tbuckley/cabot-search huggingface dataset:
Abstract 4134967: Pericardial Adipose Tissue Hypertrophy Contributes to Heart Failure via β3 Adrenergic Signaling-Mediated Activation of the TGFβ1 Pathway
Authors: Masaki Hashimoto, Kazutaka Ueda, Yusuke Adachi, Hiroyuki Sowa, Bowen Zhai, Kohei Karasaki, Norihiko Takeda, Issei Komuro
Journal: Circulation (2024)

Background: The heart is surrounded by pericardial adipose tissue (PeAT). An increase in PeAT volume has been associated with the development of heart failure; however, the precise molecular mechanisms by which hypertrophic PeAT contributes to heart failure remain to be elucidated. Aims: To clarify the involvement of PeAT hypertrophy in the development of heart failure. Methods: Male C57BL/6 mice (8-10 weeks old) were fed a high-fat diet (HFD) for 8 weeks to induce PeAT hypertrophy. Cardiac pressure overload was induced by transverse aortic constriction (TAC) with a 26-gauge needle. Results: PeAT volume significantly increased in HFD-fed mice compared to those on a normal diet (ND) (25.28 ± 4.1 mg vs. 9.35 ± 0.73 mg, p&lt;0.01). Eight weeks after TAC, HFD-fed mice (TAC+HFD) exhibited more pronounced cardiac dysfunction (fractional shortening: 45.21 ± 2.21% vs. 55.99 ± 1.91%, p=0.002, left ventricular mass: 130.3 ± 7.80% vs. 106.8 ± 3.77%, p=0.0154), upregulation of cardiac fibrosis-related genes ( Col1a1 , Col3a1 ), and greater fibrotic area in the left ventricle compared to ND-fed TAC mice (TAC+ND). Simultaneously, the TGFβ/Smad pathway was activated in the left ventricles of TAC+HFD mice. Notably, surgical removal of hypertrophic PeAT improved cardiac function in TAC+HFD mice, while transplantation of PeAT from HFD-fed mice into TAC+ND mice worsened cardiac function. In TAC+HFD mice, local noradrenaline concentration in PeAT decreased, along with reduced activation of hormone-sensitive lipase, a downstream target of β3 adrenergic receptor signaling. Local free fatty acid concentrations also decreased in the PeAT of HFD-fed mice. In the RAW 264.7 macrophage cell line, a decrease in palmitic acid, a major fatty acid, led to increased expression of TGFβ1. Conclusions: These results suggest that HFD-induced PeAT hypertrophy suppresses β3 adrenergic receptor signaling and free fatty acid release, increasing TGFβ1 expression in the macrophages and resulting in cardiac fibrosis and dysfunction. Our findings provide new insights into the pathogenesis of PeAT hypertrophy in heart failure development.
Abstract 4137564: Management of Atrial Flutter (AFL) Using Intrinsic Antitachycardia Pacing (iATP) Protocol
Authors: Joshua Silverstein, Manasvi Gupta, Chaojing Duan, Caitlin Phalunas, George Shaw, Emerson Liu, Tharian Cherian, William Belden, Mati Friehling, Elizabeth Belden, Minesh Lathia, Grace Bailey, Amit Thosani
Journal: Circulation (2024)

Background: The recently introduced iATP algorithm augments traditional ventricular antitachycardia pacing (ATP) with programmed stimulation (PS) resulting in greater efficacy terminating ventricular tachycardia than traditional ATP in avoiding ICD shocks. The use of iATP in the atrium may similarly enhance termination of atrial arrhythmias, avoiding prolonged arrhythmia burden or need for cardioversion. Objective: To compare efficacy of 3 atrial ATP protocols (PROT[GS1] ) in either converting AFL to sinus rhythm or accelerating AFL to atrial fibrillation (AF). Methods: Patients presenting in AFL for ablation were recruited. Patents underwent all three pacing protocols, twice, and in random order (6 times total). 1. PROT 1 – Ramp pacing at 91% of tachycardia cycle length (TCL) for 13 beats with 5 or 10ms decrement, avoiding pacing cycle length (CL) &lt;160 ms. 2. PROT 2 – Ramp pacing at 81% of TCL for 13 beats again with 5 or 10ms decrement, avoiding CL &lt;160 ms. 3. PROT 3 (iATP) – Drive train of 88% of TCL for 15 beats with singles, doubles, and triples down to atrial effective refractory period. If AFL terminated, it was re-induced with PS or burst pacing. Termination and CL acceleration to AF are defined as the positive effect. No effect is defined as the negative effect. CL acceleration and termination were treated similarly in the analysis because AF is clinically easier to manage than AFL. Results: Of the 21 patients enrolled, 17 completed the entire protocol. 4 patients (excluded from analysis) did not complete the protocol due to non-inducibility following AFL termination. The TCL of the AFL ranged from 190ms to 290ms. PROT 1 terminated AFL 6 out of 34 attempts (17.6%). PROT 2 terminated AFL 7 out of 34 attempts (20.5%). iATP terminated AFL 13 out of 34 attempts (38%). It also accelerated AFL more frequently than the other two protocols (PROT 1:1, 2:4, 3:8). Conclusion: Atrial iATP was significantly more effective in either terminating or accelerating AFL, compared to ramp pacing protocols.
Abstract 4134896: Clinical and Echocardiographic Markers for the Prediction of Incident Atrial Arrhythmias in Hypertrophic Cardiomyopathy
Authors: Srisha Kotlo, Tommy Chiou, Ololade Akingbade, Anthony Kanelidis, Rachel Campagna, Gene Kim, Andrew Beaser, Jeremy Slivnick
Journal: Circulation (2024)

Introduction: Hypertrophic cardiomyopathy (HCM), in addition to increasing the risk for heart failure and sudden cardiac death, augments the risk for atrial fibrillation (AF) and atrial flutter (AFL). We aimed to identify clinical and echocardiographic risk factors that are predictive of incident AF/AFL in HCM patients. Methods: This retrospective study included 99 HCM patients from University of Chicago without prior AF/AFL, followed for a median of 3.2 years (IQR: 11.5 months-6.9 years). Clinical data were obtained via chart review; echocardiographic findings were obtained using AI software (Us2.ai) with measurements audited by a level III echocardiography reader. Statistical testing included Chi-square/Fisher’s exact (categorical variables) and T-test/Wilcoxon rank sum (continuous variables). Univariate and multivariate Cox regressions assessed predictive value of risk factors for AF/AFL. Results: 18 HCM patients (18%) developed AF/AFL ( Table 1 ). On univariate analysis, older age (HR 1.06, 95%CI 1.02-1.11, p=0.002), hypertension (HR 8.32, 95%CI 1.10-63.20, p=0.04), diabetes (HR 3.90, 95%CI 1.51-10.03, p=0.005), prior stroke (CVA, HR 3.81, 95%CI 1.34-10.86, p=0.012), and NYHA class II-IV (HR 8.48, 95%CI 2.97-24.21, p&lt;0.001) predicted AF/AFL. E/A (p=0.04), E/e’ (p=0.028), MV-A (p=0.022), and LVEF (p=0.02) were also significant predictors ( Figure 1 ). LVEF (HR 0.92, 95%CI 0.87-0.98, p=0.013) remained a significant predictor of AF/AFL on multivariate analysis controlling for age, hypertension, diabetes, CAD, CVA, and NYHA class. Conclusions: Traditional risk factors including age, hypertension, diabetes, CVA, and NYHA class are significant predictors of incident AF/AFL in HCM patients, highlighting the need for comprehensive risk factor evaluation. Even after adjustment for these clinical markers, LVEF independently predicts new AF/AFL in HCM patients, underscoring the importance of routine echocardiographic assessment for risk stratification in this patient population.
Prevention and Treatment of Cancer-Related Infections, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology
Authors: Lindsey Robert Baden, Sankar Swaminathan, Nikolaos G. Almyroudis, Michael Angarone, Aliyah Baluch, Nicolas Barros, Brian Buss, Stuart Cohen, Brenda Cooper, Augusto Dulanto Chiang, Zeinab El Boghdadly, Kevin Gregg, Hana Hakim, Dora Ho, Fareed Khawaja, Rachael Lee, Francesca Lee, Cathy Logan, Kristen Manley, Ashrit Multani, Anupam Pande, Steven Pergam, Jennifer Pisano, Jennifer Saullo, Mindy Schuster, Susan K. Seo, Shmuel Shoham, Randy Taplitz, Jeffrey Topal, John W. Wilson, Andrea Zimmer, Carly J. Cassara, Rashmi Kumar, Zeenat Diwan
Journal: Journal of the National Comprehensive Cancer Network (2024)

There is an increased risk of infection in patients with cancer that results in higher morbidity and mortality. Several risk factors can predispose these patients to infectious complications. Some such factors include immunocompromised states like neutropenia, allogeneic hematopoietic cell transplantation, and graft-versus-host disease, while others include immunosuppressive agents like corticosteroids, purine analogs, monoclonal antibodies, and other emerging cancer therapeutics like CAR T-cell therapy. The NCCN Guidelines for the Prevention and Treatment of Cancer-Related Infections address infection concerns that may be observed in these immunocompromised populations and characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This paper highlights 2 recently updated sections of the guidelines, namely, infection concerns related to CAR T-cell therapy and antimicrobial prophylaxis recommendations, including vaccination, in patients at high-risk for infections.
Abstract 4135095: Outcomes of Atrial Fibrillation Patients with Thrombocytopenia: Insights From a Nationwide Database
Authors: Ahmed Younes, Ahmed Maraey, Ahmed Elzanaty
Journal: Circulation (2024)

Background: While anticoagulation is crucial for atrial fibrillation (AF) patients to prevent ischemic events, those with thrombocytopenia have a potential increased risk of bleeding. This study examines the outcomes of hospitalized AF patients with thrombocytopenia. Methods: The National Inpatient Sample (NIS) from 2016-2020 was analyzed to identify adult patients with AF and thrombocytopenia (using the proper ICD-10 codes). Multivariate logistic and regression analyses were performed after adjusting for multiple patient and hospital confounders to compare outcomes between patients with and without thrombocytopenia. The primary outcome was all-cause inpatient mortality. Secondary outcomes included major bleeding (defined as gastrointestinal, intracranial, pulmonary, or unspecified bleeding), hypovolemic shock, packed red blood cell (pRBC) transfusion, ischemic stroke, length of stay (LOS), and total charges. Results: Among 2,016,244 AF admissions, 75,545 patients (3.75%) had thrombocytopenia. Thrombocytopenia was associated with increased inpatient mortality (adjusted odds ratio [aOR] 2.47, 95% CI 2.21-2.77, p &lt; 0.001). Thrombocytopenia was also associated with increased risk of major bleeding (aOR 1.99, 95% CI 1.8-2.19, p &lt; 0.001), hypovolemic shock (aOR 3.11, 95% CI 2.29-4.24, p &lt; 0.001), pRBC transfusion (aOR 3.07, 95% CI 2.8-3.37, p &lt; 0.001). There was no significant difference in ischemic stroke risk (aOR 0.67, 95% CI 0.37-1.21, p &lt; 0.19) but thrombocytopenia was associated with longer LOS (aMD 1.5 days, 95% CI 1.41-1.59, p &lt; 0.001) and higher total charges (aMD $16,508, 95% CI 14,805-18,211, p &lt; 0.001). Conclusions: Thrombocytopenia in hospitalized AF patients is associated with increased mortality, bleeding risk, and healthcare costs, with no clear impact on ischemic stroke. These findings highlight the need for careful risk-benefit assessment and individualized management strategies for this vulnerable patient population.
Abstract 4137488: Mild elevation of [K <sup>+</sup> ] <sub>0</sub> reduces atrial fibrillation burden and enhances the efficacy of flecainide to suppress the arrhythmia: an experimental study.
Authors: Alexander Burashnikov, Charles Antzelevitch
Journal: Circulation (2024)

Background: It is desirable to improve rhythm control management of atrial fibrillation (AF). Extracellular potassium ([K + ] 0 ) may affect AF generation and anti-AF efficacy of the sodium channel blockers. Methods: AF burden (i.e., percentage of time spent in AF) was determined in Langendorff-perfused guinea pig hearts in the range of [K + ] 0 of 3-6 mM in the presence and absence of flecainide (1.0 µM). Spontaneous and single premature beat-induced AF were monitored for 30 min in the presence of acetylcholine (0.3 µM). Results: Spontaneous AF episodes were consistently recorded at 3 mM [K + ] 0 but not at 4-6 mM [K + ] 0 either with or without flecainide. AF burden was progressively reduced with elevation of [K + ] 0 and anti-AF efficacy of flecainide progressively increased at the higher [K + ] 0 (Figure). * p&lt;0.05 vs. 3 mM [K + ] 0 with no flecainide; ** p&lt;0.05 vs. 3 mM [K + ] 0 with flecainide; # - p&lt;0.05 vs. respective no flecainide. n=5-6 per group. Conclusion: Our findings indicate that mild elevation of [K + ] 0 significantly reduces AF burden and enhances the efficacy of flecainide to decrease AF burden.
Abstract 4137531: A Pharmacist Medication Titration Program for Patients with Cardiac Sarcoidosis and Systolic Heart Failure
Authors: Daniel Sykora, Nicole Olson, Robert Churchill, Boyoung Kim, Melanie Bratcher, Mohamed Elwazir, Kathleen Young, Omar Abou-Ezzeddine, John Bois, John Giudicessi, Leslie Cooper, Andrew Rosenbaum
Journal: Circulation (2024)

Introduction: Cardiac sarcoidosis (CS) often results in systolic heart failure (HF) and responds favorably to guideline directed medical therapy (GDMT). A multidisciplinary team approach to HF care is recommended but few published examples exist in CS patients. Methods: We queried an institutional registry of 599 CS patients (2000-2023) for patients with index LVEF &lt; 50% (within 90 d of index CS evaluation) and follow-up TTE within 11-36 months. In our CS medication therapy management (MTM) program (started 1/8/2019), pharmacists conduct independent visits with CS patients (in person or remote), discuss GDMT tolerance and symptoms, review monitoring laboratory studies, and adjust GDMT (ACEi/ARB/ARNi, beta-blocker, MRA, and/or SGLT2i) via collaborative practice agreement with the CS cardiologists. Patients were classified as MTM (≥1 MTM encounter) or NMTM patients (0 encounters). We compared (1) GDMT, (2) cardiac remodeling, and (3) clinical outcomes (event free survival to first heart failure hospitalization, LVAD, heart transplant, or death). Results: Nineteen percent (113/599) CS patients met inclusion criteria (34% female, 92% white, median age 57 y, 19% definite CS, 58% probable CS, 31% presumed CS), with 44 MTM (median 11.5 encounters, IQR 11) and 69 NMTM patients. Both MTM and NMTM patients were on a median 2 GDMT agents at index evaluation (p=0.21). At follow-up (median 19 mo MTM, 15 mo NMTM, p=0.05), MTM patients were on more GDMT agents than NMTM (median 3.0 vs 2.0, p&lt;0.001), with higher % target dose of ACEi/ARB/ARNi (98% vs 71%, p=0.009), beta-blocker (87% vs 57%, p=0.004), and SGLT2i use (30% vs 9%, p=0.004), but similar MRA use (48% vs 32%, p=0.09). Immunosuppressive therapy was used in 88% patients (89% MTM vs 87% NMTM, p=0.79). Index LVEF was similar (MTM 36%, NMTM 32%, p=0.07). Mean change in LVEF (excluding LVAD/transplant patients) demonstrated a non-significant trend towards improved remodeling in MTM (+8.6%) vs NMTM patients (+5.5%; p=0.39). MTM patients exhibited lower risk of the clinical outcome (1/44 MTM vs 16/69 MTM patients; univariable HR 0.08 [95%CI 0.01 - 0.63], log-rank p=0.016). Conclusions: A pharmacist MTM program for CS patients with HF is associated with improved GDMT uptitration and clinical outcomes, emphasizing the value of collaborative multidisciplinary CS care.
Abstract 4134911: Coronary Artery Calcium Predicts Cardiovascular Events in Individuals with Controlled Atherosclerotic Risk Factors: A Multi-Cohort Study
Authors: Idine Mousavi, Mahmoud Al Rifai, Michael Blaha, Raimund Erbel, Khurram Nasir, Salim Virani, Roger Blumenthal, John McEvoy, Andreas Stang, Sara Schramm, Boerge Schmidt, Mouaz Al-Mallah, Miguel Cainzos, Christie Ballantyne, VIJAY NAMBI
Journal: Circulation (2024)

Background: There is residual risk of atherosclerotic cardiovascular disease (ASCVD) that remains despite adequate risk factor (RF) control. Coronary artery calcium (CAC) has demonstrated value in ASCVD risk stratification. We evaluated the value of CAC in identifying residual risk of ASCVD events among those with traditional RF control. Methods: Participants without clinical ASCVD were pooled from the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. RF control was classified as “guideline-concordant” and “optimal” (Figure 1). Participants were stratified by the number of controlled RFs at baseline and CAC score (CAC = 0, 1-99, ≥100). Cox proportional hazards models examined the association between CAC and incident ASCVD events. Results: The study included 14,780 individuals (mean age 58 years (SD: 11), 54% female, 59% White, 27% Black, 50% CAC = 0). Over a median follow-up of 14.6 years, there were 1,441 incident ASCVD events. The distribution of CAC and ASCVD event incidence is shown in Panel A; 10% of those with 3 optimal RFs and 19% of those with 3 guideline-concordant RFs controlled had CAC &gt; 100. The rate of ASCVD events decreased with more RFs controlled and increased with higher CAC. Overall, optimal RF control was associated with lower ASCVD event rates compared to guideline-concordant control. At every level of RF control, CAC &gt; 100 was associated with increased HRs for incident ASCVD (Panel B). Those with CAC ≥ 100 and controlled RFs experienced ASCVD rates numerically comparable to or exceeding those with uncontrolled RFs but CAC = 0 (Panel A). Adjusted HR (95% CI) for ASCVD events with CAC &gt; 100 compared to CAC = 0 was 5.0 (2.0, 12.9) in optimal RF control and 3.7 (2.6, 5.4) in guideline-concordant RF control. Conclusion: There is significant heterogeneity in residual ASCVD risk among those with optimal or guideline-concordant traditional RF control and CAC can help identify this risk. Irrespective of RF control, a higher CAC burden was associated with increased ASCVD risk. Future studies could use CAC testing to identify those with higher residual ASCVD risk despite effective traditional RF control to target for novel therapies.
Abstract 4134685: Cardiopulmonary Exercise Testing for Characterization and Prognostication in Hypertrophic Cardiomyopathy: A Meta-Analysis
Authors: Isabela Landsteiner, Ahmad Masri, Sara Saberi, Martin maron, Shaina McGinnis, Catharine Griskowitz, Chloe Newlands, Roberto Barriales-Villa, Anjali Owens, Gregory Lewis
Journal: Circulation (2024)

Background: Hypertrophic cardiomyopathy (HCM) carries substantial risk of adverse cardiac events. Consequently, detailed physiologic assessment and accurate risk stratification in HCM are of high clinical importance. Aim: To synthesize current evidence on the utility of cardiopulmonary exercise testing (CPET) for characterization and prognostication of HCM. Methods: PubMed, Embase, Scopus, and Web of Science were systematically searched for eligible studies from database inception to November 2023. Studies that had at least one CPET performed in HCM patients, with corresponding test data reported, were included. Abstracts with no full-text and studies focused on pediatric populations were excluded. The primary outcome was a composite endpoint of cardiovascular adverse events. Hazard ratios (HR) and 95% confidence interval (CI) from Cox proportional hazard model were meta-analyzed. This study was performed following the PRISMA guidelines and registered under PROSPERO (CRD42023487759). Results: Sixty full-length manuscripts focused on CPETs performed in HCM patients were included, comprising 12,914 patients. Despite male predominance (66%) and average age of 48 years, peak VO 2 was only 6.2 [95% CI, 6.0-6.4] metabolic equivalents (21.8 [20.9-22.6] mL/kg/min), consistent with significant functional limitation. In subanalyses, peak VO 2 was 18.9 [18.0-19.9] mL/kg/min in obstructive HCM and 22.5 [20.8-24.2] mL/kg/min in non-obstructive HCM. Compared to commonly used metrics such as NYHA Class, CPET markedly enhances sensitivity to detect impaired cardiac performance ( Figure ). This meta-analysis highlights several easily-derived CPET variables that consistently predict HCM prognosis. An increase of 1 mL/kg/min in peak VO 2 was associated with a lower HR of 0.83 [0.76-0.90] for adverse cardiac events, while a 1 unit increase in the VE/VCO 2 slope was associated with a higher HR of 1.12 [1.03-1.23]. Abnormal blood pressure response to exercise conferred a 2.5-fold [2.0-3.1] increase in adverse events. Conclusion: CPET is a valuable objective method for multi-dimensional physiologic assessment and prognostication in HCM. With further standardization, CPET is well suited for more widespread clinical utilization in HCM patients.
Abstract 4134824: Evaluation of ChatGPT-4.0 and Google Bard ‘s Capabilities in Clinical Decision Support in Cardiac Electrophysiology
Authors: Xiarepati Tieliwaerdi, Gursharan Samra, Erasmus Mutabi, Saleh Saleh, Emerson Liu
Journal: Circulation (2024)

Background: ChatGPT-4.0 and Bard have shown clinical decision support (CDS) potential in general medicine, but their role in EP is unknown. This study aims to evaluate ChatGPT and Bard’s CDS potential by assessing their accuracy in multiple-choice questions (MCQs), guideline recommendations (GRs) and treatment (Tx) suggestions. Methods: Two chatbots were tested with 15 clinical vignettes (CVs) and 47 case-related MCQs from Heart Rhythm Case Reports, focusing on ablation, arrhythmia and CIEDs management. CVs included narrative diagnostic images results. 3 tasks were performed: 1) Generating GRs, rated 0 for incorrect or correct but irrelevant to the primary problem, 0.5 for correct for the primary problem, 1 for case-specific (CS) if relevant to both the primary problem and concomitant conditions (e.g. afib with HF); 2) Suggesting Tx steps, scored 0 for incorrect, 0.5 for correct and 1 for CS. Tx was deemed correct if referenced in the case or guidelines, and CS if used in the case. For Tx responses not CS, a prompt was provided before reassessment. The prompt included one similar CV and its Tx from PubMed case reports. 3) Answering MCQs, rated 1 for correct and 0 for incorrect. Welch's T-test was used for analysis. Results: Bard outperformed ChatGPT in generating CS-GRs (P = 0.01). However, there was no significant difference in CS-Tx suggestions with a prompt (P value = 0.12, Figure 1C) or without a prompt (P value = 0.59, Figure 1A). When prompted for non-CS-Tx responses, ChatGPT significantly improved from 0.66 to 0.93 (P value = 0.02), suggesting an enhanced ability to provide CS-Tx plans post-prompt. In contrast, Bard showed no notable improvement (0.73 vs. 0.76, P value = 0.79, Figure 1B). Both chatbots demonstrated similar MCQ accuracy, with scores below 70%, indicating EP training gaps or the need for prompts to activate existing knowledge. Conclusion: This study showed Bard's superiority in generating GRs and ChatGPT's remarkable improvement in suggesting Tx when external knowledge is provided, revealing their CDS potential in specialized fields.