tbuckley/cabot-search huggingface dataset:
Abstract 221: Heart Rhythm Analysis During Chest Compressions in Case of Out-of-Hospital Cardiac Arrest: Are Confirmation Analysis a Safety Issue?
Authors: Jean-Philippe Didon, Sarah MENETRE, Clement Derkenne, Benoit Frattini, Vivien Hong Tuan Ha, Daniel jost, Stephane Travers
Journal: Circulation (2023)

Purpose: During out-of-hospital cardiac arrest (OHCA), automated external defibrillators (AEDs) can analyze the patient's cardiac rhythm using a Shock Advisory System (SAS) that runs during chest compressions (CC). We aimed to evaluate the safety of a SAS that enables analysis during CC, referred to as Analyze Whilst Compressing (AWC). AWC classifies the cardiac rhythm as shockable (Sh) or non-shockable (NSh) in the presence of CC. If shockable, the rescuer backs off while the AED confirms the rhythm in the absence of CC with a confirmation analysis (CoA). We aimed to verify the safety of AWC when patients present NSh rhythm during CC. Method: In this retrospective study, we utilized data from the Paris Fire Brigade collected between 01/01/2021 and 31/01/2022. The inclusion criteria were adult OHCA patients with initial Ventricular Fibrillation analyzed by the AWC algorithm. We analyzed patients' safety by assessing false positive cases in the presence of chest compressions: ill-advised CoA compared to appropriate CoA within the first 10 minutes of intervention. The main outcome was the rate of patients presenting ill-advised CoA. Results: We analyzed 285 consecutive OHCA patients, corresponding to 2011 rhythm analyses ; 205 patients had at least 1 CoA, which led to a confirmation rate of 27.7% over 557 analyses; 175 patients had at least one appropriate CoA; 76 patients (26.6%) had at least one ill-advised CoA: 48 (16.8%) had one ill-advised CoA, 19 (6.7%) had two ill-advised CoA, six patients (2.1%) had three ill-advised CoA, two patients (0.7%) had four ill-advised CoA, and one (0.35%) had six ill-advised CoA. The global amount of ill-advised CoA was 118, which leads to an ill-advised confirmation rate of 5.9%. The rhythm distribution implied with ill-advised CoA was: 72 (61%) asystole, 45 (38%) other non-shockable, one (0.85%) transition from Sh to NSh. The hands-off time that each ill-advised CoA generated was 10 [8-18] (median [IQR]) seconds. Conclusion: AWC presents comparable results to other methods of analysis during chest compressions in detecting some non-shockable rhythms as false positives. In a majority of patients, CoA was appropriate. Only one patient (0.35%) had up to six ill-advised CoA, making his impact negligible over the cohort.
Abstract 14279: Improved Pressure-Flow Relationship With Sacubitril/Valsartan: A 6-min Walk Stress Echocardiographic Study
Authors: Natsumi Yamaguchi, Kenya Kusunose, Yukina Hirata, Susumu Nishio, Tomonori Takahashi, Yoshihito Saijo, Muneyuki Kadota, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata
Journal: Circulation (2023)

Background: In the clinical setting, there are various techniques for stress echocardiography, of which the 6-minute walk (6MW) test is a straightforward and utilized one. An abnormal hemodynamic response to exercise is indicated by a ΔmPAP/ΔCO slope of greater than 3 mmHg/L/min between rest and exercise. This response is associated with impaired prognosis in patients with exercise dyspnea and several cardiovascular diseases. Hypothesis: Our hypothesis was that pressure-flow relationship of the pulmonary circulation obtained by 6MW stress echocardiography would be enhanced with treatment. Aims: The aim of this study was to assess the effects of administration of Sacubitril/Valsartan on cardiac function in heart failure. Methods: We prospectively enrolled 39 patients with heart failure. The 6MW test was performed indoors in a flat, straight corridor. The peak tricuspid regurgitation jet, early diastolic transmitral flow velocity and early diastolic mitral motion were obtained by echocardiography post-6MW. We calculated the slope of ΔmPAP/ΔCO as a parameter of pulmonary hypertension. Follow-up echocardiographic studies were performed after 1 year. Results: Left ventricular diameter and volume were significantly reduced (LVDd; 59.3±7.7mm vs 56.0±8.6mm, P&lt;0.001, LVEDV; 160.7±49.6ml vs 136.0±54.3ml, P&lt;0.001), and LVEF was significantly improved (37.6±11.3% vs 44.9±11.5%, P&lt;0.001). Among the 31 patients who underwent 6MW stress echocardiographic study at baseline and 1 year later, 6MW distance increased after treatment (380m vs 430m, P=0.003). The ΔmPAP/ΔCO by 6MW stress decreased with treatment (6.9mmHg/L/min vs 2.8mmHg/L/min, P=0.002). Conclusions: Initiation of Sacubitril/Valsartan was associated with improvement of left ventricular size and LVEF. Additionally, the 6MW distance increased and the ΔmPAP/ΔCO was improved to within normal range with treatment. Sacubitril/Valsartan distinctly improved cardiac reactivity to exercise.
Abstract 12735: Investigating Cardiac Function After Anthracycline Exposure in Childhood Cancer Survivors With Modifiable Cardiovascular Risk Factors
Authors: BriAnna M Souder, Ian George, Clare Meernik, Kevin Oeffinger, Henry Foote, Michael J Campbell, Michelle Hildebrandt, Michael Roth, Andrew McCrary, Andrew P Landstrom
Journal: Circulation (2023)

Introduction: Anthracycline exposure can lead to cardiac dysfunction, which may possibly be worsened by secondary cardiovascular risk factors (CVRFs), such as hypertension, hyperlipidemia, obesity and diabetes. The prognostic impact of CVRFs in childhood cancer survivors is largely unknown. Now with advanced cardiac imaging, it is now possible to identify how CVRFs might influence subclinical cardiac function. Hypothesis: Anthracycline-exposed childhood cancer survivors with CVRFs will demonstrate echocardiogram-based subclinical cardiac dysfunction more frequently than those without. Methods: This is a single-center, retrospective study. Inclusion criteria are: &lt; 18 years old, history of anthracycline-containing chemotherapy and 2 echocardiograms performed. Exclusion criteria are: congenital cardiac disease, subsequent cancer relapse and inadequate imaging quality. Echocardiographic images were analyzed for longitudinal left ventricular strain, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Wilcoxon rank-sum test was used to compare measures of cardiac function between patients with at least one CVRF (at time of cancer diagnosis) and patients without. Results: There were 111 patients identified with 49.5% having dysfunction at some point in time. CVRFs were identified in 19 patients with the majority of those being obese (52.6%). At baseline, there was a statistically significant difference in mean strain between those with CVRFs vs those without (-19.4% vs -21.3%). At 1-6 months after chemotherapy completion, LVEF was significantly reduced in those with CVRFs vs those without (48.7% vs 59.7%) as well as mean strain (-15.8% vs -20.0%). At &gt;5 years after chemotherapy, there was a decrease in strain magnitude in those with CVRFs vs those without (-17.7% vs -20.5%) along with abnormal mean MPI (0.57 vs 0.44). Conclusions: Anthracycline-exposed pediatric cancer survivors with CVRFs demonstrate reduced cardiac function at baseline and both at near-and long-term follow-up. Further investigation is warranted to investigate the significance of these reduced echocardiographic measures and CVRFs among childhood cancer survivors to mitigate cardiac morbidity as they age into adulthood.
Severe vs Nonsevere Immune Checkpoint Inhibitor-Induced Myocarditis
Authors: Osnat Itzhaki Ben Zadok, Amos Levi, Sanjay Divakaran, Anju Nohria
Journal: JACC CardioOncology (2023)

The long-term contemporary outcomes of patients with immune checkpoint inhibitor (ICI) myocarditis, spanning the spectrum of clinical severity, are undetermined. We sought to investigate the characteristics and cardiovascular outcomes of patients with severe and nonsevere ICI myocarditis. This was a retrospective cohort study of patients with suspected ICI myocarditis at Massachusetts General Brigham Health System conducted between 2015 and 2022. Cases were classified as severe, nonsevere, and negative based on the International Cardio-Oncology Society criteria. One-year cardiovascular mortality, all-cause mortality, and cardiovascular readmissions were evaluated. We also evaluated 1-year ICI resumption and left ventricular ejection fraction over a median follow-up of 18 (Q1-Q3: 8-67) weeks. The study included 160 patients: 28 severe, 96 nonsevere, and 36 negative cases. Patients with severe myocarditis had an increased risk of 1-year cardiovascular mortality, particularly in the early post-myocarditis period (29% vs 5%; HR: 6.52; 95% CI: 2.2-19.6; P < 0.001). Patients with nonsevere myocarditis had a cardiovascular mortality rate similar to negative cases (HR: 0.61; 95% CI: 0.14-2.54). One-year all-cause mortality did not differ between severe, nonsevere, and negative cases (P = 0.74). Rates of 1-year cardiovascular readmissions and long-term left ventricular ejection fraction were also similar among the 3 groups. ICI resumption was low, even in negative cases. In a contemporary analysis of patients with suspected ICI myocarditis, severe ICI myocarditis was associated with increased 1-year cardiovascular mortality, which was lower than previously reported. Patients with nonsevere ICI myocarditis had outcomes similar to negative cases. The optimal management strategies for nonsevere ICI myocarditis need to be re-evaluated.
Abstract 15324: Biodegradable Polymer Ultrathin Sirolimus-Eluting Stent is Associated With Better Outcomes Compared With Polymer-Free Ultrathin Sirulimus-Eluting Stent in Complex Percutaneous Coronary Intervention: A Post Hoc Analysis of the HOST-IDEA Randomized Clinical Trial
Authors: Jung-Kyu Han, Sang-Hyeon Park, Doyeon Hwang, Seokhun Yang, Jeehoon Kang, Han-Mo Yang, Kyung W Park, Hyun-jae Kang, Bon-Kwon Koo, Hyo-Soo Kim
Journal: Circulation (2023)

Introduction: Third generation drug-eluting stents with ultrathin struts and advanced polymer technology have been introduced. However, their safety and efficacy have not been fully elucidated, particularly in complex percutaneous intervention (PCI). Aim To investigate the clinical outcomes of complex PCI using the Coroflex ISAR polymer-free sirolimus-eluting stent (SES) or Orsiro biodegradable polymer SES. Methods: This study was a post-hoc analysis of the HOST-IDEA trial that randomly assigned 2,013 patients undergoing PCI with Orsiro or Coroflex ISAR into either 3-month dual antiplatelet therapy (DAPT) or 12-month DAPT arms from January 2016 to May 2021 at 37 centers in South Korea. We compared a 1:1 propensity score (PS)–matched cohort balanced by patient and procedural characteristics. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically-driven target lesion revascularization at 1 year. Complex PCI was defined as any of the following features: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length ≥ 60 mm, left main PCI, or heavy calcification. Results: After PS matching, baseline patient and procedural characteristics were balanced between Coroflex ISAR and Orsiro groups (n=542 in each). Complex PCI was significantly associated with a higher rate of TLF compared with non-complex PCI (5.3% vs. 1.1%, hazard ratio (HR) 5.12 [95% confidence interval (CI) 2.21-11.86], P&lt;0.001). Compared with the Coroflex ISAR SES, the better outcomes of TLF associated with the Orsiro SES was more pronounced in the complex PCI group (HR 0.14 [95% CI 0.03-0.60], P =0.008 in complex PCI; HR 0.99 [95% CI 0.25-3.98], P =0.993 in non-complex PCI; P for interaction 0.054). Conclusion In patients undergoing complex PCI with third-generation DES, the Orsiro SES was associated with significantly better outcomes in terms of TLF than the Coroflex ISAR SES.
Abstract 19037: Metabolomics Reveals Aerobic Glycolysis and 1-Carbon Metabolism as Major Metabolic Signature During Human Platelet Activation
Authors: Manasa K Nayak, Madankumar Ghatge, Gagan D Flora, Anil K Chauhan
Journal: Circulation (2023)

Introduction: Evolving evidence suggests that besides signaling pathways, platelet activation involve a complex interplay between metabolic pathways to support thrombus growth. Selective targeting of metabolic checkpoints may inhibit platelet activation and provide a novel antiplatelet strategy. We examined global metabolic changes that occur during the transition of human platelets from resting to an activated state to identify metabolites and associated pathways that contribute to platelet activation. Methods: We performed metabolic profiling (through Metabolon Inc.) of resting and stimulated human platelet samples. The differential levels analysis, pathway analysis, and PCA were performed using Metaboanalyst. Metascape was used for metabolite network construction. Results: Of the 401 metabolites identified, 202 metabolites were significantly upregulated, and two metabolites were downregulated in activated platelets. Of all the metabolites, lipids scored highly and constituted ~50% of the identification. During activation, aerobic glycolysis supports energy demand and provides glycolytic intermediates required by metabolic pathways. Consistent with this, an important category of metabolites was carbohydrates, particularly the glycolysis intermediates that were significantly upregulated compared to resting platelets. We found that lysophospholipids such as 1-palmitoyl-GPA, 1-stearoyl-GPS, 1-palmitoyl-GPI, 1-stearoyl-GPI, 1-oleoyl-GPI were upregulated in activated platelets. We speculated that platelet activation could be linked to One-carbon (1C) metabolism, a set of biochemical pathways that involve transfer and use of 1C units from amino acids, for cellular processes, including nucleotide and lysophospholipid synthesis. In alignment, based on pathway enrichment and network-based prioritization, the metabolites from amino acid metabolism, including serine, glutamate, and branched-chain amino acids pathway were upregulated in activated platelets, which might be supplemented by the high levels of glycolytic intermediates. Conclusions: Metabolic analysis of resting and activated platelets revealed that aerobic glycolysis and 1-C carbon metabolism are vital to support platelet activation.
Abstract 15511: Predictors of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation in Patients With Stress Cardiomyopathy
Authors: Maroun Chedid, Kevin Buda, Mengistu Simegn, omer iqbal
Journal: Circulation (2023)

Introduction: Polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) are life-threatening complications of stress cardiomyopathy (SCM) that occur in 2-10% of patients with SCM. Hypothesis: To identify which social and medical factors are associated with an increased risk of PVT and VF in patients with SCM. Methods: All consecutive patients meeting the InterTAK (international takotsubo) diagnostic criteria for stress cardiomyopathy at the Hennepin County Medical Center between January 1 st , 2010, and December 31 st , 2022, were identified from electronic medical records. Logistic regression was used to estimate the odds ratios (OR). The receiver operating characteristic curve (ROC) was plotted to identify the best QTc cutoff at admission to predict ventricular arrhythmia. Results: A total of 296 patients were included in the study, of which 27 (9.1%) experienced PVT/VF. Baseline demographics, including gender, race, and age at diagnosis, were similar to patients without PVT/VF (median age 61 years, and 66.7% were females). Patients with PVT/VF were more likely to have a history of stimulant use (22.2% vs. 8.2%, OR =3.20 p =0.023), apical (Takotsubo) variant stress cardiomyopathy (78% vs.56%, OR=2.69 p=0.038), and an ejection fraction (EF) of less than 30% on admission (63% vs. 41.5%, OR=2.39 p=0.032) ( Table 1 ). Admission QTc interval cut-off value of 490 msec had the highest sensitivity and specificity in predicting the risk of ventricular arrhythmia (AUC=0.687). Notably, all PVT/VF events occurred within 17 hours of hospital admission. Conclusion: Nealy 1 in 10 patients with SCM had life-threatening ventricular arrhythmia. The presence of severe LV systolic dysfunction, recent stimulant use, apical variant SCM, or prolonged QTc &gt; 490 msec is associated with the occurrence of PVT/VF, with the first day of hospital admission being an especially high-risk period.
Abstract 17729: When Do Black and White Patients Die After Coronary Artery Bypass Surgery: Insights From the United States Veterans Health Administration
Authors: Karthik Raghunathan, Alex Bartholomew, Harold Wackerle, Marc Pepin, Atilio Barbeito, Tetsu Ohnuma, Julien Cobert, Eric JohnBull, Sachin Mehta, Negmeldeen Mamoun, Miriam Treggiari, Loreta Grecu, Vijay Krishnamoorthy, Karsten Bartels, WILLIAM E BRYAN
Journal: Circulation (2023)

Introduction: Black patients continue to have disproportionately higher rates of death after Coronary Artery Bypass Graft (CABG) procedures. Data are needed to guide interventions to eliminate inequity. We examine race-related differences in when death occurred after CABG by comparing the proportions of 1-yr mortality occurring within versus after the first 30-days. Hypothesis: When compared with White patients, 1-yr mortality after isolated CABG among Black patients is significantly more likely to occur within the first 30-days postoperatively. Methods: Using comprehensive death ascertainment files in the most extensive integrated health system in the US, the Veterans Health Administration (VHA), we extracted 30-day and 1-year mortality data after isolated CABG (defined using procedural codes) between January 2006 and December 2015 (follow-up through to December 2016). We classified patients as non-Hispanic Black versus White. We compare 1-yr mortality and the proportions of 1-yr mortality occurring within the first 30-days. We examine trends over the 10-year period. Results: Among 14743 White versus 1545 Black veterans who underwent isolated CABG over the 10-year period, 589 versus 85 had died within 1-yr (4% versus 5.5% respectively, p&lt;0.05). The proportions who died within the first 30-days was significantly lower among White when compared with Black veterans, 31.7% versus 36.5%, p&lt;0.05. Over the 10-year period, the difference between races in when patients died grew substantially (Figure) whereas race-related differences in 1-yr mortality decreased (Figure). Conclusions: While racial disparities in death after CABG are well known, we present the first study showing differences in when death occurs within 1-yr. Using accurate nationwide data, we found that Black patients who died within 1-yr after isolated CABG increasingly died within the first 30-days.
Abstract 17695: Atrial Myopathy as a Predictor of Ischemic Stroke Independent of Atrial Fibrillation in Native Americans: Analysis of Strong Heart Study
Authors: Rylee Barber, Jessica Reese, Ali Tauqeer, Ying Zhang, Jean Leidner, Peter Okin, Richard B Devereux, Jason G Umans, Amanda M Fretts, Stavros Stavrakis
Journal: Circulation (2023)

Introduction: American Indian individuals have high rates of ischemic stroke. This increased incidence of stroke within the American Indian patient population compared to other ethnic groups may be due to the increased prevalence of atrial fibrillation or it may be due to atrial myopathy. Recent reports suggest that atrial myopathy, may be an independent risk factor for ischemic stroke prior to the development of atrial fibrillation. Hypothesis: Determine if atrial myopathy defined by C-reactive protein (CRP) or increased left atrial diameter (LAD) index independently predicts stroke irrespective of atrial fibrillation diagnosis in American Indians. Methods: We analyzed participants from phase 2 of the Strong Heart Study, 1993-1995 (n=2000) and identified cardioembolic stroke events through 2020 (n=45). Patients were excluded if they had a baseline diagnosis of atrial fibrillation, according to chart review (n=6). To analyze if CRP or LAD index were associated with cardioembolic stroke, we divided these variables into quartiles and then used Cox regression modeling to identify independent predictors of cardioembolic stroke. Results: CRP divided into quartiles was significantly associated with cardioembolic stroke (p= 0.03; Figure 1A). Likewise, higher LAD index predicted cardioembolic stroke (p=0.002; Figure 1B). The association between cardioembolic stroke and CRP and LAD index remained significant even after controlling for age, sex, hypertension and body mass index. Conclusions: Elevated LAD index and CRP markers of atrial myopathy are associated with subsequent development of cardioembolic stroke in the absence of diagnosed atrial fibrillation in American Indians. Further research is warranted to establish whether these biomarkers could be used for screening for risk of cardioembolic stroke in American Indians.
Abstract 19064: Sex Specific Gene Profile in Canine Sinoatrial Node
Authors: Ning Li, James Fioritto, Amy Webb, Anuradha Kalyanasundaram, Stas Zakharkin, Matthew Joseph, Peter J Mohler, John Hummel, Vadim Fedorov
Journal: Circulation (2023)

Introduction: Biological sex plays an important role in cardiac function and occurrence of cardiac arrhythmias. Clinical reports show that adult females have faster resting and intrinsic heart rate (HR) while males have faster HR peak and larger HR reserve. Furthermore, inappropriate sinus tachycardia primarily occurs in females, suggesting sex-specific function and/or structure of the sinoatrial node (SAN). The aim of the study is to define sex-specific molecular features of the SAN complex. Methods: mRNA was isolated from SAN pacemaker tissue of healthy adult canines (male=4, female=4). Differential RNA expression patterns of &gt;400 genes, including fibrosis, inflammation, and metabolism markers were quantified with nCounter Nanostring fibrosis panel. Quantitative PCR was used to compare mRNAs of key ion channels related to SAN pacemaker function. Results: Nanostring panel revealed sex-specific and SAN-specific gene profiles of inflammation and fibrotic markers with multiple mRNAs higher in male (e.g. NLRP3, CD86, COL3A1, TGFB1) and several higher in females (e.g. MARCOL, IL20RB). mRNAs responsible for SAN pacemaking e.g. HCN1, HCN4, Cav1.3, and GIRK4 are higher expressed in female SAN. Sex-specific retrospective analysis of published gene profiles from non-failing human hearts showed a similar pattern to canine with HCN1, HCN4, Cav1.3 expression higher in female SAN. Conclusions: The study revealed significantly different gene expressions of fibrosis, inflammation, and pacemaking in male vs female SAN. The higher expression of HCN1/4 and Cav1.3 may explain the faster intrinsic sinus rhythm and susceptibility to SAN arrhythmias in females. The elevated fibrosis and inflammation genes in male SAN may suggest higher vulnerability to fibrotic remodeling during cardiac disease.