tbuckley/cabot-search huggingface dataset:
Abstract 4144097: Stealing from the Heart: A Case of Angina due to Coronary-Bronchial Artery Fistula after Pulmonary Embolism
Authors: Matthew Fordham, Mohamad Ghazal, Matthew Derakhshesh, Omar Daghstani, Anthony Nappi, Radmila Lyubarova, Dmitri Belov
Journal: Circulation (2024)

Introduction: Coronary-bronchial artery fistula (CBF) is a rare finding with an incidence of 0.08 to 0.61%. Patients may present with chest pain, dyspnea, or hemoptysis. Transcatheter interventions provide definitive treatment for symptomatic patients. Herein, we present a case of recurrent chest pain due to CBF involving the sinoatrial nodal (SAN) artery. Case: A 75-year-old lady presented with recurrent midsternal chest pain for several years. Her medical history was notable for pulmonary emboli (PE), and antiphospholipid syndrome. Initial investigation showed mildly elevated high sensitivity troponin to 28.9 ng/L. ECG showed normal sinus rhythm without ischemic abnormalities. Prior ischemic work-up including dobutamine stress echocardiogram and invasive coronary angiography was unremarkable. Ventilation perfusion (V/Q) scan showed multiple areas of VQ mismatch. Computed tomography coronary angiography (CTCA) showed a dominant RCA with a 2.5 mm communication between the SAN artery and left bronchial artery. After a heart team discussion, the patient was offered definitive treatment. A 6 Fr FR4 Mach 1 Guide catheter was used for selective right coronary angiography. A steerable microcatheter floppy 0.014”x 300 cm wire was used to engage the fistula originating from SAN artery (Figure 1). A micro vascular plug was successfully deployed over the wire without endangering sinus nodal supply. Post-intervention there was decrease in flow from the SAN to the bronchial artery (Figure 2). At one month follow up the patient was chest pain free. Discussion: Patients with pulmonary vascular disease might be predisposed to CBF, as chronic pulmonary ischemia might augment collateral blood flow. As a result, coronary steal phenomenon may lead to atypical angina. CTCA is a helpful screening tool, while transcatheter intervention may benefit symptomatic individuals. Conclusion: CBF should be considered in patients with history of PE and recurrent chest pain of unclear etiology.
Abstract 4144067: AI-enabled Cardiac Chambers Volumetry in Coronary Artery Calcium Scans (AI-CAC) vs. ASCVD Pooled Cohorts Equation and PREVENT Risk Scores: The Multi-Ethnic Study of Atherosclerosis
Authors: Morteza Naghavi, Anthony Reeves, Kyle Atlas, Chenyu Zhang, Thomas Atlas, Claudia Henschke, David Yankelevitz, Matthew Budoff, WENJUN FAN, Ruilin Yu, Andrea Branch, Ning Ma, Sion Roy, Khurram Nasir, Sabee Molloi, Zahi Fayad, Michael McConnell, Ioannis Kakadiaris, Javier Zulueta, David Maron, Jagat Narula, Prediman Shah, Kim Williams, george Abela, Daniel Levy, Nathan Wong
Journal: Circulation (2024)

Background: Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston score which is used for coronary artery disease prediction only. We have previously reported AI-enabled cardiac chambers volumetry in CAC scans (AI-CAC) predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). Here we compare the distribution of cardiac chambers volumes vs. risk categories of ASCVD pooled cohorts’ equation (PCE) and PREVENT TM risk scores. Methods: We applied the AutoChamber TM component of AI-CAC to 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at the baseline examination of MESA. We calculated 10-year estimated risk from the PCE and PREVENT Risk Scores based on 4 categories of risk: &lt;5%, 5-7.5%, 7.5-20%, &gt;20% using baseline risk factors. The PREVENT total CVD base model was used in analysis, which excludes urinary albumin to creatinine ratio and social depravity index. We compared the distribution of the quartiles of left atrial (LA) and left ventricle (LV) volumes to categories of both risk scores. We defined enlarged cardiac chambers as the top quartile of LA (&gt;82.7 cc) and LV (&gt;136.5 cc) volume, which corresponded to 33% and 21.1% incidence of all-CVD events over 10 years (CHD, HF, AF, stroke, CVD deaths), respectively. LA and LV volumes were standardized by adjusting for body surface area (BSA). Results: A substantial portion of cases categorized by PREVENT as low risk (10-year risk &lt;5%) had enlarged cardiac chambers (Figure 1). In females the lowest category of PREVENT had 10.6% enlarged LA cases and 26.6% enlarged LV volume cases. In males, the lowest category of PREVENT had 13.7% enlarged LA cases and 29.4% enlarged LV volume cases. Similarly, in low risk PCE, females had 12.8% enlarged LA and 24.9% enlarged LV, and males had 12.8% enlarged LA and 24.6% enlarged LV. Conclusion: In this multi-ethnic longitudinal population study, a substantial portion of cases classified as low-risk by PCE and PREVENT risk scores had enlarged LA and LV volumes detected by AI-CAC, putting them at risk for future HF, AF, and stroke.
Abstract 4144226: Is it useful to wash stored red blood cells in cardiopulmonary bypass priming fluid for neonatal cardiac surgery?
Authors: He Wang, Jia Liu, Yu Jin, Jinping Liu
Journal: Circulation (2024)

Background and Objectives: Neonatal cardiac surgery requires careful consideration of cardiopulmonary bypass (CPB) priming fluid composition due to small blood volume and immature physiology. This study investigated the impact of allogeneic stored red blood cells (RBCs) processed using an autotransfusion system in CPB priming fluid for neonates. Materials and Methods: We compared perioperative parameters, inflammatory mediators, coagulation indicators, vasoactive-inotropic score (VIS), and clinical outcomes between neonates receiving unwashed (n=56) and washed (n=45) RBCs in CPB priming fluid. Regression models were used to assess the independent association between RBC washing and patient outcomes. Results: The autotransfusion system improved stored RBC quality. The washed group showed higher peak hematocrit (P &lt; 0.01) and hemoglobin levels (P = 0.04) during CPB, an increased oxygen delivery index during rewarming (P &lt; 0.05), and lower postoperative lactate levels and VIS (P &lt; 0.05).Inflammatory (IL-6, IL-8, IL-10) and coagulation parameters (DD, FIB, FDP) fluctuated compared to baseline but did not significantly differ between groups. The washed group had a lower incidence of hyperlactacidemia and delayed sternal closure at CPB weaning. Conclusions: Adding washed allogeneic stored RBCs to neonatal CPB priming fluid reduced postoperative lactate elevation and VIS without early improvement in the inflammatory and coagulation systems.
Abstract 4144083: AI-CVD: Artificial Intelligence-Enabled Opportunistic Screening of Coronary Artery Calcium Computed Tomography Scans for Predicting CVD Events and All-Cause Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Morteza Naghavi, Anthony Reeves, Kyle Atlas, Chenyu Zhang, Thomas Atlas, Claudia Henschke, David Yankelevitz, Matthew Budoff, WENJUN FAN, Ruilin Yu, Andrea Branch, Ning Ma, Sion Roy, Khurram Nasir, Sabee Molloi, Zahi Fayad, Michael McConnell, Ioannis Kakadiaris, Javier Zulueta, David Maron, Prediman Shah, Kim Williams, george Abela, Daniel Levy, Nathan Wong
Journal: Circulation (2024)

Background: The AI-CVD initiative aims to extract all useful opportunistic screening information from coronary artery calcium (CAC) scans and combines them with traditional risk factors to create a stronger predictor of cardiovascular diseases (CVD). These measurements include cardiac chambers volumes (left atrium (LA), left ventricle (LV), right atrium (RA), right ventricle (RV), and left ventricular mass (LVM)), aortic wall and valvular calcification, aorta and pulmonary artery volumes, torso visceral fat, emphysema score, thoracic bone mineral density, and fatty liver score. We have previously reported that the automated cardiac chambers volumetry component of AI-CVD predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). In this report, we examine the contribution of other AI-CVD components for all coronary heart disease (CHD), AF, HF, stroke plus transient ischemic attack (TIA), all-CVD, and all-cause mortality. Methods: We applied AI-CVD to CAC scans of 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at MESA baseline examination. We used 10-year outcomes data and assessed hazard ratios for AI-CVD components plus CAC score and known CVD risk factors (age, sex, diabetes, smoking, LDL-C, HDL-C, systolic and diastolic blood pressure, hypertension medication). AI-CVD predictors were modeled per standard deviation (SD) increase using Cox proportional hazards regression. Results: Over 10 years of follow-up, 1058 CVD (550 AF, 198 HF, 163 stroke, 389 CHD) and 628 all-cause mortality events accrued with some cases having multiple events. Among AI-CVD components, CAC score and chamber volumes were the strongest predictors of different outcomes. Expectedly, age was the strongest predictor for all outcomes except HF where LV volume and LV mass were stronger predictors than age. Figure 1 shows contribution of each predictor for various outcomes. Conclusion: AI-enabled opportunistic screening of useful information in CAC scans contributes substantially to CVD and total mortality prediction independently of CAC score and CVD risk factors. Further studies are warranted to evaluate the clinical utility of AI-CVD.
Abstract 4144203: "Blueberry On Top" Phenomenon. A Novel Strain Pattern In Patients With Apical Variant Hypertrophic Cardiomyopathy.
Authors: Saed Alnaimat, Mariah Mascara, Yochitha Pulipati, Anantha Madgula, Georgios Lygouris, Robert Biederman
Journal: Circulation (2024)

Introduction/Background: We have recently described “blueberry-on-top” phenomenon as a novel echocardiographic strain pattern in patients with apical variant hypertrophic cardiomyopathy (ApHCM). This so called "inverse-amyloid" pattern is identified when there is impaired peak systolic strain with paradoxically advanced time to peak strain in a hypertrophied apex with relatively spared strain in the basal segments. On a standard polar map, peak systolic strain will have a pale center while time to peak strain will depict a more robust blue center. Research Questions/Hypothesis: While a “blueberry-on-top” pattern has been vaguely observed in a few prior reports, its true prevalence in patients with ApHCM is currently unknown. We sought to examine the prevalence of this strain pattern among patients with ApHCM. Methods/Approach: A series of patients diagnosed with ApHCM, confirmed by cardiac MRI, were included. Patients with apical aneurysm, prior myocardial infarction, or aortic stenosis were excluded. All patients had a standard transthoracic echocardiogram. For uniform reporting, all echocardiogram studies were post-processed using Tomtec (Build No. 514944, Germany) which is a vendor-independent speckle tracking analysis software. Both peak longitudinal strain and time to peak strain values were exported into a standard color-coded polar map (bull's eye plot). A pixel-averaged polar map of all patients included was generated using a python script developed using an open CV library. Results/Data: From a cohort of 340 patients with HCM, 14 patients with ApHCM were included. Mean age was 66 years, and 50% were males. Mean LVEF was 69%. Mean scar burden by LGE quantification was 12% which is mostly localized to the hypertrophied apex. In patients who had genetic testing (n=10), half of patients had either pathogenic mutation or variant of unknown significance (VUS). About two thirds of patients had a strain pattern (inverted T waves) on EKG. Baseline characteristics are summarized in table 1 . A “blueberry-on-top” strain pattern was observed in 92% (n=13) of patients, while one patient had a distorted strain pattern due to apical foreshortening. A pixel-averaged polar map of all patients is shown in figure 1 . Conclusions: This is the first-in-human report establishing the prevalence of “blueberry-on-top” strain pattern in a series of patients with ApHCM. This newly recognized strain pattern is unique and can be used as a supportive diagnostic feature in patients with ApHCM.
Abstract 4144233: Left Atrial Appendage Thrombus Prediction with Statistical Shape Modeling
Authors: Colin Mackenzie, Alan Morris, Shane Ruckel, Shireen Elhabian, Erik Bieging
Journal: Circulation (2024)

Introduction: Shape of the left atrial appendage (LAA) has been proposed a predictor of stroke in patients with atrial fibrillation (AF). Prior literature employ qualitative assessments of LAA shape, which limits reproducibility. Statistical shape modeling is a quantitative method for assessment of shape. CT is increasingly utilized for identifying LAA thrombus prior to cardioversion in patients with AF. In this study we use particle based statistical shape modeling to quantify shape of the LAA, both independently and with the left atrium (LA), and evaluate if shape correlates with presence of LAA thrombus. Methods: We collected 132 cardiac CTs from consecutive studies of patients over 14 months obtained for evaluation of LAA thrombus prior to cardioversion. Of these, 16 patients were excluded. The LA and LAA were manually segmented independently from the systolic phase of the remaining 116 patients. Shape analysis was then performed using Shapeworks software (SCI, University of Utah) to compute shape parameters of the LAA in isolation as well as the LA and LAA in combination without controlling for scale or orientation. The shape parameters explaining the greatest shape variance were considered for the model until at least 80% of shape variance was included. A logistic regression model for prediction of LAA thrombus was created using these shape parameters with forward and backward stepwise model selection. Results: Of the 116 studies analyzed, 6 patients had thrombus in the LAA. Average shapes of the patients with and without thrombus differed in overall size as well as prominence of the LAA. Four shape parameters accounted for 81.2% of the LAA shape variance while six shape parameters accounted for 80.5% of the combined LA and LAA variance. The first shape parameter was predictive of LAA thrombus using both shape of the LAA only (p = 0.0258, AUC = 0.762), and when LAA shape was combined with LA shape in a joint model (p = 0.00511, AUC = 0.877). Conclusion: Statistical shape modeling of the LAA, with or without the LA, can be performed on CT image data, and demonstrates differences in shape of these structures between patients with and without LAA thrombus. Patients with LAA thrombus had a larger overall LAA size, LA size, and a more prominent LAA with distinctive morphology. Findings suggest that statistical shape modeling may offer a quantitative and reproducible approach for using LAA shape to assess stroke risk in patients with AF.
Abstract 4144113: Comparative Safety and Efficacy of Transfemoral versus Subclavian Approaches in Transcatheter Aortic Valve Implantation: A Meta-Analysis
Authors: Ahmed Elfaituri, Hazem Abdelkarem Faraj, Alhasan Saleh Alzubi, Ala Khaled, Muhammed Elfaituri
Journal: Circulation (2024)

Background: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure for high-risk aortic stenosis patients. While the transfemoral approach is traditionally preferred, the subclavian route is gaining recognition as a feasible alternative when transfemoral access is not viable. However, a detailed comparison of the safety and efficacy between these two approaches is not well-established. Objective: This meta-analysis aims to rigorously compare the safety and efficacy of the transfemoral and subclavian approaches in TAVI procedures. Methods: A comprehensive literature search was performed across PubMed, EMBASE, Cochrane Library, and Scopus databases up to December 2022. Studies that compared the transfemoral and subclavian TAVI approaches to various clinical outcomes were included. Statistical analyses were conducted using R software (version 4.0.3) with metafor and meta packages, and results were synthesized using Odds Ratios (OR) within a random-effects model framework. Results: The search identified 11 relevant studies involving 11,787 patients (10,740 transfemoral TAVI and 1,047 subclavian TAVI). Comparative analysis revealed no significant differences between the two approaches in procedure success (OR 1.36; 95% CI 0.86-2.15; P=0.19; I2=0%), in-hospital mortality (OR 0.77; 95% CI 0.45-1.31; P=0.33; I2=0%), 30-day mortality (OR 1.07; 95% CI 0.75-1.52; P=0.71; I2=0%), stroke incidence (OR 0.89; 95% CI 0.55-1.47; P=0.67; I2=0%), vascular complications (OR 1.26; 95% CI 0.67-2.39; P=0.47; I2=68%), significant bleeding events (OR 0.79; 95% CI 0.49-1.26; P=0.32; I2=0%), and myocardial infarction rates (OR 0.49; 95% CI 0.19-1.32; P=0.16; I2=0%). Conclusion: This meta-analysis demonstrates that both transfemoral and subclavian TAVI approaches offer comparable safety and efficacy profiles. The choice of approach should be individualized based on patient characteristics, operator expertise, and resource availability. The absence of significant differences and the broad confidence intervals highlight the need for larger, randomized trials to validate these findings further and explore potential clinical nuances.
Abstract 4144057: AI-enabled Cardiac Chambers Volumetry in Non-Contrast Cardiac CT scans (AI-CAC) Detects HFrEF vs. HFpEF
Authors: Morteza Naghavi, Kyle Atlas, Chenyu Zhang, Anthony Reeves, Emily Jaalouk, Claudia Henschke, David Yankelevitz, Sion Roy, Matthew Budoff
Journal: Circulation (2024)

Introduction: Coronary artery calcium (CAC) scans contain more information than is currently reported. We have previously shown in the Multi-Ethnic Study of Atherosclerosis (MESA) that AI-enabled left atrial (LA) volumetry in CAC scans (AI-CAC) enabled prediction of atrial fibrillation (AF) as early as one year. Furthermore, we have shown adding AI-CAC LA volumetry to CHA 2 DS 2 -VASc risk score improved stroke prediction in MESA. We have recently reported that AI-CAC left ventricular (LV) volumetry and mass significantly predicted incident heart failure (HF) and outperformed NT-proBNP. In this report, we examined whether AI-CAC can distinguish heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF). Methods: We applied the AutoChamber TM (HeartLung.AI, Houston, TX) component AI-CAC to data from 75 patients who underwent both a cardiac CT scan and echocardiography at Harbor UCLA medical center. AI-CAC took on average 21 seconds per scan and reported estimated volume for left atrium (LA), left ventricle (LV), right atrium (RA), and right ventricle (RV). LV volume was indexed (LVVI) by dividing LV volume by body surface area (BSA) to allow a more accurate assessment of the size of the left ventricle relative to the size of the individual. The average BSA for males and female were 1.59 ± 0.3 and 1.29 ± 0.2, respectively. HFrEF and HFpEF were defined as EF&lt;40% and EF&gt;50% respectively. Results: Average EF was 57.5 ± 7.0 in males and 59.7 ± 8.1 in females, respectively. AutoChamber volume for HFpEF vs HFrEF were LA (84.8+35.3 vs 113.2+32.8 p=0.002), LV (109.9+36.7 vs 170.7+65.9 p=0.0007), RA (97.5+58.3 vs 117.2+51.1 p=0.18), RV (135.6+52.1 vs 176.2+70.8 p=0.008), LVW (116.1+39.1 vs 170.6+56.9 p=0.0005). Density plots in the figure show a clear distinction between HFpEF and HFrEF using AI measured LVVI and comparable results. Conclusion: AI-enabled automated cardiac chambers volumetry in CAC scans correlates well with echocardiography-based LVVI and detects HFrEF vs. HFpEF. Further studies are needed to evaluate the clinical utility of AI-CAC and the ability of AutoChamber for prospective detection of patients at risk of HFrEF vs. HFpEF.
Abstract 4144236: Assessing Trends in Disability-Adjusted Life Years (DALYs) and Age-Adjusted Mortality Rates (AAMR) of Ischemic Heart Disease: A Comparative Analysis of the United States and Global Burden of Disease
Authors: Muhammad Khan Buhadur Ali, Muhammad Shahzaib, Muhammad Ahmad Qureshi, MOHAMMAD AMMAR UR RAHMAN, Luqman Munir, Amna Khalid, Malik Saad Hayat, Muhammad Mukarram Shoaib
Journal: Circulation (2024)

Introduction: Ischemic heart disease (IHD) is characterized by reduced blood flow to the heart muscle due to narrowing or blockage of the coronary arteries. This leads to chest pain, shortness of breath, and can result in heart attacks. Objectives: This study aims to analyze and compare trends in disability-adjusted life years (DALYs) and age-adjusted mortality rates (AAMR) due to IHD in the United States and globally, while also focusing on risk factors like high systolic blood pressure, high LDL cholesterol levels and smoking from 1991 to 2021. Methods: We gathered data estimates on AAMR and DALYs related to risk factors in the United States and globally, including gender-specific data, from 1991 - 2021 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) database. We computed age-adjusted rates per 100,000 individuals and determined the annual percent change (APC) with a 95% confidence interval. Trends over this period were analyzed using the Joinpoint Regression Program. Results: The analysis revealed declining trends of DALYs and AAMR in both America and globally although the negative trend has been steeper in United States for both DALYs (AAPC -2.62) and AAMR (AAPC -2.70) as compared to DALYs (AAPC 1.10) and AAMR (AAPC 1.21) globally. Conversely, the trend associated with high systolic blood pressure, high LDL cholesterol and smoking as risk factors showed declining pattern with DALYs AAPC of -3.26, -3.20 and -3.50 respectively and AAMR’s AAPC of -3.29, -3.45 and -3.62 respectively across the US while the global AAPC values for DALYs were -1.17, -1.24, -1.72 respectively and for AAMR were -1.33, -.45, 1.74 respectively. The DALYs and AAMR for males and females across the US and globally showed similar declining trends with the trend being steeper in the US than globally. In the US, the AAPC values for DALYs for males and females were -2.6 and -2.7 and for mortality rates, AAPC were -2.7 and -2.9 respectively. While for males and females globally these values were -0.96 and -1.32 respectively for DALYs and -1.07 and -1.49 respectively for mortality rates. Conclusions: The data shows a steeper decline in DALYs and AAMR in the US compared to global trends. This decline is particularly evident for high systolic blood pressure, high LDL cholesterol, and smoking and is consistent across both males and females, indicating significant improvements in public health outcomes in the United States relative to global averages.