tbuckley/cabot-search huggingface dataset:
Abstract 16153: Electrocardiographic Correlations With Cardiac Magnetic Resonance in Left Bundle Branch Area Pacing
Authors: Kenneth C Bilchick, Derek Bivona, Chinmaya Mareddy, Yu Wang, Spencer Dennis, Rohit Malhotra, Pamela K Mason, Greg G Hundley, Frederick H Epstein, Kenneth A Ellenbogen
Journal: Circulation (2023)

Introduction: As the use of left bundle branch area pacing (LBBAP) continues to increase, there remains uncertainty about the mechanical effects of achieving selective LBB capture. Hypothesis: The hypothesis was that cardiac magnetic resonance (CMR) strain and functional parameters would be similar with and without LBBAP, and mechanical function would be more favorable with surface ECG parameters indicative of LBB capture. Methods: CMR was performed at 3T in two centers in the first year after implantation of dual-chamber pacemakers with LBBAP. Imaging sets were obtained with dual-chamber LBBAP (DOO mode) and, in patients with intact atrioventricular (A-V) conduction, atrial-only pacing (AOO mode), including strain imaging with displacement encoding with stimulated echoes (DENSE). Results: In 17 patients, the median LVEF with LBBAP was 50% (IQR 48-52%). The median LVEF and RVEF were similar with LBBAP on (DOO mode) and off (AOO mode) (p=0.27 and p=0.37, respectively); however, there were differences in synchrony (CURE-SVD) (p=0.0081), mean septal Ecc (p=0.011), and mean LV free wall Ecc (p=0.011) that favored atrial-only pacing with A-V conduction vs. sequential LBBAP (Figure 1). A shorter interval between R wave peaks in ECG leads V6 and V1 (V6-V1 interpeak interval), shown to be associated with selective LBB capture, was the best predictor of a greater LVEF with LBBAP (p=0.0016). A shorter paced QRS duration predicted greater global Ecc (p=0.044) and more synchrony by the CURE-SVD (p=0.027) (Figure 2). Conclusions: LBBAP reproduces biventricular function by CMR with some differences noted in CMR strain, and selective LBB capture was associated with a greater LVEF by CMR.
Abstract 14214: Comparative Analysis of Artificial Intelligence Techniques for ST Segment Elevation Myocardial Infarction and Their Risk of Mortality: A Nationwide Analysis
Authors: Amar Patel, Awais Farooq, Muhammad Qureshi, Shahryar Farooq, Adnan Liaqat, Michael Brockman, Yusuf Saeed
Journal: Circulation (2023)

Introduction: ST segment elevation myocardial infarction (STEMI) significantly contributes to patient morbidity and mortality nationwide. Determining which patient characteristics lead to an increased mortality rate is vital, and the use of artificial intelligence may highlight overlooked characteristics. Purpose: To investigate risk factor discordance between Multivariate Logistic Regression (MLR) and Multilayer Perceptron (MLP) Neural Networks in order to determine patient characteristics that lead to increased mortality. Methods: Patient data was collected from 2011-2018 from the National inpatient database (NIS) using International Classification of Disease Codes (ICD-9 and ICD-10). We selected patients hospitalized with STEMI. MLR and MLP models were used to tabulate adjusted odds ratios and Normalized Importance Scores respectively. Area under the curve (AUC) was calculated to determine if select comorbid conditions were associated with increased risk of mortality. Results: A total of 925,161 patients were included in our analysis. Our patient population was predominantly Caucasian, with males constituting 61% of our patient population. Notable contributors to mortality via MLR analysis include cardiogenic shock, AKI, ESRD, cirrhosis and pay status. Notable contributors to mortality via MLP analysis include cardiogenic shock, AKI, ESRD, hyperlipidemia and race. Overall MLP model classification accuracy is rated at 95.2%. Receiver operator AUC is calculated at 0.85. Conclusion: We found that patients STEMI had similar risk factors associated with mortality between MLR and MLP, however there was a discordance. This was predominantly in weighing certain socioeconomic risk factors as well as chronic comorbid conditions. This begets further analysis to optimize predictive capabilities.
Abstract 11315: Sex-Based Differences Following Catheter Ablation of Atrial Fibrillation: Patient Reported Outcomes and Quality of Life
Authors: Medhat Farwati, Younis Arwa, Chadi Tabaja, Mustapha Amin, Amr Farwati, Hiroshi Nakagawa, Walid I Saliba, Mohamed H Kanj, Mandeep Bhargava, Pasquale Santangeli, Tyler Taigen, Tyler Taigen, Patrick Tchou, Oussama M Wazni, Ayman Hussein
Journal: Circulation (2023)

Introduction: Catheter ablation for atrial fibrillation (AF) has been established as an effective intervention to improve quality of life (QoL). Data are scarce on sex-based differences in ablation outcomes. Objective: To examine clinical outcomes and QoL following AF ablation in females vs males from a large patient-reported outcomes (PRO) database. Methods: All patients undergoing AF ablation (2013-2021) at our center were assessed for outcomes using automated PRO surveys. The primary endpoint was AF recurrence based on PRO and electrocardiographic documentation. The atrial fibrillation symptom severity scale (AFSSS) was utilized to quantify QoL response. Baseline and 1-year patient surveys were used to estimate AFSSS as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous with 9 frequencies/durations in between). Results: A total of 7,166 patients were included (29.8% female). Compared to men, women were older (67 vs 64.2 years) and more likely to have paroxysmal AF (55% vs 45%). The rate of any post-procedural complications was low (&lt;3%) and comparable between men and women. At 3 years, the cumulative incidence of AF recurrence was higher in women compared to men (32% vs 27%; p-value&lt;0.05); Figure. In adjusted multivariable analysis, women had a 19.9% increased risk of AF recurrence compared to men during follow-up. Similar results were observed irrespective of AF type (paroxysmal vs persistent). QoL was significantly improved at 1 year in both groups; with a comparable reduction of mean AFSSS from 13.9 to 6.1 (56.3% decrease) in women and 10.88 to 4.29 (60.5% decrease) in men. Similarly, AF burden was significantly and comparably reduced in both men and women. Conclusions: Following catheter ablation for AF, women were found to be at increased risk for AF recurrence during follow-up. Nonetheless, both men and women had significant and comparable improvement in QoL and AF burden.
Abstract 17881: A Predictive Algorithm to Identify Late Gadolinium Enhancement Using Echocardiography
Authors: Katharine W Rainer, Reza Nezafat, Connie W Tsao, Jordan B Strom
Journal: Circulation (2023)

Background: Late gadolinium enhancement (LGE) on cardiac MRI (CMR) correlates with fibrosis and arrhythmic risk, but cannot be used in several clinical settings compared the availability of echocardiography (TTE). Aim: To develop and evaluate a machine learning (ML) model that uses standard clinical and echocardiography (TTE) variables to identify LGE on paired CMR. Methods: Amongst 725 patients (mean age 56.9 ± 16.5 years, 40.3% female) with TTE and CMR within 3 months at our institution, 2018-2023, we derived and tested several ML models (recursive partitioning, random forest, boosted tree, neural networks, LASSO/Elastic Net) to identify LGE on CMR using age and 24 TTE features. Ten-fold cross validation was used for internal validation. Results: A total of 165 (23%) had the presence of LGE (40% ischemic, 60% nonischemic pattern). Of tested models, a boosted neural network performed best (validation area under the curve [AUC] = 0.98; Figure ). In the validation cohort, the algorithm had a sensitivity and specificity of 93.8% and 94.6% for identifying presence of LGE. Accuracy remained high regardless of gender (M vs. F, AUC, 0.987 vs. 0.988) or race (blacks vs. whites, AUC, 0.987 vs. 0.984) and was not related to time between studies (r = -0.06, p = 0.09). Accuracy was better for ischemic LGE (AUC = 0.94) than nonischemic LGE (AUC = 0.90). Left ventricular size, age, fractional shortening, and wall thickness, were amongst the top predictors of LGE presence in the model. Conclusions: In this single center study, a boosted neural network using TTE features identified LGE on paired CMR with high sensitivity and specificity. If confirmed in external data, this suggests possible utility of ML for improving the diagnostic value of TTE for LGE assessment.
Abstract 14161: Recreational Cannabis Use and the Risk of Atrial Arrhythmias: Evidence From a Meta-Analysis of Observational Studies
Authors: Levindo Jose Garcia Quarto, Thalys Sampaio Rodrigues, Naomie Young, Suraj Patel, William Laband, Han S Lim, Anoop N Koshy
Journal: Circulation (2023)

Introduction: Tetrahydrocannabinol is known to induce sympathetic stimulation and endothelial dysfunction, potentially increasing the susceptibility to arrhythmias. While a recent AHA consensus document outlined various cardiovascular risks associated with cannabis use, there was a paucity of data linking its use with arrhythmias. Therefore, we sought to investigate the association between recreational cannabis use and the risk of atrial arrhythmias. Methods: Electronic databases were searched for articles published up to April 2023 for studies that assessed the effect of the recreational use of cannabis on the risk of atrial arrhythmias (atrial fibrillation/flutter, supraventricular tachycardia). The study was prospectively registered (PROSPERO CRD42023428219). Three reviewers independently appraised the data, with summary odds ratios (OR) and 95% confidence intervals (CIs) pooled using a random-effects model. Results: Our analysis included seventeen cohort studies with a total of 81,269,314 participants from North America, Europe and Oceania. Four studies were prospective observational in design. Mean age was 46 years [41-72] and mean female participation was 45% [31-83] across studies. Recreational use of cannabis was associated with a significantly higher risk of atrial arrhythmias (OR 1.55, 95% CI 1.13-2.13) with high degree of heterogeneity (I2=99%). On meta-regression, mean age was not a contributing factor for the observed effect (p=0.58). Conclusions: Recreational use of cannabis was associated with 1.5-fold increased risk of atrial arrhythmias. Prospective studies are warranted to further explore this relationship and the public health implications of cannabis utilization.
Abstract 15656: Early Recurrence of Ventricular Tachycardia and the Impact of Radiofrequency Ablation on Success of ICD Therapy
Authors: Dalia Giedrimiene, Chikezie Alvarez, Aneesh Tolat, Seth Fakess, Jeffrey Kluger
Journal: Circulation (2023)

The early success of radiofrequency ablation (RFA) and impact on ICD delivered therapy (including the need for antitachycardia pacing (ATP) or ICD shock) after the procedure, due to recurrent VT events, is still not clear. Hypothesis: Recurrences of VT during 12 months of follow up (FU) after RFA are associated with the need for ICD therapy (successful ATP or need for ICD shock) and related to pre-procedural ATP success or failure. Methods: We analyzed the data of 141 ventricular arrhythmia patients who underwent RFA during 2019 - 2022 by identifying 54 (38.3%) patients with monomorphic VT and implanted ICDs. Age - 69.54±10.04 years , 52 (96.3%) males, BMI - 29.1±6.2; 27 (50.0%) patients - ICM; 51 (94.4%) used antiarrhythmics and 40 (82.1%) have failed; beta-blockers use - 47 (87.0%). 20 (37.0%) had an ICD for primary prevention. LVEF - 39.2±13.8%, VT cycle - 350±80 ms. VT storm - in 46 (85.2%). Results: Out of 54 included patients, only 34 (63%) had no recurrent VT events during FU post-RFA procedure. 20 (37.0%) experienced recurrent VT events and needed ICD therapy: 8 (40.0%) responded to ATP, whereas 12 (60.0%) failed ATP and required an ICD shock. Patients’ response to ICD delivered therapy was compared between two groups of patients: 1) pre-ablation ATP failure (n=40) and 2) pre-ablation ATP success (n=14). In pre-ablation ATP failure group, 23 (57.5%) patients had no recurrent VT events, 5 (12.5%) successfully responded to ATP and 11 (27.5%) failed ATP requiring ICD shock. In the pre-ablation ATP success group, 9 (64.5%) patients had no recurrent VT, 3 (21.4%) responded to ATP, and only 1 (7.14%) required ICD shock and no VT storm episodes, whereas 12 (30%) of patients with pre-procedural ATP failure had VT storm (IQR= 0.0, 0.0, vs 1.0, 5.0 respectively; p=0.019). Patients with recurrent VT events had higher BMI then patients with no recurrent VT: 32.9±5.4 vs 28.0±6.0, p&lt; 0.033. The pre-ablation ATP failure group had a greater proportion of hemodynamically unstable VT induced during RFA (56.7% vs 23.1%; p=0.043). Conclusion: The success of ATP after RFA was associated with pre-procedural ATP response and patients with lower BMI had less recurrent VT events. Overall, pre-ablation ATP failure for VT termination may identify patients with increased risk of failure to ATP therapy.
Abstract 15625: Left Atrial Appendage Volumetric and Functional Assessment Using Cardiac CT-Derived Three-Dimensional Models
Authors: Amr Abdelradi, Andrew Atia, Mohamad Kalot, Sunitha Shyam Sunder, Umesh C Sharma
Journal: Circulation (2023)

Introduction: The left atrial appendage (LAA) is the most common site of thrombus formation in atrial fibrillation (AF) patients who develop strokes, yet its dynamic volumetric parameters remain uncharacterized. We present a quantitative analysis of cardiac phase-specific LAA volumes and function using cardiac CT-derived three-dimensional (3D) models of 920 LAA segmentations. Methods: We measured LAA volumes at 10% increments of the cardiac cycle (R-R interval) in patients with AF and controls with sinus rhythm (SR). After identifying the LAA orifice using anatomical landmarks on multiplanar CT images, we performed computational LAA segmentation using specialized software. For precise mapping, we used iterative active region-growing and cutting tools to separate the LAA from surrounding structures. We used the resulting 3D model for volumetric assessment of the LAA during the cardiac cycle. Results: We analysed 580 LAA segmentations in patients with AF and 340 segmentations in patients with SR. Both groups displayed LAA volume increase from 0 to 40% of the cardiac cycle followed by a gradual decrease during diastole. LAA volumes were significantly higher in AF at 0%, 10%, 70%, 80%, and 90% of the cardiac cycle (p =0.01, 0.021, 0.047, 0.025 and 0.011, respectively). LAA volumetric variance within the AF group was significantly greater (p&lt;0.001). LAA ejection fraction was significantly lower in AF compared to SR (40.8±16.1% vs 49.7±12.6%, p=0.003). Polynomial plots of incremental volume changes showed an accelerated rate of LAA filling in early systole in the SR, which was significantly dampened in AF. Conclusions: We present the first comparative analysis of LAA volumetric and functional assessment in patients with AF and SR. We conclude that impaired LAA filling and emptying in AF can contribute to blood stasis and thrombogenicity. Further investigations into the utility of LAA metrics as prognostic and risk-stratification tools in patients with AF are warranted.
Abstract 15597: Unlocking Rate Control in Atrial Fibrillation: A Closer Look at the Intravenous Diltiazem and Metoprolol Duel - An Updated Systematic Review and Meta-Analysis
Authors: Syed Zamrak Khan, Muhammad Aslam khan, Usman Akbar, Saad Farooq, Nouman Shafique, Ghanshyam Bhatta
Journal: Circulation (2023)

Background: Intravenous beta-blockers and calcium channel blockers remain first-line therapeutic agents for hemodynamically stable atrial fibrillation patients with a rapid ventricular rate (AF-RVR) in emergency medical settings. Material and Methods: We conducted a thorough review of various sources, including PubMed, Embase, Cochrane databases, and clinicaltrials.gov registry. Our search covered the period from the inception of these databases up to May 20, 2023. We only selected studies that compared the effectiveness and safety of diltiazem and metoprolol in adult patients with AF-RVR who were in emergency medical settings or hospitalized. We focused on whether the drugs successfully controlled heart rate and if there were any cases of hypotension or bradycardia following drug administration. Results: Among the 150 identified studies, 19 were suitable. All these studies demonstrated a low to moderate risk of bias. The meta-analysis, using the Mantel-Haenszel random-effects model, revealed a higher success rate in achieving the rate control target with diltiazem compared to metoprolol [19 studies, n = 1732, Odds Ratio (OR): 1.65; 95% Confidence Intervals (CI):1.18 to 2.32; I^2 = 58%, P = 0.001]. In terms of safety, no significant difference was observed in the risk of hypotension with either drug [15 studies, n = 1477, OR: 1.12; 95% CI: 0.76 to 1.64; I^2 = 25%, P = 0.18]. However, an incidence of bradycardia was noticed with diltiazem [7 studies, n = 1203, OR: 2.85; 95% CI: 1.25 to 6.46; I^2 = 21%, P = 0.27]. Conclusions: For patients with AF-RVR, intravenous diltiazem was more successful in achieving the desired rate control than metoprolol. Both drugs had similar rates of hypotension, but diltiazem had a slightly higher risk of bradycardia. These results indicate that diltiazem may be a better option for rate control in AF-RVR patients. However, high-quality randomized studies are needed to assess both medication's long-term safety and effectiveness in this group.
Abstract 15640: Long Term Event-Free Survival in Patients With Ischemic and Non-Ischemic Cardiomyopathy up to Thirteen Years Following Cell-Based Therapy: Results From the Hyperion Observational Cohort
Authors: Russell G Saltzman, Andrew Sundin, lina V caceres, Jairo A Tovar, Ana Maria Garzon, Maria Cabreja-Castillo, Dushyantha Jayaweera, Aisha Khan, Ivonne H Schulman, Raul D Mitrani, Joshua M Hare
Journal: Circulation (2023)

Introduction: The long-term clinical outcomes of cell-based therapies to treat ischemic (ICM) and non-ischemic dilated cardiomyopathy (NIDCM) are unknown. We therefore prospectively followed patients (pts) with ICM/NICDM treated by targeted transcatheter endocardial mesenchymal stromal cell (MSC) injections (TESI). Methods: Of the 155 pts enrolled in prior MSC TESI studies, 111 were eligible to be contacted. Of these, 47 (42%) agreed to participate and have periodic follow-up assessments (Cardiac MRI/CT, 6MWT, labs, PE, EKG, and MLHFq) for up to 13 years following their index procedure. Time-to-event information was captured from all 155 former participants. Endpoints included event-free survival, changes in left ventricular ejection fraction (EF), and ventricular remodeling. Clinical endpoint events were defined as the composite of: Death (all-cause mortality), Left Ventricular Assist Device (LVAD) placement, or Heart Transplant. Descriptive statistics were used to classify the sample, and Kaplan-Meier survival analysis was generated to examine time-to-event trends. Results: There were 134 men and 21 women, mean age 60.0±11.0 years, including 121 (78%) with ICM, and 34 (22%) with NIDCM. In pts with ICM, mean EF at baseline was 31 %±10.8% and after 1 year was 32.6%±11.8% (P=0.08). In pts with NIDCM baseline EF was 27%±10% and increased to 34%±13% after 1 year (P=0.002). Overall, 40% of pts had a decrease in LVEF, 26% had &lt;5% increase, 34% had a ≥5% increase, and 17% had a ≥10% increase in LVEF after 1 year. Increases of ≥5% LVEF post-therapy were associated with longer event-free survival in NIDCM (OR: 2.57; 95% CI: 0.6, 11.1) but not ICM (OR: 1.25; 95% CI: 0.4, 3.6). Conversely, reductions in LVEDV were associated with longer event-free survival in ICM (OR: 7.23; 95% CI: 1.9, 27.1) but not NIDCM (OR: 1.88; 95% CI: 0.4, 10.0). Conclusion: In this long-term observational cohort analysis, improvement of EF and/or reduction in LVEDV was associated with survival benefits among pts with NIDCM and ICM respectively. Future studies are needed with placebo controls to determine which pts are most likely to respond to MSC therapy. Clinical Trial Registration: URL: http://www.clinicaltrials.gov.; Unique ID: NCT03071835.
Abstract 12977: Prevalence and Incidence of Diastolic Dysfunction in Patients With Functional Tricuspid Regurgitation
Authors: Jwan A Naser, Sorin Pislaru, Vuyisile T Nkomo, Christopher Scott, Austin Kennedy, Mackram F Eleid, Yogesh Reddy, Grace Lin, Patricia A Pellikka, Barry A Borlaug
Journal: Circulation (2023)

Introduction: Isolated functional tricuspid regurgitation (FTR) in the absence of structural heart disease may develop secondary to elevation in left heart pressures caused by left ventricular diastolic dysfunction (DD), as in heart failure with preserved ejection fraction (HFpEF). FTR may also herald the presence of occult DD or indicate greater risk for new-onset DD. However, prevalence and incidence of diastolic dysfunction (DD) in isolated FTR have not been studied. Aims: Investigate the prevalence and incidence of DD across the different severities of FTR of unclear cause. Methods: Adults with normal EF and without structural heart disease undergoing echocardiography at a tertiary medical center with a repeat study ≥6 months from baseline were identified. Severe DD was defined by ≥3/4 abnormal DD parameters (medial e’, medial E/e’, tricuspid regurgitation velocity, left atrial volume index) and moderate DD by ≥2. Results: Among 30,428 patients (median age 60; 50% women), FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. Severe DD was present in 2%, 5%, 11%, and 13% patients, respectively, (p&lt;.001) and moderate DD in 9%, 19%, 31%, and 48%, respectively (p&lt;.001). The association of DD with increasing FTR was independent of all clinical characteristics. Over median 3.0 (IQR 1.5-5.4) years, incident severe and moderate DD developed more frequently with increasing FTR severity ( Figure) . Findings were confirmed in a propensity-matched subset where patients were matched for age, sex, BMI, atrial fibrillation, and comorbidities and in patients without lung disease or ≥moderate right ventricular enlargement. Conclusions: Patients with FTR of undefined etiology commonly have DD suggesting the presence of underlying left heart disease. Patients without apparent DD or HF at baseline who have FTR remain at significantly increased risk of developing DD over follow-up and may be a target population for therapies to prevent progression to clinical HFpEF.