tbuckley/cabot-search huggingface dataset:
Abstract 17726: Nonischemic Cardiomyopathy in Patients With Coronary Artery Disease
Authors: Parag Bawaskar, Nicholas Thomas, Khaled Ismail, Yugene Guo, Sanya Chhikara, Pal Athwal, Alison Ranum, Achal Jadhav, Abel Hooker, Ishan Nadkarni, Dominic Frerichs, Pratik Velangi, Tesfatsiyon Ergando, Hassan Akram, Chetan Shenoy
Journal: Circulation (2023)

Introduction: Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from revascularization. While there are several potential reasons for the lack of benefit from coronary revascularization, an underexplored possibility is the presence of coexisting nonischemic myocardial pathology. Aim: We aimed to investigate the prevalence and prognostic significance of nonischemic cardiomyopathy (NICM) in CAD. Methods: We studied a large cohort of consecutive patients with obstructive CAD on coronary angiography who had cardiovascular magnetic resonance imaging (CMR) from 2004 to 2020 for clinical indications. CMRs were analyzed for this study for the presence and type of cardiomyopathy. Patients with normal left ventricular ejection fraction and no late gadolinium enhancement (LGE) were classified as having no cardiomyopathy. Ischemic cardiomyopathy (ICM) was defined by ischemic LGE or extensive hibernating myocardium in the absence of LGE. NICM was defined by nonischemic LGE, absence of LGE without hibernating myocardium, or morphological abnormalities of NICM such as left ventricular hypertrophy. The study endpoint was a composite of all-cause death or hospitalization for heart failure. Results: Among 3,027 patients (mean age 65 years, 24% women), 18% had no cardiomyopathy, 65% had only ICM, and 17% had NICM. Of those with NICM, 38% also had ICM (dual cardiomyopathy). At a median follow-up of 4.7 years, 1,112 patients experienced the study endpoint. On Kaplan-Meier analysis, patients with NICM had a higher cumulative incidence of the study endpoint compared with no cardiomyopathy and ICM (log-rank P&lt;0.001 for both comparisons). On multivariable regression analyses, NICM was associated with a greater risk for the study endpoint-hazard ratio (HR) 1.77; 95% confidence interval (CI) 1.43-2.19; P&lt;0.001 compared with no cardiomyopathy and HR 1.27; 95% CI 1.09-1.47; P=0.003 compared with ICM, after adjustment for potential confounders. Conclusions: NICM was identified in 1 in 6 patients with CAD and was associated with worse long-term outcomes compared with no cardiomyopathy and ICM. In patients with obstructive CAD, coexisting NICM may contribute to the lack of prognostic benefit from revascularization.
Abstract 17445: Near Occlusion of the Tricuspid Valve By Metastatic Melanoma
Authors: Ekow Essien, Abdulghani Mounir, Matthew Peters, Faisal Masood, Joaquin Solis
Journal: Circulation (2023)

Introduction: Metastatic tumors to the heart can have varied clinical presentations depending on location. We present a case of right atrial (RA) metastatic melanoma with near obstruction of the tricuspid valve resulting in significant hypoxia. Case Presentation: A 34-year-old man with a history of retinoblastoma and astrocytoma presented to the emergency department with 2 weeks of progressively worsening shortness of breath. On examination he was hypoxic and in respiratory distress. Computed tomography of the chest with contrast showed a large hypoattenuating homogeneous mass in the RA that protruded into the right ventricle and extended to the superior and inferior vena cavae. Transthoracic echocardiography (TTE) showed a large (9.1 x 4.6 cm) echodensity filling the RA and almost completely obstructing the tricuspid valve. Due to worsening hypoxia, the patient underwent palliative surgical resection of the mass. Intraoperatively, the mass was densely adherent to all walls of the RA. Surgical pathology identified the mass as metastatic malignant melanoma. The patient was started on pembrolizumab and discharged home in stable condition. At his 1-month follow-up, his symptoms had improved and he had returned to work. Discussion: Metastases to the heart are more common than primary cardiac tumors. Left-sided cardiac masses are commonly benign, whereas right-sided masses raise suspicion for metastatic disease. Melanoma, lymphoma, leukemia, and breast and lung cancers commonly metastasize to the heart. The size of the RA mass in this patient was significant enough to cause hypoxia and near occlusion of the tricuspid valve. Successful palliative resection of the mass resulted in a large improvement in symptoms. Conclusion: As the incidence of malignant melanoma increases, clinicians need to have a high index of suspicion for cardiac metastasis. Early identification of cardiac metastasis is critical as these cases can often be associated with poor prognosis.
Abstract 16761: Preprocedural Frailty is Associated With Lower Cardiac Rehabilitation Use Despite Greater Benefit
Authors: Tyler M Bauer, Hechuan Hou, Donald S Likosky, Francis D Pagani, Steven J Keteyian, Devraj Sukul, Mike P Thompson
Journal: Circulation (2023)

Introduction: Increased frailty before cardiovascular procedures is associated with poorer outcomes. While underutilized, cardiac rehabilitation (CR) is guideline-recommended for patients undergoing cardiovascular procedures and may help mitigate frailty through individualized, monitored exercise and risk factor reduction. Research Question/Hypothesis: Evaluate the relationship between preprocedural frailty, CR use, and one-year mortality. Methods: Medicare fee-for-service claims data were queried for patients who underwent inpatient percutaneous or surgical revascularization or aortic valve replacement between July 2016 and December 2018. Patients were stratified into quartiles (Q1 through Q4) using the validated claims-based frailty index. CR use was defined as attending any CR session within one year of discharge. Unadjusted and adjusted logistic regression was used to compare CR use across increasing frailty quartiles, and inverse probability treatment weighting was used to evaluate the effect of CR on one-year mortality across frailty quartiles. Results: Overall CR enrollment among the 570,851 beneficiaries was 35.3%; increasing frailty was associated with decreased CR use (unadjusted: frailty Q1: 48.3% vs Q4: 20.6%, p&lt;0.001; adjusted OR: 0.61, p&lt;0.001). Unadjusted one-year mortality was lower among CR users as opposed to non-users (2.7% vs 14.6%). After weighted adjustment, the absolute reduction in mortality associated with CR use was greater among frailer patients (Q4: -12.2%) relative to less frail patients (Q1: -2.9%) (Figure). Significant interaction effects between CR use and frailty quartiles indicated stronger associations of CR on mortality among more frail patients. Conclusions: Preprocedural frailty was associated with lower CR use despite greater absolute benefits on one-year mortality. Increasing CR enrollment in frail patients may enhance outcomes after cardiac interventions.
Abstract 13916: Patient Outcomes 6 Months Following Pulmonary Vein Isolation for Atrial Fibrillation With a Novel RF Catheter: Initial Data From NEwTON AF
Authors: Gregory F Michaud, Marcos Daccarett, David Haines, Decebal G Latcu, Suraj Kapa, Devi Nair, Jim W Cheung, Li-Wei Lo, Stanislav Weiner, Manuela Cireddu, Cheng-Hung Li, Antonio Dello Russo, Jonathan D Raybuck, Scott Wehrenberg, Dhiraj Gupta
Journal: Circulation (2023)

Introduction: The combination of local impedance (LI), a direct measure of electrical resistance at the catheter tip, and contact force (CF) may facilitate treatment of atrial fibrillation (AF). This trial is designed to examine the safety and effectiveness of a novel RF catheter that allows measurement of both LI and CF. Hypothesis: Demonstrate the safety and effectiveness of a novel radiofrequency catheter with LI and CF for treatment of drug refractory, recurrent, symptomatic Paroxysmal AF (PAF). Methods: NEwTON AF is a multi-center, global, prospective, single arm study. Patients received index treatment for PAF with the study catheter. The present 6-month endpoint analysis was prospectively planned. Results: The study treated 299 patients at 45 sites in North America, Europe, and Asia. Patients were 39.5% female with a mean age of 62yrs (±12), and had a mean LVEF of 59% and an LA diameter of 3.9cm. Procedure time, LA dwell, and fluoroscopy times were 166, 136, and 15 minutes, respectively. High-power short-duration (HSPD, 45-50W) was exclusively used in 210 cases, which had notably shorter procedure times than the 82 cases that used conventional power, 148 vs 208 min, respectively. Acute procedural success was observed in 98.3% of cases. As of 6 months, freedom from documented recurrence of any atrial arrhythmia was 79.9% (Figure). Recurrence in relation to LI shows that pts with a 20Ω LI drop (in at least 60% of lesions) had better 6m outcomes (84.2% vs 73.3, p=0.04). The freedom from safety event rate at 30d was 96.0%; events included pericarditis (6), access complications (2), pulmonary edema (2), embolism (2), cerebrovascular accident (1), tamponade (1). Pericarditis was higher in pts with a history of COVID at enrollment, 16.3% vs 5.9%, p=0.025. Conclusions: This data suggests that patient outcomes and safety for this novel catheter are promising. Further data from this study, including 12m outcomes, and detailed analysis of local impedance data are forthcoming.
Abstract 13293: Predicting Successful ECMO Decannulation - A Novel Machine Learning Approach
Authors: Elizabeth Hutchins, Al Rahrooh, Jeffrey Feng, Neha Chandra, Jeffrey J Hsu, Alex Bui
Journal: Circulation (2023)

Introduction: Extra Corporeal Membrane Oxygenation (ECMO) has emerged as a crucial life support intervention, yet the decision-making process for safe decannulation remains challenging due to a paucity of data. Methods: 199 patients who underwent venoarterial ECMO for cardiogenic shock between 2015 and 2021 were identified. Demographic, hemodynamic, laboratory, and echocardiographic data obtained within 24 hours of decannulation were collected. Successful decannulation was defined as survival without relapse to mechanical circulatory support or heart transplant within 30 days. The dataset was randomly split into 80/20 train-validation splits, and four machine learning models were employed. 5-fold cross-validation and error analysis were performed. Feature importance was derived from the best performing model. Results: 103 patients were successfully weaned off ECMO. Table 1 provides patient characteristics, which were used as features in the models. Among the models tested, Random Forest (RF) exhibited the highest performance (accuracy 85.0%, precision 90.0%, recall 85.7%, AUROC 0.94). Figure 1 depicts the performance for each model as well as the ranked feature importance and Receiver Operating Curve for the RF model. The most important features were mixed venous oxygen saturation, systolic blood pressure, ECMO flow rate and pulmonary diastolic blood pressure. Conclusion: This study demonstrates the successful application of machine learning in predicting ECMO weaning outcomes. Future research will add features and patients to enhance model performance with the goal of developing a clinical tool to assist physicians caring for ECMO patients.
Abstract 14631: A Perfect Storm: Alcoholic Cardiomyopathy, Influenza B and the Battle Against Biventricular Thrombi and Pulmonary Embolism
Authors: Noreen Mirza, Mohammad Nabil Rayad, Darshan Gandhi, Iyad Farouji, Eyad Ahmed, Addi suleiman
Journal: Circulation (2023)

Introduction: Biventricular thrombi (BT) are a rare occurrence in clinical practice and when they occur in alcoholic dilated cardiomyopathy (ADCM), they are a complication of this condition. Secondary predisposing conditions that can promote thrombus formation include infections like Influenza B. Herein, we report a rare case of ADCM and influenza B propagating the development of biventricular thrombi and pulmonary embolism. Case Presentation: A 47-year-old healthy gentleman with a history of tobacco, marujuana and alcohol abuse presented with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, non-productive cough, fevers and bilateral lower extremity swelling. Initial vitals were significant for tachycardia and slightly elevated blood pressure. On examination, the patient had decreased breath sounds in the right lower lobe with rales and trace lower extremity edema. Initial labs revealed elevated BNP, High-sensitivity troponin and d-dimer. Rapid influenza B was positive. Chest x-ray showed pleural effusion and CT angiogram chest revealed filling defect in the segmental and subsegmental branches of the right pulmonary artery. Echocardiogram revealed biventricular thrombi and LVEF of 10-15% with global LV hypokinesis. He was treated with oseltamivir, enoxaparin and was started on guideline directed medical therapy. Discussion: BT formation can occur in heart failure with reduced ejection fraction. ADCM induces LV dilation which creates a stagnant environment conducive to thrombus development. Influenza B can cause a prothrombotic state due to endovascular injury by proinflammatory mediators. Due to advanced diagnostic techniques, the incidence of BT has increased however, they remain a significant challenge due to embolization risks. This is the first case that highlights that patients with ADCM in combination with influenza B are predisposed to hypercoagulable states inducing fatal BT formation thus, prompt recognition is vital.
Abstract 15660: Mitral Regurgitation in Patients With Chronic Kidney Disease: Results From the Chronic Renal Insufficiency Cohort Study
Authors: XUANYI JIN, Jing Chen, Hua He, Cong Zhao, Lucy Van Dyke, Oygen Suayp, Flor Alvarado, Arnold B Alper, AARON SWEENEY, Lydia A Bazzano, Katherine T Mills, Jiang He
Journal: Circulation (2023)

Background: Mitral regurgitation (MR) is more common in patients with chronic kidney disease (CKD) compared to the general population, However, longitudinal associations of MR and adverse outcomes in CKD, such as mortality and heart failure (HF), have not been well studied yet. Hypothesis/Aim: We aim to investigate the prevalence of MR and its association with mortality, incidence of HF, and atrial fibrillation (AF) in patients with CKD. Methods: We studied patients with CKD who had an echocardiography exam (2008-2013) in the Chronic Renal Insufficiency Cohort (CRIC) study. Independent t-tests and Chi-square tests were used to compare clinical and echocardiographic characteristics in patients with vs. without MR. The degree of MR was quantified using effective regurgitant orifice area (EROA) from apical-four chamber view and further categorized as trace, mild and moderate/severe. Kaplan-Meier (KM) Curves and Cox hazard models were used to estimate the association of MR degree and EROA with mortality, incidence of HF and AF. Results: Among a total of 2951 patients with CKD, 2167 (73.4%) patients had MR (EROA, 0.14±0.19 cm 2 ) with degrees of trace, mild, and moderate /severe MR comprising 54.3%, 12.5%, and 6.6%, respectively. Patients with MR were more likely to be female (47.39 vs. 42.73%), non-White race (51.8 vs. 46.8%), and have worse B-type Natriuretic Peptide (NTproBNP; 524.86 vs. 271.66 pg/ml) and left ventricular ejection fraction (53.7 vs. 55.8%) compared to those without MR. When stratified by estimated glomerular filtration rate (eGFR; 60-45, 45-30, &lt;30 ml/min/1.73 m 2 ), the group in the lowest eGFR category (n=703) had the highest prevalence of moderate/severe MR (9.2%, p &lt;0.05). KM Curves showed patients with CKD and moderate/sever MR had higher incidence of HF and AF than those with CKD and absent, trace, or mild MR ( p &lt;0.01). EROA was associated with the incidence of AF (hazard ratio [HR] = 1.08, p &lt;0.01) and HF (HR=1.06, p &lt;0.01), independent of age, sex, race, traditional cardiovascular risk factors, urine albumin-to-creatinine ratio, eGFR and NTproBNP, but not mortality. Conclusion: In patients with CKD, MR is independently associated with HF and AF, highlighting the importance of MR-specific interventions to improve cardiovascular outcomes.
Abstract 11919: Cardiac Conundrum: A Novel Case of Isolated Cardiac Scleromyxedema
Authors: Brittany Murphy, Nicholas Weinand, Angela Liu, Sandip Zalawadiya
Journal: Circulation (2023)

Case Presentation: A 41-year-old woman with history of diabetes, inferior STEMI with RCA PCI, and HFmrEF was transferred to our hospital with worsening cardiogenic shock on ionotropic support. She was admitted to an outside facility one month prior with worsening dyspnea on exertion, peripheral edema, paroxysmal nocturnal dyspnea, pre-syncope, and weakness. TTE demonstrated LVEF of 30-35% (40-45% previously) with severe inferior and posterior wall hypokinesis. Cardiac MRI revealed LVEF of 23%, prior RCA infarct, full-thickness late gadolinium enhancement in the left ventricular basilar wall, global abnormal parametric mapping parameters of both native T1, T2 and ECV, and severe biventricular dysfunction concerning for infiltrative cardiomyopathy. Left heart catheterization revealed nonobstructive CAD. Right heart catheterization showed severely elevated right sided filling pressures and endomyocardial biopsy revealed frequent deposits of interstitial mucin (Figure 1), later confirmed by electron microscopy; a Congo red stain was negative for amyloid deposition. Additional work up included serum protein electrophoresis, which was negative for monoclonal proteins. She had no dermatologic disease. A diagnosis of isolated cardiac scleromyxedema was made. Discussion: Scleromyxedema is a rare mucinous disorder typically characterized by cutaneous mucin deposits and fibroblastic proliferation. It is commonly associated with monoclonal gammopathies, specifically IgG lambda; however, there are rare cases without paraproteinemia. Systemic mucinous infiltration has been reported and cardiac involvement specifically has been described in up to 20% of patients, although it has never been reported without cutaneous manifestations or monoclonal gammopathy as demonstrated with our patient. The patient received IVIg treatment, however required two additional hospitalizations over the next four months for decompensated heart failure.
Abstract 15755: Associations Between Use of Assisted Reproductive Technology Intrauterine Insemination With Adverse Pregnancy Outcomes in U.S. Natality Data, 2016 - 2021
Authors: Vennela Avula, Theresa Boyer, Kevin Sun, Chiadi E Ndumele, Erin D Michos, Valerie Baker, Shannon Anderson, Arthur J Vaught, Allison Hays, Josef Coresh, Anum A Minhas
Journal: Circulation (2023)

Background/Hypothesis: Assisted reproductive technology (ART) and intrauterine insemination (IUI) may be associated with increased risk of adverse pregnancy outcomes (APOs) and contribute to future cardiovascular disease. Aims: To determine the joint association of ART/IUI and pre-pregnancy cardiometabolic factors with APOs in a national sample. Methods: We analyzed Natality Data from the National Vital Statistics System of the National Center for Health Statistics between 2016-2021. We used multivariable logistic regression to estimate the joint association of ART/IUI and pre-pregnancy cardiometabolic risk factors with APOs. Results: Among 21,625,155 deliveries, women who conceived with either ART (n=228,597) or IUI (n=136,630) were older, more likely White or Asian race, more educated, and less likely to smoke than those who conceived without fertility treatments. Compared to pregnancies conceived without fertility treatments and with no pre-pregnancy cardiometabolic risk factors, ART/IUI-conceived pregnancies were generally associated with increased risk of gestational diabetes, pregnancy induced hypertension, and eclampsia among both women with and without pre-pregnancy cardiometabolic risk factors (Table 1). Women who conceived with ART/IUI and had ≥ 2 cardiometabolic risk factors had the highest adjusted OR of gestational diabetes (2.45 [2.41, 2.67]), while those who conceived with ART/IUI and had pre-pregnancy diabetes had the highest adjusted OR of pregnancy induced hypertension (3.37 [3.00, 3.79]). Conclusions: Patients with pregnancies conceived by ART/IUI are at an increased risk of APOs, including gestational diabetes, pregnancy induced hypertension and eclampsia. The presence of pre-pregnancy cardiometabolic factors modestly increases this risk. Clinicians should consider targeted strategies to optimize the pre-pregnancy cardiometabolic health of women seeking infertility treatments.
Abstract 16161: Effects of Year Long Aerobic Exercise on Left Atrial Size in Patients With Left Ventricular Hypertrophy
Authors: Douglas Kyrouac, Michinari Hieda, James P Macnamara, Christopher Hearon, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2023)

Introduction: Habitual aerobic exercise is associated with left atrial (LA) enlargement and risk of atrial fibrillation. This risk may be accentuated in patients with increased left ventricular (LV) stiffness due to high LA pressure during exercise. We tested the hypothesis that 1 year long endurance exercise would increase LA size to a greater extent in patients with left ventricular hypertrophy (LVH) at risk for heart failure with preserved ejection fraction (HFpEF) than previously published age appropriate controls. Methods: Middle-aged adults (age 45-64 yrs) with LVH (n=53) enriched for increased HFpEF risk (N-terminal pro-B-type natriuretic peptide &gt;40 pg/mL or high-sensitivity cardiac troponin T &gt;0.6 pg/mL) and healthy subjects (n=58) were randomized to one year of high intensity aerobic exercise or yoga control. LA and LV volumes were measured using 3D echo. Results: Of 111 participants, 83 had complete data available (LVH cohort: 18 exercisers, 10 yoga; healthy cohort: 29 exercisers, 26 yoga). Baseline LA size was larger in LVH vs healthy subjects (42 ± 12 vs 35 ± 9 mL; p=0.005). There was a nominal increase in LA size in LVH exercisers compared to LVH yoga (8 ± 9 vs 4 ± 7 mL; p=0.29) which was proportional to LV size (LA/LV ratio 0.05 ± 0.07 vs 0.06 ± 0.1; p=0.81). Healthy subject exercisers increased LA size compared to healthy yoga controls (4 ± 5 vs 0 ± 6 mL; p=0.02) with no increase in LA/LV ratio (-0.02 ± 0.08 vs -0.03 ± 0.08; p=0.62). Among exercising subjects only, increase in LA size was larger in LVH compared to healthy subjects after year long aerobic training (p=0.04) with greater increase LA/LV ratio (p&lt;0.001). Conclusions: One year of aerobic training resulted in higher LA size in patients with at-risk LVH compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training may preferentially affect LA remodeling.