tbuckley/cabot-search huggingface dataset:
Abstract 14502: Contemporary Practices and Outcomes in Primary Pulmonary Vein Stenosis: A PVS Network Study
Authors: Rachel D Vanderlaan, Athar Mahmood Qureshi, Russel Hirsch, Crystal Tran, Ryan Callahan, Delphine Yung, Eric D Austin, Stephanie S Handler, David M Kalfa, Carl H Backes, Christian Pizarro, Lourdes R Prieto, Bassel Mohammad Nijres, Liezl Domingo, Sara M Trucco, Christopher J Petit, Chris Baird, Manish Bansal, Erika Vorhies, David M Overman, Alomgir Hossain, Jonathan J Rome, Ronald W Day, Dunbar D Ivy, Christopher A Caldarone
Journal: Circulation (2023)

Background and Study Aim: Pediatric pulmonary vein stenosis (PVS) remains a disease associated with high mortality, with studies primarily limited to single center reports. Using the PVS Network Registry, we report on contemporary practices and outcomes for a large cohort of children with primary PVS across North America. Methods: Children with a diagnosis of primary PVS (congenital, normal pulmonary venous connections) in the retrospective PVS Network Registry (2009-2019, n=600, 19 institutions) were analyzed using descriptive statistics, survival analysis and Cox regression analysis. Results: In the PVS Network Registry cohort, 393 patients had a diagnosis of primary PVS. In the primary PVS cohort, 199 (50%) were male, 105 (27%) had a genetic diagnosis and 192 (49%) were premature (median 29 (22-37) weeks). Medical therapies were used in 53(14%) patients, with Imatinib being most common (58%). Pulmonary hypertension medications were used in 182 (46%) patients, with sildenafil most reported (90%). Surgical and catheter-based interventions for PVS were performed in 334 (85%) patients. 203 (60%) patients had at least one PVS surgery and 231(71%) had at least one PVS catheter intervention. At the time of first procedure for PVS, 133 (39%) had bilateral disease, while 100 (30%) had ≥3 pulmonary veins involved. The median age was 0.54 years (IQR 0.91). Catheter based interventions were more common on the left PVs (60%). Repeat procedures were common (53%) with the majority being catheter reinterventions (78%), with an average of 3.24 (±2.75) catheter procedures per patient. The overall survival for children with primary PVS was 76% and 71% at 1 and 2 years. In children with ≥4 veins involved, survival was 59% and 52% at 1 and 2 years. Older age at intervention was protective (HR 0.66, P&lt;0.02), while ≥3 vein involvement was associated with poor outcome (HR 1.8, p=0.05). Conclusion: This is the largest primary PVS cohort reported and demonstrates overall 1 year survival of 76%, however, children with multivessel disease remain at high risk. Reinterventions are common, with many undergoing repeat catheterization procedures in our cohort. The PVS Network retrospective cohort provides insights into clinical practices and will provide benchmarking for future studies.
Abstract 18847: Apples to Apples: Cardiopulmonary Exercise Testing Findings in Healthy Athletes versus Equally Fit Patients With Hypertrophic Cardiomyopathy
Authors: Cliodhna McHugh, Sarah K Gustus, Bradley J Petek, Meagan M Wasfy
Journal: Circulation (2023)

Introduction: CPET is often used when athletes present for clinical evaluation of suspected pathology, including HCM. While lower than expected peak oxygen consumption (pVO 2 ) may raise suspicion for HCM, athletes with HCM frequently display normal or supranormal pVO 2 , limiting the diagnostic utility of this parameter. Hypothesis: We hypothesize that there will be differences in other CPET parameters between healthy athletes and equally fit individuals with established HCM. Aim: The aim of this study was to compare CPET parameters in healthy athletes and equally fit individuals with established HCM. Methods: Healthy athletes and HCM patients (percent predicted pVO 2 (ppVO 2 ) &gt;90%, non-obstructive, no nodal agents) were identified who had cycle ergometer CPETs for research or clinical evaluation in a single lab. CPETs were compared between HCM patients and athletes matched (2:1 ratio) for age, sex, race, height, weight, and cardiorespiratory fitness (ppVO 2 ). Results: Consistent with matching, HCM (n=30, 43.6 ± 14.2 years) and athletes (n=60, 43.8 ± 14.9 years) groups had similar, supranormal pVO 2 (40.4 ± 9.0 vs. 41.2 ± 8.9 mL/kg/min, 125% vs. 124% predicted, n.s.). While many CPET parameters were similar between groups, HCM patients had worse ventilatory efficiency with lower end-tidal CO 2 at the ventilatory threshold (VT) (42.9 ± 6.4 vs. 45.7 ± 4.8, p= 0.02), higher early VE/VCO 2 slope (through VT, 25.4 ± 4.7 vs. 23.4 ± 3.1, p=0.02), and higher nadir of VE/VCO 2 (27.3 ± 4 vs. 25.2 ± 2.6, p&lt;0.001). When stratified by ppVO 2 , these differences remained significant for those with ppVO 2 &lt; and ≥100%. Using the recommended cut-off of &lt;30, HCM patients were more likely to have abnormally high VE/VCO 2 nadir than athletes (20% vs. 5%, p= 0.03). Conclusion: Amongst equally fit individuals, ventilatory efficiency was worse in patients with HCM than in healthy athletes. Our results suggest ventilatory efficiency may be useful to integrate in with other diagnostic testing in “gray zone” clinical cases in which the diagnosis of HCM is being debated in athletes with LVH. Given ventilatory efficiency has been increasingly recognized as a key prognostic CPET parameter, future work should establish the prognostic value of VE/VCO 2 in HCM patients with intact cardiorespiratory fitness.
Abstract 18955: Post Webinar Survey Responses Regarding Maternity and Legal Rights for Cardiologists
Authors: Renee P Bullock-Palmer, Monika Sanghavi, Kamala Tamirisa, Laxmi S Mehta, Nosheen Reza, Odayme Quesada, Sonia Shah, Annabelle S Volgman, Martha Gulati, Jessica Lee, Julia A Grapsa, Gina P Lundberg
Journal: Circulation (2023)

Introduction/Background: Women are under-represented in cardiology and cardiology subspecialties. Work life challenges are often a stated reason why women do not choose cardiology. Pregnancy and motherhood represent a time of significant challenges to women in cardiology due to lack of support and discrimination. The American Heart Association (AHA)Women in Cardiology (WIC) Committee recently held a case-based webinar to increase awareness about the issues, discuss available resources for support, and understand laws protecting women against discrimination. Goals/Aims: The goal of the survey was to understand the current landscape of perceived institutional support during the maternity period and gauge awareness of the laws protecting women against discrimination. Methods/Approach: After the webinar, an email survey was sent to all those who registered on behalf of the AHAWIC Committee within 7days of the event. Results/Data: There were 189registrants for the webinar, of which 29(15%)responded to the survey. Of those who responded, 72%were female, 48%were &lt;40years of age, 33%of the attendees were mothers, and 20%reported fertility issues. Almost all respondents reported working in a hospital-based practice (90%),59%were attending physicians and 38%were trainees. Only 28%reported that their work environment was very supportive of mothers and only 31%were aware of maternal legal rights in the workplace. After the webinar, 76%planned to learn or implement new maternal rights related policies in their workplace (Figure 1). Conclusions: Pregnancy and motherhood represent a challenging time in the career of a female cardiologist or trainee. Perceived support in the workplace is low. Very few women know their legal rights, but a majority had a plan to learn more after the webinar. This survey highlights opportunities for the cardiology community and national societies to help support women cardiologists.
Abstract 16969: Assessment of the Electromechanical Window in Patients With Conventional Biventricular Pacing as Compared to Patients With Conduction System Pacing
Authors: Mykaihla Sternick, Nina Spitofsky, Alyson Owen, Behzad B Pavri
Journal: Circulation (2023)

Introduction: The Electromechanical Window (EMW) is a validated measurement reflecting electromechanical coupling of the ventricles, and is defined as the difference between electrical and mechanical ventricular activation times. A larger (more negative) EMW is associated with worse clinical outcomes, especially greater arrhythmic risk, in various clinical conditions such as long QT syndrome, risk of drug-inducd torsade, hypertrophic cardiomyopathy, etc. Cardiac resynchronization therapy (CRT) can be achieved by conventional bi-ventricular pacing (BiVP) or conduction system pacing (CSP). We assessed the EMW in patients undergoing CRT via these 2 modalities. Methods: Total mechanical activation time was measured from the 5 chamber echocardiographic view as the interval (ms) from the onset of the Q wave to aortic valve closure (mean of 3 measurements). Total electrical activation time (QTcBazett interval, ms) was measured from 12 lead ECGs recorded within 24 hours of the echocardiogram. The EMW was calculated as the difference between the QTc and the mechanical ventricular activation time. Results: A total of 60 pts (BiVP=31, CSP=29) were analyzed. There was no significant difference between the heart rates during the ECG and the echocardiogram recorded within 24 hours of each other (74.6 ± 16.5 vs 71.5 ± 12.0 bpm, P=NS). The EMW was significantly more negative in patients with BiVP as compared to CSP (-99.5 ± 70.9 vs -55.2 ± 52.7 ms, P=0.03). When restricting the analysis to patients where the ECG and echocardiographic HRs were within 10 bpm of each other, the difference remained significant (P=0.03). Conclusions: Patients in whom CRT is achieved by CSP have less negative EMWs as compared to patients with BiVP. Based on the known association of more negative EMW with increased arrhythmic risk, these data, if confirmed in larger populations with correlation to clinical outcomes, add to the growing evidence to support CSP as the preferred modality for achieving CRT.
Abstract 15620: Diagnostic Accuracy of Virtual Non-Contrast CT for Aortic Valve Stenosis Severity Evaluation
Authors: Daniel A Lorenzatti, Ari Feinberg, Pamela Pina Santana, Jonathan Daich, Javier Perez-Cervera, Rita Miranda, Sandra Halliburton, Aldo L Schenone, Andrea Scotti, Toshiki Kuno, Damini Dey, Philippe Pibarot, Marc R Dweck, Mario J Garcia, Leandro Slipczuk
Journal: Circulation (2023)

Introduction: Computed tomography (CT) aortic valve calcium (AVC) score has important prognostic and diagnostic value in patients with aortic stenosis, especially in those evaluated for TAVR, but at the expense of an additional non-contrast scan. Dual-energy CT (DECT) allows virtual non-contrast reconstructions (VNC) from conventional contrast acquisitions. Aims: Compare the diagnostic performance of VNC-AVC score as compared to TNC-AVC score for identifying severe AS. Methods: We prospectively included patients undergoing pre-TAVR CT with a DECT system (IQon, Philips). TNC-AVC score was acquired using a prospective acquisition and VNC-AVC score derived from a contrast-enhanced retrospective scan. Both scores were calculated using the Agatston method. A correction proportionality constant was applied. Concordant severe AS was defined as AVA&lt;1cm2 and either Vmax &gt;4cm/s or mean gradient ≥40mmHg. Spearman, Cohen’s Kappa, and Bland-Altman were used to assess concordance. Results: In total, 109 patients were included: mean age of 79 ± 10 yrs, 55% female, 43% with concordant severe, 43% LF-LG, and 14% moderate AS. TNC scan median radiation was 116 mGy*cm (IQR 53-366). The median TNC-AVC was 2753 AU (1652-4135), while the median VNC-AVC was 1900 AU (946-2752) after applying the constant (1.43). A strong correlation was demonstrated between methods (r=0.89; p&lt;0.001; Figure). Using accepted thresholds (&gt;1300 AU for women and &gt;2000 AU for men), 68% (n=74) of patients had severe AS by TNC. After estimating thresholds for VNC (&gt;660 for women and &gt;1519 for men), 60% (n=65) had severe AS, demonstrating substantial agreement with TNC-AVC (K;=0.71). Among individuals diagnosed with LF-LG, 38% and 34% exhibited severe AS by TNC/VNC, respectively, and only 12% and 11% in those with moderate AS. Conclusions: DECT-derived VNC-AVC demonstrates substantial agreement with TNC AVC, without requiring an additional scan and reducing both radiation exposure and acquisition time.
Abstract 13665: Clinical Outcomes and Predictors of Residual Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Kitae Kim, Madoka Sano, Junichi Ooka, Ryosuke Murai, Toshiaki Toyota, Taiji Okada, Yasuhiro Sasaki, Tomohiko Taniguchi, Atsushi Kobori, Natsuhiko Ehara, Makoto Kinoshita, Yutaka Furukawa
Journal: Circulation (2023)

Background: Although transcatheter aortic valve replacement (TAVR) improves pulmonary hypertension (PH) secondary to aortic stenosis (AS), PH can remain after TAVR. We sought to investigate the outcomes and predictors of residual PH after TAVR. Methods: A total of 491 consecutive patients underwent TAVR between 2014 and 2023 at our institution. After excluding patients without baseline or postoperative transthoracic echocardiography, we stratified 483 patients according to baseline and postprocedural PH estimated by systolic pulmonary artery pressure &gt;36 mmHg as follows: no PH group (n=285), improved PH group (n=87), residual PH group (n=111). Outcome measures were the composite of cardiac death and heart failure (HF) hospitalization. Logistic regression analysis was used to identify the predictors of residual PH. Variables included in the model were age, atrial fibrillation (AF), left ventricular ejection fraction, left atrial dilatation, moderate/severe mitral regurgitation, moderate/severe tricuspid regurgitation (TR). Results: The mean age was 83.6±5.4 years, and 314 (65%) were female. Patients in residual PH group were more likely to have AF, higher left atrial volume index, moderate/severe MR, and moderate/severe TR, compared with patients in no PH group. Compared with no PH group, the cumulative incidence of the composite of cardiac death and HF hospitalization were comparable in improved PH group (6.1% vs. 10.5 at 2 years, P=0.3), but significantly higher in residual PH group (6.1% vs. 20.6% at 2 years, P=0.002) (Figure). Multivariable logistic regression analysis showed that AF (Odds ratio [OR] 1.91, 95% confidence interval [CI] 1.09-3.32), moderate/severe TR (OR 4.09, 95% CI 2.30-7.28) were independently associated with residual PH. Conclusions: Among patients undergoing TAVR, residual PH were associated with increased risk of adverse cardiac events. AF, moderate or severe TR were independent predictors of residual PH after TAVR.
Abstract 17586: Physical Activity Associates With a Greater Reduction in Heart Failure Risk Among Individuals With Depression and/or Anxiety
Authors: Abdulaziz Al-Hamam, Shady Abohashem, Charbel Gharios, Hadil Zureigat, Guillaume GOUDOT, Simran Grewal, Wesam Aldosoky, Omar Alani, Michael Osborne, Ahmed A Tawakol
Journal: Circulation (2023)

Introduction: Physical activity (PA) has shown a dose-dependent reduction in the incidence of heart failure (HF) by mitigating stress-related neural activity (SNA). Accordingly, we postulated that the impact of PA on HF incidence may be more pronounced in individuals with chronic stress conditions (e.g., depression and/or anxiety) that associate with heightened baseline SNA. Objective: To test whether PA confers a greater reduction in HF incidence among individuals with (vs. without) pre-existing depression and/or anxiety. Methods: Among 48,673 participants (median age 60 years, 40% male) in the Mass General Brigham Biobank, self-reported PA data were collected through a health survey and converted to metabolic equivalent of task minutes per week. Data on incident HF, its subtypes, depression, anxiety, and cardiovascular risk factors were obtained using the International Classification of Disease Codes. Cox regression was employed to assess the association between PA and ten-year HF risk and to examine potential interactions. Results: PA (per each standard deviation) is independently associated with greater reductions in all HF risk among individuals with depression and/or anxiety (standardized hazard ratio [HR] [95% confidence interval (CI)]: 0.735 [0.648, 0.834], p&lt;0.001) compared to those without depression and/or anxiety (0.821 [0.781, 0.864], p&lt;0.001, p-interaction=0.038*). Similar associations were observed between PA and the risk of HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) among those in whom HF could be classified, Fig1. Conclusions: PA is associated with greater reductions in risk of incident HF, including HFpEF and HFrEF, with the greatest reductions in those with pre-existing depression and/or anxiety. These findings highlight the potential for improved cardiovascular benefits linked to PA in individuals with elevated baseline SNA.
Abstract 18478: Association of Family History and Cardiomyopathy-Associated Gene Variants of Unknown Significance in Ethnic Minority Patients With Early Onset Atrial Fibrillation
Authors: Ashwini Deshpande, Michael Hill, Jood Dabbas, Shashank Sandu, Peter Boxley, Joshua Arnold, Victor Qiao, Brandon Chalazan, David Tofovic, Dawood Darbar
Journal: Circulation (2023)

Introduction: Underrepresentation of ethnic minorities in genetic studies can complicate interpretation of variants of unknown significance (VUS) in these groups. Likely pathogenic or pathogenic (LP/P) cardiomyopathy (CM) gene variants are associated with early onset-atrial fibrillation (EOAF) in a cohort of predominantly European ancestry, but prevalence in minorities, and the role of VUS, is unclear. Three-generation family history (FH) may provide insight into the potential pathogenicity of VUS in ethnic minorities. Hypothesis: In patients with EOAF and low comorbidity burden carrying CM VUS, does positive FH suggest variant pathogenicity? Aims: To determine whether CM gene VUS in ethnic minority probands with EOAF are associated with a FH of arrhythmia, stroke, or heart failure. Methods: Of 301 individuals from the University of Illinois Health Multi-Ethnic AF Registry who underwent whole exome sequencing, we identified 89 with either LP/P variant, positive FH from medical records, or AF diagnosis age ≤55 years and ≤2 comorbidities. We examined 22 genes strongly associated with CM and graded pathogenicity according to American College of Medical Genetics criteria. A three-generation FH was obtained by contacting probands or family members. Results: A FH was obtained in 36 patients (Figure 1a; median age 52 years, 56% female, 83% African-American, 17% Hispanic/Latinx). LP/P variants were present in 3 (8%) probands, VUS in 10 (28%), and likely benign/benign (LB/B) or no variant in 23 (64%). A FH of arrhythmia, heart failure, or stroke was present in 27 subjects (75%) with a FH of heart failure more likely in VUS carriers compared to those with LB/B or no variant (70% vs 26%, p=0.02), with no difference in FH of arrhythmia or stroke. Conclusion: Probands with EOAF who carry CM VUS have greater rates of FH of heart failure than those without disease-associated variants. This suggests pathogenicity of CM VUS in ethnic minorities with EOAF.
Abstract 14592: Sepsis Cardiac Edema Related Reversible Injury (SCERRI)
Authors: Verity J Ford, Willard N Applefeld, Jeffrey Wang, Junfeng Sun, Jing Feng, VANDANA SACHDEV, Stanislav Sidenko, Zu-Xi YU, steven B solomon, Michael A Solomon, Marcus Y Chen, Charles Natanson, MD
Journal: Circulation (2023)

Background: In human septic shock, radionuclide cine angiograms found depression of LVEF and dilatation of the LV (EDV). Peaking at 48h after shock onset, the changes reversed by day 10. Nonsurvivors paradoxically had normal EFs and EDVs. Subsequent TTE studies have not consistently reproduced these findings. To investigate this paradox, we reviewed published clinical studies of cardiac function during sepsis and performed serial CMRIs in a canine model of sepsis-induced cardiac changes. Methods: Clinical studies of sepsis reporting EFs and EDVs in survivors and nonsurvivors were identified from 1980 onward. Sedated purpose-bred beagles (25, 2 y/o) intra-bronchially challenged with S. aureus or saline had serial CMRIs and histology. Results: Mean EF at 24h ranged from 31-69% across 20 clinical studies. Over these studies survivors vs. nonsurvivors, mean EF differences were only 1% (p=0.15; I 2 5%). Twelve clinical sepsis studies reported mean EDVs and showed that survivors had larger EDVs than nonsurvivors (SMD 0.36, p&lt;0.0001; I 2 57%). Like clinical studies, EFs in our S. aureus challenged animal model was similarly depressed in both survivors and nonsurvivors (41% vs. 45%, p=0.34). In animals like humans, LV EDV was significantly higher at 48h in survivors vs . nonsurvivors (40 vs. 30 ml p=0.02) while CVPs and PAOPs were similar throughout (p=ns). From 48 to 96h the septic animals EF recovers towards normal in survivors. CMRIs in septic animals vs. controls showed LV wall thinning with a progressive significant loss of dry mass (~ 1g/24h over 96h) and increased LV wall edema (2-4% total over 96h). There was no histological or biochemical evidence of myocyte necrosis, elevated troponins or BNPs, only endothelial and myocyte edema with mild myofilament loss. Conclusions: Septic shock results in ventricular wall changes not explained by loading conditions or myocardial necrosis. Sepsis-induced cardiac injury is associated with edema as demonstrated by both histopathology and CMRI. The unexpected, acute loss of LV dry mass occurred even as edema increased and the EF recovered, consistent with an adaptive, reparative process. Determining how dry mass is lost and which cells and tissues are affected may clarify mechanisms of cardiac injury and repair in septic shock.
Abstract 17670: Double Trouble: Exploring the Rare Coexistence of Right and Left Atrial Thrombus After Left Atrial Appendage Ligation and Maze Procedure
Authors: Himaja Dutt Chigurupati, Muhammad Waqas, Sivaram Neppala, Kinjal Patel, Asrar Ahmad, Addi suleiman, Claudia Komer
Journal: Circulation (2023)

Introduction: Left atrial appendage (LAA) harbors around 90% of thrombus in patients with Atrial Fibrillation(AF) related strokes. Incomplete surgical ligation and LAA stump are independent risk factors for stroke and thromboembolism in AF patients. To our knowledge, we report the first case of biatrial thrombus occurring within 1 week of surgery. Case Presentation: A 76-year-old man with Paroxysmal AF and three-vessel coronary artery disease presented with 3-week exertional and resting shortness of breath and chest pain. Troponins were negative, and EKG revealed AF. Cardiothoracic surgery planned coronary bypass, MAZE procedure, and LAA clipping. Intra-operative transoesophageal echocardiogram(TEE) showed ejection fraction of 35% without LAA clot. Post-operatively, despite anticoagulation(AC) and beta blocker therapy, AF recurred within a week. Subsequent TEE prior to anticipated cardioversion(CV) revealed thrombus on the superior vena cava border of right atrium, anterolateral wall of left atrium and near the mitral valve annulus. CV was deferred, and he was sent to rehab with AC. We hypothesize that the thrombus may be attributed to a stunned atrium caused by ischemic myocardial injury. Our case underscores the need for heightened suspicion of thrombus in individual cases. Discussion: Left atrial appendage occlusion (LAAO) was implemented as stroke prophylaxis strategy in AF during surgical interventions like maze and coronary bypass. while the European Society of Cardiology advises continuing AC after LAAO, studies suggest discontinuing AC in high-risk bleeding patients after successful surgical AF ablation and LAAO if sinus rhythm is maintained for ≥3 months. LAAOS III study shows economic benefit of concomitant surgical LAAO during cardiac surgery in AF patients with CHA2DS2-VASc score ≥2 for stroke prevention. When used alongside AC, it offers incremental benefits. Safety of discontinuing AC after LAAO requires further investigation.