tbuckley/cabot-search huggingface dataset:
Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report
Authors: Shuojohn Li, Kirpal Kochar, Matthew Pierce
Journal: Circulation (2024)

Case presentation: A 64-year-old man presented with one day of chest pain. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count. Electrocardiogram (EKG) was unremarkable. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 40% and a moderate-large pericardial effusion with signs of tamponade. Pericardiocentesis was deferred due to the lack of a safe window. Left and right heart catheterization showed no occlusive disease or chamber pressure equalization. The patient developed worsening shock, raising suspicion for myocarditis and prompting an endomyocardial biopsy (EMB). He was placed on extracorporeal membrane oxygenation (ECMO) on day 3. The EMB resulted as eosinophilic myocarditis (EM), and high dose Methylprednisolone was started. He was decannulated from ECMO on day 10. Intra-operative transesophageal echocardiogram (TEE) post-decannulation showed a normal EF without segmental abnormalities. Three hours later, a rise in CEs was noted, and EKG showed ST elevations inferiorly. TTE showed a reduced EF with multiple segmental abnormalities concerning for myocardial infarction. A repeat coronary angiogram was unremarkable. Due to the residual pericardial effusion, the patient underwent a pericardial window draining 200 cc of serosanguinous fluid. Intra-operative TEE showed an EF of 20% with no improvement after drainage. He had a cardiac arrest during the procedure and was placed back on ECMO. High-dose steroids were resumed along with intravenous immunoglobulin. Despite interventions, the patient continued to deteriorate and he ultimately expired. Discussion: EM has high mortality and a variable course, often requiring EMB for diagnosis. As in our case, about 25% of cases present without peripheral eosinophilia. Pericardial effusion occurs in 34% of cases and tamponade in 6%. A distinct feature of this case is the decompensation associated with ST elevation and segmental abnormalities, thought initially to be myocardial infarction (MI), after an initial response to steroids. While the etiology of such decompensation is unclear, relapsing EM in the setting of tapering steroids is one explanation, as myocarditis and MI can share similar clinical features. Another explanation is cardiac tamponade, which has also been reported to mimic MI and myocarditis. Air embolism from ECMO decannulation is another possibility, though air embolisms may include cerebrovascular pathology, which was not observed.
Abstract 4135327: Long-term Bleeding Events after Percutaneous Coronary Intervention in Patients with Malignancy with and without Anticoagulant Therapy
Authors: Yasuhiro Otsuka, Masanobu Ishii, Taishi Nakamura, Kenichi Tsujita, Hideo Fujita, Tetsuya Matoba, Takahide Kohro, Tomoyuki Kabutoya, Kazuomi Kario, Arihiro Kiyosue, Yoshiko Mizuno, Masaharu Nakayama, Yoshihiro Miyamoto, Hisahiko Sato, Ryozo Nagai
Journal: Circulation (2024)

Background: With the aging population, the prevalence of malignancies in patients undergoing percutaneous coronary intervention (PCI) is increasing. Active malignancy is increasingly recognized as a significant contributor to high bleeding risks. In cases where anticoagulant (AC) therapy is required, it becomes crucial to determine which is the optimal choice for cancer patients, direct oral anticoagulants (DOACs) or warfarin. The aim of this study was to investigate long-term bleeding events in patients with malignancy undergoing PCI. Methods: CLIDAS (Clinical Deep Data Accumulation System) is a multicenter database with 7 tertiary medical hospitals in Japan. This retrospective analysis using CLIDAS database included 6838 patients who underwent PCI during April 2014 and March 2020 and also who have completed 3-year follow-up were divided into two groups; No malignancy group (n=6155) and malignancy group (n=683). Malignancy was defined as patients with treatment history of malignancy. Furthermore, these patients were categorized into six groups based on the presence of malignancy and the type of AC therapy; 1) No malignancy without AC (n=5369), 2) No malignancy with DOAC (n=294), 3) No malignancy with warfarin (n=492), 4) Malignancy without AC (n=586), 5) Malignancy with DOAC (n=44), and 6) Malignancy with warfarin (n=53). The primary outcome was the incidence of bleeding events, defined according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries classification of moderate and severe bleeding. Results: During the 3-year follow-up period, 260 (3.8%) patients experienced major bleeding events after PCI. Among these patients, 180 (3.4%) were in group 1, 9 (3.1%) in group 2, 33 (6.7%) in group 3, 27 (4.6%) in group 4, 2 (4.5%) in group 5, and 9 (17.0%) in group 6. Multivariate Cox regression analysis showed that patients in the malignancy group had a significantly higher rate of bleeding events (HR, 1.50; 95% CI, 1.03-2.18). Furthermore, only the malignancy with warfarin group showed a significantly higher rate of bleeding events compared to the no malignancy without AC group (HR, 4.03; 95% CI, 1.94-8.37). Conclusions: Patients with malignancies receiving warfarin were associated with a higher risk of bleeding events. DOACs may be a safer alternative to warfarin in reducing bleeding risk in this population.
Abstract 4135289: Renal Blood Perfusion is Closely Related to Right Ventricular Volume Overload in Congestive Heart Failure
Authors: Ruisi Liu, Yu Wang, Qingzhen Zhao, Yuzhi Zhen, Lizhuo Li, Chao Liu, Yue Li
Journal: Circulation (2024)

Background: Cardiorenal syndrome (CRS) involves a bidirectional relationship where dysfunction in one organ exacerbates the other. A key factor in this interaction is the impact of right ventricular (RV) volume overload on renal blood flow, which is vital for the progression and management of heart failure (HF). Objective: This study aims to explore and quantify the relationship between right ventricular volume overload, i.e, echocardiographic assessments of right ventricular diameter (RVD), and the time-to-peak (TTP) of renal blood flow in patients with HF measured by 99mTc-DTPA renal scintigraphy. Methods: This single-center study included 304 stable, ambulatory HF patients admitted between October 2017 and August 2022. HF was diagnosed based on the 2016 ESC guidelines. Echocardiographic parameters, including RVD, and TTP of renal blood flow measured by 99mTc-DTPA renal scintigraphy, were collected. Statistical analysis was conducted using SPSS and R software, with Spearman correlation analysis used to assess the relationship between echocardiographic parameters and TTP. Results: The study showed there was a significant correlation between RVD and TTP (rs=0.535, P &lt;0.001), indicating that RV volume overload is closely related to impaired renal perfusion. The median TTP among the study population was 27.25 seconds (IQR: 21-39 seconds). Corrected for body surface area (BSA), RVD was found to be significantly higher in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) (HFrEF: 20.62 mm/m 2 , HFmrEF: 18.72 mm/m 2 , HFpEF: 18.09 mm/m 2 ; p &lt; 0.001). Furthermore, right atrial diameter (RAD) corrected for BSA (RAD/BSA) demonstrated the strongest correlation with TTP in the HFrEF subgroup (rs=0.602, p&lt;0.001). Conclusions: Our findings highlight the significant impact of right ventricular volume overload on renal perfusion, providing valuable insights into the pathophysiology of CRS. These results suggest that therapeutic strategies aimed at reducing RV overload could enhance renal perfusion and improve overall outcomes in HF patients.
Abstract 4135318: Comparison of Right Ventricular Function Changes Between Volume Control and Pressure Support Ventilation Modes: A Prospective Study Using S' Prime Values
Authors: Shreyas Yakkali, Raksheeth Agarwal, Ankit Kushwaha, ANKITA KRISHNAN, Yutika Anand Dongre, BISRAT hUSSIEN ADAL, Perminder Gulani
Journal: Circulation (2024)

Background: This study assesses changes in right ventricular function by measuring S' values during the transition from volume control-assist control (VC-AC) to pressure support ventilation (PSV). Transitioning from VC-AC to PSV reduces the mean airway pressure (P mean) which causes a decrease in right ventricular afterload and also potentially improves venous return and right ventricular preload. PSV allows spontaneous breathing efforts, possibly increasing cardiac output. Thus, we expect a consistent increase in S' value when changing ventilator modes. Methods: This prospective observational study included ICU patients on invasive mechanical ventilation for over 24 hours. The clinical team decided when to switch from VC-AC to PSV. An average of three S' measurements was taken during VC-AC and within 10 minutes of transitioning to PSV. Sedation, vasopressor use, and Richmond Agitation-Sedation Scale scores were consistent throughout the measurements. The study was approved by the Albert Einstein College of Medicine IRB (#2023-15068) Results: Seventeen patients were included in the study, with an average age of 61.29 years (SD 11.39). Of these, 6 (35.3%) were female. The mean S' during VC-AC was 12.79 ± 4.52, and upon transitioning to PSV, it was 14.56 ± 3.89 (p-value 0.47). The intra-observer variability for S' was 5.3%. Of the seventeen patients, 5/17 (29%) showed an S' change of less than 5.3% and were deemed to have no significant variation; 7/17 (41%) experienced a significant decrease in S' (15.41% ± 7.29% SD), while the remaining 5/17 (29%) showed a significant increase (19.31 ± 13.23%). Conclusion: Our study demonstrates that transitioning from VC-AC to PSV results in variable changes in right ventricular systolic function, as indicated by S' values. Contrary to our expectations of a consistent increase, the interplay between S' values and ventilator mode changes appears to be non-linear, suggesting other factors may influence cardiopulmonary interactions in spontaneously breathing ventilated patients. These findings highlight the complexity of these interactions, underscoring the need for individualized patient management and paving the way for further research with a larger cohort.
Abstract 4135425: Add-on Therapy with Dantrolene, a RyR2 Stabilizer, Terminates Ventricular Tachycardia Storm refractory to Intravenous Amiodarone in Heart Failure.
Authors: Junya Nawata, Shigeki Kobayashi, MAHO ISHIKAWA, Yuki Nakata, Kaori Murakawa, Yusuke Nakashima, Masahiro Hisaoka, Tetsuya Matsuyama, Yoshihide Nakamura, Ayumi Omuro, Masakazu Fukuda, Takeshi Suetomi, Yosuke Miyazaki, Tatsuhiro Fujimura, Mamoru Mochizuki, Motoaki Sano
Journal: Circulation (2024)

Background: Aberrant diastolic Ca 2+ leak through the cardiac ryanodine receptor (RyR2) is an important cause of heart failure (HF) and lethal arrhythmia. Dantrolene (DAN) specifically binds to the Leu 601- Cys 620 of N terminal domain in RyR2 and stabilizes the tetrameric structure of RyR2, preventing the Ca 2+ leak through RyR2. Our previous study as a proof-of-concept showed that intravenous injection (i.v.) of DAN was effective in termination and prevention of refractory ventricular tachycardia (VT) storm in HF. Research Question: How much is loading dose of DAN i.v. to terminate VT storm in HF? We hypothesized that the optimal dose was within 3mg/kg from our previous study. Aim: This study aimed to verify that 3mg/kg DAN i.v. was optimal for the termination of amiodarone-resistant VT storm in HF. Methods: This was an open-label, uncontrolled, single-center study. The detail in the study design and methods is shown in Fig.1 . We studied patients with episodes of VT storm regardless of medications, such as amiodarone and beta-blockers, recommended by HF guidelines. DAN(3mg/kg) was intravenously added on the above guideline treatment. The acute anti-arrhythmic efficacy of DAN was assessed as follows: 1) proportion of patients whose VT storm was terminated by 3mg/kg DAN i.v., 2) incidence rate of VT storm within 24 hours before and after DAN i.v.. Results: The consecutive 7 patients with refractory VT storm were enrolled in this study (median age:72 years old, male/female: 4/3, median LVEF29%). Underlying heart disease included 3 ischemic cardiomyopathy, 3 acute myocardial infarction after successful percutaneous coronary intervention and 1 tachycardia-induced cardiomyopathy. 2 of 7 patients underwent mechanical circulatory support before DAN i.v. because of pulseless VT. All patients were classified as NYHA class III/IV. 3 mg/kg of DAN i.v. ceased VT storm within 60 min in 7/7 (100%) (Fig.2, left). The number of sustained VT within 24 h after DAN i.v. were significantly lower than those within 24 h prior to DAN administration (Fig 2, right) . A representative case is shown in Fig.3 The VT storms refractory to amiodarone and landiolol (beta-blocker) as well as sedation showed complete response to 3mg/kg DAN i.v.. Conclusions: DAN, a RyR2 stabilizer, was effective in the termination of VT storm in HF resistant to guideline directed medical treatment. This is the first study to evaluate the optimal dose of DAN i.v. against the refractory VT storm in HF.
Abstract 4135497: Model-informed dosing recommendations for digoxin in interstage single ventricle heart disease
Authors: Elizabeth Thompson, Rodrigo Gonzalez Ramirez, Karan Kumar, Kiona Allen, Alexis Benscoter, Chi Hornik, Erica Del Grippo, Brett Anderson, DANYAL KHAN, Denise Suttner, John Costello, Pirooz Eghtesady, Nancy Halnon, Christoph Hornik
Journal: Circulation (2024)

Digoxin is commonly used in infants with single ventricle heart disease (SVD) and may decrease mortality in the interstage period. While labeled for the treatment of heart failure in infants, dosing recommendations do not account for alterations in drug disposition in SVD. We aimed to characterize digoxin pharmacokinetics (PK) in interstage infants with SVD. Infants &lt;3 months with SVD who received enteral digoxin per standard of care after stage 1 and prior to stage 2 palliation were included in this prospective, multicenter, open-label PK study. Preterm infants and those with creatinine &gt;2mg/dL or on extracorporeal support at enrollment were excluded. PK samples were prospectively collected and digoxin plasma concentrations quantitated by HPLC/MS/MS assay validated per FDA guidance. Population PK analysis was performed in NONMEM. Effects of covariates on PK parameters were evaluated. Dosing simulations were conducted in a virtual cohort of infants with SVD that optimized dosing to achieve trough concentrations of 0.5-2 ng/mL, the label-endorsed reference range for heart failure. Across 10 sites, 50 infants contributed 207 PK samples. Table 1 shows cohort characteristics. A 2-compartment model with transit compartment absorption and linear elimination best described the data. Renal function and weight were significant covariates. Infants with SVD had lower apparent clearance than previously reported in infants without SVD. Current labeled dosing resulted in simulated exposures above the reference range ( Figure 1 ). A new dosing regimen for infants with SVD is proposed. Digoxin PK is altered in infants with SVD. Dosing should account for renal function, age, and weight.
Abstract 4135338: Associations between plant-based diets and total mortality among Chinese older participants with cardiometabolic diseases: a prospective cohort study
Authors: Bohao Tan, Pengfei Chen, Kang Wang, Cheng Wei, Fei Luo, Jianjun Tang, Zhen-fei Fang, Qiming Liu, Xinqun Hu, Shenghua Zhou, Zhangling Chen
Journal: Circulation (2024)

Background and Aims: Plant-based diets have been associated with a lower risk of total mortality among generally health populations. However, the associations of plant-based diets with total mortality remain unclear among older people with cardiometabolic diseases, who have an elevated risk of mortality. Methods: We prospectively followed 4,485 participants (mean age: 84 years) from the China Prospective Longitudinal Survey of Health and Longevity (2006-2018), who had cardiometabolic disease in 2006. Dietary data were collected at baseline using a food-frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), in which plant-based foods received positive scores while animal foods (meat, fish and aquatic products, eggs, milk, animal fats) received reversed scores accordingly. We also created a healthful plant-based diet index (hPDI), where healthy plant-based foods (whole grains, vegetables, vegetable oils, fresh fruits, legumes, beans, garlic, nuts, tea) received positive scores, while less healthy plant-based foods (refined grains, pickles, sugar, preserved vegetables) and animal-based foods were given reversed scores. In addition, an unhealthful plant-based diet index (uPDI) was created by assigning positive scores to less healthy plant-based foods while reverse scores to healthy plant-based foods and animal-based foods. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% CIs for total mortality, with adjustment for demographics, dietary and lifestyle factors, and medical history. Results: During a 12 years of follow-up, 2,881 deaths were recorded. A higher score from PDI and hPDI was associated with a lower risk total mortality among participants with cardiometabolic diseases (HR and 95% CI for extreme quintiles of PDIs: 0.85, 95% CI 0.75–0.96, P trend &lt; 0.001; hPDI: 0.84 (0.74–0.94), P trend &lt; 0.001). A higher uPDI score was associated with a higher total mortality among participants with cardiometabolic diseases (uPDI: 1.28 (1.13-1.47), P trend &lt; 0.001). These results were consistent in subgroup analyses by age, sex, smoking status, alcohol consumption, education level, physical activity, and BMI. Conclusion: Our study suggests that among older Chinese participants with cardiometabolic diseases, adherence to an overall plant-based diet or a healthful plant-based diet, is associated with a lower total mortality, while an unhealthful plant-based diet was associated with a higher total mortality.
Abstract 4135434: Effect of early nutritional guidance for patients with acute myocardial infarction: A single center retrospective cohort study
Authors: Hiroshi Abe, Tetsuro Miyazaki, Kentaro Yasuda, Sayaki Ishiwata, Masaaki Maki, ryousuke shimai, Hiroyuki Isogai, Dai Ozaki, Hiroki Nishiyama, Kiyoshi Takasu, Kazuhisa Takamura, Takashi Tokano, Tohru Minamino
Journal: Circulation (2024)

Introduction/Background: Acute myocardial infarction (AMI) stands as a major global cause of mortality. Various intervention strategies, such as pre-hospital care, reperfusion therapies, pharmacological interventions, dietary modifications, and exercise therapies, have been researched to improve patient prognosis. Research Question: There remains a lack of evidence regarding the impact of early nutritionist-led dietary guidance on the prognosis of AMI patients. Aim: This study aimed to elucidate whether nutritional guidance by nutritionists who have national qualifications would improve the mortality and the primary composite endpoint (including acute decompensated heart failure, stroke, and acute coronary syndrome) of patients following an acute myocardial infarction. Methods/Approach: A retrospective cohort study enrolling 409 AMI patients who underwent emergency percutaneous coronary interventions between September 1, 2015, and October 31, 2023. Nutritionists guided 223 patients (54.5%) during hospitalization in this study. The nutritional guidance used in our study was also based on the definition of adequate caloric intake of 25–30 kcal per ideal body weight (kg). Under an appropriate total energy intake, a fat energy ratio of 20–25% and a carbohydrate energy ratio of 50–60% are recommended, with protein and lipid restrictions depending on the disease state. Results/Data: During a median follow-up of 39 months, 24 cases of all-cause mortality (5.9%) and 6 cases of cardiovascular mortality (1.5%) were recorded. Kaplan–Meier curves demonstrated significantly higher incidence rates of death and primary composite endpoints among patients without nutritional guidance during hospitalization. The multivariate Cox regression model revealed early nutritional guidance as a significant predictor for long-term mortality but not for primary composite endpoints. Furthermore, undernourished patients, defined as those with a geriatric nutritional risk index of 98 or less, showed a similar prognosis to those with good nutritional status after receiving nutritional guidance, indicating that nutritional guidance improves prognosis. Conclusion: Nutritionist-led dietary guidance for patients with AMI can potentially improve total mortality and is expected to be more effective in undernourished patients. Further research is warranted to explore the physiological impacts of improved diets resulting from such guidance and their effects on enhancing prognosis.
Abstract 4135239: Pausing Under Pressure: Ocular Hypertension as an Atypical Cause of Heart Block
Authors: Nicholas Pietrini, SYED HYDER, David Hamilton, Uma Jasty, Amrish Deshmukh
Journal: Circulation (2024)

A 67-year-old male with a history of hypertension presented to the emergency department with abnormal cardiac monitor results. Prior to this, he was diagnosed with primary open-angle glaucoma by ophthalmology and underwent left-sided aqueous tube shunt placement, which was complicated by hypotony requiring revision and holding of all topical glaucoma medications. Concurrently, he was noted to have an irregular heart rhythm during a routine physical. In office ECG showed normal sinus rhythm, but subsequent 14-day continuous ECG monitor showed sinus bradycardia with nadir heart rate of 21 beats-per-minute and 114 ventricular pauses (longest 4.8 seconds) primarily due to second-degree atrioventricular (AV) block, Mobitz type 1, but also periods of high-grade AV block. He was sent to the emergency department for expedited pacemaker evaluation. On further review, heart block and ventricular pauses occurred exclusively over a 12-hour period that temporally coincided with a hospitalization for acute ocular hypertension following shunt revision. His intraocular pressure peaked at 56 mmHg (normal range 10-21 mmHg), then normalized to 21 mmHg after acetazolamide and anterior chamber paracentesis. Bradycardia resolved following ophthalmic intervention. Bradyarrhythmias were attributed to excess vagal tone from acute ocular hypertension via an atypical but recognized cause of the oculocardiac reflex, and pacemaker placement was avoided. The oculocardiac reflex is a reflex bradycardia involving the trigeminal and vagus nerves. Cardiac effects are consistent with other vagally-mediated bradyarrhythmias, including sinus bradycardia, AV block, and even asystole. This reflex occurs commonly during traction on extraocular muscles during strabismus surgery, but can be seen in other orbital and ocular stimuli. To our knowledge, this is the first documented case of ocular hypertension leading to atrioventricular block through this mechanism. This case illustrates the importance of (1) clinical context of abnormal events during extended cardiac monitoring, (2) understanding the oculocardiac reflex as a cause of bradyarrhythmias, and (3) ruling out reversible medical causes of dysrhythmias prior to permanent device implantation.