tbuckley/cabot-search huggingface dataset:
Abstract 4137359: Electrocardiographic ST–T area assessed by a computerized quantitative method were associated with increased risk of cardiovascular disease, especially ischemic stroke, in patients with cardiovascular risk factor
Authors: Yuki Hirata, Tomoyuki Kabutoya, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2024)

Background: ST changes in the lateral leads, which reflect ischemic changes, are associated with cardiovascular events. However, quantitative assessment of the ST–T area and its association with cardiovascular events remains unclear. Hypothesis: Electrocardiographic ST–T areas in lateral leads (V5 and V6) quantitatively assessed by machine analysis were associated with cardiovascular events. Methods: We enrolled 4,654 subjects from the Cardiovascular Prognostic Coupling Study in Japan (Coupling Registry), who had one or more cardiovascular risk factors. The primary endpoint was composite (cardiovascular death, myocardial infarction, stroke), and the secondary endpoints were myocardial infarction and stroke. ST–T area was assessed as the area enclosed by the baseline from the end of the QRS complex to the end of the ST–T segment using a computerized quantitative method. We used the lower magnitude of ST–T area in the V5 or V6 lead for the analysis. The endpoints were compared between the lowest quartile of ST–T area (Q4) and the others (Q1–3). Results: The mean follow-up period was 53 ± 17 months. The composite endpoint was 159 cases, myocardial infarction in 27 cases and cerebral infarction in 72 cases. The lowest quartile of ST–T area (N= 1,162) had significantly more cardiovascular events than the other Q1–3 groups (N= 3,492, hazard ratio [HR] 2.25, 95% confidence interval [CI] 1.64–3.10) after adjusting for age, gender, and other covariates. The onset of myocardial infarction did not reach statistical difference (HR 2.05, 95% CI 0.94–4.46, p=0.072), but the lowest quartile of ST–T area significantly more ischemic stroke than the other Q1–3 groups (HR 2.37, 95% CI 1.48–3.75 p&lt;0.001) Conclusions: The lower summations of ST–T area assessed by a computerized quantitative method were associated with increased risk of cardiovascular disease, especially ischemic stroke, in patients with one or more cardiovascular risk factors.
Abstract 4137708: Implementation of a Standard Hydration Protocol Improves Compliance of Pre-procedural Hydration, Reducing the Incidence of Contrast-Induced Acute Kidney Injury (CI-AKI) After Percutaneous Coronary Intervention (PCI)
Authors: Ju Hyun Lee, Amilcar Avendano, Rebecca Nutt
Journal: Circulation (2024)

Introduction: Intravenous hydration and contrast media volume reduction are the most important preventive factors against CI-AKI after PCI. Multiple studies have demonstrated the effectiveness of intravenous hydration before PCI, however, varied hydration protocols have rather complicated standardization. Doctors’ preferences and local institutional factors further hinder protocol implementation, resulting in reduced compliance. Hypothesis: Standardizing hydration protocol increases the compliance rate of preprocedural hydration orders and administration, reducing the incidence of CI-AKI. Methods: A team at Memorial Hermann The Woodlands Medical Center, comprising a cardiovascular nurse coordinator, catheterization laboratory director, pharmacist, information technologist, and hospital administrators, was formed to improve PCI outcomes through a multi-faceted approach. This involved a standardized hydration protocol with direct education, continuous monitoring, and repeated internal feedback, reviewed monthly. The new protocol included normal saline pre- and post-procedure maintenance fluids, with a 250 ml normal saline bolus pre-operatively. Maintenance fluids were set at 75 ml/hr, and 20 ml/hr for patients with congestive heart failure and an ejection fraction ≤ 40%. The team reviewed 233 patients under the old protocol and 281 under the new protocol. Compliance rates of pre-procedural intravenous hydration were compared and CI-AKI incidence, defined as a &gt;50% increase or a 0.3 mg/dL increase in creatinine levels within 5 days post-procedure, was assessed. Chi square tests and t-tests were used to compare cohorts on 12 parameters and CI-AKI incidence assessment, with a p-value of 0.05. Results: Compliance with pre-procedural hydration significantly increased under the new protocol (86.1% vs 55.4%, p&lt;0.05). CI-AKI incidence was lower in the new protocol group (7.5% vs 9.9%, p=0.33). Although statistically insignificant in this preliminary analysis, the results were still promising due to a relative CI-AKI reduction of 24.3%. A sample size of 352 patients per group is needed to achieve a power of 0.8. Conclusion: The new standardized hydration protocol, coupled with education, increased compliance with pre-procedural hydration and showed a promising trend towards reducing CI-AKI among PCI patients. The final report will be presented upon study completion.
Abstract 4137672: Prevalence, Clinical Characteristics, and Outcomes in Heart Failure with Improved Ejection Fraction by Sex
Authors: Yilin Liang, Keane Lee, Rishi Parikh, Andrew Ambrosy, Thida Tan, Steven Hamilton, Maria Pabon Porras, Orly Vardeny, Sahar Naderi, Ivy Ku, Elena Vasti, Alexander Sandhu, Alan Go, Sirtaz Adatya, Ankeet Bhatt
Journal: Circulation (2024)

Background: Heart failure with improved ejection fraction (HFimpEF) is a growing clinical entity. While males are more likely to present with HFrEF, there remains little understanding of how sex relates to the epidemiology, predictors, and progression of HFimpEF. Research Question: What are the differences in epidemiology, clinical characteristics, medical management, and outcomes in patients (pts) with HFimpEF based on sex. Methods: We identified adults age ≥18 years with incident HFrEF (EF ≤40%) between January 2013 and December 2018 within Kaiser Permanente Northern California, an integrated health system serving &gt;4.5 million members. HFimpEF was defined as subsequent EF measurement &gt;40% within the following 12 months. Sex was based on self-report. Among pts with HFimpEF, we examined guideline-directed medical therapy (GDMT) use at time of incident HFimpEF, and at 6- and 12-months post-HFimpEF, stratified by sex. The incidence of worsening HF (WHF) events and all-cause death was assessed in a landmark analysis at 12 months post-HFrEF. We compared event rates between patients with HFimpEF and persistent HFrEF using Cox proportional hazards models adjusted for baseline age and EF. Results: Among 12,639 patients with incident HFrEF (female: 36%), 33% experienced HFimpEF. Females were more likely to experience HFimpEF in the 12 months following HFrEF than males (34% vs. 32%, p&lt;0.01). Among pts with HFimpEF, treatment with GDMT was similar among males and females and declined after incident HFimpEF in both sexes (Figure, Panel A). Females had similar rates of WHF or all-cause death compared to males (adjusted [a]HR: 1.10, 95% CI: 0.96, 1.26, P=0.17). Compared with those with persistent HFrEF, pts with HFimpEF had lower rates of WHF or all-cause death, a finding which was consistent by sex (male: aHR: 0.55, 95% CI: 0.50 to 0.61, female: aHR: 0.54, 95% CI: 0.48 to 0.62; Pinteraction by sex=0.78; Figure, Panel B). Conclusions: HFimpEF is more common among females compared to males, but prognosis is similar. Despite similar medical therapy, GDMT discontinuation after EF improvement is prevalent. Improvement in EF is similarly associated with improved outcomes across sex. Further data are needed to elucidate the differential etiologies of HF by sex.
Abstract 4137891: Treated HIV infection is not associated with carotid vascular inflammation or plaque progression as assessed by dynamic contrast magnetic resonance imaging
Authors: Saate Shakil, Daniel Chen, Daniel Isquith, Jamie Sapp, Isabella Pommier, Baocheng Chu, Yin Guo, Gador Canton, Niranjan Balu, Chun Yuan, Thomas Hatsukami, Charles Maynard, Xue-qiao Zhao, Francis Kim
Journal: Circulation (2024)

Background: Inflammation and immune dysregulation are thought to drive residual cardiovascular disease risk among persons living with HIV (PLWH) despite effective viral suppression with antiretroviral therapy (ART). Question: We investigated differences in carotid vascular inflammation and atherosclerosis in a longitudinal cohort of virally suppressed PLWH (n = 50; on stable ART with CD4 &gt;250 cells/mm 3 , viral load &lt;200 copies/mL for &gt;6 months) and HIV-uninfected controls (n = 51) matched for age, sex, hypertension, diabetes, smoking, hyperlipidemia, and family history of premature coronary artery disease. Methods&amp;Results: Participants were &gt; 40 years old at enrollment, 8% female, and had a high prevalence of cardiovascular risk factors ( Table 1 ). Measures of carotid inflammation and capillary permeability ( K trans ), neovascularization ( V p ), and wall thickness were assessed at baseline, 1 year, and change over 1 year by dynamic contrast-enhanced magnetic resonance imaging. Both PLWH and controls demonstrated a reduction in systolic and diastolic blood pressures and total cholesterol over 1 year; however, the difference was not significant by HIV status. PLWH had a significant reduction in triglycerides compared with controls (-48.8 mg/dL vs 12.8 mg/dL; p = 0.026). HIV was not associated with baseline, follow-up, or change in markers of systemic inflammation assessed by plasma cytokines (C-reactive protein, interleukin-6, interleukin-1ß), nor vascular inflammation or plaque as assessed by K trans , V p , carotid wall thickness, or percent wall volume ( Tables 2 &amp; 3 ). Conclusions: In contrast to other studies of chronically treated and virally suppressed PLWH, HIV infection was not associated with carotid inflammation or plaque.
Abstract 4137646: Transcriptomic Profiling of Human Myocardium at Sudden Death to Define Vulnerable Substrate for Lethal Arrhythmias
Authors: Arianne Caudal, Yu Liu, Paul Pang, David Maison, Kosuke Nakasuka, Jean Feng, Hannah Sabeth Schwarzer-Sperber, Roland Schwarzer, Ellen Moffatt, Timothy Henrich, Arun Padmanabhan, Andrew Connolly, Joseph Wu, Zian Tseng, MD
Journal: Circulation (2024)

Background: While some chronic pathological substrates for sudden cardiac death (SCD) are well-known (e.g., coronary disease and left ventricular [LV] dysfunction), the vulnerable myocardial state predisposing to fatal arrhythmia remains a critical barrier to near-term SCD prevention. Hypothesis: Myocardium of autopsy-defined SCDs exhibit distinct expression profiles vs. non-cardiac sudden deaths and trauma deaths that reflect its acute vulnerable state in the hours to days before SCD, as expression arrests upon death. Goals/Aims: Define the vulnerable myocardial substrate for lethal arrhythmia by targeted RNA profiling. Methods: We used autopsy to adjudicate arrhythmic from non-arrhythmic causes in 1,265 sudden deaths in San Francisco from 2011-2018. We performed a transcriptomic evaluation of LV sampled at the time of SCD from 245 consented cases using a curated panel of 448 genes with known or hypothesized association with SCD. Results: Comparison between Arrhythmic (n=129) and Non-Arrhythmic (n=116) cohorts revealed 31 differentially upregulated and 36 downregulated genes (p-adj&lt;0.05), related to collagen-containing extracellular matrix (upregulation of FAP , FMOD , LTBP2 ), ion transport (upregulation of KCNA5 and KCNN3 , and downregulation of KCNJ8, KCNK1, KCNJ5 ), and contraction (downregulation of MYH6 ). Fibrosis-related genes showed the highest magnitude increased expression in Arrhythmic vs. Non-arrhythmic deaths and vs. published transcriptomes from end-stage heart failure. After molecular stratification by known markers for mature ( COL1A1, COL1A2, COL3A1) and active ( POSTN , MEOX1 ) fibrosis, cases with highest expression of both had the highest proportion of arrhythmic cause of death (27/36 [75%]) vs. cases with low expression of both (87/181 [38%], p=0.006) or vs. mature only (10/14 [71%]) or active only (5/14 [36%]). Activated fibroblast gene expression was enriched in Arrhythmic female vs. Arrhythmic male cases, among other sex-specific differences in ion channel and myosin (upregulation of SCN4B , SCN8A , KCNAB1 in females, KCNJ4 and MYH7B in males) expression. Conclusions: RNA profiling of myocardium at SCD identifies active fibrosis, undetectable by conventional clinical methods, in the presence of fixed scar and selected ion channel dysregulation (more pronounced among female cases) as an acute vulnerable substrate for fatal arrhythmias, and may identify patients at elevated near-term risk for SCD and novel pathways for intervention.
Abstract 4135215: Eosinophilic Coronary Periarteritis (ECPA): An Under-recognized Coronary Disease with Fatal Consequences
Authors: Wilfredo Henriquez, Allison Hade, Dana Booth, Pamela Hsu
Journal: Circulation (2024)

Clinical presentation: A 50-year-old male with a paraesophageal hernia and grade D esophagitis presented to the ER with complaints of heartburn. He subsequently went into cardiac arrest and was diagnosed with a hemopericardium with tamponade physiology from a ruptured right coronary artery (RCA). Imaging Findings: Initial CT of the chest found a 1.5x1.5 cm dilation of the proximal RCA (Fig1A). Post cardiac arrest, repeat CT of the chest revealed an interval increase of the proximal RCA measuring 3.5x3.5 cm and a moderate-to-large hemopericardium (Fig1B). An emergent limited TEE demonstrated a large circumferential hemopericardium and biventricular standstill. Decision-making: In the ER, the initial symptoms resolved and he remained under observation. Hours later, he became bradycardic with a heart in the 20s and was found unresponsive. ACLS was activated and the patient was emergently cannulated and ECMO was initiated due to refractory cardiac arrest. Despite efforts from a multidisciplinary team including cardiology, cardiothoracic surgery and cardiac critical care, ROSC could not be achieved thus portending a poor prognosis. The family decided to withdraw care and the patient expired. Autopsy revealed a 925 mL hemopericardium from a ruptured 3.5 cm severely aneurysmal RCA and other remarkable findings included a 2 cm proximal aneurysm of left anterior descending artery and a 1 cm proximal aneurysm of left circumflex artery (Fig2A,B). Genetic testing for connective tissue disease was negative. Histopathology showed an eosinophilic predominant inflammatory infiltrate of the adventitia suggesting periarteritis (Fig2C) without signs of vasculitis in other organs. Conclusion: ECPA (eosinophilic coronary periarteritis) is a fatal entity with reported cases of sudden cardiac death and findings of vessel medial degeneration and coronary dissection. This case raises awareness of an under-recognized condition with limited guidance in diagnostic and therapeutic interventions.
Abstract 4137527: Evaluation of 10-Year Atherosclerotic Cardiovascular Risk Prediction Performance using the PREVENT versus Pooled Cohort Equations in a US Integrated Healthcare System
Authors: Hui Zhou, Yiyi Zhang, Mengnan Zhou, Soon Kyu Choi, Kristi Reynolds, Brandon Bellows, Andrew Moran, Lisandro Colantonio, Norrina Allen, Monika Safford, Jaejin An
Journal: Circulation (2024)

Background: The American Heart Association published the new PREVENT equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk. Question: Do the PREVENT equations improve risk prediction for 10-year ASCVD compared with the pooled cohort equations (PCEs) in a large diverse population? Aim: To assess ASCVD risk prediction performance of the two PREVENT equations [PREVENT Base, PREVENT Base plus optional predictors including urine albumin-to-creatinine ratio, glycated hemoglobin, and social deprivation index (PREVENT Full)] compared with the PCEs. Methods: We included adults aged 40-75 years without a history of ASCVD or diabetes from Kaiser Permanente Southern California in 2009 and followed them through 2019. Outcome was incident ASCVD defined as myocardial infarction, fatal coronary heart disease, fatal and nonfatal stroke. We compared model discrimination (Harrell’s C), mean calibration (estimated as the ratio of predicted to observed event rates), and calibration curve among the overall population and stratified by sex and race/ethnicity. Results: Of the 559,111 adults (mean age 54, 11% Black, 32% Hispanic), 10,695 developed an ASCVD event during a median follow-up of 10 years. Harrell’s C among the overall population was 0.741 (95% CI 0.736-0.745) for PREVENT Base, 0.743 (0.738-0.748) for PREVENT Full, and 0.741 (0.736-0.746) for the PCEs ( Table ). Compared with the PCEs, both PREVENT equations improved Harrell’s C in men but not in women, and in Black adults but not in other racial/ethnic groups. Both PREVENT equations were well-calibrated (mean calibration ranged 0.83-1.37; calibration slope ranged 0.71-1.28), while the PCEs overestimated 10-year ASCVD risk (mean calibration ranged 1.80-2.20; calibration slope ranged 0.34-0.45) ( Table &amp; Figure ). Conclusion: Compared with the PCEs, both PREVENT Base and Full equations improved calibration in predicting 10-year ASCVD risk, with minimal improvement in discrimination in men and Black adults only.
Modeling the epidemiologic impact of age-targeted vaccination for drug-resistant tuberculosis
Authors: Pei-Yao Zhai, Zhi-Xian Chen, Ting Jiang, Jian Feng, Bin Zhang, Xiao Zang, Yan-Lin Zhao, Gang Qin
Journal: Drug Resistance Updates (2024)

This study used a calibrated mathematical model to evaluate age-specific tuberculosis (TB) vaccination strategies, for drug-resistant (DR)-TB management in China. Prioritizing elderly vaccination significantly reduced multidrug-resistant or rifampicin-resistant TB incidence and mortality, while avoiding the need for second-line treatment, offering a promising approach to mitigate DR-TB burden by 2050.
Abstract 4137678: Maximal Oxygen Uptake Prediction From Resting and Submaximal Variables of Cardiopulmonary Exercise Testing by Using Machine Learning Methods
Authors: YongHun Lee, Jeffrey Feng, Al Rahrooh, Alex Bui, Christopher Cooper, Jeffrey Hsu
Journal: Circulation (2024)

Background: Cardiorespiratory fitness, as measured by maximal oxygen consumption (VO2max) during a cardiopulmonary exercise test (CPET), is a prognostic indicator for longevity and adverse cardiovascular event prevention. This study aims to formulate a regression model utilizing resting and submaximal variables during CPET evaluation in the general population to predict VO2max. Methods: We used 13,535 CPET results on cycle ergometer collected by the UCLA Exercise Physiology Research Laboratory over eight years. Patients were divided into a normal group (NG; n=1,400) and an other group (OG; n=12,135). The inclusion criteria for the NG were: the absence of any known clinical diagnosis, BMI &lt;30, no current use of beta blocker, and VO2max &gt;85% of the predicted value for age and sex (Wasserman equation). OG refers to all other patients not in NG. Models were trained and evaluated for each group using stratified 5-fold cross-validation. We also trained different models using only resting variables (R-VARS) and resting and submaximal exercise variables (R+S-VARS). Feature importance was assessed using Shapely additive explanations (SHAP) values to identify how the feature related to the VO2max prediction. Results: The regression models were trained on the NG, OG, and total (N+OG) groups. The optimal models were Bayesian Ridge for the NG and Light Gradient Boosting Machine for the other two groups. The mean (standard deviation) R2 when using only R-VARS was 0.67(0.037) for the NG, 0.54 (0.014) for the OG, and 0.55 (0.009) for the N+OG. When using R+S-VARS, performance increased to 0.82 (0.014) for the NG, 0.80 (0.010) for the OG, and 0.8 (0.008) for the N+OG. Chronotropic index (ci), body mass index (BMI), VO2 at the first ventilatory threshold (VO2h1kg), minute ventilation at the second ventilatory threshold (VEH2), and forced expiratory volume (FEV1) were important features across the models trained with R+S-VARS. CI, BMI, and VEH2 had a negative effect, while VO2h1kg, FEV1 had positive effect on VO2max prediction. Conclusion: Our VO2max prediction model demonstrated remarkable accuracy in this dataset representing a generally healthy, non-athlete population using R+S-VARS. Particularly noteworthy was the enhanced performance within subgroups exhibiting a lower VO2max. This methodology offers a means to assess VO2max for individuals who might not achieve maximal exhaustion during CPET due to non-cardiopulmonary reasons.
Abstract 4135059: Enhanced Expression of iNOS is Associated with Aortic Valve Stenosis in Patients Undergoing Hemodialysis
Authors: Yumi Kashima, Yoshiki Matsumura, Yusuke Kure, Masanori Matsuo, Yuya Sakamoto, Masashi Nakagawa, Kenji Shimeno, Ryo Matsumoto, Yukio Abe, Takahiko Naruko
Journal: Circulation (2024)

Background: Patients undergoing hemodialysis (HD) have a greater prevalence of aortic valve calcification and aortic valve stenosis (AS). High prevalence and rapid progression of AS have been reported in patients undergoing HD. However, the precise mechanism of the relationship between HD treatment and rapid development of AS is still unknown. Several findings suggest a pivotal role for oxidative stress in the progression and acceleration of atherosclerosis in patients undergoing HD. A considerable number of human diseases have an inflammatory component, and a key mediator of immune activation and inflammation is inducible nitric oxide synthase (iNOS). Overexpressed iNOS has been implicated in numerous pathogenetic processes, including coronary plaque destabilization. To elucidate the role of iNOS in the aortic valve of patients with AS, we studied its presence in aortic valve specimens from patients with AS undergoing HD. Methods: We enrolled 32 patients undergoing HD and 42 patients not undergoing HD who had severe AS and underwent AVR. Valve samples were analyzed immunohistochemically with antibodies against macrophages, microvessels, iNOS and 4-hydroxy-2-nonenal (4-HNE), an index of lipid peroxidation. Immunoreactivity was quantified with computer-aided polarimetry. Double immunostaining was also performed to identify cell types that stained positive for iNOS. Results: Quantitative analysis demonstrated that macrophage-, iNOS-, and 4-HNE-positive areas, as well as the number of microvessels, were significantly higher in patients with AS undergoing HD (macrophages, P &lt;0.001; microvessels, P &lt;0.05; 4-HNE, P &lt;0.05; iNOS , P &lt;0.001). iNOS-positive areas were positively correlated with 4-HNE-positive areas (R=0.71, P &lt;0.0001). Double immunostaining for both iNOS and macrophages identified iNOS-positive cells as macrophages. Conclusions: These findings indicate that accumulation of iNOS in macrophages may increase oxidative stress and contribute to the rapid progression of AS in patients undergoing HD.