tbuckley/cabot-search huggingface dataset:
Abstract 15005: Gender Differences in the Evaluation and Clinic Outcomes of Patients With Palpitations
Authors: Sun Young Jeong, Jiexi Wang, James Onwuzurike, Serena Ghanshani, Aiyu Chen, Yi-Lin Wu, Mingsum S Lee
Journal: Circulation (2023)

Background: Palpitations represent a common complaint in primary care clinics. Although usually benign, palpitations are occasionally a manifestation of cardiac arrhythmias. Aims: This study aimed to investigate whether there are gender differences in the cardiac testing pattern and clinical outcomes of patients evaluated in outpatient clinics for palpitations. Methods: This is a retrospective observational study that included adult men and women who presented to an outpatient primary care or cardiology office in an integrated health system in California with a chief complaint of palpitations. Cardiac testing pattern was captured using electronic health records. The primary endpoint was hospitalization for arrhythmia at one year. The secondary endpoint was all-cause mortality at one year. Logistic regression models were constructed to evaluate the association between female gender and the outcomes. Results: Between 2017 and 2021, 89,680 patients were evaluated for palpitations, among whom 61,064 (68.1%) were women. A high proportion of women were Hispanic. Women were more likely to be obese and less likely to have hypertension, diabetes, atrial fibrillation, heart failure, or a history of myocardial infarction. A slightly higher proportion of women were started on beta-blockers (12.8% women vs. 12.2% men, p=0.004). Women were more likely to be referred for cardiac rhythm monitoring (19.8% women vs. 18.8% men, p &lt;0.001). At one year, women had a lower rate of hospitalization for arrhythmias (0.5% in men versus 0.3% in women, adjusted OR 0.73, 95% CI 0.58-0.91). All-cause mortality was also lower for women at one year (adjusted OR 0.55, 95% CI 0.48-0.62). Conclusion: Among patients with palpitations, women were more likely than men to be treated with beta-blockers and referred for cardiac rhythm monitoring. Women had a better clinical prognosis, with a lower risk of hospitalization for arrhythmias and death at one year.
Abstract 16478: Effect of Sodium Glucose Cotransporter 2 Inhibitors on Major Adverse Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors
Authors: Pin-Chia Huang, Tomas G Neilan, Julius Heemelaar, Kevin Sheng-Kai Ma
Journal: Circulation (2023)

Introduction: The cardiac adverse events (irAEs) secondary to immune checkpoint inhibitors (ICI) are associated with a high rate of morbidity and mortality. There are no data on the effect of concomitant sodium glucose cotransporter 2 inhibitors (SGLT2i) on the rates of major adverse cardiovascular events (MACE) among patients treated with an ICI. Hypothesis: Whether, the use of SGLT2i among ICI-treated patients may reduce MACE. Methods: This was a population-based cohort study between 2014 and 2023 including cancer patients treated with ICI aged over 18 years across the United States. SGLT2i use while on an ICI was defined as the initiation of SGLT2i therapy after the first record of ICI treatment among patients currently undergoing ICI therapy. The risk of incident MACE in patients on an ICI who were also prescribed an SGLT2i therapy was compared with 1:1 propensity score-matched patients on ICI who were never prescribed an SGLT2i. Hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE were estimated using Cox proportional hazards regression. MACE was defined as a composite of myocardial infarction, heart failure (HF), and ischemic stroke. Results: There were 216 cancer patients undergoing ICI therapy who were newly treated with SGLT2i. These were compared to 216 controls. Over a mean follow-up period of six years, there were 107 MACE events. There were 44 events (20.4%) among those on an SGLT2i and 63 among controls (HR=0.61, 95% CI: 0.41-0.90; log-rank test p=0.011). Of the individual components of MACE, rates of HF were lower where there were 22 HF events (20.4%) among those on an SGLT2i and 37 among controls (HR=0.51, 95% CI: 0.30-0.86; log-rank test p=0.010). There were no differences in the rates of stroke (HR: 0.55, 95% CI: 0.29-1.04) and myocardial infarction (HR: 0.97, 95% CI: 0.38-2.43). Conclusions: In an observational, retrospective study, SGLT2i therapy was associated with a reduced risk for cardiac events compared to those who never treated with SGLT2i. These findings underscore the potential therapeutic value of SGLT2i in the prevention of MACE in cancer patients receiving immunotherapy and warrant further research.
Abstract 17934: Performance of an Electrocardiographic Deep Learning Model for Detecting Wall Motion Abnormalities: An Analysis of Impact From Cardiovascular Comorbidities and Race in an External Validation Study
Authors: Rayan A Ansari, neal bhatia, James Tooley, Vyom Thakkar, JUSTIN XU, Jessica Torres, Jagteshwar Tung, Mahmood Alhusseini, Paul L Clopton, Reza Sameni, Gari Clifford, Euan A Ashley, Marco V Perez, Matei Zaharia, Sanjiv M Narayan, Albert J Rogers
Journal: Circulation (2023)

Introduction: Cardiac wall motion abnormalities (WMA) are key prognostic indicators for major cardiovascular events and mortality (MACE), yet poorly detected by current ECG screening such as for Q waves. Given that race and gender impact the ECG, it is also unknown if ECG screening for WMA could be applied broadly. We hypothesized that deep learning of the ECG could accurately identify WMA in diverse patients with varying comorbidities at 2 Institutions. Methods: We developed a DL Convolutional Neural Network model on N=35,210 ECG records from Stanford University (iECG, Philips), labeled by natural language processing of echocardiography reports within 60 days ( Panel A ). The tested model was then externally validated on an independent set of N=2338 ECGs from Emory University (Muse, GE). Patients with ventricular pacing were excluded. The patient cohort was segmented by cardiovascular comorbidity (&lt;3, &gt;=3) and white vs. non-white race to compare model performance. Results: The Stanford cohort (62.9±16.9 years, 47% female, 58% white, 6% black, 16% Asian, 23% &gt;=3 comorbidities) differed from the Emory cohort (61.9±16.0 years, 48% female, 48% white, 41% black, 6% Asian, 52% &gt;=3 comorbidities). Nevertheless, the Stanford model detected WMA in the Emory cohort with AUC 0.723. For patients with low and high comorbidity burdens, the AUC was 0.71 and 0.69, respectively. For White and Non-White patients, the AUC was 0.74/0.70 and 0.65/0.66, respectively ( Panel B ). Conclusions: Across racial groups and patients with variable burden of comorbidities, a DL model of electrocardiograms robustly identifies WMAs in an external validation cohort despite differences in the populations. The model’s performance across different comorbidity and racial demographic groups underscores its potential for general clinical application, offering an effective tool for clinical screening and enhanced risk stratification.
Abstract 14133: Use of Computed Tomography Coronary Angiography in Pre-Operative Risk Assessment in Non-Cardiac Surgeries
Authors: Rajendra P Shah, ritu yadav, Sanchit Duhan, Neel N Patel, Fnu Raheela, Wael AlJaroudi, Timir K Paul, M Chadi C Alraies
Journal: Circulation (2023)

Introduction: Computed Tomography Coronary Angiography (CTCA) has emerged as a promising tool for detecting and evaluating coronary artery diseases (CAD). However, the role of CTCA for risk assessment tool for patients undergoing noncardiac surgeries is unknown. Methods: We searched databases like PubMed and Google Scholar to compile the literature including reviews, meta-analyses, scientific articles, and guidelines, describing the use of CTCA in the diagnosis and evaluation of cardiac risk assessment in noncardiac surgeries. Results: Based on our literature review we found that CTCA is a promising adjunctive tool for preoperative assessment in noncardiac surgeries to evaluate cardiac risk with high sensitivity and negative predictive value. VISION-CTA sub study showed that CTCA combined with Myocardial Perfusion Imaging (MPI) predicts major adverse cardiac events within 30 days of surgery with higher accuracy than either test alone. McCarthy KJ et al found an increase in the proportion of CTCAs performed from before 2018, 2018 to post 2018, (3%, 6.3%, and 26.3% respectively; p &lt;0.001) and obstructive CAD diagnosis using CTCA (0%, 30%, and 51.4% respectively; p = 0.04). Hence supporting a shift to non-invasive CTCA for pre-operative assessment of liver transplant candidates. According to Ahn J et al, CTCA shows 100% sensitivity and 99.3% negative predictive value in predicting major adverse cardiac events and can be used to stratify intermediate risk noncardiac surgery patients. Conclusions: CTCA is a valuable risk assessment tool in patients undergoing noncardiac surgery because of its high sensitivity and negative predictive value. There is a need for further research and guidelines for using CTCA as a risk assessment tool in noncardiac surgeries.
Abstract 15724: All-Cause Death and Major Adverse Events in Atrial Fibrillation With Frailty: Observations From the Korea National Health Insurance Service Data
Authors: Jong Sung Park, Pil-sung Yang, Daehoon Kim, Jung-Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Hui-Nam Pak, Moon Hyoung LEE, BOYOUNG JOUNG
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) may be a marker of frailty. Previous evidence indicated that frailty in patients with AF has been associated with increased adverse events. Hypothesis: This study aimed to investigate the effect of frailty on the use of oral anticoagulants (OAC) and clinical outcomes in a nationwide cohort of patients with AF. Methods: We included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort from 2005 to 2010. Patients’ Hospital Frailty Risk Score was calculated and patients were divided into two groups: without frailty (&lt; 5 points) and with frailty (≥ 5 points). Results: Over 7.2 years, 11,953 participants (median age, 67 years; 60.2% men) developed new-onset AF. Among these patients, 26.9% had frailty. Frailty was significantly associated with older age, female sex, polypharmacy, and comorbidities. Frailty was negatively associated with OAC prescription after new-onset AF ( P &lt; 0.001). Patients with frailty had significantly higher risk of all-cause death (hazard ratio [HR] 2.87, 95% confidence interval [CI] 2.66-3.11), cardiovascular death (HR 2.60, 95% CI 2.77-2.98), stroke (HR 2.49, 95% CI 2.25-2.75), major bleeding (HR 2.54, 95% CI 2.28-2.83), and heart failure admission (HR 1.30, 95% CI 1.11-1.53). The increased risks of all-cause death, cardiovascular death, stroke, and heart failure admission due to frailty were lower with OAC prescription. Conclusions: Frailty was negatively associated with OAC use and was a predictor of worse prognosis. However, the increased risks associated with frailty were reduced by OAC in patients with AF.
Abstract 14216: Acute Heart Failure and Mitral Stenosis in a Patient With Spindle Cell Sarcoma of the Mitral Valve
Authors: Kori Ormachea, Ariana Cranston, Arjun Khadilkar, Janina Quintero Bisono, Bistees George
Journal: Circulation (2023)

A 27-year-old male with no past medical history presented with a productive cough, intermittent hemoptysis, dyspnea, orthopnea, and lower extremity edema. He underwent an echocardiogram that was significant for a large 6.2 cm x 3.5 cm left atrial mass moving into the left ventricle across the mitral valve concerning for a myxoma. Other pertinent findings were an ejection fraction of 50-55%, severe mitral stenosis with a mean mitral valve gradient of 23, severely reduced right heart function, and severe tricuspid regurgitation. Cardiovascular surgery was consulted for evaluation of atrial mass. He underwent left atrial mass resection. The left atrial mass was attached to the mitral valve, so the mitral valve was repaired with Onyx mechanical valve. After the surgery, there was a significant improvement in right heart function, mitral valve gradient, and velocities were within the expected range. Pathology from atrial mass back with high-grade spindle cell sarcoma so Oncology was consulted. Further studies were negative for metastatic spread. He was started on adjuvant chemotherapy and currently, he is undergoing his fourth cycle. Follow-up TEE six months later noted a left atrial mass located in or where the left atrial appendage should be approximately that was 2.5cm x 1.5cm concerning for recurrence of his sarcoma. This case demonstrates a rare primary cardiac tumor, spindle cell sarcoma, which is generally aggressive and therefore has a poor prognosis. The clinical symptoms are more related to the location of the sarcoma than the histopathology. Depending on location, cardiac sarcomas generally present with heart failure as in this patient. About 25% of cardiac tumors are malignant with the majority of those being sarcomas. Initial evaluation of primary cardiac sarcomas should include echocardiography. The primary treatment is surgical resection of the mass with adjuvant chemotherapy, however, there is a high rate of recurrence and metastatic spread.
Abstract 18222: FAM210A Regulates Mitochondrial Translation and Maintains Cardiac Mitochondrial Homeostasis
Authors: Peng Yao, Jiangbin Wu, Kadiam C Subbaiah
Journal: Circulation (2023)

Introduction: Mitochondria play a vital role in cellular metabolism and energetics and support cardiac function. FAM210A (family with sequence similarity 210 member A) is a novel hub gene in mouse cardiac remodeling. Human FAM210A mutations are associated with sarcopenia. However, the physiological and molecular function of FAM210A remain elusive in the heart. Hypothesis: We aim to determine the biological and molecular mechanism of FAM210A in regulating mitochondrial function and cardiac health. Methods and Results: Tamoxifen-induced conditional knockout of Fam210a in mouse cardiomyocytes (CMs) induced progressive dilated cardiomyopathy and heart failure (HF), ultimately causing mortality. Fam210a deficient CMs exhibit severe mitochondrial morphological disruption and functional decline accompanied by myofilament disarray at the late stage of cardiomyopathy. Moreover, we observed increased mitochondrial reactive oxygen species production, disturbed mitochondrial membrane potential, and reduced respiratory activity in CMs at the early stage before contractile dysfunction and HF. Multi-omics analyses indicate that FAM210A deficiency persistently activates integrated stress response (ISR), resulting in transcriptomic, translatomic, proteomic, and metabolomic reprogramming, ultimately leading to pathogenic progression of HF. Mechanistically, mitochondrial polysome profiling analysis shows that FAM210A loss of function compromises mitochondrial mRNA translation and leads to reduced mitochondrial encoded proteins, followed by disrupted proteostasis. We observed decreased FAM210A protein expression in human ischemic heart failure and mouse myocardial infarction tissue samples. To further corroborate FAM210A function in the heart, AAV9-mediated overexpression of FAM210A promotes mitochondrial-encoded protein expression, improves cardiac mitochondrial function, and partially rescues murine hearts from cardiac remodeling and damage in ischemia-induced HF. Conclusions: These results suggest that FAM210A is a mitochondrial translation regulator to maintain mitochondrial homeostasis and normal CM contractile function. This study also offers a new therapeutic target for treating ischemic heart disease.
Abstract 15337: Study of Relationship Between Neighborhood Racial Segregation and Heart Failure Mortality
Authors: Anna L Richards, Aya M Badran, Brandon T Towns, Rabia R Razi, Qiaoling Chen, Claudia Nau, Mingsum Lee
Journal: Circulation (2023)

Background Upstream factors, including socioeconomic status, healthcare access, structural environment, contribute to the presence of disparities in cardiovascular outcomes. The impact of neighborhood-level racial segregation on cardiovascular outcomes is not well understood. Research Question The goal of this study was to evaluate the association between neighborhood racial segregation and heart failure mortality. Methods/ Approach This is a retrospective, cohort study performed at Kaiser Permanente Southern California that included patients hospitalized for heart failure between January 2010 and December 2017. Data regarding demographics, comorbidities, and outcomes, was linked to the diversity index from the US Census Bureau. This is a measure of racial segregation, the likelihood that any two people from an area will be from different race/ ethnicity groups. The cohort was divided into tertiles by diversity index. Mortality rates for each racial group was calculated. Multivariate logistic regression models were constructed to evaluate the association between race/ethnicity and mortality. Results/ Data There were 19,322 patients included in our analysis. After adjusting for demographics, socioeconomic markers, neighborhood characteristics, and comorbidities, higher mortality was noted for Black patients compared to White patients in the least diverse tertile (adjusted OR [95% CI]: 1.42 [1.15-1.74]). In the most diverse tertile, no significant difference between Black and White patients was observed (adjusted OR [95% CI] 1.02 [0.83-1.26]). Asian and White patients did not show a difference in mortality across tertiles. Hispanic patients had a statistically significant decreased mortality in the two more diverse tertiles. Conclusion: Heart failure mortality is lower in Black patients in more diverse neighborhoods. Further work is needed to look at the pathway that connects racial segregation to heart failure outcomes.
Abstract 13310: <i>TTN</i> Variants and Arrhythmic Risk Among Countywide Sudden Deaths: From the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study
Authors: Matthew Yee, David Eik, Brielle Kinkead, Julianne Wojciak, W. Patrick Devine, Andrew Connolly, Jean Feng, Ellen Moffatt, Zian H Tseng
Journal: Circulation (2023)

Background: Titin, encoded by TTN , is a sarcomeric protein necessary for normal cardiac and skeletal muscle function. Truncating variants in the A-band are a frequent cause of isolated and familial dilated cardiomyopathy (DCM) in living cohorts. Whether variants outside of the A-band confer arrhythmic risk remains unclear. We investigated the yield and distribution of TTN variants in a postmortem study of presumed sudden cardiac deaths (pSCDs) in San Francisco County. Methods: From 2/1/2011 to 12/31/2017, the Postmortem Systematic Investigation of Sudden Cardiac Death study performed complete autopsies on 889 incident deaths (age 16-90) meeting World Health Organization criteria for SCD (pSCD). Using clinical records, autopsy findings, and family history, we performed deep phenotyping to adjudicate underlying arrhythmic “SAD” (potentially rescuable with defibrillation) or non-arrhythmic “non-SAD” (tamponade, overdose, etc.) cause of pSCD. We performed clinical whole exome testing on cases with next of kin consent. Results: Of the 322 pSCDs tested (196 SAD, 126 non-SAD), we detected 5 truncating/splice variants located in non-A-band regions (p=0.03 vs. none found in the A-band) in 4 cases, all SAD. No truncating/splice variants were detected in 47 cases with autopsy evidence of DCM (cardiomegaly and short axis &gt; 3.5cm). Overall, 89 cases had at least 1 TTN variant of uncertain significance (VUS): 61 (68.5%) SADs and 28 (31.5%) non-SADs, with a trend towards more TTN VUSs among SADs (p =0.10). A total of 110 VUSs were found: 10 (9.1%) in the Z-disc, 38 (34.5%) in the I-band, 50 (45.5%) in the A-band, and 12 (10.9%) in the M-band. TTN VUSs clustered similarly throughout the gene in SADs and non-SADs. Conclusion: In this 7-year postmortem genetic study of unselected countywide sudden deaths using autopsy to adjudicate arrhythmic cause, we found TTN truncating/splice variants in non-A-band regions were associated with SAD and a trend toward association with SAD among TTN VUS carriers. In contrast to living cohorts with diagnosed DCM, no cases meeting autopsy criteria for DCM had a truncating/splice variant. Since non-survivors (i.e., SCDs) are underrepresented in DCM cohorts, our results suggest a potential role for non-A band TTN variants in arrhythmic risk.
Abstract 14202: Vasospastic Angina as a Potential Cause of Post-Acute Sequelae of COVID-19
Authors: Tadao Aikawa, Naohiro Funayama, Tohru Minamino
Journal: Circulation (2023)

Introduction: Although evidence-based practice of has progressed, little is known about underlying mechanisms of chest pain symptoms in patients with post-acute sequelae of COVID-19 (PASC) and preferred approaches for their assessment. Several mechanisms underlying COVID-19-related endothelial dysfunction have been proposed. The purpose of this study was to explore the prevalence of vasospastic angina as a cause of chest pain in PASC patients. Methods: We retrospectively reviewed 273 consecutive patients who presented to an outpatient unit for cardiovascular PASC between June 2021 and March 2023. After the initial evaluation with electro- and echocardiography, coronary computed tomography angiography or cardiac magnetic resonance imaging were performed to rule out obstructive coronary artery disease and myopericarditis if patients had intermittent chest pain and had no contraindications to these tests. When the patients’ chest pain mainly occurred at night and in the morning or was resolved by nitrates, invasive coronary angiography and acetylcholine provocation testing were performed to diagnose vasospastic angina. Results: Eight of 273 patients with PASC underwent acetylcholine provocation testing. The median time from the diagnosis of SARS-CoV2 infection to acetylcholine provocation testing was 197 (interquartile range, 120-542) days. The mean age of the patients was 37.1 years; two required oxygen support during acute COVID-19; and none had previous history of cardiovascular disease ( Figure ). Five of the 8 patients showed acetylcholine-induced multivessel coronary vasospasm and were diagnosed as vasospastic angina. Their chest pain improved with calcium channel blockers and nitrates, whereas nonfatal myocardial infarction occurred in one patient after the diagnosis of vasospastic angina. Conclusions: Our observational case series suggest that vasospastic angina should be considered as a potential cause of PASC.