tbuckley/cabot-search huggingface dataset:
Abstract 18076: MicroRNA-342-3p Rescues Post-Ischemic Cardiac Function in Diabetic Mice via HGF-MET Pathway Activation
Authors: Anurag Jamaiyar, Jingshu Chen, Winona Wu, Carmel Assa, Henry Cheng, Daniel Perez-Cremades, Mark W Feinberg
Journal: Circulation (2023)

Introduction: - Patients with diabetes have a poorer prognosis following myocardial infarction compared to healthy controls. This is partly due to impaired post-ischemic angiogenesis in the diabetic heart. The role of microRNAs (miRs) in angiogenesis is relatively unexplored. miR expression is responsive to stimuli such as hypoxia, metabolic environment, growth factors, etc. Here, we describe how miR-342-3p, a hypoxia-responsive miR, regulates angiogenesis under physiologic and diabetic conditions. Methods: - miR-342-3p or control mimic was injected into the border zone of hearts post-ischemia/reperfusion in male Ldlr -/- mice on a high fat and high sucrose (HFSC) diet. Echocardiography, histology, immunofluorescence, RNA FISH and in vitro assays were used to elucidate the mechanism of action of this miR. Results: - Ejection fraction (EF) and fractional shortening (FS) of miR-342-3p injected hearts were significantly higher by 145% and 173%, respectively, at day 14 compared to controls (p = 0.0204 and p = 0.0095). Capillary density as well as ki67+ endothelial cells were more abundant by 107% and 154%, respectively (p = 0.0371 and p = 0.0242) vs control. RNA sequencing of miR-342-3p overexpressing endothelial cells implicated HGF-MET signaling as one of the top upregulated pathways. Western blots (WB) revealed an increase in MET expression (p = 0.0255) in miR-342-3p overexpressing cells vs control. Decorin (DCN) was identified as a direct target of miR-342-3p and validated by WB and luciferase reporter assays. Hypoxia (2% O 2 ) induced miR-342-3p expression (p = 0.0023) while suppressing DCN levels. However, both high glucose (25 mM) and palmitate (100 μM) treatments blunted the miR-342-3p induction while increasing Decorin levels. Co-IP and microscopy were used to show Decorin-MET co-localization. Lastly, miR-342-3p and DCN were inversely expressed (p = 0.0188 and p = 0.0015 respectively) in diabetic and healthy ECs obtained from patients. Conclusion: - These findings establish a critical role for miR-342-3p in regulating cardiac angiogenesis post-ischemic injury in diabetic mice. Under diabetic conditions, the hypoxia induced expression of miR-342-3p is blunted, leading to Decorin mediated degradation of MET receptors, which impairs angiogenesis.
Abstract 14081: Higher Fish Intake and a Healthy Lifestyle May Be Associated With a Lower Platelet Count/Lymphocyte Count Ratio: Implication for the Anti-Atherosclerotic Effect of Fish Intake
Authors: Masaki Monden, Shigemasa Tani, Tsukasa Yagi, Tadashi Ashida, Keiichiro Kuronuma, Naoya Matsumoto, Yasuo Okumura
Journal: Circulation (2023)

Introduction: Higher fish intake and healthy lifestyle behaviors are associated with a reduced risk of atherosclerotic cardiovascular disease (ASCVD). A higher platelet count/lymphocyte count ratio (PLR), an inflammatory predictive marker of ASCVD, is reportedly associated with a higher incidence of CVD. Hypothesis: We hypothesized that higher fish intake would be associated with lower PRL, and a healthy lifestyle would also be associated with lower PLR. Methods: We conducted a cross-sectional study between April 2019 and March 2020 at the Health Planning Center of Nihon University Hospital in a cohort of 5957 participants (average age, 46.7 ± 12.9 years; 58.9%, men) with no history of ASCVD. We calculated the amount of fish intake based on the average number of days of fish intake per week and data from the Japanese National Health and Nutrition Survey. Results: The average weekly frequency and amount of fish intake were 2.25 ± 1.30 days and 140.5 ± 86.7 g, respectively. As the weekly fish intake increased (&lt; 50, 50-100, 100-150, 150-200, 200-250, 250-300, and ≥ 300 g), the PLR significantly decreased (p &lt; 0.0001). A multivariable logistic regression analysis identified higher fish intake as an independent determinant of a lower PLR. Aerobic exercise was also an independent negative determinant of PLR. Furthermore, with increasing frequency of fish intake, the proportion of participants engaging in habitual aerobic exercise increased (p &lt; 0.0001). Conclusions: The results suggest that a higher fish intake and a healthier lifestyle related to fish intake habits are associated with a lower PLR and thus may exert beneficial anti-inflammatory effects. This association may explain the preventive effects of fish intake on ASCVD risk. Further investigations are needed to clarify the causal relationships between these factors.
Abstract 13645: Prognostic Value of Aortic Valve Calcification in Asymptomatic Patients With Non-Severe Aortic Valve Stenosis and Preserved Ejection Fraction
Authors: Zi Ye, Thomas A Foley, Rohan Gajjar, Maurice E Enriquez Sarano, Hector I Michelena
Journal: Circulation (2023)

Introduction: Criteria for aortic valve intervention (AVI) in severe aortic stenosis (AS) rely on symptoms, left ventricular ejection fraction (LVEF) and AS severity. Computed tomography-based aortic valve calcification (CT-AVC) scores associated with severe AS also have prognostic value, but this remains unexplored in patients with non-severe AS. We aimed to assess the prognostic value of AVC in asymptomatic patients with nonsevere AS and preserved LVEF. Methods: We retrospectively identified 395 patients with ≥mild AS but less-than-severe AS by echocardiography, who had CT-AVC assessed within six months. AVCscore was quantified offline by Agatston method (TeraRecon software), and also indexed by LV outflow track area, i.e., AVCdensity. Patients were followed until AVI or death. The primary outcome was all-cause death under medical surveillance. Results: In 395 patients, mean age was 73±12 years, 61% were men, mean aortic valve area 1.2±0.3cm2, mean gradient 28±9 mmHg, peak velocity 3.4±0.5 m/s, LVEF 64±6%. During a follow-up of 2.2[0.74-4.94] years, 220 patients had AVI and 82 patients died. Both AVCscore and AVCdensity were associated with AVI-free survival and the best AVCscore thresholds associated with mortality were 853 in women and 1183 in men by log-rank test (both p&lt;0.001). High AVCscore and high AVCdensity were associated with increased hazard for all-cause death in unadjusted and adjusted analyses (Figure), and after further adjustment for echocardiographic severity (all p ≤0.01). Conclusions: In asymptomatic patients with less-than-severe AS, sex-specific CT-AVC scores differentiate those at higher risk for death versus lower risk. Whether AVI could modify this risk remains to be proven.
Abstract 18766: Optimizing Stroke Prophylaxis in the Emergency Department With an Electronic Clinical Decision Support Tool: A Preliminary Analysis of a Multi-Stage Multi-Center Stepped-Wedge Cluster Randomized Trial
Authors: Bradley J Hopkins, Thuan Nguyen, Erin Kinney, Joy Kim, Caitlin McCracken, Ky Bissell, Andreea Gosman, Anya DeCarlo, Mariam Anwar, Matthew R Neth, Nikolai Schnittke, Benjamin Sun, Bory Kea
Journal: Circulation (2023)

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia that is often first diagnosed in the Emergency Department (ED). AF is associated with an increased risk of stroke that can be reduced by 64% if an oral anticoagulant (OAC) is prescribed appropriately. RESEARCH QUESTION: Will education and implementation of a clinical decision support (CDS) tool in the ED increase OAC prescription for appropriate candidates diagnosed with new-onset or paroxysmal AF (pAF)? METHODS: This is the first phase of a multi-stage multi-center stepped-wedge cluster-randomized clinical trial implementing a CDS tool into the electronic health record (EHR). Step one implements an external browser link to the CDS tool in the EHR with targeted provider education, whereas steps 2 and 3 will motivate provider engagement with triggers. Data were collected from an urban academic tertiary care center and a community hospital. Patients aged greater than 17 years were selected if they had a primary diagnosis of AF/pAF during ED visits from Jan 2020-Apr 2023. The academic and community sites transitioned from the retrospective phase to Step 1 in Jan 2022 and Apr 2022, respectively. Appropriate OAC prescription was determined based on elevated stroke risk and low-moderate bleed risk. A logistic GEE model was used to study the effect of the proposed intervention on OAC prescription. ED providers were treated as a random effect to capture clustering. The model includes the CDS intervention, site, and patient characteristics sex, race, ethnicity, and age. RESULTS: Of 2031 patients, 312 met inclusion criteria and 150 were selected as appropriate OAC candidates, with 72 (52% male, median age 74) in the retrospective step and 78 (52% male, median age 76) in Step 1. Below are odds ratio estimates with corresponding 95% CI’s: CDS intervention 3.12 [1.57, 6.21] and sex female vs male 2.04 [1.04, 4.00]. Non-significant variables site, race, ethnicity, and age were included as adjusting covariates. CONCLUSIONS: Limited CDS tool education and integration is associated with improved OAC prescribing for appropriate AF/pAF patients. Future studies should assess the impact of additional CDS integration on OAC prescribing and patient outcomes.
Abstract 15268: Abnormal Single-Lead Electrocardiograms Predict Future Atrial Fibrillation Risk: The VITAL-AF Trial
Authors: Daniel Pipilas, Shaan Khurshid, Mostafa Al-Alusi, Steven Atlas, Jeffrey M Ashburner, Leila H Borowsky, David D McManus, Daniel E Singer, Steven A Lubitz, Yuchiao Chang, Patrick T Ellinor
Journal: Circulation (2023)

Introduction: The use of single-lead electrocardiograms (1L ECG) is increasing due to the proliferation of devices available to consumers. Automated software algorithms provide real time analyses using the 1L ECG signal, yet it is unclear whether these interpretations confer a future risk of AF. Aim: Investigate the risk of future AF by automated 1L ECG interpretation in patients who did not receive an AF diagnosis within 60 days of screening 1L ECG Methods: Patients enrolled in the VITAL-AF trial were categorized based on automated interpretation of 1L ECGs by the AliveCor KardiaMobile device: Normal = all 1L ECGs were interpreted as “Normal”, Possible AF = at least one “Possible AF”, Other = at least one “No Analysis” or “Unclassified” but no “Possible AF”. Time to incident AF was calculated with the beginning of the at-risk period defined as 60 days after the latest 1L ECG. Confirmatory testing was not required by the trial protocol, so the at-risk period was designed to exclude delayed AF diagnoses. Cox proportional hazard regression models were used to compare groups adjusting for age, body mass index, hypertension, myocardial infarction, diabetes mellitus, congestive heart failure and smoking status. Results: The study included 14,181 patients ( Normal n = 10,930, Other n=2,689, Possible AF n= 562). As expected, a report of Possible AF had the highest AF incidence (5.75% per year, 95% Confidence Interval [CI] 4.12-8.00) and was associated with greater risk of incident AF compared to Normal (adjusted Hazard Ratio [aHR] 2.73, 95% CI 1.87-3.98). Interestingly, a diagnosis of Other was also associated with a marked increased risk of incident AF (2.37, 95% CI 1.88-2.99) ( Figure) . Conclusions: Abnormal 1L ECGs with incident AF not confirmed within 60 days were still predictive of future AF compared to “Normal” tracings. Further monitoring may be warranted following abnormal 1L ECGs.
Abstract 14647: EchoNext: An ECG-Based Deep Learning Model to Detect Structural Heart Disease
Authors: Linyuan Jing, Joshua Finer, Dustin Hartzel, Christopher Kelsey, Daniel Rocha, Jeffrey Ruhl, Alexander Volodarskiy, Ashley Beecy, Christopher M Haggerty, Timothy J Poterucha, Pierre Elias
Journal: Circulation (2023)

Introduction: Early detection of structural heart diseases (SHD) can help improve patient outcomes. Electrocardiogram (ECG) based deep learning (DL) models have the potential to identify patients (pts) with undiagnosed disease in need of further testing such as echocardiography. Most models have focused on detecting a single abnormality. A few studies have attempted detection on a comprehensive aggregate set of outcomes, but with limited scope and external validation. Hypothesis: An ECG DL model can identify pts at risk for SHDs, with stable external validation performance regardless of hospital type (academic/community), clinical setting (inpatient/outpatient/emergency department), or demographics (race/ethnicity). Methods: We identified 426,659 ECG-echo study pairs since 2008 from 5 NewYork-Presbyterian-affiliated (NYP) hospitals, including Columbia, to train the EchoNext DL model. ECGs were associated with SHD if acquired within one year prior to an echo reporting left ventricular (LV) ejection fraction ≤45%, LV wall thickness ≥1.3cm, moderate or severe valvular disease, moderate or large pericardial effusion, moderate or severe right ventricular dysfunction, or pulmonary artery systolic pressure ≥45 mmHg. EchoNext was tested on unseen data from four other NYP hospitals, including Cornell. Results: In the external dataset (n=21,421 pts), 33% were identified with SHD. EchoNext achieved an area under the receiver operating characteristic curve (AUROC) of 0.85, with robust results with respect to individual hospital (AUROC range: 0.82-0.87), clinical setting (0.78-0.84), and patient race/ethnicity (0.84-0.86; Figure). Conclusion: EchoNext demonstrated excellent performance in detecting SHD in the largest multi-institutional, multi-racial external validation of such a model to date. This model may allow AI-enabled reflex referral to echocardiography from ECG. Prospective trials are ongoing to validate.
Abstract 12631: Recognizing and Predicting Drug-Induced Type I Brugada Pattern Using ECG-Based Deep Learning
Authors: Luigi Pannone, Paul A Calburean, Cinzia Monaco, Domenico G Della Rocca, Antonio Sorgente, Alexandre Almorad, Gezim Bala, Robbert Ramak, Ingrid Overeinder, Erwin Ströker, Gudrun Pappaert, Mark La Meir, Pedro BRUGADA, Juan Sieira, Andrea Sarkozy, Gian Battista Chierchia, Carlo de Asmundis
Journal: Circulation (2023)

Introduction: Brugada syndrome (BrS) has been associated with sudden cardiac death in otherwise healthy subjects and drug-induced BrS accounts for 55-70% of all BrS patients. Aims: This study aims to develop a deep convolutional neural network and evaluate its performance in recognizing and predicting BrS diagnosis. Methods: Consecutive patients that underwent ajmaline testing for BrS following a standardized protocol were included. ECG tracings from baseline and during ajmaline were transformed using wavelet analysis and a DCNN was trained to recognize and predict BrS type I pattern. The resultant network is referred to as BrS-Net. Results: A total of 1188 patients were included of which 361 patients (30.3%) developed BrS type I pattern during ajmaline infusion. When trained and evaluated on ECG tracings during ajmaline, BrS-Net recognized a BrS type I pattern with an AUC-ROC of 0.945 (0.921 - 0.969). The best predictive performance was obtained when predictions for all ECG leads were combined using a machine learning (ML) technique, Figure 1. When trained and evaluated on ECG tracings at baseline, before ajmaline, BrS-Net predicted the development of a BrS type I pattern during ajmaline with an AUC-ROC of 0.805 (0.736 - 0.845). The best predictive performance was obtained when predictions for all ECG leads were combined using a ML technique, Figure 2. Conclusions: BrS-Net, a deep convolutional neural network, can identify BrS type I pattern with high performance. BrS-Net can predict from baseline ECG the eventual development of a BrS type I pattern after ajmaline with good performance in an unselected population.
Abstract 15189: Association of Serum Albumin Levels and Post Stroke Outcomes in Acute Ischemic Stroke. Analysis of the Norfolk and Norwich Stroke Registry
Authors: Rosa J Thuemmler, Tiberiu A Pana, Ben Carter, Joao H Bettencourt, Anthony K Metcalf, john potter, Phyo K Myint
Journal: Circulation (2023)

Introduction: Low serum albumin levels have been associated with poor acute ischemic stroke (AIS) outcomes. We hypothesised this relationship may be non-linear and aimed to assess it in a large cohort of unselected AIS patients with long term follow-up. Method: This retrospective cohort study included patients from the Norfolk and Norwich Stroke and TIA Register: consecutive AIS patients aged ≥40 years from Dec 2003-Dec 2016 with complete follow-up data. The primary exposure of interest was admission serum albumin. Assessed outcomes were in-hospital mortality, poor functional outcome at discharge (modified Rankin score of 3-6), length of stay (LoS) &gt;4 days and long-term mortality. Poisson and Cox regressions were used to investigate the relationship between albumin and in-hospital and long-term outcomes, respectively. Restricted cubic splines modelled these relationships flexibly. All models were adjusted for confounders, including inflammatory markers on admission and stroke severity. Results: A total of 9,979 patients were included (mean age (standard deviation) = 78.3 (11.2) years, 57% female). The mean serum albumin was 36.69g/L (5.38); the median (IQR) was 37g/L (34-40). Lower-than-median albumin (&lt;37g/L) was significantly associated with up to 2-fold higher long-term mortality risk (HR max ; 95% confidence interval = 2.01; 1.61-2.49) and in-hospital mortality (RR max ; 95% confidence interval = 1.48; 1.21-1.80). Higher-than-median albumin (&gt;44g/L) was associated with higher long-term mortality (HR max 1.12; 1.06-1.19), but not in-hospital mortality. There were no significant associations between admission albumin and LoS or poor functional outcome ( Figure ). Conclusion: Albumin &lt;37g/L was associated with higher in-hospital and long-term mortality whilst levels &gt;44g/L were associated with higher long-term mortality. Future studies should explore nutritional interventions for better stroke outcomes.
Abstract 16305: Closing the Disparities Gap for Heart Transplant Patients Bridged to Transplant With Temporary Mechanical Circulatory Support
Authors: Jemi Galani, Rebecca Steinberg, Jeffrey Wang, Krishan Patel, Alexis Okoh
Journal: Circulation (2023)

Background: There are known disparities in waitlist outcomes by race and sex among patients bridged to heart transplant (BTT) with durable mechanical circulatory support (MCS). With the increasing use of temporary MCS devices (tMCS), we examined waitlist and post-transplant outcomes of patients who had BTT with tMCS. Methods: Data from the United Network for Organ Sharing (UNOS) database was used to identify patients BTT with tMCS between 2008 and 2018. Patients were stratified by race and sex. Primary outcomes were waitlist mortality within 1 year of listing and 1 year post-transplant mortality among those who successfully reached transplant. Survival was examined with the Kaplan Meier method and Cox proportional hazard modeling. Results: A total of 997 patients received tMCS as BTT, including 606 white, 203 Black, 119 Hispanic, 56 Asian, 13 other race, and 302 (30%) female patients. Baseline hemodynamics were comparable among groups. Waitlist mortality within 1 year of listing was 35.8% overall and similar for all races (p=0.418) and both sexes (p=0.617). Among those who successfully reached transplant, there were no differences in 1 year post-transplant survival by race (p=0.722) or sex (p= 0.475). On multivariable Cox proportional hazard modeling, neither race nor sex was associated with waitlist or post-transplant mortality (p=NS). Level of education (&lt;high school) was independently associated with 1 year waitlist mortality (HR 1.49, 95% CI 1.06 - 2.06). History of diabetes (HR 1.38, 95% CI 1.07-1.74) and post-transplant dialysis (HR 1.66, 95% CI 1.18-2.29) were associated with 1 year post transplant mortality. Conclusions: Unlike in BTT with durable MCS, we did not find differences in outcomes associated with race and sex among patients BTT with tMCS. Given the sharp increase in tMCS use after the 2018 U.S. allocation change, it will be important to closely monitor that access to transplantation and outcomes of BTT with tMCS patients continue to be equitable.
Abstract 15237: Feasibility and Diagnostic Accuracy of Handheld Echocardiography in Patients Hospitalized With Acute Coronary Syndrome
Authors: Jolien Geers, Patrycja Molek, Amy Balfour, Simona Botezatu, Shruti S Joshi, Audrey White, Joanne McCarley, Russell Everett, Gillian Martin, David Cusack, Bernard Cosyns, David E Newby, marc R dweck
Journal: Circulation (2023)

Introduction: Transthoracic echocardiography (TTE) is recommended in every acute coronary syndrome (ACS) patient, but is time-consuming and not always deliverable. Development of handheld echocardiography (HHE) devices provide a fast, low-cost method to facilitate rapid bedside clinical assessment of those patients. Hypothesis: We hypothesized that evaluation of hospitalized ACS patients using HHE is feasible and provide similar information to standard TTE in detecting important cardiac pathology. Methods: Patients admitted with ACS were prospectively enrolled, and underwent both bedside HHE (Philips Lumify) and clinical TTE evaluation. Independent analysis of HHE and TTE images was performed by a blinded expert team to determine key predetermined imaging findings that might alter management of ACS patients (Table 1). The TTE analysis was repeated for these variables after 1 month. Agreement of HHE vs TTE was assessed with kappa statistics and compared to agreement of TTE vs TTE as reference standard. Results: The analysis included 108 patients (mean age 65y, 78% male). Duration of HHE was a third faster than targeted clinical TTE (8.2±1.8min vs 12.1±5.0min; p&lt;0.001). Agreement in detecting the following variables was good (&gt;0.60) and similar for HHE vs TTE compared to TTE vs TTE: left ventricle (LV) dilatation, LV hypertrophy, LV ejection fraction &lt;40%, anterior and inferior wall motion abnormalities, right ventricle (RV) dilatation, pericardial effusion, aortic stenosis, ventricle septum defect, and takotsubo cardiomyopathy. Agreement between HHE vs TTE was less good than TTE vs TTE for detection of lateral wall motion abnormalities, RV dysfunction, and LV thrombus. Conclusions: In ACS patients, bedside HHE is faster and provides similar diagnostic information to TTE for the majority of key echo findings. However, important exceptions exist, in particular HHE is less good at detecting lateral wall motion abnormalities, RV dysfunction and LV thrombus.