tbuckley/cabot-search huggingface dataset:
Abstract 4145470: Long-Term Association of Metabolic Dysfunction-Associated Steatotic Liver Disease With Cardiac Failure, Arrhythmias, and Arrest
Authors: Alleh Nogueira, Lucas Tramujas, Pedro Carvalho, Nicole Felix, Pedro de Barros e Silva, Filipe Moura
Journal: Circulation (2024)

Background: The novel concept of metabolic dysfunction-associated steatotic liver disease (MASLD) emerged to facilitate diagnosis and emphasize the underlying pathophysiology. However, research validating its prognostic significance, especially for nonatherosclerotic outcomes, is lacking. Hypothesis: MASLD is associated with an increased risk of cardiovascular disease. Aim: To determine the prognostic impact of MASLD on cardiac failure, arrhythmias, arrest, key atherosclerotic cardiovascular outcomes, and all-cause mortality. Methods: In this nationwide retrospective cohort study involving 61 centers, a total of 17,073,511 adults evaluated from 2014 to 2024 were categorized into MASLD and two control groups differing on metabolic dysfunction status. We adjusted for traditional cardiovascular risk factors using propensity score matching with a greedy nearest-neighbor algorithm and 0.1-caliper for pooled standardized mean differences. Cox regressions were used to compare all-cause mortality and cardiovascular outcomes between MASLD and reference groups. Results: After a 10-year follow-up, patients with MASLD exhibited greater risks for atrial fibrillation (HR, 1.53; 95% CI, 1.51–1.56), atrial flutter (HR, 1.85; 95% CI, 1.78–1.91), ventricular tachycardia (HR, 2.04; 95% CI, 1.97–2.11), ventricular fibrillation/flutter (HR, 2.18; 95% CI, 2.00–2.37), cardiac arrest (HR, 2.64; 95% CI, 2.53–2.78), heart failure with preserved ejection fraction (HR, 2.69; 95% CI, 2.63–2.74), heart failure with reduced ejection fraction (HFrEF), ischemic heart diseases, stroke, and all-cause mortality compared with patients without metabolic dysfunction. Comparisons between MASLD and metabolic dysfunction yielded significant associations for increased risk with MASLD, except for HFrEF. Conclusion: MASLD is a strong independent risk factor for mortality, nonatherosclerotic, and atherosclerotic cardiovascular outcomes.
Abstract 4145495: Arrhythmia Risk in Healthy Young Adults Who Co-use Electronic Cigarettes&amp;Cannabis
Authors: REECE FONG, Joshua Sanchez, Samuel Lopez, Kevin Zhao, Ziva Cooper, Jeffrey Gornbein, Holly Middlekauff
Journal: Circulation (2024)

Background: Tobacco cigarette (TCIG) smoking is the most prevalent modifiable risk factor for cardiovascular (CV) disease, including sudden arrhythmic death. Although TCIG smoking among current young adults has never been lower, cannabis smoking and co-use of cannabis and electronic cigarettes (ECIG) now approaches 50%. The arrhythmia risk associated with cannabis smoking and potential amplification of risk through co-use with ECIGs remain largely unknown. Purpose: To test the hypothesis that arrhythmia risk as estimated by abnormal ventricular repolarization is increased in people who smoke cannabis and amplified by ECIG co-use. Methods: Three groups were assessed in a parallel group comparison study: 1) chronic (≥ 1 year) ECIG and inhaled cannabis co-users, 2) chronic exclusive cannabis smokers, and 3) control non-users. Participants were healthy adults aged 21-30 who do not smoke TCIGs. Participants fasted and abstained from ECIGs, cannabis, caffeine, and exercise for 8 hours before the study. Blood pressure (BP) and heart rate (HR) were recorded, followed by 12-lead ECG recordings for 5 minutes in supine position. ECG recordings were then analyzed for T(peak-end) (Tp-e) interval as well as Tp-e/QT and Tp-e/QTc ratios as a measure of ventricular repolarization and predictors of arrhythmia risk. Results: A total of 134 participants were enrolled (49 Controls, 59 Exclusive Cannabis, 26 ECIG/Cannabis Co-users). Subgroups did not differ by sex (54% F), age (24.1±2.9 y), BP, or HR. The Tp-e interval was significantly shorter in the cannabis/ECIG co-users compared to both exclusive cannabis smokers and control non-users (Figure panel A). Overall, ventricular repolarization tended to be shorter in co-users compared to both other groups (Figure panels B&amp;C). Conclusion: In otherwise healthy young people, chronic cannabis/ECIG co-use impacts ventricular repolarization in the direction not typically associated with increased arrhythmia risk. The clinical implications of Tp-e shortening in co-users require further investigation. Additionally, these outcomes only provide a glimpse of the implications of cannabis and ECIG co-use, and other outcomes of CV risk warrant investigation.
Abstract 4145357: Detecting ST Elevation Myocardial Infarction on a Noisy Single Limb-lead ECG: An Artificial Intelligence-enabled Approach Adaptable to Portable Devices
Authors: Lovedeep Dhingra, Akshay Khunte, Sumukh Shankar, Rohan Khera
Journal: Circulation (2024)

Background: While wearable and portable devices recording 1-lead ECGs can potentially enable accessible cardiovascular disease detection, most capture a single limb lead (lead I) that is clinically insufficient to define STEMI. Moreover, the acquisition is noisy. We sought to evaluate if an artificial intelligence (AI) algorithm can detect STEMI and its subtypes based on location (anterior, inferior, lateral, posterior) from noisy 1-lead ECG tracings. Methods: We extracted lead I data from ECGs in patients at a large and diverse US health system (2015-2023) to train a multi-label convolutional neural network (CNN) for detecting STEMI and its different subtypes. To ensure that the CNN identified the STEMI signature independent of associated findings, every ECG with STEMI (case) in the training set was matched to 10 ECGs without STEMI (controls) but with the same age profile, sex, and other rhythm and conduction disorders. Each ECG recording was augmented with random Gaussian noise during training to mimic real-world noises of specific frequencies, including muscle tremors, electrode motion, and others. The model was evaluated in a held-out test set of lead I tracings from ECGs recorded during ED visits for patients with chest pain. Results: We used 49,995 lead I ECGs from 39,697 individuals (65 years [IQR, 52-76], 18,926 [48%] women, 5,941 [15%] Black) for model development. The held-out test set included one ECG each from 7551 patients, including 104 (1.4%) with STEMI (84 anterior, 103 inferior, 72 lateral, 7 posterior STEMI). The model achieved high discrimination (AUROC of 0.828 [95% CI, 0.777-0.875]) for detecting STEMI from lead I ECGs in the test set, with AUROCs of 0.734 (0.656-0.802) for anterior, 0.769 (0.726-0.818) for inferior, 0.849 (0.787-0.889) for lateral, and 0.747 (0.518-0.968) for posterior STEMI. Overall, the model had a sensitivity of 91.5% (85.6-96.9), and a specificity of 43.0% (41.8-43.9), with consistent performance among demographic subgroups. Conclusion: A noise-adapted AI model using only 1-lead ECG tracings was able to identify various subtypes of STEMI with moderate to high accuracy. Using portable ECG devices and smartwatches, an AI-ECG approach can enable first-line triaging in individuals with chest pain, facilitating early detection of STEMI in the community and high-acuity settings.
Abstract 4145489: Serum Proteomics Approach to Identify the ‘Hepatic Factor’ Causing Pulmonary Arteriovenous Malformations Post-Glenn Shunt
Authors: Laura Gonzalez-Teshima, Keisuke Hakamada, Tadashi Ikeda, Kozue Murata, Kenji Minatoya, Hidetoshi Masumoto
Journal: Circulation (2024)

Introduction: Pulmonary Arteriovenous Malformations (PAVMs) are a main surgical complication of second-stage palliative Glenn shunt for single ventricle. PAVMs lead to early mortality. Currently there is no available treatment as its physiopathology remains unknown. Hypothesis: This study hypothesizes that hepatic-derived factor causing PAVMs could be proteome-derived. Goals: To discern differences in proteomic profiles of patient-paired serum from superior vena cava (SVC) and hepatic vein (HV) as a preliminary approach to identify PAVM-related hepatic vein blood-enriched factors. Methods: Paired full blood samples were collected from SVC and HV origin during routine cardiac catheterization of patients with diverse cardiac congenital malformations from 0 to 1 years of age (n=3). Serum was extracted and high abundant proteins were depleted. Single-pot solid-phase-enhanced sample preparation method and trypsinization digestion coupled with label-free data-dependent acquisition liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis was performed. Subgroup differential expression analysis by abundance ratio (SVC/HV) (Adj. P-Value&lt;0,05) was used to identify differentially upregulated proteins uniquely expressed in HV. Proteins with only one unique peptide identifier were discarded. Gene ontology biological analysis and functional pathways analysis were performed using PANTHER. Results: Differential proteomic profiles were evidenced according to serum origin. 4706 peptides coding for 605 common proteins, 68 unique proteins to SVC and 110 unique for HV were identified. From 50 protein coding genes found upregulated in HV sample (P&lt;0,05), 16 had &gt;1 unique peptide identifier and 5 were found to be uniquely expressed in HV. Overrepresentation of integrin signaling pathway was identified (fold enrichment 21.56, FDR P=0,0265) related to these 16 HV upregulated expression genes. Conclusion: Serum proteomic profile per sample origin analysis is promising for understanding PAVM physiopathology. Functional gene ontology pathway associating integrin signaling pathway enhancement in HV proteome, known to play a role in vascular anomalies, may serve as a first milestone for the “hepatic-factor” identification. Further validation experiments are required. In vitro induced pluripotent stem cell PAVM proof-of-concept model is under development.
Abstract 4145375: Examining Maternal and Fetal Outcomes Across Various Subtypes of Hypertension During Pregnancy
Authors: Laith Alhuneafat, Fares Ghanem, sana khan, Anushree Puttur, Sneha Nandy, Nada Alrifai, Ahmad jabri, Selma Carlson
Journal: Circulation (2024)

Introduction: Hypertension disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality worldwide. It can be categorized as chronic hypertension (CH), gestational hypertension (GHTN), preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).We aim to assess in-hospital maternal and fetal outcomes of women in each of these groups in comparison to normotensive controls. Methods: Study sample included women in the National Inpatient Sample dataset from 2016 to 2020 who were categorized into the 4 groups of HDP described above. They were compared to normotensive pregnancies for maternal and fetal outcomes using regression analysis after adjusting for age, race, C-section status, and comorbidities. Results: The study dataset from October 2015- December 2020 included 19,089,780 labor admissions with 2,771,809 patients affected by HDP. The HDP groups were distributed as follows: GHTN - 38%, PRE - 32%, SPE - 11%, and CHTN - 19%. Women with PRE, SPE, and CH had significantly higher rates of mortality, circulatory shock, peripartum cardiomyopathy, acute kidney injury, preterm labor, stillbirth, and cerebrovascular events compared to normotensive patients, while GHTN did not. Specifically, maternal mortality was highest in the SPE group (adjusted odds ratio [aOR] 3.16), followed by PRE (aOR 2.91) and CH (aOR 2.42). Additionally, all HDP groups had higher rates of small for gestational age and significant bleeding compared to normotensive patients. Conclusions: Pregnant patients with CH, PRE, and SPE experience various higher rates of adverse maternal and fetal outcomes when compared to normotensive patients. Future studies should examine the effect of early high-risk group identification on adverse outcomes in hypertension management.
Abstract 4145425: Patient-Facing Smartphone Application for Perioperative Cardiothoracic Surgery Care Improves Readmission Rates and Patient Satisfaction
Authors: Ian Vargas, Maria Brinn, Hakim Morsli
Journal: Circulation (2024)

Introduction: Smartphone applications increasingly are utilized to enhance patient education for optimal implementation of care plans to improve overall outcomes. We demonstrate the use of an app with instructions and built-in reminders for patients in the peri-operative phase of cardiothoracic surgery to reduce readmission rates and improve patient satisfaction. Hypothesis: We postulated that patients undergoing cardiothoracic procedures who used a smartphone application pre and post-procedure would demonstrate improved outcomes compared to non-users, including reduced 90 day rates of hospital readmission, wound complications, or post-op thoracentesis, as well as demonstrate enhanced patient satisfaction. Methods: We prospectively enrolled patients in the pre-operative phase undergoing cardiothoracic procedures including coronary artery bypass graft (CABG), valvular replacement, or patent foramen ovale closure, who either downloaded or declined the app. Patients were tracked for successful registration and use of the app. Post-operative outcomes including readmissions, wound complications, and need for thoracentesis were tracked for 90 days. Patients were also administered an in-person satisfaction survey at 14 days post-op with responses recorded. Results: App users (n=392) and non-users (n=334) with median age 67 years underwent cardiothoracic surgery between May 29, 2023 and February 2, 2024. Among app users, 23 experienced 90-day readmission compared to 49 non-users (5.9% vs 14.7%, p=&lt;0.0001). Subsequent results are similarly sequenced. No difference was observed between wound complications (3.83% vs 3.29%, p=0.700) or post-op thoracentesis (3.1% vs 1.9%, p=0.275). App users reported increased satisfaction on a five-point scale with preparation for surgery (4.9 vs 4.5, p=0.0031), surgeon communication post-op (5.0 vs 4.9, p=0.0033), preparation for recovery (4.8 vs 4.5, p=0.0291), and overall experience (5.0 vs 4.8, p=0.0130). Conclusion: We demonstrated smartphone application catalyzed patient engagement throughout peri-operative experience of cardiothoracic surgery resulted in significantly reduced 90-day readmissions and improved patient satisfaction. Extension of app usage to similar clinical contexts may lead to like outcomes.
Abstract 4146355: Sex Disparities In Mortality From Ischemic Heart Diseases In Europe, 2005-2019
Authors: Benedetta Romeo, Maria Bergami, Edina Cenko, Olivia Manfrini, Raffaele Bugiardini
Journal: Circulation (2024)

Background: Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and geography can help in tailoring effective public health policies. Methods: We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019. Results: Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women and men, sex disparities in ASMR-to-ASPR index persisted with a women-to-men ratio ranging from 1.05 to 1.36. No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12 and Germany: 4.79% vs 3.80%; ratio: 1.26). Conclusions: Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality.
Abstract 4145487: Right Upper Pulmonary Vein Thrombi Differ Significantly from Right Lower Pulmonary Vein Thrombi due to a Lack of Extending Thrombi in the Left Atrium
Authors: Hidekazu Takeuchi
Journal: Circulation (2024)

Background: Pulmonary vein thrombi (PVTs) are common, and their prevalence is underestimated. Neutrophil extracellular traps (NETs) may initiate the formation of PVTs, and NETs are associated with many diseases, such as type 2 diabetes mellitus (T2DM), atherosclerosis and heart diseases. A study of the retrieved thrombi revealed that they had calcification, indicating that they were old. PVTs can release several types of particles, potentially ranging from microclots including NETs to large clots. We reported that standard-dose heparin-warfarin treatment ameliorated mild to moderate T2DM. Heparin might improve blood flow in the microvessels of most organs by destroying histones in NETs. Other NET-associated diseases might be ameliorated, so it is important to understand the traits of PVTs. We reported several cases in which right lower pulmonary vein (RLPV) thrombi extended into the left atrium (LA). The reported shape of these extended thrombi is rod-like in many cases, as estimated using transesophageal echocardiography (TEE). Most of these thrombi cannot be detected using enhanced computed tomography (ECT). Whether LA thrombi extending from the right upper pulmonary vein (RUPV) are rod-like remains unclear. Methods: We examined thrombi in the RUPV in thirty-one patients with and type 2 diabetes mellitus (24 men and 7 women; age = 73.5 (+/- 8.9)-year-old; range: 50- to 88-year-old) using TEE and ECT. Results: None of the patients had rod-like LA thrombi extending from the RUPV in the LA. When we checked using TEE, six patients clearly had PVTs in the RUPV, in which thrombi were attached to the vessel wall and could not be detected using ECT. Thrombi extended into the LA, contacting the wall of the RUPV and the wall of the LA. Thrombi are difficult to visualize directly and are recognized as lacking in pulmonary vein blood flow. This study had two limitations. First, only thirty-one patients were included. If we check more patients, rod-like extending LA thrombi might exceptionally exist. The second was that there were several small white spot-like areas around the RUPV; however, we diagnosed them as having no thrombi. These spot-like areas might be thrombi. Conclusions: PVTs in the RUPV did not have rod-like extending thrombi in the LA. Attachments to the vessel wall were not rare, and they were detectable when using TEE but not ECT. The thrombi depicted by TEE were different from the thrombi depicted by ECT in some cases.
Abstract 4145391: Maternal Plasma Proteome: Associations with Blood Pressure during Pregnancy and Postpartum
Authors: Anum Minhas, Jacquelyn Bedsaul-Fryer, Zhichen Xiong, Gwen Sincerbeaux, Kerry Schulze, Hyunju Kim, Bige Ozkan, Hasmot Ali, Saijuddin Shaikh, Keith West
Journal: Circulation (2024)

INTRODUCTION: Pregnancy is marked by cardiovascular and hemodynamic changes to enable normal placental-fetal growth but may also predispose women to adverse outcomes including hypertensive disorders. Studies have assessed the plasma proteome of hypertension, but proteomic biomarkers of maternal blood pressure (BP) through pregnancy and postpartum remain unexplored. OBJECTIVES: Explore the 1 st trimester (TM) maternal plasma proteome in relation to systolic (S) and diastolic (D) BP in the 1 st and 3 rd third TM, and 3 months postpartum. METHODS: We obtained baseline, 1 st TM plasma samples from n=435 women from an antenatal multiple micronutrient vs iron-folic acid supplement trial in rural NW Bangladesh (West et al JAMA 2014). Phlebotomy occurred &lt; 12 wk gestation. Blood pressure was measured (mmHg) by trained staff with manual sphygmomanometers. Plasma specimens were shipped to Baltimore under liquid nitrogen, stored for ~10 years at -80 o C before processing by SomaScan ® , a synthetic aptamter-based assay that quantified relative abundance of 6,431 unique plasma proteins. We performed simple linear regression to correlate (r) protein abundance with SBP and DBP at each timepoint, adjusting for maternal age, body mass index, parity, and trial supplement allocation, defining significance as a false discovery rate (chance-corrected p-value, q) of q &lt; 0.05. RESULTS: Six proteins (led by IGFBP-2, r=-0.22 and leptin, r=0.21), 2 proteins (NRP1, r=-0.22 and APOE, r=0.21) were correlated with 1 st trimester, and 4 (LPLC1, APOF, OMGP, SLAF9) and zero proteins with 3 rd trimester SBP and DBP, respectively (q &lt; 0.05). In contrast, 41 proteins were associated with both SBP and DBP at 3-month postpartum, 39 of which overlapped, of which 37 were positively correlated (ranges: r=0.62-0.17) (Figure1A and B). Proteins postpartum were different from 1 st trimester. These included proteins involved in transcription (ex: CREBZF, GALNT2), cell proliferation (HMGN3, CUZD1), vascular function (UBE2H, EDN2), and inflammation (LIRA2). CONCLUSIONS: Findings suggest that the maternal plasma proteome from the 1 st TM is most aligned with cardiovascular tensive physiology of a non-pregnant (i.e., postpartum) person. BP during pregnancy itself (i.e. first and third TMs) may not follow the same pathways regulating it in the non-pregnant state (postpartum). The complex physiology of blood pressure regulation in pregnancy should be considered in studies exploring proteomics in pregnancy.