tbuckley/cabot-search huggingface dataset:
Abstract 17909: Pulmonary Hypertension is Associated With Morbidity, Mortality and Prolonged Hospitalization in Premature Infants With Bronchopulmonary Dysplasia
Authors: Kristian C Becker, Kurt R Bjorkman, Hieu T Ta, Kristin Schneider, Laura Bellew, Erik Hysinger, S Melissa Magness, Paul Critser
Journal: Circulation (2023)

Introduction: Pulmonary hypertension (PH) is a common comorbidity in premature infants with bronchopulmonary dysplasia (BPD). We sought to assess factors associated with PH and determine its association with morbidity and mortality in a large contemporary BPD cohort. Hypothesis: PH is independently associated with increased mortality in premature neonates with BPD. Methods: This single center retrospective cohort study identified all infants with BPD born 2010-2021. BPD severity was defined by previously established literature guidelines. PH was defined at ≥ 36 weeks post-menstrual age by echocardiography (RV pressure &gt; 40 mmHg, eccentricity index &gt; 1.1), cardiac catheterization (mean pulmonary artery pressure &gt; 20 mmHg, pulmonary capillary wedge pressure ≤ 15 mmHg and pulmonary vascular resistance ≥ 3 iWU), or treatment with enteral pulmonary vasodilators. Outcomes of death, tracheostomy, hospital duration and comorbidities were compared against a positive PH diagnosis. Univariate and multivariable models were used to assess associations of PH and covariates with clinical outcomes. Results: The sample cohort consisted of 726 neonates (median Gestational Age: 26 weeks [IQR 25.0, 28.0], 48.4% female) with PH diagnoses in 190 (26%). 92 PH patients received enteral PH therapy, with 84 (44%) on mono and 8 (5%) on dual therapy, which was discontinued by a median age 9.5 months (IQR 6.6 - 15.3). Lower gestational age (p=0.016), higher BPD severity (p&lt;0.0001), and non-white race (p=0.002) were associated with PH in multivariable models. PH was associated with higher mortality rate (18% vs 5%, p &lt;0.0001), higher tracheostomy rate (50% vs 16%, p&lt;0.0001), and longer hospital duration (median 116 (IQR 61-182) vs 58 (IQR 11-132) days, p = 0.001) in univariate and multivariable models. PH was associated with pulmonary vein stenosis (9% vs 1%, p=0.001), but not NEC, ROP or IVH after adjusting for covariates. Conclusions: This study demonstrates that BPD-PH carries an independent risk for mortality and morbidity including BPD severity, tracheostomy, pulmonary vein stenosis, and longer hospitalization. Enteral pulmonary vasodilators were used in almost half of all PH patients, with resolution of PH within 1 year of diagnosis in the majority of infants.
Abstract 14584: Differences in Pupillary Reflex Between Patients With Acute Heart Failure and Healthy Subjects. An Easy New Marker of Treatment Control in Heart Failure
Authors: Margarita Zamorano, Juan Manuel Monteagudo, Eduardo Gonzalez, Sara Fernandez Santos, Qi-Heng Zhou Xu, Isabel Rayo, Miguel Castillo, Pedro de la Villa, Jose Zamorano
Journal: Circulation (2023)

Introduction: In heart failure (HF), the sympathetic nervous system (SNS) is overactivated to try to maintain an adequate cardiac output. The pupillary reflex depends on the SNS and may be a new prognostic marker. Hypothesis: Pupillary reflex of patients with decompensated HF differs compared to controls, due to the hyperactivation of the SNS in acute HF. HF treatment may change pupillary reflex and may serve as a new marker of therapy. Aims: The aim was to compare the difference pupillary reflex between patients with acute HF and controls that may offer a new and easy prognostic factor in such patients. Methods: 107 pupillometry values of patients with decompensated HF were performed with NeuroOptics pupillometer prospectively and consecutively on admission and discharge, and compared with 42 pupillometry of controls. Results: HF patients have higher BMPD, higher MinPD and higher LC than controls.Patients with HF had higher BMPD and higher MinPD at admission vs. discharge (P&lt;0.05). No significant differences were seen between HF patients at discharge and controls. It may be that pupillary reflex values reflect better disease control at discharge. Conclusions: Patients with decompensated HF have a higher BMPD and higher MinPD. Also, HF patients presented an improvement in pupillometric values at discharge and showed no differences compared to controls.This supports the hypothesis that patients with decompensated HF present a hyperactivation of the SNS that promotes mydriasis versus miosis. SNS activity is difficult to evaluate; the pupillary reflex can be a simple and useful tool to determine its status, establish prognostic, and could help to control therapeutic management.
Abstract 18625: Mechano-Transcriptomic Interaction Mediates Spatial Variations in Early Vascular Fibrosis
Authors: Mehrdad Roustaei, Carmen S Cavallero, Jae Min M Cho, Khoa N Vu, Tzung K Hsiai
Journal: Circulation (2023)

Background: The spatiotemporal variations of wall shear stress (WSS) modulate vascular genomics and function. Despite the advances in imaging modalities and computational modeling, the link between local hemodynamics and genetic pathways underlying atherosclerosis development remains elusive. We hypothesized that differential WSS patterns in the aorta modulate fibroblast gene expression in response to high fat diet (HFD) leading to vascular stiffness. Methods: We performed ultrasound-based 4-D+time moving boundary computational fluid dynamics (CFD) on the aorta of Ldlr -/- mice fed a normal diet (ND) or HFD during 4 weeks. B-mode images (Vevo 3100) of the aortic arch were used to reconstruct a 3-D model of the lumen structure by revolving the vessel wall around the centerline in the aorta and the branches. Computational domain reconstruction was followed by image registration to generate a moving boundary model. WSS contours and velocity profiles were acquired by solving Navier-Stokes equations using svFSI code. The longitudinal strains along the outer curvature of the aortic arch over several cardiac cycles were measured, and the changes were compared with the effects of HFD. Mouse aortas were processed for single cell RNA sequencing and analyzed using the Scanpy package. Results and Conclusion: Our analysis of transcriptomics profiles revealed increased Acta2 and Postn expression in the myofibroblast subclusters, suggesting myofibroblast differentiation in response to HFD in the aortic arch. This was confirmed and localized to the lesser curvature of the aortic arch through Periostin immunostaining. We found that the increase in Postn and Acta2 is associated with reduced arterial strain or increased arterial stiffness measured in the aortic arch. In parallel, CFD analysis demonstrated that an elevated WSS along the outer curvature vs. low WSS and disturbed flow along the inner curvature in early diastole results in differential gene expression to regulate myofibroblast differentiation and modulates vascular stiffness.
Abstract 17852: A Right Atrial Mass(querader) Causing Complete Heart Block in an Otherwise Healthy Female
Authors: Lana Aleuy, Apoorva Sharma, Harshita Jain, Matthew T Brown, Tamer Attia, B Robinson Williams
Journal: Circulation (2023)

Introduction: Right atrial masses are ominous and have a broad differential including thrombus, primary cardiac tumors such as myxoma vs sarcoma, metastatic processes like lymphoma, and, rarely, autoimmune etiologies. In this case, an apple watch notification of bradycardia was a simple start to a complicated course of rapidly progressive conduction disease arising from an unusual presentation of cardiac sarcoidosis. Case Presentation: A 45-year-old previously healthy female originally presented to clinic with a one-month history of exertional dyspnea and palpitations with bradycardia noted on her Apple Watch and an ongoing event monitor revealing transient type II second-degree atrioventricular block. In the office, she was normotensive but bradycardic at 33 beats per minute with electrocardiogram revealing complete heart block with junctional escape. She was admitted for additional work-up with transesophageal echocardiogram (TEE) which was unrevealing. Cardiac magnetic resonance imaging (cMRI) identified two 2 x 2 cm right atrial masses that appeared hypermetabolic on cardiac fluorodeoxyglucose positron emission tomography (FDG cPET) in addition to bilateral hilar lymph nodes. A temporary-permanent pacemaker equipped with a lead capable of floating atrial bipolar sensing was placed while biopsy plans were arranged. Transbronchial ultrasound guided biopsy of the hilar lymph node returned benign. She then underwent two different attempts at transcatheter biopsy of the right atrial masses - one TEE guided, another intracardiac echo (ICE) guided - with most samples unrevealing except one with an inconclusive amount of spindle cells raising concerns for sarcoma. The decision was made to pursue cardiothoracic surgical resection of the right atrial masses with pathology returning with granulomatous lesions consistent with sarcoidosis. Discussion: Cardiac involvement is present in 25% of cases of sarcoidosis and most commonly manifests as conduction abnormalities, ventricular arrhythmia, and/or heart failure. Only a few cases of atrial masses are reported in the literature and its presence in this woman with heart block confounded the picture before a diagnostic biopsy of this treatable condition could be obtained.
Abstract 14885: Updated Meta-Analysis of 1 Month versus Greater Than 1 Month of Dual Anti-Platelet Therapy (DAPT) After Percutaneous Coronary Intervention Supports Shorter DAPT Duration
Authors: Jibran M Mirza, Arjun K Sharma, Tarek Nafee, Chien-Jung Lin
Journal: Circulation (2023)

Introduction: The ideal duration of dual anti-platelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains elusive, a balancing act between bleeding and ischemic risks. Recent evidence suggests a shorter duration may be safe. This updated meta-analysis evaluates the safety and efficacy of 1 month of DAPT in patients after PCI with a drug eluting stent. Hypothesis: 1 month of DAPT will be more favorable than greater than 1 month of DAPT Methods: This meta-analysis reviewed literature obtained systematically. Inclusion criteria encompassed randomized study designs comparing the efficacy of 1-month DAPT versus greater than 1-month of DAPT treatment in patients with PCI for stable coronary artery disease (CAD) or acute coronary syndrome (ACS), minimum follow-up of 12 months, and full-text studies published in peer-reviewed journals. Exclusion criteria include studies that did not include DAPT longer than 1-month, non-randomized studies, unpublished studies, and ongoing trials. We reviewed 96 articles; 7 were included in our meta-analysis. We included 2 more studies compared to the most recent meta-analysis. Our statistical analysis calculated weighted pooled risk ratios, confidence intervals, and p-values using the Mantel-Haenszel method. Results: The sample size was 24,412. The primary outcome of overall mortality favored 1 month of DAPT compared to greater than one month DAPT [RR 0.57, (CI 0.48-0.66) P&lt;0.00001]. The secondary outcomes of cardiovascular death [RR 0.68, (CI 0.56-0.83) P=0.0001] and bleeding [RR 0.70, (CI 0.63-0.78) P&lt;0.00001) favored 1 month of DAPT compared to greater than 1 month of DAPT. The secondary outcome of myocardial infarction [RR 1.25, (CI 1.08-1.44) P=0.002] favored greater than 1 month of DAPT compared to 1 month of DAPT. Stent thrombosis [RR 1.21, (CI 0.84-1.74) P= 0.31] did not meet statistical significance. Conclusions: Our meta-analysis suggests that 1 month of DAPT was associated with improved overall mortality, cardiovascular death and bleeding, at the expense of increased myocardial infarction. One month of DAPT is a reasonable treatment option for high bleeding risk patients undergoing PCI.
Abstract 15352: Deep Learning Model-Enabled Electrocardiogram to Localize Premature Ventricular Contractions in Patients Referred for Catheter Ablation
Authors: Qiying Dai, John A Wight, Gurukripa N Kowlgi, Grace Greason, Tiffany Woelber, Peter A Noseworthy, Paul Friedman, Samuel Asirvatham, Christopher V Desimone, Abhishek Deshmukh, Zachi Attia
Journal: Circulation (2023)

Introduction: Accurate pre-procedure localization of the premature ventricular contractions (PVCs) is critical in preparing for the ablation. So far, no tools exist for artificial intelligence guided PVC-localization. Hypothesis: Trained deep learning model will be able to predict the site of origin (SOO) of PVCs using 12 lead electrocardiogram (ECG). Methods: We analyzed 707 ECG-ablation pairs from 2403 patients who had at least one ECG flagged for PVCs in the 6 months prior to their procedure. First, we used a cohort of 100,000 ECGs without PVCs and 10,000 ECGs with PVCs to train a convolutional neural network (CNN) to isolate the ECG segments with PVCs in them from a 12-lead ECG (Figure 1). We then trained two models, one utilizing a 10-second 12-lead ECG, and the other with just the isolated PVC beats as input. The models were trained using the Keras framework with TensorFlow (Google). Results: The mean age of the patients in the cohort was 61.2 ± 15.0 years. 66.3 percent of patients underwent left ventricle ablation, 54.6 percent had outflow ablation, and 55.3 percent had ablation of sites with leftward axis (septal location for midline and left ventricle PVCs). The model trained on 10-second ECGs yielded validation and test AUCs of 0.941 and 0.931 for outflow, 0.898 and 0.891 for ventricle, and 0.863 and 0.846 for leftward axis (Figure 1A). The model trained on isolated segments containing PVC beats yielded validation and test AUCs of 0.966 and 0.957 for outflow, 0.879 and 0.907 for ventricle, and 0.846 and 0.829 for SOO for leftward axis (Figure 1B). Conclusions: We have trained an accurate convolutional neural network that can predict SOO using the surface ECG. Further fine-tuning would be needed to refine the model and develop prediction of specific sites.
Abstract 16644: Unusual Manifestation of Acute Pericarditis in the Setting of Primary Biliary Cirrhosis
Authors: Aqieda Bayat, Alveena Syed, Ambreen F Ali, Mustafa Atar, Tiffany Dong, Allan L Klein
Journal: Circulation (2023)

Introduction: Primary biliary cirrhosis (PBC) is an immune-mediated liver disease leading to destruction of intrahepatic bile ducts and cirrhosis. However, its association with pericarditis has not been investigated. Here, we describe a case of a female with PBC who presented with severe pericardial disease. Clinical Case: A 57-year-old female with past medical history of primary biliary cirrhosis, thrombocytosis and type 2 diabetes who presented with sudden onset sharp chest pain, worse with movement or breathing. Workup was notable for elevated D-dimer, CT chest with no evidence of pulmonary embolism but did reveal a moderate pericardial effusion, further confirmed on echocardiogram. Nuclear stress test was unremarkable. CRP 13 mg/dL and ESR 82 mm/hr. Given concern for pericarditis, she was started on colchicine and ibuprofen. On further evaluation in clinic, cardiac MRI showed severe LGE and edema consistent with active pericarditis (figure 1) with mild constrictive physiology and worsening inflammatory markers (ESR 95 mm/hr, us-CRP 118mg/L). Therefore, decision was made to start triple therapy with the addition of prednisone. Repeat cardiac MRI 6 months later showed resolution of LGE and pericardial edema (figure 2). Given clinical improvement, patient was tapered off steroids, started anakinra and weaned off ibuprofen and colchicine. She remained on anakinra for two years after which she was transitioned to single therapy with colchicine with no episodes of recurrence. Discussion: PBC commonly exists with liver autoimmune disorders, but its association with pericardial disease has not been investigated. NSAIDs are often used as first-line therapy for pericarditis, but can be detrimental in advanced liver failure, often seen in patients with PBC. Steroid use is not only advantageous in pericardial disease but also in PBC. As a result, it is critical to identify the link between pericardial disease and PBC to determine appropriate therapeutic management.
Abstract 14930: A Case of Flecainide Toxicity Causing Wide Complex Tachycardia, Unresponsiveness, Hemodynamic Instability and Pacemaker Under-Sensing
Authors: Emadeldeen Elgwairi, Brian Friedman, Dhanunjaya R Lakkireddy
Journal: Circulation (2023)

Introduction: Flecainide toxicity (FT) is an uncommon yet potentially lethal complication. We report a case of FT precipitated by acute kidney injury (AKI) in a patient with paroxysmal atrial fibrillation (AF) and a permanent pacemaker (PPM), who presented with wide complex tachycardia (WCT) and PPM under-sensing. Case presentation: An above 85-year-old female with paroxysmal AF and a PPM presented with an episode of unresponsiveness. While en route to the ED via ambulance, she had another episode associated with hemodynamic instability precipitated by a WCT. She regained consciousness after 1 biphasic DC shock. An EKG in the ED revealed sinus rhythm with atrial under-sensing and pacing spikes during ventricular refractory period (see picture). Laboratory data were consistent with AKI and normal electrolytes levels. PPM interrogation showed atrial under-sensing. Flecainide was discontinued and following drug washout the EKG changes resolved and the QRS normalized. She was discharged on amiodarone with no recurrence of arrhythmias on follow up. Discussion: Flecainide is Class 1C Antiarrhythmic drug that blocks fast the sodium channels. Prolongation of PR interval and QRS duration, in addition to supraventricular and ventricular arrhythmias, may occur with FT. Left ventricular dysfunction, myocardial scar, and high serum levels are considered risk factors for proarrhythmia. The drug half-life is prolonged in patients with renal disease/AKI. There are limited data on PPM malfunction due to FT, but it may cause increased pacing thresholds and failure to capture. Sodium bicarbonate, lidocaine, and ECMO have been used in treatment. Conclusion: FT can lead to lethal arrhythmias and PPM malfunction. Since flecainide serum levels are not always readily available, its diagnosis can be challenging. Therefore, physicians should be aware of the clinical presentation and EKG changes that accompany FT.
Abstract 16155: Achieving Coronary Artery Disease Regression: A Triumph of Lifestyle Modification and Optimal Medical Therapy
Authors: asmaa Ahmed, Andrew Takla, Ahmed Hussein, Mohamed Mohamed, Ahmed Elkheshen, Tejan Patel, Gaurav Sharma
Journal: Circulation (2023)

Background: Coronary artery disease (CAD) is the leading cause of death worldwide. Early recognition of risk factors and targeting them using lifestyle modifications and pharmacological measures is vital for secondary prevention. This case demonstrates the effectiveness of comprehensive management in achieving marked regression of CAD. Case presentation: A 45-year-old female with a history of type II diabetes mellitus, hypertension, and hyperlipidemia with markedly elevated lipoprotein (A) of 233 nmol/L presented with chronic coronary syndrome (CCS). She had a strong family history of CAD and denied smoking, alcohol use, and recreational drug use. Transthoracic echocardiography revealed preserved left ventricular systolic function with an ejection fraction of 50%, regional wall motion abnormalities in the form of inferior wall hypokinesia, and mild mitral regurgitation. She underwent coronary angiography (CA) which revealed significant three-vessel CAD. Figure 1 Decision making: She underwent successful percutaneous coronary intervention (PCI) to the RCA and PDA with two overlapping drug-eluted stents and plain balloon angioplasty to the PL branch. The patient adhered to strict lifestyle modification and was prescribed optimal anti-ischemic and anti-diabetic medications. She lost 22 lbs over two years, her LDL went down from 178 to 14 mg/dl and A1c from 12.2 to 6.8. During follow up, she started to complain of dyspnea on exertion for two weeks. Despite the marked laboratory improvement and despite she was found to be anemic at that time which can explain her symptoms, decision was to proceed to CA given her high pretest probability. A repeat CA showed marked regression in her CAD. Figure 2 Conclusion: Regression of coronary artery disease is a reality giving hope for not just stopping disease progression but achieving reduction in plaque size with optimal medical therapy, where pharmacological measures and lifestyle modifications work synergistically.
Abstract 17091: ARO-APOC3, an Investigational RNAi Therapeutic, Silences APOC3 and Reduces Atherosclerosis-Associated Lipoproteins in Patients With Mixed Dyslipidemia: MUIR Study Results
Authors: Szilard Vasas, Masoud Azizad, Peter Clifton, Daniel Gaudet, Ronald Goldenberg, Karen Modesto, Ting Chang, Stacey Melquist, Ran Fu, Javier San Martin, Christie M Ballantyne
Journal: Circulation (2023)

Background: Despite the availability of potent LDL-C-lowering therapies, patients with mixed dyslipidemia (MD) remain at high risk of cardiovascular (CV) disease due to residual risk from triglyceride (TG)-rich atherogenic lipoproteins (TRLs), ie, remnant cholesterol and/or VLDL-C. Inhibition of APOC3 has emerged as a promising therapeutic strategy for reducing this residual CV risk. Aim: We report interim results through Week 24 from MUIR, an ongoing, randomized, placebo-controlled, Phase 2b study (NCT04998201) evaluating the effects of ARO-APOC3 in patients with MD (fasting TGs 150 to 499 mg/dL and either LDL-C ≥70 mg/dL or non-HDL-C ≥100 mg/dL). Methods: Eligible subjects (n=353) were randomized 3:1 to receive either subcutaneous injections of 10, 25, or 50 mg ARO-APOC3 or matched placebo on Day 1 and at Week 12 or 50 mg ARO-APOC3 on Day 1 and Week 24. Subjects were on a stable diet and optimal lipid-lowering therapies. The primary endpoint was the percent change from baseline in fasting TGs at Week 24. Statistically significant differences were determined using mixed model repeat measures analysis. Results: At Week 24, when dosed on Day 1 and Week 12, ARO-APOC3 significantly decreased APOC3 in a dose-dependent manner up to 80% (p&lt;0.0001). Least squares (LS) mean TGs were significantly reduced by 52 to 64% (p&lt;0.0001). Least squares (LS) mean atherogenic lipoproteins were reduced by up to 27% for non-HDL-C, 19% for apolipoprotein B, and 55% for remnant cholesterol. LS mean HDL-C was increased by up to 51%. The most frequent adverse events were COVID-19 infection, worsening of glycemic control, and upper respiratory infection. Conclusions: By silencing APOC3 expression, ARO-APOC3 significantly reduced circulating TGs and atherogenic TRLs in patients with MD. The effect of ARO-APOC3 on CV relative risk reduction will be evaluated in an upcoming outcomes trial.