tbuckley/cabot-search huggingface dataset:
Abstract 4140674: Combined left atrial appendage occlusion and catheter ablation in patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Mariana R.C. Clemente, Denilsa Navalha, Vinicius Bittar, Thomaz Costa, Gabriel Prusch Fernandes, Livia Silva
Journal: Circulation (2024)

Background: Left atrial appendage occlusion (LAAO) and catheter ablation (CA) for atrial fibrillation (AF) have been increasingly performed in combination. However, the effects of this combined procedure remain unknown. Hypothesis: Combined LAAO and CA improves outcomes of patients with AF relative to isolated LAAO. Aims: To compare the outcomes of combined LAAO and CA with isolated LAAO in patients with AF. Methods: PubMed, Embase, and Cochrane Library were systematically searched from inception to March 2024 to identify studies comparing combined LAAO and CA versus isolated LAAO. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. Statistical analyses were performed using R software version 4.3.1. Results: We included eight retrospective studies comprising 51,802 patients, of whom 1,375 (2.6%) received the combined procedure, and 29,696 (57.3%) were men. Mean age of patients ranged from 63.6 to 71.4 years. Follow-up ranged from 1 to 37.6 months. Additionally, 626 (1.2%) patients had paroxysmal AF and 757 (1.4%) had persistent AF. There were no significant differences between the combined procedure and LAAO alone in terms of major bleeding (OR 0.55; 95% CI 0.09 to 3.41; p=0.52; Figure 1A), stroke (OR 1.03; 95% CI 0.35 to 3.00; p=0.96; Figure 1B), or pericardial effusion (OR 1.18; 95% CI 0.60 to 2.33; p=0.63; Figure 1C). Conclusion: In this meta-analysis, there were no significant differences in major bleeding, stroke, or pericardial effusion when comparing combined LAAO and CA with isolated LAAO.
Abstract 4141342: Impact of sodium-glucose cotransporter-2 inhibitor on postoperative atrial fibrillation and myocardial injury after coronary artery bypass grafting in patients with diabetes
Authors: Zhongchen Li, Juntong Zeng, Heng Zhang, Zhe Zheng
Journal: Circulation (2024)

Background: Recent studies showed that sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce the risk of atrial fibrillation (AF) and the recurrence of AF after catheter ablation in diabetic patients. However, there is no evidence of a relationship between SGLT2i use and the incidence of postoperative atrial fibrillation (POAF), a common complication after coronary artery bypass grafting (CABG). Additionally, the protective mechanisms of SGLT2i on cardiomyocytes suggest a possible association with reduced postoperative myocardial injury. Methods: SGLT2i use was defined as taking SGLT2i at the time of admission and discontinuing it at least 3 days before surgery. Adult diabetic patients without a history of AF undergoing primary CABG (±valve surgery) between October 2023 and December 2024 were included from a large prospective cohort. Patients with acute coronary syndromes or emergency surgery were excluded. Patients in the SGLT2i group were matched by propensity score with the control group (no SGLT2i use) at a 1:3 ratio. Generalized estimating equations were utilized for repeated measures data. Primary outcomes were the incidence of POAF and the level of high-sensitivity troponin I (hs-cTnI) within 5 days post-surgery. Secondary outcomes included in-hospital death, stroke, perioperative myocardial infarction (MI), acute kidney injury stage 2/3, reoperation, ICU stay duration, postoperative NT-proBNP levels, and blood inflammatory biomarkers. Diabetic ketoacidosis (DKA) was also monitored. Results: The cohort included 10,106 subjects, with 1,407 (13.9%) in the SGLT2i group. A total of 1,001 patients in the SGLT2i group and 3,003 in the control group were analyzed, with well-matched baseline characteristics after propensity scoring. No DKA events were found in either group. After adjusting for multiple confounding factors, the incidence of POAF was significantly lower in the SGLT2i group (19.6% vs. 25.7%, odds ratio: 0.686, 95% confidence interval: 0.592 - 0.794, P &lt; 0.001). In the SGLT2i group, hs-cTnI levels within 5 days postoperatively decreased by an average of 0.36 ng/ml (95% CI: -0.707 to -0.012, P = 0.013). No significant differences were observed in postoperative NT-proBNP, inflammatory biomarkers, or ICU stay. No differences in other perioperative clinical outcomes were observed. Conclusion: SGLT2 inhibitors can reduce the incidence of POAF and levels of hs-cTnI following CABG, without an increased risk of other perioperative adverse events
Abstract 4140767: MRI-Measured Myocardial Strain as a Predictor of Clinical Outcomes in Systemic RV.
Authors: Hidemi Kajimoto, Craig Broberg
Journal: Circulation (2024)

Background: Systemic RV dysfunction is a common concern in patients with d-Transposition of the great arteries (d-TGA) after atrial switch and congenitally corrected TGA (ccTGA). We investigated myocardial strain on MRI to predict clinical outcomes. Methods: We analyzed 50 MRI studies (33 d-TGA with atrial switch, 17 ccTGA, mean age 42 ± 13 years) after excluding studies with fewer than 30 phases or incomplete images. Feature-tracking of SSFP cine was retrospectively utilized to quantify radial, circumferential, and longitudinal strain in both 2 and 3 dimensions. Physiological class (PC) was determined by clinicians according to the 2018 AHA/ACC guidelines. Clinical events (e.g., change in PC, initiation or escalation of diuretics, mortality, arrhythmias, heart failure hospitalization) over a 5-year period were obtained through chart review. Results: Deterioration of PC was significantly associated with worsening of all strain measures (p ≤0.05 for each) except 3D global radial strain. RV ejection fraction (EF) was also significant (p ≤0.05). Importantly, in patients experiencing new clinical events within 5 years, baseline absolute values of global longitudinal strain (2D and 3D) were significantly worse (p ≤0.05 for both), whereas RVEF was not (Figure). Conclusion: MRI-measured global longitudinal strain holds promise as a prognostic indicator for clinical outcomes in adults with systemic RV dysfunction. These findings underscore its potential utility in risk stratification and guiding management decisions.
Abstract 4141384: Integrated Multi-Omics Myocardial Analysis Suggests Impaired Alternative Fuel Utilization in Heart Failure with Preserved Ejection Fraction
Authors: Mohammad Keykhaei, Navid Koleini, Mariam Meddeb, Masih Tajdini, Abigail Mulligan, Kavita Sharma, David Kass, Virginia Hahn
Journal: Circulation (2024)

Introduction: Recent transcriptomic and metabolomic studies have suggested heart failure with preserved ejection fraction (HFpEF) myocardium exhibits metabolic insufficiency. Here we integrated targeted gene expression and proteomics to identify which fuel use pathways are likely compromised in HFpEF. Hypothesis: We hypothesize HFpEF has depressed gene/protein/metabolite levels related to metabolism of fatty acids, branched chain amino acids, and anaplerosis. Methods: Myocardial septal biopsies from HFpEF patients and non-failing controls were studied by Western blot for key proteins in fuel metabolism and cross-related to metabolomics (38 HFpEF, 20 control) and bulk RNAseq (41 HFpEF, 24 control). Protein abundance between groups was tested using Welch’s t-test. Results: Protein levels of CPT1 and CPT2 enzymes needed for acylcarnitine formation and rate-limiting for fatty acid metabolism, were similar in HFpEF vs controls. Proteins related to fatty acid uptake (ACSL1, P=0.002) and oxidation (ACAD [ACADM, P=0.02; ACADVL, P=0.009], HADH [HADHA, P&lt;0.0001; HADHB, P=0.0006]), and master regulators PPARa (P&lt;0.0001) and PGC1a (P=0.01), were significantly lower in HFpEF vs controls. Key enzymes in ketone metabolism had lower protein expression in HFpEF (SLC16A1 [ketone transporter, P=0.0002], BDH1 [P=0.003], ACAT [P=0.002]). Both BCAT2 (P=0.002) and BCKDH (P=0.0006) were lower in HFpEF, suggesting impaired oxidation of branched-chain amino acid (BCAA) and branched-chain ketoacids, concordant with metabolomic data. Proteins in anaplerotic pathways that replenish TCA intermediates were also lower in HFpEF, [ME (converts malate to pyruvate, P&lt;0.0001), GOT (converts aspartate to oxaloacetate, P=0.036), and GLUD1 (converts glutamate to α-ketoglutarate, P&lt;0.0001). Protein expression of the PCC family and MUT, responsible for replenishment of succinyl CoA, did not differ between groups. Conclusions: Multi-omic analysis of metabolic pathways in HFpEF suggests significant metabolic insufficiency, with reduced expression of key proteins and their mRNAs involved with fatty acid, ketone, BCAA, and anaplerotic metabolism. This reveals the HFpEF heart as particularly energy challenged and suggests potential metabolic therapy targets.
Abstract 4141009: Novel role of Nrf3 in platelet activation and thrombo-inflammation by regulating platelet energy metabolism
Authors: Meng Zhou, Xiaoyue Zhou, Qishan Chen, Li Zhang
Journal: Circulation (2024)

Background: Thrombotic diseases such as myocardial infarction and stroke are closely associated with immune inflammation and high prevalent in COVID-19 and sepsis. The pathologic mechanism is due to dysregulation and hyperactivation of platelet induced thrombotic inflammation and vascular occlusion. We surprisingly found elevated expression of Nrf3 (Nuclear factor erythroid 2-related factor 3) in platelets from COVID-19 patients and septic mouse. Considering that the role of Nrf3 still remains unknown, we aimed to investigate the pathological mechanisms of Nrf3 in platelet and thrombo-inflammation. METHODS: Nrf3 global knockout mice and Nrf3 megakaryocyte/platelet-specific knockout mice were used for research. Platelet aggregation/secretion, integrin αIIbβ3 activation, spreading, clot retraction and calcium flux were measured. In vivo thrombus formation was detected in carotid thrombosis and pulmonary embolism. Lipopolysaccharide (LPS) intravenous injection was used to establish septic model and explore the effects of Nrf3 on platelet-induced thrombo-inflammation. RESULTS: We found that Nrf3 expression was increased in inflammation-stimulated platelets and positively correlated with increased platelet activity. In vitro detection indicated that deficiency of Nrf3 attenuated platelet activation without significant effects on platelet counts and other types of peripheral blood cells. Nrf3 -/- mice showed reduced thrombus formation with little tendency to hemorrhage. Additionally, we demonstrated that loss of Nrf3 reduced pro-inflammatory chemokines content (IL-1β, TNF-α and S100A4), platelet-leukocyte complex and neutrophil extracellular traps (NETs), and further alleviated micro-thrombosis and inflammatory infiltration in sepsis-induced multi-organ injury. Meanwhile, Nrf3 -/- platelets exhibited lower ATP content, oxygen consumption rate (OCR) and extracellular acidification rate (ECAR), indicating that Nrf3 is closely involved in platelet energy metabolism. CONCLUSION: Collectively, these results demonstrated that Nrf3 regulated platelet activity, thrombosis and platelet-induced inflammation by influencing energy metabolism, suggesting that Nrf3 could be a potential target for therapeutic intervention in patients at risk of thrombo-inflammation.
Abstract 4140779: Short-term outcomes and coronary microvascular dysfunction after percutaneous coronary intervention in severely calcified lesions: A comparison between rotational atherectomy and intravascular lithotripsy.
Authors: Hirofumi Kusumoto, Daisuke Shishikura, Yohei Yamauchi, Kazushi Sakane, Hideaki Morita, Masaaki Hoshiga
Journal: Circulation (2024)

Background: Treatment of calcified coronary artery stenosis remains challenging and is associated with worse clinical outcomes. For successful PCI of calcified lesions, it is imperative to achieve sufficient plaque modification before stent implantation. Aims: The aims of the current study were to evaluate coronary microvascular dysfunction and short-term outcomes in heavy calcified coronary lesion underwent PCI with intravascular lithotripsy (IVL) versus rotational atherectomy (RA). Methods: We retrospectively analyzed 91 patients underwent PCI with severely calcified coronary stenosis treated with atherectomy devices. Of these, coronary microvascular function was assessed using temperature-sensor guidewire (PressureWire X, Abott) in 40 patients (IVL: 21, RA: 19) before and after PCI. Procedural success including successful stent delivery with &lt;30% residual angiographic stenosis and successful stent expansion, and post-procedural clinical outcomes (30 days in-hospital) including all cause death, non-fatal myocardial infarction (MI), MI and target vessel revascularization were also evaluated. Results: A total of 61 patients underwent calcium modification with RA and 30 with IVL. The mean age was 76.1 years and a high prevalence of diabetes (59%), chronic kidney disease (30%), and dialysis (13%). There were no significant differences in procedural success rate between two groups (93% for IVL vs. 82% for RA, p=0.20) (Table). The rate of procedural complication including flow-limiting dissection, perforation and slow flow phenomenon, was lower in IVL group (13% vs. 33%, p=0.04) and non-fatal MI was high likely observed in RA group compared to IVL group (36% vs. 3%, p&lt;0.01). From the physiological analysis, resting full-cycle ratio (RFR) and fractional flow reserve (FFR) were significantly improved after PCI in both groups. Index of microcirculatory resistance (IMR) after PCI was numerically lower in IVL group compared to RA group (14.5 vs. 29.9, p=0.07). Coronary fractional reserve (CFR) after PCI was significantly higher in IVL group (2.99 vs. 1.82, p=0.02) (figure). Conclusion: IVL and RA are both effective devices to treat severely calcified coronary stenosis with similar procedural success outcomes. However, IVL was associated with lower incidence of coronary microvascular dysfunction compared to RA, indicating that consideration on device selection would be required in high risk patients with severely calcified coronary disease.
Abstract 4141125: Lower Limit of Normal for Left Atrial Strain: An updated Systematic Review with Bayesian Meta-Analysis from 10,533 Healthy Subjects
Authors: Yosuke Katayama, Deva Nirthanakumaran, Koya Ozawa, Prajith Jeyaprakash, Faraz Pathan, Tomoko Negishi, Gary Low, Kazuaki Negishi
Journal: Circulation (2024)

Background: Left atrial (LA) strain is an established marker of LA function. Our previous meta-analysis (Pathan, 2017) from 2,542 healthy subjects reported 39.4% with lower limit of normal (LLN) at 38.0%. However, subsequent original studies revealed much lower LLN, ranging from 15.1% to 28.2% (Figure). The LLN is critically important for clinical practice to distinguish abnormal LA function from normal. Thus, we hypothesised that a Bayesian meta-analysis to pool LLN from healthy individuals would determine a clinically meaningful cut-off threshold for LA strain. Aim: As there has been a large number of recent studies reporting normal LA strain since 2017, we aimed to update our systematic review and run Bayesian analysis for LLN of LA strain. Methods: Following PRISMA Guidelines, an updated systematic review was conducted by searching PubMed, Embase, and Scopus databases. Studies of LA strain were included if they involved &gt;20 healthy patients without cardiac disease or risk factors between 2016 and September 2022. Mean LA reservoir strain with 95% confidence intervals were extracted from eligible studies. We use Bayesian meta-analysis to pool the lower 95% confidence interval of the LA reservoir strain from included studies. Prior to pooling the result, we standardised the data with log transformation. The priori used in this model was based on weak informative prior with N (0,1) as the prior distribution. The posterior mean was then exponentiated to obtain the lower reference value and its 95% credible interval (CI). Results: Sixty-three studies (10,533 healthy patients) satisfied inclusion criteria. Our updated Bayesian Meta-analysis demonstrated a pooled mean of 37.8% [95% CI: 36.1, 39.4] with LLN at 22.4% [20.6, 24.3], which is more concordant with recent original studies (Figure). Conclusions: The normal mean LA strain has been updated by pooling &gt;10,000 subjects. The updated LLN of 22.5% may represent a better clinical cut-off for normal LA strain to identify individuals with abnormal LA strain.
Abstract 4141078: Hearing the Voices of Families: Barriers and Facilitators of Pediatric Cardiac Ambulatory Care During the COVID-19 Pandemic
Authors: Larissa Wenren, Maria Perez, Kira Fried, Rebecca Noymer, Shannon Engstrand, Tiffany Folks, Kathy Jenkins, Sarah de Ferranti, Susan Saleeb, Jean Connor
Journal: Circulation (2024)

Background: Social determinants of health (SDOH) , exacerbated by the COVID-19 pandemic, impact access to medical care. Research Question: Through descriptive qualitative inquiry, we explored barriers and facilitators to pediatric cardiology ambulatory care for patients with complex congenital heart disease (CCHD) during COVID-19. Methods: English- and Spanish-speaking caregivers of children with CCHD who missed at least one clinic visit during the first year of COVID-19 were recruited, with purposeful sampling of Black and Hispanic patients. Semi-structured interviews inquired about the impact of the pandemic, experience with telehealth and communication with providers, effects of SDOH, and perceived impact of their race/ethnicity on care. Content analysis summarized information and identified themes. Results: Interviews (19) were conducted: 14 in English (6 Black, 2 Hispanic, 2 White, 3 mixed race, 1 American Indian), and 5 in Spanish (5 Hispanic). Overarching themes were: Barriers to Care, Facilitators of Returning/Staying in Care, Impact of Diagnosis, and Recommendations for Improvement (Image 1). Despite challenges with finances and transportation, as well as concern for infection risk, the majority of caregivers preferred in-person care over telehealth due to physical exam, diagnostic testing, and interpersonal connection with providers. SDOH challenges including housing, transportation, and employment contributed to missing care. For some families, social vulnerability was exacerbated by their child’s CCHD diagnosis and then again by COVID-19. Universally, caregivers felt their child’s race/ethnicity did not affect the care they received. Spanish-speaking caregivers expressed their primary language as a barrier to care and their desire for more thorough explanations and teach-back from the medical team. Conclusion: While SDOH can hinder access to ambulatory cardiac care, trusting relationships with care teams facilitated engagement. Social vulnerability contributed to dynamic situations for families, especially during COVID-19, highlighting the need for routine SDOH assessment and support. English- and Spanish-speaking caregivers echoed the same challenges. Race/ethnicity was not felt to impact care received.
Abstract 4140800: Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multi-Center Cohort Study
Authors: Vibhu Parcha, John Scheinuk, Gina Josey, Syed Hyder, Usman Hasnie, Ahmed Saleh, Ammar Hasnie, Rachel Sinkey, Marc Cribbs, Joanna Joly, Samuel McElwee, Stephen Clarkson
Journal: Circulation (2024)

Introduction: Peripartum cardiomyopathy (PPCM) is the leading cause of late postpartum pregnancy-related death and often precipitates acute heart failure and cardiogenic shock. Limited contemporary data exists on long-term outcomes among PPCM patients who develop cardiogenic shock (PPCM-CS), especially those who require extra-corporeal membrane oxygenation (ECMO). Methods: This retrospective cohort study identified patients with PPCM-CS from January 2012-January 2024, using EHR-based data from academic medical centers across the US (TriNetX, Inc.). The primary outcome was all-cause mortality over a 180-day follow-up period. Secondary outcomes included acute kidney injury (AKI), new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), mechanical circulatory support (MCS), and heart transplantation (HT). The outcomes were reported in the overall population and among those requiring ECMO support. Results: We identified 856 females (mean age 36 ± 12 years; 41% White, 41% Black individuals) with PPCM-CS ( Table ). During a mean follow-up of 144 ± 63 days, all-cause mortality occurred in 17.9%. There were high incidences of AKI (53.7%), AF (19.4%), and VT/VF (29.3%) ( Fig 1 ). 8.1% of patients successfully underwent HT. There was substantial MCS use, with percutaneous ventricular assist device (pVAD) used in 8.7% and intra-aortic balloon pump (IABP) used in 11.0%. Among those requiring ECMO (N=97, 11.3%), there was high all-cause mortality (26.8%). The concomitant use of pVAD and IABP was 14.4% and 15.5%, respectively. 14.4% of ECMO-supported patients underwent successful HT. Conclusion: This study provides insights into long-term clinical outcomes among patients with PPCM-CS, highlights those requiring ECMO support. Further investigation is needed for early disease recognition and to establish optimal utilization of MCS to improve outcomes in PPCM-CS.
Abstract 4141422: Prognostic Value of Spleen Stiffness Assessed by Magnetic Resonance Elastography in Patients with Heart Failure
Authors: Akinori Takahashi, Toshiyuki Nagai, Atsushi Tada, Yoshiya Kato, Satonori Tsuneta, Yuki Mori, Takeshi Hamaya, Seiichiro Naito, Sakae Takenaka, Takao Konishi, Takuma Sato, Kiwamu Kamiya, Toshihisa Anzai
Journal: Circulation (2024)

Background: The interaction between the heart and spleen plays a crucial role in the cardio-splenic axis in patients with heart failure (HF). Several studies reported that spleen stiffness (SS) measured by magnetic resonance elastography (MRE) (SS-MRE) was a useful determinant of hepatic fibrosis and portal / venous pressure in patients with chronic liver disease. However, it is unclear whether higher SS-MRE is associated with elevated central venous pressure and worse clinical outcomes in patients with HF. Methods: We prospectively examined 216 consecutive chronic HF patients (120 male, mean age 66 ± 14 years, left ventricular ejection fraction 47 ± 17%) between April 2018 and February 2023 after excluding those with organic liver and spleen diseases. All patients underwent 3.0 Tesla MRE within 4 days of right heart catheterization. Representative images of MRE are shown in Figure 1A . We also assessed liver stiffness (LS) measured by MRE (LS-MRE). The primary outcome was a composite of all-cause death and hospitalization for HF. Results: Median SS-MRE and LS-MRE were 6.50 (interquartile range [IQR] 5.65-7.27) kPa, and 2.55 (IQR 2.33-2.83) kPa, respectively, with moderate correlation between the two parameters (r = 0.25, P &lt;0.001). There was a significant correlation between SS-MRE and right atrial pressure (r = 0.15, P = 0.032). During a median follow-up period of 2.86 (IQR 1.30-4.12) years, the primary outcome occurred in 50 patients (18 all-cause deaths and 32 hospitalizations for HF). Cox regressions showed that SS-MRE was independently associated with the risk of the primary outcome (HR 1.18, 95% CI 1.03-1.37) after adjustments for age, sex, and other significant prognostic covariates. When divided the patients into two groups according to a median LS-MRE value, SS-MRE was associated with the risk of adverse events in patients with lower LS-MRE but not in those with higher LS-MRE ( P for interaction = 0.014) ( Figure 1B and C ). Conclusion: Elevated SS-MRE was independently associated with worse clinical outcomes, especially in patients with lower LS-MRE. These findings suggest that elevated SS-MRE would reflect central venous congestion even in low LS, and is useful for risk stratification in patients with HF.