tbuckley/cabot-search huggingface dataset:
Abstract 4123480: Navigating Aspirin Allergy With Rapid Desensitization In A Patient Requiring Urgent Coronary Intervention
Authors: Omar Daghstani, Matthew Derakhshesh, Mohamad Ghazal, Radmila Lyubarova
Journal: Circulation (2024)

Introduction: Aspirin (ASA) hypersensitivity is a challenge in determining the appropriate, cost-effective therapy in patients after percutaneous coronary intervention (PCI). Various ASA desensitization protocols were studied and showed favorable outcomes. In this case, we highlight the use of rapid ASA desensitization protocols for patients requiring dual antiplatelet therapy (DAPT) post urgent PCI. Case: A 52-year-old male presented with severe left-sided chest pain associated with diaphoresis. He had a history of allergic reaction to ASA at the age of 18 years with swelling of the face and throat without shortness of breath or hypotension. Physical examination was unremarkable except for tachycardia. Workup showed no ECG abnormalities but significantly elevated, uptrending high sensitivity troponin. Medical management included clopidogrel load, heparin drip, and nitropaste for persistent pain. Urgent coronary angiography showed a severe bifurcating lesion in the LCx and OM1 arteries, successfully treated with the T stent technique using a drug-eluting stent. He received cilostazol and prasugrel, overlapped with a tirofiban drip post PCI. ASA desensitization was performed with oral ASA every 90 minutes for four doses (Figure). Vital signs were monitored every 30, 60, and 90 minutes after each dose. He was discharged home with no reported symptoms on follow up. Discussion: DAPT with ASA and oral P2Y12 inhibitors is recommended for patients with PCI. ASA desensitization could be considered for patients who are intolerant to ASA. Major clinical ASA desensitization protocols, like in ADAPTED and SCRIPPS studies, showed good outcomes in major adverse cardiovascular events. However, one limitation of these widely used protocols is the prolonged time required to achieve desensitization. The rapid protocol used in our patient who did not have ASA exacerbated respiratory disease showed effectiveness with shorter hospital stay. Conclusion: ASA desensitization is an appropriate option for patients with a history of ASA allergy requiring DAPT. Rapid desensitization protocols are associated with shorter hospitalization courses, and future efforts should evaluate their effectiveness in randomized controlled trials.
Abstract 4117690: Cardiac Rupture as a Life-Threatening Outcome of Takotsubo Syndrome: A Systematic Review.
Authors: Martin Denicolai, Matteo Morello, Marco Del Buono, Tommaso Sanna, Carla Agatiello, Antonio Abbate
Journal: Circulation (2024)

Background: Takotsubo syndrome is a reversible cause of heart failure; however, a low percentage of patients can develop serious complications, including cardiac rupture. Aims: Analyze case reports or case series of cardiac rupture in patients with Takotsubo syndrome, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. Methods: We conducted a systematic search of MEDLINE and Embase databases to identify case reports or case series of patients with Takotsubo syndrome complicated by cardiac rupture, from inception to October 2023. Results: We identified 39 reported cases, including 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and common admission symptoms were chest pain (35 [80%]) and dyspnea (14 [32%]). ST-segment elevation was present in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The mean left ventricular ejection fraction was 40±13% and an apical ballooning pattern was observed in all (100%) ventriculographies. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive (Figure). Conclusions: Cardiac rupture as a complication of Takotsubo syndrome is a rare clinical condition associated with high mortality. Elderly females, especially from White/Caucasian or East Asian/Japanese descent, presenting with ST-segment elevation in the anterior or lateral leads, and an apical ballooning pattern, are disproportionally affected. Additional studies with prospective collection of patient-level data are needed to better identify those at increased risk for cardiac rupture associated with Takotsubo syndrome and to address ways to improve mortality rates in this population.
Abstract 4114293: Impact of stent length on long-term clinical outcomes in acute myocardial infarction patients treated with second-generation drug-eluting stents
Authors: Woonggil Choi, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Cheol Ung Choi, sujin hyun, Jae Kyeong Byun, Jinah Cha, Sang Min Kim, Jang-whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Ju-Hee Lee, Dae-Hwan Bae, Min Kim, junyoung Lee, jonghee Sun
Journal: Circulation (2024)

Background: Stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, there are few data in acute myocardial infarction (AMI) patients treated with very long drug-eluting stents (DES). We conducted this study to evaluate the impact of stent length on the long-term clinical outcomes. Method: The study included a total of 9,021 AMI patients who underwent PCI with 2 nd generation DESs. The patients were categorized into 3 groups according to the stent length: group A (&lt;38mm, n=6821), group B (38 – 59mm, n=1735) and group C (≥60mm, n=465) and compared using the inverse probability of treatment-weighted (IPTW) method. The primary outcome was the incidence of major adverse cardiac events (MACEs) up to 3years. Results: After adjustment for baseline differences, stent length was still significantly associated with higher cumulative rates of MACE [Odd ration(OR) :1.15 for 38 -59mm group, 95% confidence interval (CI): 1.06-1.26, p= 0.001, OR 1.23 for ≧ 60mm group, 95% CI: 1.13 -1.34, p&lt; 0.001], especially, non-target vessel revascularization (TVR), not TVR, (table). In subgroup analysis, 3-year TVR according to stent length, Biolimus A9 stent was associated with TVR in patient with more than 38-59mm stent (OR 6.50, 95% CI: 2.60 to 16.26, p 〈 0.001). Conclusion: Even in the 2 nd generation DES era, stent length was associated with adverse long-term clinical outcomes in patients with AMI. Interestingly, long stent implantation did not affect target vessel failure but non-TVR.
Abstract 4113942: Validation of Changes in the Cutoff Values of Achilles Tendon Thickness on Radiography in the Clinical Criteria of Heterozygous Familial Hypercholesterolemia in Japan
Authors: Hayato Tada, Yasuaki Takeji, Atsushi Nohara, Masa-aki Kawashiri, Masayuki Takamura
Journal: Circulation (2024)

Background: To increase sensitivity and maintain specificity, the 2022 Japan Atherosclerosis Society familial hypercholesterolemia (FH) clinical criteria was modified. In particular, the cutoff value of Achilles tendon thickness (ATT) on radiography was changed from ≥9 mm in both men and women to ≥8.0 mm in men and ≥7.5 mm in women. The current study aimed to validate the efficacy of this modification in independent samples. Methods: Patients with FH were retrospectively reviewed. The proportions of patients with pathogenic FH mutation who had an ATT of &lt;7.5/8.0 mm (group 1), ≥7.5/8.0 and &lt;9.0 mm (group 2), and ≥9 mm (group 3) were assessed. Results: In total, 492 patients were included in group 1, 102 in group 2, and 263 in group 3. Approximately 14.0%, 55.9%, and 79.8% of patients in groups 1, 2, and 3, respectively, exhibited FH mutation. Further, 37.3%, 77.3%, and 86.5% of patients with a low-density lipoprotein cholesterol level of ≥180 mg/dL in groups 1, 2, and 3, respectively, harbored FH mutation. Moreover, the median low-density lipoprotein cholesterol levels (157, 182, and 253 mg/dL, respectively) and the proportion of patients with protein-truncating mutation (3.8%, 16.7%, and 53.2%, respectively) had a significant trend. Conclusions: There was a substantial number of patients with FH who had an ATT of ≥7.5/8.0 and &lt;9.0 mm. These patients previously had a deferred diagnosis of FH. However, they were diagnosed with FH based on the new clinical guideline.
Abstract 4112524: Novel Contactless and AI-Based Method Can Determine Heart Rate and Cardiac-Induced Vibrations of Chest
Authors: Mohammad Muntasir Rahman, Faezeh Taghva, Amirtaha Taebi
Journal: Circulation (2024)

Introduction: Seismocardiography (SCG) - measurements of cardiovascular-induced vibrations on the chest - has shown potential for providing clinical information for cardiac conditions. SCG is conventionally recorded by an accelerometer attached to a single point on chest. Recent research suggests multichannel SCG (mSCG) - measurements from multiple chest locations - can provide extra and more accurate clinical information. Current mSCG methods are limited to accelerometer arrays, laser Doppler vibrometry, and airborne ultrasound that are either costly, difficult for inexperienced users, or need bulky equipment, thereby impeding their use beyond research or clinical settings. Hypothesis: mSCG signals can be accurately estimated from tiny chest movements in chest videos recorded by ordinary cameras, e.g., those in smartphones. Methods: We enrolled 10 subjects (sbjs) with no history of CVDs (21.7 ± 1.7 years, 40% women). ECG and chest video of sbjs were recorded at rest for 15 sec during breath hold at the end of inhalation followed by another 15 sec recording during breath hold at the end of exhalation. We developed an AI-powered mobile app to record the chest videos and convert them to 0-30 Hz mSCG in right-to-left (RL) and head-to-foot (HF) directions (Fig 1a). Heart rate (HR) based on ECG RR interval and mSCG was measured and compared. Results: HR estimated from mSCG in both RL and HF directions had a good agreement with ECG-based HR using Bland-Altman analysis [RL: bias = 1.4 bpm, 95% CI = 5.6 bpm; HF: bias = 0.8 bpm, 95% CI = 6.2 bpm (Fig 1b)]. High-quality mSCG and ECG measurements were obtained for all sbjs. Conclusion: Clinically relevant information can be accurately extracted from chest videos using our novel, contactless, AI-based method. Given that the vast majority of Americans have access to a camera phone, future developments of this method may provide new means of remote and accessible cardiac monitoring.
Abstract 4112944: A diagnostic challenge overcome with persistent clinical suspicion in a case of cardiac AL amyloidosis
Authors: Allison Zimmerman, Philip Kuriakose, Amanda Godfrey, Karthikeyan Ananthasubramaniam, Jennifer Cowger, Waleed Al-Darzi
Journal: Circulation (2024)

Case: A 62-year old male with a history of chronic kidney disease and paroxysmal atrial fibrillation presented with several months of fatigue, a progressive decline in functional status (NYHA IIIb-IV), weight loss, and intermittent lower extremity swelling. Blood pressure was 92/72 mmHg on presentation, and heart rate was 90 bpm. Physical examination revealed a jugular venous pressure of 12-14 cm H2O and 2+ bilateral lower extremity edema with mild wheezing. Methods/workup: Laboratories are shown in Table 1 and were notable for a serum free light chain ratio of 0.14. Transthoracic echocardiogram (figure 1) revealed a left ventricular (LV) ejection fraction of 33% with increased LV wall thickness and severe bi-atrial enlargement. Bone marrow biopsy revealed 2% lambda restricted plasma cells without evidence of amyloid deposits; metastatic bone survey was negative. A fat pad biopsy and endomyocardial biopsy stained negative for amyloid with Congo red. Cardiac MRI showed diffuse, circumferential subendocardial late gadolinium enhancement, most compatible with cardiac amyloidosis (figure 2). The patient also had a chest CT scan that demonstrated a few patchy nodular pulmonary infiltrates. Given his extensive negative workup, he was referred to pulmonary and endobronchial biopsy was positive for amyloid on Congo red staining (figure 3). Biopsy tissue typing revealed Lambda subtype AL amyloidosis. Management: The patient was started on Daratumumab, Cyclophosphamide, Bortezomib, and Dexamethasone by Hematology. Unfortunately, about a month after his diagnosis, he developed worsening heart failure despite treatment. He was admitted to an outside hospital with refractory cardiogenic shock and passed away during that admission. Discussion: The diagnosis of AL amyloidosis requires a high index of suspicion for prompt diagnosis and treatment. We present a case in which cardiac amyloidosis was suspected based on the patient’s clinical picture and cardiac imaging; however, multiple initial biopsies were negative. An expedited, multimodal and interdisciplinary diagnostic assessment is imperative as prognosis with chemotherapy is highly dependent on extent of AL disease, patient functional status, and presence of cardiac compromise. Elevated natriuretic peptides, troponins, autonomic dysfunction, and hypotension are negative prognostic features.
Abstract 4112845: Trends in Cardiovascular Risk Factors Among Children and Adolescents by Race and Ethnicity and Socioeconomic Status, 1999-2020
Authors: Wang Junwen, Yuyang YE, Xuefeng CHEN, Xinru HU, Yong PENG
Journal: Circulation (2024)

Background: Recent findings from large-scale cohort studies indicate that risk factors such as body mass index (BMI), systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), and smoking during youth, starting in early childhood and adolescence, are associated with cardiovascular events and cardiovascular-related mortality in adulthood. The secular trends of cardiovascular risk factors among US children and adolescents remain unclear. Objectives: To examine 20-year trends in cardiovascular risk factors in the children and adolescents population by race and ethnicity and by socioeconomic status. Methods: The primary objective of the NHANES is to evaluate the overall health and nutritional status of the U.S. population. In this analysis, data from ten NHANES survey cycles, conducted from 1999-2000 through 2019-2020, were utilized. We calculated the mean and proportion changes in cardiovascular risk factors, and used linear and quadratic tests to assess the linear and nonlinear trends in their changes. Results: A total of 27891 participants aged 6 to 19-year-olds were included. Mean BMI increased significantly from 20.61kg/m 2 in 1999 to 21.71kg/m 2 in 2020 (P for trend &lt; 0.001). COT means decreased from 11.47 ng/ml to 6.17 ng/ml (P for trend &lt; 0.001). The prevalence of high COT decreased from 14.64% to 8.68% (P for trend &lt; 0.001). TC decreased from 4.22mmol/L to 4.02 mmol/L (P for trend &lt; 0.001). In the study population, TG levels decreased from 0.9mmol/L to 0.79 mmol/L (P for trend &lt; 0.001). Mean LDL levels decreased from 2.45 mmol/L to 2.27 mmol/L (P for trend &lt; 0.001). Conclusion: Positive trends were observed in the levels of TG, TC, LDL, and COT in US children and adolescents. Mean BMI and the prevalence of obesity exhibited a gradually increasing unfavorable trend.
Abstract 4112639: A Rare Case of Atypical Sarcoidosis Presenting as an Intra-Atrial Septal Mass
Authors: Rohan Dod, Zackary Tushak
Journal: Circulation (2024)

Introduction: Sarcoidosis is a granulomatous disease that can affect multiple organ systems, including the heart. Cardiac Sarcoidosis (CS) is one of the most severe manifestations. It is characterized by a dysregulated T-cell driven immune response which generates non-necrotic inflammatory granulomas with myocardial infiltration. CS has a range of clinical syndromes: impaired conduction, arrhythmias, heart failure, and sudden cardiac death. We discuss a rare presentation of CS as an intra-atrial septal mass. Case Description: A 27-year-old Caucasian female with history of depression on citalopram presented with a one-month history of palpitations, fatigue, and dyspnea with exertion. An EKG demonstrated sinus rhythm with first-degree AV block. A cardiac monitor revealed intermittent 2-1 AV block and high degree AV block occurring mostly during sleep. An echocardiogram revealed normal biventricular function and morphology. Due to the concern for infiltrative cardiomyopathy, she underwent a cMRI which revealed a focal mass centered along the intra-atrial septum extending from the fossa ovalis to the septal AV junction, measuring 4.5 cm in size. She underwent pacemaker implantation with mild improvement of symptoms. PET scan demonstrated hypermetabolic activity of the intra-atrial region. She underwent surgical resection of the cardiac mass. Pathology was significant for fibrotic tissue with non-caseating granuloma and multinucleated giant cells consistent with an extremely rare presentation of CS. She was started on immunosuppressive medications. Subsequent cMRI and PET demonstrated resolution of the mass and hypermetabolic activity. Discussion: CS is a severe condition that most commonly presents with symptoms of heart failure, conduction abnormalities, and cardiac morphological changes of hypertrophy or thinning. However, it is often missed as a diagnosis, even in patients with extracardiac sarcoidosis. It is rare for CS to present as an isolated cardiac mass, especially in a younger patient as in this case. Advances in imaging techniques such as echocardiography, MRI, and PET have improved the ability to diagnosis CS and provide timely specialized treatment. This case highlights the need to include CS as an important diagnosis on the differential for a patient presenting with conduction abnormalities, heart block, and dyspnea. It also accentuates the critical role of multimodality imaging in working up this disease.
Abstract 4112876: Sex Differences in the Relationship Between Self-reporting of Snoring and Cardiovascular Risk
Authors: Wang Junwen, Yuyang YE, Xuefeng CHEN, Xinru HU, Yong PENG
Journal: Circulation (2024)

Background: Identifying risk factors for CVD is critical for effective prevention and management. While classic CVD risk factors have been extensively studied, there is a scarcity of research on the association between snoring and CVD risk, particularly in the context of gender differences. Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. Participants were initially categorized based on the severity of snoring or the presence of snoring. Logistic regression analysis was employed to control for potential confounding variables. Within the snoring group, they were further classified by gender. The utilization of propensity score matching and logistic regression analysis ensured comparability between different genders. Results: Our study included 12,681 participants aged 18 years or older. When compared to the non-snoring group, individuals in the moderate snoring group had a higher odds ratio (OR) of 1.418 (95% CI 1.083 to 1.857, p = 0.011), while those in the severe snoring group had a higher odds ratio (OR) of 1.882 (95% CI 1.468 to 2.409, p &lt; 0.001). In the snoring group, individuals were further categorized by gender: 4527 males and 4131 females. Importantly, male patients showed a higher odds ratio for atrial fibrillation (4.945, 95% CI 1.187 to 20.598, p = 0.028) compared to females. Additionally, male patients had a higher odds ratio for coronary heart disease (2.002, 95% CI 1.152 to 3.479, p = 0.014) compared to females. Conclusion: Sex plays a significant role in the relationship between snoring and CVD risk. males with snoring have a higher risk of developing CVD compared to females. In particular, male snorers are nearly five times more likely to develop atrial fibrillation and about twice as likely to experience coronary artery disease in comparison to female snorers.
Abstract 4112589: Typology of Self-Care in Adults with Type 1 Diabetes and Impaired Awareness of Hypoglycemia
Authors: Austin Matus, Lea Ann Matura, Peter Cronholm, Michael Rickels, Barbara Riegel
Journal: Circulation (2024)

Introduction: Individuals with type 1 diabetes (T1D) complicated by impaired awareness of hypoglycemia (IAH) are at significantly increased risk for severe hypoglycemia: a marker of high risk of CVD. Tailoring interventions to promote hypoglycemia avoidance is difficult due to self-care heterogeneity among those with T1D. Aims: Map self-care heterogeneity among adults with T1D into behavioral phenotypes and identify common barriers to hypoglycemia avoidance within each phenotype. Methods: An explanatory sequential mixed methods study was performed in 200 adults with T1D. Participants reported personal, clinical, and social determinants of health, hypoglycemia awareness, and self-care of diabetes (Self-Care of Diabetes Inventory, scored 0-100, adequate ≥70) . Cluster analysis was performed to identify self-care clusters. Then, directed content analysis was applied to individual, semi-structured interviews performed in a subsample from each cluster with IAH ( n =20). Findings were integrated to develop a typology of self-care and identify barriers to hypoglycemia avoidance within each phenotype. Results: Three self-care phenotypes were identified. Experts ( n =70; mean age: 45±17 years; 24% Black; T1D duration: 25±16 years; HbA 1c : 7.36±1.67%; IAH: 20%) performed all aspects of self-care adequately (Maintenance: 84.9±8.8; Monitoring: 85.1±8.8; Management: 72.5±10). Yet, Experts with IAH reported purposefully delaying treatment of hypoglycemia due to lack of concern. Those with Inconsistent self-care ( n = 112; mean age 37±14 years; 20% Black: T1D duration: 21±13 years; HbA 1c : 7.26±1.16%; IAH: 30%) performed only self-care maintenance adequately (Maintenance: 78.6±8.9; Monitoring: 65.6±9.8; Management: 56.8±10.1). Those with Inconsistent self-care and IAH reported passive self-care monitoring that inhibited effective hypoglycemic management. Novices ( n = 18; mean age 27±7 years; 50% Black: T1D duration: 16±8 years; HbA 1c : 8.97±2.80%; IAH: 28%) reported difficulty performing all aspects of self-care (Maintenance: 51.9±7.7, Monitoring: 56.9±12.9, Management: 44.5±6.3) due to economic and psychosocial barriers. Conclusions: Self-care heterogeneity mapped onto three phenotypes that can be used to better understand patient barriers to hypoglycemia avoidance and hypoglycemia awareness restoration. This typology provides a framework for investigating how best to tailor IAH treatment considerate of self-care.