tbuckley/cabot-search huggingface dataset:
Abstract 4140100: Outcomes of Percutaneous Coronary Intervention of the Left Main Coronary Artery Bifurcation: Insights from PROGRESS-BIFURCATION registry
Authors: Pedro Carvalho, Dimitrios Strepkos, Athanasios Rempakos, Michaella Alexandrou, Deniz Mutlu, Ahmed Al-Ogaili, Barkin Kultursay, ali karagoz, Oleg Krestyaninov, Dmitrii Khelimskii, Mahmut Uluganyan, korhan soylu, Ufuk Yildirim, Olga Mastrodemos, Bavana Rangan, Sandeep Jalli, Konstantinos Voudris, M Nicholas Burke, Yader Sandoval, Emmanouil Brilakis
Journal: Circulation (2024)

Background: There is limited data on the long-term outcomes of percutaneous coronary intervention (PCI) in patients with left main coronary artery (LM) bifurcation lesions. Methods: This retrospective, observational, cohort study was performed across 6 centers in the United States, Russia, and Turkey between 2013-2024, as part of the Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). We examined procedural characteristics and follow-up outcomes of patients with versus without LM bifurcation lesions undergoing PCI. Multivariable adjusted hazard ratios (aHR) with 95% CI were calculated using Cox regression. Results: Of 1,089 patients who underwent bifurcation PCI, 289 (26.5%) underwent LM PCI. Patients in the LM group were older (70.1±11.9 vs 65.4±11.5 years; p&lt;0.001) and had more comorbidities, such as diabetes, heart failure, prior PCI, and prior coronary artery bypass graft surgery. Two-stent techniques were more commonly used in LM patients vs. non-LM patients (39.3% vs 26.5%, p&lt;0.001), with similar technical success (94.8% vs 95.9%, p=0.41) and procedural success (93.1% vs 93.1%; p=0.99). The incidence of in-hospital major adverse cardiovascular events (MACE) was higher in LM patients (7.9% vs 4.5%, p=0.04). During long-term follow-up LM PCI patients had higher mortality (aHR 3.17; 95% CI 1.22-8.18; p&lt;0.001), without significant differences in MACE (aHR 1.81; 95% CI 0.93-3.52; p=0.08), myocardial infarction (aHR 0.50; 95% CI 0.07-3.52; p=0.50), and target-vessel PCI revascularization (aHR 2.56; 95% CI 0.75-8.78; p=0.14). Conclusion: Follow-up mortality in patients undergoing bifurcation PCI, classified according to whether they underwent left main or non-left main PCI.
Abstract 4136995: Veterans Affairs (VA) Lipid Optimization Reimagined Quality Improvement Program (VALOR-QI) in Veterans with Atherosclerotic Cardiovascular Disease (ASCVD) at the San Juan VA
Authors: Loriany Alcocer, Luis Rodriguez-Ospina
Journal: Circulation (2024)

ASCVD is the principal cause of morbidity and mortality for Veterans in the VA Healthcare System. San Juan VA is one of 50 VA sites participating in a national quality improvement initiative called the VALOR QI: VA Lipid Optimization Reimagined Quality Improvement Project. Is a collaborative project between the U.S. Department of Veterans Affairs (VA) and the American Heart Association (AHA) with the goal of positively impacting Veterans’ cardiovascular (CV) health. VA sites work with an AHA QI consultant to develop and deploy a local quality improvement plan to help overcome site specific barriers preventing Veterans from achieving optimal cholesterol levels. The program’s objectives include improving clinical pathways and processes to impact ASCVD management through a Learning Healthcare System model of quality improvement designed to improve the management of dyslipidemia among those with high-risk ASCVD. The hypothesis is that patients who are part of the VALOR QI program will be more successful in reaching LDL-C target. This will help to reduce the risk of ASCVD and mortality for the patients, promoting better management of lipid levels through medications, diet and regular monitoring. As part of the methodology, the patients are enrolled to the program using the criteria of Veterans &gt; 18 years of age with diagnosis of ASCVD and LDL-C &gt; 70 mg/dl or non-HDL &gt; 100 mg/dl. The Healthcare Coach has a full track of their lipid medications, assists the patients with refills, provides educational materials, follows up with their clinical appointments, and emphasizes the importance of having a good compliance with therapy, appointments and diets to maintain the target of LDL-C. Once the patient starts with a new lipid medication, they are followed in 3 months with labs. After reaching the target the patient is followed up closely in 6 months with labs to prevent relapse. The VALOR QI Program started at VA San Juan in June 2023 and, as of May 30, 2024, had directly engaged 282 Hispanic patients. 111 (39.4%) achieved target LDL-C; 268 (95%) have any statin use; 117 (41.5%) are on any non-statin lipid-lowering therapy (LLT); 116 (41%) are on statin plus LLT; 25 (8.9%) are on PCSK9, and 133 (47.2%) received educational materials. In conclusion, this initiative led to target LDL levels in 39% of patients which represents a significant population. As this program is further implemented in our institution, we expect improvement in patient outcomes and prognosis.
Abstract 4140185: The Burden Of Substance Abuse And Mental Health Disorders In Patients Admitted With Stress Cardiomyopathy
Authors: Rama Ellauzi, Izhan Hamza, Mukhtadir Kalaiger, Muhammad Dawood Amir Sheikh, Servando Cuellar, Isaiah Ortega, Khaled Chatila
Journal: Circulation (2024)

Introduction: Several studies have linked mental health disorders and substance abuse as risk factors for stress cardiomyopathy (SC). However, the true burden of these disorders amongst patients with stress cardiomyopathy remains unknown. Methods: We used the 2016-2020 National Inpatient Sample database to identify hospitalizations for SC who underwent diagnostic catheterization. We assessed the proportion of patients diagnosed with a substance abuse or mental health disorder. Subsequently, the association of these disorders in SC compared to patients admitted for myocardial infarction (MI) was assessed using the chi-square test. Results: From 2016 to 2020, there were 33,075 hospitalizations for stress cardiomyopathy who were diagnosed by cardiac catheterization. Of these patients, 5,920 (17.9 %) had depression, 8,500 (25.7 %) had anxiety, 1058 (3.2 %) had severe stress reactions, and 16,372 (49.5 %) were diagnosed with a mental health disorder. 9,955 (30.1 %) were smokers, 5,358 (16.2%) abused hallucinogens, 5,457 (16.5 %) abused cocaine, 5,457 (16.5%) abused sedatives, 6,019 (18.2 %) abused cannabis, 5,920 (17.9%) abused opioids, 6,416 (19.4 %) abused alcohol. Subsequently, the association of stress cardiomyopathy with mental and substance abuse disorder was compared with patients admitted with myocardial infarction See Table 1. Conclusion: Mental health and substance abuse disorders are common in patients diagnosed with SC. These disorders are more commonly present in SC compared to MI. Further research is needed to assess the significance of these findings.
Abstract 4131228: Where Adults with Advanced Heart Failure Die: Insights from the CDC-WONDER Database
Authors: Farman Ali, Shaaf Ahmad, Adarsh Raja, Bazil Azeem, Muhammad Talha Maniya, Ahmed Siddiqi, Ahsan Alam, Jishant Mattumpuram, Hamza Janjua, Tariq Jamal Siddiqi, Michael Hall
Journal: Circulation (2024)

Background: Adults with heart failure (HF) are becoming more and more prevalent. The location of death and related disparities in these patients are poorly understood. Aim: The purpose of the study was to look at the locations of adult deaths from HF and identify any age, race, or ethnicity-related variations over a 25-year period. Methods: The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database provided death certificate data and the National Center for Health Statistics provided individual-level mortality data for the trend-level analysis of adults aged (20-64 and 65+ years) conducted from 1999-2023. Hospital, home, hospice and nursing home/long-term care were the categories for the places of death. Results: Between 1999 and 2023, a total of 7,644,759 adult deaths from HF were recorded (87.9% White, 53.4% female). HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. Conclusion: Prioritize end-of-life planning for HF patients with poor prognosis, regardless of age, to improve quality of life and death.
Abstract 4119554: Septal Thickness has a Variable Effect on Shock Incidence Rate by ICD Indication in Hypertrophic Cardiomyopathy.
Authors: Michael O'Shea, Srekar Ravi, Omar Baqal, Bade Fatunde, Said Alsidawi
Journal: Circulation (2024)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common cardiomyopathy. People with HCM are at risk of cardiac arrest. ACC/AHA guideline-supported indications for ICD placement include cardiac arrest or VT, family history of sudden cardiac death in a close relative ≤50, massive septal hypertrophy (MSH - septal thickness ≥30mm), apical pouch, and non-sustained ventricular tachycardia (NSVT). Methods: People attending any Mayo Clinic site on &gt; 1 occasion who underwent ICD placement for HCM who had documented cardiac magnetic resonance (CMR) results were included in the study from time of ICD placement to last device interrogation. Outcome was incidence rate of first appropriate shock. Multivariable cox regression was used to examine the association between septal thickness and shock rate, controlling for current age, sex and secondary vs primary prevention device. An interaction term for association between septal thickness and each ICD indication in turn was incorporated into regression, and stratum specific estimates produced using linear computation. Results: 326 people were included in the study, of whom 50 experienced at least one appropriate ICD shock over 1,487.95 person years (incidence rate 3.36 per 100 person years, NNT 29.76 per year). MSH was strongly associated with shock rate (HR 2.29 [1.19 to 4.40], p=0.013). In people without MSH, there was a 50% reduction in shocks where a subjective measure (syncope or family history of sudden cardiac death) was present (table 1). In this cohort, NSVT resulted in a threefold increase in incidence of shock (HR 3.15 [1.446 to 6.47], p=0.003). In the presence of MSH, there was a four-fold increase in shock rate in people who underwent ICD insertion for family history of sudden cardiac death or for syncope (table 2). There was no difference in shock rates in people with NSVT prior to ICD placement based on septal thickness (HR 0.76 [0.21 to 2.74], p=0.679). There was strong evidence of interaction between NSVT and MSH on shock rates (LR χ2 =6.94, p=0.008), such that presence of both risk factors did not increase shock rate. Concurrent presence of late gadolinium enhancement (LGE) &gt;15% on CMR and MSH was associated with a significant increase in shock rate (3.58 [1.43 to 8.98], p=0.006). Conclusion: MSH is a helpful indicator of who will benefit from ICD placement among people with a pre-existing indication for a device, particularly among those with a more subjective indication for a device.
Abstract 4148070: Clonal Hematopoeisis of Indeterminate Potential and Risk of Autopsy-defined Sudden Cardiac Death
Authors: W. Patrick Devine, Brielle Kinkead, Kosuke Nakasuka, Alexander Bick, Matthew Yee, David Eik, Ellen Moffatt, Zian Tseng, MD
Journal: Circulation (2024)

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with an increased risk of coronary artery disease (CAD) and cardiovascular (CV) mortality. Whether CHIP may affect myocardium beyond promoting CAD, or its potential association with sudden cardiac death (SCD), the most feared manifestation of CV disease, is unknown. Research Questions/Hypothesis: We hypothesize that CHIP-mutant macrophages infiltrate the myocardium and are associated with autopsy-defined arrhythmic death. Goals/Aims: (1) determine rate of CHIP at time of death in an unselected, countywide study of all incident sudden deaths; (2) evaluate whether CHIP-mutant macrophages infiltrate into myocardium; and (3) evaluate potential association of CHIP with autopsy-confirmed arrhythmic causes among countywide sudden deaths Methods/Approach: We used autopsy to adjudicate arrhythmic from non-arrhythmic (PE, stroke, overdose, tamponade) causes in 1,148 sudden deaths and 141 trauma control deaths in San Francisco County from 2011-23. DNA was extracted from frozen blood samples collected at time of death from 399 consented cases. Sequencing of 22 CHIP-associated genes was performed to ~2000x mean target coverage. All pathogenic/likely pathogenic CHIP variants at &gt;2% variant allele frequency (VAF) were considered CHIP+. DNA was then isolated from left ventricular (LV) tissue sampled at autopsy in all CHIP+ blood cases and sequenced as above. Results: Of 399 consented cases, 70 blood samples (17.5%) were CHIP+ (range 2%-39.6%; mean age 70.6 years vs. 58.1 years for CHIP-). The most frequent mutant genes were DNMT3A, TET2, and ASXL1. Proportion of arrhythmic causes among sudden deaths was similar for CHIP+ vs. CHIP- cases (36 of 70 [52%] vs. 171 of 329 [51%]). Sequencing of available LV tissue from 61 CHIP+ blood cases revealed 67% (n=41) harbored the same CHIP mutation identified in blood at &gt;0.2% VAF (range 0.2%-4.3%). Proportion of arrhythmic causes among sudden deaths was significantly higher in cases where both blood and LV were CHIP+ (24 of 41 [58.5%] vs. 5 of 19 [26.3%] CHIP+ blood/CHIP- LV, p=0.02). Conclusions: Prevalence of CHIP positivity at sudden death is similar to published studies and correlated with age. CHIP+ status in myocardial tissue but not peripheral blood was associated with arrhythmic causes of sudden death, suggesting a direct tissue effect of CHIP-mutant macrophages.
Abstract 4119560: Oxidized Phospholipids and Calcific Aortic Valvular Disease
Authors: Harpreet Bhatia, MARC DWECK, Neil Craig, Romain Capoulade, Philippe Pibarot, Patrick Trainor, Seamus Whelton, Rishi Rikhi, Karita Lidani, Wendy Post, Michael Tsai, Michael Criqui, Michael Shapiro, Matthew Budoff, Andrew DeFilippis, George Thanassoulis, Sotirios Tsimikas
Journal: Circulation (2024)

Introduction: Oxidized phospholipids (OxPL) are carried by apolipoprotein B-100-containing lipoproteins (OxPL-apoB) including lipoprotein(a) [Lp(a)]. Both OxPL-apoB and Lp(a) have been associated with calcific aortic valve disease (CAVD). Aims: We aimed to evaluate the independent associations between OxPL-apoB, Lp(a) and the prevalence, incidence, and progression of CAVD. Methods: OxPL-apoB and Lp(a) were evaluated in the Multi-Ethnic Study of Atherosclerosis (MESA) and a participant-level meta-analysis of four randomized trials of participants with established aortic stenosis (AS). In MESA, the association of OxPL-apoB and Lp(a) with aortic valve calcium (AVC) at baseline and 9.5 years was evaluated using multivariable ordinal regression models. In the meta-analysis, the association between OxPL-apoB and Lp(a) with AS progression (annualized change in peak aortic valve jet velocity (V max )) was evaluated using multivariable linear regression models. Results: In MESA, both OxPL-apoB and Lp(a) were independently associated with prevalent AVC (OR (95% CI) per SD: 1.19 (1.07-1.32) and 1.13 (1.01-1.27), respectively) with a significant interaction between the two (p&lt;0.01). Both OxPL-apoB and Lp(a) were associated with incident AVC at 9.5 years when evaluated independently (interaction p&lt;0.01). The OxPL-apoB*Lp(a) interaction demonstrated higher odds of prevalent and incident AVC for OxPL-apoB with increasing Lp(a) levels. Mediation analyses demonstrated that Lp(a) partially mediated the association between OxPL-apoB and AVC. In a 2x2 analysis, the greatest risk for both prevalent and incident AVC was observed when Lp(a) and OxPL-apoB were both above the 80 th percentile ( Figure ). In the meta-analysis, when analyzed separately, both OxPL-apoB and Lp(a) were independently associated with faster increase in V max , but when evaluated together, only OxPL-apoB remained significant (ß 0.07, 95% CI 0.01-0.12, Figure ). Conclusions: OxPL-apoB is an independent predictor of the presence, incidence and progression of AVC and established AS, particularly in the setting of elevated Lp(a) levels and may represent a novel therapeutic target for CAVD.
Abstract 4144530: IL-37 promotes resolution of Right Heart Disease-induced inflammation and atrial fibrillation.
Authors: Orlane Neuilly, Rim Younes, Mozhdeh Mehdizadeh, Charles-Alexandre LeBlanc, Feng Xiong, Patrice Naud, Jiening Xiao, Colombe Roy, Martin Sirois, Jean-Francois Tanguay, Jean-Claude Tardif, Roddy Hiram
Journal: Circulation (2024)

INTRODUCTION: Atrial Fibrillation (AF) is the most common cardiac arrhythmia. Hypertension, obesity, diabetes or right heart disease (RHD) are important risk factors for AF. Inflammation stands as a common denominator among most AF risk factors. Studies have shown that patients with AF present high levels of circulating IL-18. Our group recently described that inflammation-resolution may prevent AF in RHD, however, the mechanism remains unclear. To inhibit IL-18-induced inflammation, IL37, a specific antagonist of IL-18-receptor was shown to attenuate cardiac fibrosis in a mice model of myocardial infarction, but little is known about its efficacy to prevent AF. HYPOTHESIS: IL-37 curbs RHD-induced atrial inflammation and AF vulnerability. METHODS: To induce right-sided cardiac hypertrophy and dilation, pulmonary artery banding (PAB) was performed in male and female Wistar rats (250-300g). Sham animals did not receive the ligation. Animals were randomized into four groups: Sham and PAB treated or not with IL37 (100 ng/ml/kg). Electrophysiological studies and echocardiography were performed in vivo before sacrifices at day (D)0, D7, D14 and D21. To analyze the atrial conduction, right atrial (RA) optical mapping was performed on Langendorff-perfused hearts. Histology, western blot, and qPCR were performed to study the expression of proteins and genes involved in atrial inflammation, fibrosis, and electrical remodeling. RESULTS: Twenty-one days after surgery, PAB rats were more vulnerable to AF and developed severe right-sided hypertrophy and dilation compared to Sham. Reliable to clinical evidence, female rats might be more resistant to AF than males. AF was associated with increased RA levels of inflammatory biomarkers including IL18, IL1β, and IL6. IL37 treatment was associated with decreased atrial expression of inflammatory markers. CONCLUSION: IL37 is a potential new therapeutic strategy to reduce atrial inflammation and prevent AF vulnerability in RHD.
Abstract 4144517: Feasibility of Deep Sedation for Catheter Ablation of Atrial Fibrillation Using Pulsed Field Ablation
Authors: Romil Patel, Riya Sam, Lavisha Singh, Westby Fisher, Mark Metzl, Jose Nazari, Alex Ro, Hany Demo, Jeremiah Wasserlauf
Journal: Circulation (2024)

Introduction: General anesthesia is commonly utilized during catheter ablation of atrial fibrillation (AF) in the United States, providing patient immobility and permitting esophageal temperature management for radiofrequency ablation. Pulsed field ablation (PFA) is associated with shorter procedure time, less risk of esophageal injury, and less dependence on catheter stability compared with radiofrequency ablation. There are limited data available on performing the procedure with deep sedation as an alternative to general anesthesia with endotracheal intubation. Methods: Consecutive patients who underwent catheter ablation of AF at Endeavor Health (Chicago, IL) using pulsed field ablation (Farapulse, Boston Scientific, Marlborough, MA or PulseSelect, Medtronic, Minneapolis, MN) and deep sedation between March and May 2024 were retrospectively included in this study. Deep sedation (monitored anesthesia care) was administered by a certified registered nurse anesthetist and attending anesthesiologist, consisting of bolus and infusion dosing of propofol, dexmedetomidine, fentanyl, and midazolam at the discretion of the practitioner with continuous monitoring of vital signs and end-tidal CO2. The primary endpoint was the rate of airway complications or requirement for conversion to general anesthesia. Secondary endpoints were the rate of acute procedural success (all pulmonary veins isolated), total time in the EP lab, procedure time (from lidocaine to removal of sheaths), and non-procedure time (difference between total time in lab and procedure time). Results: A total of 40 patients (mean age 70.4 ± 13.6 years, BMI 30.2 ± 7.4, 60% females) were included in the analysis. There were no instances of airway complications or conversion from deep sedation to general anesthesia. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 156.6 ± 41.5 minutes; consisting of a mean procedure time of 107.1 ± 39.7 minutes and non-procedure time 49.5 ± 10.3 minutes. Conclusions: In this initial experience at a single center, deep sedation (monitored anesthesia care) for PFA was associated with no instances of airway complications. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases. Although patients generally were amnestic to the procedure, larger studies incorporating patient-reported outcomes are needed, as well as data regarding long-term clinical outcomes and cost.