tbuckley/cabot-search huggingface dataset:
Abstract 16037: Vaping Associated Sudden Cardiac Arrest in a Young Healthy Patient
Authors: Hasaan Ahmed, Mahmoud Ismayl, Anirudh Palicherla, Joshua May, Joseph Thirumalareddy
Journal: Circulation (2023)

Introduction and Importance: While the use of vaping has increased significantly among young individuals, the effects of the various vape aerosol chemical contents on cardiac electrophysiological dynamics remain unknown. Case Presentation: A 22-year-old female with a history of energy vaping but no significant past medical history presented with cardiac arrest. Found to have no pulse, CPR was started and initial rhythm of ventricular tachycardia was obtained. Shock was administered with follow-up rhythm of ventricular fibrillation. Patient was shocked again and entered atrial fibrillation with rapid ventricular response. She later cardioverted into sinus tachycardia and was intubated. Transthoracic echocardiogram showed normal ejection fraction but was otherwise unremarkable. Patient was extubated on day four of hospitalization. Left heart catheterization and cardiac MRI were completely unremarkable. Toxicology, urine analysis, and troponins were all negative. Patient was discharged with metoprolol tartrate, and a life-vest with outpatient follow-ups for possible implantable cardioverter-defibrillator placement in the setting of negative work up for sudden cardiac arrest. Clinical Discussion: Vaping-induced sudden cardiac arrest may be attributed to a reduction in cardiac repolarization reserve. Exposure to vegetable glycerin and propylene glycol, substances present in nearly all vape products, have been found to incite arrhythmias and disrupt cardiac conduction in animals. Acrolein,a byproduct of glycerin, has also been found to induce arrhythmias due to autonomic dysfunction. Increased prevalence of ventricular arrhythmias have also been noted with exposure to aerosols containing nicotine-free propylene glycol (PG).This likely stems from the impact of PG aerosols on the transient outward potassium current, which plays a significant role in early cardiac repolarization. Conclusion: The effects of inhaling vape aerosols remain not fully understood. While there is a perceived notion that nicotine-free aerosols may not be harmful, that remains unclear.Further studies should be conducted to evaluate for pro-arrhythmogenic effects and autonomic dysfunction from the various chemical substances present in vape aerosols.
Abstract 16044: Coronary Artery Calcium Score, a Superior Predictor of Cardiac Revascularization Risk Than Framingham
Authors: kevin coy, Aditya Singh, Mark Petrasko, Phillip Petrasko, Beatrice Rynders, Alexander Sjovold, Max Weaver, patryk T stys, Veronica Stys, Komaldeep Singh, Muhammad Hamza Saad Shaukat, Zoltan Varga, Catherine Hajek, Murat Sincan, Marian S Petrasko, Adam Stys, Tom Stys
Journal: Circulation (2023)

Introduction: The coronary artery calcium (CAC) score is a powerful independent screening tool for coronary artery disease (CAD). Elevated CAC score has been significantly associated with increased rates of revascularization, however the Framingham Risk Score remains the most used method of predicting patients’ risk for future revascularization. Hypothesis: The CAC score is a superior predictor of adverse cardiac events than the traditionally accepted Framingham Risk Score. Methods: Data was analyzed retrospectively of patients who underwent calcium score scans between August 2011 and April 2021 as part of the Sanford Cardiovascular Prevention Program and were categorized into low (&lt;100), moderate (100-399), or high (≥400) CAC groups. The accuracy of revascularization prediction between subjects with CAC score and those without CAC score were evaluated by a ROC curve. Results: A total of 28,187 patients were screened for CAC score. 46% were females and the mean age was 61.4 ± 9.9 years. ROC predictive accuracy of patients with CAC scores (0.76) compared against those with no CAC score (0.71) was found to be statistically significant (Z = -6.27, P&lt;0.01). Furthermore, total CAC was found to a significant predictor (b=.001, p&lt;0.01) of revascularization above and beyond the additional risk factors with the pseudo R2 increasing from .08 for starting risk factors to .15 when total CAC was added for a pseudo R2 change of .07 Conclusions: In our study, CAC scoring was not only able to better predict the need for future revascularization compared to Framingham components but also able to improve the specificity of revascularization prediction when added to the Framingham components.
Abstract 16869: Prevalence of Valvular Heart Disease in the Elderly as Observed in a Large-Scale Echocardiographic Database
Authors: Michinari Hieda, Kayo Rikumaru, Yuko Yamamoto, Shutaro Futami, Kazumi Yamashita, Toru Maruyama, Hiroshi Hara
Journal: Circulation (2023)

Introduction: In Japan, the aging population is increasing, leading to a rapid rise in elderly patients with heart failure. To determine the post-test probability of valvular heart diseases, it is crucial to understand the pre-test probability and likelihood ratio. Hypothesis: Therefore, we surveyed the prevalence of valvular diseases among elderly individuals in a large-scale echocardiographic database of echocardiology. Methods: We reviewed 4,023 patients (1,486 males and 2,537 females, 79.4±14.3 years) who underwent echocardiographic examinations at our hospital from October 2017 to September 2022. The prevalence of valvular heart diseases was calculated by dividing the number of patients with valvular diseases by the total number of patients surveyed. We analyzed the data by age, gender, and severity of valvular disease to determine the prevalence in each subgroup. Results: Among the 4,023 individuals included in the study, 2,652 elderly patients (65.9%) had valvular diseases: 808 cases of aortic stenosis (AS) (20.1%), 1,356 cases of aortic regurgitation (AR) (33.7%), 1,899 cases of mitral regurgitation (MR) (47.2%), and 52 cases of mitral stenosis (MS) (1.3%). A total of 981 individuals (24.4%) had moderate or severe valvular disease, including 225 patients of AS (5.6%), 178 patients of AR (4.4%), 560 patients of MR (13.9%), and 18 patients of MS (0.5%). In gender-specific analysis, women had a higher prevalence of valvular heart disease than men, with approximately 1.3 to 2.5 times higher incidence in average males. Conclusions: We investigated the prevalence of valvular heart disease in the elderly using a large-scale echocardiographic database and found that over 65% of elderly individuals had valvular heart disease. In particular, AS and MR had relatively high prevalence rates for moderate or severe valvular disease, highlighting the importance of screening through routine physical examinations and echocardiographic tests.
Abstract 14224: Cryoballoon Ablation of Atrial Fibrillation in Octogenarian
Authors: Rong Bai, Alexis Montoya, Yu Liao, Truc Vy Lam, carla lockhart, Yi Dai, Praneeth Katrapati, Jake Martinez, Jaime Stempihar, Joy Rodriguez, Camelle Jones, Katie Paveglio, Michael Zawaneh, J Peter P Weiss, Roderick Tung, Wilber Su
Journal: Circulation (2023)

Introduction: While the safety and efficacy of AF ablation using radiofrequency (RF) have been demonstrated in the very elderly, data on the application of cryoballoon ablation in this population is limited. Hypothesis: Cryoballoon ablation of AF in the very elderly is feasible and safe. Methods: Consecutive patients who was 80 years or older and underwent de novo cryoablation of AF from June 2015 to September 2021 were included. All procedures were performed under general anesthesia and with ICE guidance. Following single transseptal puncture, a 28 Cryoballoon was used for all cases; procedural endpoint was isolation of all PVs. Extra-PV ablation including CTI, linear ablation or substrate modification was performed when deemed necessary. At the end of procedure, figure-of-8 suture was applied at the groin(s) to achieve hemostasis which was removed after 4-hour bed resting if no bleeding. Results: 70 patients were included mean age of whom was 83 (median 82, range 80-94). Baseline demographics and clinical characteristics of the patients were summarized in Table 1 . PVI was achieved in all but one patient in one PV, this vein was isolated by RF touch-up ablation. CTI ablation was performed in 26 cases but none of the patients required additional ablation. No major complication including tamponade, stroke/TIA, heart failure/fluid overload, phrenic nerve injury or death was associated to the procedure. Iliac vein bleeding developed in one case (1.43%) which required transfusion and stent placement. 11 (15.7%) patients were discharged at the same day of procedure. Overall, all patients were discharged from hospital within 25.2 hours after the procedure. Of 45 patients who completed12-month follow-up, 22 (48.9%) remained in sinus rhythm. 10 patients were reported deceased during follow-up. Conclusions: Cryoablation of AF in the very elderly is a feasible and safe procedure. Most patients can be discharged within one day or even on the same day of procedure.
Abstract 18530: Associations Among Self-Reported and Physiologic Sleep Measurements and Fatigue in Adults Following Major Cardiac Events
Authors: Anna Forster, Jennifer Alwine, Kelly L Wierenga
Journal: Circulation (2023)

Background: Insufficient sleep contributes to fatigue and cardiometabolic disorders. Current sleep measures vary in accuracy, with weak correlations between self-report and physiologic measures. Developing reliably associated self-report and physiologic sleep measures can optimize data collection methods. Purpose: Investigate correlations between self-reported and physiologic sleep measures in cardiac rehabilitation patients and determine associations with fatigue. Methods: Participants (N = 25, 58% male, 89% non-Hispanic white, mean age = 61 years) recruited from cardiac rehabilitation centers participated in a three-arm RCT. Inclusion criteria were experiencing a myocardial infarction or revascularization procedure, enrollment in cardiac rehabilitation, and experiencing depression or anxiety. Participants without complete sleep measures were excluded. Data was collected at baseline, 3-, and 6-months. Sleep was measured over 8 days with an investigator-developed self-report diary and an ActiGraph GT9X Link accelerometer. ActiGraphs collected data with a 30Hz sampling rate and were scored using the autodetected sleep periods to determine total sleep time. Mean daily minutes of sleep were calculated from self-report and ActiGraph data. Participants also completed a demographics survey and Fatigue Severity Scale. Statistical methods included Pearson correlation coefficients with 95% confidence intervals (CI) estimated with Fisher's r-to-z transformation. Results: Results showed self-reported and ActiGraph measured sleep were highly correlated (r = 0.889, [95% CI 0.812, 0.935], p &lt; 0.001). Fatigue was not correlated with self-reported (r = 0.074, [95% CI -0.206, 0.342] p = 0.607) or ActiGraph measured sleep (r = 0.150, [95% CI -0.131, 0.408] p = 0.295). Even though the finding was non-significant, the correlation between fatigue and ActiGraph measured sleep was larger than self-reported sleep. Conclusion: Accurate sleep measures are essential to inform future research and interventions. Unlike past work, this investigator-developed, self-report measure was strongly correlated with the physiologic measure. Researchers should consider reliability when selecting sleep measures.
Abstract 16793: The Impact of Late Gadolinium Enhancement on Sudden Death Risk Stratification in Older Patients With Hypertrophic Cardiomyopathy
Authors: Shiro Nakamori, Martin Maron, Ethan J Rowin, Narjes Jaafar, Raymond H Chan, Jennifer Rodriguez, Silvia Pradella, CHIARA ZOCCHI, iacopo olivotto, Daniel B Kramer, Long H Ngo, Warren J Manning, Reza Nezafat
Journal: Circulation (2023)

Background: Extensive late gadolinium enhancement (LGE) is now recognized as a risk factor for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). However, risk for SCD is very low in older (≥60 years) HCM patients, and therefore utility of assessing LGE for risk stratification in this subgroup of patients is uncertain. Objectives: We assessed the relationship between LGE and SCD in older HCM patients and compared this risk to younger patients. Methods: A total of 1735 HCM patients undergoing cardiovascular magnetic resonance (CMR) for initial evaluation from 4 medical centers were followed up for a median of 3.7 years. LGE was semiautomatically quantified by manually adjusting a grayscale threshold. Results: We identified 638 HCM patients ≥60 years of age (up to 90 years), with LGE present in 337 patients (53%), including 28 patients (4%) with extensive LGE occupying ≥15% of left ventricular mass. Neither the presence nor extent of LGE was associated with increased risk for SCD events (HR ad , 1.13; 95%CI, 0.20-6.44, p=0.89 and HR ad per 10% increase, 1.49; 95%CI, 0.46-3.28, p=0.38, respectively), even after adjustment for other relevant disease variables. The risk for SCD at five years was 4% in older HCM patients with extensive LGE ≥15%, and not different compared to older patients with less LGE (1.0%, p=0.25). The performance of the AHA/ACC SCD risk model was not enhanced in older HCM patients by the addition of LGE (continuous net reclassification index, 0.25; 95%CI, -0.35-0.85, p=0.42). In contrast, the extent of LGE was associated with increased SCD risk in patients &lt;60 years, with extensive LGE associated with a 3-fold greater risk. Conclusions: The extent of LGE was not associated with increased SCD risk in HCM patients ≥60 years, even in the presence of other risk markers. These data suggest a limited role for CMR with LGE in older HCM patients to inform SCD risk stratification.
Abstract 14114: An Extreme Case of Calcific Constrictive Pericarditis
Authors: Mustafa Suppah, Hema Narayanasamy, Chris P Appleton, Said Alsidawi
Journal: Circulation (2023)

Introduction: Constrictive pericarditis (CP) can lead to cardiac dysfunction and a range of clinical symptoms. However, differentiating it from conditions like restrictive cardiomyopathy can be challenging due to the overlapping features. Case Presentation: We present a case of a 61-year-old female with a history of atrial flutter and subsequent atrial fibrillation, experiencing worsening dyspnea on exertion, lip cyanosis, and upper abdominal constriction. Extensive diagnostic workup, including Echo, CT scan, and cardiac MRI, revealed severe biatrial enlargement, ventricular interdependence, elevated filling pressures, reduced cardiac output, and extensive pericardial thickening and calcifications ( Figures 1.a and 1.b ). These findings supported the diagnosis of extensive CP. Discussion: CP is often missed and delayed in diagnosis due to its complex hemodynamics and the non-specific symptoms. Typically, the initial imaging modality to be performed is an Echo. Specific findings such as dilated vena cava, preserved tissue velocity with annuls paradoxus, abnormal respiratory septal shift, and respiratory variations in mitral/tricuspid inflow should be first clues for potential diagnosis. Furthermore, evaluation of the hepatic vein with diastolic flow reversal during expiration is a key finding. Lack of respiratory variation in the SVC is also important. Cardiac CT will assess pericardial thickness and calcification, while cardiac MRI is key for the diagnosis by showing the pericardial thickness and fibrosis as well as the septal respiratory shift and venous congestion. An invasive hemodynamic study might be required if imaging is inconclusive. this patient’s presentation, imaging findings, exercise test results and collectively supported considering radical pericardiectomy. Conclusions: This report highlights the diagnostic challenges related to CP and the importance employing a multimodality imaging approach for accurate diagnosis.
Abstract 16835: Plasma Proteomics and Risk of Incident HFpEF and HFrEF: The Atherosclerosis Risk in Communities Study
Authors: Victoria Lamberson, Yimin Yang, Peder L Myhre, Pranav Dorbala, Humaira Rasheed, Leo F Buckley, Brian Claggett, Margherita De Marzio, Kimberly Glass, Ron C Hoogeveen, Christie M Ballantyne, Josef Coresh, Bing Yu, Jacob Joseph, Yan Sun, Torbjorn Omland, Amil M Shah
Journal: Circulation (2023)

Introduction: Heart failure with preserved (HFpEF) and reduced (HFrEF) ejection fraction differ in pathophysiology and treatment response. Determining shared and unique protein biomarkers for these phenotypes can aid in understanding their biological mechanisms. Methods: We studied 4485 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who were free of HF and had aptamer-based proteomic measurements (SomaLogic, Boulder, CO) at study Visit 5 (2011-2013). For 4955 aptamers corresponding to 4712 unique proteins, we fit separate multivariable Cox proportional hazards regression models to test for associations with HFpEF and HFrEF. Replication of significant associations was conducted using data from the Norwegian Trøndelag Health Study (HUNT, n=3262). Two-sample Mendelian randomization (MR) was used to assess potential causal associations with HFpEF and HFrEF using summary statistics from the Million Veterans Program. Results: Mean age at Visit 5 was 75±5 years, 58% were women, and 17% reported Black race. At a median follow-up of 7.2 [IQR 5.6-7.8] years, 193 HFpEF and 157 HFrEF events occurred. After Bonferroni correction for multiple testing, 16 aptamers were significantly associated with both HFpEF and HFrEF, 45 were significantly associated with HFpEF only, and 9 aptamers were associated with HFrEF only (Figure). These associations replicated in HUNT (p&lt;0.05) for 6 out of 45 proteins for HFpEF only, and 4 out of 9 proteins for HFrEF only. MR identified a potential causal effect of CD7 on HFrEF. No causal associations were found for HFpEF. Conclusions: Partially distinct sets of circulating plasma proteins associate with HFpEF and HFrEF. A greater proportion of these associations replicated for HFrEF (4 of 9) than HFpEF (6 of 45) in two distinct population studies, highlighting the heterogeneity of HFpEF. Further study of these proteins may lead to additional insights into the differing biology of these phenotypes.
Abstract 15449: <i>Cardiopulmonary Best Abstract Award</i> : Pausing Reveals Exercise-Induced Uncoupling: Exploring the Dynamics of RV-PA Coupling in the Six-Minute Walking Test
Authors: Nils Kremer, Manuel J Richter, Athiththan Yogeswaran, Zvonimir Rako, Enrico Maggio, Werner Seeger, Khodr Tello
Journal: Circulation (2023)

Background: The six-minute walking test (6MWT) is a commonly used test for assessing the functional capacity of patients with pulmonary hypertension (PH), providing functional and prognostic information. Functional capacity depends on RV-PA coupling, the matching of right ventricular contractility to afterload. However, the dynamics of RV-PA coupling during the 6MWT have never been studied. Methods: We used a wireless hemodynamic monitoring system (CorLog, emka-medical, Germany) to continuously measure right ventricular pressure in 10 patients with PH (8 = group I, 1 = III, 1 = IV) during a 6MWT. We calculated right ventricular ejection fraction (RVEF) and Ees/Ea based on the pressure signal as shown in the figure (panel a). Dyspnea was evaluated using the Borg scale. Results: By analyzing the hemodynamic response during the 6MWT, we identified two patterns: 1) Improved/preserved coupling: Five patients exhibited an initial improvement in Ees/Ea and maintained coupling at least at the baseline level throughout the test, without requiring pauses. 2) Uncoupling associated with pauses: Five patients experienced a slight increase in Ees/Ea at the beginning, followed by a progressive loss of coupling and ejection fraction, necessitating pauses. During pauses, Ees/Ea values restored, enabling patients to resume walking. Patients of the second phenotype reported higher levels of dyspnea. The highest reported Borg score was 8 ± 0.9 vs. 4.6 ± 1.2 in the first group. Also, the covered distance was shorter in the second group (159 ± 64m vs. 288 ± 88m, p=0.03). Both groups showed differences in Ees/Ea (0.47 [0.46 - 0.57] vs. 0.34 [0.30 - 0.43], P=0.05) and RVEF (34 ± 4.1% vs. 28.5 ± 2.6%, P=0.03) at baseline, with Group One exhibiting superior values. Conclusion: This is the first investigation into the significance of RV-PA coupling in real-life exercise limitation and dyspnea during the 6MWT. Pauses observed during the 6MWT can serve as indicators of exercise-induced uncoupling.
Top 10 research priorities for cutaneous squamous cell carcinoma: results of the Skin Investigation Network of Canada Priority Setting Initiative
Authors: Philippe Lefrançois, Zein Doueidari, Omer Kleiner, Rachael Manion, Jan Dutz, Anie Philip, An-Wen Chan, Tarek Afifi, Yuka Asai, Sheila Au, Kathleen Barnard, Helen Catherall, Ryan DeCoste, Aaron M Drucker, Patrick Fleming, Julie Fradette, Lucie Germain, Robert Gniadecki, Sandra Holdsworth, Yuanshen Huang, Peggy Larsen, Melanie Laurin, Ivan V Litvinov, Jacklyn Loder, Sarvesh Logsetty, Morris F Manolson, Meggie Morand, P Régine Mydlarski, Melissa Nantel-Battista, Teresa M Petrella, Vincent Piguet, Girish Shah, Ilya Shoimer, Debbie Ward, Helen Wirrell, Mary Zawadzki, Youwen Zhou, David Zloty
Journal: British Journal of Dermatology (2023)

The Skin Investigation Network of Canada (SkIN Canada) completed a national priority-setting initiative to identify the top 10 knowledge uncertainties for SCC based on the James Lind Alliance principles. Overall, 64 patients, clinicians and researchers provided input in two survey rounds and one workshop. The top 10 list of research priorities will help the skin research community, funders and policymakers to address key knowledge uncertainties for the benefit of patients with SCC.