tbuckley/cabot-search huggingface dataset:
Abstract 19013: Symptomatic Spontaneous Automaticity in a Decrementally Conducting Left Free Wall Accessory Pathway in a Patient With Congenital Heart Block
Authors: Alap P Shah, Richard Trohman, Kousik Krishnan, Christopher Madias
Journal: Circulation (2013)

Introduction: A 20 year-old female with a history of a coil-occluded patent ductus arteriosus and congenital complete atrioventricular (AV) block was admitted for a wide complex tachycardia (WCT) associated with palpitations and dizziness. Her LV function was normal and no additional structural heart disease was noted on a cardiac MRI. Electrophysiology (EP) study was performed. Methods: N/A Results: EP study showed sinus tachycardia with 1:1 antegrade conduction via a left-sided accessory pathway. The accessory pathway demonstrated decremental conduction, adenosine responsiveness, and no retrograde conduction. The earliest ventricular activation was noted in the distal coronary sinus electrode. At slower atrial rates (70-100 bpm), there was isorhythmic dissociation (see figure) between the accessory pathway (QRS identical to maximal pre-excitation) and the sinus node strongly suggesting spontaneous accessory pathway automaticity. The accessory pathway was successfully ablated by targeting an accessory pathway potential located at the anterior aspect of the mitral valve. Post-ablation, there was complete AV block with a narrow junctional escape rhythm at a rate of 64 beats per minute. The patient underwent placement of a dual chamber pacemaker. Conclusion: This is, to our knowledge, the first reported case of a left-sided accessory pathway with both spontaneous automaticity and Mahaim-like properties.
Abstract 13238: Association of Worsening Arterial Stiffness With the Progression of Stage A/B Heart Failure
Authors: Hiroe Aisu, Makoto Saito, Shinji Inaba, Toru Morofuji, Kayo Takahashi, Takumi Sumimoto, Takafumi Okura, Jitsuo Higaki
Journal: Circulation (2016)

Introduction: Several studies have suggested that an enhanced and deteriorating arterial stiffness is associated with an increase in left ventricular (LV) afterload and LV diastolic dysfunction, which may contribute to heart failure (HF) progression. We sought to investigate the independent and incremental role of worsening arterial stiffness in new-onset HF in patients with preclinical HF. Methods: We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation, and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. Results: HF was observed in 30 patients (7%). The change in baPWV (ΔbaPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction, and baPWV at baseline (Per 10% increase, Hazard ratio, 1.23-1.42). Even in patients with an LV ejection fraction of ≥40%, ΔbaPWV was significantly associated with the primary outcome after similar adjustments. When the patients were divided into groups based on the optimal cutoff value of ≥15% ΔbaPWV and the generally accepted external cutoff value of ≥1750 cm/s for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ΔbaPWV (Figure). Conclusions: In patients with stage A/B HF, the deterioration of arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.
Abstract 19006: Peripartum Aortic Dissection in Women With Marfan Syndrome
Authors: Shaine A Morris, Pirouz Shamszad, Wayne J Franklin, Alan C Braverman, Dianna M Milewicz
Journal: Circulation (2013)

Purpose: There is a known increased risk of aortic dissection (AD) in Marfan Syndrome (MFS) during pregnancy, although quantification of that risk has been difficult to obtain. The purpose of this study was to assess the incidence of AD in pregnant women with MFS and to compare the risk in MFS to other known risk factors. Methods: The Texas Inpatient Public Use Data File (TIPUDF) contains administrative data on the majority of Texas hospital discharges. Inclusion criteria were all TIPUDF discharges 1999-2012 associated with pregnancy, including antepartum status, delivery, or postpartum status using designated ICD9 codes. Patients with MFS were then identified, as were patients with aortic dissection or rupture. MFS patient admissions were reviewed for readmission and repeat pregnancy by matching zip code, age, and race. Diagnoses of Turner Syndrome (TS), Ehlers-Danlos Syndrome (EDS), bicuspid aortic valve (BAV), coarctation, other aortic valve disorders, atherosclerosis, hypertension (HTN), and cocaine use were also identified. Results: Of &gt;37 million admissions, 5286576 were associated with pregnancy. Among those, there were 208 admissions in 152 patients with MFS, representing 171 pregnancies. Aortic dissection was coded in 41 admissions, representing 38 total ADs. Six ADs were in MFS, for an incidence in MFS and pregnancy of 3.5%. No AD was reported in TS, EDS, or BAV, although 2 events were in patients with isolated aortic valve disorders. The majority of the MFS AD events were post-partum (n=5), 3 of which were on an admission coincident with delivery. The site of AD was thoracic or thoracoabdominal in 5 (85%), with 1 limited to the abdomen, compared to abdominal site only in 40% of the non-MFS pregnant women with AD. After controlling for HTN and other known risk factors, there was a high risk for AD in MFS pregnancies compared to non-MFS pregnancies (OR &gt;1000 [95%CI &gt;999 to &gt;999]. All MFS AD patients survived, although overall mortality in AD with pregnancy was 10.5%. Conclusions: Although AD is rare in pregnancy, it is common in pregnant women with MFS, often occurring postpartum. Careful reproductive planning and close cardiac monitoring during pregnancy, but also after delivery in MFS are warranted.
Abstract 19020: Angiotensin Converting Enzyme-2 Activation Attenuates Right Ventricular Hypertrophy and Dysfunction After Pulmonary Artery Banding in Rats
Authors: Vinayak Shenoy, Yanfei Qi, Michael Katovich, Mohan Raizada
Journal: Circulation (2013)

Background: Right ventricular (RV) hypertrophy and dysfunction are important prognostic factors in pulmonary hypertension. Pharmacological therapies aimed at improving RV function reduce symptoms, enhance cardiac hemodynamics, and potentially increase survival in pulmonary hypertensive subjects. We hypothesized that activation of angiotensin-converting enzyme 2 (ACE2) using Diminazene (DIZE) will improve RV function in a chronic pressure overload model of pulmonary artery banding (PAB). METHODS: Chronic pressure-overload RV hypertrophy and dysfunction was induced by PAB in adult male rats (9 weeks of age). A subset of rats was treated with DIZE (15mg/kg/day, subcutaneous injection) following PAB. After 5 weeks of banding, right ventricular hemodynamics and cardiac functions were evaluated. RESULTS: Five-weeks of PAB resulted in significant increase in right ventricular systolic pressure, which was not affected by DIZE treatment (Control: 31± 1mmHg; PAB: 49± 3mmHg; PAB+DIZE: 44± 2mmHg). However, DIZE injection significantly improved RV function. Specifically, DIZE decreased right ventricular end diastolic pressure (RVEDP; Control: 3.55± 0.71mmHg; PAB: 10± 0.92mmHg PAB+DIZE: 7.51± 0.83mmHg), reduced +dP/dt (Control: 2466± 62mmHg/s; PAB: 3055± 172mmHg/s; PAB+DIZE: 2670± 193mmHg/s) and -dP/dt (Control: -1735± 54mmHg/s; PAB:-2628± 166mmHg/s; PAB+DIZE: -2281± 144mmHg/s). In addition, DIZE decreased RV hypertrophy as measured by RV/LV+S ratio (Control: 0.24± 0.01; PAB: 0.42± 0.02; PAB+DIZE: 0.37± 0.010). CONCLUSIONS: Treatment with DIZE, an ACE2 activator led to significant improvements in RV function and decreased hypertrophy in a chronic pressure-overload rat model. Thus, DIZE may represent a novel treatment for RV dysfunction and failure.
Abstract 13306: Advanced Care Planning in Persons Who Die From Heart Disease
Authors: Joy R Goebel, Olga Korosteleva, Elizabeth A Ortega, Timothy Manning, Yemisrach T Lodebo
Journal: Circulation (2016)

Introduction: The unpredictable trajectory of persons dying from cardiovascular disease (CVD) may make planning for future care challenging. In order to target quality improvement (QI) efforts, it is necessary to identify factors associated with advanced care planning (ACPing) in CVD. Methods: The Health Retirement Survey (a nationally representative sample) provided data for a secondary data analysis of 1304 individuals’ ≥65 years of age that died of CVD from 2002-2012. Proxies of decedents reported ACPing activities (identifying a durable power of attorney for health care [DPOA_HC], completing a living will, or engaging in a conversation about care preferences at end of life (EoL). Demographic and clinical factors were also recorded. Results: Proxies reported 78% of decedents engaged in some level of ACPing (60% had a DPOA_HC, 56.5% had a conversation about EoL treatment preferences, and 47.3% completed a living will). In bivariate analysis, being older, female, Caucasian, widowed, dying at home/hospice/other, having higher income or education, and more symptoms were associated with any type of ACPing (chi-squared test p-value ranges between &lt;0.000 and 0.028). In the multivariate regression model, older age (OR=1.026, 95%CI [1.002, 1.052], p=0.037), Caucasian race (OR=1.754, 95%CI [1.126, 2.735], p=0.013), more education (‘high school grad’: OR=1.723, 95%CI [1.151, 2.580], p=0.008; ‘some college’: OR=2.659, 95% CI [1.451, 4.871], p=0.002; ‘college grad’: OR=3.404, 95%CI [1.710, 6.774], p&lt;0.000), higher income (‘$10,001-$88,000’: OR=1.670, 95%CI [1.000, 2.791], p=0.050; ‘&gt;$88,000’: OR=2.012, 95%CI [1.150,3.520], p=0.014), and more symptom burden (OR=1.350, 95%CI [1.217, 1.498], p&lt;0.000) were associated with any type of ACPing. Conclusions: The majority of individuals dying of CVD participate in ACPing. QI efforts to improve ACPing should target non-Caucasian individuals with less education, less income, younger age, and lower symptom burden.
Abstract 19011: Is It Necessary to Pre-Stent Right Ventricular Outflow Tract Prior to Percutaneous Pulmonary Valve Implantation in All Patients?
Authors: Daniel R Turner, Nikhil M Thatte, Pooja Gupta, Sanjeev Aggarwal, Harinder Singh, Thomas J Forbes, Srinath T Gowda
Journal: Circulation (2013)

Background: Bare metal stent placement prior to Melody valve insertion (MVI) is common. We analyzed acute and short-term outcome following MVI with and without pre-stenting (PS) the conduit. Methods: This is a retrospective single-center study. Patients (pts) were divided into two groups, with and without PS. The conduits were divided into homograft (HG) and valve with supporting ring (VSR) groups. Results: From June 2010 to May 2013, 49 pts underwent MVI. Conduits were HG in 24 (49%) and VSR in 25 (51%). Primary indication was stenosis in 20 and regurgitation in 29 pts. PS was performed in 16 (33%) vs. no PS in 33 (67%) pts. Major procedural complication included conduit (HG) rupture requiring covered stent placement in 1 pt. In the entire cohort, baseline peak RVOT gradient at cath was 27.14 ± 14.55 vs. 14.82 ± 9.83 mmHg post-implantation (p &lt; 0.0001). Baseline pulmonary regurgitation (PR) was moderate to severe in 36/40 (90%). Only 2 had moderate or greater PR post-implant. Freedom from Melody stent fracture was 95.83% (in 23/24) at 9.85 months and freedom from melody valve dysfunction was 93.7% (45/48) at median 16.5 months of follow up. The pre- and immediate post-implantation RVOT gradient (12.81 ± 14.14 mmHg vs. 12.09 ± 11.88 mmHg, p=0.852) and degree of PR were not significantly different between the PS and no PS group. At follow-up, Melody valve dysfunction and freedom from stent fracture were not significantly different between the groups. In pts with VSR, RVOT gradient post-implant was not significantly different between the PS and no PS groups; however pts with no PS showed a trend towards lower post-implant RVOT gradient (20.38 ± 10.72 vs. 12.76 ± 10.23, p=0.059). There were no VSR pts with stent fracture and only 1 had moderate PR on follow-up. Conclusion: We demonstrated excellent procedural and short term success in all pts despite absence of pre-stenting in the majority of pts. Patients with VSR and no pre-stenting had better or comparable hemodynamic results and no stent fractures at short term follow-up. Pts with VSR may not require pre-stenting prior to MVI.
Abstract 13981: Predictive Value of Local Prolonged Electro-Mechanical Interval in the Concealed Stage of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Authors: Thomas P Mast, Arco J Teske, Anneline S Te Riele, Judith A Groeneweg, Crystal Tichnell, Brittney Murray, Harikrishna Tandri, Jeroen F van der Heijden, Birgitta K Velthuis, Peter Loh, Pieter A Doevendans, D Dooijes, Toon A van Veen, Jaques M de Bakker, Ted P Abraham, Cynthia A James, Hugh Calkins, Richard N Hauer, Maarten J Cramer
Journal: Circulation (2015)

Introduction: The concealed stage of ARVD/C is associated with increased risk of life-threatening arrhythmias. However, presymptomatic arrhythmic risk stratification of ARVD/C mutation carriers is challenging. Activation delay is a hallmark of arrhythmogenesis. Deformation imaging may unmask activation delay in the absence of ECG and structural abnormalities. Methods: From the merged transatlantic ARVD/C database three groups were compared 1) mutation-positive definite ARVD/C patients (n=108), 2) asymptomatic mutation carriers (AMC) not fulfilling Task-Force criteria (TFC) and without history of ventricular arrhythmias (n=35) and 3) healthy controls (n=50). All underwent echocardiographic deformation imaging and ECG according to TFC. As a surrogate for local activation delay the electro-mechanical interval (EMI) was measured, defined as time between first ECG-detected deflection and local onset of shortening. Arrhythmic outcome (PVC count, VT) of AMC was correlated to EMI and ECG TFC. Results: EMI was prolonged in all RV segments in ARVD/C patients. In AMC prolonged EMI was detected in the subtricuspid area in 17/35 subjects, Terminal Activation Duration ≥ 55ms was the only TFC-defined ECG abnormality found in this group (9/35). After a mean follow-up of 3.1±2.7 years 11/35 subjects experienced an increase in ventricular arrhythmia burden. Prolonged subtricuspid EMI was the only parameter significantly correlated to ventricular arrhythmias during follow-up (Figure 1). Conclusions: Deformation imaging reveals activation delay in all ARVD/C patients. In AMC prolonged EMI in the subtricuspid area is often detected without any additional abnormalities. Prolonged EMI is a new parameter unmasking activation delay in early ARVD/C stages and may contribute to risk stratification.
Abstract 13951: Right Anterior Oblique in Addition to Left Anterior Oblique Projections Are Useful to Implant Right Ventricular Pacemaker Lead Into Mid-Septum and Achieve More Physiological Pacing
Authors: Akihiro Tanaka, Masami Nishino, Naotaka Okamoto, Naoki Mori, Nobuhiko Makino, Yasuyuki Egami, Ryu Shutta, Jun Tanouchi
Journal: Circulation (2015)

Introduction: It has been reported that it is difficult to implant right ventricular (RV) leads to the true mid-septum using conventional fluoroscopic criteria. Thus, we investigated which is the best method to achieve the true RV mid-septum using 3 dimensions (3D) reconstruction of 64-slice multidetector computed tomography (64 MDCT). Methods and Results: We retrospectively analyzed 33 patients in whom we intended to place RV lead into the septum using conventional fluoroscopic criteria, 40 degree left anterior oblique (LAO40), and performed 64 MDCT later. 3D reconstruction of 64 MDCT revealed that the right ventricular lead was anchored on the true mid-septum in 10 patients (only 30%; MS group, n=10), anterior wall in 19 patients, and free wall in 4 patients (non-MS group, n=23). After implantation of the pacemaker, we evaluated the predictive value of MS group when we used electrocardiography criteria (q wave or negative QRS complex in lead I), 90 degree left lateral (LL90) view and 30 degree right anterior oblique (RAO30) view using 3D reconstruction of 64 MDCT in addition to LAO view. As shown in a table, the method using both LAO and RAO views was the best to achieve the true RV mid-septum among these methods. MS group had significantly shorter paced QRS duration and ΔQRS (paced QRS-own QRS) than non-MS group (139±21.9ms vs. 155.3±10.9ms, p=0.03 and 24.2±21.2ms vs. 55.5±9.1ms, p=0.0001). Conclusions: The true mid-septum RV pacing could achieve more physiological pacing. Not only confirming rightward orientation in LAO view but also aiming the middle of the cardiac silhouette in the RAO view may be a simple and accurate way to achieve the true RV mid-septum positioning.
Abstract 13093: An Imbalance in Cardiomyocyte Glucocorticoid and Mineralocorticoid Receptor Signaling Leads to Heart Failure
Authors: Robert H Oakley, Diana Cruz-Topete, Julie F Foley, Page H Myers, Bo He, Elizabeth Murphy, Pierre Chambon, Monte S Willis, John A Cidlowski
Journal: Circulation (2016)

Stress is increasingly associated with adverse cardiac outcomes; however the mechanisms underlying these effects are poorly understood. Glucocorticoids are primary stress hormones that regulate cell and tissue homeostasis through two closely related nuclear receptors, the glucocorticoid receptor (GR) and mineralocorticoid receptor (MR). Cardiomyocytes express both these receptors but little is known concerning their coordinated actions in heart physiology and whether an imbalance in their signaling contributes to cardiac disease. Here, we show that patients with failing hearts have a disparity in the relative levels of GR and MR compared to non-failing donor hearts. To examine the in vivo function of glucocorticoid signaling in the heart, we generated mice with cardiomyocyte-specific deletion of GR (cardioGRKO), MR (cardioMRKO), or both GR and MR (cardioGRMRdKO). The cardioMRKO mice exhibited normal heart function whereas the cardioGRKO mice spontaneously developed cardiac hypertrophy and left ventricular systolic dysfunction. Surprisingly, the cardioGRMRdKO mice were protected from the cardiac disease observed for the cardioGRKO mice. At a molecular level, pathological gene changes present in the GR deficient hearts were also found in the double knockout hearts whereas specific cardioprotective gene changes were detected only in hearts from the cardioGRMRdKO mice. Re-installation of MR into the cardioGRMRdKO hearts by adeno-associated virus gene delivery reversed these cardioprotective gene changes and resulted in cardiac dysfunction. These findings reveal critical gene-regulatory roles for both GR and MR in the heart and suggest that an imbalance in these two signaling pathways leads to heart disease. Therapies designed to modulate cardiomyocyte glucocorticoid signaling to favor more GR and less MR activity may provide new approaches for treating the failing heart.
Abstract 18887: Ruboxistaurin Improves Cardiac Function in the Swine Heart After Myocardial Infarction
Authors: Thomas E Sharp, Maria C Scimia, Remus M Berretta, Timothy Starosta, Jeffery D Molkentin, Steven R Houser
Journal: Circulation (2013)

Introduction: Myocardial Infarction (MI) is a major health problem that causes cardiac dysfunction and often leads to heart failure. Previously, we and others have demonstrated that protein kinase C alpha (PKCα) activity is up-regulated in cardiac disease. This enhanced PKCα activity has been linked to depressed cardiac contractility in the diseased heart. In the present study we tested the effects of Ruboxistaurin, a PKCα inhibitor, on cardiac contractile function in a swine MI model. Hypothesis: Increased PKCα activity is involved in the progression of myocardial contractility defects in the post MI heart. Methods and Results: MI was induced in female Göttingen mini- pigs (6-7 months of age) by occlusion of the left anterior descending coronary artery (LAD) using an inflated percutaneous transluminal coronary angioplasty (PTCA) balloon for 90 minutes, followed by reperfusion. Cardiac structure and function was evaluated using echocardiography before and 4, 8, and 12 weeks post MI. During the 12 weeks after MI there was a progressive depression of pump function (Ejection Fraction [EF] 66.52% ± 1.16 [baseline] to 32.66 % ± 1.02 [12 weeks after MI] p &lt;0.0001) and dilation of the LV volumes (End-diastolic volume [EDV] was 40.38 ml ± 3.01[baseline] to 75.73 ml ± 3.18 [12 weeks post MI] p = 0.0123 and End-systolic volume [ESV] was 15.14 ml ± 2.32 to 50.75 ml ± 1.86 p= 0.0004). The acute inotropic effects of an oral dose of ruboxistaurin (20mg/kg) were tested in animals 12 weeks post MI. Ruboxistaurin treatment significantly increased EF (from 32.66% ± 1.02 to 41.43% ± 2.87 p =0.0282). Ruboxistaurin treatment also significantly reduced EDV and ESV (from 75.73 ml ± 3.18 to 63.58 ml ± 4.06 p =0.0494, and from 50.75 ml ± 1.86 to 37.45 ml ± 3.52 p =0.0156 respectively). Conclusion: These data show that acute administration of the PKCα inhibitor ruboxistaurin can increase cardiac contractility and reduce heart size in swine with post MI cardiac dysfunction. These results suggest that PKCα activity suppresses cardiac contractile function and that removal of this inhibitory activity enhances cardiac pump function.
Abstract 13870: Routine Follow Up Coronary Angiography versus Clinical Follow Up Only in Patients With Multi-vessel Disease Following Percutaneous Coronary Intervention With Drug-eluting Stents: 3-year Clinical Follow Up Results
Authors: Seung Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
Journal: Circulation (2015)

Background: It is unclear whether the routine follow up (FU) coronary angiography (CAG) regardless of patient’s symptoms after successful percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) in patients (pts) with multi-vessel disease (MVD) is beneficial or not. Methods: The study population consisted of 642 consecutive MVD pts underwent PCI with unrestricted utilization of DESs from January 2004 to May 2011. Routine FU CAG was performed between 6 to 9 months following index PCI and was decided by individual physician’s discretion. Rests of the pts were clinically followed and ischemic driven events were captured. Clinical events including mortality, myocardial infarction and clinically driven PCI before 9 months were excluded in both groups. Cumulative clinical outcomes up to 3 years were compared between the Routine CAG group (n=374 pts) and the Clinical FU group (n= 268 pts). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model. Results: After PSM analysis, 2 propensity-matched groups (193 pairs, n = 386 pts, C-statistic=0.744) were generated and the baseline characteristics of the two groups were balanced. At 3 years, the incidence of target lesion revascularization (TLR) and target vessel revascularization (TVR) and major adverse cardiac events (MACEs) was higher in the Routine CAG group than the control group (Table). Conclusions: Despite the expected beneficial effects, routine FU CAG following index PCI with DESs in MVD pts was associated with higher incidence of repeat PCI including TLR and TVR and MACE up to 3 years.