tbuckley/cabot-search huggingface dataset:
Abstract 4148156: A Comparison of Characteristics and Outcomes in Patients with and without Adult Congenital Heart Disease Undergoing Catheter Ablation for Ventricular Tachycardia
Authors: Pragyat Futela, Aastha Poddar, Gurukripa Kowlgi
Journal: Circulation (2024)

Background: Patients with adult congenital heart disease (ACHD) form a unique subset of patients with complex ventricular tachycardia (VT). Objective: To evaluate the clinical and procedural characteristics and outcomes of patients with congenital heart disease who present for VT ablation. Methods: A single-center, retrospective study of patients undergoing VT ablation was conducted. The primary composite outcome was recurrent monomorphic VT, and repeat ablation. Results: Out of 508 procedures for ventricular tachycardia ablation, 37 were performed in ACHD patients. These patients were younger compared to the non-ACHD subtype.(Table 1). Out of 26 patients with congenital heart disease, a majority had a diagnosis of tetralogy of Fallot (57.6%) and 69% had 2-3 prior open-heart surgeries, including ventriculotomy (53.8%), ventricular septal defect repair (65.3%), and pulmonary valve replacement (57.6%) (Table2). They had a higher mean LVEF,and lower burden of comorbidities including hypertension, chronic kidney disease, and myocardial infarction compared to their non-ACHD counterparts and had been on fewer antiarrhythmics at baseline. ACHD patients were less likely to require epicardial access, but the requirement for induction meds was higher, and energy delivery times were longer. There were no significant differences in the VT characteristics and mapping techniques between the two groups. There were no significant differences in outcomes including complications, and time to recurrence, and a Kaplan-Meier analysis showed no significant difference in VT free survival when ACHD patients were compared to patients without ACHD (Figure 3). After adjusting for age, sex and comorbidities, ACHD was not a predictor of having VT recurrence or repeat ablation (aHR =1.1 (0.7-1.9), p=0.6) Conclusion: VT ablation in patients with ACHD is safe, and as effective as ablation in non-ACHD patients. Procedure times tend to be longer owing to a more challenging substrate.
Abstract 4146952: Clinical Characteristics, Survival Rates, and Prevalence of Cardiovascular Readmissions in Patients with Primary Malignant Cardiac Tumors
Authors: Maligireddy Anand Reddy, William Frick, Sierra Dickey, shrishti sinha, Barbara Okeke, Niteesh Chitturu, Lolita Golemi, Revanth Reddy Bandaru, Sumrah Khan, Chaitanya Rojulpote, Chien-Jung Lin, Deana Mikhalkova
Journal: Circulation (2024)

Background: Primary malignant cardiac tumors (PMCT) pose a unique clinical challenge due to their rarity, limited treatment options, and aggressive disease course. The aim of this study is to understand clinical characteristics and survival rates based on initial presentation of patients admitted with PMCTs. Methods: From 2016 to 2020, we employed the National Readmission Database to identify individuals ≥18 years of age who were initially admitted with a diagnosis of PMCT. Kaplan-Meier survival analysis was reported as hazard ratios to estimate survival rates. All statistical analyses were performed using Stata 18.0 software. Results: We identified 1,646 patients with PMCTs (mean age 54.9 years, 52.2% female).The all-cause in-hospital mortality rate was 10.9% (n=180). Amongst surviving patients at index admission, overall 30-day readmission rate was 25.7%, while the 90-day readmission rate was 32.7% post the index admission. Heart failure, atrial fibrillation, and ventricular tachycardia/ventricular fibrillation were the leading causes of index hospitalization, 30-day and 90-day readmission ( Table 1) . When assessing survival rate based on the index admission, a significant difference was noted amongst patients based on their acute coronary syndrome (ACS) status; HR: 2.7 [1.01- 7.45], p=0.048. A trend for significance was observed based on atrial fibrillation (AF) status; HR: 1.5 [0.92- 2.6], p=0.096. There was no difference in survival rates amongst patients based on their HF status; HR: 1.07 [0.63- 1.81], p=0.811. A sub-analysis of patients with heart failure with preserved (HFpEF) and reduced ejection fraction (HFpEF) revealed similar results; HR: 0.5 [0.16- 1.59], p=0.239. Conclusion: Patients with PMCTs have comparable survival rates despite variations in clinical presentations on index hospitalization. Elevated 30-day (25.7%) and 90-day (32.7%) readmission rates underscore the need for patient centered, pre-discharge management.
Abstract 4147012: Classic Physiology Revealed During Mitral Valve Transcatheter Edge-to-Edge Repair: A Case of Hypertrophic Obstructive Cardiomyopathy Resulting in Severe Mitral Regurgitation
Authors: Michael Axline, David Axline, Gaston Cudemus, Laura Muller, Dhiran Verghese, Juan Sierra, Wael Dakkak, Sankalp Patel, Robert Cubeddu
Journal: Circulation (2024)

Case This case demonstrates classic cardiac physiology revealed in an unorthodox manner. Our patient is a 76-year-old male with a past medical history of HOCM, CAD, mild mitral regurgitation who presents to the hospital in the setting of chest pain. Work up revealed a high sensitivity troponin trend concerning for NSTEMI. Patient underwent a left heart cath where he was found to have a proximal LAD lesion with 99% stenosis requiring stenting. Post-intervention patient developed recurrent chest pain and a stat echocardiogram raised concerns for impending cardiogenic shock. Patient thus underwent emergent left and right heart cath. Impella LVAD placed for hemodynamic support. TEE was later obtained revealing moderate to severe mitral regurgitation, representing a progression from prior. At this time both advanced heart failure and structural heart service were consulted. The progression of the patient’s mitral regurgitation was thought to be impacting clinical deterioration and mitral valve transcatheter edge-to-edge repair (TEER) was discussed to address MR in the setting of obstruction. A multidisciplinary meeting resulted in decision to proceed with mitral valve TEER. Baseline hemodynamic gradients confirmed the presence of HOCM with peak-to-peak pressure gradient of 110 mmHg. Intraoperative TEE confirmed the presence of SAM and severe MR. The patient was prepared for a Pascal ACE clip, though in setting of this procedure phenylephrine was required for blood pressure support, revealing improvement in both SAM and MR. The patient was hemodynamically challenged with phenylephrine resulting in temporary resolution of MR and LVOT obstruction. These findings demonstrated a competent mitral valve with regurgitation resulting from HOCM physiology. After a multidisciplinary discussion, decision made to abort and withhold MV TEER. Discussion: This case demonstrates classic HOCM physiology in the setting of an attempted TEER procedure. With the addition of phenylephrine and increased afterload SAM resolved, as did much of the patient’s valvular regurgitation. This confirmed a competent mitral valve impacted by HOCM physiology rather than primary mitral valvular pathology. This case demonstrates the impact of structural imaging and competent imagers in the setting of complex anatomy and physiology. In this case TEE findings from provocative hemodynamic testing prevented unnecessary procedures.
Abstract 4148117: Efficacy of TRISCORE in predicting the long-term survival in patients undergoing transcatheter tricuspid valve replacement or surgical tricuspid valve replacement: a systematic review and meta-analysis
Authors: Eric Katsuyama, Julia Fernandes, Christian Fukunaga, Naieli Andrade, Alonzo Prata, Pedro Gabriel Scardini, Wilson Falco Neto, Ana Carolina Coan, Rafael Petri Santos Pinheiro, Luciana Gioli-Pereira
Journal: Circulation (2024)

Background: Tricuspid regurgitation (TR) is a prevalent disease in the population and is usually progressive. Most patients are treated with conservative management due to the risk involving transcatheter tricuspid valve replacement (TTVR) and surgical tricuspid valve replacement (STVR). The TRI-SCORE was developed to evaluate the severity of patients with TR and their risk of undergoing a correction procedure. However, there is still controversy regarding the cutoff value of the score. Therefore, we aim to perform a systematic review and meta-analysis comparing the cutoffs ≥6 with &lt;6 of the TRI-SCORE in patients with TR undergoing TTVR or STVR. Methods: We systematically searched Embase, Pubmed, and Cochrane for randomized controlled trials (RCT) and observational studies comparing cutoffs of &gt;=6 with &lt;6 of the TRI-SCORE in patients with TR undergoing STVR or TTVR. We focused on the primary outcomes of (1) all-cause mortality. A prespecified subgroup analysis was performed comparing STVR with TTVR. Odds Rartion(ORs) with 95% confidence interval (CI) were pooled across studies using a random effect model. Results: We included three studies encompassing 2063 patients, of whom 441 had a cutoff ≥6 (42.12%) at the TRISCORE.. The mean follow-up was 2.5 years). In the pooled analysis, our results show all-cause mortality significant decrease at the cutoff of &lt;6 in TRISCORE, with lower mortality events (OR 1.15; 95%CI 1.06-2.26; p&lt;0.01; Fig.1). The subgroup analysis revealed a significant subgroup difference between STVR and TTVR for the outcome of all-cause mortality (p&lt;0.01) favoring the STVR group (OR 2.13; 95%CI 1.51 - 3.01;p&lt;0.01; Fig.1). Conclusion: In our meta-analysis of patients with TR undergoing TTVR or STVR, a cutoff ≥ 6 at the TRISCORE was associated with a worse prognosis, with significantly higher rates of all-cause mortality and 30-day mortality. The subgroup analysis demonstrated a higher benefit in =TTVR subgroup
Abstract 4147446: Safety and Outcomes of Leadless Pacemaker Retrieval in the United States
Authors: Temidayo Abe, Ndausung Udongwo, Michael Fatuyi
Journal: Circulation (2024)

Introduction: While the utilization of leadless pacemakers is growing, the safety of device retrieval remains an important question that has yet to be addressed. Methods: Using the State Inpatient Database (2016 to 2021), we identified 426 cases of leadless pacemaker (Medtronic MICRA) revision or replacement using ICD-10-PCS codes 02WA3NZ and 02PA3NZ. In-hospital mortality and procedure-related complications, including vascular or access site injuries, pericardial and myocardial injuries, bleeding, and emergent open-heart surgery, were examined. Additionally, healthcare resource utilization and post-discharge outcomes were assessed. Results: The mean age of the patients was 69 ± 14 years. Most procedures (77%) were performed electively at large urban teaching hospitals. Device malfunction was a secondary diagnosis in 10% of cases, and infection occurred in 14%. The in-hospital mortality rate was 7.4%, with 29% experiencing procedure-related complications, primarily post-procedural bleeding (64%) and pericardial injury (23%). These complication rates remained unchanged throughout the study period and were more likely to occur in patients with a high comorbidity burden and those undergoing non-elective procedures. The mean length of stay was 12.1 days, and the inflation-adjusted cost was approximately $76,432. The 30-day all-cause readmission rate was 14%. Conclusion: Leadless pacemaker retrieval presents significant risks, with complication rates remaining unchanged over the past five years. Prior to retrieval, careful evaluation is essential, and retrieval protocols should be optimized.
Abstract 4147019: <i>Role of Fractional Excretion of Uric Acid as a Predictor of Cardio-renal Syndrome in Acute Decompensated Heart Failure Patients: An Observational Study</i>
Authors: Shekhar Kunal, Bhushan Shah, sanjeev kathuria, SUNIL KUMAR
Journal: Circulation (2024)

Cardio-renal syndrome (CRS) is a growing health, economical, and societal problem.The diagnosis and treatment of patients with acute decompensated heart failure (ADHF) especially complicated with CRS are challenging and hence, we aimed to determine the prevalence of CRS in ADHF patients and also determine the role of fractional excretion of uric acid (FeUa) in prediction of CRS in patients with ADHF. Methods: In this hospital-based, observational study, a total of sixty-five patients with ADHF and who met the inclusion criteria were recruited and their demographic details were recorded. Blood samples were collected, and various laboratory parameters were measured at day-1, day-3, and day-7. The fractional excretion of sodium (FeNa) and FeUa were calculated. Results: The mean age of participants was 52.32 ± 14.04 years, and 67.69 % were males. The prevalence of CRS in ADHF patients was noted to be 18.46 %. At baseline, the B-type natriuretic peptide (BNP) level for the enrolled patients was observed to be 8690.06 ± 6181.32 pg/ml. The serum creatinine and serum uric acid elevated as the day of hospitalization increased, and the maximum was observed at day-7 i.e., 1.35 ± 0.54 mg/ml and 11.08 ± 15.83 mg/ml, respectively. Declining trend in the FeNa (%) was noted, and the values at day-1, at day-3, and at day-7 were 1.25 ± 1.18, 1.01 ± 1.08, and 0.80 ± 0.79, respectively. The FeUa (%) value increased at day-3 from 5.60 ± 7.47 to 6.95 ± 7.43. However, decrease FeUa value was observed at day-7 (5.78 ± 5.63 %). On receiver operative curve analysis, FeUa served to be a negative predictor of CRS in ADHF patients with an area under the curve of 0.489. Conclusion: The FeUa seems to be a negative predictor of CRS in patients hospitalized with ADHF. However, multi-parametric techniques and biomarkers which are available for investigating cardiovascular diseases and kidney diseases may offer opportunities for the evaluation of CRS.
Abstract 4147317: Impact of the Addition of Cardiac MRI Features and Sex Interactions with a Validated Clinical Risk Score to Improve Discrimination of Risk
Authors: Diane Rizkallah, Carl Ammoury, Kashyap Bodi, Theerawat Korkerdsup, Nancy Obuchowski, Tom Kai Ming Wang, Katrina Poppe, Robert Doughty, Tess Calcagno, David Chen, Christopher Nguyen, Wai Hong Tang, Deborah Kwon
Journal: Circulation (2024)

Introduction: The “Meta-analysis Global Group in Chronic Heart Failure” (MAGGIC) score is a validated clinical score, but does not include quantitative insights provided by cardiac magnetic resonance (CMR). We sought to determine if CMR parameters result in further discrimination of risk prediction. Methods: We evaluated 1414 ischemic and non-ischemic cardiomyopathy (ICM vs NICM) patients, who were referred for CMR between 2001-2017. The primary endpoint was the composite event of death, transplant, or LVAD. The data was split equally into development and validation cohorts using stratified randomization with presence/absence of an event and ICM/NICM as the two strata. A Cox proportional hazards regression model was first developed in the training patient cohort using only the MAGGIC score alone (baseline model). CMR measures with associated interactions with sex were then added to the baseline model in addition to ICM vs NICM categorization. The final fitted model was tested on a validation cohort of 704 patients. Uno concordance index was estimated with Wald test to assess significance. Results: There were 782 ICM patients and 674 NICM patients, with the following characteristics: 31.8% female, mean age 58±14 years, LVEDVi 131±45.0 mL/m 2 , LVEF 30±11%, LAEF 38±17%, RVEF 43±13%, LGE 8±11% and mitral regurgitant fraction 15±15%. The final model with CMR parameters is described in table 1. The MAGGIC score was a significant predictor of outcomes with a c-index of 0.635±0.0190, which increased to 0.656±0.0154 after adding CMR features and cardiomyopathy classification in the validation cohort ( p&lt;0.001 for c-index difference ). Interaction of male sex and LVEDVi and RVEF yielded a maximum likelihood estimation (MLE) of -0.0077 (p=0.003) and 0.016 (p=0.023) respectively, suggesting attenuated impact of increasing LVEDVi and declining RVEF on risk in men compared to women. Conclusion: Integration of CMR parameters with novel sex interactions with the MAGGIC score significantly improves discrimination of risk. Further studies are needed to validate this CMR-enhanced risk score and to determine its association with adverse outcomes and differential therapeutic benefit in external patient cohorts.
Abstract 4146625: Automated Detection and Measurement of Aortic Aneurysms in a Clinical Population
Authors: Ian Dinsmore, Jonathan Luo, William Triffo, Evan Ryer, James Elmore, David Carey, Tooraj Mirshahi
Journal: Circulation (2024)

Introduction: Aortic aneurysms (AA*) are enlargements of the aorta that can be life-threatening if left untreated. Early detection is essential and typically relies on imaging. However, routine screening is only performed for at-risk groups, such as older male smokers. Computed tomography (CT) scans performed for other reasons could be used to enhance early AA* detection. This could lead to significantly increased screening rates and reduce AA* related deaths. Hypothesis: A subgroup of the clinical population who would not undergo routine screening for AA* will have a CT showing aortic ectasia or an aortic aneurysm. Goals: To automatically measure aortic diameters from routine CT imaging on a large scale and provide early AA* detection. Methods: We trained a deep-learning model on a public dataset of 982 CT scans split into 933 training/validation samples and 49 independent testing samples. We segmented the aorta in both non-contrast and contrast CT images and applied real-time image augmentation during training to enhance the data. The aorta segmentation model achieved a Dice Similarity Coefficient of 0.96 during training, and 0.95 during testing. Using an automated centerline analysis, we measured the maximum cross-sectional diameter of the thoracic (ascending and descending), and abdominal aorta. Results: We extracted 34,805 unique abdominal and 26,629 unique chest CTs and measured aortic diameter in each scan. Men had significantly larger abdominal and thoracic aortic diameters than women (p-value &lt; 1e-26, unpaired t-test): ascending: 37.9±4.3 vs 34.2±4.0mm; descending: 31.5±4.2 vs 27.8±3.7mm; abdominal: 24.4±7.0 vs 20.0±4.1mm (men vs women, mean±SD). We manually reviewed 51 ascending, 51 descending, and 91 abdominal aorta diameters. We compared the diameters to the automatic measurements, finding mean absolute errors of 1.6mm, 1.0mm, and 2.8mm, respectively. Evaluating this cohort against ICD10 codes showed that out of 1,362 patients with an abdominal diameter &gt; 3cm, 277 (20%) did not have a AAA diagnosis. Out of 1,126 patients with a descending diameter &gt; 4cm or an ascending diameter &gt; 4.5cm, 386 (34%) did not have a TAA diagnosis. Using existing CT images, we identified a large number of subjects who may be at risk for AA* but have not received routine screening for the disease. Conclusions: By using a deep-learning segmentation model on CT imaging, we can automatically and accurately measure aortic diameter and detect AA*.
Abstract 4147354: Life’s Essential 8 among adults living with cardiovascular-kidney-metabolic (CKM) syndrome: 2013-2020 National Health and Nutrition Examination Survey
Authors: Khadijat Adeleye, Chelsea Akubo, Tosin Tomiwa, Janice Dugbartey, Mojisola Olusola-Bello, Valerie Sullivan, Bunmi Ogungbe
Journal: Circulation (2024)

Introduction: Cardiovascular-kidney-metabolic (CKM) syndrome is a multifaceted condition impacting cardiovascular, kidney, and metabolic health. Life’s Essential 8 (LE8), key measures for improving and maintaining cardiovascular health, may predict health outcomes, but its relationship with CKM syndrome is unclear. Objectives: This study aimed to examine LE8 scores within CKM stages 1-4 among the US adult population. Methods: Data from the National Health and Nutrition Examination Survey (NHANES, 2013-2020) were analyzed. CKM was categorized into 4: presence of excess adiposity, prediabetes (stage 1), metabolic risk factors, CKM or CVD risk factors, high-risk kidney disease (stages 2-3), clinical CVD with CKM risk factors (stage 4). Each LE8 factor was scored between 0 and 100 points and categorized into quartiles Q1 (low): 0-38, Q2 (moderate): &gt;38–50.65, Q3 (high): &gt;50.65–63, and Q4 (very high): &gt;72.86. We fitted a weighted generalized linear model adjusting for race/ethnicity, age, gender, education, poverty income ratio, insurance, and employment. Result: We include 9,019 adults with CKM; mean age 50.7(±15) years, 49% female. For stage 1 CKM, high (β =0.98 (95% CI: 0.97–0.99) and very high (β =0.95(95% CI:0.93- 0.97) LE8 quartile were significantly associated with lower risk of CKM, compared to low LE8 quartile (figure). Also, Increasing LE8 scores progressively showed reductions in the risk of stage 2 CKM in high (β =0.96 (95% CI: 0.97–0.99) and very high (β =0.91, 95% CI: 0.97–0.99) LE8 quartiles. Similar to stage 2, increasing LE8 scores significantly reduced the risk of stage 3 CKM in the high (β =0.96 (95% CI: 0.97–0.99) and very high (β =0.91, 95% CI: 0.97–0.99) LE8 quartiles. Greater reduction in CKM stage 4 risk was observed for moderate (β = 0.98, 95% CI: 0.97–0.99), p=0.009; high (β =0.92 (95% CI: 0.89–0.95), and very high (β -0.82, 95%CI:0.75- 0.89), LE8 quartiles. Conclusion: The association between LE8 scores and CKM stages suggests that improving LE8 scores may reduce the prevalence and severity of CKM syndrome among adults. These findings contribute to the importance of early intervention strategies targeting cardiovascular and metabolic health.
Abstract 4146972: Left Atrial Reservoir Strain as an Independent Predictor of Ischemic Stroke Following Coronary Artery Bypass Grafting
Authors: Hamza Maqsood, Shifa Younus, Iqra Maryam, muhammad khaliq, Aamir Ali, Muhammad Hassan Cheema, Muhammad Hussnain Cheema, Humais Choudhary, Tauseef Hussain
Journal: Circulation (2024)

Introduction: Acute ischemic stroke (AIS) represents a significant long-term complication following cardiac surgery, often linked with unfavorable outcomes. Left atrial (LA) mechanics, notably LA strain, have been identified as predictors for both stroke and atrial fibrillation in various populations. However, conflicting evidence exists regarding the clinical relevance of postoperative atrial fibrillation (POAF), and its contribution to the relationship between LA mechanics and ischemic stroke remains uncertain. Objective: Our study examined the significance of left atrial strain parameters as autonomous predictors of acute ischemic stroke (AIS) among patients undergoing coronary artery bypass grafting (CABG). Additionally, we investigated the association between AIS and postoperative atrial fibrillation (POAF) in CABG patients. Methods and Materials: For a retrospective cohort analysis, we enrolled patients undergoing isolated coronary artery bypass grafting between 2021 and 2023. Transthoracic echocardiography was conducted preoperatively. The main outcome assessed was ischemic stroke. We explored the relationship between left atrial (LA) reservoir strain and ischemic stroke using uni- and multivariable Cox proportional hazards regression models, with adjustments for postoperative atrial fibrillation. Results: We analyzed a cohort comprising 410 patients, among whom 78 (19%) developed postoperative atrial fibrillation (POAF). Over a median follow-up period of 1.4 years, 19 patients (4.6%) experienced ischemic stroke. In univariable analysis, a significant association was observed between left atrial (LA) reservoir strain and ischemic stroke (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.97–1.23, p &lt; 0.005) per 1% absolute decrease. Even after adjusting for factors including LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.07, 95% CI 1.01–1.21, p &lt; 0.005 per 1% absolute decrease; HR 3.6, 95% CI 1.23–11.04, p &lt; 0.005 for &lt; vs. &gt;median). The inclusion of POAF as a covariate did not affect the significance of LA reservoir strain in the model. Conclusion: Our study concluded that among patients who underwent CABG, LA reservoir strain independently predicted ischemic stroke over the long term.