tbuckley/cabot-search huggingface dataset:
Abstract 15898: Appropriateness of Cardiology Clinic Notes Transcribed by a Popular, Publicly Available Artificial Intelligence Model (GPT-4)
Authors: Ashish Sarraju, Fatima Rodriguez, Luke Laffin, Dennis Bruemmer, Leslie Cho, David Ouyang
Journal: Circulation (2023)

Introduction: Artificial intelligence large language models (LLMs) such as GPT-4 have gained millions of users and public attention. GPT-4 may have the potential to support medical workflows, especially clinical note transcription. However, whether GPT-4 can appropriately transcribe simple cardiology clinical encounters into notes has not been evaluated. Research Question Can GPT-4 accurately and appropriately transcribe clinic encounters of simple cardiology presentations into medical notes? Methods: Five hypothetical encounters were created as detailed dialogue between a physician and patient, covering subjective and objective data, assessment, plan, and counseling. Encounters covered presentations of stable angina, primary prevention, secondary prevention, familial hypercholesterolemia, and acute pericarditis. GPT-4 was prompted to transcribe each encounter using three prompts: 1) to transcribe a medical note; 2) to transcribe a medical note and add additional relevant recommendations; and 3) to transcribe a medical note and add additional relevant recommendations with reference to specific AHA guidelines. Each note was graded by a board-certified cardiologist at a tertiary center as appropriate (accurate transcription and recommendations) or inappropriate (inaccurate transcription or recommendations). Results: With prompts 1 and 2, all GPT-4 notes were classified as appropriate (Table). With prompt 3, all notes were transcribed accurately but had inaccurate references to AHA guidelines and were classified as inappropriate. Conclusion: GPT-4 has the potential to appropriately transcribe dialogue-based clinic encounters of simple cardiology conditions to medical notes. However, beyond direct transcription, supportive guidelines or references provided by GPT-4 for encounters may be inappropriate. Efforts to develop LLMs for cardiology clinical encounter transcriptions should account for these limitations.
Abstract 15002: Cardiovascular Disease Risk Prediction by Random Survival Forest: The Korean National Health Insurance Service-National Health Screening Cohort
Authors: Sooyoung Park, Sarah Ratcliffe, Kathryn Bowles, Connie M Ulrich
Journal: Circulation (2023)

Introduction: Risk prediction is critical for cardiovascular disease (CVD) prevention and management. Existing CVD risk prediction models including the Framingham Risk Score (FRS) are based on the Cox proportional hazard ratio regression. Adaptation of a data mining approach could improve the accuracy of CVD risk prediction by being free from the linearity assumption. The aim of study was to construct Korean population-based CVD risk prediction models using random survival forest and to compare their predictive accuracy to the FRS in a 14-year Korean cohort. Methods: This was a secondary data analysis using a Korean population-based cohort. Out of 463,783 eligible participants, 70% were selected for training dataset using stratified random sampling, and the remaining 30% served as test dataset. Random survival forest was adopted to build risk prediction models using the training dataset. The test dataset was used to test the validity of the new models and the FRS. Results: Three random forest-based models were developed, and they were good in discrimination in both men and women with the c-statistics ranging from 0.698 to 0.747 while the c-statistics for the FRS were 0.692 and 0.733 in men and women, respectively. All random forest-based models showed good calibration, whereas the FRS tended to overestimate the CVD risk for men. Conclusions: The random survival forest-based models showed comparable performance with the FRS in a Korean population-based cohort. Continuous efforts are needed to improve the accuracy of CVD risk prediction for the Korean population and to utilize CVD risk prediction in clinical practice.
Abstract 17556: Predictors of Mortality and Burden of Arrhythmias in the Hospitalized Population With End-Stage Heart Failure; a Five-Year Retrospective Population-Based Study
Authors: Endurance O Evbayekha, Carlos Gaibor, Yara Jelwan, Leonela Bastidas, Rani Kuttab, Amer Abbas, Brittany Dixon, Shane LaRue
Journal: Circulation (2023)

Introduction: Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). We aimed to identify arrhythmias contributing to poor QoL and mortality in the inpatient setting. Hypothesis: The burden of arrhythmias in eHF may be overwhelming and a significant predictor of mortality. Understanding this may help proffer clinical management and improve outcomes. Methods: We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariate logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. Results: There were 22703 hospitalizations with eHF (mean age 67 years ±16), 66.5% (15091) were men, 59% (13018) were Caucasians, 27.2% (6017) were Blacks, 8.7% (1924) were Hispanics and 2.9% (505) Asians. Of these, 50.4% (11434) had atrial fibrillation (AFIB), 5.3% (1201) supraventricular tachycardia (SVT), 2.6% (586) ventricular fibrillation (VFIB), 1.6% (372) complete heart block (AVB3), and 0.4% (85) type 2 degree block (AVB2). All subgroups had independent associations with mortality, and VFIB was the highest predictor; adjusted odds ratio (aOR) 5.8 (4.6-7.1, p&lt;0.0001), AFIB 4.3 (3.9-4.5, p&lt;0.0001), SVT 1.9 (1.6-2.4, p&lt;0.0001), AVB3 1.8 (1.3-2.4, p&lt;0.0001), and AVB2 1.3 (0.6-3.0, p=0.5). Conclusion: Our analysis revealed that a high percentage of the in-hospital population with end-stage heart failure is burdened with atrial fibrillation. Ventricular fibrillation, atrial fibrillation, supraventricular tachycardia, and complete heart block all carried independent mortality risk, with ventricular fibrillation having the highest risk. Proactive management of arrhythmias in this population is warranted.
Abstract 18471: Cardiovascular Risks Among the Transgender Population in Rural United States: Spotlight on the Appalachian Region
Authors: Ebubechukwu Ezeh, Maddie Perdoncin, Mohammed Al-Hiari, Chukwuemeka Ogbu, MELISSA MARCUM, Elizabeth Saunders, Jason Mader
Journal: Circulation (2023)

Introduction: Previous findings suggest that transgender (TGD) populations have disproportionately higher cardiovascular (CV) risks. We aimed to evaluate the prevalence and odds of CV risk factors in the TGD population in rural Appalachia. Methods: Our case-control study enrolled 92 self-identified TGD people and 73 randomly selected cisgender people. The average age for the TGD and cisgender groups were 29.2 and 29.9, respectively. CV risks of interest examined in both groups were tobacco use, hypertension (HTN), prediabetes/diabetes mellitus (DM), obesity, and hyperlipidemia (HLD). Univariate analysis was used to generate the prevalence of risk factors. Multivariable logistic regressions, adjusted for age and family history of ASCVD, were used to estimate the odds ratio and 95% confidence Interval of having risks of interest. Results: This analysis included 89 and 69 TGD and cisgender individuals, respectively. There was a &gt;6-fold increase in tobacco use (adjusted OR 6.64 [2.59-17.01]) and 4-fold increase in prediabetes/DM (adjusted OR 3.98 [1.05-15.15]) among the TGD population. Among the TGD population, there were increased odds of obesity (OR 13.39 [3.30-54.30] and HLD (OR 3.46 [1.03-11.59]) in the trans-male group compared to the trans-female group. Also, surgical and/or hormonal treatments were significantly associated with higher odds of tobacco use (OR 6.67 [2.80-15.98]), and statin need (OR 3.97 [1.14-13.81] in the TGD group. Conclusion The TGD population have disproportionately higher odds of CV risks in rural Appalachia, worse among trans-male and individuals who received hormonal and/or surgical treatment. This study is limited by sample size.
Abstract 17490: Impaired Cerebrovascular Oxygen Delivery, Reserve, and Metabolism in Adult Fontan Patients
Authors: Silvie Suriany, Botian Xu, Clio Gonzalez-Zaccarias, Jian Shen, Sharon O'Neil, Ashok Panigrahy, Bradley Peterson, Jon Detterich, John C Wood
Journal: Circulation (2023)

Introduction: Patients with univentricular hearts undergo a three-stage surgical palliation, culminating in total caval-pulmonary connection (Fontan procedure), maximizing delivery of oxygenated blood to the systemic circulation. Prior brain research in this population has highlighted genetic predisposition, in-utero oxygen delivery, surgical insults, and pre-Fontan cyanosis as possible mechanisms of brain injury, but none have examined the impact of the Fontan repair on brain hemodynamics. Study Purpose: To determine the sufficiency of brain O 2 delivery, cerebrovascular reserve (CVR), brain O 2 extraction fraction (OEF), and cerebral metabolic rate of O 2 (CMRO 2 ) in adult Fontan patients, compared to permeability-surface area (PS) of blood brain barrier (BBB) integrity to water, and endothelin levels. Hypothesis: We hypothesized that brain O 2 delivery, CVR, PS, and CMRO 2 would be decreased in Fontan patients, proportional to endothelin levels, an established surrogate for low cardiac output. Methods: We have enrolled 35 Fontan patients (age 20.8 ± 2.5 years, 21M) and 24 control subjects (age 23.4 ± 4.8 years, 9M) to undergo brain MRI, excluding all subjects with known stroke, seizure, or genetic abnormalities. We collected total cerebral blood flow (CBF), OEF, CVR, and PS using 3T MRI. Results: Table 1 summarizes differences in O 2 delivery, CBF, OEF, CMRO 2 , CVR, PS, and endothelin levels in the study cohort. O 2 delivery, CBF, CVR, and CMRO 2 were decreased in Fontan patients; OEF and PS were not different. Endothelin was increased but uncorrelated with the brain metrics. CMRO 2 was correlated with PS (r 2 = 0.19, p&lt;0.001). Conclusion: Adult survivors of Fontan palliation have decreased brain O 2 delivery and reserve, without compensatory OEF increases, leading to lower CMRO 2 . Decreased CMRO 2 was associated with decreased PS, but not endothelin, suggesting microvascular dysfunction rather than low cardiac output as the fundamental etiology.
Abstract 13946: Predictive Value of FDG-PET/CT Derived Coronary Artery Calcium Scoring in Non-Small Cell Lung Cancer Patients
Authors: Aryan Zahergivar, William F Auffermann, Jordan Chamberlin, Ismail Kabakus, Jeremy R Burt
Journal: Circulation (2023)

Introduction/Background: Coronary artery calcium (CAC) scoring on PET-CT has emerged as a potential prognostic tool in patients with cancer. Research Question/Hypothesis: CAC determined using non-ECG gated PET-CT data is a useful predictor of major adverse cardiac events (MACE) and overall survival in non-small cell lung cancer (NSCLC) patients. Goals/Aims: To investigate the association between CAC scores, MACE, and survival outcomes in NSCLC patients. Methods/Approach: We retrospectively analyzed baseline staging PET-CT (n=130) or CT (n=24), clinical history, demographics, and follow-up survival data of NSCLC patients. Patients were divided into four groups based on their CAC scores according to the 2016 SCCT/STR guidelines. Cox regression analysis was performed to assess the association between CAC score and survival, CAC score and MACE, and smoking history and survival. Results/Data: The mean age of the population was 66.3 ± 10.8 years with 42.9% never smokers. Of the 154 patients evaluated, 49.3% died during a mean follow-up period of 3.5 years. Cox regression analysis revealed a trend toward improved survival rates of patients with lower CAC scores (P= 0.081 for No/Minimal risk and P= 0.039 for Mild group). Current or prior smoking was significantly associated with decreased survival (P = .013, HR = 1.8). Logistic regression analysis showed a significant inverse relationship between CAC scores and MACE (n=32) for no risk/minimal (P = .001) and mild risk (P &lt; .001) groups. Additionally, there was an inverse association between CAC and number of observed acute MI for no /minimal risk group (P= .02) and mild risk group (P= .003). Conclusion: Our findings suggest that lower CAC scores, measured at initial staging PET-CT, are associated with decreased MACE and acute MI in NSCLC patients. Further studies are needed to validate these findings and explore the potential of CAC scoring as a routine prognostic tool in NSCLC management.
Abstract 17917: Effect of Transcatheter Aortic Valve Replacement (TAVR) on the Dicrotic Notch in Patients With Severe Aortic Stenosis
Authors: Odette Iskandar, Shivabalan Kathavarayan Ramu, Maryam Muhammad Ali Majeed-Saidan, Habib Layoun, James J Yun, Grant W Reed, Rishi Puri, Amar Krishnaswamy, Samir R Kapadia
Journal: Circulation (2023)

Background: The dicrotic notch in the aortic pressure waveform is seen around the time of closure of the aortic valve at the end of systole and the beginning of diastole. We aim to study the change in the dicrotic notch post TAVR in patients with severe AS and its impact on clinical outcomes. Methods: We included patients with severe AS who underwent TAVR consecutively between 2019-2020. Central aortic pressure waveforms were reviewed from the SyngoDynamics imaging software (Siemens Healthcare, Malvern, PA) for the invasive hemodynamic data obtained during TAVR. Heights of the systolic, diastolic blood pressure and dicrotic notch waveforms are measured. Dicrotic notch index (DNI) is calculated as the difference between the SBP and dicrotic notch divided by the pulse pressure (see figure 1). The invasive hemodynamics are compared between pre and post TAVR using independent samples t test. Statistical significance was defined as two-tailed p-value less than 0.05. Survival analysis is performed using cox regression. Results: A total of 724 patients (1448 studies) were evaluated. There is significant increase in dicrotic notch pressure (p&lt;0.001) and DNI (p&lt;0.001) post-TAVR in the overall population. Women (n=310) had a higher pre-TAVR and post-TAVR DNI (p&lt;0.001 and p&lt;0.01 respectively). Figure 1 shows hemodynamic characteristics of before and after TAVR. Heart failure hospitalization (HFH) or mortality at 3 years (composite outcome) was present in 146 patients (20.1%). DNI was lower in patients reaching composite outcomes compared to patients surviving without HFH (p&lt;0.001). Conclusion: Higher DNI after TAVR is associated with lower HFH and mortality after TAVR. Simple measurement of DNI offer substantial prognostic value to patients with severe AS undergoing TAVR.
Abstract 18248: Physical Activity and Nutrition Self-Efficacy Associates With Perceived Everyday Discrimination in African American Women: The Step It Up Physical Activity Intervention
Authors: Foster Osei Baah, Yvonne Baumer, Hannatu Tarfa, Ayushi Dave, Mario Pita, Manuel A. Cintron, Lola Ortiz-Whittingham, Sandy Reynolds, Fnu Abhinav Saurabh, Potharaju Kameswari, Andrew Baez, Keitra Thompson, Colby Ayers, Sam Neally, Kaveri Curlin, Nithya Vijayakumar, Valerie Mitchell, Ayanna Wells, Marie Marah, Billy Collins, Tonya Dodge, Gwenyth Wallen, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Background: Increased self-efficacy facilitates health promoting behaviors such as physical activity (PA). Perceived discrimination may limit PA among minoritized populations, but little is known about the relationship between PA and nutrition self-efficacy (PANSE) and perceived discrimination (PD) among African American (AA) women with overweight/obesity. Methods: We examined the associations between PANSE and PD in 106 AA women in the Step It Up, a community-engaged, digital health intervention. All completed the PANSE (higher scores = higher self-efficacy), the everyday discrimination scale (higher scores = higher frequency of everyday discrimination), and a sociodemographic survey. We used linear regression to assess the associations between PANSE and PD adjusting for covariates and the interaction effects of discrimination and income. Results: The participants had a mean age of 55.9 (SD±12.7) years with mean BMI 36.3 (SD±6.9) kg/m2. PD was negative and significantly associated with PANSE in both our unadjusted model and after adjusting for age and educational level (Table 1). The association trended marginally significant in the third model when we adjusted for income. We found no interaction effect between PD and income. Conclusion: PD is associated with PANSE among this AA women cohort. This suggests an urgent need for future research to better extricate the relationship between PD and PANSE to inform interventions that addresses everyday discrimination among diverse population groups; particularly in AA women with overweight/obesity.
Abstract 14503: Chemokine Ligand 18 (CCL18) is a Long-Term Predictor of All-Cause Mortality, but Did Not Predict CVD Events
Authors: Dennis W Nilsen, Reidun Aarsetoey, Thor Ueland, Pal Aukrust, Annika Michelsen, Volker Poenitz, Trygve Brugger-Andersen, Harry Staines, Heidi Grundt
Journal: Circulation (2023)

Introduction: Chemokines mediate leukocyte recruitment and activation. Chemokine ligand 18 (CCL18) is mainly expressed by a broad range of cells such as monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability. Circulating CCL18 levels are transiently elevated in patients admitted with unstable angina pectoris, but data on myocardial infarction (MI) are scarce. Aim: To assess the utility of CCL18 as a prognostic marker of CVD in patients hospitalized for chest pain of suspected coronary origin. Methods: The population consisted of 871 consecutive patients (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log e -transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within 24-months and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, and TnT. Results: Plasma samples from 849 patients were available. By 24 months FU, 138 (15.8%) patients had died; 86 were cardiac deaths. The univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30-1.83), p=0.000], and for cardiac death [HR 1.32 (95% 1.06-1.64), p=0.013]. Applying multivariable analysis, the associations were no longer significant. At 7 y FU, a total of 332 (38.1%) patients had died. After multivariable adjustment, CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01-1.29), p=0.030], but not for MI (n=203) or stroke (n=55). The positive association between CCL18 and all-cause mortality was lost when combined with CVD events; all-cause mortality or MI (n=404, p=0.75), and all-cause mortality or MI or stroke (n=422, p=0.79). Conclusions: CCL18 predicts long-term all-cause mortality, but had no independent prognostic bearing on short-term cardiac death and CVD events during long-term FU.
Abstract 15784: Clonal Hematopoiesis of Indeterminate Potential is Associated With Increased Risk of Incident Hypertension
Authors: Mohammadreza Naderian, Seyedmohammad Saadatagah, Ozan Dikilitas, Iftikhar J Kullo
Journal: Circulation (2023)

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) is associated with an increased risk of heart failure (HF) and stroke, particularly HF with preserved ejection fraction and hemorrhagic stroke (HS). Hypothesis: We hypothesized that CHIP is associated with incident hypertension and this association mediates the effect of CHIP on HF and HS. Methods: In 200K UK-Biobank participants with exome sequencing, we ascertained CHIP as variant allele fraction (VAF) ≥2% and large CHIP as VAF ≥10%. Hypertension, HF, and HS diagnosis were determined based on the ICD-9 and ICD-10 codes. Cox proportional hazards models were used to test the association of both CHIP and the CHIP subtypes based on the most implicated driver genes (i.e., DNMT3A , TET2 , and ASXL1 ) with incident hypertension. Logistic regression models were used for mediation analyses, quantifying the extent to which hypertension mediates the effects of CHIP. Results: After excluding those with hematological malignancy (n=1,025) and pre-existing hypertension (n=14,754), 184,760 participants (56.14±8.12 years, 44.25% male, and 95.33% white ethnicity) were included. During a median follow-up of 12.2 years, 42,049 (22.76%) participants developed hypertension. CHIP mutations were significantly associated with incident hypertension (Table). Mutations in DNMT3A and TET2 but not ASXL1 drove this association. Mediation analysis revealed 17.9% (9.4% - 38.2%, P&lt;0.001) of the effect of CHIP on HF and 5.7% (2.4% - 22.4%, P&lt;0.001) of the effect on HS were mediated through the increased risk of hypertension. Conclusion: CHIP is associated with an increased risk of hypertension. The association of CHIP with HF and HS is partially mediated by hypertension. These findings suggest a new mechanistic pathway for the association of CHIP with cardiovascular diseases.
Abstract 14259: Contractile Effects of Glucagon in Atrial Preparations From Transgenic Mice and Men
Authors: Joachim Neumann, Wilhelm Hußler, Britt Hofmann, Ulrich Gergs
Journal: Circulation (2023)

Glucagon, a peptide composed of 29 amino acids, produced mainly in the pancreas can also stimulate cardiac function. Glucagon might contribute to hyperglycemia in diabetes mellitus type 2 and is thus of clinical relevance. There is controversy in the literature whether glucagon affects force and beating rate in the human atrium and which receptor is involved. Hence, we studied the effect of glucagon on atrial preparations of wild type mouse hearts (WT), from transgenic mice with cardiac overexpression of the human glucagon receptor (GR-TG) and for comparison in human right atrial preparations. We noted that glucagon exerted concentration- and time-dependent positive chronotropic effects in atrial preparations from WT and GR-TG starting at 0.1 nM glucagon and amounting to 25 % of pre-drug value at 3 nM glucagon (n=8, p&lt;0.05). These effects were antagonized by the glucagon receptor antagonist SC203973 (1 μM), the inhibitor of cAMP dependent protein kinase H89 (1 μM), by the M-cholinoceptor agonist 1 μM carbachol, by the A1-adenosine receptor antagonist R-phenylisopropyladenosine (1 μM) and the inhibitors of hyperpolarization-activated cyclic nucleotide gated channels namely ivabradine (1 μM) or cesium chloride (2 mM) (n=5-6, p&lt;0.05). In left atrial preparations from GR-TG but not WT, glucagon exerted starting at 1 nM a positive inotropic effect. Interestingly, in human atrial preparations glucagon at 1 μM in the additional presence of the phosphodiesterase III inhibitor cilostamide (1 μM) increased force of contraction by 34 % (n=5, p&lt;0.05). We conclude that glucagon can exert contractile effects in mammalian hearts via GR, but they exhibit considerable regional and species differences. The physiological and therapeutic relevance of glucagon in the human heart needs to be fully elucidated.