tbuckley/cabot-search huggingface dataset:
Abstract 4144685: External validation and comparison with REVEAL 2.0 of the 6-strata system for risk stratification in PAH: are we reinventing the wheel?
Authors: Charles Fauvel, Yongqi Liu, Priscilla Correa-Jaque, Allen Everett, Manreet Kanwar, Rebecca Vanderpool, Sandeep Sahay, Raymond Benza
Journal: Circulation (2024)

Background: A recent study from the French Pulmonary Hypertension Network showed that stroke volume index (SVI) or mixed venous oxygen saturation (SvO2) may improve risk stratification at follow-up in pulmonary arterial hypertension (PAH) patients with intermediate-risk (according to the European 4-strata system). This resulted in a refined 6-strata system, associated with a discrimination improvement. Research Questions: This 6-strata system has not been externally validated and compared with the U.S. based REVEAL 2.0 risk score. Aims: To externally validate the refined 6-strata system and compare its performance with the current REVEAL 2.0 risk score. Methods: A harmonized dataset from 8 PAH randomized controlled trials generated in collaboration with the FDA was used for this analysis. The REVEAL 2.0 and the refined 6-strata was calculated for individual patients at first follow-up. The outcome assessed was 1-year all-cause death. Discrimination capacities using C-index and 95% confidence interval were calculated. Results: A total of 1,692 PAH patients were included: median age 50 (37, 62) years, mPAP 50 (39, 60) mmHg, PVR 9.0 (6.1, 13.1) WU, 6MWD 393 (330, 441) m, NTproBNP 1,933 (148, 1882) pg/mL. Of these, 99% and 76% of patients classified as strata 1 and 2 (low-risk) by the 6-strata system respectively, were classified as low-risk by REVEAL 2.0. Similarly, majority of patients within the strata 3/4 and 5/6 were classified as intermediate and high risk by REVEAL 2.0, respectively. ( Figure 1 ). C-index were 0.73, 95%CI [0.68, 0.78], 0.75, 95%CI[0.70, 0.80] and 0.78, 95%CI[0.73, 0.83] for the 4-strata, 6-strata and REVEAL 2.0 risk scores, respectively. There were no significant survival differences at 1-year between patients from strata 1 to 4 ( Figure 2 ). Conclusion: This is the first external validation of the modified 6-strata system. Although the discrimination capacities with the 6-strata is higher than with the 4-strata, yet it does not add incremental information regarding 1-year survival compared to REVEAL 2.0 risk score.
Abstract 4144725: Frequency of Occurrence of, and Risk Factors for, Thromboembolism Before and After Cardiac Surgery in Children with Surgical Congenital Heart Disease: A Case-Control Study
Authors: Amy Kiskaddon, Arabela Stock, Danh Pham, Heather Tinling, Shannon Frank, Alyssa Miles, James Quintessenza, Neil Goldenberg
Journal: Circulation (2024)

Background: Thromboembolism (TE) is a common complication in pediatric congenital heart disease (CHD) requiring cardiac surgery. Data describing the frequency, timing, and factors associated with TE and TE recurrence are limited. Aim: To describe frequency, occurrence, and risk factors for, TE before and after cardiac surgery in children with surgical CHD. The secondary aim was to determine frequency of TE recurrence. Methods: A single-center retrospective study (10/2020-11/2023). Patients &lt;18 years of age with radiologically confirmed TE either within 12 months before or after cardiac surgery were compared with randomly selected patients without TE (1:2 ratio). Data included age, CHD diagnosis/surgery type, hemodynamics, hematologic indices, near-infrared spectroscopy (NIRS), infection, respiratory status, length of stay, mortality, timing/location of incident/recurrent TEs. Descriptive and inferential (Mann-Whitney U for continuous, Chi-square for categorical variables) statistics were utilized. Results: Among 302 patients, 45(15%) developed a TE: 16(35.6%) within 12 months before and 29(64.4%) within 12 months after cardiac surgery. TE types were: 11(24.4%) arterial, 32(71.1%) venous, and 2(4.5%) intracardiac. In univariate analyses, age &lt;12 months (p=0.01), single-ventricle (p=0.03), intra-cardiac lines (p=0.02), cardiac-catheterization (p&lt;.001), mechanical ventilation (p&lt;.001), infection (p=&lt;.001), mechanical circulatory support (p=.003), lower cerebral NIRS (p&lt;.001), lower somatic NIRS (p&lt;.001), and higher heart rate (p&lt;.001) were associated with TE. Age &lt;30 days (p&lt;.001), mechanical ventilation (p&lt;.001), and infection (p=.03) were associated with TE before surgery. Single-ventricle (p=0.003), central-venous/intracardiac lines (p=0.04), cardiac-catheterization (p&lt;.001), mechanical ventilation (p&lt;.001), infection (p=.03), lower cerebral NIRS (p&lt;.001), lower somatic NIRS (p&lt;.001), higher heart rate (p&lt;.001) and post-op LOS (p&lt;.001) were associated with TE after surgery. Patients with TE had a longer median (IQR) post-op LOS 20[8-48] vs. 6[4-12] days, p&lt;.001, and higher mortality (11%vs.2.2%,p=0.04). Recurrent TE occurred in 10(22.2%). Conclusions: In children with CHD, the frequency of occurrence of TE before/after surgery and TE recurrence is high. Putative risk factors for the development of TE have been identified and should be further evaluated in multivariable models via future collaborative studies.
Abstract 4144779: Cardiac Tamponade And Constrictive Effusive Pericarditis Caused By Metastatic High-Grade Follicular-Derived Thyroid Carcinoma
Authors: Supraja Achuthanandan, Vahagn Tamazyan, Azka Naeem, Hakob Harutyunyan, Alejandro Munoz Martinez, Adnan Sadiq, Gerald Hollander
Journal: Circulation (2024)

Case Presentation: A 76-year-old male, non-smoker, with history of HLD and NIDDM, presented with several weeks of dyspnea and cough, unresponsive to outpatient treatments. He was normotensive and found to have new onset atrial fibrillation at a rate of 110bpm and pulsus paradoxus with a difference of 15mmHg. CT chest showed a 2.2cm thyroid nodule along with a pericardial effusion (PE), confirmed to be tamponade on TTE (Fig.1). A TTE showed resolution of tamponade after the pericardial window (Fig.2). Pericardial fluid cytology was positive for malignant cells. Patient was discharged, had an outpatient PET CT which showed uptake in the thyroid, pericardial region&amp;right supraclavicular lymph node (LN). The patient developed symptoms of heart failure, prompting his 2nd visit to the hospital after 3 weeks. A repeat TTE showed a small PE with effusive-constrictive physiology (Fig.3). He was started on high dose steroids and diuresed as tolerated, but his symptoms did not improve. He underwent thyroid nodule and right supraclavicular LN biopsy, which revealed high grade follicular thyroid carcinoma (FTC). His course was complicated by multiorgan failure, prompting transfer to another facility for pericardiectomy; during which he was found to have extensive tumor infiltration into the myocardium; he then went into shock and passed away shortly after. Discussion: Effusive-constrictive pericarditis (ECP) is a rare clinical condition characterized by PE with constrictive physiology1. Hancock defined ECP as a pathophysiological form of cardiac compression due to a constricted visceral pericardium and PE, with the hallmark sign of persistently elevated right atrial pressure despite removal of pericardial fluid2. ECP can rarely be caused by malignancies, attributing 5% of cases2. FTC is a well-differentiated thyroid malignancy that typically metastasizes to distant sites such as the lungs and bones, but pericardial involvement is extremely rare. To date, there has been one reported case of PE caused by FTC, but the PE did not reaccumulate, possibly due to early recognition and radiation therapy3. To our best knowledge, this case report represents the first documented case of ECP caused by FTC. Our case demonstrates the complexity of diagnosing/managing it, which underscores the need for a multidisciplinary approach and comprehensive diagnostic evaluation in patients with PE, especially when associated with malignancies that rarely metastasize to the pericardium.
Abstract 4144765: Delayed Management in the Borderline Left Heart Provides Additional Insight Into the Left Heart Potential
Authors: Emitt York, Luke Eckersley, Kim Haberer, Angela McBrien, Lisa Hornberger
Journal: Circulation (2024)

Introduction: Prediction of successful biventricular outcome following a fetal diagnosis of borderline left heart (BLH) can be challenging. A postnatal algorithm of delaying interventional decisions to allow for optimized left heart preload and consequent growth was therefore developed. We review our experience, examining changes in left heart dimensions and clinical outcomes using this algorithm. Methods: We identified all fetal BLH cases encountered in our institution from 9/2008-4/2024 with neonatal management and a repeat postnatal preintervention echo available. BLH was defined as a left ventricular (LV) end diastolic dimension(LVEDd) and/or mitral valve(MV) diameter (4 chamber) z score of &lt;-2 at last fetal echo. Pre and postnatal medical records were reviewed. Z-scores of LVEDd, MV and aortic valve(AoV) diameters and LV end diastolic volume indexed to body surface area(LVEDVi)), and left/right heart ratios were compared between initial neonatal echo and either last echo before intervention or at &lt; 6 weeks in those without intervention. Findings were also compared between those with vs without a successful biventricular(BiV) outcome. Results: Forty-eight fetuses with a BLH were included. Mean gestational age at last fetal echo was 35.2±2.4 weeks and at birth 38.3±2.0 weeks, and birth weight was 3.0±0.7Kg. Successful BiV outcome occurred in 43(90%), 35 following neonatal intervention (31 with coarctation/arch repair +/- ventricular septal defect), whereas, 5(10%) required single ventricle(SV) palliation (Norwood in 4, transplant with failed BiV repair in 1). Findings at initial (day 1) and repeat echo (BiV 13.8±12.9 and SV 6.4±5.1 days) are presented in the table. Initial MV and AoV diameters and left/right valve ratios were greater and there was a significant increase in size with time for LVEDd, MV and AoV in the BiV compared to the SV group (Table, Figure). When comparing only BiV neonates with surgical intervention who had a similar interval to 2 nd study as SV neonates (6.7 ±3.7days), significant increase in LVEDd and MV size occurred in BiV but not SV neonates. All but 1 BiV infant (noncardiac death at 5 months), survived with mean age at last follow-up of 6.0±4.4years. Conclusions: Delayed decision making confers valuable data about the left heart potential in the BLH newborn. Smaller initial MV and AoV and little or no change in LVED and MV dimensions may be useful in identifying those who should undergo SV palliation.
Abstract 4144538: Ivabradine in Patients With Postural Orthostatic Tachycardia Syndrome: A Single-Arm Systematic Review and Meta-analysis
Authors: Ivo Queiroz, Arthur Tavares, Lucas Barbosa, Cynthia Mesquita, Christian Fukunaga, Giovanna Leandro, Tulio Pimentel, Arthur Monteiro, Maria Luiza Rodrigues Defante
Journal: Circulation (2024)

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an excessive increase in heart rate upon standing and other autonomic symptoms. Optimal treatments for this disease are still under research. Ivabradine, a selective inhibitor of the If channel, has emerged as a potential treatment for POTS due to its ability to reduce heart rate without affecting blood pressure. In this context, we conducted a systematic review and meta-analysis to assess the impact of ivabradine on Symptoms in POTS patients. Methods: We systematically searched Pubmed, Embase, and Cochrane databases for studies assessing the efficacy and safety of ivabradine in patients with POTS. We calculated event prevalence for binary outcomes and mean value for continuous outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane's Q and I2 statistics Results: We included ten studies, comprising 267 patients, of whom 130 (48.68%) were females, with a mean age of 34,68 years, and the heart rate (HR) before ivabradine use ranged between 94.20 and 117.66 bpm. The analysis showed an improvement of symptoms in 90.89% (95% CI: 80.34-98.07;) of patients, and a decrease of 14.46 bpm in HR (95% CI: 7.69-21.24; ), which ranged between 79.82 and 98.25 bpm (95% CI; ). Additionally, we observed side effects events in 9.58% of patients (95% CI: 3.69-17.30;). Conclusion: In patients with POTS, ivabradine appears to be a viable treatment option. Further comparative and more powerful studies are necessary to assess the efficacy and safety of ivabradine in this population.
Abstract 4144386: Obstructive Sleep Apnea does not Affect Atrial Remodeling and Ablation Success in Persistent Atrial Fibrillation Patients: Insights from DECAAF II
Authors: ghassan bidaoui, Han Feng, Mayana Bsoul, Ala' Assaf, Hadi Younes, Nour Chouman, Francisco Tirado Polo, Yingshuo Liu, Yishi Jia, Chanho Lim, Abboud Hassan, Eli Tsakiris, Joe Abi-Rached, Yanpei Hui, Besim Ademi, Mario Mekhael, Charbel Noujaim, Swati Rao, Omar Kreidieh, eoin donnellan, Amitabh Pandey, Nassir Marrouche
Journal: Circulation (2024)

Background: Previous literature suggests that Obstructive sleep apnea (OSA) increases atrial fibrillation (AF) recurrence after catheter ablation, but its impact on atrial remodeling has not been investigated. Objective: The study assesses the impact of OSA and continuous positive airway pressure (CPAP) on atrial remodeling, AF burden, arrhythmia recurrence, QoL improvement. Methods: The study population consists of patients with persistent AF with late-gadolinium enhancement (LGE) MRI before and after undergoing catheter ablation from the DECAAF II trial. We compared a subgroup with OSA with the rest of the cohort. The three study outcomes were measured with the following: arrhythmia recurrence and AF Burden based on single-lead smartphone-based daily electrocardiogram (ECG) strips, and SF36 questionnaires (baseline, 3-month, 12 month). Survival analysis of arrhythmia recurrence was performed using cox regression analysis, controlling for confounders. Results: The study population consists of 815 patients. We compared 84 OSA patients with the remaining 731 non-OSA population. Amongst OSA patients 29 patients were treated with CPAP. Baseline characteristics including baseline fibrosis (18.8 vs 18.86; p=0.9426), left atrial volume index (LAVI) (62.4 mm 3 vs 62.6 mm 3 p=0.95), and comorbidities were not different between OSA and non-OSA patients except for body mass index (30.9 vs 35.1; p&lt;0.001). OSA patients had more lateral fibrosis compared to non-OSA patients (2.6 vs 2.18; p=0.002). Both groups demonstrated equivalent LAVI decrease (9.5 mm 3 vs 9.57 mm 3 ; p=0.975), QoL improvement (11.8 vs 8.23; p=0.116), AF burden (14.8%vs 14.2% p-value=0.8222), and time-to-recurrence (p= 0.15). OSA is not associated in this cohort of persistent AF with ablation failure even after controlling for age, sex, body mass index (BMI), CPAP use, baseline fibrosis, and LAVI. Conclusion: Catheter ablation for AF results in similar improvements in atrial remodeling, QoL, AF burden, and arrhythmia recurrence for both OSA and non-OSA patients, irrespective of CPAP treatment.
Abstract 4144389: Obstructive Sleep Apnea is Associated with Ablation Failure in Paroxysmal Atrial Fibrillation Patients Only: Insights from a left atrial MRI Database
Authors: ghassan bidaoui, Hadi Younes, Han Feng, Mayana Bsoul, Ala' Assaf, Nour Chouman, Francisco Tirado Polo, Yingshuo Liu, Yishi Jia, Chanho Lim, Abboud Hassan, Yanpei Hui, Eli Tsakiris, Joe Abi-Rached, Besim Ademi, Charbel Noujaim, Swati Rao, Omar Kreidieh, eoin donnellan, Amitabh Pandey, Nassir Marrouche
Journal: Circulation (2024)

Background: Obstructive sleep apnea (OSA) may influence the outcomes of catheter ablation in atrial fibrillation (AF) patients, but its impact at different stages of AF is not well understood. Objective: This study aims to evaluate whether OSA influences catheter ablation outcomes differently in patients with paroxysmal AF compared to those with persistent AF. Methods: We included AF patients with and without obstructive sleep apnea (OSA) in a late gadolinium enhancement (LGE) MRI database of patients who underwent catheter ablation. Our study population was stratified based on the type of AF: paroxysmal or persistent. Patients were followed for 24 months post-ablation, with a 3-month blanking period. To analyze time-to-AF recurrence, we used Kaplan-Meier curve along with the log-rank test to compare recurrence rates between patients with and without OSA in both AF types. Additionally, we used Cox regression analysis to adjust for potential confounders. Results: 324 patients with paroxysmal AF (mean age: 64.5) and 512 patients with persistent AF (mean age: 65.2) were included. The left atrial (LA) volume was similar between OSA and non-OSA patients in both the paroxysmal AF cohort (83.1 mm3 vs. 83.6 mm3; p=0.73) and the persistent AF cohort (115 mm3 vs. 119 mm3; p=0.37). Patients with OSA exhibited a higher prevalence of comorbidities, including congestive heart failure (CHF), coronary artery disease, obesity, and diabetes, compared to non-OSA patients (p&lt;0.05). After adjusting for these comorbidities, OSA was significantly associated with a higher rate of AF recurrence following ablation in paroxysmal AF patients (HR=2.249; p&lt;0.001). However, OSA did not significantly impact ablation outcomes in persistent AF patients (HR=1.014; p=0.836). Conclusion: OSA significantly impacts the success of catheter ablation in patients with paroxysmal atrial fibrillation (AF), leading to higher rates of AF recurrence. However, this association was not observed in patients with persistent AF.
Abstract 4144351: Association of Blood Pressure Time in Target Range with Outcomes Among NIH "All of Us” Cohort
Authors: Neel Agarwal, Julie St John, Luke Laffin
Journal: Circulation (2024)

Novel means to account for BP fluctuations are being scrutinized to assess longitudinal control, including BP time in target range (TTR) assessment. TTR quantifies the percentage of time a patient’s BP is in the desired range. The present analysis sought to determine the relationship between BP TTR and long-term outcomes among participants in the NIH “All of Us” cohort. Systolic and diastolic BP TTR are differentially associated with long-term outcomes among low-risk primary prevention participants compared to high-risk primary, as well as secondary prevention participants. “All of Us” is an 800,000 participant cohort that is followed longitudinally and collects demographics, adverse events, medications, procedures, and laboratory and clinical measurements. A participant’s systolic BP was noted to be in target range if it was between 110-130 mm Hg and diastolic BP was in target range if it was between 70-80 mmHg. TTR was calculated via traditional and Rosendaal linear interpolation (RLI) methods. Participants were grouped into high and low-risk primary and secondary prevention groups and sorted into four groups based on the percentage of TTR: &lt;25%, 25–50%, 50-75%, or ≥75%. Descriptive statistics, hazard ratios, and survival curves were generated to assess the association between TTR and a composite outcome of major adverse cardiovascular events and all-cause mortality. 156,183 participants had at least 4 BP readings and were analyzed. The cohort had a mean systolic BP of 125 mm Hg and diastolic BP of 74 mm Hg. Among secondary prevention patients, a lower risk of the composite outcome was seen among individuals with ≥75% systolic TTR compared with &lt;25% using the traditional (HR 0.48, CI(0.28, 0.81), p=0.006) and RLI (HR 0.49, CI(0.28, 0.87), p=0.014). In high-risk primary prevention participants, higher systolic BP TTR by RLI was associated with decreased risk and in low-risk primary prevention participants, higher systolic BP TTR by the traditional method was associated with decreased risk. Survival curves corroborated this trend (Figure). Diastolic BP TTR analysis demonstrated similar associations. Systolic and diastolic BP TTR predict long-term cardiovascular and all-cause mortality among the “All of Us” cohort.
Abstract 4144724: Native aortic stenosis progression: a focus on sex differences.
Authors: Paolo Springhetti, Kathia Abdoun, Andreanne Powers, Lionel Tastet, Jonathan Beaudoin, Philippe Pibarot, Marie-Annick Clavel
Journal: Circulation (2024)

Background: Paucity of evidence is available on sex-differences in the progression, left ventricular (LV) remodelling and long-term outcome in patients with native mild-to-moderate aortic stenosis (AS) and preserved LV ejection fraction (LVEF). Objectives: To assess the sex-differences in the progression, LV remodelling and long-term outcome of native AS. Methods: Baseline and follow-up echocardiographic data of patients with at least mild-to-moderate AS [aortic valve area(AVA)≤1.5 cm2, maximum aortic velocity(Vmax) ≥2.5 m/s or mean gradient(MG)≥25 mmHg] were prospectively collected between 2014 and 2019 and retrospectively analysed. Patients with LVEF&lt;50%, or mitral or aortic regurgitation &gt;mild were excluded. AS progression (analysed by annualized progression ratios in echocardiographic parameters), all-cause death, aortic valve replacement (AVR), were investigated stratifying for sex. Results: We included 677 patients with a mean age of 70.8±13.2 years, 258 (38.1%) women. During a median 5 years follow-up, 118(17.4%) deaths and 211(32.2%) AVR occurred. After inverse-propensity-weighting (IPW), men had faster progression rate of AS compared to women (MG: mean difference 1.77[1.10-2.43] mmHg/year, p&lt;0.0001; and Vmax: mean difference 9.56[5.7-13.4] cm/s/year, p&lt;0.0001). While women had higher annualized progression ratio in LV mass-indexed (mean difference 2.51[4.56-0.45] mg/m 2 /year, p=0.017), relative wall thickness (mean difference 0.007[0.01-0.003], p=0.039), but lower stroke-volume-indexed (SVi) (mean difference 0.80[1.10-2.43]ml/m 2 /year, p=0.012). Similar results were obtained after 1:1 matching. Relative to women, men presented similar incidence of all-cause mortality (HR 1.07[0.72-1.56], p=0.73) and AVR on competitive risk analysis (IPW-Sub Hazard Ratio SHR 0.93 [0.61-1.41], p=0.74). Conclusions: Mild-to-moderate AS in men presented accentuated hemodynamic progression over time; however, women were more likely to develop LV hypertrophic/concentric remodelling accompanied by lower flow. Similar long-term outcomes were observed in men and women. These results emphasize the importance of evaluating LV remodelling and flow pattern in AS, and not only the AS severity. The slower hemodynamic progression of AS observed in women may be linked to their tendency in reducing SVi, due to distinct LV remodelling pattern.