tbuckley/cabot-search huggingface dataset:
Abstract 15939: Site of Origin Associated With Differences in Day-to-Day Variability of Premature Ventricular Contractions
Authors: Catherine Vanchiere, Gabriela Narowska, Rebecca Garber, Joshua M Cooper, Edmond Cronin
Journal: Circulation (2023)

Background Premature ventricular contractions (PVC) from the ventricular outflow tracts are well characterized, but there is limited literature to describe how other sites of origin (SOO) correlate with clinical and electrophysiologic characteristics. Methods We analyzed single lead ambulatory loop monitors (Zio, iRhythm, San Francisco, CA) from 1/2017-3/2020 (n=581) at a single institution. All included subjects had a PVC burden &gt;1% and monitoring period of &gt;72 hours. Twelve-lead ECG of the PVC for each subject was reviewed by an electrophysiologist to identify the SOO. Demographic information, clinical presentation, and cardiac testing results were collected from the electronic medical record. Those without a PVC captured on ECG or with atrial fibrillation or flutter were excluded. Analysis was performed via calculation of odds ratios for presence of dichotomous characteristics and two-tailed t-tests for comparison of means, stratified by outflow tract (OT) versus non-OT SOO and perivalvular (PV) versus non-PV SOO. Results Of 39 subjects who met criteria for inclusion, stratified by SOO (analysis 1: OT (n=18), non-OT (n=21), analysis 2: PV (n=30), non-PV (n=9)), there were no significant differences in the odds of developing certain symptoms or exhibiting certain PVC characteristics. PVCs from OT vs. non-OT and PV vs. non-PV locations had similar burden and numbers of single PVCs, couplets, and triplets. Odds of reporting symptoms were higher with OT than non-OT PVCs (OR 1.49, 95% CI 0.86 - 2.58) and with PV than non-PV PVCs (OR 1.70, 95% CI 0.85 - 3.41). PVC-Native QRS Duration index was no different between SOO groups. Day-to-day variability of PVC burden was higher in OT vs. non-OT SOO (p=0.08), with no difference in PV vs. non-PV SOO (p=0.90). Odds of RV dysfunction were higher in PV vs. non-PV SOO (OR 8, 95% CI 1.54 - 41.64). Coupling interval was longer in non-PV PVCs vs. PV PVCs (n=29, p=0.02). Discussion Electrophysiologic characteristics of PVCs from different sites of origin were similar, suggesting common mechanisms. OT PVCs exhibited more day-to-day variability, emphasizing the need for extended monitoring to characterize true PVC burden. Exploratory analysis by SOO suggests more frequent symptoms with OT PVCs, and RV dysfunction with non-PV SOO.
Abstract 11956: Arumenamide-787 Suppresses Arrhythmogenesis Associated With the J Wave Syndrome as Well as Hypothermia
Authors: Mena Abdelsayed, Jose M Di Diego, Hector Barajas-Martinez, Robert H Cox, Victoria Robinson, Joseph Jung, Bence Patocskai, Mohamed Fouda, Peter C Ruben, Charles Antzelevitch
Journal: Circulation (2023)

Background: The J-wave syndromes (JWS), comprised of Brugada (BrS) and early repolarization syndromes (ERS), increase the risk of life-threatening ventricular arrhythmias in patients resulting in sudden cardiac death. There are limited therapeutic strategies to treat these life-threatening conditions. Present management is via an implantable cardioverter defibrillator and/or medication, including quinidine. However, these treatments may have serious side-effects. Thus, novel therapies are needed to treat JWS. In this study, we investigate the effects of ARumenamide-787 (AR-787) in suppressing the electrocardiographic and arrhythmic manifestations of JWS and hypothermia. Methods: We studied the effects of AR-787 on sodium current (I Na ) and the delayed-rectifier potassium current (I Kr ) in HEK-293 cells stably expressing the α- and β1-subunits of the cardiac (Na V 1.5) sodium channel or the hERG channel. In addition, we studied its effect on the transient outward potassium current (I to ) and calcium current (I Ca ) from dissociated canine ventricular myocytes, along with action potentials and ECG from coronary-perfused right (RV) and left (LV) ventricular wedge preparations. The I to agonist, NS5806, I Ca blocker, verapamil, and sodium current (I Na ) blocker, ajmaline, to induce the electrocardiographic and arrhythmic manifestations of JWS (prominent J waves/ST segment elevation, phase 2 reentry, and polymorphic VT/VF) in right and left canine ventricular wedge preparations. Results: AR-787 exerted pleiotropic effects on the cardiac ion channels. The predominant effect was an inhibition of I to and enhancement of I Na , with subtle effects to inhibit the I Kr and augment I Ca . AR-787 diminished the electrocardiographic J wave and prevented and/or suppressed all arrhythmic activity in canine RV and LV experimental models of BrS, ERS and hypothermia. We observed no arrhythmogenic effects of AR-787 on I Kr . Conclusions: Our findings point to AR-787 as a promising candidate for the pharmacologic treatment of JWS and hypothermia. AR-787 suppresses the electrocardiographic and arrhythmic manifestations of JWS and hypothermia without significant prolongation of the QT interval, as with the classic BrS drug, quinidine.
Abstract 16377: 68Ga-DOTATATE Measurements Predict Progression of Aortic Valve Calcification in Humans
Authors: Wesam Aldosoky, Guillaume GOUDOT, Shady Abohashem, Simran Grewal, Iqra Qamar, Erin Hanlon, Omar Alani, Giovanni Civieri, Charbel Gharios, Michael Osborne, marc dweck, Pedram Heidari, Ahmed A Tawakol
Journal: Circulation (2023)

Introduction: Aortic valve (AV) inflammation contributes to calcification (AVca). 68Ga-DOTATATE (GADT), a positron emission tomography (PET) tracer that binds to somatostatin receptors, has emerged as a reliable marker for tissue inflammation. However, the diagnostic and prognostic value of AV GADT uptake in AVca remains unexplored. Hypothesis: We aim to investigate the relationships between baseline AV GADT uptake with baseline AVca and its progression. Methods: A total of 698 individuals (median age 63, 46% male) underwent clinical GADT PET/computed tomography (CT) imaging from 2017 to 2023; 245 had follow-up scans (median 1.3 yrs interval). AV inflammation was measured as the maximum standardized uptake value of GADT uptake within the AV on baseline PET/CT. AVca was quantified in baseline and follow-up CT scans (HU&gt;130). AVca progression was assessed as the difference between baseline and follow-up AVca. Individuals with a square root difference of annualized AVca change ≥ 2.5 were characterized as “progressors” and &lt;2.5 as “non-progressors”. Demographic and clinical data were collected from medical records. Results: Baseline AV GA DT correlated with baseline AVca (standardized β=0.11; p=0.004; Fig 1A ). Further, baseline AV GA DT associated with AVca progression (odds ratio [95% confidence interval]=3.1 [1.5, 6.6]; p=0.003, Fig 1B ) and remained significant after separately adjusting for baseline AVca (3.8 [1.1, 13.8]), hypertension (2.8 [1.3, 6.2]), diabetes (3.0 [1.4, 6.3]), hyperlipidemia (2.4 [1.0, 5.3]), smoking (3.1 [1.5, 6.7]), and chronic kidney disease (2.9 [1.4, 6.3]), but became borderline with adjustment for age and sex (2.4 [0.9, 5.9]; p=0.054; Fig 1C ). Conclusions: Our study highlights the use of GADT for assessing AV inflammation and predicting AVca progression. These findings underscore the role of inflammation in driving AVca progression and have potential implications for risk assessment and evaluating therapies in AV disease.
Abstract 13938: Trends in In-Hospital Implantation of Implantable Cardiac Monitors in the Unites States: 2016-2019
Authors: Acile Nahlawi, Ghazal Sanadgol, Leon Ptaszek, Jeremy N Ruskin
Journal: Circulation (2023)

Introduction: Implantable cardiac monitors (ICM) are widely employed for long-term cardiac rhythm monitoring. While a majority of ICMs are implanted on an outpatient basis, national estimates on their use in the inpatient setting are lacking. Methods: The National Inpatient Sample and the National Readmission Database were queried to identify inpatient ICM implantations between 2016 and 2019. Baseline characteristics, in-hospital outcomes, readmission rates, and trends over time were assessed for the study population and compared between the largest diagnostic cohorts: neurologic and cardiac. Results: A total of 101,430 adults underwent in-hospital ICM implantation between 2016 and 2019 (52.9% neurologic, 39.2% cardiac). Patient characteristics and outcomes are shown in Table 1. There was a 170% increase in inpatient ICM procedures from 2016 to 2019. Significant changes in patient profiles and readmission rates were observed over the study period. The trends are shown in Table 2a. After adjusting for confounders, patients with cardiac indications were more likely to have complications and be readmitted, but had lower mortality, length of stay, and hospitalization cost compared with the neurology cohort. The ORs are shown in Table 2b. Conclusions: The number of inpatient ICM implantations has increased significantly, likely reflecting expanding indications. The profiles of patients receiving ICM also changed to include more primary neurologic indications, comorbidities, and non-white races. Small and medium sized hospitals performed the procedure more frequently. Complication rates were extremely low and remained constant during the study period.
Abstract 16179: Psychiatric Status in Young Adults With Surgically Corrected D-Transposition of the Great Arteries (d-TGA) -The Boston Circulatory Arrest Study
Authors: Michelle Z Gurvitz, Alexandra Roseman, Adrienne Kovacs, Lori Sahakian, Clare Hobson, Onella Dawkins-Henry, David Wypij, Jane W Newburger, Patricia Ibeziako
Journal: Circulation (2023)

Background: The Boston Circulatory Arrest Study (BCAS) is a longitudinal investigation of neurodevelopmental and mental health (MH) outcomes of newborns with d-TGA who underwent the arterial switch operation. Goal: We describe current and lifetime MH outcomes in this now adult cohort. Methods: We enrolled 88/149 surviving and eligible infant BCAS study participants (29±1.3 yrs; 73% male) between 2017 and 2021; 77 were evaluated prior to the COVID-19 pandemic. The Structured Clinical Interview for DSM-5 Disorders - Research Version, which includes modules exploring anxiety, mood, externalizing, trauma and stress-related, and substance use disorders, as well as suicidality, was administered and captured lifetime (any point in life) and current (within the last 1-12 months) diagnoses. Results: One participant was not interviewed and was referred for further care after endorsing current suicidal ideation. Of 87 interviewees, 62 (71%) met criteria for ≥1 lifetime psychiatric disorder, with 41% diagnosed with lifetime mood disorder and 25% with lifetime anxiety disorder. In addition, 37% noted lifetime substance use disorders, most commonly with alcohol use. Four (5%) had a lifetime history of post-traumatic stress disorder. For comparison, general US similar age population prevalence of lifetime mood, anxiety, and substance use disorders were 21-24%, 30-35% and 17-18% respectively. Forty (46%) participants met criteria for ≥1 current disorder, with 11% diagnosed with mood disorders and 16% with anxiety disorders and 22% with substance use disorders. Further, 31% of participants had a history of suicidal ideation, 10% of non-suicidal self-injury, and 6% of suicide attempt compared to 5%, 1% and 0.4% respectively in a similar age general US population. Conclusions: MH disorders are common in young adults with d-TGA, with almost three-quarters meeting criteria for a psychiatric disorder by age 35. Mood and anxiety disorders are particularly common, and almost one-third endorse a history of suicidal ideation. Substance use is also common and warrants inclusion in history-taking of adolescent and adult CHD patients. Ongoing surveillance to identify patients with MH disorders in order to initiate treatment is vital for young adults with CHD.
Abstract 14768: Elevated Baseline Serum High Sensitivity Cardiac Troponin Levels and Mortality Post Transcatheter Aortic Valve Replacement: A Meta-Analysis
Authors: Sai Priyanka Mellacheruvu, Adil S Mohammed, Sarayu Santhosh, Venkata Akhil Makarla, Roshni Soni, Muneeb Siddiqui, Ayodya Perera, Bilal Khan Mohammed, Zainab Gandhi, Zaki Ur Rahman Mohammed, Sandeep Singh, Rupak Desai
Journal: Circulation (2023)

Introduction: High-sensitive cardiac troponins (hs-cTn) have been associated with worse prognosis and increased mortality post transcatheter aortic valve replacement (post-TAVR). However, limited data on the association prompted us to perform a meta-analysis for further understanding. Methods: PubMed, SCOPUS and Google Scholar were searched until May 2023 using relevant keywords. A random effects model was employed to estimate the odds of pooled pre-procedural hs-cTn levels and post-TAVR mortality. Inter-study heterogeneity was assessed using I2 statistics, and leave-one-out sensitivity analysis was performed with a significance level of p&lt;0.05 Results: The final analysis included six studies (n=4672) with a mean age of 82.7±5.6 and 46% female participants. There are 2 retrospective and 3 prospective studies with median follow up of 1 year. The population exhibited a high prevalence of hypertension, hyperlipidemia, and diabetes. All individuals who underwent TAVR had aortic valve area measuring &lt;1cm2. The combined mean logistic EuroSCORE was calculated as 20.91%±12.88. An increase in pre-procedural hs-cTn levels was associated with significantly higher unadjusted (OR 2.29, 95% CI 1.85-2.84, p&lt;0.01, I2=61.34%) and adjusted odds (aOR 2.01, 95%CI 1.62-2.50, p&lt;0.01, I2=52.81 %) of post-TAVR mortality (Fig. 1). Subgroup analysis revealed elevated mortality risk in both retrospective (OR 1.86, 95% CI: 1.33-2.60, p&lt;0.01) and prospective (OR 2.21, 95% CI: 1.62-3.01, p&lt;0.01) studies (Fig. 1). Furthermore, increased mortality risk persisted during both short-term (less than 2 years; OR 1.86, 95% CI: 1.33-2.60, p&lt;0.01) and long-term (more than 2 years; OR 2.21, 95% CI: 1.62-3.01,p&lt;0.01) follow-up (Fig. 1). Leave-one out sensitivity analysis confirmed the robustness of findings. Conclusion: This meta-analysis provides compelling evidence that elevated pre-procedural levels of hs-cTn serve as a significant predictor of post-TAVR 1-year mortality.
Abstract 17896: Implantable Cardioverter Defibrillator in Cardiac Resynchronization Therapy Recipients With Advanced Chronic Kidney Disease
Authors: Ido Goldenberg, Valentina Kutyifa, Wojciech Zareba, David T Huang, Spencer Z ROSERO, Arwa Younis, Claudio D Schuger, Scott McNitt, Bronislava Polonsky, John Steinberg, John S Steinberg, Ilan Goldenberg, Mehmet K Aktas
Journal: Circulation (2023)

Introduction: The effectiveness of the implantable cardioverter defibrillator (ICD) in preventing sudden cardiac death (SCD) is well-established in heart failure patients with reduced ejection fraction (HFrEF). However, the benefit of the ICD in advanced chronic kidney disease (CKD) patients remains elusive, particularly in those who are cardiac resynchronization therapy (CRT) recipients. Hypothesis: In CRT recipients with CKD, the benefit of the ICD may be attenuated due to the competing risk of mortality before experiencing an arrhythmia. Methods: A total of 1015 patients receiving CRT with defibrillator (CRT-D) for primary prevention of SCD were included from the MADIT-CRT and RAID trials. Patients were categorized into two groups based on kidney disease (KD) stage: Stage 1-3a (S1-S3a) CKD and Stage 3b-5 (S3b-S5) CKD. The primary endpoint was the occurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF). Results: The cumulative incidence of any VT/VF was 23.5% in patients with (S1-S3a)KD and 12.6% in those with (S3b-S5)KD (p&lt;0.001 [Figure left panel]). Death without VT/VF occurred in 6.6% of patients with (S1-S3a)KD and 21.6% of patients with( S3b-S5)KD (p&lt;0.001 [Figure right panel]). A multivariate competing risk regression model revealed that patients with (S3b-S5)KD had a 43% lower risk of experiencing any VT/VF compared to those with (S1-S3a)KD (HR=0.56, 95% CI [0.33-0.94], p=0.03). Over two years of follow-up, patients with (S3b-S5)KD had nearly a five-fold increased risk of death without VT/VF compared to those with (S1-S3a)KD (HR=4.63, 95% CI [2.46-8.72], p for interaction with time=0.012). Conclusions: The benefit of the ICD may be attenuated in CRT recipients with advanced CKD due to a lower incidence of arrhythmias and a higher risk of non-arrhythmic death. Future prospective trials should investigate whether CRT without a defibrillator is more suitable for these patients.
Abstract 18997: Management of Immune Checkpoint Inhibitor Mediated Myocarditis
Authors: Sarah Mudra, Austin Culver, Ashwin Kumar, Abdullah Yesilyaprak, Ankit Agrawal, Amit K Dey, Alexander Rizk, Jason Li, Adam Johnson, Kevin McGowan, Muhammad Majid, Meredith Njus, Luke Lawrence, Allan L Klein
Journal: Circulation (2023)

Clinical Presentation: A 52-year-old female with metastatic Stage IVB (T4N3M1c) lung adenocarcinoma presented with worsening dyspnea. She had just completed her 3 rd round of carboplatin/pemetrexed/pembrolizumab/MK-5890 chemotherapy. Upon examination she was noted to be hypertensive and tachycardic with an elevated high-sensitivity troponin T. ECG showed sinus tachycardia, left axis deviation, and flattened T waves in lead V5 and V6. In the ED, she subsequently developed supraventricular tachycardia and was admitted to the ICU. TTE demonstrated moderately reduced EF of 30-35%. TTE also identified hypokinesis in the basal to mid anterior and lateral walls and apical akinesis. Initial CMR showed an EF of 31% with akinesis of the mid and apical anterior, septal and inferior wall. Given the clinical and imaging findings, she was diagnosed with myopericarditis secondary to pembrolizumab and started on 1 mg/kg methylprednisolone taper for 60 days. Repeat CMR after completion of steroid taper showed evidence of weighted T2 edema in myocardium and pericardium. Late gadolinium enhancement (LGE) in inferior and lateral epicardium and adjacent pericardium as well as patchy LGE throughout the myocardium with significant EF improvement (57%) (Figure 1A-B). In our patient, multi-modality imaging was used to confirm the diagnosis and monitor treatment response. Discussion: Immune checkpoint inhibitors (ICI) are a novel class of immunotherapies used in certain malignancies. Initial treatment of myocarditis consists of cessation of further ICI and administration of corticosteroids. Additionally, symptomatic myocarditis treatment should be started. Reinitiating ICI therapy should ultimately be done with shared decision making.
Abstract 14411: Block in the Fasciculoventricular Pathway in a Complex Arrhythmia Presentation
Authors: Mustafa Suppah, Shruti K Iyengar, Komandoor S Srivathsan
Journal: Circulation (2023)

Background: Fasciculoventricular pathway (FVP) is a rare form of preexcitation without known clinical tachycardia. As it is connected to the His bundle, they conduct whenever it is engaged. Conduction through the His Bundle but block at FVP has not been reported. Case presentation: We present a case of a 42-year-old male with a history of Wolff-Parkinson-White syndrome (WPWS), supraventricular tachycardia (SVT), syncope, embolic stroke, paroxysmal atrial fibrillation, hypertension, hypothyroidism, Sjogren's syndrome and prior unsuccessful attempts at elimination of the preexcitation. He underwent electrophysiology (EP) study for presumed SVT ablation. The EP study identified an FVP as the cause of preexcitation, and the planned accessory pathway ablation was deemed unnecessary. Atrial tachycardia originating from the right superior pulmonary vein (PV) was induced, eventually degenerating into atrial fibrillation, and the patient successfully underwent pulmonary vein isolation with the resolution of symptoms. Discussion: FVP is usually an incidental finding when patients with symptomatic preexcitation are studied. If tachycardia is induced, it is unrelated to the preexcitation. The FVP is connected to the His bundle and invariably conducts if the impulse engages the His Bundle. We are unaware of a case when the His bundle conducts, but the impulse loses preexcitation due to a block in the FVP. This unusual finding was noted in our case. To further confirm the location of the accessory pathway, IV adenosine was given with a complete heart block suggesting the preexcitation is beyond the level of the AV node and within the conduction system. It is not at the annulus with independent atrial and ventricular insertion, typical of an accessory pathway. Conclusions: This case demonstrates an FV pathway's unusual conduction block and physiological characteristics.
Abstract 19033: Increased Prevalence of Gaps in Care for Patients With Congenital Heart Disease Are Associated With Social Determinants of Health Including Childhood Opportunity Index
Authors: Adam Alberts, Benjamin Brewer, Varsha Zadokar, claude beaty, Ming-Hui H Chen, Sarah D De Ferranti, Devyani Chowdhury, Abbas H Zaidi
Journal: Circulation (2023)

Background: Lifelong continuity of care is imperative for patients with congenital heart disease (CHD). Unfortunately, gaps in care (GIC) are common. Hypothesis: Social determinants of health are associated with GIC in patients with CHD. Methods and Results: A total of 2511 patients followed at Nemours Cardiac Center (NCC) with CHD were seen in the clinic between January 2005 and December 2022. Patients were divided into 3 cohorts based on anatomic complexity described in 2018 AHA/ACC adult congenital guidelines as simple, moderate, and complex CHD. Patient characteristics were analyzed, including race, ethnicity, gender, language, insurance status, and Childhood Opportunity Index (COI) based on home address zip code. GIC of &gt; 3 years were identified in 56% (n=1168) of patients. Linear regression model showed that the proportion of GIC stayed consistent for complex CHD with an increase of 0.1% per year and had a significant increase for those with simple and moderate CHD (Figure 1) with a yearly increase of 1.1% and 0.6% respectively. On the multivariable model GIC were associated with a non-Delaware residence (P&lt;0.001), simple to moderate CHD (P&lt;0.001), having less than two caregivers listed (P&lt;0.001), not having public insurance (P&lt;0.001), being none-white (P&lt;0.007), age (P&lt;0.001) Overall COI (P&lt;0.007) with a c-Statistic of 0.692. Conclusions: Over half of the patients with CHD experienced a substantial GIC. GIC were consistent for those with complex CHD but increased significantly for those with simple to moderate CHD over almost two decades and were associated with various SDOH factors including COI. Providing consistency in practice, minimizing practice variation especially for those with mild and moderate CHD and understanding the role of SDOH factors can help decrease GIC and improve patient care for this vulnerable population.