tbuckley/cabot-search huggingface dataset:
Abstract 17738: Cardiac MRI vs Coronary Angiography in Stable Coronary Artery Disease: A Head-to-Head Comparison
Authors: Sagar Nagpal, Sindhu Pokhriyal, Pooja bhandari, manar jbara, Suyog Patel
Journal: Circulation (2023)

Introduction: Coronary angiography has been the gold standard invasive procedure for diagnosing and treating coronary artery disease (CAD). However, it poses risks and complications. In contrast, cardiac MRI offers non-invasive tools for early detection and diagnosis of CAD, presenting an alternative to angiography with fewer associated risks. Hypothesis: Our study aims to investigate if MRI can replace invasive procedures in stable CAD, reducing the need for such procedures while maintaining comparable diagnostic outcomes to coronary angiography. Methods: An extensive literature search was conducted, involving PubMed and Google Scholar databases up to February 2023. After careful evaluation, four clinical trials (CARMENTA, CE-MARC, MR INFORM, and MR Impact 2) comparing MRI and angiography in stable coronary artery disease were included in our study. Animal studies, expert opinions, literature reviews, and studies without reported MRI outcomes were excluded. Results: In the MR INFORM trial, among 221 patients with significant CMR-detected ischemia, 184 had confirmed angiographic lesions, while 35 did not. There were no significant differences in major adverse cardiovascular events or angina-free status at 1 year between the CMR and angiogram groups. The CE MARC 2 trial involving 752 patients reported a sensitivity of 86.5% and a specificity of 83.4% for multiparametric CMR, with a positive predictive value (PPV) of 77.2% and a negative predictive value (NPV) of 90.5%. The CARMENTA trial demonstrated a significant reduction in invasive coronary angiograms with CMR as the initial evaluation (87% vs. 100%), without significant differences in outcomes or the detection of obstructive coronary artery disease compared to computed tomography angiography. In the MR Impact 2 trial, CMR exhibited a sensitivity of 75% (±7%) and a specificity of 59% (±8%). The PPV, NPV, and accuracy for CMR were 70% (±5%), 65% (±5%), and 68% (±5%), respectively. Conclusions: CMR shows promise in diagnosing coronary artery disease, correlating well with angiography and reducing invasive procedures without significant outcome differences. Further research is needed to assess its clinical utility, highlighting its potential role in practice.
Abstract 15259: The Novel Antisense Oligonucleotide CDR132L Improves Cardiac Function in Heart Failure Across Different Species
Authors: Janika Viereck, Sandor Batkai, Celina Genschel, Steffen Rump, Wilfried Hauke, Mariann Gyongyosi, Denise Traxler, Rabea Hinkel, Christian Kupatt, Arthur A Levin, Thomas Thum
Journal: Circulation (2023)

Introduction: The chronic progressive condition of heart failure (HF) is, to date, largely irreversible and continues to impose global morbidity. MicroRNAs exert substantial roles in HF progression by orchestrating pathological genes and pathways. Medications directly tackling the roots of the disease are rare, but inhibition of miR-132, a microRNA that was shown to be upregulated upon cardiac remodeling and HF, is a promising approach. Thus, CDR132L, a clinical-stage synthetic antisense oligonucleotide miR-132 inhibitor, can be an innovative therapy for patients with HF. Hypothesis: To examine the effect of CDR132L, different studies were conducted, including in mice and pigs and in a first-inhuman phase 1b safety and tolerability study that revealed preclinical and exploratory efficacy data. Results: MiR-132 transgenic mice developed reduced left-ventricular ejection fraction (LVEF) and cardiac dilatation. CDR132L treatment significantly improved LVEF and reversed cardiac dilatation. The results were confirmed in a porcine transverse aortic constriction model, where the LVEF was significantly improved in the CDR132L treatment group compared to control animals (48.9% vs. 36.1%). In post-MI HF pigs subjected to different treatment and dosing regimens, resulted in a significant and dose-dependent improvement of the cardiac function, illustrated by an up to 10.4% improvement in LVEF to the placebo group at day 56. During a monthly treatment, 87.5% of the animals treated 5x 5 mg/kg with CDR132L showed a ΔLVEF of &gt;7% compared to the placebo group. Additionally, CDR132L improved contractility and the diastolic function by reducing cardiac stiffness. A successful translation of these preclinical results into humans was performed in a CDR132L safety and tolerability Phase 1b clinical trial in HF patients. In an exploratory analysis, the combined endpoint, consisting of patients with a decrease in NT-proBNP levels and/or an absolute increase in LVEF, was significantly met by 79% of the patients in the pharmacodynamically active CDR132L group. Conclusion: Pharmacological miR-132 inhibition by CDR132L improved cardiac function in multi-species models of HF, highlighting the therapeutic potential for clinical use in HF patients.
Abstract 14977: Radial Artery Usage Rate Differs in Hospital Types in Coronary Artery Bypass Graft Surgery: An Insight Into National Inpatient Sample
Authors: Qianyun Luo, Renxi Li, Stephen Huddleston
Journal: Circulation (2023)

Introduction: In coronary artery bypass grafting (CABG), the left internal mammary artery (LIMA) may not be utilized, and a secondary conduit is chosen to treat coronary artery disease. Radial artery (RA) and greater saphenous vein (GSV) are both viable secondary conduits to, although RA grafting is associated with higher patency and superior long-term survival. This study aimed to compare the rate of RA graft usage in CABG among different hospital types. Methods: Patients received CABG between Q4 2015-2020 were extracted from National Inpatient Sample (NIS) based on ICD10-PCS. Patients less than the age of 40 were excluded for congenital heart defects. Preoperative variables included sex, age, race and ethnicity, socioeconomic status (SES), Elixhauser comorbidities, and hospital characteristics. The rate of RA versus GSV usage were compared with respect to hospital location/teaching status and bed sizes, while all preoperative variables besides the variable of interest were adjusted by multivariable analysis. Results: There were 56,318 CABG cases identified with 11,708 RA and 44,610 GSV grafting. RA grafting usage was lower in rural hospitals (aOR 0.59, p&lt;0.01), urban private practice (aOR 0.69, p&lt;0.01), and hospitals with large bed sizes (aOR 0.91, p&lt;0.01) while the rate is higher in urban teaching hospitals (aOR 1.50, p&lt;0.01) and hospitals with medium bed sizes (aOR 1.14, p&lt;0.01). Conclusion: This study reveals different RA graft usage for CABG among different hospital types. RA harvest can be more time consuming and resource intensive than GSV harvest. Increased familiarity overcoming these obstacles might increase RA graft usage.
Abstract 342: Willingness to Participate in an Active Pediatric Critical Care Interventional Trial Using Exception From Informed Consent
Authors: Catherine E Ross, Muhammad Asad, Robert A Berg, Monica E Kleinman, Michael Donnino
Journal: Circulation (2023)

Introduction: Emergency interventional trials using Exception From Informed Consent (EFIC) are rare, but pooled survey data preceding 27 EFIC studies show that 73% of respondents were willing to be enrolled in the associated trial. However, given the hypothetical nature of these surveys, the actual rate of willingness to participate in an active EFIC trial and any associations with demographic characteristics are unknown. Aims: To 1) compare the actual rate of willingness to participate in an EFIC trial with that from previously published hypothetical surveys for the same trial; and 2) describe demographic characteristics associated with actual willingness rates. Hypothesis: We hypothesized that the actual rate of willingness to participate in an EFIC trial would be lower than the hypothetical survey rate. Methods: From April 13 to June 5, 2023, we attempted to notify all eligible patients/families of an active EFIC trial enrolling in our PICU and gave them the option to opt out from enrollment. Responses were recorded, and patient demographics were abstracted from the medical record. Major exclusion criteria were age over 25 years and state custody. Surveys were performed prior to trial initiation with a similar screening process. Likert scale responses for willingness to participate were dichotomized. Results: Of 207 families contacted, 149 (72%) were willing to participate in the trial which was similar to our pre-trial survey data (43/58 [74%]; p = 0.87). Willingness rates varied by race category (Asian 5/5, 100%; Black 8/18, 44%; Hispanic 22/33, 67%; White 66/84, 79%; Other 12/20 60%; Unknown 36/47, 77%; p = 0.03) but not patient age (willing, median 5 years [IQR 1, 13] vs not willing, median 7 years [IQR 1,4]; p=0.84). Conclusion: The actual rate of willingness to participate in an EFIC trial in the PICU was similar to the hypothetical rate reported in pre-trial survey data, suggesting surveys may reasonably reflect attitudes of potential participants. Willingness rates varied by race, though a significant proportion of data was missing. Reasons for racial differences in research engagement should be explored to better understand the consequences of long-standing structural racism in the US and the impact on future trial participation for these groups.
Abstract 13485: Distinction of Characteristics Associated With Successful Venoarterial Extracorporeal Membrane Oxygenation Decannulation in Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest
Authors: Garima Dahiya, Meagan Nowariak, bellony nzemenoh, Daniel Gonzalez, Jason Bartos, Rahul Singh, Ziou Jiang, Alejandra Gutierrez, Demetris Yannopoulos, Andrea M Elliott
Journal: Circulation (2023)

Introduction: Assessment for readiness of decannulation from venoarterial extracorporeal membranous oxygenation (VA ECMO) is largely based on anecdotal data and provider experience, with high failure rates of 30-70% reported in literature. Compared to patients cannulated for cardiogenic shock, in-hospital cardiac arrest and post-cardiotomy, patients cannulated for out-of-hospital cardiac arrest (OHCA) extracorporeal cardiopulmonary resuscitation (ECPR) represent a unique population. Aims: We sought to identify parameters impacting decannulation success among OHCA patients treated with ECMO-facilitated resuscitation. Methods: Consecutive OHCA patients treated with previously described Minnesota Resuscitation Consortium ECPR protocol from 2015 to 2022 were eligible for inclusion. Hemodynamics, patient characteristics, mechanical circulatory support, and echocardiographic data were compared among patients with successful versus failed decannulations, defined as death due to cardiac causes or recannulation on VA ECMO within the same hospitalization. Results: Among 390 ECPR protocol patients, 125 (32%) were deemed ready for decannulation with 88% successful (N=110) and 12% failed decannulations (N=15). Feature importance analysis was performed by leveraging multiple models, to identify strength of variables associated with decannulation success. Multivariable logistic regression showed left ventricle ejection fraction (coeff 0.14), pressors (coeff -0.12), pulsatility (coeff 0.08) and VA ECMO flow (coeff 0.05) prior to decannulation played a role in success. The ROC-AUC for LVEF alone was 0.57, however, incorporation of additional variables improved the predictive power with an ROC-AUC of 0.86 (Figure 1). Conclusions: Our findings accurately predict decannulation success and emphasize consideration of multiple factors impacting outcomes. Prospective validation of a composite score combining these variables is warranted.
Abstract 18852: Machine Learning to Predict Atrial Fibrillation Recurrence Using Pulmonary Vein Morphology
Authors: Golnoush Asaeikheybari, Majd El-Harasis, John Barnard, M. Benjamin Shoemaker, Rod S Passman, Amit Gupta, Vidya Sankar viswanathan, Hyun Su Kim, Taylor Schilling, William Telfer, Animesh A Tandon, Samuel Harwood, Han Sun, Alison Jin, Mina K Chung, Anant Madabhushi
Journal: Circulation (2023)

Introduction: Predicting risk of recurrence and sites of recurrence after atrial fibrillation (AF) ablation help direct ablation strategies. While the left atrium (LA) has been implicated as a possible site of AF recurrence leading to ablation directed toward LA substrates, reconnection of pulmonary veins (PVs) has been observed as a mechanism of recurrence on repeat ablations. Hypothesis: Regions of statistical shape differences between AF recurrence (AF+) and non-recurrence patients (AF-) within the PV on a CT scan might be associated with sites of recurrence, that features extracted from these regions may be better predictors of AF recurrence. Methods: A Hierarchical Atlas construction method for PV branching shape analysis was developed. Patients with the median volume of LA plus PV in each cohort were selected as the templates. All CT scans in each cohort were registered to the cohort’s template. Then, each branch was individually registered to the branch’s template and resulting control points applied to the LA and other PV branches to maintain connectivity. This process was repeated with 6 iterations to better adjust branching. Two separate atlases of AF+ and AF- were constructed. The areas of significant shape differences on the PV, surfaces of interest (SOIs), between the two groups were obtained via a General Linear Model based t-test on the atlases. Normal and curvature-based features were extracted from SOI regions. A Gradient Boosting classifier was trained based on these features. Cross-validation and atlas construction involved 104 cases. 50 cases served as a holdout set. Results: The classifier trained on SOI features on CT scans achieved AUCs of 0.76 (cross-validation) and 0.74 (holdout set). SOIs include sites within the left superior PV and the right PV carina. Conclusions: This finding appears to suggest that SOI regions on PVs tend to be associated with recurrence and hence may be candidate sites for additional ablation for preventing recurrence of AF.
Abstract 18805: Large-Scale Genome-Wide Association Study of Dilated Cardiomyopathy Identifies Genes and Pathways Contributing to Pathology
Authors: Sean L Zheng, Albert Henry, James S Ware, Tom Lumbers
Journal: Circulation (2023)

Introduction: Dilated cardiomyopathy (DCM) is a primary heart muscle disease that has long been considered a Mendelian disorder, but recent evidence highlights the important role of common genetic variation. Better characterization of the genetic architecture will provide opportunities for improved diagnosis and risk stratification. Methods: We performed a GWAS meta-analysis of 14,256 DCM cases and 1,185,671 controls of European ancestry from 16 studies. To improve discovery power, we performed multi-trait analysis of GWAS (MTAG) with three genetically correlated cardiac imaging traits in 36,203 individuals. We performed gene-level burden analysis &lt;0.1% for rare predicted truncating variants (PTV) with minor allele frequency &lt;0.1% in prioritized genes against DCM and quantitative CMR traits in UK Biobank (UKB) and 100,000 Genomes Project (GeL). A polygenic score (PGS) generated using a Bayesian framework was assessed for association with the same outcomes in UKB participants. Results: We identified 80 independent genomic loci associated with DCM at a false discovery rate &lt;1% in GWAS or at P &lt; 5 x 10 -8 in MTAG, of which 65 were novel ( Figure ). We prioritized a single high-confidence gene at 61 loci, including established genes for Mendelian cardiomyopathies ( TTN , BAG3 , FLNC , MYBPC3 , FHOD3 , ALPK3 ). Rare variant analysis highlighted novel associations with DCM and quantitative traits for PTVs in NEDD4L and MAP3K7 in UKB that were replicated in GeL. PGS was associated with DCM, with a 4-fold increased risk for those at the top centile compared to the median distribution. Penetrance of rare variants were higher for those in the top quintile of PGS compared to bottom quintile (7.3% vs. 1.7%, P &lt;0.005). Conclusion: We have performed the largest DCM GWAS, resulting in 80 significant loci (65 novel). We identify novel DCM-causing genes and generate a PGS that associates with DCM and modulates penetrance in carriers of Mendelian disease-causing rare variants.
Abstract 16260: Children With Increased Native T1, Extracellular Volume and T2 Values on Initial Cardiac Magnetic Resonance Imaging for Acute Myocarditis Have Less Improvement in Late Gadolinium Enhancement on Follow Up Imaging: Risk Factor for Adverse Events?
Authors: Danish Vaiyani, Andrea L Jones, Matthew A Harris, Kevin K Whitehead, David Biko, Sara Partington, Kathryn Restaino, Kimberly Y Lin, Mark A Fogel
Journal: Circulation (2023)

Introduction: Late gadolinium enhancement (LGE) in pediatric patients with acute myocarditis has been shown to be a risk factor for adverse events. On follow up cardiac magnetic resonance imaging (CMR), some patients show improvement and/or resolution of LGE but others do not. Factors associated with residual LGE have not been described. Hypothesis: Measurements on initial CMR would be associated with degree of improvement of LGE on follow up CMR. Methods: We conducted a retrospective cohort study of patients &lt;21 years with acute myocarditis who underwent initial CMR within 14 days of presentation and returned for follow up CMR. Those who suffered cardiac arrest or with autoimmune disease, known cardiomyopathy or congenital heart disease were excluded. LGE was defined as tissue with signal intensity 5 standard deviations above mean signal intensity of unaffected myocardium on viability imaging; this mass was measured and indexed to total left ventricular mass. Strain was measured using CMR feature tracking. Spearman’s correlation was used to determine associations between change in indexed LGE mass on follow up CMR to values from initial CMR. Results: We enrolled 36 patients aged 16.4 years (IQR 14.9-17.2 years) with median time to follow up CMR 229 days (IQR 171, 407). Native T1 (Figure 1), T2, peak T2 relaxation times and ECV on initial CMR inversely correlated with change in indexed LGE mass on follow up CMR while indexed right ventricular end diastolic volume (RVEDVi) on initial CMR positively correlated. (Table 1) Strain and ventricular function did not correlate with change in LGE mass on follow up CMR. Conclusions: Elevated T1 and T2 values and ECV on initial CMR in patients with acute myocarditis are associated with less improvement of LGE on follow up CMR; increased RVEDVi was associated with greater improvement. Further work is needed to determine which are the most useful predictors of residual LGE following myocarditis in children.
Abstract 13481: A Rare Case of Pembrolizumab (Keytruda®) -Associated Thyrotoxicosis Causing Atrial Dysrhythmias
Authors: Poonam Bhyan, Amandeep Goyal, Sarah Barker, taher tayeb, Siva Naga S Yarrarapu, Tarun Dalia, Roopesh Sai Jakulla, Mohammad Alarfaj, Chaitra Gopinath, Zubair Shah, Brian C Weiford
Journal: Circulation (2023)

Introduction: Immune-Check-Point Inhibitors such as pembrolizumab (Keytruda®) are associated with the development of several immune-related adverse events. Case: 70-year-old malewith history of pleomorphic sarcoma of the right lower extremity with metastases to the lungs was started on Pembrolizumab 3 weeks before presenting to the ER with complaints of generalized weakness and palpitations. The patient was tachycardic and EKG showed atrial tachycardia at 144 beats/minute with right bundle branch block (RBBB) ( FIG 1B ). RBBB had been previously noted on EKG ( FIG 1A ). High-sensitivity-troponins were in the range of 29 to 37 ng/l. The TSH on admission was 0.01 mcu/ml with free T4 of 4.7 ng/dl (&gt; twice the upper limit of normal). Of note, TSH was normal prior to the initiation of Pembrolizumab (2.01 ng/dl). Anti-microsomal anti-thyroid peroxidase (TPO) antibodies were also elevated. US thyroid showed heterogeneous thyroid parenchyma concerning for thyroiditis. The patient received multiple doses of IV metoprolol and IV digoxin for rate control before converting spontaneously to normal sinus rhythm, and was then started on metoprolol succinate to maintain the heart rate. Decision Making: Based on the patient’s recent history of initiating Pembrolizumab therapy and normal thyroid function before, his thyroid dysfunction was attributed to the immunotherapeutic agent leading to atrial dysrhythmias. Endocrinology team was consulted, and prednisone 40 mg daily was started. Repeat free T4 after 5 days came down to 2.5 ng/dl. The patient was discharged home on oral Metoprolol and slow prednisone taper in the next few weeks and outpatient follow-up with endocrinology. Conclusion: Thyroid dysfunction is one of the most common immune-related adverse effects of Pembrolizumab that can cause multisystem dysfunction such as dysrhythmias. Therefore, clinicians should be familiar with their unique adverse effects to minimize morbidity and enable appropriate management.
Abstract 13507: Outcomes Among Coronary Artery Disease Patients Hospitalized for Left Ventricular Assist Device Implantation: A United States Population-Based Cohort Study
Authors: Bruce Adrian Casipit, Abiodun Idowu, Hussein Al Sudani, Carlo Casipit, Kevin Bryan Lo, Ola Khraisha, Aman M Amanullah
Journal: Circulation (2023)

Introduction: Coronary Artery Disease (CAD) is a significant cause of morbidity and mortality among the general population. Previous studies suggested that significant CAD increased the risk for adverse outcomes including acute coronary syndrome and ischemic cardiomyopathy, which if severe enough warrants advance therapeutic options including implantation of a left ventricular assist device (LVAD). However, there is paucity of data exploring the in-hospital outcomes of patients with CAD admitted for LVAD implantation. Hypothesis: CAD does not impact outcomes in patients undergoing LVAD implantation. Methods: A retrospective cohort study using the National Inpatient Sample 2018-2020 database. Patients aged &gt; 18 years with known CAD admitted for LVAD placement were identified in the database. Multivariate logistic regression analysis was used to adjust for potential patients' and hospital level confounders. Outcome of interest were in-hospital mortality, ST-Elevation Myocardial Infarction (STEMI), LVAD thrombosis and ischemic stroke among patients with CAD hospitalized for LVAD implantation. Results: We identified a total of 76,757 patients admitted for LVAD implantation in the years 2018-2020, of which 55.93% (n= 42,930/76,757) had CAD. The overall mortality rate among patients admitted for LVAD implantation was 27.47% (n=21,080/76,757). Among those with concomitant CAD, the mortality rate was significantly higher at 28.93% (12,263/42,930, P=0.00). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, concomitant CAD among LVAD recipients was found to be an independent predictor of overall in-hospital mortality (aOR 1.24; 95% CI (Confidence Interval), 1.14-1.36; p&lt;0.001) but did not increase the risk of STEMI (aOR 1.48; 95% CI, 0.98-1.34; p=0.09), LVAD thrombosis (aOR 1.04; 95% CI, 0.51-2.14; p=0.91) and ischemic stroke (aOR 0.76; 95% CI, 0.38-1.39; p=0.33). Conclusions: Among hospitalized patients for LVAD implantation, concurrent CAD increased the risk for in-hospital mortality but did not increase the risk for STEMI, LVAD thrombosis and ischemic stroke. Prospective studies with control of potential confounders may better delineate these associations.