tbuckley/cabot-search huggingface dataset:
Abstract 19004: Clinical Outcomes Following Treatment for Tricuspid Regurgitation: Repair vs. Replacement
Authors: Shreya Chodisetty, Kanika Kalra, Robert A Guyton
Journal: Circulation (2023)

Background: Tricuspid regurgitation (TR). previously regarded as the ‘forgotten valvular disease’, has gained a lot interest lately due to its deleterious effects on the right ventricle and long-term outcomes. Surgical literature on outcomes after isolated tricuspid surgery is limited. Although, the guidelines recommend repair of the tricuspid valve, few studies compare outcomes of replacement with repair. Research Question and Aims: Whether, tricuspid repair or replacement is the optimal therapy for TR is not fully understood. Therefore, we sought to compare outcomes and survival after the two techniques. Methods: Our institutional STS database was queried to identify patients who underwent surgery for TR from 2017-2022. Of the 200 patients identified, 84 were excluded due to major concomitant procedures. After exclusion, 70 patients underwent tricuspid replacement and 46 underwent repair. Pre-, intra- and post-operative characteristics were tabulated and compared using t-tests and fisher’s exact test. 5-year survival was analyzed using Kaplan-Meier curves. Results: Tricuspid repair was notably done in a significantly older patient population compared to replacement (p=0.005) likely due to presence of more endocarditis in the younger population who underwent replacement (Figure 1). Tricuspid repair was associated with a significantly longer cross-clamp time. Post-operative complications including pacemaker implantation rates were not significantly different between the groups. 30-day and 5-year mortality rate was also not found to be significantly different between the two interventions. From the limited mid-term echo follow up, TAPSE reduced to 1.5 from 2.1 in the repair group (p=0.01). Conclusions: Younger patients with endocarditis underwent more replacements than repairs. 30-day outcomes and 5-year survival were not significantly different in the two groups however, RV function seemed to worsen in patients who underwent TV repair.
Abstract 16426: A Risk Model to Predict Atrial Fibrillation in Diabetes Using Machine Learning: The ACCORD Study
Authors: Erik J Offerman, Sarah Harirforoosh, Wenjun Fan, Nathan D Wong, David M Donaldson
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, which necessitates identifying factors that can precipitate this dysrhythmia. We utilized the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to build an AF risk prediction model specifically in the type 2 diabetes (T2DM) population, using machine learning (ML) approaches, and comparing to the established CHARGE-AF risk model. Methods: We utilized a patient cohort from the ACCORD clinical trial without prior AF. Baseline characteristics were collected as potential risk factors and incident AF was defined from ECG at follow-up. A random forest (RF) binary classifier was trained with 27 variables, including age, race, sex, smoking, waist circumference, BMI, blood pressure (BP), history of heart disease, medications, cholesterol, renal function, and left ventricular hypertrophy by ECG. All ACCORD subjects had T2DM, therefore this variable was not included. The CHARGE-AF model consisted of a Cox proportional hazard model trained on the following variables: age, race, height, weight, systolic/diastolic BP, current smoking, heart failure, prior MI, and BP medication. Area under ROC curve (AUC) was measured with randomized, stratified, 5-fold cross validation with 80/20 splits. Imputation and resampling methods were used for missing data and class imbalance. Results: Out of 9307 patients in the ACCORD cohort, 175 developed AF during the study period of 6.26 years, with a mean time to AF event of 3.68 years. The RF model, with an AUC of 0.912, showed improved prediction of AF over the Cox model, which had an AUC of 0.784. Permutation feature importance revealed age, race, waist circumference, weekly alcohol consumption, sex, and GFR as the most predictive features of the RF model (Fig 1). Conclusions: The CHARGE-AF risk model performed modestly on the ACCORD cohort, while a RF model showed superior performance.
Abstract 18621: Platelet Aggregation is Heightened in Those With Metabolic Syndrome and Less Effectively Mediated by Aspirin Therapy
Authors: Maria Teresa Mata Vivas, Michael Garshick, Kamelia Drenkova, Jeffrey Berger
Journal: Circulation (2023)

Background: Patients with metabolic syndrome (MetS) are at a higher risk of developing cardiovascular disease (CVD); however, interventions to mitigate this risk are not fully known. Platelets play a significant role in atherothrombosis, and aspirin is an important, yet controversial therapy used for the primary prevention of CVD. In this study, we examined platelet phenotype in MetS and degree of inhibition from ex vivo aspirin administration. Methods: In a study examining the mechanisms of atherothrombosis in pro-inflammatory conditions, patients without clinical CVD were enrolled and underwent phenotyping. Patients with MetS (n = 34, age 53.3 ± 13 years, 59% male) were compared to patients with no MetS (n = 63, age 41.1 ± 16 years, 52% male). Platelet aggregation of freshly isolated platelets was measured via light transmission aggregometry (LTA) in resting and stimulated conditions, in response to agonists adenosine diphosphate (ADP), high and low dose of arachidonic acid (AA), and after ex vivo aspirin (ASA) administration. Results: MetS patients were older and similar in sex and race (Figure 1A). As expected, patients with MetS had higher individual components of MetS, yet similar LDL-C (Figure 1A). Platelet aggregation to low dose ADP (p=0.09) and AA (p=0.04) was significantly increased in MetS (Figure 1B). Platelet aggregation in response to AA and coincubation with ASA was significantly lower in the no MetS cohort (Figure 1C). The efficacy of aspirin therapy was significantly lower in MetS (Figure 1D). In response to high dose AA after ASA treatment, platelet aggregation increased as number of MetS parameters also increased (Figure 1E). However, no individual metabolic syndrome parameter appeared to be driving these findings (Figure 1E). Conclusion: Among MetS patients, platelet aggregation is heightened and less inhibited by aspirin than those with no MetS. Additional research is warranted to explore possible anti-platelet strategies in patients with MetS.
Abstract 14674: Under- or Over-Estimation of Patients’ Health Status by Physicians in the Care of Patients With Atrial Fibrillation
Authors: Nobuhiro Ikemura, Shun Kohsaka, Takehiro Kimura, Yoshinori Katsumata, Kojiro Tanimoto, Ikuko Ueda, Hiroshi Miyama, Takahiko Nishiyama, John Spertus, Seiji Takatsuki
Journal: Circulation (2023)

Introduction: A primary objective of managing atrial fibrillation (AF) is to optimize patients’ health status (HS), symptoms, function, and quality of life, with an accurate assessment. However, the accuracy of physicians’ estimation of patients’ HS, and its impact on treatment decisions, remains unreported. Aims: To explore the discordance between physicians’ estimation and patients’ HS in those with newly-recognized AF and its association with subsequent care. Methods: From 2018-2020, newly diagnosed or referred AF patients at two outpatient practices in Tokyo completed the Atrial Fibrillation Effect on QualiTy of Life questionnaire (AFEQT, 20 items with a 7-point Likert scale). Blinded to patients’ AFEQT, treating physicians quantified patients’ HS using 3 items reflecting each AFEQT domain. Both physicians’ and patients’ raw responses were averaged, with higher scores indicating worse HS. We defined under-estimation as the physician reporting a score ≤-1 lower and over-estimation as a score ≥1 higher than the patient’s average. We examined the association of HS estimation with treatment and compared 1-year changes in AFEQT. Results: Among 330 patients with newly-recognized AF, physicians correctly estimated patients’ HS in 187 (56.7%), under-estimated its severity in 22 (6.7%), and over-estimated it in 121 (36.7%). Treatment escalation, defined as alteration or initiation of antiarrhythmic drugs, referral for cardioversion, or catheter ablation, occurred in 65.2%, 40.9%, and 61.9% of patients in the correctly, under-, and over-estimated groups, respectively. After adjusting for patient’s characteristics, under-estimation was independently associated with a lack of treatment escalation (adjusted OR 0.30, 95% CI 0.11-0.81) and with less improvement in the AFEQT Symptom scale at 1-year (-3.5 [SE 0.8] vs. 7.0 [SE 3.6] points in under- vs. correctly and over-estimated patients, P=.005) Conclusions: Under-recognition of AF patients’ HS is associated with less aggressive treatment and less health status improvement at 1 year. Standardized assessments of patients’ health status with validated questionnaires may help reduce under-and over-estimating patients’ HS, resulting in greater treatment appropriateness and better outcomes.
Abstract 14969: Association Between Apolipoprotein A-I and Ischemia Risk at Different Diabetes Statuses in Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Real-World Study
Authors: Kailun Yan, Jiawen Li, Yulong Li, Jinqing Yuan, Xueyan Zhao
Journal: Circulation (2023)

Introduction: Recently, growing attention has shifted to apolipoprotein A-I (ApoA-I), revealing compelling relationship between low ApoA-I and ischemia risk. Diabetes mellitus (DM) frequently coexists with abnormal ApoA-I levels. However, the association between ApoA-I and ischemia risk under different diabetes statuses in patients undergoing percutaneous coronary intervention (PCI) remains unclear. Hypothesis: We hypothesized that diabetes status could modify the relationship between ApoA-I levels and ischemia risk in PCI patients. Methods: This prospective study included consecutive 10724 patients treated with PCI throughout 2013. Patients were categorized into 3 subgroups: DM, pre-DM, and normal group. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE, including all-cause death, myocardial infarction, stroke, and revascularization). Results: Among 10232 PCI patients finally included, 2139 (20.9%) MACCEs occurred at 5-year follow-up. There was a significant interaction between ApoA-I and diabetes status (P for interaction = 0.044). In the DM group, an L-shaped curve was observed (Figure 1A), and multivariate Cox regression analysis revealed that only the lowest quintile level of ApoA-I exhibited an increased risk of MACCE (hazard ratio [HR], 1.336; 95% CI, 1.101-1.620; P = 0.003) (Figure 1B). However, neither the normal group nor pre-DM groups could observe the association between ApoA-I and MACCE (both P &gt;0.05). Further sensitivity analysis, stratifying ApoA-I into two groups based on median level, also indicated the highest MACCE in those combined with lower ApoA-I levels and DM (Figure 1C). Conclusions: In a large-scale 5-years follow-up study, we were the first to demonstrate that diabetes status modified the ischemia risk of low ApoA-I levels, highlighting the clinical importance of low ApoA-I levels for risk stratification and focusing on diabetes status in future therapy targeting ApoA-I.
Abstract 14728: Implementation of a Resident-Led Cardiac Point-of-Care Ultrasound Curriculum for the Internal Medicine Residency Program at UT Southwestern
Authors: Jaskeerat Gulati, Christine Yen, Matthew Almonte, Parth Shah, Natalie Hoeting, Sarah Godfrey, Anish B Bhatt
Journal: Circulation (2023)

Introduction: The American Society of Echocardiography recommends integration of cardiac point-of-care ultrasound (cPOCUS) into training programs. There is no defined strategy on how to create and implement this on a large scale. Aim: To implement and assess the efficacy of a novel, pilot-tested, resident-led, simulation-based cPOCUS curriculum within the Internal Medicine (IM) internship at UT Southwestern (UTSW). Methods: All 62 categorical interns in the 2022-2023 class in the UTSW IM residency program completed our cPOCUS curriculum during their outpatient weeks over a three-month period. All tests and workshop guides were developed by current IM residents, cardiology fellows and faculty in a fashion that is reproducible annually, even as residents and fellows change. All interns underwent two educational workshops. Workshop 1 focused on acquisition and recognition of basic cardiac anatomy. Workshop 2 focused on abnormal cardiac pathology. Pre-and post-tests assessed their ability to identify cardiac windows, identify abnormal cardiac pathology, and rate their comfortability on a 5-point Likert scale. Results: Analysis was conducted on 39 of 62 responses containing both pre- and post-tests. Of the 39 interns, 6 (15%) scored below 70% on the pre-test. On the post-test, 38 out of 39 (97%) interns scored at least 80%. Furthermore, 4 of the 6 lowest scoring interns on the pre-test scored 100% on the post-test. There was a significant increase in the average pre- and post-test scores by 6% (p=0.02), with greatest improvement in the ability to identify LVEF &lt;40% (12% increase). Post-curriculum, 33 of 39 interns (85%) “agreed” or “strongly agreed” that they felt comfortable interpreting cPOCUS, compared to only 3 of 39 interns prior. Conclusions: Our simulation-based cPOCUS curriculum was successfully implemented within a large intern class at an academic center, with a 100% participation rate. Post-curriculum, there was a significant increase in cPOCUS interpretation scores and increased comfort with acquisition and interpretation. Our curriculum is sustainable, requires minimal cost, and serves as an archetype for the implementation of simulation-based cPOCUS curricula into “inpatient month + clinic week” block-based training programs.
Abstract 13595: Sex-Specific Burden of Peripheral Arterial Disease Across the United States: Analysis of the Global Burden of Disease 1990-2019
Authors: Scott E Janus, Tarek Chami, Jamal Hajjari, haytham mously, Anshul Badhwar, Mustafa Al-Jammal, Nicole Chahine, Jun Li, SALIL DEO, Sadeer Al-Kindi
Journal: Circulation (2023)

Background: Peripheral arterial disease is a ubiquitous disease that varies in terms of morbidity and mortality due to biologic sex, including the impact of traditional and non-traditional risk factors and sex-specific conditions that adds complexity and contributes to the existing disparities. Thus, understanding the sex-specific trends of PAD in the United States population is critical for developing targeted interventions. We sought to analyze the burden of PAD in male and female patients across the US from 1990 to 2019. Methods: Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of PAD from 1990-2019, across US states. The GBD defined PAD based on studies that used symptom-based criteria and expressed the burden of PAD as the age-standardized prevalence and disability adjusted life years (DALYs) rates. We additionally estimated the regional relative change in DALYs. Results: In 2019, there were 5.4 million males and 7.1 million females with PAD in the US. Absolute PAD prevalence and DALYs increased in both sexes between 1990 and 2019, figure. The 2019 age-standardized prevalence of PAD (per 100,000) in the US in 2019 was 2,124 (95% Uncertainty Interval (UI): 1905-2354), and 2,302 (95% UI: 2,079-2,522) for females. Between 1990 and 2019, females had higher increase in age-standardized PAD DALYs compared with males (13.8% vs 5.5%). Significant state-level geographic variance was noted in age-standardized prevalence of PAD in both sexes (2-fold difference between lowest and highest state), figure. Conclusion: The burden of PAD is increasing in the US owing to the aging population. The absolute prevalence of PAD is higher in women compared with men in the US. Over the past 3 decades, there has been a more significant increase age-standardized PAD DALYs in women as compared with men. Future studies are needed to investigate and target these disparities.
Abstract 14403: Echocardiographic Predictors of Phenotype Development in Hypertrophic Cardiomyopathy Mutation-Carriers
Authors: Grazia Canciello, Felice Borrelli, Gaetano Todde, Suet Nee Chen, Ciro Santoro, ERRICO FEDERICO F PERILLO, Leopoldo Ordine, Giovanni Esposito, Maria-Angela losi, Raffaella Lombardi
Journal: Circulation (2023)

Introduction: Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterized by unexplained left ventricular (LV) hypertrophy (LVH). Genetic family screening of probands identifies mutation carriers (Gen+) without phenotype (Phen-), who require clinical follow-up. Hypothesis: Identification of early phenotype signs may facilitate clinical management of Gen+/Phen-. We assessed if echocardiography LV global longitudinal strain (GLS) and strain rate (SR) may predict LVH development in Gen+/Phen- HCM. Methods: We identified 16 Gen+/Phen- (25% women; age 20±11 years). Echocardiogram was performed at baseline, when no phenotype was evident, and repeated yearly. The end of follow up was the HCM diagnosis date in subjects who developed HCM (FU-Phen+) and the last visit date in those who didn’t develop HCM (FU-Phen-). Mitral inflow peak E and A velocities and Tissue Doppler E’ and A’ peak velocities were measured. LV GLS and SR-peak during isovolumic relaxation (SRIVR) were calculated offline independently by two investigators blind to the clinical data. Results: GLS and SRIVR were not age-dependent (p=0.08 and 0.55, respectively), whereas E/E’ ratio was directly related to age (p=0.011). During follow-up (8±5 years, interquartile range 5-10 years) 5 subjects became FU-Phen+. At baseline, FU-Phen+ compared to FU-Phen- were older and had higher maximal wall thickness, higher EF, less negative GLS and lower SRIVR (Table). Abnormal baseline GLS, despite a normal EF, and reduced SRIVR indicate reduced systolic deformation and covert diastolic dysfunction which may be caused by disarray preceding LVH and fibrosis. Conclusions: This is the first HCM preclinical study to compare at baseline HCM Gen+/Phen- subjects who will develop to those who will not develop LVH. We identified sensitive, easily obtainable, age- and load-independent echocardiographic predictors of phenotype development in HCM gene carriers who may undergo early preventive treatment.
Abstract 14337: Identification of New Clinical Phenotypes of Sudden Cardiac Death Using Artificial Intelligence
Authors: Patricia Jabre, Younes Youssfi, Wulfran Bougouin, Frankie BEGANTON, Nicolas Chopin, Xavier Jouven
Journal: Circulation (2023)

Introduction: Current classifications of Sudden Cardiac Death (SCD) are based on cardiovascular (CV) conditions and risk factors, and frequently fail to explain numerous SCD cases. Hypothesis: a data-driven machine learning approach could identify new clinical phenotypes of SCD in the general population, using a wide range of CV and non-CV variables. Methods: All case of SCD over 18y that occurred between 2011-15 in Paris and suburbs were included in the Paris Sudden Death Expertise Center. Data from the French National Health Insurance database that occurred up to 10y before SCD were collected (drugs, examinations,diagnosis). We performed a non-supervised statistical approach to identify relevant clinical phenotypes of SCD, using clustering and dimension reduction methods. A validation was performed between 2016-20. Results: 12,651 SCD subjects were included. Mean age was 68y, and 61% were men. The clustering analysis identified 8 distinct clusters of SCD, with homogeneous characteristics. 3 clusters were already well known: a group mainly composed of aged women (3,307, 38% men, 81y), one with mainly CV diseases (3,638, 74% men, 74y) and one of young subjects with very few comorbidities (2,645, 65%men, 54 y). 4 non-CV clusters were identified: a group with psychiatric and/or neurologic disorders (862), a group with chronic or acute pulmonary diseases (688) and a group with malignant neoplasms of different sites and related drugs (518), and a group with kidney diseases (279). The last group was composed of subjects with characteristics related to social deprivation (alcohol related disorder, hepatitis, HIV, etc) (252).The same 8 clusters were identified in the validation cohort (11,485). Conclusions: By extending far beyond CV pathology, our approach provides for the first time a global picture of SCD, revealing the involvement of extra CV medical fields that might eventually lead to discover new pathways and help identifying high risk subjects.
Abstract 17051: Oxytocin Receptor in the Spinal Neuraxial Modulation of Ventricular Excitability
Authors: Abigail Hellman, Kimberly Howard-Quijano, Yuki Kuwabara, Siamak Salavatian, Madison Fisher, Aman Mahajan
Journal: Circulation (2023)

Introduction: Cardiac sympathoexcitation is a major contributor to the pathogenesis of ventricular tachyarrhymias (VTs) during ischemia reperfusion (I/R) and chronic myocardial infarction (MI). Afferent network connections in the intermediolateral cell column (IML) and dorsal horn (DH) control sympathetic output to the heart. Our team reported spinal cord stimulation (SCS), decreased cardiac sympathoexcitation and reduced VTs during ischemia. Oxytocin (OXT) is a known neuromodulator; however, whether OXT signaling can modulate the cardiospinal neural network is unknown. Hypothesis: SCS neuromodulation is reducing sympathoexcitation and VTs through OXT signaling pathways. Methods: Two models of cardiac ischemia were used in Yorkshire domestic swine. In acute I/R, a suture was placed around the left anterior descending (LAD) coronary artery, after sternotomy. Chronic infarction (MI) was created by accessing the femoral with fluoroscopy guidance. Polystyrene microspheres (1ml) were injected via a 3mm angioplasty balloon catheter to the LAD. Animals then recovered post-MI for 6-8wk. SCS treatment was delivered through a four-pole lead which was inserted in the epidural space (T1-T4)(50Hz, 0.4ms pulse duration). T2-T4 spinal cord was collected postmortem for molecular analysis. Fluorescence in situ hybridization (FISH) protocol for RNAscope Fluorescent v2 Assay (ACD) was followed. Cell counts represented as 3 puncta or more centered around DAPI. Results: We report that OXT receptor positive cells significantly decreased as a result of I/R and MI (p&lt;0.001, two-way ANOVA n=4-5 animals, average of 2-3 slices per animal). Within the DH the majority of OXT positive cells were inhibitory GABAergic neurons. Within the IML, a majority of the cells regulated by I/R and MI were microglia, and both an inhibitory and excitatory population contributed to the onset of ischemia. SCS treatment after I/R and MI resulted in the recovery of this OXT receptor cell population. Conclusions: By evaluating the role of OXT in reducing cardiac sympathoexcitation at the level of the spinal cord, we provide new insights into optimizing current neuromodulation approaches and developing new pharmacologic therapies.