tbuckley/cabot-search huggingface dataset:
Abstract 15441: Impact of the COVID-19 Pandemic on Cardiac Implantable Electronic Device Procedures and Complications in the United States
Authors: Caleb Carver, Kamleshun Ramphul, Saurabh Deshpande, Hassan Khan, Raheel Ahmed, Edmond Obeng-Gyimah, Brian Schuler, Mohammed Khanji, Hiroyuki Sawatari, Syed Emir Irfan Wafa, Virend K Somers, Deepak Padmanabhan, Rui Providencia, Anwar Chahal
Journal: Circulation (2023)

Introduction: The impact of COVID-19 was felt across cardiology as resources were redirected to critical care, delaying elective cardiology procedures. Hypothesis: To evaluate differences in outcomes of cardiac implantable electronic device (CIED) procedures in 2020 (height of COVID) vs. 2016-2019 (pre-COVID). Methods: Adults &gt;= 18 years undergoing CIED procedures were identified from National Inpatient Sample Databases (NIS) 2016-2020. Complications and mortality were assessed based on the type of device: Permanent Pacemaker (PPM); Implantable Cardioverter Defibrillator (ICD); Cardiac Resynchronization Therapy with Pacemaker (CRT-P) or defibrillator (CRT-D): Leadless PPM; Generator explant (GE), and Lead extraction (LE). Results: A 13.8% drop in CIED admissions was recorded between 2019 and 2020 (p&lt;0.01). Fewer procedures involving PPM, ICD, CRT-P, CRT-D, LE, and GE were observed between 2019 and 2020. Leadless PPM utilization rose consistently between 2016-2020 (47.6% increase during 2020 vs 2019)(Figure). In 2020, a higher proportion of patients were classified with a Charlson Comorbidity Index score of ≥3 (severe) (47.4% in 2020 vs. 42.9% in 2016-2019, p&lt;0.01). The table shows significantly higher complications during CIED implants with no changes in mortality related to procedures. Conclusions: Patients admitted for CIED implants in 2020 had more severe comorbidities and expressed considerable differences in complications than pre-COVID era (2016-2019), but mortality remained unchanged. Leadless PPM use increased during pandemic, as against a decrease in the use of other CIEDs.
Abstract 14193: Safety and Efficacy of Catheter Ablation of Atrial Fibrillation With Pulsed Field Ablation versus Thermal Energy Ablation: A Systematic Review and Meta-Analysis
Authors: Omar M Aldaas, Amer M Aldaas, Frederick Han, Kurt S Hoffmayer, David E Krummen, Gordon Ho, farshad raissi, Ulrika Birgersdotter-Green, Gregory K Feld, Jonathan C Hsu
Journal: Circulation (2023)

Introduction: Pulsed field ablation (PFA) has emerged as a novel energy source for the ablation of atrial fibrillation (AF) using ultrarapid electrical pulses to induce cell death via electroporation. Hypothesis: Ablation of AF with PFA will be more safe and as effective as thermal energy sources. Methods: We performed an extensive literature search and systematic review of studies that evaluated the safety and efficacy of ablation of AF with PFA and compared these to landmark clinical trials of ablation of AF with thermal energy sources. Freeman-Tukey double arcsine transformation was used to establish variance of raw proportions followed by the inverse with the random effects model to combine the transformed proportions and generate the pooled prevalence and 95% confidence intervals (CI). Results: We included 24 studies for a total of 5,203 patients who underwent ablation of AF. Among these patients, 54.6% (n=2,842) underwent PFA and 45.4% (n=2,361) underwent thermal ablation. There were significantly fewer periprocedural complications in the PFA group (2.05%; CI 0.94-3.46) compared to the thermal ablation group (7.75%; CI 5.40-10.47) (p=0.001). When comparing AF recurrence up to one year, there was a statistically insignificant trend towards a lower prevalence of recurrence in the PFA group (14.24%, CI 6.97-23.35) compared to the thermal ablation group (25.98%, CI 15.75-37.68) (p=0.132) as shown in Figure 1. Conclusion: Based on the results of this meta-analysis, PFA was associated with lower rates of periprocedural complications and similar rates of recurrent AF with up to one year of follow-up when compared to ablation with thermal energy sources.
Abstract 15063: Incidence and Risk Factors for Heart Failure in 20 000 Newly Diagnosed Diabetes Patients
Authors: Carl Lejonberg, Tomasz Czuba, Louise Bennet, Olle Melander, Maria F Gomez, Emma Ahlqvist, Gustav Smith
Journal: Circulation (2023)

Introduction: Heart Failure (HF) is a diabetes complication causing high mortality and morbidity but has received relatively limited attention compared to other complications such as acute myocardial infarction (AMI). Substantial residual HF risk remains after achieving current treatment targets, suggesting important additional pathophysiological mechanisms beyond conventional risk factors. Aim: to study the incidence and risk factors for HF in newly diagnosed diabetes patients. Methods: We used a contemporary, regional inception cohort (n=19,938) from Scania County in Sweden, to study the incidence and risk factors for HF from initial diabetes diagnosis. Biochemical and questionnaire data were collected within 1 year from initial diagnosis in newly diagnosed diabetes patients (&gt;90% participation rate). We combined baseline data with information on incident HF and AMI diagnoses from a nationwide patient register, and applied Cox-regression models for analysis. Results: A total of 819 patients (4%) had been diagnosed with HF before diabetes diagnosis (median 3 years earlier) and 1245 (6%) with AMI. The cumulative incidence of HF in patients free from HF at diabetes diagnosis was 5%, similar to AMI (3%), during up to 13 years follow-up (median 5 years). Of patients with incident HF, 27% had a prior AMI. No type 1 diabetes (T1D) patient had incident HF, while HF risk was similar in type 2 diabetes, latent autoimmune diabetes in adults (LADA) and secondary diabetes. In non-T1D diabetes patients, male sex (HR 1.52) and higher age at onset (HR 1.08), BMI (HR 1.04), and insulin resistance (HR 1.17) were independently associated with higher incidence of all-cause HF and HF without prior AMI (p&lt;0.05). Baseline fasting glucose, HbA1c and autoantibodies were not associated with HF. Conclusions: Our findings demonstrate high incidence of HF over the decade after initial diabetes diagnosis, comparable to AMI. We further identify insulin resistance, but not hyperglycemia or autoantibodies, as risk factor for HF.
Abstract 14782: Pre- and Post-Hemodialysis Differences in Heart Failure Diagnosis by Current Heart Failure Guidelines in Patients With End-Stage Renal Disease
Authors: Kim Bong Joon
Journal: Circulation (2023)

Introduction: Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). Hypothesis: This study estimated pre- and post-HD in ESRD HF diagnosis prevalence using the current guidelines. Methods: We prospectively investigated ESRD patients on HD using echocardiography between pre and post HD. We used structural or functional abnormality criteria of 2021 ESC guideline of HF Results: A total of 54 patients were enrolled. The mean age was 62.6 years and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, 20 (37.0%) had ischemic heart disease. Mean NT-pro BNP level was 11959.9pg/dL. The mean ideal body weight was 59.3kg, mean HD time was 237.4 minutes, and mean real filtration was 2.8 kg. The mean LVEF was 62.4% and mean LVEDD was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower LAVI (33.3 ± 15.9 vs. 40.6 ± 17.1 ml/m 2 , p=0.030), TR jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p&lt;0.001), and RVSP (32.1 ± 10.3 vs. 38.4 ± 11.6 mmHg, p=0.005) compared with pre-HD. There was no difference in LVEF, E/E’ ratio, or LV GLS. A total of 88.9% for pre-HD and 66.7% for post-HD had at least structural or functional abnormalities according to recent HF guidelines (p=0.007). Conclusions: Our data show that post-HD echocardiography showed significantly reduced LAVI, TR jet V and RVSP compared to pre-HD. The difference of prevalence of HF was 22.2% between pre- and post- HD.
Abstract 17111: Spontaneous Regression of Cardiac Angiosarcoma in a 17-Year-Old Male
Authors: Noor Sharrack, Martine Parent, Christopher Lethaby, Maryum Farooq, Sven Plein, Ananth Kidambi
Journal: Circulation (2023)

Description of Case: A fit and healthy 17-year-old male was admitted with a 10-day history of chest pain and SOB. He was taking no medication and had no significant past medical or family history. Clinical examination revealed signs of pericarditis with widespread ST elevation and PR depression on ECG. TTE showed a moderate, global pericardial effusion. He was treated for pericarditis with anti-inflammatory medication and discharged with follow up a few weeks later. Repeat TTE demonstrated a mass in the pericardial space adjacent to the RV free wall. Urgent CMR was requested to exclude malignancy and showed a large, irregular heterogenous mass adjacent to the RA and RV with invasion into the RV free wall. CMR characterisation including first pass perfusion was indeterminate. CT TAP showed no distant metastases. Percutaneous biopsy was non diagnostic and serial CMR 3 weeks later showed significant reduction of the mass. PET-CT confirmed reduction in the size of the mass although there was moderate heterogeneous FDG uptake, more suggestive of malignancy rather than a benign lesion. Given the apparent resorption of the mass, repeat CMR was planned 3 months later. Repeat CMR (6 months after initial CMR) showed significant increase in the size of the cardiac mass. Surgical biopsy confirmed cardiac angiosarcoma and was unresectable. After MDT discussion, the patient was started on doxorubicin, dexrazoxane and pazopanib. This has failed to control the tumour, and he has now commenced a trial of paclitaxel. Discussion: Spontaneous regression of cardiac rhabdomyoma in infants has been described, but this does not extend to other primary cardiac tumours or adults. The re-emergence and significant increase in size of the mass suggests initial regression may have been a percutaneous biopsy effect causing collapse or resorption of the necrotic core. Suggested mechanisms include disruption of the tumour feeding artery during biopsy or activation of the immune system.
Abstract 12811: Incidence and Phenotypic Predictors of Arrhythmias in Idiopathic Pulmonary Arterial Hypertension
Authors: Ashwin Reddy, Jennifer Middleton, Sarah Nethercott, Gary Polwarth, Joanna Pepke-Zaba, Claire Martin, Alex M Rothman, Mark Toshner
Journal: Circulation (2023)

Introduction: Arrhythmias are common in patients with idiopathic pulmonary arterial hypertension (IPAH). However prospective analysis of arrhythmias in a large cohort of IPAH patients using implantable cardiac monitors (ICMs) is lacking. Aims: Establish the rate of arrhythmias in a prospective cohort of IPAH patients using ICMs. Determine factors that predict arrhythmia occurrence in IPAH. Elucidate whether arrhythmia incidence is related to adverse outcomes. Methods: ICMs were implanted into 80 IPAH patients across two UK centres. Arrhythmia and clinical worsening events (defined as death, transplant or hospitalisation due to PAH worsening) were prospectively recorded and characteristics associated with arrhythmia incidence identified. The arrhythmia rate in IPAH patients was compared to 72 age and sex-matched patients without IPAH who had ICMs implanted for clinical indications. Comparisons of data were performed using analysis of variance, χ2 or Kruskal-Wallis calculations as appropriate. The Cox proportional hazards model was used to resolve independent risk factors for significant arrhythmia occurrence. A two-tailed probability level of &lt;0.05 was considered significant. Results: Over 186 patient-years follow-up 79 arrhythmia events were noted in 40% IPAH patients vs 78 events in 41% comparators. Arrhythmia incidence was related to right atrial (RA) enlargement at time of implant, baseline conduction disease and symptom reporting. Arrhythmia incidence predicted clinical worsening (figure).20% of patients had targeted arrhythmia intervention as a direct consequence of ILR studies. Only RA size was independently associated with clinically significant arrhythmia on multivariate analysis Conclusion: Arrhythmias are frequent in IPAH patients and predict worse outcomes. RA enlargement is independently associated with clinically significant arrhythmia incidence. IPAH should be considered a high-risk group for continuous monitoring studies.
Abstract 14165: Left Atrial Appendage Emptying Velocity as a Predictor of Energy Required for Successful DC Cardioversion in Patients With Atrial Fibrillation
Authors: Bhuvi Raxwal, Sujal Patel, Yash Tongar, dipak M parekh, Amir Samir
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) is a prevalent cardiovascular disease in the elderly population. Restoring sinus rhythm in AF often involves antiarrhythmic drugs, direct current (DC) cardioversion, and ablation. The predictive value of left atrial appendage (LAA) emptying velocity in determining the energy required for successful DC cardioversion remains uncertain. Aim: To study the association between LAA emptying velocity and the amount of energy required for cardioversion in patients with AF undergoing DC cardioversion. Methods: A total of 79 consecutive AF patients were enrolled in the study. Transesophageal echocardiography was performed to exclude the presence of clot formation, after which patients underwent DC cardioversion using escalating biphasic energy levels of 100 joules, 200 joules, and 360 joules to restore sinus rhythm. Patients were stratified into two groups based on LAA emptying velocity: the low-velocity group (≤30 cm/sec) and the high-velocity group (&gt;30 cm/sec). Clinical characteristics were compared between the groups. Results: Of the 79 patients, 49 had a low LAA emptying velocity (LAAEV). The low-velocity group was older, with a mean age of 75 years compared to 70 years in the high-velocity group. The severity of mitral regurgitation was similar between the two groups. Patients with reduced LAA emptying velocity required significantly higher joules for successful cardioversion compared to the high-velocity group (192 joules vs. 155 joules, p-value = 0.02). Sleep apnea was more prevalent in the high-velocity group. The utilization of antiarrhythmic medications did not differ significantly between the groups (55% vs. 63%, p-value = 0.25). Conclusions: The study showed AF patients with low LAA emptying velocity require higher energy levels for successful cardioversion, suggesting that LAA emptying velocity may serve as a predictor of energy requirement in DC cardioversion for restoring sinus rhythm in AF patients.
Abstract 17893: Deep Learning for the Prediction of Myocardial Scarring Through Electrocardiograms
Authors: Jeff Zhang, Hao Zhang, Neil Jethani, LARRY A CHINITZ, Yindalon Aphinyanaphongs, Lior Jankelson
Journal: Circulation (2023)

Introduction: Cardiac Magnetic Resonance Imaging (MRI) with Late Gadolinium enhancement (LGE), the gold standard for myocardial scarring evaluation, is limited by cost, time, and expertise required. The Electrocardiogram (ECG), in contrast, is a widely available and affordable diagnostic tool. We applied deep learning (DL) models to ECGs to directly predict the presence of LGE on MRI. Methods: Patients who underwent a cardiac MRI and had at least one ECG collected from 2012 to 2022 were considered. Patients were classified into positive and negative for myocardial scarring via their MRI reports, labeled by experts. Patients with non-specific scarring were excluded from the dataset. Patient ECGs most recent to their MRI were utilized as input for the model. MRI reports and ECG waveforms were collected from NYU Langone Health. We implemented a 34-layer Neural Network architecture, adapted from a state-of-the-art arrhythmia detection model, to learn from a 10 second ECG sampled at 250hz. We evaluated the model using area under the receiver-operating curve (AUROC), specificity, sensitivity, and precision. Results: 8813 patients with MRI and ECG were included. 1559 were excluded due to non-specific scarring. 2739 patients were positive for scarring. Patients were split into a 70% train, 10% validation, and 20% test dataset. The deep learning model obtained a test set AUROC of 0.80 [95%CI, 0.77 - 0.81]. At 20% false positive rate, we obtained a sensitivity of 0.63, specificity of 0.80, and precision of 0.64. Conclusions: This study suggests that our DL model can predict for the presence of LGE from a surface ECG. A future direction of this work would be to evaluate the use of DL for the prediction of LGE location, quantity and specific phenotypes of myocardial disease.
Abstract 14297: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: Findings From the Third National Health and Nutrition Examination Survey
Authors: Meaghan E Kavanagh, Zefeng Zhang, Andrea J Glenn, Andreea Zurbau, Julianah O Oguntala, Vasanti S Malik, Robert G Josse, Cyril W Kendall, David J Jenkins, John L Sievenpiper
Journal: Circulation (2023)

Introduction: The Portfolio Diet, a dietary pattern that combines cholesterol-lowering plant foods, reduces several cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk predominately in White populations. As NHANES III (1988-1994) purposely over-sampled non-Hispanic Blacks and Mexican Americans, undertaking an analysis of the Portfolio Dietary Pattern in NHANES III will expand the generalizability of previous findings. Objective: To examine the relation of the Portfolio Dietary Pattern with CVD and all-cause mortality in NHANES III. Methods: We included 14,035 adults (76% non-Hispanic White, 11% non-Hispanic Blacks, 5% Mexican Americans, 8% other) without reported CVD. Diet was assessed by a 24-hour recall and supplemented with a food frequency questionnaire using the Portfolio Diet Score (PDS), with positive points given to nuts, plant protein, viscous fibre, phytosterols and plant monosaturated fat sources, and negative points given to foods high in saturated fat and cholesterol. To identify cause of death we used the NHANES III Linked Morality File (2019). SAS PROC SURVEYPHREG was used to run Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by tertiles of PDS for CVD and all-cause mortality with adjustment for behavioral, sociodemographic, family history, and baseline clinical and dietary characteristics. Results: During a median follow-up of 23 years, a total of 1,809 CVD deaths were documented over 321,950 person-years. After multivariable adjustment, higher PDS was associated with a lower risk of CVD mortality (HR 0.85; 95% CI: 0.73-0.99) and all-cause mortality (HR 0.86; 95% CI: 0.77-0.95) when comparing the highest to lowest tertiles of intake. A 25-percentile increase in PDS (6 points) tended towards an association with a lower risk of CVD mortality (HR: 0.88; 95% CI: 0.76-1.01) and was associated with lower risk of all-cause mortality (HR: 0.90; 95% CI: 0.85-0.96). Conclusion: Among US adults greater adherence to the Portfolio Dietary Pattern was inversely associated with CVD and all-cause mortality. These findings improve the generalizability of the Portfolio Dietary Pattern for CVD prevention in diverse populations.
Abstract 16723: Comparison of Myocardial Strain During Active Labor in Parturients With Hypertensive Disorders of Pregnancy via Speckle-Tracking Echocardiography
Authors: Marilyn Kouassi-Brou, Eunjung Choi, Pablo Martinez-Camblor, Leigh Hickerson
Journal: Circulation (2023)

Introduction: Hypertensive disorders of pregnancy (HDP) are increasing in prevalence in the USA and affect maternal morbidity and mortality. Hypothesis: Echocardiographic strain abnormalities may be more prevalent in patients with HDP in active labor, which may unmask subclinical left ventricular dysfunction. Methods: A total of 59 healthy term parturients (≥37 wks gestational age) in active labor (≥6cm cervical dilation) underwent echocardiography to assess cardiac function during peak physiologic stress. Speckle tracking strain analysis was performed using apical 4-, 3- and 2-chamber views during uterine contraction and relaxation with a S5-1 Philips Sparq probe and analyzed with Qlab 9 strain analysis software (Philips, Andover, MA, USA). Abnormal strain cutoff was &gt;-20%. Mean ± SD summarized continuous variables; absolute and relative frequencies for categorical. Welch T-test and Chi-square were used for group comparisons. Results: HDP was present in 21 subjects and absent in 39. Mean age, parity, and prevalence of diabetes did not differ significantly between the two groups. The HDP group had a higher mean BMI (Table 1). The non-HDP group had strain abnormalities in two segments during uterine relaxation, absent during contraction. The HDP group had abnormalities in 5 segments during uterine relaxation, 4 of which were persistently abnormal during uterine contraction (Fig 1). Conclusions: Abnormal strain values were detected at a higher rate in HDP group than in non-HDP group in active labor. Future research is needed to determine if subclinical strain abnormalities in those with HDP during active labor are predictive of developing future cardiovascular disease.
Abstract 17063: Pericardial Patch Augmentation of the Anterior and Posterior Tricuspid Leaflets Relieves Leaflet Tethering and Improves Coaptation in an Acute Porcine Model
Authors: Hannah Rando, Rachael W Quinn, Laeben Lester, Zachary Darby, Ifeanyi Chinedozi, Jin Kook Kang, James S Gammie
Journal: Circulation (2023)

Background: Tricuspid annuloplasty is generally effective in treating functional tricuspid regurgitation (TR), but patients with severe annular dilation or leaflet tethering have a high risk of recurrence. Hypothesis: We hypothesized that anterior and posterior patch augmentation (APA) of the tricuspid valve (TV) would reduce leaflet tethering, improve coaptation, and effectively treat TR. Methods: We evaluated APA repair in an acute porcine model. The TV was accessed via a right thoracotomy and cardiopulmonary bypass (CPB) was initiated with bicaval venous and ascending aortic cannulation. The anterior and posterior TV leaflets were separated from the annulus, and a 1.5 cm wide partial reverse frustum-shaped pericardial patch was implanted. 3D transepicardial echocardiography was used to image the TV pre- and post-implantation. Geometric measurements were assessed using Tomtec and compared with paired t-tests. Results: APA repair was performed in five pigs (weight 60-80 kg). All animals were weaned from CPB in sinus rhythm. TR was trace or absent in all cases after APA repair. There were no changes in pressure gradient (0.5 vs 0.5, p&gt;0.9) or annular area (11.2 vs 10.1 cm 2 , p=0.19). APA repair was associated with a decreased tenting height and angle of the anterior (height: 9.0 vs 4.6 mm, p=0.03; angle: 20.9° vs 16.1°, p=0.04) and posterior (height: 9.8 vs 5.5 mm, p=0.03; angle: 28.1° vs 21.8°, p=0.03) leaflets. Central coaptation length increased in all leaflets (septal: 3.8 vs 6.6 mm, p=0.04, anterior: 4.7 vs 12.7 mm, p&lt;0.01, posterior: 4.5 vs 13.2 mm, p&lt;0.01). Conclusions: APA repair was feasible, safe, reduced leaflet tenting, and improved coaptation. This novel repair method shows promise for patients with severe annular dilation or leaflet tethering who otherwise have a high risk of recurrence with annuloplasty alone. Furthermore, by avoiding suture placement near the conduction system, it may reduce the risk of post-operative conduction abnormalities.