tbuckley/cabot-search huggingface dataset:
Abstract 15769: Ventricular Interdependent Phenotype of CPC-Pulmonary Hypertension With Normal Left Atrium and Pericardial Restraint: Impact on CPET Metrics and Clinical Outcomes
Authors: Giovanna Zampierollo-Jaramillo, Anas Abed, Wanxin Tu, Mariana Garcia-Arango, Ahmed ElShaer, Shannon Heffernan, Amir Esmaeeli, James Runo, Sofia Masri, Farhan Raza
Journal: Circulation (2023)

Background: Combined pre- and post-capillary pulmonary hypertension (Cpc-PH) has overlapping pathophysiology due to left heart disease and pulmonary vascular disease, which may vary in an individual patient. Hypothesis: While the majority of CpcPH patients have left heart disease with abnormal left atrium, a minority of CpcPH patients have normal left atrium and develop elevated left-sided pressures due to exaggerated ventricular interdependence and pericardial restraint. Aim: to define ventricular interdependent sub-phenotype of CpcPH. Methods: 30 CpcPH patients undergoing invasive cardiopulmonary exercise test with complete echocardiographic data were identified. Abnormal left atrium group was defined as left atrial volume index ≥40mL/m 2 and E/E' ≥10, and rest was defined as normal left atrium group. p-value &lt;0.05* Results: Key metrics of abnormal (n=23) vs normal (n=7) left atrium subjects are shown in Figure. In the same order (abnormal vs normal), age was 65±15 vs 61±16, female gender 6 (26%) vs 4 (57%), BMI 34±8 vs 38±10, H2FpEF score 5.8±2.3 vs 5.3±1.7, BNP 514±406 vs 191±280, eccentricity index 1.12±0.25 vs 1.24±0.38, RV:LV ratio 0.9±0.3 vs 0.9±0.2, E' medial 5.6±1.7 vs 9.7±4.0*, E' lateral 6.8±2.2 vs 9.2±1.9*, TAPSE/PASP 0.33±0.12 vs 0.41±0.18, epicardial fat 6±2 vs 6±3, delta ETCO 2 -1.9±2.0 vs +1.7±2.1. Rest hemodynamics: mPAP 42±6 vs 37±11, PAWP 21±3 vs 18±3*, CO 4.9±1.4 vs 5.4±0.8, PVR 4.6±2.2 vs 3.4±1.5. With exercise: mPAP/CO slope 9.2±6.5 vs 6.1±4.5 and PVR 3.8±2.5 vs 2.7±1.2. Comorbidity burden between the two groups did not have a statistically significant difference. On one-year follow-up, incidence of mortality and heart failure hospitalizations were: 16 (69%) vs 1 (14%)*. Conclusions: A subset of CpcPH with normal left atrium have increased pericardial restraint and lower left ventricular transmural pressure. This likely leads to LV compression and Cpc-PH physiology. This sub-cohort has better exercise capacity and clinical outcomes.
Abstract 13403: Age-Related Echocardiographic Characteristics in Patients With Heart Failure With Preserved Ejection Fraction in PARAGON-HF
Authors: Xiaowen Wang, Hicham Skali, Maja Cikes, Orly Vardeny, Carolyn S Lam, Margaret M Redfield, Annamaria Kosztin, Eileen Omeara, Wilfried Mullens, John J McMurray, Amil M Shah, Scott Solomon, Sheila Hegde
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) may have different characteristics by age groups. Aim Compare clinical and echocardiographic characteristics in patients with HFpEF enrolled in the PARAGON-HF echocardiography substudy by age groups. Methods: Echocardiography was performed in 1097 patients in PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction), where patients with left ventricular ejection fraction (LVEF) &gt;=45% were enrolled. Clinical and echocardiographic characteristics were compared in patients who were &lt;65, 65-74, and &gt;75 years of age. Results: Younger patients were more likely to be male, obese, have prior myocardial infarction (MI) and diabetes, but less likely to have atrial fibrillation (AF, Table 1). Older patients had smaller left ventricular (LV) dimension indices, more likely to have concentric hypertrophy or remodeling, higher LVEF and better global longitudinal strain, and more likely to have left atrial enlargement and echocardiographic evidence of higher LV filling pressure (Table 1). Echocardiographic measures of pulmonary pressure and right ventricular function were similar across age groups. After adjusting for sex, race, region, history of MI, diabetes, AF, and body mass index, every 10 years of increase in age was associated with 5.1 mL/m 2 decrease in LV end-diastolic volume index (95% confidence interval [CI] 3.9 - 6.5, p &lt; 0.001), 0.4% increase in absolute global longitudinal strain (95% CI 0.1% - 0.7%, p = 0.017), and 1.07 increase in E/e’ septal ratio (95% CI 0.42 - 1.73, p = 0.001). Conclusions: Compared with younger patients, older patients with HFpEF were more likely to be female with AF, have better systolic function and higher LV filling pressure. These findings demonstrated the heterogeneity in cardiac structure and function in HFpEF by age and may have implications for treatment and future clinical trial recruitment.
Abstract 12956: Novel Digital Strategy for Improving Diversity in Cardiovascular Clinical Trials
Authors: Sneha S Jain, Marco V Perez, Kaylin T Nguyen, Adrian F Hernandez, Mintu Turakhia, Kenneth W Mahaffey
Journal: Circulation (2023)

Background: Diversity of trial participants is crucial for the generalizability of clinical trial findings. Cardiovascular trials often underrepresent non-white participants, women, and older individuals. Investigators for the Apple Heart Study (AHS) and the Project Baseline Health Study (PBHS) used a digital platform or ‘waiting room’ to invite interested individuals in the United States to learn about the study, sign an electronic consent, and provide some baseline information including assessment of key inclusion/exclusion criteria. For AHS, the direct-to-participant approach led to the recruitment of participants that were comparably aligned with the US census. For PBHS, participants were enrolled from a ‘waiting room’ using specific parameters to meet the pre-specified target of mimicking the US census for race and ethnicity. Methods: We describe the sex, age, and race/ethnicity of the population enrolled in AHS and PBHS. AHS was a completely siteless/virtual trial, while PBHS did traditional assessments at physical locations while also having virtual components. Results: A total of 419,297 participants were enrolled in just 8 months in the AHS and 2502 were enrolled in PBHS. The sex, age, and race/ethnicity of the study populations are shown (see Table). 42-55% were women, 11.6% were Hispanic, 8-16% were black, 6-10% were Asian and 63-68% were white. AHS enrolled from all 50 states, while PBHS enrolled from 4 locations in California and North Carolina. Conclusion: In two direct-to-participant clinical trials, we were able to recruit participants that were comparably aligned with the US census. The digital strategies used were successful in both siteless and traditional site-based research studies. The direct-to-participant recruitment approach and digital waiting room are potentially scalable methods for digital recruitment and enrollment to improve diversity in pivotal cardiovascular studies.
Abstract 14077: Anticoagulation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
Authors: Amman Yousaf, Muhammad J Ahsan, Soban Ahmad, Azka Latif, Muhammad Zoraiz Ahsan, Ahmed Qavi, Magdi G Ghali, Sivakumar Ardhanari, Andrew M Goldsweig
Journal: Circulation (2023)

Introduction: To maximize reperfusion and thrombus breakdown, anticoagulation therapy may be continued after percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). However, limited evidence exists to support this practice. Methods: An electronic search was conducted using MEDLINE and EMBASE databases from inception to March 19th, 2023. Eligible studies comparing 30-day outcomes of post-procedural anticoagulation (PPAC) with no PPAC after PCI in patients with ACS were screened for inclusion. The primary outcome was 30-day mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effect model. Results: Total 6 studies (3 observational, 3 post-hoc analyses of randomized controlled trials) with 61,901 patients (PPAC=38,900, no PPAC=23,001) were selected. There were no significant differences in all-cause mortality (RR 0.79 [0.52-1.19], P=0.26), cardiac mortality (RR 0.69 [0.43-1.11], P=0.13), myocardial infarction (RR 0.86 [0.61-1.21] P=0.39), stroke (RR 1.18 [0.87-1.59], P=0.29), and major bleeding (RR 0.91 [0.65-1.27], P=0.58) between PPAC and no PPAC groups. However, PPAC was associated with a higher rate of stent thrombosis at 30 days (RR 1.34 [1.04-1.73], P=0.02). Conclusions: Overall, PPAC following PCI for ACS did not improve survival or cardiovascular morbidity. However, there was a slightly higher incidence of stent thrombosis in the PPAC cohort. Further randomized studies are necessary to confirm these findings.
Abstract 12943: Long-Term Ablation Outcome in Patients With Coexistent Metabolic Syndrome and Long-Standing Persistent Atrial Fibrillation Undergoing First Catheter Ablation: Results From a Propensity-Matched Population
Authors: Sanghamitra Mohanty, PremGeeta Torlapati, carola gianni, Bryan MacDonald, Angel Mayedo, Domenico G Della Rocca, John D Burkhardt, G Gallinghouse, Amin Al-Ahmad, Rodney Horton, Mohamed Bassiouny, Luigi Di Biase, Andrea Natale
Journal: Circulation (2023)

Introduction: Procedure-outcome after catheter ablation in long-standing persistent atrial fibrillation (LSPAF) is reported to be highly variable with different ablation approaches. Metabolic syndrome (MS), a pro-inflammatory state, is also considered to be closely associated with recurrent AF. Purpose: We evaluated the long-term outcome with different ablation strategies in patients with coexistent MS and LSPAF Methods: Consecutive patients with LSPAF and MS undergoing their first catheter ablation were classified into two groups; group 1: standard ablation: PVAI extended to the entire posterior wall (PW) plus empirical isolation of superior vena cava (SVC) and group 2: standard ablation+ ablation of non-PV (NPV) triggers. Ablation strategy was based on operators’ discretion. In order to attenuate the between-group imbalance of the baseline covariates, a propensity score-matching technique was used resulting in 108 and 432 (1: 4) patients in gr 1 and 2 respectively. Arrhythmia-monitoring was performed quarterly for 1 year and biannually afterwards. Ablation success was assessed off-antiarrhythmic drugs (AAD). Results: All patients received PVAI plus isolation of left atrial PW and SVC (standard ablation). Following the standard ablation, high-dose isoproterenol challenge (25-30 μg/min for 10-15 min) was performed in group 2 (n=432) patients to identify non-PV triggers. These were detected in LAA (294, 68%), CS (315, 73%), inter-atrial septum (125, 29%) and crista terminalis (76, 17.6%). These sites were ablated using additional radiofrequency energy. Isoproterenol challenge to reveal non-PV triggers was not performed in group 1 (n=108) patients. Procedural complications included 3 (2.7%) and 6 (1.4%) groin hematomas in group 1 and 2 respectively (p=0.31). At 6 years of follow-up, the single-procedure off-AAD success rate was 19 (17.6%) in group 1 and 231 (53.4%) in group 2 (p&lt;0.001) Conclusion: In our study patients with LSPAF and metabolic syndrome, standard ablation plus ablation of all detectable non-PV triggers during the first procedure was demonstrated to be significantly more effective in achieving long-term arrhythmia-free survival compared to standard ablation alone.
Abstract 14091: Subclinical Cardiac Dysfunction in the Patients Treated With Anthracycline-Containing Chemotherapy in the Chronic Phase
Authors: Tetsuya Tani, Masayoshi Oikawa, Himika Ohara, Daiki Yaegashi, Yu Sato, Tetsuro Yokokawa, Shunsuke Miura, Tomofumi Misaka, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Anthracycline-induced cardiotoxicity is a concerning problem in the treatment of a variety of cancers. The highest incidence of anthracycline-induced cardiotoxicity was observed during the first year after the completion of chemotherapy, but the changes in cardiac function and biomarkers after the first year have not been adequately investigated. Methods: We analyzed 105 consecutive patients who were followed up for 24 months after starting anthracycline-containing chemotherapy in our hospital from June 2018 to April 2021. Echocardiography and blood test for troponin I and B-type natriuretic peptide (BNP) were performed at baseline, 3 months, 6 months, 12 months, and 24 months after starting the chemotherapy. Results: The cancer types included 71 breast cancers, 18 hematologic cancers, 11 gynecologic cancers, and 5 soft tissue tumors. Compared to baseline, troponin I levels were increased at 3 months (0.011±0.007 ng/ml vs. 0.021±0.021 ng/ml, P&lt;0.05) and 6 months (0.023±0.047 ng/ml, P&lt;0.001), then, recovered to baseline levels. In contrast, BNP levels remained unchanged for 12 months but increased at 24 months compared to baseline (31.9 [5.8-625.7] pg/ml vs. 15.5 [5.8-89.2] pg/ml, P&lt;0.01). In addition, the left ventricular ejection fraction was decreased from baseline to 6 months (65.4±4.8% vs. 63.6±4.5%, P&lt;0.05) and 24 months (63.6±4.7%, P&lt;0.05). Multivariate logistic analysis revealed that age (OR 1.049, 95% CI [1.006-1.097], P=0.029) and total anthracycline dose (OR 1.011, 95% CI [1.002-1.022], P=0.026) were predicting factors for elevated BNP levels above the normal range (&gt;18.2 pg/ml) at 24 months. Conclusion: Subclinical cardiac dysfunction was developed after more than one year. Long-term follow-up is desirable to detect cardiac dysfunction in patients treated with anthracycline-containing chemotherapy.
Abstract 12917: Incremental Utility of 3D Printing to Guide the Surgical Management of Cardiac Sarcoma
Authors: Joseph Kassab, Ahmed Bakhshwin, Ryan Klatte, Michel Chedid El Helou, Joseph El Dahdah, Habib Layoun, Eric E Roselli, Serge C Harb
Journal: Circulation (2023)

Background: Intimal sarcoma is an extremely rare and aggressive malignancy that originates in the heart and major vessels. Due to its rarity, ambiguous clinical presentation, and rapid progression, diagnosing and treating this neoplasm presents significant challenges. Case presentation: A 61-year-old female with a history of left atrial sarcoma underwent mass excision in 2019 and 2020, along with several rounds of chemotherapy and immunotherapy. A follow-up cardiac MRI revealed a concerning lesion in the posterior left atrium with evidence of interval size progression on a subsequent CT, suggestive of a recurrence (Panel A). To aid in surgical planning, 3D segmentation of the patient's CT scan was performed, and a 3D model of her heart and lesion were printed (Panel B). This was particularly valuable as it was her third redo surgery, and there were concerns about the surrounding anatomy. Upon reviewing the multimodality imaging and 3D model, the patient was deemed a suitable candidate for a redo surgery. She underwent left atrial sarcoma resection with left atrial floor reconstruction using a bovine pericardial patch and left inferior pulmonary vein reimplantation (Panel C). Histological studies were consistent with recurrent intimal sarcoma (Panel D). The patient is currently in remission. Conclusion: Multimodality imaging was crucial in diagnosing the recurrence of the sarcoma. However, 3D printing of the heart and lesion with detailed segmentation of the left atrium and surrounding structures played a significant role in surgical planning. This highlights the growing use of 3D printing in cardiac surgery planning.
Abstract 12975: Metabolic Reprogramming in Adult Cardiomyocytes Promotes Heart Regeneration
Authors: Patrick C Hsieh
Journal: Circulation (2023)

Cardiac regeneration after injury is limited by the low proliferative capacity of adult mammalian cardiomyocytes. However, certain animals readily regenerate lost myocardium through a process involving dedifferentiation, which unlocks their proliferative capacities. We tested if dedifferentiating or reprogramming adult cardiomyocytes may recover their proliferative capability and thus promote heart regeneration after injury in mice.We bred mice with inducible, cardiac specific expression of the Yamanaka OSKM factors, enabling adult cardiomyocyte reprogramming and dedifferentiation in vivo. Two days after OSKM induction, adult cardiomyocytes presented a dedifferentiated phenotype and increased proliferation in vivo. Microarray analysis revealed that upregulation of ketogenesis was central to this process. Adeno-associated virus-driven HMGCS2 overexpression induced ketogenesis in adult cardiomyocytes and recapitulated cardiomyocyte dedifferentiation and proliferation observed during partial reprogramming. This same phenomenon was found to occur after myocardial infarction, specifically in the border zone tissue, and HMGCS2 knockout mice showed impaired cardiac function and response to injury. Finally, we showed that exogenous HMGCS2 rescues cardiac function after ischemic injury. Our data demonstrate the importance of HMGCS2-induced ketogenesis as a means to regulate metabolic response to cardiomyocyte injury, thus allowing cell dedifferentiation and proliferation as a regenerative response. (Cheng et al . Circulation 2022).
Abstract 14048: Stromal Cell-Derived Factor-1α-Encapsulated Nanoparticles Specifically Target the Ischemic Myocardium and Attenuate Myocardial Injury via Proangiogenic Effects
Authors: Shin Yajima, Manoj K Manna, Yuanjia Zhu, Stefan Elde, Danielle Mullis, Akshay Venkatesh, Sidarth Ethiraj, Tsuyoshi Ueyama, Brandon T Wesley, Kenzo Ichimura, Yasuhiro Shudo, Jayakumar Rajadas, Y Joe J Woo
Journal: Circulation (2023)

Hypothesis: Intravenously injected nanoparticles (NPs) containing stromal cell-derived factor-1α (SDF-1α) (SDF-NPs) could sustainably target the ischemia reperfusion (I/R)-injured myocardium and induce robust angiogenesis by increasing systemic EPC levels, thereby attenuating myocardial I/R injury. Methods: Male Wistar rats were subjected to myocardial I/R insult by ligating the left anterior descending artery for 30 min followed by reperfusion. At reperfusion, rats were randomized to receive intravenous injections of 5 mL/kg of phosphate-buffered saline (PBS), 6 μg/kg of NPs, SDF-1α, or SDF-NPs. One and 4 days after the treatments, SDF concentrations in the plasma and cardiac tissue, and the EPC population in the circulating blood were assessed. Therapeutic efficacy was investigated using histopathology and cardiac functional studies 4 weeks after the treatments. Results: Four days after the treatments, intravenously injected SDF-NPs circulated and accumulated selectively in the ischemic myocardium (Figure), with an SDF concentration roughly three times that of the other three treatments. SDF-NP-treated rats had more EPCs in the blood and preserved capillaries and arterioles in the ischemic border myocardium 4 weeks after treatment, which improved microvascular perfusion, reduced fibrosis, and preserved heart function. Of note, the hearts treated with SDF-NPs retained left ventricular function at 4 weeks compared to 1 day post-treatment, with an increase in the ejection fraction of 2.7±1.2%. The other three treatments decreased left ventricular function at 4 weeks (PBS: -7.8±1.2%, P&lt;0.001; empty NPs: -3.9±1.3%, P=0.004; and SDF solution: -5.1±1.3%, P=0.001). Conclusions: Intravenous SDF-NPs selectively accumulate in ischemic cardiac tissue, protecting the myocardium from I/R injury via angiogenic effects along with EPC migration. This novel cardioprotective drug may be clinically translatable.
Abstract 12961: Heart Failure Redesign Across a Newly Integrated Health System
Authors: Kismet Rasmusson, Jenna Miller, Jeffrey Goss, Rami Alharethi, Ruchika Husa, Corey Lum, Vicki Koceja, Kaley Graham, Jennifer Springer, Theresa Ketterling, Merrilee Phillips, Reuben Evans, Carrie Willis, Susan Longman, Simon Payne
Journal: Circulation (2023)

Introduction: Heart Failure (HF) challenges are magnified when healthcare mergers and expansions occur requiring significant integration of operational and clinical effort. With enterprise support, we brought HF teams together from a newly merged system to 'redesign' HF care aiming to provide high level, consistent, evidence-based, patient-centered care in a novel, adaptive model where such roadmaps do not exist. Hypothesis: Integrated care across a large network can be patient centered, of high value, with a proper framework. Methods: Representatives from 3 distinct, newly aligned regions of Intermountain Health completed a care redesign program aimed to integrate HF services. Current processes, tools, education were evaluated then mapped to identify barriers and most impactful areas to guide redesign. Results: Over 6 months, 45 multidisciplinary HF specialists met weekly. Current state was mapped for 9 markets across 3 regions reaching &gt;38,089 patients. Baseline data revealed areas for improvement: readmissions, mortality, advanced care planning, transitions in care. 141 barriers were identified, 39 of high impact, 15 are the primary focus; includes increasing access to stage-based care, implementing a guideline-directed referral pathway and providing market-specific resources. 4 teams built an operating system to support a new HF standard (image). Elements culminated in a consistent care path across the HF Stages for the newly formed enterprise. Implementation is underway; outcomes will be forthcoming. Conclusion: Building HF care across a large healthcare organization takes both clinical and operational leadership through shared learning. With a vision and framework this redesigned system aims to increase ease and access while providing high quality, patient-centered, consistent care regardless of location. Attention to high areas of opportunity requires operational prioritization, subject matter expertise, and resource support.
Abstract 14017: Clinical Characteristics and Treatment Patterns in Patients With Heart Failure: Results From the Icareme Middle East and Africa Cohort
Authors: Bassem Zarif, Yuksel Cavusoglu, Firas Al Badarin, Constantine Akwanalo, Kuven Naidu, Ahmed Reja, AbdelKareem Khawaldeh, Paola Atallah, Susana Goncalves, Hardik Vasnawala, Ahmed HADAOUI
Journal: Circulation (2023)

Introduction: Heart failure (HF) is a leading global health problem affecting more than 64 million people worldwide. Co-existing cardiovascular renal and metabolic (CVRM) diseases confer poorer prognosis with an increased risk of outcomes. Although Middle East and Africa (MEA) region bears a disproportionately high burden of CVRM diseases, there is a scarcity of real-world data on patients’ characteristics, risk factors, and management practices. Aims: To describe the clinical features, comorbidities, and treatment patterns in patients with HF from the MEA-HF cohort of iCaReMe Registry. Methods: iCaReMe Registry is a multinational, prospective, observational study (NCT03549754) collecting data on the management and quality of care of patients with HF, HTN, T2D and or CKD. We included in this baseline cross-sectional analysis data of HF patients enrolled between Feb 2018 and Dec 2022 from 8 countries (Egypt, Ethiopia, Jordan, Kenya, Lebanon, South Africa, Turkey, and United Arab Emirates). Results: : Overall, 2239 adults (mean±SD age of 58.4±12.6 years, 61.7% males) with HF were enrolled. Of the 85.7% patients with available LVEF data, 67.6% had HFrEF; 83.8% had NYHA class II-IV symptoms. Comorbidities included HTN (56.4%), T2D (50.3%), CAD (47.8%), dyslipidemia (33.0%), and CKD (26.5%). Mean UACR was 516.1 mg/g and mean eGFR was 70.7 ml/min/1.73m 2 reported in 13.8% and 80.9% of patients respectively. Overall, 24.1% had history of hospitalization for heart failure. The prescribed treatments at baseline included ACEi/ARB (72.1%), beta-blockers (74.8%), diuretics (65.2%), aldosterone antagonists (45.1%), SGLT2i (41.3%) and ARNI (18.8%). Conclusions: The substantial prevalence of CV comorbidities across the ejection fraction spectrum justifies the need to improve heart failure care with the strengthening of the use of therapies with morbidity and mortality proven benefits.