tbuckley/cabot-search huggingface dataset:
Abstract 4144731: Trends in Rheumatic Heart Disease Mortality in India (2010-2021) and Projections to 2030
Authors: Kamleshun Ramphul, GURJOT SINGH, Kanishka Goswami, Manraj Sekhon, Arush Rajotia, Shruti Aggarwal, Shaheen Sombans, Jasninder Dhaliwal
Journal: Circulation (2024)

Introduction: In 2021, India reported an estimated 166,017 deaths related to Rheumatic Heart Disease (RHD). Since 2010, the Indian government has implemented various initiatives to reduce this burden. The Indian Council of Medical Research (ICMR) launched the "Jai Vigyan Mission Mode Project," focusing on raising awareness, early detection, treatment, and infrastructure strengthening. The National Programme for Prevention&amp;Control of Cancer, Diabetes, Cardiovascular Diseases&amp;Stroke (NPCDCS) and Rashtriya Bal Swasthya Karyakram (RBSK) programs have established NCD clinics and cardiac care units, conducted health education campaigns, and trained medical staff for RHD prevention and control. Key initiatives include using RHD registers, regular penicillin prophylaxis, and promoting early diagnosis and treatment. The development of the low-cost Sree Chitra Valve has also increased treatment affordability. This study aims to evaluate the impact of these government efforts on reducing RHD-related mortality in India. Methods: Data from the Global Health Data Exchange (GHDx) for the 2021 Global Burden of Disease was analyzed to assess the global burden of RHD cases from India and the death rates per 100,000 population between 2010 and 2021 and predictive models adopted for estimates till 2030. Results: Between 2010 and 2014, the global mortality linked to RHD from India increased from 45.23% to 46.94%, then decreased gradually to 44.47% in 2021. Our predictive model estimates that India will contribute around 40.96% of global RHD deaths by 2030. Initially, the age-standardized RHD death rate per 100,000 population was lower among females than males, but it rose higher than males from 2013 onwards. A continuous reduction in the rate was observed in females from 2013 to 2021. Meanwhile, a declining trend was seen among males and combined (male + female) over the study period. By 2030, the overall death rate per 100,000 population is estimated to reach 9.23 (95% CI 7.24-11.22)(Figure 1). Conclusion: Our study confirms the downward trend of RHD mortality rates in India, likely linked to the multiple health initiatives. This highlights the need for sustained public health efforts to continue reducing RHD mortality.
Abstract 4144620: Outcomes with Drug-Coated Balloon Versus Drug-Eluting Stents for De-Novo Coronary Artery Disease: A Meta-Analysis
Authors: Hritvik Jain, Ramez Odat, Neha Pervez, Aman Goyal, Jyoti Jain, Nandan Patel, Ashish Yadav, Janhvi Shah, Jagriti Jha, Siddhant Passey
Journal: Circulation (2024)

Background: Drug-eluting balloons (DEB) are promising alternatives to drug-eluting stents (DES) for managing de novo coronary artery disease (CAD). Given the scarcity of available data, our objective was to evaluate the outcomes of DES versus DEB in CAD patients. Methods: Databases such as PubMed, Embase, Cochrane Library, and Google Scholar were searched to identify studies comparing clinical outcomes between DCB and DES in de novo CAD patients. Using a random-effects model, pooled estimates of the mean difference (MD) and odds ratio (OR) were calculated along the 95% confidence intervals (CI), with statistical significance set at p&lt;0.05. Results: The pooled analysis included 19 studies with 3643 de-novo CAD patients (1588: DCB; 2055: DES). DCB was associated with a significantly lower mean lumen diameter at follow-up [MD: -0.27; 95% CI: -0.40, -0.15; p&lt;0.0001] than DES. No statistically significant differences in mean in-stent late lumen loss [MD: 0.14; 95% CI: 0.00, 0.28], cardiovascular mortality [OR: 1.10; 95% CI: 0.57, 2.12], all-cause mortality [OR: 0.79; 95% CI: 0.45, 1.37], myocardial infarction [OR: 0.67; 95% CI: 0.41, 1.10], major adverse cardiovascular events [OR: 1.06; 95% CI: 0.67, 1.68], target lesion revascularization [OR: 1.32; 95% CI: 0.88, 2.00], and stent thrombosis [OR: 0.89; 95% CI: 0.39, 2.05] were noted. Conclusion: While the DCB group exhibited a notable decrease in the minimum lumen diameter during follow-up compared to the DES group, no statistically significant differences were observed in other outcomes. Further studies with larger sample sizes are required to confirm this comparison.
Abstract 4144410: Mechanical Complications in Hemorrhagic Myocardial Infarction: Insights from Wall Strain Index Ratio for Predicting Cardiac Rupture (MIRON-STRAIN)
Authors: Keyur Vora, Huaibi Huo, Andreas Kumar, Rohan Dharmakumar
Journal: Circulation (2024)

Background: Mechanical complications following Myocardial Infarction (MI), such as ventricular rupture, significantly impact patient morbidity and mortality. Reperfused MI characterized by intramyocardial hemorrhage (hMI), has been identified to be the most severe form of myocardial injury. However, whether hMI portends a higher risk for mechanical complications is not known. The Wall Strain Index (WSI) Ratio, which is a measure of myocardial deformation and one that has been previously validated for cardiac rupture, is a desirable biomarker for examining the potential mechanical differences in strain development in hMI vs. non-hMI. Research Question: Do patients with hMIs have a higher radial and circumferential Wall Strain Index (WSI) Ratio compared to patients without hMI? Methods: We performed a retrospective cohort study (MIRON-STRAIN, NCT06450912) in mechanically revascularized STEMI patients (n=181) who underwent CMR (cine, T2* and LGE) approximately 2 days after PCI. WSI Ratio was computed using the 2D-strain module in CVI 42 (circumferential&amp;longitudinal). Parametric statistics was performed using Shapiro-Wilk test and non-parametric statistics was performed using Mann-Whitney U test. Results: Patients with hMI (n=104) showed significantly higher radial and circumferential WSI Ratios compared to non-hMI patients. The radial WSI Ratio was approximately 58% higher in hMI relative to non-hMI patients (1.36±0.72 in hMI vs. 0.86±0.55 in non-hMI (p&lt;0.001)). The circumferential WSI Ratio was 103% higher in hMI patients compared to those with non-hMI (1.22±0.87 in hMI vs. 0.60±0.44 in non-hMI (p&lt;0.001)). Median and IQR values for radial and circumferential WSI ratios showed significant differences, indicating the development of higher myocardial stress in hMI. Additional findings in hMI included higher LV EDV (122.08±33.22 ml vs. 100.78±31.92 ml, p&lt;0.001), and Infarct Size (%LV, 38.69±14.27% vs. 16.20±12.11%, p&lt;0.001). Conclusion: The Wall Strain Index Ratio is significantly elevated in hMI patients, indicating hMI patients carry a significant risk for mechanical complications. Our findings suggest that WSI Ratio can serve as a valuable biomarker for enabling timely and targeted monitoring and critical care.
Abstract 4144327: Hemodynamic and Myocardial Relevance Of Microvascular dysfunction After Elective Percutaneous Coronary Intervention.
Authors: Pedro Jallad, Danilo Maksud Maksud, Bruno Alves, Jean Carlos Calderon, ROGER GODINHO, Brunna Pileggi, Neuza Lopes, Luis Henrique Gowdak, Alexandre Abizaid, CARLOS CAMPOS
Journal: Circulation (2024)

Background: Previous research has established that a cut-off value of the index of angiographic-derived microcirculatory resistance (AMR) greater than 250 mmHg*s/m is indicative of poorer clinical outcomes in cases of primary PCI. This study aims to investigate the correlation of AMR post elective PCI &gt; 250 mmHg*m/s in coronary flow velocity ratio (CFVR) and high-sensitivity troponin (hsT) peak. Methods: Between June 2021 and December 2023, a total of 330 patients with successful elective PCI and without side branch occlusion were selected for microcirculation analysis using AngioPlus Core (Shanghai Pulse Medical Technology Inc) in a tertiary cardiology hospital at São Paulo, Brazil. HsT peak, AMR and CFVR were compared. Results: Our patient cohort was stratified based on post PCI AMR, utilizing a threshold of 250 mmHg*s/m (Figure 1A), with 162 patients in group &gt; 250 mmHg*s/m (mean 299.4 ± 42.5 mmHg*s/m) and 168 patients &lt;250 mmHg*s/m (mean 214.6 ± 28.1 mmHg*s/m). The AMR &gt; 250 mmHg*s/m group exhibited lower CFVR pre PCI (p &lt;0.001, Figure 1B) and post PCI (p &lt;0.001, Figure 1C), associated with a higher peak hsT (p &lt;0.001, Figure 1D). In relation to AMR and μFR parameters, we found higher μFR (p = 0.005, Figure 2A) in patients with CMD (AMR &gt; 250 mmHg*s/m, figure 2A), but no statistically difference in delta μFR (p = 0.08, Figure 2B). Lower AMR pre PCI (p &lt; 0.001, Figure 2C) and higher delta AMR (p = 0.003, Figure 2D) are associated with AMR &gt; 250 mmHg*s/m. Conclusion: We demonstrate that an AMR exceeding 250 mmHg*m/s following elective successful PCI is associated with reduced coronary flow velocities and myocardial injury. These indexes have potential utility in clinical practice as risk stratification tools.
Abstract 4144601: Predictive Significance of Nutritional Status Assessment with the Prognostic Nutritional Index in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Hideaki Kanzaki, Shinichi Kurashima, Yuki Irie, Atsushi Okada, Makoto Amaki, Kensuke Takagi, Naonori Kawamoto, Satsuki Fukushima, Takeshi Kitai, Chisato Izumi
Journal: Circulation (2024)

Background: Nutritional impairment significantly affects physical and cognitive functions, immune response, recovery, and quality of life in the elderly. However, the impact of malnutrition on the prognosis of patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Objective: The aim of this study was to investigate whether additional assessment of nutritional status is meaningful in predicting the prognosis of patients undergoing TAVR. Methods and Results: A total of 654 consecutive patients (mean age 83 ± 6 years, 65% female) who underwent TAVR were included. Nutritional status was evaluated at baseline using the prognostic nutritional index (PNI), calculated as follows: [10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count (/mm 3 )]. The primary endpoint of this study was all-cause mortality, with a median follow-up period of 3.4 years. Kaplan–Meier analysis showed that patients with severe malnutrition, defined as a PNI of &lt;40, had higher mortality rates (log-rank test, P &lt;0.001). Cox multivariate analysis found that PNI was an independent prognostic factor. Furthermore, the Harrell’s C-statistic of the multivariate analysis for predicting mortality improved from 0.666 to 0.715 (P = 0.002) when PNI was added. Cubic spline analysis revealed that a PNI of less than 40 was associated with a steep increase in the hazard ratio for mortality. Conclusion: Evaluating nutritional status in patients undergoing TAVR provides additional information for predicting clinical outcomes, with PNI being a useful predictive indicator.
Abstract 4144448: Evaluation of 3D Bioprinted Pulsatile Conduits Engineered Using Human Stem Cell-Derived Cardiomyocytes in a Murine Model
Authors: Syed Faaz Ashraf, Jaci Bliley, Tai Yi, Joseph Leland, Amanda Kang, Maria Stang, Caner Dikyol, Anne Behre, Edith Tzeng, christopher breuer, Adam Feinberg
Journal: Circulation (2024)

Introduction: Patients with single ventricle disease and Fontan circulation suffer long-term morbidity due to the lack of a sub-pulmonary ventricle. The concept of a pulsatile Fontan conduit, functioning as a sub-pulmonary ‘neo-ventricle,’ using engineered heart tissue (EHT), may be a potential solution. To this end, we developed a tissue-engineered vascular conduit with EHT that allowed surgical implantation into a murine model for in-vivo assessment. Methods: Mouse-scale conduits were fabricated from type I collagen using freeform reversible embedding of suspended hydrogels (FRESH) 3D bioprinting. The conduits were cellularized using human stem cell-derived cardiomyocytes and cardiac fibroblasts. Electrophysiology was assessed using calcium imaging. The conduits were surgically anastomosed to the infra-renal inferior vena cava (IVC) as an end-end interposition graft in severe combined immunodeficiency (SCID)/beige mice. The conduit's patency and the EHT's contractility were monitored with monthly ultrasounds. Explanted conduits underwent histology, immunohistochemistry (IHC), and immunofluorescent (IF) imaging. Results: Sixteen contractile conduits were produced. In vitro calcium imaging demonstrated anisotropic calcium wave propagation along the conduit at day 14. Twelve grafts were implanted in the mouse IVC and half of the grafts (n=6) were explanted 6 months postoperatively. At explant, five showed synchronous contractile behavior in-vivo of the EHT around the collagen conduit. Interconnected networks of sarcomeric alpha actinin-positive cardiomyocytes were observed on IHC and IF. Neo-vascularization was seen infiltrating the EHT on histology. Six mice remained alive at 11 months post-operatively, three with contractile activity seen via ultrasound. All twelve grafts were patent on ultrasound with no stenosis. Conclusion: We have produced mouse-scale pulsatile conduits using human embryonic-derived cardiomyocytes and bioprinting that are robust enough to withstand surgical anastomosis to the IVC and remain patent. We observed functional beating of the EHT at 11 months in vivo. This model could be used to assess and improve the in-vivo function of EHT towards producing a larger-scale pulsatile Fontan conduit.
Abstract 4144353: Evaluating Electrocardiographic Predictors of Left Ventricular Ejection Fraction Decline after Conduction System Pacing: Using Time-to-notch in Lead I
Authors: Tommy Chiou, Jeremy Treger, Amulya Gampa, Dipayon Roy, Zaid Aziz, Andrew Beaser, Srinath Yeshwant, Cevher Ozcan, Gaurav Upadhyay
Journal: Circulation (2024)

Background: While conduction system pacing (CSP) has shown promise in mitigating the risk of pacemaker-induced cardiomyopathy compared to traditional right ventricular pacing, some patients undergoing CSP may experience declines in left ventricular ejection fraction (LVEF). We aimed to identify ECG predictors of LVEF decline after left bundle branch area pacing (LBBAP) or deep septal pacing (DSP). Methods: Consecutive patients undergoing LBBAP or DSP at a single center who had baseline LVEF &gt;35%, follow-up echocardiogram at least 90 days post-implant, &gt;20% ventricular pacing, and no coronary intervention during follow-up were retrospectively studied. Post-implant ECGs were analyzed for LBBAP capture (delayed RV activation with RSR’ pattern in V 1 or QRS duration &lt;120 msec) or DSP (all others), V6 R wave peak time (&lt;75 msec if narrow QRS or RBBB, &lt;85 msec if LBBB), lead I time to notch &gt;75 msec, and RS/rS pattern in V6. Primary outcome was absolute LVEF decline ≥15%. Results: A total of 67 patients met inclusion criteria with mean age 73 years, 45% female, 63% African American, 34% CAD, 18% cardiomyopathy, and 60% median LVEF (IQR 52-68%) at baseline. LBBAP was achieved in 39 (58%) and DSP in 28 (42%). Median pacing at follow-up was 99% over median follow-up of 15.6 (IQR 8-23) months. No differences were noted with respect to demographics, clinical comorbidities, or LBBAP vs DSP among patients with and without LVEF decline ≥15% (Table). Among ECG predictors, notch time in Lead I &gt;75 msec was significant on univariate logistic regression analysis (OR 4.431, 95% CI 1.11-17.72, p=0.035, Figure) and with multivariate adjustment for age, baseline LVEF, history of cardiomyopathy or CAD. Conclusion: Lead I notch time &gt;75 msec on post-implant paced ECG was associated with LVEF decline at follow up, albeit with broad confidence intervals. These findings suggest utility in evaluating paced QRS patterns after CSP to identify patients at risk for pacemaker-induced cardiomyopathy.
Abstract 4144297: The Presence of Arm Pain Predicts Coronary Artery Occlusion Requiring Revascularization in Patients with NSTEMI
Authors: Dillon Dzikowicz, Chi-Ju Lai, Sankalp Babarao Saoji, Jessica Zegre-Hemsey, Holli Devon, Linwei Wang, Wojciech Zareba
Journal: Circulation (2024)

Introduction: Non-ST elevation myocardial infarction (NSTEMI) represents about 70% of ACS cases, and nearly one-third of these patients have an occluded coronary artery that may benefit from revascularization. The 13-item ACS Symptom Checklist is a validated tool designed for rapid assessment of Acute Coronary Syndrome (ACS) symptoms. We aimed to evaluate the effectiveness of the ACS Symptom Checklist in differentiating NSTEMI patients with and without an occluded artery. Methods: All NSTEMI patients treated at the University of Rochester Medical Center between 2015-2023 (n=3515) were included. The 13-items from the ACS Symptom Checklist were extracted using natural language processing (NLP) before coronary angiography or within 24 hours of presentation. An occluded coronary artery was one requiring revascularization with percutaneous coronary intervention. Chi-Square was used to assess the sensitivity and specificity of each symptom for an acutely occluded coronary artery. We used logistic regression models to assess the odds of an acutely occluded artery after controlling for age, obesity, and diabetes and stratified by sex. Results: Patients were predominantly male (58%, n=2048), older (69 + 13 years), and White (85%, n=2988), and 15% (n=524) underwent revascularization. Diabetes (18%, n=629) and obesity (40%, n=1387) were common comorbidities. Upper back pain (10.5% vs. 14.1%, p=0.03), palpitations (19.3% vs. 23.9%, p=0.02), arm pain (21.0% vs 16.7%, p=0.05), unusual fatigue (8.9% vs. 22.2%, p&lt;0.01) significantly differentiated between NSTEMI patients with and without an occluded coronary artery as observed in Table 1. Among men, less upper back pain (OR=0.559, 95% CI 0.361-0.865), palpitations (OR=0.678, 95% CI 0.503-0.915), and unusual fatigue (OR=0.365 95% CI 0.270-0.493) were significant predictors of coronary occlusion. Only a higher likelihood of arm pain (OR=1.184, 95% CI 0.893-1.569) predicted occlusion. Results were similar for women. Conclusion: Only arm pain, a common symptom of ischemia, predicted an occluded coronary artery in patients with NSTEMI and there were few sex differences. NLP confirmed that the presence of arm pain can cue clinicians into the probability of ischemia in this large sample of patients. Prospective studies are needed to validate these findings.
Abstract 4144347: Evaluating Hospital Volume Based Outcomes on Catheter Ablation for Atrial Fibrillation; A National Registry Study
Authors: Sean Bouza, Waseem Wahood, Bryan Curry, Kunal Lal
Journal: Circulation (2024)

Introduction: Catheter ablation is a common treatment of atrial fibrillation (AFib). However, the relationship between hospital procedural volume and patient outcomes remains unclear. This study aims to investigate whether the volume of catheter ablation procedures performed for AFib at a hospital influences patient outcomes. It is hypothesized that hospitals with higher procedure volumes will demonstrate superior outcomes due to staff expertise, protocols, and resource allocation. Methods: National Inpatient Sample (NIS) was queried from 2005 to 2020 for admissions involving catheter ablation for atrial fibrillation. Hospitals were divided into tertiles based on their volume of catheter ablation. Multivariable, Hierarchical logistic regression was utilized to assess risk factors of in-hospital mortality, discharge other than home (DOTH), and vascular complications. Negative binomial regression was utilized to assess factors of total charge and length of stay (LOS) of the two higher volume tertiles, to the first, lowest volume, tertile. Results: A total of 534,097 admissions were identified;182,354 (34.1%) in the lowest tertile, 178,525 (33.4%) in the 2nd tertile and 173,219 (32.4%) in the 3rd and highest tertile. Those in the 2nd and 3rd tertiles had similar odds of in-hospital mortality compared to the first tertile (2nd: OR: 1.05, p=0.62; 3rd: OR: 0.86, p=0.17). Those in the 2nd and 3rd tertiles had lower odds of DOTH compared to the first tertile (2nd: 0.85, p&lt;0.001; 3rd: OR: 0.75, p&lt;0.001). Those in the 2nd tertile had similar odds of vascular complications compared to the first tertile (OR: 0.87, p=0.16), while those in the 3rd tertile had lower odds of vascular complications (OR: 0.71, p=0.001). Compared to the first tertile, those in the 2nd and 3rd tertiles were associated with lower average LOS by 9.7% (p&lt;0.001) and 20.4% (p&lt;0.001), respectively. There was no difference in total charge among the 2nd and 3rd tertiles compared to the first tertile (2nd: Coef: -1.9%, p=0.17; 3rd: Coef: 0.9%, p=0.69). Conclusions: Higher hospital volumes for catheter ablation procedures may be associated with lower odds of DOTH and vascular complications as well as lower average LOS. However, in-hospital mortality and total charge was comparable among the three tertiles. Further research is needed to fully understand the relationship between hospital catheter ablation volume and patient outcomes, including postoperative management and discharge planning.
Abstract 4144385: Advanced Cardiac MRI Parameters Phenomapping to Predict Outcomes in Patients with Nonischemic Cardiomyopathy
Authors: Carl Ammoury, Yanjun Wu, Theerawat Korkerdsup, Tom Kai Ming Wang, Diane Rizkallah, Kashyap Bodi, Tess Calcagno, David Chen, Christopher Nguyen, Wai Hong Tang, Xiaofeng Wang, Deborah Kwon
Journal: Circulation (2024)

Background: Non-ischemic cardiomyopathy is a classification that includes several heterogenous phenotypes. Derivation of distinct phenotypes may enable improved risk stratification. Comprehensive functional, morphologic, and substrate assessment of the myocardium can be leveraged to derive distinct phenogroups through unsupervised latent class/cluster analysis but requires accurate and reproducible imaging biomarkers. We sought to evaluate the impact of cardiac magnetic resonance (CMR) imaging parameters to derive distinct phenotypes in NICM patients. Methods: Consecutive NICM patients referred to CMR between 2001 and 2017 were evaluated. Latent Class Analysis (LCA) was performed to identify phenotypes enriched by comprehensive CMR assessment. The primary endpoint was death, heart transplant, or left ventricular assist device implantation. Kaplan–Meier survival curves were estimated, and differences between phenotypic groups were assessed by the log-rank test. Decision tree modeling was used to predict the latent class membership. LCA and Decision tree analysis were completely blinded to the clinical outcomes. Results: A total of 458 patients were identified (53.2 ± 15.7 years, 40.7% females), with 83 primary events. LCA identified 3 distinct clusters of patients, with significant differences in overall outcome (p&lt;0.0001, Figure 1A). Principal component analysis demonstrated 3 well demarcated clusters. Weighted variable analysis demonstrates the variable importance for determining phenogroup status (Figure 1B). Decision tree analysis (Figure 1C) demonstrated high accuracy (0.89) to predict LCA phenogroup status. Conclusion: CMR enriched phenomapping identified 3 distinct NICM phenogroups associated with significant differential risk profiles, with advanced CMR measures including comprehensive myocardial strain assessment being important imaging parameters used for phenogroup stratification. Decision tree analysis provided an accurate, simplified, and explainable method to enable a novel approach for patient selection. Future studies are needed to determine if distinct phenogroups are associated with differential treatment response to various interventions.