tbuckley/cabot-search huggingface dataset:
Abstract 4134333: Blood pressure reduction in diabetic patients with resistant hypertension: results from the aprocitentan PRECISION study
Authors: John Flack, George Bakris, Roland Dreier, Mouna Sassi-Sayadi, Markus Schlaich, Jiguang Wang, Michael Weber, Krzysztof Narkiewicz
Journal: Circulation (2024)

Background: In patients with resistant hypertension (RHT), diabetes is a frequent comorbidity that increases the risk of cardiovascular events. The phase-3 PRECISION study demonstrated the efficacy of aprocitentan (APRO), a dual endothelin ET A /ET B receptor antagonist, to lower blood pressure (BP) in patients with RHT. In this pre-planned PRECISION post hoc analysis, we evaluated the BP lowering effect of APRO in diabetic patients. Methods: Eligible patients were hypertensive despite treatment with ≥3 antihypertensive medications from different classes. After ≥4 weeks of combination therapy (amlodipine/valsartan/hydrochlorothiazide), patients still hypertensive received single-blind placebo for a run-in period, followed by a 4-week double-blind part (APRO 12.5 mg, 25 mg, or placebo), a 32-week single-blind part (APRO 25 mg) and a 12-week double-blind withdrawal part (APRO 25 mg or placebo). The primary endpoint was change from baseline to Week 4 in mean trough office SBP. Results: Out of 730 patients, 395 (54%) had diabetes (APRO 12.5 mg, n=112; 25 mg, n=107; placebo, n=116). At Week 4, APRO reduced office SBP (12.5 mg: −14.6; 25 mg: −14.1 mmHg) vs placebo (−9.4 mmHg) in diabetic patients, with no treatment/diabetes status interaction (p=0.77). The reduction was maintained at Week 36 (−16.2 mmHg). APRO also reduced mean 24-hour ambulatory SBP at Week 4 (12.5 mg: −7.4 mmHg; 25 mg: −9.5 mmHg) vs placebo (−2.2 mmHg), most pronounced on night-time values (12.5 mg: −8.9 mmHg; 25 mg: −13.1 mmHg; placebo: −1.6 mmHg). At Week 40, after 4 weeks of withdrawal, office SBP increased in placebo patients (+3.6 mmHg) and remained stable with APRO 25 mg (+0.2 mmHg). A substantial reduction in urine albumin–creatinine ratio of 33% and 37% was observed at Week 4 for APRO 12.5 mg and 25 mg, respectively, compared with an increase of 11% for placebo. Edema/fluid retention were the most common adverse events; they were mild-to-moderate in most cases and dose dependent (9%, 23%, and 2% of patients receiving APRO 12.5 mg, 25 mg, and placebo, respectively, up to Week 4). During the study, 11 patients were hospitalized for heart failure (10 treated with APRO 25 mg and one with placebo). Among these, 6 had chronic kidney disease stage 3–4, and 5 had medical history of heart failure; no cases were fatal. Conclusion: APRO produced clinically relevant and sustained BP reduction in diabetic patients with RHT, consistent with the effect observed in the overall population.
Abstract 4120577: Discrimination of Fabry Disease and Cardiac Amyloidosis Using Cardiac MRI and Echocardiography: A Comprehensive Analysis
Authors: Hazuki Sugiyama, Tomoko Kato, Yoshi Furusawa, Chisato Takamura, Masahiro Terashima
Journal: Circulation (2024)

Background: Discriminating Fabry disease from cardiac amyloidosis based on conventional imaging techniques can be challenging due to overlapping features. We aimed to investigate the discriminatory ability of cardiac MRI (CMR) and echocardiography imaging, to differentiate between these conditions. Methods: Cardiac MRI and echocardiography with SR imaging were performed on patients with suspected Fabry disease (n=39) or cardiac amyloidosis (n=79). Various imaging parameters, including late gadolinium enhancement (LGE) patterns and T1 mapping values derived from CMR, E/e’ and global longitudinal strain (GLS) were analyzed. Discrimination scores were calculated using multivariate analysis, with sensitivity and specificity determined for selected parameters. Results: In Fabry patients, LGE patterns predominantly exhibited a subendocardial distribution (66%), whereas amyloidosis patients showed transmural LGE (93%). LV mass index and T1 mapping values were higher (150±20 vs. 90±15 g/m 2 , 1208±104 vs. 822± 210ms both p p&lt;0.001) in cardiac amyloidosis compared to Fabry disease. Echocardiographic parameters demonstrated significantly reduced GLS (-12±2 vs -18±3%, p&lt;0.001), larger LA size (50 ± 5 mm vs. 40 ± 5 mm, p&lt;0.001) and higher E/e' ratio (15 ± 3 vs. 8 ± 2, p&lt;0.001) in cardiac amyloidosis compared to Fabry disease. Multivariate analysis identified LGE patterns and GLS as significant discriminators, and combining both parameters can discriminate Fabry and Amyloidosis with a sensitivity of 80.0%, specificity of 90.0%, and predictive accuracy of 85.0%. Incorporating LA size, LV mass index and E/e’ further improve the predictive accuracy to 92.0%. Conclusions: Cardiac MRI and echocardiography demonstrate promising discriminatory ability in distinguishing Fabry disease from cardiac amyloidosis. GLS emerges as a valuable parameter, reflecting myocardial function and aiding in accurate diagnosis. Integration of these imaging modalities into clinical practice could enhance diagnostic accuracy and guide appropriate management strategies.
Abstract 4142793: Development of an Angiography-Based Multimodal AI Model for Predicting the risk of In-Stent Restenosis
Authors: miao yu, Fangshun Tan, yu jiang
Journal: Circulation (2024)

Background: Despite advances in Second-generation drug-eluting stents (DES), 5-10% of patients still experience in-stent restenosis (ISR) after percutaneous coronary intervention (PCI), which generates significant financial burden and elevates the risk of acute coronary syndrome (ACS) and rehospitalization. Thus, early identification of patients at high risk for ISR is crucial for guiding clinical stratification and early intervention. Aims: To develop and validate a multimodal artificial intelligence (AI) model based on coronary angiography images for predicting ISR risk in patients post-DES implantation. Methods: To establish an accurate predictive model, our approach begins with the pre-training on 100,000 angiographic images to enhance the model’s capability in recognizing image features. Subsequently, we employ the DenseNet architecture as the primary deep learning model, incorporating angiographic images from 2,000 cases of DES-treated de novo lesions—1,000 from patients who did not experience ISR within two years and 1,000 from those who did. A multivariate logistic regression analysis, including radiomic features, clinical baselines, and functional information, constructs the predictive model. Additionally, a separate prospective cohort of 300 cases was assembled for validation to simulate real-world application and to verify the model's reliability and accuracy. Results: Our study successfully developed an AI prediction model for ISR, utilizing a large cohort of coronary angiography images, which effectively predicts ISR with high accuracy. Leveraging the DenseNet architecture and finely tuned machine learning algorithms, the model achieved a sensitivity and specificity of 90% in the validation cohort. The ROC curve from the test phase demonstrated an AUC above 0.90, underscoring the model’s exceptional diagnostic capabilities. Furthermore, the implementation of this model in a prospective cohort confirmed its reliability and practical utility in real-world clinical settings. Conclusions: This study introduces the first multimodal AI model using angiographic imaging to predict ISR. By demonstrating high diagnostic accuracy and reliability in real-world settings, this model serves as an essential tool for early ISR detection and intervention, ultimately helping to reduce the incidence of major adverse cardiac events (MACEs) and mortality.
Abstract 4147634: Important Role of Prediabetes in Stroke Patients including ESUS
Authors: Priyanka Boettger, Henning Lemm, Michael Buerke
Journal: Circulation (2024)

Stroke including ESUS is one of the common causes of disability and death worldwide. Furthermore, diabetes mellitus and prediabetes are among the main risk factors for cerebrovascular events. If the criteria for apparent diabetes mellitus is not met, a glucose metabolism disorder may still exist. Prediabetes can be present as impaired fasting glucose (IFG), impaired glucose tolerance or an increased, but not yet diabetic, HbA1c. To determine the frequency of diabetes mellitus (DM) and prediabetes mellitus (PDM) in patients with cardiovascular events, we analyzed the aspects of prediabetes in a stroke population of one of the largest stroke centers in Germany and collected the data in a prospective manner over 6 months. Among 714 included patients, 163 (30.8%) suffered a cryptogenic Stroke, including 98 (19%) ESUS. 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. &gt;50% had a diabetic or prediabetic metabolic state, among which, the highest proportion was seen in lacunar strokes, followed by atherosclerotic infarctions. &gt;80% of lacunar, &gt;70% of atherosclerotic infarctions, 60% of ESUS, 50% of cardioembolic infarctions indicate DM or PDM. Both PDM and DM show a positive correlation with age. PDM is most common in 75-84y old patients. In the male population, PDM is most prevalent in the oldest patients (&lt;85y) at &gt;50%, and least prevalent in the youngest patients (&lt;65y) at 15%. In this age group, women show a significantly higher frequency of DM and PDM. The highest number of female patients with glucose metabolism disorders is seen in the age group of 66-74y at &gt;40%. In the oldest patient group, relatively speaking, more than twice as many men are affected by glucose metabolism disorders as women (52% vs. 24%). In summary the largest relative proportion of prediabetics and diabetics is seen at 80% among the lacunar infarction group and the second largest proportion at 70% among those with atherosclerotic infarctions. Among ESUS and cryptogenic stroke patients show a proportion of over 60% with impaired glucose tolerance. PD presents a positive correlation with increasing age, just like other risk factors. 40% of the 75-84-year-olds have DM or PDM. Therefore, diabetogenic micro- and macroangiopathies could be a major contributing factor to the causes of stroke.
Abstract 4145890: P-Wave Parameters on 12-Lead Electrocardiogram after Catheter Ablation: A Comparison between Pulsed Field Ablation and Cryoablation
Authors: Sakshum Chadha, Seth Newman, Abhishek Maan, Jacqueline Mirza, Srilakshmi Garikapati, Daniel Musikantow, Mohit Turagam, jacob Koruth, William Whang, Marc Miller, Joshua Lampert, Srinivas Dukkipati, Vivek Reddy
Journal: Circulation (2024)

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). The most popular current methods of CA include radiofrequency ablation (RFA) and cryoablation (CRYO) which are thermal methods of ablation known to affect the autonomic nervous system through ablation of cardiac ganglionated plexi (GP). Pulsed[SC1] -field ablation (PFA) is a newer method of CA with demonstrated efficacy that preferentially affects cardiac cells and spares surrounding structures such as GP through irreversible electroporation which does not lead to chronic fibrosis like RFA or CRYO. Elevations in the marker the marker P terminal force (PTF) have been associated with AF/stroke and have been known to correlate with atrial fibrosis, and higher PTF after cryoablation for patients with paroxysmal AF has been associated with an increased risk of recurrence. The differences in P-wave parameters pre and post PFA have not been studied. Objective: To investigate the differences in P-wave parameters after PFA and compare them to CRYO. Methods: We identified 40 patients who underwent PFA (20 patients) or CRYO (20 patients) for paroxysmal AF and compared P-wave parameters including duration and amplitude in leads aVF, V1 and the PTF calculated as the duration x amplitude of the terminal negative component of the P-wave in V1. Data were obtained from 12-lead electrocardiograms obtained pre and post ablation. Results: The mean age of patients in our study was 61 with 75% male and 33% on antiarrythmics. We noticed a significant reduction in PTF for patients who underwent CRYO (54 mVmS at baseline compared to 36.8 mVmS after CRYO, p = 0.04) and no significant reduction in PTF for patients who underwent PFA (46 mVmS at baseline compared to 38 mVmS after PFA, p = 0.27). There was also a significant increase in HR after CRYO (65 bpm at baseline compared to 78 bpm after CRYO, p=0.01) and no significant change in HR after PFA (61 bpm at baseline compared with 60 bpm after PFA, p=0.8). There was no statistical difference in both groups looking at aVF or total V1 duration or amplitude pre and post ablation. Conclusions: CRYO leads to a significant change in PTF after ablation while PFA does not, consistent with the notion that PFA does not lead to fibrosis and PTF is not a useful marker for measuring risk of recurrence of AF post PFA.
Abstract 4145819: Reducing the Burden of the Opioid Epidemic by Adopting a Novel Pain Control Strategy Utilizing Pectoral Nerve Block in Adults Undergoing Transvenous Cardiac Device Implants
Authors: Ganesh Nair, Kirollos Gabrah, Brandon Doty, Arun Mahtani, Devi Nair
Journal: Circulation (2024)

Introduction: Despite early mitigation efforts, the opioid pandemic in the United States has persisted and affected many Americans. A public health emergency was declared urging all prescribers to use caution in prescribing opioids. Alternative approaches to postoperative pain management during transvenous cardiac device implants (TCDI) in adults have not been described. Methods: We report a single-center retrospective analysis of 612 consecutive patients that underwent TCDI between January 2021 and January 2024 with ultrasound guided pectoral nerve block (PNB) using liposomal bupivacaine prior to implant for postoperative pain management. Pain scores (0-10) were recorded systematically in the postoperative period, at discharge, and at wound check follow-up. Any need for opioid use in the postoperative period was recorded as well. Results: A total of 612 patients were evaluated, 50% female with a mean age of 71.2 years. All patients received PNB successfully with no device site infection or hematomas. The mean Visualized Analog Scale (VAS) pain scores at 1, 3, and 5 hours after the procedure, at discharge, and at the follow-up visit were 1.93, 1.22, 1.10, 1.05, and 0.13 respectively. During follow-up, no patients required opioids for pain control throughout the entire postoperative period of 14 days. Conclusion: Pectoral nerve block with liposomal bupivacaine can be performed safely preoperatively during TCDI and provides adequate pain control without need for opioid use postoperatively. Further research is needed to assess broad scale implications of this approach to larger patient populations.
Abstract 4114716: Concurrent Ethanol Infusion with Pulsed Field Ablation Augments Electroporation of Porcine Atria
Authors: Taro Koya, Naoto Otsuka, Jason Tri, yang ying, William Sauer, Samuel Asirvatham, Duy Nguyen
Journal: Circulation (2024)

Background: Pulsed field ablation (PFA) is a promising modality for treatment of cardiac arrhythmias. PFA increases cell permeability, thereby promoting cell apoptosis. Although greater PFA energy may produce larger lesions, it also carries risks of side effects such as arcing, hemolysis, and microbubbles. Chemical ablation using ethanol (EtOH), such as with injection of the Vein of Marshall, has been used to treat atrial myocardium for refractory atrial arrhythmias. Hypothesis: We hypothesize that PFA in the atria can increase EtOH uptake through PFA-generated pores, thereby augmenting ablation efficacy by utilizing the cell permeability effects of PFA. Aim: The aim of this study is to investigate the effects of local EtOH infusion after PFA on lesion size in porcine atria. Methods: The atria of five porcine subjects were ablated in vivo with low PFA power settings (250V, at 20μs for 50 pulses separated by 200 ms) using a focal bipolar irrigated ablation catheter and BTX 830 electroporation generator (Harvard Apparatus). After PFA, 2 ml of 90 % EtOH vs. saline (control) was infused through the catheter tip to the site of ablation. We compared electrogram voltage amplitude reduction and ablation lesion parameters before and after PFA. Results: A total of 14 control lesions and 14 EtOH lesions were analyzed. There was significant difference in voltage reduction between two groups ( Figure 1A-B ). On gross pathology, there were significant differences in ablation lesion maximum surface diameter, lesion depth, and volume between the 2 lesion sets ( Figure 1C ). Conclusion: Concurrent EtOH infusion after PFA enhanced acute efficacy of electroporation in porcine atria. Adjuvant therapy has the potential to improve efficacy without requiring higher energy parameters, thereby reducing PFA risks. Further studies to assess chronic efficacy are warranted.
Abstract 4135617: Large Scale Proteomics Identifies Circulating Biomarkers Relating Atrial Fibrillation to Heart Failure: the Atherosclerosis Risk in Communities Study
Authors: Fernando Giugni, Victoria Lamberson, Yimin Yang, Lin Chen, Kunihiro Matsushita, Ron Hoogeveen, Christie Ballantyne, Josef Coresh, Bing Yu, Amil Shah
Journal: Circulation (2024)

Introduction: There is a bidirectional relationship between atrial fibrillation (AF) and heart failure (HF) risk. Data regarding shared and unique pathways underlying each are limited. Aims: Identify plasma proteins associated with both incident AF and HF and determine the extent to which associations with one outcome are conditional on interval occurrence of the other outcome. Methods: Among participants in the community-based Atherosclerosis Risk in Communities study free of HF and AF at study visit 5 (2011-2013), we measured 4,955 plasma proteins (SomaScan aptamer-affinity assay). We performed parallel analyses of individual protein associations with incident HF and AF using multivariable Cox regression adjusted for demographic and clinical covariates at Bonferroni significance. We then repeated the analysis for each outcome in models censoring participants with interval occurrence of the other outcome (i.e. incident AF censoring for interval HF, and vice versa). We tested associations of AF-related proteins with echocardiographic and Zio patch measures at Visit 5. Results: Among 4,118 participants included, mean age was 75±5 years, 60% were female, and 18% reported Black race. We identified 83 proteins associated with incident HF (n=355 incident events at 7 [IQR 6-8] year follow-up) and 24 with incident AF (n=517 incident events at 8 [7-9] years), of which 10 were associated with both. In models of incident HF censoring for interval AF, 63 (76%) proteins remained significantly associated with HF. In contrast, in the analysis of incident AF censoring for interval HF, only 4 (17%) proteins remained associated with AF, of which 3 were also associated with HF risk (Figure). These 4 AF-related proteins were associated with measures of LV diastolic function (LA volume, E/e’. average), LV mass index, LA function (LA reservoir, LA contraction), and supraventricular ectopy density (all p&lt;0.05). Conclusion: Nearly half of proteins reflecting AF risk also associate with HF, greater than 80% of AF-associated proteins are HF-dependent, and even those that are not correlate with measures of LV remodeling and dysfunction. These findings suggest that AF-related mechanisms among older adults are part of a wider HF syndrome.
Abstract 4134305: Intraoperative indicators depending on QRS morphology are required to narrow QRS width during CRT implantation
Authors: Takanao Mine, Soichiro Terao, Miho Sugitani, Takehiro Kogame, Masaharu Ishihara
Journal: Circulation (2024)

Introduction: Various indicators to detect the most delayed electrical or mechanical activation site of left ventricular (LV) have been studied using intracardiac electrocardiogram or speckle tracking echocardiogram to narrow QRS width in patients with cardiac resynchronization therapy (CRT). Hypothesis: Unusual intraoperative indicators are required to narrow QRS width in patients with non-LBBB (left bundle branch block) during CRT implantation. Methods: Nineteen patients (14 men, 71±12yrs, 7 with left bundle branch block: LBBB / 10 non-LBBB / 2 pacing-depend, 6 ischemic cardiomyopathy, LVEF 29.6±8.9%, QRS 152±28ms) underwent CRT implantation. Q-LV (an interval from QRS onset to LV potential), RV-LV (from RV to LV), RVp-LV (from RV pacing to LV), and S-QRS (from LV pacing stimulation to QRS onset) were measured in multi-sites of coronary sinus (CS) veins using a 5 mm spacing 2Fr 8-polar catheters. Q-peak strain (an interval from QRS onset to peak radial strain) was evaluated by speckle tracking echocardiogram in each LV segment during sinus rhythm (SR) and RVp. QRS narrowing was defined as the difference between the QRS interval during SR (or RVp) and the QRS interval with biventricular pacing. Results: Parameters were evaluated in 17±7 (8-32) sites of 1.9±0.9 (1-4) CS branches in each patient. In LBBB patients, longer Q-LV during SR, extended RV-LV during SR, and lengthy Q-peak strain during SR were associated with QRS narrowing. Shorter S-QRS during LVP and longer RVP-LV during RVP were related to QRS narrowing in non-LBBB patients. (Table) Conclusion: Suitable indicators depending on QRS morphology are required for QRS narrowing in CRT implantation. The parameters using speckle tracking echocardiogram to detect mechanical LV delay sites might not be useful in patients with non-LBBB.
Abstract 4113405: The Role of Cardiac Power Output and Stroke Work Index in Balloon Pulmonary Angioplasty Therapy for Chronic Thromboembolic Pulmonary Hypertension
Authors: Nicole Nashed, Lawrence Ang, Alma Fregoso, Jonathan Omens, Taylor Buchalla, Paul Chavez, David Poch, JENNY YANG, Hyong Kim, Ehtisham Mahmud
Journal: Circulation (2024)

Background: Right ventricular (RV) and left ventricular (LV) measures of cardiac power output (CPO) and stroke work index (SWI) are existing markers of cardiac function and clinical outcomes. These metrics have not been used to evaluate the effects of balloon pulmonary angioplasty (BPA) therapy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: CTEPH patients who underwent at least six BPA sessions and were included in the UC San Diego BPA registry were included for analysis. Left and right ventricular CPO and SWI during each session were recorded. Cardiac output was measured using the thermodilution technique. Differences in continuous variable measurements before versus after BPA therapy were evaluated using the Student T-test. P-value &lt;0.05 was significant. Results: A total of 66 subjects underwent six consecutive BPA sessions (55.5% female, BMI 28.3±6.10kg/m 2 ,16.7% prior pulmonary thromboendarterectomy surgery) and were included for analysis. Measurements of RV function, including RVCPO (Pre-BPA 0.38±0.14 vs Post-BPA 0.30±0.13 W, p=0.001)(Figure 1) and RVSWI (Pre-BPA 16.52±5.09 vs Post-BPA 14.14±4.00 g*m/beat/m 2 , p=0.004) significantly decreased after BPA therapy. Measurements of LV function, including LVCPO (Pre-BPA 1.00±0.32 vs Post-BPA 1.04±0.31 W, p=0.523) (Figure 2) and LVSWI (Pre-BPA 37.13±10.14 vs Post-BPA 39.73±9.37 g*m/beat/m 2 , p=0.152) did not change significantly after BPA therapy. The ratio of LVCPO/RVCPO increased in stepwise fashion from baseline to the last BPA session (2.82± 0.95 vs. 3.54±1.31 W, p&lt;0.001)(Figure 3). Conclusions: Hemodynamic work expended by the RV decreased after BPA therapy, while work expended by the LV remained unchanged during BPA therapy. The ratio of LV-to-RV work increased in a stepwise manner during consecutive BPA sessions. These measurements may be useful parameters to monitor clinical response to BPA therapy.