tbuckley/cabot-search huggingface dataset:
Abstract 4137138: Incidence and Risk factors of Early Mortality in Symptomatic Acute PE: Recent Insights from the COMMAND VTE Registry-2
Authors: Soichiro Kobayashi, Yoshito Ogihara, Yugo Yamashita, Ryuki Chatani, kazuhisa kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Ryusuke Nishikawa, Toru Sato, Kaoru Dohi
Journal: Circulation (2024)

Background: Acute pulmonary embolism (PE) remains a major health burden with substantial morbidity and mortality. Over the past decade, the acute phase management of venous thromboembolism (VTE) has undergone considerable change. These includes a decline in the use of thrombolytic therapy and inferior vena cava filter, the widespread adoption of direct oral anticoagulant (DAOCs), and the increase in early discharge and initial outpatient treatment facilitated by DOACs. Given these advancements, it is crucial to reassess early mortality risk factors in patients with PE. Objectives: This study aimed to elucidate the mortality and prognostic factors for 30-day early mortality in patients with acute symptomatic PE in recent years. Methods: We utilized the data from the COMMAND VTE Registry-2, a multicenter registry, enrolling 5197 consecutive VTE patients across 31 centers in Japan between January 2015 and August 2020. We selected 2020 patients who presented with acute symptomatic PE. We investigated prognostic factors for early mortality in acute symptomatic PE using the multivariable hazard model. Results: In the entire study population, the mean age was 67.3±15.2 years, with 59.3% of patients being women. Active cancer was reported in 26.2%. Massive PE was observed in 7.3% (n=147), sub-massive PE in 42.6% (n=860), and non-massive PE in 44.2% (n=892). During follow-up period of 30 days, 114 patients had died, resulting in the cumulative overall mortality rate of 5.6%. Death was considered to be due to PE in 54 patients (47.4% of deaths). Patients who died within 30-days were more often male and older than those in the survivor group (44.2% vs. 59.9%, P=0.0396) (70.1±15.6 vs. 67.1±15.2, P=0.0368). Multivariable analysis identified active cancer (HR 3.01 [95%CI 2.00-4.53]), hypotension (HR 2.91 [95% CI 1.92-4.40]), tachycardia (HR 2.17 [95%CI 1.42-3.30]), hypoxemia (HR 1.97 [95%CI 1.15-3.37]), leucocytes (&lt;4000, 12000&lt;) (HR 1.80 [95%CI 1.22-2.68]) and age (≥ 80 years) (HR 1.69 [95%CI 1.10-2.58]) were independent prognostic factors for early mortality in acute symptomatic PE. Conclusions: In this large VTE registry from recent years, several independent prognostic factors for 30-day early mortality in acute symptomatic PE were identified, consisting of active cancer, hypotension, tachycardia, hypoxemia, leucocytes (&lt;4000, 12000&lt;) and age (≥ 80 years).
Abstract 4137204: Classifying Left Ventricular Hypertrophy from ECG in Overall Population and Bundle Branch Blocks: Machine Learning Models are Superior to Published ECG Criteria
Authors: Ashley DeBauge, Christopher Harvey, Amulya Gupta, Amit Noheria
Journal: Circulation (2024)

Background: Published ECG criteria for left ventricular hypertrophy (LVH) have low diagnostic yield, esp. with right/left bundle branch block (RBBB/LBBB). Machine learning (ML) may improve LVH classification. Hypothesis: ML performs better than published LVH criteria to classify LVH from ECG in overall population, and subgroups of RBBB/LBBB. Methods: In addition to standard ECG features like rates, intervals, axis etc., R, S and overall QRS amplitudes, and voltage-time-integrals were extracted from standard 12 leads and reconstructed vectorcardiographic X, Y, Z lead representative beats. Further, a variational autoencoder was used to extract latent encodings from the representative beats. ML algorithms (logistic regression, random forest, light gradient boosted machine, multilayered perceptron, residual network, and convolutional neural network) were trained to predict LVH (LV mass index women &gt;95, men &gt;115 g/m 2 ) from ECG features on a training set of adult ECGs and echocardiogram within 45 days of each other (general population N=240,476, RBBB n=22,110, LBBB n=12,563). We obtained ROC AUCs in a separate validation set for LVH classification by (a) individual ECG variables, (b) published LVH criteria and (c) ML models. Results: As shown in Tables 1-2 and Figure 1 , for LVH classification among the validation sets, AUCs were highest for ML models, intermediate for univariable models and least for published criteria (best ML model vs. best criteria: general population women 0.77 vs. 0.63, men 0.78 vs. 0.63; RBBB women 0.70 vs. 0.57, men 0.77 vs. 0.57; LBBB women 0.71 vs. 0.55, men 0.72 vs. 0.54). Conclusions: ML models perform better than published LVH criteria at classifying LVH from ECG in overall population, RBBB and LBBB.
Abstract 4137248: Mechanical chest compression increases intrathoracic bleeding complication in patients receiving extracorporeal cardiopulmonary resuscitation
Authors: Yoshihisa Matsushima, Tatsuhiro Shibata, Rei Yamakawa, Miyu Hayashida, Koudai Shibao, Toshiyuki Yanai, Takehiro Homma, Takashi Ishimatsu, Shoichiro Nohara, Maki Otsuka, Yoshihiro Fukumoto
Journal: Circulation (2024)

Background: Mechanical cardiopulmonary resuscitation (CPR) is widely used to ensure high-quality CPR while reducing the burden on the medical team; however, it carries the risk of intrathoracic bleeding complications. Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest also poses significant challenges due to major bleeding complications. To date, no studies have specifically investigated bleeding complications when mechanical CPR is combined with ECPR. Aim: To compare the risk of major intrathoracic bleeding between manual and mechanical CPR in ECPR patients. Methods: We retrospectively analyzed 85 patients (mean age 59.6 ± 13.3 years, 90.6% male) who underwent ECPR at our hospital between April 2017 and March 2024 after failure to achieve a return of spontaneous circulation for more than 15 minutes despite appropriate CPR. From April 2020 to June 2023, our emergency department actively used mechanical CPR devices. Patients were divided into manual and mechanical CPR groups. The primary outcome was major intrathoracic bleeding requiring transcatheter arterial embolization (TAE), and the association between mechanical CPR and the outcome was examined. Results: There were 40 patients in the manual CPR group and 45 in the mechanical CPR group. Age, sex, medical history, acute coronary syndrome, out-of-hospital cardiac arrest, presence of bystander CPR, initial rhythm, total cardiac arrest time, and CPR time did not differ between the two groups. Only BSA showed a significant difference (1.75 ± 0.17 vs 1.84 ± 0.17m 2 , p = 0.018). The primary outcome occurred in 1 case (2.5%) in the manual CPR group and 9 cases (20%) in the mechanical CPR group. Univariate analysis using Firth's penalized logistic regression showed that age, thoracic transverse diameter, and mechanical CPR were significantly associated with the primary outcome. After multivariate adjustment, the associations between the primary outcome and age (HR 1.09 [1.02-1.20], p = 0.013), mechanical CPR (HR 6.62 [1.25-68.60], p = 0.024), and the outcome remained significant. Conclusions: In ECPR patients, mechanical CPR is significantly associated with an increased risk of major intrathoracic bleeding requiring TAE compared to manual CPR.
Abstract 4137053: Association of Childhood Opportunity Index and No Show Rates in a Pediatric Cardiology Clinic.
Authors: Pietro Elliott, Mishaal Ather, Miranda Lynch, Kimberly Guglielmo, Devyani Chowdhury
Journal: Circulation (2024)

Introduction: Childhood Opportunity Index (COI) measures access to quality education, safe housing, and healthcare based on zip codes. These scores can influence patient behaviors, such as no-shows (NS), which can affect resource utilization and health outcomes. Objective: To quantify the correlation between COI and NS through odds ratio (OR) in a pediatric cardiology clinic. Methods: Patient data was collected from a single, independent pediatric cardiology practice for all visits between 2019 to 2021. COI was categorized into 3 subdomains; education, health and environment, social and economic according to zipcode from Diversitydatakids. The COI was split into low (&lt;40), moderate (40-60U), and high (&gt;60U). Additional variables included age, insurance type, lead time (time from scheduling to appointment date), and telehealth status. Multiple logistic mixed-effect models, both unadjusted (single predictor) and adjusted (multiple predictors), were used to obtain OR for NS. Results: There were 11,474 total encounters. 92% were completed appointments and 8% were NS. Unadjusted model showed statistical significance (p&lt;.05) with increased odds of NS for low COI education, low COI social and economic, and low COI, compared to high COI as the reference category (Table 1). Adjusted model 2 showed similar significant results for the low COI overall category, while for adjusted models 1 and 3, none of the COI categories were statistically significant. In all 4 models, OR for all age categories, all lead times, and public and mixed insurance types were significant. Conclusion: The unadjusted and adjusted model 2 showed that patients with lower COIs were more likely to NS. Public insurance and longer lead times were indicators of NS while higher ages were indicators for completed appointments. Therefore, efforts need to be made to identify vulnerable patients; younger patients, and those with lower COIs and public insurance; and address barriers such as arranging transport and sending reminders that can help decrease NS. Interestingly, the NS rate was lower than the national average. Future research is needed to assess the impact of NS on patient outcomes.
Abstract 4137180: Effectiveness of Exercise-based Interventions in the Prevention of Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis
Authors: Dandan Zhang, Xingyu Xiong, Hexiao Ding, Ruisi Ma, Ting Liu
Journal: Circulation (2024)

Introduction: Breast cancer patients receiving anticancer therapy are at risk of developing cancer therapy-related cardiac dysfunction (CTRCD). While exercise has been shown to improve cardiorespiratory fitness in these patients, its effectiveness in preventing CTRCD remains unclear. Research Questions: How do exercise-based interventions affect CTRCD in breast cancer patients? Which exercise modality is most effective in preventing CTRCD? Goals: This network meta-analysis aimed to synthesize the available evidence on the effectiveness of exercise-based interventions based on cardiac function parameters and to identify the optimal exercise modality for preventing CTRCD. Methods: A comprehensive search was conducted in PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from inception to March 4, 2024. Studies that used exercise interventions, either exercise alone or with other interventions, were included. Outcome measures included at least one cardiac function parameter such as left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS). Pairwise and network meta-analyses were performed using R software (v.4.3.3). Results: A total of 1149 participants from 14 RCTs were included. Compared to the usual care, exercise-based interventions significantly improved LVEF (MD=1.68; 95% CI=0.59-2.77; p＜0.05) and GLS (MD=1.40; 95% CI=0.59-2.21; p＜0.05). Based on the ranking probabilities, combined aerobic and resistance exercise was the most effective way to improve LVEF (4 studies, SUCRA: 96.46%), followed by cardiac rehabilitation (2 studies, SUCRA: 45.31%) and aerobic exercise (4 studies, SUCRA: 41.57%). In terms of improving GLS, combined aerobic and resistance exercise also ranked highest (3 studies, SUCRA: 87.77%). However, cardiac rehabilitation (2 studies, SUCRA: 46.70%) and aerobic exercise (1 study, SUCRA: 44.92%) were still less effective. Conclusion: This network meta-analysis provides low-certainty evidence for the potential efficacy of exercise-based interventions in preventing CTRCD, especially the combined aerobic and resistance training. Further rigorous studies are needed to confirm the effectiveness of exercise-based interventions in the prevention of CTRCD.
Abstract 4137264: Subclassification of Peripheral Artery Disease Based on Muscle Force: Leg Failure with Reduced Muscle Force and Leg Failure with Preserved Muscle Force
Authors: Yuqian Tian, Ali Hakim, Farahnaz fallahtafti, Michael Moulton, Panagiotis Koutakis, Jonathan Thompson, Jason Cook, Julian Kim, zhen zhu, Holly Despiegelaere, Gleb Haynatzki, Sara Myers, Iraklis Pipinos
Journal: Circulation (2024)

Introduction: All claudicating patients with peripheral artery disease (PAD) exhibit leg failure, as evidenced by distinct walking impairment. However, based on a detailed evaluation of leg biomechanics, some claudicating patients maintain preserved leg muscle strength, while others demonstrate reduced strength. In this study, we aim to compare the clinical and physiological characteristics of the two groups. Methods: Fifty-four claudicating patients were categorized into two groups: leg failure with preserved muscle force (LEF-PF) versus leg failure with reduced muscle force (LEF-RF), based on the peak torque (PT) from performing maximum isometric plantar flexion contractions on a Biodex system. All patients underwent history and physical exam, measurement of leg hemodynamics, walking performance and quality of life, and gastrocnemius biopsy to evaluate the histology and biochemistry of the affected leg muscles. We used independent samples T test and chi-square test to compare the two groups. Results: LEF-PF (N=19, PT 92±15 Nm) and LEF-RF (N=35, PT 49±13 Nm) had similar demographic and comorbidity profiles. While ankle-brachial index didn't differ between the two groups, during the reactive hyperemia test, ankle pressure of LEF-RF dropped more significantly (p=0.021) upon occlusion release and took longer to recover (p=0.023). Both groups performed similarly on the Gardner Treadmill test, but LEF-PF performed better in the 6-Minute Walking test (p=0.062). LEF-PF also trended towards higher scores on the modified falls efficacy scale (p=0.056). Histologically, gastrocnemius muscle from LEF-PF had larger myofibers, while biochemically, they exhibited lower mitochondrial respiratory activity dependent on complex-II compared to LEF-RF. Conclusion: Our study presents a novel approach to understanding the physiology of claudication, focusing on the strength of the ischemic muscles. Despite comparable demographics and hemodynamics at rest, notable differences separate the two groups during stress-induced hemodynamics, walking performance, myofiber histology, and mitochondrial biochemistry. Further investigations are necessary to elucidate the underlying mechanisms behind the differences in muscle strength among patients with claudication. Such insights may enhance our understanding of PAD physiology and potentially correlate with variations in mortality rates, progression to more advanced PAD stages, and responses to different therapeutic interventions.
Abstract 4136863: Diffuse Functional and Structural Abnormalities in Fibrosis: Potential Structural Basis for Sustaining Atrial Fibrillation
Authors: Eugene Kwan, elyar ghafoori, Wilson Good, Misha Regouski, Boyce Moon, Jeffrey Fish, Edward Hsu, Irina Polejaeva, Rob MacLeod, Derek Dosdall, Ravi Ranjan
Journal: Circulation (2024)

Background: Structural remodeling is associated with atrial fibrillation (AF), but detailed structural and functional characteristics is not well defined. Goal: Using a novel transgenic goat model with cardiac-specific overexpression of TGF-β1 leading to increased cardiac fibrosis, we evaluated detailed structural and functional differences between fibrotic and healthy regions of the atria. Methods: Ex-vivo MRI and histology were used to evaluate fibrosis, fiber disarray, and structural anisotropy. Ex-vivo MRI intensity values were scaled to standard deviations around the mean. The functional analysis examined conduction speeds and direction heterogeneity. Conduction anisotropy was measured along the fiber direction obtained with diffusion tensor imaging. Results: The transgenic goats (n=12) had, on average, 21% of the left atria labeled as fibrotic determined from ex-vivo MRI. The histology samples taken from the labeled fibrotic regions had an increase in fibrosis percentage compared to labeled healthy regions (7.78±3.76% vs 2.80±1.86%, p&lt;0.01). The structural anisotropy was lower in fibrotic regions (0.196±0.002 vs 0.244±0.002, p&lt;0.01). Fiber disarray was greater in the fibrotic regions (20.3±0.2° vs 19.2±0.1°, p&lt;0.01). The fibrotic regions had slower conduction speeds (0.78±0.02 m/s vs 1.12±0.02 m/s, p&lt;0.01) and more aligned conduction directions (30.5±0.2° vs 31.6±0.1°, p&lt;0.01), potentially developing unidirectional conduction block. Conduction anisotropy, measured on the fiber directions, was found to be lower in the fibrotic regions (1.86±0.05 vs 2.10±0.02, p=0.04). As scaled MRI intensity increased, the conduction speed, heterogeneity, and anisotropy all decreased. Conclusions: Functional and structural differences exist between fibrotic and healthy regions of the atria. Though statistically significant, the changes are not discrete. The correlation showed gradual functional abnormalities with MRI intensities. Fibrotic regions tended to have increased fiber disarray, slower conduction, and more unidirectional propagation with lower conduction and structural anisotropy. Diffuse functional and structural abnormalities may allow fibrotic regions to serve as a substrate to sustain AF.
Abstract 4137113: The Effectiveness of Cardiac Resynchronization Therapy in Patients with Cardiac Sarcoidosis: A Retrospective Analysis
Authors: Maryam Sani, James Flynn, Ashkan Abdollahi, Nisha Gilotra, Jonathan Chrispin
Journal: Circulation (2024)

Background: Cardiac sarcoidosis (CS) manifests in a wide range of clinical presentations, including conduction system abnormalities, ventricular arrhythmias, and systolic heart failure. Although cardiac resynchronization therapy (CRT) has shown efficacy in treating select nonischemic cardiomyopathy patients, its specific impact on CS patients remains less explored. This study aimed to evaluate the outcomes of CRT therapy in CS patients, focusing on implantable cardioverter defibrillator (ICD) therapies, heart failure (HF) hospitalizations and mortality. Methods: We retrospectively reviewed all patients with a clinical or histological diagnosis of CS who underwent device implantation (ICD or Permanent Pacemaker (PPM)) with or without CRT therapy at Johns Hopkins Hospital between 2004 and 2024. Baseline characteristics and echocardiographic parameters were assessed. Heart failure hospitalizations, the frequency of ATP (Anti-Tachycardia Pacing) or ICD shocks, and all-cause mortality were also evaluated as the outcomes. Results: The study included 212 patients (40.1% female, average age 52.8 ± 11.1 years). Eighty-five patients underwent CRT implantation (82 CRT-D and 3 CRT-P), whereas the rest received either an ICD or a PPM without CRT therapy. Most CRT devices (58.82%) were upgrades from an initial PPM or ICD. Over a follow-up of 6.15 ± 4.43 years, 27 (12.74%) patients were hospitalized for heart failure (HF), 86 (40.56%) experienced ATP or ICD shocks, and 17 (8.02%) died. The composite outcome was observed in 103 patients (48.5%), with no significant differences between CRT and non-CRT groups ( P = .51). Survival analysis indicated significantly reduced freedom from HF hospitalizations in the CRT group compared to non-CRT group ( P = .01). However, ATP/ICD shocks did not have a significant difference. CRT recipients showed an improvement in left ventricular ejection fraction (LVEF) from 35.3 ± 12.6% to 38.9 ± 13.6% at 6 months ( P = .01). Non-recipients showed no significant change in LVEF ( P = .43). Conclusions: Over an average six-year follow-up period, CRT upgrade does not appear to affect ATP/ICD shock and mortality in CS patients, although it is associated with significantly higher rates of heart failure (HF) hospitalizations compared to CS patients with an ICD or PPM alone. These findings underscore the complex response of CS patients to CRT, highlighting the need for further research to optimize treatment strategies within this subgroup.
Abstract 4136884: Incidence and Characteristics of Peri-Procedural Complications of Cardiac Implantable Electrical Devices in Breast Cancer Survivors
Authors: Eleanor Keller, Laura Noteware, Melissa Accordino, Eileen Connolly, Deepak Saluja, Anne Goldberg, Elaine Wan, Gabriel Sayer, Angelo Biviano, Nir Uriel, Hirad Yarmohammadi, Jayant Raikhelkar
Journal: Circulation (2024)

Introduction: Breast cancer (BC) is the most common non-cutaneous cancer in women. Several BC treatments increase the risk of conduction abnormalities and heart failure, potentially requiring cardiac implantable electrical devices (CIEDs). Due to vascular access devices, surgical management, and chest wall radiation, these patients are subject to upper extremity vascular alterations. There is limited data regarding CIED use in this population. Research question: Do patients with BC and CIEDs have different procedural approaches or complications compared to the general population? Aims: This study aimed to evaluate CIED placement and periprocedural complications in patients with a history of BC. Methods: This was a retrospective study of CIEDs placed at our institution between 2005 and 2023. Patients with a diagnosis of BC prior to time of placement were included. Complications included those within 30 days of the procedure. Results: We analyzed 109 female patients (median age of 73 years, IQR 66-80) who received pacemaker (PPM, 58.7%), cardiac resynchronization therapy defibrillator (CRT-D, 22%), implantable cardioverter defibrillator (ICD, 16.5%), or cardiac resynchronization therapy pacemaker (CRT-P, 2.8%). The median time from cancer diagnosis to device placement was 13 years (IQR 7-21). Oncologic therapies are included in Figure 1. In patients with unilateral cancer, most devices (78.4%) were placed contralaterally, with 32% of all devices being right sided. Anatomy related to chemotherapy port altered intraoperative approach in 2 cases and bilateral lymph node dissection necessitated subcutaneous ICD in 1 case. Complications were noted in 12 patients (11%) and included hematoma, lead revision, upper extremity DVT, pericardial effusion, stress cardiomyopathy, perforation, site infection, and worsening of chronic lymphedema. Conclusions: BC survivors undergoing CIED placement appear to be at higher risk of periprocedural complications when compared to the general population. They are more likely to undergo right sided device placement to avoid vascular access ipsilateral to prior surgery or radiation. Further studies are required to understand the long-term outcomes of CIED placement in this cohort of patients.