tbuckley/cabot-search huggingface dataset:
Abstract Sa907: The Impact of the COVID-19 Pandemic on Favorable Neurological Outcome after Out-of-hospital Cardiac Arrest Witnessed by Emergency Medical Service Personnel
Authors: Takefumi Tsunemitsu, NORIHIRO NISHIOKA, Tetsuhisa Kitamura, Taku Iwami
Journal: Circulation (2024)

Background: Different from the negative impact of COVID-19 pandemic on outcomes after out-of-hospital cardiac arrest (OHCA) collapsed before emergency medical service (EMS) arrival, there was a report suggested that COVID-19 pandemic did not affect outcomes after OHCA witnessed by EMS personnel. However, no large-scale studies have examined the impact of COVID-19 pandemic after EMS-witnessed OHCA, focusing on favorable neurological outcomes. Research Questions: Does COVID-19 pandemic affect favorable neurological outcomes after EMS-witnessed OHCA? Aims: To assess COVID-19's impact on favorable neurological outcomes after EMS-witnessed OHCA. Methods: We performed an interrupted time series analysis (ITSA) with a prospective, nationwide, population-based registry in Japan to assess trends of incidence and favorable neurological outcome (Cerebral Performance Category 1 or 2) at 30 days with adult EMS-witnessed OHCA between pre-pandemic (January 2016-March 2020) and pandemic (April 2020-December 2021) periods. Subgroup analyses were performed by stratifying regions by infection spread status defined by whether a state of emergency has been declared. To assess whether there are differences in trends between areas with and without COVID-19 spread, we performed a controlled ITSA between the two areas. Results: We identified 58,315 patients with adult EMS-witnessed OHCA, 41,112 during the pre-pandemic period and 17,203 during the pandemic period. There was no significant increase in the incidence of EMS-witnessed OHCA during the pandemic period (0.03 per 100,000 person-years; 95% confidence interval [CI], –0.02 to 0.08; p = 0.21). Favorable neurological outcome significantly decreased (relative risk [RR], 0.80; 95% CI, 0.71 to 0.91; p &lt; 0.01). In subgroup analysis, favorable neurological outcome significantly decreased in areas with COVID-19 spread (RR, 0.67; 95% CI, 0.56 to 0.81; p &lt; 0.01), while there was no significant difference in areas without COVID-19 spread (RR, 0.91; 95% CI, 0.77 to 1.07; p = 0.24). A controlled ITSA showed that favorable neurological outcome significantly decreased in areas with COVID-19 spread compared to without COVID-19 spread (RR, 0.77; 95% CI, 0.60 to 0.98; p = 0.04). Conclusion: Unlike previous studies, our research with a nationwide, population-based registry showed that COVID-19 pandemic influenced favorable neurological outcome in EMS-witnessed OHCA. This trend appears to be more pronounced in areas with widespread infection.
Abstract 4147769: Outcomes of Elevated Homocysteine in Heart Failure Hospitalizations. A Propensity Matched Retrospective Analysis
Authors: Endurance Evbayekha, Favour Nelson, Ovie Okorare, Rachel Palumbo, Imoh Ebong, Garba Rimamskep Shamaki, Tamunoinemi Bob-Manuel
Journal: Circulation (2024)

Introduction: Elevated homocysteine (HC) predisposes individuals to a prothrombotic state and may increase the risk of poor outcomes, including strokes and deep venous thrombosis (DVT). Previous studies did not find any mortality benefit after normalizing serum homocysteine levels. However, studies on the impact of HC on outcomes such as peripheral vascular disease (PVD) and chronic limb ischemia (CLI) in heart failure (HF) are lacking. We aimed to address this gap. Methods: We examined the 2016 to 2021 Nationwide Inpatient Sample database and used the ICD-10 codes to identify the population with HF. We then stratified them into HC and non-HC groups. HC was defined as a composite of homocystinuria and methyltetrahydrofolate deficiency. Chi-square and Student T-test were used to compare continuous and categorical variables. A greedy neighbor 1:1 propensity score matching (PSM) followed by multivariable logistic regression models accounted for confounders and predicted the outcomes. Our primary outcomes were PVD and CLI, while secondary outcomes were ischemic stroke, pulmonary embolism (PE), and DVT. Results: There were 3,415 HF hospitalizations with HC, with a mean age of 66.6 + 14.8, and 55.9% (1,910) were females. After PSM, 1,420 HC hospitalizations were matched to 1,420 no-HC hospitalizations. Compared to the non-HC group, there was no difference in PVD 1.15 (0.96-1.37) and CLI 0.66 (0.28-1.51), each p&gt; 0.05. However, ischemic stroke 3.3 (2.30-4.69), PE 6.3 (3.46-11.51), and DVT 3.6 (2.26-5.8) were significantly associated with the HC group, p&lt;0.005, each. Conclusions: Among the hospitalized population with heart failure, those with elevated homocysteine showed a higher association with ischemic stroke, DVT, and PE but no difference in peripheral vascular disease or chronic limb ischemia.
Abstract Sa506: Early Serial Somatosensory Evoked Potentials Can Assess Brain Injury Severity and Recovery in Swine Cardiac Arrest Models
Authors: Laura Harding, Joshua Mergos, Mohamad Tiba, Traci Cramer, Nicholas Greer, william stacey, Claudio Sandroni, Thomas Sanderson, Robert Neumar, Cindy Hsu
Journal: Circulation (2024)

Introduction: Bilateral absent cortical N20 somatosensory evoked potentials (SSEPs) at 12 and 24 hours after return of spontaneous circulation (ROSC) can predict poor neurologic outcome in cardiac arrest patients. However, it remains unknown if early SSEPs can be used to assess the efficacy of neuroprotective therapies after cardiac arrest. We hypothesized that the rate of SSEP recovery during the first 24 hours after ROSC can differentiate brain injury severity. Methods: Eighteen Yorkshire swine (50-60 kg) were subjected to 5 (VF-5) or 10 minutes (VF-10) of ventricular fibrillation followed by advanced cardiac life support until ROSC. Sham animals were included to control for the effects of sedatives and instrumentation. Bilateral median nerves were stimulated with 35 mA at the forepaws. Cortical signal amplitudes were collected for 1 hour before cardiac arrest (baseline), for the first 4 hours after ROSC, and at 6, 12, 18, and 24 hours after ROSC for 15 minutes at each time point. Two-way ANOVAs were performed to determine inter- and intra-group differences using GraphPad Prism. Results: VF-5 (n= 9) and VF-10 (n=9) animals showed similar and significant N20 suppression from baseline during the first 6 hours after ROSC compared to sham animals (n = 4; Table 1 , Figure 1 ), but both recovered during the first 24 hours after ROSC. VF-10 animals showed trends toward slower N20 recovery compared to VF-5 animals. VF-5 animals demonstrated mean (SD) N20 recovery to 97.1 (33.5)% of baseline by 24 hours after ROSC, whereas VF-10 animals (n= 9) had mean (SD) N20 recovery of 63.9 (28.7)% of baseline by 24 hours after ROSC. Sham animals (n=4) demonstrated the known attenuating effect of Propofol on N20 amplitude to a mean (SD) of 68.9 (15.4)% of baseline by 24 hours after ROSC. Conclusions: Our study demonstrates the feasibility of using serial N20 cortical SSEPs to assess brain function recovery and potentially quantify brain injury severity during the first 24 hours after ROSC in swine cardiac arrest models. Future studies are needed to better understand the impact of prolonged sedation on N20 amplitude and correlate the rate of N20 recovery with blood-based biomarkers and histological findings to confirm the construct validity of early SSEPs in our swine cardiac arrest models.
Abstract Sa706: Sex Differences in ROSC and Survival from Out of Hospital Cardiac Arrest
Authors: Pam Pam Gwo, Eric Burguera-Couce, Julie Nichols, Joseph Piktel, Kenneth Laurita, Lance Wilson
Journal: Circulation (2024)

Background: Determining factors predicting return of spontaneous circulation (ROSC) and survival after out of hospital cardiac arrest (OHCA) are a high priority for guiding clinical decision making and understanding differences in patient outcomes. Although sex differences in OHCA outcomes have been described, there are inconsistent reports, and mechanisms underlying these differences remain unclear. Aim: To determine whether sex differences and arrest factors are associated with ROSC and survival after OHCA. Hypothesis: Sex differences in both ROSC and survival are associated with differences in both arrest characteristics and care delivery. Methods: Single site observational study of consecutive adult emergency medical services (EMS) patients with OHCA at a large tertiary care center between 1/1/2018-3/31/2024. EMS reports, continuous EMS ECG recordings and electronic health records were analyzed to identify the presence ROSC and determine demographics, arrest characteristics, and survival. Statistical significance was determined using Chi-square and logistic regression (LR) analyses. Results: 344 (71%) patients had ROSC and 139 patients (29%) had no ROSC. Patients with ROSC vs. no ROSC were similar regarding age, race, and ethnicity. Patients with ROSC were more likely to be female (p&lt;0.003), and female patients with ROSC were more likely to have both a primary arrest rhythm of VT/VF and asystole (p &lt;0.05), rearrest (p&lt;0.013), and had a longer time from arrest to ROSC (34 vs. 25 min, p&lt;0.1). Interestingly, in a LR model, female sex was associated with greater 6-month survival (OR: 3.3, 1.6-6.5, p&lt;0.003). There were no sex differences in patients receiving post-arrest cardiac catheterization or targeted temperature management. Conclusion: Despite generally worse arrest characteristics, female sex was associated with increased ROSC and survival. Given this, and similar delivery of post-arrest care, these data suggest that in this cohort, sex differences, rather than care delivery, may underlie differences in outcome. Whether additional disparities in arrest and post-arrest care contribute will be important to determine.
Abstract 4147767: Advanced Machine Learning Models for Classifying Transthyretin Amyloidosis in Clinical Settings
Authors: Anurag Verma, Po Ya Hsu, Colleen Kripke, WILLIAM HOWARD, Giorgio Sirugo, Kelly Myes
Journal: Circulation (2024)

Introduction: Early and accurate classification of transthyretin amyloidosis (ATTR) is crucial for improving patient outcomes. However, nonspecific symptoms and heterogeneous disease variations have made ATTR diagnosis challenging. Leveraging advancements in machine learning (ML) and large language models (LLMs), this study aims to enhance diagnostic accuracy by analyzing electronic health records (EHRs) data. Hypothesis: Can the integration of innovative feature formulation and large language models improve the performance of ML models in diagnosing ATTR using EHR data? Goals/Aims: Our primary goal was to develop a robust ML model that classifies the presence of ATTR in patients with high precision for clinical implementation. We aimed to utilize advanced feature formulation techniques and LLMs to capture complex patterns in patients’ EHR data. Methods: A cohort of 1,158,426 patients from University of Pennsylvania Health System was retrospectively analyzed, of whom 261 ATTR patients and 52,200 patients sharing at least one comorbidity were selected for ML model training. Appropriate data engineering was conducted to handle missing values and feature construction. We innovated EHR feature formulation, which incorporated clinical, demographic, and patient history data. Moreover, we integrated an LLM to extract meaningful patterns and context from unstructured data. Various ML algorithms were evaluated, with hyperparameter tuning performed to optimize model performance. Results: The developed model demonstrated a performance of F1 score 0.6, along with a precision of 74% and sensitivity 51% and an area under the precision-recall curve (AUPRC) of 0.5. These results highlight the model's potential in reliably classifying ATTR. The next step involves the clinical evaluation of patients, including recalling patients for technetium scan and ATTR genetic testing to confirm the diagnosis. Conclusion(s): Our study demonstrates that the integration of innovative feature formulation and large language models can substantially enhance the performance of machine learning models in predicting ATTR. This approach not only enhances diagnosis rate but also provides a scalable solution for clinical implementation. Further investigation by clinicians will validate the model's effectiveness in a real-world setting, potentially transforming ATTR diagnosis and patient management.
Abstract 4147172: Targeting Percent Impedance Drop May Improve Atrial Fibrillation Ablation Success
Authors: Joseph Adewumi, Lucasz Cerbin, Rachel Murphy, Syed Rafay Ali Sabzwari, Daniel Varela, Bilal Saqi, Carmel Ashur, Alex Grubb, Kishan Padalia, Christopher Barrett, Johannes Von Alvensleben, Alexis Tumolo, Lohit Garg, Ryan Aleong, Michael Rosenberg, Paul Varosy, Wendy Tzou, Matthew Zipse, Amneet Sandhu
Journal: Circulation (2024)

Background: Contemporary power-modulated radiofrequency (RF) ablation prioritizes power, force and time as variables impacting lesion formation. Targeting specific impedance values remains less well defined but may be important due its effect on current delivery. Objective: To characterize 1) baseline unipolar RF impedances at PV ostia, and 2) the impact of baseline impedance (BI) and impedance change on procedure success. Methods: We reviewed one hundred and seventy-five consecutive patients with paroxysmal or persistent atrial fibrillation (AF) undergoing first time RF ablation at our institution between 2020-2021, to accommodate at least one year of follow-up. Two Megadyne impedance patches were placed on the flank of all patients in a standard fashion. BI was measured at PV ostia under intracardiac echocardiography imaging and averaged across all sites. Patients were stratified into low and high impedance groups relative to the median. Results: Patients with higher BI were slightly younger with larger BMI (p = 0.0001). Mean BI varied by anatomical site, with the roof, ridge, and posterior wall having higher BIs than anterior and inferior regions (125.7 ohms vs 122.8 ohms, p = 0.017). Regions with low BI had higher mean current values achieved (599 mA vs 559 mA, P = 0.000013). There was no significant difference in the BI between groups regarding one year recurrence or first pass isolation. However, the most frequent region requiring additional ablation was the right posterior wall, and there the percent impedance drop was the lowest at 4.87%. Conclusion: Baseline pulmonary vein impedances are higher at the roof, ridge, and posterior wall. To achieve similar first pass isolation rates, these regions had larger absolute impedance drops resulting in similar percent impedance change. The region associated with worst first pass isolation rates had percent impedance drop &lt;5%. Targeting percent rather than absolute impedance drop may improve atrial fibrillation success.
Abstract 4147581: Survival Prediction after Cardiac Resynchronization Therapy: Clinical Scores versus Ejection Fraction
Authors: Joe Demian, Aritra Paul, Niraj Varma, J. Emanuel Finet, Arshneel Kochar, Feras Bader, Oussama Wazni, Wilson Tang, John Rickard
Journal: Circulation (2024)

Background: Left Ventricle Ejection Fraction (LVEF) has been a key predictor of long-term patient outcomes post-CRT. However, clinical scores may offer superior predictive value. Hypothesis: We hypothesized that clinical scores assessed at 6 months post-CRT would be better predictors of long-term survival. Aims: To compare the predictive accuracy of various clinical and LVEF for 2-year survival in patients who underwent CRT. Methods: This prospective cohort study included patients who underwent CRT at the Cleveland Clinic between May 2016 and June 2022. A set of clinical scores and LVEF were assessed at 6 months post-CRT. Our primary endpoint was Event-Free Survival (EFS) – defined by the absence of both significant cardiac interventions (LVAD implantation or heart transplant) and mortality. Scores included 6 Minute Walk Distance (6MWD; &lt;1200ft), Gait Speed (GS, &lt;0.7m/s), Timed Up and Go Test (TUG, &gt;12s), SOF Frailty Index (SOF, ≥2) and the 5-level EuroQol-5 Dimension (EQ-5D-5L, &gt;10). Each parameter was individually incorporated into a base Cox proportional hazards models while adjusting for baseline parameters. The predictive accuracy was compared using the concordance index (C-index). Results: Overall, 527 patients were recruited, of which 346 (66%) were men and 422 (81%) received a defibrillator. Median (IQR) values for age, QRS duration, LVEF, and NYHA class were 71 years (IQR: 62-78), 160ms (IQR: 146-176), 29% (IQR: 23-35), and 2 (IQR: 2-3), respectively. The response rate at 6 months post-CRT was 322 (67.9%), and the 2-year EFS rate was 400 (75.9%). Significant predictors of 2-year mortality included 6MWD (HR: 2.8542, p&lt;0.001), GS (HR: 3.2145, p&lt;0.001), TUG (HR: 2.5056, p&lt;0.001), SOF (HR: 2.7371, p&lt;0.001) and EQ-5D-5L (HR: 2.3324, p&lt;0.001), and LVEF was not a significant predictor (HR: 0.9901, p=0.337). C-index values of the clinical scores – 6MWD (0.748), GS (0.746), TUG (0.741), SOF (0.753), EQ-5D-5L (0.730) – proved superior to LVEF (0.719). Conclusion: Our findings show that clinical scores are better predictors of two-year EFS following CRT than LVEF. Thus, incorporating functional assessments into post-CRT evaluation may improve survival prediction and patient management.
Abstract 4147293: The GLP1 Receptor Agonist Semaglutide Ameliorates Myocardial Ischemia-Reperfusion Injury in a Porcine Model Mediated by the RISK and SAFE Molecular Pathways
Authors: Carlos Santosgallego, Torsten Vahl, Kiyotake Ishikawa, Maria Belen Picatoste Botija, Nijas Nazar, Nisna Adiya, Shehanaz Shajahan, Javier Sanz, Juan Badimon
Journal: Circulation (2024)

Introduction: GLP1 receptor agonists (GLP1RA) improves outcomes by reducing event rates of myocardial infarction (MI). Whether GLP1RA also reduce MI size by ameliorating myocardial ischemia-reperfusion (I/R) injury remains incompletely understood. The main cardioprotective pathways to induce myocardial salvage are RISK (activation of Akt) and SAFE (activation of STAT3). We hypothesized that semaglutide increases myocardial salvage, reduces myocardial infarction (MI) size, improves left ventricular (LV) systolic function, and decreases apoptosis and oxidative stress in a porcine model of I/R mediated via activation of both RISK and SAFE pathways Methods: Myocardial I/R injury was induced in Yorkshire pigs by balloon occlusion of the proximal LAD for 60 min, followed by reperfusion. Animals randomly received semaglutide 0.5mg the day before I/R (to mimick patients on chronic GLP1RA), or saline for controls (n=6/group). Animals were evaluated at 1-day post-MI with cardiac MRI, 3D-echo, histology (apoptosis and oxidative stress) and molecular biology (activation of RISK and SAFE). To mechanistically study the effect of each molecular pathway, two additional groups were treated with GLP1RA+wortmannin (inhibitor of RISK) and GLP1RA+AG490 (inhibitor of SAFE) Results: Despite similar of myocardium at risk in both groups (42.8±2.2% vs 42.2±2.7%, p=NS), semaglutide significantly reduced LGE-determined MI size (33.1±2.3% vs 41.1±2.8% of LV, p&lt;0.01), resulting in larger salvaged myocardium (23.2±6.4% vs 4.1±3.9% of AAR, p&lt;0.01), and improved LV systolic function (MRI-determined LVEF 42.6±3.2% vs 34.4±5.4%, p&lt;0.01). Semaglutide reduced apoptosis (19.3±5.1% vs 40.4±9.1% of TUNEL+ cells, p&lt;0.01) and oxidative stress (12.7±4.7% vs 38.2±9.5% of 8-hydroxydoexyguanosine+ cells, p&lt;0.01). Semaglutide increased the phosphorylation of both Akt and STAT3 (ie semaglutide activated RISK and SAFE). Importantly, these cardioprotective effects of semaglutide were mediated via RISK and SAFE activation because both the inhibition of RISK (with wortmannin) and SAFE (with AG490) pathways abrogated these GLP1RA-induced benefits on I/R injury (Figure) Conclusions: The GLP1RA semaglutide increases myocardial salvage, reduces MI size, improves LV systolic function, and decreases apoptosis and oxidative stress in a porcine model of I-R mediated via activation of both RISK and SAFE pathways. This mechanism might explain part of the cardiovascular benefits of semagutide in large clinical trials
Abstract Sa704: Black and Hispanic Patients Have Lower Survival Outcomes Than White Patients in Out-of-Hospital Cardiac Arrests Witnessed by 9-1-1 Responders
Authors: Madhura Pande, Eric Yow, Paul Chan, Audrey Blewer, Daniel Mark, Hussein Al-Khalidi, Comilla Sasson, Bryan McNally, Rabab Al-Araji, Joseph Ornato, Stephen Powell, Monique Starks
Journal: Circulation (2024)

Introduction: In the U.S., patients of Black race and Hispanic ethnicity have lower survival from out-of-hospital cardiac arrest (OHCA) when they are not witnessed by 9-1-1 responders than White patients. Whether these racial and ethnic differences also exist for OHCAs witnessed by 9-1-1 responders (first responders and EMS) is unknown. Hypothesis: For 9-1-1 responder-witnessed OHCAs, survival is lower among Black and Hispanic patients, as compared to White patients. Methods: Using the Cardiac Arrest Registry for Enhanced Survival, we performed a national retrospective analysis of 9-1-1 responder-witnessed OHCA from 2013-2022. Descriptive differences by race and ethnicity were assessed by estimates by absolute standardized difference (%), with ≥10% indicating a meaningful difference. Multivariable logistic regression models with generalized estimating equations were used to quantify the association between race or ethnicity and survival outcomes. Results: A total of 75,356 adult patients with OHCA witnessed by first responders or EMS identified as Black (31.6%), Hispanic (8.7%), or White (59.6%) were included. Black and Hispanic patients were younger, less likely to have a shockable rhythm, and more likely to be in lower income census tracts compared with White patients (Table). There were no important treatment differences observed with CPR or AED use, but Black and Hispanic patients were less likely to receive defibrillation (Table). Black patients had lower survival to hospital discharge than White patients (14.7% vs. 18.7%; aOR 0.86, 95% CI 0.81-0.91), whereas survival was similar for Hispanic vs. White patients (15.2% vs. 18.7%; aOR 0.92, 95% CI 0.84-1.00). However, both patients of Black race (aOR 0.71, 95% CI 0.66-0.76) or Hispanic ethnicity (aOR 0.85, 95% CI 0.78-0.93) had lower survival rates to discharge with good neurologic function than White patients. Conclusion: Patients of Black race and Hispanic ethnicity have lower survival outcomes for 9-1-1 witnessed OHCAs, as compared to White patients. Whether this is due to unmeasured confounding from comorbidities or differences in care deserves further study.