tbuckley/cabot-search huggingface dataset:
Abstract 18225: Left Atrial Volume Index and Outcomes in Paroxysmal Atrial Fibrillation (pAF) in the Real-AF Registry
Authors: Iva Minga, Kevin Lee, Catherine O Lazarus, Allyson Varley, Christopher Thorne, Jose Osorio, Matthew Singleton, Paul Zei, Benjamin DSouza, Joshua Silverstein, Mark Metzl
Journal: Circulation (2023)

Introduction: Catheter ablation via pulmonary vein isolation Is one of the most commonly performed procedures for treating paroxysmal atrial fibrillation (pAF). Left atrium size affects ablation strategies and outcomes in patients with pAF. We analyzed the left atrium index (LAi) to determine associations with recurrent arrhythmias at 12 months post-ablation and the ablation strategies used. Methods: The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (pAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. Left atrial volume was reconstructed using CARTO 3D. LAi was separated into normal range: &lt; 34 ml/m2, mildly enlarged 35 - 41 ml/m2, moderately enlarged 42 - 48 ml/m2, and severely enlarged &gt; 49 ml/m2 based on the American Society of Echocardiogram guidelines. Ablation strategies were divided into pulmonary vein isolation (PVI) alone or PVI+ ablation, including PVI and additional atrial arrhythmogenic substrates. Recurrence of arrhythmias at 12 months post-ablation and ablation strategies were compared. Results: A total of 1824 were included. In patients with pAF 12.2% developed recurrent arrhythmia at 12 months. When compared to normal LAi, patients with pAF with moderately and severely enlarged LAi were more likely to have a recurrence of arrhythmias at 12 months (Table 1). Women with pAF and moderately and severely enlarged LAi were more likely to have recurrence of arrhythmias (Table 1). A total of 1433 underwent PVI only ablations, and 391 underwent PVI+ ablations. Abnormal LAi was also associated with patients undergoing PVI+ ablations compared to PVI only ablations (Table 1). Conclusions: In patients with pAF and abnormal LA size was associated with more recurrent arrhythmias at 12 months post-ablation. Patients with enlarged LAi were more likely to have PVI+ ablations.
Abstract 17207: Usefulness of Polygenic Risk Score for Intraventricular Septal Diameter in Patients With Hypertrophic Cardiomyopathy
Authors: Akihiro Nomura, Takehiro Sato, Masahiro Noguchi, Yasuaki Takeji, Hayato Tada, Kenshi Hayashi, Atsushi Tajima, Masayuki Takamura, Noboru Fujino
Journal: Circulation (2023)

Background: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant monogenic disease characterized by thickened heart muscles, particularly at the intraventricular septum (IVS), and an increased risk of arrythmias and sudden death. Recently, in addition to monogenic screening, the polygenic risk score (PRS) has been proposed as a potentially useful tool for risk stratification in several cardiovascular diseases. However, it remains unclear whether PRS is also beneficial for risk stratification of patients with HCM. Methods: We recruited and genotyped HCM patients from the Kanazawa University Mendelian Disease (KUMD) HCM registry and controls from the KUMD non-HCM familial hypercholesterolemia registry. The PRS was calculated from over 3 million genotyped with imputed variants of each participant for IVS diameter (PRS IVS ) using a publicly available summary statistic at the National Bioscience Database Center. We assessed the PRS IVS distributions among the monogenic HCM, causal variant negative HCM, and control groups. We also tested the associations of PRS IVS with the IVS diameters within each group. Results: We evaluated a total of 400 participants (267 HCM patients, including 79 with monogenic HCM and 188 with causal variant negative HCM, and 133 controls) for the analyses. Compared to the controls, PRS IVS was significantly higher in both monogenic HCM (0.12923 in Monogenic HCM vs. 0.09057 in controls, age- and sex-adjusted p = 0.02) and causal variant negative HCM patients (0.11127 in causal variant negative HCM vs. 0.09057 in controls, p = 9.9x10 -4 ). However, no associations were found between PRS IVS and IVS diameters in any of the groups. Conclusions: In this study, both the monogenic HCM and causal variant negative HCM groups demonstrated significantly higher PRS IVS than non-HCM controls. However, we found no evidence to suggest that PRS IVS might be useful for risk stratification in patients with HCM.
Abstract 16815: Outcomes of Cardiac Sympathetic Denervation via Cautery Ablation for Ventricular Arrhythmia: A Single Center Study
Authors: David H Yoo, James S Allan, Moussa C Mansour, Edwin Kevin Heist, Zain Sharif, Theofanie Mela
Journal: Circulation (2023)

Introduction: Cardiac sympathectomy denervation (CSD) has been demonstrated to reduce ventricular arrhythmia (VA) burden and to improve arrhythmia-free survival. Early evidence for the clinical antiarrhythmic benefits for CSD was established in patients with long-QT syndrome and catecholaminergic polymorphic VT (CPVT). Its benefit has subsequently been shown to extend to other undifferentiated cardiomyopathies. Hypothesis: Literature on CSD for VA has been limited due to a small number of patients. Our retrospective study is to review patients who underwent CSD for VA at our center via cautery ablation. Methods: We identified 9 patients who underwent CSD from 4/2018 to 2/2022. Electronic medical record was reviewed for clinical history and outcomes. Results: Mean age was 52±17 and 5 patients (55.6%) were male. Seven patients (77.8%) had nonischemic cardiomyopathy (NICM) and 2 patients (22.2%) had CPVT. Mean LVEF was 43±19% and 5 patients (55.6%) had heart failure with NYHA class 3±0.7. Five patients (55.6%) underwent CSD in outpatient setting and 4 patients (44.4%) had polymorphic VT. Six patients (66.7%) had prior catheter-based VT ablation, 1 patient (11.1%) had prior ganglion block, and 4 patients (44.4%) had history of VT storm. All patients were on antiarrhythmics ranging from a beta blocker monotherapy to a combination of class Ic, class III, and a beta blocker. Seven patients (77.8%) had a defibrillator prior to CSD. All patients underwent CSD (7 with bilateral and 2 with left only) without any procedural complication. Five patients (55.6%) had recurrence of VA in 423±567 days with follow-up duration of 729±478 days. Three patients (33.3%) underwent heart transplant or LVAD and three patients (33.3%) died in 426±396 days since CSD. Overall, 3 patients (33.3%) including 2 CPVT patients and one NICM patient with normal EF were free of death, sustained VT, or advanced heart failure therapies. Conclusions: CSD via cautery ablation is safe and effective for patients with refractory VA to antiarrhythmics and/or VT ablation. Success rate appeared to be higher in patients with CPVT and normal EF. Lower rate of survival and freedom from VT or transplant/LVAD compared to published literature may reflect our sick population.
Abstract 145: Deploying Early Cooling at ICECAP Sites: A Barrier Assessment
Authors: Rachel Beekman, Peyton Kline, Sharon D Yeatts, Romergryko Geocadin, Robert Silbergleit, William J Meurer
Journal: Circulation (2023)

Introduction: Best practices for implementing early temperature control in comatose survivors of cardiac arrest have yet to be defined. We surveyed sites enrolling in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial to understand variability in temperature control practices and identify barriers to rapid induction of cooling. Methods: A 23 question electronic survey was sent to principal investigators at 68 active ICECAP sites. Participants were queried on temperature control practices and asked to upload institutional protocols. Results: Fifty-two sites (76.5%) responded to the survey. While 45 sites (86.5%) had an institutional temperature control protocol, only 33 (63.5%) had an emergency department (ED)-specific protocol. Intravascular cooling was available at 21 sites (40.4%). The most frequent barriers to early initiation of temperature control were clinical skepticism regarding the importance of early cooling (n=32, 35.9%), insufficient nursing availability (n=18, 20.2%), lack of access to a cooling device in the ED (n=17, 19.1%), inability to achieve target temperature despite rapid connection to a cooling device (n=17, 19.1%), and delay due to procedures or intensive care unit transfer (n=5 5.6%). ED average boarding time exceeded two hours in 23 sites (44.2%). Fourteen (28%) sites did not have institutional protocols for early sedation or paralysis to help rapidly lower core body temperature during induction of temperature control. Paralytics were infrequently used during the induction phase; at the majority of sites (n=30, 61.2%) paralytics were used less than 20% of the time. Activation in the ICECAP trial resulted in quality improvements to institutional cooling protocols (n=14, 26.9%), such as purchase of cooling devices for the ED, development of sedation or paralytic protocols, and educational initiatives to shorten the time to target temperature. Conclusion: Many of the identified barriers for rapid initiation of temperature control are modifiable. Nursing and provider education regarding the importance of early cooling and development of standardized sedation and paralytic protocols may be effective strategies to improve early cooling practices.
Abstract 12881: Lnc(RNA)-ing COX-2 and Cardioprotection: A PACERR Story
Authors: Elizabeth J Hennessy, Garret A Fitzgerald
Journal: Circulation (2023)

NSAIDs are amongst the most commonly used drugs by adults, but their use is complicated by an increased risk of adverse cardiovascular events that are consequent to suppression of cyclooxygenase-2 (COX-2) dependent prostaglandin (PG) formation, particularly prostacyclin (PGI 2 ). Amongst the mechanisms HDL may help to mediate cardiovascular risk is via its regulated expression of COX-2 and production of PGI 2 by vascular cells. This affords restraint on thrombogenesis, atherogenesis and hypertension. Another might be to accelerate cholesterol efflux by macrophages in the atherosclerotic plaque. Depletion of COX-2 has been reported to reduce efflux coincident with an altered HDL phenotype that fosters atherogenesis. Long non-coding RNAs (lncRNAs) contribute to the regulation of essential cellular processes, such as the progression of cardiovascular disease. Through the investigation of lncRNAs involved in the cellular response to HDL we have uncovered a regulatory role for a lncRNA encoded on the opposite strand of COX-2, called PACERR. Examining the human GTEx database, we found PACERR is most highly expressed in vascular tissues including aorta with several cis -eQTLs modulating aortic PACERR expression. Patients in the Penn Medicine Biobank with these SNPs exhibit an increase in odds ratio towards vascular inflammatory traits including polyarteritis nodosa (PAN). HDL induces the expression of PACERR in vascular cells, signifying its potential role in mitigating risk towards cardiovascular disease phenotypes. Using gain-and-loss of function approaches we have found that PACERR modulates HDL induced COX-2 and prostaglandin formation by smooth muscle and endothelial cells under flow as well as HDL mediated cholesterol efflux by macrophages via the regulation of the cholesterol transporter ABCG1. By modulating the expression of PACERR in vitro and in vivo, we have elucidated a mechanism by which both HDL and COX-2 have a linked cardio-protective effect contributing to our understanding of the heterogeneous effects of current drugs used to raise HDL cholesterol levels and the cardiotoxicity of NSAIDs observed in clinical trials.
Abstract 17675: Association Between Obesity and Heart Failure and Related Atrial Fibrillation: Patient-Level Data Comparisons of Two Cohort Studies
Authors: Young Shin Lee, Pil-sung Yang, Eunsun Jang, Daehoon Kim, Hee Tae Yu, Tae-Hoon Kim, Jaeson Uhm, Jung-Hoon Sung, Hui-Nam Pak, Moon-Hyoung Lee, BOYOUNG JOUNG
Journal: Circulation (2023)

Introduction: Differences in obesity-mediated association between heart failure (HF) and HF-related atrial fibrillation (AF) among Asians and Europeans was evaluated. Methods: Using the Korean National Health Insurance Service-Health Screening (K-NHIS-HealS) cohort and U.K. Biobank, we included 395,173 Korean and 477,214 UK adults aged 40-70 without previous HF who received check-ups. The incidence and risk of HF was evaluated in relation to different body mass index (BMI). Results: The proportion of obese individuals was significantly higher in the UK Biobank (24.2%) compared to the K-NHIS-HealS cohort (2.7%, P&lt;0.001). During the follow-up period of 7.3 and 11.7 years, 684 and 3,183 subjects in the K-NHIS-HealS cohort and UK Biobank, respectively, developed HF. The incidence of HF and HF-related AF was higher in the UK than in Korea across all BMI categories, even after age and sex adjustment. For obese individuals, the age- and sex-adjusted incidences of HF were 0.50 and 1.16 in Korea and the UK, respectively. The risk of HF was notably higher in the British population compared to Koreans, with adjusted hazard ratios of 1.81 (95% CI, 1.30-2.53) and 2.20 (95% CI, 1.98-2.45) in obese participants (P for interaction&lt;0.001). After adjusting for clinical variables, a 5-unit increase in BMI was associated with a 52% greater risk of HF-related AF in the UK Biobank cohort (P&lt;0.001), but not in the Korean NHIS-HealS cohort (P=0.275). Conclusions: Obesity was associated with increased risk of HF and HF-related AF in both populations. The higher incidence in the UK population was likely because of the higher proportion of obese individuals.
Abstract 15201: Obicetrapib as an Adjunct to Stable Statin Therapy Significantly Lowers LDL-C, Non-HDL-C, and Apolipoprotein B in Japanese Patients: Results From the Japan Phase 2 Study
Authors: Mariko Harada-Shiba, Douglas Kling, John J Kastelein, Marc Ditmarsch, Erin Wuerdeman, Andrew Hsieh, Stephen Nicholls, Michael Davidson
Journal: Circulation (2023)

Background: Obicetrapib is a selective CETP inhibitor that has been shown to reduce LDL-C, non-HDL-C, lipoprotein particles, and apolipoproteins when used as monotherapy, and in combination with ezetimibe, on background high-intensity statins. Previous studies of obicetrapib were conducted in predominantly Caucasian participants. There is a lack of clinical experience with obicetrapib when used in combination with stable statin therapy among Asian population. Objectives: This study was designed to fill the gap in clinical experience and to characterize the safety, efficacy profile of obicetrapib within the Asian population. Methods: The Phase 2 study is a trial of Japanese participants who had not achieved treatment goal in accordance with the 2022 Japan Atherosclerosis Society Guidelines and with LDL-C &gt;70 mg/dL or non-HDL-C &gt; 100 mg/dL and TG &lt; 400 mg/dL, while receiving stable statin background therapy. Participants were randomized 1:1:1:1 to obicetrapib 2.5 mg (n=25), obicetrapib 5 mg (n=25), obicetrapib 10 mg (n=26), or placebo (n=26). The primary endpoint was percent change in LDL-C from baseline to week 8. Key secondary endpoints included changes in ApoB, non-HDL-C, and HDL-C. Standard safety assessments were conducted. Results: Obicetrapib produced significant lowering of median LDL-C (45.8%, P&lt;0.0001), ApoB (29.7%, P&lt;0.0001), non-HDL-C (37.0%, P&lt;0.0001) and raising of HDL-C (158.9%, P&lt;0.0001). Placebo demonstrated median change of -0.9%, -0.4%, -0.4% and +5.2% for these parameters respectively. Obicetrapib was well tolerated with similar treatment emergent adverse events compared to placebo. There were no clinically significant changes in laboratory parameters, vital signs, or physical examinations in any treatment group. Conclusions: Similar to previous studies, obicetrapib 2.5 mg, 5 mg, and 10 mg resulted in significant reductions in LDL-C, ApoB, and non-HDL-C in the Asian population. All doses of obicetrapib were safe and well tolerated.
Abstract 16296: Exploring Data Collection on Sexual Orientation, Gender Identity, and Pronouns in Heart Failure Patients: A Call for Improved Documentation and Barrier Identification
Authors: Colleen Schinderle, John Thurber, Amin Yehya
Journal: Circulation (2023)

Introduction: Up to 25% of bisexual, transexual, queer or questioning (LGBTQ) patients avoid medical care for the fear of mistreatment and being stigmatized for their sexual orientation and/or gender identity. In patients with heart failure (HF) the number of individuals who identify as LGBTQ is unknown. The latest upgrade in the electronic medical records (EMR), however, allows to capture patients’ demographics including and gender, sex, sexual orientation, and pronouns, and would allow to fill this knowledge gap. Hypothesis: In this analysis we aimed to identify the percentage of individuals who identify as LGBTQ among patients recently discharged for acute HF decompensation. Methods: In an advanced HF and heart transplant program, patients age &gt;18 discharged with heart failure as their primary diagnosis August 2022 and February 2023 were identified. The EMR were queried for patients’ demographics including sex, gender identity, sexual orientation, and preferred pronouns. Results: We identified 449 patients. Of those, 234 patients identified their sex as female (52.1%) of whom 194 identified their gender identity as females; 215 patients identified themselves as male (47.9%) of whom 172 identified as males. Gender identity of the remaining 83 patients were not listed in the EMR. Only 13.2% of patients had their sexual orientation listed with 0.7% identifying as gay or lesbian, 0.2% unsure, and 12.7% as straight. The majority of patients 87.8% didn’t have their pronouns listed, 5.8% as she/her/hers, 6.0% as he/him/his, and 0.2% unknown (Figure). Conclusions: In this sample of HF patients, data related to sexual orientation and pronouns were rarely collected. Future work should focus on identifying the barriers that might have caused the limited data collection in this population.
Abstract 18245: ViTrack™ : A Computer Vision Technology for Continuous Blood Pressure and Advanced Cardio Hemodynamics
Authors: Mohan Thanikachalam, Greg Boverman, Gokul Prasath Rajamanickam, Stamatios Aleiferis, Brendan Huang, José Wong
Journal: Circulation (2023)

Introduction: There is an unmet need for a wearable device for accurate and continuous non-invasive blood pressure (BP) and other cardio-hemodynamic parameters in real-world situations. Methods: To address the need, we have developed ViTrack™, a wrist wearable optomechanical sensor capable of 3D contact sensing at the microscale. ViTrack, based on a fundamentally new method, utilizes pressure-dependent spatiotemporal skin displacement to directly measure beat-to-beat SBP and DBP. ViTrack also measures heart rate and respiratory parameters, and advanced hemodynamic parameters. In real-world settings, patient activities such as body or arm movements introduce motion artifacts that interfere with BP measurement. To address this, ViTrack’s 3D imaging system has been enhanced with advanced computer vision and AI/ML techniques to ensure precise and consistent measurements, regardless of patient movement or wrist position relative to the heart (hydrostatic pressure change). Methods: We have built a minimum viable product. Animal studies (n = 12) showed that the device correlates well (R2 value = 0.958) with invasive arterial pressure (IAP). In outpatient settings, in more than 120 subjects, both male and female, with a wide range of BP (86-180 SBP; 60-110 DBP), when compared to the auscultatory method, ViTrack measures BP in accordance with FDA standards (Association for the Advancement of Medical Instrumentation [AAMI] standard: mean offset &lt; 5mmHg; standard deviation &lt;8 mmHg). Subsequently, in unconstrained patients (n=14), we compared the ViTrack continuously over 2 hours against IAP in real-life ICU conditions. The arm with ViTrack was unconstrained, while the opposite arm was constrained because of the IAP line. With the implementation of the computer vision and AI/ML algorithms, when beat-to-beat measures were averaged across 20 seconds and compared to IAP, ViTrack demonstrated excellent accuracy for both DBP (mean error = -1.37 mmHg [SD = 3.8 mmHg]) and SBP (mean error = -2.69 mmHg [SD = 5.99 mmHg]). Conclusions: Studies show that ViTrack, a wearable device, can accurately and continuously measure BP in real-world settings. The technology could disrupt the way we measure and manage BP. A multi-center trial is further validating the technology.
Abstract 17813: Markers of Cellular Damage, Inflammatory Response, Coagulation and Platelet Activity, and Apoptosis During Catheter Ablation for Atrial Fibrillation Using Radiofrequency and Pulsed-Field Energy
Authors: Pavel P Osmancik, Barbora Bacova, Veronika Kunstatova, Veronika Sochorova, Marek Hozman, Petr Waldauf, Sabri Hassouna, Jakub Karch, Jana Vesela, Lukas Poviser, Lucie Znojilova, Vera Filipcova, Dalibor Herman
Journal: Circulation (2023)

Introduction: Pulsed-field ablation (PFA) presents a new technology for the ablation of AF using non-thermal ablation energy. Ablation energies producing thermal injury are associated with an inflammatory response, platelet activation, and coagulation cascade activation. The study aimed to compare markers of cell damage and platelet and coagulation activation in patients undergoing PVI using PF and radiofrequency (RF) energy. Hypothesis: PFA will be associated will more pronounced myocardial damage, but less pronounced activation of platelets and inflammation. Methods: Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster, USA) or PF (Farapulse, Boston-Scientific, USA) energy. Markers of myocardial damage (high-sensitivity troponin I), apoptosis (Fas ligand, caspase-3), inflammation (interleukin-6), coagulation (D-dimers, Fibrin monomers, von Willebrand antigen and factor activity), platelet activation (P-selectin, activated Gp IIb/IIIa antigen and CD42b), and neuron axon damage (NGF-β) were measured before the procedure (T1), after transseptal puncture, (T2), after completing the ablation in the left atrium (T3), and one day after the procedure (T4). Results: Sixty-five patients were enrolled in the PFA (n=33) and RFA (n=32) groups. Both groups were similar in baseline characteristics (age 60.5±12.7 vs. 64.0±10.7 and 20 (60.6%) non-paroxysmal vs. 20 (62.5%) paroxysmal AF). Procedural and left atrial dwelling times were substantially shorter in the PFA group (55:09±11:57 vs. 151:19±41:25 min, p&lt; 0.001; 36:00±8:05 vs. 115:58±36:49 min, p&lt;0.001). Troponin release (1 d after the procedure) was substantially higher in the PFA group (10,102, IQR 8,272-14,207 vs. 1,006, IQR 603-1,433) and was ten times higher in PFA patients. However, during the procedure, markers of platelet activation, coagulation activation, and inflammation were similar between groups. Conclusions: PF ablation was associated with substantially more myocardial damage compared to radiofrequency ablation. However, coagulation activation, platelet activation, and inflammatory responses were similar.