tbuckley/cabot-search huggingface dataset:
Abstract 4145066: Risk for appropriate ICD intervention and complications in patients implanted after an out-hospital cardiac arrest compared to patients implanted for primary and other secondary prevention indication
Authors: Enrico Baldi, catherine klersy, Antonio Curcio, simone savastano, Martina Nesti, Pietro Palmisano, Gianmarco Arabia, Gabriele Dell'Era, Matteo Casula, Veronica Dusi, Valentina Guerini Giusteri, Pasquale Crea, Nicolo Martini, Federico Guerra, Lucy Barone, Vincenzo Russo, Stefano Cornara, Roberto Rordorf
Journal: Circulation (2024)

Background: it is unclear if patients implanted with an implantable cardioverter defibrillator (ICD) after an out-of-hospital cardiac arrest (OHCA) have a higher risk of appropriate device therapy than patients implanted for primary and other secondary prevention. Aims: to assess if appropriate device interventions (ATP/shocks) are higher in patients implanted after OHCA compared to patients implanted for primary and secondary prevention other than OHCA. To verify also if mortality, implantation-related complications (pneumothorax, hemothorax, hematoma, cardiac tamponade), device-related complications (lead displacement and fracture, infections) and inappropriate shocks/ATP are higher in OHCA patients. Methods: a retrospective multicenter international study. We included all the patients implanted with an ICD in 2015 and 2016 in the centers. Follow-up was concluded if death or at the last follow-up available until 12/2023. Patients were divided according to ICD indication (secondary prevention after OHCA, other secondary prevention, primary prevention). Results: 1386 patients (79% males; median age 67, IQR 59-74) from 15 centers were included (median follow-up 83 months): 111 patients in OHCA group, 134 in other secondary prevention group and 1141 in primary prevention group. Considering the first appropriate intervention, a significant difference among the three groups was observed (Fig.1A) and, at post-hoc comparison, the OHCA group was at higher risk than primary prevention (HR 1.51, 95%CI 1.06-2.17, p=0.02), but was at similar risk than other secondary prevention (HR 0.79, 95%CI 0.51-1.23, p=0.3). This was confirmed also after correction for age, gender, history of atrial fibrillation, aetiology and multi-comorbidity (Fig.2A). Considering the number of appropriate interventions during follow-up, the risk of OHCA group was lower than other secondary prevention (IRR 0.28, 95%CI 0.11-0.68, p&lt;0.01) and similar to primary prevention (IRR 0.97, 95%CI 0.47-1.96, p=0.93), also after correction for the other predictors (Fig.2B). The three groups showed no differences in survival (Fig.1B), implantation-related complication, device-related complications (Fig.1C) and inappropriate shocks/ATP. Conclusion: Our study highlights how OHCA patients represents a peculiar population with the same chance of survival and rate of complications compared to primary and other secondary prevention patients suggesting the need of more studies to improve their long-term treatment.
Abstract 4145146: Familial Hypercholesterolemia With Concurrent Premature Coronary Artery Disease and Renal Artery Stenosis - A case report.
Authors: Kesar Prajapati, Nisarg Desai, Vikranti Sailor, Sibasis Sahoo
Journal: Circulation (2024)

INTRODUCTION: Familial Hypercholesterolemia (FH) is an underdiagnosed hereditary disorder of Low-density lipoprotein cholesterol (LDL-C) metabolism ,strongly associated with atherosclerotic cardiovascular disease (ASCVD). We present an FH case which shows the importance of early management. CASE REPORT: A 40 year old female with a history of Diabetes Mellitus, Hypertension (HTN), Non ST Elevation Myocardial Infarction (NSTEMI) came for angina like chest pain for 6 months. Her Coronary Angiography (CAG) showed Triple Vessel Coronary Artery Disease with 90% Left Main, 90% Left Anterior Descending, 80% Left Circumflex (LCX), 95% Right Coronary (RCA) arteries occlusion; Coronary Artery Bypass Grafting (CABG) was done. Her medical records showed poorly managed systolic blood pressure readings up to 180-200 mm Hg and hypercholesterolemia despite being on 3 antihypertensives and statins. On physical examination BMI 22 kg/m 2 , xanthelasmas, corneal arcus, elbow and achilles tendon xanthoma(figure.1),B/L Renal and carotid bruit was present. Her brother had premature CAD, daughters had hypercholesterolemia signs. Lab results indicated high cholesterol with, LDL 372.8 mg/dl; LDL/HDL 11.65. Multi-slice CT showed diffuse atheromatous changes of descending aorta, mesenteric arterial system and &gt; 60% bilateral (L&gt;R) renal artery stenosis(RAS). By Dutch Lipid Clinic Network criteria phenotypic FH was diagnosed and sent to lipid clinic for FH management. DISCUSSION: FH is an Autosomal Dominant disorder that leads to high LDL-C, escalating CAD risk by 20-fold. High intensity Statins cut LDL-C by 50%, pivotal in FH management. In our case late diagnosis of FH led to uncontrolled HTN due to RAS alongside CAD; Early diagnosis and medical management could have prevented the outcome as early initiation of statin in FH reduces their risk to age-matched population levels. Conclusion: FH is a systemic atherosclerosis often at subclinical level that needs to be investigated, also patients with premature ASCVD(male&lt;55, female &lt;60 years) and uncontrolled HTN with renovascular pathology should be screened for FH as early intense pharmacological management prevent serious atherosclerotic complications.
Abstract 4145273: Utilization and Efficacy of an Automated Transthoracic Echocardiographic Report Data Extraction
Authors: Nischal Praveen, Anish Shah, Michael Hill, David Tofovic
Journal: Circulation (2024)

Background: Extraction of unstructured and semi-structured medical data is a key prerequisite for the application of bioinformatics. Portability, scalability, and protection of health information remain key problems in data analytics in medicine that cannot easily be solved using machine learning techniques alone, highlighting the importance of multi-faceted approaches. Research Question / Hypothesis: Can rule-based algorithms reliably and identify and extract transthoracic echocardiographic (TTE) report findings for use in a data analytics pipeline? Methods: Deidentified adult TTE reports were obtained between 09/14/2020 to 03/30/2023 within a single urban academic healthcare system. A rule-based algorithm was developed using derivatives of regular expressions in R to capture chamber parameters, cardiac function, and valvular disease. The accuracy was evaluated in a subset of manually adjudicated reports by study cardiologists. Results: Of the 1000 reports obtained, we were able to extract 23079 (78.4%) populated data points out of 29423 maximal data points for 37 variables. Out of 803 manually verified NA data points, 743 (92.5%) were accurate. The mean net accuracy of all variables was 99.8% (see Table 1). Continuous data points showed 100% accuracy. Modes of failure for data extraction were in categorical variables (7.5% of the 23 features), with the most common being in left atrial size (n=6), mitral valve structure (n=5), aortic valve structure (n=13), tricuspid valve structure (n=2) and right ventricular function (n= 7). All other categorical variables showed 93.6% mean accuracy of NA data points. Conclusions: A rule-based algorithm is effective at converting cardiologist-read TTE reports into datasets ready for use data analytics. Moving forward, it would be important to test this tool on metrics of speed, cluster computing and scalability.
Abstract 4145195: Native Tricuspid Valve Hematoma and Pulmonary Artery Pseudoaneurysm Mimicking Cardiac Behcet's
Authors: Zaid Naseer, Mohammad Motaweih, Najy Issa, John Kerley, Matthew Aiken, Mohammed Choudhry, Aaron Schatz
Journal: Circulation (2024)

We report a case of a giant organizing hematoma attached to a native tricuspid valve in a 32-year-old man. In the absence of predisposing valvular disease, trauma, endocarditis, or a hypercoagulable disorder, intracardiac hematoma formation on a native tricuspid valve is an extremely rare entity with no reported incidence. A recently incarcerated 32-year-old man presented with subacute hemoptysis, dyspnea, and night sweats. He had a history of unexplained penile ulcers. His exam was notable for multiple tattoos and a systolic murmur. Chest CTA revealed a 4.6 cm x 2.5 cm right ventricular mass, multiple pulmonary nodules, and bilateral pulmonary emboli. Transesophageal echocardiogram identified a large irregularly bordered mass attached to the anterior tricuspid valve leaflet and right ventricular free wall. Cardiac MRI confirmed a lobulated mass within the right ventricle and an additional 2 cm lesion adjacent to the septum. Multiple sets of blood cultures were negative. Patient had a positive QuantiFERON TB gold and a negative AFB culture, suggesting TB latency. An extensive infectious, hematologic, and rheumatologic workup was otherwise negative. Despite anticoagulation and antibiotics, the mass remained unchanged. The mass was surgically resected, and the tricuspid valve was replaced with a bioprosthetic valve. Histopathology demonstrated an exuberant inflammatory response with organizing granulation tissue from a non-neoplastic process such as organizing hematoma. Postoperatively, the patient developed worsening hemoptysis, requiring intubation and bronchoscopic removal of large airway clots, and upper extremity deep venous thrombosis. Repeat CTA showed multiple pulmonary artery pseudoaneurysms, raising suspicion for vasculitis. Our patient met the International Criteria for Behcet’s, with a score &gt; 4. Hughes Stovin Syndrome is a rare hypothesized cardiovascular variant of Behcet’s Disease that presents with pulmonary artery aneurysms, venous thrombosis, and intracardiac thrombi. Hematomas on a native cardiac valve in this context have never been reported and may result from similar local endothelial vasculitic processes. Steroids are the mainstay treatment, and anticoagulation is avoided in the presence of pulmonary artery pseudoaneurysms. Vasculitis should be considered in cases of unusual cardiac masses. Although vascular lesions in Behcet’s syndrome are rare, their recognition is essential as they can be fatal if improperly treated.
Abstract 4144999: Cardiac Magnetic Resonance Imaging in Tetrology of Fallot Patients and Relationship to Obesity
Authors: Patrick Dusza, Andrew Tran, Kan Hor
Journal: Circulation (2024)

Obesity is associated with increased cardiovascular risk and adverse cardiac changes such as left ventricular hypertrophy (LVH) and in TOF higher body mass index (BMI) contributed to increase risk. Previous multicenter study concluded that right ventricular (RV) dysfunction contributed to cardiovascular event. Current recommendations for pulmonary valve replacement (PVR) in TOF patients use indexed RV endiastolic volume (RVEDVi) to determine timing of PVR. In the presence of obesity, RVEDVi may underestimate the severity of RV volume load. We sought to determine both diastolic (RVEDV) and systolic (REVSV) volume in obese and non-obese patients and the impact of the volume on right ventricular ejection fraction (RVEF). We conducted a retrospective study of adult TOF patients &gt; 18 years age in obese (BMI ≥ 30 kg/m2) and non-obese (BMI &lt; 30 kg/m2) patients with a cardiac magnetic resonance imaging (CMR) prior to PVR for pulmonary regurgitation (PR). CMR database and electronic records were reviewed to compare anthropometric, demographic, and CMR variables between obese and non-obese patients. Table 1 shows demographic and CMR results between non-obese (n = 57) and obese (n = 32) patients. Indexed ventricular volume were smaller in obese compared to non-obese patients (LVEDVi 78.7±12.1 vs 84.3±14.9 mL/m2, p=0.04; RVEDVi 157.4±21.5 vs 169.4±32.7 mL/m2, p=0.03), in contrast the non-indexed volume were significantly larger (LVEDV, 166.7±32.9 vs 148.8±30.5 mL, p=0.006; RVEDV 333.1±61.3 vs RVEDV 297.6±56.6 mL, p=0.004). There is an association with ventricular volume with lower RVEF. In both groups the mean RVEF was abnormal but not different (43.2±8.7 vs 43.8±8.4%, P=NS). Patients with lower RVEF trended towards a lower LVEF especially in the obese group (Figure 1A-F). Our study showed that indexed ventricular volume was smaller in obese patients and may lead to false reassurance suggesting underestimation of the volume load from the PR. Our patients have lower RVEF which correlated with larger volume and evidence of ventricular-ventricular interaction with lower LVEF in patients with lower RVEF. When assessing timing of PVR in asymptomatic TOF patients, other parameters beyond indexed volume in those with elevated BMI should be considered including ejection fraction and different methods of indexing RV volume similar to LVM. Future larger and longitudinal studies are needed to determine if delayed repair in obese patients lead worse remodeling and outcomes.
Abstract 4145147: Prescription of Sodium-glucose cotransporter-2 inhibitors and Glucagon-like peptide-1 receptor agonists among Veterans with diabetes and cardiovascular disease
Authors: Fatima Qaisrani, Jingyi Wu, Lauren Eberly, Sameed Ahmed Khatana
Journal: Circulation (2024)

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor (GLP-1) agonists (GLP-1a) improve cardiovascular (CV) health outcomes among individuals with type 2 diabetes and CV disease. US military Veterans have a higher prevalence of both diabetes and CV disease than the general population. Understanding what rates of SGLT2i and GLP-1a prescription are in this population is important for identifying strategies to improve CV outcomes. Methods: Using data from the Veterans Affairs Corporate Data Warehouse data, we identified all Veterans with type 2 diabetes and at least one of the following conditions – coronary artery disease, peripheral arterial disease, cerebrovascular disease/stroke, or congestive heart failure (either reduced or preserved ejection fraction). The study population was limited to people with active care with a primary care, cardiology, or endocrinology provider. We then examined trends in prescription of SGLT2i and GLP-1a from 2017 to 2022. Prescription rates among subgroups of gender and race were also evaluated. Differences between groups were compared using Chi-squared tests. Results: A total of 826,590 Veterans with both diabetes and CV disease were identified. Prescription rates of SGLT2i increased from 1.6% in 2017 to 22.3% in 2022 while GLP-1a rates increased from 2.0% to 12.0%. As of 2022, prescription rates of SGLT2i were similar between men and women (22.2% vs. 22.8%) while rates for GLP-1a were lower among men (11.8% vs. 18.6%, p&lt;0.001). Among race subgroups, prescription rates were similar, but Black Veterans had the lowest rates for both categories of medications compared to white Veterans: 22.1% vs. 22.4%, p=0.03 for SGLT2i and 10.6% vs. 12.4%, p&lt;0.001 for GLP-1a. Conclusions: Although prescription rates of SGLT2i or GLP-1a among Veterans with diabetes and CV disease have rose considerably between 2017 and 2022, as of 2022, a substantial proportion of Veterans with diabetes and CV disease were yet to be prescribed SGLT2i or GLP-1a. There also existed some disparities based on gender and race in prescription rates. Identifying, and removing, barriers towards prescribing these medications is crucial for improving the CV health of Veterans.
Abstract 4144811: Durability of Left Bundle Branch Area Capture over Time: A Single Center Retrospective Analysis
Authors: Ali Jafry, Ali Noory, Amit Thosani, Joshua Silverstein, Emerson Liu, William Belden, John Chenarides, Mati Friehling, George Shaw, Tharian Cherian
Journal: Circulation (2024)

Background: Left bundle branch area pacing (LBBAP) is a rapidly growing and widely adopted conduction system pacing (CSP) technique. However, little is known about the durability of left bundle branch area capture (LBBAC) over time. Objective: Evaluate durability of LBBA capture after achieving acute LBBAC at time of implant. Methods: Consecutive LBBAP implants or CSP upgrades by a single operator were retrospectively evaluated. A Medtronic (MDT) C315 sheath was used to deliver a MDT 3830 lead to the LBBA in all cases. QRS width, LV activation time (LVAT), V6-V1 inter-peak interval (V6-V1I) and the presence of R’ in V1 at the time of initial CSP implant and at most recent follow up ECG were measured to determine durability of LBBAC over time. LBBAC was defined as presence of R’ in V1, along with LVAT &lt; 90 msec. Loss of LBBAC was defined as loss of R’ in V1 in follow up along with either increase in QRS duration and/or LVAT. Results: We attempted LBBAP in 108 pts with acute success in 92 (85.2%). The remaining 16 patients (14.8%) demonstrated deep septal pacing. Mean QRS duration at implant for those achieving acute LBBA capture was 130 +/- 12 msec, with mean LVAT of 72 +/- 12 msec, and V6-V1I of 46 +/- 18 msec. After excluding patients with minimal RV pacing and those lost to follow up, 46 patients with acute LBBAC had follow up ECGs available. After a median follow up of 300 days, 44 patients (96%) retained LBBAC with stable QRS duration (125 +/- 16 msec), LVAT (70 +/- 16 msec), and V6-V1I (43 +/- 19 msec). Two patients (4.3%) lost LBBAC, as evidenced by loss of R’, transition to an RV septal paced morphology, and increased LVAT and paced QRS duration. Pacing thresholds remained stable over time. No patients required upgrade for pacing induced cardiomyopathy. Conclusion: In this retrospective study, LBBAC is durable over approximately one year follow up. Longer term follow up data is required to determine long-term durability of this pacing technique, particularly in patients with CRT indications.
Abstract 4145158: CD38 Activation by Disturbed Flow (d-flow) Promotes Endothelial Cell (EC) Senescence-Associated Stemness (SAS) through Glutaminolysis Enhanced by Pyruvate Dehydrogenase (PDH) Inhibition, Leading to Atherothrombosis
Authors: Sivareddy Kotla, Jonghae Lee, Abigail Osborn, Rajneesh Pathania, Weiqing Chen, Venkata Subrahman K Samanthapudi, Gilbert Mejia, Oanh Hoang, Kyung Ae Ko, Keila Carolina Ostos Mendoza, Khanh Chau, NHAT TU LE, Keri Schadler, Jared K Burks, Erin Seeley, Philip Lorenzi, Paul Brookes, James Martin, Guangyu Wang, Eduardo Chini, Junichi Abe
Journal: Circulation (2024)

Background: D-flow’s impact on metabolic reprogramming, particularly glycolysis, needs reevaluation due to its conflicting role in atherosclerosis. We show that d-flow reduces LATS1/2 expression, leading to both EC proliferation and senescence. However, the exact molecular mechanisms remain elusive. Methods: We utilized EC-specific Lats1 +/- /Lats2 -/- knockout (LATS1/2-EKO) mice in a partial left carotid ligation (PLCL) model under hypercholesterolemia with AAV-PCSK9 injection to mimic d-flow. Anti-CD38 antibody (Ab68) and IgG2a control were administered intraperitoneally every 5 days at a dose of 5 mg/kg starting one day before PLCL. Plaque characterization was performed using imaging mass cytometry and sequential immunofluorescence (COMET TM ), integrating spatial metabolite data from Bruker timsTOF Flex Mass Spectrometer, and spatial single-cell metabolite data via the Visiopharm platform. Results: EC LATS1/2 depletion induced a unique atherothrombosis lesion with induced EC proliferation and senescence-associated secretory phenotype (SASP). Utilizing spatial single-cell metabolomics, we cataloged 134 distinct metabolites within the ECs. Subsequent overrepresentation analysis revealed that pathways related to glutamate and the citric acid cycle were enhanced in LATS1/2-EKO mice. Specifically, CD38-dependent downregulation of the pyruvate dehydrogenase (PDH) substrate lipoamide decreased PDH enzymatic activity, linking to CD38 to senescence induction. This inhibition led to a metabolic shift towards YAP-dependent glutaminolysis, and upregulated the citric acid cycle. The use of a glutaminase 1 inhibitor (CB-839) significantly curtailed senescence-associated stemness (SAS), underscoring the pivotal role of CD38 in driving glutaminolysis that contributes to d-flow-induced SAS. Moreover, the application of Ab68 but not IgG2a control decreased atherothrombosis formation following PLCL in LATS1/2-EKO mice. However, the effectiveness of Ab68 in attenuating atherosclerosis in wild-type mice was less pronounced. Conclusions: In the presence of d-flow, upregulated CD38, resulting from reduced LATS1/2 expression, triggers EC responses characterized by increased glutaminolysis and the emergence of an EC SAS phenotype. These processes play a crucial role in a unique form of atherothrombosis. Additionally, CD38’s impact on reducing PDH activity, along with YAP and CD38-mediated enhancement of glutaminolysis, constitutes critical pathways for inducing EC SAS by d-flow.
Abstract 4145039: Prevalence, Penetrance, and Phenotypic Manifestation of Incidental Cardiomyopathy-Associated Genetic Variants in a Quaternary Medical Center-based Population
Authors: Marta Figueiral, Luca Fazzini, Jennifer Tan-Arroyo, Rory Olson, Josh Bublitz, Janet Olson, Eric Klee, Naveen Pereira
Journal: Circulation (2024)

Background: Cardiomyopathies (CM) are a leading cause of heart failure. Identification of genetic risk preemptively may allow detection of the earliest phenotypic manifestations through implementation of interval-based cardiac screening. Previous population-based genetic screening studies have limited follow-up and inadequate phenotyping. Hypothesis: Disease penetrance of CM variants is significantly higher than previously reported. Aims: To determine the prevalence, penetrance, and disease expression of incidental CM-related genetic variants in an unselected, richly phenotyped, adult population. Methods: We analyzed a random sample of 10,000 patients from a quaternary medical center-based biobank cohort for reportable variants in 22-cardiomyopathy genes. Prioritization of genetic variants was performed using Semi-Automated Variant Interpretation, a novel software that has been previously developed and validated at our center. Prioritized variants were then manually curated by 2 independent variant interpretation specialists. Clinical phenotypes and outcomes of participants with likely pathogenic/pathogenic (LP/P) variants were determined. Results: LP/P cardiomyopathy variants were present in 1% of our cohort (n=104) within the following genes: TNNT2 (n=1), DES (n=2), LMNA (n=2), MYL2 (n=2), TNNI3 (n=2), DSG (n=4), FLNC (n=4), DSC2 (n=6), SCN5A (n=7), PKP2 (n=10), DSP (n=12), MYH7 (n=14), TTN (n=17), MYBPC3 (n=21). Only 1 participant carried two different LP/P variants. A definitive disease penetrance defined as heart failure or cardiomyopathy was found in 34% of genotype positive (G+) individuals. Possible disease penetrance defined as presence of structural heart disease identified by echocardiography was found in an additional 16% of participants (concentric left ventricular hypertrophy, diastolic dysfunction, biatrial and left atrial enlargement). Combined definitive and possible disease penetrance was found in 50% of G+ individuals. Arrhythmias and/or cardiac conduction disease (atrial fibrillation, atrioventricular block, ventricular arrhythmia) were present in 31% of G+ individuals. Conclusion: Cardiomyopathy associated LP/P variants are present in a small subset of a large quaternary medical center population as previously reported but unlike prior studies, disease penetrance manifesting as cardiac structural abnormalities and heart failure is high in G+ individuals.