tbuckley/cabot-search huggingface dataset:
Abstract 11685: Effects of Pectus Excavatum Surgical Repair on Cardiac Volumes and Systolic Function as Assessed by 3D Transesophageal Echocardiography
Authors: JUAN M FARINA, Deepa R Mandale, Dawn E Jaroszewski, Mohamed R Aly, Michael M Botros, Ryan S Moosavi, Hemalatha Narayanasamy, Carolyn M Larsen, Hari P Chaliki, David Majdalany, william freeman, Said Alsidawi, Steven J Lester, Chadi Ayoub, Susan Wilansky, Reza Arsanjani, Tasneem Z Naqvi
Journal: Circulation (2023)

Introduction: The consequences of external cardiovascular compression and cardiac displacement from pectus excavatum (PEx) are debated. The complex geometry of the right (RV) and left ventricle (LV) along with distortion from the extrinsic chest deformity pose significant limitations to reliable assessment of LV and RV volumes and function using transthoracic 2D-echocardiography in this population. Hypothesis: A 3D-echocardiography approach can reliably assess the effects of external cardiac compression and the benefits of surgical correction on RV and LV function in PEx patients. Methods: Adult patients undergoing minimally invasive repair of PEx between Oct-2021 and Feb-2023 were included in this prospective study. Intraoperative transesophageal (TEE) 6 beat full volume video loops incorporating LV and RV were captured and compared before and after surgical correction of the PEx. TomTec Software® was used for offline 3D/4D reconstruction ( Figure 1 shows changes in 3D RV and LV shape pre- and post-surgery). Result: The study included 102 patients (mean age of 32.1 ±11.8 years; Haller index 4.9 ±2.5; 60.8% males). Post PEx repair, there was a significant (p&lt;0.001) increase in the 3D RV volumes, RV ejection fraction (EF), RV stroke volume and RV strain ( Figure 1 ). Additionally, there was a significant improvement in 3D LVEF, 3D LV strain (longitudinal and circumferential), LV twist, and torsion ( Figure 1 ). Conclusion: In this PEx cohort, 3D/4D TEE imaging demonstrated significant increases in RV volumes and in RV and LV systolic function after surgical repair. These findings support the negative cardiovascular consequences of PEx compression and benefits of surgical repair.
Abstract 11731: Efficacy of a New Generation Fast-Pullback, High-Frequency Intracoronary Optical Coherence Tomography Imaging on the Reduction of Contrast Medium in Clinical Practice
Authors: Shiro Uemura, Takeshi Nishi, Giovanni Ughi, Hiroshi Okamoto, Ryotaro Yamada, Teruyoshi Kume
Journal: Circulation (2023)

Introduction: Intracoronary optical coherence tomography (OCT) is an imaging modality that uses near-infrared light to generate high-resolution images, and now plays an important role in research and clinical practice as it provides insights into vascular biology and diagnostic guidance for percutaneous intervention (PCI). An existing concern is that OCT imaging could increase the total amount of contrast media administered during the procedure, resulting in adverse outcomes such as impairment of renal function or worsening of heart failure in some patients. Aims: We sought to investigate whether a novel, fast-pullback, high-frequency OCT (HF-OCT) enables acquisitions with a reduced amount of contrast agents while retaining the same qualitative and quantitative lesion assessment to conventional OCT. Methods: This study is a single-center, prospective, observational study including 10 patients with stable coronary artery disease. A total of 28 individual coronary arteries were assessed by both fast-pullback HF-OCT and by conventional OCT. The fast-pullback, HF-OCT system consists of a 1.8-Fr Vis-Rx® Micro-Imaging Catheter and an HF-OCT Imaging console (Gentuity LLC, Sudbury, MA). Results: The contrast volume used in each OCT run for the HF-OCT system was significantly lower than for the conventional OCT system (5.0±0.0 vs. 7.8±0.7ml, P&lt;0.001). No significant difference was found in the median value of the clear image length between the 2 OCT systems (74 mm [IQR; 63, 81], 74 mm [IQR; 71, 75], P=0.89). Fast-pullback HF-OCT showed comparable measurements to conventional OCT, including minimum lumen area (3.27±1.53 vs. 3.21±1.53 mm2, P=0.27), proximal reference area (7.03±2.28 vs. 7.03±2.34 mm2, P=0.96), and distal reference area (5.93±1.96 vs. 6.03±2.02 mm2, P=0.23). Qualitative OCT findings were comparable between the fast-pullback HF-OCT runs and conventional OCT with respect to identifying lipid-rich plaques, calcifications, layered plaques, macrophages, and cholesterol crystals. Conclusions: With the fast pullback function of a novel HF-OCT imaging system, we acquired OCT images using a significantly lower amount of contrast volume while retaining a comparable qualitative and quantitative lesion assessment to conventional OCT.
Abstract 11737: Clinical Background and Outcomes of Super-Elderly Patients With Hemodynamically Stable Acute Myocardial Infarction
Authors: Hiroshi Okamoto, Takeshi Nishi, Masanobu Ishii, Kenichi Tsujita, Satoshi Koto, Shiro Uemura
Journal: Circulation (2023)

Background and hypothesis: An increasing proportion of the population is living into their nineties and beyond, as are the number of super-elderly patients (over the age of 90 years) who present with acute myocardial infarction (AMI). The decision to perform emergency revascularization in these patients is difficult because they commonly have multiple comorbidities and are at high risk for invasive procedures. Aims: In order to help stratifying decision-making, this study was planned to clarify the clinical background, in-hospital outcome, and effect of primary percutaneous coronary intervention (PPCI) in super-elderly AMI patients with stable hemodynamics on admission. Methods: Between April 2012 and March 2018, 6,427 hemodynamically stable AMI patients over 90 years of age were identified in a nationwide Japanese administrative database (the JROAD-DPC registry). clinical characteristics, in-hospital occurrence of in-hospital adverse outcomes, and the effect of PPCI were examined. Results: The AMI patients included 4,242 females (66.2%) with a mean BMI of 20.7±4.0 and 2,828 patients (44.0%) with Killip class 1 on admission. The rate of 30-day all-cause mortality was 14.0% and full-score Barthel index, an ordinal scale used to measure performance in activities of daily living (ADL), at discharge was 20.8%. In-hospital complications occurred in 38.2% of patients, which consisted of heart failure after admission (16.0%), life-threatening arrhythmia (3.5%), the use of IABP (3.8%), ECMO (0.2%), mechanical respiration (12.8%), dialysis (1.5%), major bleeding (3.6%), sepsis (1.6%), and pneumonia (10.3%). PPCI was performed in 36,79 patients (57.2%). Patients who underwent PPCI had significantly lower 30-day all-cause mortality (9.4% vs 20.2%, p&lt;0.05) and significantly lower major non-cardiac events (14.9% vs 17.1%, p&lt;0.05). Conclusions: Super-elderly AMI patients (≥90 years of age) were at high-risk for in-hospital mortality rates and In-hospital complications, even if they were hemodynamically stable on admission. PPCI is associated with improved in-hospital outcomes. Therefore, PPCI may provide acceptable outcomes even in these super-elderly AMI patients.
Abstract 11763: A Unique Presentation of Heart Failure With Severe Pulmonary Hypertension and Pericardial Effusion in a Young Patient With a Ruptured Sinus of Valsalva Aneurysm
Authors: Asad Ahmed, Varshitha Tumkur Panduranga, Ridhima Goel, Joseph A Casillas, Umida Burkhanova, Inna Bukharovich, Sabu John
Journal: Circulation (2023)

Case: 26 y/o female immigrant from a developing nation presented with shortness of breath at rest. On physical exam, she desaturated to 75% with minimal movement, had an audible pansystolic murmur, and 2+ pitting edema. Initial presentation was indicative of decompensated Heart Failure (HF). 2D Echocardiogram (Echo) showed a right sinus of Valsalva aneurysm (SOV) with a left to right shunt to the pulmonary artery, as well as, severe pulmonary hypertension (PHTN) and moderate pericardial effusion. CT Scan of the chest showed a right Ruptured SOV (RSOV) with a dissection flap extending into the aorta. Transesophageal Echocardiogram confirmed the diagnosis; noted a right RSOV extending into the pulmonary artery causing severe pulmonary HTN leading to HF and pericardial effusion. The patient underwent surgical correction with full recovery and resolution of symptoms. Conclusions: SOV is a rare cardiac complication with variable etiology. Congenital causes are often found early in age and resolved surgically. Cases regarding the management of adults, especially in the critical care setting, are not well described. Here we report a 26-year-old female who rapidly developed HF with PHTN and pericardial effusion secondary to an RSOV. This case shows the importance of Echo in managing HF and determining its etiology. Using Echo we saw a dilated Inferior Vena Cava of 2.7 cm characteristic of HF. Next, we were able to visualize a dilated RSOV with a shunt to the right, subsequent turbulent flow through the Aortic valve, and severe tricuspid regurgitation. Lastly, we were able to see elevated pulmonary artery systolic pressure secondary to the shunt, and subsequent pericardial effusion (fig 1). The patient's symptoms were initially managed with IV diuretics and resolved with surgery. This is a rare case of right-sided RSOV extending into the pulmonary artery, its successful treatment, and the important role of Echo in treating HF and PHTN.
Abstract 11668: Transcriptomic Analysis Reveals Sex Differences in Gene Expression Profiling of Stenotic Aortic Valves
Authors: Emma Le Nezet, Martine Voisine, Rose Tam, Zhonglin LI, Nathalie Gaudreault, Nancy Cote, Sebastien Theriault, Yohan Bosse, Marie-Annick A Clavel
Journal: Circulation (2023)

Introduction: In aortic stenosis (AS), women present less aortic valve calcification and more aortic valve fibrosis than men for the same hemodynamic severity. However, the specific mediators that drive the fibro-calcific differences between men and women remain unclear. We aim to assess the transcriptome of stenotic aortic valves explanted during aortic valve replacement, according to patient’s sex. Methods: Transcriptomic profile was obtained from 240 explanted human aortic valves. Among these 240 patients (120 women and 120 men), 62 women were matched with 62 men for age (within 2 years), body mass index (within 2 kg/m 2 ), arterial pressure (within 10/5 mmHg), diabetes (exact), hypertension (exact) and AS severity (Table 1). Genes were classified in 6 key processes of AS development: oxidative stress, inflammation, lipid metabolism, fibrosis, apoptosis and calcification following a literature review. Results: One hundred and ninety (190) genes were differently regulated between men and women: 132 on autosomes and 58 on sexual chromosomes. Among these genes, 106 were over-expressed and 84 were under-expressed in women compared to men (Figure 1). Different genes involved in processes of inflammation, lipid metabolism and calcification were up-regulated both in women and men (women: NET1 , KIF1A, CES1, RCN2; men: FERMT3, APOD, CPAMD8, STC2 ). Genes involved in apoptosis ( SFRP4 ) and fibrosis processes ( TGFβ2 , FRAS1 ) were overexpressed in women. Conclusions: This study provides evidence that sex may influence aortic valve gene expression through different mechanisms in females and males, favoring pro-fibrotic and pro-apoptotic processes in women.
Abstract 11686: Aortic Stenosis is Independently Associated With Smoking, Diabetes Mellitus, Hypertension, Hyperlipidemia, Renal Disease, COPD, and Caucasian Ethnicity in Addition to Advanced Age, Rheumatic Fever, and Bicuspid Aortic Valve
Authors: Brandon Timmerman, Mehrtash Hashemzadeh, Mohammad Reza Movahed
Journal: Circulation (2023)

Hypothesis: Aortic valve stenosis is known to be associated with age, rheumatic fever, and bicuspid aortic valve but its association with other cardiovascular risk factors is less known. The purpose of this study was to investigate any association between aortic stenosis and other common cardiovascular risk factors. Method: The large Nationwide Inpatient Sample database was utilized to study these associations using uni- and multivariate analyses. Data was extracted from the first available database that used ICD-10 codes specifically coding aortic stenosis alone, which occurred in the year 2016. Results: In the database of patients over age of 40, a significant association was identified between aortic stenosis and smoking (OR: 1.12, CI 1.1 - 1.15, P &lt; 0.001), diabetes mellitus (OR: 1.19, CI 1.17 - 1.21, P &lt; 0.001), hypertension (OR: 1.36, CI 1.33 - 1.39, P &lt; 0.001), hyperlipidemia (OR: 1.47, CI 1.44 - 1.49, P &lt; 0.001), renal disease (OR: 1.46, CI 1.43 - 1.48, P &lt; 0.001), chronic obstructive lung disease (COPD) (OR: 1.16, CI 1.14 - 1.18, P &lt; 0.001), obesity (OR: 1.35, CI 1.32 - 1.39, P &lt; 0.001), and Caucasian race (OR: 1.47, CI 1.42 - 1.52, P &lt; 0.001), in addition to known factors such as age, rheumatic disease and bicuspid aortic valve. Conclusion: Based on this large database study, we found a new association of aortic valve stenosis with race and many cardiovascular risk factors such as smoking, renal disease, COPD, Caucasian race, and obesity. The role of these new risk factors in the pathogenesis of aortic stenosis warrants further investigation.
Abstract 12044: Sex-Related Differences in Long-Term Outcomes Across the Spectrum of Left Ventricular Ejection Fraction in Acute Decompensated Heart Failure Patients
Authors: Akane Kawai, Yuji Nagatomo, Midori Iwashita, Yukinori Ikegami, Makoto Takei, Ayumi Goda, Takashi Kohno, Atsushi Mizuno, Mitsunobu Kitamura, Shintaro Nakano, Munehisa Sakamoto, Yasuyuki Shiraishi, Shun Kohsaka, Takeshi K Adachi, Tsutomu Yoshikawa
Journal: Circulation (2023)

Background: An important knowledge gap remains on sex-related differences in heart failure (HF) management. Recently, it has been recognized that patients, particularly women, with supra-normal left ventricular ejection fraction (snLVEF) are at high risk of adverse outcomes. Aims: We sought to evaluate the sex related differences of long-term outcomes across the spectrum of LVEF in acute decompensated HF (ADHF) patients. Methods: We analyzed 3943 ADHF patients (age 77 years; 59.8% male) who were enrolled in WET-HF multicenter registry in Japan from 2006 to 2017. The association of long-term outcomes across the spectrum of LVEF were compared between men and women. Results: In both HF with reduced EF (HFrEF; LVEF &lt; 50%) and preserved EF (HFpEF), female patients were older and had lower body mass index, lower prevalence of ischemic etiology, and smaller LV chamber size. In HFrEF, implementation of guideline-directed medical therapy such as the combination of renin-angiotensin-system inhibitor (RASi), β-blocker and mineralocorticoid receptor antagonist (MRA) was significantly lower in women at discharge, even after adjustment for covariates (RASi + β-blocker : odds ratio [OR], 0.80, p=0.049; RASi + β-blocker + MRA: OR, 0.73, p=0.016). Female patients showed higher incidence of the primary endpoint, defined as the composite of cardiac death and ADHF readmission during 1,000 days after discharge ( p = 0.009, log-rank test). However, female sex did not remain significant after adjustment for covariates. Restricted cubic spline analysis demonstrated a U-shaped relationship with a nadir at LVEF 60% between LVEF and the hazard ratio of the primary endpoint in women, but this relationship was not observed in men ( p for interaction = 0.048, Figure A, B ). This trend was more evident after excluding patients with valvular heart disease ( p for interaction = 0.014, Figure C, D ). Conclusions: In women, not only low LVEF but also snLVEF were associated with worse long-term outcomes.
Abstract 11680: Presenilin 1 Deletion in Smooth Muscle Cells Ameliorates Hypermuscularization and Stenosis in Elastin Aortopathy
Authors: Junichi Saito, Jui M Dave, Freddy D Lau, Daniel M Greif
Journal: Circulation (2023)

Introduction: Smooth muscle cell (SMC) accumulation is central to the pathogenesis of elastin-defective arterial diseases, such as atherosclerosis, pulmonary hypertension and supravalvular aortic stenosis (SVAS). We previously demonstrated that elastin deficiency activates the Notch pathway in aortic SMCs, resulting in hypermuscularization and stenosis. Activation of Notch is catalyzed by the enzyme gamma-secretase, but the role of specific catalytic subunits presenilin (PSEN)-1 or PSEN-2 in elastin aortopathy is not defined. Psen1 (-/-) mice die shortly after birth with intracranial hemorrhage and bone abnormalities, while Psen2 (-/-) mice are viable. Methods: Western blot and qRT-PCR for PSEN-1 and -2 were performed on human aortic SMCs in culture and wildtype and elastin null aortas at postnatal day (P) 0.5. Genetic deletion of cell type-specific Psen1 and/or global Psen2 was performed on the elastin mutant background. For SMC- or endothelial cell (EC)-specific Psen1 deletion, pregnant dams were injected with tamoxifen at embryonic days 14.5 and 15.5, and elastin mutant pups carrying no Cre, Acta2-CreER T2 , or Cdh5-CreER T2 were analyzed at P0.5. Results: PSEN-1 and -2 are upregulated in aortic SMCs with elastin deficiency in human and mouse. Global Psen2 deletion partially attenuates Notch downstream gene expression and SMC proliferation, mitigating elastin aortopathy while Psen1 deletion in SMCs more significantly inhibits this aortopathy and improves survival of elastin null pups. In contrast, Psen1 deletion in ECs does not improve aortic disease. The combination of global Psen2 deletion and SMC-specific Psen1 deletion has additive rescue effects on elastin aortopathy. In addition, SMC-specific Psen1 deletion rescues hypermuscularization in newborns heterozygous for the elastin null gene, which genetically mimics human SVAS. Conclusions: Elastin insufficiency in SMCs leads to upregulation of PSEN-1 and -2, which induce Notch signaling and SMC proliferation. Among PSEN subunits and vascular cell types, SMC PSEN-1 plays the major role in elastin aortopathy. Selective inhibition of SMC PSEN-1 may be an attractive therapeutic strategy for SVAS to improve efficacy and mitigate off-target effects of gamma-secretase blockade.
Abstract 11801: Timing of Critical Congenital Heart Defect (CCHD) Detection at 7 U.S. Sites, the Birth Defects Study to Evaluate Pregnancy Exposures (BD-STEPS), 2014-2018
Authors: Shannon E Moss, Elizabeth Ailes, Karrie F Downing, Michael P Fundora, Elijah H Bolin, Suzan L Carmichael, Jill Glidewell, Rebecca F Liberman, Matthew E Oster, Gary M Shaw, Sherry L Farr
Journal: Circulation (2023)

Background: CCHD detection prenatally or at birth hospitalization may reduce infant mortality and morbidity, yet little is known about prevalence and characteristics associated with timing of detection. Objective: To examine prevalence and characteristics associated with prenatal and late (&gt;3 days after birth) detection of CCHD among infants in BD-STEPS, a multi-site population-based case-control study of risk factors for birth defects. Methods: Liveborn infants with non-syndromic CCHD without genetic causes born 2014-2018 with interviewed mothers were included. Timing of detection was based on date of earliest fetal or postnatal echocardiogram. Multivariable log-binomial models calculated adjusted prevalence ratios (aPR) for prenatal (vs postnatal) and late (vs not late) CCHD detection, by clinical and demographic characteristics. Log-linear models evaluated trends over time. Results: Among the 588/672 infants with CCHD and complete data, most infants’ mothers were Non-Hispanic White (53.4%), had some prenatal insurance (94.4%), and were multiparous (74.5%). Prenatal detection increased from 2014 to 2018 (24.7% to 40.1%) while late detection decreased (22.4% to 8.7%, Fig 1). Hypoplastic left heart syndrome had the highest prenatal detection (58.6%); late detection was highest for coarctation of the aorta (41.7%). Prenatal detection was more likely in infants of mothers 30-34 vs. 25-29 years at delivery (aPR=1.4, 95% confidence interval 1.0-1.9), and with additional non-cardiac defects (1.2, 1.1-1.4), and less likely among infants of mothers with &lt;11 years of education vs. &gt; bachelor’s degree (0.6, 0.3-1.0). Late detection was more likely among infants of mothers without prenatal insurance (1.8, 1.1-3.1), and less likely among those with non-cardiac defects (0.4, 0.2-0.8). Conclusion: From 2014 to 2018, prenatal detection increased and late detection decreased. Yet, disparities in detection by maternal insurance and education were observed.
Abstract 12067: Association Between Practice Type and Psychological Well-Being of Interventional Cardiologists: An International, Anonymized Survey
Authors: Bahadir Simsek, Athanasios Rempakos, Michaella Alexandrou, Spyridon Kostantinis, Judit Karacsonyi, Bavana V Rangan, Deniz Mutlu, Olga C Mastrodemos, Ajay J Kirtane, Anna E Bortnick, Hani Jneid, Lorenzo Azzalini, Milkas Anastasios, Khaldoon Alaswad, Mark Linzer, Mohaned Egred, Salman S Allana, Sunil V Rao, Yader Sandoval, Emmanouil S Brilakis
Journal: Circulation (2023)

Introduction: The association between practice type (academic vs non-academic) and the psychological well-being of interventional cardiologists (ICs) has received limited study. Methods: We examined the association between practice type and the well-being of ICs using an online, anonymous, and international psychological well-being survey. Results: Out of the 1,093 participating attending ICs, 33% worked in academic positions. Most IC attendings were from the United States (53%) and men (91%). Academic ICs had similar hours worked per week (60 [52-70] vs 61 [53-70], p=0.34) and vacation &gt;3 weeks/year (73% vs 69%, p=0.238) with non-academic ICs. However, academic ICs were less often on call ≥3 times/week (21% vs 30%, p=0.001), reported lower emotional exhaustion (6.0 [2.8-7.2] vs 6.5 [3.9-7.7], p=0.002), numerically higher life satisfaction (7.4 [5.6-8.5] vs 7.0 [4.9-8.2], p= 0.064), less frustration with their work (5.3 [2.5-7.4] vs 6.4 [3.0-8.0], p=0.005), and less stress (6.8 [5.0-7.9] vs 7.0 [5.1-8.0], p=0.027) (Figure). Burnout contributors were similar between the groups, except for stress related to COVID-19 (2.2 [1.0-5.2] vs 3.0 [1.0-6.6], p=0.003) and excessive regulations (4.8 [1.8-7.0] vs 5.3 [2.2-7.5], p=0.003), which were rated lower by academic ICs. Academic ICs were less likely to request better hospital infrastructure (7.1 [4.9-8.7] vs 7.8 [5.9-9.5], p=0.001), but more likely to request higher compensation (7.6 [6.1-9.2] vs 7.3 [5.2-8.8], p=0.05) to improve their well-being. Conclusions: Our survey demonstrates that an academic setting is associated with better psychological well-being. Elucidating the underlying reasons for this finding may help to improve well-being for ICs working in non-academic centers.