tbuckley/cabot-search huggingface dataset:
Abstract 4144650: Stereotactic Radioablation for Septal Ventricular Tachycardia
Authors: Michele Magnocavallo, Domenico Marchesano, Marco Polselli, Paolo Di Renzi, Gianmarco Grimaldi, Filippo Maria Cauti, Cristian Borrazzo, Randa El Gawhary, Antonio Bisignani, Alessandra Castelluccia, Pietro Rossi, PierCarlo Gentile, Stefano Bianchi
Journal: Circulation (2024)

Background: Intramural septal substrate represents a major challenge in patients undergoing Ventricular Tachycardia (VT) ablation because the septal thickness could make difficult for radiofrequency to achieve transmural lesions. Although novel approaches have been proposed to treat septal VT, about half of patients experienced VT recurrence and the risk of peri-procedural complications including Atrioventricular Block (AVB) remained high. Stereotactic Arrhythmia Ablation (STAR) was introduced to treat VT refractory to catheter ablation nevertheless no data are available in the setting of septal VT. Objectives: to evaluate the arrhythmic burden in patients with septal VT treated with Magnetic Resonance Imaging guided STAR (MRgSTAR). Methods: We enrolled consecutive patients with septal VT substrate. The therapy target was achieved combining anatomical/functional and electrophysiological data (Fig. 1). Patients were treated with a single fraction of 25Gy adopting MRgSTAR (Fig. 2). All patients were clinically followed-up and all implantable cardiac device were remote monitored. The efficacy outcome included recurrences of any sustained VT beyond the 6-weeks blanking-period after MRgSTAR. The safety outcome was the incidence of adverse events and AVB. Results: We included 11 patients with septal substrate VT [median age:68yrs (IQR:64.5–78yrs); 100% male]. Clinical presentation was electrical storm in 81.8% of patients. No complications occurred after MRgSTAR and six (54.5%) patients were discharged the same day of treatment. During a mean follow-up of 12±6 months, the efficacy outcome occurred in three (27.3%) cases. A significative reduction of Implantable Cardioverter Defibrillator (ICD) therapy (23.6 before MRgSTAR vs 1.7 after MRgSTAR, p-value:&lt;0.001) was observed (Fig. 3). Left ventricular ejection fraction increased significantly after treatment [38%(IQR:33.5-42%) before MRgSTAR vs 43.8%(IQR:35–47%) after MRgSTAR; p-value:0.04]. No adverse effects were observed in ICD system performance, lead thresholds, or lead impedances at any point after treatment. In the seven patients with preserved AV conduction, no AVB or left/right branch block were reported after STAR. No difference in the percentage of ventricular pacing was described before and after STAR [3.5% (IQR:2.75-4%) before STAR vs 4.5% (IQR: 3.25–5.5%) after STAR; p-value: 0.24]. Conclusions: MRgSTAR represents a safe and effective strategy for the treatment of septal VT.
Abstract 4144539: A Heart-pounding Case of Cardiomyopathy in Pregnancy
Authors: Linh Tran, Ian Everitt, Arthur Vaught, Andreas Barth, Anum Minhas
Journal: Circulation (2024)

Introduction: Pregnancy-induced cardiomyopathy is typically idiopathic, with no predisposing condition identified. In some cases, women with pre-existing genetic mutations may initially present with cardiomyopathy in pregnancy. Case: A 30-year-old G2P1001 woman presented to Labor&amp;Delivery with frequent palpitations, dyspnea on exertion, and reduced exercise tolerance in the third trimester. Her previous pregnancy was complicated by frequent premature ventricular contractions (PVCs) but otherwise unremarkable. She had a family history of early-onset atrial fibrillation in her mother and a maternal cousin with pregnancy-induced arrhythmias. ECGs and telemetry demonstrated significant ectopy (bigeminy, non-sustained ventricular tachycardia) and atrial arrhythmias including supraventricular tachycardia, atrial tachycardia, and atrial fibrillation (Figure 1). Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 20-25%, reduced from 50% 2 weeks prior. Ectopy was associated with reduced fetal heart rate variability suggestive of fetal malperfusion, for which an urgent C-section was performed at 38 weeks and 6 days. Following delivery, she was started on amiodarone, metoprolol, and spironolactone, as part of guideline-directed medical therapy. Subsequent TTEs showed improvement in EF to 30-35% at 2 days and 45-50% at 4 weeks postpartum. Cardiac MRI showed no evidence of fibrosis or inflammation. Given her maternal family history of arrhythmic events, genetic testing was pursued. Genetic testing revealed a pathogenic SCN5A variant (c.638G&gt;A (p.Gly213Asp)). Discussion: SCN5A variants are associated with dilated cardiomyopathy, conduction disorder, and arrhythmias. It is a rare variant of pregnancy-induced cardiomyopathy. This case highlights the value of genetic testing in patients with significant arrhythmia burden and cardiomyopathy in pregnancy and a family history of cardiomyopathy and arrhythmias. For pregnant women with genetic variants predisposing to arrhythmias and cardiomyopathy, comprehensive longitudinal, multidisciplinary care is essential at a referral center with Cardio-Obstetrics expertise and an Inherited Heart Disease Clinic.
Abstract 4144666: Outcomes of Ventricular Tachycardia Ablation Among Patients with Chronic Kidney Disease: Insights from the National Inpatient Sample Database 2018-2021
Authors: Mohammad Ali Sheffeh, Judy Sheffeh, Omar Baqal, Shamaiza Waqas, Naveen Vuppuluri, Robert Cieslak, Firas Zahwe, Anthony Kawa, Benjamin Collins-Hamel
Journal: Circulation (2024)

Background: There is limited data on the safety and efficacy of ventricular tachycardia (VT) ablation in patients with chronic kidney disease (CKD). We examined the outcomes of patients with CKD undergoing VT ablation in a nationally representative cohort of patients. Methods: The National Inpatient Sample Database (NIS) was analyzed from 2018 to 2021 to identify patients ≥18 years old with VT undergoing ablation. Patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, or pre-excitation syndrome were excluded. Patients were divided into those with CKD and without CKD. A multivariable logistic regression model was utilized to assess the association of CKD with in-hospital mortality and outcomes after adjusting for confounders. Results: Our cohort included 1608 VT ablation procedures, of which 428 (27%) were performed on CKD patients. Mean age was 63 (±13) years, 318 (19%) were female, and 1194 (74%) were White. 1475 (92%) of the procedures were done at an urban teaching hospital, and 1240 (77%) at a private non-profit hospital. On multivariable analysis, CKD was associated with significantly higher odds of death (adjusted odds ration [aOR]: 3.43; 95% confidence interval [CI]: 1.79-6.5; p=0.0002), acute decompensated heart failure (aOR: 3.1; 95% CI 2.24-4.56; p&lt;.0001), bleeding (aOR: 1.53; 95% CI1.02-2.28; p&lt;.03), and acute kidney injury (aOR: 4.49; 95% CI3.42-5.9; p&lt;.0001). There was no difference in the odds of acute myocardial infarction, stroke, cardiogenic shock, vasopressor use, mechanical ventilation, and pericardial tamponade or pericardial procedures Figure . Conclusion: Patients with CKD undergoing VT ablation have an increased risk of mortality and adverse in-hospital outcomes when compared to patients without CKD. These hypothesis-generating findings need validation in future prospective studies for optimal pre-procedural risk stratification.
Abstract 4144467: Associations between High-density Lipoprotein Cholesterol Efflux and Brain Health
Authors: John Giacona, Jijia Wang, Rong Zhang, Brendan Kelley, Ihab Hajjar, Binu Thomas, Laura Lacritz, Fang Yu, James de Lemos, Anand Rohatgi, Wanpen Vongpatanasin
Journal: Circulation (2024)

Previous studies have linked plasma levels of high-density lipoprotein cholesterol (HDL-C) with impaired cognitive function. However, few studies have investigated the associations between plasma HDL functionality and brain structure and function. Thus, our study aimed to elucidate the associations between plasma HDL measures and brain structure/function in a multiethnic cohort of middle-aged adults. Accordingly, we conducted a cross-sectional study in 1,826 adults (mean age 51.0±9.7 years, 58% female, 47% Black adults) without preexisting cardiovascular disease or stroke who participated in the Dallas Heart Study to determine associations between HDL measures and brain structure/function. Whole brain white matter hyperintensities (WMH) and grey matter volume (GMV) was measured using a 3-T MRI scanner and normalized to total cranial volume (TCV), and the Montreal Cognitive Assessment (MoCA) was used to measure cognition. HDL cholesterol efflux capacity (HDL-CEC) was assessed using fluorescence-labeled cholesterol efflux from J774 macrophages and was expressed in arbitrary units. HDL particle measures were assessed using NMR spectroscopy. Adjusted multivariable linear regression models were performed with standardized beta estimates reported. Higher HDL-CEC and small HDL particles (HDL-P) were positively associated with GMV/TCV after adjustment for relevant risk factors (β=0.078 [95% CI: 0.029, 0.126], Figure , and β=0.063 [95% CI: 0.014, 0.111], respectively, all p&lt;0.05). Conversely, there were no associations between HDL measures and WMH or MoCA after adjustment (all p&gt;0.05). Associations of HDL-CEC and small HDL-P with GMV were not modified by race/ethnicity or ApoE-ε4 status. In conclusion, higher HDL function and small HDL-P were associated with higher GMV after adjustment for traditional risk factors and were not modified by race/ethnicity or ApoE-ε4 carrier status. As such, these findings suggest that better HDL functionality is linked with larger brain GM volume in middle-aged adults. Since GMV loss has been linked to the development of mild cognitive impairment (MCI) and conversion of MCI to Alzheimer's disease, our study may have implications for prevention of age-related decline in cognitive function.
Abstract 4144461: The Impact of Vitamin D Status on Driveline Infections and Cerebral Vascular Accidents in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Wesley Borman, Luke Landrigan, maya guglin
Journal: Circulation (2024)

Introduction: Left ventricular assist devices (LVADs) have become an increasingly common treatment option for patients with advanced heart failure, serving as either a bridge to transplantation or destination therapy. Despite major advancements in the field of mechanical circulatory support, cerebral vascular accidents (CVA) and driveline infections (DLI) continue to have a detrimental impact on morbidity and mortality. Research Question: Is there a higher incidence of DLI and CVA in vitamin D deficient patients that are undergoing LVAD implantation? Goals/Aims: We aimed to evaluate vitamin D deficiency as a potential risk factor for DLI and CVA in patients undergoing LVAD implantation. Methods: We performed a retrospective chart review of patients that underwent LVAD implantation at our institution from 2010 to 2022. Patients with vitamin D levels measured within 90 days of implantation were classified into either vitamin D sufficient ( &gt; 30 ng/ml) or deficient (&lt;30 ng/ml). The Kaplan-Meier method estimated 18-month freedom of DLI and CVA. The Cox proportional hazards model estimated the effect of deficiency on DLI/CVA risk. Baseline characteristics were recorded (table 1), and a multivariate cox model corrected for differences. Patients who were transplanted or expired were censored at their last clinic visit. Results: The study included 134 patients (mean age 53 +/- 13.23, 71.8% male), with 92 in the deficient group and 42 in the sufficient group. During the study period, 36 patients (27.5%) underwent transplant or expired, and there were 32 DLI and 7 CVA events. DLI-free survival was significantly higher in the sufficient group (90.5% vs. 69.6%, log rank p = 0.014). Patients in the sufficient group were found to be significantly older, but no other significant differences were found (Table 1). The unadjusted and age-adjusted hazard ratios for DLI were 3.430 (95% CI: 1.203 – 9.782, p = 0.021) and 3.190 (95% CI: 1.111 – 9.160, p = 0.031) respectively. No difference in CVA incidence was observed. Conclusion: Our findings support vitamin D deficiency as a potential modifiable risk factor for DLI, warranting further research to establish causality and assess the impact of vitamin D repletion on infection rates. Vitamin D levels did not appear to influence CVA incidence.
Abstract 4144380: Association Between an Atrial Fibrillation Polygenic Risk Score and Incident Atrial Fibrillation
Authors: Graham Peigh, Ashley Mulford, Zhuqing Shi, Huy Tran, Jun Wei, Annabelle Ashworth, Jianfeng Xu, Alan Sanders, Qamar Arman, Jeremiah Wasserlauf
Journal: Circulation (2024)

Background: Prior population-based cohort studies demonstrate that an atrial fibrillation (AF)-specific polygenic risk score (AF-PRS) is an independent predictor of incident AF. Further data on the performance of the AF-PRS in a real-world population may inform AF screening techniques in high-risk patients. Objective: The objective of the current study is to evaluate the association between an AF-PRS and incidence of AF in a real-world cohort. Methods: Data from the Endeavor Health Genomic Health Initiative (GHI), utilizing DNA from blood samples of consenting patients, were analyzed. All participants in the GHI with complete genetic information (low pass whole genome sequencing with imputation) and without an existing diagnosis of AF (per ICD-10 codes) were included and followed through a censoring date of 7/21/2023. AF-PRS (PGS002756) was calculated for each patient. A high-risk AF-PRS was defined as 1.5x relative risk for AF based on the UK biobank, which corresponds to the 13 th percentile of risk. Multivariate analyses were completed to determine associations between this AF-PRS and outcome variables. Results: There were 15,803 patients in the GHI (53.7yrs [52.4-53.9], 34.3% male) followed for a median of 8 years. Among them, 2,206 (14.0%) had a high-risk AF-PRS. Those with high-risk AF-PRS were less likely to be male, had a higher BMI, and a greater percentage of family history of AF (Table). A high AF-PRS risk, compared to low AF-PRS risk, was associated with greater incidence of AF (HR 1.89 [1.55-2.31], p&lt;0.001) after adjusting for age at recruitment, gender, and genetic background (top 10 ancestry principal components) (Fig 1). Those with a high-risk AF-PRS also had a younger age at AF diagnosis (Fig 2). Conclusions: In a real-world cohort of patients with complete genetic sequencing, a high-risk, compared to low-risk, AF-PRS was associated with greater incidence of AF and younger age at AF diagnosis. The findings, along with other risk factors, could provide a rationale for screening measures in selected patients at increased risk of developing AF.
Abstract 4144763: Impact of Anemia on Clinical Outcomes in Atrial Fibrillation Patients on Oral Anticoagulants: A Systematic Review and Meta-analysis.
Authors: Ahmed Mazen Amin, Ramez Odat, AlMothana Manasrah, Mohamed Elgebaly, Ali Al-Shammari, Michael Nakhla, Dina Ayman, Mohamed Ahmed Ali, Ahmed Wael Hageen, Ahmed Helmi, Mohamed Abuelazm, Basel Abdelazeem
Journal: Circulation (2024)

Background: Anemia is frequently observed as a comorbidity in atrial fibrillation (AF) and is associated with poor clinical outcomes. Purpose: We aim to investigate the impact of anemia on clinical outcomes in AF Patients on oral anticoagulants. Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024 and conducted a prognostic systematic review and meta-analysis. All analyses were performed using R V. 4.3.1. Results: With the inclusion of 23 studies, our cohort comprised a total of 286,781 patients. Anemia was significantly associated with an 86% increase in the risk of major bleeding (HR: 1.86 with 95% CI [1.61, 2.14], P&lt; 0.01), a 25% increase in the risk of intracranial hemorrhage (HR: 1.25 with 95% CI [1.02, 1.54], P= 0.03), a 92% increase in the risk of gastrointestinal bleeding (HR: 1.92 with 95% CI [1.68, 2.19], P&lt; 0.01), and a 91% increase in the risk of all-cause mortality (HR: 1.91 with 95% CI [1.46, 2.51], P&lt; 0.01). However, Anemia did not significantly affect the risk of stroke, TIA, or systemic embolism (HR: 1.07 with 95% CI [0.93, 1.22], P= 0.36). Conclusion: Anemia was significantly associated with an increased risk of major bleeding, intracerebral hemorrhage, gastrointestinal bleeding, and all-cause mortality without impacting stroke, TIA, or systemic embolism. Further research is warranted to compare the effects of DOACs and vitamin K antagonists. Clinically, it is imperative to closely monitor the anemic status of patients due to these elevated risks.
Abstract 4144734: Effect of Methylprednisolone on Inflammation and Clinical Outcomes in Neonates Undergoing Cardiac Surgery: A Randomized Controlled Trial
Authors: Yu Jin
Journal: Circulation (2024)

Background: Corticosteroids are widely used in neonatal cardiac surgery for anti-inflammatory purposes. Previous research has demonstrated that perioperative use of methylprednisolone (MP) leads to a reduced inflammatory response. Nevertheless, the benefit of MP for postoperative clinical outcomes is controversial, especially in neonates. This study aimed to evaluate the effect of MP on postoperative inflammation and outcomes in neonatal cardiac surgery with cardiopulmonary bypass (CPB). Methods: From September 2020 to August 2023, 86 neonates who underwent cardiac surgery with CPB were enrolled in this double-blind randomized controlled trial. After anesthesia induction, the MP group received a single dose of 30 mg/kg MP, and the placebo group received an equal volume of saline solution. The primary endpoints were plasma concentrations of interleukins (IL-6, IL-8, and IL-10) and D-dimer. Composite outcomes included death, respiratory infection, cardiac arrest, the need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and prolonged mechanical ventilation. Results: MP did not reduce the odds of a composite outcome (OR, 1.208; 95% CI, 0.515-2.832; p = 0.664), which occurred in 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the control group. Consistent with the observed anti-inflammatory effects, MP resulted in significantly lower concentrations of proinflammatory cytokines (IL-6 and IL-8) and higher concentrations of an anti-inflammatory cytokine (IL-10). The postoperative vasoactive inotropic score (VIS) was significantly lower, while postoperative procalcitonin and nadir mixed venous oxygen saturation (SvO 2 ) during the first 24 h were distinctly greater in the MP group. No differences in postoperative D-dimer, blood glucose or insulin administration were detected between the two groups. Conclusion: Compared with placebo, the prophylactic administration of 30 mg/kg MP to neonates who underwent cardiac surgery with CPB did not improve clinical outcomes. However, a decreased inflammatory response was detected.
Abstract 4144604: Evaluating the Risk of Cardiomyopathy in Breast Cancer Patients: A National Cohort Study
Authors: Omar Obeidat, Mohamed Ismail, Hashim Al-Ani, Mohd Daise, Qusai Alqudah, Mohammad Tarawneh, Saeed Abughazaleh, ann tong
Journal: Circulation (2024)

Introduction: Breast cancer and cardiovascular disease are significant global health concerns for women. Our study is a significant advancement in understanding cardiomyopathy risks associated with breast cancer in the U.S. population. Unlike previous studies focusing mainly on treatment-related cardiomyopathy, our research identifies risks across various cardiomyopathy subtypes in breast cancer patients. This novel approach reveals the intricate relationship between different cardiomyopathies and breast cancer, filling a crucial gap in existing medical research. Moreover, by considering racial disparities, our study offers vital insights into the differential health impacts on diverse demographic groups, enhancing our knowledge of the interplay between these medical fields. Methodology: The research was conducted as a retrospective cohort analysis using data from the National Inpatient Sample (NIS) spanning 2016 to 2019. It targeted female patients over 18 with a diagnosis of breast cancer, carcinoma in situ, or a personal history of breast cancer. Case identification relied on ICD-10 codes. A pivotal aspect of the methodology was implementing propensity score matching to ensure balanced comparison groups, considering variables like age, race, hypertension, and diabetes. Statistical analysis involved logistic regression, Chi-Square tests, and T-tests, executed using 9.4 SAS software. Results: The study compared 589,940 breast cancer patients with an equal number of controls, matched demographically. Comorbidity prevalence was similar in both groups, with slight variations in myocardial infarction and heart failure history. Breast cancer patients exhibited a higher prevalence of cardiomyopathy (4.0% vs. 3.2%), with an increased adjusted odds ratio (OR) especially for dilated, restrictive, and drug-related cardiomyopathies. Interestingly, they had lower odds of obstructive and hypertrophic cardiomyopathy. Racial disparities were evident, with Black patients facing higher risks for most cardiomyopathies, while Hispanic and Asian or Pacific Islander patients showed varied risks. Similar patterns were observed in the control group. Conclusion: The findings highlight a significant link between breast cancer and an elevated risk of cardiomyopathy, advocating for the integration of cardiovascular monitoring into breast cancer management.
Abstract 4144475: Predictors of progression to left ventricular systolic dysfunction in hypertrophic cardiomyopathy patients with borderline left ventricular systolic function
Authors: Hyun-Jung Lee, Sang-Shin Park, Nurjanar Galimkhan, Seo-Yeon Gwak, Kyu Kim, Iksung Cho, Chi Young Shim, Jong-Won Ha, Geu-Ru Hong
Journal: Circulation (2024)

Background: In patients with hypertrophic cardiomyopathy (HCM), borderline left ventricular (LV) ejection fraction (LVEF) was reported to be a significant risk factor for developing LV systolic dysfunction (LVSD), which is associated with poor prognosis. However, the natural history of patients with borderline LVEF and risk factors for progression to overt LVSD are incompletely characterized. Methods: HCM patients who had two or more echocardiography exams between 2005 and 2023 and a borderline LVEF of 50–59% on the initial exam were included. Patients who progressed to LVSD during follow-up were compared with patients with preserved LV systolic function. Results: Among 2,282 HCM patients evaluated, 145 patients (6.4%) with borderline LVEF at baseline were included (median age 61, IQR 51-72; male 67%). Compared to patients with normal LVEF (≥60%), patients with borderline LVEF had more atrial fibrillation (AF) (16% vs. 38%), less obstructive physiology (18% vs. 6.2%), larger left atrial (LA) size, and lower LV global longitudinal strain (LV-GLS) (-16.1 vs. -13.7%) and LA reservoir strain (LARS) (27.7% vs. 21.7%) (all p&lt;0.001). During median follow-up of 6.5 [IQR 3.2–10.9] years, 30 patients (21%) progressed to LVSD. Patients who progressed to LVSD were younger (55 vs. 64 years, p&lt;0.001), had less hypertension, lower LVEF (55% vs. 57%, p&lt;0.001), larger LV and LA dimensions, and higher ESC sudden cardiac death risk scores (2.1% vs. 1.4%, p&lt;0.001) compared to patients with preserved LVEF. They also had lower baseline LARS (18.2% vs 22.6%, p=0.028) and LA contraction strain (9.3% vs. 12.2%, p=0.011), while there were no differences in LV-GLS and LA conduction strain. On multivariable Cox regression analysis, independent predictors of LVSD progression were identified as younger age (HR 0.82, 95% CI 0.70–0.97, p=0.017, per 5 years), lower LVEF (HR 0.80, 95% CI 0.71–0.91, p&lt;0.001), larger LV end-diastolic dimension (HR 1.17, 95% CI 1.06–1.30, p=0.002), and lower LARS (HR 0.94, 95% CI 0.89–0.98, p=0.011). Conclusions: Among HCM patients with borderline LVEF, 21% progressed to overt LVSD. Younger age, lower LVEF, larger LV size and lower LA strain at baseline predicted the development of LVSD.