tbuckley/cabot-search huggingface dataset:
Abstract 18993: Regional Disparities in Authorships of Cardiovascular Research Presented at the American Heart Association’s Scientific Sessions Reporting Healthcare Disparities 2020-2023
Authors: Nanush Damarlapally, Adil S Mohammed, Priyatham Gurram, Suvidha Manne, Arankesh Mahadevan, Shabnam Abrishami, Sai Prasanna P Lekkala, Chenna reddy Tera, Ashwini Mahadevaiah, Sai Priyanka P Mellacheruvu, Ananth V Guddeti, Shaylika Chauhan, Rupak Desai
Journal: Circulation (2023)

Background: Geographic and temporal distribution of disparity authorships is unclear. Our aim was to examine authorship trends in 2020-2023 American Heart Association (AHA) abstracts reporting social and demographic disparities. Methods: We reviewed 801 AHA conference abstracts, analyzing 723 reports. Regional information of authors and their reported disparities related to gender, race, region, healthcare access (HCA), comorbidities (CO), socioeconomic status (SES) were collected. Descriptive and trend analyses were performed using Chi-square tests, and Pearson's and Kendall's Tau b correlation tests. P &lt;0.05 was considered significant. Results: We analyzed 1440 primary and senior authorships from 723 abstracts. The majority of authors (92%) were from North America, predominantly USA (90%), with a significant representation from the South (33.6%) vs. other regions (Image 1). Disparities on outcomes such as race, gender, SES, CO, geographical locations, and HCA were reported as 53.9%, 33.9%, 26.6%, 24.9%, 17.8%, and 13.6% respectively. From 2020 to 2023, there was a declining trend in authors reporting on gender (ptrend&lt;0.001) and HCA (ptrend-0.03) disparities, whereas disparities on SES had an increasing trend (ptrend&lt;0.001). An increase in reporting of gender disparities was associated with increased reporting of racial disparities (r = .081, τb = .081). We also found positive correlations between SES and HCA (r = .155, τb = .155). Conversely, there was a negative correlation between gender and SES (r = -0.133, τb = -0.133), and between CO and healthcare access HCA (r = -0.078, τb = -0.078). All correlations were statistically significant (p &lt; 0.05). Conclusion: The trends show that authors have reported more SES disparities in recent times compared to HCA, race, and gender. With expected financially challenging times ahead, to address these findings, it remains important to focus research on income based equalities in HCA and outcomes.
Abstract 13381: Syncope as a Presentation of Waldenstrom Macroglobulinemia
Authors: Jian garcia cruz, Julio Perez Rodriguez, Roy Kondapavuluru, Eunbee Cho
Journal: Circulation (2023)

Syncope as defined by ACC/AHA is defined as a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone with rapid and spontaneous recovery without clinical features of other non-syncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness. Syncope is a common complaint treated in the emergency department and a major reason for hospital admissions. A rare etiology to this common symptom is Waldenstrom macroglobulinemia. Case: A 49-year-old man presented to the emergency department, referred for hypercalcemia. On review of records, the patient was noticed to have been seen previously in emergency visits for two episodes of syncope and recurrent anemia. The laboratory studies at the time of admission were remarkable for hemoglobin of 7.3, WBC of8.32, hematocrit of 28.5, MCV 77.2, platelets of 124,000. Complete metabolic panel showed a total protein of 13.1, calcium of 11.2 with an albumin of 1.6 and corrected sodium of 117. EKG demonstrated a sinus rhythm with left atrial enlargement and nonspecific T wave abnormalities. Echocardiogram demonstrated a LVEF of 60-65% with normal LV wall motion, posterior wall thickness, and septal wall thickness with grade 1 diastolic dysfunction. CT of the head was unremarkable. Further work up for recurrent microcytic anemia. Bone marrow biopsy was obtained which demonstrated a Waldenstrom macroglobulinemia. Further follow up revealed that the patient has not had any other syncopal episodes since initiation of treatment. Conclusion: Although current literature suggests a broad differential diagnosis for the symptom of syncope, Waldenström macroglobulinemia remains a rare etiology of syncope with an estimated incidence of 1000 to 1500 cases diagnosed per year. Waldenstrom macroglobulinemia can cause hyperviscosity syndrome in about 30 percent of the population with Waldentroms, which when severe and coupled with anemia and plasma volume expansion has been reported as arare cause of syncope. Syncope evaluation should be detailed with history and physical examination and hyper-viscosity syndromes, a medical emergency, should be considered as differential diagnosis of syncope.
Abstract 18428: Effect of Continuous Positive Airway Pressure on Atrial Remodeling in Patients With Obstructive Sleep Apnea and Paroxysmal Atrial Fibrillation; a Randomized Controlled Trial
Authors: Tove Elizabeth F Hunt, Gunn Marit Traaen, Richard J Massey, Lars Aakeroy, Christina Bendz, Britt Øverland, Harriet Akre, Sigurd Steinshamn, Jan Pål Loennechen, Kaspar Broch, Øyvind H Lie, Thomas Helle-Valle, Anne Kristine Anstensrud, Kristina Hermann Haugaa, Lars Gullestad, Ole-Gunnar Anfinsen, Svend Aakhus
Journal: Circulation (2023)

Introduction: Obstructive sleep apnea (OSA) is known to cause left atrial (LA) remodeling. The effect of continuous positive airway pressure (CPAP) on LA remodeling in patients with OSA and paroxysmal atrial fibrillation (AF) has not been assessed. Hypothesis: We aimed to assess the impact of CPAP treatment on reverse LA deformation and volume in patients with AF and OSA. Methods: In this secondary analysis of a prospective randomized controlled trial, we screened patients with AF for OSA. The majority of patients were referred for pulmonary vein isolation (PVI). We included AF patients with OSA defined as apnea-hypopnea index (AHI) &gt; 15/h. Patients were randomized to CPAP treatment or standard care. Transthoracic echocardiography was performed to assess atrial remodeling by two-dimensional speckle tracking LA reservoir strain (by AFI LA) and LA volume index (LAVI) in apical 2- and 4-chamber views in sinus rhythm at baseline and at 12 months’ follow-up by an investigator blinded to allocated arm. AF burden was monitored by an implantable loop recorder in all patients. Results: We included 104 patients (62 ±7 years old, 77% men, BMI 30 ± 4) of whom 50 were randomized to CPAP and 54 to standard care. PVI was performed in 83 patients six months after the baseline exam. There was no clear improvement in LA reservoir strain in either group from baseline to follow up (CPAP: 30 ± 8 % vs 32 ± 9 %, p = 0.15; standard care: 28 ± 7 % vs 30 ± 6 %, p = 0.11), and there was no difference between the groups (p=0.41). Similarly, LAVI did not change in the CPAP group (38±8 mL/m 2 vs 36± 10ml/m 2 , p= 0.16) or in the standard care group (39± 10 mL/m 2 vs 37 ± 12 ml/m 2 , p= 0.20) during follow-up, with no difference between the two groups (p =0.62). In patients who underwent PVI, the AF burden decreased in both treatment arms, with no between-group difference (p = 0.69). Conclusions: In AF patients with OSA, treatment with CPAP did not improve reverse left atrial remodeling within 12 months. Although the trial was relatively small, these results suggest that CPAP is unlikely to have a major impact on normalization of LA function after atrial fibrillation ablation in this patient group.
Abstract 16649: Clonal Hematopoiesis as a Predictor of Left Ventricular Reverse Remodeling in Non-Ischemic Dilated Cardiomyopathy
Authors: Shunsuke Inoue, Seitaro Nomura, Zhehao Dai, Takahiro Jimba, Toshiyuki Ko, Eisuke Amiya, Masaru Hatano, Hiroyuki Morita, Issei Komuro
Journal: Circulation (2023)

Background: Clonal hematopoiesis of indeterminate potential (CHIP) is an independent risk factor of major adverse cardiovascular events, including heart failure (HF) with reduced left ventricular ejection fraction (LVEF). Although genetic mutations are known to affect clinical prognosis and left ventricular reverse remodeling (LVRR) in non-ischemic dilated cardiomyopathy (DCM), the prevalence and clinical significance of CHIP in DCM remain elusive. Objectives: The principal aim of this study is to delineate the distribution and prognostic impact of CHIP in non-ischemic DCM. Methods: We included 198 cases of DCM with LVEF ≤ 40% and no identifiable cause for left ventricular systolic dysfunction from the Japanese multi-center cohort. Whole exome sequencing was performed for germline analysis, and deep target sequencing focusing on CHIP driver genes for somatic analysis was conducted. We detected cardiomyopathy-related pathogenic mutations and CHIP driver mutations using GATK best practices and Mutect2, respectively. The primary endpoint was LVRR, defined as an absolute increase in LVEF by ≥ 10% at a one-year follow-up echocardiogram. Results: Twenty-seven CHIP driver mutations were detected in 24 (12%) of the DCM patients. The mean read coverage for CHIP driver mutation was 2156. DNMT3A was the most frequent mutated gene in CHIP, followed by TET2 . Ninety-two (46%) patients have cardiomyopathy-related pathogenic mutations. TTN was the most frequent mutated gene, followed by LMNA . Although the CHIP-positive group showed similar LVEF and prevalence of cardiomyopathy-related pathogenic mutations compared with the CHIP-negative group, the occurrence of LVRR was significantly lower in the CHIP-positive group (47.0% vs. 20.8%, P=0.018). Multivariate logistic regression analysis revealed that CHIP (odds ratio (OR): 0.23, P=0.022) and cardiomyopathy-related pathogenic mutations (OR: 0.28, P&lt;0.001) were independent negative predictors of LVRR. Conclusions: Determining germline and somatic mutations in DCM significantly predict clinical prognosis.
Abstract 16980: Real World Performance of a Conduction System Pacing Lead
Authors: Anne J Wong, Melanie J Kapphahn-Bergs, Ishan S Nadkarni, Robert G Hauser, Jessica R Whelan, Susan A Casey, Dawn R Witt, Alan J Bank, Matthew D Olson, Evan T Walser-Kuntz, Jay D Sengupta
Journal: Circulation (2023)

Introduction: With the shift towards conduction system pacing (CSP), a technique that preserves ventricular synchrony unlike standard right ventricular pacing (RVP), the use of the smaller diameter fixed-helix Medtronic 3830 4Fr Select Secure lead and its’ special delivery catheter has dramatically increased. The near and long-term performance of the 3830 lead in a large real-world setting remains poorly characterized. Thus, we evaluated our experience with the 3830 lead in comparison to the Medtronic 6Fr stylet-driven active fixation CapSureFix Novus 5076 lead used for conventional RVP. Hypothesis: The performance of the 3830 CSP lead is equivalent to that of the 5076 RVP lead. Methods: Patients with 3830 CSP or 5076 RVP leads implanted at our institution between January 1st, 2018 and March 1st, 2022 were included. All patients were followed at our institution and lead complications, revisions, explants, and upgrades to present day were tracked. Groups were compared using the chi-squared and Fisher’s exact tests in R 4.2.3. Results: The outcomes for 2,077 patients receiving either a 3830 CSP lead (n=1,018) or a 5076 RVP lead (n=1,059) are shown in the table. Initially, 13 (1.3%) 3830 leads could not be implanted vs. 3 (0.3%) 5076 leads (p=0.011). Subsequently, however, total revisions were similar between groups (p=0.20), and there were no significant differences in dislodgement, infection, or need for upgrade. One 3830 lead fractured and was replaced; otherwise, there were no lead failures in either group. The distribution of time from implant to event was also similar (p=.376). Conclusion: The long-term performances of the 3830 and 5076 leads are similarly satisfactory. A small proportion of 3830 leads could not be implanted, but overall septal or CSP was reliably achieved with few complications or need for lead revision or upgrade.
Abstract 13153: Non-Rheumatic Streptococcal Myocarditis Manifesting as Acute Non-ST-Elevation Myocardial Infarction
Authors: Juthipong Benjanuwattra, Michel Juarez, Brandon Rogers, Leigh A Jenkins
Journal: Circulation (2023)

Case presentation: A 24-year-old healthy man presented with acute, constant, non-radiating, chest pain with pleuritic quality. Three days prior, he had developed fever, sore throat, cervical lymphadenopathy, and tachycardia. Amoxicillin was given for a positive rapid streptococcal test. He was afebrile and bradycardic at 50 bpm. Lab showed leukocytosis (WBC 20,000/μL, neutrophil 80%), elevated ESR 70 mm/hr, CRP 23 mg/dL, and rising hs-cTn from 800 to 1,700 ng/L. Anti-streptolysin O and anti-DNase-B were normal. Tests for adenovirus, EBV, CMV, and other respiratory viruses were negative. Initial EKG showed sinus bradycardia with ST depression and T-wave inversion in V1-V2 and III. CXR and echo were unremarkable. He received intravenous penicillin G and indomethacin. Chest pain resolved on the following day. Repeat EKG showed resolution of bradycardia, ST depression, and T-wave inversion in V2. Indomethacin, colchicine, and amoxicillin were given upon discharge. Discussion: In contrast to acute rheumatic fever (ARF), a condition caused by molecular mimicry leading to cross-reactive humoral and cellular immune responses between cardiac and Streptococcus pyogenes antigens, the pathophysiology of non-rheumatic streptococcal myocarditis is presumably toxin-mediated. Although the revised Jones criteria were fulfilled in our patient, the temporal relationship between pharyngitis and the onset of carditis must be taken into account to distinguish these two entities. Concurrent myocarditis and pharyngitis suggest non-rheumatic streptococcal myocarditis, as opposed to a delayed presentation in ARF. Latency from pharyngitis to chest pain was reportedly around 3 days. The absence of valvular heart disease and streptococcal antibodies, such as anti-streptolysin O and anti-DNase B, are a clue to diagnosis. A recent case-series also suggested male-predominance. There has been an increase in a diagnosis of non-rheumatic streptococcal myocarditis due to a widespread use of diagnostic modalities such as MRI. Clinicians should consider this condition in a differential diagnosis of acute coronary syndrome, particularly in any young individuals with chest pain, elevated cardiac biomarkers, EKG changes, and simultaneous streptococcal pharyngitis.
Abstract 18114: Generating Human Artery and Vein Cells From Pluripotent Stem Cells Highlights the Arterial Tropism of Nipah and Hendra Viruses
Authors: Lay Teng Ang
Journal: Circulation (2023)

Introduction: biology research endeavors to generate specific subtypes of endothelial ‘‘cell types’’ such as artery and vein cells. Despite substantial progress, incomplete knowledge of artery and vein development challenges efforts to generate artery and vein cells from human pluripotent stem cells (hPSCs). Hypothesis: We hypothesize that TGFb and PI3K are artery and vein-specifying signals, respectively. We can efficiently specify artery cells by inhibiting vein-specifying signals and vice versa in chemically defined media. Methods: To generate artery cells, we activated TGFb and inhibited PI3K signaling (amongst other signals). Conversely, to generate vein cells, we inhibited TGFb and activated PI3K signaling. Results: We generate &gt;90% pure artery and &gt;80% pure vein endothelial cells from hPSCs within 3-4 days of differentiation, respectively. Both artery and vein cells could form 3D blood vessel networks in vitro and in vivo , sense and respond to shear stress, and uptake low-density lipoproteins. These cells modeled viral infection of human vasculature by Nipah and Hendra viruses, which are extraordinarily deadly and require biosafety-level-4 containment. Generating pure populations of artery and vein cells showed that Nipah and Hendra viruses preferentially infected arteries; arteries expressed higher levels of their viral-entry receptor. Virally-infected artery cells fused into syncytia containing up to 23 nuclei, which rapidly died. Despite infecting arteries and occupying 6%-17% of their transcriptome, Nipah and Hendra largely eluded innate immune detection, minimally eliciting interferon signaling. Conclusions: In conclusion, we efficiently generate artery and vein cells, introduce stem-cell-based toolkits for biosafety-level-4 virology, and explore the arterial tropism and cellular effects of Nipah and Hendra viruses. This large-scale supply of human endothelial cells could also enable applications, including vascular disease modeling and tissue engineering synthetic blood vessels.
Abstract 16003: A Case of Ventricular Fibrillation Arrest in a Healthy Young Female With Newly Discovered Mitral Annular Disjunction
Authors: Sheena Amin, Brendan O'Gorman, Gregory Dadekian
Journal: Circulation (2023)

Introduction: Mitral annular disjunction (MAD) is an under-recognized cause of ventricular arrhythmias. Case Presentation: A previously healthy, athletic 43-year-old female suddenly collapsed during a staff meeting at a medical center. Cardiopulmonary resuscitation was initiated and she was found to be in ventricular fibrillation, requiring three defibrillation shocks to achieve ROSC. EKG was notable for prolonged QTc without signs of pre-excitation or Brugada syndrome. Patient denied any personal or family cardiac history but endorsed frequent palpitations in the past. No electrolyte derangements were identified. Coronary angiography revealed normal origins of the coronary arteries and no evidence of obstructive disease. Transthoracic echocardiogram demonstrated normal left ventricular systolic function, normal wall thickness, and no regional wall motion abnormalities. There was mild bileaflet mitral valve prolapse with mild mitral regurgitation and mitral annular disjunction measuring 0.7 cm. Cardiac MRI was obtained and demonstrated biventricular dilation (consistent with athlete’s heart) with evidence of MAD. The myocardium was normal with no evidence of late enhancement. She underwent dual-chamber cardioverter-defibrillator implantation for secondary prevention. Discussion: Mitral annular disjunction is a structural abnormality involving atrial displacement of the mitral annulus, leading to an abnormal separation between the posterior mitral valve leaflet and basal ventricular myocardium during systole. Etiology of MAD remains unclear. It is estimated to be present in 8.7% of the general population and in over 30% of individuals with mitral valve prolapse. This case presents an example of a previously healthy patient with sudden cardiac arrest. After extensive workup, MAD was identified as the most likely trigger for her new onset arrhythmia. This case highlights the severe, and potentially fatal, arrhythmias that can arise from MAD. It is important to recognize MAD seen on echocardiograms and counsel patients on potential complications. Patients with MAD and increased risk factors should undergo further evaluation with cardiac MRI and/or electrophysiology studies.
Abstract 11994: Lithotripsy-Assisted Transcatheter Aortic Valve Implantation: An Emerging Approach to Vascular Access Issues in Severe Peripheral Arterial Disease
Authors: Meet Shah, Zeel K Patel, Afif Hossain, Sarthak Patel, Abhishek Sharma
Journal: Circulation (2023)

Introduction: Advances in minimally invasive valvular interventions like transcatheter aortic valve implantation (TAVI) allow for treatment of an increasingly older population. Severe calcific iliofemoral peripheral arterial disease (PAD) can preclude large sheath introduction necessary in TAVI. Conventional peripheral angioplasty has limited efficacy in these situations given its high-pressure dilation, which increases the risk of vascular complications. Intravascular shockwave lithotripsy (IVL) for PAD is an emerging and safe alternative for vascular access. Case Description: A 90-year-old man with severe symptomatic aortic stenosis (AS), coronary artery disease (CAD) status-post CABG and extensive PAD was referred for TAVI following balloon aortic valvuloplasty. Transthoracic echocardiogram showed severe, low-flow, low-gradient AS despite recent balloon aortic valvuloplasty. Abdominal imaging showed severe atherosclerosis and calcification of the bilateral common and external iliac arteries. Prior to TAVI, peripheral angiogram was performed, followed by IVL for a total of nine runs, each for fifteen seconds with a 7x60mm balloon to the right iliac and femoral arteries. Then, the right femoral groin sheath was upsized from six to eighteen French, followed by deployment of a 29mm Medtronic Evolute Pro+ self-expanding bioprosthetic aortic valve. Following successful TAVI, the patient was discharged home on aspirin and clopidogrel. Conclusion: IVL utilizes pulsatile mechanical shockwaves to modify plaque burden without altering arterial elasticity or structural integrity, which greatly reduces the risk for vascular complications in severely calcified arteries. The DISRUPT-PAD-III trial showed IVL was superior to percutaneous transluminal angioplasty with fewer complications in patients with calcified PAD. Therefore, IVL can be a safe alternative approach for PAD limiting vascular access in percutaneous valvular interventions.
Abstract 15115: Efficacy and Safety of miR-132 Inhibitor CDR132L in Patients With Reduced Left Ventricular Ejection Fraction After Myocardial Infarction: Rationale for and Design of the HF-REVERT Trial
Authors: Johann K Bauersachs, Scott Solomon, Stefan D Anker, Maria Isabel Antorrena Miranda, Sandor Batkai, Gerasimos Filippatos, Piotr Ponikowski, Orly Vardeny, Wilfried Hauke, Thomas Thum
Journal: Circulation (2023)

Background: Inhibition of miR-132 effectively prevents and reverses heart failure (HF) in relevant models, making it an attractive HF target. CDR132L is a synthetic antisense oligonucleotide (ASO) selectively blocking miR-132. Translational in vitro and in vivo studies have demonstrated meaningful efficacy of CDR132L on left ventricular (LV) structure and function. CDR132L was safe and well tolerated in a Phase 1b study in chronic HF patients. The indicative effects of the miR-132 inhibitor CDR132L may be particularly beneficial in patients with active adverse remodelling, e.g. after acute myocardial infarction with early decline in ejection fraction. These patients have been relatively understudied and therapeutic options are limited. Method: The HF-REVERT (P h ase 2, Multicenter, Randomized, Parallel, 3-arm, Placebo-controlled Study to Assess E f ficacy and Safety of CD R 132L in Pati e nts with Reduced Left V entricular E jection F r ac t ion (≤ 45%) after Myocardial Infarction; NCT05350969) is a proof-of-concept study to evaluate the efficacy of CDR132L in improving cardiac function and safety in patients with reduced LV ejection fraction (LVEF). HF-REVERT aims to assess the efficacy and safety of 5 mg/kg and 10 mg/kg CDR132L, given as 3 single intravenous doses administered 28 days apart as an add-on to standard-of-care treatment, in a larger cohort of patients (N = 280) with HF and reduced LVEF (≤ 45%) after MI with a follow-up of 10 months. Key inclusion criteria are the diagnosis of acute STEMI/NSTEMI and the development of systolic dysfunction (LVEF ≤ 45%) after MI index event and elevated N-terminal pro B-type natriuretic peptide (NT-proBNP). The study consists of a 6-month double-blind treatment period with a read out of the primary endpoint LVESVI (left ventricular end systolic volume index) followed by a 6-month open label observation period. Discussion: The HF-REVERT trial currently tests CDR132L in patients with MI and systolic dysfunction. This trial may therefore underpin the concept of miR-132 inhibition to prevent/reverse cardiac remodeling in HF patients. The results will inform the design of a subsequent outcome trial to test the effect of CDR132L in HF patients.