tbuckley/cabot-search huggingface dataset:
Abstract 4144382: Covering or Encircling the Fibrotic Substrate in the Left Atrium: Does it Matter? Insights from DECAAF II
Authors: ghassan bidaoui, Han Feng, Mayana Bsoul, Ala' Assaf, Hadi Younes, Nour Chouman, Francisco Tirado Polo, Yingshuo Liu, Yishi Jia, Chanho Lim, Abboud Hassan, Eli Tsakiris, Joe Abi-Rached, Yanpei Hui, Besim Ademi, Mario Mekhael, Charbel Noujaim, Swati Rao, Omar Kreidieh, Amitabh Pandey, eoin donnellan, Nassir Marrouche
Journal: Circulation (2024)

Background: Left atrial fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The optimal way to target atrial fibrosis has not been determined still. Purpose: The aim of this study is to determine whether left atrial fibrosis, as detected by late gadolinium enhancement MRI (LGE-MRI), should be covered, encircled, or both, in addition to PVI, to improve ablation success in patients with persistent AF. Methods: We conducted an analysis of DECAAF II participants who were randomized to the PVI plus MRI-guided atrial fibrosis ablation arm. These patients underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. Left atrial ablation lesions were collected from intra-procedural electro-anatomical maps and were superposed on 3D left atrial MRI images of fibrosis. We divided the patients into three groups based on whether atrial fibrosis was covered, encircled, or both. After ablation, patients were instructed to provide single-lead smartphone-based ECG strips once daily and following symptoms based on which AF burden and recurrence after ablation was assessed. Uni- and multivariable regression models were developed to assess the association of the technique used with time-to-atrial arrhythmia recurrence. Results: 393 patients were included in our analyses. At baseline, patients were similar in comorbidity burden, age, sex, and left atrial volume. However, baseline fibrosis was different amongst the groups (19% vs 18% vs 20%; p-value=0.02). LA volume decrease was higher when atrial fibrosis was both encircled and covered simultaneously (31 mm3 vs 21 mm&lt;span style="font-size:10.8333px"&gt;3&lt;/span&gt; vs 23 mm&lt;span style="font-size:10.8333px"&gt;3&lt;/span&gt;; p= 0.006). The primary outcome of atrial arrhythmia recurrence was similar among all the groups as shown in figure A (p=0.17). Even after controlling for possible confounders such as age, body mass index, sex, comorbidities, left atrial volume index, and baseline fibrosis, the technique used to target atrial fibrosis was not associated with recurrence (p=0.07). Moreover, AF burden in the follow-up period was not different across the patient groups as shown in figure B (p=0.63). Conclusion: Among patients with persistent AF, neither covering nor encircling atrial fibrosis in addition to PVI affected atrial arrhythmia recurrence after catheter ablation. More studies should be done to optimize atrial fibrosis targeting and modification.
Abstract 4144416: Long-Term Cumulative LDL-C Exposure and ASCVD Events in Young Adults with CAC=0: Insights from the CARDIA Study
Authors: Allison Peng, Alexander Razavi, Tia Bimal, Maya Rubin, Norrina Allen, John Wilkins, Laurence Sperling, Jamal Rana, Seamus Whelton, Michael Blaha, Roger Blumenthal, Eugenia Gianos
Journal: Circulation (2024)

Introduction Cumulative exposure to LDL-C over time is independently associated with incident atherosclerotic cardiovascular disease (ASCVD), while the absence of coronary artery calcium (CAC) is associated with a low risk of ASCVD events regardless of baseline LDL-C. Whether cumulative LDL-C exposure influences clinical risk stratification in individuals with CAC=0 is unknown. Objectives: To assess whether cumulative LDL-C exposure in young adults with CAC=0 was associated with incident ASCVD events or future conversion to CAC&gt;0. Methods: This analysis included Coronary Artery Risk Development in Young Adults (CARDIA) participants who underwent CAC scans at year 15 (Y15) (n=3043) or Y25 (n=3189) with measures of LDL-C from Y0 (baseline), 2, 5, 7, 10, 15, 20, 25, 30, and 35. Of those with CAC measured at Y15 and Y25, 2734 (89.9%) and 2282 (71.6%) had CAC=0, respectively. Cumulative LDL-C exposure was calculated using area under the curve (LDL-AUC) for three different time intervals: Y0-15, Y0-25, and Y15-25. Univariate and multivariate Cox regression models (adjusted for age, sex, race, and traditional ASCVD risk factors) were used to determine the association of LDL-AUC (per 100 mg/dL x years) with incident fatal and non-fatal ASCVD events with mean follow-up time 19.1 years after Y15 and 9.7 years after Y25. Logistic regression was used to measure the association of LDL-AUC with conversion from CAC=0 to CAC&gt;0. Results: Of those with CAC=0 at Y15 (58% female, mean age 40 years) and Y25 (65% female, mean age 50 years), the event rate was 2.8 and 3.0 per 1000 person-years, respectively. After multivariate adjustment, LDL-AUC [Y0-15] in individuals with CAC=0 at Y15 was not associated with a significant increase in risk for ASCVD events (HR 1.01, 95% CI: 0.97-1.05). LDL-AUC [Y0-25] was associated with a significantly increased risk for ASCVD events after multivariate adjustment in those with persistent CAC=0 at Y25 (HR 1.05, 95% CI: 1.01-1.09). There was a significant association between LDL-AUC [Y15-25] and conversion from CAC=0 at Y15 to CAC&gt;0 at Y25 (OR 1.10, 95% CI: 1.05-1.14). Conclusions: In young adults with CAC=0, long-term cumulative exposure to LDL-C remains independently associated with a significant increase in ASCVD events and development of future CAC. While the risk of cardiovascular events is low for those with CAC=0, risk is detectable over longer exposure to greater cumulative LDL-C, confirming the continued importance of long-term LDL-C control.
Abstract 4144323: Does Location Matter? Comparison of Myocardial Substrate in Patients with Non-Ischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation
Authors: Kirtivardhan Vashistha, Abhishek Maan, Seth Newman, Jacqueline Mirza, Srilakshmi Garikapati, Eric Stanton, Sakshum Chadha, Daniel Musikantow, Mohit Turagam, jacob Koruth, William Whang, Marc Miller, Joshua Lampert, Srinivas Dukkipati, Vivek Reddy
Journal: Circulation (2024)

Background: Although there is an association between scar burden and an increased risk of recurrent arrhythmic events; but there is a limited data on the location of myocardial substrate and its association with the stage of non-ischemic cardiomyopathy (NICM) assessed by left ventricular ejection fraction (LVEF). Hypothesis: Location and extent of arrhythmogenic scar burden in patients with NICM represent the progression of the disease. Aim: To evaluate: Association of location and extent of myocardial substrate (Isolated Septal vs. Septal and Non-Septal involvement) with LVEF. Comparison of arrhythmic burden according to location of the myocardial substrate based on findings during VT ablation. Methods: We performed retrospective data collection in patients with NICM who underwent VT ablation procedure and stratified them according to EF of &lt; 35% vs. &gt; 35%. For the initial analysis, we compared the location of myocardial substrate (Isolated septal vs. Septal + Non-Septal involvement) assessed with the use of Cardiac magnetic resonance imaging (cMRI) and electroanatomical mapping. We also compared the number of distinct mmVT morphologies induced during ablation according to the location of the myocardial substrate. Results: We analyzed a total of 183 consecutive patients with NICM who underwent VT ablation during the time frame of 11/2016 to 11/2023 and had cMRI with mapping data available. The mean age of patients in our study cohort was 60.9 years (IQR 53-71) and 20.7% of population were females the mean LVEF in study was 39%. Isolated septal involvement was more common in patients with LVEF &gt; 35% than the patients with LVEF &lt; 35% (32.3% vs. 25.3%, p = 0.04). Despite isolated septal involvement, the total number of distinct mmVT induced during VT ablation were similar to the group with Septal + Non-septal involvement. (2.03 vs. 1.82, p = 0.22) Conclusion: Our results suggest a temporal involvement in the extent of arrhythmogenic substrate as in; septal involvement might represent an earlier stage in NICM patients. Despite the finding, isolated septal involvement seemed to have an equivalent risk as an arrhythmogenic VT substrate based on the findings of distinct morphologies of mmVT induced during ablation.
Abstract 4144425: Identification and Management Practices of MINOCA at a Tertiary Care Center
Authors: Kathryn Manalo, Xiarepati Tieliwaerdi, Alexis Arrigo, Yochitha Pulipati, Sanchaya Khetrapal, Andrew Oehler
Journal: Circulation (2024)

Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is an ischemic cause of chest pain with normal appearing coronary vessels on angiography. The prognosis for these patients is extremely dependent on etiology highlighting the importance for appropriate evaluation. Currently, several imaging modalities have been useful in diagnostic workup, however no diagnostic guidelines have been developed. As a result, many patients are likely not getting proper evaluation. The study's main objective is to observe practice variations in the diagnostic evaluation for patients meeting criteria for MINOCA. A review of electronic medical records of patients presenting to a tertiary care center between Jan 2018 – Dec 2022 for chest pain who were referred for left heart catheterization was performed. Patients with prior history of obstructive CAD, whose imaging evaluation uncovered obstructive stenosis or had stenosis &gt;50% as measured on LHC were excluded. Next, patients diagnosed with a nonischemic cause of hospital presentation were excluded. Examples of nonischemic etiologies include stress induced cardiomyopathy, myocarditis and pulmonary embolism. Data regarding medical management and follow-up imaging were collected. A total of 2,763 patients were reviewed. Among them, 168 patients met the exclusion criteria. Approximately 60% (n=101) of patients were female with an average age of 60 years. Medical management with aspirin (n=123), DAPT (n=22), beta-blocker (n=98), calcium channel blocker (n=58), statin (n=130), anti-anginal therapy (n=55), diuretics (n=47), and ACEi/ARB (n=69) were observed. Additional imaging was seen in only 26% of patients. The imaging modalities used were cardiac MRI (cMRI), fractional flow reserve (FFR) and intravascular ultrasound (IVUS). The most common imaging modality was cMRI (n=35), followed by FFR (n=8) and IVUS (n=1). MINOCA was identified in 6% of patients presenting with AMI and was primarily comprised of women, which is consistent with other reported figures. Our data demonstrates that nearly 75% of these patients were placed on medical therapy without further evaluation. MINOCA is a diagnosis with multiple pathophysiological etiologies that requires thorough workup including additional imaging for complete evaluation. This study demonstrates the importance of considering MINOCA as a potential diagnosis in patients presenting with AMI and the need for guidelines on its evaluation.
Abstract 4144260: Diversity is Essential in Cardiovascular Medicine and Subspecialties: A Comprehensive Report of Gender, Racial, and Ethnic Representation among Cardiovascular Fellows from 2005 to 2022
Authors: Omar Obeidat, Saeed Abughazaleh, Mohammad Tarawneh, Nausheen Akhter, ann tong
Journal: Circulation (2024)

Introduction: The diversity of the healthcare workforce is essential for equitable and effective patient care. This comprehensive report analyzes the representation trends among cardiovascular fellows in the US over an 18-year period, focusing on gender, racial, and ethnic representation. Methods: Utilizing data from the National Graduate Medical Education Census, this study analyzes trends in representation across gender, race, and ethnicity among cardiovascular medicine fellows. It examines the expansion of cardiology programs and fellow positions in specialties, assessing the evolution of diversity between 2005 and 2022 using J point trend analysis software. Results: Growth Trends in Cardiology Specialties (2005-2022): Cardiology exhibited significant growth, with an AAPC of 2.6% for programs and 2.0-3.2% for fellow positions. IC showed an AAPC of 2.0% for programs and 2.8% for fellow positions. EP had a lower AAPC for programs (1.7%) but a higher rate for fellow positions (5.2%). Gender Disparities: Women constituted 22% in CVM, 12.3% in EP, and 11% in IC. Despite these disparities, there was a promising increase in the representation of women over time, with a higher AAPC for women compared to men, indicating a shift towards greater gender diversity. Racial and Ethnic Composition and Trends: White and Asian fellows accounted for over 70% of the total, while Black and Hispanic fellows made up less than 12%. The representation of White fellows decreased significantly, while Black fellows showed a significant increase in CVM. Hispanic fellows did not exhibit a significant increase and even showed a decrease in IC. Medical School Backgrounds: USMDs comprised the majority of fellows, but DOs displayed the highest growth rate, particularly in EP (AAPC of 7.9%). IMGs had the highest AAPC in IC at 4%. Conclusion: Our analysis revealed continued racial and gender disparities in the cardiology specialty. This report calls for concerted efforts from academic institutions, healthcare organizations, and policymakers to implement effective strategies for diversity and inclusion, reflecting the aim of creating a workforce that mirrors the diversity of the population it serves.
Abstract 4144326: Mid-Term Outcomes of Surgical Resection of Pediatric Cardiac Fibroma and Modified Ventricular Reconstruction Procedure
Authors: Zheng Dou, Shoujun Li
Journal: Circulation (2024)

Introduction: Primary cardiac fibroma (CF) was the second most common type of cardiac tumor, with surgical resection being the optimal strategy. However, as the tumor grew, a larger tumor also presented challenges during surgery. Particularly when compared to adults, children have smaller ventricles and thinner ventricular walls. The integrity of the ventricular wall decreased after the resection of large occupation, leading to reduced ventricular function or complications such as ventricular aneurysms. This study presents a single-center retrospective review of pediatric CF cases in our hospital, and presented the outcomes of our modified ventricular reconstruction procedure. Methods: We retrospectively reviewed pediatric patients under the age of 14 underwent CF resection and modified ventricular reconstruction procedure from January 2018 to December 2023, excluding metastatic cardiac tumors. 2 steps were performed during modified ventricular reconstruction procedure. Step 1: interventricular septum reconstruction. For larger defects, two pericardial stripes were used to clamp the defect on both sides of the endocardium and then running sutured, while primary closure for smaller ones. Step 2: free wall reconstruction. Two pericardial stripes were used to clamp resection margin on ventricular free wall and then running sutured. Results: 10 (58.9%) boys and 7 girls were included in this study, with a median age at surgery of 28.8 (7.8, 48.3) months and a median body weight of 13.0 (8.9, 15.3) kg. 7 patients had a tumor index (TI, the longest diameter of the cardiac tumor divided by the body surface area) greater than 10, with one patient reaching an exaggerated value of 22.1. During a median follow-up period of 17.4 months, no deaths, left ventricular failure, malignant arrhythmias, tumor recurrence were observed in the other patients. Conclusion: Our modified ventricular reconstruction procedure has proven successful. It has changed the fate of young patients with large tumors who would have otherwise needed heart transplants, offering high suture strength and reducing postoperative complications. Moreover, its relatively straightforward surgical approach facilitates learning and implementation in different centers.
Abstract 4144473: Effect of Obesity on Cardiovascular Remodeling and Aerobic Capacity in Adults with Coarctation of Aorta
Authors: Andrea Hsu, Ahmed Ali, Snigdha Karnakoti, Alexander Egbe
Journal: Circulation (2024)

Background: We hypothesized that patients with coarctation of aorta (COA) and obesity would have more advanced cardiovascular remodeling and impaired aerobic capacity compared to COA patients without obesity. The purpose of this study was to assess the relationship between obesity, cardiovascular remodeling, and aerobic capacity in adults with repaired COA. Methods: The study comprised of 3 groups: (1) Obese COA group (n=177) (COA patients with body mass index [BMI] &gt;30 kg/m2); (2) Non-obese COA group (n=572) (COA patients with BMI ≤30 kg/m2); (3) Control group (n=59) (subjects without structural heart disease and BMI ≤30 kg/m2). Cardiovascular remodeling was assessed using the following indices: (1) Arterial stiffness - total arterial compliance index (TACI). (2) Left ventricular hypertrophy - LV mass (LVM) and relative wall thickness (RWT). (3) LV diastolic function - Doppler-derived estimated LV end-diastolic pressure (LVEDP) and Tau. (4) Right ventricular-pulmonary artery coupling - RV free wall strain and right ventricle systolic pressure (RVFW/RVSP). Aerobic capacity was assessed using predicted peak oxygen consumption (VO2). Results: The obese COA group had higher LVM, RWT, LVEDP, and Tau, well as lower RVFWS/RVSP, TACI and peak VO2 compared to non-obese COA group and controls. There was a correlation between BMI and LVM (r=0.39, p&lt;0.001), RWT (r=0.47, p&lt;0.001), estimated LVEDP (r=0.43, p&lt;0.001), tau (r=0.22, p=0.008), RVFWS/RVSP (r=- 0.24, p&lt;0.001), and predicted peak VO2 (r= -0.48, p&lt;0.001). Conclusions: These findings underscore the cardiovascular implications of obesity in the setting of COA, and provide opportunities for interventions to address obesity and improve outcomes in the COA population.
Abstract 4144270: Air purification with portable air cleaners and its effect on blood pressure : An updated systematic review and meta-analysis of 21 studies.
Authors: Shrouk Ramadan, Ahmed Mohamed, Hossam Elbenawi, Raneem Afify, Mariam Desouki, Ibrahim Elkhayat, Amr Ossama Gaber Arafa, Mohamed Elnady, Mahmoud Mohamed Elshafey Shams, Mahmoud Elesawy, Ahmed Abdelaziz
Journal: Circulation (2024)

Background: Air pollution is a leading cause of cardiovascular diseases including ischemic heart disease and stroke contributing to millions of deaths, with elevated blood pressure, endothelial dysfunction, and systemic inflammation being some of the most important underlying mechanisms. Various studies showed a promising beneficial effect of indoor air purification on various health outcomes, including blood pressure. We aimed to assess the effect of indoor air purification on systolic blood pressure (SBP) and Diastolic blood pressure (DBP) and provide a rationale for home use of these filters. Methods: We searched PubMed, Web of Science, Cochrane and Scopus for published literature up to May 2024. We included studies that assessed air purification, including HEPA filters or electrostatic air filters, as an intervention compared to no intervention. The primary outcome of interest was mean changes in blood pressure both systolic and diastolic. Secondary outcomes were biomarkers of inflammation and oxidative stress. Mean difference (MD) and 95% CI was used in a fixed-effect model to analyze the data. Results: A total of 21 studies were included in our meta-analysis with a total of 1955 participants. Air purification was associated with a significant reduction in systolic blood pressure (SBP) (MD: -2.42, 95% CI: -3.42, -1.41), and diastolic blood pressure (DBP) (MD: -1.11, 95% CI: -1.76, -0.46). However, there was no significant changes in levels of inflammatory biomarkers or oxidative stress. Conclusion: Indoor air purification was associated with significant reductions in systolic and diastolic blood pressure levels, but questions arise whether these reductions are clinically relevant or not. Further studies should assess these findings. Conclusion: Indoor air purification was associated with significant reductions in systolic and diastolic blood pressure levels, but questions arise whether these reductions are clinically relevant or not. Further studies should assess these findings.
Abstract 4144289: Left atrial appendage isolation in catheter ablation of atrial fibrillation: An updated systematic review and meta-analysis.
Authors: Ahmed Mohamed, Mahmoud Elesawy, Raneem Afify, Shrouk Ramadan, Mariam Desouki, Mohamed Elnady, Mahmoud Mohamed Elshafey Shams, Ibrahim Elkhayat, Hossam Elbenawi, Amr Ossama Gaber Arafa, Ahmed Abdelaziz
Journal: Circulation (2024)

Introduction: Atrial fibrillation is the most encountered arrhythmia in clinical settings, with an estimate of 6 million cases in the United States. A growing amount of evidence has been supporting the role of left atrial appendage in left sided atrial fibrillation with conflict results. We aim in this study to provide a more in-depth guide for optimal left sided atrial fibrillation ablation strategy. Methods: We searched PubMed, Web of Science, Cochrane and Scopus for published studies until May 2024. We included relevant studies that compared the left atrial appendage electrical isolation versus the standard ablation and reported our outcomes of interest. The main outcomes of the study were the recurrence of atrial arrhythmia and the incidence of stroke or transient ischemic attack during the follow-up period. Data were pooled as Mean difference (MD) or risk ratio (RR) with their 95% CI using a fixed-effect model. Results: Eleven studies with 3040 patients were included in the final analysis. Left atrial appendage electrical isolation was associated with a significant reduction in atrial arrhythmia recurrence compared to the standard ablation alone (OR: 0.41, 95% CI: 0.35 to 0.48). However, it was also associated with a significant increase in stroke or transient ischemic attack incidence (OR: 1.48, 95% CI: 1.09 to 3.12). Conclusion: Left atrial appendage electrical isolation led to a significantly lower atrial arrhythmia recurrence, but this was achieved with an increased risk of stroke and transient ischemic attack incidence during the follow-up period.