tbuckley/cabot-search huggingface dataset:
Abstract 4145822: The Enigma of Chest Pain: Rare Presentation of ALCAPA Syndrome in a Young Adult
Authors: Baban Kumar, Taher Sbitli, Sabeeh Islam, Ashu Singh, Shaniza Haniff, Ashwin Shive Gowda, Adam Abbas, Akash Parashar
Journal: Circulation (2024)

Introduction: Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital anomaly(incidence:1 in 300,000 live births) typically presenting during infancy. Adult presentations are even rarer due to a high mortality rate of nearly 90% in the first year of life without surgical intervention. This report examines an adult patient with exercise-induced chest pain who received a delayed diagnosis of ALCAPA via multimodal imaging. Case Summary: A 21-year-old male presented to the emergency department(ED) with severe retrosternal chest pain radiating to both shoulders and arms, which began during exercise 30 minutes prior. He had a history of similar, milder episodes during exercise, previously treated as musculoskeletal pain and gastroesophageal reflux disease in the ED. His medical, social, and family histories were unremarkable. Physical examination revealed a soft, continuous murmur along the left sternal border. During this visit, An EKG done showed sinus tachycardia at 110 bpm and deep T-wave inversions in the anterolateral leads, a dynamic ST-T changes from his baseline.Serial Cardiac biomarkers and a lipid profile were within normal ranges. Initially managed for acute coronary syndrome-unstable angina with antithrombotic therapy, beta-blockers, and nitrates, he underwent urgent coronary angiography. This revealed a dilated right coronary artery (RCA) with retrograde flow to the left coronary artery (LCA) into the main pulmonary artery (PA) via collaterals, with no evidence of atherosclerosis (Figure 1).Echocardiography (Figure 2) and coronary CT angiography (Figure 3) confirmed the diagnosis of ALCAPA. The patient underwent successful surgical repair with aortic reimplantation of the LCA and was discharged in good health. Discussion: In adult ALCAPA patients, good collateral circulation may develop; however, myocardial ischemia can occur due to the "coronary steal phenomenon" and poor collateral flow regulation, leading to angina, arrhythmias, and sudden cardiac death. ALCAPA should be considered a differential diagnosis in adults presenting with exercise intolerance, as most sudden cardiac death cases occur by the fourth decade. A high index of clinical suspicion and a multimodality imaging approach is essential for the early diagnosis of this rare coronary anomaly, underscoring the critical role of early surgical intervention in preventing catastrophic, life-threatening events.
Abstract Su802: Feasibility of detecting CPR compression frequency using machine-learning software in video footage of CPR
Authors: Wolfgang Wetsch, Niels-Benjamin Adams, Michael Schmitz, Hannes Ecker
Journal: Circulation (2024)

Background: Several studies have demonstrated that video assisted cardiopulmonary resuscitation (V-CPR) is efficient in improving cardiopulmonary resuscitation (CPR) quality and patient outcome. However, currently the technique depends on 911 dispatchers who evaluate the video footage and may thus be subject to inter-operator variations. Research Question: We hypothesized that using an open-source machine learning supported software (“artificial intelligence” – AI) would be able to provide real-time feedback on CPR frequency in a video of CPR. Aims: To evaluate the feasibility and accuracy of a selected AI software to correctly detect the actual compression frequency in video footage of CPR performed in a CPR manikin. Methods: MediaPipe Pose Landmark Detection (Google LLC, Mountain View, CA, USA), an open-source AI software using machine-learning models to detect human body postures in images and videos, was programmed to assess compression frequency of nine videos showing CPR on a manikin, each with a different fixed compression frequency and compression depth. Camera angle and distance were standardized. Frequency was assessed from compression to compression with AI software and the manikin’s internal software (QCPR, Laerdal, Stavanger, Norway). After testing for Gaussian distribution, means were compared using Wilcoxon matched-pairs signed rank test. Results: There were high levels of agreement between compression frequencies derived from AI and manikin’s software (Statistic comparisons are presented in Figure 1, correlations of measurements are presented in Figure 2 ). Conclusions: In this pilot study, an open-source landmark detection AI software was able to assess CPR compression frequency with high agreement to actual frequency derived from a CPR manikin. Since the software used is currently not intended for medical use, further development is necessary before the technology can be evaluated for real-life CPR.
Abstract 4134309: From Heartache to Headache: Cryptococcal Meningitis Post-Heart Transplant in a Chronic Hepatitis B and Sarcoidosis Patient
Authors: Tyler Kingma, Kerry Singh, Andrew Feingold, Andrew Scatola
Journal: Circulation (2024)

Introduction: We report the case of a heart transplant patient on chronic immunosuppression diagnosed with cryptococcal meningitis. Up to 5% of solid organ transplant patients develop cryptococcosis, carrying a 50% mortality rate in central nervous system involvement. Case Presentation: This is a 57-year-old male with a past medical history of heart failure with reduced ejection fraction (HFrEF) status post orthotopic heart transplantation (on prednisone 7.5 mg daily, mycophenolate, tacrolimus and sirolimus), pulmonary sarcoid, and chronic hepatitis B (on tenofovir and entecavir) who presented with headache, nausea, vomiting and seizure-like activity. The patient’s heart rate was 129 beats per minute, blood pressure 188/92 mmHg, but was afebrile. He eventually underwent a lumbar puncture with the cerebrospinal fluid (CSF) positive for cryptococcal antigen (1:2560). The patient was started on liposomal amphotericin B and flucytosine. Mycophenolate and sirolimus were held in the setting of his infection. The patient’s hospital course was complicated by acute kidney injury likely secondary to elevated tacrolimus levels while on fluconazole. He was ultimately discharged with plans to repeat CSF studies as an outpatient. Discussion: Here we report a case of cryptococcal meningitis in a heart transplant patient in the context of pulmonary sarcoidosis, chronic hepatitis B and quadruple immunosuppression. Of note, as part of rejection surveillance, the patient undertook serial AlloSure and AlloMap testing. Sirolimus was added to his regimen due to persistently elevated AlloSure scores. Indeed, immunosuppressive agents are the leading risk factor for cryptococcosis in organ transplant patients. Our patient also has two important risk factors for cryptococcal infection. Firstly, sarcoidosis is associated with T-cell dysregulation, compromising cell-mediated immunity. Additionally, hepatitis B carriers have an increased predisposition for cryptococcal infections, notwithstanding that our patient had been on dual antiviral therapy. Conclusion: Quadruple immunosuppression in heart transplant patients, especially in the context of risk factors such as sarcoidosis and hepatitis B infection, can result in cryptococcal meningitis and should be considered in patients with suggestive symptoms. Effective prophylactic regimens for such higher risk patients may be a potential area for further investigation.
Abstract 4147606: The Risk of Cardiac Events Associated with Psychiatric Drugs in Patients with Long QT Syndrome.
Authors: Iuri Ferreira Felix, Vanessa Karlinski Vizentin, Raquel Neves, Sahej Bains, Johan Bos, John Giudicessi, Michael Ackerman
Journal: Circulation (2024)

Introduction: Long QT syndrome (LQTS) is a potentially life-threatening genetic heart disease. Patients with LQTS may also have co-existent mental health illnesses that may benefit from psychiatric medications. However, because many of these medications have QT-prolonging potential (www.crediblemeds.org), many of these patients receive suboptimal mental health care. Objective: To evaluate the frequency, management, and incidence of breakthrough cardiac events (BCEs) in patients with LQTS and concomitant mental health issues treated with psychiatric medications. Methods: A retrospective review was conducted on patients cared for in Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic between 2000 and 2024 focusing on patients with LQTS and a concomitant psychiatric diagnosis requiring medication with known, possible or conditional risk of torsades de pointes (TdP). Electronic medical records were reviewed for data. BCEs were defined as LQTS-triggered syncope, seizures, appropriate ICD therapy, sudden cardiac arrest (SCA), or sudden cardiac death (SCD). Patients with missing information were excluded. Results: Overall, 195 /1899 LQTS patients [10%, 86 (43%) with LQT1, 83 (42%) with LQT2, and 16 (8%) with LQT3] had a concomitant psychiatric diagnosis requiring medication [150 female (76%), mean age at diagnosis 27 ± 18 years, median follow-up time 6.6 years (IQR 2.9-13)]. The most common psychiatric conditions were depression (71%), anxiety (62%), and ADHD (9%). The mean duration of therapy was 3.36 +/- 3.48 years and the most common medications used were fluoxetine (26%), sertraline (14%), and escitalopram (11%). There was no significant difference in QTc after starting the first psychiatric medication when compared to baseline (473 ± 33 vs 474 ± 35 ms, p=0.6). Prior to their LQTS diagnosis and while therefore untreated, 61/195 (31%) had at least 1 LQTS-associated cardiac event. This occurred in the setting of a psychiatric drug in 7 patients (11%). Following LQTS diagnosis and treatment, 14/195 patients (7%) have experienced a non-lethal BCE of which only 3/14 (21%) while on psychiatric medications. Conclusions: Although avoidance of medications with known QT-prolonging potential is prudent, attention to patient’s overall well-being besides just their LQTS must be given. After correct diagnosis and treatment, LQTS patients with concomitant mental health issues may be safely and effectively treated with medications known to prolong QTc.
Abstract 4136926: Premature Ventricular Complexes and Nonsustained Ventricular Tachycardia in Cardiac Sarcoidosis
Authors: Jose de Melo, Julia Debertin, Matteo Castrichini, Andrew Rosenbaum, John Bois, Omar Abou-Ezzeddine, Suraj Kapa, Abhishek Deshmukh, Samuel Asirvatham, Konstantinos Siontis
Journal: Circulation (2024)

Introduction: The prevalence and prognostic significance of PVC and NSVT in cardiac sarcoidosis (CS), especially in patients with normal or mildly decreased LV function, are not well known and were investigated in the current study. Methods: We included 192 patients with definite and probable CS with LVEF&gt;35%, no prior history of VT/VF or sudden cardiac death, who underwent up to 48 hours of Holter monitoring. They were followed retrospectively for the composite endpoint of sustained VT/VF, advanced heart failure therapy, and all-cause mortality. We performed multivariable analysis for the association of PVC burden and NSVT with the composite endpoint. Covariates were considered if they were present in at least 95% of the study sample and were significantly associated with the composite endpoint in univariable analysis. Results: The median PVC burden in the overall population was 0.3% (IQR 0.02-2.5%) and 36 (18.8%) patients had a PVC burden ≥5%. Sixty-two (32.3%) patients had NSVT detected during monitoring. The PVC burden and prevalence of NSVT in patient subgroups are shown in Figures 1 and 2. A total of 33 (17.2%) patients experienced one of the composite endpoints at a median follow-up of 3 years. In the multivariable analysis (Figure 3), PVC burden ≥5% versus &lt;5% (HR 3.96 [1.19, 5.97], p-value &lt;0.01) and presence of NSVT (HR 4.55 [2.09, 9.94], p-value &lt;0.01) were associated with the composite outcome. Conclusion: Our results suggest that a high PVC burden and the presence of NSVT carry isolated prognostic value in CS. In addition, ventricular ectopy does not appear to be an indicator of disease activity based on abnormal uptake on PET scan.
Abstract 4144514: Human Immunodeficiency Virus Associated Cardiomyopathy- A Rare Cause of Heart Failure With Reduced Ejection Fraction in Era of Highly Active Antiretroviral Therapy
Authors: Muhammad Sabri, Chaitra Janga, Faiza Riaz, Sudeep Nugooru, Donald Haas
Journal: Circulation (2024)

Introduction: Human Immunodeficiency Virus Associated Cardiomyopathy (HIVAC) is characterized by left ventricular (LV) systolic or diastolic dysfunction with or without LV dilatation and heart failure symptoms. The introduction of antiretroviral therapy (ART) has changed the fulminant systolic heart failure presentation of HIV myocarditis to diastolic heart failure. We present a unique case of dilated cardiomyopathy in a young patient without advanced HIV illness which has rarely been documented in the literature. This is a rare presentation of HIVAC in the post-ART era. Case Report: A 32-year-old male with a past medical history (PMH) of the human immunodeficiency virus (HIV) presented with complaints of new onset worsening shortness of breath and lower extremity edema for four weeks. He was diagnosed with HIV seven years ago and was not compliant with ART. Laboratory testing showed a cluster of differentiation 4 (CD4) 823 and HIV load 2550. Myocarditis was ruled out by normal troponin levels and no new changes on the electrocardiogram (ECG). Transthoracic echocardiogram (TTE) showed dilated left ventricle (LV), LV global hypokinesis, LV ejection fraction (LVEF) 10-15%, dilated right ventricle, biatrial dilation, moderate to severe mitral regurgitation, severe tricuspid regurgitation, pulmonary artery (PA) systolic pressure 73 mmHg and no pericardial effusion. Coronary angiography was negative for coronary artery disease (CAD). The patient was started on carvedilol and outpatient evaluation for a left ventricular assistance device. Discussion: Systolic dysfunction in patients with HIVAC carried a poor prognosis in the pre-ART era and was common in patients with elevated c-reactive protein (CRP), tobacco use, and previous myocardial infarction (MI). After the advent of ART, systolic dysfunction is rare and replaced by diastolic cardiomyopathy in the setting of ART use. Diagnosis is usually by excluding other etiologies and biopsy is not necessarily required. Management is usually guideline-directed medical therapy (i.e. beta blocker, renin-angiotensin-aldosterone antagonists, sodium-glucose cotransporter-2) and device-based therapy but there is still data lacking to assess its benefit.
Abstract 4144566: Building CPR/AED Confidence through Community Volunteer Prevention Screening Sessions: The Impact of the Eric Paredes Save A Life Foundation
Authors: Kunal Goel, Jacob Baradarian, Maureen Legg, Rhina Paredes, John Rogers
Journal: Circulation (2024)

Introduction: Sudden cardiac arrest (SCA) remains a leading cause of death among young individuals, often occurring without prior symptoms. Public confidence in recognizing SCA warning signs, understanding risk factors, and using cardiopulmonary resuscitation (CPR) and Automated External Defibrillators (AEDs) is generally low. The Eric Paredes Save A Life Foundation addresses this gap by offering free cardiac screenings and educational sessions. This abstract evaluates the foundation's impact on participants' confidence in these critical areas. Goals: The primary objectives were to enhance participants' confidence in identifying SCA warning signs and risk factors, performing CPR, using AEDs during cardiac emergencies, and communicating youth heart health concerns to healthcare providers. Methods: Volunteer-led prevention screening sessions were conducted, incorporating educational components on SCA warning signs, risk factors, and hands-only CPR and AED training. Post-session surveys were administered to 1,123 participants to assess their confidence levels in these areas. Results: The screening sessions significantly increased participants' confidence. Specifically, 96% of participants reported heightened confidence in recognizing SCA warning signs and understanding risk factors. Additionally, 94% felt more assured in discussing youth heart health with providers. Confidence in performing CPR during a cardiac emergency rose to 92%, while confidence in using an AED reached 89%. These results demonstrate the effectiveness of the sessions in empowering individuals with essential life-saving skills. Conclusions: The Eric Paredes Save A Life Foundation's prevention screening sessions are highly effective in improving participants' confidence in recognizing SCA warning signs, understanding risk factors, and using CPR and AEDs. The substantial increase in confidence levels underscores the importance of community-based education and training programs in reducing SCA-related fatalities among youth. These findings support the need for ongoing and expanded initiatives to further enhance public health outcomes and preparedness for cardiac emergencies.
Abstract 4143256: Non-invasive, Radiation-free, Non-contrast Myocardial Volume Oxygen Consumption Quantification Using Free-breathing MR Blood Oximetry
Authors: Chia Chi Yang, Archana Malagi, Li-Ting Huang, Yuheng Huang, Ghazal Yoosefian, Xinheng Zhang, Xingmin Guan, Anthony Christodoulou, Debiao Li, Hui Han, Rohan Dharmakumar, Hsin-jung Yang
Journal: Circulation (2024)

Background: Myocardial oxygen consumption (MVO 2 ) is a central marker in measuring cardiac energetics. Current methods to quantify MVO 2 are inaccessible due to the requirement of invasive procedures or PET agents that require onsite cyclotrons. Hypothesis A free-breathing, non-ECG-gated, motion-resolved Cardiac MR blood oximetry technique can noninvasively quantify MVO 2 in standard clinical MRI scanners without using ionizing radiation and contrast agents. Method: The developed free-breathing CMR imaging technique was prescribed in a 3T clinical scanner to the mid left ventricle (LV) and the cross-section of the coronary sinus(CS) slices of the heart to obtain the corresponding blood oxygenation (SbO 2 ) and the hematocrit (Hct) in heart chambers. 2D phase contrast CMR was performed in the CS to quantify the myocardial blood flow (MBF). The MVO 2 was quantified with Fick’s law (MVO 2 =arterio-venous oxygen difference x MBF). We examined the developed method in healthy pigs (N=7) under rest and adenosine stress and validated it against invasive blood sampling. In addition, we tested the method’s clinical feasibility in healthy human volunteers (N=4). Results: Comparable blood oxygenation levels (SbO 2 ) and MVO 2 were measured and compared between the non-invasive CMR and invasive ground truth (Fig. 1). Significantly increased coronary sinus SbO 2 is observed in both methods during adenosine infusion. It is accompanied by decreased MVO 2 and rate pressure product (RPP) (Rest: CMR=10.2±2.7ml/min, Inv.=10.8±6.9 ml/min, RPP=7956.9±620.9 mmHg/min; Stress: CMR=5.3±1.9 ml/min, Inv=6.3±3.6 ml/min, RPP=5338.2±618.3 mmHg/min). In Fig. 2, the healthy human volunteers' MVO 2 estimations(14.1±6.7ml/min) shows no statistical difference compared to the previous invasive measurements(16.5±4.8 ml/min, Ganz, et al. circulation 1971). Conclusions: The proposed noninvasive CMR technique can quantify MVO 2 in standard MRI scanners without using a needle. It has the potential to provide an accessible, risk-free assessment of myocardial metabolism for patients with potential metabolism impairments.
Abstract 4145889: Association between Pulmonary Artery Elastance and all cause mortality in patients with Heart Failure: A Meta-Analysis
Authors: Sai Priyanka Mellacheruvu, Jai Sivanandan Nagarajan, Srivatsa Surya Vasudevan, Adhvithi Pingili, Priyanka Mohnani, Shreyjit Kaur, Kokou Selom Adompreh-Fia, Thiruvikram Sivakumar, Harini Pendem, Bisharah Rizvi
Journal: Circulation (2024)

Background: Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patients Methods: A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis. Results: Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 - 1.19, p &lt; 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders. Conclusion: This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.