tbuckley/cabot-search huggingface dataset:
Abstract 4144744: Sex difference in Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement and long-term clinical outcome
Authors: Paolo Springhetti, Kathia Abdoun, Eric Dumont, Francois Dagenais, Dimitri Kalavrouziotis, Siamak Mohammadi, Philippe Pibarot, Marie-Annick Clavel
Journal: Circulation (2024)

Importance: Prosthesis-Patients Mismatch (PPM) is associated with multiple adverse event after aortic valve replacement (AVR), especially increased long-term mortality. Despite women are more likely to have PPM, sex-differences in PPM outcomes remain poorly explored. Objectives: To evaluate PPM incidence and sex-differences in PPM impact in a large cohort of patients underwent surgical aortic valve replacement. Design, Setting and Participants: We included 7,319 patients who underwent Surgical AVR between 2000 and 2021. PPM was defined accordingly to Valve-Academic-Research-Consortium-3 criteria, adopting correction for Body Surface Area &gt;30 kg/m2 and retrieving the predicted effective orifice area of the aortic valve prosthesis. The cohort was followed up prospectively from Surgical AVR until November 2023. Main Outcomes and Measures: Primary endpoint was defined as long-term mortality and secondary endpoint as long-term cardiovascular (CV) mortality. Mortality was established and Cardiovascular mortality adjudicated by Quebec national database. Results. Severe PPM incidence was rare (1.1%), more prevalent in women (2.5%) than in men (0.5%, p&lt;0.0001). Any-degree-PPM (22.8% of patients) was also more prevalent in women (31.9% vs. 19.7%, p&lt;0.0001). Over a median follow-up of 13 years, there was 3,231 (44.1%) all-cause deaths, with 1,238 (16.9%) being from CV causes. PPM was associated to excess mortality (HR:1.30[1.20-1.40]; p&lt;0.0001) and CV mortality (HR: 1.39[1.23-1.57]; p&lt;0.0001) in the whole cohort without interaction between sexes (p=0.94 and p=0.74). After comprehensive multivariable adjustment, PPM resulted an independent predictor of long-term mortality and CV mortality in women (both p≤0.04) but no in men (both p≥0.66). Conclusion and relevance: In this large series of AVR patients, PPM was more prevalent in women, in whom it was an independent predictor of mortality. This finding suggests that sex-specific management of aortic valve intervention may be of importance and warrants further studies focusing on this aspect.
Abstract 4144722: Electrophysiological Effects of Transcutaneous Vagal Nerve Stimulation in Humans
Authors: Neal Olarte, Heajung Nguyen, Yuliya Krokhaleva, Houman Khakpour, Duc Do, Justin Hayase, Stavros Stavrakis, Marmar Vaseghi
Journal: Circulation (2024)

Background: Cervical vagus nerve activation has been shown to have significant cardiac hemodynamic and electrophysiological effects. Transcutaneous vagal nerve stimulation (tVNS) has been reported to benefit patients with atrial fibrillation, though the potential electrophysiological effects of tVNS beyond the atrium remain unclear. Aims: The purpose of this study was to evaluate the electrophysiological effects of tVNS in patients with structurally normal hearts. Methods: Patients with structurally normal hearts undergoing electrophysiology study for supraventricular tachycardia were recruited and randomized to low-level stimulation of the right or left tragus (1 mA below discomfort threshold personalized for each patient pre-procedure, 20 Hz, 250 µs). After completion of ablation, hemodynamic and electrophysiologic parameters were measured before, during 30 min of tVNS, and at approximately 15 min after tVNS had ended. Variables were compared using one-way ANOVA, and if significant, paired comparisons were performed using the paired Student’s t-test. Results: Eighteen patients were randomized and 16 (mean age 47.0±16.1 years; 50% female) underwent the full protocol (9 right and 7 left). TVNS reduced systolic blood pressure (SBP) and was associated with significant increases in RR interval, atrial and atrioventricular nodal refractory periods (AVNERP), atrio-His (AH) interval, atrioventricular nodal Wenckebach cycle length (AVWBCL), and ventriculoatrial block cycle (VABCL) length (figure). There were no significant differences in sinus node recovery time (SNRT), His-ventricular (HV) interval, and ventricular refractory periods (VERP); 15 min post-tVNS, significant differences were still observed in SBP, RR interval, AERP, and AVWBCL, suggesting neural memory, though the effects on AVNERP and VABCL had diminished. Conclusions: TVNS is associated with measurable increases in the conduction time of the AV node and AV nodal and atrial, but not ventricular, refractory periods. Increases in AERP and AV nodal effects may explain the benefit of tVNS observed in atrial fibrillation and may potentially be leveraged to slow or terminate AV nodal dependent supraventricular tachycardias.
Abstract 4144701: Characterizing Pulmonary Artery Growth in Single Ventricle Patients Palliated through Fontan Procedure
Authors: Cathlyn Medina, Philip Carmon, Henry Foote, Gregory Fleming, Reid Chamberlain
Journal: Circulation (2024)

Introduction: Pulmonary artery (PA) size influences risks for complications in patients with Fontan physiology. Optimal strategies to augment PA growth over the course of single ventricle surgical palliations are not well understood. Hypothesis: In single ventricle surgical palliations, PA growth will be concentrated in periods of pulsatile blood flow. Aim: Describe PA growth through early childhood in patients with Fontan palliation. Methods: Retrospective, single-center study of Fontan patients between 1998-2022. Absolute PA diameters (right+left PA) and Nakata index (NI) were measured by angiogram and growth compared at three intervals: pre-Glenn, pre-Fontan, and 5yrs post-Fontan. Post-Glenn, pulsatile blood flow was defined as native antegrade flow (with or without PA band) or systemic shunt (surgical or ductal stent). Multivariable linear regression assessed predictors of PA size 5yrs post-Fontan. Results: In 195 patients, hypoplastic left heart syndrome was most common (60/195, 32%). Passive PA flow at Glenn occurred in 164/195(84%). Median age at Fontan was 38 (33,46) months. Absolute PA size increased during both pre-Glenn to pre-Fontan interval (p&lt;0.001) and pre-Fontan to 5yrs post-Fontan interval (p&lt;0.001), but relative growth by NI decreased after Glenn (p&lt;0.001) with no further change post-Fontan (p=0.29). Overall PA and LPA growth velocity was significantly higher in pulsatile than passive Glenn patients (2.0 mm/yr [1.3, 2.7] v 0.7 mm/yr [0.1, 1.7], p=0.01 and 1.0 mm/yr [0.5, 1.5] v 0.2 mm/yr [-0.4, 0.5], p=0.009 respectively, Figure 1). In multivariable analysis, post-Fontan PA size was significantly associated with pre-Fontan size (0.3 mm/mm [0.1, 0.6], p=0.02) but not cardiac diagnosis (p=0.67), initial Stage I surgical type (p=0.10), or use of stent angioplasty (p=0.28). Conclusions: Through single ventricle surgical palliations, absolute PA size increases, while growth velocity remains stable after Glenn. Post-Fontan PA size is primarily driven by pre-Fontan PA size suggesting importance of efforts to improve PA growth during Glenn period. Maintaining pulsatile flow during Glenn represents a viable strategy to augment PA growth and preferentially improve left PA growth through Fontan.
Abstract 4144674: Left Versus Right Ventricular Pacing during TAVR and Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis
Authors: Basma Khalefa, Mohammed Ayyad, Maram Albandak, Alaa Ayyad, Mazen Negmeldin Aly Yassin, Syed Karam Gardezi, Ahmed K. Awad
Journal: Circulation (2024)

Introduction: While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in four databases from inception to December 15 th , 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD). Results: Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup analysis of the TAVR studies only revealed similar trends with higher short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51], P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P&lt;0.001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P&lt;0.00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P = 0.02). Major vascular complications (RR 1.78, 95% CI: [0.86-3.70], P-value = 0.12), Cerebrovascular accidents (RR 1.67, 95% CI: [0.78-3.57], p-value = 0.18) and all bleeding (RR 0.95, 95% CI: [0.51-1.76], p-value = 0.86) were all comparable between both groups. Conclusion: Left ventricular pacing is a plausible alternative to RV pacing in patients undergoing TAVR or valvuloplasty, particularly in the absence of high-grade conduction disturbances. LV pacing has demonstrated superior outcomes with lower short-term mortality rates, lower incidence of cardiac tamponade, and pacemaker implantation. On the other hand, RV pacing could be the preferred modality of treatment if baseline conduction abnormalities are present.
Abstract 4144283: A Novel EMR-Based Algorithm with the Virtual Echocardiography Screening Tool (VEST) to Screen Patients for Pulmonary Arterial Hypertension
Authors: Gabriela Narowska, suneesh Anand, Chethan Gangireddy, John Enevoldsen, Martin Keane, Daniel Edmundowicz, Paul Forfia, Anjali Vaidya
Journal: Circulation (2024)

Introduction: Pulmonary arterial hypertension (PAH) remains an underrecognized, fatal disease. Limited awareness, non-specific symptoms, and late referral to accredited PH centers all contribute to an overall poor prognosis. The previously validated Virtual Echocardiography Screening Tool (VEST) uses 3 routine transthoracic echocardiogram (TTE) parameters (left atrial size, transmitral E:e’ and systolic interventricular septal flattening) to recognize a high PAH likelihood. A positive VEST score has been shown to have 80% sensitivity and 76% specificity for PAH hemodynamics, while a VEST score of +3 has 92.7% specificity for PAH hemodynamics with a positive predictive value of 88.0%. Aim: We aimed to implement a novel algorithm via our electronic medical record (EMR) as an automated VEST calculator to identify patients with a high likelihood of PAH. Methods: An automated EMR VEST calculator was applied retrospectively to 4,952 patients who underwent TTE with TR velocity &gt;/= 2.9 m/s at an accredited PH center from 12/2021-8/2023. Automated EMR VEST scores were validated by comparison to 60 manually scored echocardiograms. Those with VEST score of +3 (highest risk for PAH) underwent chart review to identify whether they were seen by a PH specialist. Results: There was 100% correlation between the automated EMR VEST scores and the manual results. Of the 4,952 patients, 1,655 had a positive automated EMR VEST score, and 355 had a score of +3, predicting the highest likelihood of PAH and warranting urgent referral to an accredited PH center. Of those patients with a +3 score, 103 (29.0%) were never seen by a PH specialist (Fig 1). Conclusion: VEST is a validated, noninvasive and accessible screening tool for identification of patients with a high likelihood of PAH likely to benefit from early referral to a PH center. We present a novel, accurate, and automated EMR algorithm for determination of the VEST score to prompt urgent referral for PH expert evaluation and timely initiation of complex medical therapies. These findings highlight the potential of future artificial intelligence and machine-learning applications for improved recognition of life-threatening PAH.
Abstract 4144669: Hospital-at-Home Digital Health Testing in Underserved versus the General Population
Authors: Rachita Navara, Douglas Corsi, Azeem Rathore, Mohammed Ali Ashary, Jasneet Devgun, Katherine Malcolm, Christopher Cheung, Maria Dopierala, Devon Chen, Yi-Ting Hsieh, Luke Bharane Samikanu, Ecem Ozkan, Aditi Pallod, Olayiwola Bolaji, Faizal Ouedraogo, Favour Markson, Ronal Joel, Kunj Patel
Journal: Circulation (2024)

Background: Racial and socioeconomic disparities in healthcare access are well-documented. Minority and rural populations face barriers and often have limited access to healthcare services and facilities. Digital health solutions can help bridge these gaps. Previous studies examining digital health usage patterns have reported mixed findings, with some showing lower adoption among minority/underserved groups and others finding no significant differences compared to the general population. Hypothesis: Minority and rural patients would participate in the digital health intervention at similar rates as non-minority, affluent patients when provided with equal access to cardiologist and device training. Aims: To analyze the variance in usage of digital health products between underserved and general patient populations. Methods: The 5,000-patient clinic serves a population of underserved minority and affluent non-minority patients. All patients were offered cellular-enabled blood pressure cuffs and weight scales that transmitted data automatically to a physician portal as part of routine care. Patients consented to have their data used for research and were instructed to use these devices &gt; 4 times per week for six months, with periodic reminders from clinic staff. Patient participation was tracked, and digital records were analyzed. Results: Demographic information of enrolled patients (n=18) is reported (Figure 1). There was an overall 90% retention rate throughout the six-month study period, including 90% retention from African American patients, 87.5% from indigent patients, and 100% from both rural and inner-city residents. Conclusion: With a modest sample size, this data suggested that minority and rural populations may participate in digital health and remote patient monitoring interventions at the same rate as the general population of patients. This study supports the growing potential of digital health to improve healthcare access for minority and rural communities.
Abstract 4144409: Visualizing Chronic Myocardial Infarction using Native T1-weighted Signal Intensity Patterns with Similar Image Contrast as LGE MRI
Authors: Khalid Youssef, Xinheng Zhang, Ghazal Yoosefian, Yinyin Chen, Shing Fai Chan, hsin-jung yang, Keyur Vora, Andrew Howarth, Andreas Kumar, Behzad Sharif, Rohan Dharmakumar
Journal: Circulation (2024)

Background: The identification of chronic myocardial infarction (MI) typically relies on contrast-enhanced MRI, late-gadolinium enhancement (LGE) MRI. Native (contrast-free) T1 mapping at 3T has been shown to identify chronic MI but visualization of it is more difficult compared to LGE MRI. Data-driven utilization of distinctive native T1-weighted MRI signal intensity patterns in infarcted and remote myocardium may be a superior alternative to standard native-T1 mapping. We hypothesized that native T1-weighted signal intensity patterns can be used to generate images of chronic MI with similar contrast-to-noise ratio (CNR) to LGE MRI. We tested this hypothesis using a data-driven approach applied to native T1-weighted signal patterns of chronic MI and compared the resulting CNR to the CNRs of LGE and native T1 maps at 3T. Methods: The study included a dataset of spatially aligned short-axis, native-T1-weighted and LGE images of hearts from canine (n=24) with surgically implemented chronic MI. Unsupervised clustering techniques (self-organizing maps and t-distributed stochastic neighbor embedding) were used to analyze the T1-weighted images to arrive at native T1-weighted pixel intensity patterns. Data-driven native mapping (DNM) utilizing deep neural networks were used to map these patterns to corresponding pixels in LGE images. This allowed for creation of visually enhanced maps with improved chronic MI contrast. Pearson correlation analysis compared DNM with standard T1 maps. Results: Native T1-weighted images showed distinct pixel intensity patterns between infarcted and remote myocardium. CNR from DNM (mean ± SD, 15.01±2.88) was significantly higher than native T1 maps (5.64±1.58, p&lt;0.001) but not different from LGE images (15.51±2.43, p=0.40). Infarcted areas in LGE images correlated more strongly with DNM (R 2 =0.85) than with native T1 maps (R 2 =0.71, p&lt;0.001). Conclusion: Native T1-weighted pixels contain information that can be extracted using the DNM approach to enhance image contrast between infarcted and remote myocardium. The proposed approach allows for robust visualization of chronic infarct territories without contrast agents, offering a viable contrast-agent-free alternative to LGE MRI. Patient studies are needed for clinical translation.
Abstract 4144261: Hispanic/Latino Patients with Heart Failure with Preserved Ejection Fraction: A Participant Level Pooled Analysis of 3 Contemporary Trials
Authors: Maria Pabon, Brian Claggett, Marcos Fernandez, Tracy Makuvire, Akshay Desai, Eldrin Lewis, Pardeep Jhund, Marc Pfeffer, Bertram Pitt, John McMurray, Scott Solomon, Muthiah Vaduganathan
Journal: Circulation (2024)

Introduction: Prior studies have suggested that Hispanic/Latino patients with HFpEF in the US may have lower mortality rates than non-Hispanic/Latinos. However, few contemporary data exist examining the clinical risks faced by Hispanic/Latino patients with HFpEF, especially in global settings. Methods: We performed a participant-level pooled analysis of the TOPCAT (Americas region), PARAGON-HF, and DELIVER trials, including participants with symptomatic HF and an LVEF &gt;40% (in DELIVER) or ≥45% (in TOPCAT and PARAGON-HF). Hispanic/Latino ethnicity was self-reported. The risk of the primary endpoint, cardiovascular death or HF hospitalization, was compared among Hispanic/Latino and non-Hispanic/Latino patients using Cox regression models adjusted for relevant clinical covariates, stratified by trial and region of enrollment. Results: Of the 12,826 participants, 2,013 (16%) were Hispanic/Latino. 71% of Hispanic/Latino patients were enrolled in Latin America, 19% in North America and 10% in Europe. Hispanic/Latino participants were less likely to have a history of atrial fibrillation (36% vs. 56%), had a higher eGFR, and had better functional status but had similar levels of natriuretic peptides as compared to non-Hispanic patients (Figure 1). During a median follow-up of 2.6 years, Hispanic/Latino participants experienced similar rates of the primary outcome (adj HR 1.12; 95% CI 0.90-1.39; p=0.29) and secondary outcomes as compared to non-Hispanic/Latinos ( Table 1 and Figure 1 ). Findings were similar when including only patients enrolled in the Americas (n=4,728; adj HR 1.05; 95% CI: 0.78-1.41; p=0.77). There were no interactions with age, sex, BMI, or diabetes status. Conclusions: Contrary to prior reports, this pooled analysis of HFpEF participants enrolled in 3 contemporary global trials showed that Hispanic/Latino patients experienced similarly heightened risks of adverse cardiovascular outcomes and mortality as non-Hispanic/Latino patients.
Abstract 4144360: Neurohormonal therapies at baseline and follow-up and survival in patients with wild-type transthyretin cardiac amyloidosis
Authors: Alberto Aimo, Giacomo Tini, Giuseppe Vergaro, Paolo Milani, Mattia Zampieri, Angelo Caponetti, Francesca Fabris, Andrea Foli, Carlotta Mazzoni, Christian Gagliardi, Simone Longhi, Giulia Saturi, Matteo Serenelli, Gioele Fabbri, Laura De Michieli, Giuseppe Palmiero, Giuseppe Ciliberti, Samuela Carigi, Giulia Mandoli, Valeria Rella, Roberta Mussinelli, Matteo Cameli, Francesca Marzo, Giuseppe Limongelli, Alberto Cipriani, Stefano Perlini, Laura Obici, Federico Perfetto, Gianfranco Sinagra, Marco Merlo, Beatrice Musumeci, Elena Biagini, Francesco Cappelli, Giovanni Palladini, Michele Emdin, Marco Canepa
Journal: Circulation (2024)

Background: Transthyretin cardiac amyloidosis (ATTR-CA) typically manifests with heart failure (HF). Discontinuing beta-blockers and avoiding angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) in patients with ATTR-CA has been recommended. Methods: We investigated the prescription of neurohormonal therapies and their relationship with all-cause mortality in a multicenter cohort. Results: Patients (n=926) had a median age of 79 years (interquartile range 74-83), 90% were men, 17% had a left ventricular ejection fraction (LVEF) ≤40%, and 27% were in New York Heart Association (NYHA) class III/IV. At diagnosis, 60% of patients were on beta-blockers, 58% on ACEi/ARB/ARNI, and 35% on MRA. Patients on beta-blockers had more often NYHA class III/IV, a greater burden of comorbidities, and lower LVEF, and those on ACEi/ARB/ARNI had more comorbidities. Nonetheless, the survival of patients on beta-blockers or ACEi/ARB/ARNI was not significantly shorter over a 2.5-year follow-up (1.6-3.8) (p=0.577 and p=0.977, respectively), and patients on both drugs had not a worse outcome than those not receiving any neurohormonal drug (p=0.575). During the entire follow-up, the number of neurohormonal drugs remained unchanged in 54%, decreased in 27%, and increased in 19%. Patients with a number of neurohormonal drugs either unchanged or increased had a lower risk of mortality (odds ratio 0.71, 95% confidence interval 0.53-0.95, p=0.023). Conclusions: ATTRwt-CA patients on beta-blockers or ACEi/ARB/ARNI at diagnosis did not have a shorter survival. Beta-blockers were discontinued less often than ACEi/ARB/ARNI. There was no sign of better outcomes in patients discontinuing these therapies, or worse outcomes in those starting them.