tbuckley/cabot-search huggingface dataset:
Abstract 14773: Automated Cardiovascular Calcium Burden: Unlocking the Future of TAVR Prognosis With Artificial Intelligence
Authors: Ding Yi Zhang, Saleena Gul Arif, Maude Roberge, Rushali Gandhi, Yaman Zarour, Farida El Malt, Albert Shalmiev, Jordan Benzur, Mhd Diaa Chalati, Nissim Benizri, Neetika Bharaj, Marc Afilalo, Jonathan Afilalo
Journal: Circulation (2023)

Background: Calcific valve disease is now understood as a dynamic inflammatory process that alters the tissue’s adaptive response to stress stimuli. Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for severe aortic stenosis. Manual analysis of calcifications in pre-TAVR CT scans is time-consuming and subjective. Hypothesis: Deep learning (DL) models can accurately quantify cardiovascular calcification and predict post-procedural outcomes in TAVR patients. We aimed to develop such a model and investigate its correlation with long-term all-cause mortality in TAVR patients. Methods: This post-hoc analysis examined patients from the FRAILTY-AVR trial and the Royal Victoria Hospital TAVR registry. A 3D UNet-based DL pipeline was developed and trained to detect and quantify coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) based on pre-procedural CT images. Quantification involved segmentation and CT image analysis techniques. Cox regression analysis, adjusting for various covariates, evaluated the primary endpoint of all-cause mortality one year after TAVR. Results: The study included 585 TAVR patients (mean age: 82.5 years; 44% females) with a median follow-up of 506 days. At one year, 27.5%(161) reached the primary endpoint of all-cause mortality. Hazard ratios for MAC, AVC, TAC, and CAC were 1.26 (95% CI: 1.06-1.51, P=0.010), 0.99 (95% CI: 0.83-1.18, P=0.91), 1.07 (95% CI: 0.89-1.29, P=0.46), and 0.89 (95% CI: 0.72-1.09, P=0.26), respectively. Adjustments for covariates did not significantly change these hazard ratios. Mean calcification volumes were 770 mm3 (AVC), 737 mm3 (CAC), 3076 mm3 (TAC), and 629 mm3 (MAC). No substantial correlations were observed between the four calcifications or cardiovascular co-morbidities however, each score may yield meaningful information. Conclusions: High mitral annular calcification, quantified by our AI pipeline, was independently associated with increased one-year post-TAVR mortality. AI enables efficiency, objectivity, and improved insights, enhancing clinical decision-making and personalized care.
Abstract 14323: Significance of Angio-IMR to Predict Heart Failure Post-TAVI
Authors: Kosuke Fujita
Journal: Circulation (2023)

Background/Introduction: The number of transcatheter aortic valve implantation (TAVI) procedures is currently increasing. However, a substantial number of patients suffer from repeated heart failure (HF) after the TAVI procedure. The association between Index of Microvascular Resistance (IMR) and HF is already known, especially in HFpEF. Purpose: The aim of this study was to assess the prognostic significance of IMR for HF after TAVI. Method and Result: 120 consecutive patients who underwent coronary angiography (CAG) before undergoing TAVI in our hospital between 2018 and 2021 were included in the analysis. Quantitative Flow Ratio (QFR) analysis was performed for each coronary artery, excluding cases undergoing PCI before or after TAVI. The angiography derived IMR was then obtained from the QFR values. Finally, 65 patients were available for IMR analysis. Of these, 12 were hospitalized or underwent medical intensification for HF exacerbations after TAVI. IMR was significantly higher in patients with HF compared without HF. (73.8 (31 to 121) vs 59.7 (26 to 153), p=0.041) No other significant differences were found in age, QFR values, EF, i-EOA on echocardiography after TAVI, STS score, and BNP values before TAVI. All patients with HF were female. Conclusion: It is suggested that angio-derived IMR values before TAVI might be a useful predictor of heart failure after TAVI.
Abstract 14364: Atrial Fibrillation With Rapid Ventricular Response Induced Ventricular Tachycardia Terminated by Intrinsic Anti-Tachycardia Pacing - A First in Literature Case Report
Authors: Sai Vikram Alampoondi Venkatarmanan, Shane Tsai
Journal: Circulation (2023)

Background: Intrinsic anti-tachycardia pacing (iATP) is a novel tailored algorithm that has shown increased efficacy against ventricular tachycardia (VT), including fast VT. We describe a case of atrial fibrillation (AF) with rapid ventricular response (RVR) induced VT terminated by iATP. Case description: A 71-year-old male with coronary artery disease, heart failure (EF 30-35%), atrial fibrillation, VT status post biventricular implantable cardioverter defibrillator and failed renal transplant presented with syncope during dialysis. His home medications included amiodarone, metoprolol, apixaban. He was hemodynamically stable on presentation. He had bilateral pitting edema with a systolic murmur and bilateral basilar crackles on exam. His labs were consistent with anemia and end stage renal disease. His device interrogation (Figure) showed AFRVR which degenerated to VT with final cycle length (CL) of 290 msec. First round of ATP with S1x10 burst pulses (88%, CL 250msec) and S2 extra stimuli (CL 230 msec) failed to terminate the VT. Post pacing interval (PPI) was 450 msec. Given calculated remote distance, another five rounds of adaptive iATP with similar S1 pulses but faster S2 and addition of S3 extra stimuli were delivered but were unsuccessful in terminating VT. Finally, the seventh round of iATP (S1x10 at CL 260 msec, S2 at 240 msec) was successful at conversion to sinus rhythm briefly before reverting to AF with controlled ventricular pacing. Discussion: ATP decreases ICD shocks but is programmed empirically and there is less success with fast VT. iATP analyses the PPI of the prior failed sequence to adjust the subsequent ATP therapy by altering the number of burst pulses (S1) and addition of ramp extra stimuli. Computational models and early clinical experience have shown increased efficacy of iATP in terminating fast VT without concomitant increase in VT acceleration. To the best of our knowledge, this is first case report of AFRVR induced VT terminated by iATP.
Abstract 15996: Pre-Operative Predictors of Permanent Pacemaker Implantation Post Aortic Valve Replacement: A Retrospective Cohort Evaluation
Authors: Bernice Tsang, Meysam Pirbaglou, Zahra Azizi, Pouria Alipour, Jenny Gao-Kang, Jaejoon Yang, Alfredo Pantano, Mouhannad Sadek, Yaariv Khaykin
Journal: Circulation (2023)

Introduction: Permanent pacemaker (PPM) implantation following Aortic Valve Replacement (AVR) is common. While AVR modality choice (i.e. surgical vs. transcatheter) affects PPM risk, identifying pre-operative factors associated with increased PPM risk can benefit enhanced risk assessment and care decisions. Methods: This study is a retrospective evaluation of pre-operative factors associated with PPM risk within 1-month post-AVR at a tertiary care centre (2014-2020). Pre-AVR conduction abnormalities were classified as left bundle (LBBB), right bundle branch blocks (RBBB), and other abnormalities (left anterior/posterior fascicular block, intraventricular conduction delay) in combination with RBBB, LBBB, or alone. Results: Of the 776 (mean age= 74, 66% male) patients, 89 (11.5%) subsequently received PPM. As per pre-AVR electrocardiogram, 76 (9.8) were not in sinus rhythm and 214 (27.6%) had conduction abnormalities, including: 81 (10.4%) LBBB and LBBB + other, 91 (11.7%) RBBB and RBBB + other, and 42 (5.4%) other abnormalities. Pre-AVR rhythm (18.4 vs. 10.7%, p=0.05) and conduction abnormalities (19.2 vs. 8.5%, p&lt;0.0001) were significantly associated with the need for post-AVR PPM. No statistically significant differences were observed in other demographic-clinical characteristics. Logistic regression, adjusted for age and sex, indicated significantly higher post-AVR PPM risk for patients with RBBB and RBBB + other (OR= 3.84, 95%CI: 2.21-6.66, p&lt;0.0001) and other miscellaneous (OR= 2.58, 95%CI: 1.13-5.93, p&lt;0.03) abnormalities, but not for LBBB and LBBB + other (OR= 1.14, 95%CI: 0.52-2.50, p&lt;0.75) compared to participants with no pre-AVR conduction abnormalities. Females experienced significantly lower need for PPM (OR= 0.60, 95%CI: 0.35-1.00, p= 0.05). Conclusions: Pre-AVR RBBB and other conduction abnormalities alone or together, but not LBBB are associated with significantly higher need for post-AVR PPM.
Abstract 13475: Implementation of a Digital Disease Management Platform for Heart Failure: AMAZE
Authors: Kaavya Paruchuri, Rachel Bernardo, Sara Haidermota, Kim Lannery, Phoebe Finneran, Megan Wong, Tinamarie Sanborn, Melvin G Joice, Janet Boyle-Kelly, Sara Silacci, WHITNEY HORNSBY, Karthik Linganathan, Tope Olufade, James L Januzzi, Pradeep Natarajan
Journal: Circulation (2023)

Background: Optimal heart failure (HF) management after hospitalization requires ongoing care coordination. Digital approaches with a unified disease management platform (DMP) experience may improve patient care. Objective: A single-arm single-institution pilot study to assess feasibility of implementation and engagement with a DMP among HF patients for 60 days post-hospitalization. Methods: The DMP included a clinician electronic medical record-integrated dashboard and patient-facing smartphone app that provided patient-reported data entry, educational materials, and secure messaging. Eligible patients admitted to a cardiology service were onboarded with a smartphone DMP app at discharge. Clinical outcomes were compared between the intervention group and propensity-matched historical controls at the same institution and matched contemporary and historical controls at a nearby institution. Results: 70 of 167 eligible patients (41.9%) enrolled over the 6-month recruitment period and 51 (71.4%) completed the study. Mean age of completed participants was 65.8 (SD 12.9) years; 36 (70.6%) were male and 22 (43.1%) had HF with reduced ejection fraction. Daily DMP engagement (patient-reported data entry or in-app messaging) ranged from 35%-78% and participants engaged a median 44 (IQR 14-53) days during the 60-day study period. There was no correlation between age, sex, or clinical comorbidities and daily engagement. Compared to matched historical controls at the same institution, the study cohort had significantly fewer all-cause readmissions (HR 0.39, 95% CI 0.19 - 0.80, p=0.009). Matched contemporary and historical controls over the same time period on a cardiology service at a nearby institution had no reduction in readmission rates. Conclusions: Implementation of a post-hospitalization HF-specific DMP is feasible and may yield improvements in readmission rates, supporting the role for future randomized controlled trials (NCT04782973).
Abstract 18021: Environmental Circadian Desynchronization and Metabolic Stress Drive Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Varun Mandi, Jeongkyung Lee, Rajaganapathi Jagannathan, Ping Yang, Vinny Negi, FENG LI, Yijen L Wu, Dhivyaa Rajasundaram, Vijay Yechoor, Mousumi Moulik
Journal: Circulation (2023)

Background: The pathogenic mechanisms underlying HFpEF (Heart Failure with preserved Ejection Fraction), which accounts for 50% of heart failure, remain unclear. Elevated endoplasmic reticulum (ER) stress has been implicated in HFpEF. Circadian disruption (CD) as seen in shift workers has been associated with an excess risk for chronic age-related disorders, including cardiovascular disease. Currently, the role of CD in HFpEF is not known. Hypothesis: The dual 'hits' of chronic metabolic stress and circadian disruption lead to increased ER stress, impaired unfolded protein response (UPR), and adverse cardiac remodeling resulting in HFpEF. Methods: High fat diet (HFD) fed C57BL6 male mice were subjected to chronic shifted light-dark (LD) cycles mimicking shift work (Shift), with appropriate controls. Metabolic (glucose tolerance, insulin sensitivity, body fat) and cardiac function parameters (systolic and diastolic function by ECHO, MRI, and terminal PV-loops) were collected. Cardiac tissue was analyzed using qPCR, western blot, bulk RNA-seq, spatial transcriptomics, proteomics, and histology. For in vitro studies, Bmal1 was deleted in H9C2 cells using CRISPR/Cas9. Results: ‘HS’ mice (HFD &amp; Shift) had the most insulin resistance, glucose intolerance, and obesity, compared to ‘HR’ (HFD &amp; Regular LD), ‘CS’ (Normal Chow &amp; Shift) and ‘CR’ (Chow and Regular LD) groups. ECHO and MRI revealed preserved EF in all groups, with diastolic impairment in both HS and HR (↑MV E/E’, ↓MV E/A, and ↓LV diastolic strain) groups, HS&gt;HR. Only ‘HS’ mice showed ↓cardiac compliance (↑β in EDPVR) and ↑lung weight suggestive of HF consistent with HFpEF. Gene and protein expression revealed dysregulation of numerous UPR pathway molecules (Atf6, Chop, Bip, Perk, and others) in HS mice. Mechanistically, Bmal1 deletion in CMs resulted in similar dysregulation of UPR genes. HS mouse hearts showed increased fibrosis, and spatial transcriptomics displayed enrichment of ATF4-related pathways in CMs and activated fibroblasts. Conclusions: The dual hit of metabolic and circadian stress induces HFpEF, which cannot be recapitulated by only one stressor. Our results identify previously unrecognized roles of UPR perturbation in driving HFpEF under circadian and metabolic stress.
Abstract 18261: Efficacy and Safety of Bempedoic Acid for Prevention of Cardiovascular Events and Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Farah Yasmin, Hala Najeeb, Abdul Moeed, Eman Ali, Saad Ur U Rahman, Mohammad S Khan, Nishant Shah, Erin D Michos
Journal: Circulation (2023)

Background: Bempedoic acid (BA) is considered an alternative therapy for hyperlipidemia (HLD) in statin-intolerant patients. Given the positive results from the CLEAR-OUTCOMES trial, we performed a meta-analysis pooling recently conducted randomized control trials (RCTs) to provide a comprehensive clinical evaluation of the safety and efficacy of BA. Hypothesis: Bempedoic acid therapy in HLD patients with statin intolerance may be associated with a significant reduction in LDL-C levels, and CV events. Methods: All RCTs reporting CV outcomes and/or % change in LDL-C from baseline till completion of follow-up duration in HLD patients with statin-intolerance were included in MEDLINE, Google Scholar, and Scopus databases (Inception to April 2023). The outcome measures were summary random effects risk ratio (RR) and mean differences (MD) with 95% confidence intervals. Results: Twelve RCTs were included with 18 510 patients (10,033 BA vs. 8,477 placebo). BA therapy resulted in greater significant % reduction in LDL-C levels post-treatment (mean difference from baseline: 21.73% [-26.94, -16.51], p&lt;0.00001) with no significant impact of the male sex, age, and follow-up duration on LDL-C upon meta-regression analysis. The risk of MACE (RR, 0.86 [0.79, 0.93], p &lt; 0.0004), coronary artery revascularization (RR, 0.81 [0.72, 0.91], p = 0.0005), and myocardial infarction (RR, 0.71 [0.51, 0.99], p= 0.04) were significantly reduced with BA ( Figure 1) . However, no significant reduction in cardiac death (RR, 1.05 [0.89, 1.24], p = 0.56) was observed. A total of 1,019 new-onset DM events (521/6027 with BA; 498/4946 with placebo) were reported, and demonstrated a non-significant lower risk of new-onset or worsening DM (RR 0.83; 95% CI [0.62, 1.13]; P = 0.24) with BA vs. placebo. Conclusion: BA was observed to be safe, efficacious, associated with improved cardiovascular outcomes, and with no effect on new-onset or worsening DM among HLD patients with statin intolerance.
Abstract 14611: Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening
Authors: Catherine Pollak, Andrew Parambath, Samantha Coratti, Laurie Norton, Catherine Reitz, Aileen John, Kevin Volpp, Shivan Mehta
Journal: Circulation (2023)

To reduce atherosclerotic cardiovascular disease (ASCVD) risk, the American College of Cardiology/American Heart Association recommends routinely assessing traditional cardiovascular risk factors and calculation of 10-year ASCVD risk for adults 40-75 years of age and traditional ASCVD risk factors for adults 20-39 years of age at least every 4-6 years. For many patients, the ASCVD risk can’t be calculated due to a missing comprehensive lipid panel. In our health system, 23% of adult patients had not had labs within the past 5 years. We aim to evaluate the effect of behavioral economic interventions on lipid screening uptake. We hypothesize that reducing effort for patients and clinicians through default bulk ordering and salient communication through outreach letters with PCP endorsement, time-limited components and physical lab orders will result in greater completion of lipid screening compared to usual care (H1), and that increased salience through additional complementary communication (text message reminders and scheduling assistance) will result in higher response rates compared to usual care, and bulk order and outreach alone (H2). Results from a mini-pilot on 100 patients indicated that bulk ordering and text message concierge service increased response rate (21%) compared to conventional outreach (12%) or bulk-ordering only (9%). We are conducting a pragmatic randomized clinical trial among patients from two primary care practices at an academic health system. Eligible patients aged 20-75 years and overdue for a lipid panel are randomized to 3 intervention arms (N=1,000,1:2:2 ratio): usual care (1), outreach and bulk orders (2), outreach, bulk orders and text message reminders (3). The primary outcome is the completion of the lipid panel within 3 months. Secondary outcomes include completion of the lipid panel within 6 months, the number of patients with an elevated ASCVD risk score and the number of patients who receive statin prescription due to this information. Results from the pilot trial launching in June 2023 are forthcoming. They will provide data that can be used to design future interventions that test the use of various behavioral economic tools to increase completion of lab tests, a necessary input into calculation of patient risk.
Abstract 15646: Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery
Authors: Michaella Alexandrou, Spyridon Kostantinis, Athanasios Rempakos, Bahadir Simsek, Judit A Karacsonyi, James Choi, Paul Poommipanit, Khaldoon Alaswad, Mir B Basir, Michael S Megaly, Rhian Davies, Stewart Benton, Farouc A Jaffer, Dimitrios Karmpaliotis, Lorenzo Azzalini, Kathleen Kearney, Ahmed M ElGuindy, Nidal Abi Rafeh, OMER GOKTEKIN, sevket gorgulu, Jaikirshan Khatri, Nazif Aygul, Wissam Jaber, William Nicholson, Stephane Rinfret, Oleg Krestyaninov, Dmitrii Khelimskii, Bavana V Rangan, Olga Mastrodemos, Salman S Allana, Deniz Mutlu, Ahmed Al-ogaili, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis
Journal: Circulation (2023)

Background: The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study. Methods: We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023. Results: Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p&lt;0.001) and procedural (80.8% vs 86.8%, p&lt;0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p&lt;0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p&lt;0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p&lt;0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar. Conclusions: Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up. Abbreviations: eGFR= estimated glomerular filtration rate
Abstract 17509: Gender-Specific Differences in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Thomas Morland, Mostafa Abbas, Jeffrey Shuhaiber, Eric S Hall, H Lester Kirchner, Yasser El-Manzalawy
Journal: Circulation (2023)

Background: Several studies suggested that females undergoing coronary artery bypass grafting (CABG) have poorer outcomes than males. However, we noted contradicting findings regarding short and long-term mortalities among females. Our aim is to assess gender-specific differences in pre and post -operative CABG risk factors and outcomes. Methods: Our cohort included 7,687 adult patients who underwent CABG surgery between 2006 and 2022 in a large rural healthcare system. Patients were grouped by gender and continuous variables were summarized using median and inter-quartile range. Appropriate statistical tests were conducted to assess differences. Results: There were 1827 (23.8%) females and 5860 (76.2%) males. Females were slightly older ((68, 60.5, 75) vs (67, 65, 73), p&lt;0.0001), with higher total number of Elixhauser comorbidities ((6, 3, 8) vs (4, 3, 7), p&lt;0.0001), higher cha2ds2vasc scores ((4, 3, 5) vs (3, 2, 4), p&lt;0.0001) and higher prevalence of stroke history (12.4% vs 10.3%, p=0.013). Analysis of risk factors used for computing the Society of Thoracic (STS) scores revealed several significant differences (with p&lt;0.001) between females and males including sleep apnea (12.1% vs 15.7%), diabetes (52.7% vs 43.4%), depression (25.5% vs 13.9%), and BMI ((31.6, 14.4, 35.5) vs (28.8, 25.8, 33.7)). Compared to males, females had greater need for blood transfusions (49.8% vs 33.6%), prolonged post-operative pulmonary ventilation (33.8% vs 24.4%), mediastinal drainage (13.4% vs 6.4%) and more frequent acute cardiac arrests (7.2% vs 4.8%). In addition females had higher 30-day mortality (0.93% vs 0.84%, p=0.014), 1-year mortality (4.2% vs 2.9%, p=0.0003), 1-year incident stroke (2.2% vs 1.5%, p=0.05), longer hospital length of stay (LoS) in hours ((143.4, 116.9, 191.6) vs (120.7, 96.9, 167.2), p&lt;0.0001), ICU LOS in hours ((96, 48.8, 143.9) vs (77.9, 39.4, 120), p&lt;0.0001), and duration from discharge to all-time mortality in days ((1513, 523.5, 2723.5) vs (1740, 622, 2921), p=0.008). Conclusions: Female gender is linked to several pre-operative and post-operative risk factors and are at greater risk of adverse outcomes following CABG surgery. Further work is needed to understand the causes of these discrepancies and to limit their effect on outcomes.