tbuckley/cabot-search huggingface dataset:
Abstract 4146588: Class 1C Antiarrhythmic Drugs are Safe in Patients with Arrhythmia-induced Cardiomyopathy Following Recovery of Left Ventricular Ejection Fraction
Authors: Ryan Pohlkamp, Vignesh Chidambaram, Amudha Kumar, Nikhila Ghanta, Adetayo Odueke, Srikanth Vallurupalli, Hakan Paydak
Journal: Circulation (2024)

Background: Class 1C antiarrhythmic drugs (AADs), such as flecainide and propafenone, are effective first-line agents for rhythm control in atrial tachyarrhythmias. The Cardiac Arrhythmia Suppression Trial (CAST) suggested class 1C AADs increase mortality in patients with myocardial ischemia, limiting their use to those without structural heart disease. Still, the safety and efficacy of class 1C AADs in arrhythmia-induced cardiomyopathy (AiCM) following recovery of LVEF are unexplored. Goals: To evaluate the safety and efficacy of class 1C AADs in treating atrial tachyarrhythmias in patients with AiCM following recovery of LVEF compared to patients with no prior cardiomyopathy. Methods: We conducted a retrospective cohort study at a single academic center, including adult patients with atrial fibrillation, flutter, or tachycardia and a history of AiCM with recovered LVEF prescribed class 1C AADs since 2010. The control group included patients with atrial tachyarrhythmias prescribed class 1C AADs without prior reduced LVEF. Patients with ischemic or other structural heart diseases were excluded. Primary outcomes were all-cause mortality and sustained ventricular arrhythmias. Secondary outcomes were recurrent atrial tachyarrhythmia, need for electrical cardioversion (ECV) or ablation, and medication discontinuation. Statistical analyses used Cox proportional hazards models. Results: Among 356 patients (308 control, 48 AiCM), no significant difference was observed in mortality (7.0% vs. 6.3%, unadjusted HR 0.84, 95% CI 0.25-2.80, p=0.822; adjusted HR (aHR) 0.90, 95% CI 0.15-5.32, p=0.906) or ventricular arrhythmias (3.6% vs. 4.2%, HR 1.14, 95% CI 0.25-5.12, p=0.838; aHR 1.36, 95% CI 0.18-10.50, p=0.767). The recurrence of atrial arrhythmia was similar between the control and AiCM groups (34.4% vs. 41.7%, p=0.328). The need for ECV and ablation, while greater in the AiCM group, was not significantly different between the groups. However, medication discontinuation was significantly higher in the AiCM group (45.8% vs. 29.9%, p=0.027), primarily due to recurrent arrhythmias and medication intolerance. Conclusions: Class 1C AADs appear safe in patients with atrial tachyarrhythmias and AiCM following recovery of LVEF, comparable to those without prior cardiomyopathy. However, AiCM patients exhibited higher rates of medication discontinuation, indicating potential challenges in treatment adherence. Further large-scale studies are needed to confirm these findings.
Abstract 4146612: The Endothelial Cell Translatome Varies by Organ and Disease Status in a Murine Heart Failure with Preserved Ejection Fraction Model
Authors: debiao zhao, Ahmed Fayyaz, Sarah Chau, Surendra Dasari, Aolin Du, Yu Huo, Margaret Redfield, Ying Wang
Journal: Circulation (2024)

Background: Dysfunction of systemic vascular endothelial cells (ECs) is common in heart failure with preserved ejection fraction (HFpEF). We sought to determine if organ-specific EC translational heterogeneity is present in HFpEF. Using a transgenic mouse model (RiboTag EC ), we analyzed the translatome (the mRNAs bound with ribosomes) of organ-specific ECs in a mouse HFpEF model induced by hypertensive/metabolic stresses. Methods: Six-month-old male RiboTag EC ( Cdh5 CreERT2+ / Rpl22 HA/+ ) mice, expressing a hemagglutinin tag in EC ribosomal protein Rpl22, were fed a high-fat diet and L-NAME water (N=4) or a normal diet and water (N=5) for 7 weeks. Organs were collected for Translating Ribosome Affinity Purification, RNA isolation, and RNA-seq. RNA-seq data were visualized using uniform manifold approximation and projection (UMAP). Differentially expressed genes (DEGs; absolute fold change ≥ 2 and false discovery rate (FDR) adjusted p-value ≤ 0.05). Pathway enrichment analyses were conducted (Ingenuity Pathways Analysis (IPA)). Results: In UMAP, the EC translatome clustered by organ (heart, lung, skeletal muscle, and liver) highlighting organ-specific EC heterogeneity and by disease (HFpEF) status with cardiac ECs showing the most dramatic changes with HFpEF (Fig A). Cardiac ECs in HFpEF (vs Control) had 283 downregulated and 23 upregulated DEG (Fig B) out of 14,923 genes identified. There were significant differences in 142 canonical pathways (16 upregulated, 126 downregulated), including LXR/RXR activation, DHCR 24 signaling, regulation of insulin-like growth factors, eNOS signaling, acute phrase response (all down regulated) and IL-1b-mediated inhibition of RXR and unfolded protein response (both up regulated) (Fig C). Conclusion: HFpEF induction caused extensive translational changes in EC but particularly cardiac ECs. In cardiac ECs, metabolism, anti-inflammatory, vasodilation, tissue repair, and angiogenesis pathways were inhibited, while pro-inflammatory response, insulin resistance, and proteostasis pathways were activated.
Abstract 4145379: The Trojan Worm: A Tale of Strongyloides and Eosinophilic Myopericarditis
Authors: Vikas Yellapu, Lindsey Magid, Michael Morgan, Jovan Plamenac
Journal: Circulation (2024)

We present a perplexing case of a 33-year-old male with no prior cardiac history who presented to the emergency department with a 5-day history of worsening pleuritic chest pain and dyspnea. The patient had recently returned from El Salvador, where he resided near the beach. Notably, his chest pain worsened with inspiration but was not positional. He denied fevers, chills, or family history of cardiac disease, but reported recreational marijuana use. Initial evaluation revealed normal vital signs and electrocardiogram, but marked eosinophilia (12%) and mildly elevated C-reactive protein. High-sensitivity troponin levels peaked at 8400 ng/L, raising suspicion for myocardial injury. Echocardiography demonstrated preserved left ventricular ejection fraction but revealed a moderate pericardial effusion. Pericardial fluid analysis showed benign reactive mesothelial cells. Given the patient's travel history and eosinophilia, a broad differential diagnosis was considered, including parasitic etiologies such as Chagas disease. However, serological testing for Chagas was negative. Interestingly, IgG antibodies for Strongyloides stercoralis were positive, implicating strongyloidiasis as the underlying cause of the eosinophilic myopericarditis. The patient was treated with non-steroidal anti-inflammatory drugs, colchicine, and empiric ivermectin therapy. A cardiac magnetic resonance imaging study was ordered to further characterize the myocardial involvement, but the patient was unfortunately lost to follow-up. This case highlights the importance of maintaining a broad differential diagnosis and considering travel-related exposures in patients presenting with eosinophilic myopericarditis. Strongyloidiasis, though uncommon, can manifest with cardiac involvement and should be considered in at-risk populations, particularly those with eosinophilia and a compatible travel history. It is also important to have a high clinical suspcision for stronglodies induced myopericarditis in high risk patinets such as ours as typical treatment with steroids could result in furthur desemination of strongyloidias infection leading to fulminant eosinophillic myocarditis.
Abstract 4145417: Insomnia Moderates the Relationship Between Psychological Distress and Obesity Risk in the American Heart Association Go Red for Women Strategically Focused Research Network
Authors: Giada Benasi, Nour Makarem, Bin Cheng, Marie-Pierre St-Onge, Brooke Aggarwal
Journal: Circulation (2024)

Introduction: Poor sleep is associated with adverse mental and cardiometabolic health outcomes. However, there are limited data on the interplay between insomnia and psychological distress domains and their influence on adiposity indicators among women. Aims: To evaluate associations of psychological distress domains with adiposity indicators and elucidate differences by insomnia status in a racially and ethnically diverse cohort of women. Hypothesis: We hypothesized that psychological distress would be associated with worse anthropometric indicators of adiposity and that insomnia would exacerbate these relations. Methods: This is a cross-sectional study of a community-based cohort of 237 women (69% racial/ethnic minority, 34.1±13.5y). Validated questionnaires assessed perceived stress (4-item Perceived Stress Scale), chronic stress (4-item Global Perceived Stress Scale), stressful life events exposure within the past year (8-item Life Events Checklist), and depression (2-item Patient Health Questionnaire). Insomnia was assessed using the validated Insomnia Severity Index, and BMI and waist circumference (WC) were measured by trained study personnel. Linear regression models adjusted for age and socioeconomic status examined associations of psychological distress with BMI and WC in the overall sample and by insomnia status. Results: There were no significant associations between psychological distress and anthropometric markers of adiposity in the overall sample. Although a statistically significant interaction between insomnia and stressful life events was observed (p-interaction&lt;0.05), in stratified analyses, higher exposure to stressful life events was more strongly associated with higher BMI and WC among individuals with vs. without insomnia (BMI: β=1.17±0.97 vs. 0.05±0.26 and WC: β=1.23±0.75 vs. -0.07±0.25), but these associations were not significant (p&gt;0.05). Notably, associations of chronic stress with BMI varied by insomnia status (p-interaction=0.052). Specifically, higher chronic stress was associated with lower BMI (β=-1.55±0.72, p=0.044) among individuals with insomnia, but null results were observed among those without insomnia (β=0.07±0.16, p=0.66). Conclusions: Insomnia may moderate the association of stress with adiposity indicators. These findings highlight the complexity of the relations between sleep disorders, stress, and obesity risk and warrant replication in a larger sample and among males.
Abstract 4145447: Impact of Acquired Thrombophillia on Inpatient Outcomes Among Hospitalized Patients With Acute Coronary Syndrome
Authors: Demilade Soji-Ayoade, Aniekeme Etuk, Olalekan Olanipekun, Abidemi Akeju, Carlos Rueda, Ellen Thompson
Journal: Circulation (2024)

Introduction: Acute Coronary Syndrome(ACS) is a disease entity that can have high mortality if other risk modifiying factors are inadequately controlled. In this study, we examined the effect of acquired thrombophillas like antiphospholipid syndrome, Heparin induced thrombocytopenia (HIIT) and Jak 2 Mutation on outcomes in inpatients hospitalized with ACS;all of which can be commonly associated with myocardial infarction and other arterial thombotic sequelae, Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2016 and 2020. Multivariate logistic and linear regression modelling was used to access the impact of acquired prothrombotic factors on inpatient outcomes among hospitalized patients with acute coronary syndrome.Our primary outcome of interest was in-hospital mortality. Secondary outcomes were length of stay and cost of hospitalization or total hospital charges. Results: Of the 2,389,836 hospitalizations with acute coronary syndrome, 32% had a diagnosis of an acquired prothrombotic factor. Among those with these acquired prothrombotic factors, 40% had a diagnosis of HIT, 25% had a diagnosis of APS and 35% had a diagnosis of JAK 2 mutation. In the adjusted analyses, patients who had acute coronary syndrome with a concurrent diagnosis of an acquired prothrombotic factor (AOR: 2.28; 95% CI: 1.84-3.99) had higher odds of mortality compared to those without an acquired prothrombotic factor. Length of stay (ß: 1.23; 95% CI: 1.01-1.76) was found to be longer among those with acquired prothrombotic factor relative to those without. Furthermore, having an acquired prothrombotic factor was associated with higher hospital charges (ß: 1281.22; 95% CI: 28.65-4364.98) compared to those without an acquired prothrombotic factor. Conclusion: Acquired thrombophilias are associated with increased in-hospital mortality , length of stay and cost of hospitalization. Further studies are needed to elucidate the predictors of higher mortality in these patients, which could be translated into clinical practice to further identify high risk patients
Abstract 4145329: Automated Detection of ST-elevation Myocardial Infarction in High-Acuity Settings Using Artificial Intelligence Applied to Images of 12-lead Electrocardiograms
Authors: Lovedeep Dhingra, Dhruva Biswas, Akshay Khunte, Veer Sangha, Sumukh Shankar, Arya Aminorroaya, Rohan Khera
Journal: Circulation (2024)

Background: The diagnosis of suspected ST-elevation myocardial infarction (STEMI) requires electrocardiograms (ECGs) done in emergent settings across the world. Despite access to ECG machines, the expertise of clinicians reading them is scarce. Automated reads are often inaccurate. We sought to address this challenge by developing an AI-enabled approach for automated cardiologist-level diagnosis from photos of 12-lead ECGs. Methods: We identified patients undergoing ECGs in a large, diverse US health system (2015-2023). We used self-supervised pretraining to develop a convolutional neural network to first detect ECG features without any diagnostic flags, designed to enhance the efficiency of training a STEMI-specific model. To ensure the model learned the signature for STEMI independent of other ECG features, each STEMI ECG (cases defined by reads by cardiologists) was matched to 10 ECGs of those without STEMI (controls) but of the same age, sex, and with the same set of conduction and rhythm abnormalities on their ECGs. To mimic variations in ECG formats in real-world clinical settings, the training ECGs were randomly plotted using any of 2880 unique formats, with variations in lead layouts, background colors, label fonts, grid, and signal line widths. The model was evaluated on a held-out set of ECG images from patients presenting to the emergency (ED) with chest pain. Results: The model development set included 49,995 ECGs from 39,697 individuals (age 65 years [IQR, 52-76], 18,926 [48%] women, 5941 [15%] Black). The test set included 7551 patients who had presented to the ED with chest pain (1 ECG/individual, median age 50 years [IQR, 34-62], 4063 [54%] women, 1661 [22%] Black). Of these, 104 (1.4%) had STEMI. The model achieved an AUROC of 0.95 (95% CI, 0.93-0.96) and AUPRC of 0.21 (0.15-0.28), with a sensitivity of 90.3% (84.0-95.8) and specificity of 87.7% (87.0-88.4). The model performance was consistent among demographic subgroups of age (AUROC 0.95-0.97), sex (AUROC 0.93-0.97), and race/ethnicity (AUROC 0.95-0.96). Conclusion: We have developed an AI algorithm that can diagnose STEMI on photos of ECGs with high accuracy, potentially enabling the triaging of patients in low-resource settings by offering accurate diagnosis at the point of care. The reliance on ECG images across formats and layouts ensures its use without changing ECG acquisition or related infrastructure.
Abstract 4145450: Trends in Heart Failure Mortality Among Adults with Chronic Ischemic Heart Disease in the United States from 1999 to 2020
Authors: Shurjeel Qazi, Muhammad Majid, Syed Hassaan Ali, Huzaifa Ansari, Sana Qazi, Muhammad Khan, Ankit Agrawal, Ushasi Saraswati, Ezra Amsterdam, Allan Klein
Journal: Circulation (2024)

Introduction: The previous literature identifies chronic ischemic heart disease (CIHD) as a major contributor to heart failure (HF), accelerating its progression due to reduced coronary perfusion and decreased myocardial contractility. Significant disparities in mortality rates persist despite advancements in treatment,. This study characterizes trends in mortality across various demographics in the US. Methods: CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to identify HF-related mortality in patients with underlying CIHD from 1999-2020. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to calculate annual percentage change (APC). Results: A total of 2,165,216 deaths occurred in patients with CIHD due to HF from 1999-2020 (AAMR = 37.3, 95% CI: 37.3-37.4). AAMR decreased from 51.8 in 1999 to 31.9 in 2012, then increased to 35.1 in 2020 (APC: 5.1). Increased mortality rates were observed in males (AAMR = 49.8) compared to females (AAMR = 24.4) (Figure, Panel A). AAMRs were highest in Non-Hispanic (NH) Whites (38.5, 95% CI: 38.5–38.6), followed by NH blacks (32.0, 95% CI: 31.8-32.1), NH American Indian/Alaska Native (28.8, 95% CI: 28.3–29.5) and Hispanics (26.6, 95% CI: 26.6–26.7). NH Asian/Pacific Islanders had the lowest mortality rates (17.3, 95% CI: 17.1–17.5) (Figure, Panel B). We observed that mortality rates were highest in the Midwest region (40.1, 95% CI: 39.9 – 40.1). The West region reported mortality rates of 37.3 (95% CI: 37.2 – 37.4), followed closely by the South region (AAMR = 36.3, 95% CI: 36.3 – 36.4) while the Northeast reported the lowest mortality rate (AAMR = 35.7, 95% CI: 35.6 – 35.8). (Figure, Panel C). Rural areas had higher mortality rates than urban areas (Rural: 44.5, 95% CI: 44.3–44.7; Urban: 33.9, 95% CI: 33.8–34). Conclusion: Despite recent improvements, HF-CIHD-related mortality has shown a rise in recent years. AAMR increased among men, NHW, NHB, NH-API, Hispanics, the Midwest region, and rural areas. These results emphasize the necessity for focused interventions and strategic allocation of healthcare resources to address these disparities and enhance outcomes for vulnerable populations.
Abstract 4145513: Substrate Characterization and Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Non-Ischemic Dilated Cardiomyopathy and Isolated Apical Scar
Authors: Yi Wen Becky Liao, Bryan Baranowski, Mandeep Bhargava, Thomas Callahan, Mina Chung, Jeff Courson, Thomas Dresing, Koji Higuchi, Nolan Hight, Ayman Hussein, Mohamed Kanj, Arshneel Kochar, Robert Koeth, Justin Lee, David Martin, Kenneth Mayuga, Shady Nakhla, John Rickard, Walid Saliba, Jakub Sroubek, Tyler Taigen, Niraj Varma, Oussama Wazni, Pasquale Santangeli
Journal: Circulation (2024)

Background: Patients with non-ischemic dilated cardiomyopathy (NIDCM) and ventricular tachycardia (VT) typically have a basal perivalvular substrate with predominant antero-septal or infero-lateral distribution. Isolated apical substrate responsible for VT in NIDCM has not been previously characterized. Objectives: The purpose of this study is to characterize the prevalence, characteristics and catheter ablation outcomes of NIDCM with isolated apical VT substrate. Methods: Patients with NIDCM and VT from an isolated apical scar were identified from a prospective registry of consecutive patients with NIDCM undergoing VT ablation between 2018 and 2023. Isolated apical scar was defined as apical abnormal bipolar low voltage area (LVA, &lt;1.5 mV for the endocardium, &lt;1.0 mV for the epicardium with abnormal electrograms) demonstrated to participate in VT with activation, entrainment and/or pace mapping in the absence of abnormal electroanatomic substrate in other LV segments. Patients with hypertrophic cardiomyopathy were excluded. Results: Out of 208 patients with NIDCM and VT undergoing catheter ablation during the study period, 5 (2.4%; age 52±10 years, LVEF 37±12%) had isolated apical substrate and underwent a total of 8 ablation procedures (2 endocardial, 6 endo-epicardial). One patient had isolated apical scar on pre-procedural cardiac MRI. All patients had both endocardial and epicardial scar identified. At the end of the procedure, non-inducibility of any VTs was achieved in all cases. After a median follow-up of 11 months (range 6-14 months) after the last procedure, there were no deaths and all patients remained free from recurrent VT. Conclusion: In patients with NIDCM, isolated apical VT substrate is rare. Endo-epicardial catheter ablation is typically needed in these patients and is associated with good VT control over follow-up.
Abstract 4145360: Same-Day Discharge Following Catheter Ablation of Atrial Fibrillation in the United States
Authors: Amneet Sandhu, Li Qin, Karl Minges, Sarah Zimmerman, Ryan Borne, Vincenzo Polsinelli, Michael Ho, Jonathan Hsu, Sana Al-Khatib, James Freeman, Steven Bradley, Sunil Rao, Adrian Hernandez, Wendy Tzou, Paul Varosy, Paul Hess
Journal: Circulation (2024)

Introduction: Patients undergoing atrial fibrillation (AF) ablation have historically been hospitalized overnight or longer post-procedure. We conducted this study to characterize national rates of same-day discharge, associated clinical factors, variation across hospitals and in-hospital outcomes. Methods: The NCDR AF Ablation Registry was used to identify all index procedures from January 1 st , 2016, to June 30 th , 2023. Patients were stratified by post-procedure disposition into 3 cohorts: (1) same-day discharge, (2) overnight hospitalization ( &lt; 1-day) or (3) &gt;1-day hospitalization. Rates of same-day discharge, associated clinical factors, hospital-level variation and unadjusted post-procedural complication rates were analyzed. Results: Among 139,391 patients who underwent index AF ablation across 197 hospitals in the US, 51622 (37.0%) were discharged the same-day, 78220 (56.1%) hospitalized overnight and 9549 (6.9%) hospitalized for &gt;1-day post-procedure. Shown in Figure 1, the rate of same-day discharge increased from 0.99% (Quarter 1 of 2016) to 62.3% (Q2 2023), p&lt;0.0001 for trend, with a sharp rise in Q1 of 2020 and corresponding decline in those hospitalized overnight (83.3% in Q1 2016 to 32.9% Q2 2023, p&lt;0.0001 for trend). The quarter during which AF ablation procedure was conducted was associated with same-day discharge (OR 1.26, 95% CI 1.256-1.264, Figure 2). In contrast, Black race (OR 0.71, 95% CI 0.65-0.78), persistent AF classification (OR 0.85, 95% CI 0.82-0.88) and prior non-AF catheter ablation (OR 0.89, 95% CI 0.85-0.93) favored overnight hospitalization. Variation in same-day discharge across hospitals was significant (MOR 4.12, 95% CI 3.48-4.79). Aggregate major and overall in-hospital complication rates were 0.70% and 2.13%, respectively. In comparison, major and overall complication rates were 0.03% and 0.19% for same-day discharge and 0.24% and 0.98% for overnight hospitalization. Conclusion: Rates of same-day discharge following AF ablation increased over time and surpassed overnight hospitalization by Q1 2021. Those with paroxysmal AF and fewer comorbid conditions were more likely to undergo same-day discharge with substantial variation across hospitals. Peri-procedural complication rates of those undergoing same day discharge were comparable to overnight hospitalization. With substantial growth in same-day discharge and development of outpatient or ambulatory procedural centers, our findings may assist future procedural policy development.