tbuckley/cabot-search huggingface dataset:
Abstract 18508: Usability of Novel Automated Software for Guiding Remote Titration of Antiarrhythmic Drugs
Authors: Rachita Navara, Bishow M Paudel, Esha Ananth, Sheth Sujay, Jasneet Devgun, Daniel Lucy, Devon Chen, Aditi Pallod, Maria Dopierala, Riya Ravuri, Ecem Ozkan, Babikir Kheiri, Katherine Malcolm, Ramkumar Venkateswaran, Alejandro Alvarez Martinez, Rania DeLeon, John Higgins, Kunj G Patel
Journal: Circulation (2023)

Introduction: We tested the first novel software application to accurately measure QTc using a machine learning algorithm from a mobile ECG and recommend patient-specific antiarrhythmic drug (AAD) dosing. The software was developed to address disparities in AAD hospitalizations that disproportionately affect minority patients. We evaluated the usability of the software interface using the validated Post-Study System Usability Questionnaire (PSSUQ) and mobile Health App Usability Questionnaire (MAUQ). Methods: Ten medical providers, 16 clinic staff, and 16 patients tested the novel software interface for remote titration of Sotalol and Dofetilide medications, followed by the validated PSSUQ and MAUQ surveys. An observer also evaluated each step of the software for completion and noted any challenges. Results: Providers rated the software interface highly, with an overall mean PSSUQ of 6.9 ± 0.2 and MAUQ of 6.8 ± 0.2, and 100% strongly agree on information quality (PSSUQ questions 7-12). Clinic staff and patients provided the highest ratings for system usefulness, with an overall PSSUQ mean of 6.4 ± 1.2 and MAUQ mean of 6.0 ± 1.2, ease of app use and user satisfaction, mean of 6.3 ± 1.1 and 5.9 ± 1.3 respectively. Eighty percent of users found the system easy to use and were satisfied, with 76% rating the app as an acceptable way to receive healthcare services and felt comfortable communicating with their providers using the app. Conclusion: The novel automated software application, designed to improve access to antiarrhythmic drugs and reduce healthcare disparities, received high usability ratings, indicating feasibility for remote administration of antiarrhythmic drugs.
Abstract 13748: Safety and Efficacy of Extended Endovascular Treatment for Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection
Authors: Sara Allievi, Santi Trimarchi, Joseph S Coselli, Ibrahim Sultan, Derek R Brinster, Joseph E Bavaria, Bradley G Leshnower, Puja Kachroo, Arminder Jassar, Raffi Bekeredjian, Chih Wen pai, Davide Pacini, Truls Myrmel, Kim A Eagle, Himanshu J Patel, Marc Schermerhorn
Journal: Circulation (2023)

Introduction: Prior studies reported that extended TEVAR could improve false lumen remodeling in acute type B aortic dissection (TBAAD). However, extended aortic coverage is also a risk factor for spinal cord ischemia (SCI). This study aimed to evaluate the safety and efficacy of extended TEVAR for TBAAD. Methods: Patients who underwent TEVAR for TBAAD between 01/2002-01/2023 in the IRAD Interventional Cohort were analyzed and stratified based on treatment extent: “extended” if aortic coverage &gt; 200 mm, “not-extended” if ≤ 200 mm. Patients with prior aortic repair were excluded. We assessed postoperative SCI and mortality with univariate analysis. Secondly, we compared mid-term outcomes with cumulative incidence function (Gray's test) and Kaplan-Meier estimate (log-rank test). Results: Of 4,146 TBAADs, 350 met inclusion criteria. Compared with not-extended patients (173, 50.3%), patients with extended TEVAR (171, 49.7%) were more frequently Black (29.9% vs. 16.6%; p=.006) and less frequently had aortic valve disease (1.4% vs. 6.5%; p=.03). The indication for extended TEVAR was more frequently extension of incident dissection (15.5% vs. 5.5%; p=.02). Extended TEVAR more frequently had proximal seal in the arch (60.6% vs. 48.2%; p=.03), and distal seal in the thoraco-abdominal (22.1% vs. 7.6%; p=.002), or infrarenal aorta (10.8% vs. 3.5%; p=.02). Extended TEVAR had higher rates of postoperative SCI (6.7% vs. 3.8%; p=.31) and mortality (9.9% vs. 6.4%; p=.24), although the difference was small and not significant. Moreover, after median follow-up of 23.8 months, extended TEVAR had different estimates (albeit not significant) for 3-year complete false lumen thrombosis (48.9% vs. 40.2%; p=.79), 4-year reoperation (13.3% vs. 7.7%; p=.35), and aortic growth (74.6% vs. 47.0%; p=.70), but similar survival (84.7% vs. 83.0%; p=.84). Conclusions: Extension of incident dissection was more common in the extended TEVAR patients.. Although these patients had almost double the rate of SCI, this wasn’t significant. Our findings suggest that extended and not extended treatment for TBAAD may have similar postoperative and mid-term outcomes. Further studies with bigger sample size, and longer follow-up are needed to confirm these results.
Abstract 13330: Swimming Exercise in Youth Athletes is Associated With Reduced Cardiovascular Risk Factors: An Analysis of the HeartBytes Dataset
Authors: Saaniya Farhan, Sean Dikdan, Drew Johnson, David Shipon
Journal: Circulation (2023)

Background: The American Heart Association has defined cardiovascular health using eight components related to cardiovascular disease (CVD) risk, including BMI, blood pressure, and physical activity. Swimming exercise has been widely promoted for the prevention of CVD; however, its relationship with CVD risk factors has rarely been examined in adolescents and compared to that of land-based exercise. Methods: Data was obtained from in-person surveys and physical examinations conducted by the nonprofit Simon’s Heart organization. Multivariate logistic regression models adjusting for age, sex, BMI, participation in sports, and activity level per week were performed to assess the relationship between swimming exercise and each outcome. Chi-square tests between swimmer and non-swimmer athletes were run to compare outcomes by exercise modality. Results: Among 7,154 adolescents ranging from ages 12 to 20, 686 (9.6%) were swimmers (52% male, age = 14.6 ± 1.85, BMI = 20.8 ± 3.65, mean arterial pressure (MAP) &gt; 100 = 1.7%); 5,642 (78.9%) were involved in non-swimming sports (55.4% male, age = 15.1 ± 1.82, BMI = 21.6 ± 5.77, MAP &gt; 100 = 3.42%), and 813 (11.4%) did not play sports. Swimmers were less likely than all non-swimmers to have an obese BMI or BMI greater than 30 (OR: 0.49, CI: 0.26-0.85, p = .018) and a high MAP or MAP greater than 100 (OR: 0.44, CI: 0.20-0.84, p = .025). Similarly, tests of differences between swimmer and non-swimmer athletes were significant for obese BMI ( p = .002) and high MAP ( p = .002). A significantly higher proportion of swimmers (53.1%) versus non-swimmer athletes (38.8%) performed more than 10 hours of physical activity per week ( p &lt; 0.001), and swimmers were more likely to be highly active (OR: 1.59, CI: 1.35-1.87, p &lt; .001). A lower percentage of swimmers reported abnormal cardiac symptoms such as chest pain compared to non-swimmer athletes, but these differences were non-significant. Conclusions: This study identified a lower likelihood of two CVD risk factors among swimmers, which is consistent with existing literature suggesting a cardiovascular benefit to swimming exercise. This may be explained by higher levels of physical activity per week among swimmers. More studies are needed to further elucidate the effects of swimming on CVD risk.
Abstract 14911: Effusive Constrictive Pericarditis: A Rare Complication of SARS-CoV-2 Infection
Authors: Eson J Ekpo
Journal: Circulation (2023)

Background: SARS-CoV-2 infection can result in cardiac complications, including myocarditis, left ventricular dysfunction, arrhythmias, and acute myocardial injury. Reports of effusive constrictive pericarditis (CP) are rare, and recommendations on management are limited. Description of Case: A 30-year-old male with recurrent episodes of effusive pericarditis after SARS-CoV-2 infection 11 months prior and anasarca presents with worsening fatigue, dyspnea, and weight gain. His echocardiogram showed pericardial thickening, annulus reversus, and interventricular septal bounce. Computed tomography showed pericardial thickening and a complex pericardial effusion. Right and left heart catheterization revealed elevated filling pressures, equalization of diastolic pressures, and ventricular discordance (Figure 1). Infection, malignancy, and autoimmune etiologies of CP were ruled out. Decision Making: The patient was initiated on anti-inflammatory therapy and aggressively diuresed with no improvement in his symptoms. Given recurrent episodes of pericarditis with constriction, the patient underwent a radical pericardiectomy with posterior pericardial release. The pericardium was 1 cm thick with severe fibrosis. Surgical pathology showed acute and chronic pericarditis with negative testing for Mycobacterium tuberculosis. Conclusion: Idiopathic, post-cardiac surgery and post-mediastinal radiation are the most common causes of CP. Acute pericarditis is a known complication of SARS-CoV-2 infection, but ongoing inflammation leading to CP is rare. CP presents with signs of heart failure and should be considered in patients with persistent symptoms of pericarditis.
Abstract 15900: Probing Mitochondrial Dysfunction in Mouse Hearts With Doxorubicin-Induced Cardiotoxicity Using Ungated 4D Oxy-Wavelet MRI
Authors: Devin Raine Everaldo Cortes, Margaret Stapleton, Kristina Schwab, Noah Coulson, Elizabeth Mazzella, Dalton West, Thomas Becker-Szurszewski, Sean Hartwick, Anthony G Christodoulou, Yijen L Wu
Journal: Circulation (2023)

Introduction: Despite advances in cancer therapy greatly improving patient survival, more than two-thirds of cancer survivors will still face serious life-threatening cardiomyopathy caused by anti-cancer anthracyclines. Doxorubicin (Dox), a well-known, well studied anthracycline, is a major cause for long-term morbidity and mortality among cancer survivors. Pertinent to this issue is the lack of non-invasive imaging tools that can detect DOX induced cardiomyopathy before irreversible tissue damage is done. Current research of cellular mechanisms underlying DOX-induced cardiotoxicity has shown that mitochondrial dysfunction are central to this cardiomyopathy. Hypothesis: We hypothesize that this mitochondrial dysfunction precedes clinical changes in cardiac strain and left-ventricle ejection fraction. Methods: To probe mitochondrial function non-invasively, we use motion-and-time resolved 4D functional MRI, coined 4D Oxy-Wavelet. Our methodology can capture dynamic changes in the blood oxygenation level dependent (BOLD) signal with high spatiotemporal resolution. Our cyclic hypoxia challenge leverages the need for in-tact mitochondrial function to maintain homeostatic oxygenation during hypoxia. We combine our 4D-fMRI methodology with a cyclic hypoxia challenge to stress-test the mitochondria in a mouse model of DOX-induced cardiotoxicity. We use a novel time-frequency analysis of the event-driven BOLD response to automate the detection of mitochondrial dysfunction in-vivo. Results: C57BL6/J were given Dox over the course of one week. 4D oxy-wavelet MRI was performed at baseline, day 1, 3, 4, and 7 to evaluate the ability to rapidly detect acute DOX induced cardiotoxicity. We found that as early as day one post exposure, mice exhibited a passive response to the hypoxia challenge, representing an inability to maintain homeostatic oxygen and underlying mitochondria dysfunction, that was maintained through this acute period.
Abstract 13177: The Association Between Insufficient Valve Expansion and Aortic Valve Calcification for Transcatheter Valve Implantation With Self-Expandable Valve
Authors: Daisuke Isomatsu, Akihiko Sato, Yuki Muto, Tomofumi Misaka, Masayoshi Oikawa, Atsushi Kobayashi, Akiomi Yoshihisa, Kazuhiko Nakazato, Takafumi Ishida, Katsuhiro Takahashi, Ryo Yamakuni, Hirofumi Sekino, Kenji Fukushima, Hiroshi Ito, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Transcatheter aortic valve implantation (TAVI) has emerged as the preferred treatment for severe aortic stenosis. Nevertheless, severe calcification remains a factor leading to insufficient valve expansion and paravalvular leakage (PVL) after TAVI, mainly when using the self-expandable valve. We aimed to investigate the relationship between calcification and valve expansion using pre- and post-operative computed tomography (CT) scans, by comparing with valve phantoms as a reference standard. Methods: We enrolled 62 consecutive patients (mean age: 84.2 ± 4.4 years, 23 male) who underwent TAVI with the Evolut PRO+. We measured the aortic valve's calcium volume (Ca-Vol) by contrast-enhanced CT. The shorter diameter (mm) and the area (cm 2 ) of the base of the implanted valve were measured. We performed CT scans of valve phantoms for each size and defined the measured shorter diameter and the base area as the reference standard. We calculated the insufficiency of valve expansion as the ratio of the patient valve's shorter diameter and base area to that of the phantom valve. PVL was defined as more than mild regurgitation by transthoracic echocardiography. Results: The base area of valve phantoms was 3.6, 4.1, 6.4, and 8.4 cm 2 for 23, 26, 29, and 34 mm, respectively. The shorter diameter and base area of the implanted valve were 15.7 ± 2.6, 15.2 ± 2.8, 17.3 ± 4.0, 23.9 ± 1.8 mm, and 2.7 ± 0.7, 2.5 ± 0.6, 3.4 ± 1.0, and 6.2 ± 1.6 cm 2 for 23, 26, 29, and 34 mm (n=4, 31, 24, and 3, respectively). Significant inverse correlations were observed between Ca-Vol and shorter diameter ratio (r 2 = 0.1, P = 0.009), area ratio (r 2 = 0.1, P = 0.006), and PVL (r 2 = 0.4, P &lt; 0.001), respectively. On the other hand, there was no significant correlation between area ratio and PVL (r 2 = 0.004, P = 0.6). Conclusion: Severe calcification in the aortic valve was associated with insufficient valve expansion and PVL for the Evolut PRO+.
Abstract 14636: Social Determinants of Health and Clinical Outcomes in a Diverse Hypertrophic Cardiomyopathy Cohort
Authors: Rohan Ganti, Ludwine Paul, jacques kpodonu, Neal K Lakdawala, Monica Ahluwalia
Journal: Circulation (2023)

Introduction: Contemporary studies are needed to evaluate impact of social determinants of health (SDH) and clinical outcomes in diverse hypertrophic cardiomyopathy (HCM) populations. Hypothesis: Among predominant Black/Hispanic minority population, HCM-related death is higher than reported literature and may be related to SDH. Methods: Data from HCM patients were obtained in a large academic safety-net hospital from 2017 to 2022. Outcomes including heart failure (HF), atrial fibrillation, stroke, ventricular arrhythmias, septal reduction therapy (SRT) and death were obtained by chart review. Zip codes were extracted using the SDH database from the Neighborhood Atlas from University of Wisconsin to determine area deprivation index (ADI 1-10, higher ADI signifies greater neighborhood disadvantage). Chi-square and binary logistic regression analyses were conducted to assess association between ADI and outcomes, adjusting for demographic data. Results: At baseline, 118 HCM patients, were 52 ± 15 years old, 44% female, 54% Black, 20% Hispanic, 10% White, BMI 31± 6 kg/m2, and ESC score 2.4 ± 1.9. Seventy-eight (82%) patients had nonobstructive HCM (22 % apical variant) with maximal wall thickness of 19 ± 6 mm; 14% had late gadolinium enhancement (LGE) &gt; 15%. Among 50% patients with genetic testing, 31% had a pathogenic/likely pathogenic sarcomere variant and 44% had variants of unknown significance. Over 6.3 years follow up (IQR 6.6), 20% patients developed incident HF, 19% AF, 8% SRT, and 6 (5%) patients suffered HCM-related death. Among the 23% of patients who had an ICD placed, 15% had appropriate ICD shock over 7 ± 7 years. Among the 105 patients with available zip codes, 44% patients had ADI &gt; 6. There was no association between ADI and global outcome (OR [95% CI] = 1.32 [0.6-2.9], p = 0.49) or HCM-related death (OR [95% CI] = 0.46 [0.7-2.9], p = 0.41). Conclusions: Compared to published literature, our cohort was mainly Black/Hispanic with high degree of apical remodeling and low frequency of obstruction, highlighting need for focused efforts to improve HCM diagnosis in this population. Further, global outcome and HCM-related death were not related to zip-code level SDH. Larger diverse cohorts are needed to include individual level SDH in relation to outcomes.
Abstract 12854: Early and Late Features of Intracardiac Flow in Repaired Tetralogy of Fallot (rTOF) Patients Using Doppler Velocity Reconstruction (DoVeR)
Authors: Priyanka Hardikar, Brett Meyers, Craig A Sable, Pavlos Vlachos, Yue-Hin Loke
Journal: Circulation (2023)

Background: Intracardiac flow analysis has implicated flow energy loss (FEL), kinetic energy (KE) and vortex strength (VS) as markers of ventricular dysfunction in repaired Tetralogy of Fallot (TOF); no studies have investigated early vs. late intracardiac flow conditions after repair. We utilized novel echocardiography (echo) based Doppler Velocity Reconstruction (DoVeR) to determine FEL, KE and VS in pre-operative TOF vs early post-repair (&lt;1 month) and late post-repair (&gt;10 years). Methods: This was a single-center retrospective cross-sectional study on TOF patients with pre- and post-operative surveillance transthoracic echo. Apical 4 chamber color Doppler views were collected. The streamfunction-vorticity formulation was used to reconstruct left ventricular (LV) blood velocity fields by DoVeR. Velocity flow fields were evaluated for peak FEL, KE and VS. The FEL was also normalized against KE to account for physiologic variations. Data were compared via one-way ANOVA. Results: Echo studies from 14 pre-operative (1.7±0.5 months), 14 early-post repair (3.6±2.3 months) and 15 late-post repair (16.5±6.6 years) TOF patients were included. There was significant variation in FEL, KE, VS, and normalized FEL across timepoints (all p&lt;0.05) (Figure B). In general, when compared to pre-operative TOF, the early post-repair cohort had lower FEL/KE/VS corresponding to reduction in ventricular volume load; however late post-repair cohort had higher FEL/KE/VS, suggestive of effects from long-term interventricular interactions. Conclusion: The LV intracardiac flow in TOF changes early after initial repair and late after repair. DoVeR could potentially be used to serially evaluate TOF patients.
Abstract 13652: Machine Learning Prediction of RV End-Diastolic Volume in Patients With Pulmonary Regurgitation
Authors: Naveen Arivazhagan, Jennifer Cohen, Grace Kong, David Barris, Rosalie Castaldo, Marjorie Gayanillo, Kali Hopkins, Maya Kailas, Xiye Ma, Molly Marshall, Erin Paul, Melanie Tan, Surkhay Bebiya, Jen Lie Yau, David Ezon, Girish N Nadkarni, Son Q Duong
Journal: Circulation (2023)

Introduction: RV end-diastolic volume (RVEDV) by cardiac MRI (cMRI) guides intervention in congenital heart disease. Guideline directed linear and area measurements from two-dimensional echocardiography (2DE) have poor univariable linear correlation with RVEDV. We hypothesized that non-linear modeling of 2DE RV measurements may predict cMRI volume. Aims: We sought to develop a prediction algorithm for RVEDV from guideline-directed RV 2DE measurements. Methods: Patients from 2009 to 2022 with &gt; mild pulmonary regurgitation and cMRI +/- 3 months were included. 2DE measurements were: RV end-diastolic (RVED) apical 4-chamber area, basal RVED diameter (d), mid RVED d, tricuspid annulus d, RVED length; PSLAX proximal RVOT d; PSSAX proximal RVOT d, distal RVOT d. A gradient-boosting decision trees algorithm (XGBoost) regressed cMRI RVEDV (mL) using 2DE inputs (including missing data) with leave-one-out crossvalidation. Predicted RVEDV was BSA-indexed to examine performance at clinical threshold 150 mL/m 2 . Intraclass correlation coefficient (ICC) in 30 samples was measured. Results: Of 243 subjects (median age 21 [IQR 16-31] y, 58% tetralogy of Fallot, 22% congenital pulmonary stenosis s/p intervention), 19% had cMRI RVEDV &gt; 150 mL/m 2 . Missing ranged from 5% (basal RVED d) to 17% (PSSA proximal RVOT), and ICC ranged from 0.46 (basal RVED d) to 0.78 (tricuspid annulus). Mean absolute error was 40 mL (27 mL/m 2 ). At the predicted threshold 150 mL/m 2 had 39% sensitivity, 87% specificity, 40% positive predictive value, and 86% negative predictive value for true RV dilation. Conclusion: Prediction of RVEDV from guideline recommended 2DE RV measurements is possible. Detection of clinically significant RV dilation has low sensitivity but may be helpful in ruling out cases. Sources of error include interrater variability and missing data due to poor visualization of the RV on 2DE. Future work to develop a consistent and informative feature set for modeling is required.
Abstract 15977: Utilizing Admission Bloodwork to Risk Stratify for Acute Kidney Injury in Hospitalized Patients With NSTEMI or Unstable Angina Undergoing Invasive Coronary Angiography± PCI
Authors: Davis Leaphart, Rohan Shah, Stephen G Ellis, Grant W Reed
Journal: Circulation (2023)

Introduction: AKI after invasive coronary angiography (CAG) or PCI is common with an estimated incidence of 7-9%. This complication incurs approximately a $9,500 higher cost of stay, with proportional length of stay increases with absolute elevations in serum creatinine (sCr). While the majority of adverse events occur within 30 days of procedure, there is evidence of increased mortality, stroke, and MACE at 1 year and 5 years following index AKI. This study aimed to identify risk factors for AKI in hospitalized NSTEMI and unstable angina undergoing CAG ± PCI. Methods: Patients who were admitted for NSTEMI or UA who underwent CAG from 2011-2022 in Northeast Ohio Cleveland Clinic hospitals were identified from the EMR. Admission and serial blood work results in addition to demographics, past medical history, and hospital course were compiled and analyzed via multivariable logistic regression using R statistical software. KIDAGO definitions of AKI were utilized to define presence of AKI. All patients declared ESRD prior to admission were excluded from analysis. Results: 4,174 cases were included in the analysis with mean age 66.5 years, 63% male, and 81% Caucasian. 7% developed AKI and there was no difference in the proportion of race, gender, or prevalence of ischemic heart disease between those who developed AKI and those who did not. Patients who developed AKI were older (70.9 vs. 66.1 years, p&lt;0.001), and were more likely to have a history of CHF (22.2 vs 10.1%, p&lt;0.0001), CKD (26.3 vs. 9.5%, p&lt;0.001), CVA (22.5 vs 15.3%, p=0.001), and hypertension (66.6 vs 59.4%, p=0.016). Multivariable logistic regression was performed on admission blood work in the presence of known risk factors for AKI, Table 1. Conclusions: In patients admitted with NSTEMI or UA who undergo CAG ± PCI, admission blood work helps identify patients at risk for AKI even in the presence of traditional risk factors such as IABP, age, and history of CKD.