tbuckley/cabot-search huggingface dataset:
Abstract 15838: To Tear Again: Recurrent and Complicated Spontaneous Coronary Artery Dissection
Authors: Hasnoor Sandhu, Rahil Desai, Dalpinder Sandhu
Journal: Circulation (2023)

Background: SCAD is as an infrequent cause of ACS with a predominance affecting a mean age of 42.6 years and 82% of patients being female. SCAD can be classified as primary or secondary, where primary dissections occur spontaneously, and secondary causes involve the aortic root and are a direct consequence of coronary interventions, surgery, or trauma. Case: 26-year-old female with no previous cardiac or significant family history presented with severe mid-sternal chest pain, radiating to both arms and back, and associated with nausea and cold sweats. Cardiovascular exam was unremarkable. Troponins were elevated at 0.18 and 0.59. Echo showed anteroseptal wall hypokinesis, consistent with Takotsubo cardiomyopathy. ECG showed anterolateral ST elevations. The patient went for cardiac catheterization and had spontaneous dissection of the left main into the LAD/diagonal with 100% occlusion of the LAD and 99% occlusion of the ramus/circumflex. Impella device was implanted due to persistent shock, V. fib., and cardiac arrest. Stents were placed in the proximal, mid, and distal LAD, ramus/circumflex, and LCA. The patient had an LVEF of 25%. Follow-up echo showed an LVEF of 30%, with subsequent Impella removal. Following week, LVEF increased to 45-50%. The patient began aspirin 81 mg, atorvastatin 10 mg, bisoprolol 5 mg, prasugrel 10 mg, and rivaroxaban 10 mg. Over the next few years, she had recurrent chest pain, syncope, palpitations, and a non-viable pregnancy at 12 weeks of gestation due to premature bleeding complications. 3 years after the initial SCAD, the patient presented with spiral dissection of the RCA, requiring three stents. LVEF was 30%. She is being managed with aspirin 81 mg, atorvastatin 20 mg, bisoprolol 10 mg, and prasugrel 10 mg. Discussion: The initial age of presentation of this patient makes this case unique. Risk of recurrent SCAD was present in 17% of patients at a median age of 2.8 years after the initial episode. Triggers for recurrent SCAD include extreme emotional/physical stress and pregnancy. Pregnancy it is not recommended in this patient population. Beta-blockade and adequate BP control are mainstay in medical management and reduce the reoccurrence of SCAD.
Abstract 18378: Ischemic Heart Diseases Mortality is Decreasing in Older Women: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 1990-2019
Authors: Saeed Abughazaleh, Yaman Mkhaimer, Saqr Alsakarneh, Ahmad Al Nawaiseh, Qais Hamarsha, leen Rawabdeh
Journal: Circulation (2023)

Introduction: Ischemic heart diseases (IHD) are a major cause of mortality in the US despite that there is limited data on recent age and sex-specific mortality rates. Aim: This study aimed to conduct a time-trend analysis of mortality rates of IHD in the US using the global burden of disease (GBD) database. Methods: Mortality data was obtained from the GBD database. Age-adjusted mortality rates were stratified by gender and age-specific groups: younger adults (≤55 years) and older adults (&gt;55 years). Annual percentage change (APC) and average APC (AAPC) were estimated using Joinpoint Regression Software (v.4.9.0.1, NCI). Results: 959,513 patients were diagnosed with IHD in the US in 2019. Overall, mortality rates have decreased in older adults but remained stable in younger adults (AAPC = -2.9 vs -1.0, AAPC difference = 1.9, P &lt; 0.001). Similar trends were observed in men, with an AAPC difference between older and younger adult men (0.9, P &lt; 0.001). In women, while similar results were seen, there was a greater AAPC difference between younger and older adult women (2.6, P &lt; 0.001), suggesting that the disparity in IHD mortality rates between age-specific groups arises from women. Conclusions: Our study showed decreasing IHD mortality rates among older adults and women over the past three decades. Further research is warranted to understand the factors behind the decreasing mortality rate in older adults, particularly older women.
Abstract 15781: Associations Between Hysterectomy and Incident Metabolic Syndrome: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Eric K Broni, Justin B Echouffo Tcheugui, Anna Palatnik, Ernest Graham, Ruth-Alma Turkson-Ocran, Yvonne Commodore-Mensah, Chiadi E Ndumele, Erin D Michos
Journal: Circulation (2023)

Background: Metabolic syndrome is linked to increased risk of incident atherosclerotic cardiovascular disease (CVD), heart failure, and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy independently increases long-term risk for CVD. Despite these associations, extant literature on the independent link between ovary-sparing hysterectomy and metabolic syndrome is scarce. We, therefore, examined the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multi-ethnic cohort. Methods: We studied 1,355 female MESA participants who had data on self-reported history of hysterectomy, oophorectomy, and hystero-oophorectomy and were free of metabolic syndrome and CVD at exam 1 (2000-2002). Metabolic syndrome was defined by the NCEP Adult Treatment Panel III criteria. We used multivariable Cox regression models to evaluate the associations between hysterectomy/oophorectomy subgroups and incident metabolic syndrome from exams 2 (2002-2004) to 6 (2016-2018). Results: The mean ± SD age was 59.0 ± 9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese-American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy [HR 1.32; 95% CI (1.01-1.73)] and hystero-oophorectomy [1.40 (1.13-1.74)] were strongly associated with metabolic syndrome (Table) . Conclusion: Hysterectomy with ovarian preservation is independently associated with a higher risk of metabolic syndrome. If our findings are confirmed by other studies, screening and preventive strategies focused on females with ovary-sparing hysterectomy and the pathways driving these associations should be explored.
Abstract 17197: Team-Based Care for Uncontrolled Hypertension in Accountable Care Organizations: A Simulation Study
Authors: Aditi S Rao, Vaishnavi Sawant, Yiyi Zhang, Marie A Krousel-wood, Teryl Nuckols, Siqin Ye, Joseph E Ebinger, Kelsey Bryant, Andrew E Moran, Brandon K Bellows
Journal: Circulation (2023)

Background and Objectives: Team-based care (TBC) is associated with greater blood pressure (BP) reductions than usual care, particularly when non-physicians titrate antihypertensive medications, but has yet to be widely adopted. This analysis projected the effectiveness of TBC among patients with uncontrolled hypertension from three accountable care organizations (ACOs): Columbia University Medical Center (New York), Cedars-Sinai Medical Center (California), and Ochsner Accountable Care Network (Louisiana). Methods: The Cardiovascular Disease (CVD) Policy Model is a computer model that simulates modifiable hypertension care processes (i.e., office visit frequency, BP measurement accuracy, medication intensification, and patient medication adherence) and has been validated to reproduce TBC outcomes. We used the CVD Policy Model to simulate the ACO population aged &gt;=65 years with BP &gt;=140/90 mmHg at two outpatient visits in 2015, and project BP and CVD outcomes out to 10 years with usual care alone vs. one year of TBC followed by a return to usual care. Hypertension usual care processes were derived from national sources and published literature. The model was calibrated to reproduce systolic BP reductions with TBC at one year vs. usual care from a published meta-analysis, which were stratified by the team member responsible for antihypertensive medication titration: -5.0 (95%CI -7.9, -2.2) mmHg with physician titration and -10.5 (95%CI -16.2, -4.8) mmHg with non-physician titration. Results: The ACO population with uncontrolled BP (N=9,788) had a mean (SD) age of 76.3 (7.8) years; 66.6% were white and 59.8% female. The mean BP (SD) at baseline was 151.1 (13.0)/78.1 (10.6) mmHg and 39.1% had a history of CVD. Compared with usual care at 10 years, TBC with non-physician titration was projected to increase the proportion with BP &lt;140/90 mmHg by 16.0% and TBC with physician titration by 4.2%. Relative to usual care, TBC with non-physician titration was projected to prevent 20.8 CVD events per 1000 individuals and TBC with physician titration to prevent 6.6 CVD events. Conclusion: Universal adoption of TBC, especially with non-physician titration, could improve achievement of quality benchmark BP control goals and prevent CVD events in ACO populations.
Abstract 14374: The Atrium Conduction Mappings Using Omnipolar Technology for Detecting Epicardial Connection in Patients With Atrial Fibrillation
Authors: Takehiro Kogame, Takanao Mine, Eiji Fukuhara, Miho Sugitani, Masaharu Ishihara
Journal: Circulation (2023)

Background: Epicardial connection (Epi-connection) between the right atrium (RA) and right pulmonary vein (RPV) has been known to complicate pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Meanwhile, the omnipolar voltage detected using EnSite™ Omnipolar Technology (OT) has been reported to facilitate the recognition of wavefront direction and see every signal in 360 degrees. Purpose: We investigated whether epicardial RA-RPV connection can be evaluated with OT mapping before PVI. Methods: We prospectively studied 113 consecutive patients (74 males, age 71±10 years, 68 paroxysmal AF) who underwent initial pulmonary vein isolation (PVI) for AF. The RA-RPV connections before PVI were assessed using OT mappings during right atrial pacing. True Epi-connections were defined as cases that required additional ablation medial to the PV more than 1 cm from the ablation line after the right PVI. Results: RA-RPV connections before PVI were detected in 7 out of 113 patients (6.2%). True Epi-connections were confirmed in 7 out of 113 patients (6.2%, 6 patients with carina and 1 with right superior PV) and were not related to any other clinical data, blood samples, or echocardiographic findings. Only 5 out of 7 patients with RA-RPV connections before PVI showed True Epi-connections (Figure). Conclusion: The prevalence of Epi-connections is not high, however, the conduction mapping using OT could be useful for detecting Epi-connection (especially non-carina Epi-connection) before PVI.
Abstract 17552: Pre-Existing Right Ventricular Lead Performance After Transcatheter Tricuspid Valve Replacements (TTVR)?
Authors: Rand Ibrahim, neal bhatia, Faisal M Merchant, Mikhael F El-Chami, Michael S Lloyd
Journal: Circulation (2023)

Introduction: Transcatheter tricuspid regurgitation (TTVR) is an investigational method for nonsurgical candidates with severe tricuspid regurgitation (TV). Many of these patients possess transvenous right ventricular (RV) leads, which can be a cause for TTVR. Outcomes regarding RV lead viability and functionality after TTVR have varied widely. We sought to describe the outcomes and management of RV leads after TTVR at our institution. Hypothesis: We expect transcatheter tricuspid valve replacement to negatively impact the performance of pre-existing right ventricular leads. Methods: This was a retrospective observational analysis of patients who received TTVR at our center independent of other clinical trials. Statistical analysis was performed using SPSS BMI Software. Results: A total of 30 patients underwent TTVR between 2021 and 2023. Nine patients had CIEDs, including one with SICD and one with transcatheter pacemaker. This resulted in 7 (23%) with an RV lead crossing the TV at the time of TTVR (3 Evoque valves, 5 S3 valves). The RV leads were connected to a pacemaker (PM) in five (71%) patients, an implantable cardiac defibrillator (ICD) in one and a CRT-D in another. On average, the patients underwent TTVR 5 years after cardiac implantable electronic device (CIED) implantation. All patients received RV lead testing at least once after TTVR and they were followed up for a median of 7 months after TTVR. 3 patients underwent pre-emptive lead extraction, which let to four (57%) patients with “jailed” RV leads. 3 of the four patients with jailed leads had lead dysfunction requiring system revision or reprogramming - including elevated lead threshold, clinical evidence of transient loss of capture, and non-jailed atrial lead undersensing post TTVR. Conclusions: We report a high incidence of lead malfunction due to RV jailing with TTVR and good outcomes of those undergoing preemptive extraction strategies. Approaches such as leadless systems and coronary sinus systems may be useful in this patient population.
Abstract 18841: Long-Term Cardiovascular Outcomes of Immune Checkpoint Inhibitors-Related Myocarditis: A Large Single-Center Analysis
Authors: Lorenzo Braghieri, Ahmad M Gharaibeh, Lubika Nkashama, Osama Abu-Shawer, Bianca Honnekeri, Max Puthenpura, Cassandra Calabrese, Venu Menon, Pauline Funchain, Rohit Moudgil
Journal: Circulation (2023)

Introduction: Immune checkpoint inhibitors (ICI) have revolutionized the oncology landscape. Despite ICI-related cardiovascular adverse events being rare, they are often fatal in the short-term. Whether ICI-related myocarditis portends a worse long-term prognosis is unclear. Aims: To determine the long-term cardiovascular (CV) comorbidity burden and CV mortality after ICI-related myocarditis. Methods: The ICI-related adverse event registry, which includes 4195 patients who received ICI between 2011 and 2019, was screened to identify patients with ICI-related myocarditis. ICI-related myocarditis was defined according to Bonaca criteria by two independent Authors and discrepancies were further adjudicated by a staff cardiologist. Controls were randomly selected. Patients’ demographics, comorbidities, cancer history, labs, and myocarditis features on presentation were collected. Primary outcomes were freedom from CV comorbidities (a composite of atrial fibrillation, stroke, myocardial infarction, and heart failure) and freedom from CV death (CVD) at 2 years from the initiation of ICI. ICI-related myocarditis was treated as a time-varying covariate. Freedom from primary outcomes was analyzed via Kaplan-Meier analysis and Cox proportional models with backward regression were used to account for confounding. Results: A total of 76 patients developed ICI-related myocarditis at a median time of 167 days (36.8% female, mean age 69, 47% primary lung cancer). Overall, 65% and 75% of patients had EKG changes and new wall motion abnormalities, respectively. Mean LVEF was 43%, median NTproBNP was 2057, and median peak TnT was 0.81 on presentation. At 2-years follow-up, patients who developed ICI-related myocarditis had significantly lower freedom from CV comorbidities (67% vs 86.8%, p&lt;0.001) and CVD (93.4% vs 99.3%, p=0.003). On multivariable analysis, development of ICI-related myocarditis was an independent predictor of CVD (HR 8.28, p=0.048), but not cardiovascular comorbidities (HR 2.21, p=0.08). Conclusions: This is the largest case-control study on ICI-related myocarditis demonstrating significantly worse long-term CV outcomes. Future studies are needed to optimize the management of ICI-related myocarditis survivors.
Abstract 17679: Prognostic Implications of Left Ventricular Hypertrophy Regression Based on 4-Tiered Classification of Left Ventricular Hypertrophy
Authors: Gyu Tae Park, Hyue Mee Kim, In-chang Hwang
Journal: Circulation (2023)

Introduction: 4-tiered classification of left ventricular (LV) hypertrophy (LVH), which accounts for increased LV wall thickness and LV volume, has been suggested to identify subgroups of patients at differential risk. This study was conducted to evaluate prognostic impact of 4-tiered classification of LVH in newly diagnosed hypertension patients with LVH. Methods: We retrospectively enrolled patients who had LVH on echocardiography at the time of diagnosis and had serial echocardiography taken within a 6-18-month interval with anti-hypertensive medication. Patients were divided into 5 groups based on 4-tiered LVH classification (eccentric LVH with dilatation or without dilatation, concentric with dilatation or without dilatation), and LVH regression group by the follow up echocardiography. The primary outcome was the composite of adverse cardiovascular (CV) outcomes, including CV death, hospitalization for heart failure, coronary revascularization, stroke, and aortic events. Results: Among the 837 patients in the five groups the concentric LVH group and dilated eccentric group demonstrated significantly higher incidence of CV outcomes. Compared with LVH regression group, those with dilated concentric (adjusted hazard ratio [adjHR]: 8.95; 95% confidence interval [CI]: 4.34 to 18.48), dilated eccentric (adjHR: 6.24; 95% CI: 2.96-13.18), non-dilated concentric (adjHR: 2.04; 95% CI: 1.26-3.32) LVH exhibited increased in CV risk according to multivariable cox-regression analysis. However, the non-dilated eccentric LVH group did not demonstrate a significant increase in CV risk (adjHR: 0.75; 95% CI: 0.24-2.35). Conclusions: In patients with hypertension, regression of LVH during anti-hypertensive treatment is associated with better CV outcomes. However, non-dilated eccentric group were not increase CV risk compared with regression group. The 4-tiered LVH classification can be helpful to stratifying CV risk in patients with hypertension.
Abstract 13473: 3D Fusion Between SPECT Myocardial Perfusion Imaging and Invasive Coronary Angiography to Guide Revascularization in Patients With Stable Coronary Artery Disease
Authors: Zhihui Xu, Saurabh Malhotra, Chen Zhao, chunjian li, zekang ye, Rui Hua, Cheng Wang, Weihua Zhou
Journal: Circulation (2023)

Objective: We evaluated the value of 3-dimensional (3D) fusion of SPECT myocardial perfusion imaging (MPI) with invasive coronary angiography (ICA) to guide revascularization. Methods: A retrospective observational study of 621 patients who underwent SPECT MPI and ICA. Based on the location of perfusion defect and stenosis on ICA, patients were classified into matched, unmatched, or normal groups via 3D fusion. The concordance between treatments was defined as, matched if there was revascularization in concordance with 3D fusion recommendation or if patient did not require revascularization; otherwise, they were classified as discordant. Major adverse cardiac events (MACE) (cardiac death, myocardial infarction, unstable angina requiring hospitalization or ICA, and unplanned revascularization) after revascularization of lesion recommended by 3D fusion were compared with those that the patients actually received. Results: Over a five-year follow-up period, 16% experienced MACE. Rates of MACE were 69% for matched findings, 22% for unmatched findings, 9% for normal findings (P&lt;0.01). Among the 366 patients who had at least one vessel with a stenosis of &gt;=50%, those whose treatments were concordant with the fusion had significantly better outcomes compared to those who were not (P&lt;0.05), primarily observed in the intermediate stenosis group (stenosis: 50-79%) (P&lt;0.01) (Fig. A). Further, in the intermediate stenosis patients, the revascularization ratio in the concordant group was significantly higher in the LCX (31.2% vs. 14.3%, P&lt;0.01) than that in the discordant group. (Fig. B) Conclusions: 3D fusion prior to coronary revascularization can guide coronary revascularization to improve outcomes, among patients with stable CAD patients and intermediate stenosis.
Abstract 12824: Quantitative Autonomic Testing ‘Early’ and ‘Late’ After Recovery From Acute COVID-19 Illness
Authors: Lorraine Mascarenhas, Ritsuko Kohno, Dana McDonald, Shaun Colburn, David G Benditt
Journal: Circulation (2023)

Background: Cardiovascular (CV) autonomic dysfunction (AD) is a known potential complication following acute COVID-19 illness and may contribute to persistent symptoms, such as fatigue and postural intolerance. However, the quantitative assessment of CV AD after an acute COVID-19 infection is largely unexplored. Objective: Compare CV autonomic testing in patients presenting ‘early’ and ‘late’ after an acute COVID-19 illness. Methods: CV autonomic testing was undertaken in symptomatic patients presenting ‘early’ (0-10 months) and ‘late’ (11-20 months) after an acute COVID-19 illness. Findings were compared to autonomic testing results in healthy control subjects. Measures included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) time to BP nadir and recovery during AS, iii) Valsalva ratio (VR), and iv) respiratory sinus arrhythmia (RSA). Unpaired student t-test was used to compare findings (mean ± SD) in post-COVID patients to controls. A p-value of &lt;0.05 was statistically significant. Results: Control (n=82, mean 33 years, 87% female), ‘early’ (n= 37, mean 38 years, 89% female) and ‘late’(n=18, mean 43 years, 72% female) groups were similar in age and sex. Compared to controls, VR was abnormally low in both the ‘early’ and ‘late’ groups (‘early’ 1.5 and ‘late’ 1.4 vs. controls 1.7, both p&lt;0.03) ( Table ). Other autonomic measures did not differ significantly from controls. However, compared to the ’early’ group, the ‘late’ group exhibited a trend toward more marked AD ( Figure ). Conclusion: Patients presenting ‘early’ and ‘late’ after an acute COVID-19 illness exhibit similar severity of autonomic disturbance. Potentially, the ‘late’ group experienced more severe COVID illness leading to delayed referral for troublesome AD symptoms. Nonetheless, our findings suggest that abnormal CV AD findings may persist without apparent improvement for lengthy periods (up to 20 months in this study) after acute COVID-19 infection.
Abstract 18215: The Silent Intruder Unveiled: A Case of Renal Malignancy Presenting as Cardiac Mass
Authors: Muhammad Hasib H Khalil, Mobeen Haider, Yousra Khalid, Saad Ur U Rahman, Christopher Bodine
Journal: Circulation (2023)

Background: Cardiac mass is a space-occupying lesion within the cardiac cavity. Its differential diagnosis includes thrombus, vegetation or tumor. Diagnosis is on imaging. Primary cardiac tumors are benign, solitary masses attached by a stalk in the atria. Carcinomas are metastatic from direct invasion or hematogenous spread. Right-sided cardiac masses present with shortness of breath, fatigue, syncope, and night sweats. We discuss a patient with a right atrial (RA) mass as the presenting sign of renal malignancy. Case: A middle-aged female with no prior cardiac history presented to the hospital with complaints of shortness of breath. On presentation, the patient was hemodynamically stable. Echocardiogram showed a 4.9 x 2.9cm mobile RA mass heterogeneous in texture and attached to the interatrial septum with a narrow stalk. Further views showed that the RA mass continued into the inferior vena cava (IVC) and filled it entirely. A CT scan abdomen demonstrated a heterogeneous mass involving the left kidney extending from the left renal vein into the IVC and ultimately extending up to the RA. Given the high suspicion of renal cell carcinoma (RCC), a biopsy was offered however the patient declined further workup. Discussion: RCC can invade through the renal vein into the IVC and involve the right heart. Cavoatrial tumor thrombus extension is seen in 1% of RCC. In this case, the RA mass was the first step in the diagnosis of renal malignancy. It is imperative to assess for the extension of a RA mass into the IVC as it has diagnostic implications. Treatment is resection performed on cardiopulmonary bypass for intracardiac exploration and preventing embolization.