tbuckley/cabot-search huggingface dataset:
Abstract 14282: Electrocardiography Rules out Myocardial Abnormalities on Cardiac Magnetic Resonance Imaging in Post-Hospitalized COVID-19 Patients: A Multicenter Observational Study
Authors: Azlan Helmy Abd Samat, Masliza Mahmod, Adam J Lewandowski, Mark Philip Cassar, Mohammed Akhtar, Alastair Moss, Charlotte Manisty, Thomas Treibel, Zakariye Ashkir, Celeste McCracken, Elena Lukaschuk, Stefan Piechnik, Vanessa Ferreira, Cheng Xie, Dan Cuthbertson, Graham Kemp, Chrysovalantou Nikolaidou, Christopher Miller, Amedeo Chiribiri, Declan O'Regan, Susan Francis, Richard P Steeds, Jonathan Weir-McCall, Jim M Wild, Sven Plein, Gerry McCann, Rachael Evans, chris brightling, Stefan Neubauer, Betty Raman
Journal: Circulation (2023)

Introduction: The diagnostic performance of EKG in ruling out myocardial abnormalities following COVID-19 is unclear. Aim: To assess the ability of EKG to exclude cardiac abnormalities on cardiac magnetic resonance imaging (CMR) in post-hospitalised COVID-19 patients. Methods: Post-hospitalized patients (n=212) &amp; comorbidities matched controls (n=38) underwent CMR and 12-lead EKG. EKG assessments included depolarization &amp; repolarization abnormalities [ QTc , corrected QT dispersion ( QTc disp ), JT ( JTc ) &amp; T peak-end ( cTPe ) intervals]. CMR abnormalities were defined as reduced left ventricular ejection fraction (LVEF), high T1 &amp; T2 Z scores and high extracellular volume and pathological late gadolinium enhancement. Results: At 5.6 months post-discharge, patients had a higher burden of EKG abnormalities vs controls (72.2% vs 42.1%, p=0.001 ) (Figure A) . CMR abnormalities were comparable despite patients having lower LVEF. Abnormal EKG findings and prolonged repolarization were more common in patients with CMR abnormalities vs patients with normal CMR and controls ( Figure A &amp; B ). Area-under-the-receiver-operating curve (AUROC) of routine EKG abnormalities to discriminate abnormal CMR was 0.56 (95% CI 0.47-0.65), p=0.185. Inclusion of JTc &amp; QTc disp improved the AUROC to 0.64 (95% CI 0.55-0.74), p=0.002. Inclusion of JTc ≥340ms &amp; QTc disp ≥40ms improved the sensitivity from 81.6% to 99.9% with higher negative predictive value (84.7% to 99.9%) ( Figure A ). Conclusions: Post-hospitalized COVID-19 patients have more EKG abnormalities than comorbidities-matched controls. A normal EKG with normal repolarization is effective in ruling out significant CMR abnormalities.
Abstract 15371: Mice Lacking S-Nitrosoglutathione Reductase (GSNOR <sup>-/-</sup> ), a Mouse Model of Preeclampsia, Exhibited Nitroso-Redox Imbalance and Deterioration of Cardiovascular Structure and Function in Postpartum Mothers
Authors: Raul A Dulce, Wayne Balkan, Joshua M Hare, Shathiyah Kulandavelu
Journal: Circulation (2023)

Introduction: Preeclampsia (PE), a leading cause of maternal mortality, is linked to persistent pathological changes in the heart, predisposing the mother to increased risk of chronic cardiovascular (CV) disease later in life. PE is characterized by increased S-nitrosylated (SNO) proteins and nitroso-redox imbalance. We recently showed that mice lacking S-nitrosoglutathione reductase (GSNOR -/- mice), a denitrosylase that regulates protein S-nitrosylation, exhibit the clinical features of PE including maternal hypertension, blunted increase in cardiac output, abnormal remodeling of left ventricular (LV) cardiac structure, dysregulation in nitrosylation and nitroso-redox imbalance. Hypothesis: The nitroso-redox imbalance seen during pregnancy in GSNOR -/- mice persists in postpartum (PP), leading to increased maternal susceptibility to CV injury. Methods: Pregnant control (WT [C57Bl/6J]) and GSNOR -/- mice (N=5) were examined at baseline, late-stage pregnancy (17.5 dpc) and 6 weeks PP. LV structure, cardiac output and stroke volume were determined using echocardiography (Vevo 2100). Cardiomyocytes (CM) were isolated at 6 weeks PP and ROS and peroxynitrite levels determined using fluorescent dyes. Results: In WT mice, all normal maternal CV adaptions to pregnancy, reverted to pre-pregnant levels 6 weeks PP. In contrast, GSNOR -/- mice exhibited increased cardiac output (+21% vs. -19% in WT), stroke volume (+21% vs. -41% in WT), and LV chamber dimension (+13% vs. -4% in WT) at 6 weeks PP, indicating high cardiac output LV cardiomyopathy. CM isolated from GSNOR -/- hearts showed ~5-fold more ROS generation (9.9x10 -4 ±9x10 -5 vs. 2.1x10 -4 ±1.5 x10 -4 ΔF/F max .min -1 ) and elevated peroxynitrite levels (0.318±0.011 vs. 0.243±0.012 ΔF/F 0 ) compared to WT at 6 weeks PP, suggesting the presence of nitroso-redox imbalance. All changes P&lt;0.05. Conclusion: Postpartum GSNOR -/- (preeclamptic) mothers exhibited cardiac dysfunction which was accompanied by the presence of of nitroso-redox imbalance. These changes may predispose the mother to higher risk for future CV injury.
Abstract 200: A Newly Drug Delivery System Combined With the Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pig With Hemorrhagic Shock Model
Authors: Takahiro Yamanaka, Koichiro Homma, Tadashi Matsuoka, Tomoyoshi Tamura, Sayuri Suzuki, Daiki Kaito, Soichiro Ono, Katsuya Maeshima, Junichi Sasaki
Journal: Circulation (2023)

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock (HS) has grown in popularity. However, REBOA has a risk of complications related to blocking the blood flow downstream to the visceral organs. Several drugs have been reported so far to mitigate ischemia, including hydrogen gas (H 2 ); however, they could not reach the downstream of REBOA as they are distributed through the bloodstream. This study aimed to develop a system to deliver drugs to the ischemic organs where REBOA blocks the bloodstream. Methods: Herein, a female 40-kg swine volume-regulated HS model was used. In addition to the REBOA in zone 1, a catheter was inserted for drug delivery retrograde into the right femoral artery. The top tip of the catheter was positioned distal to the REBOA balloon. After HS induction (20% of the total blood volume), drug delivery capability was evaluated in three REBOA use patterns, such as controlled HS in normal time of full inflation , uncontrolled HS with liver injury in extended time of full inflation, and partial inflation. Simultaneously with the REBOA inflation, the intra-aortic irrigation of a drug-containing solution, H 2 -dissolved saline, was initiated. Results: The occlusion by the REBOA was achieved in all cases after shock induction (approximately 40 mmHg). In all patterns, the concentration of H 2 in the portal vein, which represents the concentration of outflow from the intestine and inflow to the liver, increased immediately after the irrigation. A full inflation setting required 30 mL/min of irrigation speed to obtain the minimum effective concentration of H 2 (1%), whereas a partial inflation setting required 2 mL/min. Conclusion: A drug delivery system combined with the REBOA was developed, which enabled the drugs to be administered downstream of REBOA. The newly developed system can potentially overcome the major limitations of REBOA.
Abstract 16062: Acute Myocarditis and Pericarditis in Post-Acute Sequelae of COVID-19: Initial Insights From the IMPACT-COVID-19 Study
Authors: Alexander Calderone, Mohammed Adam Benharrats, Roxanne Coderre, Matthias Friedrich, Alain Piche, Emilia Liana Falcone, Michael Chetrit, Mary Ann Fitzcharles, caroline boudreault, Michel T Nguyen, Jiayi Ni, Thao Huynh
Journal: Circulation (2023)

Introduction: Myocarditis and/or pericarditis were reported in patients with Post-Acute Sequelae of COVID-19 (PASC). Goals: We aim to determine the prevalences, risk factors, and discriminative values of inflammatory biomarkers for acute myocarditis/pericarditis in patients with PASC. Methods: IMPACT-COVID-19 is an ongoing prospective longitudinal cohort enrolling adults with PASC and at least one symptom suggestive of potential cardiac disorder (dyspnea, palpitation, chest pain and dizziness) in Quebec, Canada (years 2021-ongoing). We obtained baseline inflammatory, cardiac biomarkers, electrocardiograms, echocardiograms, and cardiac magnetic resonance imaging (CMR). We defined myocarditis/pericarditis as either 1) positive Lake Louise criteria on CMR, 2) pericardial effusion or 3) chest pain with elevated cardiac biomarkers or inflammatory biomarkers. Results: The following results were based on the initial 256 patients enrolled (with a median of 279 days after their initial COVID-19 infection). Most were female (73%), and White (86%) with a mean age of 45 years. Seventy-six patients (30%) had acute myocarditis and/or pericarditis. One hundred and three patients (40%) had an emergency room (ER) visit for the index COVID infection and this was associated with an increased risk of myocarditis/ pericarditis: (odds ratio: 2.39 (95% confidence intervals: 1.21, 4.72). The ESR was elevated in patients with myocarditis/pericarditis compared to patients without myocarditis/pericarditis (18 mm/h vs 12 mm/h; p:0.02). There was no observed difference in CRP (1.85 mg/L for patients with myocarditis/pericarditis versus 1.54 mg/L for patients without myocarditis/pericarditis, p:0.51). ROC c-statistics were 0.61 for ESR and 0.49 for CRP. An ESR of ≥14 mm/h has the best predictive value for myo/pericarditis. Conclusions: Our findings suggest that clinicians should be aware that patients with PASC, especially those who required an ER visit for their COVID-19 infection, are at increased risk for acute myocarditis/pericarditis. ESR should also be considered in the diagnostic tests for PASC-related myocarditis/pericarditis.
Abstract 13368: Availability of PGE1 in Northern California Hospitals: Before and After Routine CCHD Screening
Authors: Lesje DeRose, Hitendra Patel
Journal: Circulation (2023)

Introduction: Fetal echocardiogram and critical congenital heart disease (CCHD) screening has improved early detection of CCHD. CCHD screening has been recommended for all infants since 2011 and mandated in California since July 2013. In patients with suspected ductal dependent congenital heart disease, early intervention with prostaglandin E1 (PGE1) is the standard of care to reduce morbidity and mortality. Hypothesis: In 2004, we assessed the availability of PGE1 in Northern California hospitals that care for newborn infants and found that 32% of hospitals with obstetric services did not have the ability to institute PGE1 infusion. As California has adopted CCHD screening for all newborn infants prior to hospital discharge, our aim was to assess the percentage of hospitals that perform CCHD screening as well as reassess PGE1 availability. Our hypothesis was that CCHD screening would increase the availability of PGE1 at hospitals providing obstetric services. Methods: The initial study contacted 117 Northern California hospitals to determine PGE1 availability. We contacted the same hospitals, ending up with 106 hospitals due to closures and mergers. The newborn nursery and/or NICU for each of these hospitals was contacted to determine CCHD screening practices and availability of PGE1. Mileage to the nearest level IV NICU was used as a gross estimate of distance to a tertiary care center. Results: In 2004, 92 of 117 hospitals had obstetric service, and 30 (32.6%) of those did not have PGE1. In this study, 74 of the 106 provided obstetric services. All performed CCHD screening, but 15 (20.3%) did not have ability to provide PGE1 infusion. 8 of the 15 hospitals were more than 30 miles (range 1.5 - 192 miles) from the closest level IV NICU. Conclusions: All hospitals in Northern California providing obstetric service are performing CCHD screening. However, 20.3% of these hospitals still do not have the ability to administer PGE1 infusion. Of these, 53% were in suburban and rural areas of Northern California, with significant transportation distance to a tertiary care center. Delay in initiating PGE1 infusion in patients with ductal dependent CCHD may lead to morbidity or mortality, and increasing PGE1 availability is an opportunity to improve access to care.
Abstract 17014: Differences in the Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients With Ischemic versus Non-Ischemic Cardiomyopathy
Authors: Tiffany Woelber, Rahul Dhawan, Qiying Dai, Christopher V Desimone, Ammar M Killu, Konstantinos Siontis, Abhishek Deshmukh, Gurukripa N Kowlgi
Journal: Circulation (2023)

Background: Catheter ablation is an effective tool to reduce ventricular tachycardia (VT) burden. There is a lack of robust data studying the characteristics and outcomes of VT ablation in patients with ischemic (ICM) versus non-ischemic cardiomyopathy (NICM). Aims: The aim of this study was to assess the impact of ICM vs NICM on outcomes of VT ablation. Methods: A single-center, retrospective study of patients undergoing catheter ablation for VT was conducted. Results: A total of 168 patients, undergoing 200 VT ablation procedures, were included in this study. NICM group (112 procedures) was compared to ICM group (88 procedures). Patients in the ICM group were older (66.6 ± 13.4 vs 58.9 ± 14.4 years) and had higher rates of prior myocardial infarction (65.9% vs 3.6) and coronary artery bypass graft surgery (40.9% vs 1.8%). Overall, ICM group had more comorbidities like hypertension (80.7% vs 52.7%), diabetes mellitus (23.9% vs 12.5%), chronic kidney disease (45.5% vs 35.7%), stroke (17% vs 7.1%), and lower left ventricular ejection fraction (36.8 ± 13.2% vs 43.1 ± 14.7%). The ICM group had lower incidence of prior cardiac valvular surgery (9.1% vs 29.5%). The inducibility of VT (93% vs 93.5%; p= 1.0) and the number of different VT morphologies induced during the case (1.9 ± 1.5 vs 2.3 ± 2.5; p=0.19) was similar between the two groups. There was no acute mortality in either group. There was a non-significant trend towards greater VT recurrence in the NICM group (43.2% vs 33.3%, p= 0.19). However, patients with NICM had a lower VT-free survival as determined by Kaplan-Meier analysis (p=0.05) [Figure]. Long term mortality was higher in ICM group when compared to NICM group (18.2% vs 8.9%, p&lt;0.01). Conclusion: Patients undergoing VT ablation in the NICM group when compared to the ICM group were noted to be younger, had fewer comorbidities, and lower long-term mortality. However, they had significantly less VT-free survival, likely owing to more challenging substrate responsible for VT.
Abstract 18793: Demographic and Regional Trends in Mortality From Cardiac Arrest in the USA From 1999-2020
Authors: Sarath Lal Mannumbeth Renjithlal, Mohamed M Eid, Nikhil Cordeiro, Dinesh Abhijeeth Shanker, Fahad Eid, Claudine Abdou, Sanjana Shanmukhappa, Gerald Hollander
Journal: Circulation (2023)

Introduction: Cardiac Arrest (CA) is a major public health problem associated with high mortality. We aim to assess the demographic and racial trends of mortality associated with CA between 1999 and 2020. Methods: A cross-sectional analysis of the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research database (CDC-WONDER) was conducted to investigate the trends in mortality associated with CA (ICD codes -I46.0, I46, I46.9, and I49.0). Using Joinpoint regression analysis, the study calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and corresponding annual percentage changes (APC), along with 95% confidence intervals. Demographic and racial trends were evaluated. Results: 394,021 CA-related deaths occurred from 1999 to 2020. Annual trends show that the AAMR reduced from 8.3 (95% CI 8.2-8.4) in 1999 to 4.7(95% CI 4.6-4.8) in 2020. The overall AAMR from 1999-2018 had an Annual Percentage Change (APC) decrease of -2.0 (95% CI: -2.4 to -1.6). From 2012 to 2020, the APC was 0.4(95% CI: -0.3 to 1). When stratified by sex, males had a worse AAMR at 6.4 (95% CI: 6.4-6.4), and women were found to have an AAMR of 4.5 (95% CI: 4.4-4.5). When stratified by ethnicity, AAMR was highest among African Americans at 9.3 (95% CI: 9.2-9.3), followed by White at 5.0 (95% CI 5.0-5.0), followed by Asian or Pacific Islanders at 3.6(95% CI 3.5-3.7) and American Indian or Alaska Native patients at 3.0 (95% CI2.9-3.2). When stratified by geographical area, Non-metro, rural areas had worse AAMR than urban areas. Conclusions: There has been a general decrease in CA-associated mortality from 1999 to 2012 in the United States. However, since 2012, the mortality has been stable and not improving. Our data shows that the AAMR is worse in men, African Americans, and rural populations. In the setting of no improvement of AAMR since 2012, further research is needed to identify the causes and potential strategies to improve AAMR.
Abstract 14772: Subcutaneous Implantable Cardioverter Defibrillator Extractions: A Single-Healthcare System Analysis of Incidence and Indications
Authors: Arati A Gangadharan, Graham Peigh, Joshua Sink, Mariam Arif, Herman Carneiro, Mahmoud Elsayed, Hawkins Gay, Xu Gao, Kaustubha Patil, Alexandru Chicos, Susan S Kim, Albert C Lin, Rishi Arora, Anna Pfenniger, Rod S Passman, Bradley P Knight, Nishant Verma
Journal: Circulation (2023)

Introduction: The subcutaneous implantable cardioverter defibrillator (SICD) serves as an alternative to traditional transvenous implantable cardioverter defibrillators in patients who meet criteria for ICD implantation without concurrent need for cardiac pacing. Data on SICD extraction is limited. This study examines the rates of SICD extraction. Methods: A retrospective study of all patients who underwent SICD implantation between 2010 and 2022 at a single healthcare system was performed. The primary endpoint was rate of SICD extraction. Results: A total of 402 patients (67.4% male; 48.5 ± 14.4 years old) underwent SICD implantation. Of these, 158 (39.3%) were for primary prevention in patients with heart failure with reduced ejection fraction, 125 (31.1%) for secondary prevention of ventricular tachyarrhythmias, and 69 (17.2%) for primary prevention in patients with hypertrophic cardiomyopathy with high-risk features. 29 (7.2%) patients (86.2% male; 51.5 ±12.9 years old) underwent SICD extraction during a mean follow up of 4.5 years. The median length of time between implant and explant was 49.1 [26.7-64.9] months. The most common indications for SICD extraction were need for pacing (17.2%), infection (17.2%), inappropriate shocks due to oversensing (13.8%), and lead failure (10.3%). There were no significant differences in average age, sex, or comorbidity profile between those who did and did not necessitate SICD extraction (extraction: 51.5 ± 12.9 years; no extraction: 48.4 ± 14.5 years; p=0.26) (Table). Conclusions: In appropriately selected patients undergoing implantation of the SICD, the likelihood of needing the device extracted was low at only 7.2% over 4.5 years, with the most common indications for extraction being need for pacing and infection. Further work must be done to determine whether these results regarding rates of, and indications for, SICD extractions are transferrable to other health systems.
Abstract 12799: Geographic Variation in Cardiac Amyloidosis in U.S. Veterans From 2012 to 2021
Authors: Vinod Aggarwal, April Mohanty, Ryan Seltzer, Hamza Ghannam, Sandesh Dev
Journal: Circulation (2023)

Background: Prior studies suggest variability in cardiac amyloidosis (CA) detection across the U.S. with underdiagnosis in some regions. Research Question: It is unknown whether geographic variation exists in the occurrence of CA amongst U.S. Veterans in a contemporary cohort. Method: This is a retrospective observational cohort study. CA was defined as ≥ 1 heart failure (ICD9/10) and ≥ 1 amyloidosis diagnosis. For geographic mapping the location was the state of the diagnosing Veterans Affairs (VA) facility. The population at risk was patients in each state with ≥1 VA encounter during the year. The outcomes were incidence and prevalence rates of CA at the state and U.S. Census regional level (per 100,000 patients). The data source was the VA Corporate Data Warehouse (MDClone ADAMS platform). Results: The incidence and prevalence rates of CA by region are shown in the Table, and by state in the Figure. There was an increase in incidence and prevalence in all regions in 2012 and 2021. In both years, incidence and prevalence were highest in the Northeast and lowest in the South. Conclusion: Despite increasing recognition of CA in the VA Health System, there is regional variation in incidence and prevalence in 2012 and 2021. VA facilities in the Midwest, West and especially the South may have differences in CA detection relative to those in the Northeast region. Further research into health system, provider, and patient factors leading to this variation is needed to ensure health equity and quality of care for patients with CA.
Abstract 13469: A Comprehensive Echocardiographic Assessment of Patients With Chronic Myeloid Leukemia on Dasatinib
Authors: Chen Chen, Maria P Hernandez, Jessica Altman, Vinesh Appadurai, Nausheen Akhter
Journal: Circulation (2023)

Background: Dasatinib, a tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia (CML), is known to cause cardiotoxicities; however, little is known about the echocardiographic changes associated with this drug. Here we present a comprehensive echocardiographic assessment of patients with CML on dasatinib receiving care at a quaternary facility. Methods: We performed a retrospective cohort analysis on consecutive adult patients with CML receiving dasatinib between 2017-2022 who had a baseline and follow-up echocardiogram. Comprehensive clinical, laboratory and advanced echocardiographic data with speckle-tracking analyses (Tomtec Arena, Germany) were included. Results: Among 41 adult patients with CML (average age 64±16 years old, 39% female) who were prescribed with dasatinib (initial dose 100mg once daily), at baseline, 7 (17%) patients had heart failure with preserved ejection fraction (HFpEF), 11 (27%) coronary artery disease, and 3 (7%) pulmonary hypertension. There was a statistically significant increase in the indexed LV end-diastolic diameter and LV mass in pre- vs post-dasatinib echocardiograms; however, there was no significant change in ejection fraction or global longitudinal strain. There was no significant change in RV structure or function measures. There was a significant increase in LA volume index and decrease in lateral e’ velocity in pre- vs post-dasatinib echocardiograms. A trend towards declining LA reservoir strain post-dasatinib was noted. Ten (24%) patients had a progression in diastology grading after the initiation of dasatinib. Five out of 7 patients with HFpEF at baseline had progression in diastolic function post-dasatinib. Conclusions: Dasatinib was associated with significant changes in LV end-diastolic diameter, LV mass, LA volume, and diastolic parameters in patients with CML. These findings require further corroboration with a larger patient cohort and correlation with clinical outcomes.