tbuckley/cabot-search huggingface dataset:
Abstract 4144930: A novel approach for LV delay evaluation: non-invasive QLV measurement using UHF ECG
Authors: Lukas Poviser, Petr Stros, Jana Vesela, Karol Curila
Journal: Circulation (2024)

Introduction: Cardiac resynchronization therapy (CRT) improves quality of life, left ventricular (LV) systolic function and reduces heart failure hospitalizations and mortality. LV pacing at sites with prolonged electrical delay, such as invasively measured LV delay (QLV), is most effective in correcting electrical dyssynchrony in patients with LBBB-type intraventricular conduction abnormalities. UHF-ECG is a non-invasive tool optimized to calculate ventricular dyssynchrony between segments under the standard V1–V8 chest leads. However, the association between LV delay assessed by UHF-ECG and invasively assessed LV delay is still unknown. Our study aimed to compare invasive measurements of LV delay with LV delay using UHF ECG in patients with LBBB and undergoing CRT. Methods: We retrospectively analyzed electrophysiologic recordings, angiographic images, and UHF-ECG recordings from consecutive BVP-CRT procedures. The study included patients with symptomatic heart failure with LVEF ≤ 40 %, QRS duration ≥ 130 ms and spontaneous sinus rhythm with a non-RBBB morphology. The QLV interval was measured from the QRS complex onset to the steepest deflection of the local electrogram from the implanted CS lead. To quantify LV delay using UHF ECG, the time from the QRS onset to the activations in V6, V7, and V8 was measured. The left ventricular lateral wall was segmented into two regions: the basal segment (activating under V7-V8 leads) and the apical segment (activating under the V6 lead). Each LV lead electrode was assigned to a segment based on angiographic images. Results: Our study included 32 patients with an average LVEF of 30 ± 6 %, ischemic cardiomyopathy had 12 and Strauss criteria for LBBB met 28 patients. The average intrinsic QRSd was 171 ± 16 ms and spontanous e-dys was 82 ± 32 ms. There was no statistically significant difference between measured QLV and LV delay using UHF ECG (4.0 ± 8.4 ms; mean ± SD, p = 0.48) and linear regression analysis showed strong correlation between them (r = 0.95). Also, there was no difference in measurements between the apical and basal segments (3.3 ± 8.3 ms; mean ± SD, r = 0.95 for basal segment, r = 0.94 for apical segment, p = 0.14). Conclusions: Our study demonstrated that UHF-ECG measurements of LV activation delay are strongly correlated with invasively measured electrical LV delay in patients with LBBB undergoing CRT. This suggests that UHF-ECG can accurately identify sites of prolonged electrical delay.
Abstract 4145054: Artificial Intelligence-Enhanced Electrocardiogram Trajectories for Age Estimation: Prognostic Assessment and Differential Prediction of Atrial Fibrillation Occurrence
Authors: Taehyun Hwang, Seng Chan You, Sangyeol Kim, Sujeong Eom, Dachung Boo, Subin Kim, Daehoon Kim, Tae-Hoon Kim, Jae-Sun Uhm, Hui-Nam Pak, Moon-Hyoung Lee, Hee Tae Yu, BOYOUNG JOUNG
Journal: Circulation (2024)

Background: The use of Artificial Intelligence (AI) to estimate age from 12-lead electrocardiogram (ECG) data has shown promise as a biomarker for predicting future cardiac disease risk. However, the long-term outcomes based on the temporal variations in the AI-ECG age gap remain uncertain. Hypothesis: This study aims to longitudinally track the differences between AI-predicted age and actual chronological age using ECG data and evaluate whether significant clinical differences in atrial fibrillation (AF) occurrence exist among various patient groups. Methods: From a single-center cohort not previously used for AI-ECG age prediction (121,702 individuals, 522,261 ECGs), 5,317 individuals with 24,368 ECGs who had an initial ECG and a follow-up ECG in the fifth year, along with at least one intervening ECG, were included for analysis. The absolute age gap, defined as the absolute difference between ECG-predicted and chronological age, was constrained to ±10 years for this analysis. Latent class trajectory modeling was employed to categorize groups based on the AI-ECG age gap trajectories. Results: The analysis identified four distinct trajectory groups based on age gap patterns: Consistently Young ECG (28.7%), Reversed ECG Aging (35.5%), Accelerated ECG Aging (8.0%), and Consistently Old ECG (27.9%). Both the Accelerated ECG Aging group (adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.07-2.79, p-value = 0.025) and the Consistently Old ECG group (adjusted HR 1.78, 95% CI 1.27-2.49, p-value &lt; 0.001) had a significantly higher cumulative incidence of AF compared to the Consistently Young ECG group. Four independent predictors of these trajectories were identified: baseline age, chronic kidney disease, diabetes mellitus, and hypertension. Conclusion: The study identified four distinct AI-ECG age gap trajectory groups, with the Accelerated ECG Aging and Consistently Old ECG groups showing a significantly increased risk of AF occurrence.
Abstract 4144798: Hemodynamic Insights Using Pressure Volume Loops into Transcatheter Repair Effects on Left Ventricular Function in Patients with Primary Mitral Regurgitation
Authors: Sherif Nagueh, Payam Pournazari, Priscilla Wessly, Taha Hatab, Arvind Bhimaraj, Nadeen Faza, Stephen Little, Sachin Goel
Journal: Circulation (2024)

Background: Mitral transcatheter edge to edge repair (M-TEER) is an effective treatment for high surgical risk patients with primary mitral regurgitation (MR). Some patients have persistently elevated left atrial (LA) pressures despite successful reduction of MR. We sought to study the underlying reasons for elevated LA pressures after M-TEER. Methods: LV systolic and diastolic functions were evaluated using conductance catheters to obtain pressure volume loops in 22 patients with primary MR and control group of 17 heart transplant recipients with normal function and normal LV EDP response to exercise. LA pressures and LA operating chamber stiffness were obtained, and MR severity was assessed by echocardiography. Results: In comparison with the control group which had all indices of LV systolic and diastolic function in the normal range at rest and with exercise, primary MR patients had increased LV volumes and diastolic pressures, time constant of LV relaxation (t), and LV chamber stiffness constant (all P≤0.01). After M-TEER, LV and LA volumes and pressures, LA operating chamber stiffness, and MR regurgitant volume decreased (all P&lt;0.05), without significant change in LV chamber stiffness constant. Post M-TEER. patients with LA V pressure ≥20 mmHg had significantly higher LA operating chamber stiffness [0.32 (0.13-0.7) vs 0.08 (0.05-0.21) mmHg/mL], time constant of LV relaxation (59±6 vs 48±12 ms), and LV chamber stiffness constant (0.07±0.02 vs 0.05±0.02) versus patients with V pressure &lt;20 mmHg (for all 3 variables: P&lt;0.05). However, there were no significant differences in heart rate, LV systolic function indices (including LV EF), LV volumes, LV energetics, LA volumes, mitral valve area, and residual MR regurgitant volume. Conclusion: After M-TEER, there is no significant change in invasive indices of LV contractility. LV chamber stiffness constant is abnormally increased before M-TEER without a significant change afterwards. Patients with LA V pressure ≥20 mmHg after M-TEER, have worse LV diastolic function and higher LA operating chamber stiffness in comparison with patient having LA V pressure &lt;20 mmHg post M-TEER.
Abstract 4145015: BRASH Syndrome: A Rare But Rapidly Reversible Cause of Cardiogenic Shock
Authors: Steven Imburgio, Palak Patel, Abbas Alshami, Jesus Almendral, Renato Apolito, Mattthew Schoenfeld, Jeffrey Selan, Brett Sealove
Journal: Circulation (2024)

Case Presentation: A 98-year-old female with hypertension, atrial fibrillation on Metoprolol succinate 100 mg daily, and stage 3a chronic kidney disease presented to the emergency department with altered mental status. On arrival, her heart rate was 30 BPM and blood pressure was 79/47 mmHg. Physical examination revealed lethargy, bradycardia, and cool extremities. An electrocardiogram showed junctional bradycardia at 36 BPM with a known right bundle branch block. Laboratory tests indicated shock with elevated lactic acid (2.6 mmol/L), creatinine (1.71 mg/dL from a baseline of ~1.20 mg/dL), transaminitis (aspartate transaminase 68 U/L, alanine transaminase 79 U/L), and hyperkalemia (potassium 6.1 mmol/L). The diagnosis of BRASH syndrome was made based on bradycardia, renal dysfunction, AV nodal blockade, shock, and hyperkalemia. Due to concerns of cardiogenic shock resulting from profound bradycardia, an intravenous dopamine infusion was initiated, and the patient was transferred to the cardiac critical care unit. She responded to medical management addressing hyperkalemia and bradycardia, and did not require renal replacement therapy or pacemaker placement. Following these interventions, her mental status, vital signs, and signs of end-organ damage rapidly improved. The patient was downgraded and subsequently discharged with close cardiology follow-up. Discussion: This case highlights the under-recognized diagnosis of BRASH syndrome as a cause of cardiogenic shock. BRASH syndrome, an acronym for Bradycardia, Renal failure, AV node blockers, Shock, and Hyperkalemia, is typically observed in patients on AV nodal blocking medications. The proposed pathophysiology involves an acute kidney injury, often precipitated by dehydration in elderly patients with preexisting kidney disease. The renal impairment leads to hyperkalemia and accumulation of AV nodal blocking medications like beta-blockers, which act synergistically to produce significant bradycardia. This results in substantial cardiac shock, further worsening renal perfusion and fueling a vicious cycle. Clinicians should recognize the combination of features rather than focusing solely on individual components of the syndrome. Immediate recognition and initiation of advanced measures such as inotropic support can reverse the underlying disease process and lead to a promising recovery. BRASH syndrome, though rare, is a rapidly reversible cause of cardiogenic shock if promptly identified and managed.
Abstract 4144832: Adult congenital heart disease (ACHD) as career? Examining encouraging and discouraging factors around the globe in the Global ACHD Survey.
Authors: Katia Bravo, MHD Osama Srour, Petra Jenkins, Raquel Luna, Oktay Tutarel, Geetha Kandavello, Carlos Guerrero, Edgar García Cruz, Judith Ackerman, maria amalia elizari, Miriam Valdez Ramos, Blanche Cupido, Dominica Zentner, Murad Almasri, Sabrina Phillips, Christopher McLeod, Luke Burchill, Renee Bullock-Palmer, Jonathan Windram
Journal: Circulation (2024)

INTRODUCTION: There is a significant shortage of specialized Adult Congenital Heart Disease (ACHD) cardiologists despite a rising prevalence of adults with this condition. AIM: Our study explores the specific motivations and deterrents that influence adult and pediatric cardiologists’ ACHD career decisions, which could serve as the basis for future solutions to overcome this shortage in each specific region. METHODS: An anonymous global survey was distributed to adult and pediatric cardiologists and trainees via email, social media, and medical society newsletters. The survey included demographics, ACHD exposure, career considerations, Likert scale ratings, and open-ended inquiries on ACHD career recommendations. Respondents included non-ACHD and ACHD cardiologists (defined as those caring for ACHD with or without formal training). The analysis covered regional variations across continents. Responses with less than 75% completion were excluded. RESULTS: A total of 811 valid responses were collected (53.5% female, 48.3% aged 31-40, and 43.3% White). ACHD cardiologists were 21%, mostly practicing in North America (44.1%) and Europe (32.9%). Almost all ACHD cardiologists (94.7%) recommended it as a career. Among the 641 non-ACHD cardiologists, 85.7% had been exposed to ACHD, however, only 35.1% considered pursuing it themselves. For ACHD cardiologists the top global motivators for pursuing an ACHD career were awareness of the field and its significance, mentor's influence, and sufficient clinical exposure during residency (Figure 1A). Factors that deterred non-ACHD cardiologists included a lack of compensation compared to other cardiology subspecialties, limited job opportunities, and the longer duration of training (Figure 1B). Absence of specialized training and educational programs emerged as a major deterrent in all continents except North America. The lack of mentorship or role models in ACHD was particularly pronounced in Africa and Central and South America. Limited exposure to ACHD during training was a significant issue in Europe and Africa. CONCLUSION: Most ACHD cardiologists recommend a career in ACHD. However, only a few non-ACHD cardiologists recommend it. Influential mentors, clinical exposure motivate; low compensation, lengthy training deter. Regional disparities require targeted interventions for better ACHD cardiologist recruitment.
Abstract 4144845: Clinical Characterization of Arrhythmia-Induced Cardiomyopathy in Patients With Persistent Tachyarrhythmia and Idiopathic Heart Failure: Insights from DECAAFII
Authors: Ala' Assaf, Han Feng, Mayana Bsoul, ghassan bidaoui, Hadi Younes, Mario Mekhael, Charbel Noujaim, Omar Kreidieh, Amitabh Pandey, Swati Rao, eoin donnellan, Philipp Sommer, christian mahnkopf, Nassir Marrouche, Christian Sohns
Journal: Circulation (2024)

Background: Catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure (HF) reduces mortality and hospitalizations and improves ejection fraction (EF). Arrhythmia-induced cardiomyopathy (AIC) is diagnosed after complete resolution of HF following AF ablation. Aim: We aim to identify the prevalence and pre-ablation predictors value of AIC among patients with persistent AF and HF enrolled in the DECAAF II trial. Methods: We utilized the DECAAF II database, where 815 patients with persistent AF underwent late-gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) before and three-months after receiving CA for AF. Patients were randomized to receive pulmonary vein isolation (PVI) in addition to substrate modification (SM) or standard PVI alone. Ejection fraction was collected before, and three months after CA. Patients were asked to submit a single-lead ECG every day or when feeling symptoms using a single-lead handheld ECG device. AF Burden was defined as the percentage of monitored time spent in AF. For this analysis, we only included patients diagnosed with HF with available LV function data before and after CA. We defined AIC as HF and AF patients who experience EF improvement to ≥50% after ablation, with at least 10% improvement in EF. Results: We identified 119 patients with HF and persistent AF; 72 (60.5%) fulfilled criteria for AIC, and 47 (39.5%) were non-AIC patients[SC1] . At baseline, AIC patients had an LVEF of 39.1±7.9, non-AIC had 39.2±7.9 (p=0.9). There was no difference between the two groups in baseline characteristics, AF burden [SC2] or AF recurrence (Table). The distribution of fibrosis from LGE-CMR prior to ablation was the only significant pre-ablation predictor of AIC among patients with HF and persistent AF. Patients with AIC had significantly lower percentage of fibrosis in the septal wall compared with non-AIC patients (12.2±10 vs 20.7±11.4, p &lt;0.001), regardless of the total amount of LA fibrosis. Conclusion: In this post-hoc analysis of the DECAAF II trial, we found that up to 60% of patients with HF and persistent AF have AIC rather than primary cardiomyopathy. We also described LGE-MRI as a significant differentiator between AIC and other cardiomyopathies complicated with arrhythmia.
Abstract 4144785: Identification of ARMCX3 as potential mitochondria-related biomarker for pulmonary arterial hypertension using integrated bioinformatics analysis and machine learning
Authors: Zeying Zhang, Qiming Liu
Journal: Circulation (2024)

Background: Acquired mitochondrial dysfunction is one of the characteristics of pulmonary arterial hypertension (PAH). Exploring potential biomarkers from mitochondrial perspective may be effective in the diagnosis and treatment of PAH. We aimed to screen for potential mitochondria-related biomarker(s) associated with PAH using integrated bioinformatics approach and machine learning algorithms. Methods: On the basis of gene expression profiles of PAH and healthy samples from the GEO database, hub differentially expressed mitochondrial genes were identified Integrated machine learning algorithm and bioinformatics analysis were performed, including functional enrichment analysis, consensus clustering, and weighted gene co-expression network analysis. Then, the potential biomarkers for PAH were accessed by single-cell data analysis, drug prediction, miRNA-transcription factor-mRNA network construction, and receiver operating characteristic curves. Finally, we explored the associations between the hub mitochondrial genes and immune cell infiltration. Results: One hub mitochondria gene ARMCX3 was identified. ARMCX3 has strong stability and high accuracy in predicting PAH patients. Single-cell analysis showed that ARMCX3 was highly expressed in pulmonary vascular smooth muscle cells and endothelial cells. Molecular docking and drug prediction showed estradiol is a potential targeted drug for ARMCX3. 127 miRNA-TF-mRNA regulatory relationships were established. Immune cell infiltraion analysis showed that ARMCX3 is correlated with the content of immune cells. Conclusions: ARMCX3 was identified as potential biomarker of PAH based on the machine learning algorithms and bioinformatics analysis, which elucidata the molecular mechanisms underlying PAH development.
Abstract 4144899: Invasive vs conservative strategy in management of patients with Non-ST elevation myocardial infarction: A systematic review and meta-analysis of over a million patients.
Authors: Ahmed Farid Gadelmawla, Ahmed Mohamed, Ahmed Abdelaziz, Rehab Diab, Ahmed Mansour, Atef Hassan, Mohamed Elnady, Raneem Afify, Mariam Desouki, Shrouk Ramadan
Journal: Circulation (2024)

Introduction: Non-ST elevation myocardial infarction (NSTEMI) significantly contributes to the burden of cardiovascular diseases, affecting millions of patients. The management of NSTEMI has evolved and it involves invasive and conservative strategies, the optimal management remains unclear. We conducted this systematic review and meta-analysis to compare the two different strategies and their long-term outcomes. Methods: We systematically examined the clinical outcomes of conservative and invasive management of patients with NSTEMI using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, myocardial infarction (MI), and major bleeding. Odds Ratios (OR) and 95% CI were used in a fixed-effect model to analyze the data. Results: Our study included 24 studies with a total of 1,076,572 patients. the invasive strategy was significantly associated with a reduction in all-cause mortality (OR: 0.52, 95% CI: 0.51 to 0.53), and the incidence of myocardial infarction (OR: 0.84, 95% CI: 0.73 to 0.97). However, the invasive strategy showed a significant increase in major bleeding events (OR: 1.93, 95% CI: 1.87 to 1.98). Conclusion: The invasive strategy showed better clinical outcomes on the long-term follow-up related to all-cause mortality and myocardial infarction, with an increase in the incidence of major bleeding events.
Abstract 4145138: Use of Cardiac Magnetic Resonance Imaging to Assess Response to Oral Treprostinil Therapy in Pediatric Pulmonary Hypertension Patients <sup>1</sup>
Authors: Susana Gaviria, Sarah Kollar, Yue-Hin Loke, Uyen Truong
Journal: Circulation (2024)

Background: Pulmonary hypertension (PH) contributes to significant morbidity and mortality in pediatric patients. Cardiac catheterization remains standard of care for diagnosis and serial monitoring in PH patients despite its significant risk of morbidity and mortality. Cardiac magnetic resonance (CMR) imaging provides critical information about the right ventricle (RV) and left ventricle (LV) and may have significant prognostic power. We aim to use CMR to demonstrate response to oral Treprostinil in pediatric PH patients. Methods: This is a retrospective, multi-center study of 9 PH patients who underwent a baseline CMR study, as well as a follow up study 24 weeks following transitioning to oral Treprostinil from intravenous/inhaled formulations. Feature-tracking (Qstrain, Medis) was performed on short/long-axis cines to assess RV global longitudinal strain (GLS), LV GLS, and LV global circumferentialstrain (GCS). Volumetric data and conventional functional parameters were also compared, pre and post initiation of oral Treprostinil therapy. Results: Eighteen CMR studies from 9 patients were analyzed. Average baseline RV ejection fraction (EF) was 48.1% compared to post therapy RV EF 51.9% (p = 0.188). Average baseline RV GLS was -20.5% compared to post therapy RV GLS -23.3% (p = 0.025), Figure 1. Overall, there was no significant difference in LV EF, LV GLS, and LV GCS after transitioning to oral therapy. Increased RV EF post initiation of oral Treprostinil therapy correlated with increased magnitude LV GCS (r = 0.701, p = 0.036), reflecting critical interventricular interaction in the disease process. Conclusion: Assessment of RV strain is more sensitive in detecting improvement in cardiac performance following initiation of oral Treprostinil in pediatric PH patients compared to ejection fraction. Future studies should focus on the development of novel CMR biomarkers in place of cardiac catheterization in assessing cardiac performance in PH patients. 1. This abstract was written by one of ISS investigators, Dr. Truong, who is using data from TDE-PH-206 (pediatric oral Treprostinil study) to investigate cMRI parameters.