tbuckley/cabot-search huggingface dataset:
Abstract 4142002: Peak Frequency Analysis Distinguishes Nearfield from Farfield Signals During Atrial Fibrillation Ablation
Authors: Peter Ting, Chirag Barbhaiya, Lior Jankelson, Douglas Holmes, Alexander Kushnir, Robert Knotts, Felix Yang, Scott Bernstein, David Park, Larry Chinitz, Anthony Aizer
Journal: Circulation (2024)

Background: The failure to distinguish nearfield and farfield signals is a common reason for ablation failure. Peak frequency (PF) analysis of electrograms is hypothesized to distinguish nearfield from farfield cardiac signals, although in vivo proof is lacking. Hypothesis: Using electrically isolated pulmonary vein (PV) tissue for analysis, PF will distinguish nearfield from farfield electrograms during atrial fibrillation (AF) ablation, identifying successful PV isolation and validating PF as a predictor of catheter proximity to electrical signals (nearfield versus farfield). Methods: We created a cohort of twenty patients with paroxysmal AF undergoing wide area circumferential PV isolation between July 2023 and January 2024. Left atrial and PV maps of PF (EnSite OT Near Field, Abbott, Inc) were generated before (Figure A) and after (Figure B) each PV isolation attempt and if dissociated potentials were present. The highest PF in each PV was selected in each PF map. PV electrograms were defined as farfield or nearfield based on the presence or absence of exit and entrance block. PV electrograms of dissociated potentials were considered nearfield. In the first 10 patients, a cutoff value was selected to predict nearfield versus farfield signals. The performance of this cutoff was assessed in the remaining 10 patients. If the PF remained elevated after PV isolation, pacing maneuvers were used to identify the source of the signal. Results: PF was lower in isolated PVs compared to connected PVs or dissociated potentials within PVs (Figure C). In the derivation cohort, a PF of 300 Hz had 93.2% (95% CI 81.3% - 98.6%) sensitivity and 100% (95% CI 95.0% - 100.0%) specificity for identifying the signal as farfield. In the validation cohort, this cutoff was associated with 90.0% (95% CI 76.3% to 97.2%) sensitivity and 100.0% (95% CI 93.6% to 100.0%) specificity. All farfield signals with a PF over 300 Hz were SVC signals detected in the right superior PV. Conclusions: PF distinguishes nearfield PV from farfield left atrial signals during AF ablation. PF analysis improves the recognition of PV isolation. Future studies modifying mapping and ablation strategies by utilizing PF as a tool to define nearfield versus farfield should be pursued to improve ablation outcomes.
Abstract 4141963: Patient Perspectives of Genetic Testing in Adult Congenital Heart Disease
Authors: Angela Onorato, Kathryn Vannatta, Karen Texter, Katherine Spayde, Rachel Gosselin, BIMAL CHAUDHARI, Isaac Kistler, Vidu Garg, May Ling Mah
Journal: Circulation (2024)

Background: Long-term survival of patients with congenital heart disease (CHD) has increased significantly in the past 40 years, resulting in the largest adult congenital heart disease (ACHD) population in history. Pathologic genetic variation significantly contributes to development, heritability, and outcomes of CHD. International guidelines for genetic testing in syndromic, familial, and complex CHD requiring intervention were published in the last decade and did not address the ACHD population, who was diagnosed well before this era. Perceptions of ACHD patients regarding genetic testing are unknown. Aims: Assess the proportion of ACHD patients that have received genetic testing compared to those that would be considered for testing based on current recommendations. Assess interest and perceived risks and benefits of genetic testing and how these are impacted by clinical and family factors. Methods: Single center prospective cohort survey of consecutive ACHD patients 18 years or older seen in outpatient clinics over a 5-month period. Results: Data were provided by 124 survey respondents, 48.4% female with median age 29.1 years (IQR 23.1-37.8). A majority of respondents (68.3%) have children or plan to have children. Few respondents (10.5%) report prior genetic testing. The majority desire genetic testing (65.3%), while only 8.1% would not choose to have testing performed. Respondents mostly believe testing should occur either during infancy (36.1%) or in adulthood before having children (29.5%). Personal and family health considerations were among the most important motivating factors for consideration of genetic testing, while financial factors were not as prioritized, as shown in Figure 1. Few respondents felt genetic testing would have a negative impact on their mental health (4.2%); the majority felt there would be a positive (53.3%) or neutral (42.5%) effect. Conclusions: Many ACHD patients would have received genetic testing if born in the current era, but very few have been offered such testing given a lack of recommendations in the ACHD population. Broadening genetic evaluation for the adult CHD population should be considered given patient interest and current pediatric CHD recommendations.
Abstract 4142011: HFpEF risk assessment using H <sub>2</sub> FpEF score in community-dwelling young Hispanic adults
Authors: Andrew Kim, XFadiX XMusfeeX, Soumya Patnaik, Miryoung Lee, Emma Molina, David McPherson, Joseph B McCormick, Susan Fisher-hoch, Susan Laing
Journal: Circulation (2024)

Heart failure with preserved ejection fraction (HFpEF) prevalence has increased with the global increase in cardiometabolic risk factors and yet, diagnosis remains underrecognized in the community with concomitant undertreatment. H 2 FpEF scoring is a validated tool for dyspnea evaluation but has potential to identify individuals with increased HFpEF risk in larger patient populations. Hispanics are known to have a high prevalence of cardiometabolic risk factors, specifically obesity, hypertension and diabetes, which predispose to HFpEF. As HFpEF is often considered a disease of the elderly, this study aimed to determine HFpEF risk and define demographic and clinical covariates associated with this risk, in community-dwelling young Hispanic adults. Methods: Demographic, cardiometabolic biomarkers and echocardiographic data were obtained in 1285 participants (66% females, mean age 53±15 years) without any cardiovascular disease history from a sample of the Cameron County Hispanic Cohort. Those with left ventricular systolic dysfunction (n=30) were excluded. H 2 FpEF scoring was performed, and the sample was divided into low risk (0-2 points) or intermediate-high risk (3-7 points). Analysis focused on those ≤60 years of age and multivariate logistic regression analyses were conducted. Results: Intermediate-high risk H 2 FpEF score was seen in 43% (n=555) of the sample. Among those ≤60 years of age (n=852, mean age 45±12 years), one third (33%) were at intermediate-high risk for HFpEF based on the H 2 FpEF scoring tool. Those classified with increased HFpEF risk were slightly older (mean difference of 5 years), had larger waist circumference, had higher fasting blood glucose and more insulin resistance, and were more likely to have dyslipidemia, diabetes and the metabolic syndrome. After adjusting for covariates, among young Hispanics, age [OR=1.06 (1.01-1.11)] and the metabolic syndrome [OR=2.57 (1.06-6.36)] remained significantly associated with odds of having increased H 2 FpEF score. Discussion: We showed that a large proportion of community-dwelling Hispanics in our cohort have increased HFpEF risk, which is consistent with the demonstrated underdiagnosis of HFpEF in other ethnic groups. In young Hispanics, metabolic syndrome is significantly associated with a higher H 2 FpEF score regardless of BMI. Defining elevated HFpEF risk in young adults may be relevant for prevention and early intervention, specifically targeting cardiometabolic risk control in young Hispanics.
Abstract 4141974: Impact of Timing of Pacemaker Reimplantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Devices on Hospital Outcomes
Authors: Qi Xuan Ang, Min Choon Tan, Yong Hao Yeo, Pattara Rattanawong, Dan Sorajja, Luis Scott, Yong-mei Cha, Andrea Russo, Justin Lee
Journal: Circulation (2024)

Background: The optimal timing of pacemaker reimplantation following transvenous lead removal (TLR) of infected cardiac implantable electronic device (CIED) remains unclear. Objective: Our study aimed to assess the impact of timing to pacemaker reimplantation after TLR of infected CIED on hospital outcomes. Method: Using the Nationwide Readmissions Database, patients aged ≥18 years who underwent new pacemaker implantation with percutaneous approach following TLR of infected CIED from 2017 to 2020 were identified. The study population was stratified based on the timing of pacemaker reimplantation following TLR of infected CIED: early (&lt;5 days) vs delayed (≥5 days). Weighted-propensity-score matched conditional multivariable logistic regressions were performed to determine the impact of the timing on various outcomes. Results: In our study, 469 (66.9%) patients received early device reimplantation, and 232 (33.1%) patients received delayed device reimplantation (≥5 days). Post-procedurally, patients in the delayed group had a higher risk of prolonged hospital stay (95% CI OR: 42.37 (6.36 – 282.11); p&lt;0.01) and non-home discharge (95% CI OR: 2.00 (1.35 – 2.95), p&lt;0.01). There was no significant difference between both groups in the early mortality, 30-day readmission, and procedural complications. Conclusion: Our study suggests that time-to-device reimplantation from TLR of infected CIED did not affect the overall short-term in-hospital outcomes. However, delayed device reimplantation was associated with a higher rate of prolonged hospital stay and non-home discharge.
Abstract 4142041: Re-evaluating the Use of Race/Ethnicity in the MESA Risk Score
Authors: Quinn White, Spencer Hansen, Robyn McClelland, Craig Johnson, Brittany Murphy, Andrew DeFilippis, Wendy Post
Journal: Circulation (2024)

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) Risk Score is used to predict 10-year coronary heart disease (CHD) risk based on traditional risk factors and coronary artery calcium (CAC). Discussions around the potential for equity consequences when using race/ethnicity as a predictor in models for clinical decision-making have prompted other risk scores, such as the PREVENT score, to no longer include race/ethnicity. To this end, we developed a revised score omitting race/ethnicity and compared its performance to the original MESA score. Methods: MESA is a longitudinal multi-ethnic observational cohort study of 6,814 participants, who were aged 45 to 84 and did not have prevalent cardiovascular disease upon study entry in 2000-2002. Model development was done using regularized Cox regression. The regularization process had two stages. The first used LASSO regression for variable selection, where we considered age, CAC, total and HDL cholesterol, systolic blood pressure (SBP), sex, diabetes, family history of heart disease, hypertensive medication, current smoking, and lipid-lowering medication use. Interactions were considered between the variables age, sex, and CAC with all other predictors; anti-hypertensive medications with SBP; and lipid-lowering medications with total cholesterol. The second stage involved ridge regression to mitigate over-fitting. We then compared the calibration and discrimination of the model including race/ethnicity to that of the model that did not. Results: The updated model excluding race/ethnicity included the same main effects, but several interactions were also selected in the LASSO step. When comparing the performance of the models including race/ethnicity to those excluding it, no significant differences were found. For example, there was no significant difference in AUC between the model excluding race/ethnicity and that including it, with a difference of 0.00323 (95% bootstrap CI: -0.000715 to 0.00717). Harrell’s C-statistic was comparable between the models, at 0.800 in the model without race/ethnicity and 0.797 in that including it. Other metrics revealed a similar picture, where calibration and discrimination did not differ the inclusion of race/ethnicity. Conclusions: We developed a MESA risk score model that does not use race/ethnicity as a risk factor that performs similarly to the risk score model including race/ethnicity. This risk score will be made publicly available for clinical CHD risk prediction.
Abstract 4142024: MicroRNA 486 is Myogenic and Remodels Dystrophic Transcriptome in Limb-Girdle Muscular Dystrophy Type 2B (Dysferlinopathy)
Authors: JAE YONG KIM, Bathri Vajravelu
Journal: Circulation (2024)

Introduction: Dysferlinopathy, a subgroup within muscular dystrophies, is an autosomal recessive myopathy that entails a spectrum of progressive muscle degeneration with a pathogenic mechanism of impaired sarcolemma. Its genetic etiology is rooted in mutations in the DYSF gene at Chromosome 2p13. The DYSF gene encodes for dysferlin, a type II transmembrane protein prominently expressed in skeletal muscle and cardiac tissue. Dysferlin plays a pivotal role in calcium-dependent membrane repair and regulate macrophage activation in skeletal muscles. MicroRNAs (miRNAs), highly conserved non-coding RNA transcripts under 25 nucleotides, modulate translational repression via mRNA degradation. Reduced expression of miR-486, a muscle enriched miRNA, has been correlated with the disease severity in Duchenne muscular dystrophy. However, the expression level of miR-486 and its role has not been elucidated in dysferlinopathy. Hypothesis: We hypothesized that miR-486 expression is differentially expressed in dysferlin-deficient skeletal muscle, function as a regulator of cell cycle kinetics, differentiation, and is essential for the sarcolemma repair machinery. Methods: Tissue expression analysis of miR-486 was performed across ten mice tissues. Subsequently, miR-486 was overexpressed and silenced in both wild type and dysferlin deficient murine myoblasts (C2C12 cells) via cellular transfection (n=3). Differential expression of miR-486 levels and various cell cycle genes were validated using qRT-PCR. Myoblast fusion assay, along with immunohistochemistry was undertaken to determine cellular differentiation. Bioinformatics approach was undertaken for pathway analysis of miR486 in dystrophic muscles. Results: We confirmed that miR486 is myogenic, demonstrated by highest expression in skeletal muscles. We found reduced expression of miR486 by more than two folds in dysferlin-deficient myoblasts compared to the wild-type. Overexpression of miR-486 increased Ki-67 and MCM2 expression in wild-type myoblasts, indicating its pro-proliferative role. Conclusion: The results thus far suggest that dysferlinopathy is associated with aberrant expression of miR-486, which plays a role in regulating myoblast proliferation. We are currently focused on elucidating how miR-486 influences myoblast differentiation and characterizing the underlying molecular mechanisms by quantifying the gene expression changes driven by modulation of miR-486.
Abstract 4141975: Feasibility of Using Wearables to Obtain High-Fidelity ECG Signals for Cardiovascular Disease Screening in Palestinian Refugees in Jordan
Authors: Hadeel Atoum, Rui Qi Ji, Mutaz Abu-Hananneh, Hamzah Alduraidi, Jafar Alshraideh, Ervin Sejdic, Salah Al-Zaiti
Journal: Circulation (2024)

Background: Refugee populations often experience high rates of cardiovascular disease (CVD). Factors such as significant physiological stress, trauma, limited access to healthcare, substance abuse, and poor lifestyle choices contribute to disease progression and an increased incidence of cardiovascular events. We sought to evaluate the feasibility of using wearables to obtain high-fidelity ECG signals for CVD screening in refugees in Jordan. Methods: This observational cross-sectional study involved outpatients at one of four regional United Nations’ primary care clinics for Palestinian refugee in Jordan. Research assistants collected health histories from consented patients and recorded a 30-second, 6-lead ECG using a handheld, Bluetooth-enabled, wearable device (KardiaMobile 6L, AliveCor Inc., Mountain View, CA, USA). The digital ECG signals were stored on the Bluetooth-synced mobile device and then exported to a cloud server for offline analysis. The raw ECG recordings were preprocessed, and a single median beat was calculated per lead. Waveforms were segmented, and duration and amplitude measures were determined using a previously validated custom algorithm (University of Pittsburgh, PA, USA). All ECG recordings were reviewed by an independent physician. Result: The sample included 31 patients (age 52±13, 64% Females). Risk factors were prevalent in this group, including hypertension (74%), high cholesterol (65%), diabetes (64%), in-camp living (33%), and smoking (30%). Figure 1 shows the population-averaged median beat with 99% CI distribution of this sample. Mean QRS duration was 95±23 ms (range 53−150) and QTc interval was 403±53 (range 267−513). Most patients were in normal sinus rhythm (84%), and remaining patients were in atrial fibrillation or flutter (16%). Other clinically significant abnormalities included non-specific ST-T changes (9.7%), left bundle branch block (1.6%), and LVH with left ventricular strain (1.6%). Conclusion: This pilot study demonstrated that it is feasible to obtain high fidelity ECG signals using wearables to screen for CVD in refugees. Such affordable, noninvasive, point-of-care screening tools could enable early diagnosis and treatment in these patients.
Abstract 4141988: The Power Duo: Combining LA Volume Index and Strain to predict AF Recurrence after ablation
Authors: Narathorn Kulthamrongsri, JUAN FARINA, Deepa Mandale, Hicham El Masry
Journal: Circulation (2024)

Background: Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), but many patients experience recurrence post-intervention. Evaluating left atrial strain (LAS) to measure LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) could help predict AF recurrence, especially in patients with no evident signs of severe LA myopathy. Goal: This study aims to assess the prognostic value of pre-ablation LAS in both paroxysmal AF (paAF) and persistent AF(peAF) in patients with no evident signs of severe LA myopathy. Methods: This retrospective study encompassed AF patients who underwent their first CA procedure at Mayo Clinic Arizona from October 2018 to February 2022 and had a LAVI &lt;40 ml/m2 and LVEF &gt;55%. Transthoracic echocardiography parameters, including the three LAS phases, were collected using TOMTEC software on the closest date before the CA procedure. Receiver operating characteristic (ROC) curve analysis was used to evaluate the capability of LAS to detect patients with AF recurrence after CA from those without recurrence. Results: Out of 335 AF patients who underwent CA during the study period, 40 cases had LAVI &lt;40 ml/m2 and LVEF &gt;55% (72.5% male; mean age 69.2 ± 8 years). Of these, 15% (6/40) experienced recurrence, while 85% (34/40) maintained sinus rhythm. The mean values of LASr, LAScd, and LASct for all patients were 16.82, 11.23, and 6.87, respectively. ROC analysis indicated that the area under the curve (AUC) for LASr, LAScd, and LASct was 0.582, 0.502, and 0.710, respectively. (Graph 1A, Table 1A) LASct was the only parameter associated with AF recurrence (AUC: 0.71). Additionally, we developed a novel marker termed LAVI-LASct by combining LAVI and LASct values, which demonstrated improved discrimination with an ROC value of 0.74 (Graph 1B). Conclusions: LASct demonstrated predictive capability for AF recurrence in patients with no severe LA dilation and preserved LVEF, potentially due to its ability to detect early atrial dysfunction preceding visible structural changes or myocardial pathology. The addition of LAVI values provided better discrimination for the ROC model. Further research is needed to confirm the clinical relevance of LAS in AF patients undergoing ablation.
Abstract 4142028: An Intensive Lifestyle Intervention Improves Cardiovascular Health Outcomes in Patients with Type-2 Diabetes
Authors: Pramod Tripathi, Thejas Kathrikolly, Lidiya Sul, Matthew Lee, aravinda Nanjundappa, Samir Kapadia, Nidhi Kadam
Journal: Circulation (2024)

Background: Type 2 diabetes (T2D) is associated with an elevated risk of cardiovascular (CV) complications, including hypertension, dyslipidemia, obesity, and inflammation. Addressing CV risk factors is crucial for reducing morbidity and mortality in affected individuals. Integrated lifestyle interventions have emerged as promising strategies for managing T2D and its associated CV risks, emphasizing the importance of dietary modifications, physical activity, and stress management in improving health outcomes Research Aim This study evaluated the impact of an intensive lifestyle intervention (ILI) on both traditional and non-traditional cardiovascular risk factors in patients with type 2 diabetes (T2D) Methods: This retrospective study of 6028 patients diagnosed with T2D (≥18 years), who enrollled in a one-year online ILI program at Freedom from Diabetes Clinic, Pune, India between January 2021 and December 2022. The intervention included a personalized plant-based diet, exercise regimen, stress management, and medical support. Baseline and endline data on CV risk factors, socio-demographics, anthropometry, and medical history were extracted. The primary outcome was an improvement in the CV profile. Results: The mean age of the study population was 51.7±10.4 years (64% male) with a mean diabetes duration of 10.9±7.6 years. At baseline, the majority (67.7%) were on glucose-lowering medication; 39.9% and 51.9% were on anti-hypertensives and statins, respectively. Despite being on medication, 70.2% had poor glycemic control (HbA1c&gt;7%); while dyslipidemia (triglycerides ≥150 mg/dl), obesity (≥25 kg/m2), and hypertension (≥140/90 mmHg) affected 38.8%, 56.3%, and 18.7% of the patients, respectively. Following intervention, there was significant improvement in HbA1c (-17.1%) and weight (-5.3%) (p&lt;0.05). Significant improvements in traditional CV risk factors such as obesity (decreased to 43.2%) and dyslipidemia (decreased to 30.1%) were observed (p&lt;0.05). Moreover, there was significant improvement in non-traditional risk factors (p&lt;0.05), including urine microalbumin (≥25 µg/ml; decreased from 17.8% to 12.9%), CRP (1–10 mg/dl; decreased from 57.7.3% to 56.5%), and postprandial hyperglycemia (&gt;140 mg/dl; decreased from 65.7% to 48.7%). Conclusion: The ILI program showed significant improvements in CV risk factors and glycemic parameters among patients with T2D highlighting the impact of a comprehensive approach to managing CV risks associated with T2D.