tbuckley/cabot-search huggingface dataset:
Abstract 4145249: THE TWO-HIT HYPOTHESIS?: NEW ONEST SEVERE CARDIOMYOPATHY AND CARDIAC ARRYTHMIA IN A HIGH RISK PATIENT WITH NEUROGENIC ORTHOSTATIC HYPOTENSION ON DROXIDOPA
Authors: Yan Naung Htay, Varun Victor, Lakshmi Murugesan, Thi Ri, Dilanthy Annappah, Billal Sikandar, Ataul Qureshi, Ryan Koene
Journal: Circulation (2024)

Introduction: Droxidopa (DD) is the second FDA approved drug after midodrine for neurogenic orthostatic hypotension (nOH). Isaacon et al reported that 19 (5.4%) of total 350 patients on droxidopa had 25 cardiac events, most commonly atrial fibrillation in a mean duration of 363 days. Currently, limited long term cardiovascular safety data is available. We encountered a patient with nOH on DD, who developed symptomatic frequent premature ventricular contractions (PVCs) and severe cardiomyopathy (CM). Case: A 52-year-old woman with a long-standing nOH had persistent lightheadedness, dizziness, presyncope and hypotension despite midodrine, fludrocortisone, and non-pharmacological measures. Her past medical history was significant for nodular lymphocyte dominant Hodgkin lymphoma status post AVBD chemotherapy in 2001, with recurrence in 2012, which was treated with autologous stem cell transplantation. Patient was switched to DD from midodrine for nOH and responded well. However, she developed frequent PVCs(13%), left bundle branch block(QRS 127 ms), with new onset CM approximately 2 years later. The ischemic work-up with coronary angiography was normal and cardiac MRI showed no late gadolinium enhancement. DD was stopped and patient was started on GDMT for HFrEF with subsequent improvement in PVC burden(1%). GDMT uptitration was limited due to hypotension. Without EF recovery up to 2 years, she received CRT-D placement. Discussion: CM after anthracycline therapy is rare after 5 years. Our patient’s last exposure to doxorubincin was 17 years before the onset of CM. Serial echocardiograms showed normal cardiac function over years. A potential association of developing takotsubo cardiomyopathy was suggested in patients on DD by Sato et al, the potential mechanism being the increased adrenergic drive. The rapid development of non-ischemic, non-infiltrative CM and cardiac arrythmia, which subsequently improved by stopping the DD, is alarming for DD’s potential side effect. Conclusion: Caution should be taken in prescribing DD in patients with nOH, who are at higher risk for development of cardiac arrythmia and cardiomyopathy. Further studies and data are needed in identifying or excluding the potential cardiovascular side effects.
Abstract 4144872: Feasibility and Outcomes of Using an Intraprocedural Artificial Intelligence System in Recognizing Regions of Dispersion and Generating Sequential Maps to Assist in Radiofrequency Ablations for Persistent Atrial Fibrillation
Authors: Kirollos Gabrah, Brandon Doty, Jonathan Cain, Noel Maldonado, Bridget Lee, Arun Mahtani, Jamarcus Brider, Feross Al-Hindi, Devi Nair
Journal: Circulation (2024)

Background: Pulmonary vein isolation (PVI) is the cornerstone therapy during catheter ablation of atrial fibrillation (AF) isolation. 30% of patients continue to have recurrent AF despite pulmonary vein (PV) isolation. Defining targets for catheter ablation in PV non responder subgroup continues to be challenging despite technological advances. Volta AF-Xplorer™ (VX) is an artificial intelligence (AI) system that analyzes intracardiac signals using electrocardiograms to recognize regions of spatial temporal dispersion and generate sequential maps as targets for ablation. Objective: We aim to assess the clinical feasibility and outcomes of the VX AI mapping algorithm during RF catheter ablations to treat recurrent persistent AF in PV non responders. Methods: A single center prospective analysis of patients undergoing repeat ablation for recurrent persistent AF using VX mapping software was performed. All patients had previous PVIs, with recurrence of AF and failed at least 2 antiarrhythmic drugs. Patients underwent 3D mapping using Carto and Ensite X mapping systems with real time detection and annotation of spatial temporal dispersion using the Volta technology. The identified targets were ablated until endpoints of termination and non inducibility was achieved and intraprocedural data points were recorded. Results: 19 patients with a mean age of 67±10.15 years 63.2% male were included in this analysis. Average total procedure time was 68±33 min and average mapping time was 17±10 min. Ablations were performed under zero fluoroscopy. PVI was confirmed in all cases. Ablation was performed at dispersion points identified using the AI mapping system. Termination was achieved in 18 out of the 19 cases (94.7%). 16 patients converted directly to normal sinus rhythm (NSR) and 2 patients to atrial flutter and then to NSR. The one patient that did not terminate required cardioversion but was not inducible with pacing maneuvers. Conclusion: This experience highlights the clinical safety, utility, feasibility, and outcomes of the Volta AF-Xplorer AI mapping software during catheter ablation of PV non responders for recurrent persistent AF.
Abstract 4145226: Sex Differences in Associations Between Adverse Childhood Experiences, Psychological Distress and Health Status in Patients with Recent Myocardial Infarction
Authors: Alexis Bartelloni, Milla Arabadjian, Sinia Sareen, Stefany de Brito, Nathaniel Smilowitz, Harmony Reynolds, Tanya Spruill
Journal: Circulation (2024)

Introduction: Adverse childhood experiences (ACEs) are associated with psychological distress in adulthood and increased cardiovascular disease (CVD) risk. Less is known about these relationships in patients with established CVD. Objective: To examine associations between ACEs and psychological distress and disease-specific health status in adults with recent myocardial infarction (MI). We hypothesized that MI patients with higher ACE exposure will report greater distress and poorer health status with stronger associations in women than men. Methods: We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Five ACEs were assessed: living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Outcomes were elevated perceived stress (PSS4 ≥6) and depressive symptoms (PHQ2 ≥3) and disease-specific health status (Seattle Angina Questionnaire [SAQ7 summary score]). We used chi-square tests, t-tests and linear regression to test univariate and multivariate associations, overall and by sex. Results: The 143 participants (36.4% women, mean age 61.5 years [SD=13.4]) completed questionnaires at median 40.5 days post-MI (IQR=22-64.5). At least one ACE was reported by 51% of participants (53.8% women vs. 46.2% men, p=0.73). Women had somewhat poorer health status than men (69.2±22.8 vs. 74.5±18.8; p=0.07) but similar rates of elevated stress (64.7% vs. 51.7%, p=0.16) and depressive symptoms (21.6% vs. 16.9%, p=0.51). Women with ≥1 ACE had poorer health status (62.6 vs. 77.1, p=0.01) and higher rates of elevated stress (78.6% vs. 47.8%, p=0.02) and depressive symptoms (32.1% vs. 8.7%, p=0.04) than those without ACEs; there were no associations in men. After adjusting for age, body mass index, time since MI and participation in cardiac rehabilitation, greater ACEs exposure (0-5) was associated with poorer health status in women (B=-7.2, SE=2.4, p=0.005) but not in men (B=1.9, SE=2.2, p=0.38); the association in women was reduced when further adjusting for PSS4 and PHQ2 scores (B=-3.7, SE=2.8, p=0.20), suggesting a possible mediating effect of distress. Conclusions: Higher ACE exposure is associated with greater psychological distress and worse disease-specific health status in women post-MI. These associations were not observed in men despite similar levels of ACE exposure. ACEs screening may help identify women who could benefit from psychosocial support after MI.
Abstract 4145033: Trends in-hospital mortality and 90-day outcomes in cardiac implantable electronic device management amongst patients with and without ERSD, a national analysis
Authors: Maligireddy Anand Reddy, Lolita Golemi, Chaitanya Rojulpote, William Frick, Somshukla Ghosh, Jason Siebert, Ali Khan, Rabya Saraf, Shivaraj Patil, Chien-Jung Lin, Deana Mikhalkova, Nicholas Ierovante, Philip Mar
Journal: Circulation (2024)

Background: Cardiac implantable electronic device (CIED) infections pose risks, with outcomes potentially influenced by underlying comorbidities such as end-stage renal disease (ESRD). Objective: To evaluate the differences in clinical outcomes of CIED-infection management between patients with and without ESRD. Methods: From 2016 to 2020, we employed the National Readmission Database to identify patients ≥18 years of age who were admitted with CIED-related infections. CIED/lead extraction was defined as a composite of extraction of device, with or without revision or replacement in index hospitalization. Patients were stratified based on ESRD status. Results: Patients with ESRD had a higher rate of mortality in index hospitalization than no-ESRD (14.82%, vs 5.95%, p&lt;0.001). CIED-related infection was the leading cause of readmission in both groups (40.7% vs 79.5%). 90-day readmission mortality (6.5% vs. 3.7%, p=0.458) and hospital readmission rates (1.09% vs 1.46%, p=289) were comparable between ESRD vs no- ESRD patients. ESRD patients had longer length of stay (29.5 vs. 16.8 days, p&lt;0.001) and higher total charges ($559185 vs. $317353, p&lt;0.001). Over a 5-year period, CIED extraction rates remained unchanged, with no improvement in its associated mortality (p=0.805). Conclusion: CIED-related infections in ESRD patients have nearly a 3-fold increase in mortality during index hospitalization but no significant differences were observed during a 90-day mortality.
Abstract 4144852: Contemporary Practice Patterns of Vasoactive Agents in Cardiogenic Shock: An Analysis of the AHA Cardiogenic Shock Registry
Authors: Siddharth Patel, David Berg, Erin Bohula, Michael Palazzolo, Mitchell Krucoff, David Morrow
Journal: Circulation (2024)

Background: Contemporary practice patterns regarding selection of vasoactive agents in cardiogenic shock (CS) have not been well characterized. Methods: This analysis utilized CS admissions (n=4,311) captured in the American Heart Association (AHA) CS Registry across 64 sites from 2022-2024. Vasoactive agents used within 6h of CS onset were captured in the eCRF, and categorized as inodilators (dobutamine, milrinone), inopressors (norepinephrine, epinephrine, dopamine), or pure vasopressors (vasopressin, phenylephrine). CS etiology was classified as per the Shock Academic Research Consortium definitions: AMI-CS and HF-CS (acute-on-chronic and de novo HF). Subgroup analyses were performed by preceding cardiac arrest status. Results: Overall, 3,331 patients (77% of all CS) were treated with ≥1 vasoactive agents in the initial 6h of CS onset (46% with single vs. multiple agents). Inopressors were the most frequently used vasoactive category, with norepinephrine being the most frequently utilized agent ( Fig A ). Phenylephrine and dopamine were the least frequently employed ( Fig A ). Stratifying by CS etiology, inodilators were more commonly used for HF-CS vs. AMI-CS (OR [95% CI], 3.05 [2.59-3.59]), driven primarily by those with acute-on-chronic vs. de novo HF (OR 2.95 [2.30-3.78]), as well as in patients with pre-existing pulmonary HTN (OR 2.13 [1.61-2.81]). A total of 743 patients had preceding cardiac arrest; inopressors were more frequently used among those with vs. without preceding cardiac arrest (OR 7.96 [5.84-10.85]; Fig B ). Among patients who were treated with ≥2 agents in the initial 6h (n=1,788), the most common two-agent combinations were norepinephrine with epinephrine (45%), norepinephrine with vasopressin (40%) and norepinephrine with dobutamine (30%). Conclusions: Norepinephrine is the most commonly utilized vasoactive agent (~2/3) in a broad population presenting with CS in contemporary practice, with epinephrine being used in ~1/3. However, CS etiology and illness severity are associated with differential practice patterns for vasoactive selection. These data provide the first snapshot of the landscape of contemporary vasoactive therapy in the US in the AHA CS Registry.
Abstract 4145244: Burden and Impact of Pulmonary Embolism in Young Adults Hospitalized With Sarcoidosis - Underreported Data from Nationwide Analysis (2016-2020)
Authors: Harsh Sura, Aditi Bhanushali, Pooja Suchday, Shrikanth Sampath, Lohithasya chowdary Chunduru, Purvik Byralinge Gowda, Moulika Kari, Abhimanyu Karumanchi, Rupak Desai
Journal: Circulation (2024)

BACKGROUND: Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism but little is known about its impact, especially in young adults. We aim to determine the burden and impact of pulmonary embolism (PE) in young adults hospitalized with sarcoidosis. METHOD: The study investigates the prevalence and consequences of PE in young adults aged 18-44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016-2020) with relevant ICD-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns. RESULT: Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% (p&lt;0.001) in 2020. Sarcoidosis-PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism, and prior history of VTE. In contrast, the sarcoidosis-PE- group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia, and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (OR: 2.92, 95% CI: 1.18-7.24, p &lt;0.02) in the sarcoidosis-PE+ group as compared to sarcoidosis-PE- group. The sarcoidosis-PE+ group also had higher hospital costs and length of stay. CONCLUSION: The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis-PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.
Abstract 4145070: Genetic and Family Analysis of Probands with Peripartum Cardiomyopathy and Dilated Cardiomyopathy and Their First-Degree Relatives
Authors: Evan Kransdorf, Rashmi Jain, Daniel Kinnamon, Elizabeth Jordan, Hanyu Ni, Ray Hershberger
Journal: Circulation (2024)

Introduction: Peripartum cardiomyopathy (PPCM) presents as left ventricular systolic dysfunction (LVSD) during pregnancy or the post-partum interval. The underlying cause of PPCM remains incompletely defined, with hypotheses suggesting either pregnancy-related environmental (e.g., hormonal, hemodynamic) cause or genetic cause similar to dilated cardiomyopathy (DCM). Hypothesis: If PPCM results principally from pregnancy-related environmental cause, then first-degree relatives (FDRs) of women with PPCM will have lower risk of DCM than FDRs of women with DCM because they cannot share this risk. Conversely, if DCM genetics underlies both PPCM and DCM, then FDRs of women with PPCM or DCM are equally likely to share these genetic factors and will have comparable risks. Aims: In female probands with PPCM or DCM from the DCM Precision Medicine Study, evaluate proband DCM-relevant rare variant genetics; in their FDRs, compare the age-specific cumulative risk of DCM, LVSD, or LV enlargement [LVE]. Methods: Of 452 female probands with DCM, 72 met criteria for PPCM; all underwent exome sequencing and analysis of rare variants in 36 DCM genes. Their 665 FDRs were assessed for DCM, LVSD, or LVE. Hierarchical logit models were used to describe the distribution of the most deleterious variant identified (none, variant of uncertain significance, or pathogenic/likely pathogenic) in probands. For FDRs, binary data on the presence or absence of DCM, LVSD, or LVE at enrollment were used to model age-specific cumulative risk in a Weibull proportional hazards model. Models accounted for site heterogeneity and, in FDRs, intrafamilial correlation. Results: The odds of finding a DCM-relevant rare variant were comparable between female probands with PPCM and DCM (OR=1.07, 95% CI: 0.37-3.11, p=0.90) adjusting for ancestry, ethnicity, and diagnosis age. DCM-relevant rare variants of PPCM probands were similar to those of DCM probands for ClinGen gene evidence category (p=0.55) and variant predicted impact (loss-of-function, missense, or other; p=0.90). Age-specific cumulative risk of DCM, LVSD, or LVE was not different among FDRs of women with PPCM or DCM (HR=0.96, 95% CI: 0.59-1.57, p=0.87) adjusting for proband ancestry and diagnosis age and FDR sex. Conclusion: Data from female probands indicate that PPCM and DCM have a similar rare variant genetic basis. FDRs of both PPCM and DCM probands show similar risks of DCM, LVSD, or LVE, further supporting an underlying genetic cause for PPCM.
Abstract 4145246: Regional Disparities in the Cardiology Workforce: Insights from the U.S. Bureau of Labor Statistics
Authors: Azeem Rathore, Hafiz Muhammad Waqar Younas, Daniel Hanna, tara kronen, Prakash Upreti, Pankaj Mathur, Dinesh Kadariya, M Chadi Alraies
Journal: Circulation (2024)

Background: Access to cardiology services remains a persistent challenge. Identifying regional disparities in the workforce can help inform healthcare policies toward equitable access of cardiologists. Methods: We conducted a cross-sectional analysis of the 2023 U.S. Bureau of Labor Statistics report, focusing on employment estimates, mean wages, and location quotients (LQs) for cardiologists. Data was aggregated at national, state, and metropolitan levels. Results: Nationally, 15,190 cardiologists were employed, with a mean annual wage of $421,330. Regional disparities in wages were apparent, with Northeastern states like New York ($402,840), New Jersey ($331,430), and Connecticut ($381,730) offering higher salaries while states like Utah ($267,030) and South Carolina ($287,360). The states with the highest LQs were Connecticut (2.47), Rhode Island (2.46), and Delaware (2.07) while Louisiana (0.16), South Carolina (0.22), and Utah (0.29) had the lowest LQS. Urban areas like Boston-Cambridge-Nashua, MA-NH (1.39) and New York-Newark-Jersey City, NY-NJ-PA (2.14) demonstrate robust demand, while regions like Cedar Rapids, IA (3.28) and Winchester, VA-WV (4.63) display concentrated demand despite lower employment figures. Conclusion: Significant regional gaps in cardiologist employment and compensation exist across the U.S., particularly pronounced in urban centers with advanced healthcare infrastructure. States with historically lower health outcomes, such as Mississippi and West Virginia, also had lower LQs highlighting the ongoing demand for specialized care, such as cardiology. States like Utah, which rank highly in many health outcomes, show low demand for cardiologists despite a low LQ, indicating a healthcare system meeting patient demands. By aligning healthcare resources with the specific needs of each region, policymakers can work toward achieving more equitable healthcare access and improved health outcomes nationwide.
Abstract 4145225: Sodium Glucose Cotransporter 2 Inhibitors After Acute Myocardial Infarction: An updated systematic review and meta-analysis.
Authors: Pedro Gabriel Scardini, Eric Katsuyama, Alonzo Prata, Wilson Falco Neto, Christian Fukunaga, Ana Carolina Coan, Julia Fernandes, Rafael Petri Santos Pinheiro, Naieli Andrade, Luciana Gioli-Pereira
Journal: Circulation (2024)

Background: Sodium-glucose co-transporter two inhibitors (SGLT2i) have recently been included in heart failure (HF) guidelines due to their benefits in reducing mortality and hospitalization rates. However, the benefits of SGLT2i in patients with post-acute myocardial infarction (MI) remain controversial. Therefore, we aim to perform an updated systematic review and meta-analysis comparing SGLT2i with placebo in patients after an acute MI. Methods: We performed a systematic review and meta-analysis to determine the impact of SLGT2i in patients with post-acute MI with or without diabetes type II (DM II). We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SGLT2i and placebo in patients following an acute MI. The primary outcome assessed was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes:(2) cardiovascular (CV) mortality and (3) MI recurrence. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model. Results: Our meta-analysis included ten RCTs comprising 25908 patients, of whom 14098 (54.4%) received SGLT2i therapy and 15078 (58.2%) had type II diabetes. The mean age was 62 years, and the mean follow-up was 21.2 months. In the pooled analysis, HF hospitalization was significantly lower in the SGLT2is group (RR 0.76; 95%CI 0.68,0.84; p&lt;0.001; Fig. 1). There was no statistically significant difference between the groups in terms of MI recurrence rates (RR 1.05; 95%CI 0.79,1.39; p=0.7; Fig. 2 A) and CV mortality (RR 0.91; 95%CI 0.75,1.11; p=0.34; Fig. 2 B). Conclusion: In this updated meta-analysis of patients with a history of acute myocardial infarction, the administration of SGLT2i was significantly associated with reduced hospitalization rates for heart failure. However, our results show no benefits in MI recurrence and CV mortality endpoints.
Abstract 4144897: Complex Pathogenesis and Clinical Presentations of Pediatric Infectious Endocarditis in the Modern Era
Authors: Paul Rosenberger, Takeshi Tsuda, Bahram Kakavand, Abdul Bhat, Danilo Tadeo
Journal: Circulation (2024)

Background: Infective endocarditis (IE) can induce serious acute and chronic impacts on the cardiovascular system in children. Congenital heart disease (CHD) is a common predisposing factor, but IE can occur without CHD, suggesting its complex pathogenesis. Methods: A retrospective chart review was performed for patients with an admission diagnosis of IE. Demographic data, clinical manifestations, isolated organisms, treatment, and outcomes were studied. Results: A total of 76 IE cases were divided into unrepaired CHD (13), repaired CHD (31), and non-CHD (32) (Table 1). There was no significant difference in age or sex between the three groups. Although a majority of the patients presented with nonspecific symptoms, a high incidence of thromboembolic events was noted in the Non-CHD group. Five patients with repaired CHD had DiGeorge syndrome. Overall, Staphylococcus aureus (S. aureus) was the most common organism; a high incidence of methicillin-resistant S. aureus was noted only in the Non-CHD group. Surgical intervention and hospitalization days were comparable between the groups. Recurrence was noted only in 2 cases. In 13 patients with thromboembolic events at presentation, vegetations were identified in the right (7), left (2), and both (2) sides of the heart (Table 2). Embolic events were noted as pulmonary embolism (5), arthritis/osteomyelitis (5), stroke (2), liver abscess (1), and renal embolism (1). Two patients developed an embolism in both pulmonary and systemic circulation. There were 5 total deaths, 3 of which occurred in the Non-CHD group. Two of these deaths in the Non-CHD group were directly attributable to embolic strokes from IE. Conclusions: Distinct clinical pictures of IE were identified with and without underlying CHD. The IE without CHD was characterized by a high incidence of thromboembolic events and mortality rate. The pathogenesis and clinical presentation of IE has become more diverse due to more advanced and comprehensive medical treatment.