tbuckley/cabot-search huggingface dataset:
Abstract 15989: Gore Cardioform Device Complicated by Delayed Right Atrial Disk Expansion
Authors: Jean Pierre Iskandar, Summanther Kaviratne, Nikhila Rao, Nilesh Rao, Krishna Rao, Frederick Ling
Journal: Circulation (2023)

This is a 31-year-old male with a recently discovered secundum atrial septal defect (ASD) with significant left-to-right shunt and associated right ventricular enlargement and dysfunction underwent an uncomplicated percutaneous ASD closure device placement earlier in 2023. Five weeks later, upon repeat transthoracic echocardiogram (TTE), the patient was found to have new onset atrial flutter and what was thought to be a large device-related thrombus abutting the right atrial disc. The patient was admitted to the hospital, started on systemic anticoagulation, and AV nodal blocker therapy. X-rays and a transesophageal echocardiogram (TEE) were performed and showed a Gore Cardioform ASD occluder device that was complicated with significant expansion of the right atrial disk and loosening of fabric likely in the setting of displacement of locking pin (Figure 1A-B). No clear thrombus was visualized. The patient underwent an uncomplicated ASD closure device removal, ASD repair with pericardial patch, right sided Maze, and left atrial appendage ligation in May of 2023 (Figure 1C). We report a case of extreme expansion of the right atrial disk of the Gore Cardioform septal occlusion device. Very few cases of right or left atrial disk expansion have been reported but only in the immediate post-implantation period. This is thought to be secondary to immediate post-operative increase in left atrial pressures. In our patient, intra-procedural TEE and immediate post-procedural TTE the day after showed a well-apposed device across the ASD with no residual shunt. Furthermore, the wedge pressure measured during the procedure was within normal limits. Extreme expansion of the right atrial disk five weeks after the implantation has not been reported. While we know that the pin unlocking caused the expansion of the atrial disk, it is currently unclear as to what initiated this series of events.
Abstract 17188: Electrocardiographic Algorithms for Localization Ventricular Ectopy From the Ventricular Outflow Tracts Demonstrate Poor Accuracy and Agreement
Authors: Albert Howell, Kelly Arps, Albert Sun, Hau-Tieng Wu, Zak Loring
Journal: Circulation (2023)

Background: Premature ventricular contractions (PVCs) and ventricular tachycardia (VT) commonly arise from the outflow tracts of the left and right ventricles and can be treated with catheter ablation when symptomatic or associated with cardiomyopathy. Accurate localization of these ectopic sources aids procedural planning. Several different electrocardiographic (ECG) algorithms have been published, but their relative performance has not been assessed. Objective: Compare the accuracy and agreement of three ECG algorithms for PVC localization. Methods: ECGs from patients who underwent catheter ablation for PVCs or VT originating the outflow tract region were analyzed using three published PVC localization algorithms. The predictions from these algorithms were then compared to the site of successful catheter ablation (right ventricular outflow tract [RVOT], left ventricular outflow tract [LVOT], or epicardium). The accuracy and agreement of the three algorithms were compared. Results: A total of 43 patients were evaluated and ectopy was suppressed via ablation from a single chamber in 37 (86%) of patients. VT/PVCs originated from the RVOT (N=10), LVOT (N=26), and epicardium (N=1). The three studied algorithms demonstrated accuracy rates of 46-70%. The algorithms disagreed on the predicted ectopy location for 19 (51%) patients. When all algorithms agreed (N=18), the prediction was accurate for only 11 patients (61%). Conclusion: Rules-based ECG algorithms demonstrate poor performance and use of different published algorithms frequently result in disparate results. More accurate and consistent methods incorporating individualized electroanatomic variation may improve accuracy and periprocedural management for PVC and VT ablation.
Abstract 14720: Persistence and Adherence to Proprotein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies and Ezetimibe in Real - World Settings
Authors: Lama Ghazi, Jenna Jones, Lisandro Colantonio, Bharat Poudel, Ying Wen, Zhixin Wang, Ligong Chen, Vera A Bittner, Mark Woodward, Bethany Kalich, Robert S Rosenson, Nafeesa Dhalwani
Journal: Circulation (2023)

Introduction: Non-statin cholesterol-lowering therapies (proprotein convertase subtilisin/kexin type 9 monoclonal antibodies [PCSK9mAb] and ezetimibe) have been shown to reduce atherosclerotic cardiovascular disease (ASCVD) events in randomized clinical trials of patients treated with statin therapy. Effectiveness in the real world, however, is contingent on treatment persistence and adherence. Aim: To estimate the proportion of patients who were on therapy, persistent and had high adherence at 365 days following the initiation of a PCSK9mAb versus ezetimibe in real-world clinical practice. Methods: We included adults initiating a PCSK9mAb (n= 16,588, 44% ≥ 65 years, 56% male, 78% with ASCVD) or ezetimibe (n=83,086, 35% ≥ 65 years, 51% male, 46% with ASCVD) from Medicare and MarketScan commercial health insurance databases between 7/2015 and 12/2019. We assessed 3 outcomes using pharmacy claims within 365 days following initiation (assessment period): 1) percentage of patients on therapy: percentage of patients with medication supply in the last 60 of 365 days following initiation; 2) persistence: not having a gap of ≥ 60 days between the last day of supply from one pharmacy claim and the next claim; 3) high adherence: having a day of supply for ≥ 80% of the 365 days. Results: Percentage on therapy, persistence, and high adherence were higher among patients on PCSK9mAb versus ezetimibe at 365 days (Table 1). When, restricted to participants who were persistent at 365 days, adherence to both PCSK9mAb and ezetimibe was high. The adjusted multivariable-adjusted risk ratio [95% CI] for percentage on therapy, persistent and having high adherence to PCSK9mAb versus ezetimibe was: 1.20 [1.18, 1.21], 1.22 [1.20, 1.24], and 1.16 [1.14, 1.18]. Conclusions: Patients initiating PCSK9mAb were more likely to be on therapy, persistent and with high adherence at 365 days compared to their counterparts who initiated ezetimibe. Funding: Amgen Inc.
Abstract 17240: Preoperative Pectoralis Muscle Area Index is Associated With Increased Post-LVAD Length of Stay and 90-day Readmission
Authors: Matthew R Carey, Annamaria Ladanyi, Mia Nishikawa, Abraham Bordon, Alberto Pinsino, Farhana Latif, Gabriel T Sayer, Koji Takeda, Nir Uriel, Paolo C Colombo, Melana Yuzefpolskaya
Journal: Circulation (2023)

Background: In LVAD pts, preoperative sarcopenia, as measured by pectoralis muscle area index (PMI), has been associated with mortality and GI bleed; however, the association with length of stay (LOS) and readmission is unknown. Methods: This was a single-center retrospective cohort study of pts who underwent LVAD 01/2015-10/2018. Preoperative pectoralis muscle area was measured on CT chest prior to implant using Tera Recon, adjusted for height squared to give the PMI. Multivariable negative binomial regressions were used to assess the association between PMI and LOS. Subhazard ratios (SHR) and cause-specific hazard ratios (CSHR) were used to assess the association between PMI and freedom from 90-day readmission. Results: Of 254 LVAD pts, 95 had a preop CT chest and were included (median days CT to LVAD: 7 [IQR 3-13]). Pts with PMI in the lowest quartile (PMI &lt; 4.86 cm 2 /m 2 ) constituted the low PMI cohort; all others served as the reference cohort. Baseline characteristics are shown in the Table. During index hospitalization, 2 low PMI pts died vs 7 reference; 0 low PMI pts were transplanted vs 2 reference. Low PMI was associated with longer post-LVAD LOS (adjusted incidence rate ratio 1.31 [95% CI 1.03-1.66], p =0.03) and increased risk of 90-day readmission (aSHR, accounting for risk of death and transplantation, 3.77 [1.17-12.1], p =0.03; aCSHR 3.67 [1.35-9.96], p =0.01) (Fig). The most common reason for readmission in low PMI pts was infection (n=3). Conclusions: Low PMI is associated with longer LOS and higher likelihood of 90-day readmission after LVAD. PMI could be used to identify sicker patients at risk for more intensive medical intervention and potentially higher health care cost.
Abstract 15299: Cardiogenic Shock and Flash Pulmonary Edema in an Uncommon Nonischemic Nonmyxomatous Spontaneous Rupture of Anterolateral Mitral Valve Papillary Muscle
Authors: Steven D Hartman, Marissa A Donatelle, Karthik Vedantam, Javier Arreaza Caraballo, Esteban Escolar
Journal: Circulation (2023)

Introduction: Mitral valve papillary muscle rupture is a rare condition that presents a cardiac emergency requiring rapid identification and treatment. Here we present a case of flash pulmonary edema and cardiogenic shock from severe mitral regurgitation (MR) secondary to spontaneous rupture of the anterolateral papillary muscle. Case Presentation: A 48-year-old female with hypertension presented to the ED with acute shortness of breath. In the ED, she was tachycardiac, hypertensive, tachypnic and saturating 75% on room air. On physical exam a 3/6 systolic murmur was present at the apex. ECG had no signs of ischemia. TTE showed severe MR with a fail anterior mitral leaflet. The patient was intubated and taken emergently to the cath lab for intra-aortic balloon pump placement, TEE (Figure 1A) and coronary angiogram, which was normal (Figure 1B, 1C). She was taken to the OR for successful mitral valve replacement surgery. Discussion: The rapid clinical decline and emergent management of patients who develop cardiogenic shock with pulmonary edema from acute non-ischemic papillary muscle rupture presents a significant challenge for clinicians. The cause of papillary muscle rupture most often occurs due an ischemic event, but can occur spontaneously as in this case. Rapid identification of the etiology of the clinical symptoms is of upmost importance to increase chances of survival. On review, 11 cases have been published between 2000-2015 discussing nonischemic nonmyxomatous spontaneous papillary muscle rupture of which the majority had a posterior muscle rupture. In our case, the 48-year old patient only had mild chordal calcification and essential hypertension and presented with nonischemic nonmyxomatous rupture of the anterolateral muscle. With prompt identification and urgent multidisciplinary team intervention, the patient was eventually discharged after replacement and is doing well at 6 months follow-up.
Abstract 15836: Paraganglioma Presenting as Myocardial Infarction With Decompensated Heart Failure
Authors: Sashank M Dusi, Alec Miller, Julie Kim, Jesse Frye, On Chen
Journal: Circulation (2023)

Description of Case: Paragangliomas are extra-adrenal catecholamine secreting tumors, classically presenting with paroxysmal hypertension, headache, and diaphoresis. However, presentations vary significantly, and can mimic cardiac pathologies including myocardial infarction and aortic dissection. A 52-year-old male with history of hypertension and 1 year of palpitations presented for substernal chest pressure with associated dyspnea, nausea and diaphoresis. He reported two days of cough and nasal congestion, and recent addition of metoprolol for palpitations. His family history was notable for early ACS. On examination, he was tachycardic (140 bpm), hypertensive (220/140 mmHg), and hypoxic requiring non-rebreather mask. EKG revealed sinus tachycardia with 1mm J point elevations in V2 and V3. Chest X-Ray and bedside ultrasound indicated pulmonary edema and reduced systolic function. Nitroglycerin infusion was initiated and he was admitted to the Cardiac ICU. Laboratory testing showed a Troponin-T of 0.15 ng/L (normal &lt;0.01 ng/L), ntPro-BNP 2764 pg/mL, lactic acid 3.2 mmol/L, and respiratory swab positive for Influenza A. A CT Aorta ruled out acute dissection but identified several large retroperitoneal masses. Urgent cardiac catheterization demonstrated non-obstructive CAD. Echocardiography noted severely reduced ejection fraction of 30-35%. With diuresis and alpha blockade, he clinically improved and was discharged. Plasma and urine studies revealed elevated metanephrines. He underwent open paraaortic mass resection and pathology later confirmed paraganglioma. Discussion: With angina, elevated troponins, and acute decompensated heart failure, this presentation was initially concerning for ACS. However, the absence of obstructive CAD warranted further investigation. While concomitant Influenza A infection raised concern for viral myocarditis, abdominal imaging proved crucial in diagnosing paraganglioma.
Abstract 12649: Harnessing Ambulatory Monitoring Data to Improve Prediction of Heart Failure
Authors: Hannah Schwennesen, Zhen Li, Bradley G Hammill, Amy Clark, Sean Pokorney, Melissa Greiner, Evangelos Hytopoulos, Mintu Turakhia, Justin Cambra, Jonathan P Piccini
Journal: Circulation (2023)

Introduction: Despite growing evidence that atrial fibrillation (AF) burden impacts clinical outcomes, few clinical risk scores incorporate individual-level arrhythmia characteristics. We analyzed predictors of hospitalization for heart failure (HF) in patients using both clinical history and ambulatory cardiac monitoring data. Methods: We evaluated patients who underwent Zio XT ambulatory monitoring in the US (2014-2020). The monitoring data were linked with clinical data from Centers for Medicare and Medicaid Services. Patients on anticoagulation or anti-arrhythmic therapy and those with evidence of sustained VT, known ventricular fibrillation/flutter, prior ablation, prior left atrial appendage occlusion, or cardiac arrest in the prior year were excluded. We randomly divided our dataset into a 70% training dataset and 30% testing dataset. Predictive models were generated using LASSO Cox regression for variable selection in the training dataset and evaluated on testing dataset among ambulatory ECG variables and the components of CHA 2 DS 2 -VASC. Results: Among 224,682 patients in the training dataset, 4,021 (1.8%) were hospitalized for HF within 1 year. A model that included components of the CHA 2 DS 2 -VASC and all ECG variables (excluding multicollinear variables) had greater discrimination and calibration for HF hospitalization (C-statistic 0.85 [0.84-0.86]), compared with the CHA 2 DS 2 -VASC score alone (C-statistic 0.73 [0.72-0.74], Figure ). ECG findings with the greatest predictive value were the presence of premature ventricular couplets (HR 1.54 [1.43-1.65]) and presence of AF (HR 1.53 [1.35-1.72]). Conclusion: A model that incorporates both ECG variables from ambulatory monitoring data and the components of the CHA 2 DS 2 -VASC provides better discrimination for the risk of HF hospitalization compared with the CHA 2 DS 2 -VASC risk score alone. Premature ventricular couplets and AF are highly associated with HF hospitalization.
Abstract 13441: Outcomes of Percutaneous Atrial Septal Defect Closure Following Mitraclip and Transcatheter Mitral Valve Replacement
Authors: Anas Hashem, Amani Khalouf, Mohamed Salah Mohamed, Mahmoud Ismayl, Anthony H Kashou, Rody G Bou Chaaya, Tarek Nayfeh, Devesh Rai, Samian Sulaiman, Sudarshan balla
Journal: Circulation (2023)

Introduction: Data on clinical outcomes of percutaneous closure of iatrogenic atrial septal defect (PC-ASD) in patients undergoing transcatheter edge-to-edge repair (TEER) or mitral valve replacement (TMVR) remains limited. We used a real-world USA database to evaluate the differences in the in-hospital outcomes between both groups. Hypothesis: Is there a clinical significance for PC-ASD in patients undergoing TEER or TMVR? Methods: We used the National Inpatient Sample (2015-2020) by utilizing ICD-10 codes to identify all patients who underwent TEER or TMVR with or without PC-ASD. Multivariate logistic regression was used for adjusted outcomes (adjusted odds ratio [aOR]). Results: A total of 44,065 eligible weighted hospitalizations were included: 39,625 (89.9%) of the patients underwent TEER and 4,440 (10.1%) underwent TMVR. Rates of PC-ASD were higher in TMVR group compared to TEER group (10.7% vs. 2.0%, p&lt;0.01). In patients who underwent TEER without PC-ASD, PC-ASD was more associated with acute heart failure (AHF) (aOR 1.42 [1.19-1.68], p&lt;0.01) and longer hospitalizations (aOR 1.64 [1.41-1.89], p&lt;0.01), without significant difference in inpatient mortality (aOR 0.97 [0.61-1.54], p&lt;0.01), cardiogenic shock (aOR 1.13 [0.85-1.51], p=0.21), need for mechanical circulatory support (MCS) (aOR 0.98 [0.61-1.54], p=0.18), and stroke. Compared to patients who underwent TMVR without PC-ASD, PC-ASD was associated with higher inpatient morality (aOR 1.65 [1.13-2.4], p&lt;0.01), need for MCS (aOR 1.91 [1.33-2.73], p&lt;0.01) without significant difference in AHF (aOR 1.19 [0.94-1.51], p=0.18] and cardiogenic shock (aOR 0.83 [0.56-1.22], p=0.43). Remarkably, PC-ASD was less associated with stroke (aOR 0.27 [0.10-0.72], p&lt;0.01). Conclusions: Rates of PC-ASD after TEER were lower than after TMVR and were associated with worse in-hospital mortality and need for MCS in TMVR but not in TEER. Also, PC-ASD was less associated with stroke after TMVR.
Abstract 14359: Life’s Essential 8 and Cardiovascular Health of Veterans: The Million Veteran Program
Authors: Xuan-Mai T Nguyen, Yanping Li, Yuk-lam Ho, Serena Houghton, Kerry Ivey, Mary Pyatt, Timothy M Treu, Daniel Posner, Ruifeng Li, SRIDHARAN RAGHAVAN, David Gagnon, John Gaziano, Luc Djousse, PETER WILSON, Kelly Cho
Journal: Circulation (2023)

Background and Hypothesis: The American Heart Association (AHA) recently proposed the Life’s Essential 8 (LE8) score as an enhanced measurement tool for cardiovascular health. No studies to date have estimated its association with the risk for atherosclerotic cardiovascular disease (ASCVD) incidence and prognosis. Methods: A prospective cohort study of 384,518 Veterans enrolled in the VA Million Veteran Program (MVP) (2011-2021). LE8 score was developed using AHA guidelines. Primary outcome was total ASCVD. Secondary outcome was hard ASCVD which included non-fatal myocardial infarction, non-fatal stroke, and fatal CVD. Results: Based on 1.16 million person-years of follow-up among Veterans with no ASCVD at baseline, 46,295 Veterans had ASCVD events during follow-up. LE8 score was associated with ASCVD and its subtypes in a linear dose-response manner (Figure 1A). The overall population-attributable fractions for all non-ideal LE8 scores was 59% (95%CI: 51%-66%) for ASCVD, where non-ideal blood pressure was most influential (Figure 1B). Based on 0.6 million person-years of follow-up among patients with ASCVD at baseline, the hazard ratio for incident or recurrent hard ASCVD was 0.52 (95%CI: 0.48-0.56) comparing veterans with ≥650 to those with LE8 score &lt;350, with a dose-response linear association pattern. Conclusions: Based on 1.76 million person years of follow-up among Veterans, a high LE8 score was associated with a significantly lower ASCVD risk and a lower likelihood of developing adverse cardiovascular events regardless of ASCVD status at baseline. Theoretically, an ideal LE8 could potentially prevent almost 59% of ASCVD in this study. Our results support the importance of AHA’s promotion of LE8.
Abstract 15846: Impaired Contraction and High Susceptibility to Arrhythmias in a Mouse Model of Desmoplakin-Mediated Arrhythmogenic Cardiomyopathy
Authors: Emmanuel M Camors, Buyan-Ochir Orgil, Neely Alberson, Enkhsaikhan Purevjav, Jeffrey A Towbin
Journal: Circulation (2023)

Introduction: Desmoplakin (DSP) is a key protein for cardiac myocyte cell-to-cell adhesion that connects the desmosomes present in intercalated discs to the cytoplasmic network of desmin intermediate filaments. Pathogenic variants of the human DSP gene often lead to left ventricular (LV)-dominant and biventricular forms of arrhythmogenic cardiomyopathy characterized by a dilated LV, arrhythmias, and an elevated risk of sudden cardiac death. Nonetheless, the pathophysiological pathways triggered by DSP variants remain unknown. Hypothesis: We hypothesized that DSP pathogenic variants modify cardiomyocyte excitation-contraction coupling leading to life-threatening ventricular arrhythmias. Methods: We created a novel knock-in mouse model based on the human DSP p.S2859LfsX5 variant that leads to a murine protein truncated from its last 9 amino-acids. We compared one-year-old sedentary heterozygous (Dsp +/- ) animals to WT littermates and defined histologic, cellular, and molecular outcomes of the variant. Results: Western blotting revealed 50% Dsp reduction (N= 5 hearts/group; P &lt; 0.05) in mutant right ventricle (RV) indicating mutant protein instability. Histologic assessments of Dsp +/- hearts revealed LV chamber enlargement and RV wall thinning in the absence of fibrosis and lipid infiltration. Dsp +/- myocytes isolated from LV and RV free walls and field stimulated at 3 Hz exhibited 30-40% reduction in sarcomere shortening (n= 17-25 myocytes/ventricle/3-4 hearts/group; P &lt; 0.05), while their Ca 2+ handling properties remained normal. Pacing of Dsp +/- isolated myocytes (LV and RV) in the presence of (100 nmol/L) isoproterenol provoked a 20-30% increase in Ca 2+ release due to sarcoplasmic reticulum Ca 2+ overload (n= 15-20 myocytes/ventricle/3-4 hearts/group; P &lt; 0.05). Finally, surface ECGs showed that activation of the sympathetic pathway (isoproterenol + caffeine) in 6-month-old Dsp +/- mice increased mutant heart susceptibility to ventricular arrhythmias. Conclusions: The pathogenic variant p.S2859LfsX5 promotes biventricular dysfunction due to the loss in myocyte contraction capacity and catecholaminergic-mediated ventricular arrhythmias from cardiomyocyte Ca 2+ overload.
Abstract 18976: In-Hospital Outcomes in Patients Undergoing Protected Left Main Percutaneous Coronary Intervention With Percutaneous Left Ventricle Assist Device Protection
Authors: Jacek Legutko, Pawel Kleczynski, Luke Niewiara, Artur Pawlik, Katarzyna Weglan, Ewa Kwiatkowska, Bartus Stanislaw
Journal: Circulation (2023)

Introduction: Left main disease (LMCA) is a known risk factor for patients’ poor outcomes. Percutaneous revascularization of LMCA in heart failure patients is associated with a particularly high periprocedural risk. Percutaneously introduced left ventricle assist devices (pLVAD) are a potential tool to improve patient outcomes in these high-risk procedures. Hypothesis: Our study aimed to assess short-term clinical outcomes of protected left main percutaneous coronary intervention with the use of a pLVAD. Methods: A prospective registry of patients with chronic heart failure, undergoing protected LMCA PCI included 66 patients, 89% male, the median age of 71.5 y.o, 40 (60.6%) after prior myocardial infarction, 31 (47%) after prior PCI and 12 (18.2%) after CABG, with CTO RCA in 17 (25.6%) of cases. Percutaneous LVAD was used in all patients, 72% access site was the right femoral artery, additional plaque modification techniques were used in 46 (69.7%) patients, IVL was applied in 25 (37.9%) of cases and high-speed rotational or orbital atherectomy was used in 21 (31.2%) of cases. Median of 3 [2;4] DES was implanted. Results: During the in-hospital follow-up, a significant improvement of the left ventricle ejection fraction was observed (median LVEF 30% post PCI vs22% at baseline, p&lt;0.001) as well as a significant decrease of NTproBNP levels (765 [IQR: 194, 6,370] at discharge vs 7113 pg/ml [IQR:1,945, 15,646] at baseline, p=0.01]. There was 1 in-hospital death due to cardiogenic shock. A safety monitoring revealed 11 hematomas, including 3 cases that needed vascular surgery. Bleeding according to BARC 3a was recorded in 17/66 (28%) and BARC 3b in 3/66 (5%) of cases. Conclusions: Percutaneous LVAD support is a feasible method to perform protected left main PCI with a good safety profile when applied by experienced operators A significant improvement of the LVEF can be observed after left main revascularization Further research is needed to confirm the presented results.