tbuckley/cabot-search huggingface dataset:
Abstract 4119129: PREDICTING 30-DAY ALL-CAUSE READMISSION AFTER STROKE: THE APPLICATION OF MACHINE LEARNING TO LINKED REGISTRY DATA
Authors: Raed Hailat, Gustavo de los Campos, Mike Thompson, Adrienne Nickles, John Oostema, Mathew Reeves
Journal: Circulation (2024)

Background: Thirty-day readmission following hospital discharge for stroke is an important quality measure for US hospitals. Current US prediction models for post stroke readmission based on electronic medical records from single healthcare systems or hospitals have modest discrimination (AUC range 0.64 - 0.74). Aim: To develop 30-day all-cause readmission prediction model using a machine learning (ML) based method trained on linked stroke registry and administrative claims data. Methods: Using probabilistic linking, we matched acute stroke (ICD-10 I61-I63) discharges from 31 hospitals participating in the Michigan Acute Stroke registry between 2016-2020 to multipayer administrative claims data provided by the Michigan Value Collaborative for Medicare and Blue Cross Blue Shield of Michigan commercial beneficiaries. Stroke registry data included patient demographics, clinical characteristics, past medical history, and treatments. Claims data was used to identify readmissions within 30 days of discharge. We used multivariable LASSO logistic regression- a simple ML technique to predict 30-day all-cause-readmission and evaluated the prediction accuracy using a hospital-split internal validation scheme to generate hospital-specific and pooled AUC estimates with 95% confidence intervals (Figure 1). Results: Of 19,382 linked stroke discharges, 2,724 (14.1%) were readmitted within 30-days. Readmitted patients were older, more likely to be male, black, and have higher stroke severity (NIHSS &gt;5). Registry hospitals were either primary (64%) or comprehensive (26%) stroke centers. Hospital-specific 30-day readmission ranged between 9.9%-23.1% ( P &lt;.001) with an average of 14.1% (95% CI:13.6%-14.5%) (Figure 2). Hospital specific AUC estimates ranged between 0.60-0.80 with a pooled AUC of 0.68 (95% CI:0.65-0.70) (Figure 2). Conclusions: ML prediction model fitted to linked registry data can be used to predict hospital-specific and statewide readmissions post stroke.
Abstract 4117085: Frequency and Patterns of Paroxysmal Supraventricular Tachycardia Episodes Among Patients Opting For Acute Drug Treatment: Analysis of the NODE-303 Open-Label Etripamil Trial
Authors: Nihar Desai, James Ip, Derek Hu, Peter Noseworthy, Maria Lenor Parody, Sean Pokorney, Farhad Rafii, Narendra Singh, Bruce Stambler, Silvia Shardonofsky, David Bharucha, A. John Camm
Journal: Circulation (2024)

Background: Etripamil nasal spray (NS) is a fast acting, self-administered calcium channel blocker in development for the termination of AV-nodal-dependent supraventricular tachycardia (SVT). Prior randomized, placebo-controlled and open-label studies have demonstrated favorable safety and efficacy of etripamil in converting paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm (SR) self-administered without direct medical supervision. Research Question/Hypothesis: To assess patterns and annualized PSVT episode frequency among patients opting to self-administer acute treatment with etripamil. Methods: NODE-303 was an event-driven, multi-center, open-label Phase 3 study, conducted in North and South America to evaluate the safety and efficacy of etripamil in patients with documented PSVT over multiple episodes. Test dosing was not performed prior to at-home use. Enrolled patients, upon perceiving symptoms of PSVT: applied an ambulatory ECG monitor, performed a previously trained vagal maneuver and, if symptoms persisted, self-administered etripamil NS 70 mg. During the study, the protocol was amended to allow a repeat dose (70 mg) if symptoms persisted 10 min after the first dose. Each patient could self-treat up to 4 episodes. Results: Of 1,116 enrolled patients, 503 (45.1%) treated ≥1 perceived PSVT episode (safety population). Etripamil achieved conversion to SR in 60% of patients by 30 minutes and 70% by 60 minutes. A total of 220, 118, 62, and 103 patients completed the study with 1, 2, 3, and 4 etripamil-treated perceived episodes of PSVT, respectively, with an average time on study of 440 days. Among these patients, the average number of annualized etripamil-treated PSVT episodes was 3.2 (standard deviation 3.8). Annualized use: etripamil was self-administered for 0-2 PSVT episodes per year, 2-6 episodes, 6-12 episodes, and &gt;12 episodes, in 54%, 32%, 10%, and 4% of patients, respectively (Figure). Conclusions: This analysis aimed to assess the annualized use of etripamil NS in a real-world setting, by analyzing how often patients would self-administer the drug for PSVT episodes. Of patients that self-administered etripamil (n=503), the majority treated &gt;1 episode and the annualized frequency of episodes treated with etripamil was 3.2 episodes/yr.
Abstract 4122134: Relationships between aortic valve area planimetry on four-dimensional cardiac computed tomography and survival following transcatheter aortic valve replacement
Authors: Aro Daniela Arockiam, Tiffany Dong, Elio Haroun, Joseph El Dahdah, Ankit Agrawal, Rishabh Khurana, Ushasi Saraswati, Jaideep Bhalla, Aritra Paul, Serge Harb, Zoran Popovic, L Rodriguez, Rishi Puri, Grant Reed, Amar Krishnaswamy, Brian Griffin, Samir Kapadia, Tom Kai Ming Wang
Journal: Circulation (2024)

Background: Aortic valve area planimetry (AVA CT ) is feasible on four-dimensional computed tomography (4D-CT) for grading aortic stenosis severity, with superior spatial but inferior temporal resolution to echocardiography, however its prognostic utility is not well-established. We evaluated the prognostic value of AVA CT in patients with significant aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Methods: We studied 1035 native aortic valve stenosis patients (age 79.0±9.0 years, 429 (41.5%) women) undergoing TAVR during 2019-2020. AVA CT and indexed to body surface area (AVAi CT ) were retrospectively measured on contrast-enhanced 4D-CT at peak systole, and standard statistical analyses performed to evaluate its associations with all-cause mortality during follow-up. Results: Mean AVA CT and AVAi CT were 1.02±0.21 cm 2 and 0.53±0.12 cm 2 /m 2 respectively, with 240 (23.2%) deaths during mean follow-up of 2.1±0.9 years. Areas under curves and optimal thresholds for identifying severe aortic stenosis (defined as AVA&lt;1.0 cm 2 on echocardiography) were 0.78 and &lt;1.10 cm 2 for AVA CT and 0.83 and &lt;0.65 cm 2 /m 2 for AVAi CT . AVA CT and AVAi CT below these thresholds representing severe aortic stenosis were independently associated all-cause mortality during follow-up, with hazards ratios (95% confidence intervals) of 1.84 (1.34-2.53) and 2.38 (1.48-3.81) respectively in multivariable analyses. The Figure illustrates Kaplan-Meier survival curves for the cohort based on A) AVA CT and B) AVAi CT thresholds. Conclusion: Optimal thresholds of AVA CT (&lt;1.10 cm 2 ) and AVAi CT (&lt;0.65 cm 2 /m 2 ) were independently associated with worse survival in patients undergoing TAVR, indicating that AVA CT and AVAi CT as potentially useful additional imaging biomarkers in the diagnostic and prognostic evaluation of aortic stenosis patients.
Abstract 4116425: " Navigating High-Risk Terrain: Clinical Outcomes of Percutaneous Coronary Intervention (PCI) in Breast Cancer Patients - A National Inpatient Sample Analysis "
Authors: Anusha Kavarthapu, Bhuvana Tantry, Nishant Patel, Prahasith Kamani, Rohit Sekandlapuram, Gautham Upadhya, Francesco Rotatori
Journal: Circulation (2024)

Background: Breast cancer is the most prevalent malignancy affecting women globally and is one of the leading causes of cancer-related deaths. Cardiovascular disease (CVD) holds the highest mortality rate among women. However, the prognosis of percutaneous coronary intervention (PCI) patients with underlying breast cancer has not been well-studied. Methods: The National Inpatient Sample (NIS) 2017-2020 database was used to identify PCI patients with ICD-10 codes for a retrospective analysis. PCI patients were then divided into those with and without underlying breast cancer. Multivariable logistic regression was performed for composite post-PCI outcomes analyses. Results: Among 2,815,610 patients admitted for PCI, 3,935 had breast cancer. Patients with underlying breast cancer experienced worse post-PCI outcomes, including a higher risk of major bleeding (OR, 3.7; 95% CI, 2.9 - 4.8; P &lt; .001) and post-PCI cardiac arrest (OR, 8.003; 95% CI, 5.39 - 11.8). The need for devices such as Impella and IABP was also higher in the breast cancer subpopulation compared to those without (OR, 6.8; 95% CI, 5.7 - 8.0) and (OR, 8.4; 95% CI, 7.44 - 9.668), respectively. Although the incidence of stroke was higher in the subpopulation, intra/post-PCI stroke was lower. Breast cancer patients undergoing PCI showed no significant difference in hospitalization charges or length of stay. Conclusions: In conclusion, our study sheds light on the intricate relationship between breast cancer and percutaneous coronary intervention (PCI) outcomes. These findings underscore the importance of tailored care and close monitoring for breast cancer patients undergoing PCI.
Abstract 4116300: Valvular Abnormalities and Risk of Abdominal Aortic Aneurysm Associated with Fluoroquinolone Use; A Retrospective Cohort Study
Authors: Hania Shahin, Allen Seylani, Yohannes Haile, Catherine Lowe, Carolynne Vo
Journal: Circulation (2024)

Introduction: Fluoroquinolones (FQ) are efficacious antibiotics whose antimicrobial effect is achieved through bacterial DNA gyrase inhibition. However, there is evidence suggesting that FQ may cause impaired collagen synthesis and an increase in tissue collagen degradation. Collagen serves as a predominant structural constituent of the aortic wall and heart valves. These structures undergo tissue maintenance, which necessitates the regulated expression of MMPs and TGF-β. In this study, we hypothesized that prolonged usage of FQs may increase risk of valvular abnormalities and abdominal aortic aneurysm. Methods: We conducted a retrospective cohort study utilizing de-identified patient data from the TriNetX platform, an extensive electronic health records (EHR) system. The cohorts consisted of smoker patients who used FQs for more than two consecutive weeks, Cohort A, N= 352,215 and smoker patients without a history of FQ use, Cohort B, N=350,912. Propensity score matching balanced baseline characteristics between cohorts: age, sex, ethnicity, and comorbidities. Results: The risk of developing AAA among smokers with a history of FQ use was 1.222% while the risk was 0.806% among smokers without history of FQ use (P&lt; 0.0001, 95% CI (0.63,0.691), Risk Ratio (RR)= 0.66). The risk of developing nonrheumatic (NR) aortic insufficiency among smokers with history of FQ use was 1.479% while smokers with no history of fluoroquinolone use had a 0.95% risk (P&lt;&lt;0.0001, 95% CI (0.616,0.67), RR= 0.643). The risk of developing NR mitral insufficiency in smokers with history of FQ use was 3.873% versus their smoker FQ naive counterparts risk of 2.317% (P&lt; 0.0001, 95% CI (0.582,0.615), RR= 0.598). NR tricuspid insufficiency in smokers with FQ usage was also increased versus their smoker FQ naive counterparts at 3.089% and 1.758%, respectively (P&lt; 0.0001, 95% CI (0.552,0.587), RR =0.569). Conclusions: This study uncovered a significant association between FQ use, risk of AAA, and NR-valvular insufficiencies among smokers. In particular, male smokers are at highest risk of developing AAA. This same population is at risk for prostatitis that would likely need treatment with FQs, further increasing their risk. Despite the efficacy of this class of antibiotics, caution is paramount when prescribing FQs in individuals who are actively smoking or have any connective tissue pathologies.
Abstract 4115832: Statin Intolerance due to Muscle Symptoms Affects Management of Patients: Insights from the CLEAR Outcomes Trial
Authors: Ulrich Laufs, Abraham Lincoff, Stephen Nicholls, Na Li, William Sasiela, Leanne Bloedon, Paula Robinson, Steven Nissen, Paul Thompson
Journal: Circulation (2024)

Background: In CLEAR Outcomes the non-statin bempedoic acid (BA) 180 mg daily reduced MACE-4 (nonfatal MI, nonfatal stroke, coronary revascularization, or CV death) by 13% in 13970 patients at high CV risk with statin intolerance (SI) over a median of 40.6 months. This is the largest prospective database of patients with SI. Aims: To assess whether there were differences in SI symptom history and whether this influenced the clinical course during CLEAR Outcomes. Methods: SI symptoms and impact on activities of daily living (ADL) were recorded prior to randomization. Patients were grouped post hoc as reporting only statin associated muscle symptoms (SAMS), only non-muscle adverse effects (NonSAMS), or BOTH. Results: At baseline 6887 (49.3%) patients reported SAMS, 2485 (18%) NonSAMS, and 4587 (33%) BOTH. SI symptoms had a moderate/severe impact on ADL in 62% SAMS, 48% NonSAMS, and 69% BOTH. Use of any lipid modifying treatment at baseline was 43% SAMS, 36% NonSAMS, and 42% BOTH. Compared to placebo, BA reduced LDL-C at 6 months by 21% in SAMS, 22% in NonSAMS, and 21% in BOTH. There was no difference in the effect on MACE-4 by SI group. New use of moderate/high intensity statin during the study was relatively infrequent (3.2-8.0%) but higher in PBO than BA in all SI groups and was not generally maintained at study end (Table 1). Muscle adverse events (AE) were more frequent and resulted in higher rates of treatment DC in SAMS/BOTH vs NonSAMS (Table 2). There was no difference between BA and PBO in the rate of muscle related AE. Conclusion: SAMS are the predominant cause of SI in patients in CLEAR Outcomes. Patients with a history of SAMS had higher rates of muscle AE and study drug DC due to muscle AE versus NonSAMS. Muscle AE rates and study drug DC were balanced between BA and PBO within each SI symptom subgroup. CLEAR Outcomes exhibits the challenges of treating patients with SI. These data also demonstrate that BA can be useful in reducing CV risk in this patient population.
Abstract 4116281: Improvement in Valvular Regurgitation Severity with Atrioventricular Junction Ablation: Conduction System and Biventricular Devices
Authors: Hussein Krayem, Charles Nation, Bharath Peddibhotla, Sagar Prabhu, Rafae Shaikh, VAISHNAVI GADELA, Jeffrey Kolominsky, Michael Kontos, Naveed Naz, Hem Bhardwaj, Cory Trankle, Jeremy Turlington, Jordana Kron, Richard Shepard, Pranav Mankad, Jayanthi Koneru, Kenneth Ellenbogen, Ajay Pillai, Zachary Gertz
Journal: Circulation (2024)

Background: Ablate-and-pace strategies for permanent atrial fibrillation (AF) have shown mortality benefit with biventricular pacemakers (BiV). The mechanism of benefit is not well understood, but may involve cardiac remodeling. We sought to characterize the effects of AV junction ablation (AVJA) in patients receiving BiV or conduction system pacing (CSP) devices on valvular regurgitation. Objective: To evaluate the effects of AVJA in permanent AF on valvular regurgitation as measured by standard 2D echocardiography. Methods: Consecutive patients undergoing BiV/CSP after AVJA for permanent AF with tricuspid regurgitation (TR) and/or mitral regurgitation (MR) between January 2018 and January 2023 at our institution were analyzed. Ejection fraction (EF), TR severity, and MR severity were compared pre-AVJA and post-AVJA. Results: A total of 102 patients met the above criteria. Median clinical follow up time was 902 days (IQR 578-1537 days) from AVJA. In patients with at least 1+ MR at baseline (N=65), there was significant improvement in MR severity post-AVJA (p=0.003). At baseline, 51% of patients had 1+ MR, 36% of patients had 2+ MR, 10% of patients had 3+, and 3% of patients had 4+ MR. Post AVJA, 45% (29 patients) had improvement in MR severity, 40% (26 patients) had no change, and 15% (10 patients) worsened. The greatest improvement was seen in patients with reduced baseline EF(defined as EF&lt;50%). All 3+ and 4+ MR improved to at least 2+ MR post-AVJA in this subset. In patients with at least 2+ TR at baseline (N=28), there was also significant improvement in TR severity (p=0.029). Conclusion: AVJA with physiologic pacing in patients with permanent AF is associated with improvement in MR and TR severity.
Abstract 4116298: Once Weekly Utreglutide (GL0034), a Glucagon-like Peptide-1 Receptor Agonist, at 4 × 450 µg Doses Reduces Blood Pressure, Lipids, and Body Weight in Post-menopausal Females: A Phase I Study
Authors: Rajamannar Thennati, Vinod Burade, Muthukumaran Natarajan, Pradeep Shahi, Ravishankara Nagaraja, Sudeep Agrawal, Thierry Duvauchelle, Richard Pratley, Bernard Thorens, Tina Vilsboll
Journal: Circulation (2024)

Background: Utreglutide (GL0034), a novel, once weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), previously demonstrated significant reductions in body weight (BW) after a single dose ascending study in individuals with obesity . BW reductions after pharmacological treatment of obesity with GLP-1RA is associated with blood pressure (BP) lowering effects. Aim: This phase I study assessed the safety, tolerability, and cardio-metabolic effects of utreglutide after multiple ascending doses in post-menopausal female volunteers with overweight and obesity. Methods: In this randomized, double-blind, placebo-controlled study 12 post-menopausal female volunteers with overweight/obesity, aged 18 to 65 years old with a body mass index (BMI) ≥26 kg/m 2 were randomized (9:3) to subcutaneous utreglutide fixed doses (4 × 450 µg); or placebo once weekly for four weeks. Safety, tolerability, and key cardio-metabolic parameters were assessed. Biomarker measurements included oral glucose tolerance test (OGTT) insulin and glucose area under the curve (AUC), systolic- and diastolic BP, lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and non-high-density lipoprotein (non-HDL), creatinine, potassium, BW and leptin. Results: Utreglutide was generally well tolerated and related adverse effects were mainly gastrointestinal with dose-dependent nausea, vomiting and decreased appetite. Reductions in OGTT AUCs of insulin ( p &lt;0.05) and glucose ( p &lt;0.01) were noted on Day 23 after four weeks treatment with Utreglutide. This was accompanied by a decrease ( p &lt;0.001) in mean systolic and diastolic BP on Day 23 from baseline (BL). On Day 23, significant reductions in TC ( p &lt;0.01), LDL ( p &lt;0.05) and non-HDL ( p &lt;0.05) were observed. BW reduction versus BL ( p &lt;0.001) was 2.0 kg and 1.8 kg respectively on Day 29 and End of Study (EoS). Leptin levels significantly reduced from BL on Day 23 ( p&lt; 0.01) and EoS ( p &lt;0.001). No significant changes were observed for TG, creatinine and potassium (Table). Conclusions: Once weekly utreglutide dosing for four weeks at a dose of 450 µg in post-menopausal females with overweight and obesity, demonstrated clinically relevant reductions of systolic and diastolic BP. This was associated with improved performance of OGTT AUC of insulin and glucose, lipids, BW and leptin with an overall good tolerability and with potential to demonstrate cardio-metabolic benefits.
Abstract 4117731: Interleukin-1 Blockade in Patients With ST-Segment Elevation Myocardial Infarction Across the Spectrum of Coronary Artery Disease Complexity.
Authors: Martin Denicolai, Matteo Morello, Michele Golino, Giuliana Corna, Marco Del Buono, Carla Agatiello, Benjamin Van Tassell, Antonio Abbate
Journal: Circulation (2024)

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and complex coronary artery disease (CAD) face a poor prognosis, including increased heart failure (HF) risk. Interleukin-1 (IL-1) blockade with Anakinra inhibits the acute inflammatory response and prevent HF after STEMI, but data on its effects based on CAD complexity are lacking. Aims: To assess the effects of Anakinra in patients with STEMI, across the spectrum of CAD complexity. Methods: We performed a pooled secondary analysis of 139 patients with STEMI from three randomized clinical trials (VCUART studies) comparing Anakinra (N=84) versus placebo (N=55). Multivessel CAD was defined as the presence of at least one ≥70% stenosis in a non-culprit vessel of &gt;2.5 mm diameter, not stented during index coronary intervention. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery), SYNTAX II and Gensini scores were calculated, and patients were divided by the median. We evaluated a composite endpoint of new-onset HF, HF hospitalization, or all-cause death at 1-year follow-up using Kaplan-Meier survival curves, Cox regression analysis for Hazard Ratios, and calculated interactions between groups. Results: We included 139 patients with STEMI, 85 (61%) with single vessel CAD and 54 (39%) with multivessel CAD. According to the spectrum of CAD complexity, 60 (43%) presented a SYNTAX score &gt;9, 59 (42%) a SYNTAX II score &gt;24 and 65 (47%) a Gensini score &gt;32. New-onset HF, HF hospitalization, or all-cause death occurred in a total of 23 patients: 7 among the 84 subjects in the Anakinra group and 16 within the 55 patients in the placebo group. We found no statistically significant interactions between CAD complexity and allocation to Anakinra or placebo for the composite endpoint (Figure). Conclusions: Among patients with STEMI, IL-1 blockade with Anakinra significantly reduced the risk of new-onset HF, HF hospitalization, or all-cause death compared to placebo, regardless of the number of vessels affected and the spectrum of CAD complexity.