tbuckley/cabot-search huggingface dataset:
Abstract 12947: Restoration of Sinus Rhythm Significantly Improves Left Ventricular Function in Patients With Very Low Ejection Fraction
Authors: Sanghamitra Mohanty, PremGeeta Torlapati, Vincenzo Mirco La Fazia, carola gianni, Bryan MacDonald, Angel Mayedo, Domenico G Della Rocca, Mohamad Bassiouny, G Gallinghouse, John Burkhardt, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale
Journal: Circulation (2023)

Introduction: Left ventricular (LV) dysfunction is a common sequelae of supraventricular tachycardia, especially atrial fibrillation (AF). We evaluated the impact of restoration of sinus rhythm following successful catheter ablation on LV function in AF patients with ejection fraction of ≤20%. Methods: Consecutive AF patients with LVEF ≤20% undergoing their first catheter ablation were included in the study. All received isolation of pulmonary veins, left atrial posterior wall and superior vena cava. Additionally, non-PV triggers were ablated at the operator’s discretion. Echocardiogram was performed at baseline and 6 months post-ablation to measure the LVEF. Arrhythmia-monitoring was performed at 1, 3 and 6 months with event recorders, 12-lead ECG and 7-day Holter monitoring. Results: A total of 63 patients undergoing catheter ablation for AF were included (age: 62.5 ± 9.9 years, male: 82.5%). Majority of the patients had LVEF of ≤15% (n=48, 76%); remaining 15 patients had LVEF of 16-20%. Mean LA diameter was 4.94 ± 0.57 cm and 82.5% of patients had non-paroxysmal type of AF. Median duration of AF was 27 months. Follow-up echocardiogram at 6 months of follow-up detected significant improvement in LVEF [Mean difference: 15.2 ± 11.7% (p &lt; 0.001)]. All patients were arrhythmia-free at that time point: 47 (74.6%) off-drugs and 16 (25.4%) patients on previously ineffective anti-arrhythmic drugs. Conclusion: Restoration of sinus rhythm following successful catheter ablation was associated with significant improvement in LVEF in patients with severe LV dysfunction
Abstract 14138: A Rare Encounter With Unusual Metastasis: Metastatic Right Ventricular Tumor Secondary to Cervical Cancer
Authors: Ekendilichukwu Nnadi, Nazima Khatun, Varshitha Tumkur Panduranga, sabu john
Journal: Circulation (2023)

Background: Metastasis of cervical carcinoma to the heart is a rare and uncommon phenomenon. Cervical cancer most commonly metastasizes to the lungs, liver, bones, and lymph nodes in four ways: 1) hematogenous spread, 2) lymphatic spread, 3) transvenous extension, and 4) direct extension. We present a case of a patient with cardiac metastasis from cervical cancer who initially suffered nonspecific symptoms thought to be secondary to a pulmonary embolism. Case presentation: A 41-year-old African American woman with a history of stage IIIB squamous cell carcinoma (SCC) of the cervix was being evaluated in the hospital for exertional dyspnea and chest pain. She was tachycardic and lung auscultation revealed decreased breath sounds bilaterally. Laboratory results were unremarkable. Initially, there was concern for pulmonary embolism (PE), computed tomography angiography with contrast demonstrated no evidence of PE but a hypoenhancing defect within the right ventricle (RV) with multiple diffuse bilateral pulmonary nodules. Echocardiography revealed RV mass vs thrombus. A cardiac MRI revealed a large infiltrative irregular mass. These findings favored evidence of a tumor rather than a thrombus. Imaging findings are illustrated in Figure 1. The patient subsequently underwent a biopsy of the right lower lobe lung nodule. The biopsy revealed metastatic SCC positive for p16, p40, and PD-L1. The patient was being treated but the prognosis was poor. Conclusion: Metastasis from cardiac tumors with primary cervical cancer is uncommon with a poor prognosis and average life expectancy of less than 6 months when diagnosed. Only 4% of cases of cardiac metastasis from cervical cancer are diagnosed as antemortem. A multimodality approach with prompt diagnosis is necessary for improving prognosis.
Abstract 15707: Dietary Potassium and Sodium Intake and Cardiovascular Fitness in United States Community Dwelling Young Adults
Authors: Nikki Zangenah, Sushrut S Waikar, Ashish Verma
Journal: Circulation (2023)

Introduction: Low cardiovascular fitness strongly predicts cardiovascular disease and all-cause mortality in adults. Higher sodium (Na) and lower potassium (K) intakes have shown to be associated with adverse cardiovascular events. However, the association of K and Na intake with cardiovascular fitness is unknown in young adults. Methods: We included data on participants aged 20 to 49 years from three cycles (1999-2004) of the National Health and Nutrition Examination Survey. Estimated VO2max was measured using submaximal exercise test. 24-hour dietary interview format was used to estimate Na and K intake. The main exposure of interest was Na and K intake per 1000mg/day, and a nine-category variable for joint Na and K intake was generated by dividing Na and K intake into tertiles (low, moderate, high). The main outcome measure was eVO2max scaled to standard deviation (1-SD). The cross-sectional association between Na and K intake and eVO2max was assessed using survey design-based multivariable linear regression adjusted for clinically and biologically plausible confounders. Results: There were 3222 participants, with mean age 33.9 years; 48% were female and 70.6% identified as White. Only 27 (0.8%) participants met the dietary recommendation goal for Na (&lt;2g) and K (&gt;3.5g) intake per the World Health Organization. K intake per 1000mg was positively associated with a (1-SD) increase in eVO2max (β estimate = 0.04, P value = 0.01) in a fully adjusted model. Na intake per 1000mg was positively associated with (1-SD) increase in eVO2max (β estimate = 0.004, P value = 0.80) without reaching statistical significance in a fully adjusted model. The association of K intake and eVO2max was modified by Na intake ( P value = 0.01). The joint category with moderate Na intake and high K intake was positively associated with eVO2max (β estimate = 0.21, P value = 0.009) compared to the joint category with low Na and K intake in a fully adjusted model. Conclusion: These findings suggest that higher potassium intake is associated with higher cardiovascular fitness independent of blood pressure, especially in conjunction with lower sodium intake. Higher potassium intake may have a role in improving cardiovascular fitness in young adults and could prevent future cardiovascular events.
Abstract 14155: Handgrip Exercise Provoked High Sensitivity Cardiac Troponin I Increase in Women With No Obstructive Coronary Artery Disease: Relations to Myocardial Function
Authors: ANA IRIBARREN, Michael D Nelson, Jenna Maughan, Okezi Obrutu, Galen Cook-Wiens, Mitra Mastali, Jennifer E Van Eyk, Eileen M Handberg, Carl Pepine, C Noel N Bairey Merz, Janet Wei
Journal: Circulation (2023)

Background: Among women with signs and symptoms of ischemia and no obstructive coronary arteries (INOCA) around 10% develop heart failure with preserved ejection fraction (HFpEF). Mechanisms contributing to AMI and HFpEF progression in INOCA are poorly understood. Purpose: To characterize clinical profile and stress cardiac magnetic resonance imaging (CMRI) myocardial features of INOCA patients with and without increased troponin levels in response to handgrip exercise. Methods: Women with suspected INOCA underwent cardiac MRI and invasive coronary function testing (CFT), including coronary sinus (CS) cannulation, handgrip exercise testing, and serial CS plasma sampling before, after 3 minutes of isometric handgrip stress at 30% of maximal voluntary contraction, and after 5 minutes of recovery. High sensitivity cardiac troponin I (hsTnI) was measured using commercial immunoassay (R-PLEX, Meso Scale Discovery, Rockville, MD) and compared using t-tests. Results: A total of 51 women with complete data were included, of whom 31 (60.7%) had handgrip provoked increases in hsTnI levels from baseline, while 20 (39.2%) did not. Baseline characteristics are shown in Table. Patients with increased hsTnI levels had greater impaired global longitudinal strain rates and early diastolic strain rates (radial and circumferential) compared to those without increased hsTnI. No significant differences were observed in myocardial perfusion reserve index (MPRI). Conclusion: Women with INOCA demonstrating objective evidence of handgrip exercise provoked myocardial injury exhibit evidence of myocardial dysfunction not related to myocardial perfusion. Further prospective research is needed to understand the sequence of relations between coronary microvascular dysfunction contribution to HFpEF progression.
Abstract 12930: Atrial Myopathy and the Risk of Incident Atrial Fibrillation in People With Newly Diagnosed Cavotricuspid Isthmus-Dependent Atrial Flutter
Authors: Benjamin P Walters, Michael Farbaniec, Mario Gonzalez, Gerald Naccerelli, Ankit Maheshwari
Journal: Circulation (2023)

Background New cavotricuspid isthmus-dependent atrial flutter (AFL) is associated with increased risk of incident atrial fibrillation (AF). It is unclear which patients with AFL will develop AF. Hypothesis: Patients with new AFL who have co-existing atrial myopathy, detected by measuring left atrial emptying fraction (LAEF) and left atrial reservoir strain (LARS), may be at increased risk for developing AF. Methods: There were 210 patients who received an ablation or cardioversion for AFL at a tertiary care medical center between 2015-2022. Patients were excluded for prior AF (118), congenital heart disease (16), valve surgery and heart transplant (9), no echocardiogram available (9), and less than 6 months of follow up (9). Data was obtained by retrospective chart review. Covariates included coronary heart disease, heart failure, diabetes, age, sex, vascular disease, and stroke. Exposure variables included LAEF and LARS. We used Cox proportional hazards models to estimate the risk of AF for LAEF and LARS. Results: 49 patients (mean age 62.3 years, 18.3% female) met criteria for inclusion, and 18 developed atrial fibrillation over a mean follow up period of 29.9 months (19.7 months). Those who developed AF had lower LAEF and LARS compared to those who did not. For every 5% decrease in LAEF and LARS, there was a 1.79 (1.33, 2.38) and 5.26 (1.75, 16.67)-fold increase in risk of AF after adjustment for covariates. Conclusion: Co-existing atrial myopathy, measured by decreased LAEF and LARS, is associated with increased risk of AF in people with new AFL.
Abstract 12920: Double Peak of Cardiac Troponin T in Non ST-Segment Elevation Myocardial Infarction
Authors: Francesca Daus, Sara Pezzini, Alfredo Bianchi, Laura Lenatti, giorgio bassanelli, Andrea Farina, Roberto Spoladore
Journal: Circulation (2023)

Introduction: cardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction. In previous literature it was shown that hs-Troponin T blood assay follows a typical biphasic kinetic in patients (pts) affected by ST segment elevation myocardial infarction (STEMI), treated by primary percutaneous coronary intervention (PCI), while this does not appear to be the case for creatinphosphokinase (CPK) and hs-Troponin I assays. Hypothesis: According to these previous data, we studied hs-troponin T and CPK kinetics in pts suffering from non-ST segment elevation myocardial infarction (NSTEMI). Methods: we retrospectively analysed blood samples for cardiac biomarkers in NSTEMI pts consecutively admitted to the coronary care unit of our institution from January 2022 to May 2023. Results: A total of 83 pts were included. 89% of pts were treated by PCI; 98% of these pts received PCI within 24 hours from hospital admission. Among the 83 enrolled pts, only 11% was treated by surgical revascularization and/or anti-ischemic pharmacological therapy. A double peak of hs-troponin T was observed only in pts treated by PCI (p=0,0001). In these pts the mean time to first hs-troponin T peak was at 35,84 ± 4,4 hours while the mean time to second hs-troponin T peak was at 78,62 ± 8,7 hours. CPK value at hospital admission was 208,6 ± 34,8 U/L while first hs-troponin T peak was 560,1 ± 112,9 ng/L; the second hs-troponin T peak was 240,3 ± 33,7 ng/L, in absence of CPK double peak. Conclusions: similarly to previous studies in STEMI pts, our data confirm the presence of hs-troponin T double peak, in the absence of CPK second dispersion, also in NSTEMI pts. The hs-troponin T second peak is strongly related to PCI procedure while pts undergoing conservative treatment or surgical coronary revascularization do not show such a kinetic. Another interesting issue is the absence of CPK second dispersion. This could suggest a potential trivial meaning of hs-troponin T second peak. Therefore, the second peak could not be of any significance for prognostic evaluation and appropriate timing of pts discharge from acute cardiac care units.
Abstract 14030: Hemodynamic Metrics Can Be Accurately Assessed by a Non-Invasive Sensor Patch: The Portable Technology for Wireless Cardiomyopathy Tracking (Patchwrk) Study
Authors: Zak Loring, Nicholas B Bolus, Brennan B Torstrick, Danielle Wilson, Melissa LeFevre, Brett Atwater, Anita M Kelsey, Jonathan P Piccini
Journal: Circulation (2023)

Background: Echocardiographic timing intervals provide valuable prognostic information in patients with pre-clinical cardiac dysfunction. Diastolic filling time (DFT) can identify left bundle branch block (LBBB) patients at higher risk for cardiomyopathy. The need for specialized equipment limits the utility of echo in longitudinal assessment. Hypothesis: A non-invasive multimodal sensor Sansa patch will enable accurate assessment of hemodynamic parameters such as DFT, ejection time (ET), and pre-ejection period (PEP). Methods: Fifty patients scheduled for clinically indicated echocardiography were prospectively enrolled and had simultaneous application of the Sansa patch at the time of echocardiography. Timing intervals were analyzed using continuous wave (CW), pulsed wave (PW), and tissue Doppler imaging (TDI). Data from the Sansa electrocardiogram (ECG), seismocardiogram (SCG), and phonocardiogram (PCG) were independently analyzed to identify valve openings/closures to estimate DFT, ET and PEP. Agreement between echo and Sansa estimates was assessed using the coefficient of determination (R 2 ) and compared with agreement between different echo views. Results: Forty-six of the 50 patients (92%) had data of sufficient quality for analysis. The mean ejection fraction was 53±8% and 11 patients (24%) had LBBB. By echo, the mean DFT, ET, and PEP were 408±137 milliseconds (ms), 297±35ms, and 107±32ms respectively. Sansa estimates for DFT, ET and PEP were 431±135ms, 286±43ms, and 89±34ms respectively. The R 2 for Sansa DFT compared to echo was 0.85. Comparing TDI and PW estimates of DFT within the same patients demonstrated an R 2 of 0.82. Conclusion: Non-invasive Sansa patch monitoring accurately identified key cardiac timing intervals within the error observed between standard echo views. These measures have prognostic value and monitoring them in the ambulatory setting may allow early cardiomyopathy detection and upstream intervention.
Abstract 14027: The Use of Anthropometric Indices as Indicators of Hypertension in Patients With Diabetes Types 2: A Large-Scale Cross-Sectional Study
Authors: Mohammad Keykhaei, Hossein Farrokhpour, Sina Rashedi, Aryan Ayati, Anahita Anvari, Shaghayegh Zokaei, Soghra Rabizadeh, Manouchehr Nakhjavani
Journal: Circulation (2023)

Introduction: Obesity is associated with hypertension and diabetes mellitus (DM), increasing cardiovascular disease risk and mortality. While body mass index (BMI) is widely used to measure obesity, it has several limitations. Therefore, alternative anthropometric indices such as waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), and a body shape index (ABSI) have been suggested. Hypothesis: This study aims to identify the most effective anthropometric index for predicting hypertension in patients with type 2 DM. Methods: In this cross-sectional study, patients with type 2 DM were included and classified into two groups based on the presence or absence of hypertension. Demographic and clinical data were collected and anthropometric measurements were taken. Multivariate logistic regression analysis was used to identify factors associated with hypertension. Receiver operating characteristic (ROC) curves were performed to determine the diagnostic performance of various anthropometric indices, with a subgroup analysis based on the status of patients DM. Results: The study population included 977 male and 1454 female patients with DM, among whom 50.3% and 67.1% had hypertension. Both male and female patients with hypertension were older, had a longer duration of DM, and had higher anthropometric measurements, blood pressure, and lipid profiles. ROC curve analysis revealed that although all indices could significantly predict hypertension (0.55-0.76 in men and 0.68-74 in women), WHtR and BRI had the highest ability to identify patients with hypertension in men irrespective of DM status being controlled or not. (WHtR: 0.76, 95% confidence interval (CI): 0.73-0.79, BRI: 0.76, 95% CI: 0.73-0.79). WC had the highest diagnostic performance in all female patients and female patients with uncontrolled DM (0.75, 95% CI: 0.72-0.75 and 0.75, 95% CI: 0.72-78, respectively). All indices remained significant in the logistic regression after adjusting for potential confounders. Conclusions: While WHtR and BRI were better predictors of hypertension in men with DM, WC had a better diagnostic performance in women with DM.
Abstract 14021: Micra VR Leadless vs. Single-Chamber Transvenous Pacing Outcomes in the Medicare Advantage Population
Authors: Colleen Longacre, Lucas Higuera, George H Crossley, Mikhael F El-Chami
Journal: Circulation (2023)

Introduction: Medicare Advantage (MA) patients are typically healthier and report better outcomes compared to fee-for-service (FFS) Medicare patients. While the benefits of leadless pacing have been demonstrated in the FFS population, no study has evaluated leadless pacemakers in the 100% MA population. Hypothesis: The benefits of leadless pacing extend to the MA patient population. Aims: To compare patient characteristics and outcomes between Micra VR and single-chamber transvenous pacing among MA patients vs. FFS patients. Methods: MA Encounter data was used to identify patients implanted with a Micra VR leadless pacemaker (N=4,970), or a single-chamber transvenous pacemaker (N=6,615) from 2017-2019. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day complication rates. Cox models were used to compare 2-year chronic complications and reinterventions between groups. MA results were compared to results of the Micra Coverage with Evidence Development (CED) study of FFS patients. Results: MA Micra VR patients had a higher comorbidity burden (mean Charlson Comorbidity Index (CCI) 5.3 vs. 4.9, P&lt;0.001) and higher rates of end-stage renal disease (ESRD) (7.3% vs. 1.5%, P&lt;0.001) compared to transvenous patients. After adjusting for patient differences, Micra VR patients had similar rates of acute complications at 30 days (adj. 7.0% vs. 6.8%, P=0.76). At 2 years, Micra VR patients had significantly lower adjusted rates of chronic complications (adj. HR 0.75, 95% CI: 0.61-0.91, P&lt;0.001) and reinterventions (adj. HR 0.57, 95% CI: 0.44-0.75, P&lt;0.001) and there was no difference in adjusted all-cause mortality (adj. HR 1.05, 95% CI: 0.97, 1.14, P=0.26). Compared to FFS patients, MA patients had lower rates of ESRD (7.3% vs. 12.0%) and lower rates of emergency admission (5.4% vs. 12.0%), though their overall comorbidity burden was similar (mean CCI 5.3 vs. 5.1). The comparative benefits compared to transvenous were similar in magnitude in the MA vs. FFS populations. Conclusion: Compared to transvenous pacing, MA patients treated with a Micra VR leadless pacemaker had reductions in chronic complications and reinterventions at 2 years of similar magnitude to those observed in the Medicare FFS population.
Abstract 14018: Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients
Authors: Ayelet Shapira-Daniels, Dana S King, Sari Reisner, Lauren B Beach, Oseiwe 'Benjamin' B Eromosele, Sandhiya Ravichandran, Robert Helm, Emelia J Benjamin, Carl Streed
Journal: Circulation (2023)

Background: Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones. Aim: We aimed to explore the prevalence of arrhythmias in transgender and nonbinary ( TGNB ) adults. Methods: This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription. Results: Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p&lt;0.01). Prevalence of arrhythmias appeared similar among TGNB adults who used GAHT and those who did not (1.5% vs 1.9% in TGM, 1.2% vs 2.1% in TGW). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.