tbuckley/cabot-search huggingface dataset:
Abstract 18784: Impaired Left Atrial Strain is a Risk Factor for New-Onset Atrial Fibrillation
Authors: Jason Sherer, Shani Dahan, Ygal Plakht, Mostafa Al-Alusi, Shaan Khurshid, Steven A Lubitz, Patrick T Ellinor, Antonia Van Kampen, Judy Hung
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals. Left atrial (LA) strain, a measure of LA function and remodeling, holds potential as a prognostic indicator for AF development. We aimed to examine whether LA strain is associated with new onset AF. Methods: We performed a nested case-control study within an electronic health record-based longitudinal cohort of primary care patients from a multi-institutional healthcare system spanning 2001 to 2018. Cases included patients who developed new-onset AF during a follow-up period of 7.3 years and had undergone transthoracic echocardiography (TTE) within three years of the follow-up start. Several LA strain parameters were compared between the case and control groups, including Peak Atrial Longitudinal Strain (PALS), Left Atrial Conduit Strain (LACS), and Peak Atrial Contraction Strain (PACS). Results: The study included 216 patients who developed AF during follow-up each matched with a corresponding age- and sex-matched control without AF. The AF group had significantly lower PALS (25.9 ± 8.9 vs. 34.3 ± 10.4, p&lt;0.001) and LACS (13.6 ± 5.2 vs. 19.9 ± 7.6, p&lt;0.001) compared to the non-AF group. Subgroup analyses of AF patients, stratified by the time to AF development, revealed more substantial differences between the AF and non-AF groups when the initial TTE was conducted closer to the onset of AF. Specifically, when the TTE was performed within 2 years prior to AF onset, the disparities in LA strain parameters were more pronounced compared to TTEs conducted between 2-5 years prior or beyond 5 years prior to AF onset. Conclusions: Impaired left atrial strain is strongly associated with new-onset AF, particularly when measured 2 years prior to AF onset, indicating a higher risk of developing AF in the near future. Incorporating LA strain assessment into clinical decision-making can enhance the evaluation of individuals at risk for AF.
Abstract 16315: Associations Between Angiogenic Biomarkers in Early Pregnancy and Predicted 30-year Risk of Cardiovascular Disease 2-7 Years After Delivery
Authors: Toluwalase Awoyemi, Xiaoning Huang, Rebecca McNeil, Jasmina Varagic, Victoria L Pemberton, Janet M Catov, C Noel N Bairey, Judith Chung, David Haas, Lisa Levine, George Saade, Robert Silver, Uma Reddy, Brian Mercer, Lynn Yee, Philip Greenland, William Grobman, Sadiya S Khan
Journal: Circulation (2023)

Introduction: The placenta is a vascular organ that secretes angiogenic proteins during pregnancy. Abnormalities in these biomarkers are associated with higher risk for adverse pregnancy outcomes, which include hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM). However, the association between abnormalities in angiogenic proteins and long-term CVD risk is uncertain. Aims: To determine the association between angiogenic placental proteins measured in early pregnancy and predicted 30-year risk of CVD 2-7 years after delivery. Methods: In this analysis, we included nulliparous individuals from the prospective multicenter nuMoM2b Heart Health Study (nuMoM2b-HHS) with available data on angiogenic protein concentrations in the first trimester (vascular endothelial growth factor [VEGF], placental growth factor [PlGF], endoglin, and soluble fms-like tyrosine kinase-1 [sFLT-1]). The primary outcome was predicted 30-year risk of CVD based on the Framingham model, which integrates traditional risk factor levels into an absolute risk estimate. Multivariable linear regression estimated associations between log-transformed angiogenic protein concentrations and predicted 30-year risk of CVD, adjusting for maternal age, gestational age, insurance type, and smoking status at the first trimester visit. Analyses were repeated stratified by HDP or GDM. Results: Of 987 nuMoM2b-HHS participants included, the mean age was 26.9 (SD 5.9) years and the mean gestational age at biomarker assessment was 11.4 (1.6) weeks. Higher log-transformed concentrations of VEGF (per 1-SD) were associated with greater predicted 30-year risk of CVD by 0.68% (0.34, 1.02). Conversely, higher log-transformed concentrations of endoglin and sFlt-1 were associated with lower 30-year predicted risk of CVD by 0.85% (-1.15, -0.55) and 0.70% (-1.00, -0.41), respectively. There was no association between PlGF and 30-year predicted risk of CVD. Results were similar in those with or without HDP or GDM. Conclusions: Concentrations of VEGF, endoglin, and sFLt-1 measured in early pregnancy were associated with predicted long-term risk of CVD 2-7 years after delivery in all birthing individuals whether or not they experienced an adverse pregnancy outcome.
Abstract 17940: Effects of Continuous Accelerated Pacing on Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: Three Year Follow Up of the myPACE Randomized Clinical Trial
Authors: Margaret Infeld, Jamie Cyr, Alexandra Novelli, Kramer J Wahlberg, Rebecca Rawlings, Tim B Plante, Markus Meyer
Journal: Circulation (2023)

Background: Heart failure with a preserved ejection fraction (HFpEF) is prevalent and has few evidence-based therapies. In a trial of HFpEF patients with specialized pacemakers, an accelerated personalized pacing rate averaging 75 bpm (myPACE) improved quality of life, NT-proBNP, physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60bpm (usual care). The one-year myPACE trial was not powered for clinical outcomes, but most patients elected to remain on their assigned treatment. Methods: The myPACE study was a single-center, blinded, randomized controlled trial that enrolled patients from June 2019 to November 2020. In this per-protocol analysis of clinical events over a 3-year follow-up, we included trial participants who remained on their assigned heart rate after study completion. The outcome of this analysis is a composite of the first clinical event (urgent visit or hospitalization for heart failure or atrial fibrillation, unstable angina or myocardial infarction, stroke, and death). Events were obtained by chart review and adjudicated by two blinded investigators. A Kaplan-Meier event-free survival plot and a log-rank test evaluated differences between the two treatment arms. Results: Of the 100 myPACE trial participants, most (40/48 myPACE and 48/52 usual care) remained on their assigned heart rate over a median (IQR) of 3.3 (2.6, 3.7) years after enrollment. The median (IQR) age was 75(69-80), and 45% were female. Accelerated personalized pacing was associated with reduced adverse clinical outcomes by about 60 percent. The Kaplan-Meier event-free survival plot for the composite of clinical events is shown in the Figure. Conclusions: In a per-protocol clinical event analysis of the extended myPACE study, those who continued the myPACE accelerated pacing protocol had fewer adverse clinical events than those with a lower rate setting of 60 bpm.
Abstract 15711: Association Between State Tobacco Surcharge Policy and Health Insurance Enrollment, Health Care Utilization, and Smoking Cessation Behaviors
Authors: Yu Wang, Paul J Chase, Sally Honeycutt, Laurie P Whitsel
Journal: Circulation (2023)

Introduction: The Patient Protection and Affordable Care Act allows insurers to charge up to 50% higher premiums to people who use tobacco. Several states have outlawed tobacco surcharges or capped the surcharges to lower levels. Evidence on the impact of state policies limiting tobacco surcharges is limited. This study aims to examine the association between state tobacco surcharge policies and individuals’ health insurance enrollment, health care utilization, and smoking cessation behaviors. Methods: This study used data from the Population Assessment of Tobacco and Health (PATH) Study Wave 6 (Mar-Nov 2021). The study sample was adults 18-64 years old who reported smoking cigarettes 20 or more days in the past 30 days (N=4,235). Exposure was living in states limiting tobacco surcharges (outlawed or capped). Outcome variables were currently covered by health insurance, seen a health professional in the past 12 months, intention to quit within 12 months, and any quit attempt in the past 12 months. Single-wave sample weights and balanced repeated replication method were applied to generate representative estimates and variances. Multivariate logistic regressions were used to estimate the associations between exposure and outcomes, controlling for socio-demographic variables, other tobacco use status, and state Medicaid expansion and tobacco control policies. Results: Among study sample, 19.8% (95% CI: 16.0%-24.3%) lived in states limiting tobacco surcharges. Bivariate associations showed that people living in states limiting surcharges were more likely to be covered by health insurance (84.5%, 95% CI: 81.2%-87.3% vs. 75.0%, 95% CI: 72.9%-77.1%, p &lt; 0.001). After adjusting for covariates, the association between state policies and health insurance coverage became statistically insignificant (adjusted odds ratio, aOR=1.09, 95% CI: 0.80-1.47). Participants living in states limiting surcharges were less likely to have intention to quit within 12 months (aOR=0.78, 95% CI: 0.65-0.94). Other associations were not statistically significant. Conclusions: This study indicated that people living in states limiting tobacco surcharges had lower intention to quit smoking. More studies are needed to evaluate the impact of tobacco surcharge policies.
Abstract 17861: Separating Patients With Long-Term Success versus Acute Response From Atrial Fibrillation Ablation Using Explainable Machine Learning
Authors: Prasanth Ganesan, Maxime Pedron, Ruibin Feng, Samuel Ruiperez-Campillo, Albert J Rogers, Brototo Deb, Hui Ju Chang, Kelly A Brennan, Viren Srivastava, Paul L Clopton, Sanjiv M Narayan
Journal: Circulation (2023)

Introduction: It is difficult to predict outcomes from atrial fibrillation (AF) ablation. In particular, it is unclear what physiology explains patients with long-term AF elimination yet no acute response, or vice versa. Hypothesis: We hypothesize that different combinations of electrophysiological and clinical features predict long-term outcome or acute response to AF ablation. We tested this hypothesis using machine learning of a large Registry. Methods: We studied N=561 patients at pulmonary vein isolation (65±10 years, 28% female) with rich clinical data (44 elements, ECGs), and 64 pole global electrograms (EGMs). We propensity matched the dataset 70/30 for training/testing (fig A). We extracted (i) 4 EGM features: dominant frequency (DF), similarity over time, rate (CL), and voltage; (ii) 6 ECG features; (iii) 44 clinical features. We compared 6 ML models including logistic regression to predict 1 year and acute outcomes in the test set, then used explainability (e.g. Shapley scores) to explain the top models and contributing features for each outcome. Results: Of 561 patients, N=390 (69.5%) had 1 year success and N=278 (49.6%) had AF termination by ablation. The best ML model predicted acute response (Random Forest), provided AUROC = 0.83 (fig B) with highest predictors of AF type, RR interval, CL, DF, and voltage. Conversely, the best model for long-term success provided AUC of 0.65 (accuracy of LT vs acute: p&lt;0.001 McNemar test), but top features were PR interval, QRS axis, AF duration, and age (shapley Rsq = 0.11, fig C). Predictors for long term outcome poorly predicted acute outcome and vice versa (fig C). Conclusions: Clinical features for long-term and acute response to AF ablation were quite different, applying several classification methods to a well-characterized registry. Confirmation in other registries may reveal novel phenotypes to guide clinical decision making or procedural planning, and shed mechanistic insights.
Abstract 12646: Autoantibodies Targeting Endothelin Type-A Receptors Associate With no Reflow After ST-elevation Myocardial Infarction
Authors: Giovanni Civieri, Martina Perazzolo Marra, Giulia Masiero, Marta Vadori, Laura Iop, Emanuele Cozzi, Sabino Iliceto, Francesco Tona
Journal: Circulation (2023)

Introduction: No-reflow (NR), where the coronary artery is patent after treatment of ST-elevation myocardial infarction (STEMI) but tissue perfusion is not restored, is associated with worse outcome. Although several mechanisms contributing to NR have been identified, its pathophysiology is still not completely understood. Autoantibodies activating endothelin-1 receptors type A (ETAR-AAs) exert their detrimental effects through vasoconstriction, fibrosis, and inflammation. Interestingly, all these factors are also involved in NR. Hypothesis: We hypothesized that, after reopening of the epicardial coronary artery, the preexistence of ETAR-AAs might have detrimental effects on coronary microcirculation, resulting in microvascular obstruction (MVO) and, thus, NR. Methods: Our prospective study was conducted at Padua University Hospital between January 2022 and December 2022. Consecutive patients with STEMI who underwent PPCI within 6 h after the onset of symptoms were enrolled. Blood samples were obtained from all patients within 12 hours after the admission for ETAR-AAs level measurement. MVO was assessed by cardiac magnetic resonance imaging, within 15 days after successful PPCI. The seropositive threshold was provided by the manufacturer (&gt;10 U/ml). Results: We recruited 50 patients with STEMI. MVO was observed in 24 patients (48%). ETAR-AAs were higher in patients with MVO (8.9 U/mL (interquartile range [IQR] 6.8-16.2 U/mL) vs. 5.7 U/mL [IQR 4.3-7.7 U/mL], p=0.002). The prevalence of MVO was higher in patients with ETAR-AAs seropositivity (72% vs. 38%, p=0.03). ETAR-AAs seropositivity was independently associated with MVO (OR 3.2, 95% CI 1.3-7.1; p=0.03). Conclusions: ETAR-AAs concentration are associated with MVO in STEMI patients. These findings set the stage for a better pathophysiological understanding of NR and may open new options in the management of myocardial infarction.
Abstract 15667: The Transvalvular Pressure Gradient to Valve Area Ratio: A Novel, Simple Doppler Echocardiographic Parameter to Adjudicate Low-Gradient Aortic Stenosis Severity
Authors: Sebastien Hecht, Mohamed-salah Annabi, Viktoria Stanova, Abdellaziz Dahou, Ian G Burwash, Matthias Koschutnik, Philipp Bartko, Jutta K Bergler-Klein, Julia MASCHERBAUER, Stefan Orwat, Helmut Baumgartner, Joao Cavalcante, Henrique Ribeiro, Josep Rodes-Cabau, Marie-Annick A Clavel, Philippe Pibarot
Journal: Circulation (2023)

Background: In patients with low-gradient (LG) aortic stenosis (AS), dobutamine stress echocardiography (DSE) or aortic valve calcium scoring (AVCS) by computed tomography is required to confirm AS severity and the indication for intervention. Hypothesis: We hypothesized that the mean transvalvular gradient to effective orifice area ratio (MG/EOA, in mmHg/cm 2 ) measured during rest echocardiography predicts true-severe AS (TSAS) and clinical outcomes in LG-AS patients. The present study aimed to assess the diagnostic accuracy and prognostic value of the MG/EOA ratio in LG-AS patients. Methods: The diagnostic accuracy of the MG/EOA ratio to predict TSAS was assessed in: i) an in vitro dataset obtained in a circulatory model, and ii) an in vivo dataset collected in 198 patients recruited in the prospective observational cohort TOPAS study (NCT01835028), using receiver operating characteristic (ROC) curve analysis. The prognostic value of this parameter was assessed using spline curve analysis and multivariate Cox regression, using a composite of aortic valve replacement or all-cause mortality at 2-years as clinical endpoint. Results: The MG/EOA ratio at rest predicted TSAS with an area under the ROC curve of 0.99 [0.98-1.00] in the in vitro dataset and 0.92 [0.87-0.95] in the in vivo dataset of LG-AS patients. In the in vivo dataset predominantly composed of patients with a low flow state, the optimal cut-off of MG/EOA ratio was 29 mmHg/cm 2 with a normal flow state (percentage of correct classification: 95%) and 25 mmHg/cm 2 with a low flow state (85%). In LG-AS patients, a MG/EOA ratio ≥ 23 mmHg/cm 2 was associated with increased risk of the composite endpoint (unadjusted HR=2.16 [1.58-3.06], p&lt;0.001; adjusted HR=2.80 [1.94-4.03], p&lt;0.001). The net reclassification index (NRI) of the resting parameter MG/EOA was 0.57 (p&lt;0.001), which was similar to projected EOA (NRI=0.61, p&lt;0.001) measured by DSE. Conclusion: We propose a new, easily obtainable parameter from standard echocardiography that outperforms other rest echocardiographic parameters and is non-inferior to DSE with respect to diagnostic accuracy and prognostic value. The MG/EOA ratio can be useful in LG-AS to confirm AS severity and may thus avoid the use of additional tests such as DSE or AVCS.
Abstract 14603: Post-Myocardial Infarction Secondary Mitral Regurgitation Elevates Circumferential Strain in the Remote Zone and Contractile Dyssynchronicity in a Swine Model
Authors: Yuta Kikuchi, Daisuke Onohara, Michael Silverman, Chase King, Stephanie Tom, Riya Govin, Robert A Guyton, Muralidhar Padala
Journal: Circulation (2023)

Introduction: Post-myocardial infarction (MI) secondary mitral regurgitation (SMR) worsens left ventricular function and mortality, due to the volume overload it imposes on the ventricle. In this study, we sought to investigate the effects of the volume load from SMR on regional myocardial mechanics and dyssynchrony. Methods: Ten Yorkshire swine were induced with MI by occluding the left circumflex branch. Cardiac MRI and PV loop were performed at baseline (prior to MI), and at termination (3 months after MI). SMR was quantified using epicardial echo. Pigs were divided into 2 groups: no/mild MR (nmMR, n=4) and moderate/severe MR (msMR, n=6). MRI images were analyzed to measure infarction size, end-diastolic (EDV) and end-systolic volume (ESV), circumferential strain (CS), and standard deviation of time to peak of CS as systolic dyssynchrony index (SDI) to evaluate the dyssynchrony. The myocardial region was divided into the infarction, border, and remote zone, based on the LCx-supplied region (Fig. A and B1) . Results: There were no differences in infarction size between the two groups. The changes (Δ) of EDV and ESV from baseline to 3M were greater in msMR compared to nmMR (63.8±24.6mL vs 33.5±9.2 mL, p&lt;0.05, and 48.1±18.9 mL vs 23.0±4.9 mL, p&lt;0.05, respectively) (Fig. B) . Group-wise comparison of CS between baseline and 3M for each zone demonstrated that CS in the infarction zone decreased in both groups. However, CS in the remote zone was elevated at 3M only in msMR (-12.07±3.65 % vs -16.36±3.07 %, p&lt;0.01) and there was a strong correlation between EDV and CS in the remote zone (Pearson r=-0.6614, p=0.01) (Fig. C) . Also, SDI of CS was significantly elevated at 3M in msMR (0.09741 vs 0.1255, p=0.015) (Fig. D) . Conclusions: Elevated CS in the remote zone and dyssynchrony due to volume load could impair LV function, potentially increasing oxygen demand and reducing pumping efficiency.
Abstract 14474: Racial Disparities in Arrhythmias Among Patients With Cardiac Sarcoidosis in the United States From 2016-2020
Authors: Azeem Hassan, Kamleshun Ramphul, Raheel Ahmed, Ali Hasan, Muzammil Farhan, Hasan Ahmad, Joseph Okafor, Caleb Carver, Ayesha Jadoon, Khadija Amanullah, Sebastian Mactaggart, Yumna Jamil, Maham Bilal, Sajeel Ahmed, Rahat A Memon, Hemamalini Sakthivel
Journal: Circulation (2023)

Background: Cardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. Methods: Caucasian and African American (AA) patients with a diagnosis of CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: A total of 8825 patients with cardiac sarcoidosis comprising 44.1% Caucasian and 45.8% AA patients were included. Both cohorts had a male preponderance (Caucasian males: 64.3% vs. AA males 55.2%, p&lt;0.01). AA patients had a longer mean length of stay (7.74 vs. 6.64 days, p&lt;0.01), a higher mean Charlson Comorbidity Index score (3.36 vs. 2.63, p&lt;0.01), a greater prevalence of cirrhosis (3.2% vs. 2.1%, p&lt;0.01), diabetes (44.7% vs. 31.2%, p&lt;0.01), alcohol abuse (4.0% vs. 2.2%, p&lt;0.01), smoking (37.4% vs. 26.8%, p&lt;0.01), obesity (31.1% vs. 27.9%, p&lt;0.01) and chronic kidney disease (40% vs. 28.1%, p&lt;0.01). Caucasian patients had a greater history of hypertension (17.1% vs. 14.5%, p&lt;0.01) and prior percutaneous coronary intervention (6.2% vs. 3.1%, p&lt;0.01). Moreover, AA patients had a lower incidence of various cardiac arrhythmias (vs. Caucasians) such as atrial fibrillation (31.3% vs. 36.2% vs, p&lt;0.01), ventricular tachycardia (29.8% vs. 37.9% p&lt;0.01), ventricular fibrillation (5.3% vs. 7.2%, p&lt;0.01) and complete atrioventricular block (AVB) (6.4% vs. 14.6%, p&lt;0.01). However, a higher incidence of complications such as cardiogenic shock, acute kidney injury and death were reported among AA patients (Table 1). Conclusion: Our study demonstrates a higher incidence of cardiac arrhythmias among Caucasian patients but higher complications and mortality among AA patients with cardiac sarcoidosis. Keywords: Cardiac sarcoidosis, arrhythmias, racial disparities.
Abstract 18001: Coronary Artery Vasospasm Secondary to Capecitabine: A Case Report
Authors: Miguel Mejia Morales, Praful Maroo
Journal: Circulation (2023)

Case Description: A 49-year-old male with recent diagnosis of rectal cancer presented to ED for chest tightness, which had never experienced before. He had started Capecitabine for chemotherapy three days before. The patient had no history of CV disease or risk factors, was a never smoker and never used illicit substances. He is a SWAT/police officer who runs an 8-minute mile every morning without problems. In ED, was initially chest pain free. ECG with 1 mm ST segment depressions in V1 - V3. Five hours later, developed chest tightness again, and ECG revealed diffuse ST-elevations. Was started on nitroglycerin drip and admitted for monitoring. His chest tightness and ST segment elevations resolved completely. High-sensitivity troponin T was initially 37, and down trended to 27 over 4 hours. He was transitioned to long-acting Nifedipine. The chest tightness did not recur and was discharged with discontinuation of Capecitabine. Outpatient CTA of coronary arteries and echocardiogram were normal. A diagnosis of coronary artery vasospasm secondary to Capecitabine was confirmed. Discussion: Coronary artery vasospasm is the most common cardiotoxic effect of Capecitabine. It happens more frequently during the first three doses and can occur in patients with no hx of CV risk factors. The management consists of discontinuation of the medication. Long-acting CCB can be used for prevention. CTA of coronaries can be used to assess patients at low-to-intermediate risk of CAD.