tbuckley/cabot-search huggingface dataset:
Abstract 15025: Impact of Type of Transcatheter Heart Valve and Anatomic Features on Complexity of Percutaneous Coronary Intervention in Patients After Transcatheter Aortic Valve Replacement
Authors: Norihito Takahashi, Shinichiro Doi, Tomotaka Dohi, Endo Hirohisa, Hiroki Nishiyama, Iwao Okai, Sakiko Miyazaki, Hiroshi Iwata, Shinichiro Fujimoto, Shinya Okazaki, Tabata Minoru, Tohru Minamino
Journal: Circulation (2023)

Introduction: Approximately half of the patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) present with concomitant coronary artery disease (CAD). Percutaneous coronary intervention (PCI) after TAVR is gaining increasing importance. Consequently, we investigated the factors that influence PCI procedures in patients following TAVR. Methods: We included consecutive 633 patients with severe aortic stenosis who underwent TAVR at our institution from 2016-2022. The primary endpoint was the time from puncture to initial coronary angiography. Results: The median age was 84 (81 - 87) years old, 39% were male, and 173 (27.3%) had concomitant coronary artery disease. Of these, 39 (22.2%) were treated conservatively, 22 (12.5%) underwent coronary artery bypass and TAVR, 64 (36.5%) underwent PCI before TAVR, and 46 (26.2%) underwent PCI after TAVR. The success rate of PCI after TAVR was 100% for both types of valves. The median initial angiography time from puncture was 16.2 minutes (10.6 - 29.1), significantly longer in the Self-expandable valve (SEV) group [22.0 minutes (14.1 - 59.2)] compared to the Balloon-expandable (BEV) group [14.9 minutes (8.1 - 21.1)] (p = 0.026). PCI to the right coronary artery [29.0 min (17.2 - 49.5)] took significantly longer than PCI to the left coronary artery [14.0 min (8.0 - 18.1)] (p = 0.001). Conversely, there was no significant association with CT measurements such as aortic angle, annulus area, coronary height, or valve size, and transcatheter heart valve size (p &gt; 0.05). Factors that predicted difficulty in engaging coronary arteries (&gt;30 min from puncture to first contrast) were SEV [odds ratio 6.4, 95% confidence interval (1.2 - 38.2), p = 0.024], RCA [odds ratio 6.0, 95% confidence interval (1.3 - 33.4), p = 0.020]. Conclusions: Despite the high completion rate of PCI after TAVR, the use of SEV and the approach to the right coronary artery can pose challenges.
Abstract 15536: Impact of Social Determinants of Health on Atherosclerotic Cardiovascular Diseases Incidence
Authors: Audrey Paulin, Hasanga D Manikpurage, Sebastien Theriault, Benoit Arsenault
Journal: Circulation (2023)

INTRODUCTION: Individuals with an unfavorable socioeconomic status have a higher risk of developing chronic diseases such as atherosclerotic cardiovascular disease (ASCVD). However, the shared contribution of socioeconomic status, psychosocial factors and living environment on ASCVD risk remains unknown. We investigated the contribution of these social determinants of health on the incidence of ASCVD. METHODS: We developed a polysocial risk score (PsRS) using latent class analysis based on socioeconomic factors (household income, level/quality of education and employment status), psychosocial factors (living alone, social support, social activities, social isolation, emotional distress, and diagnosis of psychiatric disorders), and living environment (social deprivation score, crime rate, housing quality, housing stability, proximity to green/blue spaces and proximity to nature). The study sample included 319 842 participants of the UK Biobank, free of ASCVD recruited between 2006 and 2010. As of August 2021, 23 840 of them had incident ASCVD (fatal or nonfatal myocardial infarction, ischemic stroke, or cardiac revascularization procedures). Participants were divided into three groups based on latent class analysis adjusted for age. The impact of the PsRS on incident ASCVD was assessed using Cox proportional hazards for all participants, women and men adjusted for age, sex, and ethnicity. RESULTS: Compared to participants with a low PsRS, those with an intermediate score had a slightly higher risk of ASCVD (hazard ratio [HR]=1.05 [95% CI, 1.01-1.09], p=0.024) while those with a high PsRS had a higher risk of ASCVD (HR=1.46 [95% CI, 1.40-1.52], p&lt;0.001). The effect of the PsRS on ASCVD incidence appeared to be more pronounced in women (HR=1,59 [95% CI, 1.48-1.71], p&lt;0.001 and HR=1.39 [95% IC, 1.32-1.46], p&lt;0.001, respectively, for women and men with a high PsRS compared to individuals with a low PsRS within the same sex). CONCLUSION: A PsRS based on the living environment as well as socioeconomic and psychosocial factors was associated with incident ASCVD in participants of the UK Biobank. Multifactor approaches targeting both social determinants of health and traditional risk factors could reduce the burden of ASCVD in the general population.
Abstract 14766: Acute Impact of Transapical Ventricular Reshaping Device on Dilated Left Ventricle With Functional Mitral Regurgitation in Swine Model
Authors: Daisuke Onohara, Chase King, Stephanie Tom, Yuta Kikuchi, Brooks A Lane, Muralidhar Padala
Journal: Circulation (2023)

Introduction: Functional mitral regurgitation (FMR) after myocardial infarction (MI) exacerbates morbidity and mortality. Correcting FMR plays a critical role in mitigating or reversing ventricular remodeling in MI patients with FMR. However, the COAPT trial demonstrated that FMR correction yields favorable results in smaller left ventricles (LVs) but not in severely dilated LVs. In this study, we evaluated the efficacy of a transapical device in MI swine model with FMR, which can perform papillary muscle approximation (PMA) and simultaneous reduction of LV volume. Methods: Yorkshire pig (n=15) were used in this study. MI was induced by percutaneous occlusion of the left circumflex artery, which caused LV dilatation and FMR by 3 months. The device was implanted through the LV apex to achieve PMA and LV reshaping until FMR was eliminated (Figure A). The immediate effects of the device implantation on the mitral valve and the LV were assessed using echocardiography and pressure-volume loops. Results: The device implantation decreased inter-papillary muscle distance from 24.5±3.8mm to 16.7±3.8mm (p&lt;0.0001), and significantly reduced FMR. Coaptation length significantly increased from 3.4±0.7mm to 5.5±1.2mm (p&lt;0.0001). End-diastolic volume decreased from 153±48ml to 117±33ml, a 23.5% reduction (p=0.0004). The end-systolic pressure-volume relationship and preload adjusted dP/dt max significantly increased after the device implant, indicating an improvement of LV contractility. There were no differences observed in Tau and end-diastolic pressure-volume relationship, depicting minimal acute impact on diastolic ventricular function after device implantation (Figure B and C). Conclusions: This transapical reshaping device effectively corrects FMR in very enlarged LVs, but also reduces systolic chamber wall stress by reducing the LV volume. An acute improvement in LV systolic function was observed, potentially indicating a therapeutic effect.
Abstract 17647: Potential Candidates for Partial Oral Treatment in Patients With Endocarditis at a US Center
Authors: Mia Pries-Heje, Erin Connolly, Dylan Hartman, Andy Kim, Mary-Ruth Joyce, Akinobu Itoh, Mark Cunningham, Patrick T Ogara, Yee-Ping Sun, Samuel Slavin, James Maguire, Ayaz Aghayev, Brittany N Weber, Marcelo Di Carli, Joji Suzuki, Kasper Iversen, Lindsey Baden, Henning Bundgaard, Ann Woolley
Journal: Circulation (2023)

Introduction: In the Danish POET trial, oral step-down antibiotic therapy was non-inferior to intravenous antibiotic therapy (IVAB) in stabilized patients with left-sided infective endocarditis (IE). It is unknown whether oral treatment for IE can be efficacious in the US population. Aim Identify patients with IE who may have been candidates for POET treatment in a US cohort and assess the reduction of IVAB days and differences in characteristics and outcomes compared to participants in the POET trial. Methods: Retrospective study of patients admitted with IE at a US single center in Jan 2021 - July 2022. Possible candidates for POET treatment were patients with left-sided IE and infection with S. aureus , E. faecalis , Streptococcus , or coagulase-negative staph (CoNS), who had reached stabilization of infection or were discharged. Primary outcome was a composite of all-cause mortality, relapse of bacteremia, embolism or unplanned cardiac surgery within 6 months. Results: Of 152 patients with IE, 90 (59%) were possible candidates for POET treatment. Median length of IVAB after stabilization was 33 days (IQR 24-37). Compared to POET-trial patients, POET candidates in the US cohort were younger (64 vs 70 years), more often had diabetes (30% vs 17%), cancer (30% vs 8%), intravenous substance use (8% vs 1%) or pacemakers (18% vs 9%) [Table]. Prevalence of S. aureus (35% vs 22%) and CoNS infections (23% and 6%) was higher; Streptococcus was less common (30% vs 49%). Primary outcome occurred in 25 patients (28%) compared to 42 patients (10%) in the POET-trial (p&lt;0.001). Conclusions: More than half of patients admitted with IE were possible POET candidates, for whom 4 weeks of IVAB may have been converted to oral antibiotics. Candidates in the US cohort had more comorbidities and primary outcome was three times higher than in the POET trial. Prospective studies are needed for verification of POET treatment in higher-risk US IE patients.
Abstract 12757: Osimertinib-Associated Cardiotoxicity: Insights Into Echocardiographic Changes and Patients at Increased Risk
Authors: Jonathan N Le, Jordan O Gasho, Olivia Peony, Asneh Singh, Katrina Silos, Sungjin Kim, Anthony Nguyen, Karen L Reckamp, Kamya Sankar, Andriana P Nikolova, Katelyn M Atkins
Journal: Circulation (2023)

Introduction: Osimertinib is a third-generation epidermal growth factor (EGFR) tyrosine kinase inhibitor used in the treatment of EGFR-mutant non-small cell lung cancer (NSCLC). While osimertinib has known cardiotoxicity risks, there is a paucity of detailed transthoracic echocardiographic (TTE) changes and known predictors. Hypothesis: Osimertinib is associated with TTE changes other than reduced EF in patients with NSCLC; further, those with pre-existing cardiac risk factors may be at increased risk of cardiotoxicity. Methods: Single-center retrospective analysis of patients with NSCLC with available TTEs after starting osimertinib between 2007-2022. Cardiac event (any grade ≥2 cardiac common terminology criteria for adverse events [CTCAE]) cumulative incidence was estimated and Fine and Gray regressions performed (adjusting for non-cardiac death as a competing risk). Results: In total, 85 patients were included (mean age was 68 years, 67% female). Median interval between osimertinib initiation and first follow-up TTE was 17.6 months. After a median follow-up of 35 months, 17 patients developed grade ≥2 CTCAE (2-year cumulative incidence, 19.2%; 95% confidence interval [CI]: 11%-29%). These CTCAEs include QTc prolongation (n = 10), EF decline of ≤50% or ≥10% drop from baseline (n = 5), new valvular regurgitation/stenosis on imaging (n = 5), and supraventricular arrhythmia (n = 3). A pre-treatment TTE was available for 38 patients prior to osimertinib initiation. Comparing post- vs pre-osimertinib TTEs, there was significant LVEF decline (58 ± 11% vs 61 ± 8%), increased diastolic dysfunction (40% vs 32%, mitral regurgitation (49% vs 24%), and tricuspid regurgitation (45% vs 24%), all p &lt;0.01. On multivariable analysis, preexisting arrhythmias (hazard ratio [HR] 3.90; 95% CI 1.11-1.13; p = 0.034) and BMI (HR 1.07, 95% CI 1.00-1.14; p = 0.04) were associated with an increased risk of cardiac events. Conclusions: Osimertinib was associated with a nearly 20% 2-year cumulative incidence of cardiac events and multiple echocardiographic changes. BMI is a potential modifiable risk factor to mitigate Osimertinib-associated cardiac events. These findings highlight the need for close surveillance in these higher cardiac-risk patients with NSCLC.
Abstract 16484: Utility of Steerable Sheaths and Intracardiac Echocardiography for Typical Atrial Flutter Ablation
Authors: Levi Fry, Amrish Deshmukh, Jackson Liang
Journal: Circulation (2023)

Introduction: Sheaths (SS) and intracardiac echocardiography (ICE) are being increasingly utilized to improve safety, efficacy, and efficiency of catheter ablation procedures for different arrhythmias. The utility of these tools to guide ablation of typical atrial flutter (AFL) are not well characterized. Hypothesis: The use of SS plus ICE during typical AFL ablation leads to improved procedural and long-term outcomes as well as shorter procedural, fluoroscopy, and total radiofrequency times. Methods: In this retrospective chart review, medical records were abstracted for patients undergoing typical AFL ablation alone between 7/2019-5/2023. Demographics, medical history, and baseline procedural data were collected. Procedural outcomes were achievement of bidirectional block and complications. Long term outcome was recurrence of typical AFL or unblocked cavotricuspid isthmus (CTI) at repeat ablation (for any arrhythmia). Data analyzed with intention-to-treat analysis. Results: 197 patients were identified. The use of SS plus ICE had the shortest procedural time (69.81 ± 34.49 mins, p&lt;0.001), total radiofrequency time (362.91 ± 502.62 secs, p=0.005), and fluoroscopy time (5.28 ± 3.34 mins, p&lt;0.001) (Figure 1). When patients were divided based on SS alone, both procedural and radiofrequency times were shorter with the use of SS vs no SS (81.04 ± 40.37 vs 91.74 ± 37.67 mins, p&lt;0.001; 370.02 ± 460.44 vs 602.27 ± 592.28 secs, p=0.001), however, fluoroscopy time was longer (8.25 ± 7.75 vs 6.60 ± 5.58 mins, p&lt;0.001). There was no difference between acute procedural success rates. Those in SS group were less likely to have recurrent typical AFL or unblocked CTI on redo ablation (0 out of 49 [0%] vs 6 out of 148 [4%]). Conclusion: Typical AFL ablation using SS plus ICE resulted in shorter procedural, total radiofrequency, and fluoroscopy times with similar acute procedural success rates. The use of SS (regardless of ICE) is associated with increased long-term success rate.
Abstract 13487: Amazon Pharmacy's RxPass to Achieve Modest Out-of-Pocket Savings on Generic Prescription Medications
Authors: David A Oddleifson, ZhaoNian Zheng, Rishi K Wadhera
Journal: Circulation (2023)

Introduction: In January 2023, Amazon introduced a $5/month medication subscription service called RxPass for its Amazon Prime members. The service covers over 80 generic medications, including 12 for cardiovascular conditions. We evaluated how much US adults could save by using RxPass and determined the characteristics of those most likely to benefit. Method: In this observational study of adults aged 18-64 years who were prescribed at least one medication in the RxPass formulary, we used the 2019 Medical Expenditure Panel Survey (MEPS) to estimate the number of adults who spent more than the $199 annual cost of Amazon Prime &amp; RxPass on eligible medications. A multivariable logistic regression model was then fitted to assess individual characteristics associated with saving under RxPass. Results: If the weighted study population of 50,845,777 adults (standard error [SE] ±1,711,996) obtained eligible medications from Amazon’s RxPass, only 5.1% (2,602,310 [±119,628]) would achieve savings. The estimated average out-of-pocket spending on eligible medications for those who would save by using RxPass was $354 (SE ±$16.1) per year. The estimated average out-of-pocket savings from using RxPass was $155 (SE ±$16.1) per year (Figure), resulting in a total savings of $404,482,986 (SE ±$49,831,316) per year. Lack of insurance coverage and being prescribed a greater number of RxPass-eligible medications were each associated with a higher likelihood of achieving savings under RxPass. Being from a racial or ethnic minority background was associated with a lower likelihood of savings. Conclusion: These findings suggest that Amazon RxPass will achieve only modest out-of-pocket savings for a limited number of working-age adults. The observed racial and ethnic disparities reflect well-documented barriers in medication access. Adjustment of the RxPass pricing structure is necessary for the program to improve access and adherence to common generic medications.
Abstract 17174: New Criteria for Block Across Anterior Mitral Line That Includes Bachmann’s Bundle in Patients With Scar Perimitral Flutter
Authors: Ahmad Jabri, Sivacharan Buddhavarapu, Megan Gruber, Dina Alayan, Ela Ahmad, Enrique Soltero, Fares Sukhon, Ohad Ziv, Soufian Almahameed
Journal: Circulation (2023)

Background: The recurrence rate of scar perimitral flutter (SMF) after anterior mitral line (AML) ablation remains high. Epicardial connections from high right atrium (HRA) to high lateral left atrium (HLA) including the Bachmann bundle (BB) plays a significant role in perimitral flutter recurrence. Hypothesis: We hypothesize that block across BB (BBB) during endocardial anterior line ablation reduces recurrence of atrial tachycardia (AT) and SMF. Methods: Patients undergoing left atrial ablation with SMF that were treated with AML were retrospectively enrolled. Pulmonary veins isolation and bidirectional AML block achieved in all patients. Baseline HRA-HLA, final HRA-HLA, and delta HRA-HLA intervals measured. Changes in HLA activation sequence determined. BBB identified when HRA-HLA interval increased with change in HLA activation sequence and confirmed with differential pacing. (Figure 1). The primary endpoint was recurrence of AT/SMF Results: We identified 101 patients, 51% comprised of women, with a mean age of 69. Patients who had AML without evidence of BBB were 48 compared to 53 patients who had AML with evidence of BBB. The mean baseline, final and delta HRA-LAA were 123 ± 42ms, 219 ± 45 ms and 96± 21 ms respectively in patients with BBB. After median follow up of 48 months, AT/SMF recurred in 43 % of patient without BBB vs 15 % in patient with BBB (p&lt;0.008) (Figure 2). In patients with BBB, delta HRA-HLA &gt;107ms discriminated between recurrence and no recurrence (p&lt;0.023ms and 93% negative predictive value) Conclusion: During endocardial AML ablation for SMF, bidirectional block with evidence of BBB is associated with significant reduction in AT/SMF recurrence.
Abstract 14769: Peripheral Venous Pressure Measured With a Novel Miniature Pressure Transducer Correlates With Central Venous Pressure in Heart Failure, Heart Transplant, and Left Ventricular Assist Device Patients
Authors: Sarah Flint, Aaron Wengrofsky, Peter P Vlismas, Elliot Wiesenfeld, Yogita M Rochlani, Patricia chavez, Sasha Vukelic, Sandhya Murthy, Shivank Madan, Omar Saeed, Snehal R Patel, Jooyoung Shin, Ulrich P Jorde, Daniel B Sims
Journal: Circulation (2023)

Introduction: Peripheral venous pressure (PVP) has been shown to accurately correlate with central venous pressure (CVP) when measured using a conventional manometer and pressure tubing. We investigated the correlation between PVP as measured by a novel pressure transducer and CVP in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients. Methods: A prospective, cross-sectional study examining PVP from February 2022 to May 2023 was conducted. The analysis was limited to patients undergoing right heart catheterization (RHC) admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. PVP was transduced from an antecubital or more distal peripheral intravenous (IV) catheter site using a miniature digital, disposable pressure transducer (Centurion Compass Universal HG, Medline). Pressures were compared using Pearson’s correlation coefficient. Results: 99 patients were enrolled with a mean age of 62 ± 12 years and a mean ejection fraction (EF) of 41 ± 21%. 74% of the patients had heart failure, 17% were HTx patients, and 9% were LVAD patients. The PVP measured with the novel pressure transducer was found to be highly correlated to CVP measured by RHC (r=0.80, p &lt; 0.0001) (Figure). High correlation was also noted when broken down by HF (r=0.77, p &lt; 0.0001), HTx (r=0.95, p &lt; 0.0001), and LVAD groups (r=0.90, p &lt; 0.0003). There was a high degree of correlation for HF patients with EF &lt; 50% (r=0.74, p &lt; 0.0001) and EF &gt; 50% (r=0.90, p &lt; 0.0001). A high degree of correlation was found for all peripheral IV insertion sites: antecubital (r=0.86, p=0.000071), forearm (r=0.76, p&lt;0.00001), and hand (r=0.84, p&lt;0.00001). Conclusions: There is a high degree of correlation between PVP measured by a novel pressure transducer and CVP in HF, HTx, and LVAD patients. PVP measurements using this transducer are a reliable estimate of volume status in these patient populations.
Abstract 17865: Machine Learning With Multimodal Pre Ablation Imaging for Predicting Recurrence in Atrial Fibrillation Patients
Authors: Abhishek Midya, Golnoush Asaeikheybari, Amogh Hiremath, Vidya Sankar Viswanathan, Han Sun, Samuel Harwood, Hyun Su Kim, Taylor Schilling, William Telfer, Alison Jin, Justin Baraboo, Maurice Pradella, Michael Markl, Rod S Passman, Majd El-Harasis, Ben B Shoemaker, Animesh A Tandon, John Barnard, Mina K Chung, Anant Madabhushi
Journal: Circulation (2023)

Purpose: Catheter ablation is a popular treatment option for atrial fibrillation (AF), but AF recurrence is common. Currently, no marker exists to reliably predict the risk or location of recurrence (AF+). In this work, a multimodal imaging approach was employed to identify surface of interest (SOI) associated with recurrence using pre-ablation MRI and CT scans. Hypothesis: Shape of the left atrium (LA) plays a critical role in AF recurrence. The difference between AF+ and AF- may be identified on pre-ablation scan and may find potential sites for additional pre-emptive ablation. Method: Two representative template scans were selected from each group and all patients were registered to these respective templates to develop an atlas for each group. The two atlases were then co-registered, and the difference areas were obtained using a t-test with 500 permutations. The SOI was identified as the area that showed statistically significant (p &lt;0.05) differences between the AF+ and AF-. The process was repeated 5 times to obtain most frequent SOI. Since no ground truth for SOI exists, we used a multimodal imaging approach to construct atlases on CT and MRI; the corresponding SOIs were compared. Results: 102 CT (51 AF+) and 160 MRI (79 AF+) scans collected from Cleveland Clinic and Vanderbilt University were randomly sampled 5 times. At each iteration 20 patients from AF+ and AF- patients were randomly chosen and employed to create atlases for generating SOIs. The dice sore of MRI and CT derived SOI were 0.75± 0.08 and 0.82±0.05, respectively. The SOI region was below the LA appendage and left inferior pulmonary vein on both CT and MRI. The ratio of significant region to LA volume were [9%-18%] and [8%-19%] for CT and MRI, respectively indicating a good agreement between two SOIs. Conclusion: We identified SOI associated with AF+ from CT and MRI and found correlation between them at sites expected to be near the vein of Marshall, an area increasingly targeted for recurrent AF after prior ablation.