tbuckley/cabot-search huggingface dataset:
Abstract 8864: Left Bundle Branch Area Pacing is Non-Inferior to His Bundle Pacing in Achieving Physiologic Repolarization and T-Wave Memory Resolution
Authors: Anshul Gupta, Behzad B Pavri
Journal: Circulation (2021)

Introduction: We have previously reported that His bundle pacing (HBP) results in more physiologic ventricular repolarization as compared to conventional biventricular pacing. Left bundle branch area pacing (LBAP) is increasingly used as the preferred modality of physiologic pacing due to ease of implantation and low long-term pacing thresholds. LBAP and HBP are comparable in terms of achieving physiologic left ventricular (LV) depolarization. However, their effects on ventricular repolarization have not been assessed. Established ECG markers of arrhythmic risk can be used to compare ventricular repolarization across these two modalities of physiologic pacing. Hypothesis: LBAP is not inferior to HBP in its effects on ventricular repolarization and T-wave memory resolution. Methods: The following parameters were analyzed in patients with HBP (n = 34) and LBAP (n = 16) from post-implant ECGs: 1) QTc: QT corrected using Bazett’s formula in lead V5, and if not measurable, in V4 or V6 2) QTc Dispersion: Longest minus shortest QTc from precordial leads 3) Tp-Te Transmural: T-peak minus T-end in same lead as 1) 4) Tp-Te Total: Earliest T-peak minus latest T-end from all precordial leads 5) Tp Dispersion: Latest minus earliest T-peak from precordial leads To analyze T-wave memory resolution, QRS-T angles were compared using ECGs within 10 days of and after ≥ 25 days post implant. Results: See tables. Median time from implant to 1st ECG for both groups was ≤1 day. None of the repolarization parameters were significantly different in HBP vs. LBAP groups. Conclusion: All repolarization markers of arrhythmic risk were similar in HBP vs. LBAP. Both modalities showed similar effects on T-wave memory resolution. These data suggest that LBAP, in addition to achieving physiologic LV depolarization, is not inferior to HBP in achieving physiologic ventricular repolarization. These observations further support the increasing use of LBAP as the preferred modality for physiologic pacing.
Abstract 6985: Real-World Incidence and Factors That Contributes to the Development of Acute Kidney Injury in Patients Receiving Impella for Hemodynamic Support in a Community Based Health Care System
Authors: Arvind Kalyan Sundaram, Stephen J Voyce, Samantha Crissinger, Erin Vanenkevort, Srilakshmi Kandadai
Journal: Circulation (2021)

Introduction: Impella is a peripherally inserted ventricular assist device used for providing hemodynamic support in patients with cardiogenic shock and/or high risk percutaneous coronary interventions (PCI). The aim of the study was to examine the incidence and factors that can impact acute kidney injury (AKI) in a real world, community-based patient population. Methods: A retrospective observational study was conducted on patients with an Impella placed between January 2015- March 2020 at three hospitals within the Geisinger Health Care System. Results: Of the ninety-nine patients identified, 58 patients (58.3%) developed AKI. In those who had Impella placed electively (n=15), 3 patients (20%) developed AKI. In the urgent group (n=35), 9 patients (25.8%) developed AKI. In the emergent group (n=28), 12 patients (42.9%) developed AKI and in the salvage group (n=20), 8 patients (40%) had AKI. The acuity of the procedure did not significantly impact the subsequent development of AKI (p = 0.38). Chronic kidney (CKD) was present in 35 patients (35.4%) in the group and 15 (42.9%) developed AKI. In the 64 patients without CKD, 17 patients (26.6%) had AKI. The difference among the two group was not significant (p = .097). Patients with higher BMI had a lower likelihood of developing AKI compared to the lower BMI patients (p = .001). Patients with a longer duration of Impella implantation had a lower incidence of AKI (p = .001). Conclusions: AKI is a common complication associated with Impella placement, but its development does not appear to be related to the acuity of the procedure. 2. In the current study, the presence of CKD was not a risk factor for developing AKI. 3. Patient with higher BMI and longer duration of Impella had lower likelihood to develop AKI.
Abstract 14426: Comparing Performance of MARKER-HF, a Machine Learning Derived Risk Score, and the Seattle Heart Failure Model in Patients With Heart Failure in a Large, Integrated Health System
Authors: Faraz S Ahmad, Ted Ling Hu, Ramsey M Wehbe, Raja K Mutharasan, Jane E Wilcox, Lucia Petito, Claudio Campagnari, Barry H Greenberg, Avi Yagil, Eric D Adler
Journal: Circulation (2021)

Introduction: Patients with heart failure (HF) who advance from Stage C to Stage D experience progressively higher morbidity and mortality rates. Cardiovascular societies recommend using 1-year mortality risk (≥20%) as a trigger for evaluation by a HF specialist. Application of available risk scores to identify patients at increased risk using electronic health records (EHR) is challenging. Consequently, we compared the performance of MARKER-HF, a machine-learning risk model that uses readily available structured data in the EHR, to the Seattle Heart Failure Model (SHFM), which requires elements derived from both structured and unstructured data, for estimating 1-year mortality risk. Methods: We analyzed an EHR database for ambulatory patients with HF seen in primary care and cardiology clinics from 1/1/10-12/31/19 at Northwestern Medicine. Eligibility criteria included ages ≥18 years old, at least 1-year of follow-up or death within 1-year, no history of heart transplantation or left ventricular assist device implantation, and availability of the 8 variables used to calculate MARKER-HF (diastolic blood pressure, creatinine, blood urea nitrogen, hemoglobin, white blood cell count, platelets, albumin, and red blood cell distribution width). Unavailable or missing variables required for SHFM were imputed. In all HF patients and in those with reduced ejection fraction (HFrEF), we evaluated model discrimination for 1-year mortality using area under the curve (AUC) and compared AUCs with the DeLong test. Results: In a sample of 7130 patients, of whom 1012 died within 1-year, 46.9% were female and median age was 71 (IQR 60-82). The AUC for MARKER-HF and SHFM were 0.69 and 0.64, respectively, for all HF patients and 0.69 and 0.67, respectively, for patients with HFrEF (n=1899). The AUCs for MARKER-HF and SHFM were different for the entire HF population (DeLong p-value=0.01) but not in the HFrEF sub-group. Conclusion: In patients with ambulatory HF at an integrated health system, MARKER-HF produced 1-year mortality estimates with equal (HFrEF) or higher (all HF) discrimination than SFHM using fewer and more readily available variables. These findings suggest that MARKER-HF may facilitate the identification of patients with advanced HF using EHR data.
Abstract 14359: A Hybrid Finite Element and Smoothed-Particle Hydrodynamics Method Can Simulate Peri-Procedural Complications of Thrombectomy
Authors: S. Mostafa M. J. Sarayi, Danial Faghihi, Muhammad Waqas, Adnan H Siddiqui, Vincent M Tutino
Journal: Circulation (2021)

Introduction: Ischemic stroke is a major cause of mortality and morbidity worldwide. Stent retriever thrombectomy (SRT) is a preeminent treatment for large vessel stroke. While effective, SRT only attains first pass success in 30% of cases, and can cause complications, like embolus formation. In silico modeling of SRT facilitates understanding the cause of such complications. Hypothesis: A combination of finite element analysis (FEA) and smoothed-particle hydrodynamics (SPH) can accurately simulate SRT. Methods: We developed a workflow to simulate key SRT steps including stent packaging, delivery, deployment, and clot extraction. The Solitaire X stent was reconstructed from microCT, and FEA with Timoshenko beam elements was used to simulate the superelasticity of the Nitinol wires. Inspired by their structure and components, clots were modeled with a hybrid FEA-SPH method: initially represented in FEA, but as the clot is deformed by the stent, the elements convert to SPH particles, allowing integration of the stent and clot. These methods were used to model SRT of 3 clots with increasing stiffness in a rigid, straight vessel under flow arrest. For validation, the results were compared to in vitro experiments matching the simulations. Results: Our SRT simulations were similar to in vitro tests. In 3 tests, the softest clot was retrieved, but a portion of the tissue was cleaved, creating an embolus, the moderately stiff clot was retrieved successfully, while the stiffest clot was unable to be retrieved. The stress-strain curve of the stent in moderately stiff case showed typical superelastic behavior, and the clot’s curve showed hyperelastic behavior. Conclusions: This study shows the capability of a hybrid FEA-SPH to model SRT and several related clinically-important complications with high accuracy. In the future, this workflow could be used to study mechanisms of peri-procedural complications, or to develop safer, more effective thrombectomy devices.
Abstract 9177: Prognostic Value of Chronic Kidney Disease and Cardiac Sympathetic Dysfunction Assessed by <sup>123</sup> I-metaiodobenzylguanidine Scintigraphy for Lethal Arrhythmic Events in Chronic Heart Failure
Authors: Kazuaki Amami, Shinya Yamada, Takashi Kaneshiro, Akiomi Yoshihisa, Naoko Hijioka, Minoru Nodera, Yasuchika Takeishi
Journal: Circulation (2021)

Introduction: Clinical implication of chronic kidney disease (CKD) and cardiac sympathetic nerve activity (CSNA) for lethal arrhythmic events has not been fully elucidated in patients with chronic heart failure (CHF). Hypothesis: The combination of CKD and abnormal CSNA, assessed by 123 I-metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy, may provide useful prognostic information for the incidence of lethal arrhythmic events. Methods: We studied 165 consecutive hospitalized CHF patients without dialysis. In a clinically stable condition, cardiac 123 I-MIBG scintigraphy was performed. CKD was defined as estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73m 2 , and abnormal CSNA was defined as late heart to mediastinum ratio &lt;1.6. We then investigated the incidence of lethal arrhythmic events (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator therapy, or sudden cardiac death). Results: During a median follow-up of 5.3 years, lethal arrhythmic events were observed in 40 patients (24.2%). The patients were divided into 4 groups according to the presence of CKD and CSNA abnormality: non-CKD/ normal CSNA ( n = 52), CKD/ normal CSNA ( n = 39), non-CKD/ abnormal CSNA ( n = 33), and CKD/ abnormal CSNA ( n = 41).The Kaplan-Meier analysis showed that CKD/ abnormal CSNA had the highest event rate (log-rank p = 0.004). In addition, the multivariable Cox proportional hazard analysis after the adjustment of multiple confounders showed that CKD/ abnormal CSNA was an independent predictor for lethal arrhythmic events compared to non-CKD/ normal CSNA (HR, 4.667, p = 0.006). However, the other two groups did not show significant differences compared to non-CKD/ normal CSNA. Conclusions: The combination of CKD and abnormal CSNA, assessed by cardiac 123 I-MIBG scintigraphy, had a significant prognostic value for the incidence of lethal arrhythmic events in patients with CHF.
Abstract 9189: Diagnostic Validity of Genetic Testing for Hypertrophic Cardiomyopathy - A Systematic Review and Meta-Analysis
Authors: Melissa A Kelly, Allison Cirino, Brittany P Hansen, Stephanie Harris, Andrea M Murad, Jaime Natoli, Jennifer Malinowski, Susan Christian
Journal: Circulation (2021)

Introduction: Hypertrophic cardiomyopathy (HCM) is a routine indication for genetic testing. However, our understanding of the impact of genetic testing on clinical outcomes is limited. This study systematically summarizes the diagnostic validity of genetic testing for patients with HCM and at-risk relatives. Methods: PubMed (MEDLINE), Embase, CINAHL, and Cochrane Central Library were queried using keywords pertaining to HCM, genetic counseling, and genetic testing. The initial search was conducted on July 7, 2017 and updated on March 2, 2020. Abstracts and full-texts were reviewed for original research studies where genetic testing was performed in ≥10 patients with HCM, or their relatives. A total of 132 articles met inclusion criteria. Review was performed according to PRISMA guidelines. Relevant data were extracted and validated by a second reviewer. Risk of bias and quality were assessed using the Cochrane Risk of Bias or Newcastle-Ottawa tools in duplicate. Disagreements were resolved through discussion or a third reviewer. Pooled analyses were performed using random-effects models. Results: Detection rate was significantly higher in pediatric cohorts compared with adults (56% vs. 42%; p=0.01) and in adults with a family history compared to sporadic cases (59% vs. 33%; p=0.005). Use of current variant interpretation standards from the American College of Medical Genetics and Genomics (ACMG) and the Association of Molecular Pathology (AMP) significantly lowered adult detection rate from 42% to 33% (p=0.0001). The mean difference in age-of-onset in adults was significantly younger for genotype-positive versus genotype-negative cohorts (8.3 years; p&lt;0.0001), MYH7 versus MYBPC3 (8.2 years; p&lt;0.0001), and individuals with multiple versus single variants (7.0 years; p&lt;0.0002). Disease penetrance in adult cohorts was 62%, but differed significantly depending on if probands were included or excluded (73% vs. 55%; p=0.003). Conclusions: This meta-analysis is the largest, if not the first, to refine and quantify historical understandings of detection rate, genotype-phenotype associations, and disease penetrance for HCM, therefore allowing everyday clinical questions to be answered with more confidence
Abstract 9205: Cardiovascular Health Metrics in Patients Hospitalized With an Acute Coronary Syndrome
Authors: Jordy Mehawej, Eric Ding, Hawa O Abu, Darleen Lessard, Jane Saczynski, David D McManus, Catarina I KIEFE, Robert Goldberg
Journal: Circulation (2021)

Background: The Life’s Simple 7 (LS7) is a guiding metric for primordial/primary prevention of cardiovascular disease. However, little is known about the prevalence and distribution of LS7 metrics in patients with an acute coronary syndrome (ACS) at the time of hospitalization. Methods: Data were obtained from patients hospitalized for an ACS at six hospitals in Central Massachusetts and Georgia (2011-2013). The LS7 assessed patient’s smoking, diet, and physical activity, based on self-reported measures, while patient’s body mass index, blood pressure, and serum cholesterol and glucose levels were abstracted from medical records. All items were operationalized into three categories: poor (0), intermediate (1), or ideal (2). A total summary cardiovascular health (CVH) score (0-14) was obtained and categorized into tertiles (0-5, 6-7, and 8-14). Results: The average age of study participants (n=1,110) was 59.6 years and 35% were women. CVH scores ranged from 0-12 (mean=6.2). Patients with better CVH scores were older, White, had lower burden of comorbidities, had less symptoms of anxiety, depression, and stress, better quality of life, more social support, and greater healthcare activation. One-third of patients had only one ideal CVH measure, less than 1% had five ideal measures, and no participant had more than five ideal CVH factors. Conclusions: Our results indicate that ACS patients have low CVH. Sociodemographic, clinical, and psychosocial characteristics differed across CVH groups. These findings highlight potential areas for educational and therapeutic interventions to reduce the risk of cardiovascular disease and promote CVH in adult men and women.
Abstract 9969: Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Individuals with Absent Coronary Artery Calcium: Results from the Multi-Ethnic Study of Atherosclerosis
Authors: Mahmoud Al Rifai, Michael J Blaha, VIJAY NAMBI, Steven Shea, Erin Michos, Roger S Blumenthal, Christie M Ballantyne, Moyses Szklo, Philip Greenland, Michael Miedema, Khurram Nasir, Jerome I Rotter, Xiuqing Guo, Jie Yao, Wendy Post, Salim S Virani
Journal: Circulation (2021)

Introduction: We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) among individuals with absent coronary artery calcium (CAC=0) over long-term follow-up. Methods: We included participants with CAC=0 at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of individuals free of clinical ASCVD at baseline. After calculating crude event rates, we used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors [cigarette smoking, diabetes mellitus, hypertension, preventive medication use (aspirin and statin), family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers] and adjudicated incident ASCVD events. Results: The study population consisted of 3,416 individuals with CAC=0 (mean (SD) age 58 (9) years; 63% were female, 33% White, 31% Black, 12% Chinese-American, and 24% Hispanic. At a median follow-up of 16 years, there were 189 ASCVD events (101 CHD, 98 stroke). The unadjusted 16-year incidence rates of ASCVD were ≤5 per 1000-person-years among individuals with CAC=0 with the exception of current cigarette smoking (7.30), diabetes mellitus (8.92), hypertension (5.44), and chronic kidney disease (6.75). ASCVD event rates were 6.19 per 1000 person-years among those with estimated baseline ASCVD risk 7.5%–&lt;15% and 5.87 per 1000 person-years among those with estimated ASCVD risk 15%–&lt;20%. After multivariable-adjustment, risk factors that were significantly associated with ASCVD: hazard ratio (HR) 95% confidence interval (CI) included current cigarette smoking: 2.12 (1.32,3.42), diabetes mellitus: 1.68 (1.01,2.80), and hypertension: 1.57 (1.06,2.33). Conclusion: In a middle-age population free of ASCVD at baseline, current cigarette smoking, diabetes mellitus, and hypertension are independently associated with incident ASCVD over 16-year follow-up among those with CAC=0. If considering a long treatment horizon, it may be reasonable to continue to recommend statin therapy in the presence of these risk factors despite the absence of CAC.
Abstract 9218: The Long Non-Coding Rna <i>Caren</i> Improves Cardiac Dysfunction in Aged Mice
Authors: Michio Sato, Keishi Miyata, Tsuyoshi Kadomatsu, Koichi Node, Yuichi Oike
Journal: Circulation (2021)

Background: Heart failure (HF) is the predominant cause of hospitalization and amongst the leading causes of death in developed countries. Especially, the prevalence of HFpEF is increasing and its prognosis is not improving. Our understanding of HFpEF pathophysiology is incomplete and optimal treatment remains uncertain. Under such circumstance, recently, it has been reported that some lncRNAs expressed in heart play important roles in cardiac development and disease. Methods and Results: Using a gene trapping approach in mouse embryonic stem cells, we identified Caren (for car diomyocyte- en riched noncoding transcript), a cytoplasmic lncRNA abundantly expressed in cardiomyocytes. Caren overexpression in cardiomyocytes activated mitochondrial biogenesis by upregulating of Tfam protein and attenuated TAC-induced activation of Ataxia Telangiectasia Mutated (ATM), a key regulator of DNA Damage Response (DDR). Moreover, TAC operated mice treated with AAV6- Caren relieved reduction of fractional shortening (%FS) and improved dilatation of left ventricular. Next, proteomics analysis revealed that Histidine triad nucleotide-binding protein1 (Hint1) which activates the ATM-DDR pathway was reduced in Caren transgenic mice. Moreover, 24-month-old WT mice treated with AAV6- Caren diminished systolic and dilatation capacity were improved. And electron microscopy analysis revealed that mitochondrial cristae were restored and the numbers of mitochondria were increased in the heart of 24-month-old WT mice treated with AAV6- Caren compared with the mice treated with AAV6-GFP as control. Conclusion: A cytoplasmic lncRNA Caren improves not only systolic function but also diastolic function in failing / aged heart by suppressing the ATM-DDR pathway and activating mitochondrial bioenergetics.
Abstract 14352: Echocardiographic Findings With Troponemia and Its Correlation in COVID-19 Patients
Authors: Rashid Alhusain, yasar sattar, David Song, Abdalaziz Awadelkarim, John Dayco, Lekiesha Porter, Mohammed Uddin, Nathan Zaher, Sarah Kisha, Mohammed Ali, Mohamed Zghouzi, Waqas Ullah, M C Alraies
Journal: Circulation (2021)

Introduction: Echocardiogram findings with Troponemia and its correlation in COVID 19 patients are not well studied Methods: Mean and standard deviation (SD) for continuous variables with normal distribution were reported. Pearson chi-square was performed to see the clinical correlation of dependent variables including regional wall motion abnormalities (RWMA), diastolic dysfunction (DF), paradoxical septal wall motion (PSWM) and pericardial effusion in COVID-19. The primary outcome was to observe the effect on in-hospital mortality and 1 year mortality of echocardiographic findings. Our secondary outcome was to retrospectively see the association of gender with echocardiographic findings. Results: In this small, retrospective, single-center study from an epicenter city of COVID-19 at the Detroit Medical Center. We included a total of 122 patients with confirmed COVID-19. The mean age of the cohort was 67.3 years SD= 14. The mean troponin (Tn) at baseline admission was 173 ng/l SD±762 (normal=3-17 ng/l), while the peak Tn were 693 SD±2941. The baseline RSVP was 16 SD±20, while the peaked RSVP was 4 SD±13. Statistically significant associations of RWMA are shown in figure 1. We also found statistically significant differences in DF with presence of MVR (21/35; p&lt;0.05), and RWMA (event/total; 14/35; p&lt;0.05). We also found significance for RV dilation on initial echo for RVH (11/31; p&lt;0.05), and peaked MVR (6/31; p&lt;0.05). We also found statistically significant differences of PSWM for inpatient mortality (3/3; p&lt;0.05), RVH ( 2/ 3; p &lt;0.05), and LTVMV (3/3 ; p &lt;0.05). We found statistical significance of pericardial effusion and LTVMV (3/14; p &lt;0.05). We found statistical significant correlation of gender and RVH on admission echocardiogram: (Male 15/79; Female 2/43; p&lt;0.05), and RWMA (Male 7/79; Female 0/43; p&lt;0.05). Conclusion: COVID-19 patients have high mortality in the presence of RWMA and PSWM