tbuckley/cabot-search huggingface dataset:
Abstract 11965: Impact of Atherothrombotic Risk Stratification in Patients With Heavily Calcified Lesions Following Rotational Atherectomy
Authors: Toru Yoshizaki, Takamitsu Nakamura, Takeo Horikoshi, Yousuke Watanabe, Tsuyoshi Kobayashi, yukio saito, Jun-ei Obata, Takao Sawanobori, Hajime Takano, ken umetani, Tetsuya Asakawa, Akira Sato
Journal: Circulation (2023)

Background: Patients who undergo percutaneous coronary intervention (PCI) with rotational atherectomy (RA) are at high risk of adverse clinical outcomes, and there are few clinical risk stratification tools for these patients. The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) is a simple 9-point risk stratification tool. A previous study reported that TRS 2°P was useful in predicting adverse clinical events in patients with acute coronary syndrome. However, it is unclear whether TRS 2°P predicts adverse clinical events in patients with heavily calcified lesions, requiring RA. Hypothesis: This study aimed to investigate whether TRS 2°P is useful for the prediction of adverse clinical events in patients undergoing PCI with RA from the Japanese multicenter PCI registry. Methods: We conducted a study with 196 patients who underwent PCI with RA out of 7,391 patients who underwent PCI in a multicenter, prospective cohort registry. Patients were divided into 3 groups according to the tertiles of the TRS 2°P: 65 patients in the T1 group (TRS 2°P&lt;3), 66 patients in the T2 group (TRS 2°P=3), and 65 patients in the T3 group (TRS 2°P&gt;3). The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of cardiac death, acute coronary syndrome, and ischemic stroke. Results: A cumulative 2-year MACCE occurred in 41 (24%) patients during the follow-up period. The cumulative incidence of MACCE was significantly higher in the T3 group than in T1 group (log-rank p=0.02). Multivariate Cox analyses revealed that the T3 group was associated with an increased risk of MACCE compared to T1 group (adjusted hazard ratio, 2.66; 95% confidence interval, 1.04–6.77; p=0.04). The addition of TRS 2°P to conventional risk factors, including male sex, number of diseased vessels, and low-density lipoprotein cholesterol levels, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.39, p=0.027; IDI 0.072, p&lt;0.001). Conclusions: Atherothrombotic risk stratification using TRS 2°P is useful for identifying high-risk patients with heavily calcified lesions following RA.
Abstract 12498: AAV-Mediated LINC Complex Uncoupling Ameliorates Pathology in a Mouse Model of <i>LMNA</i> Dilated Cardiomyopathy
Authors: Hendrikje Werner, Esther S Gan, Connie Loh, Jennifer Ng, Nyein Thet Khaing, Jinqiu Zhang, Mervyn Ong, John Lee, David W Russell, Yann Chong Tan, Colin Stewart, Brian Burke, Yin Loon Lee
Journal: Circulation (2023)

Mutations in the LMNA gene, encoding lamin A/C, are one of the most frequent genetic causes of dilated cardiomyopathy. While gene therapy using adeno-associated virus (AAV) vectors show promise for the treatment of monogenic diseases, LMNA DCM mutations tend to be autosomal dominant and gain-of-function, precluding typical gene replacement approaches. Lamin A/C forms a filamentous network, the nuclear lamina, underlying the nuclear envelope that is thought to function in maintaining structural integrity of the nucleus by resisting cytoskeletal forces transmitted to the nucleus during cardiac contraction. Our hypothesis is that disruption to the lamin A/C network leads to nuclear envelope rupture as the weakened nuclear lamina cannot resist excess cytoskeletal force. Uncoupling the linkage between the cytoskeleton and nucleus might therefore reduce LMNA -associated pathology. This linkage is known to be mediated by the nuclear envelope-localized linker of nucleoskeleton and cytoskeleton (LINC) complex. Using AAV-mediated expression of a LINC complex uncoupling transgene, GSLA01, we were indeed able to prevent the progression of ventricular dilation, cardiac fibrosis, and decline in ejection fraction observed in a LMNA dilated cardiomyopathy mouse model. We decided to explore structure-function relationships in GSLA01 in our lead optimization studies. We generated a series of truncations of full-length GSLA01 comprising different lengths of its coiled coil domain. In vitro assays indicated that most truncations examined were able to uncouple the LINC complex. Selected truncations were delivered using AAV to LMNA DCM mice after inducing cardiac-specific deletion of Lmna with tamoxifen. Full-length GSLA01 extended the lifespan of LMNA DCM mice from 39 to ~170 days. The truncations mostly performed on par or better than full-length GSLA01 in extending the lifespan of LMNA DCM mice, to more than 250 days for certain constructs. Reducing cytoskeletal force transmission to the nucleus by uncoupling the LINC complex appears to be a viable strategy for treating LMNA -linked pathology, and multiple GSLA01 truncation variants can be used to achieve this effect.
Abstract 13752: Current Management and Outcomes of Acute Intramural Hematoma
Authors: Arturo Evangelista, Kevin M Harris, Bradley Taylor, Maral Ouzounian, Alan C Braverman, William T Brinkman, Roland R Van Kimmenade, Melissa Levack, John Eidt, Derek R Brinster, Chih Wen pai, George Arnaoutakis, marco di eusanio, Dan Gilon, Eric M Isselbacher, Kim A Eagle
Journal: Circulation (2023)

Background: Optimal management of intramural hematoma (IMH) remains controversial. Previous studies offer conflicting information on how outcomes differ between patients with acute aortic dissection (AAD) and IMH. Methods: Patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2023 were stratified by AAD and IMH. True IMH, defined as the presence of intramural hematoma in the absence of both double lumen and intimal flap, was noted in 605 patients (7.7%). Results: IMH was more common in Type B patients (12.7% IMH versus 5.1% with Type A). In both groups, IMH patients were older (mean age 70.4 vs. 61.3 years, p&lt;0.001) and less frequently male (51.4% vs. 67.2%, p&lt;0.001). Marfan Syndrome was less common with IMH (1.1% vs. 4.0%, p&lt;0.001).For both dissection types, IMH patients less frequently demonstrated presenting mesenteric ischemia (Type A: 0.8% vs. 4.3%, p=0.003; Type B: 0.7% vs. 6.3%, p&lt;0.001) or limb ischemia (Type A: 3.2% vs. 12.3%, p&lt;0.001; Type B: 2.7% vs. 9.3%, p&lt;0.001). Tamponade at presentation was more common in Type A IMH (17.9% vs. 11.6%, p=0.005). Type B IMH patients had less presenting renal failure (7.5% vs. 16.9%, p&lt;0.001). Medical management alone was more commonly employed as a treatment strategy for IMH versus AAD, both in Type A (18.8% vs. 8.7%, p&lt;0.001) and Type B (78.7% vs. 56.9%, p&lt;0.0001). Correspondingly, Type B IMH patients had less endovascular management (15.6% vs. 29.3%, p&lt;0.001). Surgery was delayed beyond 48 hours of diagnosis in almost twice as many surgical Type A IMH patients (14.9% vs. 8.4%, p=0.009). Additionally, medically managed type A IMH patients had lower mortality than those with AAD (33.3% vs. 58.0%, p=0.001), although medical mortality was still higher than that of surgical patients with IMH (33.3% vs. 12.0%, p&lt;0.001). Kaplan-Meier analyses of 1-year post-discharge death, late intervention, and aortic growth were similar between groups. Conclusions: Intervention was less common among patients with IMH for both Type A and Type B. While a select subset of non-operative IMH patients had more favorable in-hospital outcomes compared to those with AAD, this mortality was still higher than for those IMH patients receiving surgery.
Abstract 18734: Comparison of Hypertension Prevention Education Among Community Health Students, Online Chat-Based Artificial Intelligence Model, and Physician
Authors: Aayush Visaria, Eesha Vijayakumar, Christopher Aseervatham, Andrew Arredondo, Anshruta Chidananda, PRIYANSHI SHAH, Angeles Pinas, Pierre Saad, Seung Jae Moon
Journal: Circulation (2023)

Introduction: Health literacy and preventive education remain the core of hypertension management. Emerging language processing, artificial intelligence (AI) tools have the potential to provide effective preventive information. We sought to compare the quality of responses to commonly asked questions about hypertension by community health students, a physician, and an AI tool. Methods: Through a structured, student service-learning program, 270 trained undergraduate students conducted 56 health fairs across 19 locations in NJ from Jan 2022 - March 2023. We identified the 10 most commonly asked questions related to blood pressure and asked a physician, a trained student, and ChatGPT to answer them in paragraph format within 200 words. Four independent, blinded expert reviewers graded each response from 1 to 3 (3=best, 1=worst response relative to others). We assessed the reliability across responses using the Fleiss' Kappa statistic. We used ANOVA with post-hoc pairwise comparisons to determine differences in average response score. Results: Among 30 responses, there was a significant difference in score by response type (physician, 2.0 [SD, 0.6]; student, 1.8 [0.5]; ChatGPT, 2.2 [0.6], p=0.001). Post-hoc, pairwise comparisons revealed student scores were significantly lower than ChatGPT scores (p=0.0038), but there was no difference between physician and ChatGPT responses (p=0.81). Scores were moderately reliable across expert reviewers (kappa = 0.56). Qualitatively, student and physician scores were rated to be more empathetic and personalized, but less comprehensive and actionable. Conclusions: A language-processing, AI-based tool performed as well, if not better, than a physician and trained community health students to provide preventive education related to blood pressure. Further quality improvement initiatives need to be done to better understand the utility of AI tools to augment preventive education and to more effectively train students/physicians to provide comprehensive and actionable strategies.
Abstract 14711: Prediction of Persistent High-Need High-Cost Cardiology Patients With and Without Renal Failure
Authors: Ursula W de Ruijter, Z.L.R. R Kaplan, Jan H Cornel, Hester F Lingsma, Willem A Bax
Journal: Circulation (2023)

Introduction: Heart failure (HF) and coronary artery disease (CAD) are increasingly complex disease entities, in particular in older patients with multiple long-term conditions. High-Need High-Cost (HNHC) patients are at risk of receiving inefficient care that does not contribute to better outcomes. Prediction models may help to identify patients at risk of becoming HNHC with potential benefit for care coordination interventions. Aim: To predict persistent HNHC status at outpatient presentation for cardiovascular populations with HF, CAD, with and without renal failure (HF&amp;RF; CAD&amp;RF). Methods: We performed a retrospective cohort study in the claims database of a large healthcare insurer in the Netherlands. We included patients with consecutive data between 2015 - 2019, at their first outpatient appointment in 2016. Potential predictors were based on the previously published Persistent High Utilizer (PHU) model and collected in the year prior to presentation. HF, CAD and RF were defined by Diagnosis Treatment Combination insurance codes. The outcome of interest was PHU status, defined as belonging to the top 10% of total annualized healthcare expenditures for three consecutive years. To account for inflation, all costs were scaled towards 2015. Predictor effects were quantified through logistic multivariable regression analysis as odds ratios. Models were validated internally by bootstrapping procedure. Model performance was assessed as discrimination, quantified by the C-statistic. Results: 219.567 patients were included, of whom 2.0% ( n =4286) became PHU. The most important predictors were chronic kidney disease diagnosis (OR 3.1 95%CI 2.4-4.1), gastroenterology involvement (OR 3.0 95%CI 2.7-3.3) and COPD diagnosis (OR 2.1 95%CI 1.8-2.5). Model performance in the overall population was good (C-statistic 0.77). Model performance varied in the more homogeneous populations with HF ( n =2261; n =157 PHU), CAD ( n =7221; n =292 PHU), HF&amp;RF ( n =163; n =40 PHU) and CAD&amp;RF ( n = 196; n =34 PHU) resulting in C-statistics of 0.74, 0.78, 0.60 and 0.67 respectively. Conclusions: Persistent HNHC status can be predicted in the outpatient setting for patients with HF and CAD. These models can be used to select cardiology patients for HNHC care coordination.
Abstract 19071: An Agitated Young Heart: A Rare Presentation With a Favorable Outcome Under the Right Circumstances
Authors: Pranav Pillai, ShengNan Zheng, Bahjat AlAdili, Munis Raza, SOHAIL IKRAM
Journal: Circulation (2023)

Introduction: Commotio cordis (Latin: agitation of heart) is sudden death triggered by a blunt, often innocent-appearing blow to the chest. It is the third most common cause of sudden cardiac death (SCD) in young athletes, after hypertrophy cardiomyopathy, and coronary anomalies. Around 10-20 cases are added to the Commotio Cordis (CC) registry annually. Ventricular fibrillation seems to be the most common arrhythmia in commotio cordis in 40% of cases. Case Presentation: A 22-year-old male with no known medical illness presented after sudden cardiac arrest. According to a bystander, he fell to the ground and lost consciousness within a few seconds of being “elbowed in his chest” during a basketball game. EMS provided bag valve mask ventilation for respiratory distress but were unable to record the rhythm. On initial presentation to the emergency room, he was found to be in ventricular tachycardia (VT) with hemodynamic instability. He was cardioverted, and his VT deteriorated to ventricular fibrillation. He was intubated for airway protection, received two rounds of CPR and another 200 J defibrillation that restored his sinus rhythm with return ofspontaneous circulation (ROSC). Bedside echocardiogram revealed global hypokinesis with EF 30-35%. EKG showed marked ST elevation in AvR with deep ST depression in other leads. Code STEMI was activated, and an emergent coronary angiogram was done which revealed normal coronary arteries and anatomy. Subsequent EKG within an hour was essentially normal. A repeat echocardiogram on the next day showed an improved EF of 65%. Discussion: Commotio cordis is fatal, with only about 25% of the cases on CC registry resulting in survival. A chest blow must be confined to a small area of the precordium within a 20 msec window during upstroke of T wave that results in ventricular fibrillation. Sustained ventricular tachycardia is even rare, with only one case report found on literature review. It is likely that his VT favored a better prognosis.
Abstract 13465: Tirzepatide vs. Semaglutide for Secondary Prevention of Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus With an Initial HbA1c of &gt;8.5 - A Value for Money Analysis
Authors: Joseph Azuri, Enis Aboalhasan, Ben Sluckis, Ariel Hammerman, Ronen Arbel
Journal: Circulation (2023)

Introduction: Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) indicated to reduce major adverse cardiovascular events (MACE) in patients with Type-2 Diabetes Mellitus (T2DM) and established cardiovascular disease. Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and GLP-1RA for the same purpose. Comparing the value for money of the two therapies in people with poorly controlled diabetes is essential for prioritization. Methods: We calculated the cost needed to prevent one MACE with either drug by multiplying the annualized number needed to treat (aNNT) to prevent one MACE by the annual cost of the therapy. Efficacy estimates were extracted from pre-specified cohorts of patients with an initial HbA1c above 8.5% in the SURPASS and SUSTAIN-6 trials. Drug costs were based on US GoodRx prices as of February 2023. Results: The aNNT to prevent one MACE in patients with an initial HbA1c of &gt;8.5 with tirzepatide was 79 (95% CI: 44-∞) compared to 78 (95% CI: 42-∞) with semaglutide. The annual cost of tirzepatide is $13,286 versus $17,495 for semaglutide. Accordingly, the CNT to prevent one MACE with tirzepatide is $1,049,594 (95% CI: $584,584-∞) compared to $1,364,611 (95% CI: $734,790-∞) with semaglutide. Conclusions: Tirzepatide provides slightly better, but comparable, value for money than semaglutide when prescribed for secondary prevention of MACE in patients with an initial HbA1c &gt;8.5.
Abstract 12762: Plasma Lipidomic Signature of Peripheral Artery Disease in Young and Middle-Aged American Indian Individuals: The Strong Heart Family Study
Authors: Mingjing Chen, Guanhong Miao, Mary J Roman, Richard B Devereux, Ying Zhang, Jason G Umans, Shelley Cole, Oliver Fiehn, Jinying Zhao
Journal: Circulation (2023)

Introduction: Dyslipidemia is an independent risk factor for peripheral artery disease (PAD). Ankle-brachial index (ABI) is a sensitive and cost-effective tool for screening and predicting PAD. The association between individual lipid species and the progression in subclinical PAD, assessed by change in ABI, remains to be determined, especially in understudied populations at high risk. Hypothesis: To identify individual molecular lipid species associated with PAD progression in American Indians, independent of traditional risk factors. Methods: Using an untargeted lipidomic method by liquid chromatography-mass spectrometry, we repeatedly measured 1,542 individual lipid species in 2,830 fasting plasma samples at two time points (2001-2003 and 2006-2009, mean 5 years apart) from 1,415 unique American Indians in the Strong Heart Family Study. Participants were free of prevalent PAD at both time points. ABI was measured in the right arm and bilateral (both left and right posterior tibial artery) using a handheld Doppler and was analyzed as a continuous variable. We first identified baseline lipid species associated with change in ABI by generalized estimating equation models, adjusting for baseline age, sex, BMI, smoking, eGFR, diabetes, hypertension, lipid-lowering medication and baseline ABI. We then examined the longitudinal association between change in lipid species and change in ABI, adjusting for same covariates plus baseline lipids. Results: Participants (63% female) were aged between 18-65 (mean 38) at baseline and 22-72 (mean 43) at follow-up. Higher baseline levels of 36 lipid species were positively (ORs: 1.01 - 3.60), whereas 16 lipid species were inversely (ORs: 0.26 - 0.98), associated with change in ABI. Longitudinal changes in 77 lipid species, largely glycerolipids, glycerophospholipids, and sphingolipids, were significantly associated with change in ABI during 5-year follow-up. Conclusions: Baseline plasma lipid species and their longitudinal changes over time are significantly associated with PAD progression beyond known risk factors. These findings shed light on the role of dyslipidemia in PAD among young and middle-aged American Indians who suffer high rates of obesity, diabetes and other cardiometabolic disorders.
Abstract 16668: Characterisation of the Structural Phenotype in Atrial Fibrillation by Combined Cardiac Computed Tomography and Atrial Magnetic Resonance Imaging: Towards a Differentiated Approach to Patients With Atrial Fibrillation
Authors: Johanna Tonko, Angela Lee, John Whitaker
Journal: Circulation (2023)

Rational: Atrial remodelling (AR) is the persistent change in atrial structure and/or function and contributes to the initiation, maintenance and progression of AF. Left atrial (LA) size, geometry, fibrosis, wall thickness (LAWT) and ejection fraction (LAEF) have all been shown to vary with pathological AR. The association of these global remodelling markers with each other for differentiating structural phenotypes in AF is not well investigated. Method: Patients referred for first-time AF ablation and controls without AF were prospectively recruited to undergo cardiac CT and MRI with 3D atrial LGE sequences. LAWT based on the eikonal equation, atrial myocardial mass, LA volume and sphericity were calculated from CT. Biplane LA EF and LA fibrosis burden (IIR method) were derived from atrial MRI. Results were compared between patients with AF and controls. Statistical significance was set at α 0.05. Results: 42 AF patients (64.3% male, age 64.6+/- 10.2 , CHA2DS2-VASc 2.48+/- 1.5, 69.0% paroxysmal AF, 31% persistent AF, LVEF 57.9+/-10.5%) and 37 controls (64.9% male, age 56.6+/-7.2, CHA2DS2-VASc 1.54 +/-1, LVEF 60.4 +/- 4.9%) were recruited. Patients with AF had a significantly higher LAWT, mass, fibrosis burden, left atrial size and lower LAEF compared to controls. There was no significant correlation between % fibrosis with LAWT (p 0.573), mass (p 0.775), volume (p 0.407) or sphericity (p 0.855). LAWT had a weak positive correlation with LA volume (p=0.041), but not with sphericity (p 0.86). LAEF had a weak negative correlation with fibrosis (p 0.025) and LAWT (p 0.017) Conclusion: AF is associated with significant quantifiable structural changes yet individual remodelling markers do not or only weakly correlate with each other suggesting different remodelling subtypes exist (e.g. fibrotic, hypertrophic, dilated). Structural phenotyping may provide insight in the individual AF mechanism and inform a more differentiated approach to the heterogenous AF population.
Abstract 18058: Dorsal Root Ganglion Nerve Block Causing Reverse Takotsubo Cardiomyopathy
Authors: Jiwen Li, Mirela Tuzovic, Evaline Cheng
Journal: Circulation (2023)

A 65-years-old female presents to the emergency room after C2 dorsal root ganglion nerve block for cervicogenic headaches, where intraoperatively she became hypotensive and unresponsive with sinus tachycardia to the 140s. She required brief intubation and intravenous vasopressors for resuscitation and was quickly extubated with complete neurologic recovery within hours of presentation. Her vital signs were within normal limits. She had no clinical signs of heart failure on exam. Laboratory values were within normal limits except for elevated hs- troponin which peaked at 1136ng/L. Her EKG showed nonspecific ST changes and T-wave inversion in the high lateral leads. She underwent transthoracic echocardiogram and was found to have basal to mid inferior wall and inferoseptum akinesis with reduced left ventricular ejection fraction of 35-40%. She was initially asymptomatic, but six hours after presentation developed radiating left arm pain then crushing chest and throat pain, with an uptrend in her troponins to 6539, without dynamic EKG changes. She was urgently taken to the cath lab and was found to have clean coronaries, and ventriculography was performed with findings consistent with reverse takotsubo. She was started on low dose beta blockers and ARBs with complete resolution of symptoms. Reverse takotsubo is a rare variant of takotsubo cardiomyopathy, where basal and midventricular segments of the left ventricle are akinetic, with the majority of patients recovering systolic function within months. This condition is frequently triggered by an intense trigger. To our knowledge, this is the first described case of a high-cervical nerve block precipitating takotsubo.