tbuckley/cabot-search huggingface dataset:
Abstract 13269: Clinical and Electrophysiological Features of New Onset Ventricular Arrythmias Following Catheter Ablation of Atrial Fibrillation
Authors: Adnan Ahmed, Danish Bawa, Rangarao V Tummala, Douglas J Darden, Scott Koerber, Rajesh Kabra, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Naga Venkata Pothineni
Journal: Circulation (2023)

Introduction: Data on new onset ventricular arrhythmias (VAs) following catheter ablation of atrial fibrillation (AF) is sparse. Hypothesis: We aimed to assess the incidence of new onset VA post AF RFA. Methods: We conducted a retrospective study of all patients at our institution that underwent AF ablation who also developed symptomatic high burden premature ventricular complexes (PVCs) requiring catheter ablation within 1 year of the index AF ablation procedure. All patients underwent post AF ablation monitoring with either 48 hr Holter monitors or implantable cardiac monitors. New onset VA was defined as symptomatic new onset PVC with &gt;5% burden. Data on PVC morphology and successful ablation sites was analyzed. Results: Out of 175 patients that underwent AF ablation during the study period, 2.8 % (n=5) patients developed new onset high burden PVCs requiring catheter ablation therapy within 1 year of AF ablation. Mean age was 68.6 + 11 years and all patients were male. Mean baseline LVEF was 56 + 9.6% and mean PVC burden was 10.3 + 8.8 %. A total of 9 PVCs were mapped in 5 patients. The number of VA morphology was 1 in 2 (40%) patients, 2 in 2 (40%) and 3 in 1 (20%) patient. Site of origin for the PVCs was in the left ventricle in all patients, with majority (55%) localizing to the LV outflow tract and summit region (table). Average time from AF RFA to PVC ablation was 4 + 2.9 months. PVC ablation was successful in all patients except one where ablation was deferred due to proximity to the conduction system. Conclusions: New onset VAs following catheter ablation of AF tend to localize to the LV outflow tract and areas of bipolar voltage abnormality. Potential mechanisms of new onset PVCs could include altered sympathetic tone due to ablation of cardiac ganglia, unmasking of PVCs due to regularization of ventricular rate and withdrawal of anti-arrhythmic medications. Further prospective studies are needed to understand true incidence of new onset VAs following AF ablation.
Abstract 13302: Associations of Allostatic Load With Brain Macro-Morphology, Subclinical Cerebrovascular Disease, and Microstructural Integrity of White Matter Pathways: The Boston Puerto Rican Health Study
Authors: Fan Chen, Bang-Bon Koo, Tammy Scott, Yi Guan, Sherman Bigornia, Rafeeque Bhadelia, Katherine L Tucker
Journal: Circulation (2023)

Introduction: Allostatic load (AL), a measure of overall body wear and tear, has been associated with structural and functional alterations of the brain, but the evidence remains scarce. We aimed to evaluate the prospective associations of AL with brain MRI measures in the Boston Puerto Rican Health Study (BPRHS). Research Questions: Whether AL is associated with 1) brain macro-morphology: brain age and volumes, 2) subclinical cerebrovascular disease: white matter hyperintensity (WMH) and brain infarcts, and 3) microstructural integrity of white matter (WM) pathways in Puerto Rican adults. Methods: Adults from the BPRHS cohort who provided blood and urine samples at baseline, 2-y, and 6-y visits and underwent MRI scans at 13-y visit were included in analyses (n=226). AL was evaluated as a composite score (0-11) of 11 physiological parameters in five body systems. An overall AL score was calculated by averaging the scores of the baseline, 2-y, and 6-y visits, with higher scores indicating greater dysregulation. We evaluated brain age and volumes using T1-weighted MRI, WMH and brain infarcts using T2-weighted MRI, and microstructural integrity of WM pathways using diffusion tensor imaging. Multivariable logistic regression models were used to examine the associations between AL and brain infarcts, and linear regression models were used for other MRI outcomes. Results: Mean age at baseline was 54.6 ± 6.6 y, with 79.2% female. Higher AL was associated with higher brain age z scores (β = 0.129, P = 0.031) and lower volumes of total WM, cerebral WM (especially parietal and temporal lobes), cerebellum, and brain stem. Higher AL was also associated with higher grades of WMH (β = 0.207, P = 0.024) and higher odds of small vessel infarcts [OR (95% CI) = 3.50 (1.56-7.87), P = 0.002], but not large vessel infarcts [OR (95% CI) = 1.33 (0.73-2.40), P = 0.348]. Diffusion tensor imaging parameters showed that participants with higher AL had more microstructural deterioration patterns in major WM pathways. Conclusions: Higher AL score was associated with brain macro- and microstructural disruptions and a higher risk of subclinical cerebrovascular disease, suggesting that AL may be a potential indicator of the need for early intervention in preventing neuronal damage in older adults.
Abstract 267: Neighborhood Socioeconomic Status Influences Rates of Pre-EMS Cardiac Arrest Resuscitation
Authors: Aditya C Shekhar, N. Clay Mann
Journal: Circulation (2023)

Introduction: Out-of-hospital cardiac arrest is a leading cause of both morbidity and mortality in the United States and globally. After cardiac arrest onset, emergency medical services (EMS) might not arrive before irreversible injury takes place. Thus, pre-EMS resuscitation - including CPR and automated external defibrillator (AED) use - is associated with improvements in outcomes. We sought to determine if rates of pre-EMS CPR and pre-EMS AED use vary across neighborhood socioeconomic status using a database of EMS activations throughout the United States. Methods: The National Emergency Medical Services Information System (NEMSIS) is a large and nationally-representative database of EMS activations populated from more than ten-thousand EMS agencies throughout the US. We examined cardiac arrests in adult patients (18+ years of age) between January 2017 and December 2019 where EMS providers documented the ZIP code of the arrest, whether CPR prior to EMS arrival was provided, and whether an AED was applied prior to EMS arrival. The ZIP code of the arrest was used to group arrests based on socioeconomic status data from the US Census Bureau. Rates of pre-EMS CPR and pre-EMS AED use were then compared, and ZIP codes with under 5% of residents below the poverty line served as benchmarks. Results: 366,280 cardiac arrests met inclusion criteria. Both Pre-EMS CPR and pre-EMS AED use were highest in ZIP Codes where less than 5% of the population is below the poverty line (p&lt; .00001). Furthermore, a consistent decrease in rates of pre-EMS interventions was seen as the percent of individuals below the poverty line increased (Figure 1). Conclusion: We found a strong relationship between neighborhood socioeconomic status and pre-EMS cardiac arrest interventions. One explanation may be access to CPR training. Further studies should continue to interrogate cardiac arrest disparities that have already been reported and seek to identify new unreported disparities as well.
Abstract 17674: Serum Brain-Derived Neurotropic Factor Levels Predict the Recurrences of Atrial Fibrillation Following Catheter Ablation
Authors: Minoru Nodera, Shota Kakehashi, Moe Mukai, Daisetsu Aoyama, Kanae Hasegawa, Hiroyasu Uzui, Hiroshi Tada
Journal: Circulation (2023)

Background: Brain-derived neurotropic factor (BDNF) is a growth factor with roles within the nervous system and cardiovascular system. It has been reported that serum BDNF is decreased in diseases related to persistent stress, such as chronic inflammation. Atrial fibrillation (AF) is also considered to be one of the diseases related to chronic inflammation, although the relationship between serum BDNF and AF remains unclear. Methods: This prospective study included 68 consecutive patients (44 men; 69 [58-69] years) who underwent first session of paroxysmal AF ablation. Before and 3 months after the ablation, blood samples were obtained to measure the several biomarkers that are known to be related to AF in addition to serum BDNF. AF recurrence was defined as the appearance of AF after 3 month blanking period following the ablation. Results: The serum BDNF levels before ablation were significantly increased after AF ablation (3.5 [1.6-16.6] ng/ml vs. 22.1 [16.2-27.4] ng/ml, p&lt;0.001). During follow-up period of 10±2 months, AF recurrence occurred in 5 (7%) patients. The serum BDNF at 3 months post-ablation were significantly lower in patients with recurrent AF than in those without (19.6 [13.8-20.8] ng/ml vs. 22.0 [17.5-27.1] ng/ml, p=0.019). Furthermore, the serum BDNF at 3 months post-ablation was an independent predictor of AF recurrence (odds ratio 0.912, 95% confidence interval 0.835-0.996, p=0.040). According to the ROC curve analysis, the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml was associated with AF recurrence with 100% sensitivity and 54% specificity (area under the curve=0.817, p=0.019). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in the group L (the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml) than the group H at 3 months post-ablation &gt;22.0 ng/ml) (p = 0.02) [figure 1]. Conclusions: Lower serum BDNF levels at 3 months after blanking period following the AF ablation might be a predictor of AF recurrence.
Abstract 14765: Long-Term Outcomes of Second-Generation Drug-Eluting Stents versus Coronary Artery Bypass Graft: A Sistematic Review and Meta-Analysis
Authors: Andre Carvalho Ferreira, Almir Lacalle, Gabriel Prado Saad, Ana Lima, Maria E Benitez Gonzalez, Camila Guida
Journal: Circulation (2023)

Introduction: Long-term data is limited on the comparative outcomes of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) versus coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD). Hypothesis: Our aim was to conduct a systematic review and meta-analysis comparing mortality and cardiovascular outcomes in patients with left main or multivessel CAD who underwent PCI with an S-DES versus CABG with a minimum mean follow-up period of 3 years. Methods: We searched PubMed, Embase, and Cochrane for studies that examined our clinical question. Three reviewers independently performed study selection and data extraction. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. The data from observational studies were extracted and pooled as multivariable-adjusted HR or propensity score matching to minimize confounding. Results: We included 10 studies, 2 of which were randomized controlled trials (RCT), with a total of 25,866 patients, of whom 11,482 (44.3%) underwent PCI. The mean follow-up ranged from 3.0 to 11.8 years. S-DES had a significantly higher risk than CABG for all-cause mortality (HR 1.36; 95% CI 1.10-1.68; p=0.005) and myocardial infarction (MI) (HR 1.89; 95% CI 1.12-3.18; p=0.02). No significant difference between the groups was found for major cardiovascular events (HR 1.10; 95% CI 0.98-1.23; p=0.11) and stroke (HR 0.83; CI: 0.60-1.15; p=0.27). In a subgroup analysis of RCTs, there was no significant difference between patients who underwent S-DES or CABG. Conclusion: In this meta-analysis of RCTs and multivariable or propensity-matched observational studies, our findings suggest that PCI with S-DES is associated with an increased risk of mortality and MI events compared with CABG in patients with left main or multivessel CAD.
Abstract 11932: Discharge Dichotomy: Lack of Appropriate Discharge Follow Up in ST-segment Elevation Myocardial Infarction With Non-Obstructive Coronary Arteries (STE-MINOCA) Patients
Authors: Shreya Makkapati, Morgan Venuti, Anika Ross, Oby Ibe, Daohai Yu, XIAONING LU, Sabrina Islam, Michael Gannon
Journal: Circulation (2023)

Introduction: Readmission after acute myocardial Infarction is a challenge in health care. Guidelines recommend early follow-up as those who do not have established follow-up are 10 times more likely to be re-hospitalized. This allows for close review of cardiac symptoms and medications. While there is substantive data about early follow up in the obstructive ST-Segment Elevation Myocardial Infarction (STE-Obstructive) populations improving readmission rates, there are minimal guidelines regarding follow up for STE-MINOCA patients. Hypothesis: Does time to post-discharge outpatient care impact rate of readmission between STE-Obstructive and STE-MINOCA patients? Methods: A single center, retrospective cohort study analyzed demographics and discharge pathways of patients meeting STEMI criteria who underwent coronary angiography. Discharge medications, follow up appointment, and readmissions were examined. Simple and multiple logistic regression analyses were used to explore the association between discharge pathways and clinical factors in two STEMI populations. Results: 377 of 433 patients survived discharge with a median age of 59. Of those who survived, 63.9% were male, 44.3% Black, 30.2% Hispanic, and 82.7% had government-issued insurance. STE-Obstructive patients had significantly higher rates of follow up (p=0.0006) and earlier than STE-MINOCA patients (p=0.052) (Table 1). Despite differences in follow up, readmissions for cardiovascular issues were not significantly different between the STE-MINOCA and STE-Obstructive patients. Of note 64% of STE-MINOCA patients who were readmitted did not have follow up prior to readmission. Conclusions: STE-MINOCA patients had longer time to follow up and less follow up than STE-Obstructive patients. Readmission rates between the two groups were similar. Further studies are required to explore the role of earlier follow up in STE-MINOCA clinical trajectory.
Abstract 15834: The Utility of Intra-Operative Coronary Doppler Profiles in Predicting Early and Late Major Adverse Cardiovascular Events After Arterial Switch Operation
Authors: Alison J Howell, Lynne E Nield, Sachiko J Kadowaki, Oishika Tarafdar, Luc L Mertens, Chun-Po Fan, Osami Honjo
Journal: Circulation (2023)

Introduction: Coronary artery transfer is the most important technical point in the arterial switch operation (ASO). Intra-operative echocardiography identifies aberrancies in coronary artery Doppler profiles guiding immediate surgical management. Objective: We sought to determine whether abnormal intra-operative coronary artery Doppler profiles are associated with major adverse cardiovascular events (MACE; death, transplantation, heart failure, arrhythmia, need for coronary re-intervention) following ASO at 30-days, 5 &amp; 10 years. Methods: Single centre retrospective review of patients undergoing ASO between 2009 - 2022. Transesophageal or epicardial intra-operative coronary artery Doppler profiles were analysed. Patient variables were abstracted from records. Freedom from MACE was estimated using Kaplan-Meier methods. Results: 347 patients were included. Coronary anatomy was usual (1LCx2R) in 237 (68%), single sinus ostia in 24 (7%), intramural in 14 (4 %). Overall 30-day MACE was 11.2% [8.3%, 15.1%], increasing to 25% [12.1, 47.4%] with single sinus ostia &amp; 35.7% [16.7%, 65.7%] with intramural. Overall 5 &amp; 10-year MACE was 16.5% [12.9, 20.9%], 33.8% [18.5%, 56.4%] with single sinus ostia &amp; 50.0% [27.8%, 77.1%] with intramural. A higher probability of MACE was seen with coronary Doppler reverse flow, absence of normal pattern (Table 1) and a higher peak velocity (Figure 1). Overall 30-day mortality was 1.2% [95%CI 0.4%, 3.0%] and at 5 &amp; 10 years was 6.5% [4.3%, 9.8%]. Conclusions: Intra-operative abnormal coronary artery Doppler profiles during ASO may identify those at highest risk of early and late adverse events, guiding follow-up surveillance strategies.
Abstract 19057: Temporal Changes in Patient Predicted Survival With Heart Failure and Predictive Characteristics
Authors: Supriya Shore, Blair Richards, Brahmajee K Nallamothu, Keith D Aaronson, Thomas Cascino
Journal: Circulation (2023)

Background: Accurate understanding of life-expectancy is critical to shared decision making for heart failure (HF) patients. HF patients largely over-estimate their life expectancy compared to model predicted estimates in cross-sectional studies. This study evaluates if patient understanding of prognosis associated with HF changes over time. Methods: We analyzed 298 ambulatory patients with high-risk HF from the prospective, multicenter, REVIVAL registry. Patients were asked to predict their survival in the absence of advanced HF therapies at baseline enrollment and follow-up visits at 6-month intervals. Changes in patient predicted survival from baseline to follow-up were assessed using a repeated measures regression analysis, adjusted for baseline predicted survival, time and patient characteristics. Results: Included patients had a median (IQI) age of 62 (65-78) years, 224 (75%) were male and had a median (IQI) number of 4 (2-5) assessments of patient predicted survival. At baseline enrollment, 38% patients overestimated their survival by 30% or more than the Seattle Heart Failure model. With time, on an average, patient predicted survival did not change (Figure 1a). Black race and higher baseline INTERMACS score (suggesting less severe disease) correlated with an increase in patient predicted survival over time. Whereas a higher baseline patient predicted survival correlated with a decrease in predicted survival over time (Figure 1b). Conclusions: In a cohort of high-risk HF patients, patient predicted survival was greater than model predicated and did not change with time. These findings suggest continued poor understanding of disease prognosis that could impact decision-making for therapies and highlight the need to develop strategies to improve prognosis communication with HF patients.
Abstract 17621: Acute Coronary Syndrome Due to Septic Emboli From Infective Endocarditis
Authors: Raviteja Alla, Jonathan Lopez, Mudit Dutta, Neil Patel, YASMEEN TAHA
Journal: Circulation (2023)

Case Description: A 34-year-old female with a history of IV drug use and valvular infective endocarditis requiring multiple valve replacements presented with weakness and abdominal pain. She was found to be in septic shock requiring vasopressors and antibiotics. EKG was initially without ischemic changes. Imaging revealed multiorgan infarction including the spleen, left kidney, and parietal and temporal lobes of the brain with concomitant subarachnoid hemorrhage. TTE showed multiple masses on the mitral valve and new stenosis of the recently replaced tricuspid valve, concerning for multi-valvular involvement. LV systolic function was normal. Blood cultures were positive for MRSA and Strep agalactiae. Severe troponin elevation along with diffuse ST elevations in V3-6 prompted cardiology consultation, however intervention was deemed inappropriate due to presence of subarachnoid hemorrhage, thrombocytopenia and multiorgan failure. The patient was soon transitioned to comfort care after a discussion with family. Discussion: Acute coronary syndrome (ACS) secondary to infective endocarditis is a rarely cited phenomenon. Standardized management and treatment for ACS is difficult in the setting of co-existing multiorgan failure. In this case, our patient with infective endocarditis subsequently developed ACS secondary to septic emboli from large perivalvular vegetations. We emphasize vigilance for acute coronary events during infective endocarditis without source control.
Abstract 15107: Dramatic Impact of a Liaison-Mediated Referral Strategy on Cardiac Rehabilitation Participation After Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Authors: Alexandra I Mansour, Milan Seth, Mike P Thompson, Mary Casey, Steven J Keteyian, Frank Smith, Hitinder S Gurm, Devraj Sukul
Journal: Circulation (2023)

Background: While cardiac rehabilitation (CR) improves outcomes after percutaneous coronary intervention (PCI) it remains underutilized. A liaison-mediated referral, where a healthcare professional explains CR’s benefits and places a referral before discharge, may promote CR use. Hypothesis: We hypothesize a liaison-mediated CR referral is associated with greater CR participation after PCI. Methods: This was a retrospective cohort study of patients who underwent PCI across 48 hospitals in Michigan between January 2021 and April 2022 and were referred to CR before discharge. Clinical registry data was linked to Medicare and commercial claims to identify the primary outcome of CR participation, defined as attending ≥1 CR session within 90 days of discharge from the index PCI admission. Bayesian hierarchical logistic regression modeling was used to compare CR participation between patients with and without a liaison referral, adjusting for patient characteristics. Cox-proportional hazard modeling was used to compare days elapsed between discharge and first CR session between liaison cohorts. Results: Among 9,023 patients referred to CR after PCI, 4,323 (47.9%) underwent a liaison referral and 3,390 (37.6%) attended ≥1 CR session within 90 days of discharge. The liaison and non-liaison cohorts had a mean age of 69.3 vs 69.4 years, and 68.3% vs 68.4% were male, respectively. The liaison cohort had a higher unadjusted 90-day CR participation rate compared with the non-liaison cohort (Figure). After adjustment, the liaison cohort had a significantly higher odds of attending ≥1 CR session and a shorter delay in attending the first session compared with the non-liaison cohort (28 vs 33 days, p&lt;0.001) (Figure). Conclusion: A liaison-mediated CR referral is associated with higher odds of post-PCI CR participation and may mitigate delays in CR enrollment. This may be an effective referral strategy to improve CR participation rates and patient outcomes after PCI.
Abstract 15986: Very Rare Case of a Interatrial Thrombus Following Watchman Device Placement
Authors: Astha Prasai, Omofolarin Babayale, Mohamed Salah M Mohamed, Ahmad Latifi, Rawa Sarji
Journal: Circulation (2023)

Introduction: Device related thrombus (DRT) is a known complication of left atrial appendage closure (LAAC). We present a case of a thrombus at the interatrial septum following LAAC detected eight months after the procedure. Case: Eighty-six years old woman with a history of coronary artery disease s/p percutaneous coronary intervention with drug eluting stent to right coronary artery in 2016, heart failure with preserved ejection fraction, atrial fibrillation (AF) s/p 27mm Watchman device placement (on aspirin only) due to recurrent episodes of hematuria, hypertension, hyperlipidemia, chronic kidney disease presented to the hospital with complaints of right flank pain. Initial labs were unremarkable except for anemia, hemoglobin of 10g/dl. Computed tomography (CT) abdomen and pelvis showed an incidental finding of new mass like filling defect within the left atrium. Transthoracic echocardiogram (TTE) showed mobile mass 1.7 x 1.6 cm attached to the interatrial septum on the left atrial side.(Figure 1.A) Low dose apixaban was started. Follow up transesophageal echocardiogram (TEE) in four months interval showed the thrombus attached to the interatrial septum had slightly reduced in size to 1.5 x 0.9 cm, but an additional large thrombus measuring 2.5 x 1.3 cm was seen on top of the Watchman device (Figure 1.B) and Apixaban was increased to full dose. Discussion: Incidence of DRT after LAAC is 3.74% with most cases occurring in the first year after LAAC. Exposed and incompletely endothelialized device are foci for DRT. Iatrogenic pericardial effusion, hypercoagulable state, deep implant, renal insufficiency, non-paroxysmal AF are some of the factors increasing the risk of device related thrombus. Most cases of DRT described are attached to the device. In our case, a large interatrial thrombus was identified incidentally which likely formed at the site of septal puncture during device insertion which highlights the importance of follow up echocardiogram at intervals.