tbuckley/cabot-search huggingface dataset:
Abstract 4145350: Association of Zip Code and Incidence of Driveline Infection in Patients with Left Ventricular Assist Devices (LVADs): Do social determinants of health impact outcomes in LVAD recipients?
Authors: Ashvita Ramesh, Ana Pico, Erin Coglianese
Journal: Circulation (2024)

Introduction: Driveline infection (DLI) is common after left ventricular assist device (LVAD) implantation and is associated with high morbidity/mortality. Socioeconomic status (SES) is a well-validated risk factor for poor outcomes among patients with heart failure, but its influence on adverse events in patients post-LVAD is poorly understood and may be overestimated. The primary aim of this study was to determine the association between markers of SES and DLI in LVAD recipients. Methods: We conducted a single-center retrospective study of patients who received durable LVAD implants from January 2016 to November 2023. The Distressed Communities Index (DCI), a validated measure of SES, was generated using home zip codes. Baseline patient demographics, insurance, pre-implant device data, and pre-implant laboratory data were also collected. Variables associated with DLI were analyzed with regression and Cox proportional hazard models. Results: Of 159 included patients, 23% were found to have at least one DLI. Patients were categorized as prosperous (29%), comfortable (21%), mid-tier (24%), at-risk (18%), and distressed (8%) based on their DCI, with baseline variables similar across DCI groups. Hispanic ethnicity (17% v 7%, p=0.016) and higher pre-implant BMI (mean 27.5 v 25.6, p=0.017) were associated with DLI (Table 1). While the absolute number of days with LVAD was found to be predictive of DLI (HR 0.998, 95% CI: 0.997-0.999, p=0.001), DCI was not found to be predictive of DLI (HR 1.179 95% CI: 0.918-1.514, p=0.196). Of note, BMI was not predictive (HR 0.983, 95% CI: 0.937-1.031, p=0.475). Conclusion: In this single center population, SES did not independently predict DLI after LVAD implantation. Our study is consistent with the current body of literature in demonstrating that there are no variables consistently associated with DLI, though no study thus far has evaluated SES. This is a key finding, as SES may factor in the assessment of candidacy for LVAD and concern for complications. This may inappropriately bias against LVAD implantation in patients who live in distressed communities. Further studies are necessary to evaluate if DCI impacts other adverse outcomes post LVAD.
Abstract 4145351: Wearable-Echo-FM: An ECG-Echo Foundation Model for Single Lead Electrocardiography
Authors: Elizabeth Knight, Evangelos Oikonomou, Arya Aminorroaya, Rohan Khera
Journal: Circulation (2024)

Background: Single-lead electrocardiograms (ECGs) are widely available on wearable and portable devices and can be leveraged as screening tools for structural heart disorders (SHDs) with novel deep learning ECG applications. However, scope of model development is limited by the need for large numbers of labeled examples. We present a novel approach to encode unstructured echocardiographic information on 1-lead ECGs to enable the design of wearable-adapted artificial intelligence (AI)-ECG models with efficient development for detecting SHDs. Methods: We linked 274057 unique ECGs from 77378 patients with reports of echocardiograms done within 30 days across a large, diverse health system (2015-2019). We extracted lead I ECG signals that are typically acquired on wearable devices. We defined 2 discrete encoders, a convolutional neural network (CNN) for ECGs and a RoBERTa-based text encoder for echocardiographic reports. We applied contrastive pre-training for 200 epochs to learn a shared signal-text embedding. In a transfer learning experiment involving an age- and sex-matched training pool of temporally-distinct ECGs all from 2019-2023, we trained sequentially smaller amounts to detect LVEF&lt;40%, LVDD (left ventricular diastolic dysfunction), and a composite measure of LVEF&lt;40%, moderate or severe aortic stenosis, aortic regurgitation, mitral regurgitation, and/or severe LVH (IVSd ≥15 mm) using our Wearable-Echo-FM pre-trained versus standard single-lead ECG CNN model. We examined the performance of these models on the same test set. Results: There were a total of 11923 patients (1 ECG per patient, age, 65.3±17.2 2016 (17%) women) in the test set. For models trained on 100% data, the Wearable-Echo-FM model achieved AUROCs comparable to a standard CNN for LVEF &lt; 40% (0.894 vs 0.884), LVDD (0.849 vs 0.843) and a composite of SHDs (AUROC of 0.887 vs 0.869) in the test set. In few-shot learning experiments that only used 0.5% of the training data (~1000 ECGs), the pre-trained model achieved an AUROC of 0.855 vs. 0.548 for the standard model for LVEF &lt; 40%, 0.819 vs. 0.582 for LVDD, and 0.863 vs. 0.496 for the composite SHD. Conclusions: We propose an ECG-Echo foundation model that learns shared embeddings between 1-lead ECGs and complex structural cardiac phenotypes recorded on unstructured echocardiographic reports. Our approach enhances the efficiency of developing AI algorithms for SHD screening on wearable and portable devices.
Abstract 4146134: Assessing the Effectiveness of Ferric Carboxymaltose for Treating Iron Deficiency in Heart Failure Patients Along with its Effect on Clinical Parameters
Authors: Drumadala Gajbhiye, Shifa Younus, Muhammad Hussnain Cheema, Muhammad Hassan Cheema, Noor Fatima, Aeman Zafar, Aamir Ali, Alamdar Hussain, Tauseef Hussain, Humais Choudhary
Journal: Circulation (2024)

Introduction: Ferric carboxymaltose (FCM) treatment has been shown to alleviate symptoms and enhance the quality of life in individuals with heart failure characterized by reduced ejection fraction and iron deficiency. Despite prior evidence highlighting its benefits, its impact on clinical parameters remains insufficiently investigated. Our study sought to evaluate the impact of ferric carboxymaltose (FCM) treatment on hospital admissions and mortality rates. Methods and Materials: In this prospective, multicenter study, consecutive heart failure patients meeting criteria of a left ventricular ejection fraction of 40% or lower and iron deficiency were enrolled. Participants were allocated into two cohorts, one receiving intravenous ferric carboxymaltose alongside standard heart failure therapy, while the other received a placebo. Ferric carboxymaltose or placebo was administered every 6 months as required, guided by iron indices and hemoglobin levels. The primary endpoint consisted of a hierarchical composite, including death within 12 months post-randomization and heart failure-related hospitalizations within the same timeframe. Significance was determined at a p-value of 0.05. Results: Out of the 1500 patients enrolled, 830 were allocated to the ferric carboxymaltose group and 670 to the placebo group. By the end of the 12-month period, 78 patients (9.4%) in the ferric carboxymaltose group and 73 (10.8%) in the placebo group had experienced mortality (P = 0.82). Additionally, there were 102 and 193 hospitalizations for heart failure in the ferric carboxymaltose and placebo groups, respectively, by the end of the 12 months (P = &lt;0.001). The repeated administration of ferric carboxymaltose demonstrated a favorable safety profile with acceptable adverse events observed in most patients. Conclusion: Among heart failure patients with reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose was linked to a notable decrease in the likelihood of hospitalizations due to heart failure without any observable impact on mortality rates.
Abstract 4145465: A Bridge from Sweet to Sour: A Case of Recurrent Myocardial Stunning in Diabetic Ketoacidosis
Authors: Vikyath Satish, Maisha Maliha, Kuan Yu Chi, Sriram Sunil Kumar, Pawel Borkowski, Rhea Vyas, David Jose Javier Rodriguez Szaszdi, Amrin Kharawala, Jiyoung Seo, Sumant Pargaonkar, Leandro Slipczuk, Aldo Schenone
Journal: Circulation (2024)

Background: Myocardial bridging (MB) is a common congenital anomaly wherein a coronary artery segment takes an intramyocardial course. While often benign, MB may be associated with myocardial ischemia/stunning (MS), acute coronary syndromes (ACS), or even sudden cardiac death during periods of increased cardiac demand. Case presentation: A 47-year-old male with a history of type 1 diabetes mellitus was admitted to the Intensive Care Unit for diabetic ketoacidosis (DKA). He complained of epigastric pain with an electrocardiogram showing transient ST-elevation in the anterior and inferior leads. Cardiac troponin showed an upward trend with a peak of 0.202 ug/L and an elevated NT-proBNP of 5,014 pg/mL. A transthoracic echocardiogram (TTE) revealed left ventricular systolic dysfunction (LVEF 40%) with akinesis of the mid to apical anterior and septal walls, consistent with the left anterior descending (LAD) artery territory. Emergent left heart catheterization (LHC) revealed patent coronary arteries with severe mid-LAD MB with TIMI 3 flow. He was managed conservatively with guideline-directed medical therapy for heart failure, and subsequent TTE nine months later showed normalization of LV wall motion (LVEF 65%). Five months later, the patient was readmitted for DKA with elevated troponin. A repeat TTE demonstrated LV systolic dysfunction (LVEF 35%) with wall motion abnormalities (WMA) mirroring the initial presentation. Discussion: Our patient presented with recurrent episodes of ACS/MS complicated by LV systolic dysfunction along the LAD territory during periods of DKA, a known stressor for myocardial ischemia. The absence of obstructive coronary atherosclerosis on LHC, coupled with severe mid-LAD MB, suggests that the MB was the likely culprit for recurrent ACS/MS. Although stress cardiomyopathy was considered a differential diagnosis, this was less likely given the uncharacteristic pattern of WMA sparing the apical lateral and inferior walls as opposed to apical ballooning and the presence of an alternative diagnosis. Conclusion: This unique case underscores the importance of recognizing MB as a rare but potential cause of ACS/MS and LV dysfunction in patients with precipitating stressors such as DKA.
Abstract 4145342: GLP-1 Agonists are Associated with Fewer Unplanned Hospital Visits in Patients with Cardiovascular Disease and Comorbid Substance Use Disorder
Authors: Jahanzeb Javed, Anthony Spadaro, Emillie Cinevert, Benjamin Simmons, Emily Gordon, Julius Gardin
Journal: Circulation (2024)

Background: Improved outcomes related to the use of glucagon-like peptide 1 (GLP-1) agonists in patients with cardiovascular disease (CVD) have been well documented. Small studies have shown benefits of GLP-1 agonists in reducing substance use in patients with substance use disorders (SUDs). In patients with CVD, co-occurring SUDs are known to worsen outcomes. The use of GLP-1 agonists to improve outcomes related to both CVD and SUD could improve healthcare disparities in this marginalized population. Hypothesis: The use of GLP-1 agonists in patients with CVD and SUD could improve outcomes related to both disease processes. Aim: Our aim is to describe clinical outcomes in patients with CVD and SUD who were prescribed GLP-1 agonists. Methods: This is a single-center retrospective cohort study of patients with CVD and SUD on a GLP-1 agonist. As previous studies have shown that change in body mass index (BMI) correlates with adherence to GLP-1 agonists, we stratified subjects by change in BMI over a two-year study period. Using SPSS, we analyzed number of hospital visits and conducted frequency analyses by type of CVD, type of SUD, and change in BMI during our study period. Results: The study population consists of 81 patients on GLP-1 agonists who have SUD and CVD. BMI decreased in 55 patients (67.9%), increased in 24 patients (29.6%), and remained the same in 2 patients (2.5%). Correlation analysis was conducted between change in BMI and the number of hospital visits related to SUD and CVD, indicating positive correlation between change in BMI and reduction in hospital visits related to both SUD (r=0.136, p= 0.230) and CVD (r=0.142, p= 0.208). Subgroup analyses were also performed by specific SUD type; patients with cocaine, cannabinoid, or alcohol use disorders had decreased hospital visits related to CVD (p&lt;0.05) while those with opioid or polysubstance use disorders did not (Table 1). Conclusion: GLP-1 agonists, previously established to reduce adverse CVD outcomes, may be especially beneficial in patients with both CVD and SUD. More research is needed to determine how to optimize the benefit from treatment with GLP-1 agonists in this vulnerable patient population.
Abstract 4146141: The Association of Geriatric Syndromes with Cardiovascular Disease: Insights from ARIC Visit 5 on Cardiovascular Risks in Older Adults
Authors: Kehinde Tom-Ayegunle, Justin Echouffo Tcheugui, Iyalomhe E Oshozimhede, Ariela Orkaby, Min Ji Kwak, Parag Goyal, Ajar Kochar, Michael Nanna, Abdulla Damluji
Journal: Circulation (2024)

Introduction: Older adults face a high burden of cardiovascular disease (CVD), exacerbated by geriatric conditions such as multimorbidity and polypharmacy. The collective influence on CVD risk remains unclear. We hypothesize that the coexistence of multiple geriatric syndromes increases the risk of incident CVD events . Methods: We conducted a cross-sectional study among individuals aged 45–64 years using a logistic regression to assess the association between geriatric syndrome(had ≥3factors) and CVD events at the end of Visit 5(period prevalence) in the Atherosclerosis Risk in Communities(ARIC study). We examined the following geriatric conditions: multimorbidity (≥2 chronic conditions), polypharmacy (≥5 medications), cognitive impairment vision impairment, hearing impairment, urinary incontinence, functional decline, frailty, and sarcopenia. Primary outcome was prevalence of 3-point MACE, defined as: death, acute myocardial infarction (AMI), or stroke. Results: Among the 5,141 participants, 13% had no geriatric conditions, 18% had one, 17% had two, and 52% had ≥3. Participants with ≥3 geriatric conditions were generally older, female, White, and overweight with hospitalization rates of 3. Overall,18% of the cohort experienced MACE events and 82% didn’t, with death being the most common at 9%. Those with ≥3 geriatric conditions had the highest prevalence of stroke (5%), AMI (11%), and death (13%) as compared to 2,1 and 0 geriatric conditions which were 2%,6%,7% and 1%,3%,6% and 1%,2%,3% respectively. In the adjusted model, having ≥3 geriatric conditions was associated with significantly higher odds of AMI (OR = 6.47; 95% CI: 3.57-13.18), stroke (OR=6.33; 95% CI: 2.83-18.08), death (OR = 3.51; 95% CI: 2.20-5.95), and MACE (OR=4.92; 95% CI: 3.44-7.28) compared with having no condition Conclusion: We found a strong association between the number of prevalent geriatric conditions and increased cardiovascular risk in the older adults. This highlights the need for integrated care models to identify geriatric conditions in older adults with cardiovascular disease in order to tailor prevention and treatment.
Abstract 4145478: When a Cutie Takes Your Breath Away: A Case of Cutibacterium Acne-induced Pericardial Effusion
Authors: Natale Wasef, Patrick Benjamin, Adam Stys
Journal: Circulation (2024)

Introduction: Pericarditis is an inflammation of the pericardium, a thin sac-like membrane surrounding the heart, which can progress to life threatening cardiac tamponade. It can be caused by infections (viral, bacterial, fungal, or parasitic), autoimmune conditions, injuries, or underlying medical conditions. Common symptoms include chest pain, fever, shortness of breath, and fatigue. In the case presented, the patient suffered from a severe form of pericarditis caused by a rare infectious etiology, leading to the development of cardiac tamponade. Case Summary: A 29-year-old female with type II diabetes and hypothyroidism presented with a week of shortness of breath, chest pain, lightheadedness, and loss of consciousness. Workup showed WBC (20.6), CRP (283), and ESR (85). Echocardiogram revealed a large pericardial effusion with right ventricular collapse, indicating cardiac tamponade. She underwent pericardiocentesis, draining 400 ml of exudative fluid. Unfortunately, the effusion rapidly re-accumulated, requiring a pericardial window procedure with drainage of fibrinous, loculated fluid over 2 days, improving her symptoms. She was discharged on colchicine and NSAIDs, however she returned 5 days later with recurrent symptoms and fever. The culture of the previous fluid showed Cutibacterium acne. Histopathology of pericardial biopsy revealed fibrinoid pericarditis. She was treated with ceftriaxone, and transitioned to doxycycline for 14 days, along with 14 days of ibuprofen and 3 months of colchicine. At 3-month follow-up, she was asymptomatic with no effusion recurrence. Conclusion:: As bacterial pericarditis cases rise, the initial work-up should include investigating bacterial etiology. This raises the question of antibiotic coverage for patients presenting with pericardial effusion until bacterial etiology is excluded and also advocate for elective pericardiocentesis in bacterial effusions without tamponade physiology.
Abstract 4146122: Potential Protective Roles of Clonal Hematopoiesis of Indeterminate Potential in Angina Pectoris
Authors: Yidan Zheng, Zihao Zhou, Xingyu Qian, Shiyan Hu, Xu Jingyu, Yuqi Liu, Fuqiang Tong, Pengning Fan, zhe chen, Da Zhu, Xiangbin Pan, Nianguo Dong, Li Xu, Fei Li
Journal: Circulation (2024)

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) poses strong relationship to the occurrence of cardiovascular diseases with the process of aging. IL-1β is associated with both CHIP and atherosclerotic lesions stabilization. However, potential protective effects of CHIP and IL-1β elevation in angina pectoris have been barely explored. Hypothesis: We hypothesis CHIP protects against angina pectoris via preventing atherosclerotic lesions rupture by the effect of IL-1β. Methods: In UK Biobank population with exome sequencing data, participants with any CHIP or large CHIP were defined as those with variant allele fraction (VAF) ≥ 2% or 10% respectively on any CHIP gene. Angina pectoris, stable angina pectoris and unstable angina pectoris was defined as main diagnosis of inpatient record in terms of ICD-10 code I20, I20.8 and I20.0, respectively. The effects of CHIP on angina pectoris were estimated in logistic regression models, including age, sex, and history of atherosclerotic heart disease as covariates. Propensity score matching (PSM) of 1:1 was applied for more stringent analysis. Proteomics analysis was carried out using linear regression model. Results: Total 465769 participants were included for final analysis (aged 56.5±8.1 years, 45.7% male) after excluding those with hematological malignancy. Covariate-adjusted models showed that large CHIP significantly protected against angina pectoris (OR=0.863, p=0.019), especially the unstable angina pectoris subtype (OR=0.931, p=0.028). Both any CHIP and large CHIP of specific genes manifested significantly protective effects on angina pectoris (OR any =0.104, p&lt;0.001; OR large =0.017, p&lt;0.001) and unstable angina pectoris subtype (OR any =0.123, p&lt;0.001; OR large =0.033, p&lt;0.001) after PSM. Proteomic analysis showed IL-1β was significantly elevated among serum cytokines in CHIP population and positively associated with large CHIP (p=0.007). Conclusion: CHIP posed protective effects against angina pectoris, especially the unstable subtype. The underlying mechanism may be attributed to the atherosclerotic lesions stabilization mediated by higher serum IL-1β level. These findings suggested the novel perspective for the complex roles of CHIP in cardiovascular disease.
Abstract 4146227: Combining metabolomic profiling with exome sequencing in the UK Biobank to predict cardiac outcomes and interpret variants of uncertain significance in familial hypercholesterolemia
Authors: Luke Jostins-Dean, Kirsten Schut, Sini Kerminen, Peter Wurtz, Jeffrey Barrett
Journal: Circulation (2024)

Background: Familial hypercholesterolemia (FH) is an inherited disorder resulting in high levels of LDL-C from birth. Premeature coronary heart disease occurs in half of affected men by age 50 years. While many genetic variants that cause FH are well understood, many other variants in FH genes are of uncertain clinical significance. Furthermore, the variability in residual cardiovascular risk of FH carriers after statin treatment is not fully understood. We here investigate whether metabolomic and genomic data from the UK Biobank cohort can aid in interpretation of candidate pathogenic FH variants, and characterise future risk of severe cardiac events in FH carriers. Methods: We have quantified 249 metabolomic parameters in 490,830 blood samples from UK Biobank cohort. Among 186,483 participants with exome sequence data we identified 896 who carried known pathogenic FH variants and 405 who carried variants of unknown significance in an established FH gene. We fitted a logistic predictive model to identify pathogenic mutations using LDL levels, statin use and 17 principal components of the metabolomic parameters. We further tested whether metabolomic and genomic scores for predicting future risk of myocardial infarction (MI), trained in the general population (i.e. individuals without FH), could predict risk in FH carriers. Results: A model including all metabolites had a higher accuracy at identifying known pathogenic FH variants compared to LDL and statin use alone. Our model identified 8 FH variants marked as uncertain significance in ClinVar with significant evidence of predicted pathogenicity. We found that our metabolomic risk score predicted 10-year risk of MI among FH carriers (HR=1.96 per SD, p = 0.0011). This was stronger than the effect in the general population (HR = 1.64 per SD, p = 2.5e-168). A combined metabolomic and polygenic risk score had an even larger effect at predicting MI in carriers (HR = 3.06 per SD, p = 2.0e-6), and was significantly better at predicting MI in carriers than in non-carriers (HR = 3.06 vs 1.88 per SD, interaction p = 0.042). Conclusion: Familial hypercholesterolemia is an important source of risk for early cardiovascular disease. Population-scale metabolomics can help distinguish pathogenic from benign variants that have not yet been characterised. Metabolomic and genomic scores can also identify individuals at most elevated risk, and provide even more information to FH individuals than in the general population.