tbuckley/cabot-search huggingface dataset:
Abstract 4122369: Beyond Closure: A Case Report on Coronary Steal Syndrome by Previously Embolized Internal Mammary Artery Side Branch
Authors: Jose Fuentes, Karla Garcia Almonte, Claudia Suero, Ana Paula Urena Neme, Jorge Tarafa, Pedro Urena V
Journal: Circulation (2024)

Background: Internal mammary artery (IMA) side branch flow diversion post- coronary artery bypass grafting (CABG) and its role in coronary steal syndrome remains controversial. However, evident association persists when substantial side branches stem from the IMA, possibly due to relatively lower peripheral resistance as compared to higher coronary resistance. Intervention has shown promise in ameliorating reversible ischemia in these cases. Recanalization of previously occluded side branch is rare and has only been reported within a 6 month period. We report a case of recanalization of a previously occluded side-branch after 4 years with recurrence of symptoms. Case: A 63-year-old male underwent CABG with LIMA-LAD in 2020 and coil embolization of LIMA side branch for symptomatic coronary steal syndrome (figure 1). Angina recurred 3 years later, leading to right coronary artery stent placement. He now presents with palpitations and dyspnea on exertion. Vital signs and physical exam was unremarkable. ECG showed a normal sinus rhythm with no signs of ischemia. A 24-hour Holter showed significant polymorphic ventricular ectopy and episodes of sustained ventricular tachycardia (arrhythmic burden 12.4%). Transthoracic echocardiogram showed an ejection fraction of 71% and slightly decreased left ventricular global longitudinal strain (-16.6%). Decision-making: A diagnostic cardiac catheterization was performed which showed patency of bypass and stent with no signs of occlusion or restenosis, rather revealing a permeable, previously occluded side-branch (figure 2A) and resurgent coronary steal phenomenon. Repeat coiling was performed, achieving complete cessation of flow (figure 2B) and evident increased flow to the LAD. Resolution of symptoms was observed and post-procedure Holter showed normal sinus rhythm with no arrhythmic changes. Conclusion: Recanalization of an IMA side branch after complete occlusion with multiple coils is rare, particularly beyond 6 months. This appears to be the first reported case of the phenomenon, occurring after 4 years. Administration of heparin for recent stent placement, continuation of oral antiplatelet therapy and distal coil location may have contributed to restoration of flow, despite the presence of intraluminal coils. Repeat coiling proved successful in relieving symptoms.
Abstract 4119619: Congruency of Stated Aortic Stenosis Severity and Reported Doppler Exam Values in a Large Health Care System Based on ACC/ASE Guidelines
Authors: Sarwar Kokoy, Tim Woods
Journal: Circulation (2024)

Background: Peak aortic valve Doppler velocity, mean aortic valve gradient, and Doppler estimated aortic valve area are key measures recommended for assessing aortic stenosis severity. Discordance often occurs among these measures, posing diagnostic challenges. Failure to accurately diagnose severe aortic stenosis is critical. This study focuses on the discordance between reported aortic valve area (AVA) and stenosis severity, comparing guidelines from the ASE and ACC seen in Table 1. Goals: Assess the incidence of discordance between reported AVA and severity of aortic stenosis and compare how the differing guideline recommendations of the ASE versus ACC for defining severe AS by AVA would affect reporting severity in a large clinical practice. Methods: A query of all transthoracic echocardiograms obtained in patients 18 years of age and above was performed in a large multi-hospital healthcare system between Jan 1 and Jun 30 of 2023. This group was then filtered to include only exams in which the reported aortic valve area was 1 cm2 or less, excluding all cases with prosthetic aortic valves. This group was then further filtered to contain only those patients in whom the physician did NOT report severe aortic stenosis. Results: Between Jan and June 2023, 16,675 subjects ages 18-95 (avg 74) underwent transthoracic echocardiograms in our healthcare system, with 190 (1.1%) reported as having an AVA ≤ 1 cm2. Of those exams, 63 (33% of those with AVA ≤ 1) were not reported as having severe aortic stenosis. Of those 63 exams, 35 (56%) had a reported SVI &lt; 35 ml/m2 compatible with a low flow state. However, only 1 of those 35 cases mentioned flow-status in labeling the stenosis severity in the report. Based on the ASE Doppler AVA definition of severe AS (&lt; 1.0 cm2 (≤ 0.94 )) vs ACC (≤ 1 cm2 (≤1.04), the AV Doppler and SVI data contained in the reports should have led to the grading of the aortic valve as being ”Severe” or “Moderate” aortic stenosis as described in Table 2. Conclusion: Discordance in labeling severe aortic stenosis relates to differing AVA criteria. Cases are often termed "moderate to severe" under ACC criteria. The majority (56%) of cases failing to describe severe AS despite meeting AVA criteria were in low flow states, suggesting this phenomenon is not well understood in clinical practice. Various factors contribute to these findings, warranting further investigation.
Abstract 4120249: What Happens to Automated External Defibrillator Rhythm Strips after a Cardiac Arrest?
Authors: Carmel Ashur, Francis Zirille, Paul Varosy, Amneet Sandhu, Alexis Tumolo, Michael Rosenberg, Lohit Garg, Syed Rafay Ali Sabzwari, Christopher Barrett, Lukasz Cerbin, Bilal Saqi, Daniel Varela, Joseph Adewumi, Matthew Zipse, Wendy Tzou, Ryan Aleong
Journal: Circulation (2024)

Background: Following an out of hospital cardiac arrest (OHCA), rhythm strips stored on an automated external defibrillator (AED) help guide important medical decisions, including possible implantable cardioverter defibrillator (ICD) implantation. However, this information is often difficult to obtain. Objective: To evaluate how frequently AED rhythm strips are reviewed following an OHCA prior to placing an ICD. Methods: Using the Cardiac Arrest Registry to Enhance Survival (CARES), we identified patients from 1/2015-12/2023 who were transferred to our institution following an OHCA. Patients were excluded if resuscitation was not attempted, death occurred during the hospitalization or patient identifying information was not available. Results: Of 907 OHCAs identified, 119 patients ( Table 1 ) met the inclusion criteria. The AED rhythm strip was in the electronic medical record on hospital arrival in 22% of cases and only after provider initiation in 6% of cases. None of the rhythm strips from a bystander-only delivered AED shock (n=17) were available on arrival, with only 24% retrieved during the hospitalization, taking 4.5±2.1 days from the date of arrest. Patients with an AED rhythm strip available (n=34) were more likely than those without a rhythm strip (n=85) to have a cardiac MRI (38% v. 13%, p=0.02) and genetic testing (15% v. 1%, p=0.02) done and have an ICD placed (53% v. 27%, p=0.04) or be discharged on a new anti-arrhythmic drug (15% v. 4%, p=0.04). Figure 1 Of the 42 patients who had an ICD placed during the index hospitalization, 54% were implanted without knowing the type of shockable rhythm or confirmation that an appropriate AED shock had been delivered. Conclusion: Rhythm strips help guide clinical decisions when assessing the need for ICD implantation. There is a systems gap in the process of transferring rhythm strips from AEDs to hospital providers following an OHCA.
Abstract 4120924: Effect Of Colchicine On Myocardial Infarction: Updated Systematic Review And Meta-analysis Of Randomized Controlled Trials
Authors: Ayesha Younas, Tehreem Khan, Hafsa Arshad Azam Raja, Muhammad Talha Shaukat, Aqsa Munir, Norma Gamarra, Vikash Jaiswal
Journal: Circulation (2024)

Background: Colchicine, in multiple ways, has beneficial as well as adverse effects on patients with myocardial infarction. Objective: Our current study aims to study the efficacy as well as harmful effects of colchicine on patients with myocardial infarction. Methods: A comprehensive search was conducted on PubMed, the Cochrane Library, Scopus, Google Scholar, and Clinical trials till May 2024, and Randomized controlled trials were searched investigating the effect of Colchicine on patients with Myocardial Infarction. The quality of trials was assessed with the Cochrane risk of bias tool. Our primary Outcomes include adverse cardiovascular events while secondary outcomes include All-cause Mortality, adverse gastrointestinal effects, levels of hs-CRP, incidence of stroke, cardiac arrest, and hospitalization urgency. Risk ratios and mean differences were pooled under the Random-effect Model. Results: Statistical analysis shows that colchicine did not impact all-cause Mortality (RR =1.00, 95% CI=0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI=0.33-1.95, P=0.63, I2=0), incidence of stroke(RR=0.45, 95% CI= 0.17-1.19, P=0.11, I2=36%) recurrent myocardial infarction (RR=0.78, 95%CI=0.57-1.06, P=0.11, I2=11%) and levels of hs-CRP (MD= -0.87, 95% CI=-1.80-0.06, P=0.07, I2=67%). However, colchicine shows statistically significant reduction in cardiovascular events(RR=0.75, 95%CI=0.60-0.94 , P=0.01, I2= 48%) , hospitalization urgency(RR=0.46, 95% CI=0.31-0.68, P=0.0001, I2=0%) and statistically significant increase adverse gastrointestinal events (RR=1.86, CI=1.14-3.02, P=0.01, I2=79%). Conclusion: Hence, we conclude that colchicine reduces adverse cardiovascular events, hospitalization urgency and increases adverse gastrointestinal events especially diarrhea in patients with myocardial infarction. However, colchicine did not reduce all-cause deaths, cardiac arrest, stroke incidence, the incidence of recurrent myocardial infarction, and hs-CRP; we still believe that the effect of colchicine on myocardial infarction needs further investigation and encourages the researcher to conduct more trials, especially with long-term follow-up.
Abstract 4119195: Proteomic Analysis of Primary Angioplasty in Acute Myocardial Infarction: Implications for Left Ventricular Remodelling and Recovery of Function
Authors: Jin Un Kim, Callum Little, Vanessa Acquah, Markella Ponticos, Tushar Kotecha, Roby Rakhit
Journal: Circulation (2024)

Introduction: Acute myocardial infarction (AMI) is a leading global cause of mortality. Following primary percutaneous coronary intervention (PCI), 25% require hospitalisation for symptomatic heart failure. Further understanding of the molecular pathogenesis and the temporal relationship of the protein profile associated with ischaemic insult and subsequent cardiac remodelling is required to improve risk stratification following AMI. Methods: 20 patients with AMI presenting to Royal Free Hospital in London were recruited for proteomic analysis (O link Proximity Extension Immunoassay) at presentation and at 24 and 72 hours following primary PCI. All underwent initial CMR on admission and at 6 month follow up to assess for myocardial oedema, left ventricular volumes and function and assessment of scar. Results: Proteomic biomarkers that increased on discharge following AMI were: IGFBP2 (8% increase, p=0.001), MMP-10 (5% increase, p=0.001), TIMP4 (14.4% increase, p&lt;0.001), CSF-1 (3.4% increase, p&lt;0.001), CHI3L1 (15% increase, p&lt;0.001), ST2 (19% increase, p=0.001), TGF-alpha (17% increase, p=0.001), IL6 (38% increase, p&lt;0.001), and NT-proBNP (93% increase, p&lt;0.001). The only biomarker that significantly decreased was IGFBP-1 (24% decrease, p=0.003). Notably, increased post-PCI biomarkers correlated with reduced infarct size at follow-up, including CCL23 (R=-0.6, p=0.016), IL6 (R=-0.051, p=0.04), NT-proBNP (R=-0.72, p=0.002). High biomarkers at initial presentation associated with reduced left ventricular end diastolic volume (LVEDV) were CSF-1 (R=-0.64, p=0.03) and CCL23 (R=-0.76, p=0.006). Discussion: Following AMI, we observed increase in proteins implicated in inflammation, angiogenesis and tissue repair. IGFBP1 as a stress hormone significantly decreased after PCI. Markers that showed linear association with reduced cardiac preload measured by LVEDV were linked with angiogenesis promotion and resolution of inflammation.
Abstract 4119913: Aging-Associate Peptide Medin Induces Proinflammatory Activation in Human Brain Vascular Smooth Muscle Cells
Authors: Nina Karamanova, Kaleb Morrow, Alana Maerivoet, Jillian Madine, Maria Lozoya, Volkmar Weissig, Ming Li, Raymond Migrino
Journal: Circulation (2024)

Background: Medin is one of the most common amyloidogenic proteins and accumulates in the vasculature with aging. Vascular medin accumulation is associated with Alzheimer's disease, vascular dementia and aortic aneurysms. In vitro , medin has been shown to induce endothelial proinflammatory activation and in ex vivo human cerebral arterial tissue, medin induces both endothelial and smooth muscle dysfunction. The role of medin in vascular smooth muscle (VSMC) activation remains unknown. Aim: The aim of the study is to determine using gene transcription assay whether medin induces VSMC activation and phenotypic transformation. Methods: Human brain vascular smooth muscle cells (HBVSMCs, passages 6-10) were exposed to medin at doses observed in human tissues (0, 0.5, 1 and 5 υM) for 20 hours and reverse transcription polymerase chain reaction (rtPCR) was used to quantify gene expression of proinflammatory factors (interleukin (IL)-6, IL-8, IL-1b) and structural and enzyme proteins associated with VSMC phenotypic transformation (ACTA2, MYH11 and NOX4). In separate experiments, HBVSMCs were exposed to vehicle, medin 5 υM without or with small molecule NFκB inhibitor RO106-9920 (10 υM) or NLGM1 nanoliposome (70% phosphatidylcholine, 25% cholesterol, 5% monosialoganglioside, 100 υg/mL, agent shown to reverse medin-induced endothelial dysfunction and proinflammatory activation). Results: Medin induced a dose-dependent increase in gene expression of IL-6, IL-8 and IL-1b but did not alter gene expression of ACTA2, MYH11 and NOX4 (Fig. 1). Co-treatment of medin with RO106-9920 and NLGM1 showed a trend (not statistically significant) of reduced IL-6 and IL-8 (Fig. 2). Conclusions: Physiologic doses of medin induced pro-inflammatory activation of HBVSMCs but did not affect gene expression of structural proteins (ACTA2 and MYH11) and enzyme (NOX4) involved in VSMC phenotypic transformation. Although the mechanisms behind this effect remains to be explored, results suggest that medin may be an important mediator of aging-associated vascular inflammation.
Abstract 4120912: Non-Alcoholic Fatty Liver Disease is Associated with Coronary Flow Reserve Impairment: A Pilot Meta-Analysis
Authors: Hritvik Jain, Jyoti Jain, Ramez Odat, Aman Goyal, Mushood Ahmed, Nandan Patel, Mohammed Dheyaa Marsool Marsool, Jagriti Jha, Siddhant Passey
Journal: Circulation (2024)

Background: Non-alcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the global population. Significant epidemiological data links NAFLD to an increased risk of coronary artery disease. Both, coronary artery disease and NAFLD are linked to underlying insulin resistance and inflammation as drivers of the disease. Coronary flow reserve parameters including coronary flow reserve velocity (CFRV), baseline diastolic peak flow velocity (DPFV), and hyperemic DPFV are non-invasive markers of coronary microvascular circulation. The existing literature contains conflicting findings for these parameters in NAFLD patients. Aim: This meta-analysis aimed to compare CFRV, baseline DPFV, and hyperemic DPFV in between NAFLD patients and healthy controls. Methods: A comprehensive systematic search was conducted on PubMed, Embase, Cochrane Library, and Google Scholar from inception until 8th May 2024 to identify relevant studies. We pooled the standardized mean differences (SMD) with the 95% confidence intervals (CI) using the inverse variance random-effects model. A p-value of less than 0.05 was considered statistically significant. Results: We included 4 studies with 1139 participants (226: NAFLD and 913: controls). The mean age in the NAFLD group was 54.55 ± 7.62 years and in the control group was 54.2 ± 7.6 years. NAFLD was associated with a significantly lower CFRV [SMD: -0.77; 95% CI: -1.19, -0.36; p&lt;0.0002] and hyperemic DPFV [SMD: -0.73; 95% CI: -1.03, -0.44; p&lt;0.00001] compared to the controls. NAFLD demonstrated a statistically insignificant trend towards reduction in the baseline DPFV [SMD: -0.09; 95% CI: -0.38, 0.19; p=0.52] as compared to healthy controls. Conclusion: NAFLD patients are at a higher risk of coronary microvascular dysfunction as demonstrated by reduced CFRV and hyperemic DPFV. The presence of abnormal coronary flow reserve in NAFLD patients provides insights into the higher rates of cardiovascular disease in these patients. Early aggressive targeted interventions towards impaired coronary flow reserve in NAFLD subjects may lead to improvement in clinical outcomes.
Abstract 4119992: 12-lead electrocardiograms predict adverse cardiovascular outcomes of emergency department patients
Authors: Julian Haimovich, Marton Kolossvary, Ridwan Alam, Raimon Padros I Valls, Michael Lu, Aaron Aguirre
Journal: Circulation (2024)

Introduction: Chest pain is a common cause for presentation to the emergency department (ED). Identifying patients at increased risk of adverse cardiovascular outcomes may help guide testing. Aims: We sought to determine if deep learning enabled 12-lead electrocardiogram (ECG) analysis may improve prediction of adverse cardiovascular outcomes of ED patients presenting with chest pain compared to conventional approaches. Methods: A pretrained convolutional neural network was applied to derive numerical representations of the index ECG waveforms from patients presenting to the Brigham and Women’s Hospital (BWH) ED with chest pain. We trained a neural network model (‘CP-AI’) to predict 30-day major adverse cardiovascular events (MACE) defined as myocardial infarction (MI), pulmonary embolism (PE), aortic dissection (AD), or mortality using age, sex, cardiac biomarkers (troponin and d-dimer), and the numerical ECG representations as inputs ( Figure 1 ). In a holdout sample of Massachusetts General Hospital (MGH) ED patients, we compared the performance of the CP-AI model to alternative models fit on (1) demographics (‘Age and Sex’) (2) demographics + cardiac biomarkers (‘Biomarker Model’), and (3) demographics + numerical ECG representations (‘ECG Model’). Results: The BWH derivation sample included 18,811 individuals (51% female, mean age 65 ± 16 years). The MGH validation sample included 14,476 individuals (45% female, mean age 65 ± 15 years). The CP-AI model significantly outperformed the comparison models for prediction of 30-day MACE with an area under the receiver operating characteristic curve (AUROC) of 0.82 [95% CI 0.81-0.83] ( Figure 1 ). CP-AI also significantly outperformed the comparison models for classification of the 30-day MACE components including MI (AUROC 0.91 [95% CI 0.90-0.92]), PE (AUROC 0.74 [95% CI 0.72-0.76]), and mortality (AUROC 0.86 [95% CI 0.85-0.87]), but not aortic dissection (0.71 [95% CI 0.68-0.75]). Conclusions: The integration of deep learning ECG analysis with conventional assessment improved prediction of adverse cardiovascular of ED patients presenting with chest pain.
Abstract 4117454: PCSK9 Inhibitors for ASCVD Risk Reduction in Asian Populations — a meta-analysis of efficacy and safety profiles
Authors: Jesslyn Hariyanto, Jessica Anastasia Setiawan, Catherine Jillian Hardi, Sunanto Ng
Journal: Circulation (2024)

Background: Dyslipidemia is increasingly prevalent in the Asia-Pacific region, correlating with higher mortality rates for ASCVD among this population. Statins, the cornerstone for dyslipidemia management, face higher intolerance in Asians compared to other races. PCSK9 inhibitors have emerged as a promising therapeutic additive to other lipid-lowering therapies. However, current trials predominantly involve caucasian populations, emphasizing the need for efficacy data across other ethnic groups. This meta-analysis aims to analyze the efficacy and safety profile of PCSK9i in Asian populations at high risk for ASCVD. Methods: We searched PubMed, Scopus, and Cochrane for RCTs from the past 10 years on PCSK9i vs. placebo in Asian populations at risk for ASCVD. Efficacy was measured by the mean difference in LDL levels from baseline. Safety parameters included ALT/AST, CK levels, and binding antibodies. Analysis was done with Review Manager, assessing heterogeneity with I^2 statistics. Results: Eleven studies in Singapore, Japan, the Philippines, India, South Korea, China, and Taiwan included 5443 patients (73% male, mean age 60.6, mean baseline LDL 114 mg/dL) with follow-up from 12 weeks to 16 months. Inclisiran was used in 3 studies, evolocumab in 5, alirocumab in 2, and tafolecimab in 1, alongside statins or ezetimibe. PCSK9i reduced LDL by -74.21 mg/dL and increased the likelihood of &gt;50% LDL reduction compared to placebo (RR: 37.41, 95% CI: 16.31-85.82, P &lt; 0.00001; I^2: 0%). PCSK9i significantly improve the achievement of LDL levels &lt;70 mg/dL compared to placebo (RR: 15.77; 95% CI: 7.12 - 34.91, P &lt; 0.00001; I^2: 82%) Adverse events showed a non-significant risk of &gt;3x ULN increase in ALT/AST ( RR 0.58; 95% CI: 0.33-1.05; P = 0.78, I^2: 0%) and &gt;5x ULN increase in creatine kinase (RR 0.32; 95% CI: 0.07-1.49; P = 0.97; I^2 = 0%). No significant difference in binding antibodies was observed (RR: 2.50, 95% CI: 0.13-49.47, P = 0.55; I^2 = 65%) Conclusion: In Asian populations, PCSK9 inhibitors effectively lower LDL levels without significant adverse events. The considerable heterogeneity in LDL reduction may result from variations in dosing, different agents used, baseline LDL levels, and geographical diversity. Future research should explore effects across more ethnicities to enhance generalizability.
Abstract 4121890: Resting Heart Rate Trajectories over 25 Years: Patterns, Predictors, and Prognostic Impact in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ning Meng, Yejin Mok, Elsayed Soliman, Lin Chen, Christie Ballantyne, Scott Solomon, Kuni Matsushita
Journal: Circulation (2024)

Background: Abnormal resting heart rate (RHR) is associated with cardiovascular events and mortality. Longitudinal RHR trajectories may offer unique prognostic, but research exploring these trajectories over extended periods and their prognostic implications is limited. Methods: Using data from 5,794 participants in the Atherosclerosis Risk in Communities (ARIC) study, we first characterized RHR trajectories over 25 years (from visit 1 [1987-89] to visit 5 [2011-13]) with latent class growth mixture models. Then, we determined the predictors of those trajectories using multinomial logistic regression (n=5,432 with data on predictors of interest). We ran Cox models to quantify the associations between RHR trajectories with cardiovascular outcomes (coronary heart disease, heart failure, stroke) and all-cause mortality (n=4,329 free of cardiovascular disease at baseline). Results: We identified one typical pattern (stable/slight decline, 88.4%) and three atypical patterns (stable-slight increase, 9.2%; increase-decrease, 2.0%; stable-sharp increase, 0.4%) (Figure-Left panel). Obesity, ever smoking, a history of heart failure, and lower education levels predicted the atypical patterns. The stable-increase (combined for slight and sharp) trajectory was significantly and robustly associated with heart failure and all-cause mortality (Figure-Right panel). The increase-decrease trajectory showed a hazard ratio of ~2 for coronary heart disease, although statistical significance was restricted in the demographically adjusted model. Conclusions: We identified one typical (stable/slight decline) and three atypical (increase-decrease, stable-slight increase, and stable-sharp increase) RHR trajectories over 25 years. The atypical trajectories, particularly the stable-increase pattern, were associated with poorer prognosis. These findings highlight the value of monitoring long-term RHR trajectories for cardiovascular risk assessment.