tbuckley/cabot-search huggingface dataset:
Abstract 14235: Alcohol Septal Ablation Using Septal Branches From the Non-Left Anterior Descending Artery Demonstrates Similar Effectiveness Compared to Septal Branches From Left Anterior Descending Artery
Authors: Yoshihiro Harano, Yoshiaki Kawase, Yuki Sahashi, Hitoshi Matsuo
Journal: Circulation (2023)

Introduction: Alcohol septal ablation (ASA) is performed on symptomatic, drug-refractory hypertrophic obstructive cardiomyopathy to reduce pressure gradient in the left ventricular outflow tract (LVOT), usually using the major septal branch from the left anterior descending (LAD) artery. In some cases, a septal branch from other than LAD may be selected as an alternative target that perfuses the basal septum. The aim of this study is to evaluate the effectiveness and safety of ASA using non-LAD branches compared to ASA using major branches directly from the LAD. Methods: We conducted a single-center, retrospective, observational cohort study comprising patients who underwent ASA between 2011 and 2023. The primary outcome was the success rate, defined as a pressure gradient in the LVOT of less than 30 mmHg one year after ASA. The secondary outcomes were all-cause death, cardiac rehospitalization, and newly-developed conduction system disorders. Results: The study enrolled 36 patients (age: 66.6± 12.7 years; 13 men), and pressure gradients in LVOT before ASA were not significantly different in the two groups (76±50 mmHg in the non-LAD group (n =17) vs. 76±39 mmHg in the LAD group (n = 19), p= 0.90). The non-LAD and LAD groups had similar success rates of 88.2 % and 86.7 %, respectively, at one year (p &gt; 0.99). The decrease in the pressure gradient in LVOT was similarly observed in both groups (61±44 mmHg in the non-LAD group vs. 61±35 mmHg in the LAD group, p=0.87). No patient died in either group within one year following ASA. The study found a non-significant incidence of newly-developed conduction system disorder (11.8 % in the non-LAD group vs. 5.3 % in the LAD group, P= 0.92). Conclusions: ASA using the non-LAD artery demonstrated similar effectiveness in decreasing the pressure gradient in the LVOT and similar safety compared to using the septal branch from the LAD at one year. Therefore, the non-LAD artery may become an alternative option for the target vessel in ASA.
Abstract 13584: Prognostic Value of Combined Assessment of Cardiac Magnetic Resonance and Fluorodeoxyglucose Positron Emission Tomography in Patients With Cardiac Sarcoidosis
Authors: Sho Kazui, Sakae Takenaka, Toshiyuki Nagai, Satonori Tsuneta, Kato Yoshiya, Hirokazu Komoriyama, Yuta Kobayashi, Akinori Takahashi, Kiwamu Kamiya, Taro Temma, Takuma Sato, Atsushi Tada, Yutaro Yasui, Michikazu Nakai, Takahiro Sato, Ichizo Tsujino, Kohsuke Kudo, Satoshi Konno, Toshihisa Anzai
Journal: Circulation (2023)

Background: Although the combined assessment of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) was useful for the detection of cardiac sarcoidosis (CS), its prognostic value remains unclear. Methods: We examined 90 consecutive CS patients diagnosed by both CMR and FDG-PET before prednisolone (PSL) therapy between September 2008 and April 2023 in our hospital. We calculated the overlap rate of FDG uptake area in the LGE-positive area to evaluate the association between concordance of FDG/LGE areas and adverse events. Patients were divided into two groups according to the median concordance ratio (overlap rate) between FDG and LGE areas (70 %). The primary outcome was a composite of sustained ventricular tachycardia/fibrillation (VT/VF), worsening heart failure, and sudden cardiac death. Results: Median interval between CMR and FDG-PET was 6.5 (IQR 3.0-24.0) days. There are no significant differences on age, sex, left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) level, and extent of LGE between the groups. During a median follow-up period of 3.2 (IQR 1.0-6.2) years, the primary outcome occurred in 25 (28%) patients. Patients with lower concordance showed a higher incidence of the primary outcome (Figure A), and lower improvement in LVEF after PSL therapy (Figure B) compared to those with higher concordance. In multivariable Cox regressions, lower concordance was significantly associated with the primary outcome adjusted for history of VT/VF (HR 7.37, P = 0.001), LVEF (HR 7.75, P = 0.001), log BNP (HR 5.62, P = 0.006), and extent of LGE (HR 11.75, P = 0.017). Conclusions: Lower concordance ratio of FDG/LGE before PSL therapy was associated with higher incidence of adverse events and lower improvement of LVEF. Assessment of active inflammation in the extent of LGE might be useful for risk stratification and prediction of the response to PSL in patients with CS.
Abstract 16714: An Injectable Thermo-Responsive Hydrogel as a Tool for Cardiac Tissue Engineering Efforts: In vitro and in vivo Biocompatibility Assessment
Authors: Maydha Kumar, Maria Cavasin, Ronald J Vagnozzi, Dae Won Park, Timothy A McKinsey, Kunhua Song, Matthew Taylor, Luisa Mestroni, Brisa Pena
Journal: Circulation (2023)

Background: Heart failure (HF) is a major contributor to the global burden of cardiovascular disease. Current treatments for HF do not regenerate muscle nor function and so cardiac transplantation remains the only definitive treatment for HF. Thus, novel therapies for HF are still needed. To overcome this limitation, we engineered an injectable thermo-responsive hydrogel that transitions from a liquid-solution to a gel-based matrix upon reaching body temperature allowing for a liquid injection rapidly followed by gel localization. Previously, we demonstrated the potential of our hydrogel for cardiac tissue applications using primary cardiomyocytes. Goal: The goal of this project is to assess the biocompatibility of the thermo-responsive hydrogel with human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) and its effect on mice heart tissue. Methods: 3D cell culture: 9x104 hiPSC-CM were encapsulated for 21 days using 150μl of hydrogel solution (1.5% w/w) and cell function was assessed afterwards. Mouse intracardial injection: a left thoracotomy was performed via the fourth intercostal space in an adult C57BL/6 mouse model. Then, three injections of 10 μl of either (i) lipofectamine, (ii) hydrogel (1% w/w) or (ii) saline were injected into the left ventricle anterior wall. After injections, the thoracotomy site was closed, and the animals recovered. Four weeks post inject the tissues were harvested and prepared for studies. Results: We found that our hydrogel promotes hiPSC-CMs alignment, elongation with increased Cx43 localization and improved contraction function when compared with traditional 2D fibronectin controls. Furthermore, the in-vivo biocompatibility in mice (intracardial injection) proved that our hydrogel is well tolerated by cardiac tissue. Conclusion: Our results indicated that the injectable thermos-responsive hydrogel is a biocompatible material with potential to be used in cardiac tissue engineering efforts.
Abstract 13566: Voice as a Biomarker to Detect Acute Decompensated Heart Failure: Pilot Study for the Analysis of Voice Using Deep Learning Models
Authors: Jieun Lee, Eung Ju KIM
Journal: Circulation (2023)

Acute decompensated heart failure (ADHF) is a systemic congestion state requiring timely management. Admission for ADHF is closely related to the readmission and post-discharge mortality in patients, which makes it imperative to detect ADHF in its early stage. Body fluid overload due to ADHF can change voice characteristics by causing edema of lung, larynx, and vocal cord. Voice is a noninvasive and accessible biomarker which can be monitored even in telemedicine practices, but there are few studies in the area. We hypothesized that there would be certain differences of voice characteristics in patients with ADHF when admitted to the hospital and at discharge. This was a prospective study conducted in a tertiary hospital in Korea. Patients with ADHF needed admission were eligible for enrollment, and those with respiratory infection, sepsis, lung/vocal cord disease, acute coronary syndrome, or serum creatinine&gt;3mg/dL were excluded. A total of 112 patients were enrolled between July 1, 2020 and December 31, 2022. Voice was recorded two times: at admission for ADHF, and at discharge. Patients were asked to phonate five Korean vowels (‘a/e/i/o/u’) for 3 seconds each, and then to repeat the sentence ‘daehan minkook manse’ five times. Voice was classified by Convolutional Neural Networks (CNNs). Mel-Spectrogram was conducted to convert the audio from waveform to the spectrogram, and then, transfer learning was done to further classify the voice characteristics. Deep learning models including DenseNet, InceptionNet, and ResNet were conducted to classify voice samples and identify potential characteristics associated with ADHF. We trained the models to classify whether certain voice belongs to ADHF state or recovered state. We treated it as a binary classification task, and the best performing model achieved a classification accuracy of 79% with DenseNet. Interestingly, the classification accuracy conducted with CNNs was highest for ‘u’ achieving 72%, compared to other vowels. To the best of our knowledge, this is the first study to try to detect ADHF with voice using deep learning models, especially with CNNs. We achieved a best classification accuracy of 79%. Our results proposed the possibility of voice as a useful biomarker to detect ADHF in its early stage.
Abstract 13717: Apixaban vs Warfarin for LVAD Anticoagulation
Authors: Cullen Soares, Yash Desai, Erik Sorensen, Lynn Dees, Albert J Hicks
Journal: Circulation (2023)

Introduction: Left ventricular assist devices (LVADs) are a therapy for the management of end stage heart failure. LVADs are typically managed with long-term therapeutic anticoagulation with warfarin to prevent thrombotic complications. Direct oral anticoagulants (DOACs) are easier to manage than warfarin for other medical conditions requiring therapeutic anticoagulation. There is limited data regarding DOAC safety in patients with LVADs. Hypothesis: There is no significant difference in outcomes for patients with LVAD when on DOAC compared to warfarin. Methods: In a single center retrospective analysis from February 2019 to May 2023, patients with LVAD who were switched to the DOAC apixaban (due to warfarin complications or compliance problems) were compared to patients who remained on warfarin. Overall survival, number of hospitalizations, bleeding and thrombotic complications were compared within/between groups. Results: 72 patients were included. DOAC group vs warfarin group: n=12 vs 60, mean age = 52.5 vs 54.2 years; Male 75% vs 81.7%; black 66.7%; vs 58.3%. For DOAC group, 10 out of 12 were on warfarin prior to DOAC. Of these 10, incidence rates for bleeding related admissions were 4.2 per 1000 days on initial warfarin and 0.76 per 1000 days after switching to DOAC. Relative risk reduction of bleeding related admissions decreased by 81.9%. In the DOAC group, thrombosis related admissions on initial warfarin were 0, compared to 1 after switching to DOAC. When comparing DOAC and Warfarin groups, there were no statistically significant difference in bleeding or thrombotic complications (HR = 0.61; 95%CI= 0.21 to 1.46; HR= 0.74; 95%CI= 0.02 to 6.08, respectively) or mortality (HR = 0.44; 95%CI: 0.01 to 3.12). Incidence rates for bleeding related admissions were 0.98 per 1000 days and 1.59 per 1000 days, for DOAC and Warfarin, respectively. Incidence rates for thrombotic related admissions were 0.16 per 1000 days and 0.22 per 1000 days, for DOAC and Warfarin, respectively. Conclusions: There was no statistically significant difference in bleeding, thrombotic events, or mortality in LVAD patients receiving DOAC compared to Warfarin. Switching to DOAC improved bleeding rates in LVAD patients that suffered bleeding complications with Warfarin.
Abstract 13259: Large-Scale Plasma Proteomics Identifies C1QTNF1 as a Potential Causal Risk Factor for Aortic Stenosis
Authors: Khaled A Shelbaya, Victoria Lamberson, Yimin Yang, Pranav Dorbala, Leo Buckley, Brian Claggett, Hicham Skali, Line Dufresne, Jamie C Engert, Ta-Yu Yang, George Thanassoulis, James S Floyd, Thomas Austin, Anna E Bortnick, Jorge R Kizer, Renata Caroline C Costade Freitas, Sasha A Singh, Elena Aikawa, Christie M Ballantyne, Ron C Hoogeveen, Bing Yu, Josef Coresh, Kuni Matsushita, Amil M Shah
Journal: Circulation (2023)

Background: Despite the increasing prevalence of aortic stenosis (AS) and associated morbidity, limited data exist regarding circulating risk factors for AS development. Methods: Among Atherosclerosis Risk in Communities study participants with available proteomics (Somascan v4) at study Visit 5 (2011-13; n=4,899; age 76 ± 5 years, 57% women), we used multivariable linear regression to evaluate the association of 4,877 plasma proteins with peak aortic valve (AV) velocity and AV dimensionless index. We then tested their associations, when assessed at study Visit 3 (1993-95; n=11,430; age 60 ± 6, 54% women), with incident AV-related hospitalization post Visit 3 (median follow-up 22, IQR 14 - 25 years) using multivariable Cox PH regression. For the resulting candidate proteins, we tested associations with incident adjudicated AS in the Cardiovascular Health study (CHS) and assessed for potentially causal effects on AS and AV peak velocity using two sample Mendelian Randomization (MR). pQTLs were obtained from 3 previously published European studies, summary statistics for AS from the recently completed TARGET GWAS, and summary statistics for AV peak velocity from an ARIC GWAS. Results: We identified 52 plasma proteins with consistent associations with AV peak velocity, AV dimensionless index, and incident AV hospitalization. Of these 52 proteins, genetic instrumental variables (IVs) for MR analysis were available for 42. After multiple testing correction, a multi-SNP IV for C1QTNF1 demonstrated a potential causal effect on AS, such that higher genetically determined levels of C1QTNF1 associated with greater odds of AS. That same multi-SNP IV also demonstrated concordant MR association with peak AV velocity. C1QTNF1 was also associated with AS events in CHS (Figure). Conclusion: Large-scale proteomics in a longitudinal community-based cohort identifies C1QTNF1, an adiponectin paralog associated with inflammation, as a potential novel risk factor for AS.
Abstract 16069: Patient Education and Medication Checklists for Optimization of Guideline-Directed Medical Therapy
Authors: Amber B Tang, Anna Dermenchyan, Chidinma Melton, David Cho, Pooya Bokhoor, Richard Yaw, Julie Gaspar, Nina Lou Delavin, Gregg C Fonarow
Journal: Circulation (2023)

Introduction: Despite strong evidence on the benefits of guideline-directed medical therapies (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), the use of GDMT remains suboptimal in clinical practice. Hypothesis: We hypothesized that patient educational videos, coupled with an interactive medication checklist provided to patients, would improve prescription of GDMT in outpatient cardiology clinics. Methods: Patients over the age of 18 years with a diagnosis of HFrEF and a cardiology clinic appointment during the study period were included. Electronic health record communications were sent to patients the week prior to their scheduled cardiology appointments. The communication included (1) short videos on GDMT and (2) a medication checklist to be completed by the patient and brought to their upcoming appointment. The primary outcomes were initiation and uptitration of GDMT. Results: A total of 253 patients (mean age 67 +/- 14 years) were included, of which 69% were male, 10% black, and 11% Hispanic. At baseline, 86% of patients were on an evidence-based beta-blocker, but only 17% were at goal doses (Figure). Additionally, only half of eligible patients were on a mineralocorticoid receptor antagonist (MRA) or sodium-glucose cotransporter-2 inhibitor (SGLT2i). Post-intervention, there was a significant increase in the number of patients on a renin-angiotensin-aldosterone inhibitor (75.9% to 78.3%, p=0.04) and SGLT2i (50.2% to 52.7%, p=0.04). There was also a 0.8% increase in the number of patients on target doses of MRAs, although this did not reach statistical significance. Conclusions: Educational materials and checklists provided to patients prior to clinic appointments were associated with improved initiation and uptitration of GDMT. This intervention may be a scalable and low-cost way of engaging patients in their medical care and encouraging shared decision making, although further study is needed.
Abstract 19078: Coronary Artery Disease in Very Young Adults: Characteristics, Associated Factors and In-Hospital Mortality
Authors: Paul M Ndunda, pavida pachariyanon, Joseph Golden, Kenechukwu Nwagbara, Tyler Pierotti, Kyle Felipe Dacdac, Morni Modi, Alison Hawkins, Alyssa Lobello, Kalgi Modi
Journal: Circulation (2023)

Introduction: Premature CAD carries a poor long-term prognosis. However, there is little data on CAD in very young adults. Understanding the characteristics and associated factors in this population is paramount to the prevention and improvement of outcomes of CAD. Aims To assess characteristics, associated factors, and in-hospital mortality in adults aged 18-35 years with significant CAD (S-CAD) undergoing invasive coronary angiography. Methods: This is a retrospective cohort study of patients who underwent coronary angiography in a single academic center from 2003-2023. S-CAD was defined as major epicardial CAD with at least 50% stenosis. Chi-square, Fischer exact, and Mann Whitney U tests were used to analyze categorical and continuous variables respectively. Logistic regression was used for multivariable analysis. Results: A total of 330 patients were included in the study. Patient characteristics are presented in table 1. Factors associated with the incidence of S-CAD include ST elevation, elevated troponin, total cholesterol, LDL, triglyceride, glucose, high WBC &amp; platelet count, low Platelet: WBC ratio, and no cocaine use (p &lt;0.05). On multivariable analysis, ST elevation (OR 5.67 (2.15 - 14.94), high troponin (OR 1.11 (1.03, 1.19), total cholesterol (OR 1.01 (1.01, 1.03), and glucose levels (OR 1.01 (1.01, 1.01) were statistically significant (p&lt;0.05). There was no significant difference in in-hospital all-cause mortality between the group with and without S-CAD (2.2% and 0.8% respectively; OR 2.75 [0.38, 19.80] p=0.56). Cardiovascular (CV) mortality was 2.2% and 0% respectively (p=0.07). The CV deaths were from STEMI with cardiogenic shock. Conclusions: Total cholesterol and glucose levels were associated with the incidence of S-CAD. STEMI was the presenting syndrome in a high proportion of patients with S-CAD. Despite young age, in-hospital mortality was similar to published rates in the general adult population.
Abstract 13147: Monitoring Central Arterial Pressure on the Chest Surface: Initial Results From Two Pilot Studies in Human Subjects
Authors: Michael Arustamyan, nagalakshmi nagarajan, Rebecca A Gutmann, Saket Girotra, Ramzi N El Accaoui, Stacy Hoffman, Alan West, Patrick J Strollo, Barry London, Shareef Mansour, Vladimir Shusterman
Journal: Circulation (2023)

Central arterial pressure (AP) monitoring is essential for personalized patient management but requires direct arterial line (Aline) access. We report the first results from two pilot studies tracking central AP in humans using a noninvasive, high-fidelity MEMS array (APEX, PinMed, Inc., Pittsburgh, PA) versus an Aline ( Study 1 ) and a brachial cuff ( Study 2 ). Methods: The APEX array was designed and optimized for the chest surface using a realistic, full-scale physical model (Fig. 1A) and a validated, large-scale computational model of circulation. Study 1: AP was recorded in 7 CVICU patients (age: 73±7y, 43% female; pressure ranges for systolic, diastolic, and mean: 91-198, 46-83, and 61-121 mm Hg, respectively). Study 2: AP was recorded during moderate physical activity (handgrip followed by leg lifts) in 30 subjects (age: 46±10y, 53% female; pressure ranges for systolic, diastolic, and mean: 90-210, 49-116, and 67-147 mm Hg, respectively). Results: Study 1: AP was recorded over 2.7±1.7hr with no adverse events. Individual changes in AP recorded by APEX and Aline were similar (mean pressure [MP] range for individual changes &gt;10 mm; Fig. 1B, r: 0.4-0.8); the differences were small (RMSE for MP: 4.8 mm, r 2 : 0.93, Fig. 1C). Study 2: Individual AP changes recorded by APEX and brachial cuff were similar (Fig. 2A). The accuracy was similar for the entire group (N=30) and for the subgroup of subjects with high BMI (n=15); there were no significant differences between the subgroups of female and male subjects (Fig. 2B, 2C). Conclusions: If confirmed in larger studies, the surface MEMS array has the potential to enable noninvasive central-AP monitoring in clinical and ambulatory settings.
Abstract 14314: Streamlining Cardiovascular Assessment Through Expert Intervention: Reduction in Superfluous Troponin I Testing Requests
Authors: Ariana E Fernandes, Raissa Diniz, Celia Strunz, Sumita Nairo, Leila Antonangelo, Daniela Calderaro, Francisco Cardozo, Luciana S Fornari, Danielle M Gualandro, Bruno Caramelli
Journal: Circulation (2023)

Introduction: Cardiac troponin (cTn) measurements play a pivotal role in diagnosing and managing myocardial infarction (MI). Nonetheless, to prevent unnecessary expenditure, it is essential to optimize the usage of cTn testing. The AHA guidelines underscore the importance of minimizing low-value care, considering the widespread prevalence and substantial expenses related to cardiovascular disease. Hence, our study hypothesis is that expert-recommended cTn testing could effectively decrease unnecessary testing requests. Aims: This study aims to contrast the frequency of normal and of serial cTn I test results within a General University Hospital (GUH) setting and a specialized Cardiology University Hospital (CUH). Methods: Our cross-sectional study encompassed all cTn I tests performed at both GUH and CUH between November 2022 and March 2023. We excluded patients receiving postoperative care following invasive cardiac procedures and those engaged in research protocols. We categorized the study population by sex and age (&lt;60 or ≥60 years), as well as by whether the cTn I test was serially conducted (≥2 times within 24 hours). A serial cTn I test, as recommended by the 4th Universal definition of MI to detect any rise and/or fall, was considered a correct request. We utilized the chi-square test for categorical variables and the Mann-Whitney test for continuous data, setting a 5% significance level. Normal reference levels were &lt;16 and &lt;34 ng/L for women and men, respectively. Results: The study incorporated a total of 5,360 tests performed in GUH, with 46.2% on women and 60.9% on individuals aged ≥60 years. In CUH, 8,487 tests were conducted, with 42.0% on women and 53.8% on individuals aged ≥60 years. GUH displayed a higher proportion of normal cTn I test results compared to CUH (70% versus 45%, p &lt; 0.0001) and a lower percentage of serial cTn I tests (40.3% versus 53.4%, p &lt; 0.0001). Moreover, GUH demonstrated a lower median troponin value of 8 (2.5-33.8) versus 37 (7-455) in CUH, p &lt; 0.0001. Conclusions: The increased prevalence of normal cTn I results and the lower frequency of serial cTn I tests in GUH indicate potential economic inefficiencies related to excessive cTn I testing requests. Expert intervention could help in avoiding unnecessary cTnI test requests.