tbuckley/cabot-search huggingface dataset:
Abstract 18473: Role of Linguistic Acculturation and Physical Activity With Risk of 1 Year Hospital Readmission After Suspected Acute Coronary Syndrome
Authors: Emily K Romero, Chang Xu, Gabriel J Sanchez, Margaret E Murdock, Gaspar J Cruz, Ammie Jurado, Andrea T Duran, Benjamin D Boudreaux, Donald E Edmondson, Keith M Diaz
Journal: Circulation (2023)

Background: Disparities in acute coronary syndrome (ACS) outcomes after hospital care exist beyond racial and ethnic factors. In particular, low linguistic acculturation (LA) may impact care and lead to poorer prognosis. Few studies have examined LA’s impact on outcome disparities post-hospitalization and identified modifiable behaviors, such as physical activity (PA) engagement, that can mitigate risk. Aim: To evaluate the association of LA with 1-year hospital readmission risk among patients evaluated for ACS and examine PA as an effect modifier. Methods: Patients evaluated for ACS in the emergency unit (n=609, 47.8% female, 58.0% Hispanic, 63±12yrs) were studied. LA was classified into three levels (low, intermediate, high) based on patient’s self-reported native and preferred languages and English fluency. Continuous total PA was objectively assessed 30 days post-discharge via a GENEActiv accelerometer worn on the non-dominant wrist. One-year all-cause hospital readmissions were ascertained via hospital medical record searches. Cox regression models used high LA as referent group. Results: Over 1-year follow-up, 264 (44.0%) patients had a subsequent hospital admission. Low LA was associated with increased 1-year readmission risk after adjusting for demographic factors, comorbidities, disease severity, and PA indicators (intermediate HR=1.44; 95% CI: 0.91-2.28; low HR=1.63; 95% CI: 1.05-2.55; p-trend=0.035). PA moderated this association (p-interaction=0.003). Low LA was only associated with greater risk of 1-year readmission among those with low PA levels (below median of 158 min/day; HR=1.88; 95% CI: 1.00, 2.79). Among those with high PA, the association between low LA and risk of readmission was attenuated and not statistically significant (HR=1.46; 95% CI: 0.75, 2.83). Conclusion: Among a diverse cohort of patients with suspected ACS, LA was associated with reduced risk of 1-year hospital readmission. PA significantly moderated this relationship, with higher volumes of PA attenuating the positive association between low LA and increased risk of 1-year hospital readmission. These findings implicate low LA as a potential risk factor for readmission post-ACS and suggest increased engagement in PA can help mitigate this risk.
Abstract 14863: Omega-3 Fatty Acids Intake and Oxylipins Production in Response to Short-Term Ambient Air Pollution Exposure in Healthy Adults
Authors: Haiyan Tong, Siqi Zhang, Hao Chen, James Samet
Journal: Circulation (2023)

Rationale: Exposure to air pollution is associated with adverse health effects through systemic inflammation and oxidative stress. One mechanism of beneficial effects of omega-3 polyunsaturated fatty acids (n-3 FA) is mediated via their inflammation resolution process by generating bioactive lipid mediators known as oxylipins. Objective: This study examined the association between n-3 FA-derived bioactive oxylipins and short-term exposure to ambient air pollution in healthy adults. Methods: Fifteen healthy adults were enrolled into either high or low n-3 groups based on n-3 FA intake and the participants underwent 4-5 blood collections for lipidomic profile of 55 oxylipins. Associations between ambient ozone, nitrogen dioxide (NO 2 ), and fine particulate matter (PM 2.5 ) levels and plasma oxylipins were assessed using mixed-effects models stratified by fatty acids levels. Results: Average concentrations of ozone (40.8±11.1 ppb), NO 2 (5.3±3.8 ppb), and PM 2.5 (10.2±4.1 μg/m 3 ) were below national ambient air quality standards during the study period. Compared to the low n-3 group exposed to ozone and PM 2.5 , high n-3 group had significant reduction in arachidonic acids (AA) derived pro-inflammatory oxylipins produced by lipoxygenase (LOX). For instance, 12 HETE was negatively associated with ozone levels [for an IQR increase in ozone, -58.1% (95% CI:-96.8, -19.4) vs. 14.5% (95% CI:-33, 62)] and PM 2.5 concentrations [for an IQR increase in PM 2.5 , -29.6% (95% CI:-49.1, -10.1) vs. 28.5% (95% CI:-3.8, 60.9)] at lag4 in the high n-3 group while the association was null in the low n-3 group. In contrast, high n-3 group exposed to ozone and PM 2.5 had significant increases in EPA and DHA derived pro-resolving oxylipins produced by LOX and cytochrome p450 (CYP) and soluble epoxide hydrolase (sEH) compared to the low n-3 group. Conclusions: We observed negative associations between short-term ambient air pollutants and pro-inflammatory oxylipins in the high n-3 groups, while the associations between short-term ambient air pollutants and pro-resolving oxylipins were positive in the high n-3 groups, suggesting that n-3 derived lipid mediators may mediate the inflammation resolution process in response to low levels of ambient air pollution in healthy adults.
Abstract 13292: Vacuum Cleaning a Four-Chamber House: A Case of Using Percutaneous Aspiration Thrombectomy for an Infected Right Heart Clot
Authors: Phuong Uyen Vo, Mark Rea, Charles Matriano-Lim
Journal: Circulation (2023)

Introduction: Infected SVC thrombi are rare serious complications of indwelling catheters and usually require cardiothoracic surgery. However, there is limited literature regarding the use of aspiration thrombectomy in treating endocarditis. Description of Case: A 40 year-old male with end-stage renal on hemodialysis through left internal jugular (IJ) tunneled dialysis catheter (TDC), due to failed AV fistula attempt, and recent parietotemporal-intraparenchymal hemorrhage s/p craniotomy presented with altered mental status and subjective fever. Labs showed leukocytosis with bandemia, elevated procalcitonin, and metabolic acidosis. Mental status change was primarily attributed to acute metabolic encephalopathy. Patient was started on broad antibiotics before found in sepsis from MRSA bacteremia, which likely came from his TDC and required vancomycin monotherapy. Transthoracic echocardiogram found a pedunculated mass along the atrial septum. TDC was removed for source control with tip’s culture growing MRSA. Transesophageal echocardiogram (TEE) confirmed a right atrial-SVC junction thrombus. Heparin infusion was started. A temporary femoral central line was placed for dialysis. Patient underwent a TEE-guided percutaneous aspiration thrombectomy with the Inari FlowTriever® catheter that significantly debulked the thrombus, which culture also grew MRSA. Patient clinically defervesced and downtrended leukocytosis but blood cultures sterilized after antibiotics were escalated to daptomycin and ceftaroline. A new right IJ TDC was safely placed. He was discharged on six-week daptomycin and remained infection-free upon follow up. Discussion: FlowTriever® catheter effectively aspirated the infected right heart clot for source control, expediting the bacteremia resolution - an imperative criterion for new TDC reinsertion. The technology is promising for inoperable patients as adjunct therapy to antibiotics when treating endocarditis.
Abstract 13553: Traumatic Right Atrium Perforation Causing Pneumopericardium and Pneumothorax, Treated Conservatively
Authors: Diva Maraj, Hussein Othman
Journal: Circulation (2023)

Background: Pneumopericardium after pacemaker implantation is an extremely rare complication. Patients can present with symptoms such as chest pain, shortness of breath, or be completely asymptomatic. We present a case of a 68-year-old male who underwent dual chamber pacemaker implantation complicated by a pneumopericardium and contralateral pneumothorax. Case Report: A 68-year-old male with a past medical history of coronary artery disease status post percutaneous coronary intervention to the obtuse marginal artery and left circumflex, hypertension and benign prostatic hyperplasia presented with syncope while driving. Telemetry showed symptomatic long pauses up to 6.2 seconds and a dual chamber pacemaker implantation was recommended via the left subclavian vein approach. It was noted that the patient had multiple attempts to place the right atrium lead. Two days after the procedure, the patient developed severe right-sided chest pain and an electrocardiogram showed diffuse ST segment elevations consistent with pericarditis. A chest computed tomography (CT) showed a large right-sided pneumothorax and pneumopericardium and a chest tube was placed. The pacemaker was interrogated and showed a stable function and the patient was managed conservatively. A repeat CT chest showed significant improvement in both the pneumopericardium and the pneumothorax and the patient did well on follow up. Discussion: Ipsilateral pneumothorax and cardiac perforation are not uncommon following pacemaker implantation; however, contralateral pneumothorax and pneumopericardium are extremely rare. In our patient, it appears that the right atrium lead perforated through the right atrium into the right pleural space creating a fistula between the pericardial and pleural spaces. This was not detected on the initial chest x-ray and was only seen on subsequent CT chest imaging. Treatment of pneumopericardium usually involves lead revision or extraction; however, conservative therapy can be successfully attempted with close monitoring, as in our case.
Abstract 15689: Ablation for Atrial Fibrillation in Patients With Rare Pathogenic Variants in Cardiomyopathy and Arrhythmia Genes
Authors: Majd A El-Harasis, Zachary Yoneda, Katherine Anderson, Fei Ye, Joseph Quintana, Jose R Martinez-Parachini, Gregory Jackson, Bibin Varghese, Diane Crawford, Lili Sun, Hollie L Williams, Matthew O'Neill, Giovanni E Davogustto, James L Laws, Brittany Murphy, Kelsey Tomasek, Yan Ru Su, Emily Solem, Emma Metz, Carly Smith, Douglas Stubbs, Dakota Grauherr, Quinn Wells, Gregory Michaud, pablo saavedra, Juan C Estrada, Travis Richardson, Sharon Shen, Arvindh Kanagasundram, Jay A Montgomery, Harikrishna Tandri, Christopher R Ellis, George H Crossley, Prince Kannankeril, Lynne W Stevenson, William G Stevenson, Steven A Lubitz, Patrick T Ellinor, Dan M Roden, Ben B Shoemaker
Journal: Circulation (2023)

Introduction: Patients with rare, pathogenic cardiomyopathy (CM) and arrhythmia variants can present with atrial fibrillation (AF), with or without overt ventricular involvement. The efficacy of AF ablation in these patients is unknown. Research Questions/Hypothesis: To test the hypotheses that: 1) patients with a pathogenic variant in any CM or arrhythmia gene have a higher risk of recurrence following AF ablation, and 2) patients with a pathogenic variant associated with a specific gene group (arrhythmogenic left ventricular CM [ALVC], arrhythmogenic right ventricular CM [ARVC], dilated CM [DCM], hypertrophic CM [HCM], or a channelopathy) have a higher risk of recurrence. Methods: We performed a prospective observational cohort study in participants referred for AF catheter ablation who underwent whole exome sequencing. Our primary outcome was AF recurrence, defined as &gt;30 seconds of AF, atrial flutter, or atrial tachycardia that occurred at least 90 days after AF ablation. Results: Among 1,366 participants, 109 (8.0%) had a pathogenic or likely-pathogenic (P/LP) variant in a CM or arrhythmia gene. In multivariable analysis, presence of a P/LP variant in any gene was not significantly associated with recurrence (HR 1.15 (0.84-1.60), p=0.53, Figure 1A ). When analyzed according to gene group, P/LP variants in the ALVC gene group, predominantly LMNA , were associated with increased recurrence (N=10; HR 3.75 (1.84-7.63), p&lt;0.001), compared to those in the ARVC gene group (N=6; HR 1.97 (0.62-6.27), p=0.25), DCM gene group (N=50; HR 0.98 (0.59-1.63), p=0.94), HCM gene group (N=33; HR 1.28 (0.76-2.17), p=0.35), and channelopathy gene group (N=17; HR 0.58 (0.21-1.56), p=0.28), as shown in Figure 1B, 1C . Conclusions: Our results support the continued use of AF ablation for most patients with rare pathogenic CM or arrhythmia variants, including TTN . However, patients with ALVC variants, such as in LMNA , may be at a significantly higher risk for arrhythmia recurrence.
Abstract 17322: Closing the Loop: Use of Amplatzer PFO Occluder Device in Case of LVAD-Associated Aortic Insufficiency
Authors: Omkar Betageri, Persey Bediako, Maxwell E Afari, Walter DeNino, Atman Shah, J R Estrada
Journal: Circulation (2023)

Description of Case: A 72-year-old woman with destination therapy Heartmate 3 left ventricular assist device (LVAD) presented with NYHA Class III symptoms. Review of her echocardiograms since LVAD implantation revealed progressive central aortic insufficiency (AI) with subsequent LV dilatation, managed with reduction in LVAD speed. Patient declined surgical aortic valve replacement and/or repair. After a multidisciplinary discussion, the patient opted to pursue percutaneous aortic valve closure. Cardiac CT demonstrated no aortic valve thrombus and identified appropriate anatomy for closure with an 18x25 mm Amplatzer PFO Occluder device (Graphic 1). Preoperative TEE revealed LV ejection fraction of 15% with moderate to severe AI and fibrosis of the aortic valve commissures with no aortic valve movement. The aortic valve was closed with the Amplatzer PFO Occluder with an 18mm disk that sat on the LV side of the aortic valve within the AV annulus and the 25mm disk sitting on the aortic side of the aortic valve within the sinus of Valsalva. TEE and intracardiac echocardiography demonstrated excellent device placement with two residual trace AI jets at the non-left and left-right commissure. Following LVAD speed increase, the degree of AI remained unchanged and she was discharged with improved symptoms. Discussion: Moderate-severe AI develops in about 15-25% of patients within 1 year of LVAD implantation. There are previous reports of LVAD-associated AI closure with an Amplatzer cribiform device. We describe the first known use of the Amplatzer PFO Occluder device for the management of LVAD-associated AI. While transcatheter aortic valve replacement (TAVR) is an attractive option to treat LVAD-associated AI, securing the transcatheter heart valve in the absence of calcifications remains a challenge.
Abstract 17467: Carvedilol Outperforms Metoprolol in Preventing Postoperative Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Mohamed R Abouzid, Samar Eldahtoury, Shereen Naccour, Junaid Anwar, Shorouk Elshafei, Ankit Vyas, Chima Nwaukwa
Journal: Circulation (2023)

Introduction: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. Current guidelines suggest beta-blockers for the prevention of POAF. Carvedilol is a nonselective beta-blocker with anti-inflammatory, antioxidant, and various cationic channel-blocking effects. This meta-analysis aims to compare the efficacy of carvedilol versus metoprolol in the prevention of POAF. Methods: We considered randomized controlled studies (RCTs) and retrospective studies that demonstrated the efficacy of carvedilol versus metoprolol in the prevention of POAF. Pooled data were analyzed using either the fixed-effect or random-effect model in Review Manager 5.3. The incidence of POAF was the primary endpoint, while mortality rate and bradycardia were secondary outcomes. Results: A total of five RCTs and two retrospective studies (1000 patients) were included in this meta-analysis. The overall effect did not favor either of the two groups in terms of mortality rate [Risk ratio 0.45, 95 % CI (0.1-1.97), P=0.29] as well as incidence of bradycardia [Risk ratio 0.63, 95 % CI (0.32-1.23), P=0.17]. However, the incidence of POAF was lower in patients who received carvedilol compared to metoprolol [Risk ratio 0.54, 95 % CI (0.42-0.71), P &lt; 0.00001]. Conclusion: In patients undergoing cardiac surgery, carvedilol has been shown to successfully minimize the occurrence of POAF. It appeared to be more effective than metoprolol. To definitively establish the efficacy of carvedilol compared to metoprolol and other beta-blockers in the prevention of POAF, large-scale, well-designed randomized controlled trials are required.
Abstract 17177: Safety and Efficacy of Direct Oral Anticoagulants in Comparison to Warfarin in Obese Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Alla Adelkhanova, Prakash Raj Oli, Vivek Jha, Dhan B Shrestha, Jurgen Shtembari, Ghanshyam Shantha
Journal: Circulation (2023)

Introduction: Obesity affects nearly 650 million adults worldwide and the prevalence of obesity has been steadily increasing. Obesity has adverse effects on cardiovascular health, increasing the risk for developing hypertension, coronary artery disease, heart failure and atrial fibrillation (AF). It is well known that anticoagulation is warranted in patients with AF, however the safety and efficacy of direct oral anti-coagulant (DOAC) over vitamin K antagonist (VKA) are not well explored in the obese population. This meta-analysis aimed to compare DOAC to VKA in obese populations with AF. Methods: The PRISMA guidelines were followed for this meta-analysis, and it was registered in PROSPERO (CRD42023392711). PubMed, Medline, Embase, Cochrane Library and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened title and abstract, followed by full text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as effect measure. Results: 2259 studies were identified from the database search and 19 studies were included in the analysis. There were significantly lesser odds of ischemic (OR 0.71, 95% CI 0.66-0.75) and hemorrhagic stroke (OR 0.47, 95% CI 0.35-0.62) in the DOAC group compared to VKA group. There were also lower odds for occurrence of systemic embolism (OR 0.67, 95% CI 0.54-0.83) and major bleeding (OR 0.62, 95% CI 0.54-0.72) in the DOAC group. Conclusions: Based on this meta-analysis it can be concluded that DOACs are safer and more efficacious than vitamin K antagonists in the obese population with AF.
Abstract 18721: Increased Predisposition to Hypertrophic Cardiomyopathy in Mitochondria Gene <i>CYP2E1</i> Rare Variant Carriers
Authors: Qiya Huang, Channa Zhang, Minjie Lu, Xiaochen Bo, Jizheng Wang, lei song
Journal: Circulation (2023)

Introduction: With a prevalence of up to 1 in 200, hypertrophic cardiomyopathy (HCM) is the most common monogenic hereditary cardiovascular disease. Previous studies have observed that mitochondrial dysfunction and mitochondria-associated metabolic remodeling are major metabolic features in HCM. However, the impact of mitochondrial gene mutations on HCM were poorly understood. Methods and Results: We selected 2272 mitochondrial genes from the Mitocarta database 3.0 and screened rare variants from the whole-exome sequencing data in 985 HCM patients (excluding patients with HCM phenotypes, including mitochondrial myopathy) and 759 non-HCM controls. We found that CYP2E1 rare variants were significantly enriched in HCM patients (OR = 9.56, Bonferroni corrected P = 0.001). Patients with or without CYP2E1 rare variants shared similar demographic and echocardiographic variables at baseline. With a median follow-up time of 5.31 years in 735 HCM patients, we revealed that HCM patients with CYP2E1 rare variants were more likely to experience myocardial infarction (HR 14.1, P &lt; 0.001). Conclusion: We demonstrated that rare variants in the mitochondrial gene CYP2E1 might increase the risk of HCM onset and may be associated with the occurrence of myocardial infarction endpoints in HCM. We hypothesize that the mechanism is related to the extensive and complex mitochondrial metabolic processes in which CYP2E1 is involved. Our findings provided new evidence for the association between mitochondrial gene variants and HCM, and more multi-center evidence is needed to confirm this association in the future.
Abstract 17100: Evaluating Chatgpt Responses on Atrial Fibrillation for Patient Education
Authors: Thomas J Lee, Daniel J Campbell, Omar Elkattawy, Rohan Viswanathan
Journal: Circulation (2023)

Introduction: ChatGPT is an artificial intelligence (AI) chatbot released in November 2022. It is a large scale language model that has gained widespread popularity for its fine-tuned conversational abilities, attracting over 1.8 billion monthly visitors. A noted drawback to the AI chatbot is its tendency to confidently present users with inaccurate information. Goals: To evaluate the quality of ChatGPT responses to questions pertaining to atrial fibrillation for patient education. This includes the accuracy of answers, estimated grade level, and references of answers. Methods: ChatGPT was prompted four times then was asked 16 questions derived from the American Heart Association's frequently asked questions on atrial fibrillation. Prompts included: no prompt (Form 1), patient-friendly prompt (Form 2), physician-level prompt (Form 3), and prompting for statistics/references (Form 4). Responses were scored as incorrect, partially correct, correct, or correct with references (perfect). Flesch-Kincaid grade level and response lengths were recorded. Proportions of responses at differing scores were compared using chi-squared analysis. The relationship between form and grade level was assessed using ANOVA. Results: Across all forms scoring frequencies were: 1(1.6%) incorrect, 5 (7.8%) partially correct, 55 (85.9%) correct, and 3 (4.7%) perfect. Proportions of responses that were at least correct did not differ by form (p=0.350); responses that were perfect did (p&lt;0.001). Form 2 answers had a lower mean grade level (12.81 ± 3.38) than Forms 1 (14.23 ± 2.34), 3 (16.73 ± 2.65), and 4 (14.85 ± 2.76) (p&lt;0.01). Conclusions: ChatGPT provides accurate and comprehensive answers to most questions about atrial fibrillation regardless of prompting. Interestingly, when prompted as a patient, ChatGPT will provide lower grade level responses. Given ChatGPTs rapid popularity and usage, cardiologists may seek to further investigate its accuracy and utility for patients.