tbuckley/cabot-search huggingface dataset:
Abstract 13727: Cost-Effectiveness of Sotagliflozin in Heart Failure Patients With Preserved and Reduced Ejection Fractions—Results From the SOLOIST-WHF
Authors: William S Weintraub, Sarahfaye Dolman, Paul Kolm, Zugui Zhang
Journal: Circulation (2023)

Background: SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure) showed patients with diabetes and recent worsening heart failure (HF), sotagliflozin initiated before or shortly after discharge lowered incident cardiovascular deaths, hospitalizations, and HF urgent visits. In this study, we evaluated the cost-effectiveness of sotagliflozin in all patients and those with preserved (HFpEF ≥50%) and reduced (HFrEF &lt;50%) ejection fraction. Methods: We ran a Markov microsimulation model based on treatment effects from SOLOIST-WHF, healthcare costs and utilities from national sources, and estimated net costs for sotagliflozin of $434 (range from $407 to $612) monthly, to calculate projected lifetime healthcare costs, HF and CVD events, survival, and quality-adjusted life-years (QALYs) for sotagliflozin vs placebo in SOLOIST-WHF eligible patients from a payer perspective. Outcome measured as the incremental cost-effectiveness ratio (ICER), incremental costs / QALYs gained. Sensitivity analyses assessed and quantified uncertainties. Results: Over a lifetime, sotagliflozin compared to placebo added 0.39 QALYs (4.43 vs. 4.04 QALYs) and 0.64 life-years (7.12 vs. 6.48) at an incremental cost of $29,449 (95% uncertainty interval (UI): $26,610-$32,528) for an ICER of $75,510 per QALY gained (UI: $55,640-$98,300). In HFpEF patients, sotagliflozin compared to placebo added 0.43 QALYs (4.53 vs. 4.10 QALYs) and 0.68 life-years (7.14 vs. 6.46) at an incremental cost of $26,615 (UI: $23,376-$29,694) for an ICER of $61,488 per QALY gained (UI: $41,618-$84,280). In HRrEF patients, sotagliflozin added 0.37 QALYs (4.33 vs. 3.96 QALYs) and 0.63 life-years (7.09 vs. 6.46) at an incremental cost of $30,012 (UI: $26,773-$33,251) for an ICER of $77,996 per QALY gained (UI: $58,126-$100,780). The benefit of sotagliflozin in QALY mainly results from the decrease in CVD deaths. Findings were sensitive to drug cost and number of readmissions. Conclusions: This study demonstrates that sotagliflozin priced from $407 to $612 per month is a clinically and economically favorable medication in patients with diabetes, recent worsening heart failure, with both preserved and reduced ejection fraction.
Abstract 14575: Pupillary Reflex as an Independent Marker of Mortality in Decompensated Heart Failure. A Longitudinal and Prospective Study
Authors: Margarita Zamorano, Juan Manuel Monteagudo, Eduardo Gonzalez, Sara Fernandez Santos, Miguel Castillo, Isabel Rayo, Pedro de la Villa, Jose Zamorano
Journal: Circulation (2023)

Introduction: In heart failure (HF) compensatory mechanisms are triggered to maintain adequate cardiac output. Among them, hyperactivation of sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS. Aims: The aim of the study is to analyze whether changes in the pupillary reflex in HF are useful in the prognostic stratification of these patients. Hypothesis: Pupillary reflex may be a prognostic marker in patients with decompensated HF. Methods: We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 hours after admission and prior to discharge. The basal maximum pupillary diameter (BMPD) before contraction, was measured. Results: Of the 107 patients, 51% were women and 49% men, mean age was 79 +/- 10 years, 77% had hypertension, and 34% Diabetes.6 patients died during admission, 11 died in the first month after discharge and 4 patients were readmitted in the first month.Of the patients who died, all had on admission BMPD &gt; 3.8 mm. No patient with a BMPD &lt; 3.7 mm died. The area under curve ROC for predicting the combined endpoint of 1- month mortality and admissions for HF using BMPD was 0.823. The BMPD presented a weak correlation with heart rate and ejection fraction. It did not correlate with age, gender, BNP, mean E/e, left atrial volume indexed, creatinine, hematocrit, sodium. Conclusions: Patients with decompensated HF presented at admission a higher BMPD. This supports the hypothesis that decompensated HF present a hyperactivation of the SNS that promotes mydriasis. BMPD is provides a good independent predictor marker of in-hospital and 1-month mortality in patients admitted with HF. Pupillometry may be a new, non-invasive and simple tool that helps in the prognostic stratification of acute HF patients.
Abstract 14560: Diabetes Mellitus and Hypertension Subtypes in Relation to Cardiovascular and All-Cause Mortality
Authors: Jeffrey E Jones, Kevin S Tang, WENJUN FAN, Nathan D Wong
Journal: Circulation (2023)

Background: Diabetes mellitus (DM) is associated with increased arterial stiffness indicated by isolated systolic hypertension (ISH). Whether this relates to greater cardiovascular disease (CVD) mortality remains unclear. We compare by DM status the association of hypertension subtypes with CVD and all-cause mortality. Methods: We included data from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up until 2018. We used systolic and diastolic blood pressure cut points of 130 and 80 mmHg to define ISH, isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH) with DM based on self-report, glucose ≥126 mg/dL if fasting or ≥200 mg/dL if non-fasting, use of DM medications or insulin, or HbA1c≥6.5%. The incidence of CVD and all-cause mortality was examined among hypertensive subtypes (vs. normotension) using Cox regression, adjusting for age, ethnicity, gender, tobacco use, dyslipidemia, and use of antihypertensive agents. Results: 23,198 individuals (projected to 194 million) were included of which 14% had DM (projected to 19 million). In those with vs. without DM, 40% vs. 60% were normotensive, 5% vs. 9% had IDH, 39% vs. 18% had ISH, and 16% vs. 13% had SDH (p&lt;0.001). Adjusted analyses showed increased risk of CVD and all-cause mortality with ISH and IDH in patients with and without DM. IDH was significantly associated with increased CVD and all-cause mortality in individuals with DM but not in individuals without DM (p&lt;0.0001 for interaction comparing the relation of subtypes with mortality endpoints by DM status). Conclusions: All hypertension subtypes were significantly associated with increased CVD and all-cause mortality in patients with DM, whereas in patients without DM only ISH and SDH carried increased mortality risk. The strength of association was also significantly greater in patients with DM.
Abstract 13997: Identification of Novel Spectral Densities in Arterial Pressure Time Series for Cardiovascular Risk Stratification in Early Prediabetes: Machine Learning Beyond Conventional Frequency Domain Analysis
Authors: Abdalrhman Mostafa, Nour-Mounira Bakkar, Mohamed Abdelhack, Ahmed F El-Yazbi
Journal: Circulation (2023)

Introduction: Despite the extensive use of average BP for diagnosis of cardiovascular disease (CVD), research has shown that changes in BP variability can better reflect CV deterioration. As patients with type 2 diabetes present to the clinic with pre-established CVD, there is a pressing need for early identification of aberrant BP fluctuations useful for risk appraisal. Hypothesis: We hypothesized that deep learning models with superior capacity in feature extraction would enable comprehensive characterization of arterial pressure (AP) time-series allowing CV risk stratification in early prediabetes. Methods: We trained a convolutional neural network (CNN, Figure 1A) to classify spectrograms generated using short-term Fourier transforms of beat-to-beat AP signals collected from control vs. prediabetic rats of both sexes fed a high-calorie diet for 12 or 24 weeks, representing young and old rats. Model performance was assessed on different sampling rates for binary and multi-level classifications of sex, age, and diet. Saliency maps were generated by back-propagation of model scores to extract frequency values crucial for classification. Conventional frequency domain analysis was performed on the original AP time-series and the power spectral densities (PSD) were determined for the frequencies identified for each classification task. PSD were compared among sex, age, and diet groups using 3-way ANOVA and principal component analysis. Results: The model successfully classified AP spectrograms according to age, sex, and diet revealing sex- and age-specific CV deteriorative processes in early prediabetes (Figure 1B-E). Saliency maps identified frequencies of 2, 13, 19, and 43 Hz as crucial for DietxAgexSex classification. Comparison of PSDs for these frequencies was not sufficient for CV risk separation (Figure 1F, G). Conclusions: Employing a CNN overcomes the shortcomings associated with CV risk stratification using conventional methods.
Abstract 17625: Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI
Authors: Yasser Jamil, Michael Nanna, Cassius I Ochoa, Carlos Mena-Hurtado, Robert R Attaran
Journal: Circulation (2023)

Introduction: Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to complex vasculature. The BASIL-2 trial demonstrated superiority in endovascular treatment compared with surgical bypass in patients with IPPAD. However, the choice of endovascular modality has not been conclusive. Hypothesis: Combining plain balloon angioplasty (POBA)+atherectomy is associated with improved clinical outcomes compared to POBA. Methods: Patients that underwent POBA vs POBA+Atherectomy for IPPAD from the Vascular Quality Initiative database were identified. Propensity score matching (PSM) was employed to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Patient characteristics and long-term outcomes between the two treatment groups were compared. Results: A total of 10,494 individuals (74.6%) were treated with POBA, while 3,569 (25.4%) were treated with POBA+atherectomy. PSM ensured minimal differences in baseline characteristics, such as indication for procedure and prior revascularization. The atherectomy group was associated with higher technical success and lower perioperative complications, such as renal complications and hematoma, at the expense of higher rates of distal embolization. During long term follow up, patients who underwent atherectomy had lower rates of major amputation but lower freedom from reintervention. There were no differences in major adverse limb events and mortality. Conclusion: Combining POBA with atherectomy appears to be a safe approach in IPPAD, with lower rates of long-term amputation at the cost of higher risk for future re-intervention.
Abstract 14992: Impact of Coronary Artery Disease on Rate vs. Rhythm-Control of Atrial Fibrillation
Authors: Sunnia T Chen, Christopher V Desimone, Freddy Del-Carpio Munoz, Gurukripa N Kowlgi, Abhishek Deshmukh
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is a common arrhythmia that can impair quality of life and increase cardiovascular mortality. Previous studies have shown potentially better outcomes with rate-control agents in patients with coronary artery disease (CAD). Yet, optimal treatment of AF is not yet known. Methods: Leveraging data from the AFFIRM trial, we performed a post-hoc analysis examining outcome differences in patients on rate vs. rhythm-control agents, based on CAD status. The primary outcome was defined as death from any cause; secondary outcomes included ischemic stroke, major bleeding, and hospitalization after baseline. Univariate and multivariate modeling were used to determine risk factors associated with designated outcomes. Results: Of 4060 patients enrolled, 1551 patients had CAD at baseline. There were no differences in treatment randomization based on CAD status; however, more patients with CAD had worse heart function and comorbid CHF. More patients with CAD ultimately used some form of rate-control compared to those without. Overall, CAD patients were more likely to experience death (HR 2.08 [1.79-2.42], P&lt;0.001), specifically those on rhythm-control (HR 1.24 [1.01-1.52], P=0.04, Figure). CAD patients were also more likely to have ischemic stroke (HR 1.24 [1.00-1.53], P=0.05). When comparing CVD vs. non-CVD death, only CAD patients on rhythm-control exhibited a significantly higher rate of CVD death (HR 1.39 [1.03-1.89], P=0.03), while no differences in primary outcomes were noted for all other groups (P&gt;0.05, Figure). In multivariate modeling, the effect of treatment arm on risk of CVD death in CAD patients diminished upon accounting for age, smoking, rhythm at randomization, first episode of AF, CHF, and LVEF&lt;50% (HR 1.18 [0.93-1.50], P=0.17). Conclusions: AF patients with CAD on rhythm-control agents exhibited worse CVD outcomes, which may be more reflective of heart disease severity rather than treatment effects.
Abstract 18776: ECG-GPT: Automated Complete Diagnosis Generation From ECG Images Using Novel Vision-Text Transformer Model
Authors: Akshay Khunte, Veer Sangha, Gregory Holste, Lovedeep S Dhingra, Arya Aminorroaya, Zhangyang Wang, Rohan Khera
Journal: Circulation (2023)

Background: Artificial intelligence can automate the diagnosis of a multitude of rhythm and conduction disorders from ECGs, but is limited by a dependency on discretely defined labels. Moreover, most models also frequently rely on signal data, limiting their application in low-resource settings, where such models are needed most and ECGs are available in image form. Methods: 1.4 million 12-lead ECGs and accompanying cardiologist diagnosis statements from Yale were used to develop a model capable of generating ECG report statements. This encompassed a wide array of conditions. To develop a model capable of report generation across ECG layouts, 12-lead signal recordings were plotted randomly in multiple formats. The gold-standard diagnosis statements were processed using to remove identifiable information and standardize diagnosis reporting. An ECG-specific vision encoder-decoder model with a pretrained BEiT transformer encoder with a 384x384 pixel input size and a generative pretrained transformer, GPT-2, as a decoder was developed (B). Results: In a held-out test set of 100,000 ECGs, representing ECG interpretation with up to 255 tokens and over 41 distinct cardiovascular conditions, the model performed well across conventional metrics, with ROUGE-L and BLEU-1 scores of 0.695 and 0.502, respectively (C). The model’s clinical validity was assessed by computing agreement between cardiologist and model-generated diagnosis statements. The model generated text reports with accurate identification of diverse set of rhythm and conduction disorders, with AUROCs for predicting atrial fibrillation, right bundle branch block, and sinus tachycardia of 0.95, 0.94, and 0.96, respectively (D). Conclusions: Our vision encoder-decoder model generates an ECG report from ECG images in any layout. This approach represents an automated and accessible strategy for generating cardiologist-level reporting on ECGs, useful for low-resource settings.
Abstract 14249: Sex and Gene Based Differences in Age Related Penetrance of Dilated and Arrhythmogenic Cardiomyopathy
Authors: Nicole K Bart, Sophie Stroeks, Sadiya S Khan, Nosheen Reza, Iacopo Olivotto, Christoffer Vissing, Corine Sinnette, Anjali T Owens, Alessandra Fornaro, Luisa Mestroni, Matthew Taylor, Adam S Helms, Sanjay K Prasad, Sara Saberi, Supriya Shore, Job Verdonschot, Gianfranco sinagra, Marco Merlo, Marta Gigli, Lisa D Wilsbacher, Stephane Heymans, Matthew Wheeler, Euan A Ashley, Matteo Dal Ferro, Alessia Paldino, Sharlene Day, Alejandro de Feria, Lynne W Stevenson, Carolyn Ho, Brian Claggett, James S Ware, Victoria N Parikh, Upasana Tayal, Neal K Lakdawala
Journal: Circulation (2023)

Background: Approximately 40% of cases of dilated (DCM) and arrhythmogenic cardiomyopathy (AC) are caused by rare genetic variants of large-effect. Sex-based differences in the penetrance of genetic DCM and AC have been described, however, findings have been inconsistent. Age at the time of diagnosis can be used as an indicator of age-related penetrance. In this study we aimed to describe differences in age at diagnosis in subgroups of patients with DCM and AC; the latter defined as ventricular arrhythmias preceding or superseding systolic LV dysfunction. Methods: Patients with DCM and AC were identified using data from 3 centers participating in the international SHaRe registry. Age at diagnosis and other baseline characteristics were compared across genetic subtypes; including patients with pathogenic and likely pathogenic (LP/P) variants (G+), variants of unknown significance (VUS), without identifiable genetic cause (G-) and subgroups with LP/P variants in 3 genes most frequent in this cohort ( TTN , LMNA , and DSP ). Results: Of 3662 patients with DCM and AC, 1341 were females (37%) and 3551 probands (97%). There were no significant differences in LVEF (38±14 vs. 41±14, p=0.07) or NYHA III-IV symptoms (14% vs. 11%, p=0.2). Genetic testing was performed more frequently in females (27% vs. 22%; p&lt;0.01) but the frequency of LP/P variants did not differ significantly by sex (female 49% vs. male 38%, p=0.07). In the entire cohort, the age of diagnosis did not vary between females and males; however, females with LP/P variants in TTN were 9 years older (p&lt;0.01) whereas females with LP/P variants in DSP were 10 years younger (p=0.037) at diagnosis than males (figure). Conclusion: Sex-based differences in age related penetrance of DCM and AC may differ across disease genes. Increased vigilance is warranted for early presentation of AC. Future research should examine the factors that underlie this heterogeneity and determine associated differences in clinical outcomes.
Abstract 12817: The Mediator Role of Physical Function in the Relationship Between Caregiver Contribution to Self-Care and Caregiver Quality of Life in Heart Failure
Authors: Seongkum Heo, Minjeong An, SUN HWA KIM, JungHee Kang, KyungAh Cho, jisun Yang, JinShil Kim
Journal: Circulation (2023)

Introduction: Caregivers of patients with heart failure (HF) commonly show reduced physical function and quality of life (QOL). Caregiver contribution to self-care maintenance (CC-SC maintenance) may result in reduced physical function, and, in turn, poor QOL. However, these relationships have not been tested in caregivers of patients with HF. Aim: To test the mediating role of physical function in the relationship of CC-SC maintenance to caregiver QOL in HF. Hypothesis: Physical function mediates the relationship between CC-SC maintenance and caregiver QOL in caregivers of patients with HF, controlling for covariates (i.e., age, marital status, relationship to patient, comorbidity, depressive symptoms, and caregiver confidence to self-efficacy). Methods: In this cross-sectional, correlational study, data on physical function (Korean Activity Status Index), CC-SC maintenance (Caregiver Contribution to Self-care Maintenance), caregiver confidence to self-care (Caregiver Confidence in Contributing to Self-care Scale), caregiver QOL (EuroQol Quality of Life Scale), depressive symptoms (Patient Health Questionnaire-9), and sociodemographic characteristics (Sociodemographic Questionnaire) were collected from 92 caregivers of patients with HF (mean age = 53.8) from 4 hospitals in South Korea. PROCESS macro for SPSS was used to test the hypothesis. Results: CC-SC maintenance was associated with caregiver QOL indirectly through the effect on physical function. Higher levels of CC-SC maintenance (p = .021) were significantly associated with poorer physical function, and poorer physical function (p &lt; .001), but not CC-SC maintenance (p = .362), was significantly associated with poorer caregiver QOL (F = 7.021, R 2 = .435, p &lt; .001), controlling for the covariates (standardized indirect effect = -.105, bootstrap 95% CI = -.217, -.017). Conclusions: The findings of this study supported the hypothesis. Physical function was a mediator in the relationship between CC-SC maintenance and caregiver QOL, implying that CC-SC maintenance was associated with QOL only indirectly through the effects on physical function. Healthcare providers should consider CC-SC maintenance and physical function of caregivers at the same time to improve their QOL.
Abstract 12693: Invasive Derivation, Validation, and Prognostic Association of a Quantitative Echocardiographic Estimate of Pulmonary Artery Wedge Pressure
Authors: Thomas Lindow, Manouras Aristomenis, Per Lindqvist, Daniel Manna, Björn Wieslander, Rebecca Kozor, Geoff Strange, David Playford, Martin Ugander
Journal: Circulation (2023)

Background: Grading of diastolic dysfunction (DD) commonly leads to indeterminate classifications and provides little information on treatment effect or disease progression. A quantitative non-invasive estimate of LV filling pressures would have clinical utility. Aim: To invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP), and to compare its prognostic performance with diastolic dysfunction grading. Methods: Echocardiographic measures were used to estimate PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analyzed in the National Echocardiography Database of Australia (NEDA). Results: In patients who underwent both RHC and echocardiography within two hours (n=90), ePAWP was derived using left atrial volume index (LAVi), mitral peak early velocity (E), and pulmonary vein peak systolic velocity (PVs). In an external validation cohort (n=53), ePAWP showed good agreement with invasive PAWP (mean±SD difference 0.5±5.0 mmHg) and good diagnostic accuracy for estimating PAWP &gt;15mmHg (area under the curve [95% confidence interval] 0.94 [0.88-1.00]). Among patients in NEDA (n=38,856, median [interquartile range] follow-up 4.8 [2.3-8.0] years, 2,756 cardiovascular deaths), ePAWP associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading (hazard ratio (HR) 1.08 [1.07-1.09]) and provided incremental prognostic information to diastolic dysfunction grading (C-statistic: 0.68 vs. 0.65, p&lt;0.001). Increased ePAWP associated with worse prognosis across all grades of diastolic function (HR normal: 1.07 [1.06-1.09]; indeterminate: 1.08 [1.07-1.09]; abnormal: 1.08 [1.07-1.09]. Conclusion: Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.