tbuckley/cabot-search huggingface dataset:
Abstract 14933: A Rare Case of Cardiac Angiosarcoma Presenting as Hemorrhagic Pericardial Effusion
Authors: Christina Mansour, Judy Jun, Gregory Ranches
Journal: Circulation (2023)

Cardiac sarcomas are exceptionally rare, with an incidence of only 0.02% and comprising less than 1% of all primary cardiac tumors. Consequently, diagnosis of the disease can be challenging due to non-specific presenting symptoms and diverse clinical manifestations. We present a unique case of cardiac sarcoma that highlights these challenges. A 70-year-old man with a history of hypertension, hyperlipidemia, and latent tuberculosis presented with palpitations, chest pain, and dyspnea, was found to have hemorrhagic pericardial effusion with tamponade. Pericardial fluid studies were negative for malignancy, and echo not suggestive of cardiac mass or pericardial abnormalities. He presented several months later with hemoptysis and was found to have innumerable pulmonary nodules on CT chest and a mediastinal mass adjacent to the right atrium. Bronchoscopy was negative for infection or malignancy. Ultimately the patient underwent CT-guided lung biopsy, which showed a malignant spindle cell neoplasm with a positive stain for vimentin and vascular markers suggestive of angiosarcoma of unknown primary. Given unclear relation of his mediastinal mass, cardiac MRI was done which showed a rapidly enhancing bulky neoplasm with abnormal contrast enhancement arising from the lateral right atrium (Figure 1) consistent with metastatic cardiac angiosarcoma. Patient was started on systemic anthracycline-based chemotherapy; however the overall prognosis remains poor. Given the rarity of cardiac sarcomas, prognosis is generally poor due to the advanced stage at the time of diagnosis. These tumors exhibit aggressive behavior and have a high propensity for metastasis. Due to their infrequency, knowledge and research is limited regarding effective treatments. This case highlights the significance of considering cardiac angiosarcoma in cases of hemorrhagic pericardial effusion even in the absence of obvious cardiac mass or pericardial nodularity on initial presentation.
Abstract 13529: Outcomes After Emergency Department Visits for Dyspnea: Population-Based Interrupted Time-Series Analysis of Implementation of B-Type Natriuretic Peptide Assays
Authors: David Bobrowski, Husam M Abdel-Qadir, Candace D McNaughton, Anna Chu, Xuesong Wang, Peter Austin, Harindra C Wijeysundera, Heather Ross, Douglas S Lee
Journal: Circulation (2023)

Introduction: The population-level impact of hospital-based natriuretic peptide (NP) implementation in a universal health care system is unclear. We examined temporal associations between introduction of NP testing in-hospital with outcomes after emergency department (ED) visits for dyspnea. Hypothesis: Implementation of NP testing is associated with improved outcomes for ED patients seeking care for dyspnea. Methods: Administrative databases were linked to identify adults ≥40 years of age with a first ED visit for dyspnea between 2014 and 2019 at hospitals introducing onsite NP testing between 2016 and 2018 in Ontario, Canada. We calculated quarterly rates of 1-year age- and sex-standardized mortality and readmission (all-cause, cardiovascular, heart failure [HF]), restricted to 2 years before and after NP introduction to minimize temporal advances in treatment. We conducted an interrupted time series analysis using linear regression and Newey-West autocorrelation adjusted standard errors to quantify rate of change in outcomes before and after NP introduction. Time zero at each hospital was set at 2 years prior to the introduction of NP tests for each hospital (point of interruption). Results: We studied 20,294 patients (median age 69 years, 52% female) before and 21,857 patients (median age 68 years, 53% female) after NP introduction across 16 hospitals. The cohort before NP introduction had a higher prevalence of prior HF and chronic obstructive pulmonary disease (P&lt;0.01). Rates of all outcomes were stable prior to NP introduction. Following NP introduction, there were significant declines in rates of all-cause mortality (-1.5/100 persons per year), all-cause readmission (-3.6/100 persons per year), cardiovascular readmission (-1.4/100 persons per year) and HF readmission (-0.8/100 persons per year; Figure). Conclusions: Introduction of hospital-based NP tests was associated with decreasing rates of adverse outcomes after ED visits for dyspnea.
Abstract 15289: Phase-Specific Survival After Endovascular versus Open Surgical Repair of Descending Thoracic Aortic Aneurysm
Authors: Nidhi Iyanna, Takuya Ogami, Yujiro Yokoyama, Hisato Takagi, Derek Serna-Gallegos, Danny Chu, Ibrahim Sultan, Toshiki Kuno
Journal: Circulation (2023)

Background: Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). However, recent studies have suggested comparable or potentially favorable outcomes after OSR. This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings. Methods: A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes. The search was performed up until March 2023. All-cause mortality was analyzed in specific phases: within 1 year, 1-2 years, and beyond 2 years. Results: Eight studies met the inclusion criteria, including 4 studies using propensity-score matching and 4 studies reporting risk-adjusted outcomes, comprising 14,873 patients with DTA undergoing OSR (n=10,882) and TEVAR (n=3,991). No randomized controlled trials were identified. Operative mortality was similar between the two interventions (odds ratio 0.92, 95% CI 0.70-1.21, p = .57, I 2 = 0%). However, overall long-term mortality was significantly higher after TEVAR compared to OSR (hazard ratio (HR) 1.30, 95% CI 1.05-1.59, p = .01, I 2 = 0%). Phase-specific analysis revealed comparable risks of mortality within 1 year and between 1 and 2 years after interventions, while the risk of mortality was significantly higher after TEVAR compared to OSR beyond 2 years (HR 1.77, 95% CI, 1.19-2.63, p = .01. I 2 = 0%). Conclusion: This study demonstrated comparable operative mortality between OSR and TEVAR, but higher long-term mortality associated with TEVAR in patients with DTA. The phase-specific analysis highlighted the survival advantage of OSR beyond 2 years after surgery compared to TEVAR. These findings suggest a need for reconsidering OSR indications in the management of DTA.
Abstract 18229: The Effectiveness of a Student-Delivered Weight Loss Program in a High-Risk Urban Practice
Authors: Cynthia Cheng
Journal: Circulation (2023)

Introduction: Obesity is a global epidemic contributing to CVD, the leading cause of death worldwide. Diet, exercise, and lifestyle are crucial to CVD prevention and treatment. The Healthy Eating Index (HEI) is a 13-component dietary analysis tool based on the Dietary Guidelines for Americans, with higher scores associated with lower CVD risk. Calculating the HEI involves a 24-hour food recall and complex scoring. The Diet Risk Score (DRS), a 9-question, efficient alternative screening tool, has been validated against the HEI. JeffWLP, a unique low-cost, long-term student-delivered nutrition education program, evaluates improvement in DRS. Hypothesis: JeffWLP participants in JeffWLP would demonstrate significant weight loss, increased physical activity, and improved DRS in urban at-risk patients. Methods: In this randomized controlled trial, 30 obese adults from an underserved urban population were randomized to intervention (n=18) or control/usual care (n=12) groups. Mean age was 46 +/- 13 years. 80% were African American, and 90% were female; mean baseline BMI was 38 +/- 5. Mean socioeconomic status, self-assessed using the MacArthur Scale, was 6 (maximum 10). JeffWLP includes 12 core weekly group and individual nutrition education counseling sessions, meal replacements, and an exercise component, followed by unlimited bimonthly maintenance counseling. Vitals were obtained pre, mid, and post-core intervention. Results: JeffWLP participants achieved mean weight loss of 6.1 +/- 7.8 lbs (p=0.01), or 2.7 +/- 3.3% body weight (p &lt; 0.01) in 12 weeks. Mean DRS improved by 7 +/- 6 points (p &lt;0.001). Number of weekend steps walked increased by 3500 +/- 3150 (p = 0.016). Pilot JeffWLP patients (n=7), sustained weight loss of 4.8 +/- 8.1 lbs, 285 days after enrollment (p = 0.17). Conclusions: Our study demonstrates the cost-effectiveness of JeffWLP for improving weight loss, exercise, and dietary risk in 12 weeks. We anticipate additional sustained improvements in this ongoing study with double the sample size; this additional data will be available at the AHA meeting. JeffWLP empowers medical students to improve health outcomes in disadvantaged, at-risk underserved populations affordably, addressing critical health disparities.
Abstract 14884: Variation of Immune Function Assay Within the First Year After Heart Transplantation
Authors: Kayvon Ghoreshi, Nicholas S Hendren
Journal: Circulation (2023)

Introduction: The ImmuKnow® immune function assay (IFA) is used in heart transplant recipients to measure lymphocyte-mediated cell immunity via CD4 cell ATP production. Values &lt;225 ng/mL are associated with increased infection risk; however, serial changes in the first year after heart transplant are not well reported. We evaluated IFA trends for heart transplant recipients over the first year after transplantation. Methods: This is a single-center cohort study of consecutive heart transplant recipients from 1/1/2014-8/31/2022 that had an IFA obtained within 30-days of transplant and &gt;1 subsequent IFA within the first year after transplant. We described the relative and absolute change of mean IFA in 90-day increments through the first year after transplant, including sex specific differences. Multivariable logistic regression models tested the independent association of patient-level clinical characteristics factors with IFA values &lt;225 ng/mL. Results: In the study cohort, (121/315) (38%) had an IFA within 30-days prior to transplant. Most patients were white non-Hispanic (46%) and male (74%). IFA values decreased from the pre-transplant baseline with mean absolute changes of 92 ng/mL (-24%), 120 ng/mL (-31%), 121 ng/mL (-32%), and 114 ng/mL (-28%) every 90 days after transplant, respectively (panel B). The highest prevalence of an IFA value &lt;225 ng/mL occurred 90-180 days post-transplant in 55/103 (53%) patients. Female patients had a greater absolute and relative decrease in IFA values from baseline and each 90-day period (panel C). In exploratory analysis, at the time of transplant age &gt;60 was associated with a lower risk of IFA values &lt;225 during days 90-180 post-transplant (OR 0.24, p=0.02). A creatinine &gt;1.4 mg/dL was associated with IFA values &lt;225 during 90-180 (OR 3.15, p=0.02) and 180-270 (OR 3.44, p=0.03) days. Conclusion: Heart transplant recipients experienced ~25% reduction in IFA value from baseline in the first-year post-heart transplant.
Abstract 13370: Single-Cell RNA-seq Reveals Transcriptomic Modulation of Alzheimer’s Disease by Activated Protein C
Authors: Mohammad K Fatmi, Lily Slotabec, Hao Wang, Bi Zhao, Ji Li
Journal: Circulation (2023)

Introduction: Alzheimer’s Disease (AD) causes neuroinflammation characterized by degradation of neurological functions resulting in memory loss and confusion. Activated Protein C (APC), a plasma zymogen, has shown promising cytoprotection, anti-inflammation, and anti-apoptotic properties. ScRNA-seq allows for examining the underlying mechanisms by which APC therapy on AD at the cellular level. Hypothesis: APC treatment can ameliorate AD symptoms of 5xFAD transgenic mice. The scRNA Seq analysis could provide detailed responses of various cell populations to Alzheimer's disease pathogenesis and molecular aspects of APC therapy. Methods: Whole brain tissue were collected at 7 months, APC-treated 5xFAD mice received daily recombinant APC or saline injections. The 10x Genomics Next Gem kit was used to dissociate the tissue for sequencing. Bioinformatic analysis was performed using Seurat in R and an integrated dataset was used to compare multiple single-cell samples. Results: Bioinformatic analysis of 5xFAD versus wild type (WT) C57BL/6J mouse brain revealed much of the sample consists of microglial cells. Interestingly, 5xFAD versus WT brains have notable decreases in astrocyte and neuron populations. Administration of recombinant APC rebounds these populations to comparable levels as WT while dramatically reduces the microglial population in 5xFAD versus WT brain. The largest proportion of oligodendrocytes are also recorded after APC treatment. Differential expression testing conveys transcriptomic regulation of known AD critical genes such as Apoe , Ctsb , Trem2 , and Tyrobp by APC. Consequently, GO term enrichment uncovers inflammatory biological processes such as microglial activation to be downregulated by APC-treated 5xFAD. Additionally, recuperation of nervous system developmental processes was found in APC-treated 5xFAD mice. Conclusions: APC treatment drastically impacts the cellular pathophysiology of AD. Differential expression testing of APC treated 5xFAD versus WT mice revealed transcriptomic downregulation of AD implicated genes throughout multiple cell-types. Administration of APC significantly impacts AD implicated genes associated with AD pathogenesis through enrichment analysis.
Abstract 16545: Effect of Residual Risk of Inflammation and Lipoprotein(a) on Adverse Cardiovascular Outcomes in Optimally Treated Patients According to Glucose Tolerance Status
Authors: Peizhi Wang, Jinqing Yuan
Journal: Circulation (2023)

Introduction: Currently, risks of residual inflammation and residual lipoprotein(a) [Lp(a)] remains in patients with coronary artery disease (CAD) even after lipid-lowering therapy. Hypothesis: This study aims to investigate the association between dual residual risk of inflammation and Lp(a) and adverse cardiovascular events in a large, multicenter cohort with CAD, which has not been investigated. Methods: A total of 3,546 patients with CAD were consecutively enrolled. Based on the Lp(a) and hypersensitive C-reactive protein levels, patients were divided into those with no residual risk, residual Lp(a) risk (RLR), residual inflammatory risk (RIR), and residual cholesterol and inflammatory risk (RLIR). All patients were followed for the major adverse cardiovascular events (MACEs), including all cause mortality, non-fatal myocardial infarction, and non-fatal stroke. Multivariable Cox proportional hazard model was conducted to determine hazard ratio (HR) of MACEs for RIR, RCR, and RCIR with different glucose tolerance status. Results: Over an average of 2.01 years follow-up, 326 MACEs were recorded. Multivariate Cox analysis showed that higher RIR were significantly related to an increased risk of MACEs, while elevated RLR were associated with a slightly but non-significantly increased MACEs risk. Moreover, when participants were subgrouped according to RLR, RIR and glucose tolerance status together, High RLR+High RIR+Diabetes group had significantly higher risk of MACEs [hazard ratio (HR) 2.93, 95% confidence interval (CI) 1.71-5.02] compared with the reference group (Low RLR+Low RIR+Non-diabetes). Conclusions: The combination of RLR, RIR and glucose tolerance status potentiated the adverse effect on MACEs among statin-treated patients with CAD, suggesting that multiple residual risk factors assessment may be a better strategy to improve stratification in very-high risk population.
Abstract 17360: Epstein Barr Virus in the Heart: A Case of Infectious Mononucleosis Causing Myopericarditis
Authors: Sameer Acharya, Brett Schuchardt, Jaimie Rogner, Jessica Duke, maurice vaughan
Journal: Circulation (2023)

Introduction: The most common causes of myopericarditis are Coxsackie B followed by Coxsackie A, Echovirus, and Poliovirus. However, Epstein Barr Virus (EBV) may uncommonly cause myopericarditis and can mimic acute coronary syndrome (ACS). Case: A 19-year-old healthy non-smoker male presented with acute onset of central, positional chest pain preceded by a 5 day-long course of viral prodromal symptoms including sore throat. EKG showed inferolateral ST segment elevations (Figure 1). HS-Troponin T was markedly elevated (initial; 988, 1 hour; 1171). He was started on ibuprofen and colchicine for suspected myopericarditis. TTE showed LVEF 50% with borderline mild posterior and lateral wall hypokinesis with no pericardial effusion (Figure 1). Although, the presentation and PR depression were consistent with pericarditis, focal wall motion abnormality led to consideration of right or circumflex CAD such as coronary dissection. This was ruled out by coronary angiogram (Figure 2). Cardiac MRI demonstrated the epicardial pattern of gadolinium enhancement consistent with myopericarditis (Figure 2). Subsequently, patient tested positive for IgG (6.4) and IgM (3.2) [normal range 0.8 to 1.1] against EBV Capsid Antigens with unremarkable remaining viral panel results. His symptoms improved significantly with ibuprofen and colchicine. He was also treated with metoprolol succinate and lisinopril due to reduced ejection fraction. Conclusions: Cardiac complications from EBV infection are uncommon. Sometimes, the EKG with pericarditis can mimic ACS warranting an invasive test. Therefore, clinicians must maintain a high level of suspicion for myopericarditis resulting from EBV.
Abstract 15188: Mid-Cavity Takotsubo Cardiomyopathy Post CAR T-cell Therapy
Authors: Mansi Oberoi, Robbie Garvin, Cason Christensen, Thomas R Porter
Journal: Circulation (2023)

Introduction: CAR T-cell therapy has been reported to have cardiovascular (CV) adverse effects mostly in context of cytokine reconstitution syndrome (CRS). Although pathophysiology of CAR T-cell cardiotoxicity (CTCC) is not fully understood, it is thought to be IL-6 mediated which has been implicated as a mediator of myocardial depression in infectious and inflammatory states. Another mechanism is direct cardiotoxicity from potential cross-reactivity with unrelated peptides expressed by normal tissue. We present a case of Takotsubo cardiomyopathy following CAR T cells. Case: 61 year old male with h/o Waldenstrom's macroglobulinemia, DMT2, HLD was admitted for CAR T cell therapy. Following infusion, he developed chills, diaphoresis, tachypnea, tachycardia, chest tightness lasting several hours. EKG had dynamic ST depressions in inferolateral leads with elevated hstroponin (6000 pg/ml). Despite severe pancytopenia, heparin was started for acute coronary syndrome. Pain resolved with morphine and he received tocilizumab for CRS. Echo showed a mid-cavitary variant of Takotsubo involving right and left ventricles with depressed systolic function (LVEF 30-35%; Image). Coronary angiogram was deferred due to bleeding risk. Repeat echo in 2 days showed persistent mid-cavity hypokinesis with slight improvement in LVEF (40%) after initiating beta blocker. The temporal relation of acute mid-cavity dysfunction to CAR T-cells indicates most likely CTCC. Heparin was stopped and he was managed conservatively with plan to reassess LVEF in 2 months. Conclusion: Patients undergoing CAR T-cell therapy should be assessed for CV symptoms using biomarkers and imaging for early detection of cardiotoxicity and prompt initiation of supportive treatment. We present a case of acute mid-cavity left ventricular dysfunction (a Tako-tsubo variant) that was temporally related to CAR T cell infusion. Further studies are needed to determine the frequency of this acute form of CTCC.
Abstract 18212: The Fat Embolism Enigma: Unveiling the Intricate Complications of Breast Reconstructive Surgery
Authors: Muhammad Hasib H Khalil, Mobeen Haider, Saad Ur Rahman, Yousra Khalid, Osama Alsara, Christopher Bodine
Journal: Circulation (2023)

Background: Fat embolism can occur after plastic surgery, especially when injecting fat into subcutaneous tissue. It can be asymptomatic or can have hypoxia, mental status changes, and petechiae rash. Diagnosis is challenging but the workup includes imaging to exclude other differentials including pulmonary thromboembolism. Echocardiography assists in identifying fat emboli. Case Presentation: A middle-aged female with no prior cardiac history was undergoing right-sided breast reconstructive surgery with liposuction from the abdomen and fat grafting. Intraoperatively, the patient became hypoxic and hypotensive. The patient was started on vasopressors. A CT-Angiogram Chest revealed multiple bilateral pulmonary emboli, with some emboli having negative Hounsfield units (HU). Anticoagulation was started. Fat emboli could not be excluded. The patient was ultimately transitioned to venoarterial extracorporeal membrane oxygenation. Transthoracic echocardiogram showed right ventricular (RV) hypokinesis with preserved apical function and multiple, mobile, irregular masses in the RV. Figure 1 With the patient’s history, this was concerning for fat emboli. A transesophageal echocardiogram (TEE) showed multiple (4 visualized) masses seen in the RV, caught into the subvalvular tricuspid apparatus on the chordae and the RV trabeculation. (Largest mass: 1 cm in diameter). Figure 2 A bilateral lower extremity venous duplex was negative. The patient was diagnosed with obstructive shock secondary to fat embolism. She was eventually weaned off of mechanical support and discharged in stable condition. Discussion: Autologous fat grafting (AFG) has gained popularity in reconstructive and aesthetic surgery. It is important to remain vigilant about fat embolism as a complication that presents as sudden hypoxia and obstructive shock in the appropriate setting. DVT should be ruled out. Echocardiography can assist in diagnosis. Treatment is supportive.
Abstract 15136: Toward the Development of an AI Application to Diagnose Ischemic Heart Disease From a Medical Interview
Authors: Kosuke Fujita, Honoka Kanno, Gaku Nakazawa
Journal: Circulation (2023)

Background: Interviewing technique for patients with chest pain depends on each doctor’s skill. Therefore, an artificial intelligence (AI)-based interview system may be useful to stratify probability of ischemic heart disease based on patient’s complaint. Methods: As a definitive diagnosis corresponding to the interview is needed as a sample, a medical interview is taken from patients presenting with chest pain as a chief complaint, which is combined with the patient's baseline data to develop an AI algorithm. Results: The items used as input attributes in the interview are listed in Table 1. A multilayer perceptron (MLP) was applied to the subjects (N=125) for the prediction of patients diagnosed with angina pectoris (54 cases). These models were validated using the leave-one-out method. Comparisons were made with models in which each of diabetes (45 cases), dyslipidemia (88 cases), hypertension (95 cases) and smoking (never: 60 cases; past: 50 cases; current: 15 cases) were added as attributes in addition to the items in Table 1. (Table 2) The ROC curves of the multilayer perceptron with only the questionnaire items in Table 1 as input attributes and the multilayer perceptron with the dyslipidemia attribute added are shown in Figure 1. Conclusion: It was found that the diagnosis of angina pectoris could be detected interview data while the prediction accuracy was improved by adding the attribute of dyslipidemia. Further investigation is needed to complete a highly accurate AI-based application by increasing the number of samples.