tbuckley/cabot-search huggingface dataset:
Abstract 14258: Are Anticoagulants Necessary for Isolated Distal Deep Vein Thrombosis? From COMMAND VTE Registry 1 and 2
Authors: Yohei Funauchi, Toru Takase, Yugo Yamashita, Kazuhisa Kaneda, Ryuki Chatani, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Ryusuke Nishikawa, Gaku Nakazawa
Journal: Circulation (2023)

Background: Anticoagulation for isolated distal deep vein thrombosis (DVT) remains controversial and is rarely recommended; however, all available data are from the warfarin era, and the effects of DOACs remain unknown. Objective and Methods: A large cohort of patients with acute venous thrombosis in the Contemporary Management and Outcomes in Patients with Venous Thromboembolism Registry (COMMAND VTE Registry 1 and 2) in Japan were included for analysis. We then evaluated the patient characteristics, clinical outcomes of symptomatic isolated distal DVT, and the risk-benefit of anticoagulation therapy by comparing direct oral anticoagulant (DOAC) and warfarin. Results: From a total of 8224 patients in the COMMAND registry, we excluded those with isolated distal DVT who had an event within 30 days of the initial venous thrombosis, leaving 1054 patients for the study. Among the 1054 patients included, 599, 312 and 143 were on DOACs, warfarin and no anticoagulant respectively. Overall, Kaplan-Meier analysis during a median follow-up of 988 days showed that anticoagulation significantly prevented recurrent VTE (P = 0.011), with no difference between warfarin and DOACs (P = 0.862). No clear increase in bleeding events were observed regardless of anticoagulation status (P = 0.327). Subsequent analysis stratified entries into transient (N = 318), Persistent (N = 353), and Unprovoked (N = 383) groups according to risk of venous thrombosis. In the persistent group, anticoagulation significantly prevented recurrent VTE (P = 0.025), with no difference between DOAC and warfarin (P = 0.939). In the transient group, anticoagulation was not effective in preventing recurrent VTE, with warfarin use significantly increasing bleeding events compared to those with DOAC or no anticoagulation (P = 0.030). Multivariate analysis showed that anticoagulation was independently associated with decreased incidence of venous thrombosis in the persistent group [HR: 0.262 (0.094-0.727), P = 0.010]. Conclusion: In symptomatic isolated distal DVT, anticoagulation is effective in preventing exacerbation of venous thrombosis; however, warfarin may increase bleeding events among the patients with transient DVT risk.
Abstract 17444: Racial and Ethnic Disparities in Anthracycline Cardiotoxicity
Authors: Lili Zhang, Justin Song, Waqas Hanif, Rachel Clark, Magued Haroun, Carol Fernandez Hazim, Caroline McNaughton, Leandro Slipczuk, Mario J Garcia, Min Pu, Tomas G Neilan, Della Makower, Roberto Alejandro Sica, Earle C Chambers, Carlos J Rodriguez
Journal: Circulation (2023)

Introduction: There are limited data on anthracycline cardiotoxicity in racially and ethnically diverse populations. Aims: Our study sought to examine the incidence of cardiotoxicity and the changes in left ventricular ejection fraction (LVEF) in cancer survivors treated with anthracycline in a multiracial/ethnic community. Methods: We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer. Patients with preexisting heart failure were excluded. The endpoint was the development of cardiotoxicity (defined as clinical HF or drop in LVEF≥10% to LVEF&lt;53%). Results: Our retrospective cohort included 925 patients (22% Non-Hispanic White (NHW), 25% Non-Hispanic Black (NHB), 31% Hispanic, and 2% Asian). Hypertension, diabetes, and hyperlipidemia were more prevalent in NHB, Hispanic, and Asian patients than in NHW patients. The mean cumulative anthracycline dose was 197±99 mg/m 2 and the mean LVEF was 64±5.7%, both similar across racial and ethnic groups. During a median follow-up of 21 months, 116 patients (13%) developed cardiotoxicity. The incidence of cardiotoxicity was significantly higher in NHB (16%), Hispanic (15%), and Asian (18%) patients compared to NHW patients (7%) (p=0.045). Of the 116 patients with cardiotoxicity, 21 patients had reduced ejection fraction (LVEF&lt;50%) and 81 had preserved ejection fraction (LVEF≥50%). Significantly more Hispanic patients developed cardiotoxicity with reduced ejection fraction (33.3%) compared to NHW (14.3%) and NHB (6.1%) patients (p=0.014). The mean decline in LVEF was higher in NHB patients (4% ± 9%) and Hispanic patients (6% ± 10%) than in NHW patients (3% ± 7%). Conclusions: In a large racially and ethnically diverse cohort of cancer survivors treated with anthracycline-based chemotherapy, NHB and Hispanic patients had an increased risk of cardiotoxicity and a greater decline in LVEF compared to their White counterparts.
Abstract 18098: Prolonged Filtered QRS Duration on Signal Averaged Electrocardiogram is Associated With Structural Remodeling in Hypertrophic Cardiomyopathy
Authors: Hernan L Vera Sarmiento, Talha Tanriverdi, David Hurtado-de-Mendoza, Sanjay Sivalokanathan, Ketty Dolores Cerna, Daiyin Lu, Stefan Zimmerman, Sunil K Sinha, Celia P P Corona-Villalobos, M Roselle Abraham
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, electrical remodeling and fibrosis that lead to inhomogeneous ventricular depolarization and arrhythmias. Signal averaged ECG (SAECG) is useful for non-invasive risk stratification in ischemic cardiomyopathy. However, the association between SAECG and structural remodeling in HCM has not been investigated. Methods: We retrospectively studied 594 HCM patients from the Johns Hopkins HCM Registry, who underwent echocardiography and cardiac magnetic resonance (CMR) imaging within 12 months of SAECG or 12-lead ECG. Seventy-three patients underwent SAECG and were divided into 2 groups (Normal-SAECG, Abnormal-SAECG) based on filtered QRS duration and/or presence of late potentials . Results: Abnormal SAECG was seen in 50% of HCM patients (37/73). Of the 37 HCM patients with abnormal SAECG, 29 patients only had prolonged filtered QRS duration ( fQRS&gt; 114ms ), and 8 patients had prolonged fQRS duration as well as late potentials ( LAS40 &gt;38ms; RMS40 &lt;20μV). Mean fQRS and LAS40 were significantly higher in the Abnormal-SAECG group ( fQRS : 125.7 vs 107msec, p&lt;0.0001; LAS40 : 31.2 vs 22.9msec; p=0.002; RMS40 : 40 vs 54μV; p=0.07). HCM patients with abnormal SAECG also had 1) larger left atrial size (p=0.03), lower global LV peak systolic strain (p=0.04), systolic strain rate (p=0.008), early diastolic strain rate (p=0.01) by ECHO; 2) greater LV mass index (p=0.004) 3) Higher prevalence and amount of late gadolinium enhancement (LGE) reflecting LV-scar (p=0.045 and 0.01) by CMR; 4) higher prevalence of repolarization abnormalities on 12-lead ECG (p=0.02). Adverse outcomes (sustained-VT/VF, heart failure, death) were similar in the 2 groups. Filtered QRS duration (SAECG) was positively correlated with LV mass index (r=0.43, p=0.0002), QRS duration on 12-lead ECG (r=0.67, p=0.000), and negatively correlated with global LV early diastolic strain rate (r= -0.34, p=0.009) in our HCM cohort. Conclusion: In HCM, prolonged filtered QRS on SAECG reflects a greater degree of structural remodeling characterized by more LV hypertrophy, larger LA size, worse cardiac mechanics, and higher prevalence and amount of fibrosis.
Abstract 17211: Barriers and Predictors of Physical Activity Maintenance: The STRRIDE I Reunion Cohort
Authors: Katherine A Collins, Johanna L Johnson, Cris A Slentz, Leanna M Ross, Kim M Huffman, William E Kraus
Journal: Circulation (2023)

Introduction: STRRIDE I (Studies of Targeting Risk Reduction Interventions through Defined Exercise) was an 8-month exercise intervention conducted from 1998-2003. Participants were randomized to an inactive control group or one of three exercise groups differing in amount and intensity. Ten years later, participants returned for follow-up assessments as part of the STRRIDE I Reunion study. Hypothesis/Research Questions: 1) What barriers influence physical activity (PA) maintenance ten years following a supervised exercise intervention? 2) What factors predict PA maintenance ten years following a supervised exercise intervention? Methods: At baseline and post-intervention STRRIDE I assess clinical markers including height, weight, blood pressure, waist circumference, body composition, peak V˙O 2 , glucose, insulin, and lipids. For the Reunion study, 104 participants completed a 3-month PA recall questionnaire, which included self-reported barriers to current PA participation. For the clinical variables, baseline, post-intervention, and change scores (post minus baseline values) were used to generate three separate predictive models. Models were generated using a backward bootstrap variable selection algorithm followed by multiple linear regression. Results: Ten years after completing STRRIDE I, the mean self-reported PA was 77.9 + 76.5 minutes/week. The most commonly reported barriers to PA maintenance were lack of self-motivation (41%), time constraints (33%), illness or injury (29%), and family obligations (23%). The model utilizing baseline variables as predictors of PA maintenance had an adjusted R 2 value of 0.05, while the model utilizing post-intervention variables had an adjusted R 2 of 0.12. The model utilizing change scores to predict PA maintenance had an adjusted R 2 of 0.17; changes in mean heart rate explained the greatest variance in PA maintenance (partial R 2 = 0.10). Conclusions: Continued PA participation beyond a structured exercise intervention setting continues to be challenging for individuals. When trying to predict PA maintenance, where you start or how you finish the intervention may not be as imperative; rather, how you respond in certain variables may be the most important predictors of PA maintenance.
Abstract 14310: Evaluation of Ventricular Pacing Suppression Algorithmsin Dual Chamber Pacemaker: Results of 'Leader' Study
Authors: Jongmin Hwang, Seongwook Han, Hyoung-Seob park, Tae Wan Chung, seung-jung park, Chan-Hee Lee, Jinhee Ahn, Eue-keun Choi, Myung Hwan Bae, Young Soo Lee, Sang Won Park, Dae In Lee, Minsoo Ahn, Yoo Ri R Kim, Jaemin Shim
Journal: Circulation (2023)

Introduction: Several algorithms have been proposed to reduce unnecessary right ventricular (RV) pacing, and their operations are based on two different mechanisms: (i) atrioventricular (AV) hysteresis (AVH) and (ii) DDD to AAI pacing mode change. Hypothesis: The purpose of our study was to evaluate the efficacy and safety of two ventricular pacing suppression algorithms: Intrinsic Rhythm Support (IRS) plus algorithm (using AVH, IRSplus) and VP suppression (DDD to AAI mode change) algorithm (VpS). Methods: This was a multicenter, randomized study conducted in 11 tertiary hospitals in South Korea. Patients with sinus node dysfunction and receiving dual-chamber permanent pacemaker implantation were included in this study. After the implantation, patients maintained a fixed AV interval for three months. The AV conduction time was determined as the "atrial pacing to ventricular sensing interval" observed from the marker channel during the PPM implantation was set as the sensed AV delay. The paced AV delay was set to be the sensed AV delay+30ms. Subsequently, patients were randomly assigned to either the VpS or IRSplus algorithm group and were followed for 12 months with assessments every 6 months. Results: A total of 118 patients were enrolled, and the total RV pacing percentage (Vp%) of the patients during the 3 months with a fixed AV interval was 10.9±16.0 on average. They were randomly assigned to VpS and IRSplus groups, with 62 and 56 patients in each group. Six months later, the average Vp% was 14.6±18.8 to 2.7±6.0, P&lt;0.001 and 6.8±10.9 to 1.1±4.0, P&lt;0.001 for the VpS and IRSplus groups, respectively. This trend was maintained for additional 6 months (VpS group: 4.6±9.5; IRSplus group: 1.2±3.8). The effects of algorithms were more pronounced in groups with an intrinsic PR interval of &lt; 200ms, and the IRSplus showed better efficacy (Figure). Conclusions: The two ventricular pacing suppression algorithms were effective in reducing Vp% compared to the fixed AV interval.
Abstract 14697: Developing a Machine Learning Algorithm Using Routine Clinical Data for the Detection of Hard Cardiovascular Disease Events
Authors: Ian Kelly, Jacob R Whitehill, Robert Goldberg
Journal: Circulation (2023)

Introduction: Machine learning (ML) may enhance prediction of hard cardiovascular disease (CVD) events (e.g., myocardial infarction, stroke, cardiac arrest). Developing ML algorithms using routinely-collected clinical data offers a practical method to improve CVD event prediction. This study aimed to train ML algorithms to predict 10-year risk of hard CVD events using common clinical variables and compare performance to pooled cohort equations (PCEs). Hypothesis: ML algorithms trained on data from the Multi-Ethnic Study of Atherosclerosis (MESA) and Atherosclerotic Risk in Communities (ARIC) would outperform PCEs in predicting 10-year risk of hard CVD events when tested on a PCE-valid subset. Methods: Data from MESA and ARIC were obtained. Pooled baseline data were used for algorithm training. Patients with prior CVD or lacking 10-year follow-up were excluded. The primary endpoint was hard CVD event within 10 years of baseline. Variables of interest included patient history, anthropometry, and serum lipid levels. Cohort data was split into training (75%) and test (25%) sets. Models trained were neural network, gradient boost machine, k-nearest neighbors, and an ensemble model. Results: In total, 17,775 patients (5,703 MESA, 12,072 ARIC) with mean age of 56.2 ( + 8.2) years and 54.6% female were included. During the 10-year follow-up period, 1,344 (7.6%) had a first-time hard CVD event. The ensemble model had the highest AUC on the full test set (0.783 [95% CI 0.76-0.81]), followed by the gradient boosting machine (0.781 [0.76-0.81], neural network (0.780 [0.76-0.81]), and k-nearest neighbors (0.737 [0.71-0.76]). The gradient boosting machine demonstrated highest sensitivity (76.0%), while the ensemble had highest specificity (78.6%). In the PCE-valid subset, the ensemble model had the highest AUC (0.780 [0.75-0.81]) and outperformed PCE (AUC = 0.757 [0.73-0.78], p = 0.001), as did the gradient boosting machine (AUC = 0.779 [0.75-0.81], p = 0.003]) and neural network (AUC = 0.776 [0.75-0.80], p = 0.007). Conclusions: The ensemble, gradient boosting machine, and neural network improved prediction of hard CVD events over PCEs within a PCE-valid subset despite training on a broader cohort. Future studies should validate results on an external dataset.
Abstract 14453: Patent Foramen Ovale Closure in Patients With and Without Nickel Hypersensitivity Using Two Different Devices
Authors: Anastasios Apostolos, Stamatios Gregoriou, MARIA DRAKOPOULOU, George Trantalis, Eleni Chatzidimitriou, Sotiris Tsalamandris, Maria Karmpalioti, Andreas Synetos, Constantina Aggeli, Alexander Stratigos, Konstantinos Tsioufis, Konstantinos Toutouzas
Journal: Circulation (2023)

Background: Transcatheter PFO closure has been established as a safe and effective approach for secondary prevention in patients with ESUS. The Amplatzer® PFO occluder and Gore Helex® septal occluder are two FDA-approved devices, which consist of a nickel-titanium alloy frame. While nickel is the first cause of hypersensitivity reaction worldwide, the potential occurrence of nickel hypersensitivity following PFO closure is still under investigation. Aim: Our aim is to investigate whether patients with nickel allergy are more susceptible to experiencing adverse events after device implantation and to explore the potential role of device selection. Methods: We prospectively enrolled patients undergoing PFO closure. Before the procedure, nickel skin patch tests were performed in all the patients. The patients were randomized to receive either Amplatzer® or Gore® device. During a three-month follow-up period, we evaluated the primary endpoint, which was a composite outcome including patient-reported chest pain, palpitations, headaches, and rash. We used the chi-squared test to evaluate the primary endpoint and performed multivariate binary logistic regression analysis to assess the effect of device selection on the primary endpoint. Results: A total of 50 patients (50% female, 45.4±10.3 years old) completed the follow-up and were included in the present analysis. Among them, 29 patients received the Gore device, while the remaining 21 patients received the Amplatzer device. Fourteen patients were diagnosed with nickel hypersensitivity. The primary endpoint was reached in 40% of the analyzed patients. The occurrence of the primary endpoint was significantly higher in patients with nickel hypersensitivity compared to those without (50% vs. 13.3%, p=0.005). Additionally, multivariate binary logistic regression analysis demonstrated no association between device selection and the composite outcome (p=0.892). Conclusions: Our preliminary results indicate that patients with nickel hypersensitivity are more likely to develop symptoms such as chest pain, palpitations, headaches, and rash following the procedure. However, the completion of our study is necessary to obtain more reliable and conclusive results.
Abstract 13464: Considering Race and Ethnicity in Cardiovascular Risk Assessment
Authors: Shaun R Wesley, Kerly Guerrero, Medina Mishiyeva, Weirui Xiao, Krishna K Patel, Peter S Bernstein, Diana S Wolfe, Loralei L Thornburg
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD) remains one of the leading causes of mortality in American adults, with disparities among racial and ethnic groups due to differential healthcare access and systemic racism. To better characterize the validity and generalizability of the AHA/ACC’s 2019 guidelines for primary prevention of CVD and 2018 special report on the use of the risk assessment tool for ASCVD, we examined the racial and ethnic composition of the study populations used in the underlying cited works. Methods: We reviewed all the references cited in the guidelines for our primary outcome, inclusion of race and ethnicity information. In addition, data were collected on study design, location (international, US, or both), reported sex/gender of participants, and total participants. We further assessed discussion of race and ethnicity within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (&gt;5 sentences). Finally, we pooled the racial distributions for all study populations and compared it to national rates in the US population of 76% White, 14% Black, 6 % Asian, 19% Hispanic. Results: Of the 58 cited articles, 12 (20.6%) reported racial and/or ethnic backgrounds of participants. Of those 12 articles, 7 (12% of total) included cursory discussions of race and ethnicity, while the remaining 5 included no such discussion. Only 3 (5%) reported both race and sex distributions, none of which allowed calculation of race by sex. The pooled racial averages were 20% Black, 1% Asian and 9% other, with 11% identifying ethnicity as Hispanic. Conclusion: The majority of the guideline source data provides no information regarding the racial and ethnic backgrounds of study participants. Studies that do address race and ethnicity show an overrepresentation of white individuals compared to the general US population and provide no data specifically addressing the risk to people who are neither white nor male. This leads to potential underestimation of risks and imprecise risk calculations for non-white populations due to small sample sizes in the original studies. It is crucial to include diverse participant groups in studies at population rates to ensure precise risk calculations, improve CVD prevention, and reduce mortality rates.
Abstract 17979: Cardiogenic Shock - The Index Presentation of Cardiac Sarcoidosis; Challenges in Diagnosis and Management
Authors: Bradley Bakst, Noor Chima
Journal: Circulation (2023)

Cardiac sarcoidosis often presents with ventricular dysrhythmias but can manifest as cardiogenic shock. We discuss a patient who presented with the latter requiring escalating support serving multiple challenges including making a definitive diagnosis &amp; its management. 59 year-old male presented in cardiogenic shock requiring inotropic assisted diuresis. Due to continued clinical decline, he underwent Impella 5.5 placement for mechanical circulatory support (MCS). Echocardiogram showed ejection fraction of 25-30% with global hypokinesis. Reviewing his prior medical records, revealed a lymph node biopsy with non-caseating granulomas 5 years ago concerning for sarcoidosis. Due to his dependence on temporary MCS, we were unable to confirm with a cardiac MRI. Knowing that FDG-PET can only elucidate the site of active sarcoidosis, it was pursued as the only viable imaging modality. His FDG-PET scan was positive for involvement of the inferior wall &amp; right atrium. He was placed on immunosuppression with mycophenolate mofetil &amp; prednisone. During his hospitalization, serial FDG-PET scans were performed showing resolution of active inflammation which allowed for weaning of immunosuppressants. Despite treating his active disease, his course was complicated by worsening renal failure requiring hemodialysis, MCS-dependent heart failure, placement of a left ventricular assist device (LVAD) and fungemia. Following treatment, he was placed on lifelong suppression with fluconazole. Given his renal failure and infection, he was not a candidate for heart transplant. His infection also precluded our ability for long-term immunosuppression. There are no guidelines or detailed pathways on managing cardiogenic shock in patients with cardiac sarcoidosis. Our case highlights the challenges faced when shock is the index presentation as it increases the risk of end organ damage which therefore requires expedited work up for destination therapy. Though LVAD is a viable option for patients with cardiac sarcoidosis, duration of immunosuppression, long term follow up for scar, risk and treatment of infection in patients that are not transplant candidates is largely unexplored. More studies are needed to help guide management of shock in this patient population.