tbuckley/cabot-search huggingface dataset:
Abstract 4140250: A Case Series of Papillary Fibroelastomas on the Coumadin ridge
Authors: Omar Aboukhatwa, Elias Akiki, Reto Kurmann, Kathryn Larson, Michael Keeney, Melanie Bois, Kyle Klarich
Journal: Circulation (2024)

Background: Papillary fibroelastomas (PFE) arising between the left upper pulmonary vein and left atrial appendage, commonly referred to as the coumadin ridge or Q-tip, are extremely rare and best detected by transesophageal echocardiography (TEE). Although PFEs are benign, they have been associated with a range of serious embolic events. Objective: To analyze the characteristics, clinical findings, and diagnostic techniques of PFEs originating from the coumadin ridge. Methods: We describe 13 cases of pathology proven papillary fibroelastomas uniquely attached to the Q-tip. Patient data, including demographics, mass characteristics and diagnostic imaging were collected and analyzed. Results: Thirteen patients with pathology-proven PFEs attached to the coumadin ridge were included in the study. The median age of the cohort is 73 (IQR 67-77), and 54% of the patients were male. Tumor sizes ranged from 2mm to 20mm with a median of 5mm (IQR 3.5-8.5). Twelve (92%) of the PFEs were initially visualized on TEE, and one case was diagnosed postoperatively by pathologists after the excision of the left atrial appendage. The majority of cases were incidental diagnoses, with 46% of cases incidentally discovered intraoperatively by routine TEE, and 30% visualized on TEE done for diverse reasons including valvular assessment, exclusion of infective endocarditis, and coronary artery disease (CAD) assessment. One case was incidentally detected on CMR performed as part of a metastatic tumor workup. Four (30%) patients presented with symptoms of stroke/TIA, of which 2 had a previous history of stroke. One patient had symptoms of both TIA and angina pectoris. Cardiovascular disease risk factors were prevalent: 69% had hyperlipidemia, 46% had atrial fibrillation (Afib), 31% had CAD, 54% had hypertension, and 46% were former smokers. Conclusions: Masses on the Q-tip are rare but significant intracardiac sources of embolism. Accurate identification and categorization of these masses are challenging, yet critical, to guide appropriate surgical intervention and improve patient outcomes. Further studies are needed to establish standardized diagnostic and treatment protocols for this unique presentation of PFEs.
Abstract 4139436: Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure
Authors: Joshua Jacobs, Iyanuoluwa Ayodele, Adam Bress, Madeline Sterling, Ambarish Pandey, Catherine Derington, Alexander Zheutlin, Kevin Shah, Stephen Greene, Brooke Alhanti, Rosalia Blanco, Gregg Fonarow
Journal: Circulation (2024)

Introduction: Less than 20% of eligible patients with heart failure with reduced ejection fraction (HFrEF) receive all four pillars of guideline-directed medical therapy (GDMT). Understanding disparities in sex, race, ethnicity, and adverse social determinants of health (SDoH) is necessary to equitably optimize quadruple therapy. Methods: Utilizing the American Heart Association Get With The Guidelines® Heart Failure registry, we conducted a retrospective cross-sectional study to examine the associations between exposures of race and ethnicity, sex, and adverse SDoH (insurance status and a documented social need [any barrier to accessing healthcare]) with quadruple therapy optimization (QTO) at discharge in patients with HFrEF hospitalized between 7/1/2021-9/30/2023. The outcome was a novel QTO score incorporating SGLT2Is as a pillar of quadruple therapy (Figure 1A). Associations between each exposure and QTO score were assessed using multivariable adjusted linear models to calculate adjusted mean differences (AMDs) and 95% confidence intervals (CIs). Results: Among 82,637 included patients (median age 66.0 years, 32.5% female, 57.0% non-Hispanic White, 76.4% prior HF), the overall mean QTO score was 56.2% (standard deviation 25.5). The use of each GDMT component is shown in Figure 1B. After adjustment, Non-Hispanic Black (AMD 2.56 percentage points [95% CI, 2.17, 2.96]) and Hispanic individuals (AMD 0.73 percentage points [95% CI, 0.13, 1.33]) had higher QTO scores vs. Non-Hispanic White individuals. Females had higher QTO scores than males (AMD 1.93 percentage points [95% CI, 1.56, 2.29]). Patients with Medicaid/no insurance (AMD -1.30 percentage points [95% CI, -1.71, -0.88]) and Medicare (AMD -1.70 percentage points [95% CI, -2.16, -1.23]) had lower QTO scores vs. private insurance (Figure 1C). Those with vs. without an identified social need had lower QTO scores (AMD -3.40 percentage points [95% CI, -4.10, -2.71]) (Figure 1D). Conclusion: Disparities in quadruple therapy optimization were most evident for patients with adverse SDoH. Patients with Medicaid/no insurance, Medicare, or an identified social need had lower QTO scores. Future efforts should focus on reducing these gaps to improve equitable GDMT use.
Abstract 4138850: PASCAL versus MitraClip in mitral valve transcatheter edge-to-edge repair: A systematic review and meta-analysis.
Authors: Ahmed Mohamed, Ahmed Abdelaziz, Raneem Afify, Ahmed Elshahat, Mahmoud Elesawy, Mahmoud Mohamed Elshafey Shams, Mariam Desouki, Ibrahim Elkhayat, Basel Abdelazeem, Sandi Banour
Journal: Circulation (2024)

Introduction: Mitral regurgitation is the second most common valvular heart disease, it has a high prevelance in older patients, transcatheter mitral valve edge-to-edge repair has been introduced as an alternative treatment to mitral valve surgery especially in the elderly, MitraClip is used as a standard treatment for transcatheter mitral valve edge-to-edge repair (M-TEER). PASCAL has recently been used with minimal evidence comparing both of them. Aim: We aimed to compare the outcomes of both device systems on mitral regurgitation residuals and clinical outcomes. Methods: PubMed, Scopus, WOS, and Cochrane were retrieved from inception until May 2024 for relevant clinical studies that compared PASCAL to MitraClip approaches in M-TEER procedure and reported the primary outcome of interest, which was the grade of MR at follow-up. Other reported outcomes were technical success, Death from any cause, and reintervention, Dichotomous data were analyzed using OR and 95% CI with a fixed-effect model. Results: Seven studies were included with a total of 1834 patients. MR ≤ 2 at discharge was less with MitraClip (RR, 0.67, 95%CI [0.45 to 1]), and MR ≤ 2 at follow-up was less with MitraClip (RR, 0.84, 95% CI [0.64 to 1.1]), MR ≤ 1 at follow up was significantly less with MitraClip (RR 0.69, [0.56 to 0.85]). However, there were no significant differences in technical success, Death from any cause, or reintervention between the two systems used. Conclusion: MitraClip and PASCAL are similar in procedural success, with better outcomes for PASCAL regarding Mitral regurgitation grades after the procedure. The guide to proceed with MitraClip or PASCAL should be guided by mitral valve anatomy, the etiology of MR, and device-specific features. Also, Large-volume RCTs are warranted to validate the current findings.
Abstract 4138176: Identifying Clinical Stability After Heart Failure Discharge: A machine learning-based decision aid based on continuous ECG and accelerometry
Authors: Claire Martin, Konstantinos Sideris, Miguel Cacho-Soblechero, Jadranka Sekaric, Thomas Hanff, CARSTEN SCHMALFUSS, Neil Lewis, KARIM SALLAM, Heather Hanson, Lina Brinker, Matt Pipke, Erick Andres Perez Alday, Srilakshmi Alla, Steven Steinhubl, Jay Edelberg, Michael Koren, Stephan Wegerich, Gregory Kurio, Stylianos Serghiou, Josef Stehlik
Journal: Circulation (2024)

Introduction: Heart failure (HF) is typified by disease exacerbations resulting in high readmission rate and mortality. Continuous electrocardiographic (ECG) and activity (ACT) data offer promise of a scalable noninvasive solution that may reduce 30-day readmissions. Using a data-driven approach, we developed a machine learning (ML) model including the FDA-cleared multivariate change index (MCI) to identify HF patients at low risk for near-term decompensation. Methods: The LINK-HF clinical trials used the Prolaio system to continuously record physiological parameters using a wearable device. We used ML to build predictive models of a composite outcome of near-term (7-day) risk of emergency room use, hospitalization or death. The model was derived using data from the previously published LINK-HF1 study (2015-2016), and externally validated using data from the control arm of the LINK-HF2 trial (2021-2024). Covariates were developed in LINK-HF1 and a selection procedure used the bootstrap to identify the 100 covariates most commonly chosen when training a ML model to classify patients into high vs. low near-term risk. All combinations of the top 3 covariates were then used to develop the final model. The best-performing model in the training set was evaluated in the validation set. Results: Patient data were segmented into 7-day windows, yielding 4,243 training windows (200 [4.7%] with events) and 3,551 validation windows (109 [3.1%] with events) (Fig. 1A). The chosen model utilized covariates related to changes in heart rate, atrial fibrillation burden, and MCI to achieve an area under the receiver operating characteristic curve (AUROC) of 73% (95% Confidence Interval [CI], 69-76%) in the validation set. The model stratified patients into high and low risk, with a Hazard Ratio (HR) for the outcome of 3.9 (95% CI, 2.7-5.6; P-value, 4 x 10-13) in the validation set (Fig. 1B). Conclusions: Using multivariable wearable sensor data and ML, we developed a model able to identify HF patients at low vs. high near-term risk for decompensation. Future work will determine how this knowledge may optimize and personalize HF care, improving outcomes and efficiency in care delivery.
Abstract 4139998: New-onset atrial fibrillation following coronary artery bypass graft surgery: A systematic review
Authors: Darshan Gandhi, Atul Prakash, Gaurav Patel, Clint Vaz, Ariadna Garcia Risk, Ashish Guragain
Journal: Circulation (2024)

Background: Post coronary artery bypass surgery atrial fibrillation (Post-CABG AF) was reported to have variable incidence ranging from 10 to 40% and also noted to have a significant risk of stroke and all-cause mortality. This systematic review evaluated the incidence and adverse outcomes of post-CABG AF. Methods: The search period was from 1 January 2010 to September 30, 2023. We conducted a literature search in PubMed of English language, peer-reviewed manuscripts. We included observational and experimental studies among patients who underwent CABG and developed new-onset atrial fibrillation. We analyzed the overall incidence of new-onset AF, 30-day mortality, and adverse outcomes, including cerebrovascular accidents. Results: Thirty-two manuscripts, including findings from two randomized controlled trials conducted among patients with post-CABG new onset atrial fibrillation were reviewed, comprising of 150,788 patients. Of these, 39,327 (26%) developed new-onset post-CABG AF. The median age of patients with new onset post-CABG is 67.5 (IQR 66-69) years, with 52.5% males. The average incidence of cerebrovascular accidents calculated from four manuscripts was 6.26% and 3.38% among patients with and without new-onset AF post-CABG, respectively, with RR 1.92 (95% CI 1.69 - 2.18). Four studies described 30 days of mortality risk, which averaged at 3.05% and 1.46% among patients with and without new-onset AF post-CABG, respectively, with RR 2.08 (95% CI 1.77,2.45). Conclusion: This systematic analysis shows a higher incidence of post-CABG new-onset AF, along with a significant increase in 30-day mortality risk and incidence of cerebrovascular accident when compared to patients who did not develop new-onset AF postoperatively. We propose further studies on determining solutions for post-CABG AF.
Abstract 4138159: Dual antiplatelet therapy duration and stent type in patients with high bleeding risk: A Systematic Review and Network Meta-Analysis
Authors: Tetsuya Saito, Toshiki Kuno, Tomohiro Fujisaki, Rahul Gupta, Kaveh Hosseini, Hisato Takagi, Jose Wiley, Sripal Bangalore
Journal: Circulation (2024)

Background: It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (e.g., durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)). Objectives: We aimed to study the stent type and DAPT duration appropriate for patients with HBR. Methods: PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified (Figure). The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model. Results: Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES versus standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES versus short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]). Conclusions: In patients with HBR who underwent PCI, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.
Abstract 4139942: Trends in Thromboembolic Events Related Mortality in Atrial Fibrillation Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database
Authors: Muhammad Abdullah Naveed, Ahila Ali, Rabia Iqbal, Muhammad Omer Rehan, Bazil Azeem, Usman Akbar, Karthik Gonuguntla, yasar sattar, Muhammad Khan, Zain Ul Abideen Asad, Bilal Munir, sudarshan balla
Journal: Circulation (2024)

Background: Thromboembolic events in atrial fibrillation (AF) patients represent a significant health concern among older adults in the United States. This study investigates trends and demographic disparities in mortality rates due to thromboembolic events in AF patients aged 65 and older from 1999 to 2020. Methods: Utilizing the CDC WONDER database from 1999-2020, this retrospective analysis focused on ICD code I48 for AF and related stroke codes (I26, I63, I74, and I82). Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions. Results: Between 1999 and 2020, thromboembolic events in AF accounted for 422,525 deaths among adults aged 65+ in the U.S., primarily occurring in medical facilities (45.0%). The overall AAMR for thromboembolic events in AF-related deaths increased from 47.3 in 1999 to 49.1 in 2020, with an AAPC of -0.15 (95% CI: -0.37 to 0.07, p = 0.169). A significant decline occurred from 1999 to 2006 (APC: -1.45; 95% CI: -3.22 to -0.63, p &lt; 0.000001), followed by a mild rise from 2006 to 2020 (APC: 0.50; 95% CI: 0.25 to 0.88, p = 0.013). Older women exhibited higher AAMRs compared to older men (women: 46.4; men: 43.5). Among racial/ethnic groups, White patients had the highest AAMRs (48.7), followed by Black population (33.5), American Indians (30.1), Asians (28.8), and Hispanics (27.3). All racial groups saw significant increases in AAMRs except Asian population, who experienced a slight decrease. The highest AAPC was observed in Blacks (1.46; 95% CI: 0.94 to 1.84, p &lt; 0.000001). AAMRs varied by state, ranging from 29.2 in Nevada to 83.9 in Vermont. The Western region had the highest average AAMR (52.0). Nonmetropolitan areas had higher AAMRs than metropolitan areas (51.6 vs. 44.4). Conclusion: This analysis reveals stable yet slightly increasing mortality rates for thromboembolic events in AF among older adults in the U.S. over the past two decades, highlighting ongoing public health concerns. Addressing disparities and improving healthcare access for vulnerable populations are crucial to reducing these mortality rates and improving health outcomes.
Abstract 4139484: Electrophysiologic Characteristics, Outcomes and Potential Predictors of Acute Success After Ventricular Tachycardia Ablation in Patients with Cardiac Sarcoidosis: Systematic Literature Review and Meta-Analysis
Authors: Juan Rodriguez-Riascos, Hema Srikanth Vemulapalli, Padmapriya Muthu, Shruti Iyengar, RAJVI GAJENDRA CHAUDHARY, Komandoor Srivathsan
Journal: Circulation (2024)

Background: Cardiac sarcoidosis (CS) is a rare condition marked by conduction disturbances, and ventricular tachycardia (VT) resulting from reentrant pathways. VT ablation is typically considered for patients with refractory VT. This systematic review aims to synthesize reported outcomes and identify potential predictors for the success of VT ablation in CS patients. Methods: A systematic literature review was conducted following the PRISMA guidelines, searching PubMed, Cochrane, Embase, and Scopus databases up to May 2024. A random-effects model was used to evaluate electrophysiologic and procedural variables and compare outcomes to identify potential predictors of success. Results: After excluding duplicates, 473 titles and abstracts were screened. Twenty-five studies were fully reviewed, and 9 studies comprising data from 311 CS patients who underwent VT ablation were included. The mean age of patients was 50.5 years, with 30% being female. Epicardial mapping was performed in 29% (CI 22-36%; 72/251) of cases, and 96% (CI 77-100%; 65/72) of those underwent epicardial ablation. The prevalence of VT storm before the procedure was 28% (CI 16-42%; 89/259), with a suppression success rate of 84% (CI 73-93%; 64/76). The acute complete success rate defined as lack of inducibility was 58% (CI 49-66%; 174/307). During follow-up, which ranged from 19 to 58 months, 34% (CI 21-48%; 113/271) of patients survived free from the composite outcome of death, transplantation, or VT recurrence. Patients with acute success had fewer inducible VTs (MD –1.1; CI: -1.8 to -0.5; p &lt; 0.001). No other variables were significantly associated with acute success. However, patients with acute success tended to be older than those with partial or unsuccessful outcomes (MD 7.5; CI: -0.2 to 15.1; p = 0.055). Conclusion: VT ablation in patients with CS shows acceptable acute success rates. Patients presenting with VT storm have a high rate of arrhythmia acute suppression. A lower number of inducible VTs is associated with higher acute success rates. Despite these results, the prognosis remains poor, with a significant proportion of patients experiencing disease recurrence, death, or requiring heart transplantation.
Abstract 4139301: Simultaneous Optogenetic Stimulation, Voltage, and Calcium Mapping of Human Engineered Cardiac Tissue
Authors: Bijay Guragain, Hanyu Zhang, Yalin Wu, Yongyu Wang, Yuhua Wei, Garrett Wood, Lei Ye, Gregory Walcott, Jack Rogers, Jianyi Zhang
Journal: Circulation (2024)

Introduction: Optogenetics can precisely stimulate cardiac tissue, while optical mapping of voltage (Vm) and calcium transients (CaT) can image electrophysiological function with high spatiotemporal resolution. Here, we present a novel method that combines optogenetic actuation with dual Vm/CaT optical mapping. The optogenetic channels and CaT indicator are genetically encoded, while the Vm indicator is an organic dye. Methods: For model tissue, we used cardiac spheroid (600-800 µm in diameter) comprising cardiomyocytes and cardiac fibroblasts that were differentiated from human induced pluripotent stem cells. We used lentivirus to express the optogenetic actuator CheRiff and the calcium reporter jRCaMP1b, and stained with a voltage dye, RH237. CheRiff was optically excited using royal blue LED light (450 nm), and both RH237 and jRCaMP1b were excited using a single green LED light source (560 nm) that excites both indicators. The two indicators emit in different bands; fluorescence was split with a dichroic mirror and directed to two cameras to image Vm and CaT simultaneously without crosstalk (Fig. A). Results: We first used electrical field stimulation to activate the spheroid while simultaneously imaging Vm and CaT. This demonstrated the efficacy of the recording system (Fig. B[I]). We then switched to optogenetic stimulation to demonstrate the all-optical system and acquired similar signals (Fig. B[II]). Conclusions: This relatively simple system enables all-optical actuation and readout of cardiac electrophysiology. The genetically encoded optogenetic actuator and CaT indicator can be expressed in engineered tissue, while the organic Vm indicator can be used to stain both wild-type tissue and engineered tissue. We expect the system to be useful to investigate electrical coupling between engineered tissue grafts and host tissue because it enables actuation and readout of engineered tissue to be unambiguously separated from host tissue.
Abstract 4139400: Transvenous Lead Extraction Outcomes in Hemodialysis Patients: Assessing the Risk of Infection
Authors: Aritra Paul, Katsuhide Hayashi, Bryan Baranowski, Arshneel Kochar, David Martin, Tyler Taigen, John Rickard, Ayman Hussein, Oussama Wazni, Thomas Callahan
Journal: Circulation (2024)

Introduction: CIED implant volume remains high, leading to an increase in TLE (Transvenous Lead Extraction) procedures to manage a growing population with aging leads. However, data on TLE outcomes for dialysis patients is limited. Aims: To determine if dialysis patients in the current era have worse outcomes after TLE (procedural success rate, major complications, and 30-day all-cause mortality (ACM)); and to find predictors for the same. Methods: We included all TLE procedures at our institution between 2013-2022 (n=1614; dialysis=53; non-dialysis=1561). Data was collected retrospectively from electronic medical records. Outcomes were first analyzed for all patients; followed by subgroup analyses for dialysis patients with infection, since that was the most common indication for TLE (48/53; 90.6%). Within the subgroup, we looked at intracardiac mass on echo, positive blood culture, and pocket infection as predictors. Results: Mean age of our sample was 62.3 years and 66.8% were male. Lead age and combined lead age were significantly different between dialysis and non-dialysis patients (8.8 vs 5.6 years; p&lt;0.001, and 11.1 vs 16.5 years; p=0.02). Success rate and major complications rate was similar (96.2% vs 95.5%; p=0.8, and 3.8% vs 2.1%; p=0.4), but 30-day ACM rates were significantly worse among dialysis patients (13.2% vs 2%; p&lt;0.001). Multivariate analysis found dialysis, lead extraction due to infection, and NYHA Class 3 or 4 to be independent predictors of 30-day ACM among the entire study population (Table 1). Within the subgroup, only intracardiac mass was associated with significantly worse 30-day ACM (33.1% vs 6.1%; p=0.01), which was confirmed with multivariate analysis [OR=22.4 (1.8-280.4); p=0.02] (Table 2). Conclusion: Dialysis is an independent predictor of 30-day ACM after TLE, along with lead extraction due to infection, and NYHA Class 3 or 4. Within the subgroup of dialysis patients with infection, visualization of intracardiac mass on echo is a predictor of 30-day ACM.