tbuckley/cabot-search huggingface dataset:
Abstract 4145655: Association Between Social Vulnerability Index and Heart Failure Mortality in the USA
Authors: Laura Gonzalez, GODFREY TABOWEI, Anu Radha Twayana, Shahmeer Lodhi, Rami Al-Ayyubi
Journal: Circulation (2024)

Background: Heart failure (HF) is a primary cause of hospital readmissions with extremely high projected annual costs. Social Vulnerability Index (SVI) assesses a community's ability to recover from external impacts on public health and provides valuable insights into community-level health outcomes. We aim to identify the association between SVI and HF. Methods: We used a national database (CDC WONDER) to identify the mortality of HF patients in the USA who were ≥25 years in 2020. HF was identified by specific ICD codes I11.0, 13.0, I13.2, and I50. We obtained the SVI per county from the CDC Database. We used the Pearson correlation coefficient (PCC) to examine the association between HF mortality and total SVI overall and within subgroups. Additionally, we employed ANOVA to evaluate the relationship between SVI quartiles and mortality. Results: In 2020, out of 215,907,184 individuals, 113,401 died of HF (40.7% were female and 37% male, 65.9% were of white race, and 8.8% Hispanic). Age-adjusted mortality rate (AAMR) was higher in males (65.3 vs 50.7 in females) and in Black race (75.8 vs 55.8 in White). However, the AAMR was lower in Hispanics (33.5 vs 58.6). Mortality rate increased from 0.044% in 2016 to 0.052% in 2020. The SVI ranged from 2.6045 to 12.7688. Texas, Mississippi, and Georgia were the states with the most counties in the 4th quartile of the SVI. In 2020, Mississippi, Alabama, and Louisiana had the highest AAMR (94.9, 88.6 and 76.4). A weak positive linear relationship was observed between HF mortality and total SVI, with a PCC of 0.2546, p &lt;0.001. When divided into groups, socioeconomic status showed a moderate positive linear relationship, while household showed a weakly positive relationship, with PCC values of 0.32 and 0.27, respectively. For racial and ethnic minorities and house and transportation type, there was a very weak positive relationship (PCC 0.03 and 0.04), not statistically significant. The rate of change of mortality from 2016 to 2020 also had a weak positive linear relationship with SVI (PCC 0.13, p &lt;0.001). When ANOVA was applied, the F-statistic was 24.1 (p &lt;0.001), indicating significant variation between the SVI quartiles, especially for quartile 4. Conclusion: There is a positive association between SVI and HF mortality rates. Counties with greater social vulnerability experience higher mortality rates from HF, suggesting that targeted public health interventions in high-SVI areas could potentially improve outcomes.
Abstract 4145636: Associaion Between Daily Steps And Calf Muscle Oxygen Saturation In Patients With Symptomatic Peripheral Artery Disease
Authors: Andrew Gardner, Polly Montgomery, Ming Wang, Xue Wu
Journal: Circulation (2024)

Purposes: We determined whether patients with peripheral artery disease (PAD) who walked at least 7,000 steps/day had better microvascular function, assessed by calf muscle oxygen saturation (StO 2 ), and more favorable vascular biomarkers than patients who walked less than 7,000 steps/day. A secondary aim was to determine whether group differences in calf muscle StO 2 and vascular biomarkers persisted after adjusting for severity of PAD, and demographic and clinical characteristics. Methods: Five hundred and sixteen patients were assessed on daily ambulatory activity for one week with a step activity monitor, and were grouped according to whether they walked fewer than 7,000 steps/day (Group 1; n=306) or for 7,000 steps/day or greater (Group 2; n=210). Patients performed a standardized Gardner-Skinner graded treadmill test, and calf muscle StO 2 was continuously measured over the medial gastrocnemius muscle of the more symptomatic leg using near-infrared spectrometry. Additionally, patients had blood samples drawn for measurement of high-sensitivity C-reactive protein (HsCRP). Results: Exercise time to reach the minimum calf muscle StO 2 was significantly longer (p=0.025) in Group 2 (297±339 sec) than in Group 1 (210±232 sec). Additionally, HsCRP was significantly lower (p&lt;0.001) in Group 2 (4.0±4.5 mg/L) than in Group 1 (6.8±10.7 mg/L). In multivariable linear regression models, exercise time to minimum calf muscle StO 2 was significantly associated with physical activity group status after adjusting for ankle/brachial index (Model 1) (p=0.032), and after adjusting for age, race, sex, education, and body mass index (Model 2) (p=0.044). HsCRP was significantly associated with physical activity group status after adjusting for Model 1 (p&lt;0.001), Model 2 (p&lt;0.001), and the two models combined (Model 3) (p&lt;0.001). Conclusions: Walking at least 7,000 steps/day was associated with better microvascular function in the calf muscle during exercise and with lower vascular inflammation in patients with symptomatic PAD. The clinical significance is that community-based walking for at least 7,000 steps/day is a simple goal that is associated with more favorable vascular outcomes in patients with symptomatic PAD.
Abstract 4146680: Detecting Atrial and Ventricular Ectopy from the Apple Watch with an novel Deep Learning algorithm
Authors: Alan Kennedy, Peter Doggart, David Albert
Journal: Circulation (2024)

Introduction: Personal electrocardiogram (ECG) devices have significant potential for monitoring abnormal heart rhythms outside clinical environments. However, the reliability of these devices heavily depends on their automated ECG analysis capabilities, which guide patients on whether medical consultation is necessary. Many consumer-grade devices, such as the Apple Watch ECG (AW-ECG), frequently classify atrial and ventricular ectopy as ‘inconclusive’. Hypothesis/Objective: To evaluate the performance of a novel deep learning algorithm in detecting atrial fibrillation (AF), premature ventricular contractions (PVCs), and premature atrial contractions (PACs) from AW-ECG recordings. Method: A database of 2,500 AW-ECG recordings was analysed, each annotated by four electrophysiologists, with a consensus annotation used as the ground truth. The algorithm's performance in detecting AF, PVC, and PAC was assessed by measuring sensitivity, specificity, and positive predictive value (PPV) against the electrophysiologists' consensus. Results: For AF detection, the AI algorithm achieved a sensitivity of 94% (95% CI: 90, 96), specificity of 99% (95% CI: 99, 100), and PPV of 94% (95% CI: 90, 96). For PVC detection, the sensitivity was 84% (95% CI: 79, 88), specificity was 99% (95% CI: 99, 100), and PPV was 91% (95% CI: 87, 94). For PAC detection, the sensitivity was 71% (95% CI: 65, 77), specificity was 97% (95% CI: 97, 98), and PPV was 75% (95% CI: 69, 80). Conclusion: The study highlights the potential of a novel AI algorithm to accurately detect AF, PVCs, and PACs from AW-ECG recordings. The integration of this algorithm into AW-ECG analysis could significantly improve the identification of atrial fibrillation and ectopic beats, thereby reducing the frequency of inconclusive interpretations and minimising the need for human review.
Abstract 4145698: Temporal Trends in Survival and Hospitalizations in Transthyretin Cardiac Amyloidosis with and without LV Systolic Dysfunction
Authors: Ronit Kar, Abdullah Azhar, Brent Medoff, Bharadwaj Satyavolu, Prem Soman
Journal: Circulation (2024)

Background: The impact of left ventricular systolic dysfunction on survival and hospitalizations in patients with transthyretin cardiomyopathy (ATTR-CM) remains underexplored. Methods: Patients with confirmed ATTR-CM were categorized into HFrEF (LVEF &lt; 50%) and HFpEF (LVEF ≥ 50%) groups. Regression models identified predictors of reduced ejection fraction. Kaplan-Meier survival analysis, multivariable Cox proportional hazards models, and time-varying Cox models were used to assess survival and heart failure (HF) hospitalization rates. Results: 132 patients with ATTR-CM were enrolled between 2015 and 2020 and followed for 4 years. Of these, 57 (43%) had HFrEF and 47% were on Tafamidis. Logistic regression showed no association between clinical characteristics and HFrEF status. Kaplan-Meier analysis showed no significant difference in HF hospitalization rates between HFrEF and HFpEF patients (58% vs 44%, respectively, p=0.110). When examining mortality, unadjusted Kaplan-Meier analysis showed a trend towards higher mortality in HFrEF patients compared to HFpEF patients. (p=0.066). Multivariable Cox analysis revealed that, after controlling for Tafamidis use (39% and 52% in HFrEF and HFpEF, respectively), HFrEF was associated with a higher risk of mortality compared to HFpEF (HR 1.99 [1.056–3.746], p=0.017). Additionally, time-varying Cox modeling indicated that HFrEF significantly predicted early mortality (p&lt;0.0001), with the impact of HFrEF on mortality diminishing over time due to a significant interaction term between HFrEF and time (p&lt;0.0001). Conclusion: In ATTR-CM patients, the risk of mortality of HFrEF patients compared to HFpEF patients is higher initially and equalizes with time, with no difference in HF hospitalization. The mechanism underlying this intriguing trend needs further study.
Abstract 4146671: Validation of Xenon (Xe)-Liposomal Cerebroprotection for Ischemic Stroke
Authors: Xing Yin, Jean Wu, Melanie Moody, Jaroslaw Aronowski, David McPherson, Sean Savitz, Keith Booher, Shaoling Huang
Journal: Circulation (2024)

Background: Xe-liposome therapy has shown cerebroprotection in adult stroke animals. This study aims to validate the Xe therapeutic effect by MRI in adult rats and the therapeutic effect in an aged animal. Method: A 2-hour MCAO was induced in adult rodents. The MCAO animals were then divided into two groups: one receiving no treatment and the other receiving Xe-liposomal treatment (3 doses within 2-6 hours after stroke followed by 1 dose per day). Diffusion-weighted MRI conducted at 2, 6, and 24 hours post-MCAO, were analyzed by our image center. For aged rats (14 rats, 74 weeks old, male and female), MCAO (1.5 hours) was induced and then divided into two groups: stroke without treatment (n=5) and stroke with Xe-liposome treatment (n=9) and given 3 doses at day one and once per day for following days. Neurological function was tested by Limb placement and rotarod, and infarct volumes were measured two days post-stroke/treatment. Results: MRI (Fig.) demonstrated that infarct volume growth ratio was lower in the Xe-treated animals than those without treatment, indicating a protective effect of Xe against ischemic injury. MCAO induced 25% ± 5.4% infarct volume in the aged animals. Xe- reduced the infarct size to 6.7% ± 3.4%. Xe treatment demonstrated improved neurological functional recovery in these aged stroke animals. Conclusions: Xe-liposomal treatment reduces ischemic core growth in adult rats and has a therapeutic effect in aged stroke animals. These results support further development of Xe-based therapies for stroke.
Abstract 4145945: Comparison of Catheter Ablation of Ventricular Tachycardia Between Ischemic and Non-ischemic Cardiomyopathy
Authors: junaid Mir, Majd Al-Ahmad, Nitish Singh Nandu, Anas Al-Ahmad, Anam Basharat, Jawad Basit, M Chadi Alraies
Journal: Circulation (2024)

Background: Ventricular Tachycardia (VT) is a common arrhythmia encountered in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM). VT ablation is one of the treatment options of VT in ICM and NICM. There is scarcity of research comparing the outcomes of VT ablation in ICM and NICM. Methods: This is an analysis of the National Inpatient Sample of the years 2016 to 2020. We identified patients who were admitted for VT ablation using ICD-10-PCS codes. We divided the population into two groups by secondary diagnosis of ICM and NICM. The risk of mortality and in-hospital complications in the VT ablation/ICM group was compared to the VT ablation/NICM group using multivariate logistic regression analysis. Results: During 2016-2020, there were a total of 246240 patients who were admitted with for VT ablation, of which 28745(11.7%) patients had ICM while 58989 (23.95%) had NICM. After adjusting for demographics, VT ablation with NICM had lower odds of cardiogenic shock (aOR (adjusted odds ratio) 0.80; 95% CI 0.67–0.95 p =0.012), invasive mechanical ventilation (aOR 0.65; 95% CI 0.53–0.78p &lt; 0.001), lower length of stay (LOS) (aMD (adjusted mean difference) - 0.42; 95% CI -0.7 – -0.14 days p= 0.003) but higher odds of arrhythmia other than VT (aOR 1.33; 95% CI 1.2 – 1.49 p&lt;0.001), compared to VT ablation with ICM. (Figure 1) Conclusion: VT ablation in NICM has lower odds of cardiogenic shock, invasive mechanical ventilation, and lower LOS but higher odds of arrhythmia other than VT, compared to VT ablation in ICM. Further studies are needed to elucidate it further.
Abstract 4145652: Complete Versus Incomplete Revascularization Strategy in Myocardial Infarction and Multivessel Coronary Artery Disease in ≥65-Year-Old Patients: A Meta-Analysis.
Authors: Akshat Banga, Sawai Singh Rathore, Hans Mautong, Biki Sah, Jaiprakash Gurav, Fahimeh Talaei, Ameer Farrukh, Vikas Bansal
Journal: Circulation (2024)

Background: Invasive management strategies for myocardial infarction (MI) and multivessel coronary artery disease (MV-CAD) include complete revascularization (successful revascularization of all coronary artery lesions or segments ≥1.5 mm in diameter with ≥50% diameter stenosis) and incomplete revascularization (including culprit-only revascularization). However, non-culprit lesion management strategy in elderly patients remains ambiguous due to a lack of representation of this cohort in randomized trials (RCTs) and higher cardiovascular complication risks. Methods: We performed a meta-analysis comparing clinical outcomes of elderly individuals (age ≥65 years) with MI and MV-CAD submitted to complete vs. incomplete (including culprit-only) percutaneous coronary intervention (PCI). The outcomes of interest were all-cause death, cardiovascular mortality, recurrent MI, and any revascularization. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Thirteen studies (3 RCTs, 1 post hoc analysis of previous RCT, and 9 observational studies) with a total of 12,289 patients were included. Complete revascularization (CR) was performed in 5,232 patients, while 7,057 patients underwent incomplete revascularization (IR). The mean age was 80.46 years for CR and 80.73 years for IR and the mean durations of follow-ups ranged from 12-78 months. As compared to IR, the CR group was associated with significantly lower risk of all-cause mortality (OR 0.59, 95% CI 0.49 to 0.71, p&lt;0.0001) (Figure 1), cardiovascular mortality (OR 0.56, 95% CI 0.40 to 0.77, p=0.0005), recurrent MI (OR 0.62, 95% CI .47 to 0.81, p=0.0005) (Figure 2), and any revascularization (OR 0.47, 95% CI 0.26 to 0.86, p=0.01). Conclusion: Among elderly patients with MI and MV-CAD, CR is associated with a lower risk of all-cause mortality, cardiovascular mortality, recurrent MI, and any revascularization.
Abstract 4145930: Heart Failure with Preserved Global Longitudinal Strain: A Distinct Phenotype in Patients with Preserved Ejection Fraction: Data from A Real-World Registry
Authors: Gi Rim Kim, Kyu Kim, Seo-Yeon Gwak, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim
Journal: Circulation (2024)

Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome caused by various pathophysiologic mechanisms, and has recently received increasing attention. Many research results show that the longitudinal left ventricular (LV) function is deteriorated, however, in the real world, we often encounter patients with preserved LV global longitudinal strain (GLS). This study sought to determine the prevalence, characteristics, and outcome of patients with preserved LV GLS in a real-world registry of HFpEF. Method: The registry data included 1,798 patients with HFpEF (72.2 ± 11.6 years, 55.2% female) who met the inclusion criteria of previous randomized controlled trials (New York Heart Association class II or higher symptoms, LVEF &gt; 40%, and NT-proBNP &gt; 300 pg/mL) at a single tertiary hospital between 2014 and 2021. LV GLS analysis was performed using vendor-independent 2D speckle-tracking imaging software ( TomTec ; Image Arena 4.6, Munich, Germany). Patients with LV GLS ≤ -18% were defined as heart failure with preserved GLS. The primary outcome was a composite of heart failure admissions and cardiovascular death. Results: In this population, 757 (42.1%) patients had preserved LV GLS. The patients with preserved GLS were tended to be younger (71.7 ± 11.5 vs. 72.7 ± 11.6 years, p=0.073) and more female predominance (60.6 vs. 51.3%, p&lt;0.001), and wider pulse pressure (61.0 ± 17.4 vs. 54.8 ± 18.1 mmHg, p&lt;0.001) compared with those with reduced GLS. The average NT-pro BNP of the preserved GLS group was 2242.4 ± 4391.8 pg/ml and the average LV GLS was -20.1±1.6%, which were significantly lower than each value of the reduced GLS group. In terms of echocardiographic characteristics, the patients with preserved GLS had higher LV ejection fraction (68.8 ± 5.8 vs. 62.5 ± 8.6%, p&lt;0.001) and stroke volume (78.1 ± 21.4 vs. 61.9 ± 19.3, p&lt;0.001). During 21.3 months (interquartile range 6.6-39.7 months) follow-up, the group with preserved GLS had a better primary outcome than the group with reduced GLS (log-rank p &lt; 0.001) (Figure) Conclusion: Heart failure with preserved GLS is common among patients with HFpEF in real-world data. This phenotype is more common in females, is associated with higher stroke volume and arterial stiffness, and ultimately shows a favorable outcome.
Abstract 4145951: Mortality in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis
Authors: Mayank Jha, Arya Harikrishna, Jubran Al Hooti, Muhammad Saad Ur Rehman, Hritvik Jain, Madho Mal, Mobeen Haider, Priya Hotwani, Nayanika Tummala, Muhammad Aamir, Yasotha Rajeswaran
Journal: Circulation (2024)

Background: Cardiac amyloidosis is an underdiagnosed cause of heart failure. The mean survival rate without treatment is low, signifying the importance of early diagnosis. The prognosis depends on the time of diagnosis and the severity of the disease before recognition and treatment. We performed a systematic review to evaluate patient characteristics and mortality in individuals with cardiac amyloidosis. Methods: PubMed, Scopus and Cochrane were systematically searched from the database inception to May 2024 to evaluate for mortality outcomes in patients with cardiac amyloidosis. The statistical analysis was performed using R-Studio software, and proportions with 95% confidence intervals (CI) were calculated using a random-effects model. The Kaplan Meier survival plots was also plotted for eligible studies. Results: Eighteen studies involving 7,268 patients were included. Patients with cardiac amyloidosis mostly presented with dyspnea and peripheral edema. Among the electrocardiographic abnormalities, atrial fibrillation was observed in 31.1% of patients, whereas atrioventricular block was observed in 6.2% of patients. Furthermore, 37.2% of patients experienced heart failure, 36.3% experienced reduced ejection fraction, and 3.2% of patients experienced cardiogenic shock. Majority of the patients were found to have an increase in left ventricular wall thickness (77.8%). The mortality associated with cardiac amyloidosis varied from 0% to 100%, with a summary estimate rate of 54% (95% CI: 31% to 77%). The median survival rate for 50% patients was around 2 weeks, which declined significantly over the next one week resulting into the cumulative survival of over only 21 days. Conclusion: Our results highlight the importance of considering cardiac amyloidosis in the differential diagnosis of all patients with heart failure or non-ischemic cardiomyopathy, particularly when there is an increase in ventricular wall thickness. Our review revealed a high mortality rate associated with cardiac amyloidosis. Early diagnosis and better therapeutic modalities have the potential to improve patient outcomes and reduce mortality rates.
Abstract 4145936: Ethnic differences in Body Mass Index Cut-off Values Associated with Cardiovascular Risks in South Asians Compared to White Population: A Systematic Review and Meta-analysis
Authors: Elnaz Shahmohamadi, Melissa Middeldorp, Jonathan Ariyaratnam, Mohanaraj Jayakumar, John Fitzgerald, Adrian Elliott, Prashanthan Sanders
Journal: Circulation (2024)

Background: BMI is a modifiable risk factor for stroke and heart disease. However, there is limited or no data on the association of BMI with adverse outcomes and the absence of data on Black, South Asian, and Arab populations. Thus, national, and global recommendations for BMI cutoffs to prevent obesity-related complications among minority populations are debatable. Aims: This review aimed to identify a holistic estimate of the optimal BMI cutoffs at which cardiovascular adverse outcomes could be predicted amongst south Asian populations. Methods: A systematic search was conducted in PubMed, Google Scholar, and Cochrane database to identify community-based studies that reported BMI cut-off values for individuals in South Asian countries from 2004 onward. To determine ethnicity-specific BMI cut-offs for obesity equivalent to the BMI threshold for obesity in White populations (≥30 kg/m 2 ), a random-effects meta-analysis was performed for data associated with type 2 Diabetes. The pooled estimate of cut-off points was calculated, with studies weighted by the inverse variance of their individual estimates. Results: We included 7 studies, comprising a total of 143,380 participants from South Asian countries. The pooled estimate for the BMI cutoff associated with type 2 diabetes, equivalent to a BMI of 30.0 kg/m 2 in White populations, was 23.3 kg/m 2 (95% CI: 22.0-24.6). Summary receiver operating characteristic (SROC) curves were created using a linear regression model to summarize the studies' ROC curves. The highest Youden index indicated that the optimal BMI cut point for hypertension and dyslipidaemia among South Asian males was 23.3 kg/m 2 (95% CI: 22.2-24.6) and 24.3 kg/m 2 (95% CI: 21.2-27.4), respectively. For South Asian females, the optimal BMI cut point for hypertension was 24.0 kg/m 2 (95% CI: 22.9-25.2) and for dyslipidaemia was 24.7 kg/m 2 (95% CI: 23.0-25.9). Conclusion: Revisions to BMI cutoffs specific to different ethnicities are necessary to ensure that minority ethnic groups receive proper clinical monitoring. This will help enhance the prevention, early diagnosis, and timely management of cardiovascular risk factors.