tbuckley/cabot-search huggingface dataset:
Abstract 4142012: Ectasias of Multiple Coronary Arteries and a Coronary Cameral Fistula Between Right Coronary Artery and Coronary Sinus
Authors: Shijun Sung, Hannah Gray
Journal: Circulation (2024)

Case Description: A 59-year-old male with history of hypertension, diabetes, Hashimoto’s thyroiditis presented with new, progressive shortness of breath. No murmur or extra heart sound were heard, and the lung sounds were normal. Exam was notable for significant lower extremity edema. Echocardiography showed reduced LVEF of 30%, and cardiac catheterization found hemodynamically significant shunt with Qp:Qs of 1.47:1. Coronary angiography revealed a tortuous and extremely aneurysmal RCA, as well as multivessel coronary artery disease (mvCAD) involving LAD, D1, LCx, OM1. Notably, the LAD had multiple aneurysmal segments and areas of eccentric stenosis upto 90%. Multislice CT angiography further characterized the RCA, which extends to the coronary sinus (CS) distally forming a coronary cameral fistula (CCF). Cardiac MRI did not show significant ischemic findings. The patient received medical therapy consisting of antiplatelet agents, high dose statin, beta blocker and ACE inhibitor, as well as diuretics. Patient underwent surgical closure of fistula and a 2-vessel coronary artery bypass graft surgery, with a LIMA pedicle graft to the LAD, and SV graft to the LCx. Postoperatively, patient was continued on medical therapy with improvement of symptoms. At the time of discharge, LV systolic function improved to 39% and there were no findings concerning for coronary artery thrombosis or fistula repair failure. Patient was planned to gradually start cardiac rehab. Discussion: CCF is a rare anomalous connection between coronary arteries and a cardiac chamber or other major blood vessels of the heart. CCF can be congenital or acquired and has many variations. It is often clinically silent. However some patients can develop heart failure, angina, and arrhythmia due to significant intracardiac shunt or coronary steal phenomenon. In this case presentation, it is likely that his heart failure was caused by the significant left to right shunt due to the fistula. He had concomitant ischemic cardiomyopathy in the setting of severe mvCAD, however the notable ectasia of LAD suggests there is a underlying disease that also affected RCA, leading to formation of the CCF. In addition to diagnostic coronary angiogram, advances in noninvasive cardiac imaging allow further identification and characterization of these fistulae. Surgical approach was appropriate in this patient given the findings complex mvCAD and the CCF with significant hemodynamic shunt.
Abstract 4141987: Bionanomatrix coated flow diverters promote faster endothelialization and occlusion of brain aneurysms
Authors: Jennifer Sherwood, Patrick Hwang, Brigitta Brott, Ram Kadirvel, David F Kallmes, Ho-wook Jun
Journal: Circulation (2024)

Introduction: Intracranial aneurysms are associated with local degradation of the vessel wall resulting in the formation of a blood-filled sac. Approximately 6 million people are estimated to have intercranial saccular aneurysms in the US alone. Most aneurysms remain undetected until rupture, resulting in hemorrhage which carries a high mortality rate (&gt;50%). Flow diverters are placed across the aneurysm neck to divert blood flow away from the sac, preventing rupture once occluded. However, flow diverters carry significant risk for thromboembolism, which is a major cause of morbidity. The elevated risk of thromboembolism is likely due to endothelial injury of the parent artery at the neck of the aneurysm. We hypothesize that the bionanomatrix can promote faster endothelialization and aneurysm occlusion thereby reducing the risk of thromboembolism after flow diverter treatment. Methods: The bionanomatrix is composed of peptide amphiphiles containing endothelial cell adhesive ligand (YIGSR) and a nitric oxide (NO) donor (KKKKK), both components critical for recruiting and retaining endothelial cells on the device. The NO releasing bionanomatrix was coated onto the flow diverters using ultrasonic spray coating, and the NO effects on endothelial cell (EC) and smooth muscle cell (SMC) proliferation on the coated devices was assessed, in vitro, using calcien-AM staining. For the in vivo study, an elastase-induced rabbit aneurysm model was created. The bionanomatrix coated and uncoated flow diverters were implanted into the rabbit aneurysm model for 4 weeks. The coated and uncoated flow diverters were then analyzed for endothelialization, smooth muscle cell proliferation, and aneurysm occlusion by angiography, gross image, and immunohistochemistry analyses. Results: In vitro , the bionanomatrix coated flow diverters significantly enhanced endothelial cell proliferation as well as reduced smooth muscle cell proliferation on the flow diverters compared to the uncoated device. In vivo, after 4 weeks, the bionanomatrix coated flow diverters demonstrated enhanced neck coverage, more complete endothelialization, and reduced smooth muscle thickness on the coated flow diverters compared to the uncoated devices as seen by gross image analysis and histology. Conclusions: The bionanomatrix coated flow diverters can successfully promote faster endothelialization and brain aneurysm occlusion which is critical for reducing the risk of thromboembolism after neurointervention.
Abstract 4142044: The prognostic value of criteria for diagnosis of Immune Checkpoint Inhibitor Related Myocarditis: a comparison of the Bonaca et.al. criteria and European Society of Cardiology (ESC)-International Cardio-Oncology Society (ICOS) guidelines
Authors: Milagros Pereyra, JUAN FARINA, Ahmed K. Mahmoud, Isabel Scalia, Maria Cecilia Tagle-Cornell, Courtney Kenyon, Mohammed Tiseer Abbas, Nima Baba, Joerg Herrmann, Reza Arsanjani, Chadi Ayoub
Journal: Circulation (2024)

Background: Myocarditis is a dreaded complication of immune-checkpoint inhibitor (ICI) therapy but challenging to diagnose. There are no published data comparing the two leading diagnostic criteria for ICI myocarditis and their association with cardiovascular events. Methods: Patients treated with ICI and cardiac Troponin (cTnT) measurements thereafter at a tertiary institution from 2011 to 2022 were identified. Charts were reviewed for ICI-related myocarditis according to the Bonaca et. al criteria and the ESC-ICOS guideline criteria. A propensity matched control group was identified of patients treated with ICI but without developing myocarditis. Medical records were reviewed for baseline characteristics and long-term outcomes, including cardiac death, MACE (myocardial infarction, TIA/stroke, new heart failure diagnosis), and arrhythmias (V-tach, A-fib, complete heart block). Results: A total of 59 patients were identified as having a diagnosis of ICI-related myocarditis per Bonaca criteria (16 having definite, 13 probable and 30 possible myocarditis), and 47 met the ESC-ICOS guideline criteria. Mean age was 73.1±10.2 years, 60.1% were male, median follow-up was 2.5 years. ICI-related myocarditis as diagnosed by both diagnostic criteria had prognostic value for cardiac death (HR 13.94, 95%CI 1.84-105.64, p=0.011 per Bonaca, HR 6.22, 95%CI 1.77-21.88, p=0.004 per ESC-ICOS), MACE, (HR 3.17, 95%CI 1.34-7.47, p=0.008 per Bonaca, HR 2.97, 95%CI 1.37-6.45, p=0.006 per ESC-ICOS), and arrhythmias (HR 1.93, 95%CI 1.10-3.38, p=0.022 per Bonaca, HR 2.09, 95%CI 1.21-3.60, p&lt;0.001 per ESC-ICOS), (Figures 1 and 2). There was no significant difference for cardiac death (AUC 0.75 for Bonaca, AUC 0.74 for ESC, p=0.765) or MACE (AUC 0.66 for Bonaca, AUC 0.66 for ESC, p=0.916) when both criteria were compared with each other. Conclusion: The ESC-ICOS criteria were more restrictive than the Bonaca criteria for the diagnosis of ICI-related myocarditis but similar in terms of prognostic value.
Abstract 4141978: Surveying Healthcare Professionals' Awareness and Management of Inflammation as a Residual Cardiovascular Risk Factor.
Authors: Maciej Banach, Stanislaw Surma, Fahad Alnouri, G B John Mancini, Dragos Vinereanu, Ioanna Gouni-Berthold, Zeljko Reiner, Pierre SABOURET, Gustavs Latkovskis, Arman Postadzhiyan, Patrick Moriarty, Branislav Vohnout, Jacek Jozwiak, Michael Shapiro, Nathan Wong
Journal: Circulation (2024)

Introduction: Inflammation is a recognized residual CVD risk factor. However, the knowledge, diagnosis, and management of inflammation-related CVD risk among healthcare professionals (HCPs) remain scarce. Methods: The survey, consisting of 20 questions dedicated to HCPs, was developed by the International Lipid Expert Panel (ILEP). It was launched in March 2024 and promoted through websites, SoMe channels, and newsletters. Many questions allowed for multiple responses. The questionnaire is ongoing and available at the ILEP webpage. Results: We collected 264 responses within 3 months (64.4% males; 50.8% between 40-59 yrs.), mostly from physicians (72.7%, of which 49.6% were cardiologists, and 16.3% internal medicine specialists), but also researchers (6.8%) and academics (6.4%). HCPs from 50 countries participated in the survey. The highest response rates were from Poland: 26.9%, USA: 17.4%, Greece and Romania (4.5% for both). Only 43.4% of responders routinely measure hsCRP for CVD risk stratification, and only 20% had possibilities to measure both CRP, hsCRP, and IL-6. 28% knew the difference between CRP and hsCRP tests, and only 54.9% knew the approved hsCRP ranges to stratify CVD risk. 47.7% of the respondents recognized CRP as a causal risk factor of CVD, with only every 5 th recognizing IL-6 ( Fig.1 ). 71.2% of HCPs accepted statins, colchicine, and bempedoic acid as available therapies that might effectively reduce hsCRP elevated levels ( Fig.1&amp;2 ); 11% suggested that one should only reduce general CVD risk. Besides having rather general knowledge of the anti-inflammatory role of statins or colchicine, there are still 23.1% and 39.8% of responders that recognized anti-inflammatory properties of ezetimibe and PCSK9 modulators, respectively ( Fig.2 ). A lot of inconsistency exists on the knowledge of the potential anti-inflammatory role of natural products, with the highest number of responses indicating curcumin and omega-3 acids (61.4% for both) ( Fig.1 ). In the case of elevated hsCRP, 74.2% of HCPs recommended intensification of lifestyle changes and background CVD therapies, while 9.8% suggested using nutraceuticals, and 6.8% were prone to just monitoring the patients ( Fig.2 ). Conclusions: There is a significant gap in knowledge regarding the diagnosis, biomarkers, and management of inflammation in CVD risk stratification. Enhanced education for medical students, physicians, and patients is crucial before targeted therapies become widely available.
Abstract 4141993: Artificial Intelligence ECG Analysis More Accurately Identifies Epicardial versus Endocardial Ventricular Tachycardia and Pacing Compared with Visual Criteria
Authors: Erin Dreessens, Kendall Oliver, Sutton Fox, Kevin Sung, Omar Aldaas, Frederick Han, Kurt Hoffmayer, Jonathan Hsu, Farshad Raissi, Gregory Feld, Andrew McCulloch, Christopher Villongco, Gordon Ho, David Krummen
Journal: Circulation (2024)

Background: Accurate prediction of whether a ventricular tachycardia (VT) source or critical isthmus is epicardial may facilitate efficient and effective catheter ablation. Prior visual criteria have been described but performance may vary depending upon region. Hypothesis: We hypothesized that an artificial intelligence (AI) algorithm would provide more accurate identification of epicardial versus endocardial sources distributed throughout the left ventricle (LV) compared with visual analysis. Aims: We endeavored to assess the performance of a novel AI algorithm in separating epicardial and endocardial VT and pacing sources compared with 7 previously published ECG criteria. Methods: Patients with LV VT or pacing were enrolled. Episodes were grouped as either LV-endocardial or non-LV-endocardial (i.e., epicardial) according to site of successful ablation or location of the pacing electrode. 12-lead ECG data was analyzed using the AI algorithm to predict source location and accuracy was computed. For comparison, accuracy of 7 previously described visual ECG criteria was assessed. Results: A total of 136 arrhythmia or pacing episodes from 72 patients (mean age 66±14 y, 32% female, EF 39±16%) were analyzed, evenly distributed between epicardial (n=68, 50%) and endocardial (n=68) sources. Episodes were localized to all 17 AHA LV segments. Algorithm accuracy was 91.1% (124 of 136 episodes), exceeded the best performing visual ECG criteria (shortest precordial rS &gt;121 msec; 62.5%; 85 of 136 episodes; P&lt;0.001). Algorithm sensitivity was 0.971 [95% CI: 0.898 - 0.996] and specificity was 0.853 [95% CI: 0.746 - 0.927]. Figure A shows an example ECG from a 73-year-old patient undergoing epicardial pacing at the inferior left ventricular apex. Figures B, C, and D show orthogonal views of the local normal vector (blue) and the electrical activation vector (red), consistent with an epicardial origin. Conclusions: The AI algorithm provided improved accuracy versus visual ECG criteria. Future studies are required to assess whether such information improves procedural efficiency.
Abstract 4141973: Comparison of Six Physical Frailty Assessments in Adults with Heart Failure with Preserved Ejection Fraction
Authors: Omar Zainul, Dylan Marshall, Jennifer Lau, Brooke Kelly, Kate Zarzuela, Abdulla Damluji, Ambarish Pandey, Amy Pastva, Parag Goyal
Journal: Circulation (2024)

Background: Frailty is a known prognostic marker of adverse outcomes in adults with heart failure with preserved ejection fraction (HFpEF); however, there are over 60 frailty assessment tools and no standardized method to assess frailty in HFpEF. Goals/Aims: This study aimed to conduct a head-to-head comparison of the prevalence and prognostic value of six commonly used frailty scales in adults with HFpEF. Methods: We examined 203 ambulatory patients with HFpEF seen at Weill Cornell Medicine from June 2018 - August 2022. The following frailty scales were assessed: the Clinical Frailty Scale (CFS), the FRAIL scale (the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale), the 5-meter gait speed test, the five times sit-to-stand test (5-STS), hypoalbuminemia, and the modified body mass index (mBMI). Multivariable cox proportional-hazard models, adjusting for race and the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) prognostic risk score, were used to examine the association between frailty and the primary endpoint (a 1-year composite of all-cause mortality and all-cause hospitalization). A Bonferroni correction was included into our models. Results: The median age was 76.7 years (IQR [69.7-83.9]), LVEF was 63.0 (IQR [59.0-68.0]), and MAGGIC score was 24.0 (IQR [19.0-28.0]). The prevalence of frailty ranged from 21.2% (hypoalbuminemia) to 77.8% (5-STS), and increased with advancing HFpEF severity on all frailty scales. In the adjusted analysis, the CFS, FRAIL scale and the 5-meter gait speed test were associated with the composite of all-cause mortality and all-cause hospitalization, Figure 1 . A linear relationship was found between higher scores on the CFS, FRAIL scale, and the 5-meter gait speed test and the log-predicted odds of the composite of all-cause mortality and all-cause hospitalization. Conclusion: The CFS, FRAIL scale, and the 5-meter gait speed test demonstrated associations with adverse outcomes among adults with HFpEF. These specific tools are quick to administer and easy to interpret, and thus may be appropriate for routine use in patients with HFpEF.
Abstract 4141967: The Role of Endothelial Dysfunction and Thromboinflammatory Biomarkers in the Mediation of the Pathogenesis of Atrial Fibrillation
Authors: Jawed Fareed, Gabriel Dungan, Ameer Odeh, Debra Hoppensteadt, Fakiha Siddiqui, Mushabbar Syed
Journal: Circulation (2024)

Introduction: Atrial Fibrillation (AF) is a common cardiovascular disease with complex pathophysiology. AF induces proinflammatory processes which incite vascular endothelial activation and dysfunction. This study seeks to examine the potential relationship between various endothelial, inflammatory, thrombotic, and renin-angiotensin-system (RAS) biomarkers in AF patients. Materials and Methods: Blood samples were from AF patients (n=110) prospectively enrolled in this study prior to their first AF ablation. Control plasma samples (n=100) were used as reference and obtained from non-smoking, healthy individuals from a commercial vendor (George King, Overland Park, KS, USA). All samples were analyzed for endothelial (NO, ICAM-1, VEGF, TF, TFPI, TM, Annexin V), inflammatory (IL-6, TNFα, CRP), thrombotic (vWF, tPA, PAI-1, TAFI, D-dimer), and RAS (Renin, Ang-II) biomarkers using commercially available ELISA methods. Biomarker average comparisons and Spearman correlations were performed. Results: AF patients showed varying levels of biomarker increase compared to controls. We observed a significant decrease of Ang-II in the AF population relative to controls when stratified for the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) upon study enrollment. AF patients showed statistically significant correlations between the following biomarkers: TNFα vs IL-6 (rs=0.317, p=.004), ICAM-1 vs TNFα (rs=0.527, p=.012), Annexin V vs VEGF (rs=0.620, p&lt;.001), CRP vs VEGF (rs=0.342, p=.031), Ang-II vs tPA (rs=-0.592, p=.010), and tPA vs PAI-1 (rs=0.672, p&lt;.001). Conclusion: Our study demonstrated significant elevation of endothelial, inflammatory, and thrombotic biomarkers in AF patients compared to controls, with significant correlations between these biomarkers in the AF population. Future investigations are required to better elucidate the mechanistic pathways that lead to endothelial dysfunction and thromboinflammation in AF. This may provide novel therapeutic targets, that in addition to current anticoagulation practices, can best curtail thromboinflammatory processes in AF.
Abstract 4141968: The relationship between Iron deficiency anemia and one year rehospitalization rate in Heart Failure Patients with Reduced Ejection Fraction: A Retrospective Cohort Study.
Authors: Mohamed Reyad, Nathanael Adjei, Lisa Najarian, Pooja Rangan, Radha Gopalan
Journal: Circulation (2024)

Background: Each heart failure (HF) hospitalization is associated with significant morbidity and mortality, reduced quality of life, and extensive use of healthcare resources. Iron deficiency anemia (IDA) frequently coexists with heart failure, exacerbating therapeutic outcomes and reducing patients' overall quality of life. Hypothesis: IDA increases the rate of overall rehospitalization in HFrEF patients. Aim: Assess the influence of IDA on rehospitalization rates among patients with HFrEF. Methods: A retrospective analysis was performed on adult patients at a Metroplex Health System in Arizona who had an ICD code of HFrEF between January 2016 and December 2017. The primary endpoint was all causes rehospitalization within 1- and 12-months post-discharge. The relationship between IDA and all causes rehospitalization was assessed using multivariate logistic regression, while adjusting for potential confounders. Results: Among 1,083 patients diagnosed with HFrEF, 115 (10.62%) had IDA. The mean age (SD) and BMI (SD) of the IDA group were 64.02 (14.59) years and 29.62 (8.22) kg/m2, respectively, with 69.57% being male and 52.17% non-Hispanic white. After adjusting for age, race, gender, diabetes, hypertension, dyslipidemia, coronary artery disease, and cerebrovascular disease, the competing risk survival analysis revealed a statistically significant increase in hospital readmission rates at 12 months for IDA (adjusted subhazard ratio [aSHR]: 1.78, 95% CI: 1.38-2.30, p &lt; 0.001) and native American ethnicity (aSHR: 1.56, 95% CI: 1.056-2.311 p = 0.026). While the rate of rehospitalization at 1 month did not achieve statistical significance (aSHR: 1.19, 95% CI: 0.723-1.956, p = 0.491). Conclusion: Patients with HFrEF and IDA have higher all-cause hospital readmission rates within 12 months, highlighting the importance of managing IDA in HFrEF treatment. Addressing IDA may reduce rehospitalization burden and improve long-term outcomes.
Abstract 4141995: Impact of myocardial infarction on aortic and mitral bioprosthetic valve degeneration
Authors: Dounia Rouabhia, Florence Desroches, Amelie Paquin, Siamak Mohammadi, Marie-Annick Clavel, Philippe Pibarot, Jonathan Beaudoin
Journal: Circulation (2024)

Background: Studies have previously suggested that myocardial infarction (MI) have an impact on native aortic valve stenosis progression as well as inducing pathobiological changes in native mitral and tricuspid native valve leaflets. Inflammation, renal failure, and hypertension have been identified as potential factors accelerating structural valve degeneration (SVD). However, the impact of MI on bioprosthetic valve and SVD is unknown. Hypothesis: MI accelerates the progression of bioprosthetic valve degeneration. Methods: A retrospective cohort analysis of patients who underwent a bioprosthetic aortic or mitral valve replacement at Quebec Heart and lung Institute was done. Patients were identified through a keyword search in institutional medical records and through the local cardiac surgical database (n = 158). Inclusion required a bioprosthetic valve in aortic (n = 146) or mitral (n = 12) position, with or without history of MI after surgery and at least two echocardiograms within 5 years post-MI, along with available echocardiograms performed ≥6 months prior to the MI. Patients were matched for baseline and prosthetic valve characteristics and divided into two groups 1) No MI (controls, n= 79), 2) MI (cases, n= 79). Echocardiograms were reviewed for valve mean and maximal gradient as well as valve area derived from the continuity equation. Results: At baseline, the two matched groups had comparable characteristics and echocardiographic data. The annualized progression of prosthetic valve area was higher in the MI group (-0.04 ± 0.16 cm 2 /y vs 0.00 ± 0.11, p = 0.039). This was mostly driven by patients with aortic valve replacement (aortic valve area -0.05 ± 0.14 cm 2 /y vs 0.01 ± 0.11, p = 0.0077). Using a mixed linear model, the presence of MI had a significant interaction with the decline of aortic valve area and indexed aortic valve area (p = 0.0057, p = 0.0041). There was no difference in mean or maximal gradient between the two matched group. Annual progression rate of indexed bioprosthetic aortic valve area was faster in men compared to women in the whole population (-0.061 ± 0.01 cm 2 /m 2/ y vs -0.01 ± 0.02 cm 2 /m 2/ y for men and women, respectively; p = 0.009). Conclusion: This study suggests that bioprosthetic valve stenosis may be accelerated following a myocardial infarction. These findings could be explained by the same fibrotic mechanisms observed in native valves. More studies are needed to understand the underlying mechanisms and clinical impact.