tbuckley/cabot-search huggingface dataset:
Abstract 17474: Factors Affecting Cognitive Status in Patients With Intracranial Atherosclerosis After Surgical Revascularization: A Post Hoc Analysis of ERSIAS Phase-2 Performance Criterion (PC) Trial
Authors: Maria Paula Aguilera-Pena, Miguel Tusa Lavieri, Miguel D Quintero Consuegra, Shlee S Song, Konrad Schlick, Jennifer Harris, Alexis Simpkins, Daniel Chang, Peyton Nisson, Jeffrey L Saver, Nestor R Gonzalez
Journal: Circulation (2023)

Introduction: Cognitive decline affects a large proportion of patients with ischemic stroke. Intracranial atherosclerotic disease (ICAD) is a common stroke etiology associated with a high and prolonged risk of recurrence. In the ERSIAS phase-II trial, patients with symptomatic ICAD received revascularization with encephaloduroarteriosynangiosis (EDAS) plus intensive medical management (IMM) of stroke risk factors. We present a subgroup analysis of features affecting cognitive outcomes. Hypothesis: To evaluate the factors contributing to cognitive decline in patients who underwent revascularization for symptomatic ICAD. Methods: ERSIAS patients without aphasia that completed at least one year of follow-up were included. Cognitive status was evaluated using MoCA at baseline and each follow-up and classified as improved/preserved vs. worsened. Classification and Regression Tree Analysis (CART) was used to identify factors associated with changes in cognitive function. Factors considered were age, sex, stenosis vs. occlusion, baseline-mRS, good collateralization and compliance with diabetes (DM) hypertension (HTN), and hyperlipidemia (HLD) treatments. Results: In ERSIAS, the mean MoCA at baseline was 22.4 (SD 4.9), and 23.9 (SD 4.9) at one-year follow-up in the complete population. Thirty-nine patients were included in this analysis. Median age was 46 (IQR 37.0-56.0), and 27 (69.2%) were female. MoCA improved or remained stable in 33 (84.6%) patients and declined in 6 (15.4%). CART analysis revealed that the most relevant factors for improved MoCA were compliance with DM treatment (94.5%(yes) vs.74.2%(no) p=0.02) HLD treatment (83.3% (yes) 60.5%(no) p=0.2) and stenosis 99.1% vs. occlusion 80.9%, p=0.6 Other factors where not found to be contributory. Conclusions: Compliance with DM treatment is a significant predictor of cognitive preservation in symptomatic ICAD patients. Our findings emphasize the importance of IMM of stroke risk factors in patients with intracranial atherosclerosis, even after surgical revascularization.
Abstract 18486: Recurrent Pericarditis Following Atrial Fibrillation Ablation: Unmasking Latent Tuberculosis Infection
Authors: Ritu Yadav, Sunil K Sinha
Journal: Circulation (2023)

Background: Tuberculous pericarditis is rare in the United States but can lead to serious sequelae in the absence of diagnosis and treatment. We report a case of recurrent pericarditis following catheter ablation of atrial fibrillation (AF) due to reactivation of latent TB infection. Case Summary: A 52-year-old male with no past medical history underwent a difficult trans-septal puncture &amp; cryo-balloon PV isolation, complicated by acute pericarditis and pericardial effusion with cardiac tamponade. He underwent pericardiocentesis with removal of 260cc bloody fluid. He had resolution of chest pain with ibuprofen, but experienced recurrence after 3 months and was given a longer NSAID course. Two months later, he presented with chest pain along with night sweats &amp; low-grade fever. He had an elevated C-reactive protein, and echocardiography revealed thickened pericardium &amp; constrictive physiology. He received high-dose aspirin, prednisone, and colchicine for recurrent pericarditis. Extensive Infectious Disease &amp; Rheumatology work-up ruled out autoimmune &amp; viral etiologies but his T-Spot TB test was positive. He denied personal or contact history of TB except travel to Asia 20 years ago. CT scan ruled out pulmonary TB infection. A 6-month course of Rifampin was prescribed. He experienced a 4th episode of pericarditis while tapering off prednisone, and restarted prednisone, Ibuprofen, and colchicine. Additionally, Rilonacept was prescribed. After completing 6-months of Rifampin and Rilonacept, he had significant improvement and no further recurrences on 1 year follow up. Discussion: Pericarditis is a common complication of catheter ablation, often resulting from direct injury. We report a case of recurrent pericarditis, initially believed to be a traumatic complication of AF ablation. However, investigation revealed underlying latent pericardial TB infection. Appropriate treatment led to complete resolution without sequelae.
Abstract 13969: Etiology-Specific Prevalence of Heart Failure: A Systematic Analysis of the Global Burden of Disease Study 2021
Authors: Catherine O Johnson, Henry Dorsey, Nikki DeCleene, Christian A Razo Garcia, Renee Wong, George A Mensah, Gregory A Roth
Journal: Circulation (2023)

Background: While heart failure (HF) is a common disease worldwide with high health care costs and disease burden, the underlying causes vary widely by location. Estimates of how etiologies of HF vary globally will support clinical and public health practice, research, and related capacity building. Research Question and Goals: To provide, current, consistent and comparable estimates of etiology-specific HF prevalence as part of the Global Burden of Disease (GBD) Study 2021. Methods: We included all available population-representative data on prevalence, incidence, and mortality to estimate HF prevalence using DisMod-MR, a Bayesian geospatial model. We then estimated the proportion of HF due to each of 27 underlying etiologies using cause-specific mortality estimates, individual-level vital registration records with multiple cause of death information, and linked hospital-mortality data. These proportions were then multiplied by the estimates of HF prevalence to generate estimates of etiology-specific HF burden for all countries. Results: HF etiologies varied widely across the the seven GBD super-regions. Ischemic heart disease (IHD) was the most common underlying cause in all super regions except for Sub-Saharan Africa where hypertensive heart disease was the most common (Figure). Age-standardized prevalence of HF due to IHD ranged from 77.51 to 306.25 per 100,000 (Table). Conclusion: While IHD was the most common underlying cause of HF for most locations in 2021, there was substantial variability by location. Improved understanding of HF etiologies could guide tailored clinical and public health practice and research.
Abstract 15872: Development and External Validation of a De Novo Simulation Model to Inform Implementation Strategies for Guideline-Directed Medical Therapy of Heart Failure With Reduced Ejection Fraction
Authors: Julia H Foote, Ambarish Pandey, Anubha Agarwal, Brandon K Bellows, Colette DeJong, Priscilla Y Hsue, Dhruv S Kazi
Journal: Circulation (2023)

Introduction Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) includes four medication classes and improves survival. However, uptake and adherence to GDMT remain low. Simulation models to project long-term benefits can inform ongoing trials of GDMT implementation strategies (such as a polypill). As such, we sought to develop and validate a mathematical model of HFrEF and GDMT treatment. Methods We developed a state-transition, Markov model to simulate hospitalizations, urgent care visits, and cardiovascular and non-cardiovascular death among patients with HFrEF on 0, 2, 3, and 4 GDMT drugs. Input parameters were derived from trials, epidemiologic cohorts, national surveys, and published literature. External validation compared model-projected all-cause mortality with data from the Seattle-HF model and three major HFrEF trials (eplerenone in EMPHASIS-HF, sacubitril/valsartan in PARADIGM-HF, and dapagliflozin in DAPA-HF). Goodness-of-fit was assessed by root-mean-square-error (RMSE), with RMSE ≤ 5.0 considered to be a good fit. Results In external validation, the model accurately replicated 5-year survival curves from the Seattle-HF model among treatment-naïve patients age 65 years (RMSE 1.9), 75 years (RMSE 1.2), and 85 years (RMSE 1.9). Model projections demonstrated good fit among individuals on various combinations of GDMT, with RMSE 0.6-2.8 across all combinations tested (Figure). For a 65-year-old with HFrEF, our model projected a mean survival of 6.3 years without GDMT, increased by 2.5 years on 2-drug, 3.4 years on 3-drug, and 4.7 years on 4-drug GDMT. Conclusion Our model replicated survival outcomes with GDMT in HFrEF and demonstrated improved survival associated with more classes of GDMT. Future work will project the long-term health and economic impacts of implementation strategies to improve GDMT uptake and adherence, incorporating healthcare costs and quality-of-life measures.
Abstract 15039: Procedural and Cardiovascular Outcomes of Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Artery Lesions: A Systematic Review and Meta-Analysis
Authors: Tenzing T Thondup, Jeet Upadhyay, Shaun Khanna, Sabrina Naz, Aditya Bhat
Journal: Circulation (2023)

Introduction: Calcified coronary lesions (CCL) are associated with higher peri-procedural complications and long-term morbidity and mortality. Treatment of CCL require preparation prior to stenting, with rotational atherectomy (RA) and intravascular lithotripsy (IVL) frequently utilized for lesion preparation. There are limited comparative studies assessing procedural and cardiovascular endpoints between RA and IVL. This meta-analysis will compare procedural and cardiovascular outcomes in patients undergoing RA versus IVL. Hypothesis: We hypothesize that there are no significant differences in major cardiovascular outcomes between RA and IVL, however differences in procedural parameters may be present. Methodology: A systematic literature search of medical databases using PRISMA principles identified all relevant studies comparing RA vs IVL in CCL (PROSPERO CRD42023411701). Data for all variables were extracted and those with low heterogeneity were then meta-analyzed using a random-effect model for odds ratios (OR) or standardized mean differences (SMD). Primary outcomes assessed were of major adverse cardiovascular events (MACE) and death, whilst secondary outcomes were procedural parameters and complications. Results: 170 studies were screened, of which 4 peer-reviewed articles and 3 abstracts fulfilled criteria for inclusion. Abstracts were included to increase power. No significant between group differences were observed in contrast volume, coronary dissections and perforations, slow or no-reflow, in-hospital MACE and cardiovascular (CV) death, as well as follow-up stent thrombosis and primary CV outcomes. Of note, IVL had shorter fluoroscopy times (SMD 0.560; p&lt;0.001) and greater use of intracoronary imaging guidance (OR 0.295; p=0.007). Conclusion: No significant differences in major cardiovascular outcomes were found between RA and IVL in treatment of CCL, however differences in procedural parameters were appreciated.
Abstract 14817: Influence of Timing of Mechanical Thrombectomy in Treatment of Intermediate-Risk Pulmonary Embolism
Authors: Caleb J Chiang, Jason Bartos, Alejandra Gutierrez
Journal: Circulation (2023)

Background: Acute pulmonary embolism (PE) is associated with significant morality. Patients with signs of right ventricular (RV) dysfunction are at a high risk of adverse events. Mechanical thrombectomy reduces RV strain and therefore is often performed in intermediate-risk PE. The optimal timing of the procedure is uncertain. We aimed to assess the influence of timing of mechanical thrombectomy on outcomes in patients with intermediate-risk PE. Methods: A single-center, retrospective study collected patient data between 7/2020 and 1/2023. Adults presenting with an intermediate-risk PE who were treated with mechanical thrombectomy were included. Patients with high risk PE were excluded. We compared patient outcomes between individuals receiving intervention within 12 hours of diagnosis (early treatment; ET) to those receiving intervention after 12 hours of diagnosis (delayed treatment, DT). Our primary outcome was change in pulmonary artery pressures. Secondary outcomes included length of stay, intubation rates, vasopressor need and mortality. Results: 69 patients (52% male) were included for analysis. Of these, 37 were included in the ET group and 32 in the DT group. Presenting WHO class was higher in the ET group. Other baseline demographics, presenting vital signs, and echocardiographic parameters were similar between groups (Table). Patients in the ET group had a greater reduction in their pulmonary artery systolic pressure (PASP) after intervention compared to the DT group (-14.8 mm Hg vs. -8.3 mm Hg, p = 0.05; Fig). There were no differences in mortality, intubation rate, vasopressor or inotrope use between groups. There was no significant difference in overall hospital length of stay (LOS), though there was a trend towards shorter ICU LOS in the ET group (1.92 d vs. 4.2 d, p = 0.056). Conclusions: When performed for intermediate-risk PE ET is associated with greater reductions in PASP compared to DT.
Abstract 14422: Accuracy of a Popular Online Chat-Based AI Model in Providing Recommendations on the Management of Atrial Fibrillation in Accordance With the 2019 AHA/ACC/HRS Guidelines: A Patient versus Physician-Centered Approach
Authors: Joseph Kassab, Abdel Hadi El Hajjar, Joseph El Dahdah, Michel Chedid El Helou, Habib Layoun, Shady Nakhla, Walid I Saliba, Mohamed H Kanj, Samir R Kapadia, Serge C Harb
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is associated with reduced QOL and numerous CV events. AF patients often seek additional information beyond what their physician provides, often turning to Internet sources for guidance. Hypothesis: The rise of online chat-based AI interactions raises the question of whether this technology can assist in patient education and provide guidelines-based recommendations. We sought to evaluate if ChatGPT 4.0 could provide accurate patient and physician-centered recommendations for AF. Methods: We created 2 sets of 15 questions, one from a patient (PA) and another from a physician’s (PH) perspective. PA questions were formulated after querying “Google Trends” for the most searched terms related to AF. PH questions were formulated by expert cardiologists. Each question was submitted to the AI online model. Each cardiologist received 1 set of 30 answers and graded each answer as "accurate," "accurate with missing information (MI)," or "inaccurate." An answer was considered “accurate” if it included appropriate and complete information found in the currently published guidelines, “inaccurate” if false information was provided, or “accurate with MI” if essential information was missing according to the PH clinical expertise. Discrepancies in the PH gradings were identified and resolved. Results: 13/15 (87%) PA answers were graded as accurate. The remaining 2/15 were accurate but with MI. No PA answers were inaccurate. 6/15 (40%) PH answers were accurate. 7/15 (46%) were accurate with MI and 2/15 (13%) were inaccurate. The AI chatbot provided significantly more accurate answers to PA questions vs PH questions (p&lt;0.05, Fisher’s exact test). Conclusions: ChatGPT 4.0 provided largely accurate answers to PA questions, showing promise as a tool to assist in patient education on AF. However, the accuracy of answers to PH questions was suboptimal, reinforcing that this tool should not be used by physicians for clinical support in AF.
Abstract 14721: International Chronic Total Occlusion Percutaneous Coronary Intervention Operator Survey
Authors: Bahadir Simsek, Athanasios Rempakos, Spyridon Kostantinis, Michaella Alexandrou, Judit A Karacsonyi, Bavana V Rangan, Olga Mastrodemos, Nidal Abi Rafeh, MD, FACC, Khaldoon Alaswad, ALEXANDRE AVRAN, Lorenzo Azzalini, Ahmed El Guindy, Mohaned Egred, OMER GOKTEKIN, sevket gorgulu, Wissam Jaber, Kathleen Kearney, Ajay J Kirtane, William L Lombardi, Kambis Mashayekhi, Margaret McEntegart, William Nicholson, Stephane Rinfret, Salman S Allana, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis
Journal: Circulation (2023)

Background: Contemporary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) practice has received limited study. Methods: We performed an online, anonymous, international survey of CTO PCI operators. Results: 104 CTO PCI operators and 12 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Most were from the United States (53%), men (95%), and spent a median of 60 hours/week in the hospital. Median annual case numbers were 250 (150-400) for PCIs and 43 (10-85) for CTO PCIs (Figure). Almost half (42%) entered CTO cases into registries, mainly into PROGRESS-CTO (78%) and EuroCTO (11%). Most worked at academic institutions (55%), 55% trained dedicated CTO fellows, and 43% proctored CTO PCI. Almost half (43%) had dedicated CTO PCI days, and 54% performed dual access &gt;90% of the time. Nearly half (42%) never discharged CTO patients the same day, while 20% discharged CTO patients the same day &gt;50% of the time. After successful guidewire crossing, 51% used intravascular imaging &gt;90% of the time. Most used CTO scores including J-CTO (82%), PROGRESS-CTO (42%), and PROGRESS-CTO complication scores (24%). Coronary artery perforation was encountered within the last month by 31%, and within 1-6 months by 35%. On a scale of 0-10, the median comfort levels were: covered stents 9.7 (8.2-10), coil embolization 8.0 (5.0-9.7), and fat embolization 5.0 (2.0-9.4). The majority (55%) had a complication cart/kit and 22% conducted regular complication drills with catheterization laboratory staff. Conclusion: Our survey provides information on the contemporary CTO PCI practices.
Abstract 18056: Transhepatic and Trans-Patent Foramen Ovale Ablation of Atrial Fibrillation in the Setting of Chronic Inferior Vena Cava Occlusion: Addressing Complex Anatomic Hurdles and Achieving Therapeutic Success
Authors: SaiNikhila Ghanta, Bader Alotaibi, Tyler Alderson, Krishna Chaitanya Amerneni, Erin Priddy, Srikanth Vallurupalli, AURAS R ATREYA
Journal: Circulation (2023)

Background: Rhythm control for atrial fibrillation (AF) is the preferred approach for symptomatic patients, particularly those with reduced ejection fraction. Catheter ablation primarily consists of pulmonary vein isolation via a transseptal approach. In patients with chronic occlusion of inferior vena cava (IVC), surgical ligation of IVC, or congenital venous system abnormalities, conventional femoral venous access may not feasible. Case Report: A 78-year-old male with history of Hypertension, diabetes, coronary artery disease, bilateral DVTs s/p thrombectomy, prior IVC stenting, presented with persistent, symptomatic AF on apixaban. Given a moderately reduced EF of 40-45%, amiodarone intolerance, and contraindication to other AADs, he was referred for catheter ablation. CT venogram showed chronically occluded IVC with patent hepatic veins, therefore transhepatic access to the right atrium was obtained. Transesophageal echocardiography (TEE) was planned for transseptal puncture; however, this showed an incidental PFO. This PFO was easily engaged using a manual modification of a VersaCross transseptal sheath and after entering the left atrium, the sheath was exchanged with a bi-directional sheath (Vizigo). Using this single left atrial access, pulmonary vein isolation and posterior wall isolation were performed. The transhepatic access site was closed with coil embolization to prevent track bleeding (figure 1). Conclusion: We present a case where successful AF ablation was achieved via percutaneous transhepatic approach, with improvised utilization of a conveniently located PFO. This was guided by pre-operative CT, and intra-operative TEE which allowed us to minimize any transseptal puncture related complications. The utilization of a multidisciplinary team comprising electrophysiologists, advanced imaging cardiologists and interventional radiologists is invaluable in executing complex procedures of this nature.
Abstract 15420: Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction With a Recent Worsening Heart Failure Event
Authors: Neal Dixit, Katie Truong, Boback Ziaeian, Gregg C Fonarow
Journal: Circulation (2023)

Background: In a pooled analysis of the PARAGON-HF and PARAGLIDE-HF trials, sacubitril-valsartan was effective in the treatment of heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) in patients who experienced a recent worsening heart failure event. Research Question: The cost-effectiveness of sacubitril-valsartan in this patient population has yet to be established. Aim: We performed a cost-effectiveness analysis of sacubitril-valsartan in patients with HFmrEF/HFpEF in patients with a recent worsening heart failure event. Methods: Using a 2-state Markov model, we simulated treatment with sacubitril-valsartan vs. placebo in populations of 1,000 patients with HFmrEF/HFpEF and a recent worsening heart failure event. Clinical event rates were based on 5-year data from the I-PRESERVE trial and calibrated to reproduce event rates observed in the pooled analysis of the PARAGON-HF and PARAGLIDE-HF trials. Based on a United States health care system perspective, outcome data from the trials were used to calculate incremental cost-effectiveness ratios. Results: Treatment with sacubitril-valsartan resulted in an increase of 0.88 and 0.53 life years and quality-adjusted life years, respectively, compared to placebo. Lifetime costs increased due to the cost of sacubitril-valsartan. The incremental cost-effectiveness ratio was $96,762 (Table 1). Conclusions: Use of sacubitril-valsartan in patients HFmrEF/HFpEF with a recent worsening heart failure event displayed intermediate value by American Heart Association/American College of Cardiology standards. This study supports the current guideline recommendation to consider sacubitril-valsartan in HFmrEF/HFpEF.