortality.
Abstract 18190: Role of Specialised Heart Failure Unit in Optimisation of Guideline-Directed Medical Therapy With Focus on Renal Function - Real World Data
Authors: Elizabeth L Macken, Marco Ferrari, Salia Virxinia Pol, Lilly Mandanrano, Heba Ghazal, Omar Ali, Robin Ray, Nesan Shanmugam, Lisa Anderson, Giuseppe Rosano, Marco Metra, Debasish Banerjee, Fadi Jouhra
Journal: Circulation (2023)

Introduction: Guideline-directed medical therapy (GDMT) has proven to significantly reduce morbidity and mortality in Heart Failure. We highlighted the differences in renal function among HF patients managed on GDMT, comparing those within a dedicated HF unit (HFU) to those under General Medical (GM) and Geriatrics (GER). Aim: The purpose of this single-centre cohort study is to highlight differences in renal function outcome between these groups. Methods: Our database consists of 540 patients with AHF admitted to HFU or GM/GER from 01/08/2021 to 31/07/2022. We divided this group as follows: Group A : 267 patients from GM/GER. Group B : 273 patients in HFU.Groups were classified by ejection fraction(HFrEF/HFmrEF/HFpEF). We analyzed eGFR, K+ and Creatinine(Cr) on admission(adm) and discharge(dc). Results: Group A(GM/GER) : HFrEF patients had average eGFR of 45.70(mL/min) on adm and 43.58 on dc. HFmrEF subgroups had eGFR of 48.60 on adm and 46.54 on dc. HFpEF subgroups had eGFR of 50.16 on adm and 47.75 on dc. Group B(HFU): Patients with HFrEF had eGFR of 53.50 on adm and 50.74 on dc. HFmrEF subgroup had adm eGFR of 49.48 and 47.01 on dc. HFpEF subgroups had eGFR of 45.95 on adm and 41.72 on dc. Group A and B comparison : We have previously demonstrated (Fig.1) that among patients with AHF managed in HFU, there is better optimisation of GDMT. Within the HFrEF cohort, eGFR decreased -2.76 in Group B, with reduction of -2.12 in Group A. Group B HFmrEF showed reduced eGFR of -2.47; Group A decreased -2.06. In HFpEF, eGFR reduced -4.23 in Group B. In Group A, eGFR decreased -2.41. An inpatient mortality of 15.73% was calculated in Group A, contrasting significantly with 6.23% among the HFU cohort. Conclusion: This study highlights differences in renal function outcome between these two groups. It demonstrates that despite optimisation and initiation of GDMT in Group B - which may lead to concern for its impact on renal function - eGFR, Cr and K+ levels were not markedly different between both cohorts.
Abstract 16964: Predictive Value of Blood Cellular Indices for 30-day Mortality in Patients With Acute Pulmonary Embolism. Data From the RIETE Registry
Authors: Fakiha Siddiqui, Alfonso J Tafur, Alberto Garcia-Ortega, Bulent Kantarcioglu, Jawed Fareed, Manuel Monreal
Journal: Circulation (2023)

Introduction: In patients with acute pulmonary embolism (PE), the prognostic value of cellular indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), or systemic immune-inflammation index (SII, NLR*platelets) is uncertain. The aim of this study is to investigate the relationship between blood cellular indices (NLR, PLR and SII) and adverse outcome as 30-day mortality in a cohort of patients recruited in the RIETE registry. Methods: In this study, the data of 10085 patients from the RIETE registry were used to estimate the association between NLR, PLR or SII with the 30-day mortality in patients with acute PE. They were randomly separated into a derivation cohort (n=6,710) and validation cohort (n=3,375). Results of the logistic regression analyses in the derivation cohort were then validated using the validation cohort. Results: In the derivation cohort, median values of NLR were: 4.3 (IQR: 2.7-7.3), PLR 151 (IQR: 104-231), and SII: 958 (IQR: 568-1,739). During the first 30 days, 315 (4.7%) patients died, 32 (0.5%) developed VTE recurrences and 142 (2.1%) major bleeding. On multivariable analyses, patients who subsequently died more likely had NLR &gt;5.0 (OR: 3.08; 95%CI: 2.26-4.20), PLR &gt;160 (OR: 2.40; 95%CI. 1.75-3.29) or SII &gt;1,000 (OR: 2.14; 95%CI: 1.60-2.86). The results were further endorsed by the validation cohort where NLR &gt;5.0 (OR: 2.42; 95%CI: 1.57-3.74), PLR &gt;160 (OR: 1.87; 95%CI. 1.25-2.82) or SII &gt;1,000 (OR: 2.10; 95%CI: 1.34-3.29) predicts 30-day mortality. Conclusions: These studies suggest that patients with elevated NLR &gt;5, PLR &gt;160, and SII &gt;1000 values at baseline were determined to be at increased risk for death in 30-days.
Abstract 18034: Intracardiac Bullet: To Fish It Out or Let Love Take the Shot!
Authors: Geethika Earthineni, Divya Ratan Verma, Kishore Harjai, Hersh Maniar, Mina Mehani, Tarek Nafee, Victor Mwansa, Roland Njoh, Hanumanth K Reddy, Ajit Nagra
Journal: Circulation (2023)

Background: Gunshot wounds cause catastrophic injuries. When bullets embolize to heart, without penetrating cardiac injury, optimal management remains unclear. Case: 25 year old male, presented after multiple gunshot wounds (GSW). On exam, perirectal GSW, 3 GSWs to right thigh and 2 GSW to left thigh noted. Lungs CTA bilaterally, CVS normal S1, S2. CTA chest showed Infra renal IVC injury and large retroperitoneal hematoma. (1,2). ECHO revealed a bullet in the dependent part of right atrium, abutting the tricuspid valve (3). No chest injury noted, suggesting migration of bullet from IVC, following the trajectory of venous return to right atrium. He underwent IVC patch repair. Percutaneous approach was unsuccessful to snare the bullet using 8-mm and 14-mm triloop snare, 15-mm gooseneck snare (4), bronchial forceps (5) and balloon. Multidisciplinary team decided to abandon further percutaneous or surgical extraction attempts as the bullet firmly lodged in sub-tricuspid chordo papillary apparatus with no valvular dysfunction. Discussion: In hemodynamically stable patient with intracardiac bullet, there is no standard treatment approach. 65% of bullets entering vena cava, migrate and lodge in chordo papillary apparatus or trabeculations. Low risk percutaneous extraction approaches have gained popularity, with about 50% success. When percutaneous extraction fails, clinicians face a critical decision to observe or perform open sternotomy extraction. Numerous case reports support observation only approach. This patient has done well with observation, suggesting non-operative initial management is reasonable in hemodynamically stable patient with intracardiac bullet.
Abstract 16045: Fluoroless Arterial Access and Closure for VT Ablation: Feasibility and Safety of an Ultrasound Guided Landmark Approach
Authors: Maxine Nelson, Megan Gruber, Soufian AlMahameed
Journal: Circulation (2023)

Introduction: Ultrasound (US) guided access has become the gold standard of care for central access cannulation. The FAUST1 trial demonstrated that routine real-time US guidance was equivalent to fluoroscopic guidance but improved common femoral artery (CFA) access success and reduced complications in patients with high CFA bifurcations. The utilization of non radiation imaging modalities over the past decade has resulted in significantly reduced radiation exposure and orthopedic problems associated with prolonged electrophysiology procedures2. Hypothesis: Why do many operators still use fluoroscopy and arteriograms in addition to ultrasound guided access? Methods: A prospective single center multi-operator study was performed on patients undergoing premature ventricular contractions (PVC) or Ventricular Tachycardia (VT) ablation with arterial access. CFA access was obtained using a US guided landmark identification protocol. US probe is utilized in short and long access to identify upper and lower borders of the femoral head in relation to the CFA bifurcation. CFA access is then obtained with a modified Seldinger approach within femoral head landmarks. After arterial sheath insertion, the artery is again evaluated for closure appropriateness, assessed by absence of arterial calcifications within 5mm of arrteriotomy or stenosis &lt;5mm in diameter. Results: 20 consecutive patients undergoing PVC or PVT ablation were included. All patients underwent US only guided access to the right common femoral artery. All patients underwent successful closure with a hemostasis device. There were no vascular complications. Conclusions: Real-time US only guided CFA access is feasible and safe. Appropriate utilization of US is sufficient to avoid intravenous contrast and radiation exposure without increased complication rate.