tbuckley/cabot-search huggingface dataset:
Abstract 15405: Changes in Cardiometabolic Risk Factors Following SARS-CoV-2 Infection
Authors: Jithin Sam Varghese, Yi Guo, Mohammed K Ali, William Troy Donahoo, Rosette J Chakkalakal
Journal: Circulation (2023)

Introduction: Post-acute sequelae of SARS-CoV-2 infection consist of pulmonary and extrapulmonary conditions, including a higher incidence of type 2 diabetes, but it remains unknown whether other cardiometabolic pathways are impacted by infection. Research Question: Does SARS-CoV-2 infection predict worsening cardiometabolic risk factors? Methods: Using data from OneFlorida+ (a PCORnet CRN), we compared changes over time in body mass index (BMI), systolic blood pressure (SBP) and low-density lipoprotein (LDL). We compared an Exposed cohort with a positive SARS-CoV-2 test or COVID-19 diagnosis code between March 2020 - January 2022 (n = 75,217; age: 48.5 y, 64% female), relative to a contemporary Unexposed cohort of adult patients with negative SARS-CoV-2 tests (n = 240,575; age: 52.7 y, 61% female), and an age/sex-matched Historical control cohort (March 2018 - January 2020; n = 75,217; age: 48.5 y, 64% female). We used multiple imputation for missingness in demographic and clinical factors and inverse probability weighting for confounding and loss to follow-up. We used doubly robust marginal structural models to estimate baseline and longitudinal differences in cardiometabolic indicators by cohort. Results: At the start of the follow-up period, adjusted for covariates and relative to the Exposed, the Unexposed (BMI: -0.5 [-0.6,-0.4] kg/m 2 , SBP: -0.5 [-0.8,-0.2] mmHg, LDL: -7.7 [-14.5, -1.0] mg/dL) and Historical control (BMI: -0.4 [-0.5,-0.3] kg/m 2 , SBP: -1.0 [-1.5,-0.6] mmHg, LDL: 12.5 [-58.3, 83.3] mg/dL) cohorts had better cardiometabolic profiles ( Figure ). Relative to changes in the Exposed, control cohorts displayed faster decreases in BMI (Unexposed only), slower increases in SBP, and no changes in LDL during the follow-up period. Conclusions: SARS-CoV-2 infection was associated with weight retention and a rise in blood pressure. Longer follow-up can help identify stability and impacts of these cardio-metabolic indices on events and mortality.
Abstract 189: How Quickly Does Arterial Blood Pressure Recover After Pauses in Mechanical Chest Compressions in Humans With Out-of-Hospital Cardiac Arrest?
Authors: Rose T Yin, Per Olav Berve, Tore Skaalhegg, Andoni Elola, Tyson G Taylor, Rob G Walker, Elisabete Aramendi, Fred W Chapman, Lars Wik
Journal: Circulation (2023)

Introduction: Conventional wisdom says that arterial blood pressure (ABP) recovers slowly after interrupting CPR chest compressions (CCs). An oft-cited animal study with manual compressions and 15:2 compression:ventilation ratio showed that all 15 compressions were needed to restore pre-pause invasive pressure, implying that even short pauses substantially reduce CPR blood flow. Whether this holds true for humans receiving mechanical chest compressions is unknown. We measured recovery of ABP after pauses in mechanical compressions by LUCAS in patients treated for out-of-hospital cardiac arrest (OHCA). Methods: We analyzed data from a subset of patients enrolled in both groups of a prospective, randomized LUCAS 2 Active Decompression trial performed by an anesthesiologist-staffed rapid response car program in Oslo, Norway from 2016 to 2018. Only patients with an ABP signal and at least one CC pause longer than 2 sec were included. All CCs were mechanical. Arterial cannulation was verified, and CC pauses were identified by physician review of the patient care record and physiological signals. Pauses were excluded if ROSC or a LUCAS “soft start” occurred or epinephrine had been applied within 5 minutes of the pause. Peak compression (cAP), mean (mAP), and mean decompression arterial blood pressures (dAP) for 10 CCs before and after each pause were measured with custom MATLAB code. Results: We included 56 patients with a total of 148 pauses (mean pause duration: 10.63 ± 3.05 sec). Pre-pause mean cAP, mAP, and dAP were 95.6 ± 0.3, 49.9 ± 0.1 and 30.5 ± 0.1 mmHg. Post-pause dAP for each compression was not significantly different than pre-pause dAP (Fig. 1A,B). cAP and mAP recovered to &gt;90% of pre-pause pressure within 2 CCs. Pause duration was not predictive of post-pause pressures (Fig. 1C). Conclusions: ABP generated by mechanical CPR recovered quickly after pauses. Consequently, short pauses (such as pauses for 30:2 CPR) may pose less hemodynamic concern than previously thought.
Abstract 14601: Increased Risk of Major Adverse Cardiovascular Events Attributed to Lipoprotein(a) Across Current Atherosclerotic Cardiovascular Disease Risk Categories
Authors: Harriet Benbow, Anas Al Zabiby, Xingdi Hu, Hannah Byrne, Madlaina Costa-Scharplatz
Journal: Circulation (2023)

Introduction: AHA guidelines recommend measurement of lipoprotein(a) [Lp(a); an inherited, causal risk factor for atherosclerotic cardiovascular disease (ASCVD)] in individuals with a family or personal history of premature ASCVD. Lp(a) measurement is also recommended for recalibrating the 10-year risk score for borderline or intermediate risk individuals. However, there is limited evidence on the risk of MACE attributed to elevated Lp(a) across ASCVD risk categories. Hypothesis: To assess the impact of elevated Lp(a) levels on MACE across ASCVD 10-year risk categories. Methods: This observational, retrospective study included a primary prevention cohort of Caucasian and Black ethnicities from the UK Biobank (2006-2020). Associations of Lp(a) level (categories of 105-150, 150-190, 190-215, and 215-260 nmol/L were compared to Lp(a) &lt;105 nmol/L) with time to first MACE and MI were assessed using Cox proportional hazard models adjusted for age, sex, and ethnicity, stratified by ASCVD 10-year risk score category. Results: The cohort (N=362,061) included 55.2% female, 94.3% Caucasian and 1.6% Black. MACE incidence rates (IR, per 100 person/years) increased with 10-year ASCVD risk score: low risk IR=0.14 (n=161,183), intermediate risk IR=0.72 (n=121,272) and high-risk IR=1.52 (n=27,733). Within and across these risk categories, elevated Lp(a) conferred a significant increase in risk of MACE and myocardial infarction (MI). In the low-risk category, HRs ranged from 1.15-1.55 (MACE) and 1.32-1.72 (MI), in the intermediate risk category HRs ranged from 1.19-1.51 (MACE) and 1.37-1.77 (MI), and in the high-risk category HRs ranged from 1.12-1.55 (MACE) and 1.14-1.76 (MI) (Figure 1). Conclusions: Our study demonstrates that elevated Lp(a) increases the risk of MACE independently of ASCVD risk score. Measuring and considering elevated Lp(a) levels as part of individual ASCVD risk assessment in routine clinical practice may help improve the risk predication.
Abstract 13561: Hospital Outcomes of Chronic Kidney Disease Patients After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Devices
Authors: Qi Xuan Ang, Min Choon Tan, Fahimeh Talaei, Justin Lee
Journal: Circulation (2023)

Background: Chronic kidney disease (CKD) is a common comorbidity among patients who require transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED). However, its impact on the outcomes of this procedure remains unclear. Objective: This study aimed to investigate the impact of CKD and end-stage renal disease (ESRD) on the outcomes following TLR of infected CIED. Method: Using the Nationwide Readmissions Database, we identified and analyzed the hospital outcomes of patients aged ≥18 years, who underwent TLR of infected CIED from 2017 to 2020. The patient cohort was further stratified by the presence of CKD diagnoses. Survey-based weighted univariable and multivariable analyses were performed to investigate whether CKD of different stages independently predicts worse outcomes among these patients. Results: A total of 10,928 patients who underwent TLR of infected CIED were included in our study. Amongst, 3,794 (34.7%) patients had CKD not requiring dialysis, and 605 (5.5%) patients had ESRD on dialysis. The patients with ESRD on dialysis had the highest rates of early mortality (10.6% vs 7.7% vs 4.1%, p&lt;0.01), non-home discharge (46.1% vs 43.3% vs 30.5%, p&lt;0.01), prolonged hospitals stay (90.6% vs 84.9% vs 72.6%, p&lt;0.01), and 30-day readmission (25.5% vs 24.6% vs 17.1%, p&lt;0.01) compared to CKD not requiring dialysis patients and non-CKD patients. Via multivariable analyses, the risk of poorer in-hospital outcomes increased with the severity of CKD. Apart from cardiac arrest, CKD was not significantly associated with increased procedural complications following the TLR procedure. Conclusion: Chronic kidney disease, particularly ESRD was associated with poorer hospital outcomes following TLR of infected CIED. The procedural complications were not significantly increased in CKD patients, except for cardiac arrest. These highlight the importance of meticulous peri-procedural management in CKD patients.
Abstract 17673: Sudden Cardiac Death as the First Manifestation of Heart Disease
Authors: Harpriya Chugh, Audrey Uy-Evanado, Habiba Aziz, Arayik S Sargsyan, Kotoka Nakamura, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2023)

Background: Clinical risk stratification is most challenging in the subgroup of individuals who present with sudden cardiac death (SCD) as the first manifestation of heart disease (SCD-FM) and there is a lack of current era population-based data. Hypothesis: Occurrence of SCD-FM SCD differs by ethnicity and access to health care. Methods: Consecutive out-of-hospital cases of SCD attended by emergency medical services were ascertained prospectively from a large ongoing population-based study in the Southwest US (population ~ 850K, 2015-2022) using an established multi-source ascertainment and adjudication process. A detailed review was conducted of the lifetime clinical record and available autopsy data, for each individual. SCD-FM cases were defined as SCD with no prior heart disease diagnosis. We calculated annual age-standardized incidence of overall SCD and SCD-FM per 100,000 residents using US census data. Ethnicity-stratified incidence of SCD-FM was calculated. Occurrence of all health care visits prior to SCD was evaluated. Results: From a total of 2681 SCD cases (age 71 ± 16, female 35%) age adjusted incidence of SCD was 40[38-41] per 100,000 out of which SCD-FM was 15[14-16] per 100,000 (n=1019 (38%), age 67±18, female 33%). There was no difference in SCD-FM incidence between Hispanic and non-Hispanic residents (15 [13-17] vs 15 [14-17], p=0.84). Individuals younger than 65 yr were more likely to have SCD-FM compared to those older than 65 yr (50% vs 33%, p &lt;0.001). We observed that 91% of SCD-FM had visited healthcare providers and 3% had cardiac evaluations performed. Conclusion: A significantly higher proportion of SCD-FM were age &lt;65 but the proportion of SCD-FM did not differ by ethnicity. The vast majority of SCD-FM (91%) underwent health care visits prior to SCD but cardiac evaluations were rare (3%). These findings highlight the need to discover and develop user-friendly, cost-effective pre-screening methods to reduce SCD-FM in the general population.
Abstract 18289: A Real-World Analysis Of New-Onset Heart Failure After Anterior Wall ST-Elevation Acute Myocardial Infarction
Authors: Benjamin W Van Tassell, Azita Talasaz, Antonio Abbate, Brian Ziegelaar, Garry Redlich
Journal: Circulation (2023)

Introduction: The one-year incidence of heart failure (HF) after anterior wall ST-elevation acute myocardial infarction (STEMI) remains difficult to determine due to inconsistencies in definitions. Aims: Evaluate the 1-year incidence of HF after anterior wall STEMI in a real-world data set using a variety of potential definition criteria. Methods: A retrospective cohort study of anonymized patient data was accessed through a federated health research network (TriNetX LLC) of 56 US healthcare organizations (US Collaborative Network). Patients were identified based upon ICD-10 criteria for anterior wall STEMI during the 10-year period from 2013-2022 and the absence of pre-specified signs or symptoms of HF. One-year incidence was calculated as 1 minus Kaplan-Meier survival at 12 months after anterior wall STEMI. The analysis utilized 5 different types of definition criteria for HF. Univariate Cox proportional hazards ratio was calculated to compare risk associated with potential risk factors. Results: A total of 34,395 patients from the US Collaborative Network met eligibility criteria and were included in the analysis. One year incidence of HF based upon each definition criteria is summarized in table 1 and figure 1. Age ≥65 years, Black race, low density lipoprotein ≥100 mg/dL, elevated hemoglobin A1c, and BMI ≥35 kg/m 2 were also associated with increased risk of HF. Conclusions: Patients with anterior wall STEMI continue to be at high risk for new onset HF. In the absence of structured, prospective, systematically adjudicated diagnostic criteria, composite definitions are more likely to yield accurate estimates of HF incidence.
Abstract 15184: Moderate-to-Vigorous Intensity Physical Activity and Incident Left-Sided Degenerative Valvular Heart Disease
Authors: ziang Li, Yongjian Wu
Journal: Circulation (2023)

Hypothesis: This study aimed to examine the impact of moderate-to-vigorous intensity physical activity (MVPA) on the prevention of left-sided degenerative valvular heart disease (VHD) among middle-aged adults. Methods: In the UK biobank study, data from wrist-worn accelerometer and physical activity questionnaires were utilized to assess the role of MVPA volume on the incidence of aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). The primary cohort involved 90,865 participants ( median 8.1-year follow-up period) without prevalent VHD and heart failure, who wore accelerometers for one week. The validation cohort included 397,335 participants (median 13.8-year follow-up period) who completed physical activity questionnaires. MVPA volume was categorized according to the American Heart Association’s recommendation. Results: Accelerometer-measured MVPA showed a curvilinear relationship with reduced AS risk, with the risk reduction plateauing above 300 min/week. Compared to no MVPA, those engaging in 150-299 minutes of MVPA per week showed the most significant risk reduction [1-149 min/week: adjusted hazard ratio (HR), 0.79 (0.58, 1.08); 150-299 min/week: HR, 0.52 (0.36, 0.75); ≥300 min/week: HR, 0.57 (0.39, 0.83)]. Similar results were found when repeating the above analyses in self-reported MVPA cohort, with a relatively smaller reduction in HR ratio [150-299 min/week: HR, 0.81 (0.73, 0.91)]. No significant association was found between the MVPA volume and the risk of AR and MR in both cohorts. Conclusions: Meeting current MVPA recommendations (150-300 min/week) was associated with the lowest AS risk. Targeting adherence to accelerometer-measured MVPA thresholds may enhance AS risk reduction. Additionally, MVPA showed limited effectiveness in preventing valvular regurgitation, indicating distinct mechanisms between stenotic lesions and regurgitation lesions in degenerative VHD.
Abstract 18941: Pediatric Electrocardiogram-Based Deep Learning to Predict Left Ventricular Dysfunction and Remodeling
Authors: Joshua Mayourian, William G La Cava, Sunil J Ghelani, Rebekah Mannix, Vassilios J Bezzerides, William T Pu, Tal Geva, Audrey Dionne, Mark E Alexander, John K Triedman
Journal: Circulation (2023)

Background: Artificial intelligence-enhanced ECG algorithms show promise to detect a range of adult phenotypes, inclusive of ventricular dysfunction and remodeling. However, it remains unclear whether similar approaches provide meaningful and generalizable predictions in children. Methods: We trained a convolutional neural network on paired ECG-echos (≤ 2 days apart) from patients ≤ 18 years old without major congenital heart disease to detect human expert classified greater than mild left ventricular (LV) dysfunction, hypertrophy, and dilation (individually and as a composite outcome). Model performance was assessed by calculating area under the receiver operating curve (AUROC) in an internal test set and external setting (emergency department). Results: The main cohort comprised of 119,787 ECG-echo pairs (61,722 patients; median age 8.3 [IQR, 2.9-13.8] years; 55% male). Training, internal test, and external test sets comprised of 92,377, 24,343, and 3,067 ECG-echo pairs with 8.2%, 7.7%, and 10.0% composite outcome rates, respectively. During internal testing, AUROCs of 0.84 [95% CI, 0.83-0.85], 0.87 [95% CI, 0.85-0.88], 0.86 [95% CI, 0.84-0.87], and 0.84 [95% CI, 0.83-0.86] were achieved for the LV composite outcome, dysfunction, hypertrophy, and dilation, respectively (Figure). During external testing, AUROCs of 0.80 [95% CI, 0.77-0.83], 0.84 [95% CI, 0.80-0.88], 0.77 [95% CI, 0.72-0.82], and 0.86 [95% CI, 0.82-0.89] were achieved, respectively (Figure). Similar model performance was achieved when using quantitative z-score cutoffs for each outcome. Exploratory saliency mapping provides insight into notable ECG components that influence model predictions. Conclusions: Our artificial intelligence-enhanced pediatric ECG algorithm shows promise to inexpensively screen for and diagnose LV dysfunction or remodeling in children. Prospective trials to guide model implementation for supporting clinical decision making are warranted.
Abstract 17070: Dyslipidemia Prevalence Among a Diverse Cohort of Childhood, Adolescent and Young Adult Cancer Survivors
Authors: Matthew Dean, John Bane, Yi Hang, Ericka Miller, Sherin Menachery, David Chuquin, Adam Aston, Xiaoyan Deng, Dipankar Bandyopadhyay, Jennifer H Jordan, Uyen T Truong, Madhu Gowda, Wendy Bottinor
Journal: Circulation (2023)

Background: In the general population, dyslipidemia impacts 36% of adults between the ages of 20 and 29 years. Among survivors of childhood, adolescent, and young adult-onset cancer (C-AYAs), the prevalence of dyslipidemia in racially diverse cohorts as well as our understanding of which measured fats are most commonly abnormal are limited. Question: Among a diverse group of C-AYAs, what is the prevalence of dyslipidemia and which fats are most contributory? Methods: Individuals diagnosed with cancer at age ≤39 years and treated with anthracycline based chemotherapy between 2010-2022 were identified. Depending on age at time of collection, post-treatment lipid panels were analyzed according to AAP (&lt;20 years) or ACC/AHA (≥20 years) guidelines. Non-fasting panels were included, in accordance with ACC/AHA guidelines. The prevalence of dyslipidemia and median values for measured fats were determined. Non-parametric testing was used to examine associations between dyslipidemia, age, and race. Results: Among a diverse (40% Black, 52% White) cohort of C-AYAs (227 total) with a median current age of 25 years (interquartile range (IQR) 20-36 years) and median total doxorubicin isotoxic equivalents of 200mg/m 2 (IQR 120-300 mg/m 2 ), the prevalence of dyslipidemia was 55%. Prevalence of dyslipidemia was not associated with race (Black 55%, White 64%, Other 44%, p=0.281) or age (&lt;20 years 51%, ≥20 years 64%, p = 0.055). Among Black and White subjects, HDL was most commonly abnormal (Black 42%, White 38%), followed by triglycerides (TG) (Black 29%, White 41%). Median TG levels were significantly lower among Black individuals ≥20 years compared with White individuals (117 mg/dL vs 143 mg/dL, p = 0.030). Conclusions: Among a diverse group of C-AYAs, dyslipidemia was highly prevalent even at a younger age (&lt;20 years). Race was not associated with prevalence of dyslipidemia. Dyslipidemia was primarily driven by HDL and TG abnormalities, fats associated with metabolic syndrome.
Abstract 17833: Characterization of Central versus Peripheral Predominance of Exercise Limitation in Patients With Heart Failure and Preserved Ejection Fraction
Authors: Cheshta Prasad, Joseph Campain, Alexandra Minasian, Catharine Griskowitz, Ilya Giverts, Shaina McGinnis, Jennifer Rouvina, Alyssa Kowal, Katherine Kelly, Casey White, Peter Wagner, Rajeev Malhotra, Gregory Lewis
Journal: Circulation (2023)

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous disorder in which abnormalities in both cardiac output (CO) and peripheral oxygen extraction (CavO 2 ) contribute to impaired oxygen uptake (VO 2 ). We investigated the predominant limitation to VO 2 , according to distinct HFpEF criteria, by examining the CO vs. VO 2 relationship during incremental exercise. Methods: Participants underwent Cardiopulmonary Exercise Testing (CPET) with invasive hemodynamic assessment and were diagnosed with HFpEF based on characteristic symptoms and NTproBNP ≥125pg/mL, Supine PCWP ≥15mmHg, PCWP/CO ≥2mmHg/L/min or Peak PCWP ≥25mmHg. Calculated direct Fick CO versus VO 2 slope and peak exercise data were stratified by the expected relationship of CO(L/min) = 5хVO 2 (L/min) +5. The Mann Whitney U Test and t-test characterized those limited by cardiac output (Slope &lt;5L/min) vs. peripheral extraction (Slope &gt;5L/min). Results: In 425 dyspneic individuals meeting biomarker and/or hemodynamic criteria for HFpEF, 36% had predominantly peripheral limitation (Measured Peak CO &gt; Expected). Among those with NTpro-BNP ≥125pg/mL or resting PCWP ≥15mmHg, or both (N=220) , 31% were peripherally limited. 41% of those with a PCWP/CO ≥2mmHg/mL/min or Peak PCWP ≥25mmHg, or both (N=205) , were peripherally limited. Among all peripherally limited patients (N=151), the percentage of females, NTpro-BNP levels, Hb levels, rest and peak Ca-vO 2 , and rest and peak PVR were significantly lower compared to the cardiac limited group (Table, N=274), while resting PCWP, LVEF and HR were similar (Table). Conclusion: Despite meeting concurrent biomarker and/or hemodynamic criteria for HFpEF, peripheral-predominant limitation to exercise capacity is common which merits consideration when deploying interventions to augment exercise capacity in HFpEF.
Abstract 13971: Gender Differences in Advanced Heart Failure Characteristics and Outcomes
Authors: Naba Farooqui, Jill Killian, Jamie Smith, Margaret M Redfield, Shannon M Dunlay
Journal: Circulation (2023)

Introduction: The epidemiology and pathophysiology of heart failure (HF) differs in women and men. However, it is not well defined whether these differences extend to the subgroup of patients that develop advanced HF or if they translate to differences in outcomes. Aim: To compare the clinical characteristics and outcomes of advanced HF in women and men. Methods: This is a retrospective cohort study of all adult residents of Olmsted County, Minnesota with advanced HF (as defined by European Society of Cardiology Criteria) from 2007-2017. Differences in survival and hospitalization risks following advanced HF development in women and men were examined using Cox proportional hazard regression and Andersen Gill models, respectively. Results: Of 936 individuals with advanced HF, 417 (44.6%) were women and 519 (55.4%) were men. Women were older (mean 79 vs 75 years) with a lower overall comorbidity burden (Charlson comorbidity index 4.7 vs 5.2), less often had coronary artery disease (60% vs 79%) and hyperlipidemia (69% vs 77%), but more often had hypertension (91% vs 87%) and depression (32% vs 24%), and more often had advanced HF with preserved ejection fraction (60% vs. 30%) compared with men ( p&lt;0.05 for each). After adjustment for age, ejection fraction and comorbidities, there were no differences in risks of survival or hospitalizations ( Figure ) between women and men (p&gt; 0.10 for each). Conclusion: While advanced HF can occur in both women and men, their phenotypes differ; women more often present with advanced HFpEF and men with more atherosclerotic disease and advanced HFrEF. Despite these differences, survival is similar in women and men with advanced HF.