tbuckley/cabot-search huggingface dataset:
Abstract 15222: Slowly Conducting Anatomic Isthmuses of Repaired Tetralogy of Fallot: A Role for “Prophylactic VT Ablation”
Authors: Bryce V Johnson, Andrew Pistner, Bishoy Hanna, Graham H Bevan, Amanda Cai, Rosemary McDonagh, Eric V Krieger, Nazem W Akoum, Neal A Chatterjee, Melissa Robinson, Babak Nazer
Journal: Circulation (2023)

Background: Ventricular tachycardia (VT) is common in patients with repaired tetralogy of Fallot (rToF) and involves 5 slowly conducting isthmuses (SCAI) bound by the right ventriculotomy, ventricular septal defect (VSD) patch, tricuspid valve, and pulmonic valve. Aims: We aim to study the safety and efficacy of a strategy in which rToF patients undergo prophylactic radiofrequency ablation of any SCAI to prevent incident VT. Methods: Patients underwent voltage and activation mapping in sinus rhythm. Abnormal isthmuses were identified by low voltage (≤ 1.5 mV) without pre-existing conduction block. Isthmuses with conduction velocity (CV) ≤ 0.5 m/s (SCAI) were then ablated. Post-ablation, ventricular programmed stimulation was performed with triple extrastimuli from two sites. Outcomes of prophylactic ablation patients were compared to rToF patients undergoing clinical VT ablation within the same period. Results: Indication for prophylactic SCAI ablation included pre-pulmonic valve replacement (77%), atrial arrhythmia ablation (11%), syncope (5%), and NSVT (5%). Of 44 prophylactic patients, 32 (73%) had at least one isthmus and 25 (57%) had at least one SCAI (mean 0.7 ± 0.7 SCAI/patient), with the most common being SCAI 3 (36%) and 4 (32%) (see figure). After prophylactic ablation, bidirectional block was achieved across all SCAI and no VT was inducible post-ablation. Over a median 10.5 [IQR 3, 20] month follow-up, there was no sustained VT, sudden cardiac death, or appropriate shocks. Among 18 patients undergoing clinical VT ablation, 16 (89%) had at least one SCAI (mean 1.5 ± 0.8 SCAI/patient, p=0.0002 compared with prophylactic group), most commonly SCAI 3 (83%). One (6%) VT patient had recurrent VT during follow-up of 15.5 [IQR 6, 33] months. There were no peri-procedural complications in either group. Conclusions: Prophylactic SCAI ablation for patients with rToF is safe, acutely successful, and associated with excellent short-term outcomes.
Abstract 14154: Myotonic Dystrophy and Stress Induced Cardiomyopathy
Authors: Anindita Chanda, Sriram Garikapati, Ippokratis Konstantinidis, Mohammed Elsadany, Stephanie Saucier, Sean McMahon
Journal: Circulation (2023)

Myotonic dystrophy type 1 (MD1) is an autosomal dominant neuromuscular disease that can affect skeletal, smooth, and cardiac muscle. Patients often have cardiac involvement such as conduction diseases, ventricular arrhythmia, sudden cardiac death, cardiomyopathy and pulmonary hypertension. We describe a patient with MD1 who suffered recurrent takotsubo cardiomyopathy. Case: A 39-year-old female with history of myotonic dystrophy type 1, takotsubo cardiomyopathy with recovered ejection fraction (EF) 50-55%, gastroparesis and orthostatic hypotension presented with chest pain, nausea, vomiting, dyspnea, and diaphoresis. Initially she was hypotensive and tachycardic. The initial physical exam revealed intact mentation, cachexia, 4/5 muscle strength in all four extremities, lack of JVD, warm and well-perfused extremities without edema. Notable lab findings included a lactic acid of 2.3 mmol/L, high sensitivity troponin of 5000 ng/L and proBNP of 1520 pg/mL. Her initial ECG revealed first degree AV block, left anterior fascicular block, ST elevations in leads V 2 -V 3 and T wave inversions in lateral leads. She was admitted for further evaluation. A transthoracic echocardiogram (TTE) showed an EF of 20-25% with apical akinesis and ballooning, with a small apical mural thrombus. She was started on a heparin drip and ischemic work up was deferred given her normal coronary arteries three years prior. Serial TTEs showed improvement of her EF to 54% within two weeks. She was managed with gentle diuresis but she was unable to tolerate guideline directed medical therapy (GDMT) due to symptomatic hypotension. Improvement in her symptoms was noted with the EF recovery. Discussion: There is currently no known association between takotsubo cardiomyopathy and myotonic dystrophy type 1. To our knowledge there is one case in the literature that reported a recurrent takotsubo cardiomyopathy in MD1 patient, and this case is the second. These two cases highlight the possibility that MD1 patients may be at risk of recurrent takotsubo cardiomyopathy. We believe that additional research is needed to investigate a possible causative relationship between the two disease entities.
Abstract 19095: Enhancing Lesion Depth and Pulmonary Vein Isolation in Pulsed Field Ablation: Investigating the Effect of Voltage and Repeated Therapy Application
Authors: Lakshya Mittal, Loell B Moon, Catherine Pipenhagen, Christopher G Geurkink, Matthew Miller, Jeffrey M Fish
Journal: Circulation (2023)

Introduction: PFA has emerged as a promising approach for achieving effective PVI in the treatment of AF. This study investigates the impact of repeated therapy application and voltage on lesion depth during PFA and resulting PVI outcomes. By investigating this relationship, we seek to enhance lesion depth and optimize PFA protocols, ultimately leading to improved PVI outcomes and better management of AF patients. Methods: The VOLT TM PFA system was used to create lesions in potato sections with 37°C saline (N=3). Multiple PFA therapy repetitions were performed (1х, 2х, 4х, 6х, or 8х) at various voltages (1200V, 1400V, 1600V, or 1800V), with catheter rotation to achieve circumferential vein coverage. A chronic (30-day) canine study was performed at 1800V with 2х (Group 1, N=6) or 8х (Group 2, N=6) repetitions to understand in vitro to in vivo translation in terms of PVI success. Results: Two-way ANOVA results indicated that the effect of both voltage and therapy repetition was significant (P≤0.001) on minimum and maximum potato lesion depths. With increase in both voltage and repetition independently, lesion depths generally increased and 1800V as well as 8х produced significantly deeper lesions compared to 1200V and 1х, respectively. Functional block was achieved acutely in all veins at 30 min post treatment. Chronic functional block results were 87.5% for Group 1 (5/6 LSPV, 4/6 RSPV, 6/6 LIPV, 6/6 RIPV) and 100% for Group 2 (6/6 LSPV, 6/6 RSPV, 6/6 LIPV, 5/5 RIPV), showing increased success with repeated PFA ablation. All Group 1 PVs without chronic block were shown to be misaligned with the target vein, while 8 applications in Group 2 overcame less ideal PV alignment. Conclusions: Results suggest that through optimized voltage and therapy repetition, PFA can significantly enhance lesion depth, leading to improved PVI in AF treatment. Chronic PVI rates were improved from Group 1 to 2 at 1800V with additional PFA applications, compensating for less ideal PV alignment in Group 1.
Abstract 14289: Anti-Inflammatory Therapies to Prevent Cardiovascular Events: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors: Kevin E Boczar, Sheojung Shin, Alexander Pearson, Saba Shahab, Aishwarya Geejo, Sarah Visintini, Christophe Fehlmann, Kathryn Bezzina, Rob S Beanlands, George Wells
Journal: Circulation (2023)

Introduction: Anti-inflammatory therapies have been increasingly investigated for the reduction of cardiovascular (CV) events. The goal of this study was to summarize and compare the relative effectiveness of anti-inflammatory medications for the reduction of CV events in a systematic review and network-meta-analysis. Methods: In our systematic review, we included studies from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC, and conference abstract hand-searching. Randomized controlled trials were selected for inclusion if they included at least one anti-inflammatory treatment and involved patients with CAD. Bayesian network meta-analyses was performed to calculate risk estimates using random effects analyses in patients with ACS as well as stable CAD for the reduction of MACE. Results: A total of 14,699 studies were screened; sixty-one articles, all randomized control trials, met eligibility criteria for inclusion. A total of 41,647 patients were included in the stable CAD network analysis and 29,388 patients were included in the ACS network analysis. In the ACS analysis, both non-steroidal anti-inflammatory (NSAID) use (OR: 0.30, 95% Credible Limits [CrI]: 0.11-0.74) and colchicine use were associated with a significant reduction in MACE compared to control (OR: 0.71, 95% Credible Limits [CrI]: 0.58-0.88). In the stable CAD analysis, both corticosteroids (OR: 0.44, 95% CrI: 0.26-0.73) and colchicine (OR: 0.65, 95% Credible Limits [CrI]: 0.54-0.77) were associated with a significant reduction in MACE compared to control. Conclusions: In patients with acute coronary syndromes, NSAIDs and colchicine were associated with a reduction in the risk of major adverse cardiac events. In patients with stable coronary artery disease, both colchicine and steroids were associated with a reduction in the risk of major adverse cardiac events. For a comprehensive analysis of benefits and harms of anti-inflammatory therapies, large comparative studies or network meta-regression analyses of patient-level data will be required. Systematic review registration number: PROSPERO registry—CRD4202230328
Abstract 11396: Circulating Biomarkers Improve ChA <sub>2</sub> DS <sub>2</sub> -VASC Risk Prediction in Atrial Fibrillation: The CHA <sub>2</sub> DS <sub>2</sub> -VASc-Biomarkers Model
Authors: Samuel Short, Erin Hald, Katherine Wilkinson, George Howard, Virginia J Howard, Suzanne E Judd, Elsayed Z Soliman, Brett M Kissela, David Robinson, Robert J Stanton, Mary Cushman
Journal: Circulation (2023)

Introduction: Anticoagulation reduces stroke risk in atrial fibrillation (AF) but increases bleeding. Risk calculators are used to inform decision making for anticoagulation in AF. Yet, existing tools have substantial limitations and improvement efforts failed to change practice. Hypotheses: Biomarkers of ischemic stroke risk for general populations are associated with stroke risk in AF and improve performance of a recommended risk score (CHA 2 DS 2 -VASc). Methods: REGARDS is a prospective cohort of 30,239 Black or White adults aged ≥45 monitored for stroke. Nine blood biomarkers were measured at baseline in participants with AF, no prior stroke, and not taking anticoagulation at baseline. Hazard ratios of ischemic stroke were estimated by Cox models adjusted for demographics and stroke risk factors. Models with CHA 2 DS 2 -VASc alone and with biomarkers (CHA 2 DS 2 -VASc-B) were compared using tests of fit (likelihood ratio test and Aikake information criterion [AIC]) and predictive ability (continuous net reclassification index [NRI]). Results: Among 2,411 participants with baseline AF (median age 69, 55% female, 36% Black), 163 (7%) developed stroke over 13 years. After adjustments, higher cystatin C, growth differentiation factor 15 (GDF-15), interleukin 6, lipoprotein (a), and N-terminal pro-B type natriuretic peptide (NTproBNP) were associated with higher stroke risk (Figure A). Including all biomarkers substantially improved CHA 2 DS 2 -VASc model fit (Figure B; p &lt;0.001; ΔAIC -12.6; &lt;-10 indicates marked improvement) and predictive ability (Figure C; 5-year NRI 0.42). Adding only GDF-15 and NTproBNP resulted in the best model fit and a similar NRI, compared to all biomarkers. Conclusions: Higher levels of five blood biomarkers were associated with ischemic stroke risk in a large general population cohort with AF. Moreover, the CHA 2 DS 2 -VASc-B model was superior to CHA 2 DS 2 -VASc. Findings suggest we can better tailor anticoagulation to reduce stroke in AF.
Abstract 17244: Association of Remnant Lipoprotein Cholesterol, Type 2 Diabetes Mellitus, and Major Adverse Cardiovascular Events: Insights From the UK Biobank
Authors: Mohanad Gabani, Jeffrey Kingsley, Rishi Rikhi, Parag A Chevli, David M Herrington, Michael D Shapiro
Journal: Circulation (2023)

Background: Remnant lipoprotein-cholesterol (RLP-C) has emerged as a potential contributor to adverse cardiovascular events. While the association of low-density lipoprotein- cholesterol and atherosclerotic cardiovascular disease is well-established, the joint association of RLP-C and type 2 diabetes mellitus (T2DM) in driving major adverse cardiovascular events (MACE) remains less explored. Methods: We included a total of 118,004 participants from the UK Biobank with nuclear magnetic resonance-measured RLP-C. Participants were categorized into four groups based on their RLP-C levels and T2DM status: Group 1 (RLP-C below the median and no T2DM), Group 2 (RLP-C above the median and no T2DM), Group 3 (RLP-C below the median and T2DM), and Group 4 (RLP-C above the median and T2DM). Cox proportional hazards regression was employed to assess the association of these four categories with the time to incident MACE. The model was adjusted for age, sex, race, BMI, smoking, systolic blood pressure, anti-hypertensive and lipid-lowering therapy, and physical activity. Results: Our analysis revealed significant associations between RLP-C levels, T2DM, and the risk of MACE. Compared to the reference group (Group 1), Groups 2-4 had hazard ratio for the MACE outcome of 1.27 (95% CI: 1.18-1.37, p &lt; .0001), 1.43 (95% CI: 1.29-1.59, p &lt; .0001), and 2.04 (95% CI: 1.78-2.32, p &lt; .0001), respectively (see Figure). Conclusion: This analysis from individuals in UK Biobank free from cardiovascular disease at baseline demonstrated a significant joint association between elevated RLP-C levels and T2DM, with the risk of major adverse cardiovascular events. Keywords: remnant lipoprotein cholesterol, type 2 diabetes mellitus, major adverse cardiovascular events, UK Biobank, nuclear magnetic resonance
Abstract 13966: Change in Troponin I Levels With Intensive Blood Pressure Control: A Post-Hoc Analysis of SPRINT
Authors: Krishin Yerabolu, Naman S Shetty, Mokshad Gaonkar, Nirav Patel, Kershaw Patel, Garima Arora, Pankaj Arora
Journal: Circulation (2023)

Introduction: Cardiac troponin T (cTnT) levels have been shown to increase by intensive blood pressure (BP) control and longitudinal changes in cTnT predict cardiovascular disease (CVD) and mortality. However, similar data on cTnI, a specific marker of myocardial injury, are lacking. Methods: This post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) included participants who had cTnI values at randomization and 1-year. The cohort was stratified by change in cTnI at 1 year into ≥50% decrease, ≥50% increase, or unchanged (&lt;50% change). The difference in log(cTnI randomization ) and log(cTnI 1 year ) was calculated. The primary outcome was CVD events. Secondary outcomes included a composite of all-cause mortality or CVD events, all-cause mortality, and a composite of heart failure or all-cause mortality. Geometric mean ratios for change in log cTnI levels with intensive BP lowering compared with standard treatment were estimated using adjusted linear regression models. Adjusted Cox models were used to assess the risk of the outcomes of interest after 1 year with the change in cTnI levels. Events within 1 year were censored. Results: Among the 8,011 participants with cTnI levels at randomization and 1 year, cTnI decreased, did not change, and increased in 393 (4.9%), 6,442 (80.4%), and 1,176 (14.7%) participants at 1 year, respectively. Compared with the standard treatment, ≥50% reduction in cTnI at 1 year was more common with intensive treatment. The intensive treatment group had a 7% decrease [geometric mean ratio: 0.93 (0.91-0.95)] in cTnI compared with the standard treatment group after adjusting for covariates. An increase in the change in log cTnI at 1 year was associated with a higher risk of incident CVD events [HR adj : 1.67 (1.36-2.05)] and the composite of all-cause mortality or CVD events[HR adj : 1.36 (1.13-1.64)]. Conclusions: cTnI levels decreased with intensive BP control and the change in cTnI at 1 year predicted incident CVD events.
Abstract 14461: Impact of Intermittent vs Persistent Left Ventricle Outflow Tract Obstruction on Left Atrial Strain and Diastolic Function in a Young Hypertrophic Cardiomyopathy Cohort
Authors: Addison Gearhart, Sonia F Epstein, Kimberlee Gauvreau, Alessandra M Ferraro, Ingrid Roth, Christina M Mangano, David M Harrild, Steven D Colan, Ming-Hui Chen
Journal: Circulation (2023)

Background: Adolescents and young adults with hypertrophic cardiomyopathy (HCM) and persistent left ventricular outflow tract obstruction (LVOTO) have larger left atrial volume (LAV) and abnormal diastolic function and left atrial (LA) strain compared to those without resting LVOTO. It is unknown whether intermittent LVOTO with exercise results in smaller LAV and improved diastolic function and LA strain indices compared to persistent LVOTO. Methods: All HCM patients with echo and exercise stress echocardiography (ESE) from 2014-2022 at a single center were enrolled. The cohort was divided into 3 ESE hemodynamics groups: 1) No LVOTO (all gradients &lt; 30 mmHg, n=48); 2) Intermittent LVOTO (no rest gradient, exercise ≥30 mmHg, n=41); 3) Persistent LVOTO (rest/exercise ≥30mm Hg, n=29). LAV (biplane method), LAV Z scores, LV lateral e’, lateral e’ Z scores, LA reservoir (LASr), conduit (LAScd), and contractile (LASct) strain (TOMTEC Arena AutoSTRAIN) were analyzed. For each parameter, mean values were compared across groups using one-way analysis of variance. The Bonferroni method was used to compare Group 2 to 1 and 3. Results: 118 patients (31% F, median age 17 yrs, range 7-39) formed the cohort. Mean LAV was 64.9, 65.1, and 79.5 ml in Groups 1, 2, and 3 respectively. Differences in group means were found for LAV Z score, lateral e’, lateral e’ Z score, LASr, and LAScd (all p≤0.01). In Group 2 vs 3, LAV Z score was significantly lower (0.46 v 1.89) and LV lateral e’, lateral e’ Z score, and LAScd were significantly higher (lateral e’: 13.1 v 9.0 cm/s; lateral e’ Z score: -2.0 v -3.4; LAScd: 26.0 v 21.1%) (Fig 1). LASr did not differ significantly in Group 2 vs 3. No significant differences were found in Group 2 vs 1. Conclusion: In one of the largest young HCM cohorts, intermittent obstruction was associated with smaller LAV, better diastolic indices, and higher LA conduit strain versus persistent obstruction. Longer follow-up is needed to assess change as those with intermittent LVOTO age.
Abstract 14350: Prognostic Impact of Right Ventricular Free Wall Longitudinal Strain in Tricuspid Regurgitation: A Systematic Review and Meta-Analysis
Authors: Camila M Guida, Camila P Almeida, Andresa F Perego, Camila D dos Santos, igor H leite, Paula C Nogueira, Andrea d Vilela
Journal: Circulation (2023)

Introduction: Traditional echocardiography is limited in the early assessment of right ventricular (RV) dysfunction, especially in cases of tricuspid regurgitation (TR). In this context, right ventricular free wall longitudinal strain (RVFWLS) has emerged as a promising tool to enhance this evaluation. Hypothesis: We aimed to conduct a systematic review and meta-analysis to investigate whether impaired RVFWLS in patients with moderate to severe TR is associated with an increased risk of all-cause mortality and heart failure (HF) hospitalization. Methods: We searched Pubmed, Embase and Cochrane for studies that examined our clinical question. Two reviewers performed study selection, data extraction and assessment of bias. RVFWLS was evaluated as a binary variable: normal/near-normal vs. impaired. The latter was defined as a RVFWLS &gt; -17%. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. We also performed a subgroup analysis of multivariable analyses to minimize the effect of confounding variables. Results: We included 1,523 patients from 5 cohort studies. The mean follow-up ranged from 2.2 to 3.9 years. Mean age ranged to 62 to 84 years and 1,462 (96%) had functional TR. All-cause mortality (HR 1.06; 95% CI 1.02-1.10; p=0.002) and the composite of all-cause mortality or HF hospitalizations (HR 1.10; 95% CI 1.03-1.18; p=0.006) were significantly higher in patients with impaired RVFWLS compared with normal or near-normal RVFWLS. When considering only the multivariable analyses, patients with reduced RVFWLS also had a higher adjusted risk of all-cause mortality (HR 1.05; 95% CI 1.02-1.08; p=0.003). Conclusions: Our findings indicate that RVFWLS is an independent prognostic factor for all-cause mortality among patients with moderate to severe TR. The use of RVFWLS to guide management of this population warrants further investigation.
Abstract 18454: Temporal Trends in Assessment and Management of Iron Status in Patients With Heart Failure: A Multi-Institutional Study
Authors: Alexandra Minasian, Catharine Griskowitz, Cheshta Prasad, Joseph Campain, Kailin Chen, Lauren Walker, Diane Cocca Spofford, Rajeev Malhotra, Gregory D Lewis
Journal: Circulation (2023)

Background: Over the last decade there has been extensive investigation of iron deficiency in heart failure (HF). HFrEF patients are often refractory to oral iron supplementation whereas intravenous (IV) iron repletion has been shown to improve functional capacity, prompting a Class II guideline recommendation to assess iron stores and replete iron intravenously. The purpose of this study is to understand temporal patterns in assessment of iron status as well as utilization of oral and IV iron preparations in patients with HF. Methods: The Mass General Brigham (MGB) Research Patient Data Registry (RPDR) was used to conduct a retrospective analysis of patients with both HFrEF and HFpEF across 3 1-year intervals in 2012, 2017, and 2022. Circulating levels of iron, ferritin, and transferrin saturation (TSAT) were assessed. Patients were further classified according to the HF guideline-based definition of iron deficiency (ferritin &lt;100 ng/mL or 100-299 ng/mL with a TSAT &lt; 20%). Iron deficient (ID) HF patients were assessed for use and frequency of IV iron or oral iron for repletion. Results: Electronic health records within the MGB Healthcare System identified 23,687 total HF patients in 2012, 25,271 in 2017, and 36,059 in 2022. Among these patients, the percentage with iron studies measured within the calendar year were 48%, 62%, and 90% respectively. Of those with HF 5,557 (23%), 8,460 (33%), and 19,955 (55%) met guideline-based diagnostic criteria for iron deficiency. Oral iron supplements were used in 68%, 44%, and 19% of all ID HF patients. IV iron was given to only 4%, 11%, and 14% of ID patients ( Figure ). Conclusion: The temporal trends of iron assessment and repletion demonstrate a significant increase in assessment of iron stores by health care providers but persistent utilization of oral formulations in excess of IV formulations to treat ID. These data suggest a significant gap in implementation of a therapy associated with functional improvement in HF.