tbuckley/cabot-search huggingface dataset:
Abstract 15357: Assessing the Utility of Serial Fetal Echocardiography in Detecting In-Utero Changes for Single Ventricle Lesions
Authors: Sanghee S Ro, Ashish Saini, Gemma Morrow, Diana Ketchum, Joe Kreeger, Erik Michelfelder
Journal: Circulation (2023)

Introduction: Current guidelines recommend serial fetal echocardiograms (FE) for fetuses with single ventricle lesions (SV) to identify in-utero changes that can impact delivery management, but there is sparse data on the utility of serial FE. We aim to evaluate the incidence of serial FE changes in fetuses with SV. Hypothesis: There is a low incidence of in-utero changes in serial FE for fetuses with SV. Methods: Fetuses with SV and &gt; 1 serial visit between 1/1/2012 to 1/1/2023 were retrospectively reviewed. FE were reviewed for significant, defined serial changes in the following: atrioventricular valve, ventricular function, atrial communication, ductus arteriosus, umbilical artery, umbilical vein, systemic venous Dopplers, hydrops, arrhythmias. Fisher’s exact test was used to compare proportions with change between both segmental findings and SV sub-type. Results: A total of 721 FE for 248 patients were reviewed, the majority with hypoplastic left heart syndrome (HLHS) (64%) and tricuspid atresia (15%). There was a mean of 2.9 visits per patient and 21 days between FE. Out of 3,699 possible changes, there was a total of 56 (1.5%) changes in 41 patients seen on all follow-up FE (Table 1). The most common changes were worsening atrial level restriction (10, 2.4%) and arrhythmias (10, 2.4%), all of which were premature atrial contractions (p&lt;0.01). Out of 56 changes, only 20 (36%) were critical with clinical impact on perinatal management and 2 (4%) showed progressive, serial worsening. Most changes (85%) were noted in the third trimester. There were no differences in incidence of change on serial FE between SV sub-types (p=0.10). Conclusions: SV fetuses have a low incidence of significant physiologic change on serial FE, and progressive worsening of physiologic findings is even rarer. Special consideration should be given to those with HLHS who may develop atrial level restriction. This data should be considered in planning clinical follow-up intervals for fetal SV.
Abstract 16809: Deep-Learning-Based Assessment of Left Atrial Volume in Coronary Calcium CT: Association With NT-proBNP and Clinical Outcomes
Authors: Fernando Kay, Shawn Simek, Suhny Abbara, Colby Ayers, Sonia Garg, Ambarish Pandey, Amit Khera, Mark H Drazner, Anand Rohatgi, Matthew J Budoff, James A de Lemos, Ronald M Peshock, Parag H Joshi
Journal: Circulation (2023)

Introduction: Artificial Intelligence (AI) promises to extract imaging biomarkers for cardio-cerebrovascular (CV) risk prediction, though validation is still lacking. Recognizing the importance of left atrial pathology on CV events, we developed an AI algorithm to measure left atrial volume (LAvol) from CAC-CT. Its correlation with MRI, biomarkers, and CV incidents was then tested in the Dallas Heart Study 2 (DHS). Hypothesis: LAvol will be associated with elevations in baseline NT-proBNP levels and incident CV events. Methods: We trained a 3D U-Net model for cardiac chamber segmentation on CAC-CT, assessing congruity with manual segmentation via the Dice score. Normalized left atrial volume (LAvol/BSA) from 3D segmentations was compared to MRI using ICC, and its associations with baseline NT-proBNP and incident Afib, TIA, and stroke were evaluated with logistic regression and Cox models. Results: Cardiac segmentation showed an excellent Dice score of 0.93 ± 0.01. Moderate correlation was observed between CAC-CT estimates of LAvol/BSA and MRI (ICC 0.57, 95% CI 0.52-0.62). Our study, excluding those with prior events, comprised 1852 participants (mean age 50, 41% male, 46% black, 15% Hispanic). Upon multivariable adjustment (detailed in the table), LAvol/BSA was linked with elevated NT-proBNP (≥ 100 pg/mL) (OR 1.9, 95% CI 1.6-2.2 per 1SD LAvol/BSA). Over a 12.5-year follow-up, CAC-CT-derived LAvol/BSA showed association with a composite of Afib, TIA, and stroke (55 events) (HR 1.4, 95% CI 1.1 - 1.8), and Afib (HR 1.7, 95% CI 1.2 - 2.3), post-adjustment. No significant association was found with TIA (HR 1.2, 95% CI 0.6 - 2.1) or stroke (HR 1.3, 95% CI 0.9 - 1.8). Among 749 subjects, MRI-derived LAvol/BSA correlated with NT-proBNP (OR 1.7, 95% CI 1.44 - 2.10) but not with other clinical outcomes. Conclusions: Given associations with NT-proBNP levels and incident CV events, AI-measured LAvol from CAC-CT promises to improve risk prediction.
Abstract 16764: Changes in Triglyceride Levels During Omega-3 Fatty Acid Supplementation, and Incident Cardiovascular Events: Secondary Analysis From the OMEMI Trial
Authors: Peder L Myhre, Are Kalstad, Sjur Hansen Tveit, Kristian Laake, Dennis Nilsen, Arnljot Tveit, Svein Solheim, Ingebjørg Seljeflot
Journal: Circulation (2023)

Background: Elevated triglyceride levels are associated with increased cardiovascular risk. Omega-3 polyunsaturated fatty acids (n-3PUFA) are known to reduce triglyceride levels, but whether changes in triglycerides mediate any cardiovascular effects of n-3PUFA, remains unclear. Methods: In the randomized controlled OMEMI trial, 1014 elderly (70-82 years) patients with a recent acute myocardial infarction (AMI) were treated with 1.8 g/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo (corn oil) for two years, and followed for the primary outcome of MACE (AMI, coronary revascularization, stroke, heart failure hospitalization or all-cause death). Relative changes in triglycerides from baseline to 3 months (n=920, 91%), were associated with incident MACE (N=175) using landmark Cox regression models. Results: The median (Q1-Q3) baseline triglyceride concentration was 97 (74-135) mg/dL, and higher levels were associated with higher BMI, diabetes and heart failure, in multivariable models. After 3 months of treatment, triglycerides decreased by median -10% and 0% in the n-3PUFA and placebo groups, respectively, followed by relatively stable levels at 12 and 24 months ( Figure ). Greater triglyceride reductions at 3-months were associated with a lower risk of MACE in the n-3PUFA group (HR 1.98 [95%CI 1.23-3.17] per doubling, p=0.004; Figure ), and this persisted after adjusting for baseline triglycerides, age, sex, BMI and comorbidities (HR 2.34 [1.37-3.98], p=0.002). Changes in triglycerides did not associate with MACE in the placebo group (HR 1.13 [0.63-2.02], p=0.68). Conclusion: Treatment with 1.8 g/day of EPA/DHA modestly reduced triglyceride levels and greater on-treatment triglyceride-reductions were associated with a lower risk of MACE. Although the overall OMEMI-trial was neutral, these findings suggest that n-3PUFA-related triglyceride changes may play a role with respect to cardiovascular outcomes.
Abstract 18397: Enhanced Ultrasound Imaging of Thrombotic Microvascular Obstruction Using GpIIb/IIIa-Targeting Gold Nanoparticles
Authors: Qin Li, miaona chen, Juefei Wu
Journal: Circulation (2023)

Introduction: Thrombotic microvascular obstruction (MVO) poses a diagnostic challenge due to the lack of specific imaging techniques in clinical practice. This study introduces a novel ultrasound imaging method that utilizes gold nanoparticles (AuNPs) modified with the GPIIb/IIIa-targeting peptide Arg-Gly-Asp (RGD) to enhance the contrast of ultrasound imaging for microembolization. Methods: Targeted gold nanoparticles (RGD-AuNPs) and untargeted gold nanoparticles (GSH-AuNPs) were synthesized using the glutathione reduction method from chloroauric acid. A rat model of MVO was established by infusing microthrombi into the left hindlimb via the right femoral artery. The rats were randomly assigned to receive either RGD-AuNPs or GSH-AuNPs injected via an angiocatheter. Ultrasound imaging was performed on the left hindlimb for three hours at five-minute intervals, and the average video intensity of the images was measured. Histological staining and immunohistochemistry were performed to validate the co-localization of microthrombi and RGD-AuNPs. Results: In the RGD-AuNPs+MVO group, enhanced ultrasound signals were visible at 15 minutes and progressively increased over three hours. The average video intensity in this group was approximately three times higher than that in the GSH-AuNPs+MVO group (11.88±3.68 vs. 3.39±2.67, p&lt;0.001). No significant difference in average video intensity was observed between the GSH-AuNPs+MVO group and the GSH-AuNPs control group (3.39±2.67 vs. 3.50±2.09, p&gt;0.05), or between the GSH-AuNPs control group and the RGD-AuNPs control group (3.50±2.09 vs. 2.95±2.18, p&gt;0.05). Histological staining and immunohistochemistry confirmed the co-localization of microthrombi and RGD-AuNPs. Conclusions: Gold nanoparticles modified with the RGD peptide effectively enhance the signal of ultrasound imaging, enabling targeted imaging of thrombotic microvascular obstruction. This approach holds promise for improving the diagnosis and monitoring of MVO in clinical settings.
Abstract 17847: Typical Right Atrial Flutter Ablation Using Subclavian Venous Access in Patients With Interrupted or Occluded Inferior Vena Cava
Authors: Roopesh Sai Jakulla, Nikhil Mehta, Kofi M Osei, Sanjaya K Gupta
Journal: Circulation (2023)

Introduction: Ablation for typical atrial flutter (AFL) traditionally involves vascular access from the femoral vein to facilitate advancing catheters through the Inferior Vena Cava (IVC) to the right atrium (RA). In patients with interrupted or occluded IVC, this procedure is challenging to perform. We report a case series of typical right AFL ablation using subclavian access in interrupted or occluded IVC. Cases: A 63-year-old female with typical AFL refractory to medical therapy was referred for radiofrequency ablation (RFA). She had a history of surgically corrected atrial septal defect at age 4 years with known IVC interruption draining into RA via an azygous venous extension. Another case involved a 41-year-old male with quadriplegia and typical AFL who underwent an attempted RFA from femoral access that was aborted due to massive thrombosis of IVC. Decision making: In both cases, two sheaths were placed into the left subclavian venous system using ultrasound guidance. A coronary sinus catheter and irrigated tip ablation catheter were advanced into the coronary sinus and RA respectively. Additionally, in the second case, an intracardiac echocardiography probe was inserted via separate venous access. Using the electroanatomic mapping system, entrainment and activation mapping confirmed a tricuspid isthmus-dependent AFL. RFA was performed using an open irrigated RFA catheter in a linear fashion resulting in the termination of the tachycardia to sinus rhythm. In the first case, ablation extended from the tricuspid annulus to the os of the hepatic vein at the 06:00 position. Post ablation, hemostasis was achieved using a suture-mediated closure device. At follow-up, both patients were asymptomatic without evidence of AFL on extended-duration cardiac monitoring. Conclusion: In patients with interrupted or occluded IVC, the subclavian veins can be accessed for mapping and ablation of typical AFL when traditional femoral venous access is challenging.
Abstract 18290: Enhancing Outcomes in Dyslipidemia Management: Contemporary Insights and Perspectives From the Indian Consensus
Authors: Jay Shah, Chandra B Meena, BRJ Kannan, Sajan Ahmad, Ritankur Barkotoky, R Pradeep Kumar, Gopal C Ghosh, Saujatya Chakraborty, Kavita Tyagi, Rajat Sharma, Aravinda Prasad K, Rashmit Pandya, Amit V Sharma
Journal: Circulation (2023)

Introduction: To establish a comprehensive consensus statement on dyslipidemia management, incorporating contemporary evidence and drawing from the valuable real-world experiences of Indian physicians and cardiologists Methods: A virtual collaborative educational initiative was convened in May 2023, through a series of 13 nationwide virtual interactive meetings (n=238) at the forefront of dyslipidemia management (STRATIFY 2 Consensus Group). The cumulative clinical experience was approximately 6,000 man years, who rated their level of agreement for 10 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the updates for dyslipidemia including statins. Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score &gt; 100. GraphPad 9.5.1 and ANOVA were used for statistical analysis. Results: The highest agreement score was for, using LDL-C as a performance measure enhances cholesterol control in high-risk groups, leading to reduced cardiovascular disease morbidity and mortality (119), attainment of LDL-C goals in patients receiving high-intensity statin therapy needs improvement in real-world settings (116), combination of short-term DAPT and intensive rosuvastatin reduces the risk of recurrent stroke (113), validated risk calculators such as QRISK3 are valuable tools for guiding clinical decisions regarding the initiation of statin therapy (112), rosuvastatin 40 mg daily is more effective in reducing LDL-C levels as compared to atorvastatin 80 mg (110), Rosuvastatin is more effective than Atorvastatin in reducing LDL-C levels in diabetes mellitus (104) (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (61±25, 95% CI 44 to 80) followed by strongly agree (32±17, 95% CI 20 to 44) Conclusions: The consensus findings contribute to advancing dyslipidemia management and guiding evidence-based practices for improved patient outcomes.
Abstract 18410: Correlation Between Body Mass Index and NT-proBNP Levels in Heart Failure With Preserved Ejection Fraction: Implications for Clinical Outcomes
Authors: Soumya Vungarala, Vivek Jani, Joban Vaishnav, Virginia S Hahn, David A Kass, Kavita Sharma
Journal: Circulation (2023)

Introduction: N-terminal pro B type natriuretic peptide (NT-proBNP) is associated with increased cardiovascular events in heart failure with preserved ejection fraction (HFpEF). Adiposity is inversely correlated with NT-proBNP. It remains unclear whether obese HFpEF patients exhibit disproportionate outcomes with lower NT-proBNP. Hypothesis: We aimed to study the relationship between NT-proBNP and BMI in the Johns Hopkins University (JHU) HFpEF cohort to identify patient characteristics with increased NT-proBNP in obese HFpEF patients, adjusting for the inverse relation between NT-proBNP and BMI. Methods: We identified 338 individuals from June 2013 to November 2022. Univariate linear regression was performed between NT-proBNP and BMI. The cohort was split based on the median BMI and studentized residuals from NT-proBNP-BMI relationship (low BMI high BNP [Group 1] high BMI high BNP [Group 2] low BMI low BNP [Group 3] high BMI low BNP [Group 4]). Kruskal-Wallis test or Chi-square test was used to compare groups. Results: The median BMI of the cohort was 37kg/m 2 , and with every 1kg/m 2 increase in the BMI, the cut-off for elevated NT-proBNP reduced by 4 pg/ml. High BMI HFpEF patients were younger, predominantly female, and on diuretics (p&lt;0.05 for all), independent of their NT-proBNP levels. Group 4 patients performed better on the 6-minute walk test (240±136 m), had better renal function (eGFR: 68.7±27.3), and less left ventricular (LV) hypertrophy and only mild diastolic dysfunction on echocardiography. Surprisingly, Group 2 resembled Group 1 despite having 70% reduced median NT-proBNP (1898[1047,4409] vs 574[207,1322], p&lt;0.0001). Both “high BNP” groups exhibited lower event free survival for all -cause mortality(p=0.0001) and HF-hospitalization(p&lt;0.05). Conclusions: NT-proBNP is predictive of clinical outcomes in HFpEF even in the presence of obesity. BMI adjusted NT-proBNP may be useful in the diagnosis and prognosis of HFpEF.
Abstract 18337: Myocardial Work - A Novel Approach to Investigate the Effects of Right Ventricular Apical Pacing on Left Ventricular Regional Work and Function
Authors: Nurul H Abdul Samad, Sam Straw, Judith E Lowry, John Gierula, Klaus K Witte, Maria F Paton
Journal: Circulation (2023)

Background: Right ventricular pacing (RVp) is the most common method of delivering bradycardia pacing, but it is associated with left ventricular (LV) systolic dysfunction (LVSD) in 40% of patients. Animal models have shown that RVp-induced electrical conduction delay leads to dyssynchronous LV activation, resulting in uneven myocardial work (MW) distribution. This work redistribution is believed to trigger adaptive structural remodelling, aiming to achieve a more uniform LV load distribution. Cardiac resynchronisation therapy (CRT) responders demonstrate normalised MW distribution and baseline constructive MW measurements may predict CRT response. However, there is limited evidence on MW in patients with pacemakers. Hypothesis: Long-term RVp in atrioventricular block (AVB) patients with pacemakers may influence MW. Method and Results: One hundred and eighteen patients (mean age 75±10 years; 69% male) with AVB receiving pacemaker therapy were included. Echocardiographic assessment and MW calculations were performed pre- and post-implant. LVSD was defined as LVEF &lt;50%. Among patients, 33 (28%) had LVSD at follow-up (mean time 26±19 months). RVp significantly influenced LVEF (F (1, 18) = 1193, p &lt;0.001), while MW changes were evaluated using repeated measures ANOVA. Constructive work showed a significant interaction effect at the septal wall (F (1, 21) = 8.57, p = 0.008), with no changes observed at the lateral wall (F (1, 51) = 0.93, p = 0.35). However, wasted work exhibited significant interaction effects at both the septal and lateral walls (F (1, 21) = 16.30, p &lt;0.001 vs. F (1, 51) = 7.10, p = 0.014, respectively) (Figure 1). Conclusion: Constructive and wasted work measures at septal and lateral walls are associated with LVSD in patients receiving a pacemaker for AVB. MW may add additional predictive value in identifying people at risk of developing RVp-associated LVSD who may benefit from more complex device therapy such as conduction system pacing, or CRT.
Abstract 16808: Inflammasome Formation in Acute, Subacute and Chronic Myocarditis
Authors: Stefano Toldo, Marco Merlo, Rossana Bussani, Andrea Nordio, Marco Anzini, Gianfranco sinagra, Eleonora Mezzaroma, Antonio Abbate
Journal: Circulation (2023)

Background: Myocarditis is a syndrome of inflammation resulting in myocardial injury. The inflammasome is formed in response to injury and may lead to further injury and fibrosis. We assessed for differences in inflammasome formation in patients with biopsy-proven myocarditis myocarditis (&gt;90 days of symptoms onset) as acute (&lt;30 days), subacute (31-90 days), chronic myocarditis. Methods: We studied inflammasome formation by immunofluorescence for the scaffold protein of the inflammasome, apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), in 23 patients with biopsy-proven lymphocytic myocarditis. The number of inflammasome (cells with ASC aggregates) were counted in random high-power fields (x40). Clinical data, including the duration of symptoms, was retrieved from the Cardiomyopathy Registry. Data are presented as N [%] or median [interquartile range]. Differences between groups were assessed with Kruskal-Wallis test and correlations with Spearman test. Results: Of the 23 patients (13 [56%] males, 45 [36-52] years of age), 9 were studied during the acute phase (10 [1-20] days), 7 in the subacute phase (60 [40-67] days) and 7 during the chronic phases (150 [150-180] days). Inflammasome formation was detected in all 23 (100%) patients. We found no statistically significant differences in the total number of inflammasomes comparing acute, subacute, and chronic myocarditis (8.2 [4.2-15.5], 6.2 [3.1-22.0], 5.0 [3.7-23.0], and respectively, P=0.99, Figure), and no statistically significant correlation between the duration of symptoms and inflammasomes (R=-0.37; P=0.87). Conclusions: Patients with biopsy-proven myocarditis show persistent inflammasome formation over a range of time from symptom onset, with no significant difference between acute, subacute and chronic presentation. Further studies are needed to determine whether the inflammasome contributes to ongoing injury in patients with myocarditis.
Abstract 16806: Transcatheter Edge-to-Edge Repair Lessens Atrial Fibrillation Burden by Ameliorating Left Atrial Strain in Moderate-to-Severe Mitral Regurgitation Patients
Authors: Letizia R Romano, Antonio Curcio, Giuseppe Scalzi, Biagio Malizia, Florinda M Augusto, Anna Bartone, Iolanda Aquila, Alberto Polimeni, Giuseppe Santarpia, Ciro Indolfi
Journal: Circulation (2023)

Introduction: trans-catheter edge-to-edge repair (TEER) represents a therapeutic possibility in patients with moderate-severe mitral regurgitation (MR) considered at high surgical risk. Only in recent years, it has been realized that left atrial (LA) function plays a prognostic role in these patients. Hypothesis: since atrial fibrillation (AF) depends in part on LA geometry, we considered that two-dimensional speckle-tracking-echocardiography analysis could predict AF burden. Aim: we therefore evaluated the AF occurrence long term after TEER. Methods: one hundred nine patients treated by TEER between February ‘15 and April ’22 underwent reservoir (R_s), conduct (D_s), and contractile (C_s) evaluations strains before and 1,6,12 months after TEER. Cardiac rhythm was monitored through 24 hours Holter-ECG or previously implanted cardiac devices, when available. Statistical analysis was performed with SPSS. Comparisons were carried out by ANOVA and MANOVA. Results: to the permanent AF group (n=35), no paroxysmal (N=15), nor persistent (N=8) case was added during follow-up after TEER. Among the sinus rhythm (N=51) group, one episode of atrial tachyarrhythmia was found at device interrogation and one patient developed paroxysmal AF (2/51; 3,9%). Significant improvements in total cohort were observed at 12 months follow-up for R_s (from 10,77±5,74% to 16,28±6,93%; p&lt;0,0001), D_s (from -6,72±4,44% to -9,73±4,48%; p=0,0003) and C_s (from -5,21±5,11% to 7,72±5,4%; p=0,0184) compared to baseline. AF burden in paroxysmal AF (baseline: 9,2±4,7 hours, follow-up: 5,8±4,2 hours; p&lt;0,001) was significantly reduced as well as ventricular rate (baseline 88±14 bpm; 12 months 76±13 bpm; p&lt;0,001) in permanent AF group. Conclusions: MR reduction following TEER dictates positive LA remodelling and significant improvement of LA strain. Overall, the impact on LA geometry contributed to lessen incidence and burden of AF.