tbuckley/cabot-search huggingface dataset:
Abstract 4146630: Thyroid Hormone Supplementation for Heart Donors: a Systematic Review and Meta-analysis
Authors: Julia Fernandes, Rafael Petri Santos Pinheiro, Eric Katsuyama, Christian Fukunaga, Naieli Andrade, Alonzo Prata, Ana Carolina Coan, Pedro Gabriel Scardini, Wilson Falco Neto, Luciana Gioli-Pereira, Lígia Lopes Balsalobre Trevizan
Journal: Circulation (2024)

Background: Thyroid hormone (TH) supplementation is a well-known guideline recommendation for eligible donors of heart transplantation. However, few research data demonstrated a benefit of this therapy, and some suggest higher rates of graft failure. Therefore, we aim to expand on previous literature through a systematic review and meta-analysis comparing TH therapy to placebo in potential heart transplant donors. Methods: We systematically searched Embase, Pubmed and Cochrane for randomized controlled trials (RCT) and observational studies comparing TH therapy to placebo in heart donors. We focused on the following outcomes: (1) receptor graft complications; (2) all-cause mortality; and (3) retransplantation. A subgroup analysis was performed according to graft complications: (1) dysfunction; (2) failure; (3) loss; and (4) survival. Results: We included six studies, of which 2 were RCTs. A total of 16,452 were analyzed, of whom 10,573 (64.3%) underwent TH supplementation. The follow-up period ranged from 30 days to 10 years. The included subjects were mostly male (69.1%), with a mean age of 30.6 years. In the pooled analysis, we found no significant difference between groups in graft complications (Figure 1;RR 0.94; 95% CI 0.52-1.69; p=0.83), all-cause mortality (RR 1.13; 95% CI 0.64-2.00; p=0.67), and retransplantation rates (RR 1.21; 95%CI 0.64-2.26; p=0.55). Subgroup analysis of graft complications demonstrated similar results between groups (p=0.29). Conclusion: In our meta-analysis of heart transplant donors, TH therapy was associated with similar rates of all-cause mortality, graft complications and retransplantation rates compared to the placebo group. It is important that further studies be conducted to reassess the guidelines regarding the use of TH in eligible heart transplant donors.
Abstract 4146729: Residual Angina Following Anatomic Complete Revascularization for Chronic Coronary Disease in the ISCHEMIA Trial: Frequency, Characteristics, and Outcomes
Authors: Ayesha Singh, David Brown, Philip Jones, Zhuxuan Fu, Harmony Reynolds, William Boden, Sean OBrien, Kreton Mavromatis, Ziad Ali, Gregg Stone, Sripal Bangalore, John Spertus, David Maron, Judith Hochman
Journal: Circulation (2024)

Background: Although residual angina after revascularization for chronic coronary disease (CCD) is common, it is unclear if the cause is incomplete revascularization of epicardial coronary disease or other ischemic mechanisms such as microvascular dysfunction or vasospastic angina. Methods: Among invasively managed ISCHEMIA trial participants with angina at baseline and anatomic complete revascularization (ACR) determined by core lab analysis, the frequency of and characteristics associated with residual angina and its association with health status, medication use at 6 months, and 5-year all-cause and cardiovascular (CV) mortality were assessed. The Seattle Angina Questionnaire Angina Frequency (SAQ AF) was used in a binary fashion to define residual angina as a score &lt;100 at 3 or 6 months, whereas angina-free status was as a SAQ AF = 100 at 3 and 6 months. Results: Of 2,588 participants randomized to the invasive arm, 1,442 had angina at baseline and no prior coronary artery bypass graft surgery, and 1,034 underwent revascularization within 90 days. Among 463 patients in whom ACR was achieved, 436 had SAQ AF scores available at 3 and 6 months. Of these, 184 (42%) had residual angina. Residual angina patients did not differ from those who were angina-free in age (63 + 10 vs. 62 + 10, P=0.37), female sex (33% vs. 27%, P=0.24), hypertension (76% vs. 72%, P=0.33), current smoking (12% vs. 14%, P=0.69), diabetes (41% vs. 41%, P=0.95), ejection fraction (62 + 8 vs. 62 + 8, P=0.98), degree of baseline ischemia, and extent of coronary disease. At baseline, their health status measures including SAQ AF (71 ± 17 vs. 72 ± 118, P= 0.76) were similar. However, at 6 months, patients with residual angina had reduced quality of life (SAQ QoL: 70 + 20 vs. 83 + 20, P&lt;0.001), more physical limitation (SAQ Physical Limitation: 84 + 20 vs. 95 + 11, P&lt;0.001), more dyspnea (Rose Dyspnea Score: 1 + 1.3 vs. 0.4 + 0.8, P&lt;0.001), and were taking more anti-anginal medications (P=0.006). At 5-years, survival free of all-cause or CV death did not differ between groups. Conclusion: Residual angina following ACR for CCD is common and not predicted by any baseline demographic or clinical characteristics. It is associated with reduced QoL and health status despite greater anti-anginal medication use. The high rate of residual angina suggests that alternative mechanisms of ischemia often exist in combination with obstructive coronary disease and contribute to residual anginal symptoms.
Abstract 4147160: Hashimoto Thyroiditis and Congenital Long QT Syndrome: A Dangerous Co-morbidity Causing Torsades
Authors: Ramesh Acharya, Revathy Subramany, Deepti Pandit, Dan Schuller, Byomesh Tripathi
Journal: Circulation (2024)

Hypothyroidism leads to a prolonged QT interval due to modulation of the potassium channel by low circulating T3, leading to a disproportionate lengthening of the action potential. Patients with Long QT syndromes (LQTS) have an increased risk of symptomatic ventricular arrhythmias and sudden cardiac death (SCD), which can be exacerbated by co-existing hypothyroidism. Case Description: A 40-year-old female with a previous history of Congenital LQTS, Type 1 diabetes mellitus, anemia, and untreated hypothyroidism was brought to the hospital by EMS with an abrupt onset of palpitations and disorientation following multiple (&gt;30) AICD shocks, with no identifiable triggers. EMS telemetry monitoring in route to the hospital revealed torsades de pointes, following which she received 4g Magnesium Sulfate IV, and reverted to sinus rhythm. ECG in ICU revealed sinus rhythm with prolonged QTc of 515 ms and elevated troponin. The physical exam was unremarkable. The patient was started on electrolyte replacements and telemetry monitoring. Additional lab testing revealed high TSH with low T4 as seen in Table 1. Her myxedema coma score was markedly elevated at 40 indicating severe hypothyroidism. Thyroid peroxidase antibody was &gt;600 IU/mL indicating Hashimoto's thyroiditis. ECHO showed LVEF is 55–60% with no wall motion abnormalities. Due to elevated troponin, left-heart catheterization was done which showed normal coronaries. The patient was treated with IV hydrocortisone, IV levothyroxine, oral liothyronine, and propranolol, following which she had no more episodes of Torsades, and QTC improved to her baseline of 479 ms. The patient was discharged home with endocrinology and cardiology follow-up. Discussion: Hypothyroidism is associated with prolongation of QTc and the risk of ventricular arrhythmias. Assessment of thyroid function is of high value in QT prolongation syndromes to avoid SCD incidence. Urgent electrolyte replacement and levothyroxine replacement therapy are warranted.
Abstract 4146742: <i>Outstanding Research Award in Pediatric Cardiology:</i> Association of rurality with long-term survival after congenital heart surgery
Authors: Yanxu Yang, Eugene Huang, Jessica Knight, Matthew Oster, Lazaros Kochilas
Journal: Circulation (2024)

Objective: Disparities in health outcomes exist between metro and non-metro areas for many medical conditions, but this issue has not been examined within the context of congenital heart disease (CHD). This study aims to determine the association of metro vs. non-metro residence status with long-term survival after congenital heart surgery (CHS). Methods: This retrospective cohort study included patients from the Pediatric Cardiac Care Consortium who had initial CHS between 1990 and 2003. Outcomes were tracked using the National Death Index through 2022. Analysis was restricted to counties where PCCC patients resided. Based on the description of Rural-Urban Continuum Codes (RUCCs), we categorized counties in metro and non-metro areas per the 1993 and 2003 RUCCs, including two subgroups (adjacent to a metro area and not adjacent to a metro area). Kaplan-Meier survival estimates were plotted to compare long-term survival in patients living in metro vs non-metro areas. Comparison of survival length between areas was performed by fitting semiparametric accelerated failure time models with adjustment for covariates. Results: Among 28,504 patients (47.0% female), 19,772 (69.4%) resided in metro areas. Patients living in non-metro areas experienced an absolute lower 30-year survival following discharge post initial CHS vs. patients living in metro areas (86.5 vs. 88.4%, log-rank p=0.015) (Figure) with a 22% reduction in median survival time [adjusted time ratio (aTR): 0.78; 95%CI 0.64-0.94] after adjustment for sex, birth era, CHD severity, and chromosomal abnormality. Additional adjustment for neighborhood socioeconomic status (nSES) attenuated the association’s magnitude (aTR: 0.91; 95% CI: 0.74-1.13). Subgroup analysis indicated that decreased survival time was significant only for those living in non-metro and not adjacent to metro areas (aTR: 0.73; 95% CI: 0.57-0.93). Conclusion: In this large multicenter study, non-metro residency, particularly in areas not adjacent to metro areas, was associated with reduced median survival time, an attenuated effect explained by nSES differences. Targeted interventions are needed to reduce disparities and improve outcomes post-CHS.
Abstract 4147141: Relationship Between CVH and Survival in the Acoramidis Treated Participants Within ATTRibute-CM
Authors: Kevin Alexander, Margot Davis, Amrut Ambardekar, Jose Nativi-Nicolau, Keyur Shah, Mazen Hanna, Simon Gibbs, Jean-Francois Tamby, Suresh Siddhanti, John Whang, Jonathan Fox, Jing Du, Richard Cheng
Journal: Circulation (2024)

Background: Acoramidis is a novel, potent, investigational, transthyretin (TTR) stabilizer under development for the treatment of TTR amyloidosis that results in near-complete (≥90%) TTR stabilization. In a phase 3 study, ATTRibute-CM, acoramidis demonstrated improved clinical outcomes in participants with transthyretin amyloid cardiomyopathy (ATTR-CM), including a 50% reduction in the risk of CVH compared to placebo over 30 months. The study also demonstrated that cardiovascular hospitalization (CVH) during the study predicted a higher subsequent mortality in participants with ATTR-CM. Hypothesis: CVH portends a higher risk of mortality in participants with ATTR-CM. Since acoramidis reduces CVH, it can improve the prognosis of participants with ATTR-CM. Aim: To evaluate the relationship between CVH and survival in the acoramidis group within ATTRibute-CM. Methods: In this post-hoc analysis, the relationship between those with or without CVH and survival was analyzed within the acoramidis treatment group using the Kaplan-Meier (KM) estimator method. Results: Demographics and baseline disease characteristics were mostly comparable between acoramidis-treated participants with and without CVH, although participants with CVH had a higher baseline NT-proBNP and lower eGFR. At Month 30, in acoramidis-treated participants, those without any CVH (n=300) had a higher survival [86.8% (95% CI = 82.2, 90.3)] versus 62.4% (95% CI = 52.6, 70.7) in those who had any CVH (n=109); p&lt;0.0001 from log-rank test (Figure). Conclusion: In the ATTRibute-CM study, pts without any CVH receiving acoramidis have a higher survival rate. CVHs remain a powerful predictor of mortality. This reinforces the importance of an effective therapy that reduces CVH and in turn may improve survival in patients with ATTR-CM.
Abstract 4146762: Cardiac Inflammation as a Key Driver of Desmoplakin-Mediated Cardiomyopathy: Insights from a Novel Animal Model
Authors: Erika Joana Gutierrez Lara, Jing Zhang, Yan Liang, Van Ninh, Yusu Gu, Kevin King, Farah Sheikh
Journal: Circulation (2024)

Cardiac inflammation is increasingly recognized as an important aspect of arrhythmogenic right ventricular cardiomyopathy (ARVC), a genetic cardiac disease characterized by loss of cardiomyocytes and their gradual replacement by fibro-fatty tissue, resulting in cardiac dysfunction and sudden cardiac death. Mutations in desmosomal genes, which serve as essential mechanical anchors between cardiac muscle cells, are a principal cause of ARVC. Patients with mutations in the desmosomal gene, desmoplakin ( DSP ) exhibit a distinct cardiomyopathy, marked by its strong association with myocarditis and recurrent inflammatory episodes, leading to aggravated cardiac outcomes. However, the precise role of inflammation in driving of DSP -mediated cardiomyopathy remains to be fully elucidated. We hypothesize that DSP deficiency alters the cardiomyocyte response to acute inflammatory response, leading to chronic immune intolerance and ultimately triggering ARVC disease progression. To test our hypothesis, we subjected cardiac-specific DSP heterozygous (DSP Het) deficient mice, which displayed 50% loss in DSP protein levels and remained asymptomatic for a year, to an acute immunological challenge. This allowed us to evaluate the chronic impact on ARVC pathogenesis in the absence of pre-existing cardiac disease. Our findings reveal that acute immunological challenge in DSP Het mice elicits a destructive cardiomyocyte immune response, akin to fulminant myocarditis. Furthermore, this acute challenge is sufficient to induce classic ARVC features in DSP Het deficient mice as exemplified by: (i) enlarged heart size and ventricular chambers, (ii) fibrotic remodeling, (iii) epicardial fat tissue accumulation, with pronounced effects on the right ventricle. Additionally, we observed electrophysiological deficits, such as premature ventricular contractions and QRS prolongation, along with functional deficits associated with bi-ventricular form of ARVC, albeit with a greater impact on the right ventricle. Single nuclei RNA sequencing studies in mice revealed the presence and differences in T cell populations in hearts from mice with DSP-related myocarditis, indicating early immune antigen recognition as a potential mechanism driving disease. These studies suggest that the immune system may be an important driver of ARVC pathogenesis in patients with underlying desmosomal gene mutations, such as DSP, especially in the setting of autosomal dominant genetics.
Abstract 4147159: Feasibility of Cine Magnetic Resonance Fingerprinting for Combined Assessment of Cardiac Structure, Function and Tissue Characteristics in Cardiomyopathy.
Authors: Navya Akula, Robert Okyere, Jason Eastman, Shou Li, Jordan Pollard, Jesse Hamilton, Rashid Imran
Journal: Circulation (2024)

Introduction: Cardiac Magnetic Resonance has emerged as the non-invasive standard for assessment of cardiac structure, function and tissue characteristics in patients with suspected cardiomyopathy. However, there are several well-known barriers. Cine magnetic resonance fingerprinting (MRF) is a novel imaging technique that streamlines ‘all-in-one’ assessment of myocardial function and tissue characteristics. It allows for simultaneous quantitative assessment of biventricular size and systolic function, T 1 , T 2 maps and synthetic late gadolinium enhancement (LGE) imaging. This model compensates for various confounding factors, including arrhythmias, slice profile imperfections, inversion pulse efficiency and B1+ inhomogeneities to generate accurate and reproducible measurements. Hypothesis: Cine MRF can be used as an “all-in-one” imaging platform for diagnosis of various cardiomyopathy phenotypes. Goals: We aim to assess the accuracy of cine MRF compared to standard MRI for volumetric analysis and parametric tissue mapping. Further explore diagnostic yield of simulated images with synthetic scar imaging using MRF in comparison to standard LGE imaging. Method: Feasibility study. N= 8; 3 healthy volunteers and 5 patients with reduced ejection fraction (defined as EF &lt;50%) were scanned using 1.5 T MRI. Cine MRF was acquired using retrospective ECG gating (25 cardiac phases, spatial resolution of 1.6x1.6x8.0 mm). Slice duration (10.7s breathhold + 10s pause) of total ~4 minutes for 12 short-axis slices. MRF data were processed using a self-supervised deep learning (Deep Image Prior) reconstruction. Synthetic cine images were derived analytically from the maps. Post-contrast cine MRF maps were used to calculate synthetic PSIR LGE images.Volumetric analysis by 2 individual Level II/III readers. Bland-Altman analysis was used. Further comparative qualitative assessment of standard LGE to cine MRF derived synthetic LGE was performed. Results: Volumetric analysis using standard vs Cine MRF showed high agreement. Cine MRF parametric mapping correlated with standard T1/T2 mapping techniques with expected difference in reference ranges. Qualitative assessment of synthetic LGE images derived from cine MRF allowed for detection or exclusion fibrosis/scar that correlated with standard LGE imaging. Conclusion: Cine MRF holds promise as a single ‘all-in-one’ platform for assessment of myocardial structure, function and tissue characteristics in patients with cardiomyopathy.
Abstract 4146808: Evaluating the Impact of Simulation Training on Transesophageal Echocardiography Proficiency in Fellows: An Updated Meta-Analysis of Randomized Controlled Trials
Authors: Christian Fukunaga, Eric Katsuyama, Alonzo Prata, Julia Fernandes, Ana Carolina Coan, Rafael Petri Santos Pinheiro, Wilson Falco Neto, Pedro Gabriel Scardini, Naieli Andrade, Luciana Gioli-Pereira
Journal: Circulation (2024)

Introduction: Simulation-based training systems for Transesophageal Echocardiography (TEE) have been developed for medical education, but evidence on their effectiveness remains limited. This study aimed to evaluate the efficacy of simulation-based teaching compared to traditional methods in imparting TEE knowledge and skills to fellows. Methods: A literature search was conducted across MEDLINE, Embase, and Cochrane databases. The primary endpoint was (1) post-intervention skill or knowledge assessment. A subgroup analysis was performed comparing anesthesiology and cardiology fellows. Additionally, a secondary single-arm analysis evaluated (2) the recommendation rate for simulation training among participants who underwent this form of tutoring. Statistical analysis was done using R Studio 4.3.2. Results: We included 9 RCTs encompassing 602 fellows, of whom 293 (48.67%) underwent simulation training TEE with a mean age of 25. In the pooled analysis, the simulation group's post-test scores for TEE proficiency were significantly higher compared to the control group (SMD: 0.86; 95% [CI] 0.48-1.24; p &lt; 0.01; Figure 1A). Our subgroup analysis showed no significant difference between anesthesiology and cardiology fellows (p=0.36; Figure 1B). The Likert recommendation score indicated a high recommendation rate of 92% (95% CI 0.75-1.00; Figure 2) for the simulation education group. Conclusion: In this updated meta-analysis, fellows who underwent simulation training for TEE achieved higher post-assessment scores, and the Likert recommendation rate for simulation-based teaching was high. Additionally, there were no significant subgroup differences between the cardiology and anesthesiology fellows.
Abstract 4147235: Sex Differences in Psychosocial Factors and Angina in Patients with Chronic Coronary Disease
Authors: Anais Hausvater, Rebecca Anthopolos, Alexa Seltzer, Tanya Spruill, Jesus Peteiro, Jose Lopez-sendon, Jelena Celutkiene, Mandeep Sidhu, Elena Demchenko, Branko Beleslin, Sasko Kedev, Anna Grodzinsky, John Spertus, Jerome Fleg, David Maron, Judith Hochman, Harmony Reynolds
Journal: Circulation (2024)

Background: Sex differences in angina frequency and health status have been previously described in patients with chronic coronary disease (CCD), with women more severely affected despite lesser coronary artery disease (CAD) severity. Psychosocial factors, such as perceived stress and depression, are associated with increased angina and are more common in women and in those with ischemia and no obstructive coronary artery disease (INOCA). We examined whether perceived stress and depressive symptoms mediate sex differences in angina severity among patients with CCD, and whether this relationship differs between those with CAD vs. INOCA. Methods: The association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) and angina-specific health status (Seattle Angina Questionnaire, SAQ) at enrollment and changes over 1 year in North American ISCHEMIA participants and in the CIAO-ISCHEMIA study (INOCA) were compared using linear regression. Results: Among 1,626 participants (N=1,439 CAD and N=187 INOCA) with available SAQ, PSS-4 and PHQ-8 data, women had worse SAQ-7 summary scores than men in both CAD and INOCA cohorts (Table). Higher stress and depressive symptoms were associated with worse angina in both CAD and INOCA cohorts. Given consistency of results, cohorts were pooled for multivariable analysis. Female sex, PSS-4 score and PHQ-8 score were each independently associated with lower SAQ scores, (female vs. male difference -5.12 points, 95% CI -7.21, -3.02, p=0.001; PSS-4 -0.78 per point, 95% CI -1.06, -0.50, p=0.001; PHQ-8 -1.38 per point, 95% CI -1.58, -1.18, p=0.001) but CAD vs. INOCA was not and the effects were similar by sex. Conclusions: Women, with both CAD and INOCA, had worse angina and angina-related health status than men. High stress and depressive symptoms were each independently associated without a significant interaction by sex, and regardless of presence of obstructive CAD. Therefore, stress and depression levels are not a central explanation for worse health status in women than men with CAD or INOCA.