tbuckley/cabot-search huggingface dataset:
Abstract 4140693: Gender, Racial, and Ethnic Variations in the Disposition of Chest Pain Patients in the Emergency Department
Authors: Michelle Waples, Ethan Kramer, Rogina Rezk, Emily Meisel, Nicolas Abchee, Brandon Allen, Mohammed Ruzieh
Journal: Circulation (2024)

Introduction: Patients presenting to the emergency department (ED) with chest pain are frequently admitted to inpatient or observation units. We sought to assess gender, racial, and ethnic variations in the care of chest pain patients presenting to the ED. Methods: A retrospective chart review of patients presenting to UF Health Shands ED from 6/2019–12/2023 with chest pain was conducted. We included patients with high-sensitivity troponin I levels below the 99 th percentile (&lt;15 ng/L for women and &lt;20 ng/L for men) and moderate or high HEART score (4-6 and 7+, respectively). HEART score was determined at initial presentation. We analyzed the type of ED dispositions based on gender, race, and ethnicity. Negative predictive value (NPV) was calculated for the composite outcome of myocardial infarction (MI) and cardiovascular death or death from unknown cause within 30 days. Results: We included 1329 patients (52.7% women). Black represented 24.8% of patients, American Indian or Alaska Native 0.4%, Asian or Pacific Islander 1.1%, and white 67.7%. Hispanic or Latino represented 6.9% of patients. The proportion of patients admitted to the hospital or observation unit was lower in women than men (25.7% vs 30.7%; p=0.0002). Black patients were less likely to be admitted or observed compared to white (22.7% vs 30.3%; p= 0.006). Similarly, Hispanic or Latino patients were less likely to be admitted to the hospital or observation unit (20.7% vs 28.6%; p=0.04). There were 2 MIs and 1 death in the cohort, with 2 of these events being women but no events in black or Hispanic or Latino patients. The NPV for troponin levels below the 99 th percentile for our composite outcome was 99.8% in the cohort overall, 99.7% in women, 99.8% in men, 99.7% for white, 100% for black, and 100% for Hispanic or Latino patients. Conclusions: Among patients with chest pain presenting to the ED with moderate or high HEART score but troponin levels below the 99 th percentile, women, black, and Hispanic or Latino patients were less likely to be admitted to the hospital or observation unit. Despite these disparities, outcomes at 30 days were similar compared to other groups, and high-sensitivity troponin performed well across all groups.
Abstract 4140819: Trends and Racial Disparities in Cardiovascular Deaths in Chronic Kidney Disease in the United States, 1999-2020
Authors: Abena Agyekum, Godslove Bonnah, Webster Donaldy, Stephen Nii-Ashie Djanie, Alex Kumi, Abdul-Rahaman Ottun, Frank Adusei Poku
Journal: Circulation (2024)

Background: Previous studies have shown that chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) burden, but few studies have investigated trends in CVD deaths in CKD. We evaluated the temporal changes in the CVD-related age-adjusted mortality rate (AAMR) in CKD based on sex, race, rural-urban status, and census region from 1999-2020. Methods: This was a retrospective repeated cross-sectional analysis of national death certificate data from the CDC WONDER from 1999 to 2020. We included persons aged ≥25 years of age with CKD (ICD-10 code N18) as the underlying cause of death. We used ICD-10 codes I10-I178 to identify CVD-related deaths from the multiple cause-of-death dataset. We calculated the CVD-related AAMR in CKD per 100,000 population. The exposure variable was the year of death, and the outcome was the changes over time in CVD- related AAMR in CKD, stratified by sex, race, rural-urban status, and census region. We used the Mann-Whitney test and ANOVA for group comparisons as appropriate. Racial disparities were assessed with the Black-White AAMR ratio. Trends were evaluated with Joinpoint regression and expressed as average annual percentage change (AAPC) with 95% confidence interval (CI). P&lt;0.05 defined statistical significance. Results: Of the 4.4 billion people, 260,679 with CKD had CVD-related deaths (AAMR 5.5). The AAMR was higher in males (7 vs 4.4 in females; P&lt;0.001), Black people (12.6 vs 4.7 in White; P&lt;0.001), and the Northeast and South census regions (AAMR 5.8). The AAMR did not differ by rural-urban status. From 1999 to 2020, the overall AAMR increased from 4.7 to 6.5 (AAPC 1.6%; CI: 1.4-1.8). Similarly, the AAMR increased significantly in males (AAPC 1.5%; CI: 1.2-1.7), females (AAPC 1.4%; CI: 1.1-1.6), rural areas (AAPC 2%; CI: 1.6-2.3), urban areas (AAPC 1.4%; CI: 1.1-1.7), White race (AAPC 1.9%; CI: 1.7-2.2) and across each of the four census regions. There was no significant change in Black race (AAPC 0.2%; CI: -0.04-0.5). The overall Black-White AAMR ratio was 2.8 and it declined from 3.4 to 2.4 (AAPC -1.7%; CI, -1.9, -1.5). Conclusion: CVD-related deaths increased in CKD patients over the last two decades. While racial disparities in CVD-related deaths persisted, they narrowed during the study period. These findings underscore the need to intensify CVD screening and multidisciplinary management in CKD patients. The reasons for the persistence of the racial disparity require further study.
Abstract 4140782: Machine Learning of ECG Waveforms for Outcomes After Left Bundle Branch Area Pacing in Heart Failure
Authors: Kenneth Bilchick, Derek Bivona, Konstantinos Patlatzoglou, Fu Siong Ng, Kenneth Ellenbogen, Ajay Pillai
Journal: Circulation (2024)

Introduction: Although left bundle branch area pacing (LBBAP) has become a popular approach to physiologic pacing in heart failure (HF), there is still substantial uncertainty regarding ECG predictors of favorable outcomes with this approach. We have shown that machine learning (ML) with functional principal component decomposition (FPCD) generates accurate predictors of outcomes for cardiac resynchronization therapy (CRT), but its effectiveness for LBBAP in HF is unknown. Research Question: How does ML with FPCD applied to 12-lead ECG QRS waveforms predict improvement in the LVEF with LBBAP in HF patients compared with standard ECG criteria for selective LBBAP? Aims: The aims were to determine which FPCD lead parameters from 12-lead ECGs before and after LBBAP in HF were associated with improvement in LV function post-pacing and how these predictors compared with known ECG and clinical predictors. Methods: 12-lead ECGs in paper format were digitized, and FPCD was applied to the QRS waveforms before and after LBBAP in patients with LVEF ≤ 40% and ≥ 80% LBBAP. Logistic regression with the least absolute shrinkage and selection operator (LASSO) (Figure 1) was used to identify the ECG leads with the best FPCD predictors, and these predictors were compared with the commonly used R-wave peak time (RWPT) in lead V6 and other clinical parameters. Results: In 25 patients (40% female), the median baseline QRS duration was 156 ms (IQR 116 to 170 ms) and the median baseline LVEF was 33% (IQR 28 to 35%). In this cohort, 40% of patients had an absolute LVEF improvement of at least 15% with LBBAP. The ECG leads with the best FPCD parameters to identify patients with a 15% increase in the LVEF after LBBAP were lead III post-pacing and lead aVF pre-pacing (area under the receiver operating characteristic curve [AUROC] for model = 0.88, p=0.003) (Figure 2). The RWPT in V6 (3 V pacing output) had an AUROC of 0.60 for this outcome (p=0.63), and the difference in QRS duration before and after LBBAP had an AUROC of 0.58 (p=0.34). The model with the first FPCD weight for lead III post-pacing and ischemic cardiomyopathy (ICM) had an AUROC of 0.86 (0.0025) (Figure 3). Conclusion: Machine learning applied to ECG waveforms using FPCD was more effective in identifying LV functional improvement with LBBAP in HF compared with known ECG and clinical parameters. This approach could have an important impact for prognostication, therapy selection, and optimization during the LBBAP procedure.
Abstract 4141158: Weekend Effect on In-Hospital Outcomes of Transcatheter Aortic Valve Replacement: Insights from a Propensity-Matched National Analysis
Authors: Bo Shi, Xueping Ma, Shaobin Jia, Guangzhi Cong, Congyan Ye, Rui Yan, Shizhe Fu, Haowei Li, Baotong He, Zefeng He, Abdul Rehman, Israel GITANGAZA
Journal: Circulation (2024)

Background: The "weekend effect" on hospital admissions has been extensively studied, showing increased risks for patients admitted on weekends than those admitted on weekdays. We aimed to assess the “weekend effect” on in-hospital outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: A nationwide cohort study was conducted using the National Inpatient Sample Database. We identified 82,094 eligible patients aged ≥ 18 years admitted for TAVR between 2013 and 2021. Patients were grouped into weekend or weekday cohorts based on day of admission. Propensity score matching (PSM) and multivariate regression models were employed to evaluate outcomes. After PSM, 2,688 weekend admissions and 13,440 weekday admissions were included in the analyses. Results: Multivariable regression, adjusted for propensity score, revealed that weekend admission was associated with 45% higher odds of in-hospital mortality (adjusted odds ratio: 1.45; 95% confidence interval: 1.13–1.85). Significant heterogeneity in mortality was observed based on admission urgency, with a 3.27 times higher increased risk of death observed for elective admissions on weekends than on weekdays (P for interaction = 0.001). Moreover, weekend admissions had significantly higher adjusted odds for cardiogenic shock, permanent pacemaker implantation, endocarditis, acute kidney injury, acute ischemic stroke, and blood transfusion. There was a trend of higher in-hospital mortality for weekend over weekday admissions throughout the study period. Conclusions: Weekend admissions for TAVR had higher mortality, complications, and resource utilization, particularly in elective cases. Our findings suggest that patients admitted for TAVR during weekends are at high risk and warrant special attention.
Abstract 4140660: Clinical Outcomes of GLP-1 RA in Heart Failure with CKD patients: A TriNetX Based Global Study
Authors: Muhammad Hanif, Vikash Jaiswal, Jenish Bhandari, Junaid Ali, Sahana Devakumar, Muhammad Ishaq, FNU Sundas, Hamza Yousaf, Arshan Khan, Sabeeh Islam, Sumi Singh, Rohan Kumar Ochani, Farah Yasmin, Mayank Jha, Debanik Chaudhuri
Journal: Circulation (2024)

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are well-established glucose-lowering medications for the treatment of type 2 diabetes, and are cardio-protective by reducing the incidence of major adverse cardiovascular events (MACE). However, there is limited data available with conflicting results on safety of GLP-1RAs among patients with heart failure (HF) with chronic kidney disease (CKD) patients. Objective: To assess the potential therapeutic benefits of GLP-1RAs in HF patients with CKD. Method: We queried the TriNetX Global Collaborative Network for adult’s patients with heart failure and chronic kidney disease (CKD) from January 2005 to April 2023, and created two cohorts: one with heart failure and CKD on GLP-1 RAs and the other one heart failure and CKD on placebo as control cohort. Both the cohorts were followed for 12 months. We used the ICD-10-CM codes to identify comorbidities, and RxNorm for prescription. Demographics and laboratory values were reported by TriNetX. Propensity score matched analysis (PSM) was done for age, gender, race, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, LDL level, left ventricular ejection fraction and various drugs including ACEi, ARBi, beta blockers, aldosterone receptor antagonists, SGLT-2 inhibitors and statins. Primary outcome was all-cause mortality (ACM) while secondary outcomes were acute myocardial infarction (AMI), major adverse cardiovascular outcome (MACE) (Composite of ACM, AMI, and ischemic stroke), hemorrhagic stroke, and ischemic stroke. Resultsxs: Amongst the 1,05,414 patients (52, 707 patients in each group), the mean age of patients were 68.8 and 68.0 in GLP-1 RAs and control cohort respectively. PSM analysis showed that at one year of follow-up, GLP-1 RAs in heart failure with CKD patients was associated with significantly lower risk of primary outcome i.e., ACM (RR 0.400, 95% CI: 0.384-0.417) as compared with control. Heart failure with CKD patients on GLP-1 RAs were also associated with significantly reduced MACE (RR 0.536, 95% CI: 0.515-0.557), AMI (RR 0.633, 95% CI: 0.597-0.671), ischemic stroke (RR 0.760, 95% CI 0.712-0.811) and hemorrhagic stroke (RR 0.493, 95% CI 0.423-0.575) as compared with control. Conclusion: GLP-1 RAs use among patients with HF and CKD were associated with significant reduction in MACE, ACM, and stroke.
Abstract 4141129: Temporal Trends in Substance Use and Ischemic-Heart disease related mortality in the United States: Cross-sectional Analysis of a National Database from 1999 to 2020
Authors: Syed Husain Farhan, Shurjeel Qazi, Syeda Ayesha Ali, Adam Khan, Huzaifa Ansari, Mustafa Murtaza, Zaid Zuberi, Jawad Ishtiaq, Ayesha Noman, Abdul Basit Jawed Memon, Rabbia Siddiqi
Journal: Circulation (2024)

Background: There is a scarcity of data regarding trends in substance use (SU) and mortality related to ischemic heart disease (IHD) in the United States (US).This study aims to evaluate deaths linked to SU+IHD in the US by utilizing the CDC Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER). Methods: The CDC WONDER database was used to access the mortality data of adults aged ≥25 from 1999 to 2020. Both substance use and IHD were mentioned as contributing or underlying causes of death. Results, presented as age-adjusted mortality rates (AAMR) per 100,000 population, underwent Joinpoint regression for trend analysis and annual percentage change (APC). Results: Between 1999 and 2020, a total of 236,832 deaths were attributed to IHD among patients with substance use (AAMR = 4.9, 95% CI: 4.91-4.95). The overall AAMR depicted a consistent rising trend from 3.29 in 1999 to 7.91 in 2020.Throughout the study period, males consistently exhibited higher overall AAMRs compared to females (Male: 8.3 vs Female: 1.9). Among racial/ethnic groups, non-Hispanic American Indian [NH-AI] individuals had the highest AAMRs (10.9, 95% CI: 10.6-11.3), followed by non-Hispanic blacks [NHB] (6.5, 95% CI: 6.5-6.6), non-Hispanic Whites [NHW] (5.0, 95% CI: 5.0-5.1), and Hispanics (3.5, 95% CI: 3.4-3.5). Notably, non-Hispanic Asian/Pacific Islander [NH-API] individuals had the lowest AAMR (1.2, 95% CI: 1.1-1.2). Regionally, the West reported the highest mortality rates (6.3, 95% CI: 6.3-6.4), followed by the Midwest (4.8, 95% CI: 4.8-4.9) and the South (4.6, 95% CI: 4.6-4.7), while the Northeast reported the lowest mortality rate (3.9, 95% CI: 3.9-4.0). Moreover, when comparing urbanization status, metropolitan areas had a higher AAMR value compared to metropolitan areas in 1999, however this trend sharply reversed to non-metropolitan areas having a higher AAMR in 2020 (1999 non-metro: 3.1 vs. metro: 3.3; 2020 non-metro: 9.2 vs. metro: 7.6). Conclusion: Our findings underscore a troubling rise in IHD related mortality among substance users in the US. Addressing gender, racial/ethnic, and regional disparities is crucial for targeted interventions to reduce mortality rates and improve cardiovascular health outcomes.
Abstract 4141030: Real-world treatment patterns of mavacamten and associated background therapies in patients with obstructive hypertrophic cardiomyopathy (HCM) in the United States
Authors: Ahmad Masri, Ervant Maksabedian Hernandez, Patricia Schuler, Yan Wang, Weihua Gao, Aozhou Wu, Xu Han
Journal: Circulation (2024)

Background: There are limited data on the treatment patterns of mavacamten and background therapies in real-world patients with obstructive HCM. Aims: To describe posology, discontinuation, adherence to mavacamten, and the use of HCM background therapies in real-world patients. Methods: This was a retrospective cohort study of adult patients using the Symphony Integrated Dataverse from Apr 28, 2022 to Jan 18, 2024. Patients were included if they had ≥ 1 approved claim for mavacamten and had continuous claims activity during the 12 months (baseline) before the first claim (index date). The stable dose (defined as the dose used for 6 months consecutively), discontinuation (defined as a treatment gap ≥ 95 days without restarting), and adherence (measured as proportion of days covered [PDC]) were described for mavacamten. The use of background therapies (beta blockers, calcium channel blockers and disopyramide) was described at index and during the follow-up. Results: A total of 1867 patients (mean ± SD age 64.7 ± 12.2 years, 63.1% female, median [interquartile range, IQR] follow-up 219 [107, 346] days) were included ( Table ). Among patients with ≥ 6 (n = 993), ≥ 9 (n = 640), and ≥12 (n = 394) months of treatment, 67.3%, 86.1%, and 93.7% reached stable dose, respectively. Among patients who reached stable dose (n = 691, median [IQR] treatment duration 345 [270, 435] days), 54.8% did not require any dose adjustment, and 33.0% required only one adjustment from treatment initiation. The most commonly used stable dose was 5 mg (49.6%), followed by 2.5 mg (25.0%), 10 mg (20.5%) and 15 mg (4.8%). The discontinuation rate for mavacamten was 10.8% and 8.7% among patients with ≥1 and ≥2 claims, respectively. Mean PDC for mavacamten was 93.7 ± 9.1%. Overall, 25% of patients did not have any claim for background therapy at index. For the remaining patients (n = 1401), 11.6% discontinued and 15.1% down titrated the index HCM background therapy. Conclusions: The vast majority of patients treated with mavacamten reached stable dose with no or only one dose adjustment. Discontinuation rate was 8.7-10.8% and adherence to mavacamten was high. A substantial proportion of patients discontinued or down titrated HCM background therapy.
Abstract 4140979: CD34 <sup>+</sup> Cells Contributed to Cardiac Fibrosis Are Regulated by Hyperlipidemia
Authors: Yan Guo, Luping Du, Xuyang Wang, Xiaogang Guo, Qingbo Xu
Journal: Circulation (2024)

Background: Lipid metabolic alterations are emerging as significant mechanisms in the prognosis of cardiac remodeling induced by hypertension and could impact the therapies for cardiac fibrosis. The fatty acid transport/oxidation gene FABP4 acts as a metabolic and inflammation regulator, whose inhibition can attenuate kidney and renal interstitial fibrosis. However, its role in the heart remains unclear. Our study aimed to evaluate the density of FABP4 in patients and mouse model, and its association with cardiac fibrosis. Methods and Results: Single cell RNA sequencing of the heart and enriched Cd34-tdTomato + lineage cells in human and a murine model treated with angiotensin II were performed. Through the analysis of single-cell transcriptomes extracted from mouse hearts and human hearts tissues, we explored the transcriptomic landscape throughout cardiac fibrosis and revealed dysregulation of cardiac fibrosis, fatty acid transport/oxidation, and PPARγ signaling in the failing heart. We identified in which the FABP4 + fibroblasts were increased in diseased tissues accompanied by the accumulation of lipid droplets and cardiac fibrosis. Using pseudotime analysis, inducible lineage tracing and bone marrow transplantation models, our study showed that hypertension can expedite the differentiation of non-bone marrow-derived CD34 + cells into FABP4 + fibroblasts, leading to lipid accumulation and cardiac fibrosis. Furthermore, the PPARγ/Akt/Gsk3β pathway plays a critical role in orchestrating the differentiation process. Interestingly, both in vitro and in vivo, partial depletion of CD34 + cells using diphtheria toxin or pioglitazone treatment resulted in a notable reduction of FABP4 + fibroblasts and triglyceride in heart, along with an improvement in cardiac function through the PPARγ pathway. Additionally, GW9662, a selective antagonist of PPARγ, markedly reduced cell lipotoxicity and cardiac fibrosis. Conclusions: Collectively, our study provides valuable insights into the cellular landscape of the fibrotic heart with hypertension, indicating that the differentiation of non-bone marrow-derived CD34 + cells into FABP4 + fibroblasts accelerates the lipid accumulation and progression of cardiac fibrosis via PPARγ pathway.
Abstract 4140839: Mitral Transcatheter Edge-to-Edge Repair to Treat Systolic Anterior Motion of the Mitral Valve and a Flail Posterior Mitral Leaflet: One Clip, Two Solutions
Authors: Krishna Ravindra, Ella Anderson, Reagan Morford, Ashley Moore, Firas Kaddaha, Houman Tavaf-Motamen, Brinder Kanda
Journal: Circulation (2024)

Description of Case: An 83-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM) of the mitral valve presented to the Emergency Department with several weeks of progressively worsening dyspnea and was found to have acute hypoxemic respiratory failure. The patient was started on bilevel positive airway pressure and underwent aggressive diuresis. Transesophageal echocardiogram showed moderate aortic stenosis, HOCM with SAM of the mitral valve, a large P2 flail segment of the mitral apparatus with ruptured cords, and significant pulmonary vein flow reversal. Percutaneous transcatheter edge-to-edge repair (TEER) was pursued with intraoperative transesophageal echocardiograpic images demonstrating an excellent result with resultant mild mitral regurgitation and a mean transmitral diastolic gradient of 5-6 mmHg. Hemodynamic measurements at this time showed resolution of prior left ventricular outflow tract gradient (from 86 mmHg to 25 mmHg). Discussion: This report highlights a unique case in which a patient with known HOCM with SAM of the mitral valve developed concomitant severe mitral regurgitation from a flail posterior leaflet, leading to acute hypoxemic respiratory failure that was repaired with TEER. Current nonpharmacologic interventions for HOCM include alcohol septal ablation/myectomy, though both of these are not without their own risks. Though the use of TEER has been approved for patients with symptomatic severe mitral regurgitation who are deemed inoperable or at high surgical risk with a life expectancy &gt; 1 year, small studies have also reported the use of TEER in patients with HOCM for symptom improvement who were not candidates for septal reduction therapy. This case builds on prior reports supporting TEER as an option for patients with medication-refractory HOCM who are not candidates for surgical intervention, also highlighting that it can be done concomitantly to treat acute degenerative valvulopathies.