tbuckley/cabot-search huggingface dataset:
Abstract 18876: Safety and Efficacy of Coronary CT Angiography in Acute Chest Pain. A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Mostafa Mostafa, Mohamed Abuelazm, Mohamed Eid, Varun Victor, Claudine Abdou, Kirolos Barssoum, Karim Al-Azizi, Hani Jneid
Journal: Circulation (2023)

Background: Coronary computed tomography angiography (CCTA) allows direct visualization of coronary arteries. As a result of the high accuracy, CCTA has been proposed as an initial step in patients presenting to the emergency department (ED) with acute chest pain to rule out obstructive coronary artery disease (CAD). The effect of the initial CCTA strategy on downstream testing with coronary angiogram and coronary revascularization is yet to be delineated. Objective: To investigate the safety and efficacy of CCTA in patients presenting to the ED with acute chest pain compared to standard of care (SoC). Method: We searched PubMed, Cochrane CENTRAL Register, and ClinicalTrials.gov (inception through July 1st, 2023) for randomized clinical trials evaluating the outcomes of CCTA in acute chest pain. We used a random-effect model to calculate risk ratio (RR) with a 95% confidence interval (CI). The endpoints were all-cause mortality, major adverse cardiac events (MACE), rates of coronary angiography, and length of stay (LOS). Results: A total of 17 studies comprising 9237 patients were included in the analysis. Compared to SoC, the CCTA group had a shorter length of hospitalization (RR -0.3; 95%CI -0.64- -0.13; P = 0.0005). There was no significant difference in all-cause mortality or MACE (RR 0.8; 95%CI 0.45- 1.5; P = 0.52) and (RR -1.00; 95%CI 0.76- 1.3; P = 0.98), respectively. Rates of coronary angiography did not differ between the two groups (RR 0.93; 95%CI 0.61- 1.41; P = 0.96). Conclusion: CCTA is a reliable non-invasive imaging modality that can play a significant role in evaluating acute chest pain in the emergency department and is associated with a decrease in the length of stay without an increase in MACE. There was no increase in downstream coronary angiogram or coronary revascularization in the CCTA group.
Abstract 18720: Association of Triglyceride-Glucose Index and Risk of Coronary Heart Disease, Congestive Heart Failure, Stroke and Hypertension Among Non-Diabetic Patients: NHANES Study 2001-2020
Authors: Bisher Sawaf, Sarya Swed, Haidara Bohsas, Hidar Alibrahim, Mohamad Nour Nasif, Heba Haj Saleh, Fatema Tashrifwala, Yazan Khair Eldien jabban, Safwan H Al-Rassas, Sunita Lakhani, Hussam Al Hennawi, Mervat Naguib, Naim Battikh, Mahmoud Mahmoud, Abdul Rehman Zia Zaidi, Baraa alghalyini, Wael Hafez
Journal: Circulation (2023)

Introduction: Not enough studies addressed the predictive value of the triglyceride glucose (TYG) index for developing cardiovascular diseases. This study highlights the association between TYG index and the risk of cardiovascular disease among non-diabetic patients. Methods: Our study used the National Health and Nutrition Examination Survey (NHANES) data. Data from 2001 to 2020 was involved, and the analysis was performed using a 4-year fasting weight (WTSAF4YR) per NHANES analysis criteria. We included non-diabetic participants aged 18 years or older. The Statistical Package for the Social Sciences (SPSS) v. 28 was used for the analysis. The sensitivity and specificity of the TyG index in predicting the endpoints of interest (coronary heart disease (CHD), Congestive Heart Failure (CHF), Heart attack (HA), Stroke, and Hypertension (HTN)) were calculated by receiver operating characteristic (ROC) analysis. We performed univariate and multivariate logistic regression to analyze the associated factors with the endpoints of our study. Results: Our study involved 10,937 non-diabetic individuals. The age was 48±18 years. Individuals with a TyG index of&gt;8.96 had higher BMI, waist circumference, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p&lt;0.001). Overall, 360, 359, 385, 237, and 3254 patients had CHD, stroke, HA, CHF and HTN, respectively. We evaluated the predictor values of TyG index for CHF (AUC: 54.75%, 95% CI:0.542-0.614), stroke (AUC:52.32%,95%CI:0.529)-0.584), HA (AUC:55.67%, 95%CI:0.595-0.646), HTN (AUC: 55.59%, 95%CI:0.574-0.597), CHD (AUC: 50.31%,95%CI:0.592-0.646), and all of them were statistically significant(p-value&lt;0.05). Conclusions: The value of the TyG index was a poor indicator for the studied cardiovascular diseases (congestive heart failure, stroke, heart attack, high blood pressure, and coronary heart disease).
Abstract 16382: Inaccuracy of Non-Invasive Brachial Cuff-Measured Blood Pressure During Surgery
Authors: Sungsoo Kim, Sohee Kwon, Maxime Cannesson
Journal: Circulation (2023)

Introduction: Blood pressure (BP) is an essential vital sign to be monitored during surgery. BP is measured only by Non-Invasive brachial Cuff-measured Blood Pressure (NICBP) devices in 90% of surgeries in US. However, previous studies demonstrated possible inaccuracy of NICBP. The inaccuracy of BP during surgery is a significant public concern because it can result in missing therapeutic potentials and consequently increasing cardiovascular risks during and after surgery. However, there is no large study to evaluate the accuracy of NICBP measured during surgery. Method: It has been known that invasive intra-arterial blood pressure (IABP) measured by an arterial line catheter is an optimal reference for validation of NICBP accuracy given its highest level of accuracy. Our study collected 2,814,154 pairs of BP measurements between NICBP and IABP which were measured at the same time during surgery from 38,706 patients who received surgeries at University of California, Los Angeles from 2016 through 2023. Result: We evaluated the accuracy of NICBP compared to IABP using Confusion matrix analysis (Fig 1). We defined predicted BP classification when BP is classified by NICBP. We also defined actual BP classification when BP is classified by IABP. We categorized BP according to Mean Arterial Pressure (MAP; mmHg) into 5 groups; MAP&lt;65, 65≤MAP&lt;75, 75≤MAP&lt;95, 95≤MAP&lt;105, and 105≤MAP. True Positive rates of each classification ranged from 36.7% to 66.7% (Fig 1). It was surprising that 49.9% in actual MAP (aMAP)&lt;65, 56.9% in 65≤aMAP&lt;75, 33.9% in 75≤aMAP&lt;95, 63.4% in 95≤aMAP&lt;105, and 50.6% in 105≤ aMAP was misclassified into the incorrect BP classifications by NICBP. Conclusion: Our study demonstrated noticeable inaccuracy of BP by NICBP compared to IABP during surgery. Given high reliability solely on NICBP in measuring BP during the majority of surgery cases, the inaccuracy of NICBP may cause significant public health concerns due to unoptimized BP management during surgery.
Abstract 14308: Perioperative Cyclohexanone Exposure During Neonatal Congenital Heart Surgery Potentiates Brain Injury
Authors: Ria Gupta, Jordan Kuiper, Jessie Buckley, Mark Russell, Greg Ellis, Eric M Graham, Martin Stengelin, David Graham, Allen D Everett
Journal: Circulation (2023)

Introduction: Neurodevelopmental delay is hallmark for children with congenital heart defects. Risk factors include industrial contaminants in medical devices, such as cyclohexanone. Hypothesis: To evaluate associations between perioperative cyclohexanone and cyclohexanone metabolites with perioperative biomarkers of brain injury. Methods: From 75 neonates who underwent congenital heart surgery involving cardiopulmonary bypass (CPB), we assayed perioperative serum samples (preoperation, post-CPB, 24 hours postoperation) for cyclohexanone, two cyclohexanone metabolites (trans-1,2- and trans-1,4-cyclohexanediol), and biomarkers of brain injury: glial fibrillary acidic protein (GFAP), neurofilament light (NF-L), and Tau. We calculated the molar sum of cyclohexanone metabolites (Σmetabolites), and at each timepoint we used quantile regression to evaluate differences in median brain injury biomarker concentrations (pg/mL) per doubling in concentration of cyclohexanone or Σmetabolites (ng/mL). We adjusted associations for cyclohexanone assay batch, postnatal age at surgery (days), weight at surgery (kg), The Society of Thoracic Surgeons and The European Association for Cardio-Thoracic Surgery (STAT) mortality risk category, and total duration of CPB (min). Results: In adjusted analyses, a doubling in preoperation cyclohexanone concentration was associated with a 19 pg/mL (95% CI: 3, 35) greater median Tau concentration. Similarly, a doubling in post CPB cyclohexanone was associated with an 88 pg/mL (95% CI: 20, 156) greater median concentration of Tau and 137 pg/mL (95% CI: 54, 220) greater median concentration of NF-L. Associations with Σmetabolites were generally null, though a doubling in post-CPB concentration was associated with a 34.7 pg/mL (95% CI: -0.8, 70) greater NF-L and 54.1 pg/mL (95% CI: 15, 94) greater Tau concentration. Associations with GFAP at all timepoints were null. Conclusions: Perioperative cyclohexanone exposure is associated with worse neurodevelopmental outcomes and in this study, cyclohexanone levels were associated with NF-L and Tau which are measures of axonal damage. Interventions to reduce cyclohexanone exposure may improve long term neurodevelopment.
Abstract 17725: Prognostic Implications and the Impact of Empagliflozin on Bone Morphogenetic Protein-10 in Heart Failure: Results from the EMPEROR Program
Authors: Javed Butler, Tariq J Siddiqi
Journal: Circulation (2023)

Background: Bone morphogenetic protein (BMP)-10 is upregulated in response to cardiac injury and exerts a protective role via activating transforming growth factor β/Smad and STAT3-pathways preserving normal cardiac function by inhibiting cell death and fibrosis. Aim: To assess association of baseline characteristics and prognostic significance of BMP-10 in patients with heart failure (HF) with reduced or preserved ejection fraction, and the effect of empagliflozin on BMP-10 level. Methods: Serum BMP-10 (Elecsys®, Roche Diagnostics) was assessed in 1127 patients from the EMPEROR-Reduced and Preserved trials, categorized by tertiles of baseline BMP-10 (&lt;2.35; ≥2.35-&lt;3.11; ≥3.11 ng/mL). Results: Median baseline BMP-10 was 2.71 ng/mL. Patients in higher tertiles tended to be older, women, NYHA class III-IV, with obesity, atrial fibrillation, and worse renal function (all P&lt;0.05). Baseline BMP-10 level correlated with N-terminal pro B-type natriuretic peptides and high-sensitivity troponin T levels (Spearman rho=0.41, 0.26 respectively). Higher baseline BMP-10 was associated with increased risk for adverse outcomes ( Table 1 ). For each 2-fold increase in BMP-10, the adjusted hazard ratio (HR) for cardiovascular death (CV) or HF hospitalization was 2.85 (95% CI 1.99, 4.09, P&lt;0.0001). Empagliflozin treatment was associated with reduction in BMP-10 at week 12 (adjusted gMean ratio 0.94 [0.91-0.97], P&lt;0.001) but not week 52 (1.00 [0.96-1.04], P=0.86). Empagliflozin reduced the risk of CV death or HF hospitalization, particularly for patients at highest baseline BMP-10 level (&lt;1 st tertile HR 1.03 [0.56-1.88]; ≥1 st and &lt;2 nd tertile HR 0.74 [0.40-1.35]; ≥2 nd tertile HR 0.61 [0.40-0.92], P-trend=0.15). Conclusion: BMP-10 levels were associated with worse disease severity and outcomes in patients with HF. Empagliflozin was associated with reduction of BMP-10 at week 12. The benefit of empagliflozin on outcomes was more pronounced with higher BMP-10 levels.
Abstract 15366: Quantification of Recent Reporting Rates of Atrioesophageal Fistula After Left Atrial Ablation for the Treatment of Atrial Fibrillation
Authors: Natalie Putzel, Christopher Joseph, Julie Cooper, Jacob Sherman, Catherine O Lazarus, Erik B Kulstad, James D Daniels, Jose Nazari
Journal: Circulation (2023)

Introduction: Atrio-esophageal fistulas (AEF) are a feared and fatal complication of left atrial ablation for the treatment of atrial fibrillation (AF). The recent POTTER-AF survey suggests that AEFs continue to occur despite best efforts to prevent them. A quantification of recent incidence rates and outcomes of AEF reported to the Manufacturer and User Facility Device Experience (MAUDE) database of the U.S. FDA may further elucidate trends in this complication. Research Question(s): What are the recent trends in reporting rates of AEF, and what are the outcomes? Purpose: To quantify the number of AEF reports as well as any reported outcomes of atrioesophageal fistulas and determine any trends over the last 4 years. Methods: We reviewed data from the Manufacturer and User Facility Device Experience (MAUDE) database for complications under the category of fistula that occurred over the last 4 years (2019 to 2022 inclusive). Reports were reviewed for any descriptions of outcome, and narratives were compared in an attempt to identify and exclude any duplicate reporting. Results: In total, three product codes resulted in 121 reported AEFs. Of these, 50 (41%) were listed as fatal. When provided, the time frame of death ranged from 12 days to several weeks after the index procedure. Product codes reporting AEFs included LPB (88 cases), OAE (22 cases), and OAD (11 cases), with codes representing cardiac ablation catheters and radiofrequency generators. Incidence by year showed a generally increasing trend (21 in 2019, 22 in 2020, 41 in 2021, and 37 in 2022, Figure 1). Conclusion: The annual rate of reported AEFs has not decreased over the last 4 years, and instead shows a generally increasing trend. Reported fatality rates remain high at 41%.
Abstract 17493: Racial/Ethnic Under-Representation in Early Phase Clinical Trials
Authors: Halima White, Muhammed Idris, Anekwe Onwuanyi, Latha Palaniappan, Eldrin F Lewis, Priscilla Pemu, Kira Clark, Victor Ritter, Sa Shen, FeiFei Qin, Joseph-Kelvin Igwe, Erin R Cruz, Cati Brown Johnson, Jo Ann Cross, Marcia L Stefanick, Paul J Wang
Journal: Circulation (2023)

Introduction: There is severe underrepresentation of racial and ethnic groups in many cardiovascular clinical trials. Early-phase clinical trials examine the action and safety limits of treatment and thus, underrepresentation may have particularly deleterious effects. Hypothesis: Ethnic and Racial groups are underrepresented in early-phase trials. Methods: Using the clinicaltrials.gov database, we examined the racial and ethnic representation in Phases 1, 2, 3, and 4 in completed heart failure clinical trials (N=89) with reported results from 2016-2021. We examined the proportion of trials with a representation equal or greater than % U.S. Census population (12% for African American (AA), 19% for Hispanic/Latino (HL), and 7% for Asian (AN)) and determined the median trial representation percentage for AA, HL, and AN groups. Using Chi-square analysis we compared the percent representation across the trial phases. Results: We found that 49%, 91%, and 87% Phase 1 and 2 trials have a lower AA, HL, and AN representation, respectively, compared to that in the U.S. Population (Table 1). HL and AN representation in Phase 1 and 2 trials is particularly low. There is significant variation in AA, HL, and AN representation across all trial phases(p&lt;0.001). Conclusions: Significant underrepresentation of racial and ethnic groups persist in contemporary Phase 1 and 2 trials. Efforts to create a standard for collecting and reporting demographics along with increasing racial and ethnic group representation closer to US population may reduce the risk of future adverse events.
Abstract 16777: Do Not Clown Around With Intracardiac Myxomas: A Clinical Case of Carney Complex
Authors: Amanda M Warren, Stephanie Zilberman, Natalie DiStefano, kevin pink
Journal: Circulation (2023)

Introduction: Intracardiac myxomas are associated with cardiovascular mortality most frequently due to embolism and obstruction leading to heart failure. One of the most feared complications of intracardiac myxomas are sudden cardiac death, as these tumors are often identified incidentally. Carney Complex (CNC) is a rare disorder characterized by cardiac myxomas, psammomatous melanotic schwannomas, abnormal skin pigmentation, and endocrine disorders. Clinical Case: A 55 year old female with a past medical history of hypertension presented to the hospital with syncopal episodes and intermittent vision loss. Head computed tomography scan noted a large extra-axial mass present within the left cerebellopontine angle. A transthoracic echocardiogram showed a severely dilated left atria containing a large atrial mass (7.9 x 5.0 cm) that was causing obstruction of mitral inflow resulting in peak velocity 246 cm/S with a mean gradient of 12 mmHg. The patient was also noted to have dispersed epithelioid blue nevi present on skin examination. The patient met major criteria for diagnosis of Carney Complex. Conclusion: Carney complex (CNC) is an extremely rare autosomal dominant syndrome with less than 1,000 cases reported worldwide. Patients with familial history of intracardiac myxomas, multiple myxomas, characteristic skin findings, or endocrinopathies should be evaluated for CNC. Patients with cardiac myxoma secondary to CNC typically have a recurrence risk of roughly 30%. Patients with CNC should be screened with biannual transthoracic echocardiograms after resection and patients with suspected CNC should be worked up for additional tumor burden and endocrinopathies.
Abstract 14718: Systolic-Diastolic Coupling and Cardiac Limitations to Exercise in Patients With Hypertrophic Cardiomyopathy
Authors: William Turlington, Katrin Dias, Christopher Hearon, Erika Ivey, Vincent Delgado, Tiffany Brazile, Aslan T Turer, Mark S Link, Satyam Sarma, Benjamin D Levine, James P Macnamara
Journal: Circulation (2023)

Background: Exercise intolerance occurs in patients with hypertrophic cardiomyopathy (HCM) in part due to impaired augmentation of stroke volume (SV reserve) and diastolic dysfunction. Systolic-diastolic (S-D) coupling characterizes how systolic contraction of the left ventricle (LV) primes efficient elastic recoil during diastole. S-D coupling declines with age and is further reduced in patients with heart failure. Impaired S-D coupling may contribute to impaired cardiac response to exercise in patients with HCM. Hypothesis: We hypothesized that S-D coupling is associated with peak oxygen uptake (peak VO 2 ) and peak cardiac output (Qc) patients with HCM. Methods: Patients with HCM (HCM: n=25, age=46 ± 8.9 years) and healthy, sedentary adults (CON: n=115, age=50 ± 9.7 years) underwent cardiopulmonary exercise testing and resting echocardiography. S-D coupling is the relationship between LV longitudinal excursion of the mitral annulus during systole (S exc ) and early diastole (ED exc ) measured with tissue Doppler imaging. Peak VO 2 (Douglas bag), peak Qc (C 2 H 2 rebreathe), and SV reserve were assessed during maximal treadmill exercise. Linear regression was performed between S-D coupling and peak VO 2 , peak Qc, and SV reserve and multivariate regression with age as a covariate. Results: S-D coupling was reduced in HCM (HCM: 0.56±0.10, CON: 0.63±0.08, p &lt;0.001). In CON, S-D coupling was independently associated with age (r = 0.52, p &lt;0.001), but not peak VO 2 (r = 0.26, p = 0.473) or peak Qc (r = 0.04, p = 0.538). In HCM, S-D coupling was associated with peak VO 2 (r = 0.46 p = 0.019) and peak Qc (r = 0.56, p = 0.003) with a trend in SV reserve (r = 0.36, p = 0.071) (Figure), independent of age (VO 2 p = 0.020, Qc p = 0.004). Conclusion: Impaired systolic-diastolic coupling is associated with fitness and the cardiac response to exercise in patients with HCM. Inefficient S-D coupling may link insufficient stroke volume generation, diastolic dysfunction, and exercise intolerance in HCM.
Abstract 18984: Artificial Intelligence-Based Automated Left Ventricle Mass Quantification From Non-Contrast Cardiac CT Scans: Correlation With Contrast CT and Cardiac MRI
Authors: Donghee Han, Aakash Shanbhag, Aditya Killekar, Parker B Waechter, Nicholas Kwok, Daniel Berman, Piotr J Slomka
Journal: Circulation (2023)

Background: Non-contrast CT scans are currently not used to assess left ventricular myocardial mass (LV mass), which is usually evaluated with contrast CT or cardiac magnetic resonance (CMR). We aimed to assess the feasibility of LV mass estimation from non-contrast CT calcium scans using an artificial intelligence (AI) approach and compare it to measurements from contrast CT and CMR. Methods: A total of 316 patients (Age: 57.1±16.7, 53.2% male) who underwent coronary CT angiography (with non-contrast calcium CT and contrast CT) and CMR were included. The median interval between CT and CMR was 22 days (IQR: 3-76). An nn-Unet AI model (Total Segmentator), previously trained on data from independent sites, automatically segmented non-contrast CT structures including the myocardium. LV mass was also measured from contrast CT and CMR by experts during routine clinical reporting. Results: The AI segmentation took ~22 seconds per case. There was no significant difference in LV mass between the AI and contrast CT (136.5±55.3 vs. 139.6±58.0 g, p=0.114). An excellent correlation was observed between AI and contrast CT (r=0.84, p&lt;0.001) (Figure). Bland-Altman analysis showed a minimal bias of 3.15. Compared to CMR, both AI and non-contrast CT showed higher LV mass (136±55.3, 139.6±58.0 vs. 127.1±53.1 g, respectively, both p&lt;0.001). The correlations of AI and contrast CT with CMR were excellent with no significant differences. (r= 0.86 and 0.85, both p&lt;0.001). Bland-Altman analysis indicated small bias toward higher LV mass with AI and contrast CT (-9.35 and -12.5, respectively) compared to CMR. Conclusions: The AI-based automated LV mass from non-contrast CT showed excellent correlations and minimal biases when compared to LV mass measured from contrast CT and CMR. This fully automated measure could be applied for routine LV mass evaluation in patients with a non-contrast CT scan, providing an additional biomarker previously thought not measurable by this modality.