tbuckley/cabot-search huggingface dataset:
Abstract 4143207: Time in Target Mean Arterial Pressure Range and Mortality in HeartMate 3 LVAD Recipients
Authors: Matthew Delfiner, Jason Miller, Jeffrey Snider, Michael Genuardi, Juan Ortega-Legaspi, Stuart Prenner, Kiran Sidhu, Himabindu Vidula
Journal: Circulation (2024)

Background: The HeartMate 3 Device (HM3) is an afterload-sensitive left ventricular assist device (LVAD). International guidelines suggest a target Doppler blood pressure (BP) range between 70-90 mmHg, though this recommendation is supported mostly by expert consensus. Optimal real-world data remains lacking regarding the ideal BP for these patients. Remote patient monitoring (RPM) can be utilized for outpatient Doppler blood pressure monitoring. We aimed to evaluate the association between time spent in goal BP range and mortality in HM3 LVAD recipients. Methods: 1,427 HM3 LVAD recipients from 74 centers using the ActiCare Health RPM system, which allows patients to measure Doppler BP and upload results to their care team, were included in this analysis. Inclusion criteria included patients with at least two BP measurements. Outpatient Doppler BP values were collected, and a standard therapeutic range (70–90 mmHg) was established. The percentage of time in the therapeutic range (TTR) was calculated, categorizing patients as ≥75%, 50-75%, and ≤50%. Survival at 600 days on LVAD support and reporting frequencies were compared between groups. Results: We studied 738 HM3 LVAD recipients, implanted from 2015 to 2024, with a mean duration of 715 ± 19 days on LVAD support. 140 (19%) patients died. A total of 144,562 Doppler BP readings were analyzed, with a mean value of 82.8 ± 0.02 mmHg. There were 481 patients with TTR ≥75% (65%), 138 patients with TTR 50-75% (19%), and 119 patients with TTR ≤50% (16%). There was a significantly greater probability of survival for those with TTR ≥75% compared to ≤50% (94% vs. 85% at 400 days and 88% vs. 84% at 600 days, p = 0.05, Figure). The mean number of BP submissions per 100 days for the ≥75% group was 37.8 ± 0.87, compared to 25.8 ± 0.87 in the 50-75% group and 21.7 ± 1.25 in the ≤50% group (p &lt; 0.001). Discussion: The data suggest that HM3 patients who spend more than 75% of the time with a Doppler BP between 70-90 mmHg have greater survival compared to those who are within range less than 50% of the time. RPM can be used for closer monitoring of Doppler BP in HM3 LVAD recipients. Patients with Doppler BP 70-90 mmHg may have improved survival.
Abstract 4143294: Pacing Towards a Better Future: A Case of Tailored Pacemaker Programming in HFrEF
Authors: Lana Mango, Ahmad Younis, Aseel Rizik, Dania AbuHawas, Ahmad Turk
Journal: Circulation (2024)

Introduction: Cardiac pacing devices, including Permanent Pacemakers (PPM) and Implanted Cardioverter Defibrillators (ICD), are essential in managing various cardiac conditions. Exercise capacity in patients hinges on both cardiac function enhancement and an appropriate chronotropic response. This case report underscores the strategic use of Cardiopulmonary Exercise Testing (CPET) to determine the activation of the Rate Response to Exercise (RRE) function in a patient with Heart Failure with reduced ejection fraction (HFrEF). Case Report: Our patient is a 64-year-old male with HFrEF due to hypertensive heart disease and ICD placement. He was undergoing therapy optimization at our advanced heart diseases clinic. Initially presenting with poor functional capacity, his condition improved significantly with ongoing therapy adjustments, as reflected by his KCCQ scores. This improvement enabled a comprehensive assessment using CPET. The initial CPET trial revealed moderately reduced exercise capacity and an absent chronotropic response, with a heart rate at 65 bpm and a peak VO2 of 67% predicted, categorizing him as Weber Class B. Based on these findings, we activated the RRE function and conducted a follow-up CPET. The re-evaluation demonstrated notable improvements: extended exercise duration post-anaerobic threshold, a peak VO2 of 72% predicted, and an upgraded Weber Class A status. Summary: This case exemplifies how tailored programming of pacing devices can significantly enhance exercise capacity in HF patients. Activating the RRE function in the patient's PPM led to marked improvements in exercise capacity and prognostic indicators derived from CPET parameters, corroborating the limited existing data on this approach. Although specific guidelines are lacking, our findings highlight the utility of CPET in customizing PPM settings, particularly for HFrEF patients. This report underscores the importance of individualized treatment and invites further research into optimizing device settings to maximize patient outcomes. Leveraging CPET in routine clinical practice could revolutionize heart failure management, offering a precise and patient-centric approach.
Abstract 4143351: Early experience with percutaneous insertion of pulmonary blood flow restrictors to allow deferral of Norwood surgery
Authors: Anagha Prasanna, Jeremy Fox, Paul Tannous, Conor Ohalloran, Osama Eltayeb, Michael Monge, Alan Nugent, Kiona Allen, Stuart Berger, David Winlaw
Journal: Circulation (2024)

Deferral of the Stage 1 Norwood Palliation (S1P) for infants with hypoplastic left heart syndrome and other high-risk features is sometimes accomplished using a hybrid approach involving external pulmonary artery (PA) banding. Recently, percutaneous restriction of pulmonary blood flow has been accomplished with off-label modification of microvascular plugs (Medtronic) to delay surgical intervention. This single-center, retrospective case series examines outcomes associated with PA flow restrictors in patients at both high and standard-risk for S1P. High-risk criteria included prematurity, birth weight less than 2.5 kg, moderate or greater atrioventricular valve regurgitation, highly restrictive atrial septum, and genetic comorbidities. Primary outcomes included death, need for extracorporeal membrane oxygenation (ECMO), PA re-intervention, and variation from expected pathway post bidirectional Glenn (BDG), which includes prolonged intubation (&gt;24 hours), persistent hypoxia (saturation &lt;75%), or prolonged hospital length of stay (&gt;14 days). From September 2023 to May 2024, bilateral PA flow restrictors were placed in 9 S1P-eligible neonates (Table 1). Two patients died with flow restrictors before S1P. One patient developed progressive heart failure and underwent a successful heart transplant after having PA flow restrictors in place for 200 days. The remaining 6 patients had a S1P operation with removal of flow restrictors and PA plasty at a median of 21 days post insertion and 25 days of life. Three patients required PA stents between S1P and BDG. Four patients have progressed to Glenn, all of whom had courses that significantly varied from the expected pathway, including 2 who required early PA stenting, 4 who had prolonged hospital stays, and 1 patient who died of multiorgan failure due to failed BDG circulation. Flow restrictors can delay surgical S1P in high-risk patients, allowing for evaluation of additional comorbidities. They are a useful adjunct to the management of high-risk patients prior to S1P. However, their use appears to be associated with an important rate of PA complications, resulting in significant variation from the expected clinical course and may impact later quality of BDG circulation.
Abstract 4143416: Optical Absorption Figure of Merit for Photoplethysmography-Based Cuffless Monitoring of Blood Pressure Varies Across a Diversity of Skin Tones in the Fitzpatrick Scale
Authors: Anna Trawick, Michael Aumer, Steven LeBoeuf, Asif Ali, Sami Farooqui, Yulissa Delgado, Jonathan Reyes-Rivera
Journal: Circulation (2024)

Introduction: Well-publicized studies have shown that photoplethysmography (PPG), a key technology for pulse oximeters and consumer wearables, may have limitations for users with darker skin tones. This study assessed the correlation between skin tone and figures of merit for PPG sensing in a multiwavelength, reflection-mode, fingertip-worn PPG device. The device measures optical signals on the underside of the hand, where melanin density is relatively low; thus, this study hypothesized that the figures of merit would show an insignificant correlation with skin tone. Methods and Results: A study at Houston Cardiology Consultants saw trained professionals tend to 174 participants (Table 1). Subjects wore a multiwavelength, reflection-mode, PPG-based fingertip sensor. Subject metadata, including skin tone, were collected manually. PPG datasets were analyzed by Valencell, Inc. using the company’s standard figures of merit: AC/DC ratio, Signal-to-Noise-And-Distortion (SINAD), and Relative Peak Ratio (RPR). SINAD and RPR represent motion-artifact resistance and hemodynamic consistency, respectively. The AC/DC ratio measures the strength of the pulsatile PPG waveform against unwanted optical scatter due to melanin and other skin chromophores. Using the Fitzpatrick Scale to quantify skin tone (Figure 1), its correlation with these figures of merit was assessed. No correlation was found between the Fitzpatrick value and SINAD or RPR across optical wavelengths. However, a strong correlation between the Fitzpatrick value and AC/DC ratio was observed for all wavelengths, with the green AC/DC ratio showing the highest correlation (Table 2). Conclusion: The observed disparity in AC/DC ratio with skin tone must be considered when developing PPG-based physiological monitors to ensure they operate effectively across all Fitzpatrick values, even when these monitors target skin regions with relatively low melanin density. Engineering approaches that rely solely on green wavelengths of light, the most commonly used in consumer wearables, will face greater challenges than those utilizing longer wavelengths.
Abstract 4143185: Association between Secondary Mitral Regurgitation and Left Atrial Structural Abnormalities in Atrial Fibrillation
Authors: Ahmad Kassar, Nadia Chamoun, Yaacoub Chahine, Nazem Akoum
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is increasingly recognized as a cause of secondary mitral regurgitation (SMR), exacerbating heart failure symptoms and complicating the management of AF. Hypothesis: SMR quantified using cardiac magnetic resonance (CMR) 4D flow is associated with left atrial (LA) structural derangements in patients with AF. Goals: To demonstrate an association between the atrial volume and fibrosis with mitral regurgitation severity Methods: Patients were recruited from the University of Washington Medical Center AF clinics. CMR was used to quantify LA fibrosis through late gadolinium enhancement, LA emptying fraction (LAEF), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF) (Panel A). Total mitral valve flow, regurgitant fraction, and peak velocity were quantified using CMR-derived 4D flow and cine images (Panel B). Patients with valvular disease (rheumatic valvular disease and prosthetic valves) were excluded from the analysis. Results: A total of 44 patients were included (71 years (64-76), 39% with persistent AF, BMI 28.8 kg/m 2 ± 6.2, 45% females, 43% hypertensive, and 20% with a history of heart failure). 4D flow quantified MR was at 14% (3.7-45) which represented the median percentage of mitral regurgitant flow (MR flow/Total Mitral Flow), total mitral flow 29.2 mL (14.2-60.8), and peak velocity 194.5 cm/s ± 72.6. Using CMR cine images, median LVEF was 62.4% (56.4-66), heart rate was 65 bpm (49.5-75), left atrial volume was 97.3±39.3 mL, LAEF was 42.4±18.5%, and LVEDV was 146±44.6 mL. Left atrial fibrosis was 14.0% ± 7.9. Using multivariable linear regression, there was a significant association between LA volume and MR fraction (β = 0.35, p=0.04) after adjusting for peak velocity, LAEF, fibrosis, LVEDV, LVEF, and HR. Moreover, there was an association between HR and MR fraction (β = -0.3; p=0.04) and between total mitral flow and MR fraction (β = -0.78; p&lt;0.001). Conclusion: In a cohort of AF patients without primary valvular abnormalities, secondary mitral regurgitation quantified using 4D flow CMR was associated with advanced atrial remodeling manifesting through LA volume increase.
Abstract 4143361: Digoxin ameliorates endothelial senescence, restores functional endothelial-subcutaneous adipocyte crosstalk and enhances glucose homeostasis in type 2 diabetes mellitus
Authors: Oliver Brown, Katherine Bridge, Cheukyau Luk, Sam Straw, Natallia Makava, Pradeep Wijayagoonawardana, Muzahir Tayebjee, Christopher Saunderson, Michael Drozd, Alexander-Francisco Bruns, Natalie Haywood, Klaus Witte, John Gierula, Stephen Wheatcroft, Richard Cubbon, Mark Kearney
Journal: Circulation (2024)

Background: Normal subcutaneous adipose tissue (SAT) function is dependent on healthy endothelial function and microvascular expansion. In type 2 diabetes mellitus (DM) and heart failure (HF) this becomes synergistically dysregulated, resulting in inflamed, fibrotic and metabolically dysfunctional SAT and may drive HF progression in DM. Hyperinsulinemia is associated with adipocyte senescence, however the role of endothelial senescence in SAT and its therapeutic potential is unknown. Aims: We examine the presence and sequelae of SAT microvascular endothelial cell (SATMVEC) senescence and its effects on adipocyte function in people with DM. Next, we examine the therapeutic role of digoxin at targeting SATMVEC senescence, modulating SATMVEC-adipocyte crosstalk and restoring metabolic homeostasis. Methods: We took pectoral SAT biopsies from 59 patients with HF undergoing pacemaker implant of whom 25 (42%) had DM (HFDM). SATMVEC were isolated from SAT, treated with 1ng/mL digoxin vs control for 24 hours and then characterised for functional senescence. Crosstalk between SATMVEC and subcutaneous white adipocytes from a single healthy donor were examined using co-culture (Fig 1A). Paired digoxin vs control treated SATMVEC were co-cultured with adipocytes for 24 hours. Adipocyte health was assessed using 2-NBD-glucose uptake, RNA and protein expression. Results: Isolated SATMVEC from patients with HFDM had a senescent phenotype with increased senescence associated secretory phenotype (SASP) and senescence associated ß-gal expression (p&lt;0.05), reduced ATP production, proliferative capacity, and impaired angiogenesis (p&lt;0.05). Adipocytes co-cultured with SATMVEC from patients with HFDM had increased expression of IL-6 (Fig 1B) and reduced 2-NBD-glucose uptake (p&lt;0.05). Treatment of SATMVEC with digoxin reduced SATMVEC senescence (Fig 1C), increased adipocyte 2-NBD-glucose uptake (Figure 1D) and reduced IL-6 expression (p&lt;0.01). Conclusions: SATMVEC from patients with HFDM are senescent and when co-cultured with adipocytes, results in a proinflammatory adipocyte phenotype resistant to glucose uptake. Digoxin reduces SATMVEC senescence, restores adipocyte glucose homeostasis and may repair dysfunctional SAT in patients with HFDM.
Abstract 4143317: Left Atrial Reservoir Phase Duration and Long-Term Survival After Cardiac Resynchronization Therapy
Authors: Lars-Egil Hammersboen, John Aalen, Alexis Puvrez, Camilla Larsen, Espen Remme, Erik Kongsgaard, Jurgen Duchenne, Elena Galli, Faraz Khan, Ole Jakob Sletten, Martin Penicka, Erwan Donal, Jens-Uwe Voigt, Otto Smiseth, Marie Stugaard
Journal: Circulation (2024)

Background: Recent observations suggest that residual left atrial (LA) dyssynchrony after cardiac resynchronization therapy (CRT) may have prognostic significance. Since LA dyssynchrony implies prolongation of the LA reservoir phase, measuring the duration of the LA reservoir phase should offer similar prognostic information. Purpose: To investigate the impact of LA reservoir phase duration on long-term survival after CRT. Methods: In a recent prospective multicenter study of 168 patients, LA strain was measured by speckle-tracking echocardiography before and 7±1 months after CRT. LA reservoir strain was measured as the difference between peak and minimum global strain during the atrial cycle and LA reservoir phase duration as the time from onset shortening in the left ventricle to peak LA reservoir strain. Since LA reservoir strain &lt;18% is associated with elevated LV filling pressure, we used 18% as cutoff and for LA reservoir phase duration 516 ms in accordance with a Receiver Operating Curve. All-cause mortality was used as clinical endpoint during follow-up. Results: After 6.0±1.8 years follow-up, 35 (21%) patients had died. LA reservoir strain ≥18% after CRT was associated with favorable long-term survival (HR: 0.51, 95% CI: 0.26–0.98) (upper panel in the Figure). LA reservoir phase duration was not independently associated with survival. However, when used in patients with LA reservoir strain ≥18% after CRT, LA reservoir phase duration ≤516 ms identified patients with particularly excellent long-term survival (HR: 0.18, 95% CI: 0.05–0.63 vs patients with reservoir strain ≥18% and LA reservoir phase duration &gt;516 ms) (lower panel in the Figure). Patients with preserved LA reservoir strain but prolonged LA reservoir phase duration had similar outcome as patients with reduced LA reservoir strain (HR 1.10, 95% CI: 0.49–2.51). Conclusions: LA reservoir strain ≥18% combined with reservoir phase duration ≤516 ms is associated with excellent long-term survival after CRT. Prolonged reservoir phase duration is linked to adverse long-term outcomes in patients with preserved LA reservoir strain. Therefore, reservoir phase duration provides added value for risk prediction after CRT that may be clinically important.
Abstract 4143297: A Risk Prediction Score for Shockable Sudden Cardiac Arrest: Validation in the Framingham Heart Study
Authors: Thien Tan Tri Tai Truyen, Honghuang Lin, Marco Mathias, Harpriya Chugh, Kyndaron Reinier, Emelia Benjamin, Sumeet Chugh
Journal: Circulation (2024)

Introduction Individuals with shockable sudden cardiac arrest (SCA) have higher survival if treated with an implantable cardioverter defibrillator or automated external defibrillator. We previously developed VFRisk Score from an ongoing US West Coast study, which performs significantly better than left ventricular ejection fraction&lt;35% (C-statistic 0.81 vs 0.64). Hypothesis The VFRisk score predicts sudden cardiac death (SCD) in a US East Coast community-based cohort, the Framingham Heart Study (FHS). Methods: We performed a nested case-control study in the FHS to test VFRisk. Cases were subjects who suffered SCD among the Original and Offspring cohorts. Controls were randomly selected at a ratio of 1:3, matched on age, sex, cohort, and exam. Demographic features and comorbidities were assessed from the FHS exam closest to the SCD event. VFRisk was the sum of 13 risk factors, each multiplied by its respective coefficient including diabetes (1.4), myocardial infarction (MI, 1.4), atrial fibrillation (AF, 1.8), stroke (1.7), heart failure (HF, 2.1), chronic pulmonary disease (1.5), seizure disorder (3.5), syncope (2.8), heart rate ≥75 (1.5), prolonged QTc (1.7), Tpeak-end ≥90ms (1.7), delayed intrinsicoid deflection ≥50ms (2.1), and echocardiogram left ventricular hypertrophy (2.4). Intrinsicoid deflection was excluded due to data unavailability. Results: Among 312 cases and 935, mean ages were 69.5 and 69.7 years, respectively, with 70.8% male in both groups. SCD cases had a significantly higher prevalence of diabetes, HF, stroke, AF, and MI compared to the control group. The VFRisk score was replicated with good discrimination (C-statistic 0.71, 95% CI 0.66-0.77) for SCD. SCD cases had higher VFRisk scores than controls (3.8±2.8 vs. 1.8±1.7, p&lt;0.001). A 1-unit increase in VFRisk score was associated with a 48% increase of SCD (odds ratio 1.48; 95% CI 1.34-1.64). The highest risk score quartile was associated with 6-fold higher odds of SCD than the lowest quartile. Conclusion: The VFRisk score to predict shockable SCA was successfully replicated in the FHS. The differences in discrimination between the two studies could be explained by the inability to distinguish shockable versus non-shockable SCA in the FHS.
Abstract 4143426: Massage therapy for postoperative pain in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: Lucas Barbosa, Beatriz Araujo, Ivo Queiroz, Julia Mendes Barbosa, Yasmin Ferreira, Cynthia Mesquita
Journal: Circulation (2024)

Background: Massage therapy has been increasingly recognized as a complementary intervention that can help alleviate pain and anxiety in various clinical settings. However, the efficacy of this intervention in patients undergoing cardiac surgeries remains unclear. This systematic review and meta-analysis aims to evaluate the existing evidence of massage therapy for postoperative pain in cardiac surgery patients. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of massage therapy in patients undergoing cardiac surgeries. We pooled standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We utilized mean change from baseline values and post intervention values in separated plots to preserve the weighting of this meta-analysis. We performed a trial sequential analysis (TSA) to assess the random risk of postoperative pain with mean change from baseline values. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses. Results: Our meta-analysis included 12 RCTs comprising 1015 patients, of whom 484 (47.7%) were randomized to massage therapy. Compared with control, massage significant reduced postoperative pain based on mean change from baseline values (SMD -0.47; 95% CI: -0.73 to -0.21; p&lt;0.01; Figure A), and post intervention values (SMD -0.47; 95% CI: -0.82 to -0.12; p&lt;0.01; Figure B). Additionally, massage therapy demonstrated a significant reduction in postoperative anxiety analyzing mean change from baseline values (SMD -0.46; 95% CI: -0.73 to -0.20; p&lt;0.01; Figure C), and post intervention values (SMD -0.60; 95% CI: -0.94 to -0.26; p&lt;0.01; Figure D). For the primary endpoint, TSA indicated a low risk of type 1 error, therefore this result may not be conclusive. Conclusion: In patients undergoing cardiac surgery, massage therapy significantly reduced postoperative pain and anxiety.