tbuckley/cabot-search huggingface dataset:
Abstract 4115654: Assessing Diagnostic Performance: A Systematic Review and Meta-Analysis of Machine Learning-Based Fractional Flow Reserve versus Traditional Invasive Fractional Flow Reserve for Coronary Artery Stenosis Evaluation
Authors: Shubhika Jain, Viraj Panchal, Mariah Adams, Mansunderbir Singh, Samarth Goyal, Divya Dinesh Joshi, Rahul Vyas, Sahith Reddy Thotamgari, Vijaywant Brar
Journal: Circulation (2024)

Introduction: Fractional Flow Reserve (FFR) is a stenosis-specific index for coronary artery stenosis (CAS) detection and its effect on myocardial perfusion. Visualizing stenosis through an invasive coronary angiography (iFFR) lacks consistency and is highly subjective. Recently, non-invasive techniques have been developed using artificial intelligence (AI) and Machine learning (ML) to measure FFR (ML-FFR). We aimed to analyze the diagnostic performance of ML-FFR in comparison to iFFR in the detection of CAS. Methods: A search was carried out in PubMed, IEEE Xplore digital library, and clinicaltrials.gov where studies evaluating the risk of CAS in patients undergoing ML-FFR and iFFR were considered in terms of FFR values from 2014 to 2024. OpenMetaAnalyst was used to evaluate the diagnostic performance in terms of pooled Sensitivity(SN), Specificity(SP), Negative Likelihood Ratio(NLR), Positive Likelihood Ratio(PLR), and Diagnostic Odds Ratio(DOR) at 95% confidence interval (CI). P&lt;0.05 was considered significant. Results: A total of 9 studies including 1358 vessel lesions were analyzed. The pooled SN, SP, NLR, and PLR were 81.1%(74.3%-86.4,p=0.014), 91.8%(84.9%-95.7%, p&lt;0.001), 0.187 (0.151-0.232, p=0.575) and 9.898(5.492-17.839,p&lt;0.001), respectively with &gt;75% heterogeneity in SP and PLR. After excluding two studies, a “leave-out” analysis showed pooled SN, SP, NLR, and PLR as 79.9% (71.4%-86.3%, p=0.007), 94.4% (90.2%-96.9%, p=0.002), 0.187 ( 0.140-0.250, p=0.540) and 14.307 (8.094-25.289, p=0.004) with &lt;70% heterogeneity. The pooled DOR was 53.42 (28.26-100.99, p=0.005) at random effect model. Conclusion: ML-FFR showed significant diagnostic values signifying that it can be used as a potential non-invasive alternative to iFFR for detecting lesion severity and guiding clinical decision-making in patients with suspected CAD, especially for those who are considered high-risk or ineligible for invasive angiography.
Abstract 4123563: High Prevalence of Unrecognized Actionable Cardiac Arrhythmias in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease
Authors: Jonas Leavitt, Kristie Coleman, Gregory Dumchin, Andrew Kossack, Jacob Schwartz, Brenda Garcia, Elliot Wolf, Erica Altschul, Margarita Oks, Bushra Mina, Stavros Mountantonakis
Journal: Circulation (2024)

Background: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for developing arrhythmias due to hypoxemia, right heart failure and use of beta-agonists inhalers. Symptoms related to arrhythmias can often be masked or confounded by symptoms related to COPD exacerbation and remain undiagnosed. Objective: To identify the incidence of actionable arrhythmias in patients with no prior cardiology follow-up and moderate–severe COPD with continuous monitoring. Methods: An automatic referral for electrophysiology (EP) consult was generated in patients with moderate-severe COPD if they answered yes to one of the following: palpitations, dizziness, abnormal ECG, near syncope. Upon consultation with EP specialist, implantation of loop reorder was discussed (ILR) with the patient. Patients were then monitored for 12 months via remote monitoring. Actionable arrhythmia was defined the arrhythmia that correlated with symptoms triggered by the patient, necessitated adjustment of medications (including initiation of anticoagulation), catheter ablation and implantation of implantable cardiac defibrillator (ICD) or permanent pacemaker (PPM). Results: Out of 62 patients referred 22 (35.5%) agreed to undergo ILR implantation. Of the 22 (50.0% female, 62 ± 9.5 years) patients implanted with an ILR, 15 (68.2%) had an actionable arrhythmia after a mean follow-up of 2.7± .3 months. These included 14 symptomatic events requiring medication adjustment (10 atrial tachycardias, 4 ventricular events), 7 cases of atrial fibrillation (requiring initiation of anticoagulation in all cases and catheter ablation in 1), 1 case of sinus node dysfunction requiring pacemaker implantation, and 1 episodes of sustained ventricular tachycardia requiring ICD implantation. Conclusion: Continuous monitoring had high yield in diagnosing significant arrhythmic events in patients with moderate-severe COPD. Awareness should be raised about the high arrhythmic risk of this population and the role of continuous monitoring should be sought in larger studies.
Abstract 4115947: Empagliflozin Inhibits the Mobilization of CCR2+ Monocyte-Derived Macrophages by Reducing CCL2 Expression in Fibroblasts and Slows the Progression of Heart Failure After Pressure Overload.
Authors: Shun Morishita, Keita Horitani, Ichiro Shiojima
Journal: Circulation (2024)

Background: The positive effects of sodium glucose co-transporter-2 (SGLT2) inhibitors on reducing cardiovascular mortality and hospitalizations due to heart failure have been well established. Although numerous theories propose explanations for the cardioprotective actions of SGLT2 inhibitors, these hypotheses primarily rely on initial findings and require further validation. Studies have shown that immune cells, particularly macrophages marked by C-C chemokine receptor type 2 (CCR2), contribute to the progression of heart failure by infiltrating the myocardium and inducing detrimental structural changes following myocardial infarction or pressure overload. Purpose: This study aims to investigate whether SGLT2 inhibitors can mitigate heart damage by inhibiting the migration of CCR2+ monocyte-derived macrophages. Methods: In this experiment, male B6 mice were subjected to transverse aortic constriction (TAC) to induce heart failure. Two weeks post-TAC, with heart function confirmed as equal across all groups by echocardiography, one group began receiving daily oral doses of empagliflozin, while another served as the control. At four weeks post-TAC, cardiac function was reassessed. The animals were then euthanized, and their hearts were analyzed using flow cytometry, staining, and qPCR to evaluate heart failure and the involvement of immune cells. Additionally, isolated cardiac fibroblasts were subjected to cyclic stretching to mimic post-TAC mechanical stress. Results: Treatment with empagliflozin resulted in improved cardiac function and reduced congestion in the heart and lungs, indicating alleviation of heart failure. The treatment notably decreased myocardial fibrosis, evident from Picrosirius-red staining and reduced expression of fibrosis-related mRNA. Importantly, empagliflozin specifically reduced the number of CCR2-positive macrophages in the heart, without affecting other types of immune cells. In cardiac fibroblasts that underwent cyclic stretching, empagliflozin pre-treatment diminished the expression of C-C motif chemokine ligand 2 (CCL2), the ligand for CCR2. Conclusion: Empagliflozin’s ability to suppress CCL2 expression in fibroblasts and curtail the recruitment of CCR2+ macrophages may represent a potential strategy to decelerate heart failure progression. These findings advance our understanding of the cardioprotective mechanisms of SGLT2 inhibitors and propose novel therapeutic avenues for heart failure management.
Abstract 4124005: Sex, ethnic and social determinants of health differences in high-potency P2Y12 inhibitors prescription among patients with acute coronary syndrome: An analysis of the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry
Authors: Hend Mansoor, Remy Poudel, Haoyun Hong, Shen Li, Kathie Thomas, Stephen Sigal, Jacqueline Tamis-Holland, Abhinav Goyal, Islam Elgendy
Journal: Circulation (2024)

Background: Sex and racial differences in the outcomes of patients with acute coronary syndrome (ACS) persist and could be related to the differences in management including high-potency P2Y12 inhibitors. Aim: This study aims to examine the contribution of social determinants of health on the association between sex and racial differences in the prescription of high-potency P2Y12 inhibitor upon discharge. Methods: Patients with ACS undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history. Analyses were performed in women and men separately. Results: Among 135,153 patients with ACS who underwent PCI, 59.8% were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed high-potency P2Y12 inhibitor (66.9% vs 72%), and this pattern did not change during the study period (P=0.50) (Figure). There was a significant interaction between sex and race for high-potency P2Y12 inhibitor prescription (P&lt; 0.05). Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men after adjusting for all covariates. Conclusions: In this large contemporary observational analysis of patients with AMI undergoing PCI, women were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities; however, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription. Further efforts should be directed to minimize these sex and racial disparities.
Abstract 4116410: A Novel Deep Learning Approach for Prediction of Right Heart Failure After Left Ventricular Assist Device Implantation using Pulmonary Artery Pressure Tracings
Authors: Melissa Lamicq, Cole Buchanan, Azalfa Lateef, Miriam Atteya, Brian Houston, Ryan Tedford, Ramsey Wehbe
Journal: Circulation (2024)

Introduction: Left ventricular assist device (LVAD) offers a lifeline for advanced heart failure patients, but ~30% experience post-operative right heart failure (RHF) with significant morbidity and mortality. Current methods for predicting RHF risk have limited accuracy. This study is the first of its kind to explore the feasibility of using a convolutional neural network (CNN) deep learning model with pulmonary artery pressure (PAP) tracings acquired during pre-operative hemodynamic assessment to identify patients at risk for early RHF. Methods: A CNN model was pre-trained on PAP tracings from the MIMIC-III Waveform Database to leverage transferable knowledge and improve model performance. The model learned general features and temporal relationships in hemodynamic tracing morphology for RHF prediction. It was then adapted for classification by modifying the output layers. Post-LVAD RHF was definitively adjudicated for each instance included from our 246 patient single center LVAD database. RHF was adjudicated using the 2020 Academic Research Consortium defintion. The database included 205 non-RHF instances and 41 RHF instances. We developed a novel signal processing method utilizing computer vision to extract PAP waveform data from pre-operative right heart catheterization reports. Data was reviewed to ensure accurate pressure tracing representation. SMOTE-ENN (synthetic oversampling) and class weighting addressed dataset imbalance during training to enhance model generalizability and RHF prediction accuracy. Results: The model achieved strong performance in classifying RHF from non-RHF outcomes, as evidenced by consistent AUC scores of 0.87 and 0.85 on validation and unseen test data, respectively. These findings indicate the potential for hemodynamic tracings to predict RHF after LVAD implantation. Notably, the model maintained its performance on unseen data, highlighting its generalizability. Conclusions: This study explored the feasibility of using a deep learning model for RHF risk stratification in patients with LVADs. The model, pre-trained on PAP tracings, achieved promising classification performance assessed by AUC. Further validation with larger, more diverse datasets will refine model performance and enhance generalizability for clinical application. Leveraging hemodynamic tracings within a deep learning framework holds promise for improved clinical outcome prediction.
Abstract 4114406: Galectin-3 and Progression of Kidney Disease in Patients With Type 2 Diabetes Mellitus: Analyses From the DECLARE-TIMI 58 Trial
Authors: Paul Haller, Stephen Wiviott, David Berg, Petr Jarolim, Erica Goodrich, Deepak Bhatt, Avivit Cahn, Ingrid Gause-Nilsson, Lawrence Leiter, Darren McGuire, Itamar Raz, JOHN WILDING, Marc Sabatine, David Morrow
Journal: Circulation (2024)

Background: Galectin-3 (Gal-3) is a circulating biomarker of fibrosis, with higher levels having been associated with an increased risk of progression of kidney disease. Patients with type 2 diabetes mellitus (T2DM) are at increased risk for kidney disease with fibrosis. Aims: To study the association of Gal-3 with chronic kidney disease progression, and the effect of the SGLT2-inhibitor dapagliflozin in pts with T2DM. Methods: DECLARE-TIMI 58 was a randomized, placebo-controlled trial of dapagliflozin in pts with T2DM with or at high risk for atherosclerotic cardiovascular (CV) disease and creatinine clearance ≥60ml/min. In a nested biomarker substudy, Gal-3 was measured at baseline (Alinity, Abbott Diagnostics) in the TIMI Clinical Trials Laboratory (Boston, MA). The prespecified kidney-specific composite endpoint (Kidney-EP) was a sustained ≥40% decrease in eGFR to &lt;60 mL/min, initiation of renal replacement therapy or confirmed sustained eGFR &lt;15 mL/min, or adjudicated renal death. Cox models were adjusted for baseline eGFR, urine albumin-creatinine ratio (UACR), patient characteristics, CV risk factors, NTproBNP and hs-cTnT. Results: Among 14,530 pts, median Gal-3 was 14.9 ng/mL [IQR, 11.9, 18.4]. Gal-3 was weakly associated with UACR (r = 0.098, p &lt; 0.0001) and eGFR (r = -0.27, p&lt;0.001) at baseline. Gal-3 was independently associated with the incidence of the Kidney-EP (adj-HR 1.15 [95% CI 1.03, 1.28] per 1-SD log(Gal-3), p = 0.013). Upon stratification by quartiles, there was a gradient of higher adjusted risk of the Kidney-EP with higher Gal-3 ( Fig., A ; p-trend &lt;0.0001). There were 111 (1.5%) and 203 (2,8%) Kidney-EPs in the dapagliflozin and placebo groups, respectively. Dapagliflozin significantly and similarly reduced the relative risk of the Kidney-EP across quartiles of Gal-3 (overall HR 0.45 [95%CI 0.23, 0.85], p&lt;0.0001; p-interaction = 0.97, Fig., B ). However, there was greater absolute benefit of dapagliflozin with higher Gal-3 (ARR Q4 1.9 [95% CI 0.6, 3.2] vs. Q1 0.6% [-0.1, 1.3], ARR p-trend 0.048). Conclusion: Plasma Gal-3 is associated with progression of kidney dysfunction in patients with T2DM independently of patient characteristics, including baseline kidney function. Moreover, Gal-3 identified an increasing gradient of absolute benefit of dapagliflozin for reducing kidney disease progression.
Abstract 4114505: Cardiovascular Adverse Events After Anti-BCMA CAR-T (Ide-Cel and Cilta-Cel) for Relapsed/ Refractory Multiple Myeloma
Authors: Stefanie Palfi, Himara Koelmeyer, Melissa Alsina, Rachid Baz, Brandon Blue, Salvatore Corallo, Gabriel De Avila, Ciara Freeman, Ariel Grajales-Cruz, Kristy Harvey, Hien Liu, Taiga Nishihori, Guilherme Oliveira, Laura Oswald, Omar Castaneda Puglianini, Kenneth Shain, Zachary Wettenstein, Michael Jain, Frederick Locke, Mohammed Alomar, Doris Hansen, Dae Hyun Lee
Journal: Circulation (2024)

Introduction: Idecabtagene vicleucel (Ide-Cel) and ciltacabtagene autoleucel (Cilta-cel) are novel CAR-T therapies targeting B-cell maturation antigen (BCMA) and approved for relapsed and refractory multiple myeloma (RRMM). While cardiovascular adverse events (CVAE) are relatively common with CD-19 CAR-T, the incidence of CVAE in the real-world setting for anti-BCMA CAR-T in RRMM is largely unknown. This study aims to determine the incidence of CVAE and its associated risk factors in patients treated with ide-cel and cilta-cel. Method: This single-center retrospective cohort study evaluated RRMM patients treated with ide-cel and cilta-cel from May 2021 to December 2023. We assessed baseline cardiac and oncologic characteristics and clinical outcomes post-CAR-T. Cytokine release syndrome (CRS) and immune cell-associated neurologic syndrome (ICANS) grading followed ASTCT consensus guidelines. Result: A total of 164 RRMM patients treated with ide-cel (N=109) or cilta-cel (N=55) with at least 6 months follow-up were included. The average age was 63 years, and 57% were male. Advanced RRMM stage (R-ISS III) was present in 17% with a median of 6 prior lines of therapy. CRS grade equal or greater than 2 occurred in 22%, and ICANS grade equal or greater than 3 in 6.7%. Twenty patients (12.2%) experienced CVAE, including atrial fibrillation (7.9%), non-sustained ventricular arrhythmia (3.0%), heart failure (3.7%), and cardiovascular death (0.6%). R-ISS III was associated with increased CVAE (52.9% vs. 11.5%; P=0.001). Patients with CVAE had higher baseline ferritin and CRP levels and a higher incidence of CRS grade ≥ 2 (60% vs. 16.7%; P&lt;0.001) and ICANS grade ≥ 3 (20% vs 4.9%; P=0.001). Treatment with tocilizumab, steroids, or anakinra was more common in patients with CVAE. Conclusion: CVAE occurred relatively frequently following BCMA CAR-T therapy, with high-grade CRS identified as a consistent risk factor. Most CVAEs were manageable with appropriate supportive care, including careful observation and active treatment of CRS.
Abstract 4114461: Low-density lipoprotein cholesterol, prevalence of cardiovascular disease risk factors, and predicted cardiovascular disease risk among young adults: National Health and Nutrition Examination Survey 2015-2020
Authors: Alexander Zheutlin, Samuel Luebbe, Eric Stulberg, Alexander Chaitoff
Journal: Circulation (2024)

Introduction: It is unclear if young adults with hyperlipidemia are also more likely to have non-lipid cardiovascular disease (CVD) risk-factors or higher long-term CVD risk. As such, we assessed associations between low-density lipoprotein cholesterol (LDL-C) levels and non-lipid CVD risk factors as well as 10- and 30-year risk of CVD in young adults. Methods: We included a nationally representative sample of adults 20-&lt;40 years from the National Health and Nutrition Examination Survey (January 2015-March 2020). We described sociodemographic characteristics and CVD risk factors by LDL-C level. We used simple logistic regression to determine associations between LDL-C level and each CVD risk factor. We then calculated the median 10- and 30-year CVD risk by LDL-C category for each participant using the PREVENT risk estimating equations. Results: Among 2,133 (weighted estimation: 90.3 million) young adults, 51.0%, 32.6%, 12.5%, and 3.9% had an LDL-C &lt;100 mg/dL, 100-&lt;130 mg/dL, 130-&lt;160 mg/dL, and 160-&lt;190 mg/dL, respectively. Compared to participants with an LDL-C &lt;100mg/dL, those with an LDL-C 100-&lt;130 mg/dL, 130-&lt;160 mg/dL, and 160-189 mg/dL were more likely to have metabolic syndrome, an enlarged waist, hypertension, elevated glucose, diabetes mellitus, high triglycerides, and high hs-CRP (Table). The median 10-year risk of CVD was approximately 1% across all baseline LDL-C levels. Over a 30-year time horizon, the median risk of incident CVD exceeded 5% only in the 130-&lt;160mg/dL and 160-189mg/dL LDL-C categories (6.0% and 7.6%, respectively). LDL-C and the interaction between LDL-C and CVD risk enhancing factors were independently associated with 30-year predicted risk of CVD (p=0.006 and p=0.005, respectively). Discussion: Many young adults with an elevated LDL-C have concomitant high-risk CVD characteristics. The risk/benefit calculous for addressing this modifiable risk factor in these patients should be further explored.
Abstract 4116708: Variations in Patients’ Perceptions of Continuity of Care After Hospitalization Due to Cardiac Condition
Authors: Emma Safstrom, Anna Stromberg
Journal: Circulation (2024)

Background: Continuity of care is crucial to enabling a seamless chain of care after hospitalization due to cardiac conditions. Most measurements (e.g., continuity indexes) neglect the patient's perception of continuity. Inequality in medication and treatment is well known within cardiac care, but there is a lack of knowledge about whether there are inequalities in how patients perceive continuity of care after hospital discharge. Aims: Describe perceptions of continuity of care after hospitalization in patients with cardiac conditions and variations in age, gender, and diagnosis. Methods: This cross-sectional study included patients hospitalized at 4 hospitals in Sweden due to cardiac conditions. Data were collected using the Patient Continuity of Care Questionnaire, a 27-item questionnaire with 6-subscales. A sub-scale score &lt;4 indicates an area of concern. Factorial ANOVA was used to analyze interactions or main effects of sex, age (&lt;65 or ≥65), and diagnosis (angina, atrial fibrillation, heart failure, myocardial infarction) on perceived continuity of care. Independent t-tests or post-hoc analysis with LSD correction compared group differences. Results: A total of 1,000 patients were included, with a mean age of 72 (SD 10) years, 661 (66%) males. For the sub-scales, no significant 3- or 2-way effects were found. In the sub-scale: Information to patient (mean 4.1), significant differences were found in sex, age, and diagnosis. For the sub-scales Relations in hospital (mean 4.3) and Relations in community (mean 4.1), significant differences were found in sex and diagnosis. There were significant differences between the diagnosis groups in the sub-scale: Management of follow-up (mean 3.9). In the sub-scale: Management of communication (mean 3.7), significant differences were found in sex and age. For the sub-scale: Management of forms (mean 3.8), significant differences were found based on age. See Figure 1a-1c for details. Conclusion: Overall, patients hospitalized due to cardiac conditions reported a quite high level of continuity of care. However, statistically significant differences were found, and men, younger patients and those hospitalized due to myocardial infarction perceived higher levels of continuity or care. This indicates that patients who are more dependent on continuity of care, who might be more fragile and have a diagnosis with a complex clinical pathway, are experiencing lower levels of continuity of care