tbuckley/cabot-search huggingface dataset:
Abstract 18973: Regional Differences in Optimization of Medical Therapy for Heart Failure With Reduced Ejection Fraction: Data From the HF-OPT Trial (Heart Failure Optimization Trial)
Authors: Stefan Winter, Byron Colley, Michael Doering, David Duncker, Siva Gummadi, Christian Perings, Orvar Jonsson, Lars Maier, Michael Robertson, Robert Sanchez, Thomas Wittlinger, Christian Veltmann
Journal: Circulation (2023)

Background: Society guidelines for the optimization of guideline-directed medical therapy (GDMT) in patients with heart failure (HF) are almost identical between the United States (US) and Europe (EU). While GDMT has helped to improve survival and reduce HF hospitalization in this population, the initiation as well as titration to target doses shown to be safe and effective in clinical trials has been suboptimal. Purpose: The objective of this analysis was to assess regional differences in GDMT prescription in the United States (US) vs. Europe (EU) between 2017 and 2022.Methods: Medication data from patients (pts) with newly diagnosed heart failure with reduced ejection fraction (HFrEF) during wearable cardioverter-defibrillator use was collected from 487 pts (54% from US, 72% male, age 59±13 years). Target dose of GDMT was defined as the lowest maximum dose from either the ESC or ACC/AHA/HFSA guidelines. ACE-I/ARB/ARNI (AAA), beta blockers (BB), and mineralocorticoid receptor antagonists (MRA), were the main GDMT options for HFrEF patients at the time of HF-OPT. Association between medication with region and gender were assessed using logistic regression. Results: Compared to patients in the US, EU (Germany, Austria, France) pts were significantly more likely to receive ACE-I/ARB/ARNI and MRA and to achieve target doses by 90 and 180 days (p&lt;0.01). Interestingly, ARNI prescription rates did not differ between US and EU (39% and 47%, p=0.09) by 180 days, although target doses were more likely to be reached in the EU by 180 days (23% vs. 12%, p&lt;0.01). In contrast, rates of BB use and achieving target doses did not differ between regions (Figure). Finally, pts in the EU were more likely to receive all three medication classes by 180 days (80% vs 42%, p&lt;0.001), and more likely to be prescribed target doses of all three medications (12% vs. 7%, p&lt;0.05). After adjusting for region, there was no difference in gender for day 90 and 180 prescriptions and target doses for BB, AAA, and MRA.Conclusions: Adherence to GDMT was superior in the EU compared to the US with regards to ACE-I/ARB/ARNI and MRA. There was no difference in BB use between regions. Target dosage rates, however, were overall low in both regions.
Abstract 13336: Myocardial Protection of Chitosan Cardiac Muscle Patch in Myocardial Infarcted Mice
Authors: Kun Xiang, Huatao Zhou, Weijie Tang, Zhi Tu, Zilong Zheng, Yichen Li, Jinfu Yang, Chengming Fan
Journal: Circulation (2023)

Background: Poor grafted rate of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) via direct injection into the myocardium limits the efficacy of cardiac repair after myocardial infarction (MI). Chitosan-based scaffolds has regarded as functional biomaterial for designing delivery systems in cardiac therapies. This study aimed to enhancing the potency of cardiac repair with the hiPSC-CMs loaded chitosan cardiac patch (hCCMP). Methods: The patches were fabricated with chitosan. Characterization of the chitosan patches was evaluated through the detection of swelling rate and porosity. Biocompatibility of the hiPSC-CMs loaded patches was analysed by scanning electron microscope (SEM) and CCK8 assay. The mice were randomly divided into 4 groups (n=10 for each). Animals underwent MI-inductive surgery followed by epicardium implantation of hCCMP or Empty-patch (without hiPSC-CMs); Sham and MI mice without further intervention were set as control. 4 weeks after MI, heart function was measured via echocardiography. Engraftment was evaluated with human cardiac troponin T staining. Infarction size, left ventricular anterior wall thickness, cardiac remodeling, angiogenesis, arterialization and apoptosis was detected via immunofluorescence in infarcted boder area. Results: SEM showed that the chitosan patch had regular pore size and good 3D structure; porosity was about (96.7±0.37)%. On day3, the patch swelling rate was about (715±64.55)%. SEM, CCK8 assay showed a normal cells growth in the chitosan patch. The hiPSC-CMs grafted well with chitosan patch delivery systems and was associated with significantly improvement in LV heart function, infarction size, LV anterior wall thickness, cardiac remodeling, angiogenesis and cardiomyocyte apoptosis 4 weeks after MI. Conclusions: The 3D chitosan cardiac patch with hiPSC-CMs loaded can enhance the potency of cardiac repair after MI and present a novel and promising therapic strategy.
Abstract 16830: Feasibility and Safety of Intracardiac Echocardiography Guidance in Mitral Transcatheter Edge-to-Edge Repair: Analysis of the National Inpatient Sample Data From 2015 to 2020
Authors: Amani Khalouf, Anas Hashem, Ankit Aggarwal, Mohamed Salah Mohamed, Anthony H Kashou, Rody Bou Chaaya, Devesh Rai, Stephen H Little, Srihari S Naidu, Sachin S Goel
Journal: Circulation (2023)

Introduction: Data on use of ICE guidance in TEER procedure is limited to case reports and small case series. Our study aims to assess the feasibility, safety, utilization patterns and clinical outcomes of mitral TEER procedure with ICE guidance using a nationally representative real-world cohort of patients.Hypothesis: There is no difference between ICE-guided TEER and TEE-guided TEER in the clinical outcomes and complications. Methods: This study used the National Inpatient Sample database from quarter 4 of 2015 to 2020. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of &lt;0.05 was considered significant. Results: A total of 38,770 weighted cases of mitral TEER were identified. Of the included patients 665 patients underwent ICE-guided TEER while 38,105 had TEE-guided TEER. There were no differences in the in-hospital mortality between both groups (2.5% vs. 3.0%, p=0.58). Adjusted odds of in-hospital mortality (aOR 0.83, 95%CI [0.42-1.64]) were not significantly different. There were no differences in periprocedural complications including cardiac (aOR 0.85, 95%CI [0.54-1.35]), bleeding (aOR 1.45, 95%CI [0.93-2.33]), respiratory (aOR 0.88, 95%CI [0.61-1.25]), and renal (aOR 0.89, 95%CI [0.66-1.20]) complications between patients undergoing ICE-guided versus TEE-guided TEER. There was no difference in GI complications between both groups (aOR 1.11, 95%CI [0.46-2.70]). The adjusted length of stay was less among ICE-guided TEER (median: 1 vs. 2, p&lt;0.01) with no differences in costs of hospitalization ($137,312 vs. $153,773, p=0.06), Conclusions: In conclusion, ICE-guided mitral TEER is safe when compared with TEE guided TEER with no significant differences in in-hospital mortality, cardiac, bleeding, respiratory, and renal complications. The length of stay in ICE group is shorter as compared with the TEE group.
Abstract 14589: Impairment of Endothelial Function by Chronic Cannabis Use: An Interim Analysis of the CANDIDE Study
Authors: Leila Mohammadi, Mina Navabzadeh, Daniel D Han, Emma Reagan, Jordan Naughton, Lylybell Zhou, Rahul Almeida, Kathryn Park, Keith Uyemura, Natasha Goyal, Poonam Rao, Judith Hellman, Jing Cheng, Gregory M Marcus, Matthew L Springer
Journal: Circulation (2023)

Background: Increasing cannabis legalization has led to a surge in cannabis use. To understand the consequences for cardiovascular health, we have initiated the CANnabis: Does It Damage Endothelium (CANDIDE) study. Here, we report results of an interim analysis. Aims: To investigate the effects of chronic cannabis product use on endothelial function. Approach: We recruited 44 healthy non-tobacco smokers/vapers, 21-50 yrs, in 3 groups based on chronic cannabis use: cannabis smokers, THC edible users, and nonusers. Participants underwent assessment of brachial artery flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (PWV). Human umbilical vein endothelial cells (ECs) were exposed to sera from each individual with and without VEGF to determine serum effects on endothelial NO production. Human lung microvascular ECs were also exposed to the individual sera and cell permeability was measured by electric cell-substrate impedance sensing. Results: FMD and VEGF-stimulated NO levels were both significantly lower in cannabis smokers than nonusers (5.7±3.3% vs 12.0±8.0%, p=.037, and 1.1±0.3 nM vs 1.5±0.3 nM, p=.018, respectively; figure), comparable effects to what we have reported for tobacco smokers. In contrast, FMD, but not VEGF-stimulated NO levels, was lower in the THC edible users than nonusers (5.0±4.1% vs 12.0±8.0%, p=.031, and 1.6±0.3 nM vs 1.5±0.3 nM, p=.54). There were no significant differences in other functional properties (p&gt;.48). CD31 and IL-1β, which are circulating inflammatory biomarkers that we showed are elevated in tobacco smokers, were not elevated in cannabis smokers. The inflammatory biomarker PTX3 was lower in cannabis smokers than nonusers (p=.038). Conclusion: Chronic cannabis use impairs endothelial function but may reduce inflammation. Our findings suggest that the impairment caused by smoking cannabis vs edible THC use occurs via distinct mechanisms differing in the involvement of endothelial NO production.
Abstract 18336: Accuracy of Antiarrhythmic Drug Dosing Using a Computer-Guided Decision Tree Model
Authors: Rachita Navara, Riya Ravuri, Jasneet Devgun, RAJ KUMAR, Ecem Ozkan, Bishow M Paudel, Daniel Lucy, Esha Ananth, Sheth Sujay, Maria Dopierala, Devon Chen, Aditi Pallod, Babikir Kheiri, Katherine Malcolm, Ramkumar Venkateswaran, Alejandro Alvarez Martinez, Rania DeLeon, John Higgins, Kunj G Patel
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) is the most common heart rhythm disorder and often requires inpatient monitoring for antiarrhythmic drug (AAD) initiation, specifically for dofetilide and sotalol. No system currently offers safe at-home AAD initiation, which is needed to expand AAD access for low-risk or underserved patients and reduce mortality. Objective: Assess accuracy of AAD dosing using a computer-guided decision tree algorithm compared to physician dosing decisions. Methods: Patients in an all-comer population were instructed to take a mobile ECG (mECG; KardiaMobile 6L, AliveCor). A proprietary ML algorithm (SafeBeat Rx) interpreted QTc for each mECG and recommended a starting dose for each AAD (dofetilide and sotalol), per drug labeling. For sotalol, an initial dose of 80 mg was recommended if QTc ≤ 450 ms and HR &gt; 60 bpm; if baseline ECG criteria were unmet, 0 mg was recommended. For dofetilide, initial 500 mcg dose was recommended if QTc ≤ 440 ms. For software simulation, creatinine clearance was assumed to be normal (&gt;60 mL/min) for all patients. Recommendations were adjusted based on a higher QTc threshold &gt;550 ms if the patient’s baseline ECG showed wide QRS (e.g. artificially paced, bundle branch block). The software recommendations were compared to the gold standard: dosing selected by 2 physicians manually measuring baseline mECG QTc and selecting a theoretical starting dose accordingly, independent from software-generated results. Results: 95 patients were enrolled (40% healthy, 30% outpatients, 30% inpatients). The algorithm was highly accurate in predicting starting dose; agreement with physicians was 94.68% for sotalol and 95.74% for dofetilide. Median heart rate was 84.8 bpm (SD = 17.5) and median QTc interval was 475.5 ms (SD = 106.4). Physicians chose the manufacturer-recommended full starting dose for 85% of patients for sotalol and 86% for dofetilide, compared with 86% for sotalol and 86% for dofetilide recommended by the software. Conclusion: The decision tree model had 95% agreement with physician dose recommendations, demonstrating that the algorithm can accurately guide patient-specific AAD dosing, which helps guide remote physician-directed initiation of AAD, ultimately expanding drug access for AF patients.
Abstract 14414: Association of Genetically Predicted Biomarkers of Iron Homeostasis and Cardiomyopathy Risk: A Two-Sample Mendelian Randomization Study
Authors: Hao Huang, Hua Wei
Journal: Circulation (2023)

Background: Observational studies produced inconsistent results of the association between iron status and cardiovascular diseases. Previous Mendelian randomization (MR) study prompted a protective effect of iron status in coronary heart disease. Aims: Using genetic instrumental variables, we evaluated how the risk of non-ischemic cardiomyopathy and its different phenotypes are affected by genetically predicted systemic iron status. Methods: Two-sample MR analyses were performed to estimate the causal effect of four biomarkers of systemic iron status on diagnosed cardiomyopathy and its subtypes in 242,607 participants from the FinnGen research project. Inverse-weighted method and multiple sensitivity analysis were conducted to confirm the results. Results: The level of transferrin saturation was significantly associated with an increased risk of cardiomyopathy (OR per SD, 1.17; 95% CI, 1.13-1.38) when using nine separately selected genetic instruments. Conservative estimates were obtained by pooling results across four mutual genetic variants (rs1800562, rs1799945, rs855791 and rs57659670). Accordingly, genetically determined serum iron (OR, 1.25; 95% CI, 1.13-1.38), ferritin (OR, 1.49; 95% CI, 1.02-2.18) and transferrin saturation (OR, 1.21; 95% CI, 1.04-1.39) were positively associated with cardiomyopathy risk, while total iron binding capacity, a marker of reduced iron status, was protective (OR, 0.80; 95% CI, 0.65-0.98). The risk effect of iron status was more evident in hypertrophic cardiomyopathy and related heart failure. Red blood cell traits, blood pressure and blood lipids were not mediated in the causal effect. Results were robust in all sensitivity analyses. Conclusions: These analyses support a causal effect of increased systemic iron status on higher risk of non-ischemic cardiomyopathy. Modulation of iron status may, therefore, directly influence cardiomyopathy risk.
Abstract 18255: Ventricular Fibrillation and Cardiac Arrest as Initial Presentation in Arrhythmogenic Cardiomyopathy
Authors: Muhammad Junaid Ahsan, Amman Yousaf, Manik Veer, AKRIVI MANOLA, Jennifer Goerbig-campbell
Journal: Circulation (2023)

Background: Arrhythmogenic cardiomyopathy (ACM) is a rare inherited condition, characterized by fibro-fatty remodeling, leading to ventricular dilation, dysfunction, and arrhythmogenesis. Case Summary: Herein, we present a 22-year-old male admitted with ventricular fibrillation and out-of-hospital cardiac arrest. He received 120 minutes of CPR and received six defibrillator shocks. EKG showed diffuse T-wave inversions in anterolateral leads and prolonged QT interval. Vasopressors and anti-arrhythmic were initiated. VA-ECMO was cannulated. Echocardiogram showed biventricular systolic dysfunction with LVEF of 20%. Next day he was extubated and ECMO was decannulated. His extensive workup including a viral panel was negative. cMRI showed recovery of biventricular function with imaging characteristics consistent with myocarditis. Genetic testing revealed a pathogenic variant of the desmoplakin (DSP) gene. DSP was positive in the sister and mother. For secondary prevention, a subcutaneous ICD was placed. He was discharged on Losartan and metoprolol succinate. The patient continues to do well on subsequent follow-ups. Decision-making: cMRI showed myocardial edema, pericardial enhancement and mid-myocardial late gadolinium enhancement pattern consistent with modified lake louise criteria. As cMRI was performed post-cardiac arrest, and his presentation included V.fib with clinical and biventricular function recovery, 48 hours post-presentation, the presentation was not consistent with myocarditis. Genetic testing was pursued which was positive for DSP. Discussion: Ventricular arrhythmias can be the initial presentation of ACM in young patients, predominantly involving left ventricle. Although cMRI presentations can be similar acutely, they should be differentiated from viral myocarditis. In young patients presenting with ventricular arrhythmias, ACM should be considered regardless of family history of arrhythmias or sudden deaths.
Abstract 18505: Cancer Therapy Induced Cardiotoxicity - A Look at Frailty
Authors: Emma Hanlon, Andrea Rosas, Jordan B Strom, Aarti Asnani
Journal: Circulation (2023)

Background: Malignancy and cardiovascular disease are leading causes of death in elderly adults. While assessments of functional status have long been used for decision-making regarding initiation of chemotherapy, less is known about the association between frailty and cardiotoxicity outcomes. Aims: To evaluate the association between claims-based frailty (using the Fried phenotypic definition) and heart failure and all-cause death in patients treated with anthracyclines. Hypothesis: An increased probability of frailty will be associated with an increased risk of heart failure after treatment with anthracyclines. Methods: We performed a single center retrospective analysis of Medicare Fee-for-Service beneficiaries (≥65 years) who received anthracycline chemotherapy. The Johns-Hopkins claims-based frailty index, based on the Fried frailty definition, was generated for all participants and divided into quartiles. Cox models, adjusted for the competing risk of death, were used to model time to heart failure hospitalization or death within 5 years of anthracycline receipt (both adjudicated on chart review). Results: A total of 312 patients (mean age 74 with range 65-94, 50% female) were included of which 35 (11.2%) individuals developed heart failure and 167 (54%) died over a median 476 (IQR 149.3-2074.5) days of follow-up. Increasing quartiles of frailty were not associated with heart failure (HR 1.77, 95% CI 0.51-6.21, p = 0.4 for highest frailty quartile), but were associated with death (HR 2.04, 95% CI 1.30-3.20, p = 0.002 for highest frailty quartile). However, the association with death was mitigated by adjustment for age, gender, coronary artery disease, hematopoietic stem cell transplant and leukemia (HR 1.91, 95% CI 0.93-3.97, p = 0.08 for highest frailty quartile). Conclusions: In this single center study at a large academic center, frailty was not associated with anthracycline-associated heart failure but identified individuals at higher risk of death. Future studies are needed to investigate frailty as a risk stratification tool.
Abstract 13157: Multivariable ECG Machine Learning is Superior to QRS Duration and Traditional ECG Criteria for Detecting Left Ventricular Hypertrophy in Patients With Left Bundle Branch Block
Authors: Ashley DeBauge, Christopher Harvey, Tyan Fairbank, Sagar Ranka, Sania Jiwani, Seth Sheldon, Madhu Reddy, Amit Noheria
Journal: Circulation (2023)

Introduction: The utility of ECG to diagnose left ventricular hypertrophy (LVH) in patients with left bundle branch block (LBBB) is limited. We sought to compare the diagnostic yield of ECG using (i) QRS duration, (ii) published LVH criteria, and (iii) machine learning (ML) models to detect increased left ventricular mass indexed (LVMi) in the setting of LBBB. Hypothesis: ML is superior to QRS duration and LVH criteria to detect LVH among LBBB. Methods: 12-lead ECGs were processed to reconstruct orthogonal X, Y, Z leads using Kors’s matrix and obtain root-mean-squared (3D) ECG. R wave, S wave and overall amplitudes, voltage-time-integrals (VTIs), and other ECG features were extracted from all ECG leads. ML algorithms [logistic regression (LR), support vector classifier (SVC), decision trees (DT), random forest (RF), gradient boosted machine (GBM) and boosted trees (BT)] were trained to predict increased LVMi (women &gt;95 g/m 2 , men &gt;115 g/m 2 ) from ECG features on a training set of 2668 ECGs with typical LBBB and echocardiogram within 45 days before or after ECG. LVM was calculated using the ASE formula. We obtained ROC AUCs for prediction of increased LVMi by (i) QRS duration, (ii) published LVH criteria, and (iii) ML models in a separate validation set of adults with typical LBBB. Results: Among the validation set of 413 adults (53% women, age 73±12 yr) with LBBB, QRS duration alone had a higher AUC (women 0.657, men 0.703) for diagnosing increased LVMi compared to standard LVH criteria (Table). RF (women 0.688, men 0.738), GBM and DT models had better AUCs than QRS duration alone. Conclusions: In patients with LBBB, QRS duration ≥150 in women and ≥160 in men is a superior predictor of LVH than traditional voltage-based ECG criteria, but ML methods outperform all traditional ECG criteria and QRS duration.
Abstract 17542: Impact of New-Onset Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events
Authors: Miyo Nakano, Yusuke Kondo, Masahiro Nakano, Takatsugu Kajiyama, Ryo Ito, Toshinori Chiba, Masafumi Sugawara, Yutaka Yoshino, SATOKO RYUZAKI, Yuya Komai, Yukiko Takanashi, Yoshio Kobayashi
Journal: Circulation (2023)

Background: The association between atrial fibrillation (AF) detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke has been reported. However, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown. In previous studies regarding the cut-off value of AF duration, patients who had a history of AF or had received anticoagulant therapies were also included. Therefore, the solo effect of AF on the risk of embolic stroke cannot be reliably evaluated on these studies. The aim of this study is to identify the incidence of embolic stroke in Japanese patients with a CIED and examine the cut-off value of AF duration detected by CIEDs as a risk factor for embolic stroke. Methods: We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, AF events were checked by CIEDs. Patients who had a history of AF or had received anticoagulant therapies before and after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke. Results: We enrolled 710 consecutive patients who were followed-up at our CIED clinic. We excluded 360 patients who had a history of AF or had received anticoagulant therapies. Finally, 350 patients (follow-up period, 75±58 months; age, 70±16 years) were included in this study. During the follow-up period, 24 patients (6.9%) had embolic stroke. Receiver-operating characteristic curve analysis confirmed that 30 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke (AUC = 0.72). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥40mm (p=0.019), new-onset AF ≥ 30 seconds (p = 0.0016). Conclusion: AF episodes lasting for ≥ 30 seconds was the risk factor of embolic stroke. We should evaluate AF burden carefully in this population.