Suraj Kapa

Suraj Kapa
Mayo Foundation for Medical Education and Research | MMS · Department of Cardiovascular Diseases

About

316
Publications
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Introduction

Publications

Publications (316)
Article
Full-text available
Background Non-invasive, continuous blood pressure monitoring technologies require additional validation beyond standard cuff-based methods. This study evaluates a non-invasive, multiparametric wearable cuffless blood pressure (BP) diagnostic monitor across all hypertension classes with diverse subjects. Methods A prospective, multicenter study as...
Article
BACKGROUND The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recov...
Article
Introduction: The prevalence and prognostic significance of PVC and NSVT in cardiac sarcoidosis (CS), especially in patients with normal or mildly decreased LV function, are not well known and were investigated in the current study. Methods: We included 192 patients with definite and probable CS with LVEF>35%, no prior history of VT/VF or sudden ca...
Article
Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by fibrofatty replacement of myocardial tissue, creating areas of electrical heterogeneity and increasing the risk of ventricular arrhythmias (VAs) and sudden cardiac death (SCD). Catheter ablation is commonly performed in patients with arrhythm...
Article
Introduction: Unexplained high-grade AV block (AVB) in patients age <65 years is among the salient features of cardiac sarcoidosis (CS). Guidelines recommend that CS patients with high-grade AVB should receive an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) rather than a permanent pacemaker...
Article
Background Ventricular tachycardia (VT) is a life-threatening arrhythmia that can complicate structural heart disease. While catheter ablation is effective in treating this condition, the recurrence of VT after the procedure continues to be a concern. Consequently, there is a need for a reliable system to evaluate the likelihood of arrhythmia recur...
Article
Full-text available
Aims We aim to determine if our previously validated, diagnostic artificial intelligence (AI) electrocardiogram (ECG) model is prognostic for survival among patients with cardiac amyloidosis (CA). Methods A total of 2533 patients with CA (1834 with light chain amyloidosis (AL), 530 with wild‐type transthyretin amyloid protein (ATTRwt) and 169 with...
Article
BACKGROUND Sustained ventricular tachycardia (VT) in cardiac amyloidosis is uncommon, and the substrate and outcomes of catheter ablation are not defined. METHODS We included 22 consecutive patients (mean age, 68±10 years; male sex, 91%) with cardiac amyloidosis (ATTR [transthyretin], n=16; light chain, n=6) undergoing catheter ablation for VT/ven...
Article
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The introduction of pulsed field ablation (PFA) in electrophysiology marks a significant advancement, promising efficacy comparable to thermal ablation methods while potentially providing safety advantages. Despite a generally favorable safety profile in human trials and postmarket registries, cautious evaluation of PFA's safety is essential. This...
Article
Full-text available
Background Early diagnosis of pulmonary hypertension (PH) is critical for effective treatment and management. We aimed to develop and externally validate an artificial intelligence algorithm that could serve as a PH screening tool, based on analysis of a standard 12-lead electrocardiogram (ECG). Methods The PH Early Detection Algorithm (PH-EDA) is...
Article
Introduction: The combination of local impedance (LI), a direct measure of electrical resistance at the catheter tip, and contact force (CF) may facilitate treatment of atrial fibrillation (AF). This trial is designed to examine the safety and effectiveness of a novel RF catheter that allows measurement of both LI and CF. Hypothesis: Demonstrate th...
Article
Background: Early diagnosis of heart failure with reduced ejection fraction (HFrEF) can lead to reduced healthcare costs and improved outcomes. In this study, we evaluated the economic effectiveness of an AI algorithm for detecting low ejection fraction using 12-lead ECG data. Aims: The primary aim was to estimate the health economic impact of the...
Preprint
Full-text available
We present an automated, privacy-preserving toolset, named Blind Learning (BL), that aims to facilitate and accelerate secure access to decentralized data without moving it outside the owner’s infrastructure.
Article
Objective: To ascertain whether heart failure (HF) itself is a senescent phenomenon independent of age, and how this is reflected at a molecular level in the circulating progenitor cell niche, and at a substrate level using a novel electrocardiogram (ECG)-based artificial intelligence platform. Patients and methods: Between October 14, 2016, and...
Article
Objective: To demonstrate early aging in patients with lamin A/C (LMNA) gene mutations after hypothesizing that they have a biological age older than chronological age, as such a finding impacts care. Patient and methods: We applied a previously trained convolutional neural network model to predict biological age by electrocardiogram (ECG) [Arti...
Article
Objective: To study the relationship between the sex probability derived from the artificial intelligence (AI)-augmented electrocardiogram (ECG) and sex hormone levels. Patients and methods: Adult patients with total testosterone (TT; ng/dL) or estradiol (E2; pg/mL) levels (January 1, 2000, to December 31, 2020) with ECGs obtained within 6 month...
Preprint
Full-text available
Here's the preprint of our accepted poster submission to AMIA 2022. We present the design and implementation of an easy-to-use SMPC inference service for ML models. Our underlying cryptography primitives also demonstrate outstanding results compared to existing SMPC solutions.
Article
Full-text available
Background: Biomarkers to monitor disease activity and predict major adverse cardiac events (MACE) in CS have not been described previously. We aimed to identify biomarkers to predict MACE in cardiac sarcoidosis (CS). Methods: Patients (N=232) diagnosed with CS were retrospectively enrolled. Biomarkers including angiotensin-converting enzyme (AC...
Article
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Aims An artificial intelligence algorithm detecting age from 12-lead-ECG has been suggested to reflect “physiological age”. An increased physiological age has been associated with a higher risk of cardiac mortality in the non-transplant population. We aimed to investigate the utility of this algorithm in patients who underwent heart transplantation...
Article
Background: Ablation of ventricular tachycardia (VT) is limited by the inability to create penetrating lesions to reach intramyocardial origins. Intramural needle ablation using in-catheter, heated saline-enhanced radio frequency (SERF) energy uses convective heating to increase heat transfer and produce deeper, controllable lesions at intramural...
Article
Full-text available
Background ECG-enabled stethoscope (ECG-Scope), acquires a single lead ECGs during cardiac auscultation, and may facilitate real-time screening for pathologies not routinely identified by cardiac auscultation alone. We previously demonstrated an artificial intelligence (AI) algorithm can identify left ventricular dysfunction(LVSD) (defined as eject...
Article
Full-text available
Aims Some artificial intelligence models applied in medical practice require ongoing re-training, introduce unintended racial bias, or have variable performance among different sub-groups of patients. We assessed the real-world performance of the artificial intelligence enhanced electrocardiogram to detect left ventricular systolic dysfunction with...
Article
Full-text available
Background Artificial intelligence (AI) enabled electrocardiography (ECG) can detect latent atrial fibrillation (AF) in patients with sinus rhythm (SR). However, the change of AI-ECG probability before and after the first AF episode is not well characterized. Objective We sought to characterize the temporal trend of AI-ECG AF probability around th...
Article
18F-flurodeoxyglycose (FDG)/13N-ammonia positron emission tomography/computed tomography (PET/CT) is frequently utilized to evaluate cardiac sarcoidosis (CS) but findings can reflect other forms of myocardial inflammation or altered myocardial metabolic activity. Herein, we present five cases where cardiac PET findings suggested CS, but right ventr...
Article
Full-text available
Background Left atrial (LA) myopathy is common in patients with heart failure and preserved ejection fraction and leads to the development of atrial fibrillation (AF). We investigated whether the likelihood of LA remodeling, LA dysfunction, altered hemodynamics, and risk for incident AF could be identified from a single 12-lead ECG using a novel ar...
Article
Background Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation following mitral valve surgery (MVS) is limited. Catheter ablation (CA) can be challenging given perivalvular substrate in the setting of mitral annuloplasty or prosthetic valves. Objective To investigate the characteristics, safety, and outcomes...
Article
Full-text available
Objective To assess whether an electrocardiography-based artificial intelligence (AI) algorithm developed to detect severe ventricular dysfunction (left ventricular ejection fraction [LVEF] of 35% or below) independently predicts long-term mortality after cardiac surgery among patients without severe ventricular dysfunction (LVEF>35%). Methods Pat...
Article
Importance Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies. Objective To investigate outcomes associated with VT ablation in patie...
Article
Introduction: Cardiac Sarcoidosis (CS) is a non-ischemic cardiomyopathy (NICM) characterized by infiltration of non-caseating granulomas involving in the heart with highly variable clinical manifestations. Cardiac resynchronization therapy (CRT) has shown significant promise in NICM, though little is known about its effectiveness in patients with C...
Article
Introduction: Transthyretin cardiac amyloidosis (TTR-CA) can cause heart failure with preserved EF (HFpEF). We previously reported a clinical/echo-based score (TCAS) and defined a cut-off that predicted risk of TTR-CA in HFpEF. Herein, we assess the comparative performance of an artificial-intelligence ECG-based screening tool (AI-ECG). Hypothesis:...
Article
Introduction: LMNA encodes the nuclear envelope proteins lamin A/C that are involved in ageing processes. Mutations in LMNA cause a spectrum of phenotypes which include muscular dystrophy, arrhythmogenic dilated cardiomyopathy, peripheral neuropathy, progeroid syndrome and overlap syndrome. Early diagnosis is crucial to prevent sudden cardiac death...
Article
Introduction: Asymptomatic LV systolic dysfunction is often underdiagnosed, leading to missed opportunities for treatment. In a recently completed pragmatic RCT, an AI algorithm performed on the ECGs ordered as part of routine practice increased early diagnosis of low EF. The current study aimed to understand whether the effectiveness of the AI alg...
Chapter
In this last decade, with further maturity of catheter ablation for AF, the multicenter CABANA trial demonstrated AF ablation to be safe, more effective compared to drugs, and likely having an early role in the CHF patient. Newer energy sources for accomplishing ablation with enhanced precision and safety are in their formative stages: particle bea...
Article
Background While VT in the setting of post-myocardial infarction LVA is not uncommonly encountered, there is scarcity of data regarding the safety, efficacy and outcomes of ablation of VT in this subset of patient. Methods Our study included consecutive patients aged ≥18 with post-myocardial infarction LVA who presented to Mayo Clinic for catheter...
Preprint
Full-text available
Background: Cardiovascular event rates increase with age in all populations. This is thought to be the result of multiple underlying molecular and cellular processes that lead to cumulative vascular damage. Apart from arterial stiffness based on pulse wave velocity there are few other non-invasive measures of this process of vascular aging. We have...
Article
Research Objective An artificial intelligence (AI) algorithm based on ECG was integrated into clinical workflows to identify patients with a high likelihood of low ejection (EF), a condition that is underdiagnosed but treatable. The trial aimed to assess whether the AI-powered clinical decision support enabled early diagnosis of low EF. Study Desi...
Article
Objective To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG). Methods A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction–confirmed COVID-19 diagnosis and age-...
Preprint
Full-text available
Background: Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation following MVS is limited.) CA can be challenging given perivalvular substrate in the setting of mitral annuloplasty or prosthetic valves. Objective: To investigate the characteristics, safety, and outcomes of radiofrequency catheter ablation (CA)...
Article
Objective: To develop an artificial intelligence (AI)-based tool to detect cardiac amyloidosis (CA) from a standard 12-lead electrocardiogram (ECG). Methods: We collected 12-lead ECG data from 2541 patients with light chain or transthyretin CA seen at Mayo Clinic between 2000 and 2019. Cases were nearest neighbor matched for age and sex, with 24...
Article
Background Local impedance (LI) drop measured with micro-fidelity electrodes embedded in the tip of an ablation catheter accurately reflects tissue heating during radiofrequency (RF) ablation. Previous studies found 15-30Ω LI drops created successful lesions, while >40Ω drops were associated with steam pops. The objective of this study was to evalu...
Article
The presence of left ventricular systolic dysfunction (LVSD) alters clinical management and prognosis in most acute and chronic cardiovascular conditions. While transthoracic echocardiography (TTE) remains the most common diagnostic tool to screen for LVSD, it is operator-dependent, time-consuming, effort-intensive, and relatively expensive. Recent...
Article
Undiagnosed dilated cardiomyopathy (DC) can be asymptomatic or present as sudden cardiac death, therefore pre-emptively identifying and treating patients may be beneficial. Screening for DC with echocardiography is expensive and labor intensive and standard electrocardiography (ECG) is insensitive and non-specific. The performance and applicability...
Article
Objective Endomyocardial biopsy (EMB) is a useful diagnostic tool though the yield may be limited in many myocardial diseases. Data on the diagnostic yield and prognostic significance of EMB guided by abnormal electrograms (EGM-Bx) in suspected cardiac sarcoidosis (CS) are scarce. Methods Seventy-nine patients (mean age 56±12 years; 61% men) with...
Article
Objective To evaluate the cost-effectiveness of an artificial intelligence electrocardiogram (AI-ECG) algorithm under various clinical and cost scenarios when used for universal screening at age 65. Patients and Methods We used decision analytic modeling to perform a cost-effectiveness analysis of the use of AI-ECG to screen for asymptomatic left...
Article
Objective To validate an artificial intelligence–augmented electrocardiogram (AI-ECG) algorithm for the detection of preclinical left ventricular systolic dysfunction (LVSD) in a large community-based cohort. Methods We identified a randomly selected community-based cohort of 2041 subjects age 45 years or older in Olmsted County, Minnesota. All pa...
Article
Full-text available
We have conducted a pragmatic clinical trial aimed to assess whether an electrocardiogram (ECG)-based, artificial intelligence (AI)-powered clinical decision support tool enables early diagnosis of low ejection fraction (EF), a condition that is underdiagnosed but treatable. In this trial (NCT04000087), 120 primary care teams from 45 clinics or hos...
Article
Full-text available
Background We have demonstrated that a neural network is able to predict a person’s age from the electrocardiogram (ECG) [artificial intelligence (AI) ECG age]. However, some discrepancies were observed between ECG-derived and chronological ages. We assessed whether the difference between AI ECG and chronological age (Age-Gap) represents biological...
Chapter
Understanding cardiac pacing requires an intimate consideration of two key elements: stimulation threshold and sensing. The chronaxie is important in the clinical practice of pacing because it approximates the point of minimum threshold energy required for myocardial depolarization. One can specifically consider the situation of postdefibrillation...
Article
Background Histologic evidence is required for a definitive diagnosis of cardiac sarcoidosis (CS) by published guidelines; however, the sporadic nature of the disease may produce false negative biopsy results, causing CS to be underdiagnosed. We sought to establish a clinical category of CS absent histologic findings. Methods Patients evaluated fo...
Article
Full-text available
Sarcoidosis is a multisystem inflammatory condition with occasional cardiac involvement (CS), which may be associated with risk of venous thromboembolism (VTE). As data on VTE in CS are sparse and corticosteroid therapy has not been previously examined, we aim to determine the association between CS, corticosteroid treatment for CS, and VTE. Patien...
Article
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Background: A non-invasive, easy-to-access marker of accelerated cardiac ageing would provide novel insights into the mechanisms and aetiology of cardiovascular disease (CVD) as well as contribute to risk stratification of those who have not had a heart or circulatory event. Our hypothesis is that differences between an ECG-predicted and chronologi...
Article
Full-text available
Background An artificial intelligence algorithm that detects age using the 12‐lead ECG has been suggested to signal “physiologic age.” This study aimed to investigate the association of peripheral microvascular endothelial function (PMEF) as an index of vascular aging, with accelerated physiologic aging gauged by ECG‐derived artificial intelligence...
Article
Full-text available
Background The prognosis of left ventricular noncompaction (LVNC) remains elusive despite its recognition as a clinical entity for >30 years. We sought to identify clinical and imaging characteristics and risk factors for mortality in patients with LVNC. Methods and Results 339 adults with LVNC seen between 2000 and 2016 were identified. LVNC was...
Article
Full-text available
Objective To validate a novel artificial-intelligence electrocardiogram algorithm (AI-ECG) to detect left ventricular systolic dysfunction (LVSD) in an external population. Background LVSD, even when asymptomatic, confers increased morbidity and mortality. We recently derived AI-ECG to detect LVSD using ECGs based on a large sample of patients tre...
Article
Full-text available
In April 2019, a select group of medical, academic, and private-sector leaders in bioelectronic medicine convened in Geneva to discuss the potential for building a cross-disciplinary movement that would advance the field with key stakeholders – both those who are already active in research and commercialization as well as those who will influence t...
Article
Objectives: We sought to evaluate the procedural safety and outcomes of high power (HP) versus conventional power (CP) radiofrequency (RF) ablation during pulmonary vein isolation (PVI). Methods: A systematic search was used via MEDLINE, EMBASE, and Cochrane databases between 01/1998 and 05/2020 for studies comparing the safety and efficacy between...
Article
Background: Myocardial injury results in release of cardiac troponin (cTn) into the bloodstream, readily detected by high-sensitivity cTn (hs-cTn) assays. A noninvasive, rapid, home-based test to exclude acute myocardial injury at the time of the test and for the next 7 hours would help manage patients with suspected myocardial infarction. Since my...
Article
Background: High-sensitivity cardiac troponin (hs-cTn) assays quantify cTn in patients at very low concentrations. Myocyte injury due to ischemia or other pathologies cause blood levels to increase, which is prognostic. A noninvasive, rapid, broadly available, home-based test to detect hs-cTn increases would facilitate risk-stratification. Since my...