tbuckley/cabot-search huggingface dataset:
Abstract 4139619: Longitudinal Assessment Using a Mobile Text-Messaging Based Platform Demonstrates High Rates of Transitions in Dual Users of Electronic and Combustible Cigarettes
Authors: Madeleine Burns, Erika Minetti, Joseph Palmisano, Rachel Hoover, Aruni Bhatnagar, Rose Robertson, Rachel Keith, Naomi Hamburg
Journal: Circulation (2024)

Background/Aims: The increasing use of electronic cigarettes (e-cigs) has resulted in complex tobacco use patterns that may change with time within individuals. We developed a mobile platform to capture use patterns and transitions over time in young adults. Methods: Individuals 18-45 years old in the Cardiovascular Injury Due to Tobacco Use (CITU 2.0) study completed a detailed baseline questionnaire followed by enrollment in a text message-based mobile platform (Agile Health, Inc) that collected self-reported tobacco use patterns and transitions over 24 months. Baseline use patterns (sole e-cig use, sole combustible cigarette use, dual use, and non-use) and transitions (changing from one use group to another) monthly until last follow-up are reported. Models were used to predict likelihood of non-use (no tobacco products) or non-combustible use (sole e-cig or non-use) at follow-up. Results: 264 individuals were enrolled at baseline: 87 sole e-cig users, 46 sole combustible users, 91 dual users, and 40 non-users. On monthly follow-ups, the dual use pattern was associated with the highest rate of cumulative transitions, 3 by 6 months, compared to 1 for sole e-cig use. By last follow-up, 65% of the dual use pattern transitioned compared to relatively stable use in the sole e-cig and combustible cigarette use groups (Figure). Rate of uptake of combustible cigarette use in sole e-cig users was low (6%). In logistic regression models, compared to combustible cigarette users, dual users were more likely to make a transition (OR 5.9, p&lt;0.0001), but not sole e-cig users (OR 1.7, p=0.2). Neither group of e-cig users had a higher rate of transition to non-use than combustible cigarette users (dual use OR 1.2, p=0.7, sole e-cig OR 2.1, p=0.1). However, rates of non-combustible use at follow-up were higher in both sole e-cig (OR 55.5, p&lt;0.0001) and dual users (OR 3.2, p=0.006). Conclusions: Frequent longitudinal assessment of tobacco use patterns revealed important details regarding rates of transitions with highest levels amongst dual users of e-cig and combustible cigarettes. Rates of transition to non-use were low across all tobacco product users, with higher rates of transition to non-combustible use amongst dual users when compared to combustible users. Future studies will be important to understand methods to enhance tobacco product cessation amongst all use groups.
Abstract 4139617: Cardiovascular disease prevention and control interventions: a review of state of implementation science and implication for sub-Saharan Africa
Authors: Celestin Hategeka
Journal: Circulation (2024)

Background: As the burden of cardiovascular diseases (CVD) in sub-Saharan Africa (SSA) rises, context-specific evidence on how to successfully scale proven CVD prevention and control interventions is urgently needed. Objective: To assess the current state of implementation science on priority CVD prevention and control interventions provided within health systems in low- and middle-income countries (LMICs). Methods: EMBASE and MEDLINE databases were searched from 1990 through 2021 to identify implementation science studies on the World Health Organization priority CVD control interventions provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Extracted data were synthesized narratively using descriptive statistics. Subgroup analysis was performed to describe the available context-specific evidence in SSA. Results: Of the unique records screened for inclusion, 103 eligible studies evaluated 145 priority CVD prevention and control interventions implemented in 38 countries. Of these studies, only 8% were conducted in SSA and focused on 15 interventions. Prevention interventions accounted for 18% overall and 8% in SSA, screening for 12% overall and 23% in SSA, and treatment for 70% overall and 69% in SSA. The implementation strategies were not specified well enough. Feasibility was the most studied implementation outcome whereas sustainability was the least studied. Most studies used quantitative methods and weak study designs. Most studies reported funding (77%), with international funding being the predominant source. Most studies were pilot (86% overall vs 92% in SSA) and targeted the micro level of health system (73% vs 92% in SSA). Conclusions: Implementation research on CVD in LMICs has risen steadily over the last few decades; however, major gaps in the science persists especially in SSA. Future studies should prioritize implementation at scale, target higher levels health systems and test sustainability of CVD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
Abstract 4139762: Structural and Functional Changes in the Left Atrium Following Arteriovenous Fistula Placement
Authors: Zachary Daniel, John Leso, John Musumeci, Krishnakumar Hongalgi, Mikhail Torosoff
Journal: Circulation (2024)

Background: Arteriovenous fistula (AVF) remains the preferred method of vascular access in patients requiring long-term maintenance hemodialysis for end stage renal disease (ESRD). However, the AVF creates an acute left-to-right shunt, with the potential to cause high output heart failure. RESEARCH QUESTIONS: In patients with ESRD and AVF placement: 1) What is the effect of AVF on left atrial (LA) anatomy and function in patients with atrial fibrillation/atrial flutter (AF)? 2) What are the longitudinal effects of AVF placement on prevalence of AF? Methods: We retrospectively analyzed 179 consecutive ESRD patients who underwent AVF placement from 2008-2022 at a single tertiary academic center. Trans-thoracic or trans-esophageal echocardiograms were compared for each patient pre- and post-AVF placement. The median interval between echocardiograms was 2.3 years. Results: AF was noted in 19.0% of patients prior to AVF placement. An additional 11.2% of the overall cohort developed AF during the study period (59% interval increase). Patients with AF were older (p=0.002), had greater body surface area (p=0.037), and were more likely to have a history of diabetes (p=0.01), but otherwise there were no significant differences in baseline comorbidities. AVF placement was associated with a significant increase in LA maximum volume in the overall cohort (70.0+/-32.2 mL post-AVF from 52.1+/-21.0 mL pre-AVF, p&lt;0.001). In patients with AF, LA maximum volume was significantly larger post-AVF compared to those without AF (79.7+/-28.7 vs 60.8+/-26.8 mL, p=0.004). LA strain was significantly lower in patients with AF pre-AVF (42.8+/-11.7% vs 52.5+/-13.6%, p&lt;0.001) and post-AVF (39.9+/-13.1% vs 49.9+/-14.4%, p&lt;0.001). Incidence of newly reduced left ventricular ejection fraction post-AVF was 13% in patients with AF (7/54) compared to 6.4% (8/125, p=0.146) in those without. Conclusion: Patients who undergo AVF placement for ESRD are at significant risk for subsequent development of AF, with adverse hemodynamic consequences. Close monitoring of cardiac rhythm, anatomy, and function is warranted in the post-AVF cohort. Additional studies to examine optimal management of this vulnerable population are needed.
Abstract 4139043: Artificial intelligence-enabled detection and phenotyping of left ventricular hypertrophy on real-world point-of-care cardiac ultrasonography and its implications for patient outcomes
Authors: Evangelos Oikonomou, Gregory Holste, Andreas Coppi, Cristiana Baloescu, Robert McNamara, Rohan Khera
Journal: Circulation (2024)

Introduction: Point-of-care ultrasonography (POCUS) is routinely performed across emergency departments (EDs), but interpretation is generally restricted to acute pathology. We sought to evaluate the outcomes of individuals who had undergone an ED POCUS, but were never diagnosed with cardiomyopathy, using artificial intelligence (AI)-defined signatures of left ventricular hypertrophy (LVH) and key sub-phenotypes (hypertrophic cardiomyopathy [HCM], transthyretin amyloid cardiomyopathy [ATTR-CM], and aortic stenosis [AS]) on POCUS. Methods: First, using 261,756 videos from 9,667 standard transthoracic echocardiograms (TTEs) across a large, diverse health system, we trained a view quality-adapted, video-based deep learning model to detect a) LVH, representing the mean of a multi-label classifier for i) moderate or greater nominal severity as reported by the echocardiographer; ii) left ventricular posterior wall thickness [LVPWd] of ≥1.3 cm, and/or iii) interventricular septum thickness [IVSd] of ≥1.3 cm, and b) known cardiomyopathy defined by non-mutually exclusive labels of i) ATTR-CM, ii) HCM, and/or iii) AS ( Fig. 1A ). We deployed these tools among adult patients without known cardiomyopathy who underwent clinical POCUS across EDs (2013-2023) linked to in-hospital and out-of-hospital death data. We explored the association between distinct label output probabilities and all-cause mortality in age- and sex-adjusted Cox regression models ( Fig. 1B ). Results: Among 24,448 individuals (median age 58, [IQR 40-73] years; 13,478 [55.1%] women) followed over 2.2 [IQR: 1.1-5.8] years, higher AI-POCUS probabilities for LVH were associated with worse long-term prognosis, with a 29% higher mortality risk in the highest vs lowest AI-defined quintile (adj. HR 1.29 [95%CI: 1.13, 1.46]) ( Fig. 2A ). When stratifying based on the probability of distinct phenotypes, an ATTR-CM-like phenotype in the highest (vs lowest) quintile conferred a 39% higher adjusted risk of death (adj. HR 1.39 [95%CI: 1.22, 1.59]) ( Fig. 2B ). Similarly, there was a 14% (adj. HR 1.14 [95%CI: 1.01, 1.30]) and 15% (adj. HR 1.15 [95%CI: 1.02-1.29]) higher risk of death in the highest (vs lowest) AS ( Fig. 2C ) and HCM ( Fig. 2D ) phenotypic quintiles, respectively. Conclusions: AI-enabled automated identification and phenotyping of LVH is feasible on routine POCUS studies and identifies individuals who are at risk of premature mortality, potentially due to undiagnosed cardiomyopathy.
Abstract 4138984: Investigation of the effect of aortic valve replacement in severe aortic stenosis and transthyretin cardiac amyloidosis
Authors: Tomotaka Fujimoto, Kan Zen, Tetsuhiro Yamano, Yuki Matsubara, Takuma Iwaya, Motoyoshi Takahara, Masaki Yashige, Michiyo Yamano, Satoshi Numata, Takeshi Nakamura, Satoaki Matoba
Journal: Circulation (2024)

Wild-type transthyretin amyloidosis (ATTR) is a potential one of the underlying causes of heart failure in the elderly, and in recent years, the complication rate with severe aortic stenosis (AS) has been reported to be higher than previously expected. We suspected cardiac amyloidosis (CA) in 142 of 824 patients referred for Severe AS between March 2020 and December 2023 and screened according to guidelines. Pathology was able to diagnose cardiac amyloidosis in 13 cases (1 immunoglobulin light chain, 11 ATTR, and 1 case of unknown type). Four cases were positive for technetium 99m pyrophosphate cardiac imaging and pathology could not be confirmed. Technetium 99m pyrophosphate cardiac imaging was negative in 125 cases. Of these, 115 patients (10 patients of ATTR-AS vs. 105 patients of Lone AS) who could be followed up after 6 months were compared. The median age of all patients was 85 years (interquartile range: 83 to 88) and 30.4% were male (60.0% vs. 27.6%; p=0.065). Pre-operative high-sensitivity troponin I values were higher in ATTR-AS group (58.2 [42.1 to 177.2] pg/mL vs. 20.2 [11.1-47.5] pg/mL; p=0.001), left ventricular ejection fraction tended to be lower (51.7 [41.7 to 58.8] % vs. 63.6 [54.3 to 69.3] %; p=0.015) and left ventricular mass index (LVMi) was significantly higher; no significant differences in AS severity were observed. Only one case of ATTR-AS was treated with surgical aortic valve replacement (AVR), while the other cases were treated with transcatheter AVR. Six months after AVR, there was no regression of LVMi and no statistically significant improvement in left ventricular diastolic and systolic performance in ATTR-AS group. Furthermore, New York Heart Association cardiac function classifications tended to have residual symptoms. The effect of therapeutic intervention on the aortic valve may be limited in ATTR-AS and is reported with a literature review.
Abstract 4140358: Predictors Of The Need For Powered Extraction Sheaths During Transvenous Lead Extraction
Authors: Wissam Mekary, Mikhael El-Chami, Neal Bhatia, Michael Lloyd, Stacy Westerman, Anand Shah, Miguel Leal, David Delurgio, Anshul Patel, Christine Tompkins, Faisal Merchant
Journal: Circulation (2024)

Introduction: The need for powered sheaths, either laser or mechanically-powered, may increase risk during transvenous lead extraction (TLE). Tools to better predict the need for powered sheaths may facilitate procedural risk stratification. Methods: We identified all TLE procedures at Emory Healthcare from 2007-2023. Clinical characteristics and procedural details were collected from medical records. Although the specific details of the extraction procedure were at the discretion of the operator, extraction of targeted leads typically followed a stepwise approach of simple traction, with or without a locking stylet, followed by use of powered sheaths, if needed. Results: Out of 1,717 TLE procedures, 849 (49.4%) used powered sheaths. The dwell time of the oldest lead targeted for extraction was significantly longer in cases requiring powered sheaths: 8.7 ± 5.6 vs. 2.3 ± 2.6 years, p&lt;0.001. Powered sheath use as a function of lead dwell time is presented in Figure 1A. Even among leads with dwell times of &lt;1 year, 6% of pacing and 7% of defibrillator leads necessitated powered sheaths. The number of leads targeted for extraction was also higher in cases requiring powered sheaths: 1.8 ± 0.9 vs. 1.6 ± 0.7 leads, p&lt;0.001. In a multivariate model (Figure 1B), increased lead dwell time, increased number of leads, presence of a defibrillator and renal dysfunction were associated with increased likelihood of needing powered sheaths. In contrast, infectious indication for extraction and the presence of a coronary sinus lead were associated with lower likelihood of needing powered sheaths. Major procedural complications (1.8 vs. 0.9%, p=0.13) and procedural deaths (0.8 vs. 0.2%, p=0.09) were numerically higher with powered sheaths. Conclusion: A significant minority of leads with dwell time &lt;1 year require powered sheaths for extraction. Longer lead dwell time, increased lead number, presence of a defibrillator and renal dysfunction are associated with increased likelihood of needing powered sheaths. These data may guide pre-operative risk stratification and facilitate tailored use of resources for TLE, such as cardiac surgical back-up.
Abstract 4138150: Modern Breast Radiation and Comprehensive Echocardiography-Derived Measures of Cardiac Function
Authors: Eva Berlin, Nicholas Wilcox, Kyunga Ko, Lin Ma, Ian Messing, Casey Hollawell, Amanda Smith, Jenica Upshaw, Daniel Koropeckyj-Cox, Jessica Wang, Hayley Knollman, Amy Clark, Payal Shah, Saveri Bhattacharya, Neil Taunk, Vivek Narayan, Nikhil Yegya-Raman, Megi Sula, Benedicte Lefebvre, Gary Freedman, Bonnie Ky
Journal: Circulation (2024)

Background: Radiation therapy (RT) has resulted in significant improvements in breast cancer outcomes, but cardiac morbidity remains an important concern. We evaluated the changes in cardiac function after breast RT and the relationship between cardiac dose metrics and echocardiography-derived measures of cardiac function. Methods: We performed detailed quantitation of radiation cardiac dose metrics and echocardiographic measures of cardiac function in a prospective longitudinal cohort study of racially diverse women with breast cancer treated at a quaternary healthcare system. Radiation cardiac dose metrics included whole heart, left ventricle (LV), right ventricle (RV) and left anterior descending artery (LAD). Echocardiographic measures included LV ejection fraction (LVEF), longitudinal strain, circumferential strain, E/e’, ventricular-arterial coupling, and RV fractional area change. The mean change in echocardiogram measures from pre-RT, and 6, 12, 24, 36 months post-RT, and the association between cardiac dose metrics and echocardiogram measures, were estimated by repeated measures multivariable linear regression via generalized estimating equations. Analyses were stratified by treatment site (right versus bilateral/left). Results: 303 participants (33% African American) received adjuvant RT between 2010-2019, and had an echocardiogram performed within three months prior to the start of and after RT. The median mean heart dose (MHD) was 1.19 Gy (Q1-Q3, 0.75-2.61). LVEF increased over time (pre-RT 52.1% to 53.6% at 3 years; p = 0.004), and consistent with this, ventricular-arterial coupling decreased (pre-RT 1.02 to 0.93 at 3 years; p = 0.03). MHD was significantly associated with systolic and diastolic function measures, but the effect sizes were small. For each IQR increase in MHD, there was a 0.31% (95% CI 0.04, 0.57) worsening in longitudinal strain. The maximum LAD dose was associated with multiple echocardiographic parameters, including LVEF (-0.85, 95% CI: -1.58, -0.13), longitudinal strain (0.62, 95% CI: 0.17, 1.08), and circumferential strain (0.64, 95% CI: 0.00, 1.28) for bilateral/left-sided RT. Conclusion: Modern breast RT was not associated with a clinically important effect on echocardiographic measures of cardiac systolic and diastolic function over a median follow-up of two years. Our findings provide clinically actionable guidance and reassurance regarding the cardiac safety of RT for breast cancer patients in the modern era.
Abstract 4138960: Survival Outcomes of Adults with Fontan Circulation Followed in an ACHD Center
Authors: Andrew Freddo, Molly Eron, Antara Mondal, Alexis Zavez, Srinivas Denduluri, Sara Partington, Emily Ruckdeschel, Allison Tsao, Sumeet Vaikunth, Yuli Kim
Journal: Circulation (2024)

Introduction: More patients with Fontan circulation are surviving into adulthood and transitioning to adult congenital heart disease (ACHD) care. There are limited long-term outcome data in these patients. Research Questions: We sought to describe a cohort of adults with Fontan circulation and determine patient characteristics associated with long-term survival. Methods: A retrospective review of adults with Fontan circulation followed in our ACHD clinic between 2009 and 2023 was performed. The outcome of interest was transplant-free survival. Survival analysis was performed to explore association between patient factors and time from Fontan completion to patient death or transplant. Patients without events were censored at last follow-up date. Results: In our cohort of 429 patients, median age at first ACHD visit was 24 (IQR 22-29) years with median follow-up time of 3.9 (IQR 0.6-6.4) years. The most common underlying anatomies were tricuspid atresia (26.5%) and hypoplastic left heart syndrome (25.4%). Fontan completion, most commonly lateral tunnel (59.1%), was performed at a median age of 29.7 months. Extracardiac comorbidities in our cohort included: cirrhosis (42.9%), cyanosis (25.9%), and protein losing enteropathy (PLE) (7.0%). Forty-one patients (9.6%) died, 17 (4.0%) had a heart-liver transplant, and 2 (0.5%) had a heart transplant. Transplant-free survival at 20, 30, and 40 years after Fontan completion was 99%, 87%, and 63%. In total, 10 patients died from end-stage heart failure, 8 from sudden cardiac arrest, and 5 from post-transplant complications (Figure). Morphologic right ventricle, cirrhosis, cyanosis, and PLE were associated with worse transplant-free survival (Table). Conclusions: Factors associated with decreased transplant-free survival in a cohort of adult patients with Fontan circulation were identified. These data highlight the importance of early identification and potential intervention for these comorbidities to improve long-term outcomes.
Abstract 4139639: Clinical Outcomes after Ventricular Tachycardia Ablation With or Without Induction
Authors: Benjamin Freedman, Shu Yang, Jonathan Waks, Andrew Locke, Timothy Maher, Andre d'Avila
Journal: Circulation (2024)

Introduction: Substrate mapping may offer a safer alternative to VT mapping by avoiding prolonged episodes of VT during catheter ablation. However, VT induction to gauge procedural efficacy is still routinely attempted following substrate ablation, thereby exposing patients to potentially unnecessary hemodynamic risk. Objective: To assess the feasibility and efficacy of VT ablation without any attempted VT induction. Methods: Patients with ICDs who underwent VT ablation between August 2020 and May 2023 were assessed retrospectively. Ablation and induction strategies were at the operators’ discretion. Patients with or without attempted VT induction were compared with respect to 6-month VT burden reduction using univariable linear regression; and the 1-year incidence of recurrent VT, heart transplant or death using multivariable Cox regression. Results: Eighty-nine consecutive patients (median age 68 years, 89% male, 51% infarct-related cardiomyopathy, mean LVEF 38%) were followed for a median of 16 months after VT ablation. VT induction was attempted in 63% of patients. The median (IQR) reduction in VT burden was similar in the induction and non-induction groups (96% [0%, 100%] vs. 100% [93%, 100%], p = 0.20). There was no difference between induction and non-induction groups in the 1-year incidence of recurrent VT, heart transplant or death (62% vs. 42%, HR 1.26, 95% CI 0.61-2.62, p=0.54) after adjusting for cardiomyopathy type, VT storm, pre-ablation cardiac CT/MRI, baseline creatinine, pre-ablation VT burden and the presence of NYHA Class III-IV heart failure symptoms. Conclusion: In a single-center study of 89 consecutive VT ablations, a non-induction strategy was equally effective to an induction strategy in reducing 6-month VT burden and 1-year risk of VT recurrence, transplant or death. Our findings suggest that VT induction, recognized as a risk factor for hemodynamic compromise, may be avoided in some patients without sacrificing procedural efficacy.