tbuckley/cabot-search huggingface dataset:
Abstract 15772: From Agony to Relief: Overcoming Angina Through Endovascular Coiling of the Left Internal Mammary Artery (LIMA) to Pulmonary Artery (PA) Fistulae- A Case Report
Authors: Jake M Kieserman, Stephanie Colello, Paul Fiorilli
Journal: Circulation (2023)

Introduction: LIMA to PA fistulae are a rare complication after coronary artery bypass graft (CABG) surgery. We present a patient with angina secondary to a steal syndrome from LIMA-PA fistulae, treated with endovascular coiling. Case: The patient is a 49-year-old active male with coronary artery disease, status post CABG at age 46 with a LIMA graft to the left anterior descending artery, radial artery graft to the first obtuse marginal artery, and saphenous venous graft (SVG) to the posterior descending artery. At age 48, he developed angina and underwent stent placement to the distal right coronary artery after the SVG was found to be occluded. Several months later, he reported dyspnea and chest pain on exertion. An exercise nuclear stress test showed abnormal myocardial perfusion in the anteroseptal region, and he was referred for left heart catheterization (LHC). LHC revealed unchanged native coronary disease, patent LIMA, and a network of collateral vessels from the LIMA feeding into the pulmonary vasculature (Figure 1). The collaterals were not seen on LHC 9 months prior. CT coronary angiography confirmed multiple fistulae originating from the superior aspect of the LIMA graft communicating with the PA (Figure 1). After a multidisciplinary, patient-centered, heart team discussion, he underwent successful endovascular coiling of the collateral branches (Figure 2). Discussion: LIMA-PA fistulae is a rare cause of angina and there is a paucity of literature on management. To our knowledge, coil embolization has been described in roughly 10 cases. Here, we present a successful case of endovascular coiling of collateral vessels leading to symptomatic improvement.
Abstract 17124: Comparative Outcomes of Below-the-Knee Atherectomy Interventions: A Report From the XLPAD Registry
Authors: Sarah Weideman, David Fernandez Vazquez, Blake Bruneman, Aravinda Nanjundappa, Christopher Metzger, sameh sayfo, Zachary Rosol, Shirling Tsai, Mehdi H Shishehbor, Subhash Banerjee
Journal: Circulation (2023)

Background: Atherectomy devices are used during below-the-knee (BTK) artery interventions to tackle the calcium burden in peripheral arteries. Methods: We examined 1542 patients from the XLPAD Registry (NCT01904851) from 2006-2021 who underwent BTK endovascular intervention, stratified by use of atherectomy device or not. The primary outcome was the incidence of major adverse limb events (MALE), a composite of all-cause death, clinically driven revascularization, amputation, non-fatal myocardial infarction (MI), and stroke. Results: 710 (46%) patients were treated with an atherectomy device and 832 were not. Mean age 68 years, predominantly male (72%) and Caucasian (58%). Cardiovascular risk factors were equally distributed among both groups, except hyperlipidemia was more prevalent in the atherectomy group (83% vs. 78%, p=0.01). Both groups had similar Ankle-Brachial Indexes. Atherectomy group had more multivessel interventions (2.5 vs 1.9 lesions per case, p&lt;0.001) and SFA (54% vs. 38%, p&lt;0.001) and popliteal artery (31% vs. 26%, p&lt;0.001). Exclusive BTK interventions were evenly distributed between the groups. Atherectomy patients had greater calcification burden (32% vs 21%, p&lt;0.001), diffuse disease (58% vs. 47%, p&lt;0.001) and in-stent restenosis (9% vs. 4%, p&lt;0.001). Stents and conventional balloon use were evenly distributed, but atherectomy patients received more drug-coated balloon treatments (10% vs 7%, p=0.04). Fluoroscopy time was longer in atherectomy group (33 min vs. 30 min, p= 0.04) with higher rates of procedural (94% vs. 91%, p=0.01) and technical success (98% vs. 93%, p&lt;0.001). Only 30-day rate of amputation was higher among non-atherectomy patients (2% vs. 6%, p&lt;0.001). There were no differences in the MALE (24% vs. 22%, p=NS), only surgical revascularization at 12-month follow-up more frequent in the non-atherectomy group (1% vs. 2%, p=0.01). Conclusion: Atherectomy use is high at 46% of all BTK artery interventions in the XLPAD Registry with higher technical success than non-atherectomy interventions without differences in MALE events at 12-month follow-up.
Abstract 13571: Endothelial Jagged1 in Vascular Calcification Induced by Chronic Kidney Disease
Authors: Qunying Guo, Tae Hoon Lee, Ming Liang, Fengzhang Huang, Truong Truong, William E Mitch, Jizhong Cheng
Journal: Circulation (2023)

Introduction: Chronic kidney disease (CKD)-induced vascular calcification (VC) is a dire complication with high incidence, while its pathogenesis has not been fully elucidated. Hypothesis: We hypothesized that endothelial Jagged1 prevents vascular smooth muscle cell from osteoblast trans-differentiation thus alleviates CKD induced vascular calcification. Methods: We have generated a CKD mouse model by 5/6 nephrectomy followed by high phosphate diet (HPiD). CKD-induced VC were determined in Jagged1 EC specific KO and Notch3 KO mice. Co-culture of EC with vascular muscle cells (VSMCs) was performed to study the mechanism. Results: Endothelial Jagged1 expression was decreased in calcified arteries from CKD patients vs . normal arteries. Knockout of EC Jagged1 significantly induced artery calcification and decreased the mice survival rate vs. WT CKD mice. There was decreased expression of VSMC contractile markers and Notch3, and increased expression of ossification markers in calcified arteries from endothelial Jagged1 KO CKD mice. Furthermore, overexpression of EC Jagged1 significantly prevented artery calcification. In EC Jag1 OE /Notch3 KO CKD mice, KO Notch3 partially blocked the protective effects on VC by Jag1 OE. In co-culture experiments, KO of Jagged1 in ECs enhanced transdifferentiation of VSMCs into osteoblast cells after high-phosphate (HPi) treatment, while overexpression of Notch3 alleviated calcium deposition induced by HPi. Silencing Hes1 in VSMC led to remarkably increased Runx2 expression and more severe calcification in response to HPi treatment. Conclusions: Jagged1 expression in ECs controls CKD-induced VC. Down-regulation of EC Jagged1 impairs VSMC Notch3 activation, thus induces VSMC transdifferentiation and VC through Notch target Hes1.
Abstract 14437: Incidence and Inpatient Outcomes of Takutsubo Cardiomyopathy in the United States- An Analysis of the National Inpatient Sample
Authors: Emily P Hiltner, John Kassotis, Ankur Sethi
Journal: Circulation (2023)

Introduction: Takutsubo cardiomyopathy (TC) has been increasingly recognized as an acute cardiac syndrome characterized by typical wall motion abnormality patterns in the absence of epicardial coronary artery disease. It is unknown whether the incidence and mortality of this entity as characterized by race and gender have changed in recent years. Methods: The National Inpatient database (2009-19) was used to study trends in admissions and outcomes of TC over time. Survey estimation commands were used to determine weighted national estimates. Results: During the study period, the estimated incidence rate (IR) per million of hospital admissions for TC was found to increase with age and was higher for women than men in all age distributions (p&lt;0.001). The increase in incidence continued well into older age groups, including patients 85 years and older (Figure). Men with TC were found to have higher rates of in-hospital mortality as compared to women (13.7% vs 7.4%, respectively), however there was no difference in in-hospital mortality when compared by race in both women and men (p=0.376 and p=0.406, respectively). Conclusions: The incidence of TC has increased in both men and women of all races during the study period. There was no difference in in-hospital mortality amongst the different races, however men had higher in-hospital mortality when compared to women.
Abstract 13043: LDL-C, Lp(a) and Hs-CRP Each Predict Future Cardiovascular Events After ACS on High-Intensity Statin Therapy. An Analysis of the ODYSSEY OUTCOMES Trial
Authors: Philippe G Steg, Michael Szarek, J W Jukema, Deepak L Bhatt, Vera A Bittner, Rafael Diaz, Sergio fazio, Genevieve Garon, Shaun G Goodman, Robert A Harrington, Harvey D White, Andreas M Zeiher
Journal: Circulation (2023)

Background: Atherosclerotic cardiovascular disease (ASCVD) risk has been jointly associated with levels of LDL cholesterol (LDL-C), lipoprotein [Lp](a)] and the inflammatory marker high-sensitivity C reactive protein (hsCRP). It is unclear whether and to what extent each of these biomarkers predict ASCVD risk after acute coronary syndrome (ACS), particularly in the era of intensive LDL-C lowering. Recent analysis of 3 trials in stable ASCVD patients with hypertriglyceridemia suggested that hsCRP may be a stronger predictor for recurrent events than LDL-C; however, only 52% received high-intensity statin. Methods: The ODYSSEY OUTCOMES trial enrolled post-ACS patients not at goal for atherogenic lipoproteins a median of 2.6 months after ACS and on treatment with maximum tolerated (89% high-intensity) atorvastatin or rosuvastatin. Absolute risk of major adverse cardiovascular events (MACE, the primary composite outcome of coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke or unstable angina hospitalization) and all-cause death were analyzed as a function of baseline LDL-C, hs-CRP, and Lp(a) values in patients randomized to the placebo arm via natural cubic splines from Poisson regression models, adjusted for age, sex, diabetes, BMI, current smoking, and the other 2 predictor variables. Results: Among 9149 evaluable patients, median (Q1-Q3) LDL-C, hsCRP, and Lp(a) were 81 (71-97) mg/dL, 1.7 (0.8-3.9) mg/L, and 21.4 (6.6-60.1) mg/dL, respectively. For each parameter, a higher baseline value was associated with a substantial increase in risk of MACE ( Figure , all spline p&lt;0.0001). LDL-C and hsCRP were associated with all-cause death (p&lt;0.0001), but not Lp(a) (p&gt;0.05). Conclusion: In ACS patients receiving intensive statin therapy and not at goal for atherogenic lipoproteins, LDL-C, hs-CRP, and Lp(a) were independent predictors of MACE. LDL-C and hsCRP were independent predictors of all-cause death.
Abstract 18897: Safety and Efficacy of Coronary Intravascular Lithotripsy for Percutaneous Coronary Intervention of Severely Calcified Left Main Stenosis
Authors: Sanya Chhikara, Mahesh N Kumar, Abhinav Shrivastava, Ankush Gupta
Journal: Circulation (2023)

Introduction: Coronary Intravascular Lithotripsy has been shown to be a safe and effective modality for the modification of non-left main calcific stenosis. This study was done to evaluate the safety and efficacy of IVL during percutaneous coronary intervention (PCI) of severely calcified left main (LM) bifurcation disease. Methods: This was a prospective, single-arm observational study in which 22 patients with significant calcific LM bifurcation disease undergoing angioplasty were enrolled. Pre and Post-IVL Optical coherence tomography (OCT) was done in all patients as an imaging modality. The primary safety end-point was peri-procedure complications and freedom from major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal MI, and target vessel revascularization at 30 days, and the primary efficacy endpoint was stent expansion of more than 80% in stratified stented segment. The secondary efficacy endpoint was mean stent area more than the accepted target value of 5.0 mm 2 , 6.3 mm 2 , and 8.2 mm 2 for the ostial LCX, ostial LAD, and distal LM, respectively. Results: 15 (68.2%) patients underwent LM bifurcation angioplasty using provisional strategy and 7(31.81%) using upfront two stent strategy (DKC 22.7% &amp; TAP 9.1%). A total of 55 Ca lesions were modified using one IVL per patient with a mean size of 3.38 ± 0.40mm. Stent expansion at LM was 95.64±5.89%, left anterior descending (LAD) was 87.20±6.81% and left circumflex (LCx) was 85.56±5.89%. The primary efficacy endpoint of more than 80% stent expansion was noticed in all LM segments (22/22), 18/20 (90%) LAD segments, and 9/9 LCX segments. The primary safety endpoints were met in 21 (95.45%) patients undergoing IVL-assisted distal LM bifurcation angioplasty. Target MSAs were achieved in all 22 (100%) of all IVL-treated segments, and stent apposition was achieved in 21 (95%) of all stented segments. No perforation (0%) or slow/no flow (0%) were observed, while minor 3 (13.6%) and major dissections 3 (13.6%) were seen. None of the major dissections were flow-limiting. Conclusions: IVL appears to be a safe and effective device for percutaneous coronary intervention of severely calcific LM disease with a high success rate.
Abstract 14455: Impact of Computer-Interpreted ECGs on the Accuracy of Medical Professionals
Authors: Anthony H Kashou, Peter A Noseworthy, Thomas Beckman, Nandan S Anavekar, Michael W Cullen, Kurt Angstman, Benjamin Sandefur, Brian P Shapiro, Brandon Wiley, Andrew Kates, david Huneycutt, Andrew Braisted, John Beard, Scott Kerwin, Brian Young, Ian Rowlandson, Adrian Baranchuk, Kevin O'Brien, Stephen Knohl, Adam May
Journal: Circulation (2023)

Background: The impact of computer ECG interpretation (CEI) on medical professionals’ performance is understudied. This study aims to assess the interpretation proficiency of diverse medical professionals with and without access to CEI reports. Methods: Medical professionals from diverse backgrounds interpreted 60 12-lead ECGs with urgent and non-urgent findings. The interpretation process involved two interpretation phases: (i) 30 ECGs with clinical statements and (ii) the same 30 ECGs and clinical statements in random order along with a CEI report. Diagnostic performance was evaluated based on interpretation accuracy, time per ECG, and self-reported confidence (rated 0 [not confident], 1 [somewhat confident], or 2 [confident]). Results: Among 892 participants, there were 44 (4.9%) primary care physicians, 123 (13.8%) cardiology fellows-in-training, 259 (29.0%) resident physicians, 137 (15.4%) medical students, 56 (6.3%) advanced practice providers, 82 (9.2%) nurses, and 191 (21.4%) allied health professionals. The inclusion of the CEI significantly improved interpretation accuracy by 15.1% (95% CI, 14.3 to 16.0; P&lt;0.001), reduced interpretation time by 52 seconds (95% CI, -56 to -48; P&lt;0.001), and increased confidence by 0.06 (95% CI, 0.03 to 0.09; P=0.003) (Table 1) . Conclusions: CEI integration improves ECG interpretation accuracy, efficiency, and confidence across medical professionals. Nevertheless, even with CEI, significant gaps in ECG interpretation proficiency remain.
Abstract 17128: Detection of Hypertrophic Cardiomyopathy From Noisy Single-Lead Electrocardiography
Authors: Akshay Khunte, Arya Aminorroaya, Lovedeep S Dhingra, Veer Sangha, Evangelos K Oikonomou, Sounok Sen, Harlan M Krumholz, Christopher M Kramer, Milind Y Desai, Rohan Khera
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death among young people and be detected from ECGs using artificial intelligence. Wearable devices could allow for broad AI-based screening but obtain noisy ECGs. We report the development of a wearable-adapted AI-ECG model that retains performance for detecting HCM in noisy single-lead ECGs. Methods: In 11,883 ECGs obtained within 30 days of transthoracic echocardiograms from Yale New Haven Hospital (2015-2021), we defined HCM as interventricular septal wall thickness (end diastole) (IVSd) &gt; 15 mm and moderate to severe left ventricular diastolic dysfunction (LVDD). Standard and noise-adapted models were trained using a 1:10 age-sex matched dataset. For the noise-adapted model, each ECG was included four times in the training set, augmented each time with random gaussian noise within four distinct frequency ranges emulating different real-world noise sources. We evaluated the performance of the noise-adapted and standard models on an independent set of ECGs with four different real-world noisy artifacts, including noise extracted from a portable device ECG, at multiple signal-to-noise ratios (SNRs). Results: In single-lead ECGs without noise, the noise-adapted model outperformed the standard model, with an AUROC of 0.920 and 0.906, respectively for HCM. With the same ECGs augmented with noise ranging from half (SNR 2) to twice (SNR 0.5) the signal, the noise-adapted model maintained their performance across real-world noise signatures (A). At an SNR of 0.5, the noise adapted model had a significantly greater performance in detecting HCM in ECGs augmented with portable device ECG noise (AUROC 0.917 [0.861-0.974] vs 0.609 [0.398, 0.821]) (B). Conclusions: We developed a model which accurately screens for HCM in noisy single-lead ECGs. This approach represents a more accessible and scalable method for screening for HCM using wearable device ECGs.
Abstract 14201: Double the Trouble: Extremely Rare Incidental Finding of a Double Interatrial Septum With Atrial Septal Aneurysm and Coexisting Patent Foramen Ovale
Authors: Vishnu Bharani, Kevin Tang, Kavin Krishnam, Deniz Urgun, Ali Naqvi
Journal: Circulation (2023)

Case: A 59-year-old&amp;nbsp;female with a past medical history of hypothyroidism and IgG deficiency presents to cardiology clinic due to palpitations and premature ventricular complexes (PVCs) noted at a recent urgent care visit. In-office vitals, physical exam, labs, and EKG were unremarkable. Ambulatory cardiac monitoring showed predominantly sinus rhythm with a PVC burden of 1.4%. Echocardiogram revealed an extremely rare structural anomaly – a double interatrial septum (DIAS) with atrial septal aneurysm. Cardiac MRI (cMRI) further confirmed the presence of a DIAS enclosing an interatrial space, along with blood flow within the interatrial space and a discontinuity in the anterior right lateral atrial septum suggestive of a patent foramen ovale (PFO). There was no evidence of thrombus within the interatrial or intracardiac spaces. Mild right atrial enlargement was seen. The patient was initiated on aspirin for cardioembolic stroke prophylaxis. Discussion: DIAS is a highly rare congenital cardiac anomaly with limited number of cases in literature. It has been described as a midline third atrium resulting in a “tri-atrial heart”. As of 2018, less than 20 cases have been cited. DIAS is characterized by two parallel interatrial septa along with a clear echo lucent midline space that expands in systole and collapses in diastole. This case is unique as it is one of the few to include additional characterization with cMRI. Patients with DIAS are usually asymptomatic but can experience cardioembolic events as the interatrial space is at risk for thrombus formation. Communication across the DIAS makes these events more likely. Unlike with atrial fibrillation/flutter, no current criteria for anticoagulation (AC) initiation exists for DIAS given the scarcity of cases. While some sources advocate for use of anti-platelet agents, others have indicated a preference for oral AC. Our patient had an interatrial space and a PFO but lacked communication across the DIAS, had low bleeding risk, and no other classic risk factors of Virchow’s triad. We determined her risk for thrombus formation to be relatively low, and thus initiated her on aspirin over oral AC. Percutaneous closure of the interatrial space was deferred as it has been dismissed as a viable treatment option in the literature.
Abstract 14306: Immune Function Assay by Race/Ethnicity Within the First Year After Heart Transplantation
Authors: Kayvon Ghoreshi, Lauren K Truby, Justin L Grodin, Sonia Garg, Maryjane Farr, Nicholas Hendren
Journal: Circulation (2023)

Introduction: The immune function assay (IFA) is used in transplant recipients to measure the degree of lymphocyte-mediated cell immunity. Values &lt;225 ng/mL are associated with an increased risk of infection and it is uncertain if race/ethnicity associates with differences in IFA values after heart transplantation. We tested the association between ethnicity/race with IFA results for heart transplant recipients for the first year after transplantation. Methods: A single-center cohort study of consecutive heart transplant recipients from 1/1/2014-8/31/2022 with an IFA obtained within 30-days prior to heart transplant and &gt; 1 assay within the first year afterwards. We described the change of IFA in 90-day increments by self-reported race/ethnicity. Multivariable logistic regression models tested the association of patient-level clinical factors (age, sex, race, ethnicity, BMI, creatinine) with IFA values &lt;225 ng/mL. Results: In the cohort, (121/315) (38%) had an IFA within 30-days prior to heart transplant. Most patients were white (46%), and male (74%). All groups had decreases in IFA value post-transplant. White non-Hispanic patients had changes of -64, -131, -143, and -107 in IFA, respectively. White Hispanic patients had changes of -117, -119, -58, and -72. Asian patients had changes of -250, -241, -102, and -260. Black patients had changes of -95, -87, -118, and -113. Black patients had the greatest prevalence of an immune assay &lt;225 ng/mL during days 270-360 after transplantation. White non-Hispanic, White Hispanic, and Asian patients had the greatest prevalence of an IFA &lt;225 ng/mL 90-180 days after transplantation. In our adjusted models, race was not associated with IFA values &lt;225 ng/mL during any quarter within the first year after transplant (P &gt;0.05). Conclusion: In this small study, non-white heart transplant patients on average had lower IFA values over the first-year post-transplant compared with white non-hispanic patients.
Abstract 14618: Comparative Outcomes of Elective Endovascular Abdominal Aortic Aneurysm Repair in Patients With Preoperative Cardiac Stress Testing
Authors: Joshua J Huttler, Yasser Jamil, Paula Pinto Rodriguez, Martin Slade, edouard aboian, Jesse A Columbo, Albert J Sinusas, Eric J Velazquez, Raul J Guzman, Cassius I Ochoa
Journal: Circulation (2023)

Introduction: The use of cardiac stress testing (CST) before endovascular abdominal aortic aneurysm (EVAR) repair is controversial. While prior research has explored the utility of CST before EVAR, EVAR outcomes in patients with different CST results have not been studied. The objective of this study is to evaluate EVAR outcomes in patients with abnormal CST. Hypothesis: Patients with abnormal CST before EVAR have inferior outcomes compared to patients with normal CST. Methods: The Vascular Quality Initiative (VQI) database for EVAR was reviewed. Patients who underwent CST prior to elective EVAR were included. In VQI, abnormal CST is defined as having ischemia, infarction, or both ischemia and infarction (BII). Outcomes of patients with normal and abnormal CST were compared, including a subgroup analysis of CST abnormalities. Results: A total of 19,964 patients were included and 23.7% (4,723) had abnormal CST. Patients with abnormal CST were more commonly males with comorbidities. Patients with abnormal CST had significantly more perioperative complications including MACE and one-year mortality compared to patients with normal CST. ( Table ) Regression analysis revealed that abnormal CST was independently associated with increased perioperative MACE (OR=1.59 [1.28-1.97]) and one-year mortality (HR=1.11 [1.00-1.23]). Subgroup analysis of patients with abnormal CST showed that patients with BII had significantly more perioperative MACE (6.8% vs 4.1%, P =0.002) and mortality (1.1% vs 0.4%, P =0.040) compared to patients with either ischemia or infarction. BII was independently associated with MACE (OR=1.62 [1.06-2.41]) and 30-day mortality (OR=3.28 [1.21-8.16]) compared to either abnormality. Conclusions: Patients with abnormal CST have worse outcomes after elective EVAR compared to patients with normal CST, particularly patients with BII. CST is a useful tool for perioperative and long-term risk stratification in patients undergoing elective EVAR.