tbuckley/cabot-search huggingface dataset:
Abstract 15941: Efficacy of Frozen Elephant Trunk for Acute Type A Aortic Dissection
Authors: Shinichi Tsumaru, Takeshi Shimamoto
Journal: Circulation (2023)

Objectives: There are various treatment strategies for acute type A aortic dissection (ATAAD). In our department, total arch replacement (TAR) using the Frozen Elephant Trunk (FET) is the standard technique for DeBakey type I, which has a patent false lumen, and we assessed the outcomes and postoperative complications. Methods: Of 71 consecutive patients who underwent surgical treatment for ATAAD at our department from October 2020 to May 2023, 42 patients were included, excluding 29 patients whose the descending aorta was thrombosed or not dissected. Results: Age 64±11 years, 30 male patients (71.4%). Preoperatively, cardiac tamponade was observed in 5 cases, malperfusion in 5 cases of head, 2 cases of coronary artery, 3 cases of celiac artery, 3 cases of superior mesenteric artery, 13 cases of renal artery, and 13 cases of lower limbs. The surgical procedures were ascending aortic replacement (AAR) in 6 cases (14.2%), partial arch replacement (PAR) in 2 cases (4.8%), TAR in 5 cases (11.9%), and TAR with FET in 29 cases (69.0%). The mean operation time was 304±70 minutes, the mean cardiopulmonary bypass time 168±45 minutes, the mean cardiac arrest time 100±26 minutes, the mean circulatory arrest time 42±8 minutes, and the mean minimum bladder temperature 26.1±1.4°C. There was no hospital death, and complications included new stroke in 2 patients (4.8%). The residual dissection was AAR5/6 (83.3%), PAR1/2 (50.0%), TAR5/5 (100%), and TAR with FET24/29 (82.8%), of which AAR5/5 (100%), PAR1/1 (100%), TAR2/5 (40.0%), and TAR with FET1/24 (4.2%) had residual dissection in the proximal descending aorta. There were 3 deaths (meningitis, cerebral hemorrhage, gastrointestinal hemorrhage) with a mean follow-up of 8.9±6.7 months. The only additional treatment was preemptive TEVAR in 1 case (2.4%) for residual dissection of proximal descending aorta of TAR with FET. There was no case of stent induced new entry. Conclusions: We consider the early results for ATAAD to be favorable. Furthermore, TAR with FET promotes good thrombosis and remodeling down to the proximal descending level, suggesting that FET may contribute to improved outcomes during follow-up period. Further clinical research on mid-term outcomes is needed.
Abstract 18768: Diagnosis of Occult Atrial Fibrillation in Patients With Embolic Stroke of an Undetermined Source Based on Left Atrial Strain
Authors: Hamza Maqsood, Laraib Jumani, Momna Wazir, Samina Raza, Maryam Munir, Nabeeha Noor, Saad Mehmood, FNU Neelam, Azouba Gulraiz, Hamza Saleem
Journal: Circulation (2023)

Introduction and Hypothesis: A late electrocardiographic evaluation of patients with embolic stroke of an undetermined source (ESUS) can show atrial fibrillation as a potential cause of embolic stroke. Existing literature has highlighted that left atrial dysfunction can lead to the development of paroxysmal atrial fibrillation (PAF) and subsequent embolism. Our study sought to evaluate the diagnosis of occult atrial fibrillation in patients with embolic stroke of an undetermined source based on abnormalities in the left atrial strain. Methods: 230 patients were included in our multi-center, observational study with the mean age as 56.4 years and 26% females. We followed up on these patients for the occurrence of paroxysmal atrial fibrillation and recurrent ischemic stroke. Trans thoracic echocardiography (TTE) was done, and images were subsequently analyzed for spackle tracing deformation patterns. Primary and secondary outcomes included plotting these atrial strain values against PAF and recurrent ischemia, respectively. Results: 198 patients completed the study. Patients with newly diagnosed PAF had more abnormal left atrial reservoir strain (LASr; 27.3% ± 12.2%, P&lt;0.05) and left atrial conduit strain (LAScd; -13.7% ± 6.2%, P&lt;0.05) compared with patients who had normal rhythm. Multivariable logistic regression analysis showed that LAScd was associated with occult PAF (adjusted odds ratio [aOR] = 1.212, 95% CI, 1.043-1.314, P&lt;0.05) and the composite outcome of AF and recurrent ischemic stroke (OR = 1.146, 95% CI, 1.023-1.185, P&lt;0.05). Conclusions: Our study concluded that abnormal left atrial strain is associated with the detection of occult AF in patients admitted with embolic stroke of undetermined origin. Early detection of etiology by determining left atrial strain can lead to better prognosis and good clinical outcomes.
Abstract 17231: Importance of Intra Plaque Hemorrhage During Carotid Artery Revascularization
Authors: Karlo A Wiley, Allison Anker, Cristina Sanina, Guliz Kozdag Gold
Journal: Circulation (2023)

Introduction: The American Heart Association currently estimates that every 3 minutes a person dies from a stroke. Carotid artery stenosis, a major risk factor for new and recurrent strokes, can be treated with carotid artery revascularization. Vascular emboli released during this procedure are non-invasively detected by transcranial doppler (TCD) ultrasound as micro embolic signals (MES). In this study we aim to show the relationship between carotid plaque characteristics and MES rates that were detected by TCD-monitoring throughout the stages of the carotid artery revascularization procedures. Methods: Before elective carotid revascularization 30 patients (mean age 72±8 years; 16 males, 14 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. While 20 patients underwent carotid endarterectomy (CEA), 10 patients had carotid artery stenting (CAS). CES was divided into 9 stages: 1- Pre-procedure, 2- Dissection, 3- IC clamp, 4- Shunt placement, 5- Shunt open, 6- Endarterectomy, 7- Clamped, 8- IC opened, 9- Post-procedure. Similarly, CAS was divided into 9 stages: 1- Pre-procedure, 2- Arch-carotid angiography, 3- Wire insertion, 4- Filter deployment, 5- Pre-dilation, 6- Stent deployment, 7- Post-dilation, 8- Final angiography, 9- Post-procedure. Patients were monitored continuously with TCD to detect pre-procedural, intra-procedural and post-procedural MES rates. Results: Intraplaque hemorrhage was observed in 18 patients (60%). Patients with intra plaque hemorrhage had more MES during carotid artery dissection/arch-carotid angiography (p=0.028) and IC clamping/wire insertion (p=0.009) compared to patients without intra plaque hemorrhage in the pre-procedural stage. Conclusions: Carotid plaques with intra plaque hemorrhage is associated with higher MES during carotid artery revascularization procedures.
Abstract 15984: Toxic Twist: A Case of Bupropion Induced Brugada Syndrome
Authors: Melis Ketenci, Hillary Way, Zachary Estep, Ayara Ehinmisan, Forugh Homayounrooz, Kathryn Mitra, Joshua Lader
Journal: Circulation (2023)

Introduction: Brugada syndrome is an inherited sodium channel pathology typically diagnosed by ECG findings. The condition can also be triggered by electrolye imbalances, fever and medications. It can result in ventricular tachycardia or fibrillation which can lead to sudden cardiac death. Therefore, it is vital to recognize the Brugada pattern on ECG and identify the potential triggers. Case Presentation: 36-year-old woman with past medical history of depression and prior suicidal attempt presented to emergency department with altered mental status secondary to intentional overdose of bupropion. Vitals were HR 118 beats per minute, BP 160/95 mmHg, RR 14 and SpO2 100% on room air. Physical examination was significant for tachycardia and lethargy. Laboratory values were significant for K + :3.3 mEq/L , HCO3 - :20 mEq/L , anion gap: 15, lactic acid: 5.5 mmol/L, ABG pH: 7.3. ECG on admission showed sinus tachycardia with rate of 121 and prolonged QTc 488 ms. Patient was monitored with serial ECGs given concern for Qtc prolongation. Later in the hospital course, ECG showed coved ST segment elevation in V1-V2 followed by a negative T wave. Echocardiogram was without structural abnormalities with EF of 55-60%. ICD placement was not indicated given this condition was drug induced with type 1 Brugada pattern and there was no family or personal history of syncope, arrhythmia or sudden cardiac death. Patient’s medication regimen was optimized with discontinuation of bupropion which was contraindicated in Brugada syndrome and avoidance of medications with sodium channel blocking effects was emphasized. Discussion: Brugada syndrome is a rare but potentially fatal condition. It becomes more challenging diagnosis in the absence of personal or familial cardiac history. It is very important to consider medications as a possible trigger for the condition given the management differs from inherited type and it does not generally require ICD placement.
Abstract 13238: Persistence of High Rates of Major Adverse Cardiovascular Events at 1 Year Post-Myocardial Infarction in Patients With Multivessel Disease: A Systematic Literature Review
Authors: Maria C Bahit, Serge Korjian, Yazan Daaboul, Gerald Chi, Ginger Jiang, Peter Libby, Deepak L Bhatt, Matthew Reynolds, Roxana Mehran, Paul M Ridker, Suzanne Baron, Frank M Sacks, Susan Gabriel, Paul Nara, Alka Shaunik, Charles M Gibson
Journal: Circulation (2023)

Background: Multivessel disease (MVD) heightens the risk of major adverse cardiovascular events (MACE) in post-myocardial infarction (MI) patients. The risk of MACE is elevated in the early period after an MI, a period unaddressed by current secondary preventative therapies. Research aims: To better understand the impact of MVD on clinical and patient-centered outcomes post-MI in the current treatment landscape. Methods: A systematic literature review was conducted to identify relevant articles published between March 2019 and July 2022 from MEDLINE, Embase, Cochrane databases, and cardiovascular (CV) and health outcomes conferences. Articles reporting on pre-specified clinical or patient-centered outcomes in post-MI patients with MVD at timepoints within 1 year were included. Studies that included patients with cardiogenic shock were excluded from this review. Results: Clinical and patient-centered outcomes were reported in five randomized-controlled trials (RCTs) and 24 observational studies across 30 articles; and one RCT across two articles, respectively. Although the definition of MVD varied, it was generally characterized by ≥50% stenosis in ≥1 noninfarct-related coronary artery. Rates of individual MACE endpoints (all-cause mortality, CV mortality, MI, stroke) were variable (Table), likely due to heterogeneity in study populations and interventions. Nevertheless, a key trend was identified; MACE rates at 1-year post-MI were typically not substantially higher than those at earlier timepoints. EQ-5D scores, reflective of quality of life (QoL), increased following treatment; however, increases were marginal, indicating minimal improvements in QoL. Conclusions: MVD is associated with high rates of MACE early after MI that persist at 1 year. Novel therapies that address CV risk in the early period post-MI may support improved CV outcomes among patients with MVD. Further data on patient-centered outcomes are warranted.
Abstract 13708: Analyzing Outcomes of Atrial Septal Defect Closure in Patients With Ischemic Stroke and Thrombophilia
Authors: Andres Cordova Sanchez, Bharat Rawlley, Sherna Menezes, Ana Morales Mejia, Kenneth Adames Ramos, Armando Pichs, Debanik Chaudhuri
Journal: Circulation (2023)

Introduction: Evidence on outcomes of ASD closure after a stroke in patients with thrombophilia is limited.: We illustrate differences in long-term outcomes amongst patients diagnosed with a stroke and thrombophilia, who underwent ASD closure up to 3 months after the stroke versus those who did not. Methods: We queried the TriNetX research database to identify adult patients with thrombophilia and ASD who had an ischemic stroke from 2016 to 2021. Patients were divided into two groups: those undergoing percutaneous transcatheter ASD closure within 3 months of the stroke and those who received medical therapy only. Subgroup analyses was performed comparing ASD closure with patients who received either anticoagulation or antiplatelets, and of those with a specific diagnosis of PFO. Propensity score matching (PSM) was used to control for age, sex, hypertensive diseases, CKD, diabetes, dyslipidemias, ischemic heart disease, and tobacco use. Outcomes were measured from 1 month to 3 years after the index event and included all-cause mortality, new onset Atrial fibrillation/flutter, arterial embolism, and services associated with stroke/arterial embolism namely thrombolysis, thrombectomy, and imaging (CT, CTA, MRI, MRA) of head and neck. Results: Patients with thrombophilia undergoing ASD closure after a stroke had lower all-cause mortality compared to medical therapy [HR 0.35, 95%CI 0.165 - 0.764]. This association persisted on subgroup analysis comparing ASD closure to antiplatelet use only [HR 0.392, 95% CI 0.163,0.947] (Table 1). Conclusions: ASD closure was associated with lower mortality in patients with thrombophilia and ischemic stroke. There was no statistical difference in incidence of A.fib/flutter, arterial embolism, or services associated to stroke/embolism. There were no differences in outcomes in patients with a specific diagnosis of PFO.
Abstract 12803: Disparities in Care Among COVID-19 Patients With ST-Elevation Myocardial Infarction Admitted in Rural and Urban Teaching Centers
Authors: Rahat A Memon, Jasninder S Dhaliwal, Kamleshun Ramphul, Nomesh Kumar, Abhimanyu Ravalani, Fnu Bawna, Shaheen Sombans, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: During the pandemic of COVID-19, resources ran scarce in various regions, which impacted access and availability of treatment options. Our study aims to compare outcomes of COVID-19-positive patients (CPP) who reported a diagnosis of ST-elevation myocardial infarction (STEMI) in either rural centers (RC) or urban teaching centers(UTC). Methods: De-identified data of CPP adults with STEMI from the 2020 National Inpatient Sample for admissions between April-December 2020 were analyzed. Patient characteristics and outcomes between RC and UTC were compared. Results: We found 4690 STEMI cases among CPP. Most cases were hospitalized in UTC(4255 cases, 90.7%), with 9.3% seeking care RC (Table 1). Cases in UTC were younger (mean age 66.28 years) and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.31) than those at RC (mean age 71.75 years, p&lt;0.01, mean CCI score 4.00, p&lt;0.01). Medicare primarily covered both centers. A higher proportion of patients in RC were Whites (77.4%), while 50.0% of AMI cases at UTC were Whites. Patients at UTC also had a higher prevalence of prior stroke (6.3% vs. 3.4%, p=0.016) and lipid disorder (53.3% vs. 43.7%, p&lt;0.01) than those in RC but showed a lower prevalence of diabetes (44.3% vs. 50.6%, p=0.012). No differences in the prevalence of prior myocardial infarction, hypertension, smoking, obesity, chronic kidney disease, and sex were noted. Cases in UTC reported a higher incidence of cardiogenic shock (18.2% vs. 3.4%, aOR 6.631, 95% CI 3.850-11.421, p&lt;0.01), PCI use (42.1% vs. 20.7%, aOR 2.482, 95% CI 1.910-3.225, p&lt;0.01), and death (44.4% vs. 40.2%, aOR 1.513, 95% CI 1.197-1.912, p&lt;0.01). Conclusions: Adults with COVID-19 with STEMI admitted UTC were sicker with a higher mean CCI score and reported higher PCI use and mortality. Further studies investigating the distribution of resources during the pandemic and proposals to improve care access in rural and urban teaching hospitals should be conducted.
Abstract 16341: A Rare Case of Dual Cardiomyopathy: Acute Decompensated Heart Failure Secondary to Eosinophilic Myocarditis and Ischemic Cardiomyopathy
Authors: Kunal Goel, Andrew Chiou, Austin Robinson
Journal: Circulation (2023)

Introduction: Dual cardiomyopathy, characterized by the coexistence of two distinct forms of myocardial dysfunction, is a rare phenomenon with complex diagnostic and therapeutic challenges. We present a unique case of a patient with combined eosinophilic myocarditis and ischemic cardiomyopathy. Case Presentation: A 65-year-old female with history of peripheral eosinophilia presented with worsening dyspnea and abdominal pain. CT abdomen was notable for right renal artery thrombosis. Troponin I was elevated at 0.057 ng/ml and 0.056 ng/ml. Notably, her absolute eosinophil count was elevated to 20.34 K/mcL. EKG with LVH and repolarization abnormalities. TTE showed a severely reduced LVEF of 18% and severe global hypokinesis. Decision Making: Given her newly diagnosed cardiomyopathy, a cardiac MRI was obtained that demonstrated presence of two moderate-sized cylindrical thrombi in the LV and subendocardial late gadolinium enhancement in the basal to mid antero/inferoseptum and inferolateral wall, characteristic of both myocardial infarction and eosinophilic myocarditis (Figure 1). She underwent a coronary angiogram that revealed severe mid LAD and OM1 artery stenosis that required PCI. She was initiated on appropriate medical therapy including steroids with normalization of her peripheral eosinophilia and improvement in her clinical symptoms. Discussion: This case highlights the intricate interplay between eosinophilic myocarditis and underlying ischemic cardiomyopathy. The timely initiation of appropriate therapies, including corticosteroids for eosinophilic myocarditis and revascularization for ischemic cardiomyopathy, can lead to favorable outcomes in these complex cases. Figure 1: Cardiac MRI showing inferolateral LGE and Cylindrical LV thrombi.
Abstract 12668: Prevalence of Phenotypic Hypertrophic Cardiomyopathy Among Students Referred for Sport Pre-Participation Cardiovascular Screening
Authors: Nicholas Roma, Rasha Aurshiya, Bruce Ferraro, Leyla Gasimli-Gamache, Sudip Nanda, Jamshid Shirani
Journal: Circulation (2023)

Background: Although rare, sudden cardiac death (SCD) is a tragic event for young sports participants and has catastrophic impact on the community. Hypertrophic cardiomyopathy (HCM) is a leading cause of SCD in sports. Comprehensive initial pre-participation physical evaluation (CIPPE) is mandated for middle school, and junior and senior high school students by Pennsylvania Interscholastic Athletic Association (PIAA) primarily for reducing potential sports-related injuries and SCD. Prospective data has been limited in this age group in regard to the prevalence of HCM. Methods: Between 2015 and 2023, we prospectively screened 424 students [age 10-21 (15±2) years, 60% male, 64% Caucasian) referred for cardiovascular disease pre-participation screening based on at least one positive response on the 14-point AHA questionnaire during CIPPE. Evaluation included 12-lead ECG and rhythm strip (100%), transthoracic echo (96.4%), ambulatory heart rhythm monitor (3.8%), treadmill exercise ECG (14.5%), stress echo (2.1%), and cardiac MRI (0.9%). Results: Overall, 1 (0.24%) student was diagnosed with definitive and two were diagnosed with probable HCM [Table-1]. Conclusion: In this prospective cohort of middle school and junior and senior high school students with at least one positive response to the 14-point AHA questionnaire, 1 (0.24%) had definitive and 2 (0.47%) had probable phenotypic HCM.
Abstract 15406: Loss of Estrogen Receptor α Inhibits Angiogenic Function in Right Ventricular Endothelial Cells (RVECs)
Authors: Jiajun Li, vijaya karoor, Andrea L Frump, Tim Lahm
Journal: Circulation (2023)

Introduction: Right ventricular failure (RVF) is the leading cause of death in patients with pulmonary hypertension (PH). While the pathophysiology of RVF is complex and multifactorial, insufficient angiogenesis and impaired RV endothelial cell (RVEC) function have been identified as key contributors. 17β-estradiol (E2), the most abundant female sex steroid, exerts RV-protective effects including stimulation of angiogenesis. However, the mechanism underlying E2’s pro-angiogenic function are unknown. Hypothesis: Estrogen Receptor (ER) α is necessary for RV angiogenesis. Methods: To identify the role of ERα in RVEC function and RV angiogenesis, ERα loss-of-function mutant (ERα Mut ) rats were generated by CRISPR-Cas9. In vivo studies were performed in both male and female wild-type (WT) and ERα Mut rats. RV capillary density was assessed by immunofluorescence. RVECs were isolated from male or female WT and ERα Mut rats. Angiogenic function was evaluated by matrigel tube formation assay at 10h. RVEC proliferation (at 24h) was measured by Incucyte image-based analysis and Thymidine incorporation assay. RVEC migration (at 24h) was examined by transwell migration assay. Angiogenesis mediators in RVECs were quantified via Western Blot. P&lt;0.05 was considered significant. Results: Female WT rats exhibited increased RV capillary density compared to males (p&lt;0.001). However, loss of functioning ERα decreased RV capillary density (p&lt;0.05). Loss of ERα impaired proliferation (24h) capability in female, but not male, RVECs (p&lt;0.001). On the other hand, male, but not female, ERα Mut RVECs exhibited reduced cell migration in response to VEGF-A (p&lt;0.01). Loss of ERα reduced RVEC tube formation in both sexes (p&lt;0.05). At a molecular level, male ERα Mut RVECs expressed less VEGF-A, angiopoietin-2, and Id1 than WT (p&lt;0.01) . Conclusions: ERα is necessary for RVEC angiogenic function. However, ERα effects on angiogenesis are sexually dimorphic. Male ERα Mut RVECs exhibit reduced cell migration potential and less angiogenesis mediators, whereas female ERα Mut RVECs exhibit decreased proliferation potential in vitro and reduced female RV capillary density in vivo . Targeting ERα may allow for sex-specific therapies aimed at enhancing RV adaptation in PH.