tbuckley/cabot-search huggingface dataset:
Abstract 4142080: Bridge from Arrest to Recovery: Sudden Cardiac Arrest in a Young Patient with Concomitant Myocardial Bridge and Hypertrophic Cardiomyopathy
Authors: Fatima Iqbal, Muhammad Jafar Khan, Konstantinos Charitakis
Journal: Circulation (2024)

Case Presentation: A 27-year-old-male without any known medical history presented after witnessed sudden cardiac arrest. Initial rhythm in the field was ventricular fibrillation. He underwent CPR with three rounds of external defibrillation with 200 J and after return of spontaneous circulation (ROSC) was transferred to our facility. He was initially normotensive, bradycardic, hypothermic to 35.6°C and hypoxic requiring non-rebreather mask. He was intubated for airway protection. Post ROSC 12-lead surface ECG revealed sinus rhythm with a prolonged QT interval and left ventricular hypertrophy. Initial high-sensitivity Troponin I was elevated to 83 pg/ml that peaked to 4631 pg/m. On transthoracic echocardiogram, ejection fraction was 55-60% with moderate concentric left ventricular hypertrophy and an interventricular septum end diastolic thickness of 1.3 cm as well as normal left ventricular outflow tract pressure gradient. Coronary angiogram was notable for prominent myocardial bridge (MB) of the middle left anterior descending (LAD) artery without any evidence of atherosclerotic disease. Cardiac magnetic resonance imaging (CMR) showed asymmetric left ventricular hypertrophy with reverse septal curvature variant and evidence of patchy late gadolinium enhancement. A dual-chamber implantable cardioverter defibrillator was placed for secondary prevention of ventricular arrhythmias and sudden cardiac death. Metoprolol tartrate was started for management of hypertrophic cardiomyopathy (HCM) and MB. At follow-up visit he was asymptomatic and genetic testing was positive for heterozygous gene mutation in MYBPC3. Discussion: MBs have been recognized as a common congenital anomaly of the epicardial coronary arteries, with a higher prevalence reported in patients with HCM. We present a unique clinical scenario of a young patient with asymmetric HCM, patchy late gadolinium enhancement on CMR and evidence of prominent MB of the LAD artery. Hemodynamically significant MBs have been implicated in the degree of fibrosis in HCM which is significant due to the correlation between extent of fibrosis and adverse cardiac remodeling, and the consequent predisposition to arrhythmogenesis. However, the existing literature is inconclusive regarding the exact association between MBs and cardiovascular mortality in HCM. Here, we highlight the potentially increased risk of sudden cardiac arrest conferred by MB in HCM and the need for further studies to delineate this association.
Abstract 4142085: Exercise Pulmonary Vascular Mechanics and cardiac MRI prospective study to define Low vs. High-risk HFpEF phenotypes with Right Ventricular Failure in HFpEF
Authors: Farhan Raza, Christopher Lechuga, Mariana Garcia-Arango, Yimin Chen, Aditya Sahai, Wanxin Tu, Yeonhee Park, Naomi Chesler
Journal: Circulation (2024)

Background: Highly precise definition of high-risk features associated with HFpEF may guide targeted treatments and inform biological studies. The aim of this two-step study is to 1) define a high risk HFpEF cluster with unsupervised machine learning approach using cardiac magnetic resonance (CMR), 2) define novel pulmonary vascular mechanics at rest and with exercise in low- vs. high-risk phenotypes. Vascular mechanics defines vessel- and cardiac cycle-specific flow dynamics in pulmonary circulation. Methods: 48 HFpEF participants underwent CMR and invasive cardiopulmonary exercise testing. With unsupervised K-means clustering analyses using CMR data, two specific clusters were identified with different survival outcomes at 12-months (mortality and heart failure hospitalizations): HR=5.4 (CI:1.7-17.4), log-rank p&lt;0.01. Within this cohort (n=48), additional flow data (right ventricular outflow tract pulse wave doppler) was acquired in 13 participants at rest and 25 watts exercise, to obtain simultaneous pressure (pulmonary artery)-flow data for vascular mechanics analyses in time domain. Results: Features of low- (n=32) and high-risk (n=16) clusters are summarized in Table. High-risk cluster displayed decreased right ventricular ejection fraction and worse biventricular longitudinal strain. Among wave mechanics, characteristic impedance (proximal pulmonary artery stiffness) and backward decompression wave (pulmonary vascular reflections in diastole) were elevated in high-risk HFpEF phenotype. Conclusions: We report a high-risk HFpEF phenotype with reduced RV ejection fraction and biventricular strain, indicating myocardial limitations. Vascular mechanics revealed proximal pulmonary artery stiffness and increased wave reflections in diastole as key features in high-risk HFpEF, indicating pulmonary vascular limitations. These multimodal methods reveal that mechanism of RV failure in HFpEF likely involves both pulmonary vascular and intrinsic myocardial abnormalities.
Abstract 4142006: Small Wearable Tissue Oximeter to Evaluate Microvascular Function in Chronic Heart Failure Patients
Authors: Thibault Roumengous, Josephine Wallner, Aimen Tariq, Brian Griffin, R. Casey Boutwell, Douglas Harkins
Journal: Circulation (2024)

Background: Although microcirculatory function is known to be affected by chronic heart failure (HF), the lack of available sensing technology has limited its investigation. A noninvasive wearable tissue oximeter using near-infrared spectroscopy (NIRS) was developed to measure microcirculatory adaptation during cardiovascular stressors such as vascular occlusion testing (VOT) and mild activity such as a six-minute walk test (6MWT) as a step toward remote monitoring of HF patients during daily activities. Hypothesis: We aimed to assess microvascular responses using tissue oximetry on relevant body sites to further characterize HF patients based on their disease stage. Methods: Patients (n=20, F=3, NYHA Class I-III) completed a single visit to the clinic (approximately 30 min each). NIRSense devices were placed on the patient’s dominant arm, thigh, and sternum using a custom adhesive patch. Tissue oxygenation (StO2) and reperfusion slopes were independently calculated from sensor signals (Figure 1, B, D). Results: Mean VOT reperfusion slopes were 0.083526 +/- 0.114388 (NYHA I), 0.079975 +/- 0.43068 (NYHA II), and 0.064203 +/- 0.159261 (NYHA III). During 6MWT, Mean StO2 was 86.6% +/- 0.1% at baseline (sternum) and 83.1% +/- 0.2% at baseline (thigh). Percent change over the initial 100s of the 6MWT was 5.3 +/- 0.674% (NYHA I), 3.35 +/- 0.745% (NYHA II), 2.67 +/- 1.8% (NYHA III) for sternum and 2.45 +/- 4.28%, 2.94 +/- 2.12%, 2.5 +/- 1.19% for thigh. Reperfusion slopes were lower in the more severe NYHA class (Figure 1, C). StO2 during the 6MWT showed larger decrease after the first 100s in the more severe NYHA class (Figure 1, E). Three patients were excluded from VOT (only) analyses due to poor signal quality. Conclusion: We were able to measure tissue oxygenation kinetics during cardiovascular stressors in chronic HF population. NIRS-based tissue oximetry, particularly during VOT, can characterize microvascular function and differentiate patients based on HF stage. Data collection is still ongoing to enable statistical analyses. Continuous tissue oximetry has potential as a prognosis tool, and remote monitoring during daily activities may allow early detection and intervention in HF and pre-HF populations.
Abstract 4142154: Risk of Suicide, Hair Loss, and Aspiration with Glucagon-like Peptide 1 Receptor Agonists: A Real-World Pharmacovigilance Study from the FAERS database
Authors: Michael Nakhla, Ambica V, Prachi Balani, Aditi Ujjawal, Pramukh Arun Kumar, Mahati Dasari, Zeynep Yukselen, Kannu Bansal, Sarju Ganatra, Sourbha Dani
Journal: Circulation (2024)

Introduction: With the increasing popularity of glucagon-like peptide 1 receptor agonists (GLP1-RAs), numerous safety concerns arose pertaining to suicide, hair loss, and aspiration risks. We attempted to validate these concerns. Methods: We queried the FDA Adverse Event Reporting System (FAERS) database; a post-marketing pharmacovigilance database, from Q4/2003 till Q3/2023 to analyze public reports of these adverse events with GLP1-RAs and other diabetes medications, including sodium-glucose transporter 2 inhibitors (SGLT2is), dipeptidyl peptidase 4 inhibitors (DPP4is), sulfonylureas, metformin, and insulin. OpenVigil 2.1 is an online tool that was utilized to perform disproportionality analysis. A positive signal signifying disproportionate reporting was detected if the proportional reporting ratio (PRR) &gt; 2 and chi-squared (χ2) &gt; 4 for any drug-event pair. The studied medications were arranged in descending order according to the corresponding reporting odds ratio (ROR), which is a measure of the likelihood of reporting a certain event with a certain drug in comparison to all other drugs in the database. Results: No positive signals were observed between GLP1-RAs and either suicide, hair loss, or aspiration events. Semaglutide [ROR= 0.601 (95% CI 0.51 - 0.71)] and liraglutide [ROR= 0.282 (95% CI 0.228 - 0.35)] had higher suicidal events than DPP4is and SGLT2is. GLP1-RAs were the most reported class with hair loss [ROR= 0.605 (95% CI 0.6 - 0.64)], and semaglutide, liraglutide, and dulaglutide were the three leading medications. GLP1-RAs ranked lower with aspiration events, which were led by sitagliptin and DPP4i as a group. Only metformin and glyburide generated positive signals with suicide risk. Conclusion: GLP1-RAs exhibit higher reporting of suicide, hair loss, and aspiration events when compared to several other antidiabetic medications, despite not meeting the criteria for positive signals yet. This warrants intensive monitoring and reporting.
Abstract 4142099: Deep Learning Quantification of Aortic Compliance from Parasternal Long-Axis Echocardiograms
Authors: Justin Rhee, Eileen Lu, Shruthi Nammalwar, Grant Duffy, Milos Vukadinovic, Elizabeth Chou, David Ouyang
Journal: Circulation (2024)

Introduction: Aortic compliance is crucial for maintaining diastolic blood pressure and systemic perfusion throughout the cardiac cycle. Echocardiography is widely used for cardiovascular imaging but has limited precision in clinical phenotyping of aortic compliance. Hypothesis: We hypothesized that a deep learning approach can quantify aortic compliance by precision characterization of the aortic root in parasternal long-axis echocardiogram videos and that this deep learning measured aortic compliance would correlate with aspects of thoracic aortic repair. Aims: Develop a high precision deep learning model for quantifying aortic compliance from echocardiogram videos and explore associations with surgical repair. Methods: We used 51730 PLAX echocardiogram videos from Cedars-Sinai Medical Center, divided into training (46188), validation (5035), and test (507) cohorts. The DeepLabv3 architecture with a 50-layer residual network backbone was used for frame-level segmentation of the aortic root. Strain was obtained by dividing the change in root diameter by the minimum diameter during each cardiac cycle. Evaluation of measurements was performed on a separate cohort of 33 patients who underwent endovascular repair of the thoracic aorta. Results: The model accurately measured aortic root diameter with a mean absolute error (MAE) of 2.5mm comparing favorably with clinical inter-observer variability (MAE of 2.9mm, p=0.010). Exploratory data analysis showed increasing aortic root strain after endovascular repair (n=12, p=0.084) but no clear trends after combined endovascular and open repair (n=21, p=0.852). Aortic strain was lower in patients with prior abdominal surgery (n=12, p=0.001) and dissection that underwent repair (n=14, p=0.099), and postoperative aortic strains were lower in patients requiring surgery within 30 days (n=7, p=0.024). Conclusion: A deep learning workflow can measure aortic root diameter and identify changes in aortic compliance with higher precision than human assessment. Trends in preoperative and postoperative aortic strain in patients undergoing endovascular repair suggest utility of aortic strain phenotyping for prognosticating clinical outcomes.
Abstract 4142830: High Prevalence of Cardiovascular-Kidney-Metabolic Syndrome and Lack of Sex Disparities in Youth Referred for Hypertension Disorders: A SUPERHERO Analysis
Authors: Andrew South, Carissa Baker-Smith, Jessica Campbell, Giya Harry, John Laisure, Margaret Murphy, Elizabeth Onugha, Ashna Pudupakkam, Sandeep Riar, Sahar Siddiqui, Michael Walsh, Carol Vincent
Journal: Circulation (2024)

Background: Given the increasingly high prevalence of adverse cardiovascular (CV) health in adults and its relationship with numerous organ systems, an AHA Presidential Advisory recently defined CV-kidney-metabolic (CKM) syndrome. However, CKM syndrome prevalence and presence of sex disparities are unknown in youth with hypertension disorders. Methods: Cross-sectional descriptive and inferential analysis of baseline data from 7 sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data using standardized biomedical informatics scripts and validated by manual record review. Inclusion criteria were youth &lt;19 years old who received care from subspecialists for hypertension disorders from 1/1/2016–12/31/2023 defined by ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. We defined CKM syndrome as Stage 2, Stage 1, Stage 0, or Unclassified using ICD-10 codes and recorded BP and BMI (Figure 1). We reported mean ( SD ) and n (%) and used directed acyclic graph-informed generalized linear models. Results: Of 9,356 participants, mean age was 12.8 years ( SD 4.5) and 38% were female. CKM syndrome prevalence was 85% (20% Stage 1, 65% Stage 2), and 7% were Unclassified. Table 1 describes the various health conditions by CKM syndrome staging. Among the 8,726 participants with known staging, female sex was not associated with worse CKM syndrome (RR 1.04, 95% CL 0.95–1.14). Discussion: In this novel study of youth with hypertension disorders, CKM syndrome was common (85% at baseline) but there were no sex differences. Ongoing SUPERHERO steps are improving CKM syndrome case definition. Future analyses will investigate CKM syndrome’s relationship with social determinants of health and outcomes. Presence of CKM syndrome could inform innovative primordial and primary preventative interventions, and hypertension treatment, in youth to greatly improve CV health across the life course.
Abstract 4143171: Pattern of Disease Progression in ATTR-CM Patients Treated with Tafamidis: An Observational Study
Authors: Dimitrios Bampatsias, Abdirahman Wardhere, Lawrence Zeldin, Alfonsina Mirabal, Ariel Weinsaft, Dia Smiley, Sergio Teruya, Mathew Maurer
Journal: Circulation (2024)

Background: Consensus on a definition of disease progression in transthyretin amyloid cardiomyopathy (ATTR-CM) is lacking. Recent data showed that among a large cohort 50% of patients progressed as defined by either N-terminal pro-B type natriuretic peptide (Nt-proBNP) increase of 700 pg/ml AND 30% or increase of oral diuretics (ODI) after 1 year. However, most of the patients were not on disease modifying treatment (DMT). Aim: To describe the pattern of progression at 1 year in patients with ATTR-CM on tafamidis, the only approved drug for ATTR-CM. Methods: Patients diagnosed with ATTR-CM at Columbia University and treated with tafamidis after 2018 were enrolled in the study assuming they survived a year to measure disease progression and had data available at follow-up. A total of 16 patients died before the 1-year follow-up and were excluded from the study. Disease progression was defined as: increase in Nt-proBNP&gt;700 pg/mL and &gt;30% from baseline, ODI or increases in both compared to baseline. Survival analysis was done using Kaplan Meier curves and Cox regression adjusted for age and disease severity by National Amyloidosis Center stage. Results: A total of 157 patients were enrolled, with 62 (39.5%) having disease progression at 1-year. Of these 62 patients, 51 met one progression criterion (34 patients had ODI and 17 had NtproBNP increase), with 11 having both criteria of disease progression at 1 year. Survival analysis revealed a significantly increased risk for all-cause mortality during follow-up in patients with disease progression at 1-year (HR=2.13, 95%CI:1.04-4.35, p=0.03, Figure). Conclusion: The recently proposed criteria for disease progression performed well in a cohort of patients on DMT, which may reduce the number of patients progressing at 1 year.
Abstract 4143118: Association of Left Atrial Fibrosis with AF Burden Post-Ablation: Insights from the DECAAF II Study
Authors: Hadi Younes, Christian Mahnkopf, Charbel Noujaim, ghassan bidaoui, Mayana Bsoul, Han Feng, Abdel Hadi El Hajjar, Mario Mekhael, Lilas Dagher, Chanho Lim, Swati Rao, Francisco Tirado Polo, Yingshuo Liu, Yishi Jia, Eli Tsakiris, Ala' Assaf, Besim Ademi, Ghaith Shamaileh, Yanpei Hui, eoin donnellan, Amitabh Pandey, Nassir Marrouche
Journal: Circulation (2024)

Introduction: Left atrial (LA) fibrosis identified by delayed enhancement MRI has been linked to poor outcomes post-AF ablation. We aim to assess the relationship between LA fibrosis and post-ablation AF burden in a persistent AF population. Methods: This is a subanalysis from the DECAAF II trial which included persistent AF undergoing catheter ablation. Delayed enhancement MRI was performed up to 30 days pre-ablation. Fibrosis was quantified at a core lab and categorized into 4 stages: 1 (&lt;10%), 2 (10%-&lt;20%), 3 (20%-&lt;30%), and 4 (≥30%). AF burden was defined as the percentage of time in AF post-ablation and was monitored using a 1-lead EKG device. Results: This analysis included 658 patients. After ablation, patients were followed, categorized by Utah stage as follows: 95 in stage I, 380 in stage II, 271 in stage III, and 69 in stage IV. The mean (SD) AF burden during the blanking period (0 to 3 months) was 0.15 (0.26) for stage I, 0.17 (0.26) for stage II, 0.22 (0.29) for stage III, and 0.29 (0.30) for stage IV (p&lt;0.001). Post-blanking period (after 3 months), the mean (SD) AF burden was 0.13 (0.22) for stage I, 0.15 (0.21) for stage II, 0.19 (0.25) for stage III, and 0.27 (0.27) for stage IV (p&lt;0.001). Conclusion: A higher atrial fibrosis identified by delayed enhancement MRI was associated with increased AF burden post-ablation.
Abstract 4143109: Association Between Frailty Testing through Timed Up-and-Go Test Time and Mortality in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy
Authors: Aritra Paul, Joe Demian, Niraj Varma, J. Emanuel Finet, Arshneel Kochar, Feras Bader, Oussama Wazni, Wilson Tang, John Rickard
Journal: Circulation (2024)

Background: The use of cardiac resynchronization therapy (CRT) devices has significantly increased in usage in recent years. Identifying predictors of mortality in CRT patients remains an area of investigation. Objective: To establish a relationship between timed up-and-go test time (TUGT) and mortality in heart failure patients (HF) with CRT devices. Methods: This retrospective study included 506 patients with heart failure with reduced ejection fraction (HFrEF) who underwent CRT implantation at our institution between 2017-2022. All patients were followed up with a multidisciplinary team, including electrophysiology and HF physicians about 6 months after CRT implantation, where frailty was assessed. We used TUGT as a measure of frailty and divided patients into 2 groups: TUGT: &gt;15 seconds (n=73) and ≤15 seconds (n=433). The primary endpoint was a composite of left ventricular assist device implantation, transplant, or death at 2 years post-CRT. Data was collected retrospectively from electronic medical records. Results: The study population was 65.6% male, with a mean age of 69.1 years, and 79.4% of devices being CRT-D.Response was defined as an improvement in LVEF &gt;5% with reduction in LVESV&gt;10%; anybody not meeting this definition was classified as a non-responder. Responder and non-responder rates among TUGT &gt;15 and TUGT &lt; 15 were 60.3% vs 69.3%; and 39.7% vs 30.7%, respectively. The median (IQR) timed up and go time was 9.25s (7.48-11.7s). 52 (10.3%) patients had a composite outcome within 2 years follow up. Univariate analysis revealed that higher TUGT was significantly associated with worse outcomes (median TUGT 9.07 vs 11.9s; p&lt;0.001). Multivariate cox regression also revealed TUGT&gt;15s to be an independent predictor of our composite outcome [HR= 3.47 (1.71-7.06); p=0.001] (Table 1), with adjusted survival curves showing patients with TUGT&gt;15s have worse outcomes (Figure 1). Conclusion: Frailty testing using TUGT post-CRT implantation is a strong predictor of mortality in HFrEF patients after CRT implantation.
Abstract 4143127: Association of Serial Seattle Angina Questionnaire Assessments with Clinical Events in Chronic Coronary Disease: Insights from the ISCHEMIA Trial
Authors: Evan O'Keefe, Philip Jones, Yoon Joo Cho, John Saxon, William Boden, Gregg Stone, Sripal Bangalore, Harmony Reynolds, David Maron, Judith Hochman, John Spertus
Journal: Circulation (2024)

Background: Cross-sectional Seattle Angina Questionnaire (SAQ) scores not only measure patients’ symptoms, function and quality of life, but are also associated with prognosis in chronic coronary disease (CCD). Yet, the prognostic significance of serial SAQ scores in the modern era is unknown, particularly after revascularization. Hypothesis: Serial collection of SAQ scores can provide updatable estimates of clinical risk in patients with CCD. Aims: To describe the association of serial SAQ Summary Scores (SAQ-SS) with the primary endpoint of the ISCHEMIA trial (CV death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest), stratified by medical management and recent revascularization. Methods: Analyses were framed from the perspective of a clinician reviewing the SAQ-SS in clinic and seeking to understand whether the prior score, the current score, or the change was most prognostic of subsequent clinical events. Cox models were created using the 3-month, 6-month, and change between the 3- and 6-month SAQ-SS scores, individually, as well as those scores in combination to find the most prognostic permutation. Each model was adjusted for 17 potentially confounding covariates. We performed separate analyses for the conservative and invasive management cohorts. In the conservative group, we excluded those who underwent revascularization prior to their 6-month assessment. In the invasive group, we included only patients who were revascularized within the first three months. In both groups, we excluded patients with events prior to 6 months. Results: In both the conservatively managed (n=1965) and recent revascularization (n=1447) cohorts, unadjusted analyses estimated a 6-9% lower risk of clinical events over a median of 3.2 years for each 5-point increase in SAQ-SS score. The current SAQ-SS score was most strongly associated with clinical events, even after including the prior SAQ-SS score and all other covariates (Table). Conclusions: Routine clinical use of the SAQ provides an updatable measure of risk in patients with CCD—managed either medically or with revascularization—with the current SAQ-SS score demonstrating the strongest association with clinical events.