tbuckley/cabot-search huggingface dataset:
Abstract 4136812: Optimal Pacing for Cerebral Perfusion: Elucidating Relationship Between Resting Pacemaker Heart Rate and Pulse Pressure
Authors: Ahmed Moustafa, Muhtashim Mian, Habib Khan
Journal: Circulation (2024)

Background: Cognitive decline and dementia are significant global health concerns, with hypertension being a major risk factor. Increasingly, the elderly population is receiving pacemakers, and the pacing rates are set as low as 50bpm. Moreover, the relationship between blood pressure (BP) components, particularly diastolic BP (DBP) and pulse pressure (PP), and the risk of cognitive decline or dementia remains complex. The highest risk is observed in patients with low DBP and concurrently increased PP, likely indicating vascular stiffness. To our knowledge, no studies have assessed the programming of pacemakers to increase heart rates to target DBP and PP improving cerebral perfusion. Objectives: In patients with permanent pacemakers, resting heart rate (HR) can be artificially increased, and its consequence on hemodynamics, including PP, can be easily measured. This study aims to investigate the impact of increasing resting HR on PP in patients with poor vascular compliance. Secondary outcomes include evaluating changes in DBP, SBP, and cardiac output, as well as assessing patient tolerance to higher-paced heart rates through recording subjective symptoms. Methods: The study will employ a prospective cross-sectional interventional design. Digital plethysmography will be utilized to measure hemodynamic parameters, including systolic blood pressure (SBP), DBP, PP, and cardiac output, at baseline resting-paced heart rates. Subsequently, the pacemaker resting heart rate will be incrementally increased to a final rate of 100 beats per minute (bpm), with measurements taken 2-5 minutes after each change. Results: Ten out of twenty patients were recruited, with a mean age of 75.3 years old. The median change in PP from baseline HR of 70 to 100 was -8.7% (IQR -18.8 - +2.8, p= 0.114), SBP 4.2% (IQR 0 – 11.9, p=0.059), and DBP 20.1% (IQR 12.9 -23, p=0.005). There were no adverse outcomes and no patient-reported symptoms during higher pacing rates. Conclusion: This study provides the basis for proof of concept. Since an increased HR decreases PP, this will be subsequently tested against improvement in cerebral perfusion by cerebral Doppler studies, and its impact on cognitive function will be tested. This has the potential to change the standard of practice for patients with pacemakers and allow for collaboration across multiple specialties such as neurology, geriatric medicine and cardiology.
Abstract 4135905: The Impact of Emergent Atrial Fibrillation in Patients With Newly Diagnosed Heart Failure and Differences in Risk Among Preserved vs. Reduced Ejection Fraction
Authors: Heidi May, Stacey Knight, Viet Le, Jeffrey Anderson, Kirk Knowlton, Michael Cutler, Douglas Packer
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) and heart failure (HF) are associated with an increased risk of adverse events, with their diagnoses often coexisting. The impact of AF in HF needs additional study, with further delineation among HF type. Therefore, this study sought to determine the degree of AF burden among newly diagnosed HF patients and whether differences in risk exist between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) patients. Methods: Patients with new-onset HF between 2000-2019 were studied. To be included, patients had to have 1-year of follow-up, an ejection fraction (EF) measurement within 30 days of HF diagnosis, and no history of cancer. EF was used to define HFrEF (EF &lt;40%) and HFpEF (EF &gt; 40%). Multivariable Cox hazard regression was used to evaluate the risk of death and HF hospitalization at 1- and 3-years. Results: A total of 21,925 patients were studied with HFrEF (n=7931 [36.2%]) and HFpEF (n=13,994 [63.8%]). HFpEF patients were older (74 vs. 65 years) and more often female (53.7% vs. 33.1%). Prevalent AF was 40.5% (n=8879), being more common in HFpEF compared to HFrEF (65.2% vs. 34.8%). Among AF patients, HFpEF patients were also older (76 vs. 72 years) and more often female (52.7% vs. 30.8%) compared to HFrEF. The presence of AF was associated with an increased risk of HFpEF (OR=1.11, p=0.001). Prevalent AF was associated with an increased risk of death and follow-up HF hospitalization (Table). Death at 1-year and 3-years were similar between the HF groups (Table). However, the risk of HF hospitalization was greater among HFrEF patients (Table). Similar associations persisted when AF patients were propensity matched (Table). Conclusions: Among a newly diagnosed HF population, AF was common (40%) and was associated with an increased risk of HFpEF, death, and HF hospitalization. These results provide a rationale for aggressive management of HF and AF patients and the need for a randomized clinical trial to determine optimal therapy by ablation and 4-pillar HF therapy.
Abstract 4136805: Type 2 Myocardial Infarction Patients Have Significantly More Days Not at Home
Authors: Natalie Kolba, Alexandra Hajduk, Luis More Verde, Sumit Sohal, Michael Nanna
Journal: Circulation (2024)

Background: A Type 2 (T2) myocardial infarction (MI) occurs “secondary to ischemia due to either increased oxygen demand or decreased supply,” while a Type 1 MI (T1) is atherothrombotic. Treatment includes correction of the underlying cause and not catheterization. The current study's aim is to assess the patient-centered outcome of days not at home (DNAH) within a year of discharge among older adults hospitalized with T1 and T2 MI, and to evaluate the distribution of non-home days. Methods: Data for this analysis came from a prospective cohort study of adults ≥75 years old hospitalized with MI at 94 U.S. hospitals and linked to Medicare claims and encounter data. MI type was adjudicated according to the Fourth Universal Definition of MI. Patient characteristics were identified via chart review or self-report. DNAH was defined as the number of days dead or in a hospital, skilled nursing facility (SNF), rehab facility, or hospice. Multivariable-adjusted negative binomial regression was used to evaluate the association between MI type and DNAH in the year after discharge. Results: Of the 375 participants evaluated in this interim analysis, 264 (70.4%) had T1 MI and 111 (29.6%) had T2 MI. There was no difference in distribution of age, gender, or race. T2 patients were more likely to have heart failure (HF), coronary artery disease (CAD), COPD, and arrythmias. Patients with T2 MI had a median [interquartile range] of 5 [0-71] DNAH in the year after discharge, compared with 2 [0-10] DNAH among patients with T1 MI (p = 0.008). After adjusting for age and comorbidities, T2 patients had 137% more DNAH (IRR = 2.37, 95% CI = 1.43, 3.94, p &lt; 0.001) than T1 patients. The number of days dead or in SNF was significantly higher among patients with T2 MI compared with T1 MI, whereas the association between MI type and increase in days readmitted was borderline (p = 0.06). In the multivariable model, age, HF, and CAD were significantly associated with more DNAH, but COPD and arrhythmias were not. Conclusion: Our findings demonstrate that older patients with T2 MI have more days not at home, attributable to death, SNF stays, and to a lesser extent, rehospitalization. Interestingly, accounting for comorbidities did not significantly attenuate this association. Further studies are needed to develop guidelines for medical teams, including evaluating how receipt of cardiac interventions impacts home days in older patients with T1 and T2 MI.
Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators
Authors: Scott Turnbull, Jasmine Dugal, Randeep Gill, Shawn Wang, Chad Cross, Mohamad Mubder
Journal: Circulation (2024)

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p&lt;0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.
Abstract 4136698: Comparative Analysis of Transthoracic and Transesophageal Echocardiography for Diagnosis of High-Risk Patent Foramen Ovale
Authors: Ha Hye Jo, Ga Yun Kim, Jae-kwan Song
Journal: Circulation (2024)

Background: Transthoracic contrast echocardiography using hand-agitated saline and provocative maneuver (cTTE) has been considered a gold standard of diagnosis of patent foramen ovale (PFO), and transesophageal echocardiography (TEE) is generally recommended for selected patients who are going to undergo percutaneous closure of PFO. Recent studies have highlighted the clinical significance and prognostic implication of various anatomical features of PFO and the adjacent atrial septum, and risk stratification using the concept of ‘a high-risk PFO (HRPFO)’ has been widely accepted. We sought to evaluate the diagnostic role of TEE with contrast study (cTEE). Methods: Clinical data from patients who underwent both cTTE and cTEE without sedation for evaluation of cryptogenic stroke was retrospectively analyzed. The bubble gradings of right-to-left shunt were classified into four groups: grade 0 (none), grade 1 (&lt; 20), grade 2 (20-99 bubbles), and grade 3 (≧100 bubbles). HRPFO was defined as PFO with an atrial septal aneurysm or hypermobile atrial septum, or PFO with large amount of shunt (≧20 bubbles), or PFO size (distance between septum secundum and primum) of ≧2 mm. Results: From January 2017 to December 2022, a total of 572 patients underwent both cTTE and cTEE. The prevalence of PFO was 65.9 % (377 patients), and 331 patients (57.9% of the total, 87.8% of those with PFOs) were diagnosed with HRPFO using cTTE or cTEE. The prevalence of grade 2 and 3 was significantly higher in cTEE than in cTTE among proven PFO cases (68.7 % vs 75.6 %, P = 0.04). Among patients initially assessed as having a low-risk PFO or no PFO by cTTE, 22% were subsequently reclassified as having a HRPFO following cTEE. As a result, the positivity of HRPFO significantly increased from 46% to 56.8% after cTEE (P &lt; 0.001). The sensitivity of cTTE for diagnosing a HRPFO was significantly lower than that of cTEE (79.5 % vs 98.2 %, P &lt; 0.001). Conclusions: Diagnostic performance of cTTE can be significantly improved with the addition of cTEE without sedation. Given the beneficial effects of percutaneous closure of HRPFO, cTEE without sedation should be considered a useful screening test for patients with cryptogenic stroke.
Abstract 4135873: Time Course of Late Gadolinium Enhancement Intensity in Ventricular Myocardium after Proton Beam Irradiation in Swine
Authors: Taro Koya, Tatsuhiko Hirao, Amanda Deisher, Laura Newman, Jon Kruse, Dean Shumway, Kenneth Merrell, Douglas Packer, Konstantinos Siontis, Maryam Rettmann
Journal: Circulation (2024)

Background: Proton beam irradiation to the ventricular myocardium may enable non-invasive targeting of ventricular tachycardia. Previous work has demonstrated the feasibility of imaging ablation lesion with late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (MRI). Hypothesis: We hypothesize that proton beam irradiation will lead to progressively increasing density of LGE corresponding to lesion formation during follow-up after treatment delivery. Aim: The aim of the current study was to determine the time course of LGE intensity in ventricular myocardium following proton beam therapy. Methods: Eleven swine were irradiated with 40 Gy proton beam in the anterior or lateral left ventricular (LV) followed by LGE cardiac MRI every 4 weeks for up to 24 weeks. After manual contouring of the endocardial and epicardial myocardium, a region of interest (ROI) in the area irradiated with 0-5 Gy was contoured (remote ROI). The mean and standard deviation (SD) of the signal intensity (SI) of the remote ROI were calculated. Light LGE was defined as voxels with SI &gt; mean+2SD but &lt; mean+3SD of the remote ROI, while voxels with SI &gt; mean+3SD of the remote ROI were classified as having dense LGE. Voxels identified as bright due to image artifacts or noise were manually removed. The analysis was conducted in a fashion blinded to swine ID and time point after irradiation. Results: A total of 33 time points were analyzed (3.1 ± 1.4 MRI studies per swine). Figure 1A shows a representative time course of LGE in the same swine, progressing from diffuse light LGE at 8 weeks to dense LGE at 16-24 weeks. Figure 1B demonstrates the proportion of light versus dense LGE across timepoints in irradiated myocardial regions. At 8 weeks, light and dense LGE areas were evenly distributed. At 12 to 24 weeks, dense LGE increased to approximately 75%. The proportion of dense versus light LGE was significantly higher at 12, 16, and 24 weeks, as compared to 8 weeks. Conclusion: In ventricular myocardium, diffuse light LGE evident at 8 weeks progresses to denser LGE at 12-24 weeks following proton beam irradiation corresponding with lesion formation.
Abstract 4136704: Comparison of Early Clinical Outcomes with Balloon-Expanding Valves Versus Self-Expanding Valves in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
Authors: Hritvik Jain, Ramez Odat, Aman Goyal, Jyoti Jain, Sawai Singh Rathore, Mayank Jha, Nandan Patel, Siddhant Passey, Maryam Saleem, Hassan Suleiman
Journal: Circulation (2024)

Background: Transcatheter aortic valve replacement (TAVR) is an effective percutaneous intervention in patients with severe aortic stenosis, particularly in those with contraindications for surgical repair. Currently, two types of aortic valves are used in clinical practice: balloon-expanding valves (BEV) and self-expanding valves (SEV). The current data comparing early (30-day) clinical outcomes of BEV to SEV in patients with severe aortic stenosis undergoing TAVR are inconsistent. Methods: A systematic literature search spanning PubMed, Embase, Cochrane, and Scopus databases was conducted to retrieve randomized controlled trials (RCTs) comparing balloon-expanding valves to self-expanding valves in patients undergoing TAVR. The DerSimonian and Laird random-effects model was used to pool the odds ratios (OR) with 95% confidence intervals. Statistical significance was set at p&lt;0.05. Results: This meta-analysis included five RCTs with 2190 severe aortic stenosis patients (1097 in the BEV group and 3621 in the SEV group). BEV-TAVR was associated with a significantly lower risk of 30-day new permanent pacemaker (PPM) implantation [OR: 0.67; 95% CI: 0.48, 0.93; p=0.02] and 30-day re-hospitalization for heart failure [OR: 0.20; 95% CI: 0.04, 0.96; p=0.04] compared to SEV-TAVR. The risks of 30-day mortality, 30-day cardiac mortality, 30-day all-cause stroke, 30-day myocardial infarction, 30-day life-threatening bleeding, 30-day vascular complications, 30-day acute kidney injury, and 30-day repeat procedures for valve-related dysfunction were comparable between the two groups. Conclusion: TAVR in patients with severe aortic stenosis using BEV is advantageous over SEV in terms of 30-day new PPM implantation and 30-day rehospitalization for heart failure, with comparable risks for other outcomes. These findings underscore the safety and efficacy of newer generation valves, including Sapien 3 and EvolutPro, in TAVR. The choice of prosthetic aortic valve is dependent on individual anatomy and operator preference. Further RCTs are warranted to evaluate other newer-generation valves with varying severities of aortic stenosis.
Abstract 4136813: Redox Serum Proteomics Of Left Ventricular Assist Device Unloaded Human Heart
Authors: Sarah Halawa, Consuelo Marin-Vicente, Ayman M. Ibrahim, Dr. Kerolos Wagdy, Saifullah Soliman, Besra Samy, Peter Selwanos, hadeer khedr, SABER MOSTAFA MOSTAFA, Kerollos Samaan, Enrique Calvo, Youssef M. El Bayoumy, Amany Ellithy, Miguel Torres, Jesus Vazquez, Yasmine Aguib, Magdi Yacoub
Journal: Circulation (2024)

Heart failure (HF) is a global epidemic claiming millions of lives worldwide. Unloading the heart of end-stage HF patients via left ventricular assist devices (LVADs) is used not only as a bridge to transplantation but also as a bridge to recovery in certain selected patients. To date, assessment of patients’ recovery from HF is based on clinical and symptomatic evaluation. The use of non-invasive biomarkers that monitor the remodeling/reverse remodeling associated with HF progression/recovery is still lacking. In this study we applied mass spectrometry-based quantitative redox proteomics to identify serum biomarkers to monitor both the progression of HF and its recovery after LVAD treatment. A fingerprint of reversed behavior at the protein and at the oxidized Cys peptide level has been discovered when comparing HF and LVAD patients. HDL proteins related to lipid metabolism were decreased in HF samples and increased in LVAD patients. In addition, a number of inflammatory proteins showed a decrease in LVAD samples and an increase in HF samples. In particular APOA4, C7, F2 or SAA2 discriminated between HF and LVAD patients. A pool of peptides containing specific oxidized Cys residues showed an inverse relationship in HF as opposed to LVAD samples. Oxidized Cys-containing peptides derived from Albumin, IGK and IGG1 discriminated HF from LVAD samples. Discriminatory sensitivity and specificity were enhanced by using a combination of the proteins APOA4, C7, F2 and the above-mentioned peptide derived from Albumin. Responders and non-responders could also be separated by proteins such as APOA4, and Cys-oxidized peptides, such as the ones derived from Albumin or IGK mentioned above. This is the first study to apply redox proteomics to explore the protein profile of the LVAD unloaded human heart. These data suggest that HDL plays an important role in LVAD recovery and that a specific group of peptides is associated with the recovery process; the mechanisms involved need further study. Our data could have important implications to the management of patients in the LVAD recovery program and could serve to identify new therapeutic targets.
Abstract 4136643: Automated cardiac arrest detection using a photoplethysmography wristband: Evaluation of the time to detection of the circulatory arrest event
Authors: Roos Edgar, Niels Scholte, Kambiz Ebrahimkheil, Marc Brouwer, Rypko Beukema, Masih Mafi-Rad, Kevin Vernooy, Sing Yap, Eelko Ronner, Nicolas Van Mieghem, Eric Boersma, Aysun Cetinyurek-Yavuz, Peter Stas, Niels Royen, Judith Bonnes
Journal: Circulation (2024)

Introduction: Out-of-hospital cardiac arrest survival depends on immediate recognition and early cardiopulmonary resuscitation. For victims of unwitnessed cardiac arrest, accounting for 30-50% of cases worldwide, survival chances are dismal as help often comes too late. Automated cardiac arrest detection and alarming would offer a solution to shorten treatment delays. Within the DETECT project, a wristband with the functionality of automated cardiac arrest detection is developed. During the DETECT-1 study, we developed a photoplethysmography (PPG) algorithm to detect circulatory arrest in patients with induced circulatory arrest. Research question: In this sub analysis of the DETECT-1 study, we aim to study the delay between the actual circulatory arrest and the algorithms’ cardiac arrest alarm. Methods: Patients undergoing circulatory arrest induction during transcatheter aortic valve implantation (TAVI), subcutaneous ICD (S-ICD) implantation or ventricular tachycardia (VT) ablation wore a PPG wristband. Continuous ECG and arterial blood pressure data were collected as reference standard. PPG data were used to develop a circulatory arrest detection algorithm in three training iterations and one validation. Time to detection was defined as the difference between the algorithm’s cardiac arrest alarm and the circulatory arrest annotated based on the arterial blood pressure data. Results: The validation set consisted of 86 patients (77 TAVI, 3 S-ICD, 6 VT ablation) with 97 induced circulatory arrest events of which 95 were correctly identified by the algorithm (sensitivity 97% [95% CI 90-100%]). The median time to circulatory arrest detection was -1 second (IQR -2 – 0). In total, 50 (53%) events were detected before the annotated time (median; -1 sec), 33 (35%) events were detected at t=0, and 12 (13%) events were detected after the annotation (median; +2 sec). A total of 65 (68%) induced circulatory arrest events were detected within one second before and after the annotated start time of the circulatory arrest. Return of PPG pulsations were detected in all patients, with a median of 4 seconds (IQR 3 – 7) after pulsations returned (Figure 1 and 2). There were no differences in detection time between the three subgroups. Conclusion: The PPG algorithm detects the induced circulatory arrest events directly when blood pressure lowers. Further research is needed to validate the circulatory arrest detection algorithm and detection interval in spontaneous cardiac arrest.