tbuckley/cabot-search huggingface dataset:
Abstract 14470: Right Ventricular Flow Visualization and Characterization via High Speed Volumetric Echo-PIV
Authors: Yasaman Farsiani, Ahmad Falahatpisheh, Tawnya Brown, Antonina Caudill, Susan Jackman, Yuri Matusov, Gianni Pedrizzetti, Siddharth Singh, Arash Kheradvar
Journal: Circulation (2023)

Introduction: Although 4D echocardiography is used for many clinical applications, the evolving vortex flow in the right ventricle (RV) is relatively unknown and cannot be characterized with conventional echocardiography. An obstacle is that acquiring high frame rate (&gt;100fps) data in presence of contrast is challenging and has not yet reported. Hypothesis: High frame-rate 4D echocardiographic data in presence of contrast can elucidate RV vortex flow via volumetric Echo-PIV (V-Echo-PIV). Methods: We devised a new transthoracic echocardiography (TTE) protocol using a Philips EPIQ CV9 ultrasound system with a 3D matrix probe (X5-1c) to acquire high frame-rate 4D data for processing with V-Echo-PIV. Apical RV focused view was used for full-volume acquisition by limiting the sector width and imaging depth solely to the entire RV. Visualization of the RV flow and wall dynamics was achieved by IV administration of Optison™ and Normal Saline. VolDICOMs were processed with V-Echo-PIV to obtain RV blood flow velocity field during the full cardiac cycle. Results: We improve the frame rates' scan lines to +30Hz. A 100Hz is achieved by stitching 4 cycles. We show that 4D RV flow can be quantified and characterized at high temporal resolution using V-Echo-PIV. Fig. 1A shows cine blood velocity in a healthy subject with a 51bpm heart rate. For which, V-Echo-PIV acquired 117 three-dimensional vector fields in one cardiac cycle, given the setting of 100Hz acquisition rate. The figure features flow patterns from systole to diastole, from left to right. Fig. 1B depicts the iso-surface of transient tricuspid vortex during diastolic RV filling. Conclusions: Enabled by high speed acquition in presence of contrast, V-Echo-PIV can be used as a viable alternative to 4D Flow MRI to visualize and evaluate real-time intra-cardiac blood flow, as it requires only a very short acquisition time and can be used wherever an echocardiography machine with matrix probes is available.
Abstract 17605: Multidisciplinary Team Approach in the Management of Pregnant Women With Complex Congenital Heart Disease: A Case Series
Authors: Andrew H Nguyen, Aditya Mehta, anurag sahu
Journal: Circulation (2023)

Introduction: Women with congenital heart disease (CHD) now live well into adulthood and consider pregnancy. A multidisciplinary team approach is crucial to the management of complex pregnant cardio-obstetrics patients. Here, we present a case series of three patients where careful team-based care resulted in successful delivery and without significant postpartum complications. Case series: Baseline patient characteristics and delivery details are summarized in Table 1. Patient 1, with history of repaired bicuspid aortic valve (AV) and subsequent severe bioprosthetic aortic stenosis, presented with incalcitrant supraventricular tachycardia leading to an urgent c-section. Patient 2, with history of complete Shone complex, underwent emergent c-section in the cardiac OR with extracorporeal membrane oxygenation on standby after developing rapid atrial tachycardia. Patient 3 fortunately did not suffer difficulties during her pre-planned c-section. She had a history of partial AV canal defect and subaortic membrane causing severe left ventricular outflow tract obstruction. Despite the differences between their hospitalizations and pregnancy course, utilizing a multidisciplinary approach led to no long-term postpartum complications and delivery of healthy neonates for all three patients. Discussion: Cardiovascular (CV) disease is the leading cause of maternal mortality accounting for greater than 25% of deaths. CHD is the most common CV condition encountered in pregnant women. Consistent with the Presidential Advisory from the AHA and ACOG, development of a cardio-obstetrics team is vital to managing complex maternal CV disease and minimizing CV morbidity and mortality. Conclusion: Integrating the expertise and collaboration among a multidisciplinary cardio-obstetrics team from preconception through the postpartum period allows for individualized care necessary to optimize maternal and fetal outcomes for women with complex CHD.
Abstract 17589: Efficacy of Sacubitril-Valsartan Compared With Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker for Preventing Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis
Authors: Larissa A Lucena, Marcos Freitas, Camila Guida, Ana C Souza, Júlio César V de Sousa, Ferdinand Gilbert Saraiva da Silva Maia
Journal: Circulation (2023)

Introduction: Among patients with atrial fibrillation (AF) who underwent catheter ablation, it is unclear whether AF recurrence is lower in those who receive Sacubitril-Valsartan (SV) than in those who receive ACEi (angiotensin-converting enzyme inhibitor) or ARB (angiotensin-receptor blocker). Hypothesis: Is SV more effective than ACEi/ARB in decreasing AF recurrence after catheter ablation? Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating the efficacy of SV for preventing AF recurrence in patients who underwent catheter ablation. The outcomes of interest were AF recurrence and structural remodeling, assessed by Left Ventricular Ejection Fraction (LVEF) and Left Atrial Volume Index (LAVi). Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I 2 statistics. Results: We included 2 RCTs and 1 PMC, comprising 517 patients, of whom 256 were treated with SV, 101 received ARB, and 155 ACEis. AF recurrence was significantly lower in the SV group (RR 0.50; 95% CI 0.37-0.68; p&lt;0.00001; I 2 =0%; Figure 1A), even considering only RCTs (RR 0.55; 95% CI 0.34-0.91; p=0.03; I 2 =0%). Also, SV was associated with a significant decrease in LAVi (MD -5.34 mL/m 2 ; 95% CI -8.77 to -1.91; p=0.002; I 2 =57%; Figure 1B) compared to ARB. LVEF was similar between groups (MD 1.24 %; 95% CI -0.12 to 2.60; p=0.07; I 2 =0%). Conclusions: SV therapy was associated with a decreased risk of AF recurrence compared to ACEi or ARB, and was superior to ARB in attenuating atrial structural remodeling in patients submitted to catheter ablation.
Abstract 15805: Elevated Lp(a) and Risk of Repeat Coronary Revascularization and Cardiovascular Events Among Patients With Prior CABG
Authors: Khaled Abdelrahman, Adam Berman, Stephanie Besser, Arthur Shiyovich, David W Biery, Walter Oliver, Jon Hainer, Shelby Laychak, Daniel M Huck, Brittany weber, Marcelo F Di Carli, Christopher P Cannon, Deepak L Bhatt, Ron Blankstein
Journal: Circulation (2023)

Introduction: Elevated Lp(a) is associated with atherosclerotic, thrombotic, and proinflammatory effects. In patients with prior coronary artery bypass grafting (CABG), graft failure and progression of native CAD are associated with adverse outcomes. We sought to evaluate the relationship between Lp(a) and adverse cardiovascular events in patients with prior CABG. Methods: We included all patients with prior CABG from a large, contemporary Lp(a) registry. Cox proportional hazard models were used to estimate the association between repeat coronary revascularization (CR) - defined as percutaneous coronary intervention (PCI) or repeat CABG - as well as incident MI or CV death, stratified by tertiles of Lp(a). Results: Among the 16,419 individuals in the cohort, 878 (5.3%) patients (23.4% women, median age 66) had CABG prior to their Lp(a) test date. Among those with prior CABG, 81.7% had hypertension, 87.9% had hyperlipidemia, and 42.1% had diabetes. Patients with prior CABG had higher Lp(a) levels (46.3 nmol/L [IQR 15.8-148]) than with those without prior CABG (35 nmol/L [IQR 13-111.7]). Over a median follow-up of 11.2 years, patients in the highest Lp(a) tertile [&gt;= 95 nmol/L] were more likely to undergo repeat CR (HR 1.86 (95% CI, 1.18-2.94), p=0.008) with PCI (n=83), repeat CABG (n=5), or both CABG and PCI (n=12). This association persisted when adjusted for age, sex, race, diabetes, and hypertension (HR 1.67 (95% CI,1.05-2.67). Additionally, patients in the highest Lp(a) tertile were more likely to experience CV death or MI (HR 1.56 (95% CI, 1.17-2.08); this increased risk persisted in adjusted analyses (HR 1.59 (95% CI,1.19-2.14) (see Figure 1 ). Conclusions: Among patients with prior CABG, elevated Lp(a) is associated with a higher risk of repeat coronary revascularization and adverse CV events. Future studies should focus on the potential role of Lp(a) lowering therapies for maintaining graft patency and reducing CV events.
Abstract 15798: Clonal Hematopoiesis of Indeterminate Potential is Associated With Pro-Inflammatory Markers in Patients With Established Coronary Artery Disease
Authors: SIAMALA SINNADURAI, Enrique Vazquez, Miriam Diez-Diez, Ana Quintas, Jorge de la Barrera Martinez, Marcin Kondraciuk, Emilia Sawicka-Smiarowska, Malgorzata Chlabicz, Hari S. Sharma, Peter van der Spek, Fatima Sanchez-Cabo, Jose J Fuster, Ana Dopazo, Karol Kaminski
Journal: Circulation (2023)

Introduction: Progression of atherosclerosis is a result of systemic inflammation. Clonal hematopoiesis of indeterminate potential (CHIP) has been shown to be associated with atherosclerosis, but pathways that lead to this are still not fully elucidated. Hypothesis: CHIP may contribute to atherosclerosis by facilitating low-grade inflammatory response. Methods: 130 patients younger than 80 years, who were hospitalized for acute coronary syndrome or for myocardial revascularization were included in this study and followed for 18 months post-intervention. Targeted next-generation sequencing (NGS) was performed on peripheral blood mononuclear cells to detect CHIP mutations with a variant allelic fraction &gt; 2% in 92 genes. Subsequently, multiplexed proteomic analysis with extension proximity assays (EPA) was used to quantify circulating pro-inflammatory biomarkers potentially related to CHIP. Results: Some 17.6 % (23) of 130 patients were detected with CHIP mutations. Patients with mutations in either DNA methyltransferase 3alpha (DNMT3A) or Tet methylcytosine dioxygenase 2 (TET2) showed significantly higher body mass index (BMI) ( p =0.010), inflammatory markers (high sensitivity C-reactive protein p =0.015, interleukin- 6 p =0.002, chemerin p =0.034) as well as higher markers of myocardial overload (troponin T p =0.022 and NT-proBNP). In multivariable model adjusted for BMI, age, and gender we found that the inflammatory markers HGF, IL10RB, IL5RA, IL18, OSM, PD-L1, TNFRSF9, and TNFSF14 presented statistically significant association with CHIP (p&lt;0.01). Interestingly, these differently expressed proteins form an overlapping network between TET2 and DNMT3A mutations pointing to cytokine receptor activity, inflammatory response, and leucocyte activation pathways. Conclusions: There is a significant association between CHIP and enhanced inflammatory response in patients with coronary artery disease, even after adjustment for age and BMI.
Abstract 15793: Impact of Cardiac Rehabilitation on Cardiovascular Disease Risk Factor Management at 1 and 3 Year Follow-Up
Authors: Carlos L Alejos, Akhila S Cherukuri, Amanda R Bonikowske, Anna Svatikova, Joshua R Smith
Journal: Circulation (2023)

Introduction: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention for cardiovascular disease (CVD). CR participation is associated with improvements in secondary CVD risk factor management. However, it is unclear if CR participation is associated with maintained improvements in CVD risk factor management following CR completion. Purpose: The aim of this study was to assess the impact of CR participation on CVD risk factor management at 1 and 3 years following CR completion. Methods: This retrospective study analyzed 911 patients (73% male) enrolled in the CR program at Mayo Clinic from 2013 to 2020. Patient demographics, clinical characteristics, and CVD risk factor management were examined pre and post CR as part of clinical practice and assessed passively at 1 and 3 years following CR. Secondary prevention CVD risk factor goals included total cholesterol (&lt;200 mg/dL), HDL cholesterol (&gt;40 mg/dL), LDL cholesterol (&lt;100 mg/dL), triglycerides (&lt;150 mg/dL), systolic and diastolic blood pressure (&lt;130 and &lt;80 mmHg), and body mass index (BMI) (18.5-24.9 kg/m 2 ). Results: The mean age was 66±12 years and on average 33±9 CR sessions were attended. Table 1 shows the percentage (%) of patients meeting the secondary prevention CVD risk factor goals. The % of patients meeting the goals for total cholesterol, LDL, triglycerides, and diastolic blood pressure were higher post than pre CR. There were no changes in the % of patients meeting the goals for total cholesterol or LDL at 1 and 3 year follow up compared to post CR. At 1 and 3 year follow up, there was a lower % of patients meeting the goals for systolic and diastolic blood pressure and triglycerides (at 1 year follow up only) than post CR. No changes were present in the % of patients meeting the goals for HDL and BMI at any timepoint (all, p&gt;0.09). Conclusions: CR participation was associated with maintained improvements in lipid management, but not in triglycerides or blood pressure control at 1 and 3 years following CR.
Abstract 13113: Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis
Authors: Britton Scheuermann, Shannon Parr, Olivia Kunkel, Vanessa-Rose Turpin, Jia Liang, Carl J Ade
Journal: Circulation (2023)

Background: The global incidence of ischemic stroke is projected to increase ~20% by 2030, with one-fifth of these cases attributed to cerebral small vessel disease (cSVD). Stiffening of central arteries potentiates small vessel injury in the brain, which may precede or develop in parallel with disruption of local regulatory mechanisms such as cerebrovascular reactivity. However, evidence of these vascular etiologies of cSVD remains inconclusive. To address this, we conducted separate systematic meta-analyses to characterize the relationship between cerebrovascular reactivity or arterial stiffness and cSVD. Methods: MEDLINE and Web of Science were searched for studies reporting odds ratios (OR) using arterial stiffness or cerebrovascular reactivity as continuous predictors for the presence of cSVD. Data were extracted using predefined tables and random-effects meta-analyses were performed to determine pooled OR and 95% confidence intervals. Results: Four cross-sectional studies were included in the analysis between cerebrovascular reactivity and cSVD, including 294 participants (38.1% women). Decrements in cerebrovascular reactivity were associated with a greater cSVD burden (OR = 1.93, 95% CI: 1.15-3.24, p = 0.01, I 2 = 97.4%). For arterial stiffness, 34 cross-sectional studies comprising of 26,541 participants (52.9% women) were included. Increases in indices of arterial stiffness were associated with a greater burden of cSVD (OR = 1.13, 95% CI: 1.07-1.20, p &lt; 0.0001, I 2 = 60.2%). Conclusion: Impaired cerebrovascular reactivity and elevated arterial stiffness were both associated with an increased incidence of cSVD. While investigation of a link between cerebrovascular reactivity and arterial stiffness is a growing field, our findings suggest that the two measures have either individual or overlapping relationships with cSVD. This highlights the need for monitoring of both local and global cardiovascular regulation in high-risk individuals.
Abstract 14181: Interhospital Transfer for Heart Failure in the United States: A Patient and Hospital-Level Analysis From GWTG-HF
Authors: Eric W Rudofker, Iyanuoluwa B Ayodele, Gregg C Fonarow, Michael Ho, Pamela Peterson, Karen E Joynt Maddox, Karen Chiswell, Stephen J Greene, Larry A Allen
Journal: Circulation (2023)

Background: Cardiovascular diseases, particularly heart failure (HF), are common reasons for interhospital transfer (IHT) in the United States. IHT targets patients requiring a higher level of care, and has been associated with increased cost, length of stay (LOS), and mortality. We aim to describe the characteristics and outcomes of patients undergoing IHT, as well as variation in the use of IHT across hospitals. Methods: Patients hospitalized for HF who were admitted from another hospital were compared to those who were not within the Get With The Guidelines-Heart Failure registry between January 2015 and June 2022. Hospital characteristics were obtained from the 2018 American Hospital Association Survey. Clinical data from the receiving hospital were analyzed. Results: Overall, 662,575 patients across 622 hospitals (156,263 patients at 127 transplant centers; 19,852 patients at 55 rural sites) were included, of which 36,375 (5.5%) arrived as IHT. IHT patients were younger (70.0 vs 73.0 years), more male (58 vs 52%), white (72 vs 66%), and more often had private insurance (31% vs 27%). IHT patients had a lower median left ventricular ejection fraction (37 vs 45%), median blood pressure (130/74 vs 139/77 mmHg), and a longer mean LOS (6.3 vs 5.0 days). In a multivariable model, IHT patients had higher in-hospital mortality (OR 1.85, 95% CI 1.76-1.95), were less likely to discharge home (OR 0.79, 95% CI 0.77-0.81), and were more likely to be prescribed most guideline-directed therapies (Figure). Conclusions: More than 1 in 20 patients hospitalized for HF was transferred from another hospital. Sex, racial, economic, and geographic differences exist in which HF patients get transferred, and rates of IHT varied across hospitals. IHT was associated with higher mortality and longer LOS compared with non-transferred patients.
Abstract 17574: A Unique Incident Presentation of Cardiac Involvement in Mitochondrial Myopathy
Authors: Unnati Bhatia, Shuo Li, Zachary Demertzis, Brian Williamson
Journal: Circulation (2023)

Case: A 68 year old female with mitochondrial myopathy (MT-TK subset) and no significant cardiac history presented with shortness of breath and palpitations for 1 day. Initial vitals were HR 152, BP 174/102, RR 31, SpO2 83% on RA. Imaging showed pulmonary congestion, EKG showed new onset atrial flutter with RVR, and 2D echo showed a new drop in EF to 15% with global hypokinesis. BNP was elevated (861 pg/ml). Other labs including serial troponins were unremarkable. Patient was started on diuresis, nitroglycerin infusion, and anticoagulation. RVR persisted despite iv metoprolol, digoxin, and esmolol infusion. Cardioversion was planned but TEE revealed a LAA thrombus. Finally on day 3 of hospitalization, patient spontaneously converted to sinus rhythm. Amiodarone was added for rhythm control. Notably, a repeat 2DE showed improvement in EF to 35%, concerning for tachycardia induced cardiomyopathy. GDMT was started and patient was discharged in a stable condition. A month later patient successfully underwent cavotricuspid isthmus ablation and pulmonary vein isolation. Discussion: The heart is critically dependent on mitochondrial oxidative phosphorylation and is one of the most frequently affected organs in mitochondrial disorders (MIDs). Cardiac involvement (CI) can be structural (myocardium, coronary arteries, pericardium, aortic root), functional (impulse generation/ conduction, arrhythmias) or both. Since almost half of the cardiac ATP is used to maintain ion channel homeostasis, mitochondria is a key player in arrhythmogenesis. It is crucial to avoid conditions that may create a high metabolic demand (fever, stress) and drugs that may interfere with enzymes involved in mitochondrial metabolism (such as metformin, propofol, valproic acid, erythromycin). Antioxidants and respiratory chain cofactors are commonly used for supportive management, however benefits are inconsistent. Interventions targeted towards definite control, like ablation should be considered early. Additionally, a comprehensive cardiac evaluation is important at diagnosis considering the progressive nature of MIDs. At present, there is no targeted treatment and further studies are needed to explore mitochondria as a potential therapeutic target in arrhythmias.
Abstract 17428: Severity of Diastolic Dysfunction Predicts Risk of Myocardial Infarction
Authors: Tanmay A Gokhale, Mehak Dhande, Suresh R Mulukutla, Floyd W Thoma, Aditya Bhonsale, Krishna Kancharla, Andrew Voigt, Alaa Shalaby, Nathan A Estes, Sandeep Jain, Samir Saba
Journal: Circulation (2023)

Background: Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined. Research Question: We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction. Methods: This was a retrospective study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by the presence of an inpatient encounter with a primary diagnosis of MI. Results/Data: 136,455 patients were included (mean age 56 years; 58% women). DD was present in 18.3% of patients (14.1% Grade 1, 3.8% Grade 2, 0.4% Grade 3). Patients with DD were more likely to be older (71 vs 53 years) and have coronary artery disease (27% vs 12%), diabetes (27% vs 14%), hypertension (69% vs 47%) and hyperlipidemia (64% vs 41%), among other comorbidities. Survival free from MI was significantly lower as diastolic dysfunction severity increased (Figure 1). Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade 1: 1.51 [1.35-1.69]; Grade 2: 1.92 [1.64-2.25]; Grade 3: 2.82 [1.94-4.09]). Conclusions: Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade 3 DD is comparable to that from a prior history of coronary artery disease. These findings suggest that the severity of DD may be a useful tool in risk stratifying patients for risk of MI.