tbuckley/cabot-search huggingface dataset:
Abstract 16561: Noninvasive Left Ventricle Pressure-Volume Loop Determination Method With Cardiac Magnetic Resonance Imaging and Carotid Tonometry Using a Physics-Informed Approach
Authors: Jing Liu, Alda Bregasi, Gary F Mitchell, Niema M Pahlevan
Journal: Circulation (2023)

Introduction: The left ventricle (LV) pressure-volume loop (PV-loop) is a powerful tool for evaluating LV function. Current non-invasive cardiac MRI-based methods for estimating LV PV-loops provide limited diastolic LVP information (Circ Cardiovasc Imaging. 2019; PMID: 30630347). Aim: In this study, we introduced a new noninvasive method for PV-loop determination from cardiac MRI and noninvasive carotid pressure waveform using a physics-informed optimization method. Methods: LV volumes (LVV) were computed using short axis MRI images from a standard clinical protocol, while noninvasive carotid pressure waveforms were obtained using arterial tonometry in a clinical cohort consisting of 51 healthy and 25 heart failure (HF) participants. We formulated constraints and objective functions to optimize a time-varying LV elastance model (double-Hill) based on LVV and carotid pressure waveforms, considering LV-arterial coupling during aortic valve opening and decoupling during closure. This model allowed for individualized characterization of systolic and diastolic LV pressure and LV PV-loop. Results: In HF, our PV-loop analysis produced significantly smaller stroke work (p&lt;0.0001), mean external power (p&lt;0.05), ESPVR (p&lt;0.0001), ventricular efficiency (p&lt;0.0001), Ees/Ea (p&lt;0.0001), LV systolic pressure (p&lt;0.05), and +dP/dt (p&lt;0.05. Additionally, there was an increase in potential energy (p&lt;0.0001) and LV end-diastolic pressure (LVEDP) (p&lt;0.05) for the HF group (Fig. 1). These observations were all consistent with general PV-loop characteristics of HF patients. Previous methods failed to capture certain functional characteristics of HF, including reduced stroke work, decreased mean external power, and elevated LVEDP. Conclusions: Our physics-informed optimization method effectively captures HF-related functional changes in LV PV-loops. This method may facilitate noninvasive HF diagnostics and lead to improved therapeutic management.
Abstract 18177: Novel Pre-Operative Non-Invasive Computational 12-Lead ECG Mapping to Facilitate Surgical Ablation of Ventricular Arrhythmias
Authors: Gordon Ho, Victor Pretorius, Joelle M Coletta, Jonathan Artrip, Michael M Madani, Gregory K Feld, David E Krummen
Journal: Circulation (2023)

Background: In patients undergoing cardiac surgery who have ventricular arrhythmias (VAs) such as VT, VF, or PVCs, concurrent surgical ablation is an attractive therapeutic strategy. However, electrophysiologic mapping systems are not routinely available in the OR and it may be difficult to localize the VA origin. We developed a workflow incorporating novel 12-lead ECG computational model-based mapping to localize VAs. Hypothesis: We hypothesized that use of pre-operative computational ECG mapping can help guide surgical ablation of VAs in patients undergoing cardiac surgery. Methods: Patients undergoing cardiac surgery with pre-existing VT, VF or PVCs were enrolled with informed consent. A standard 12-lead ECG of the VA was recorded in the clinic or during non-invasive programmed stimulation in the EP lab. ECG mapping localized the VA and visualized on a 3D model. During circulatory arrest, surgical ablation was performed using either cryoablation or irrigated RF ablation probe. Follow-up was performed with event monitors or ICD monitoring. Results: A total of 7 patients (mean age 55±15 years, female 29%, EF 31%±20%) were enrolled (Table). Surgical indications included mitral annuloplasty (Pt 1), pulmonary thromboendoarterectomy + CABG (Pt 2), coronary artery unroofing (Pt 3), left ventricular assist device (Pt 4-6, Fig 1), and CABG (Pt 7). In this cohort, 5 PVCs, 3 monomorphic VT and 1 VF morphologies were localized using ECG mapping and surgically ablated at time of cardiac surgery. There was a 100% (18 to 0) decrease in VT/VF episodes and 97.2 ± 0.03% reduction in PVC burden at median 9.5 month (IQR 3.7-29.5) follow-up. No intra- or post-operative complications occurred. Conclusions: This case series illustrates feasibility and excellent efficacy of a novel preoperative ECG mapping workflow using a forward-solution algorithm to guide successful and safe concomitant ventricular arrhythmia ablation during cardiac surgery.
Abstract 17886: Temporal Trends, Healthcare Resource Utilization and In Hospital Outcomes of Infective Endocarditis Following Transcatheter Edge-to-Edge Repair Using Mitraclip Among Elderly Patients With Severe Mitral Regurgitation: A National Perspectives
Authors: Sheriff Dodoo, Bettye Apenteng, Dennis Kumi, Samuel Opoku, Ronnie Ramadan
Journal: Circulation (2023)

Introduction: Procedural proficiency combined with the careful selection of patients with severe mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, may have influenced the incidence and outcomes of infective endocarditis (IE) following mitral Transcatheter edge-to-edge repair (TEER). Objective: To assess the temporal trends, healthcare resource utilization (HRU), and in-hospital outcomes of IE post-TEER. Methods: We used the National inpatient sample registry to identify all patients aged &gt; 65 with definite IE post-TEER between 2016 and 2020. Temporal incidence trends, in-hospital mortality, length of stay, and discharge disposition were analyzed. Results: During the study period, there were an estimated 71 cases of endocarditis among patients 65 years and older following mitral TEER, representing 355 discharges (1.0% of TEER-associated discharges) nationally. The temporal trend of the incidence of IE is shown in Figure 1. Relative to its absence, the occurrence of IE following TEER was associated with a 30.3% increased risk of HRU (Patient Average Treatment effect - PATE estimate = 0.303; 95% confidence interval (CI) =0.214 - 0.391; P&lt;0.001); a 13.2% increased risk of AKI (PATE estimate = 0.132; 95% confidence interval (CI) =0.033 - 0.232; p=0.009) and a 6.2% increased risk of in-hospital mortality (PATE estimate = 0.062; 95% confidence interval (CI) =0.008 - 0.117; p=0.025) Conclusions: Among elderly patients with severe symptomatic mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, the incidence of TEER-associated IE appears to be trending downwards. The occurrence of TEER-associated IE confers small but significant high HRU, complication rates, including AKI and in-hospital mortality, compared to those without IE. High-fidelity studies are needed to elucidate these findings.
Abstract 17470: Comparison of Outcomes for Adult Patients With Subaortic Stenosis by Surgical or Medical Management: Single-Center Cohort Study
Authors: Ankit Agrawal, Aro Daniela Arockiam, Ushasi Saraswati, Sanya Chandna, Muhammad Majid, Joseph Kassab, Michel Chedid El Helou, Mustafa Atar, Joseph El Dahdah, Samer Zakhour, L L Rodriguez, Zoran B Popovic, Brian P Griffin, Tom Kai Ming K Wang
Journal: Circulation (2023)

Introduction: Surgery is recommended subaortic stenosis (SAS) patients with severe left ventricular outflow tract obstruction and symptoms, left ventricular dysfunction and sometimes aortic regurgitation, although how surgery modifies patient prognosis is not well understood. We compared the outcomes of SAS based on past and follow-up treatment disposition. Methods: This is a retrospective observation study of adult patients (≥ 18 years) evaluated for SAS on transthoracic echocardiography at our institution during 1/1/2001 to 6/30/2022. Patients were divided into three groups: 1. Patients with prior SAS surgery at index visit; 2. Patients who underwent surgery during follow-up without prior SAS surgery; and 3. Patients managed medically. Primary follow-up endpoint all-cause mortality and secondary endpoint heart failure (HF) hospitalization were compared between groups. Results: There were a total of 115, 106, and 263 patients in group 1, 2, and 3 respectively. The mean age was 45.7±20 years and 67.1% were females. Over median follow-up of 5.5 years, there were 8, 6 and 42 deaths, 3, 9 and 21 heart failure hospitalization, and 20, 15, and 25 SAS recurrences in groups 1, 2, and 3, respectively. Multivariate analysis showed that patients with shortness of breath (odds ratio 3.64, 95% confidence interval 1.20-11.05, P=0.02) and those who are treated medically (1.77 (1.03-3.05), P=0.03) are associated with higher rates of composite death and HF hospitalization. The figure illustrates the Kaplan-Meier survival curves for the primary and secondary endpoint. Group 3 had significantly worse all-cause mortality (P=0.04) and heart failure hospitalization (P=0.03) rates during follow-up. Conclusions: The cohort of adult SAS patients that were managed medically were associated with worse prognosis.
Abstract 13351: Impact of a Second Incident Arrhythmia on Outcomes in Hospitalized COVID-19 Patients: Insights From the COVID-RHYTHM Registry
Authors: Adnan Ahmed, Danish Bawa, Rishi Charate, Andrea M Russo, Jaimin Trivedi, Elaine Y Wan, Philip L Mar, Rajesh Kabra, Sandeep Gautam, Stavros Stavrakis, Tolga Aksu, Sandeep A Saha, Zhenguo Liu, Paari Dominic, Zain Ul Abideen U Asad, Deepak Padmanabhan, Jayaprakash Shenthar, Amin Al-Ahmad, Andrea Natale, Dhanunjaya Lakkireddy, Rakesh Gopinathannair
Journal: Circulation (2023)

Introduction: Incident cardiac arrhythmias are common in hospitalized COVID-19 patients, but the impact of a second incident cardiac arrhythmia during hospitalization on clinical outcomes remain unclear. Hypothesis: The aim of this study was to assess the frequency and prognostic implications of a second incident arrhythmia in hospitalized COVID-19 patients over the pandemic course till vaccine availability. Methods: The multicenter COVID-RHYTHM Registry enrolled hospitalized COVID-19 patients from 3/8/2020 to 1/24/2021. Cardiac arrhythmia included documented atrial fibrillation (AF), atrial flutter (AFL), ventricular tachycardia (VT), severe sinus bradycardia (&lt;40 bpm) or AV block. Outcomes were compared between patients with single vs. more than one incident arrhythmias adjusting for baseline variables. Results: Of 6299 hospitalized COVID-19 patients, 4398 had an had an incident cardiac arrhythmia during hospitalization, of which 822 (19%) had a second incident arrhythmia. Those with &gt;1 incident arrhythmia had a higher baseline prevalence of heart failure, chronic kidney disease, coronary artery disease and sleep apnea (Table). Those with &gt;1 incident arrhythmia had higher in-hospital mortality, need for ICU admission and need for rehab upon discharge. Length of stay was similar between the groups. Conclusions: In hospitalized COVID-19 patients with incident cardiac arrhythmias, a second incident arrhythmia during hospitalization was seen in 19%. Having &gt;1 incident arrhythmia was associated with increased need for ICU admission and reduced survival.
Abstract 14203: Speckle Tracking Analysis During Dobutamine Stress Echocardiography in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion
Authors: Toshinari Onishi, Katsuomi Iwakura, Kota Tanaka, Yasushi Koyama, Mutsumi Iwamoto, Satoshi Watanabe, Keita Yamasaki, Koji Tanaka, Yuko Hirao, Nobuaki Tanaka, Akinori Sumiyoshi, Masatsugu Kawahira, Heitaro Watanabe, Atsunori Okamura
Journal: Circulation (2023)

Background: Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A “biphasic response” in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods: DSE was performed one day before CTO-PCI in consecutive 30 patients (18 female, age=71±11 years). Since 27 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 33 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems). Results: CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-15.5±2.8 at baseline v.s. -17.3±3.8, p&lt;0.001) and left ventricular ejection fraction (LVEF) (56±6% v.s. 58±7%, p&lt;0.01) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-13.8±3.6 v.s. -16.5±4.2, p&lt;0.005). Although in 24 patients (26 regions) with biphasic response during DSE (Figure), GLS (-15.7±2.5 v.s. -17.9±3.6, p&lt;0.01), LVEF (54±6% v.s. 56±7%, p&lt;0.05), and RLS (-13.8±3.5 v.s. -16.8±4.0, p&lt;0.01) improved significantly, GLS (-14.9±4.2 v.s. -15.8±5.0, p=n.s.), LVEF (59±3% v.s. 60±3%, p=n.s.), and RLS (-13.9±4.5 v.s. -15.5±5.7, p=n.s.) didn’t change in 6 patients (7 regions) without biphasic response. Conclusion: Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.
Abstract 13405: Cardiac Computed Tomography Variables for Prediction of New-Onset Heart Failure: Multi-Ethnic Study of Atherosclerosis
Authors: Angelo L de la Rosa, Aditya Mehta, Spencer L Hansen, Robyn L McClelland, Alain G Bertoni, Matthew J Budoff
Journal: Circulation (2023)

Introduction: Heart failure (HF) prediction models utilize clinical variables. The purpose of this study was to determine if addition of cardiac computed tomography (CT) variables could improve discrimination of HF prediction scores. Methods: Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort between 45 to 84 years old and free of clinical cardiovascular disease at baseline, with complete clinical data and cardiac CT were included to evaluate new-onset HF during the follow-up period. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcification of the coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC). We evaluated if CT variables improved the Pooled Cohort equations to Prevent HF (PCP-HF) score (an internally and externally validated model of 33,010 patients predicting 10-year risk of new-onset HF). Results: Among 6,667 MESA participants (52.7% female), 426 events of new-onset HF occurred during the follow-up period. After the Cox model was adjusted for cardiac CT and PCP-HF score variables, CAC (HR 1.10; 95% CI 1.05-1.15; p&lt;0.001), AVC (HR 1.08; 95% CI 1.03-1.13; p=0.002), MVC (HR 1.06; 95% CI 1.01-1.12; p=0.015), and LVSi (HR 1.14; 95% CI 1.10-1.18; p&lt;0.001) were all significantly associated with new-onset HF. After using time-dependent ROC and stratifying by sex, AUC discrimination of new-onset HF with the PCP-HF score was improved by the inclusion of cardiac CT variables. In females, the AUC for 10-year risk of new-onset HF improved from 0.80 to 0.86 with the addition of cardiac CT variables. In males, the AUC for 10-year risk of new-onset HF improved from 0.77 to 0.84 with the addition of cardiac CT variables. Conclusions: In addition to traditional clinical risk factors, cardiac CT variables provide anatomic risk factors that improve the prediction of new-onset HF. Coronary and valvular calcification may signal poorly controlled clinical risk factors that are often associated with HF. LVSi may reflect left ventricular remodeling associated with HF. More studies are needed to further elucidate the relationship between cardiac CT anatomic risk factors and HF.
Abstract 13429: Association of Periprocedural Opiate Exposure During Cardiac Catheterization and Long-Term Opiate Dependence
Authors: Ramin Ebrahimi, Carlos Alvarez, paul dennis, A. Laurie Shroyer
Journal: Circulation (2023)

Introduction: Recent data suggest that a brief exposure to opiates during medical encounters may lead to their higher use long-term. In this study we investigated the association of peri-procedural opiate exposure with incident opiate dependence disorder (ODD) for patients undergoing invasive cardiac catheterization (ICC) Methods: The Veterans Affairs national electronic medical records for patients undergoing an ICC between 01/01/2010 and 01/01/2018 were extracted. Patients with ODD prior to the ICC date were excluded from analysis. Peri-procedural opiate use was defined as receiving morphine or fentanyl within 24 hours before or after the ICC. ODD was diagnosed using international classification of disease (ICD) 9 th and 10 th version codes. Opiates evaluated included morphine, fentanyl, or other opiates (e.g., codeine, hydrocodone, and methadone). Follow up period extended to 01/01/2020. Results: From 01/01/2010 to 01/01/2018, 223,436 patients underwent ICC; of these, 215,841 had no prior ODD. New ODD was identified in 2710 (5.80%) of the 46,624 patients who received opiates peri-procedurally compared to 3,666 (2.16%) of the 169,217 patients who did not receive opiates peri-procedurally, p-value &lt; 0.01. Conclusions: Brief peri-procedural use of opiates in patients undergoing ICC may lead to long-term opiate dependence disorder. Further research to validate these results are warranted. Potential alternatives to opiates must be considered for such patients.
Abstract 17485: Risk of Heart Failure Hospitalizations With Exposure to Colder Temperature and Regional Variations Among Older Adults in the United States
Authors: Daniel I Bisno, Nathaniel Kuhrt, Poonam Gandhi, Ashwaghosha Parthasarathi, David Robinson, Soko Setoguchi
Journal: Circulation (2023)

Introduction: Extreme cold was associated with excess heart failure (HF) deaths in ecological studies. The relationship between colder temperatures and HF hospitalizations is not well understood. Hypothesis: Lower minimum temperatures (T min ) increase the risk of HF hospitalization among older adults and the impact varies by climate regions. Methods: A time-stratified case-crossover study among adults aged ≥66 hospitalized for HF was conducted using a 20% sample of Medicare data (2008-2019, Nov-Feb). Daily T min from the Parameter-elevation Relationships on Independent Slopes model were linked to Medicare data by zip code of residence. We used bidirectional sampling to select up to 5 controls. We used conditional logistic regression with a restricted cubic spline to model non-linear effects between T min and HF hospitalization in all patients and regional subgroups. Results: Among 529,879 cases (mean age 79, 61% female, 86% white), the risk of HF hospitalization peaked at 4 °F (OR 1.29 [CI 1.28-1.30]) and plateaued over colder T min relative to the median T min (31.5°F). Above 31.5 °F, the risk was reduced by 18% for every 10 °F (Figure 1). This inverse relationship between T min and HF hospitalizations during the winter were most prominent in colder regions (Figure 2). Conclusions: T min ≤4 °F increased the risk of HF hospitalizations by upwards of 29% compared to the national median T min . The plateau at more extreme T min may be due to avoidance of outdoor exposure. A similar behavioral response may occur in warmer regions, whereas some degree of cold exposure is inevitable in colder regions. HF patients should be aware of the risks from exposure to colder temperatures during winter months.
Abstract 17497: Natural History of the Left Ventricular Ejection Fraction in Heart Failure and Sudden Cardiac Death
Authors: Sumeet S Chugh, Audrey Uy-Evanado, Harpriya Chugh, Habiba Aziz, Kotoka Nakamura, Arayik S Sargsyan, Jonathan Jui, Kyndaron Reinier
Journal: Circulation (2023)

Background: A clinical diagnosis of heart failure (HF) is associated with increased risk of sudden cardiac death (SCD), but only HF with severely reduced LV ejection fraction (HFrEF, EF ≤35%) is utilized for risk stratification. Guideline-directed medical therapy and heart disease processes may improve or reduce the LVEF. Hypothesis: There is significant variation of LVEF over time among HF patients with SCD. Methods: From a large, prospective population-based study of SCD in the Northwest US (catchment population 1 million, 2002-2018), we identified all consecutive patients with a diagnosis of HF and prior assessment of LVEF. The sub-group of patients with at least 2 prior LVEF evaluations (earliest and latest in relation to SCD) was determined. Results: A total of 1622 individuals suffered SCD with a known diagnosis of HF (65% male, age 72±14) of which 434 had 2 LVEF evaluations at least 1 yr apart prior to their SCD. At earliest evaluation, 100 (23%) had HFrEF (73% male, age 67±13), 88 (20%) had HF with moderately reduced EF (HFmrEF, 35&lt;ef&amp;lt;50) (71% male, age 72±12), and 246 (57%) had hf with preserved ef (hfpef, ef≥50) (57% 72±12). comparing the earliest latest assessment of lvef, mean lvef in hfref increased by 9±14 percentage points (p&amp;lt;0.001) from 27±6 to 36±14; hfmref decreased over time -4±14 (p="0.003)" 43±4 39±14; hfpef -8±13, 62±7 54±14. each subtype changed substantially (mean 2.9±1.5 yrs), sizeable proportions re-classified into different subtypes (Figure). Overall, the HF LVEF subtype was unchanged in 58% and altered in 42% (p&amp;lt;0.001). Conclusions: Based on the LVEF, at least 40% of HF sub-types were re-classified prior to SCD and risk assessment would be variable depending on when LVEF was measured. These findings highlight the limitations of using the LVEF as the only risk predictor of SCD.
Abstract 13123: Sex-Based Disparity in Referral for Catheter Ablation for Atrial Fibrillation at a Single Integrated Health System
Authors: Arati A Gangadharan, Lutfiyya N Muhammad, Jing Song, Rod S Passman
Journal: Circulation (2023)

Introduction: Catheter ablation for atrial fibrillation (AFCA) is indicated for patients with symptomatic AF and has proven to reduce AF burden and improve quality of life. Older studies have shown that women are less likely to undergo ablation compared to men despite having more AF-related symptoms. We investigated whether an association exists between referral patterns and this sex-based disparity in the modern era of AFCA. Methods and Results: A retrospective cohort study was conducted of outpatients with newly diagnosed AF between 2011 and 2020 using an EMR database at Northwestern Medicine. Of 5,445 patients analyzed, 2,108 were women (mean [standard deviation, SD] age 70 [13], 19.2% non-Hispanic Black) and 3,337 were men (mean [SD] age 66 [13], 11.7% non-Hispanic Black). Other characteristics including insurance status, comorbidities, and prior treatment of AF were also compared by sex. Logistic regression models adjusted for these factors were constructed to determine associations between sex and a set of binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) as well as performance of AFCA. In adjusted models, among internal medicine and primary care patients, there were no significant differences in odds of referral to or visits with general cardiology or EP between men and women. Additionally, there was no significant difference in odds to undergo AFCA between men and women once seen by EP (Figure). Conclusions: Our study demonstrates no significant difference with respect to sex in referral patterns or performance of AFCA. Further work must be done to investigate whether these results are generalizable to other health systems regarding performance of AFCA as addressing these differences, when present, could prove essential in dismantling sex-based disparities in AF treatment.