tbuckley/cabot-search huggingface dataset:
Abstract 18441: Long-Term Outcomes of Total Arch Replacement With Frozen Elephant Trunk Procedure for Patients With Acute Type A Aortic Dissection: A Single-Center Experience
Authors: jinhua wei
Journal: Circulation (2023)

Introduction: Total arch replacement (TAR) with frozen elephant trunk (FET) is an extensive surgical procedure for patients with acute type A aortic dissection (ATAAD). This study aimed to investigate the long-term outcomes of TAR with FET procedure for patients with ATAAD. Methods: A total of 670 patients with ATAAD who underwent TAR with FET procedure between January 2013 and December 2018 were included in this study. The patients were divided into two groups: the early group (n=245, 2013-2015) and the modern group (n=425, 2016-2018). In-hospital and long-term outcomes were compared between the two groups. Results: The average age and gender distribution were similar between the two groups (P&gt;0.05). The modern group had a higher prevalence of preoperative coma (P&lt;0.001). Patients in the modern group had a shorter mean duration of surgical procedure, including cardiopulmonary bypass time (189.8 ± 53.0 vs 176.0 ± 53.0 min, P=0.001) and hypothetical cardiac arrest time (22.8 ± 5.2 vs 15.1 ± 6.2 min, P&lt;0.001). Although the in-hospital mortality was lower in the modern group, the difference was not statistically significant (6.1% vs 3.3%, P=0.064). The modern group had a significantly lower incidence of postoperative major adverse outcomes compared to the early group (33.9% vs 20.2%, P&lt;0.001). The mean follow-up period was similar between the two groups. The overall long-term survival rate of patients undergoing TAR with FET procedure in this cohort was 92.7%. Patients in the modern group had a significantly lower cumulative incidence of all-cause mortality compared to those in the early group (P&lt;0.001). Cox regression analysis showed that the modern year was an independent protective factor for the long-term survival of ATAAD patients undergoing TAR with FET procedure (HR=0.336, 95% CI: 0.193-0.585, P&lt;0.001). Conclusions: The in-hospital and long-term outcomes of TAR with FET procedure for patients with ATAAD are promising and have improved over time.
Abstract 16846: Three-Dimensional Assessment of Ascending Aortic Motion by Dynamic CT in Sporadic and Marfan Thoracic Aortic Aneurysm
Authors: Nic Tjahjadi, Taeouk Kim, Prabhvir S Marway, Carlos Alberto Campello Jorge, Heather Knauer, Joost van Herwaarden, Constantijn Hazenberg, Himanshu J Patel, C A Figueroa, Nicholas S Burris
Journal: Circulation (2023)

Background: The ascending aorta exhibits a complex, 3D motion related to cyclic pressure changes and downward traction forces related to left ventricular contraction. However, most metrics of disease severity are static (i.e., diameter) and among prior studies that have investigated ascending aortic motion, 2D imaging is typically employed. Vascular deformation mapping (VDM) is an image analysis technique that accurately quantifies 3D displacement of the aortic wall. Aims We aimed to quantify 3D metrics of cyclic ascending aortic motion and distensibility in patients with aTAA, and evaluate associations between motion metrics and patient characteristics in sporadic TAA (SaTAA) and Marfan syndrome (MFS). Methods: We included adult patients with aTAA, either SaTAA or MFS, and multi-phasic CTA of the thoracic aorta. VDM analysis of CTA data was performed with metrics including: 1) Axial, in-plane and rotational displacements at the root, 2) distensibility assessed by cyclic 2D cross-sectional area change (Dist-2D) at the root [(ΔA/A diastole х PP)], and 3) distensibility assessed by VDM-derived cyclic surface area stretch [(Area ratio-1)*1/PP] at the root and tubular ascending (Dist-3D). Aortic growth rate (GR) was measured from follow-up CTA. Results: We analyzed 51 with SaTAA (33% female, 62 ± 11 years old), and 14 with MFS (50% female, 42 ± 13 years old). In SaTAA, Dist-2D was associated (β=0.59, p=0.047) with axial displacement and AI was strongly associated (β=1.03 p=0.001) with rotation. In MFS, BAV and diameter were associated with in-plane displacement (β=5.50, p=0.004; β=-0.026, p=0.001). Among MFS patients with follow-up CTAs (n=10), ascending distensibility (Dist-3D) was marginally negatively associated with ascending GR (β= -0.27, p=0.058) Conclusion: 3D analysis of aortic motion in aTAA showed differences in root motion, namely related to valve disease and age, as well as differences in aortic distensibility that may predict ascending aortic GR in MFS.
Abstract 12847: The Heart Bus: A Mobile Patient-Centered Approach to Improve Early Diagnosis of Heart Failure in the Community
Authors: Sara Svedlund, Maria Lagerstrom Fermer, Barbara Valastro, Anna Ramne, Erik Michaëlsson, Anna Rudvik, Karin Westberg, Henrik Hedner, Radna Nori, Li-ming Gan
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is associated with poor quality of life and considerable morbidity and mortality risk. Early diagnosis is expected to improve clinical outcomes, but requires imaging and laboratory analyses with frequent hospital visits. We developed a mobile care unit, the Heart Bus, to improve early diagnosis of HF. Methods: The Heart Bus was a 70 m 2 trailer with examination rooms, cardiac ultrasound, exercise testing equipment, a clinical laboratory, and 4 staff. During 2020-2022, the Heart Bus team reached out to the population in local newspapers, via HF patient digital platforms, and visited locations in the West Coast of Sweden. Eligible participants had suspected signs or symptoms of HF. Participants underwent echocardiography and tests for cardiopulmonary exercise, vascular function, adenosine-stress coronary flow reserve, and routine biochemistry and haematology. Molecular and physiological deep phenotyping were also performed in the Heart Bus to facilitate future patient stratification and precision medicine (data to be presented Nov 2023). Results: Of 218 participants screened over 18 months (12/month), 200 were included. Most participants actively reached out to take part. Twenty three participants (11.5%) had HFrEF, 54 (27.0%) had HFmrEF, and 62 (31.0%) had HFpEF; 70 (35.0%) had a previous HF diagnosis. Of the remaining patients, 60 (30.0%) had intermediate risk of HFpEF. The phenotypes of the EF-stratified HF subgroups were similar. However, participants in the HFpEF cohort had more women ( p &lt; 0.001), lower lung volume ( p &lt; 0.01), higher pulse wave velocity ( p &lt; 0.01) and poorer kidney function ( p &lt; 0.05) than those with HFrEF. Conclusions: The Heart Bus mobile clinic identified large numbers of patients with HF and may represent a cost-effective way to early HF diagnosis also for underserved communities, those located remotely, or have other thresholds for admittance to HF clinics.
Abstract 15653: Heart Failure Medications Have a Direct Inhibitory Effect on Endothelial-to-Mesenchymal Transition in an <i>in vitro</i> Model
Authors: Muthu Kumar Krishnamoorthi, Rajarajan A Thandavarayan, Arvind Bhimaraj
Journal: Circulation (2023)

Introduction: Endothelial-to-Mesenchymal Transition (EndoMT) is a process where endothelial cells can transform into mesenchymal cells. This mechanism, while well established in embryogenesis and cancer, has been accumulating evidence as a contributor to cardiovascular diseases including heart failure (HF). While current guideline-directed medications (GDMT) for HF have postulated benefits to help cardiomyocytes and the heart, further investigation on the specific impact of HF drugs on this pro-fibrotic mechanism of EndoMT is required. Hypothesis: We hypothesize that HF drugs can inhibit EndoMT in an in vitro model Methods: Human umbilical vascular endothelial cells (HUVECs) were incubated for 24 h with the drugs - metoprolol, losartan, lisinopril, dapagliflozin, and valsartan/sacubitril, at concentrations ranging from 1 mg to 1 ng per mL, to evaluate cell viability using alamarBlue TM assay. In vitro EndoMT is induced with Nω-Nitro-L-arginine methyl ester hydrochloride and angiotensin II in HUVECs. During EndoMT, HUVECs were co-incubated with the drugs to determine their effect on EndoMT. Immunofluorescence for Endothelial (VE-Cadherin) and Mesenchymal (Transgelin) markers was used to characterize EndoMT. Results: All the HF drugs tested had a dose-dependent effect on HUVEC viability. The highest drug concentration (1 mg/mL) resulted in cell death while lower concentrations (1 μg to 1 ng per mL) did not affect cell viability. A concentration of 1 μg/mL was used to investigate the drugs’ effect on EndoMT. Immunofluorescence staining revealed reduced levels of expression for Transgelin in HUVCEs induced to undergo EndoMT in the presence of the treated drugs compared to the untreated and vehicle-treated cells after 4 days of incubation. Conclusion All the HF medications inhibited EndoMT in an in vitro model. Our results show that some of the beneficial effects of the HF GDMT medications used in clinical practice could be through an inhibitory effect on EndoMT.
Abstract 12725: Day of the Week Variation of Unexpected Sudden Cardiac Death
Authors: Hanna Latola, Lasse Pakanen, Olavi Ukkola, Juhani Junttila, Heikki Huikuri, Juha Perkiomaki
Journal: Circulation (2023)

Introduction: Data on day of the week (septadian) variation of unexpected sudden cardiac death (SCD) are limited. Methods: We evaluated the incidence of unexpected SCD on different days of the week in a consecutive series of 5,869 SCD victims from Northern Finland [the Fingesture study (Finnish Genetic Study of Arrhythmic Events)]. A medico-legal autopsy was performed on all unexpected sudden death victims as it is mandatory in Finland. The autopsies were performed between the years 1998-2017. Results: The incidence of unexpected SCD in the region of Northern Finland with approximately 600,000 inhabitants on average was 55 per 100,000 inhabitants per year. The mean incidence of unexpected SCD was higher during the days form Friday to Sunday (peaking on Saturday) than during the days from Monday to Thursday (8.54±0.72 vs. 7.22±0.19 SCDs per day of the week per 100,000 inhabitants per year, p&lt;0.001, respectively) (Figure 1). The number of unexpected SCD victims with alcohol in blood was higher during the days form Friday to Sunday (peaking on Saturday) than during the days from Monday to Thursday (Figure 2). Conclusion: The incidence of unexpected SCD was highest during the days form Friday to Sunday, peaking on Saturday. There was a similar distribution of the number of SCD victims with alcohol in blood during the days of the week, suggesting that alcohol drinking with its adverse influences contributes to the septadian variation of unexpected SCD.
Abstract 18815: Spectral CT Study to Evaluate Left Atrial Remodeling Using Anatomic and Electron Density Numbers in Patients Scheduled to Undergo Pulmonary Vein Isolation
Authors: Nobusada Funabashi, Atsushi Shukuya, Hiroki Asano, Akio Kawamura, Kohki Nakamura
Journal: Circulation (2023)

Introduction: Left atrial (LA) wall remodeling, such as fibrosis and inflammation, may occur in patients with atrial fibrillation (AF) to cause a low voltage AF wave and thickened LA wall. To date, an invasive biopsy has been used to evaluate LA wall remodeling. Hypothesis: Using novel spectral CT with an effective atomic number (EAN) and electron density number (EDN), which are new parameters in addition to CT attenuation, LA anterior wall characteristics can be evaluated. Methods: A total of 13 patients (eight males, mean age 69 years) scheduled for pulmonary vein isolation (PVI) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). This revealed AF in four patients and a sinus rhythm in nine. From non-contrast, and early and late phase contrast data, EAN and EDN (%EDV) of the LA anterior wall were determined. Results: Mean EANs for the LA anterior wall were 7.35 in patients with AF, and 7.38 in patients with a sinus rhythm, respectively (P=NS), during the non-contrast phase; 8.18 and 8.17, respectively (P=NS), during the early phase; and 8.59 and 8.51, respectively (P=NS) during the late phase. Mean EDNs (%EDW) were 102.7 in patients with AF, and 103,1 in patients with a sinus rhythm, respectively (P=NS) during the non-contrast phase; 102,6 and 103.4, respectively (P=NS) during the early phase; and 103.7 and 103.5, respectively (P=NS) during the late phase. In patients with AF, both LA anterior thickness on CT and LA volume determined by transthoracic echocardiogram had a significant negative correlation with the voltage of AF waves (V2 lead) (R= -0.87 and -0.46, respectively). The EDN, but not EAN, in non-contrast, and early and late phases after contrast material showed a significant negative correlation with the voltage of AF waves (R= -0.74, -0.75, respectively). Conclusions: This is the first study in which characteristics of the LA anterior wall were evaluated by EAN and EDN on spectral CT. As well as LA anterior wall thickening and an enlarged LA volume, the EDN was an indicator of characteristic changes of the LA anterior wall that related to the low voltage of AF waves. This new parameter determined by spectral CT may evaluate characteristics of the LA anterior wall and be a predictor of future occurrence of LA remodeling that is related to the effectiveness of PVI.
Abstract 18656: Characterization of Pulmonary Vein Reconnection in Repeat Procedures After After Initial Cryoballoon Ablation Identified With High Density Mapping
Authors: Praneeth Katrapati, Rong Bai, Wilber Su
Journal: Circulation (2023)

Introduction: Catheter ablation of atrial fibrillation using the cryoballoon has become an alternate strategy to radiofrequency for pulmonary vein isolation (PVI). Both techniques, however, can result in pulmonary vein reconnection and the need for recurrent ablations. Objective: To study the incidence and specific location of pulmonary vein reconnection in patients with prior cryoballoon ablation for atrial fibrillation Methods: Retrospective analysis of patients that underwent radiofrequency ablation following a single initial cryoballoon PVI ablation was performed. Twenty patients were studied, all of whom underwent repeat ablation using radiofrequency with a mapping system (Rhythmia, Boston Scientific). A gap was defined as entrance conduction from the LA into the PV as suggested by the activation map. Results: Patients had an average of a 20 month period of normal sinus rhythm after initial ablation. A total of 48 gaps were identified in 18/20 patients (2.4 gaps per patient). The most common site of PV-LA conduction reconnection was at the superior pulmonary veins, specifically on the anterior portions. 60% (12/20) of patients had noted reconnection sites at the left superior pulmonary vein. All but one of these patients had gaps on the anterior surface of the vein. 75% (15/20) of patients were identified as having reconnection sites at the right superior pulmonary vein. All of these patients had gaps on the anterior surface of the vein. Less commonly, the left and right inferior veins each had 40% (8/20) patients with reconnection at these areas, with no consistent surface as the main site of reconnection. Further, 85% (17/20) patients had procedural ablation beyond only pulmonary vein re-isolation, owing primarily to the occurrence of atypical atrial flutters or atrial tachycardias that were seen during the repeat procedure itself Conclusion: Cryoballoon ablation is a successful technique for PVI in AF patients. However, reconnection of these sites is possible. Our analysis shows that the most common sites are at the anterior surface of the superior pulmonary veins. This could portend a potential drawback to be cognizant of during these initial procedures. Further analysis with a larger patient population will be necessary
Abstract 14402: Sociodemographic Differences Among Patients Receiving Coronary Artery Calcium Scoring vs. Non-Gated Chest CT Imaging
Authors: Allison W Peng, Megan Skye, Sneha S Jain, Ramzi Dudum, David J Maron, Alexander T Sandhu, Fatima Rodriguez
Journal: Circulation (2023)

Introduction: Gated CTs are used to quantify coronary artery calcium (CAC), a strong predictor of cardiovascular risk across diverse populations. However, inequities in access to gated CTs, typically not covered by insurance, exacerbate health disparities in atherosclerotic cardiovascular disease (ASCVD) risk assessment. Artificial intelligence can quantify CAC on non-gated chest CTs. Objective: We sought to determine sociodemographic differences in utilization of gated CAC scans vs non-gated chest CTs to identify opportunities to improve health equity in ASCVD risk assessment. Methods: We extracted electronic health record data on all gated CAC scans and non-gated chest CTs from 1/1/2021 - 12/31/2022 performed at Stanford Health Care. We excluded all patients with a history of ASCVD based on ICD codes and without any primary care encounters. Statistical analyses were performed using Pearson’s chi-squared test and t-test. Results: Out of 32,369 total CTs in our study, 5,300 (16%) were gated CAC scans and 27,069 (84%) were non-gated chest CTs. Compared with patients who received CAC scans, those who received non-gated CTs were more likely to be older, female, Hispanic, Black, have interpreter needs, and have Medicaid insurance ( Table ). They had a greater burden of comorbidities and were more likely to have visited the emergency department (16% vs. 5%) and been hospitalized (29% vs. 2%) in the prior year. Patients who underwent non-gated CTs had higher 10-year ASCVD risk scores as compared with those who underwent CAC scans (20% vs. 11%), yet only 24% were on statins. Conclusions: There are significant sociodemographic differences in patients who receive CAC scans vs non-gated chest CTs, highlighting opportunities to improve equity in access to tools for cardiovascular risk assessment through quantification of CAC on non-gated CTs. This supplemental approach can identify more diverse populations with higher ASCVD risk who may benefit from preventive therapies.
Abstract 16985: Spatial Accuracy of Non-Invasive Activation Mapping Modalities for Complex Ventricular Arrhythmias: A Direct Comparison of Electromechanical Wave Imaging (EWI) Using High Frame Rate Transthoracic Echocardiography and Electrocardiographic Imaging (ECGi) With Cardiac CT
Authors: Johanna Tonko, Melina Tourni, Elisa Konofagou, Pier Lambiase
Journal: Circulation (2023)

Background: Non-invasive identification of the site of origin (SOO) of ventricular arrhythmias is vital in informing ablation strategy. ECGi is an established method to generate 3D activation maps with a multielectrode vest combined with cardiac CT. EWI is an emerging echocardiography based modality that provides a low cost &amp; non-ionizing mapping alternative. Hypothesis: EWI more precisely localises SOO of Complex Ventricular Ectopy (VEs) &amp; intramural location than commercial ECGi. Aim: Compare spatial accuracy of EWI and ECGi to estimate SOO and validate against contact mapping. Methods: VE-ablation patients underwent preprocedural EWI &amp; ECGi to estimate SOO on the AHA segment-model. A commercial ECGi system with cardiac CT was used for reconstruction of epicardial VE activation maps. EWI was performed using a research ultrasound acquiring B-mode and high frame rate (2000fps) images with simultaneous ECG. Local electromechanical activation was defined as time-point of the downward zero-crossing on the incremental axial strain curve (250 strain curves/view) and displayed on 3D rendered maps. The site of earliest activation &amp; successful VE ablation was defined as ground truth for VE SOO. Results: 10 patients were enrolled: 50% male, age 40.8 +/- 18.1 years, LV EF 41+/-15%, 50% with scar on MRI. CT ECGi correctly identified the VE AHA segment in 8/10 (80%) cases (misclassified 2 papillary muscle (PM) VEs) but did not afford transmural localization. After excluding 1 patient with insufficient VE’s for EWI, EWI correctly identified the VE-SOO segment in 8/9 (88%) cases locating 2 subepicardial, 2 septal intramural &amp; 3 VEs at the base or intramural segment adjacent to a PM. It misclassified 1 PM VE. Conclusion Both EWI &amp; ECGI identified the VE-SOO segment in at least 80% of cases irrespective of presence of scar. EWI also correctly determined the transmural VE origin which cannot be located using commercial ECGI. This has important implications in planning ablation procedures.
Abstract 15953: Stressed Into a STEMI
Authors: Muhammad Osama, Nikita Nand, Tooba Salar, Mohamed Salah S Mohamed, Venkata Satish Pendela, Sanjay K Shah
Journal: Circulation (2023)

Introduction: Chest pain is the second most common presenting symptom in the emergency department (ED). 5.1% of all presentations with chest pain are acute coronary syndrome (ACS). ACS includes ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). We present a case of UA that progressed to STEMI after a regadenoson stress test. Case: A 55 years old male with 30 pack-year smoking history presented to the ED with sudden onset, sharp, left-sided chest pain associated with diaphoresis that lasted a few minutes. EKG showed sinus rhythm with premature ventricular complexes without ischemic changes. High sensitivity troponin at 0, 1, and 3 hours were within normal limits. While he was undergoing a radionucleotide stress test, he reported severe chest pain immediately after the regadenoson injection. Bedside telemetry showed ST elevation in inferior leads. EKG was consistent with 1mm ST-elevation in leads II, III, and aVF. He underwent an emergent coronary angiogram which revealed 100% occlusion in the mid-right coronary artery (RCA) and 80% in the second marginal distribution. He received a drug-eluting stent to RCA with the resolution of his chest pain. Discussion: Rupture or erosion of atherosclerotic plaque exposes the underlying thrombogenic core which can lead to occlusion of the coronary artery. A partial occlusion due to an unstable plaque can lead to UA or NSTEMI. STEMI results from complete occlusion of the coronary circulation. In our case, the patient presented with unstable angina however undergoing a stress test triggered him to STEMI. The administration of regadenoson led to coronary vasodilation, resulting in the redistribution of coronary blood flow away from the nearly occluded RCA but what led to plaque rupture at the same time leading to a STEMI is unclear. Conclusions: A regadenson stress test can trigger STEMI in patients with unstable angina however the mechanism is unclear