tbuckley/cabot-search huggingface dataset:
Abstract 4145121: Impact of Mavacamten on blood pressure in Hypertrophic Obstructive Cardiomyopathy
Authors: Mohanad Shehadeh, Fahad Eid, Alaa Rahhal, Amir Hanafi, Mohamed Eid, bipul baibhav
Journal: Circulation (2024)

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder characterized by thickened heart muscle and dynamic left ventricular outflow tract (LVOT) obstruction. Mavacamten (Camzyos) is a novel therapeutic agent targeting myocardial contractility. This study evaluates the impact of Mavacamten on blood pressure (BP) and other clinical parameters in HOCM patients over a 24-month period. Methods: A retrospective study was conducted on 40 HOCM patients initiated on Mavacamten, with follow-ups at 12 and 24 months. Blood pressure measurements (systolic BP [SBP] and diastolic BP [DBP]) were recorded at baseline, 12 months, and 24 months. Secondary outcomes included changes in LVOT obstruction at rest and with provocation, the New York Heart Association (NYHA) functional class, and left ventricular ejection fraction (LVEF). Results: The study population had a mean age of 67 ± 10 years, with 50% male. Baseline characteristics included a high prevalence of hypertension (78%), dyslipidemia (67%), and atrial fibrillation (31%). At 12 and 24 months, there were no significant changes in SBP (137 ± 18 mmHg to 139 ± 18 mmHg at 12 months, p=0.850, and to 132 ± 17 mmHg at 24 months, p=0.607) or DBP (78 ± 11 mmHg to 80 ± 10 mmHg at 12 months, p=0.409, and to 80 ± 10 mmHg at 24 months, p=0.468). However, significant reductions were observed in LVOT pressure gradients both at rest (48 ± 41 mmHg to 11 ± 15 mmHg at 12 months, p&lt;0.001, and to 8 ± 13 mmHg at 24 months, p&lt;0.001) and with provocation (89 ± 59 mmHg to 27 ± 32 mmHg at 12 months, p&lt;0.001, and to 22 ± 28 mmHg at 24 months, p&lt;0.001). NYHA class improved significantly, with a higher proportion of patients in class I (3% to 21% at 12 months, p=0.031, and to 27% at 24 months, p=0.016) and a reduction in class III patients (50% to 12% at 12 months, p&lt;0.001, and to 10% at 24 months, p=0.002). LVEF decreased from 69 ± 6% to 64 ± 4% at 12 months (p&lt;0.001) and remained at 64 ± 6% at 24 months (p&lt;0.001). Conclusion: Mavacamten use in HOCM patients over 24 months demonstrated stability in blood pressure but significant improvements in LVOT obstruction, NYHA functional class, and a slight decrease in the LVEF.
Abstract 4144793: Pulmonary Thromboendarterectomy in a Developing Country: Clinical and Hemodynamic Outcomes and Predictors of Hospital Mortality
Authors: Frederico Thadeu Campos, Rodrigo Bernardes, MARCOS MARINO, Roberto Luiz Marino, Virginia Guimaraes, Carlos Alberto Junior, Susan Andrade, Paula Leucas, Bruno Nascimento
Journal: Circulation (2024)

Introduction: Pulmonary thromboendarterectomy (PTE) is the definitive therapy for chronic thromboembolic pulmonary hypertension (CTEPH). Outcomes are highly dependent on local expertise and volume. We aimed to describe clinical and hemodynamic outcomes of patients with CTEPH undergoing PTE in a developing country, and to assess predictors of mortality. Methods: Single-center observational study, with prospective data collection of consecutive patients with symptomatic CTEPH who underwent PTE in a high-volume PH center in Brazil. Clinical and demographic variables were systematically collected by the Pneumology team. Hemodynamic data were collected in the right heart catheterization, prior to PTA, and in the post-procedural Swan-Ganz monitoring. Echocardiography (echo) was performed pre procedure and in the earliest available follow-up. Hemodynamic variables of interest were invasive mean pulmonary artery mean pressure (PAPm), cardiac index (CI) and pulmonary vascular resistance (PVR), and systolic pulmonary artery pressure (SPAP) on echo, compared pre and post-surgery. The outcome of interest was in-hospital mortality, and significant predictors in bivariate analysis were included in multivariate regression models. Results: At total 64 patients underwent CTEPH, 37 (58%) women, mean age of 51±14 (range 23-78) years. All but 13 patients had documented acute pulmonary embolism, and 13 (20%) had deep vein thrombosis. Functional class was NYHA 3 or 4 in 38 (59%) cases, and mean NT-ProBNP was 1182±1642pg/ml. Compared to baseline, PAPm (51.9 ± 17.0 vs. 28.5 ± 8,6 mmHg, p&lt;0.001), PVR (11.5 ± 5.3 vs. 4.7 ± 3.7 UWood, p&lt;0.001) and SPAP (87.4 ± 22.1 vs. 57.5 ± 18.5 mmHg, p&lt;0.001) decreased significantly in the post-procedural evaluation, with a parallel increase in CI (2.4±1.0 vs. 3.0±0.7 L/min/m 2 , p=0.039). In the late port-surgical echo, SPAP remained similarly low (54.1 ± 22.1 mmHg, p=0.46). In-hospital mortality occurred in 11 (17.2%) individuals, and the most frequent non-fatal complication was infection (N=5). Patients who died were more frequently women, had higher NT-ProBNP levels and higher post-operative PVR. The only independent predictor of mortality among the available variables was female sex: OR=9.6 (95% CI 1.5 – 80.7), p=0.03, in the age-adjusted model. Conclusion: PTE resulted in significant and long-standing hemodynamic improvement among patients with CTEPH. The growing multidisciplinary experience tend to improve hard clinical outcomes.
Abstract 4145142: Enhancing Inpatient Mortality Prediction in TAVR Patients: A Modified CHA2DS2-VASc Approach Using Machine Learning
Authors: Shahan Haseeb, Shafia Munir, Omair Ahmed, Muhammad Ahmad Qureshi, Himani Patel, Eric Gehres, Taha Siddiqui, Muhammad Zaman, Raiyan Ali, Manu Dwivedi, Umair Ansari, Muhammad Zulqarnain
Journal: Circulation (2024)

Introduction: Inpatient mortality remains a significant concern for patients who have undergone transcatheter aortic valve replacement (TAVR) procedures. Accurate risk prediction models are vital for optimizing patient care and outcomes in this population. The CHA2DS2-VASc score has been utilized to predict various inpatient and long-term outcomes, irrespective of patient history of atrial fibrillation. This abstract introduces a novel approach to enhance inpatient mortality prediction in TAVR patients by adapting the CHA2DS2-VASc score using Lasso regression. Methods: We used the National Inpatient Sample Database to include all patients who underwent TAVR from 2018 to 2020. All patients with and without any history of atrial fibrillation or atrial flutter were included in the analysis. We employed Lasso regression, to modify the CHA2DS2-VASc score for predicting stroke risk in patients who underwent TAVR. The data was split into a 70:30 training-testing set. The model’s performance was evaluated using the Area Under the Receiver Operating Characteristic (AUROC) curve and compared to CHADS2-VASc. Results: The study included a total population of 28,684 patients in the training set and 12,290 patients in the testing set. The median age of the entire population was 80 years (IQR: 73-85), and females accounted for 44% of the total population. The mean CHA2DS2-VASc for the entire population was 3.82 (CI: 3.81-3.84) The AUROC values were 0.8239 for the training dataset and 0.8203 for the testing dataset, indicating strong discriminative ability in both cases. This performance was significantly improved compared to the CHA2DS2-VASc score (AUROC of 0.654). Conclusion: The modified CHA2DS2-VASc score improves inpatient mortality prediction for TAVR patients. With strong discrimination (AUROC 0.8239/0.8203) compared to the CHA2DS2-VASc score (AUROC 0.654), it holds promise for tailored risk assessment and improved patient care. Prospective validation is needed and comparison with the more widely used STS score is needed to establish real-world applicability.
Abstract 4144835: Caregiving Burden Does Not Moderate the Effect of the Cardiovascular Risk Reduction Program on Engagement in Healthy Behaviors for Rural Caregivers
Authors: Misook Chung, Terry Lennie, Mary Kay Rayens, Debra Moser
Journal: Circulation (2024)

Introduction: Given the substantial evidence that adults who provide informal care for their chronically ill families are at high risk of poor health, including the development of cardiovascular disease (CVD), engagement in and maintenance of healthy behaviors are critical. Furthermore, rural caregivers living in socioeconomically austere healthcare environments face additional challenges in engaging in self-care. We conducted a CVD risk reduction intervention program for rural caregivers to promote self-care in the context of caregiving burden. Aims: The aim was to determine whether caregiving burden moderated the intervention effect on engagement in healthy behaviors. Method: In this randomized controlled trial (RCT), rural caregivers with at least two or more CVD risk factors (N=311, 76% female, 96% white, mean age=54.8 years) were randomly assigned to either intervention or control groups. The 12-week education and counseling intervention designed to promote self-care was delivered by telehealth. Outcomes were assessed at 4 and 12-month follow-ups. Caregiving experience was assessed using the Zarit Burden Interview (ZBI) and the Osbert Caregiving Burden Scale (time spent and difficulty in caregiving subscales). Engagement in healthy behaviors was assessed using the modified version of the Medical Outcome Scale-Specific Adherence Scale. ANOVA and three-way repeated measures ANOVA were used. Results: Most caregivers reported a little or no burden (n=123, 39.5%) or mild-moderate caregiving burden (n=120, 38.5%), but one-fifth reported moderate to severe burden (n=68, 21.8%) as categorized by baseline ZBI scores. Caregivers with moderate to severe burden had more time spent on caregiving (p&lt;.001) and higher levels of caregiving difficulty (P &lt;.001) at baseline. The intervention group significantly improved engagement in self-care at 4 and 12 months compared to the control group (Time X RCT Group, P &lt; 0.001), but the effect was not moderated by their caregiver burden groups (Time X RCT Group X Caregiving Burden groups, P = 0.843, Figure 1). Conclusion: The CVD risk reduction program designed for rural caregivers effectively improved engagement in heart-healthy behaviors regardless of their caregiving burden levels.
Abstract 4145107: Latest Insights in Drug-Induced Kounis Syndrome: A Systematic Review 2024
Authors: Saher Shiza, Kenneth Ong, Gaurang Suhagiya, Tazeen Nazar, Zahoor Ahmed
Journal: Circulation (2024)

Background: Kounis syndrome (KS), also known as allergic myocardial infarction, is a rare but potentially life-threatening condition characterized by acute coronary syndrome in the setting of allergic reactions triggered by drugs, foods, vaccines, or environmental exposure. Our study provides an updated comprehensive insight into this patient cohort on a large scale. Methods: We conducted a systemic literature search in PubMed, EMBASE, and Google Scholar between 2018 and 2024, using MeSH terms and keywords for “Kounis syndrome”, “drug”, and allergy to identify the cases of drug-induced KS. Initial search yielded 325 articles. After excluding duplicates, review articles and irrelevant studies, we included only 51 articles reporting drug-induced KS. Results: Our study identified 51 patients of KS with a median age of 56 ± 14 years. Of those, 56.86% were female. The most frequently implicated drugs in KS were antimicrobials (37.25%), followed by iodinated contrast media (19.60%), NSAIDs (15.68%), and antineoplastics (9.80%). Of those, 64.70% of patients were diagnosed with KS-I, 13.72% with KS-II, and 21.56% with KS-III. Chest pain (94.1%), dyspnea (90.1%), and palpitations (60.78%) were predominant initial manifestations, and most cases (78.43%) were presented within 1st hour of drug ingestion. ST-segment changes (100%) were common ECG findings, and 64.70% of patients had elevated cardiac troponin. All patients had reduced left ventricular ejection fraction (LVEF) (&lt;50%), with severe cardiomyopathy (EF&lt; 30%) in 35.29%. 96.07% of patients were discharged after a median length of hospital stays (11 ± 2.91 days) (Figure 1). Conclusion: Although rare, KS is a life-threatening adverse event of drug-induced allergic reactions. KS is challenging to diagnose due to mixed clinical presentations of acute coronary syndrome and allergic reactions. KS should be included in the differential diagnosis of patients presenting with acute coronary syndrome without typical risk factors after drug-induced allergic reactions, especially antimicrobials. Early recognition and appropriate management are crucial for optimum outcomes.
Abstract 4144823: Persistent Prothrombotic State in Post-Acute Sequelae of Mild SARS-CoV-2 Infection: Role of Extracellular Histones and Immune Complexes
Authors: Gokul Patil, Azaj Ahmed, Francis Miller, Noah Butler, Alejandro Comellas, Alpana Garg, Sanjana Dayal
Journal: Circulation (2024)

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) have become a significant healthcare burden. Sustained increases in prothrombotic markers have been reported in hospitalized acute COVID-19 patients. However, whether patients with less severe acute infection also endure a persistent prothrombotic state remains uncertain. We tested for a prothrombotic state in this cohort and examined potential mediators. We enrolled 70 adult patients with prior mild acute SARS-CoV-2 infection and sustained PASC symptoms (per WHO criteria). A control healthy group matched for age and sex was also enrolled who were not previously diagnosed with COVID-19. Markers of platelet activation and platelet-neutrophil aggregates (PNA) were quantified using whole-blood flow cytometry. Markers of extracellular traps (citrullinated histones [H3Cit] and cell-free DNA [cfDNA]), anti-dsDNA IgG, and thrombin generation potential were measured in plasma. At recruitment (6 weeks to 3 years post infection), there was increased potential for thrombin generation in the plasma from PASC compared to control reflected by increased peak and velocity index (P&lt;0.001 vs. control). In whole blood, activation with thrombin receptor activating peptide (TRAP) caused increased surface expression of P-selectin and activation of integrin αIIbβ3 in platelets (P&lt;0.001 and P&lt;0.05, respectively, vs. control). Concurrently, there was an increase in the PNA (P&lt;0.01 vs. control). Plasma levels of H3Cit, cfDNA, as well as anti-dsDNA IgG were found to be elevated (P&lt;0.0001 vs. control for all), suggesting not only an increase in extracellular trap, but also the existence of circulating immune complexes (ICs). While a histone-neutralizing aptamer inhibited P-selectin expression, αIIbβ3 activation, and PNA formation in whole blood, incubation of patient serum with anti-CD32, a FcγRIIa blocker (blocks the interaction of ICs with FcFcγRII on platelets), inhibited the activation of healthy platelets by patient sera. In conclusion, our study revealed a persistent prothrombotic state for months to years in patients who experienced mild acute infection with SARS-CoV-2. Further, our data suggest that the activation of platelet is partly mediated by extracellular histones and ICs, such as anti-dsDNA antibodies. Our findings suggest a model in which extracellular traps activate platelets directly and indirectly through ICs. This study proposes novel therapeutic interventions targeting extracellular histones and ICs-Fcγ in PASC.
Abstract 4145114: Novel Sonothrombolysis Approach to Left Circumflex Thrombus
Authors: Kelli Brush, Roshni Kalkur, Kajal Shah, Armin Helisch, Eric Rothstein
Journal: Circulation (2024)

Sonothrombolysis, the use of ultrasound waves to augment thrombolysis, has been reported in prior limited studies as an adjunctive therapy in the management of acute myocardial infarct (MI) during percutaneous coronary intervention (PCI). By facilitating the dissolution of thrombi and improving microvascular perfusion, sonothrombolysis offers a potential strategy to enhance the efficacy of PCI and improve clinical outcomes. We present a case report utilizing a novel sonothrombolysis approach with successful application of ultrasound contrast directly to the coronary vasculature to reduce thrombus burden in a left circumflex lesion. Case: A 78 year old male presented with ventricular tachycardia and NSTEMI. After stabilization he underwent a left heart catheterization which demonstrated thrombus in the mid left circumflex. Distal flow was decreased, TIMI grade 2. Intravascular ultrasound&amp;optical coherence tomography was used for visualization of thrombus, no atherosclerosis or significant calcification was seen. Mechanical thrombectomy was performed with significant residual thrombus. Sonothrombolysis was performed with ultrasound enhancing agent injected directly intracoronary through a guide catheter and high mechanical index pulses applied via echo probe. There was marked reduction in thrombus burden and TIMI 3 flow. Discussion: Despite advancements in PCI techniques, achieving optimal myocardial reperfusion remains a challenge in patients with MI, particularly those with extensive thrombotic burden. Traditional thrombolytic agents have limitations, including incomplete thrombus dissolution and delayed reperfusion. Sonothrombolysis utilizing an ultrasound enhancing agent adminsitered intravascularly with echo probe delivering high mechanical index pulses has emerged as a novel approach to address these limitations. This is the first reported case with direct application of ultrasound contrast to the coronaries via guide catheter for sonothrombolysis in the setting of an NSTEMI. There have been prior reports of pre-procedural sonothrombolysis delivered to peripheral vasculature in STEMI cases which had limited evidence demonstrating improvement in post MI outcomes. This case report contributes to the growing body of literature by providing insights into the clinical application and efficacy of sonothrombolysis in the management of MI during PCI.
Abstract 4145271: Systemic Lupus Erythematosus-Induced Libman-Sacks Endocarditis Complicated by Multiple Embolic Episodes and Atypical Secondary Valve Involvement
Authors: Jacob Roberts, David Cho
Journal: Circulation (2024)

A 42-year-old female with SLE, lupus cerebritis with related seizure disorder, and mesenteric venous thrombosis on warfarin initially presented for syncope. Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Six months later, the patient was evaluated by cardiology for hypertension diagnosed during hospitalization. She reported no further syncope, but exam revealed a 3/6 holosystolic murmur. Subsequent TTE identified severe MR with primary MV degeneration and LVEF &gt;60%. A TEE confirmed severe MR with myxomatous MV leaflets and moderate-sized nonmobile vegetations attached to the atrial side of A2 and P2 of the MV. Subsequent infectious workup including serial blood cultures were negative. The patient was diagnosed with non-bacterial Libman-Sacks endocarditis (LSE). Given a lack of symptoms and plan to resume immunosuppressive therapy and continue her anticoagulation (AC), surgical intervention was initially deferred with close follow-up. The patient continued to endorse worsening headaches and brain MRI revealed new chronic small ischemic strokes. One morning, the patient noted sudden aphasia and presented to the ED. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Cerebral angiogram further revealed FMD. Given ongoing embolic phenomena, likely from LSE, she underwent MVR with mechanical valve and LA appendage ligation and continued mycophenolate and warfarin. Two months postoperatively, the patient remained asymptomatic with normal prosthetic valve function and neurologic status. However, evaluation for extracranial FMD with CTA revealed interval development of PV vegetations. These lesions and moderate PR were confirmed on TTE. Discussion: While response to immunosuppressive therapy and AC has been reported to improve early-phase LSE, this patient continued to experience thromboembolic events resulting from LSE vegetations while on mycophenolate and warfarin. Despite continuing these therapies after MVR, she later developed PV vegetations and PR. Pulmonary valve involvement is rare in LSE, and development of new disease while on recommended medical therapy represents unusual disease progression.
Abstract 4144981: Impact of Patent Foramen Ovale on Transvenous Lead Extraction Characteristics and Outcomes
Authors: Aaron Park, John Power, Omar Aldaas, Gordon Ho, Timothy Maus, Ulrika Birgersdotter-Green, Travis Pollema
Journal: Circulation (2024)

Background: Transvenous lead extraction (TLE) may be indicated for cardiac implantable electronic device infection, malfunction, or upgrade. TLE can increase right heart pressures and mobilize debris, resulting in a right-to-left embolism and stroke via a patent foramen ovale (PFO). Aims: To identify the prevalence of PFO in patients undergoing TLE, characterize affected patients, and compare incidence of adverse events. Hypothesis: The presence of a PFO in patients undergoing TLE will result in a higher incidence of adverse events. Methods: Intraoperative transesophageal echocardiogram (TEE) is routinely performed during TLE at University of California, San Diego. Between 11/2021 and 12/2023, 200 patients had intraoperative TEE reports available, with Color flow Doppler being used to identify PFO. Lead-associated vegetation or thrombus was only reported on preoperative TEE. Patient characteristics and outcomes were collected and compared by PFO status. Results: Of 200 patients with TEE reported during TLE, mean age was 65.1 with a standard deviation of ± 15.1; 64% were male. PFO was detected in 26 (13%) patients but was not associated with different baseline characteristics. Overall, mean lead count was 2.3 ± 0.7, dwell time was 4.7 ± 3.7 years, and procedural success was 95.5% with no difference by PFO status. Most common extraction indications were malfunction (44.1%) and infection (29.6%). Preoperative TEE reported lead-associated thrombus in 0/14 (0%) patients with PFO versus 7/98 (7.1%) without PFO (p&gt;0.99) and lead-associated vegetation in 2/6 (33.3%) patients with PFO versus 12/64 (18.8%) patients without PFO (p=0.59). In-hospital stroke was not different by PFO status (1/26 3.8% PFO vs 1/174 0.6% no PFO, p=0.24) and no patients experienced myocardial infarction. In-hospital mortality was significantly higher in patients with PFO (2/26 7.7% PFO vs 0/174 0% no PFO, p=0.016). Of these two deaths in the PFO cohort, one was due to stroke-related complications and the other to sepsis. Conclusion: PFO was detected in 13% of patients on intraoperative TEE during TLE. Stroke incidence was similar by PFO status, but mortality was higher in those with PFO. Further studies are needed to understand this association.