tbuckley/cabot-search huggingface dataset:
Abstract 4142337: Takotsubo Syndrome During the COVID-19 Pandemic
Authors: Amanda Chang, Yi Wang, Joseph Phillips, Kan Liu
Journal: Circulation (2024)

Background: We previously demonstrated a significantly increased inpatient mortality of COVID-19 infection-induced male Takotsubo (TTS) patients during the early pandemic period. Since then, our management of COVID-19 prevention and treatment have evolved significantly, reducing both hospitalization and mortality rates. With these advancements, we have analyzed the clinical characteristics and outcomes of reported COVD-19-associated TTS patients since the initial pandemic. Research Question: What are the clinical characteristics and mortality outcomes of COVID-19-associated TTS patients especially in the context of improved prevention and treatment? Aims: To identify clinical characteristics and outcome correlates in patients with COVID-19-associated TTS. Methods: We completed a systematic review of 191 patients with TTS from 95 published case reports, 13 case series, and 4 observational cross-sectional/cohort studies published from April 1, 2020 to May 1, 2024 (PubMed). We performed clustering analysis using the clinical, imaging, and inpatient mortality data of 78 patients, which categorized groups of patients based on how closely associated or similar they are relative to other groups. Following this, we applied feature analysis to identify which features contributed the most to the clustering results. Results: Of all TTS cases, the mean age was 64.2±16.1 with 32.9% males. A total of 122 (63.9%) had COVID-19 infection, 21 (11.0%) had COVID-19 vaccination, and 50 (26.2%) patients had other triggers (2 patients had both COVID-19 infection and a non-infectious trigger). In-hospital mortality was 28.6% (16 of 56) for males and 13.2% (15 of 114) for females (p-value = 0.01). There was no association between COVID-19 vaccine administration and in-hospital mortality (0%, 0 of 21). There were notable differences in the clinical and demographic characteristics of TTS patients before and after September 2021 based on clustering analysis. Feature analysis indicated that COVID-19-induced TTS strongly correlated with in-hospital mortality and long-term adverse outcome in male patients. Conclusion: More male TTS patients were found during the pandemic than is expected of the traditional TTS archetype. A triad of “male, COVID-19 infection and TTS” appears to predict higher inpatient mortality. Compared to our prior study, inpatient mortality rates for TTS COVID patients have declined for all groups. Vaccine-induced TTS is associated with a benign clinical phenotype.
Abstract 4142283: Opposing Responses to Oxygen in the Rabbit Ductus Arteriosus and Fetal Pulmonary Arteries: Proteomic Analysis Reveals Significant Metabolic Differences
Authors: Rachel Bentley, Kurt Prins, Ashley Martin, Isaac Emon, Charles Hindmarch, Stephen Archer
Journal: Circulation (2024)

Introduction: The ductus arteriosus (DA) is a fetal vessel connecting the pulmonary artery (PA) and aorta, diverting oxygenated blood away from the developing lungs to the systemic circulation. Following the first breath, the DA rapidly constricts in response to increased arterial oxygen (O 2 ) which simultaneously induces relaxation of small resistance pulmonary arteries (rPA). These changes, vital for adaptation to neonatal life, separate the pulmonary and systemic circulations (DA vasoconstriction) and enable adequate perfusion of newly ventilated lungs (PA vasodilation). The underlying mechanism of these opposite O 2 responses is not fully understood. A failure of either vessel to appropriately respond to O 2 results in clinical complications, notably persistent ductus arteriosus or persistent pulmonary hypertension of the newborn. To examine the underlying differences in these fetal vessels, we performed proteomics on fetal rabbit DA and rPA. Methods: DA and rPA were isolated from male (n=4) and female (n=4) term (30 days gestation) fetal New Zealand white rabbits (protocol #2021-2122). Extracted protein was labelled with TMTpro mass tag labeling. Following HPLC fractionation, samples were run on the ThermoFisher Orbitrap Eclipse Mass Spectrometer. Analysis was completed using ThermoFisher Proteome Discoverer software and DESeq2. Results: There were 3103 significantly, differentially expressed proteins between the DA and PA(Benjamini Hochberg adjusted p&lt;0.05), 232 of which were ±1.5-fold differentially expressed ( Figure 1 ). Using KEGG pathway analysis the most significantly DA enriched pathway is “Starch and sucrose metabolism” (map00500) and the most significantly rPA enriched pathway is “Sulfur Metabolism” (map00920). There was also rPA enrichment of other metabolic pathways including “Fatty Acid Degradation” (map00071), “Pyruvate Metabolism” (map00620), and “Glycolysis/Gluconeogenesis” (map00010). Conclusions: This analysis reveals unique mitochondrial metabolic pathways that may contribute to the opposing tissue responses of these specialized blood vessels to O 2 . Exploration of these pathways may identify potential therapeutic targets and inform future investigations of differential O 2 sensing in DA and rPA.
Abstract 4142338: Atrial mechanical remodeling could be predictable for newly developed atrial fibrillation in patients with embolic stroke with undetermined source
Authors: Hee-Jin Kwon, KI-WOON KANG, Minsu Kim, Byung Joo Sun, Jun Hyung Kim
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) has been known as a main cause of embolic stroke. Well-chosen candidate to be anticoagulated should be critical for secondary prevention in patients with embolic stroke with undetermined source (ESUS). Atrial mechanical remodeling presenting cardiomyopathy could lead to not only occur atrial fibrillation but also increase risk of thromboembolism. Objective: To investigate association of LA strain, and newly detected AF in patients with ESUS. Methods: A total of 45 patients diagnosed ESUS with implantable loop recorder (ILR) who were prospectively enrolled and clinically followed for newly developed AF for secondary prevention in the 3 referral centers. Transthoracic echocardiography including LA strain analysis were performed. Results: 11 patients (24%) among all (mean age 67 years, 58% male) have developed newly AF and others have maintained sinus rhythm within 2 years. The mean age, proportion of hypertension and diabetes were similar between sinus rhythm and newly AF patients. LA diameter (36.3 ± 6.6 mm vs. 39.3 ± 6.0 mm) and E of E’ (11.0 ± 4.5 mm vs. 9.2 ± 1.1 mm) were also similar between two group. Even though peak and pump LA strain in the newly AF were lower than those in sinus rhythm without statistically significance (24.7 ± 6.4 vs. 22.3 ± 8.8 and 10.8 ± 3.8 vs. 9.2 ± 4.9). Pump LA strain (cut-off value9.1) was significantly associated with developing newly AF during follow-up (hazard ratio=4.8, 1.27-18.3, p=0.02) Conclusion: Our data demonstrated that the pump LA strain was significantly associated with developing newly AF in the ESUS. This result suggests that atrial mechanical remodeling could be predictable for newly developed AF in patients with ESUS
Abstract 4142182: Epicardial Adipose Tissue Association with Fibrotic Substrate Distribution and Rotor-attracting Locations: A Study Using Contrast Computed Tomography (CCT) Scans and Late Gadolinium Enhancement Magnetic Resonance Imaging (LGE-MRI)-based Digital Twins of Persistent Atrial Fibrillation
Authors: Kensuke Sakata, Adityo Prakosa, Carolyna Yamamoto Alves Pinto, Syed Yusuf Ali, Shane Loeffler, Eugene Kholmovski, Natalia Trayanova
Journal: Circulation (2024)

Introduction: Since pulmonary vein isolation (PVI) is often insufficient for persistent atrial fibrillation (PsAF) treatment, rotor ablation targeting AF drivers/substrates has been conducted as potential effective strategy. Recently, substrate location capable of attracting rotor (LR) has been reported to be associated with local fibrosis features. Meanwhile, epicardial adipose tissue (EAT) has been shown to be linked to developing fibrosis and arrhythmogenic substrates. Currently it is not well understood how EAT is related to the LR, and local fibrosis features. Personalized LGE-MRI-based digital twins (DTs) and cardiac CCT can be employed to investigate this. Hypothesis: EAT detected in CCT is correlated with LRs having specific local fibrosis features. Aim: To investigate the correlation between EAT, LRs, and the corresponding local fibrosis features using the merging of LGE-MRI-based DTs and CCT. Methods: Both LGE-MRI and CCT were acquired in 19 consecutive PsAF patients. Bi-atrial DTs incorporating the fibrosis distribution were created, wherein, following virtual PVI, LRs were identified by rapid pacing from 40 bi-atrial sites near fibrosis. In silico ablation was repeated until non-inducibility of rotors (Fig). EAT segmented from CCT and DT were compared after merging them using the bi-atria and 4 PVs as reference points. The distance from each tissue type in DT to the closest EAT (DCE) was calculated. The correlation between local fibrosis density feature (FD) and the median DCE at LRs was analyzed. For each LR, both volumetric FD (vFD) and endo-epi surface FD (sFD), subtracting epicardial surface FD from the endocardial surface FD to measure the dissociation of Endo-Epi surface FDs, were calculated. Results: Among 17 DTs excluding 2 without qualified CCT images, 15 DTs had 95 extra-PVI LRs in total. The DCE of fibrotic tissues (16%) was significantly shorter than that of normal tissues (84%) (p&lt;0.001). The DCE of tissues within LRs (2%) was also significantly shorter than outside LRs (98%) (p&lt;0.001). The mean DCE among 95 LRs was 4.1 mm. The vFD of the LRs with DCE &lt;4.1 mm (56 LRs) was comparable to that of LRs with DCE ≥4.1 mm (39 LRs) (p=0.543). However, the sFD was significantly higher for LRs with DCE ≤4.1 mm (p=0.010). Conclusions: EAT is associated with fibrotic tissue and LR. Higher sFD suggests shorter DCE is linked to higher FD on the endocardial surface at LRs. Detecting EAT with CCT could be useful for evaluation and ablation of PsAF substrate.
Abstract 4142467: Geographic and Temporal Trends in Stroke Mortality among Major Racial and Ethnic Populations in the United States, 2000-2019
Authors: Allana Forde, Paula Strassle, Laura Dwyer-Lindgren, Zhuochen Li, Parkes Kendrick, Ali Mokdad, George Mensah, Eliseo Perez-Stable
Journal: Circulation (2024)

Background: Despite profound disparities in stroke mortality, there is limited research on geographic variation across and within US racial and ethnic populations. Research Question/Hypothesis: Do geographic trends in stroke mortality vary across and within racial and ethnic populations living in the US? We hypothesized that changes in county-level stroke mortality would vary across and within racial and ethnic groups. Methods: We applied validated small-area estimation methods to US National Vital Statistics System death certificates to estimate stroke mortality rates by county (N=3110) and race and ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic or Latino [Latino], and White) from 2000-19. Mortality estimates were corrected for race and ethnicity misclassification on death certificates and age-standardized to the 2010 Census. Results: In 2019, age-standardized county-level stroke mortality rates per 100,000 ranged from 10.9 to 170.6 among AIAN, 11.8 to 96.9 among Asian, 17.4 to 179.7 among Black, 6.5 to 114.3 among Latino, and 14.5 to 139.7 among White populations. Despite stroke mortality declining nationally among all racial and ethnic populations, there were counties where mortality increased (AIAN: 15/474; Asian: 46/667; Black: 11/1488; Latino: 154/1478; White: 46/3051), Fig . Among these counties, median absolute increases were 3.5 (IQR 1.9-5.3; max: 26.8) among AIAN, 4.1 (1.1-5.4; max: 12.2) among Asian, 7.1 (1.0-10.2; max: 52.5) among Black, 2.4 (1.3-4.6; max: 18.3) among Latino, and 5.6 (1.9-12.3; max: 47.5) among White populations. Increased stroke mortality largely occurred in the Carolinas, Florida, and Georgia (72.4% of counties with increases) for all racial and ethnic groups except AIAN, which were mostly in Oklahoma (n=9). Geographic and temporal trends also varied across stroke type. Conclusions: Stroke mortality increased in over 200 counties nationally, with differential effects by race and ethnicity. Most increases occurred in the lower South Atlantic states. These findings underscore the importance of understanding drivers of stroke mortality disparities, as well as creating prevention and treatment strategies that target populations and places at high risk.
Abstract 4142393: Long-Term Outcomes of Septal Myectomy and Concomitant Aortic Valve Replacement at a Primary Academic Center
Authors: Preston So, Mrinal Patel, Amit Iyengar, Noah Weingarten, Jessica Dominic, Andrew Belec, Joyce Ho, Rachel Wilson, Danika Meldrum, Melissa Seiberlich, Pavan Atluri
Journal: Circulation (2024)

Background: Aortic stenosis (AS) and septal hypertrophy are significant causes of left ventricular outflow tract obstruction (LVOTO). When both are present, the severity of LVOTO increases. For symptomatic patients, the treatment involves relieving both sources of obstruction through aortic valve replacement (AVR) and septal myectomy. AVR is associated with symptomatic improvement and better long-term outcomes in valvular causes of LVOTO. However, the long-term outcomes of AVR combined with septal myectomy in patients with coexisting septal hypertrophy and AS are not well studied. Aims: This study aims to assess the long-term outcomes, associated risk factors, and prognostic indicators in patients with left ventricular outflow tract obstruction who underwent aortic valve replacement and concomitant septal myectomy. Methods: We identified a retrospective cohort of 82 patients who underwent aortic valve replacement and concomitant septal myectomy for symptomatic LVOTO at the University of Pennsylvania between 2007 and 2021. We assessed preoperative and postoperative symptoms, electrocardiograms, echocardiograms, operative data, follow-up data, and mortality. Results: The mean age of the cohort was 68.2 ± 15.1 years (range 19 to 88). Of the patients, 52% underwent AVR and concomitant myectomy only, while 48% underwent AVR, myectomy, and additional cardiac procedures. Postoperatively, the mean IVSd/PWd ratio was significantly reduced (Figure 1, p&lt;0.01). Atrial fibrillation occurred in 45% of patients, and complete heart block occurred in 30%, but neither was associated with increased mortality (Figure 2, all p&gt;0.05). The survival rates at 5 and 10 years post-operation were 74.6% and 44.8%, respectively. Additional cardiac procedures, alongside AVR and septal myectomy, did not increase mortality. Postoperative NYHA classifications at follow-up were markedly improved (Figure 3). Conclusion: Patients with symptomatic LVOTO who underwent AVR with concomitant septal myectomy have long-term symptomatic improvement. Postoperative arrhythmias are common sequelae but are not associated with increased mortality.
Abstract 4142335: Performance of a Protein Language Model for Variant Annotation in Cardiac Disease
Authors: Aviram Hochstadt, Chirag Barbahya, Anthony Aizer, Scott Bernstein, Marina Cerrone, Leonid Garber, Douglas Holmes, Robert Knotts, Alex Kushnir, Jacob Martin, David Park, Michael Spinelli, Larry Chinitz, Lior Jankelson
Journal: Circulation (2024)

Introduction: Genetic testing is a cornerstone in the assessment of many cardiac diseases. However, variants are frequently classified as Variants of Unknown Significance (VUS), limiting the utility of testing. Recently, the DeepMind group (Google, USA) developed AlphaMissense, a unique Artificial Intelligence (AI) based model, based on language model principles for the prediction of missense variant pathogenicity. Objective: To report on the performance of AlphaMissense, accessed by VarCardio, an open web-based variant annotation engine, in a real-world cardiovascular genetics center. Methods: All genetic variants from an inherited arrhythmia program were examined using AlphaMissense via VarCard.io and compared to the ClinVar variant classification system, as well as another variant classification platform (Franklin by Genoox). The mutation reclassification rate and genotype-phenotype concordance were examined for all variants in the study. Results: We included 266 patients with heritable cardiac diseases, harboring 339 missense variants. Of those, 230 (67.8%) were classified by ClinVar as either VUS or non-classified. Using VarCard.io, 198 VUSs (86.1%, CI 80.9-90.3%) were reclassified to either Likely Pathgenic (LP) or Likely benign (LB). The reclassification rate was significantly higher for VarCard.io than for Franklin (86.1% vs 34.8%, p&lt;0.001). Genotype-Phenotype concordance was highly aligned using VarCard.io predictions, at 95.9% (CI 92.8-97.9%) concordance rate. For 109 variants classified as Pathogenic, LP, Benign or LB by ClinVar, concordance with VarCard.io was high (90.5%). Conclusion: AlphaMissense, accessed via VarCard.io, may be a highly efficient tool for cardiac genetic variant interpretation. The engine's notable performance in assessing variants that are classified as VUS in ClinVar, demonstrates its potential to enhance cardiac genetic testing.
Abstract 4142231: Relationship between serum interleukin-6 levels and severity of STEMI undergoing percutaneous coronary intervention
Authors: Pham Son Lam, Nguyen Duy Toan, Dinh Cong Pho, Do Van Chien
Journal: Circulation (2024)

Background: Little is known about the clinical relevance of interleukin (IL)-6 and the severity of patients with acute ST-elevation myocardial infarction (STEMI). This study examined the possible associations of plasma IL-6 concentrations with TIMI scores in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: The descriptive, cross-sectional study was conducted in patients with STEMI with a confirmed diagnosis and percutaneous coronary angiography at 108 Military Central Hospital from April 2023 to April 2024. All information about clinical and paraclinical parameters was recorded. Blood samples for biomarker analyses, including IL-6, were collected. Results: There were 64 consecutive STEMI patients. There was 75% of males. The ROC curve analysis performed in STEMI patients showed that IL-6 could be a powerful predictor marker in the TIMI score. The area under curve was 0.905 . The cut-off point was 14.9 ng/L, showing a &lt; 4 or ≥ 4 TIMI score. Patients with IL-6 concentrations cut-off point showed a significantly higher time of STEMI, GOT, higher pulmonary arterial pressure, and longitudinal tracking of left atrial diameter. Patients with IL-6 concentrations cut-off point showed a significantly lower fractional shortening, and lower tricuspid annular plane systolic excursion. Conclusions: IL-6 levels were associated with the severity of STEMI assessed by the TIMI score. Based on the cut-off levels of IL-6 measured in patients with STEMI, our study strongly suggests that IL-6 could be a powerful marker in evaluating the time of STEMI and some echocardiography indexes.
Abstract 4142559: The effect of blood pressure monitoring program based on intelligent wearable devices on the compliance of nursing guidelines for intravenous thrombolysis in acute ischemic stroke
Authors: Hong Chang, Suai Li, Jie Zhao, Mengrao Liu, siying tian, Yuxin Wang, Ting Yang
Journal: Circulation (2024)

Introduction: It is recommended that blood pressure (BP) in patients with acute ischemic stroke should be monitored closely before and until 24 hours after thrombolysis. This study aimed to develop a BP monitoring protocol for acute ischemic stroke patients using smart wearable devices and investigate its feasibility and effectiveness. Methods: 160 stroke patients in the emergency department of a designated advanced stroke center from were recruited from March to September 2023 (Fig.1). The intervention group received the BP monitoring protocol using smart wearable devices, while the control group received traditional bedside BP monitoring using standalone devices. Process evaluation indicators included feasibility, fidelity, and stakeholder acceptability. Outcome evaluation indicators included adherence to BP monitoring guidelines, time from admission to intravenous thrombolysis, National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and the incidence of symptomatic intracranial hemorrhage. Results: The implementation rate of BP monitoring guidelines from before intravenous thrombolysis to 24 hours after thrombolysis in the experimental group was 90.00 (87.50, 95.00) %, and that in the control group was 87.50 (82.50, 92.50) % (Table 1). The results of the process evaluation showed that the feasibility and intervention fidelity of this study were good. Interviews with stakeholders (11 nurses and 11 patients) revealed that the implementation of the intervention protocol was beneficial in improving nursing efficiency and timely detection of disease changes, but the protocol needed further improvement. Conclusion: The BP monitoring protocol for stroke patients undergoing intravenous thrombolysis based on smart wearable devices is scientifically sound and feasible. It can enhance adherence to BP monitoring guidelines and promote the implementation of evidence-based nursing practices.
Abstract 4142418: Immediate Leg Mobilization is Feasible after Catheter Ablation of AF Using Large Vascular Access Sheaths (Pulsed Field Ablation and Cryoballoon Ablation)
Authors: Riya Sam, Romil Patel, Lavisha Singh, Mark Metzl, Westby Fisher, Jose Nazari, Alex Ro, Hany Demo, Jeremiah Wasserlauf
Journal: Circulation (2024)

Background: Vascular recovery from catheter ablation (CA) generally requires a period of leg immobilization. Vascular closure devices reduce the length of bedrest and promote earlier discharge, however, a period of immobilization is still routinely observed. The objective of this study was to compare a strategy of immediate leg mobilization (IM) using percutaneous suture-mediated closure devices against figure-of-eight sutures and 4h bed rest (BR) after CA of atrial fibrillation (AF) using large vascular access sheaths for cryoballoon (CBA) and pulsed-field ablation (PFA). Methods: A total of 98 subjects were analyzed (49 IM and 49 BR). Vascular closure in IM consisted of a single percutaneous suture-mediated closure device (Perclose ProStyle) delivered to each of 3 venous access sites in a single groin. Following the procedure, both legs could be mobilized immediately with no head-of-bed restriction. Ambulation was instructed at 1h post-procedure, and discharge was scheduled at 3h. Hemostasis in BR was achieved using figure-of-eight sutures delivered to one or both groins utilized for access, and 4h bedrest. In both groups, one of the sheaths consisted of a 12F to 17F access for CBA or PFA. Protamine was administered prior to the removal of sheaths. Oral anticoagulation was resumed same day. The primary endpoint was the incidence of vascular complications. The secondary endpoint was time to discharge. Results: Baseline characteristics between groups were similar (Age 67.8 ± 13.1 years, BMI 30.2 ± 6.8, LVEF 55.7 ± 12.4, 48% female). 55% of IM and 100% of BR underwent CBA. The remainder underwent PFA. There was no difference in the rate of vascular complications between the two groups (1 IM vs 0 BR, p = 0.315 ). The time to discharge was significantly shorter in the IM group (3.9 ± 0.8 vs 5.4 ± 1.0 h, p &lt; 0.0001 ). Conclusions: In this single-center study, immediate mobilization facilitated by suture-mediated vascular closure following catheter ablation using large access sheaths was associated with no difference in vascular complications compared to bedrest and resulted in earlier discharge. Larger studies evaluating cost, clinical endpoints, and patient-reported outcomes are needed.