tbuckley/cabot-search huggingface dataset:
Abstract 18515: Prevalence of Right and Left Atrium Non-Pulmonary Vein Triggers in Cardiac Amyloidosis Patients Undergoing Atrial Fibrillation Ablation
Authors: Vincenzo Mirco La Fazia, Nicola Pierucci, Carola Gianni, Sanghamitra Mohanty, Domenico G Della Rocca, PremGeeta Torlapati, Nethuja Salagundla, Mohamed Bassiouny, G Gallinghouse, John Burkhardt, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale
Journal: Circulation (2023)

Introduction: Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias due to infiltration of the amyloid protein in the atrial wall. Though non-pulmonary vein(PV) triggers are commonly seen in left atrium, they are also seen in the right side of the heart, so identifying them at the time of ablation is essential. Minimal data exists on the prevalence of triggers in amyloidosis patients. Aim: The study evaluates the prevalence of non-PV triggers during catheter ablation in atrial fibrillation (AF) patients affected by cardiac amyloidosis Methods: This is a study including 74 consecutive patients with an established diagnosis of amyloidosis ATTR diagnosed with cardiac MRI or myocardial biopsy that underwent their first AF catheter ablation. They underwent PV isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers, which are defined as ectopic triggers originating from sites other than PVs including left atrial appendage (LAA), coronary sinus (CS), interatrial septum, crista terminalis, mitral valve anulus were identified and ablation in all 74 patients. Post procedure, patients were followed up routinely with ECG during office visits, 7-day Holter monitor and event recorders for the duration of 1 year. Results: Isoproterenol-challenge revealed non-PV triggers in 51 (68.9%) patients. These triggers were mostly mapped to LAA (39, 52.7%), CS (30, 40,5%), and crista terminalis (35, 47.3%). Besides, ectopic beats were seen originating from inter-atrial septum (19, 25.6%), mitral valve annulus (10, 13.5%). More than one trigger was found in (68%) patients.At 1-year after the ablation, 65 (87.8%) were arrhythmia-free off AADs. Conclusions: Our findings suggest that non-PV triggers are highly prevalent in cardiac amyloidosis AF patients including a much higher rate crista terminalis firing compared to the standard population.
Abstract 16014: Health-Related Quality of Life in Patients With Heart Failure is Worse Than in Patients With Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020
Authors: Kriti P Shah, Sadiya S Khan, Abigail Baldridge, Kathleen L Grady, David Cella, Parag Goyal, Larry A Allen, Justin Smith, Tara Lagu, Faraz S Ahmad
Journal: Circulation (2023)

Background: People with heart failure (HF) experience impaired physical and mental health. However, health-related quality of life (HRQOL) in people with HF to those with cancer, another condition that impacts HRQOL, have not been directly compared in a contemporary population. Research Question: How does HRQOL compare in people with HF to those with lung, colon, breast, or prostate cancer? Methods: We performed a pooled analysis of Medicare Health Outcomes Survey data between 2016-2020 in participants ≥65 years with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer using two HRQOL measures. The Veterans RAND-12 generates the physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on general US population), a standard deviation of 10, and a lower score representing worse health. We used pairwise t-tests to evaluate for differences in PCS and MCS by group. We used chi-squared to compare the distribution of days with poor physical or mental health in the past 30 days as measured by CDC Healthy Days core questions. Results: Compared to participants with lung, colon, breast, or prostate cancer, participants with HF (n=71,025; 54% female, 16% Black) had lower mean PCS and MCS ( Figure ; P&lt;0.001 for HF vs each cancer). The distribution of unhealthy days differed across disease groups (all P&lt;0.001). Over half (52%) of participants with HF reported ≥10 physically unhealthy days, which is higher than those with lung (51%), colon (41%), breast (31%), or prostate cancer (28%). Nearly one-third (32%) of participants with HF reported ≥10 mentally unhealthy days, which is higher than those with lung (28%), colon (25%), breast (21%), or prostate cancer (20%). Conclusions: People with HF on average experience worse HRQOL than those with cancer. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions to improve physical and mental health.
Abstract 14660: The Effect of Sacubitril/Valsartan Therapy on Hospitalization and Mortality in Patients Non-Respondent to Cardiac Resynchronization Therapy
Authors: Krisztina Maria Szabo, Anna Zsofia Toth, Vivien Racz, Attila Csaba Nagy, Judit Barta, Attila Borbely, Zoltan Csanadi
Journal: Circulation (2023)

Background: Non-responders to Cardiac Resynchronization Therapy (CRT-NR) have poor prognosis. Sacubitril/valsartan (SV) treatment improved the outcomes of heart failure patients with reduced left ventricular (LV) ejection fraction (HFrEF) in randomized trials; however, limited data are available on the specific cohort of CRT-NRs. Aim of the study: We have compared heart failure hospitalization (HFH) and mortality rates in three patient cohorts: CRT-NR patients on S/V versus on ACEi/ARB and general HFrEF patients on S/V. Methods: 275 HF patients, including 70 CRT-NRs receiving S/V at least for 6 months (Group I); 70 CRT-NRs on ACEi/ARB treatment (Group II); and 135 HFrEF patients without CRT indication on S/V therapy at least for 6 months (Group III) were included. CRT-NR was defined as a less than 10% improvement in left ventricular ejection fraction (LVEF) 6 months after device implantation. Rates of HFH and the composite of all-cause mortality/heart transplantation/LVAD therapy were compared with a mean follow-up of 21.5 months. A subgroup analysis was also performed in patients on S/V (Groups I and III) who demonstrated a more versus less than 10% increase in LVEF after 6 months of S/V treatment (S/V super-responders versus S/V moderate responders, respectively). Results: HFH rates were similar in Groups I and III (28.5% vs. 28.1%, respectively; p&gt;0.05), while significantly higher (54.2%) in Group II (p=0.02). No significant difference in the composite mortality endpoint was demonstrated between the three groups (22.8% vs. 24.2% vs. 22.2%, p=0.08). On S/V treatment, 13 out of the 70 (18.5%) CRT-NR patients (Group I) and 24 out of the 135 (17.8%) HFrEF patients (Group III) were found to be SV super-responders. Comparing these 37 patients with the 168 S/V moderate responders, neither the HFH (24.3% vs 30.9%, p=0.07), nor the composite mortality rates (24.3% vs 23.2%, p=0.53) demonstrated significant differences. Conclusion: S/V treatment in CRT-NRs improved hospitalization rates similarly to what was observed in a general HFrEF population. No benefit in mortality rates was demonstrated in this cohort. The extent of change in LVEF on S/V was not predictive of a better response on HFH or mortality.
Abstract 13187: TikTok and Cardiovascular Health: An Analysis of TikTok as a Potential Outlet to Increase Cardiovascular Health Literacy
Authors: Liem Pham, Ezra Schneier, Natalia Dafonte, Kevin Posner, Daniel Thiemann, Pranay Vaidya, Sarah Timmapuri
Journal: Circulation (2023)

Introduction: Multidisciplinary approaches promoting continued patient education may improve patient adherence and reduce hospitalizations. The recent emergence of short video applications provides a new avenue for health-related education. Current and future patients can benefit from utilizing this new media resource to expand cardiovascular health literacy and promote positive outcomes. Methods: TikTok was queried in #cardiology, #cardiologylife, #interventionalcardiology, #pediatriccardiology, #cardiologynurse between 11/15/22-11/18/22. Inclusion criteria were English videos focused on information, inspiration, or wellness from US healthcare professionals between 2021-2022. Posts that met inclusion criteria (N=218) were statistically analyzed. A linear model was created to estimate a value for views. Results: The year 2022 had the highest values of 324,077 views, 14,901 likes, and 1170 downloads, as opposed to 2021 with 305,377 views, 6918 likes, and 508 downloads. Of the 218 videos, 127 (58.3%) involved information, 45 (20.6%) involved inspiration, and 46 (21.1%) involved wellness. The difference in mean views between 2021 and 2022 was 38,937 (p=0.23), suggesting a potential upward trend. The difference in mean likes and downloads between 2021 and 2022 was 2909 (p=0.009) and 276 (p=0.013) respectively. Linear modeling revealed a strong relationship between likes/downloads and views, but could not predict the number of views on a video. While we cannot confidently state that the mean number of views is increasing, we have determined that likes and downloads are certainly increasing with expanding engagement. Conclusions: The results of this study highlight the use of social media, specifically TikTok, as an inexpensive and passive way to improve health literacy. The increasing average number of views from 2021 to 2022 illustrates the upward trend among users and how TikTok can be used in a multidisciplinary approach to patient care and patient education. Further research is required to determine the role TikTok may play in patient care and how it may be utilized to inform the care of specific patient populations; however, the opportunities it may provide are promising.
Abstract 363: Endothelial Nitric Oxide Mediates Protection of Isolated Cardiomyocytes by Poloxamer 188 Against Hypoxia Reoxygenation Injury
Authors: Zhu Li, Matthew Barajas, Takuro Oyama, Matthias L Riess
Journal: Circulation (2023)

Background: Poloxamer (P) 188, a copolymer-based cell membrane stabilizer, has been suggested to alleviate myocardial ischemia/reperfusion injury through cell membrane stabiliztion. Recent studies found that cell-to-cell interactions between endothelial cells (ECs) and cardiomyocytes (CMs) can further protect CMs: data from our co-culture model showed that ECs, at an appropriate density, promoted protection by P188 against hypoxia/reoxygenation (HR) injury evidenced by reduced release of lactate dehydrogenase (LDH) from CMs; however, the mechanism of interaction was yet to be explored. In the present study, we examined whether L-NAME, a nitric oxide (NO) synthase inhibitor, abrogates LDH release and/or Ca 2+ overload in CMs in the presence or absence of P188 and ECs. Methods: Mouse coronary artery ECs, plated at densities of 25,000 per insert, were co-cultured with mouse CMs plated at confluency on the bottom of the corresponding well. Normoxic controls were kept under normal O 2 and media conditions for 24 hours while HR groups underwent 24 h hypoxia at 0.01% O 2 in serum- and glucose-free media, followed by 2 hr reoxygenation in normal media. P188 (300 uM), L-NAME (40 mM) or vehicle were administered upon reoxygenation. Intracellular Ca 2+ and LDH release were measured by standard kits. Statistics: ANOVA and SNK, alpha = 0.05. Results: Consistent with previous observations, ECs at this low density did not affect HR-triggered LDH release or increased Ca 2+ in CMs by themselves; in the presence of P188, however, ECs were able to reduce LDH and Ca 2+ after HR (panel 1A, 2A) synergistically. L-NAME abrogated CM protection by P188 &amp; ECs in both assays (panels 1B, 2B). Neither intervention had any effect under normoxic conditions (all panels). Conclusion: The current data in this co-culture model suggest that protection of CMs by P188 is mediated through endothelial NO release.
Abstract 14666: Prognostic Value of Artificial Intelligence-Enabled ECG for Increased Left Ventricular Filling Pressure
Authors: Eunjung Lee, William Miranda, Francisco Lopez-Jimenez, Hee Tae Yu, Paul Friedman, Zachi Attia, Jae K Oh
Journal: Circulation (2023)

Introduction: Left ventricular diastolic function and filling pressure (FP) can be assessed by echocardiography and cardiac catheterization. Recently, a novel artificial intelligence (AI)-enabled ECG has proven to be effective in identifying increased FP determined by echocardiographic assessment of diastolic function. Aims: We aimed to compare a prognostic value of AI-ECG determination of FP compared to echocardiography and catheterization. Methods: This study included 4,213 patients who had a transthoracic echocardiogram and ECG within 30 days before hemodynamic cardiac catheterization. Increased FP was defined as pulmonary artery wedge pressure &gt;15 mmHg by catheterization and grade 2 or 3 diastolic dysfunction by echocardiography based on diastolic function guidelines. Increased FP by ECG was identified using previously developed AI-ECG. AI-ECG performance was evaluated using the area under the curve (AUC) of the receiver operating curve. We assessed the risk of all-cause mortality using Kaplan-Meier estimate and multivariable Cox proportional-hazards models. Results: AI-ECG had AUCs of 0.8 and 0.7 for predicting increased FP determined by echocardiography and catheterization, respectively. Death was observed in 2,776 (34%) patients over a median follow-up of 7.7 years (IQR 7.1, 8.3). Survival of patients with normal and increased FP by AI-ECG, Echocardiography, and catheterization are shown in Figure 1a. Concordant diagnoses of normal and increased FP by AI-ECG and catheterization or echocardiography had the highest and lowest survival rates, respectively. When FP by AI-ECG was discordant, survival was better predicted by AI-ECG compared to echocardiography and catheterization (Figure 1b). Conclusion: AI-ECG for FP has a potential to discriminate prognosis further compared to FP determined by echocardiography or catheterization.
Abstract 18459: A Cell Permeable Protein Kinase C Beta II Peptide Inhibitor Mitigates the Generation of Reactive Oxygen Species in Rat ex-vivo and Porcine in-vivo Ischemia-Reperfusion Injury
Authors: James Ramsarran, Logan Clair, Juliet Melnik, Desmond Boakye Tanoh, Jennifer Dang, Taurai Augustin, Tameka Dean, Qian CHEN, Robert Barsotti, Lindon Young
Journal: Circulation (2023)

Introduction: Restoration of blood flow following myocardial infarction is necessary to salvage ischemic tissue, but reperfusion is known to cause myocardial ischemia/reperfusion injury (MIR). Cytokine induced translocation of protein kinase C beta II (PKCβII) during reperfusion (R) stimulates the production of reactive oxygen species (ROS). Dual conjugation of PKCβII peptide inhibitor (PKCβII-) with myristic acid (myr) and trans-activator of transcription (Tat) (myr-Tat-CC-SLNPEWNET [myr-Tat-PKCβII-]) enhances intracellular delivery and reduces phorbol ester-induced neutrophil ROS. We hypothesize that 20ng/kg of myr-Tat-PKCβII- would exert cardioprotective effects in porcine MIR in-vivo by reducing stimulation of ROS. Methods: Ex vivo: We tested 100nM - 10fmol myr-Tat-PKCβII- in ex-vivo rat MIR. Isolated hearts from anesthetized male SD rats underwent global I (30-min)/R(50-min). Myr-Tat-PKCβII- was given during first 5min of R. DP/dt max was measured via pressure transducer in the left ventricle. 1% TTC staining was used to determine infarct size. Data was analyzed via Fisher’s PLSD. In vivo: Regional I (1 hr)/R (3 hrs) was induced in male Yorkshire pigs. At R, myr-Tat-PKCβII- or scrambled control peptide (20ng/kg; ~100 pM blood volume [vol.] concentration [conc.]) was given by intra-arterial bolus. Ejection fraction (EF) was calculated. Infarct size was determined with Evans Blue dye and 1% TTC staining. Data was analyzed using Student’s t-test. Results: Ex-vivo: Myr-Tat-PKCβII- (100nM - 100fmol; 10-14±3%; n=3-6) significantly reduced infarct size compared to controls (21±3%; n=21; p&lt;0.05). DP/dt max was significantly improved (100pM-1pM; 961±274; n=5-6) compared to 100nM (163±77, n=3; p&lt;0.05), 100fM (481±86, n=5; p&lt;0.05), and 100pMscrambled myr-Tat-PKCβII- (386±86, n=4; p&lt;0.05). In-vivo: Myr-Tat-PKCβII- 20ng/kg (~100pM blood vol. conc.) significantly restored EF to within 1.4±0.7% of baseline and reduced infarct size to (10.0±2.8%; n=4) compared to control (6.4±2.1%; 28.5±8.3%; n=6; p&lt;0.05). Conclusions: Results suggest 20ng/kg (~100pM blood vol. conc.)) should continue to be used to test in porcine MIR in-vivo. Future studies include a 12-week porcine survival study to evaluate infarct size and cardiac function.
Genetic trio of <i>BRAF</i> and <i>TERT</i> alterations and rs2853669TT in papillary thyroid cancer aggressiveness
Authors: Rengyun Liu, Guangwu Zhu, Jie Tan, Xiaopei Shen, Mingzhao Xing
Journal: JNCI Journal of the National Cancer Institute (2023)

Abstract Background BRAF V600E and TERT promoter alterations are core components in current genetics-based risk assessment for precision management of papillary thyroid cancer. It remains unknown whether this approach could achieve even better precision through a widely recognized prognostic single-nucleotide variation (SNV, formerly SNP), rs2853669T&amp;gt;C, in the TERT promoter. Methods The genetic status of alterations and SNV were examined by sequencing genomic DNA from papillary thyroid cancer in 608 patients (427 women and 181 men) aged 47 years (interquartile range = 37-57), with a median follow-up time of 75 months (interquartile range = 36-123), and their relationship with clinical outcomes was analyzed. A luciferase reporter assay was performed to examine TERT promoter activities. Results TERT promoter alterations showed a strong association with papillary thyroid cancer recurrence in the presence of genotype TT of rs2853669 (adjusted hazard ratio [HR] = 2.12, 95% confidence interval [CI] = 1.10 to 4.12) but not TC/CC (adjusted HR = 1.17, 95% CI = 0.56 to 2.41). TERT and BRAF alterations commonly coexisted and synergistically promoted papillary thyroid cancer recurrence. With this genetic duet, TT of rs2853669 showed a robustly higher disease recurrence than TC/CC (adjusted HR = 14.26, 95% CI = 2.86 to 71.25). Patients with the genetic trio of BRAF V600E, TERT alteration, and TT of rs2853669 had a recurrence of 76.5% vs recurrence of 8.4% with neither variation and with TC/CC (HR = 13.48, 95% CI = 6.44 to 28.21). T allele of rs2853669 strongly increased TERT promoter activities, particularly the variant promoters. Conclusions The SNV rs2853669T&amp;gt;C dramatically refines the prognostic power of BRAF V600E and TERT promoter alterations to a higher precision, suggesting the need for including this SNV in the current genetics-based risk prognostication of papillary thyroid cancer.
Abstract 330: Severe Adverse Safety Events in Pediatric Out-of-Hospital Cardiac Arrest Resuscitation
Authors: Carl Eriksson, Jeanne-Marie Guise, Matthew L Hansen, Nathan Bahr, Grace Walker-Stevenson, Garth Meckler
Journal: Circulation (2023)

Introduction: Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor in spite of improvements in adult OHCA survival. Hypothesis: We hypothesized that severe adverse safety events (ASEs) are common during pediatric OHCA resuscitation and that specific patterns can be identified. Methods: Retrospective cohort study of patient care reports from 51 Emergency Medical Services (EMS) agencies across the US for children less than 18 years of age with an OHCA where resuscitation was attempted by EMS providers between 2013-2019. Results: We evaluated 1,019 encounters of EMS-treated pediatric OHCA; 46% were under 12 months of age. At least one severe ASE occurred in 610 patients (60%), and 310 patients (30%) had two or more. Children under 28 days of age had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (30%), ventilation (14%), and vascular access (19%). Logistic regression modeling found that the only factor consistently associated with severe ASEs was young age. Birth-related OHCA had 4-fold greater odds of a severe ASE compared to adolescents (95% CI 1.7-10.7) and neonates with non-birth-related OHCA had 3.2-fold greater odds of a severe ASE (95% CI 1.1-9.0). Conclusions: In this large geographically diverse cohort of children with EMS-treated OHCA, 60% experienced at least one severe ASE. The odds of a severe ASE were over 3-fold higher for neonates than adolescents, and even higher when the cardiac arrest was birth-related. Given the national increase in out of hospital births and ongoing poor outcomes of OHCA in young children, these findings are an important and urgent call to action to focus on improving care delivery and training.
Abstract 17652: Association Between Ventricular Arrhythmias and Myocardial Fibrosis in Patients With Chagas Disease Without Known Cardiomyopathy
Authors: Radhika Gulhar, Michael Jiang, Justin Hayase, Aneeq Malik
Journal: Circulation (2023)

Introduction: Chagas disease (CD) is an important cause of cardiomyopathy, arrhythmias and sudden death. The presence of myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in these patients has been correlated with an increased prevalence of ventricular arrhythmias. The incidence of ventricular arrhythmias in patients with CD without established cardiomyopathy has not been well described. Hypothesis: We aim to evaluate if there is an association between LGE on CMR and incidence of ventricular arrhythmias in patients with CD but without cardiomyopathy. Methods: Patients treated at a Chagas disease center of excellence were retrospectively analyzed for ambulatory rhythm monitoring (Holter and/or 14-day patch monitor) and CMR data. Significant ventricular arrhythmias were defined as either a PVC burden &gt;/=1% or non-sustained ventricular tachycardia (NSVT) ≥4 beats. A Fisher exact test was used to compare categorical variables. Results: There were 191 patients treated between 12/2014 and 8/2022 available for analysis. Of these, 46 patients with CD and no prior history of cardiomyopathy received both ambulatory rhythm monitoring and CMR. There were 16 male and 30 female patients with average age of 52.2 ± 11.5 years, and LV ejection fraction of 58.8% ± 14.2%. Of the 46 patients, 15 (32.6%) were found to have LGE on cMRI while 31 (67.4%) had no evidence of LGE. Within the patients with LGE, 8/15 (53.3%) were found to have significant ventricular arrhythmias. Of the patients without LGE, only 7/31 (22.6%) were determined to have significant ventricular arrhythmias (p = 0.038). Conclusions: These data suggest that for patients with CD without cardiomyopathy, the presence of LGE on CMR is independently associated with incident ventricular arrhythmias detected on ambulatory rhythm monitoring. Whether these findings indicate increased risk of sudden cardiac death requires further study.