tbuckley/cabot-search huggingface dataset:
Abstract 18037: Left Bundle Branch Area versus Biventricular Pacing in Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis
Authors: Andre Rivera, Douglas Mesadri Gewehr, Barbara Nascimento, Vinicius M Oliveira, Antonio da Silva Menezes Junior
Journal: Circulation (2023)

Introduction: Cardiac resynchronization therapy (CRT) through biventricular pacing (BVP) is the standard treatment for heart failure with reduced ejection fraction (HFrEF) and left bundle-branch block (LBBB). Left bundle-branch area pacing (LBBAP) has emerged as a potentially more effective approach. However, its superiority over BVP remains unclear. Hypothesis: Is LBBAP more effective and safer than BVP for CRT in patients with HFrEF? Methods: We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) or observational studies that reported adjusted effect estimates (i.e propensity score-matched populations or multivariate analysis), comparing the efficacy and safety of LBBAP versus BVP. We applied the random-effects model to calculate adjusted hazard ratio (aHR) and mean difference (aMD), with the corresponding 95% confidence interval. Heterogeneity was assessed using I 2 statistics. Statistical analysis was performed using R version 4.2.1. Results: Our analysis included 7 studies, yielding 2,743 patients, of whom 1,164 (42.4%) were assigned to LBBAP group. Compared with BVP, LBBAP was associated with a significant reduction of the composite of overall mortality and heart failure hospitalizations (aHR 0.67; 95% CI 0.56-0.80; I 2 =0%; p&lt;0.001; Figure 1A). Additionally, LBBAP demonstrated a significant increase in LVEF (aMD 5.77%; 95% CI 2.94-8.60; I 2 =68%; p&lt;0.001; Figure 1B) and shortening of QRS duration (aMD -25.71 ms; 95% CI -35.87 to -15.55; I 2 =0%; p&lt;0.001; Figure 2A) compared with BVP. Sub-analysis of patients with LBBB also demonstrated a significant reduction of the composite of overall mortality and heart failure hospitalizations (aHR 0.64; 95% CI 0.49 to 0.85; I 2 =0%; p&lt;0.001; Figure 2B) in LBBAP. Conclusions: This meta-analysis of RCTs and multivariable adjusted studies suggests that LBBAP is superior to BVP in patients with HFrEF undergoing CRT for both electrophysiological and clinical outcomes.
Abstract 13783: Tissue Thickness is an Essential Factor of Higher Risk of Steam Pop During Bipolar Ablation - Ex-Vivo Assessment
Authors: Takafumi Okuyama, Hisaki Makimoto, Masashi Kamioka, Tomonori Watanabe, Hiroaki Watanabe, Ayako Yokota, Takahiro Komori, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
Journal: Circulation (2023)

Introduction/Backgrounds: For ventricular arrhythmias originating deep within the myocardium, bipolar ablation can be employed. However, there is currently no standardized strategy for bipolar ablation settings such as energy and ablation time. Hypothesis and Aims: We intended to test a hypothesis that the target tissue thickness may determine the optimal bipolar ablation settings of power and duration. Methods: Using porcine cardiac tissues ex-vivo ablation experiments were conducted. Each radiofrequency (RF) ablation catheter was placed on both sides of the myocardial slice at an angle of 45 degrees and 10g contact. We investigated the depth of ablation lesions and the occurrence of steam-pop under the multiple settings of myocardial tissue thickness, energy and ablation duration. Results: We analyzed in total 194 bipolar RF applications. For myocardial slices of 10-, 15- and 20-mm thickness, we performed 60-second RF ablation of 20, 30, 40 and 50W energy settings. No transmural lesion creation was noted on the 20-mm thickness tissues even by 50W RF energy ( Figure 1 ). Transmural lesion was observed with RF energy of 30W or more on the most of the 10-mm thickness tissues. Prolonged duration of 180 seconds with 30W or more accomplished the transmural lesion on the 15-mm thickness tissues. We observed steam-pop in 11 out of 194 applications (5.7%). Steam-pops were exclusively observed on the 10mm tissue with 30W or more. Conclusion: Our data showed that (1) transmural lesion creation for 10-mm tissue is feasible under 30W or more and 60 seconds bipolar ablation, (2) for thicker tissue even 50W application of 60 seconds may not generate transmural lesion, (3) prolonged RF duration enables transmural lesion for thicker tissues, (4) steam-pop can occur on thinner tissues under higher wattage. These results suggest that we should adapt the bipolar RF settings, particularly the power and duration depending on the target tissue thickness.
Abstract 18104: The Unexpected Disaster: Unusual Form of Left Ventricular Rupture
Authors: Huthaifah Aburumman, Ahmed Abdallah, Mohammad Alshami, jeetendra patel
Journal: Circulation (2023)

Description: We present a 73-year-old female, who presented with NSTEMI. EKG showed ST depression in the inferior and anterior leads. Initial Troponin I was high (0.17 ng/mL). She received nitroglycerine with no relief of her pain, so she underwent an emergent left heart catheterization (LHC). The LHC showed two tandem 90% stenosis in the right coronary artery (RCA) and mild disease in the left anterior descending (LAD) and left circumflex (LCx) arteries. PCI to the RCA was successful. She was started on a high-intensity statin, carvedilol, dual antiplatelet therapy, and losartan. On the day after PCI, an echocardiogram showed preserved ejection fraction with no evidence of pericardial effusion. The patient was doing well until 2 days after the PCI when she was found obtunded and hypotensive. She received normal saline bolus, epinephrine, and norepinephrine, after which she improved. A bedside echocardiogram revealed evidence of pericardial effusion with tamponade physiology and a pericardial clot. The patient and her family declined further interventions and elected to proceed with comfort measures. Discussion: Mechanical complications of acute myocardial ischemia (AMI) have substantially decreased in numbers after the implication of early reperfusion therapies, but they remain fatal if not recognized early and treated. Free wall rupture (FWR) usually occurs in the first 7 days following an AMI, with an average of 2.6 days. FWR mostly happens after infarction of the LAD or LCx territories. In our case, there was no delay in reperfusion therapy and there was no evidence of infarction on the echocardiogram however the patient developed FWR as a complication and in a timeline earlier than average making this case unique.
Abstract 13299: Are There Differences in Left Ventricular and Aortic Pressures Measured With Fluid-Filled and Solid-State Pressure Catheters
Authors: Priscilla Machado, Ira S Cohen, Brian Osler, Maureen McDonald, Cara Esposito, Marguerite Davis, David L Fischman, Michael P Savage, Praveen Mehrotra, Flemming Forsberg, Jaydev K Dave
Journal: Circulation (2023)

Purpose: To compare left-ventricular and aortic pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization. Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. During catheterization, left-ventricular (LV) and aortic (AO) pressures were obtained using a fluid-filled pressure catheter (standard-of-care) and a high-fidelity solid-state pressure catheter synchronously. The pressure tracings were analyzed by two independent readers to measure LV systolic (LVSP), LV minimum diastolic (LVMDP), LV end diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Derivatives of the pressure waveforms were computed to estimate the isovolumic contraction and relaxation rates (peak ± dp/dt). The measurements were made over multiple cardiac cycles and averaged results were used for comparisons using repeated measures analysis of variance, post-hoc tests with Bonferroni corrections and Bland-Altman plots. Results: A significant main effect of the pressure catheter was noted for LVSP, LVMDP and AOSP (p &lt; 0.025). The LVSP and AOSP measured with fluid-filled pressure catheters were higher by 6.6 ± 6.9 mmHg and 4.6 ± 5.2 mmHg in comparison to the high-fidelity solid-state pressure catheter assessments. In contrast, the LVMDP measurements were 3.5 ± 5.7 mmHg lower than the solid-state pressure catheter measurements. When evaluating the differences between readers, the maximum difference was noted for LVEDP measurements (3.1 ± 2.4 mmHg; p ≤ 0.001). The differences in isovolumic contraction rate (66.4 ± 116.0 mmHg/s) and relaxation rate (60.5 ± 113.5 mmHg/s) were not significantly different between the two catheter systems after Bonferroni corrections for multiple comparisons (p &gt; 0.06). Bland-Altman analysis revealed a bias ranging from 0.8 to 6.6 mmHg for all the pressure measurements. Conclusions: There are differences in LVSP, LVMDP, and AOSP measured using fluid-filled and high-fidelity solid-state pressure catheters. Clinicians should be aware that the fluid-filled catheters commonly overestimate the true systolic pressures in the left ventricle and aorta.
Abstract 17742: Anterior Papillary Muscle Rupture After a Motor Vehicle Collision: A Rare Case of Torrential Tricuspid Regurgitation After Blunt Cardiac Injury
Authors: Deepika Potarazu, Syed Peer, paula ferrada
Journal: Circulation (2023)

Introduction: Blunt cardiac injury is difficult to diagnose in the setting of polytrauma. Here we present a rare case of a torrential tricuspid regurgitation from a ruptured anterior papillary muscle after a motor vehicle collision (MVC). Case: A 55-year-old male presented to the ED after an MVC. He was hemodynamically unstable and hypoxic en route complaining of severe chest and left leg pain. Imaging demonstrated multiple rib fractures, a left acetabular fracture, and left open distal femur fracture. EKG identified atrial fibrillation with RVR and nonspecific ST changes. Labs were significant for leukocytosis and a troponin elevation to 11.98 concerning for blunt cardiac injury. A TTE demonstrated a mobile density in the RA and RV consistent with papillary muscle rupture and severe tricuspid regurgitation. An underfilled left ventricle compressed by the right heart and dilated RV were noted with septal flattening consistent with RV pressure and volume overload. Cardiothoracic surgery was consulted and recommended delayed tricuspid valve repair after other acute injuries were addressed considering the need for full anticoagulation. While in the ICU, his orthopedic injuries were addressed though his hemodynamics were complicated by frequent orthopedic interventions requiring blood transfusions. He later underwent TV replacement and it was found that the anterior papillary muscle was ruptured at its base without leaflet perforation. One week post-operatively the patient suffered a hypoxic PEA arrest. The shock team was consulted and he underwent bedside ECMO cannulation with impella placement for LV failure. After ten days on ECMO he was decannulated. Ultimately, the patient recovered well and was discharged to acute rehab. Discussion: MVCs are a leading cause of traumatic tricuspid insufficiency. However, this life-threatening condition may go undetected due polytrauma and the presence of coexisting distracting injuries. Guidelines are needed for the specific management of traumatic tricuspid regurgitation and associated right heart dysfunction. Additionally, the need for multiple surgical interventions can preclude anticoagulation which is a unique barrier to urgent valve replacement in these patients.
Abstract 14381: A Novel Non-Invasive Screening Device for Aortic Stenosis
Authors: Serge C Harb, Joseph Kassab, Patrick H Collier, Richard A Grimm, Jay Ramchand, Samir R Kapadia
Journal: Circulation (2023)

Introduction: Severe AS is a significant health concern in the elderly population, and a large proportion of asymptomatic cases are not receiving appropriate care. Early intervention is associated with a significant reduction in long-term mortality making early diagnosis and intervention crucial. Hypothesis: Recent progress in non-invasive (NI) hemodynamic measurements and AI has prompted the exploration of NI screening tools for AS. The ClearSight® system (Edwards) is a NI monitoring device using a finger cuff for continuous hemodynamic assessment. This study aims to evaluate its accuracy as a severe AS screening tool. Methods: 7,000 consecutive patients referred for TTE were enrolled prospectively, between 12/2020 and 04/2022 and underwent concomitant non-invasive hemodynamic monitoring using the ClearSight ® system. Complete data were obtained on 6,858 patients. The development cohort consisted of 5,334 patients, whereby an AI system was trained to interpret the data obtained from the device with the TTE data serving as the gold standard for diagnosis of severe AS. After the development phase, 1,036 patients were included in the validation cohort, whereby the trained AI system used the data obtained from the device to predict the presence of severe AS. Results: Severe AS was confirmed by TTE in 54 patients. Based on the optimal threshold (ROC curve), the sensitivity for detecting severe AS in patients without other VHD was 87%, with a NPV of 98.1%, and a specificity of 80%. When including all patients, with and without concomitant non-aortic VHD, the sensitivity remained at 87% for the same threshold, with a similarly very high NPV at 98.9%, while the specificity decreased to 70.7%. Conclusions: The ClearSight ® system, a finger-cuff NI hemodynamic monitoring tool, serves as an excellent screening test for the early detection of severe AS, with high sensitivity and specificity, and a very high NPV in a large cohort of patients consecutively referred to a TTE laboratory.
Abstract 16043: Impact of Left Ventricular Global Longitudinal Strain on the Outcomes of Patients With Moderate Aortic Stenosis and Moderate Aortic Insufficiency
Authors: Maharshi Raval, Akhil Jain, Vidit Majmundar, Rupak Desai, Sajid Siddiq
Journal: Circulation (2023)

Background: Reduced left ventricular global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis (AS). Its role in predicting outcomes in moderate AS is now being reported. We aim to investigate the prognostic value of GLS in patients with moderate AS and moderate aortic insufficiency (AI). Methods: We conducted a retrospective review of 1576 patients with a diagnosis of AS and AI at a community cardiology practice. We reviewed the echocardiographic data and included 254 patients with moderate AS and moderate AI. They were retrospectively followed for 1 year from the time they initially had the echocardiography findings to note the occurrence of shortness of breath (SOB), heart failure (HF) hospitalization, or mortality during the 1 year period. Results: Out of the 254 patients that were studied, 121 patients (47.64%) had GLS ≤16%. Demographics and comorbidities such as age, sex, hypertension, diabetes mellitus (DM), obesity, and atrial fibrillation were balanced in both arms. Patients with GLS ≤16% had significantly higher SOB (50.41% vs. 32.33%, p=0.003) and HF hospitalization (17.36% vs. 9.02%, p=0.049) during 1-year follow-up. 1-year mortality was higher in GLS ≤16% arm but not statistically significant (5.79% vs. 1.5%, p=0.065). After adjusting for patient characteristics using logistic regression, GLS ≤16% was independently associated with higher odds of SOB (aOR 2.139, 95CI 1.28-3.59, p=0.004) but not for HF hospitalization (aOR 2.022, 95CI 0.94-4.35, p=0.072) and 1-year mortality (aOR 4.165, 95CI 0.78-22.12, p=0.094). Conclusions: GLS ≤16% is associated with an increased likelihood of SOB in patients with moderate AS and moderate AI. HF hospitalization and 1-year mortality were not statistically significant, but there is a clear trend towards worse outcomes in patients with GLS ≤16%. If future studies reproduce similar results and outcomes, it may be time to rethink the timing of aortic valve intervention.
Abstract 17236: Risk of Incident Atrial Fibrillation Associated With Recreational Cannabis Use
Authors: Justin T Teraoka, Janet J Tang, Francesca N Delling, Eric Vittinghoff, Gregory M Marcus
Journal: Circulation (2023)

Background: Cannabis use is increasing worldwide as legalization becomes more common. Prior studies have reported an association between cannabis use and increased risk of atrial fibrillation (AF). However, these have been cross-sectional and generally relied on diagnostic coding to identify cannabis users, which may not be representative of the typical recreational cannabis user. Goals: To examine the association between recreational cannabis use and AF risk. Methods: We utilized the UK Biobank, a prospective cohort study with serial assessments of lifestyle and medical diagnoses. Those who completed the cannabis use questionnaire and without prevalent AF were analyzed. Cannabis exposure was ascertained by self-reported lifetime use. AF events were identified using healthcare coding. Cox proportional hazard regression models were used to estimate the hazard ratios between the cannabis use groups and incident AF. Models were adjusted for age, sex, race, alcohol, coffee, smoking, education, and baseline cardiovascular comorbidities. Results: 157,305 participants (mean age 55.9 ± 7.7 years, 57.0% female, and 22.1% having used cannabis at least once) were followed for a mean 13.5 ± 1.7 years. Before multivariable adjustment, AF risk was found to be lower among occasional cannabis users (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.66 to 0.75, p &lt; 0.001) and frequent cannabis users (HR 0.63, 95% CI 0.53 to 0.75, p &lt; 0.001) compared to never users. However, after multivariable adjustment and compared to no cannabis use, neither occasional nor frequent cannabis use was associated with statistically significant differences in incident AF (HR 0.98, 95% CI 0.91 to 1.05, p = 0.58 and HR 0.98, 95% CI 0.82 to 1.18, p = 0.86 respectively) (Figure). Conclusions: Contrary to previous evidence relying on healthcare coding of cannabis use, this large prospective cohort study failed to reveal any evidence that cannabis use was associated with an increased risk of AF.
Abstract 14315: Does Gender Moderate the Effect of Virtual Cognitive Behavioral Therapy Interventions on Depressive Symptoms in Rural Cardiac Patients? Preliminary Analysis of the Combat Study
Authors: Jessica H Thompson, Misook L Chung, Frances J Feltner, Gia Mudd Martin, Martha J Biddle, Jennifer Miller, Mary Kay Rayens, Terry Lennie, Jia Rong Wu, Chizimuzo Okoli, Mary Beth Fisher, Debra K Moser
Journal: Circulation (2023)

Background: Depressive symptoms are common in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) can effectively improve depressive symptoms in patients with CHD and HF, however, traditional CBT is not accessible to most rural individuals, and some, particularly males, may be reluctant to participate in traditional CBT even if available. Therefore, we developed and tested two types of virtual CBT, video conferences with a therapist (vCBT) and self-directed CBT (iCBT). Aim: To determine whether gender moderated the effect of vcCBT or iCBT interventions on depressive symptoms in rural people with CHD and HF. Methods: This is a preliminary analysis of 4-month outcomes in an ongoing 12-month randomized comparative effectiveness trial. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). Gender was self-identified. Participants with at least mild depressive symptoms were enrolled. Participants were randomly assigned to either a 6-8 week vcCBT or iCBT without a face-to-face therapist. Repeated measures ANOVA was performed to determine whether gender interacted with either intervention to produce an effect on depressive symptoms at 4-months compared with baseline. Results: Participants (N=143) were on average 57 years old, 51% female, and 99.3 % non-Hispanic. At baseline, mean PHQ-9 score for males was 10 ± 5 and 12 ± 5 for females (p-value=0.002). Both intervention groups had a significant decrease in depressive symptoms over time (p&lt;0.001 for group by time interaction). There was no between-group difference in improvement of depressive symptoms (p=0.415). There was no moderating interaction of gender by intervention group on depressive symptoms (p=0.502). Conclusion: Both interventions resulted in a significant decrease in depressive symptoms. The lack of a gender moderating effect demonstrates that both interventions were equally effective in males and females.
Abstract 15757: Racial Disparities in Acute Respiratory Failure Incidence During Hypertensive Emergencies
Authors: Minji Seok, Amer Muhyieddeen, Martha Gulati
Journal: Circulation (2023)

Introduction: One of the most frequent complications of hypertensive emergency is pulmonary edema, which can ultimately lead to requiring mechanical ventilation because of respiratory failure. Additionally, epidemiologic studies have observed that certain races are disproportionately affected by hypertensive emergency. This analysis aimed to assess if race was also associated with increased likelihood of requiring mechanical ventilation during hypertensive emergencies. Methods: Using the 2020 National Inpatient Sample data, we identified patients admitted due to hypertensive emergencies. We excluded admissions for primary acute hypoxic respiratory failure necessitating invasive mechanical ventilation. To explore potential relationships, we employed logistic and linear regression analyses, accounting for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was &lt;0.05. Results: In 2020, among 1,221,535 hypertensive emergency hospital admissions, 124,200 (10.2%) involved patients needing mechanical ventilation due to respiratory failure. After adjusting for factors such as age, gender, hospital attributes, insurance, income, and Elixhauser comorbidities, Black and Asian/Pacific Islander patients exhibited higher likelihoods of requiring mechanical ventilation due to respiratory failure. Compared to White patients, the adjusted odds ratios were 1.06 (95% CI 1.05-1.12) for Black patients and 1.18 (95% CI 1.06-1.32) for Asian/Pacific Islander patients. Conclusions: We have demonstrated that there are racial disparities associated with development of acute hypoxic respiratory failure in the setting of hypertensive emergencies. Further research needs to be undertaken to identify if these racial differences are due to differences in blood pressure control or if clinical management differs by race in the acute hospitalization contributing to adverse outcomes.