tbuckley/cabot-search huggingface dataset:
Abstract 4146645: Evaluating Patterns of Impedance Drop for Optimal Lesion Formation in Pulmonary Vein Isolation for Atrial Fibrillation
Authors: Yusuke Okuyama, Kouhei Ueda, Toshiki Kazuma, Naomitsu Mimura, Daisuke Hattori, Miyu Sugimoto, Chisaki Takahara, Keikoku Kashou, Atsushi Tamura, Masahiko Jikan, Kanta Nakajima, Kazunori Masuda, Shunzo Matsuoka, Yoshihisa Nakagawa
Journal: Circulation (2024)

Introduction: Ablation index (AI) has been used as a predictor of forming durable lesions in pulmonary vein isolation (PVI) for atrial fibrillation (AF). Impedance drop (ID) had also been thought to be important for adequate lesion formation with radio frequency application (RF). However, relationship of ID and AI is unclear because AI does not take into account ID. In addition, there are some modes of ID, but it is unclear that what modes of dropping impedance is effective. Here, we investigated which modes of dropping impedance was effective for acute successful lesion formation. Association of ID and parameters of ablation lesion with RF including AI was also evaluated. Methods: Ablation lesions made by RF using 35W power during PVI were studied. Only lesions created for the initial PVI line were analyzed. These points were classified into 5 groups according to the ways of ID. Points with gradual ID, 2-phased ID, and steep ID were respectively classified as group 1, 2, and 3, and these three groups were investigated. Points without dropping impedance, increase in impedance, or RF duration of less than 5 seconds were excluded. Acute success rate, decrease in impedance, duration of RF, average contact force (CF) and value of AI were investigated for each group. Results: From 40 consecutive cases, 1921 lesions were obtained, of which 1843 were investigated. Group 1, 2, and 3 consisted of 511, 1184, and 148 points, respectively. Acute success rate for each group were 93.0, 98.6, and 93.2%, and was the highest in groups 2 (p&lt;0.05). AI in group 2 was the highest among three groups (464±47 vs. 476±51 vs. 467±66 for each group, p&lt;0.05). ID and CF were the largest in group 3 among three groups (7.6±3.5 vs 12.2±5.2 vs 14.6±5.9 ohm, p&lt;0.05, for each group. 12.8±5.2 vs 15.0±6.0 vs 17.6±8.3 g, p&lt;0.05, for each group). The duration of RF was longest in group 1 among three groups (24.5±4.7 vs 23.6±4.6 vs 21.0±6.2, p&lt;0.05, for each group). Conclusion: For optimal lesion formation, to obtain 2-phased ID in combination with moderate CF, ID, and the duration of RF was important. Evaluating modes of ID may make AI more reliable to create optimal lesions with RF at 35W of power.
Abstract 4146655: Transcatheter device closure of Ventricular Septal Defect in children weighing less than 30 lbs. is a safe and effective procedure based on 10-year experience from a single tertiary center in southern India
Authors: Shubhashis Saha, Amit Mandal, Oommen K George
Journal: Circulation (2024)

Introduction: Ventricular septal defect (VSD) is the most common pediatric defect which benefits from closure at an early age. This study describes the procedural and follow-up data from a 10-year experience of VSD device closure at a tertiary referral center in southern India. Methods: We conducted a retrospective clinical data review of all pediatric patients who underwent transcatheter device closure for isolated VSD in the past ten years, from May 2014 to May 2024. We included patients with body weights less than 30 lbs. and excluded patients with VSD diameter &gt;10mm and those with other congenital cardiac anomalies. Results: We included 40 patients with a mean age of 18.95 ± 13.02 months, mean weight of 17.87 ± 6.64 lbs. and male:female ratio of 23:17 (Table 1). The most common symptom at presentation was failure to thrive (22, 55.0%), and five patients (12.5%) had VSD associated with Downs syndrome. 34 (85%) children had perimembranous VSD, and the rest had muscular VSD (6, 15.0%). The mean VSD size was 6.01 ± 2.29 mm, with a mean peak gradient of 49.55 ± 23.57 mm Hg. Either Amplatzer ADO II (14, 35.0%) or Lifetech Konar MF (26, 65.0%) devices were used, mainly via the retrograde approach (37, 92.5%) with a mean total fluoroscopy time of 21.82 ± 10.01 mins. Complications associated with the procedure were minimal (as in Table 2), with 77.5% (31 of 40) patients having no residual shunts at their follow-up ECHO after 6 months. Conclusions: Transcatheter VSD device closure is a safe and effective procedure in young children weighing less than 30 lbs., with minimal complications and good outcomes at follow-up.
Abstract 4146665: Unveiling the Biological Subtypes of Left Ventricular Diastolic Dysfunction through Unsupervised Clustering of ECG Data
Authors: Samantha Shetty, Joshua Lampert, Joy Jiang, Girish Nadkarni, Akhil Vaid
Journal: Circulation (2024)

Left Ventricular Diastolic Dysfunction (LVDD) presents a challenge in terms of management given its multifaceted etiology and complex presentation. Conventional diagnostic categories may fail to fully reflect underlying pathophysiology variability. Using unsupervised clustering on electrocardiogram (ECG) data is a novel approach to capture subtle changes in the electrical signatures seen in ECGs and help uncover naturally occurring patient subtypes that may be invisible to traditional echocardiographic (echo) assessment. We performed Natural Language Processing on long-form echo reports to extract annotations of LVDD. Echo reports were paired with an ECG performed within 7 days of the echo. Patients were excluded if their ECG diagnostic codes indicated conduction abnormalities, concurrent ischemia, and prior intervention. We applied a Convolutional Autoencoder to compress high-dimensional ECG data into a 128-dimensional, feature-rich space suitable for clustering. K-means clustering was then utilized to categorize patients into groups based on transformed ECG features. Silhouette analysis was employed to determine the optimal number of clusters and quantify differences between groups. Chi-square and ANOVA tests examined for differences in age, sex, and race across clusters. We identified 22,183 patients paired with 96,921 ECGs with clinician confirmed LVDD. Silhouette score analysis on K-Means clustering identified 2 as the optimal number of clusters (Figure 1). Labels associated with each data point were visualized in 2D and 3D projections with the t-Stochastic Neighbor Embedding technique (Figure 2). Identified clusters differed significantly in terms of age, sex, and race, with p-values of &lt;0.00001 for each demographic. The identification of two distinct clusters underscores the potential of ECG-based phenotyping in revealing new biological subtypes of LVDD. Extending this technique to integrate other clinical variables and longitudinal data may enhance the clinical utility of identified subtypes. Future work will look at cluster-wise distribution of co-morbidities and longitudinal outcomes. Applying similar methodologies to other cardiac disorders may improve our approach to their diagnosis and management. Employing unsupervised clustering on ECG has proven to be effective in identifying novel subtypes of LVDD, showcasing the potential of ECG data to refine diagnostic and therapeutic strategies.
Abstract 4146681: Effect of Sacubitril/Valsartan on the Right Ventricle after High-Risk Myocardial Infarction: Insights from the PARADISE-MI Trial
Authors: Xiaowen Wang, Amil Shah, Brian Claggett, Kimia Karimi Taheri, Karola Jering, Attila Kovacs, Bela Merkely, Vivien Nagy, Maja Cikes, Jean Rouleau, Marc Pfeffer, Scott Solomon
Journal: Circulation (2024)

Background: Right ventricular (RV) dysfunction is a common complication after myocardial infarction (MI) and a risk factor for adverse events. Effect of sacubitril/valsartan (S/V) on RV function in patients after MI is unknown. Hypothesis: RV dysfunction is associated with adverse events following high-risk MI and treatment with S/V attenuates adverse RV remodeling and functional impairments in high-risk post-MI patients. Aims: To compare the baseline clinical and echocardiographic parameters by quartiles of RV fractional area change (RVFAC), and to evaluate the effect of S/V (compared to ramipril) on RV size and function from randomization to 8 months in post-MI patients with LVEF≤40% and/or pulmonary congestion. Methods: Among the 5,661 participants in PARADISE-MI trial, 544 were enrolled in the echocardiographic sub-study. Baseline characteristics were assessed across quartiles of RVFAC (N=446). Cox proportional hazards model was used to assess the association between RVFAC and clinical outcomes. Treatment effects of S/V compared to ramipril on were assessed using linear regression. The primary outcome was cardiovascular (CV) death or incident HF (defined as HF hospitalization or outpatient symptomatic HF). Results: Baseline clinical characteristics were similar across quartiles of RVFAC, with the exception that patients with higher RVFAC were more likely to be female (Table 1). Higher RVFAC was associated with higher LVEF, smaller LV chamber size, and lower E/e’ ratios (Table 1). A lower baseline RVFAC was associated with a higher risk of incident HF, but not associated with a higher risk of primary outcome or CV death (Figure 1). Changes of RVFAC, RV end-diastolic area, RV end-systolic area, tricuspid annular S’, and RV outflow tract velocity-time integral from randomization to 8 months were similar in those randomized to S/V compared to ramipril. Baseline RVFAC did not modify the treatment effect of S/V on RV size or RVFAC (p-interaction &gt; 0.16). Conclusion: In high-risk post-MI patients, a lower RVFAC was associated with worse LV systolic and diastolic function and higher risk of incident HF. Compared to ramipril, S/V was not superior in improving RV systolic function.
Abstract 4146020: Diverse Morphology and Proteomic Phenotypes of Calcification in Bioprosthetic Structural Valve Degeneration
Authors: Rachel Cahalane, Cassandra Clift, Mark Blaser, Mandy Turner, Taku Kasai, Alesandra Campedelli, Amber Hendrickx, Filip Rega, Marie Billaud, JOCHEN MUEHLSCHLEGEL, Masanori Aikawa, Laoise McNamara, Bart Meuris, Sasha Singh, Elena Aikawa
Journal: Circulation (2024)

Introduction: Fibrocalcific remodeling is an end-stage feature of bioprosthetic (BP) structural valve degeneration and calcific aortic valve (AV) disease. However, the processes governing BP calcification are understudied. Here we conduct a histopathological assessment of BP degeneration in the aortic position and build a proteomic comparison map of BP degeneration versus AV disease in humans. Methods: Macroscopic segmentation was performed on entire explanted degenerated bovine pericardial BP leaflets (n=48) and diseased AV valves (n=19) and validated with histology to classify their state (BP: non-degenerated/thrombotic/neotissue/calcified, AV: non-diseased/fibrotic/calcified). Segment-specific bulk mass spectrometry-based proteomics was performed on BP/AV tissues. Laser capture microdissection enabled spatially resolved proteomics of BP calcification within discrete bioprosthetic/thrombotic/neotissue matrices versus explanted non-calcified regions. Results: Principal component analysis revealed BP and AV proteomes (2,005 and 2,012 proteins) clustered according to their degenerated and diseased segments; BP thrombotic and BP calcified sample clusters overlapped (Fig.A). Correlations of segment proteome-wide abundances revealed the highest intra-tissue similarity between non-degenerated BP and calcified BP (r p =0.87). The highest inter-tissue similarity was found between BP neotissue and calcified AV (r p =0.69) (Fig.B). Histopathological observations supported these proteomic findings, confirming the presence of calcification within discrete BP matrices: bioprosthetic (22/59), thrombus (22/59), and neotissue (15/59) (Fig.C). Laser capture microdissection revealed that 252 proteins were enriched in either bioprosthetic, thrombotic, or neotissue matrix calcification compared to explanted non-calcified regions. Only 3% of differentially enriched proteins overlapped, suggesting different mechanisms (Fig.D). Conclusions: This is the first comparative proteomic study of segmented degenerated BP and diseased AV tissue. We identified 3 subtypes of BP calcification within bioprosthetic, thrombotic, or neotissue matrices. Spatial proteomics revealed different proteins associated with the calcification of these matrices.
Abstract 4145948: Rare Case of Left-Dominant Arrhythmogenic Cardiomyopathy with Gene Mutations in DSP and MYBPC3
Authors: Zafer Sattouf, Bilal Ali, Dev Patel, Sanjana Datla
Journal: Circulation (2024)

Background: Mutations in desmoplakin gene (DSP) are associated with arrhythmogenic cardiomyopathy (ARVC). Myosin-binding protein C gene (MYBPC3) is a sarcomere gene and is associated with hypertrophic cardiomyopathy (HCM). The expression of both of these genes has only been reported twice in the literature. It remains unclear whether the expression of both mutation carries a more severe phenotype than carrying on of the mutations only. Case Description: A 21-year-old female with history of sustained ventricular fibrillation (VT) at age 18, VT arrest at age 20,dilated cardiomyopathy with LVEF 30-35% and subcutaneous ICD, who was admitted after multiple ICD defibrillations. Device interrogation demonstrated 23 monomorphic VT episodes treated with 44 shocks by the ICD. Coronary angiogram demonstrated non-obstructive coronary arteries. Patient underwent VT ablation, complicated by incessant VT from LV summit which was eliminated during procedure. Cardiac MRI demonstrated RVEF 33%, regional dyskinesis in the sub-tricuspid area and RV outflow tract. cMRI also demonstrated subepicardial late gadolinium enhancement at the level of the mid antero/infero lateral walls with extension into the apicolateral wall and mid inferoseptal territory. These findings heightened suspicion for left ventricle fatty infiltration. However, endomyocardial biopsy negative for inflammation or granuloma, no fibrosis, negative iron and amyloid staining. Left-dominant arrhythmogenic cardiomyopathy was diagnosed based on cMRI findings, LV systolic dysfunction, and arrhythmia of LV origin. Subcutaneous ICD was explanted and replaced with a dual chamber ICD. Patient was discharged on Mexiletine and GDMT for HFrEF. Genetics testing later revealed rare co-occurance of two genetic mutations including MYBPC3 and DSP. Discussion: The presentation of both DSP and MYBPC3 mutations in patients diagnosed with ARVC has only been reported twice in the literature and a is an extremely rare phenomenon. There is currently no sufficient understanding of the genotype-phenotype correlation of DSP and MYBPC3 mutations in the clinical expression of their associated inherited cardiac diseases. Therefore, more research need to investigate this phenomena and to study whether the co-presence of both of these two mutations is associated with a more severe phenotypic expression of HCM and ARVC.
Abstract 4145958: Quantification of Sarcopenia in Chest Computed Tomography Prognosticates Cardiac Surgery Outcome
Authors: Pouya Nezafati, Craig McFarlane, Lionel Hebbard, Pankaj Saxena, Jai Raman
Journal: Circulation (2024)

Background: Sarcopenia is an objective and comprehensive marker of frailty and an important predictor of outcomes after cardiac surgery. Its utility is challenging due to difficulty in its assessment. Hypothesis: We hypothesize that sarcopenia defined as pectoralis major cross-sectional area (PMA) from CT Chest is a useful predictor of cardiac surgery outcomes. Aim: The aim of this study is to develop Gender Specific Cut-off Points for PMA as a marker for sarcopenia and to evaluate the associations between sarcopenia and post-operative cardiac surgery outcomes. Methods: This study includes 237 subjects with pre-operative CT Chest scans who underwent any Cardiac Surgery involving sternotomy from 2019 to 2023 at the Townsville University Hospital, Australia. The Pectoralis Major Muscle Area, Density and Thickness measurements were performed at the level of 4th thoracic vertebra in Axial view. The sarcopenia cut-off value was defined as the lowest sex-specific quartile in PMA. Intra and post-operative outcomes up to 30-days, were collected. Results: The Cut-off values for PMA were set at 1045mm 2 for males and 609mm 2 for females, with 59 subjects meeting the criteria for sarcopenia. Sarcopenic patients required longer hospitalization (10.8±6.93 vs 8.37±5.26 days; P=0.006), longer intubation and stay in ICU, and experienced more post-operative complications within the first 30 days after surgery (p=0.002). Post-operative mortality was similar in both groups. Logistic regression analysis revealed that sarcopenia is associated with increased risk in days of extended hospital stays (OR=5.08, 95% CI: 2.35-10.96, p&lt;0.001), ICU stays (OR=3.16, 95% CI:1.54-6.50, p&lt;0.002),and intubation (OR=2.49, 95% CI:1.09-5.67, p=0.031). Moreover, the Receiver Operating Characteristic (ROC) analysis showed that muscle thickness displayed a higher degree of accuracy than density for assessment of sarcopenia and achieved a sensitivity of 80% and specificity of 70% at cut-off values of 12.2mm in males and 8.1mm in females, with an area under the curve (AUC) of 0.85. Conclusion: Patients undergoing cardiac surgery with pre-op CT Chest can be assessed for sarcopenia with PMA or simply thickness of pectoralis major muscle. Sarcopenia defined based on CT Chest PMA is a significant predictor of post-operative outcomes in cardiac surgery patients, including longer hospitalization, ICU stay, and intubation time, as well as increased risk of post-operative complications within the first 30 days after surgery.
Abstract 4146633: Catheter-Directed Intervention for High-Risk Acute Pulmonary Embolism in Patients with Cancer: Findings from the U.S. Nationwide Readmissions Database
Authors: Manoj Kumar, Shafaqat Ali, Nso Nso, Aneeza Jamshed, Mukunthan Murthi, Nomesh Kumar, Mark Ricciardi, Qamar Arman, Javier Gomez Valencia
Journal: Circulation (2024)

Background: Catheter-Directed Interventions (CDIs) for Acute Pulmonary Embolism (PE) have been present for years but their use is limited due to paucity of data especially in patients with cancer. We examine the safety and efficacy of CDIs in patients with high-risk PE and cancer. Methods: Nationwide Readmissions Database (2016-2021) was used to analyze cancer patients presenting with high-risk PE (HR-PE) (shock, pressor or mechanical circulatory support requirement). Patients who received systematic thrombolysis were excluded. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match patient who received CDIs vs those who were treated with anticoagulation alone. Inverse Probability weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 265,196 hospitalization of cancer patients with HR-PE, X were treated with systemic thrombolysis and 795 (0.3%) of the patients underwent CDI. After propensity matching (N: 421 in each group), patients receiving CDI had a significantly lower mortality (33% vs. 41.8%, aOR:0.76 (95% CI, p: 0.008); However, bleeding complications including major bleeding (10.7% vs 6.2%, aOR:1.97 (95% CI, p: 0.018) was higher in patients receiving CDIs. No difference was observed in the risk of intracerebral hemorrhage (p&gt;0.05). Readmission rates were similar at 30-day and 90-day intervals (p&gt;0.05). From 2016-2021, mortality associated with HR-PE in cancer has not changed significantly (p&gt;0.05); however, mortality in patients undergoing CDIs has decreased from (43.8% to 22.6%, p-trend: 0.0004). There has been increasing use of mechanical thrombectomy (MT) over thrombolysis in recent years. Conclusion: CDIs for HR-PE in cancer patients are associated with significant reduction in mortality and associated with higher bleeding. Mortality has decreased across the years for patients undergoing CDIs with higher utilization of MT.
Abstract 4146674: Sex Differences in Readmissions and Outcomes of Medically-Managed Type B Aortic Dissection
Authors: Paulina Luna, Luke K. Kim, Nickpreet Singh, Teagan Iranitalab, Jim Cheung, Richard Devereux, Jonathan Weinsaft, Leonard Girardi, Alicia Mecklai, Rebecca Ascunce, Julie Marcus, Pritha Subramanyam, Amrita Krishnamurthy, Diala Steitieh, Mary Roman, Nupoor Narula
Journal: Circulation (2024)

Introduction: Medical management is recommended for patients with acute uncomplicated type B aortic dissection (TBAD), with operative intervention reserved for complicated cases. There is little research focused on sex differences in outcomes in patients with TBAD managed medically. Research Question: What is the impact of patient sex on in-hospital outcomes and readmissions for TBAD in patients who are managed medically? Methods: Hospitalizations of adults with a diagnosis of TBAD were identified using the 2016-2019 Nationwide Readmissions Database. TBAD diagnosis was deduced by inclusion of dissection of thoracic or thoracoabdominal aorta and exclusion of presumed type A aortic dissection based on prior studies. Hospitalizations associated with endovascular or open repair were excluded. Multivariable logistic regression modeling was used to investigate the association of sex with in-hospital mortality. A Cox proportional hazards model was used to assess the association between sex and readmission rates. Results: There were 52,269 TBAD hospitalizations (58% men). Compared to men, women were older (median age 72 vs 65 years), had higher in-hospital mortality (11.5% vs 8.5%), shorter median length of stay (3.95 vs 4.23 days), lower median total charges ($53,461 vs $63,655), and decreased rates of elective admissions (6.4% vs 8.2%) (all p&lt;0.05). Despite similar rates of hypertension, higher rates of atherosclerotic disease and risk factors in men, including coronary artery disease, obesity, and smoking, and decreased rates of hospital-related complications in women, including acute kidney injury, women experienced increased adjusted in-hospital mortality (odds ratio: 1.16; 95% CI, 1.06-1.27). However, there were no sex differences in readmission risk at 30, 90, and 180 days, perhaps reflecting a survivor bias. Conclusions: Women with TBAD who were managed medically experienced higher in-hospital mortality than men despite lower rates of atherosclerotic disease and risk factors. Prior research has demonstrated sex-specific differences in demographics and presenting TBAD clinical characteristics, including older age in women, varied signs/symptoms, and delays in diagnosis in women. We speculate that these features may contribute to the worse immediate outcomes observed in women. Further data are needed to delineate additional causes of adverse acute outcomes in women managed medically, including condition- (imaging and anatomic features) and medication-specific factors.