tbuckley/cabot-search huggingface dataset:
Abstract 14254: Myocarditis in Athletes and Non-Athletes: Evaluating the Persistence and Degree of Myocardial Fibrosis at Follow Up
Authors: Mark Abela, Joseph Demanuele, Lisa Buttigieg, Mark Farrugia, Bernard Borg, Lara Yamagata, KENTARO YAMAGATA, Alexander Borg
Journal: Circulation (2023)

Introduction: Myocarditis is a common acquired cardiac disorder that may lead to persistent scar. Current guidelines recommend follow up cardiac MRI (CMR) in 3-6 months for athletes. Data supporting this recommendation is unfortunately very limited. Aim: The aim of this study was to evaluate the demographic and clinical variables of patients diagnosed with myocarditis. Clinical data for those who had a follow up CMR was also evaluated separately. Methodology: Patients who had a cardiac MRI (CMR) organised between July 2019 till December 2022 because of a MINOCA/Myocarditis hospital admission were retrospectively reviewed. Those with a myocarditis diagnosis were included. An athlete was defined as an individual who engaged in &gt;4 hours of physical activity weekly or underwent organized sport. Results: 105 patients were included (mean age 35.4±15.6 years, 83.8% male). 34.3% were athletes. 12.4% had possible acute myocarditis, 10.5% had likely myocarditis and 77.1% had confirmed myocarditis on cardiac MRI (median 4 days from presentation). ECG was abnormal in 60.0%. 8.6% had arrhythmias. Echocardiography was abnormal in 26.7%. CMR revealed 15.2% reduced LV EF, 57.1% regional wall motion abnormalities, 5.7% reduced RV EF, 25.7% pericardial effusion, 84.5% myocardial oedema. Most (88.5%) had late gadolinium enhancement (LGE). 56.2% were started on anti-heart failure medical therapy. 29.5% had a CMR repeated (interval between scans 14.7±14.2 months). 77.4% showed persistent LGE, less pronounced in most (71.0%). Diffuse LGE at baseline was the only predictor for persistent scar (p=0.004). Scar persisted equally in athletes and non-athletes (p=0.666). Clinical variables were similar in both. At follow-up (24.6±15.3 months), 8.6% had adverse outcomes. The event rate was similar in athletes and non-athletes. A low LV EF on CMR (p=0.011) and abnormal ECHO (p=0.027) were the only variables that could predict outcome. Conclusion: LGE after myocarditis persists in 77.4% of cases, albeit better. No variable could predict the persistence of LGE in this cohort. Athletes and non-athletes had a similar clinical course, suggesting that repeat CMR in non-athletes is reasonable. The diagnostic utility of repeat CMR after myocarditis remains questionable.
Abstract 13276: Metabolic Pathways and Risk Biomarkers for Incident Heart Failure
Authors: Sarah C Snow, Lydia Kwee, Senthil Selvaraj, Vishal Rao, Manesh R Patel, Neha J Pagidipati, Svati H Shah
Journal: Circulation (2023)

Introduction: Metabolomic profiling provides important information about heart failure (HF) risk. Metabolites reporting on muscle fuel substrate including branched-chain amino acids (BCAAs) and ketones have been implicated in HF pathogenesis and as circulating biomarkers of risk. We sought to identify the role of these known metabolites and identify novel metabolites and related pathways associated with incident HF in a large population-based cohort. Methods: Metabolomic profiling has been performed in the UK Biobank cohort using the Nightingale NMR platform. Principal component analysis (PCA) was used for dimensionality reduction and to identify shared metabolic pathways. Cox proportional hazard models were used to test the association between each PCA factor, and of individual metabolites heavily loaded on significant factors, with time to incident HF. Results: Of n=118,021 participants with metabolomic profiling data, n=3,865 (3.3%) developed incident HF (mean [SD] follow-up: 12.5 [1.3] years). The 107 metabolite biomarkers clustered into 12 PCA factors (Table 1). Nine factors were associated with incident HF in adjusted models. Factor 5 (BCAAs, aromatic acids) was not associated with incident HF in adjusted models. However, higher levels of each individual BCAA were associated with decreased risk of incident HF, with valine as the most protective (HR 0.91 [CI 0.88-0.95], q = 3x10 -6 ). Factors 2 (large HDL) and 6 (ketones) were associated with increased risk of incident HF, while factors 4 (small HDL) and 9 (omega-3 fatty acids) were associated with decreased risk of incident HF. Conclusions: In a large population-based cohort, we found that higher baseline levels of ketones and large HDL were associated with increased risk of incident HF, while higher levels of BCAAs, small HDL, and omega-3 fatty acids were associated with decreased risk of incident HF. These results highlight known and new metabolic pathways and related circulating biomarkers of HF risk.
Abstract 14607: Management of Inappropriate Sinus Tachycardia: A Promising Breakthrough
Authors: Nicholas K Pham, Adnan Ahmed, Danish Bawa, Rachad Ghazal, Rajesh Kabra, ahmed romeya, Krishna Pothineni, Douglas J Darden, Rakesh Gopinathannair, Dhanunjaya R Lakkireddy
Journal: Circulation (2023)

Introduction: Inappropriate Sinus Tachycardia (IST) is a cardiac dysautonomia with limited treatment options. This case highlights the effectiveness of a novel sinus node-sparing hybrid surgical ablation (SNSHA) for IST. Objective: To describe a novel hybrid surgical approach for management of IST. Case Description: A 43 y/o female presented with history of palpitations/tachycardia for 5 years. A comprehensive evaluation directed towards the diagnosis of IST with resting heart rates (HR) above 100 bpm and HR changes greater than 30% with minimal exertion. A trial of ivabradine &amp; beta blockers along with lifestyle modifications offered limited relief. Patient was offered the novel SNSHA after a shared decision-making process. Methods: The SNSHA is a minimally invasive procedure performed by a CT surgeon in conjunction with an electrophysiologist involving thoracoscopic epicardial ablation of the sympathetic connections from the SVC to the IVC. The thoracoscopic approach allows for safeguarding of the phrenic nerve and sinus node followed by endocardial ablation along the lateral wall. Results: Intraprocedural pre and post ablation electroanatomic map (EAM) and electrogram (EGM) demonstrated an immediate drop in HR as shown in the Figure 1(a-d). An ILR was implanted during the procedure. On 45-day post-op visit, the patient experienced significant symptom relief and improvement in her HR as well as HR variability on ILR as shown in Figure 1(e). Conclusion: SNSHA offers a reasonable treatment option for patients with drug resistant IST. This procedure provided symptom alleviation and improvement in HR without increasing the risk of complications in comparison to sinus node modification ablation, which has previously been shown to be associated with higher incidence of pacemaker implantation.
Abstract 16055: Marantic Endocarditis - A Rare Paraneoplastic Presentation of Ovarian Carcinoma
Authors: Mobeen Haider, Muhammad Hasib Khalil, Yousra Khalid, Saad Ur U Rahman, Christopher Bodine
Journal: Circulation (2023)

Introduction: Nonbacterial thrombotic endocarditis (NBTE) or Marantic endocarditis, involves formation of sterile platelet &amp; fibrin thrombi on undamaged cardiac valves &amp; adjacent endocardium. The vegetation is associated with embolization. Case presentation: A middle-aged female without cardiac history presented to the ED with blurred vision &amp; fatigue for 3 days. The patient was afebrile with a BP of 183/97mmHg. Physical examination showed decreased visual acuity in the left eye. The EKG was normal. The patient underwent a CT scan brain that showed suspicion of bilateral occipital strokes. MRI brain revealed multiple small acute infarcts in the bilateral cerebral hemispheres &amp; cerebellum. Blood cultures were negative. Telemetry did not show atrial fibrillation. Given a suspicion of cardioembolic stroke, the patient underwent a transesophageal echocardiogram (TEE) which demonstrated a trileaflet aortic valve (AV) with abnormal irregular thickening of leaflets, concerning for vegetation &amp; moderate-severe aortic regurgitation (AR). figure 1. Our patient was diagnosed with marantic endocarditis based on TEE &amp; serial negative cultures. Apixaban was started. Further workup of the patient revealed bilateral pulmonary emboli. Abdominal imaging revealed a pelvic mass, ultimately diagnosed as clear-cell ovarian cancer. Interval TEE at 3 months demonstrated complete resolution of vegetations with preserved cusp motion &amp; mild AR. A shared decision was made to continue lifelong anticoagulation. Discussion: NBTE commonly involves mitral &amp; AV. Risk factors include trauma, circulating immune complexes, hypercoagulability, malignancy &amp; acute inflammation. Symptoms result from embolization, valve dysfunction, or impaired cardiac function. It is based on imaging after ruling out infectious etiologies. Management is anticoagulation &amp; valve replacement with the treatment of the underlying etiology. Valve replacement prevents future embolic complications.
Abstract 13423: Magnetocardiography as a Noninvasive Diagnostic Strategy for Ischemia Evaluating Following Coronary Revascularization of Patients With Non-ST Segment Elevation Myocardial Infarction
Authors: Linqi Liu, shuwen yang, Huan Zhang, Shu Zhou, Xueyao Yang, Zhao Ma, Bin Cai, Ming Ding, Chenchen Tu, Xiantao Song, Hongjia Zhang
Journal: Circulation (2023)

Introduction: Magnetocardiography (MCG) constitutes a non-invasive and radiation-free procedure that quantifies the heart's magnetic fields and has exhibited sensitive diagnostic capabilities for ischemia. Typically, MCG presents a distinctive pattern in healthy subjects, characterized by a positive and a negative pole that forms an angle of approximately 45-60 degrees within the T peak segment. Hypothesis: Our study aims to monitor the significant alterations in MCG patterns among patients with Non-ST Segment Elevation Myocardial Infarction (NSTEMI) undergoing revascularization. Methods: Patients were prospectively enrolled and MCG scans were conducted thrice: three days pre-intervention, one week post-intervention, and at a three-month follow-up. Results: Four patients underwent anatomical complete revascularization, while one patient had incomplete revascularization. When comparing the MCG patterns of patients with NSTEMI (Figures B-F) to a normal MCG pattern (Figure A), pre-intervention scans showed angular deflection (80%, except for patient 3) and an anomalous distribution of poles (100%). One week post-intervention, patients who underwent complete revascularization (Figures B-D) had myocardial enzymes normalized, along with slight angle recovery and reshaping of the poles (100%). By the three-month follow-up, these patients experienced symptom resolution, and their MCG patterns showed normalized angles with recovered poles (100%). However, the patient who underwent incomplete revascularization (Figure F) exhibited sustained myocardial ischemia symptoms, with no further angle recovery and continued anomalous distribution of positive poles, both post-intervention and during follow-up. Conclusions: The distribution of poles and angular deflection could potentially serve as indicators of ischemia. MCG may represent a promising strategy for evaluating myocardial recovery in patients with NSTEMI.
Abstract 394: Epinephrine Administration Before Defibrillation in Children With an Initially Shockable In-Hospital Cardiac Arrest Rhythm
Authors: Morgan B Swanson, Javier J Lasa, Paul S Chan, Ryan W Morgan, Robert M Sutton, Alexis A Topjian, Dianne L Atkins, Sarah E Haskell, Tia T Raymond, Saket Girotra
Journal: Circulation (2023)

Background: Contrary to current guidelines, administration of epinephrine before first defibrillation for shockable in-hospital cardiac arrest (IHCA) is common in adults and associated with lower survival. Whether these findings are also present in pediatric IHCA remains unknown. Methods: We used 2000-2020 data from the Get With the Guidelines®—Resuscitation registry to identify children (&lt;18 years) with index IHCA due to an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least 1 defibrillation attempt. Study outcomes were event survival, defined as return of spontaneous circulation for &gt; 20 minutes, survival to hospital discharge and favorable neurologic survival. Inverse probability of treatment weighting (IPTW) using propensity scores was used to adjust for confounding . Results: Among 492 pediatric IHCA index events (median [IQR] age, 7 years [0.75 to 14 years]; 351 [71%] in the ICU), 142 (29%) children with an initial shockable rhythm received epinephrine before defibrillation. Subjects receiving epinephrine before defibrillation had longer times to defibrillation compared to those receiving defibrillation first (median [IQR]: 4 minutes [2 to 8] vs. 1 minute [0 to 2]). Rates of event survival (72.7% vs. 82.8%), survival to hospital discharge (36.4% vs. 47.9%), and favorable neurologic survival (18.9% vs. 33.1%) were lower in the epinephrine before defibrillation group, Table). However, in adjusted analyses using IPTW, epinephrine before defibrillation was not associated with survival outcomes (Table). Conclusions: Nearly one in three pediatric IHCA with initial shockable rhythm receives epinephrine before defibrillation in contrast with recommended guidelines. However, unlike adults with IHCA, we did not identify a clear association between epinephrine before defibrillation and survival.
Abstract 18359: Association of Depressive Symptoms and Risk of 30- and 90-day Hospital Admissions in Patients With a New or Worsening Diagnosis of Peripheral Artery Disease
Authors: Francky Jacque, Santiago Callegari, Gaelle Romain, Jacob Cleman, Lindsey Scierka, Carlos Mena-Hurtado, Kim G Smolderen
Journal: Circulation (2023)

Introduction: Patients diagnosed with Peripheral Artery Disease (PAD) often present with a complex profile of comorbidities, including a high mental health burden. Depressive symptoms are associated with worse long-term PAD outcomes, but it is unknown whether they translate into a higher short term hospital admission. Methods: Patients with a new or worsening PAD diagnosis (Rutherford 1-3) enrolled at US in the PORTRAIT registry from 2011-2015 were included. The 8-item Patient Health Questionnaire assessed depressive symptoms (scores 0 to 24, higher scores more depressive symptoms). The Youden Criterion based on time-dependent receiver operator curves was used to describe high vs. low-risk admission groups. Adjusted Cox regression models generated risk estimates associated with continuous PHQ-8 scores and all-cause, cumulative 30- and 90-day admissions based on patients’ medical records. Results: We included 669 patients in the analysis (mean age 68.6 ± 9.6 years, 57.6% male, 73.0% white). The mean PHQ-8 Score was 4.8 ± 5.2; 61.9% was classified as low- (PHQ-8 &lt;5) vs. 38.1% high-risk (PHQ-8 ≥ 5) for admissions based on the Youden Criterion. Patients in the low-risk vs. high-risk group had admission rates of 7.7% [95% CI 5.5-10.7] vs. 12.9% [95% CI 9.5-17.5] at 30 days (p-value: 0.023) and 16.2 [95% CI 13.1-20.0] vs. 25.6% [95% CI 21.0-31.0] at 90 days (p=0.002). In the adjusted model, depressive symptoms (per 1-unit increase) were independently and proportionally associated with 30-day (HR=1.06, 95% CI 1.01-1.11; p=0.026) and 90-day (HR=1.04, 95% CI 1.01-1.08; p=0.021) admissions following PAD diagnosis (e.g. those with scores &gt;20 had a &gt;20% or &gt;30% 30- and 90-day admission risk, respectively) (Figure 1). Conclusion: Thirty- and 90-day admission risk for patients with a new or worsening PAD diagnosis is high, especially for those with depressive symptoms. Value-based PAD care should include screening and integrated care pathways for depression to mitigate this risk.
Abstract 16149: Recruitment Strategies for a Remote Implementation Study in Diabetes Management - Insights Into Optimizing Enrollment
Authors: Shahzad Hassan, Lee-Shing Chang, Caitlin Colling, Gretchen Stern, Jacqueline Chasse, Dan Gabovitch, David Zelle, Samuel Aronson, Christian Figueroa, Emma Collins, Ryan Ruggiero, Emily Zacherle, Josh Noone, Carey Robar, Thomas Gaziano, Jorge Plutzky, Lina Matta, Christopher P Cannon, Deborah Wexler, Benjamin Scirica, Alexander J Blood
Journal: Circulation (2023)

Background/Objectives: Remote clinical studies offer new outreach opportunities, but recruitment remains challenging. We report our experience in identifying potential participants from diverse sources and adopting various outreach and recruitment methods. Methods: We utilized multiple screening and recruitment methods to identify and enroll patients into an implementation study for guideline-directed care in patients with T2D at high risk of cardio-renal complications within the Mass General Brigham health network. Patients were identified by querying the EHR and invited by emails, individualized, or bulk EHR-portal messages. Traditional outreach included reviewing upcoming clinic visits, accepting provider referrals, and mailing invite letters. All screened-in patients received phone calls following the initial invitation ( Figure ). Results: Of 200 enrolled participants, 190/200 (95%) were identified from the EHR, 2/200 (1%) from upcoming clinic visits, and 8/200 (4%) from provider referrals. Of patients identified through the EHR, 49/3317 (1%) of the total enrolled were invited by an individualized EHR message, 61/3317 (2%) by e-mail, 80/588 (14%) by mailed letter, and 0/3666 (0%) by bulk EHR message. From clinic, 2/102 (2%) of upcoming visits and 8/36 (22%) of provider referrals were enrolled. Overall, 90/200 (45%) of enrolled patients came from letters or clinic while 110/200 (55%) came from electronic outreach. Conclusion: Conducting remote clinical research is feasible, however, enrollment remains labor-intensive. Traditional methods of patient engagement are difficult to scale, although they led to high enrollment rates. While the EHR was the primary method for identification of our enrolled participants, traditional approaches including manual screening, mailed letters, and provider referrals continue to play a role in patient enrollment. Innovative approaches are necessary to improve the process.
Abstract 13115: Association of Hospital Racial Composition and Anticoagulation for Atrial Fibrillation: A Nationwide Study
Authors: Utibe R Essien, Nadejda Kim, Leslie Hausmann, Donna L Washington, Maria Mor, Terrence Litam, Taylor Boyer, Walid Gellad, Michael Fine
Journal: Circulation (2023)

Introduction: Anticoagulation reduces stroke risk in atrial fibrillation (AF). Patient-level studies show significant Black-White disparities in any anticoagulant and direct oral anticoagulant (DOAC) prescribing. Little is known about whether such disparities exist at the hospital level, thus we examined the association of hospital racial composition and anticoagulant initiation. Hypothesis: Hospitals with higher rates of Black patients would have lower anticoagulation. Methods: We conducted a retrospective cohort study of patients with incident AF treated at a VA medical center (VAMC) from 2018-2021. Our independent variable was hospital racial composition, defined by the proportion of Black patients cared for at a VAMC, with Quartile 1 (Q1) being the lowest, and Quartile (Q4) being the highest. We used a multivariable logistic regression model, adjusting for clinical factors (e.g., stroke and bleeding risk), year of diagnosis, and region, to estimate the odds of any anticoagulant and/or DOAC initiation by hospital racial composition. Results: We identified 86,436 patients with incident AF at 140 VAMCs, 10.5% Black, 89.5% White, mean age 73 years. Patients in Q4 were younger with similar stroke and bleeding risk to those in Q1. Overall, any anticoagulant use was 73.4% in Q1 and 71.4% in Q4 and lower for Black vs. White patients in both quartiles (Q1: 68.9% vs. 73.5%; Q4: 69.1 vs. 72.0%). The odds of initiating any anticoagulant overall were lower in Q1 hospitals compared to Q4: adjusted odds ratio (aOR): 0.85; 95% CI 0.73-0.99; p=0.04. DOAC use was similar in Q1 and Q4 (67.6% vs. 67.2%) though lower for Black vs. White patients in both quartiles (Q1: 57.4% vs. 67.7%; Q4: 63.3 vs. 68.5%). There was no significant difference overall in the odds of initiating DOAC in Q1 hospitals compared to Q4, aOR: 0.96; 95% CI 0.83-1.12; p=0.61. Conclusions: In a national study of patients with AF in the VA, we observed a significant difference in any anticoagulant but not DOAC initiation by hospital racial composition. Racial differences in anticoagulant use existed across quartiles, as in prior work. These data suggest that racial disparities in anticoagulant use in the VA, a safety net health system, may require local rather than national-level solutions alone to eliminate them.
Abstract 14130: Efficacy and Safety of Endovascular Therapy in Stroke Patients With Large Ischemic Core in Comparison to Medical Management: Meta-Analysis of Randomized Control Studies
Authors: Anas Alameh, ahmad jabri, Fares Sukhon, Laith Alhuneafat, Safwan Khader, lola divincenzo, Enrique Soltero, farhan nasser, Aisha Siraj
Journal: Circulation (2023)

Introduction: Endovascular therapy (EVT) is a treatment recommended for stroke patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥6. However, the utility of EVT in patients with large core ischemic stroke has not been well established. Methods: This meta-analysis assesses EVT's efficacy and safety using available trials comparing EVT to medical management (MM) in stroke patients with large ischemic core. Eligibility criteria: 1) were randomized controlled trials, 2) compared EVT with MM alone, 3) studied patients presenting with LIC cerebrovascular events, and 4) reported outcomes of interest. We extracted data for the major imaging inclusion criteria, the National Institutes of Health Stroke Scale (NIHSS) score, pre-stroke mRs score, and occlusion site. We also extracted outcome data for the EVT groups vs MM groups, including measurement of early neurological recovery, and definition of sICH. Results: Our primary end point was the mean modified Rankin scale score (RSS) at 90-day follow up. EVT was associated with higher odds of significant improvement in functional status with reduction in mean mRS by -0.31 [-0.47; -0.14]) compared to MM. The odds of achieving mRS 0 to 2 was higher in the EVT arm compared to the MM arm (2.53 [1.59; 4.02]). There was no difference in achieving mRS 0 to 3, early neurologic improvement defined according to NIHSS score, overall 90-day mortality and risk of symptomatic ICH between patients treated with EVT or MM in our analysis. Conclusions: Our study suggests that EVT may lead to improved outcomes in stroke patients with large core ischemia.