tbuckley/cabot-search huggingface dataset:
Abstract 4142716: Double Guiding Catheter Technique for Orbital Atherectomy in a Heavily Calcified Coronary Bifurcation Using Microcatheter Protection for Non-atherectomy Wire
Authors: Thanaboon Yinadsawaphan, Narathorn Kulthamrongsri, Giselle Baquero
Journal: Circulation (2024)

Background: Heavily calcified coronary bifurcation lesions present significant challenges during percutaneous coronary intervention, particularly during atherectomy due to the risk of side branch occlusion from plaque shift. We describe the "Double Guiding Catheter Technique" to minimize side branch closure and wire damage to non-atherectomy vessels during bifurcation orbital atherectomy (OA). Case: A 74-year-old male with a recent NSTEMI presented for elective coronary artery revascularization. A coronary angiogram revealed non-obstructive left coronary arteries and a dominant right coronary artery (RCA) with heavily calcified stenosis at the bifurcation of the right posterolateral (RPL) and right posterior descending (RPD) branches. After placing temporary transvenous pacing and inserting sheaths in the right radial and right femoral arteries, both the RPL and RPD were wired with coronary guidewires. Using a coronary microcatheter, the wire in RPL was replaced with a ViperWire guidewire for OA, while the microcatheter in RPD served as guidewire protection. OA of RPL was successfully performed with the Diamondback 360° OA system (Cardiovascular Systems Inc), followed by multiple dilatations with non-compliant balloons and placement of two drug-eluting stents in the distal RCA to RPL and RPD, achieving good angiographic and IVUS results. Discussion: The Double Guiding Catheter Technique has been described in a few case reports of heavily calcified left main coronary bifurcation atherectomy which is limited to relatively proximal lesions due to the need to pass a second wire to a non-atherectomy vessel outside a guide extension catheter for the main branch. This is the first reported case of OA using this technique in the right coronary artery and a relatively distal part of the coronary artery. The primary advantage of this technique is eliminating the need to withdraw one of the two wires, which can be challenging when recrossing the side branch. The microcatheter can safely protect the other branch wire during atherectomy. Conclusion: By maintaining both wires with a protective microcatheter, OA of coronary bifurcation stenosis can be successfully achieved, potentially reducing the risk of wire transection.
Abstract 4142494: Prediction Of Atrial Fibrillation From Beat-To-Beat Correlations During Normal Rhythm
Authors: Esa Rasanen, Teemu Pukkila, Matti Molkkari
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting over 59 million individuals worldwide. Even wearable heart rate monitors can detect ongoing AF episodes, but none of the devices are able to assess the susceptibility to impending episodes. The prediction of AF episodes during normal rhythm would significantly improve the early treatment of AF. Research Hypothesis: Heart diseases are known to affect the short- and long-range correlations in beat-to-beat intervals, i.e., RR interval (RRI) time series. The hypothesis is that persistent alterations remain in the RRI correlations even outside of AF episodes. The study examines whether the RRI correlations can indicate the susceptibility to AF during normal rhythm. Methods: We analyze the correlations in RRIs with detrended fluctuation analysis (DFA). We enhance the analysis with its dynamical (DDFA) variant, which assesses time-dependent correlations over several ranges of scale. We attempt to discriminate the AF population with varying ratios of AF episodes (from &lt;20% to &gt;99%) from healthy controls by their RRI correlations with XGBoost classifier. Data and results: The data consist of long ECG recordings of 274 healthy controls and 84 patients with AF from Physionet and THEW datasets. The data is split into subclasses according to the relative time of the recording spent in AF: (a) &gt;99% (N=34), (b) 20-99% (N=24), (c) &lt;20% (N=26). The classification according to DDFA calculations leads to the following results in each subclass for sensitivity and specificity, respectively: (a) 94% and 97%; (b) 88% and 94%; (c) 73% and 96%. Figure 1 illustrates the differences in DDFA results between each of the studied subclasses and healthy controls. There is significant qualitative similarity between the subclasses (a-c) compared to the healthy controls in (d), especially at high heart rates. We confirmed that a small ratio of AF episodes in the data, such as in subclass (c), does not impair the DDFA results. Conclusions: The RRI correlations in the AF population show marked deviation from healthy controls even outside of AF episodes. A significant portion of the AF cases could be isolated outside the episodes with excellent specificity, paving the way for practical early screening without overflowing the healthcare system with false positives.
Abstract 4142604: Artificial intelligence-based hyperspectral technique facilitates the diagnosis of heart failure with preserved ejection fraction
Authors: Xiaomeng Yang, Zeyan Li, Xiaoyu Shi, Lilei Yu
Journal: Circulation (2024)

Background: Heart failure with preserved ejection fraction (HFpEF) is an important type of heart failure. The diagnostic process for patients with HFpEF is complex. Hyperspectral cameras have the ability to acquire high-definition hyperspectral images and have a wide range of applications and advantages. Therefore, the development of a fast and non-invasive diagnostic model for HFpEF is innovative. Hypothesis: The aim of this study is to construct a rapid diagnostic model for HFpEF patients based on hyperspectral image and artificial intelligence. Methods: We enrolled 3500 hyperspectral images from HFpEF patients and control patients, and all data were randomly divided into training group (n=2625) and validation group (n=875). The characteristic spectral information and texture information were obtained using image segmentation software and image analysis software. We used various algorithms to identify the characteristic spectral bands that can be used to identify patients with HFpEF to screen out the best model, and compared the evaluation indexes of different algorithms. We compared the autonomic indexes and lipid metabolism indexes of HFpEF patients and non-HFpEF patients to explore the potential mechanism. Results: More than 30 artificial intelligence algorithms were used to filter the spectrum that best reflects the HFpEF patients, among which random forest algorithm was the best performing model. The accuracy was 0.829, precision was 1.000, recall was 1.000, F1 Score was 0.750, specificity was 0.792, sensitivity was 0.909, and Joden index was 0.701, the area under the curve of the was 0.884. There were significant differences in autonomic indexes between the two group, as well as lipid levels and body mass index, suggesting that differences in autonomic functional activity and lipid metabolism are potential mechanisms. Conclusions: An artificial intelligence HFpEF diagnostic model based on hyperspectral imaging was developed and validated. The model can quickly and efficiently help physicians to screen HFpEF patients, as well as help early self-identification of HFpEF patients to seek timely medical treatment, thus contributing to the early detection, early diagnosis, early treatment of HFpEF patients.
Abstract 4142523: Factors Associated With Pericardial Effusion and Outcomes of Conservative Versus Surgical Treatment in Cases of Acute Type A Intramural Hematoma
Authors: Minoru Kowada, Daijiro Hori, Ryotaro Yamada, Hidetaka Kariya, Kento Fujii, Takehiro Shirasugi, Mitsunori Nakano, Manabu Shiraishi, Homare Okamura, Hideki Morita, Atsushi Yamaguchi, Naoyuki Kimura
Journal: Circulation (2024)

Background: Patients with aortic intramural hematoma (IMH) often present with cardiac tamponade. However, factors associated with the precipitating pericardial effusion remain to be elucidated. Hypothesis: Morphologic factors affect IMH-associated pericardial effusion. Aims: To identify factors associated with pericardial effusion and compare outcomes of conservative therapy vs urgent surgery in acute type A IMH. Methods: Included in the study were 195 patients hospitalized for IMH within 48 hours of onset. They were identified from among 803 consecutive patients with acute type A aortic syndrome treated at 2 aortic centers between 2009 and 2022, with 213 (27%) having IMH. Study 1: Per on-admission CT data, correlation between maximum pericardial effusion width and ascending aortic diameter or hematoma thickness was assessed. Factors associated with massive pericardial effusion (&gt;12.6 mm, upper quartile) and cardiac tamponade (systolic blood pressure &lt;80 mmHg with pericardial effusion, n=49) were assessed by multivariable analysis. Study 2: Outcomes were compared between patients who underwent conservative therapy (n=57) and those who underwent surgery (n=138). Conservative therapy was principally performed if certain conditions were met: ascending aortic diameter &lt;50 mm, hematoma thickness &lt;11 mm, absence of pericardial effusion. Results: Study 1: Pericardial effusion width was found to correlate with ascending aortic diameter (r=0.268, p&lt;0.001) but not with hematoma thickness (r=-0.053, p=0.46). Association was found between dissection extending to the abdominal aorta and massive pericardial effusion (p=0.010, OR=0.41) and between ascending aortic diameter and tamponade (p=0.048, OR=1.053). Study 2: Median age (73 vs. 73.5 years, p=0.74), sex, and comorbidities were similar between the conservative therapy group and the surgery group. Five (9%) conservative therapy group patients underwent surgery for expansion of the aorta or hematoma within 30 days of onset, with no hospital death resulting. Thirty-day mortality (10.5% vs. 5.8%, p=0.25) and 5-year survival (81.1% vs. 84.2%, p=0.33) did not differ. However, the 5-year aortic event (surgery, redissection, aortic or sudden death) rate was increased in the conservative therapy group (27.3% vs. 12.6%, p=0.003). Conclusions: Extent of dissection and aortic diameter are associated with pericardial effusion and cardiac tamponade in type A IMH. Aortic events are of increased likelihood with conservative therapy.
Abstract 4142510: Impact of Stress Hyperglycemia Ratio on Heart Failure and Atherosclerotic Cardiovascular Events After Acute Myocardial Infarction
Authors: shogo okita, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
Journal: Circulation (2024)

Background: An acute hyperglycemic status is reportedly associated with poor prognosis in patients with acute cardiovascular diseases. Although the stress hyperglycemia ratio (SHR) is a novel index to accurately represent the hyperglycemic condition on admission, relations between SHR and clinical outcomes are not fully evaluated in a setting of acute myocardial infarction (MI). Methods: This retrospective, multicenter registry study included 2,386 patients with acute MI undergoing percutaneous coronary intervention. SHR was calculated as a blood glucose level on admission divided by the estimated average glucose derived from a glycated hemoglobin level. The co-primary endpoints of this study included heart failure (HF)-related events (a composite of all-cause death and worsening and hospitalized HF) and major atherosclerotic cardiovascular events (MACE) (a composite of all-cause death, recurrent MI, and ischemic stroke), during the index hospitalization and after discharge. Results: Of the 2,386 patients, 890 (37.3%) had diabetes, and the median SHR was 1.17 [0.99, 1.45]. HF events and MACE occurred in 680 (28.5%) and 233 (9.8%) during hospitalization. SHR was identified as a factor significantly associated with both in-hospital HF events (adjusted odds ratio 1.65, 95% confidence interval 1.18-2.29, p=0.003) and MACE (adjusted odds ratio 1.50, 95% confidence interval 1.10-2.03, p=0.009). Among 2,017 patients who survived to discharge and had follow-up information, 195 (9.7%) and 214 (10.6%) experienced HF events and MACE during the median of 536 days after discharge. Patients with the high SHR (&gt;1.45, 4th quartile) had an increased risk of HF events than those with SHR ≤1.45, while the incidence of MACE after discharge did not differ significantly between the two groups (Figure). The multivariable analysis confirmed the association of SHR with long-term HF events. Conclusions: In patients with acute MI, SHR was predictive of in-hospital outcomes including HF events and MACE, while after discharge, the higher SHR was associated with a higher HF risk but not with MACE. Further studies are needed to elucidate the underlying mechanisms and potential incremental benefit of SHR in stratifying patient risks after MI.
Abstract 4142480: BMI trajectories from childhood to midlife are associated with cardiovascular morbidity and mortality
Authors: Jing Tian, Leigh Blizzard, Verity Cleland, Lydia Bazzano, Stephen Daniels, Terence Dwyer, David Jacobs, Markus Juonala, Costan Magnussen, Olli Raitakari, Alan Sinaiko, Julia Steinberger, Elaine Urbina, Kara Whitaker, Jessica Woo, Alison Venn
Journal: Circulation (2024)

Background: Few studies have examined associations of BMI trajectories from childhood with CVD events. Aims: To describe BMI trajectories from childhood to midlife and their associations with CVD morbidity and mortality. Methods: Data were from the International Childhood Cardiovascular Cohort Consortium of 7 cohorts from Australia, Finland, and the USA. Participants (n=21,410) had ≥2 measures of height and weight prior to CVD events, including ≥1 in childhood (3-19 years) and ≥1 in adulthood (≥20 years). Age-sex-standardised BMI-z scores in childhood were estimated using WHO Child Growth Standards, and in adulthood using the internal reference. Group-based trajectory modelling identified BMI-z score trajectories. Outcomes were physician-adjudicated fatal and non-fatal CVD events in adulthood. Cox proportional hazards models estimated the risk of CVD outcomes, adjusted for mean age and calendar year at childhood visits, sex, race, cohort, and childhood smoking, accounting for competing risk. Results: Six trajectories were identified, differing by attained adult BMI category: persistently low (10.3%, adult normal weight), persistently average (35.1%, normal/overweight), moderately high decreasing (29.2%, overweight), high decreasing (12.1%, class I obesity), moderately high increasing (8.7%, class II/III obesity) and persistently high (4.6%, class III obesity). Over a median follow-up of 38.1 years, 98 fatal CVD events occurred among 20,821 participants and 388 fatal or nonfatal CVD events occurred among 18,069 participants with available covariates. Compared to the persistently average trajectory, high decreasing, moderately high increasing and persistently high trajectories were associated with higher risks of fatal CVD events (adjusted hazard ratios [aHRs]: 1.88-4.16, all p&lt;0.05) and fatal or nonfatal CVD events (aHRs: 1.76-3.27, all p&lt;0.05). A higher risk of fatal and nonfatal CVD events was found for the moderately high decreasing trajectory (aHR: 1.33, 95% CI: 1.02-1.74). Conclusions: BMI z-score trajectories that started moderately high or high in childhood, even if with z-score decrease over time, were associated with overweight and obesity in adulthood and increased risks of CVD morbidity and mortality.
Abstract 4142506: Comparative Proteomic Analysis of Myocarditis: COVID-19 mRNA Vaccination vs. Pre-Pandemic Viral Etiologies
Authors: Eunsom Jang, Euisoon Kim, Mi-Hyang Jung, In-Cheol Kim, Jong-Seo Kim, Jong-Chan Youn
Journal: Circulation (2024)

Introduction: Myocarditis has been reported after mRNA-based COVID-19 vaccination, but the immune mechanisms remain unclear. This study aimed to identify the proteome-based immunopathogenesis of post-vaccination myocarditis compared to viral myocarditis in the pre-COVID-19 era. Methods: Proteomic analysis of right ventricle (RV) biopsy specimens was performed in myocarditis patients (pre-pandemic viral myocarditis: n=3, post-vaccination myocarditis: n=3) and controls (normal endomyocardial biopsy specimens of heart transplant recipients, n=4) using mass spectrometry. Differentially expressed proteins were analyzed with CIBERSORTx, Gene Ontology (GO) analysis, and Ingenuity Pathway Analysis (IPA). To examine the relationship between the SARS-CoV-2 spike protein and post-vaccination myocarditis, immunohistochemistry (IHC), mass spectrometry analysis of spike protein, and activation-induced marker (AIM) assay in T cells from RV samples were conducted. Results: In the proteomic analysis, 6,861 proteins were identified. Post-vaccination myocarditis showed increased extracellular matrix formation and cardiac fibrosis. Both pre-pandemic and post-vaccination myocarditis had elevated pro-inflammatory cytokine activities. However, post-vaccination myocarditis exhibited higher expression of interferon-alpha (IFNα) and pattern recognition receptor activation, including TLR3 and TLR7. Pre-pandemic myocarditis showed higher activation of the complement system, neutrophils, and NK cells, whereas post-vaccination myocarditis showed increased Th2 cell activation and classical macrophage activation. Spike protein and related T-cell activation were not detected. Conclusion: The immune activation in myocarditis after COVID-19 mRNA vaccination may be triggered by the mRNA in the vaccine via an IFNα-driven immune response, leading to autoimmune-like features. Further studies are necessary to validate whether these proteins correlate with clinical characteristics.
Abstract 4142198: The Fontan Circulation Demonstrates Premature Biologic Aging
Authors: Annabelle Vincent, Jennifer Woo, Sushma Reddy, Shoko Ichimura, Ankit Kushwaha
Journal: Circulation (2024)

Background: Patients with single ventricle congenital heart disease palliated to Fontan circulation have increased all-cause mortality compared to age-matched controls. The reason for this increased mortality is not clear and cannot be fully explained by the underlying cardiac disease alone. We hypothesize that premature biologic aging contributes to this increased mortality. Methods: We collected demographic, clinical data and blood from patients with Fontan circulation and controls with structurally normal hearts. We assessed biologic age using telomere length (TL) measured by quantitative PCR from buffy coat DNA. Telomeres are repeating nucleoprotein structures at the end of chromosomes which shorten with age. Between group differences were assessed using t-test. Data was presented as mean±SD and p&lt;0.05 was considered significant. Results: Mean age was 15.6±8.1 years in the Fontan cohort (N=122) vs. 18±15.8 years in controls (N=30). 63% were males in the Fontan cohort vs. 73% in controls. The Fontan cohort had a trend toward shorter TL vs. controls (1.07±0.15 vs. 1.17±0.2; p=NS). The TL difference of 0.1 suggests that the Fontan cohort is 9 years biologically older than controls. In both groups, there was a trend towards shorter TL with increasing age but was most prominent in Fontan cohort (Fig a). Patients with single right ventricles had shorter TL vs. those with single left ventricles (1.04±0.17 vs. 1.10±0.2; p=0.03), with the single right ventricle patients being 5.4 years biologically older (Fig b). The hypoplastic left heart syndrome cohort had the shortest TL of 1.0±0.14 (15 years biologically older than control) and the most co-morbidities: protein losing enteropathy (20.4%), pulmonary hypertension (6%), endocarditis (2%), stroke (12%) and cirrhosis (2%) compared to the other groups. Interestingly, there was no association between TL and systolic ventricular function by echocardiogram. Conclusions: We show for the first time, premature biologic aging in the Fontan circulation, its association with increased comorbidities and with single right ventricles being most at risk. Premature aging may predispose to heightened all-cause mortality and predispose to early onset of age-related diseases.
Abstract 4142209: Left Atrial Pressure at Time of Atrial Fibrillation Ablation: A Tool in The Diagnosis of Underlying CHF and Risk of Readmission
Authors: Jacob Jewulski, Thomas Schultz, Nicholas Fabry, Marcie Berger
Journal: Circulation (2024)

Background: Patients with CHF at time of AF ablation are more likely to have earlier (&lt;90 days) AF recurrence, more CHF exacerbations, and prolonged index hospitalization. The diagnosis of CHF in those with AF can be confounded by their overlapping symptoms leading to under-recognition and delays in care. This study aims to determine whether elevated left atrial mean pressure (LAP) at time of AF ablation, measured immediately after transseptal catheterization, allows for detection of previously undiagnosed and undertreated CHF, and whether this may serve as a marker for patients at higher risk of AF recurrence and rehospitalization. Methods: A retrospective chart review was performed of all patients ≥18 years old at an academic medical center with a diagnosis of AF and who underwent AF ablation between 5/2022 and 9/2023. The cohort was divided into those with LAP ≥15 mmHg and those with LAP &lt;15 mmHg at time of AF ablation. Baseline demographics, comorbidities, readmission rates, GDMT, and antiarrhythmic prescription rates were collected. Results: This analysis included 238 patients (31.5% female). At time of ablation, 77 (32.4%) had a LAP ≥ 15 mmHg, of which 34 (44.2%) did not have a pre-existing diagnosis of CHF. Those with LAP ≥15 were more likely to be on RAAS inhibition (57.1% vs 43.5%, p=0.048), MRA (23.4% vs 8.7%, p=0.002), and SGLT2i (23.4% vs 10.6% p=0.009) compared with those with a normal LAP. While not reaching statistical significance, elevated LAP was associated with higher NT-proBNP at time of ablation (1657 vs 930 p=0.129) despite higher BMIs (34.8 vs 30.1, p&lt;0.001), with a trend towards increased 90-day readmission (9.1% vs 3.7%, p= 0.088). Discussion: LAP measurement identified a significant number of patients undiagnosed with CHF (44.2%). Elevated LAP also trended toward higher NT-proBNP despite having a higher BMI. Although rates of GDMT were higher for those with LAP ≥15 mmHg, the group remained significantly undermedicated, particularly with SGLT2i (29.3%, p&lt;0.001) and MRA (26.3%, p&lt;0.001). This may indicate suboptimal GDMT for both HFrEF and HFpEF. While not reaching statistical significance, this lack of recognition of CHF and subsequent lapse in GDMT prescription likely influenced the trend towards increased 90-day readmissions post ablation (p=0.088). Further work is needed to determine if identification of patients with elevated LAP at time of AF ablation can be prospectively optimized on GDMT improve outcomes post ablation.