tbuckley/cabot-search huggingface dataset:
Abstract 12785: Abnormal Dynamic Remodeling of the 12-Lead Electrocardiogram is a Risk Marker for Sudden Cardiac Death
Authors: Hoang Nhat Pham, Lauri Holmstrom, Harpriya Chugh, Audrey Uy-Evanado, Kotoka Nakamura, Zijun Zhang, Stephen P Fortmann, Angelo Salvucci, Jonathan Jui, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2023)

Introduction: The ECG has always been evaluated as static risk factor for sudden cardiac death (SCD). The importance of dynamic ECG remodeling has not been investigated. Hypothesis: Abnormal ECG remodeling over time is associated with increased risk of SCD. Methods: We investigated pre-SCD ECG remodeling in SCD cases from 2 ongoing population-based studies of out-of-hospital SCD in Portland, OR (discovery) and Ventura County, CA (validation). Two archived pre-SCD ECGs performed at least 1 year apart were obtained from lifetime health records. Controls were matched on geographical region, age, sex, and duration between the 2 ECG recordings. Dynamic ECG remodeling was measured as the change in a previously validated cumulative 6-variable ECG electrical risk score (ERS) between the 1st and 2nd ECG. Results: A total of 231 SCD cases (66.5±13.6 years, 61% male), and 234 controls (65.8±11.1 years, 61% male) were included in the discovery cohort, and 203 SCD cases (70.3±14.4 years, 54% male), and 203 controls (68.4±11.8 years, 54% male) in the validation cohort. The mean time between the 2 ECG recordings in SCD cases and controls was 6.0±4.0 years vs 6.2±4.5 years (discovery) and 3.7±2.6 years vs. 3.7±1.6 years (validation), respectively. In both cohorts, SCD cases compared to controls had greater dynamic ECG remodeling over time: Discovery cohort ERS change +1.06 (95% CI +0.89 to +1.24) vs. -0.05 (-0.21 to +0.11; p&lt;0.001) and validation cohort ERS change +0.87 (+0.7 to +1.04) vs. -0.11 (-0.27 to 0.05; p&lt;0.001). In a multivariate model including clinical SCD risk factors, a 1-unit increase in the ERS was an independent risk marker for SCD: Discovery cohort OR 1.89 (95% CI 1.58-2.26; p&lt;0.001), validation cohort OR 2.17 (95% CI 1.63-2.91; p&lt;0.001). Conclusions: SCD cases were observed to have abnormal dynamic ECG remodeling prior to the SCD event, not observed in matched controls. These findings warrant further investigation of dynamic ECG remodeling as a novel risk marker for SCD.
Abstract 17876: Outcome of Ultrasound versus Fluroscopy Guided PPM Implantation
Authors: Jiwan Pradhan, Shakanti Yusif, Hamidreza Abbasi, Nadim Malik
Journal: Circulation (2023)

Introduction: Universal standard practice for venous access for implanting permanent pacemaker (PPM) is with fluoroscopy with venogram. Ultrasound (US) guided vascular access is increasingly encouraged to minimise radiation, contrast load and inadvertent injury to other structures. The incidence of US-guided vascular access related complications is unknown. Goals: To compare complications including radiation exposure with Ultrasound (US) guided vascular access, compared with fluoroscopy/venogram access. Method: Retrospective data of 205 consecutive patients implanted with PPM (elective and urgent) from August 2021 to August 2022 at single centre were collated for access-related complications and cumulative entire-procedure radiation dose. Result: 149/205 (73%) patients underwent fluoroscopy guided subclavian/axillary/cephalic vein versus access and 55/205 (27%) US-guided access. Fluoroscopy guided access was associated with complication rate of 6.8% (14/205), compared with 0.97% (2/205) for US-guided access (p=0.3602; Fisher exact test). There were no differences in radiation dosage between the two groups (p=0.1917). Conclusion: There were no statistically significant differences in vascular access-related complications or radiation dose between fluoroscopy guided and US-guided venous access for PPM implantation. US-guided access was however associated with lower complication rates. Larger robust randomized controlled trials would be required to validate these finding.
Abstract 12630: Sex Differences in Patients Hospitalized With Acute Pulmonary Embolism - A Single Center Experience
Authors: Waddah Malas, Jacob Clarke, Muhammad Malik, Punit Arora, Elizabeth Bruno, Cathryn Sawalski, Frances Greathouse, David Sutherland, Parth Shah, Mark Terence Mujer, Kevin Walsh, Parth Desai, Ahmed Elkaryoni, Amir Darki
Journal: Circulation (2023)

Background: Acute pulmonary embolism (APE) is the third leading cause of cardiovascular death following stroke and myocardial infarction. Data regarding the impact of sex differences on the presentation, management, and outcomes of patients with (APE) remains limited. This study aimed to identify baseline characteristics and treatment strategies in males (M) versus females (F) from a single center experience. Methods: We retrospectively analyzed patients who underwent evaluation by our institutional pulmonary embolism response team for APE between 3/1/2016 and 1/1/2022. Baseline characteristics, biomarkers, and outcomes of interest were compared using Pearson’s Chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables. Results: The cohort included 886 patients, of whom 48.6% were females. The mean age was (61 ± 16) years. Males were more likely to be smokers (41% vs. 26 %; p&lt;0.001), have a lower Body Mass Index (BMI) (31 ± 9 kg/m 2 , vs 33 ±10; p=0.01) and were more likely to have a history of prior stroke (12% vs 7.9%; p=0.04). The mean brain natriuretic peptide (BNP) on presentation was significantly higher in females (361 ± 624 pg/ml vs 281 ± 505; p=0.019). The mean d-dimer (F: 7,041 ± 6,438 ng/ml vs M: 9,063 ±11,447; p=0.13), troponin I (F: 1.60 ± 15.58 ng/ml vs M: 0.72±4.11; p=0.3), and lactic acid (F: 2.58 ± 3.20 mm/l vs M: 2.42 ± 2.43; p=0.6) were similar between both groups. PE severity (massive: 5.3% vs 6.4%; submissive: 58% vs: 55%; P=0.8) was similar between females and males. There were also no sex-based differences in the use of advanced therapies or outcomes. (Figure 1) Conclusion: In our APE cohort from a single center tertiary care center, sex differences in comorbidity profile (BMI, tobacco use, history of stroke) were observed. Females had a significantly higher BNP consistent with prior published literature. However, there were no sex-based disparities in PE severity, management, escalation of advanced therapies or outcomes.
Abstract 17182: A Case of Purulent Pericarditis in the Setting of Streptococcal Pneumonia
Authors: Alla Adelkhanova, Jurgen Shtembari, Dhan B Shrestha, Alexander Huh
Journal: Circulation (2023)

Introduction: Purulent pericarditis was a prevalent complication of streptococcal pneumonia prior to antibiotic era, but uncommon in the modern age. Purulent pericarditis is characterized by gross pus or microscopic purulence localized in the pericardial space. Case Presentation: A case of a 68-year-old male presenting with dyspnea, chest pain, left knee pain and edema. Medical history was significant for hypertension, diabetes, hypothyroidism. He developed respiratory failure due to pneumonia and was treated in intensive care unit. S. pneumoniae bacteremia and septic arthritis with isolation of the same pathogen from synovial fluid were diagnosed. Initial ECG showed diffuse ST elevations suggestive of pericarditis, so TTE was obtained. It showed a small, free flowing pericardial effusion along RV free wall with no evidence of hemodynamic compromise. Serial TTEs were done showing increasing size of pericardial effusion. On day 7 of hospitalization patient had several episodes of atrial fibrillation with RVR complicated by hypotension. A subsequent TTE showed a large, free-flowing pericardial effusion with signs of early tamponade. Patient underwent urgent pericardiocentesis with drainage of one liter of purulent fluid and placement of pericardial drain. Fluid analysis confirmed purulent pericarditis, gram stain and cultures were negative. Repeat TTE showed a trivial pericardial effusion and a 2.7mm mass suspicious for vegetation on the mitral valve with moderate MR, confirmed by TEE. CT surgery recommended 6 weeks of antibiotics with no surgical intervention. Patient was discharged to a skilled nursing facility for a prolonged IV antibiotic course with a follow up with cardiology. Conclusion: This case shows purulent pericarditis in the setting of pneumonia complicated by bacteremia, infective endocarditis, and septic arthritis. Although rare, purulent pericarditis is a life-threatening disease, so timely diagnosis and treatment are of essence.
Abstract 15965: Electrocardiogram-Based Artificial Intelligence Predicts Incident Heart Failure
Authors: Shaan Khurshid, Samuel Friedman, Shinwan Kany, Jonathan Cunningham, Emily Lau, Daniel Pipilas, Mostafa Al-Alusi, Joel Ramo, James Pirruccello, Victor Nauffal, Christopher Reeder, Pulkit Singh, Anthony A Philippakis, Mahnaz Maddah, Patrick T Ellinor, Jennifer E Ho
Journal: Circulation (2023)

Introduction: Heart failure (HF) is a major cause of cardiovascular morbidity. Efficient and accurate prediction of incident heart failure episodes may enable preventive efforts. Methods: Using raw 12-lead ECG waveforms, we developed a convolutional neural network to predict HF admissions (Electrocardiogram to Heart Failure, “ECG2HF”). ECG2HF was developed in 91,573 individuals in Massachusetts General Hospital (MGH), and validated in three independent test sets: MGH, Brigham and Women’s Hospital (BWH), and the UK Biobank, among individuals without a prior HF episode. HF events were identified using a validated natural language processing model (MGH and BWH), and inpatient diagnosis codes (UK Biobank). Discrimination was quantified using time-dependent average precision (AP) and area under the receiver operating characteristic curve (AUROC). Among individuals with available data, we compared ECG2HF to the Pooled Cohort Equations for Heart Failure (PCE-HF). Results: The test sets comprised MGH (15,695 individuals, age 55±17, 51% women), BWH (52,124 individuals, age 55±17, 59% women), and UK Biobank (42,135 individuals, age 65±8, 52% women). ECG2HF consistently discriminated incident HF events (MGH 10-year AP: 0.17 [95% CI 0.15-0.20], 10-year AUROC 0.88 [0.86-0.89]; BWH: 0.15 [0.14-0.17], 0.87 [0.85-0.88]; UK Biobank 3-year AP 0.036 [0.024-0.057], 3-year AUROC 0.73 [0.68-0.77]). ECG2HF risk consistently stratified longitudinal HF incidence. Compared to PCE-HF, discrimination using ECG2HF was favorable in MGH/BWH (improvement in AP 0.07 [-0.11-0.14], improvement in AUROC 0.13 [0.088-0.18]), and UK Biobank (improvement in AP 0.016 [0.0060-0.033], improvement in AUROC -0.0093 [-0.062-0.044]). Conclusions: Artificial intelligence-enabled analysis of the 12-lead ECG may facilitate identification of individuals at risk for HF to enable early treatment to reduce HF-related morbidity.
Abstract 15272: What's in a Name: Comparison of Dd-cfDNA Technologies Following Heart Transplantation
Authors: Brian Hsi, Johanna van Zyl, Hira Shakoor, Dana Farsakh, Amit Alam, Shelley Hall
Journal: Circulation (2023)

Introduction: Little is known about the comparative differences between the Allosure (CareDx) and Prospera (Natera) donor derived cell-free DNA (dd-cfDNA) assays following heart transplantation. Methods: A retrospective analysis of all patients that had both dd-cfDNA assays simultaneously performed between February 2022 and December 2023 were reviewed. A total of 233 samples obtained between 18 to 506 days post-transplant from 46 patients were reviewed. Agreement between Allosure and Prospera assays were compared utilizing their thresholds indicative of an abnormality of 0.12% (Allosure) and 0.15% (Prospera). Results: Baseline patient characteristics include median age 60 years and 59% male. There were a total of 12 biopsy specimens available with both dd-cfDNA assays. There was substantial agreement between both dd-cfDNA assays (91% agreement, Cohens kappa 0.75). Both dd-cfDNA assays were correctly suggestive of rejection when biopsy was available. Differences in elevations of dd-cfDNA were noted in cases outside of rejection and were not consistent in 20/233 samples when utilizing their cutoff values of 0.12% for Allosure and 0.15% for Prospera (McNemar’s p = 0.01)(Table 1). This discordance was due to increased classification of abnormal results with the lower threshold value for Allosure. When using identical threshold values of 0.12% or 0.15% for the two assays, this discordance is no longer present (p = 0.82 and p = 1.00, respectively). Conclusions: Both dd-cfDNA assays can be utilized for surveillance of rejection following heart transplantation. Understanding differences between the two assays is important and requires further larger studies to validate these preliminary findings.
Abstract 15140: Cerebral Hemodynamics During Left Ventricular Assist Device Speed Titration
Authors: Christopher G Favilla, Sarah Carter, Pavan Atluri, Rebecca Gitlevich, Michael Genuardi
Journal: Circulation (2023)

Introduction: Left ventricular assist device (LVAD) speed may be titrated to optimize cardiopulmonary hemodynamics, but the impact on cerebral blood flow remains poorly understood. Hypothesis: Here, we monitored cerebral hemodynamics during ramp studies, to test the hypothesis that LVAD speed correlates with cerebral blood flow and cerebral autoregulation. Methods: Patients with HeartMate3 LVADs underwent ramp study for optimization, during which cerebral blood flow velocity (CBFv) was continuously monitored by transcranial Doppler (TCD), and blood pressure was continuously monitored by finger plethysmography. Mx index was used a measure of autoregulation which correlates blood pressure and CBFv (i.e. high Mx index indicates poor autoregulation). The treating cardiologist determined the optimal speed based on cardiopulmonary dynamics (other speeds were categorized as sub-optimal). Results: Of 23 patients, 5 did not undergo speed changes. At least two speeds were explored in the remaining 18 patients. When comparing the lowest and highest speeds for each patient, higher speeds resulted in higher CBFv (p=0.02; Figure 1a ), but no change in autoregulation (p=0.38; Figure 1b ). However, when comparing the optimal and suboptimal LVAD speeds, CVFv was similar (p=0.89; Figure 2a ,), whereas the optimal speed was associated with a trend toward favorable autoregulation (p=0.09; Figure 2b ). Conclusions: Cerebral blood flow velocity is sensitive to LVAD speed titration, and cardiopulmonary optimization may improve cerebral autoregulation. A larger cohort and a broader range of speeds may further clarify the impact of speed titration on cerebral hemodynamics.
Abstract 12485: Cardiovascular Disease Risk, Cognitive Function, and Serum Biomarkers in Older Women Participating in a Lifestyle Intervention
Authors: Shannon Halloway, Annabelle S Volgman, Lisa Barnes, Michael Schoeny, Joellen Wilbur, Susan J Pressler, Deepika Laddu, Sachin Vispute, Gabriel Hall, Zoe Arvanitakis
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD), including atherosclerotic CVD (ASCVD) and stroke, increase risk of cognitive dysfunction. Serum biomarkers, including brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor 1 (IGF-1) may be associated with elevated CVD risk and are also emerging as early indicators of cognitive dysfunction. Yet, few studies have investigated associations among all three: CVD risk, cognitive function, and serum biomarkers. Aims: We examined associations between CVD risk, cognitive function, and serum biomarkers in older women with CVD. Methods: Baseline data from an ongoing lifestyle intervention trial for the prevention of cognitive decline in older women with CVD (NCT04556305) were analyzed. Women ( N =253) aged ≥65 years were recruited from ambulatory cardiology clinics. At baseline, CVD risk factors, including blood pressure, body mass index (BMI), waist circumference, and step test (cardiorespiratory fitness) were assessed. ASCVD and CHA 2 DS 2 -VASc scores were calculated to estimate clinical ASCVD and stroke risk, respectively. Serum biomarkers included BDNF, VEGF, and IGF-1. Neurocognitive tests for global cognition, including episodic memory, executive function, semantic memory, and working memory domains, were administered. Linear regression models adjusted for age, education, and race or ethnicity were used to evaluate associations of individual CVD risk factors, ASCVD and CHA 2 DS 2 -VASc scores with cognitive function and serum biomarkers, separately. Results: Of CVD risk factors, waist circumference and BMI were associated with cognition: waist circumference with global cognition, episodic memory, and executive function ( β = -.14 - -.20); BMI with executive function ( β = -.13). ASCVD and CHA2DS2-VASc scores were associated with semantic memory ( β = -.23 and -.16, respectively). Only the ASCVD risk score was associated with BDNF ( β = .18) and VEGF ( β = .24) levels. Conclusion: In older women with CVD, body composition and CVD risk scores appear to be correlated with cognitive function. Future studies should explore associations prospectively and consider serum biomarkers as mediators of the relation of CVD risk to cognitive dysfunction.
Abstract 16566: A Lifestyle-Integrated Resistance-Based Exercise Intervention for Sarcopenic Patients With Coronary Artery Disease: A Pilot Randomized Controlled Trial
Authors: Polly Wai Chi Li, Doris S yu
Journal: Circulation (2023)

Introduction: Sarcopenia is an important prognostic indicator for patients with coronary artery disease (CAD). No study has explored the effects of resistance-based exercise on sarcopenic patients with CAD. Hypothesis: Patients who receive the lifestyle-integrated resistance-based exercise intervention would have better physical performance, skeletal muscle mass, muscle strength, cardiac-related functional status, health-related quality of life (HRQoL) and psychological distress after the intervention than those who receive usual care. Aims: To examine the feasibility and preliminary effects of the strength-building lifestyle-integrated intervention among sarcopenic CAD patients on physical performance, skeletal muscle mass, muscle strength, cardiac-related functional status, HRQoL and psychological distress. Methods: This two-arm pilot randomized controlled trial recruited community-dwelling older CAD patients with sarcopenia. Patients in the intervention group received the 12-week individualized, progressive, low-to-moderate intensity resistance-based exercise intervention delivered through in-person and online supervised approach. The control group received usual care. Results: Thirty-eight participants (mean age: 69.0 ± 4.9 years) were randomized into the intervention (n = 21) or control (n = 17) group. The intervention was feasible and acceptable. The lost to follow-up rate was 7.9%, and the overall attendance was 92%. No adverse events were recorded. The intervention group showed significantly greater improvement in HRQoL (β = 0.417, 95%CI: 0.036 - 0.798, p = 0.032) and functional status (β = -1.342, 95%CI: -2.808 - -0.124, p = 0.043) than the control group at the immediate post-intervention. No significant between-group changes in physical performance, muscle mass and strength, and psychological distress were detected. Conclusions: The intervention is feasible and acceptable for CAD patients. It improves patients HRQoL and functional status. A full-scale randomized controlled trial is warranted to investigate its effects.
Abstract 13691: New Model for Prevention and Management of Venous Thromboembolism After Heart Valve Surgery
Authors: Meng He, Zhihui Zhu, Yongqiang Lai, Xiwei Zhang
Journal: Circulation (2023)

Introduction: Venous thromboembolism (VTE) is one of the possible complications that can occur after heart valve surgery. Exploring effective VTE prevention and management models for post-cardiac surgery is an important issue in perioperative management. Hypothesis: We hypothesized that a new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery. Methods: A total of 1200 patients who underwent heart valve surgery were included in this study and randomized in a 1:1 ratio into the control group and new management group. The control group received basic VTE prevention measures, while the intervention group implemented a newly designed VTE prevention and management protocol in addition to the basic preventive measures. The protocol included multidisciplinary team training and assessment, a comprehensive VTE evaluation mechanism, proper execution of preventive measures, physical and mechanical prophylaxis, patient rehabilitation training, and education. The primary outcome measure was the incidence of perioperative VTE, and secondary outcome measures included the occurrence of postoperative pulmonary embolism and all-cause mortality after heart valve surgery. Results: The intervention group included a total of 600 patients, with 57.6% being male and an average age of 56.7 ± 13.4 years. The control group also included 600 patients, with 55.5% being male and an average age of 57.5 ± 12.8 years. There were no significant differences in general clinical data between the two groups. The incidence of in-hospital deep vein thrombosis (DVT) in the intervention group was significantly lower than that in the control group (0.3% vs 1.5%, P&lt;0.05). However, there were no significant differences between the two groups in terms of in-hospital pulmonary embolism and early postoperative all-cause mortality. The intervention group showed a significantly higher accuracy rate in VTE risk assessment compared to the control group (91.3% vs 87.9%, P&lt;0.05). Conclusions: The new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery, providing important evidence for the prevention and management of VTE in cardiac surgery.
Abstract 19042: Statewide Burden of Ischemic Heart Disease Attributable to Dietary Risk Factors From 1990-2019 in United States: A Systematic and Comparative Benchmarking Study
Authors: VISHRANT P AMIN, venkata sai harshabhargav chenna, Mohit Lakkimsetti, Yashkumar G Kamani, Roopali Dahiya, Arushi Dhawan, Gangannapalle Mahesh, Sumit Kyada, HARDIK D DESAI
Journal: Circulation (2023)

Introduction: Ischemic Heart Disease (IHD) is the 1 st leading cause of deaths among all causalities in United states (US). However, there is a large statewide variation within the US due to IHD attributable to dietary risk factors. Comparable and consistent state-level burden of total IHD attributable to dietary risk factors have not been produced previously. Methods: Using Global Burden of Disease methodology, deaths, and disability adjusted life years (DALYs) due to IHD attributable to dietary risk factors were analyzed by age group, sex, year, and location across the US from 1990-2019. Results were presented in all age counts and age standardized rate per 100,000 person years. Results: The annual percentage of change (APC) in total DALYs increased by 32% for IHD attributable to a high sodium diet, followed by a 10% increase for a diet high in sugar-sweetened beverages and a 2% increase for a diet low in vegetables. In terms of total deaths, the highest APC increase was observed in Nevada (142%), followed by Alaska (98%) and Arizona (65%). Conversely, the District of Columbia and Nebraska had the lowest APC increases in total DALYs and deaths. Regarding age groups, the highest APC increase in the total number of deaths was seen in the 95+ year group (97%), followed by the 90-94 age (44%), 55-59 age (10%), and 50-54 age (3%). Conclusions: Statewide disparities of IHD attributable to dietary risk factors in the US is significant and calls for comprehensive public health strategies. By addressing the root causes and promoting healthier dietary habits, it is possible to reduce the burden of IHD, improve population health outcomes, and alleviate the strain on healthcare systems and the economy.