tbuckley/cabot-search huggingface dataset:
Abstract 4141535: Annulo-Leaflet Mitral Ring – A Distinct Form of Valvar Endocardial Fibroelastosis
Authors: Magnus von Piechowski, Daniel Diaz-Gil, Kerstin Saraci, Lavinia Rech, Nora Lang, Gerald Marx, Chrystalle Carreon, Stephen Sanders, Sitaram Emani, Pedro Del Nido, Ingeborg Friehs
Journal: Circulation (2024)

Introduction: Treatment of congenital mitral stenosis (MS) is a major challenge due to high recurrence rate necessitating reintervention. The annulo-leaflet mitral ring (ALMR) is a unique form of congenital MS, defined as fibrous ridge/membrane located above the mitral valve (MV) and/or adherent to leaflets’ atrial surface. The underlying mechanism of ALMR formation and recurrence is unknown. Objective: We sought to determine recurrence of ALMR following primary resection and to establish the cellular mechanism of ALMR formation. Methods: A retrospective single-center cohort study of patients undergoing primary resection of an ALMR between 01/2013 and 12/2023 was conducted. The primary outcome was ALMR recurrence. Mean diastolic MV gradient and type of MV disease were determined by echocardiography. In a subset of patients with available tissue, cellular analysis was performed for endocardial fibroelastosis (EFE). Results: In total, 50 patients (median age 20.5 (IQR 57) months), of which 78% had additional subvalvar MV anomalies, underwent primary ALMR resection, decreasing mean MV gradient from 9.7±4.96mmHg to 4.8±3.46mmHg (p&lt;0.001). At discharge, 2 patients (4%) had residual ALMR, 19 (38%) MS, and 21 (42%) MV regurgitation (MR). At a median follow-up of 45 (IQR 40) months, 21 patients (42%) had MS and 14 (28%) MR, 9 (18%) underwent MV replacement, 2 (4%) experienced late deaths, and 8 (16%) were lost to follow-up. ALMR recurred in 12 patients (32%), all with additional subvalvar anomalies, and 11 (29%) underwent re-resection at a median interval of 21 (IQR 24) months. Cellular mechanism is displayed in Figure 1. Conclusion: Our findings show that ALMR occurs as part of a broader MV-disease complex, resulting in a high recurrence rate. We reveal for the first time that ALMR tissue originates from the endocardium through EndMT and is, hence, a distinct form of EFE. Flow disturbances due to an abnormal subvalvar MV apparatus are the likely driving force behind EFE in ALMR recurrence, which is in support of our previous findings from other complex congenital heart defects. Pharmacologically targeting the EndMT pathway might reduce disease burden for these patients and thus, could be a novel therapeutical approach.
Abstract 4140926: Transcatheter Closure of a Large Left Main Coronary Artery to Superior Vena Cava Fistula Revealed by Symptomatic Tachyarrhythmia
Authors: Sarah Harirforoosh, Raveendra Morchi, Gira Morchi, Theodore Bryan, Pranav Patel, Michael Rochon-Duck, Ali Naqvi, Antonio Frangieh
Journal: Circulation (2024)

Introduction: Coronary artery fistulas are rare congenital anomalies that are usually incidentally discovered on cardiac imaging or coronary angiography. We present an extremely rare case of a large left main coronary artery (LMCA)/left circumflex artery (LCX) fistula to the superior vena cava (SVC) successfully managed by transcatheter closure through coil embolization. Case Presentation: A 63-year-old male competitive bodybuilder, with no prior cardiac history, presented with lightheadedness and wide complex tachyarrhythmia at a heart rate over 240 beats per minute in the field, requiring two defibrillator shocks. His subsequent EKG demonstrated diffuse ST depressions. Coronary angiography revealed a large tortuous coronary fistula from the LMCA/LCX emptying into the SVC. Transthoracic echocardiogram showed a left ventricular (LV) ejection fraction of 56% and lateral LV wall hypokinesis. Cardiac MRI demonstrated an enlarged right ventricle without delayed myocardial enhancement. Given right sided enlargement and concerns for coronary steal, decision was made to intervene. The patient declined sternotomy to preserve his active lifestyle. Thus, a nonsurgical multi-disciplinary approach was planned for fistula closure. Vascular plug placement was attempted through retrograde venous and antegrade coronary wiring but was unsuccessful due to a narrow and fenestrated single fistula ostium opening and long and tortuous fistula length. From the coronary side, stasis was achieved in the fistula through embolization using 12 microcoils. An electrophysiology study was performed, and the patient’s arrhythmia was consistent with ventricular tachycardia. A subcutaneous implantable defibrillator was inserted for secondary prevention. Discussion: This patient’s uniquely late presentation and resulting unstable arrhythmia, cardiac chamber enlargement and ischemia emphasizes the importance of identifying indications for fistula closure. Pre-procedure planning with various imaging modalities and collaboration of multiple specialties allows for productive discussion of both surgical and interventional options. Conclusion: A multidisciplinary heart team is essential in successfully treating complex arteriovenous malformations.
Abstract 4140855: A Novel Tool for Evaluating Endothelial Function: Plethysmographic Flow-mediated Vasodilation (pFMD)
Authors: Shinji Kishimoto, Tatsuya Maruhashi, Masato Kajikawa, Aya Mizobuchi, Takahiro Harada, Takayuki Yamaji, Yukiko Nakano, Farina Mohamad Yusoff, Tomohiko Yada, Tomomasa Itarashiki, Yukihito Higashi
Journal: Circulation (2024)

Background: Measurement of flow-mediated vasodilation (FMD) in the brachial artery by using ultrasound is a well-established technique for evaluating endothelial function. To make the measurement quicker and easier than the measurements of conventional ultrasound FMD (uFMD), we have developed a novel noninvasive method, plethysmographic FMD (pFMD), to assess vascular response to reactive hyperemia in the brachial artery. The aim of this study was to determine the accuracy of measurement of pFMD in comparison to that of measurement of conventional uFMD. Methods and results: This study was a multi-center, cross-sectional study. We compared pFMD by a new device using cuff pressure and volume with conventional uFMD using ultrasound in 50 men (mean age, 41±9 years). pFMD significantly correlated with conventional uFMD (β=0.59, P&lt;0.001). In Bland-Altman plot analysis of pFMD and conventional uFMD, the mean difference of pFMD and conventional uFMD was 0.78%, and limits of agreement (mean difference ±2 standard deviations of the difference) ranged from -4.53% to 6.11%. Conclusions: We demonstrated validity of the new method for measurement of pFMD, which has the capability to automate the assessment of endothelial function in a short period of time. Measurement of pFMD is easier than measurement of conventional uFMD and may have less artificial bias compared to that of conventional uFMD measurement.
Abstract 4140775: Efficacy of Colchicine in Stroke Prevention: A Meta-Analysis of Randomized Controlled Trials
Authors: Hritvik Jain, Jyoti Jain, Ramez Odat, Aman Goyal, Jehad Yasin, Nandan Patel, Ashish Yadav, Janhvi Shah, Jagriti Jha, Siddhant Passey
Journal: Circulation (2024)

Background: Stroke is the leading cause of neurological disability worldwide and contributes substantially to mortality. Colchicine is a microtubule inhibitor that has anti-inflammatory properties. In recent years, colchicine has been investigated as a potential therapeutic agent for reducing the risk of adverse cardiovascular events. Few studies have reported the risks of stroke with colchicine, with controversial results to date. Aim: This meta-analysis aimed to compare the efficacy of colchicine versus placebo for stroke prevention. Methods: We conducted a comprehensive systematic search of the major databases from inception until May 3, 2024, to identify randomized controlled trials (RCTs) comparing colchicine to placebo. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using an inverse-variance random-effects model. Statistical significance was set at p &lt; 0.05. Results: We included 13 RCTs with 13629 patients (6823: Colchicine and 6806: Placebo). The mean age in the Colchicine group was 62.1 ± 9.4 years and in the placebo group was 62.4 ± 9.1 years. Colchicine was associated with a significantly lower risk of stroke [RR: 0.51; 95% CI: -0.32, 0.80; p=0.003] than placebo. However, the risk of all-cause mortality [RR: 1.01; 95% CI: 0.66, 1.54; p=0.97] was similar between the two groups. Conclusion: This study demonstrated the efficacy of colchicine in reducing the risk of stroke. However, colchicine did not reduce the risk of all-cause mortality. Future RCTs are required to investigate this risk reduction on a larger, multicenter scale.
Abstract 4140323: Barriers and Facilitators to Outpatient Cardiac Rehabilitation Attendance Among Patients with Low Socioeconomic Status: A Qualitative Study
Authors: Lena Mathews, Miriam Chiamaka Okonkwo, Tionna Tolefree, Kerry Stewart, Lisa Benz Scott, Lisa Cooper, Chiadi Ndumele, Kunihiro Matsushita, KRISTIN RIEKERT
Journal: Circulation (2024)

Introduction: Individuals with low socioeconomic status (SES) have a higher risk of CVD events yet are less likely to utilize outpatient cardiac rehabilitation (OCR), which is an evidence-based secondary prevention strategy. Understanding barriers and facilitators to the implementation of OCR among individuals with low SES is critical to design targeted interventions to improve attendance. Aims: To identify barriers and facilitators to OCR attendance among individuals with low SES using the Capability, Opportunity, Motivation, and Behavior (COM-B) theoretical model. Methods: We purposefully recruited patients for in-depth interviews who had: a recent CVD event (≤ 3 months); documented referral to OCR; low SES (Medicaid eligible, or in the top quartile of area deprivation index); those who attended ≥ 1 session of OCR and those who did not. Semi-structured interviews were recorded and transcribed verbatim. Codes were identified using a phenomenological approach guided by the COM-B model. Results: Participants (N=26) were 54% women, 58% Black, with mean age of 67.1 (12.7 years). Barriers and facilitators identified fit the COM-B model. Capability themes included knowledge and awareness of OCR. OCR attendees (n=12) recalled discussing OCR, the benefits, and their physicians encouraging participation pre-discharge. Non-attendees (N=14) reported no, or very little knowledge about OCR, or weak recommendations by their physician. Opportunity themes included social support from caregivers/family, peers, and their healthcare team. OCR attendees described a strong support network of caregivers who helped with logistics and motivation to participate, wanting to be with peers, and outreach of the healthcare team after discharge. Non-attendees described lack of social support, logistical barriers, and no outreach. Motivation themes reflected the strong belief in the benefits of CR to improve physical and mental health, quality of life, and prevent future events among attendees. Non-attendees generally lacked a perceived need for OCR particularly if they had returned to baseline after their CVD event. Conclusions: Non-attenders of CR were distinguishable from attendees using the COM-B model, which can be used to guide intervention development. Our findings support a multi-level strategy that includes tailored education, social support, motivational enhancement, implemented by a trained health navigator, to overcome barriers to CR attendance among patients with low SES.
Abstract 4140333: Maximizing the yield of human genetics-based target discovery from circulating proteins for cardiometabolic diseases
Authors: Wenmin Zhang, Satoshi Yoshiji, Robert Sladek, Josee Dupuis, Tianyuan Lu
Journal: Circulation (2024)

Background: Circulating proteins are attractive candidate drug targets for cardiometabolic diseases. Identifying promising circulating proteins that have a causal role in disease pathogenesis is challenging and expensive. Mendelian randomization (MR) has emerged as an important tool for testing potential causal effects while mitigating biases from confounding and reverse causation. MR findings require validation by colocalization analysis to guard against bias due to correlation between genetic variants (linkage disequilibrium, LD). However, existing colocalization methods often fail to validate MR findings because of highly complex LD structures in the genome, rendering a low yield of human genetics-based target discovery. Methods: In this study, we developed a new computational method, called SharePro, to effectively assess colocalization evidence for MR-identified circulating proteins as targets for cardiometabolic diseases. Based on large-scale genome-wide association studies, we performed MR analyses to assess the associations between 1,535 circulating proteins and key cardiometabolic traits, including diastolic blood pressure, systolic blood pressure, serum hemoglobin A1c, serum low-density lipoprotein cholesterol, and serum triglycerides. We then benchmarked SharePro against state-of-the-art colocalization methods, including coloc, coloc+SuSiE, and PWCoCo, and evaluated the power and robustness of these methods in supporting MR findings. We further examined whether colocalization evidence-supported associations implicated known drug targets for cardiometabolic diseases. Results: SharePro demonstrated the highest power and robustness in supporting 160 (79.6%) of the 201 Bonferroni-significant protein-trait associations identified by MR, while existing methods supported up to 46.8% of these associations. Protein-trait associations identified by MR and supported by SharePro were more likely to implicate known drug targets for cardiometabolic diseases (Figure 1). Furthermore, eight protein-trait associations were exclusively supported by SharePro, suggesting novel targets, such as HSF1 and HAVCR2. Conclusions: SharePro most effectively supports promising protein-trait associations identified through MR for cardiometabolic diseases. Combining multiple lines of evidence using different methods may substantially increase the yield of human genetics-based drug target discovery by nearly twofold.
Abstract 4140336: Reclassification of Congenital Heart Disease Severity via Cardiac Magnetic Resonance in a Tertiary Care Center in Latin-America
Authors: Maria Carolina Manzur Barbur, Daniela Torres Gomez, Sergio Amado, Thomas Urbina, Daniela Valderrama, Oscar Perez-Fernandez, Hector M Medina, Claudia Jaimes, Julian Forero, Laura Acosta-Izquierdo, Carlos Guerrero
Journal: Circulation (2024)

Introduction/Background: Cardiovascular magnetic resonance (CMR) has emerged as an invaluable non-invasive modality for accurate diagnosis and treatment in patients with congenital heart disease (CHD). Goals/Aims: Prevalence and reclassification of CHD severity by CMR referred to a tertiary-care center in Latin America (LATAM). Methods/Approach: Single-center retrospective study analyzing our institutional CMR database. The initial CMR requisition and final diagnoses were classified according to the 2018 American Heart Association (AHA) guidelines for CHD to establish a standardized diagnosis. We evaluated the change in severity between the pre-CMR and final CMR diagnoses and its relationship to mortality after reclassification. Descriptive statistics were used to present categorical variables as frequencies and percentages. A Sankey diagram illustrated changes in severity and mortality, and the association between reclassification and mortality using chi-square tests. Results/Data: Of 10,135 CMR performed between January 2016 and December 2023, 6.4% (656) were CHD, which increased over time (6.1% of all CMR referrals in 2016 up to 8.2% in 2023). 65.2% were adults with a mean age of 29.3 years (IQR 14-43), 55.8% female sex. Based on the pre-CMR diagnosis AHA classification, 30% were classified as simple, 43% as moderate, and 12.5% as complex. Reclassification of severity occurred in 33.2% of patients after the final CMR diagnosis, with the final CMR diagnoses reclassified into simple 16.5%, moderate 67.6%, and complex 15.9%. 14.5% of the cohort were initially undiagnosed with CHD and were diagnosed through CMR. Reclassification occurred most frequently in the simple group, with 56.1% reclassified to a more severe form and 7.7% becoming severe. The moderate group had the most significant increase in the severity of the final CMR diagnosis. Despite an observed increase in mortality among patients reclassified to moderate complexity, this did not reach statistical significance (p=0.68). Conclusion(s): Our study demonstrates that CMR is feasible in LATAM for diagnosing and reclassifying severity in CHD patients. Improved diagnostic yield of CMR may aid in properly diagnosing and directing CHD patients' care in our region.
Abstract 4140260: Efficacy and Safety of Radiofrequency-Based Renal Denervation on Resistant Hypertensive Patients: A Systematic Review and Meta-Analysis
Authors: Luis Sobreira, Clara Rocha Dantas, FERNANDO BEZERRA, Vitor Tsuchiya Sano, Artur de Oliveira Macena Lobo, Jorge Cardoso, Francinny Kelly, Francisco Cezar A de Moraes, Fernanda Colombo
Journal: Circulation (2024)

Introduction: New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied. Aim: Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH. Methods: A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes. Results: All the 10 included studies were randomized controlled trials, they involved 1.182 patients, and 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD: -9.5 mmHg; 95% CI: -16.81 to -2.29; P=0.01), office diastolic BP (MD: -5.1 mmHg; 95% CI: -8.42 to -2.80; P&lt;0.001), 24 h systolic BP (MD: -4.8 mmHg; 95% CI: -7.26 to -2.42; P&lt;0.001). For 24 h diastolic BP RDN did not have a significant reduction (MD: -2.3 mmHg; 95% CI: -4.19 to -0.52; P=0.012). The heterogeneity between the studies was high, visible in the funnel and Baujat plots. The OR was non-significant for non-serious adverse events, but also clinically significant for hypertensive crises and strokes for the RDN group. Conclusions: While the pharmacological regimen of 3 or more anti-hypertensive, including a diuretic, still be the first-line option for RH treatment, our results support that radiofrequency-based RDN is superior in reducing global BP and is safe.
Abstract 4140272: Prevalence, Clinical Correlates, and Outcomes of Tricuspid Regurgitation Among Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Khush Kharidia, Fernando Giugni, Victoria Lamberson, Yimin Yang, Brian Claggett, Jeremy Van't Hof, Lynne Wagenknecht, Thomas Mosley, Hicham Skali, Amil Shah
Journal: Circulation (2024)

Introduction: Tricuspid regurgitation (TR) prevalence increases with age and is associated with higher mortality. Limited data exist regarding the prognostic relevance of TR among older adults in the general population. Objective: To estimate the prevalence of TR in late life, identify cardiac structural and functional measures associated with TR severity, and determine the prognostic relevance of TR severity. Methods: In the community-based Atherosclerosis Risk in Communities (ARIC) study, 3,046 participants underwent protocol echocardiography at the 7 th study visit (2018-2019). TR severity was assessed qualitatively as none/trace, mild, moderate, or severe by a board-certified cardiologist. Dyspnea was assessed using the modified Medical Research Council questionnaire and post-Visit 7 mortality was ascertained through the National Death Index. Cross-sectional associations of TR severity with clinical characteristics, echocardiographic measures, and dyspnea were assessed using multivariable linear and logistic regression models. Associations with death were assessed using Cox proportional hazard models adjusted for demographics. Results: Mean age was 81±4 years, 58% were women, 25% reported Black race, and mean LVEF was 63±8%. TR prevalence was 30% mild, 9% moderate, and 1% severe. Greater TR severity was associated with older age, female sex, higher HF prevalence, and loop diuretic use. Greater TR severity was also associated with lower LVEF, worse LV diastolic function (higher LAVi, E/A, E/e’ septal), higher NT-proBNP, higher prevalence of moderate-severe mitral regurgitation, greater pulmonary artery systolic pressure, and larger RV size. Severe TR was associated with higher odds of moderate-severe dyspnea (OR:2.3 [1.2-4.5], p=0.012). During follow-up (median 2.1 years [IQR 1.7-2.5]), 192 participants died. Higher TR severity was associated with greater mortality (Figure). Compared to participants with none/trace TR, even mild TR was associated with a 64% greater mortality risk. Conclusion: TR is common in late life and is associated with greater left heart disease despite generally preserved LVEF. Greater TR severity, even when mild, is a marker of increased mortality. Longer follow-up is needed to determine whether this risk is independent of concomitant left heart dysfunction.