tbuckley/cabot-search huggingface dataset:
Abstract 13779: J Wave Augmentation During CAG is Related to VF in the Acute Phase of STEMI
Authors: Yuta Sakaguchi, Yuki Hasegawa, Naomasa Suzuki, Sou Otsuki, Masaomi Chinushi, Takayuki Inomata
Journal: Circulation (2023)

Introductions and Hypothesis: Myocardial ischemia induced by contrast medium during coronary angiography (CAG) is associated with local conduction delay and J wave manifestation. However, whether J wave manifestation during CAG can predict ventricular fibrillation (VF) in the acute phase of ST-elevation myocardial infarction (STEMI) is unclear. Methods: Among 420 consecutive patients with STEMI who underwent emergent percutaneous coronary intervention, 141 patients (male, n=116; age, 65±10 years) who underwent CAG in the absence of significant coronary artery stenosis were included in this study. Patients were divided into two groups based on the development (n=17) or non-development (n=124) of VF within 48 hours after STEMI. Electrocardiograms recorded during CAG in the absence of significant coronary artery stenosis were analyzed in all subjects. Results: The frequency of J wave (≥0.1 mV) at baseline was similar between the VF (18%) and non-VF (8%) groups. However, the frequency of J wave augmentation &gt;0.1 mV above baseline during CAG was higher in the VF group than in the non-VF-group (47% vs. 8%; P&lt;0.01). The percentage of Killip class ≥3 was higher in the VF group than in the non-VF group, but there were no significant differences between the two groups in coronary risk factors, time from onset to transport to the hospital, or peak CK/CK-MB values. In a multivariate analysis, J wave augmentation during CAG was an independent factor in the occurrence of VF in the acute phase of STEMI. Conclusions: J wave augmentation during CAG was associated with VF within 48 hours after the onset of STEMI and may be useful for risk stratification of STEMI.
Abstract 16269: Heart Failure With Preserved Ejection Fraction and Sudden Cardiac Death in the General Population
Authors: Kevin J Cyr, Kyndaron Reinier, Audrey Uy-Evanado, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2023)

Background: Published data indicate that 50% of individuals with heart failure and reduced ejection fraction (HFrEF) suffer sudden cardiac death (SCD), however the burden of SCD in heart failure with preserved ejection fraction (HFpEF) remains inconclusive. Aim: Determine the prevalence of HFpEF in a community-based cohort of SCD. Methods: We prospectively identified cases with out-of-hospital SCD in a large metro area of the US Northwest (Pop. 1 million, 2002-2017) and determined HF status prior to SCD based on review of clinical records. Heart failure was subdivided into HFpEF (EF≥50%), HFmrEF (EF 40%-50%), and HFrEF (EF≤40%). In addition, since HFpEF is often underdiagnosed, we evaluated a modified H2FPEF algorithm for the identification of HFpEF among our SCD cohort with unknown HF subtypes. The score was comprised of clinical variables including age, BMI, atrial fibrillation, hypertension, and myocardial infarction. Score accuracy was assessed using receiver operating characteristic (ROC) analysis comparing known HFpEF from clinical records and echocardiography versus non-HF subjects. Next, the score was used to identify missing HFpEF cases within the HF and SCD population. Results: Among 4,683 total SCD cases, 1,013 (22%) had a clinical history of HF. Prevalence of HF sub-types was 42% for HFpEF, 19% for HFmEF and 39% for HFrEF cases. An algorithm score of 5 or greater differentiated HFpEF subjects from non-HF subjects with an AUC of 0.68 (p &lt; 0.01). The algorithm was then deployed on cases with an unknown heart failure subtype and an additional 117 HFpEF subjects were identified. The adjusted total prevalence of HFpEF was 542 subjects (53%) in the SCD the cohort with HF. Conclusion: At least 40% of the SCD cases with HF carry a diagnosis of HFpEF, and our estimates suggest the prevalence may be as high as 53%. Ultimately, these findings highlight the need to develop effective options for primary prevention of SCD in HFpEF patients.
Abstract 17094: An Ensemble Deep Learning Model to Automate Screening For Multiple Structural Heart Diseases on 12-Lead Electrocardiograms
Authors: Lovedeep S Dhingra, Arya Aminorroaya, Akshay Khunte, Veer Sangha, Sounok Sen, Norrisa Haynes, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2023)

Introduction: As echocardiographic screening is limited by access to technology, structural heart disease (SHD) is often diagnosed after the development of clinical symptoms. To enable automated and accessible screening of SHD, we developed and validated a deep-learning model for 12-lead electrocardiograms (ECGs) for various screening populations. Methods: We used 12-lead ECGs with paired TTEs at the Yale New Haven Hospital (2015-2021) to develop convolutional neural networks for detecting SHD. SHD was defined as the presence of any one of the following on a transthoracic echocardiogram (TTE) performed within 30 days of the ECG: hypertrophic cardiomyopathy (IVSd &gt; 1.5cm and diastolic dysfunction), LV ejection fraction &lt; 40%, or severe left-sided valvular disease (aortic/mitral stenosis or regurgitation). We developed an ensemble XGBoost model based on predictions for individual SHDs and patient age and sex as a single screen across all SHDs. We also simulated the model performance across cohorts with varying disease prevalence. Results: The model was developed in 456,927 ECGs/118,623 individuals (66.5±16.0 years, 45.6% women, 16.5% Black) and validated in 13,181 ECGs/13,181 individuals (65.1±17.3 years, 49.5% women, 14.5% Black). In the held-out validation set, the ensemble XGBoost model achieved an AUROC of 0.92 (95% CI: 0.91-0.94) and an AUPRC of 0.64 (95% CI: 0.57-0.70), with a sensitivity of 85% and specificity of 88%. The AUROCs for the individual disease models ranged from 0.72-0.95. (Panel A) In the test set with 10% disease prevalence, the ensemble model had a PPV 44% and an NPV of 98%. (Panel B) In simulated cohorts with 5% and 20% disease prevalence, the model had reached NPV &amp; PPV of 99% &amp; 27%, and 98% &amp; 64%, respectively. (Panel C) Conclusion: We developed a novel ensemble deep-learning model for detecting several SHDs directly from ECGs with high PPV and NPV. This approach represents a robust, scalable, and accessible modality for automated SHD screening.
Abstract 14955: Use of Cardiac Stress Testing in Nonagenarians With Chest Pain
Authors: Serena Ghanshani, Sun Young Jeong, Jiexi Wang, James Onwuzurike, Aiyu Chen, Yi-Lin Wu, Mingsum S Lee
Journal: Circulation (2023)

Background: Nonagenarians represent a growing population in the United States. Cardiac stress testing is commonly used for risk stratification in patients with chest pain. However, there is limited evidence on the benefits of stress testing in nonagenarians. Aims: The goal of this study was to investigate the utilization of cardiac stress testing in nonagenarian evaluated in outpatient clinics for chest pain, and to evaluate the incremental prognostic value of stress testing in this population. Methods: This is a retrospective observational study that included patients 90 years and above who presented for outpatient evaluation of chest pain. Referral for cardiac stress testing was captured using electronic health records. Patients were followed for one year. The associations between cardiac stress testing and subsequent cardiac catheterization, coronary revascularization, and myocardial infarction were evaluated using logistic regression models. Results: Between 2017 and 2021, 11763 patients 90 years and above presented to a clinic visit with a chief complaint of chest pain. There were 50.3% male, 61.4% White, 9.0% Black, 20.0% Hispanic, and 9.3% Asian. In this group, 320 (2.7%) underwent cardiac stress testing. Patients referred for testing had fewer cardiac risk factors, with a lower prevalence of hypertension, hyperlipidemia, and diabetes. At one year of follow-up, 6.9% of patients in the stress test group underwent cardiac catheterization, compared to 2.5% of patients in the no testing group (adjusted OR 2.87, 95% CI 1.81-4.57). Revascularization occurred in 0.63% patients in the stress testing group compared to 0.78% in the no testing group (adjusted OR 0.78, 95% CI 0.19-3.21). Myocardial infarction occurred in 3.4% in the stress testing group compared to 4.4% in the no testing group (adjusted OR 1.67, 95% CI 0.79-2.9). Conclusion: Among nonagenarians who underwent outpatient evaluation of chest pain, cardiac stress testing was associated with a significantly increased odds of subsequent cardiac catheterization, but no difference in revascularization or myocardial infarction. These observations suggest the clinical benefits of stress testing in nonagenarians may be limited.
Abstract 15452: Using a Commercial Virtual Health Platform to Effectively Treat Obesity and Improve Cardiometabolic Risk Factors at Scale
Authors: Kim Boyd, kaelen L medeiros, Donna Ryan, Isabelle Kenyon
Journal: Circulation (2023)

Introduction: Obesity is a critical risk factor for cardiometabolic disease, yet effective treatment has not been available at scale for the &amp;gt;200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically supervised obesity treatment at scale. Research Questions: This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers as well as self-reported assessment of key health behaviors in food, exercise, sleep, and emotional health. Methods: Data were analyzed for individuals who completed at least 12 months in the core program. Obesity treatment involved GLP-1 receptor agonist medications combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient questionnaires were also analyzed at baseline and 12 months. Results: The cohort includes 2,643 patients who completed at least 12 months. Average weight loss at 12, 15, and 18 months was 15.58% (n=2,397), 15.97% (n=1,319), and 15.82% (n=569). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 month endpoints showed improvement in HDL in 51% (n= 1180), in LDL for 61% (n=1174), in hs-CRP for 81% (n=956). Of n=303 with abnormal A1c at baseline, 72.9% achieve A1c &amp;lt;5.7%. Average reduction in waist circumference was 5.95 inches (n=1,507). Positive changes were also seen for patient-reported outcomes. Discussion: Given limited access to effective obesity treatment as a pathway to better cardiometabolic disease management, novel approaches must be developed. Results from 2,643 enrollees in a virtual metabolic health program demonstrate clinically significant and sustained weight loss through 18 months, with improvement in associated key cardiometabolic risk markers, health behaviors, and patient-reported outcomes. This commercial program demonstrates promising results in cardiometabolic risk improvement through medically managed weight loss delivered virtually.
Abstract 12375: Performance of Echocardiographic Measures of Right Ventricular Assessment Against Cardiac MRI in Pulmonary Hypertension - Results From the PVDOMICS Cohort
Authors: Zackary D Goff, Ambreen F Ali, Armand B Larive, Cynthia Kendrick, Deborah H Kwon, Margaret Park, Shilin Yu, Robert Frantz, Christine L Jellis
Journal: Circulation (2023)

Introduction: Assessment of right ventricular (RV) size and function by echo is challenging due to complex RV anatomy and requires integration of multiple measurements. We sought to compare accuracy of echo measures of RV size and function with cardiac MRI (CMR) in pulmonary hypertension (PH). Methods: We included patients with PH from the PVDOMICS Study who underwent both echo and CMR. Echo measures of RV size (basal dimension, area, 3D volume) and function (fractional area change [FAC], 3D RV ejection fraction [EF], RV global longitudinal strain [GLS], S’, TAPSE, Tei index) were compared to CMR derived RV volumes and RVEF. Agreement was assessed using Bland-Altman (BA) plots and Lin’s concordance correlation coefficients (ρ c ). Predictive trends were evaluated using linear regression. Results: The cohort included 446 subjects (58 ± 15 yrs, 36% male). Echo measures of RV size showed poor agreement with CMR, but substantial linear associations, when comparing CMR end diastolic volume (EDV) with: echo basal dimension (ρ c = 0.002; β = 60, R 2 = 0.47), end-diastolic area (ρ c = 0.04, β = 6.4, R 2 = 0.64), and 3D EDV (bias = 106, limits of agreement [LOA]: -14.1 to 225); and also when comparing CMR end-systolic volume (ESV) with: end-systolic area (ρ c = 0.08; β = 6.8, R 2 = 0.74) and 3D ESV (bias = 67.3, LOA: -31.8 to 166). Select echo measures of RV function demonstrated better agreement with CMR RVEF including: 3D RVEF (bias -0.23, LOA -17.9 to 17.5) and FAC (ρ c = 0.55; β = 0.89, R 2 = 0.50). Others exhibited modest or poor agreement including: RV GLS (ρ c = 0.11; β = -1.5, R 2 = 0.40), along with S’, TAPSE, and Tei index (ρ c ≤ 0.02; R 2 ≤ 0.19 for all). [Figure] Discussion: In this largest comparison of echo vs CMR measures of RV assessment in PH, echo measures of RV size agreed poorly with CMR, especially at larger RV volumes. RV functional assessment was best with echo 3D RVEF and FAC, which should be preferentially used for echo RV functional assessment. Consider CMR for more accurate volume assessment of RV size.
Abstract 18054: Contemporary In-Hospital Outcomes of Congestive Heart Failure With Multiple Myeloma; a Regression Matched Analysis
Authors: Amro Taha, Irisha Badu, Varun Victor, Lalitsiri Atti, Sanchit Duhan, Fadi Khir, Thatiana Schulze Goni, Shafaqat Ali, Maja Boshkovska Spaseski, Talal Almas, Shehzad Ali, M Chadi C Alraies
Journal: Circulation (2023)

Introduction: Multiple myeloma (MM) is a disease commonly found in elderly individuals and is associated with a high burden of cardiovascular comorbidity. Various disease manifestations in MM, including amyloidosis, anemia, hyperviscosity, hypercalcemia, intramedullary arteriovenous fistula formations, and chemotherapy-related complications, contribute to an increased risk of congestive heart failure (CHF). The objective of this study was to examine the clinical outcomes of MM patients admitted with CHF. Methods: The National Inpatient Sample database from 2016-2020 was queried to identify patients with a primary diagnosis of CHF and stratified based on the presence of MM. The primary outcome measured was in- hospital mortality. The adjusted odds ratio (aOR) of in-hospital outcomes were calculated using software STAT v.17. Results: Of the 536,700 primary hospitalizations with CHF, 1,965 (0.36%) had MM. On adjusted analysis, the CHF-MM cohort had a higher odds of cardiac arrest (aOR 2.5, 95% CI 1.2-5.5), need for new hemodialysis (aOR 2.4, 95% CI 1.6-3.6) and GI bleeding (aOR 2.1, 95% CI 1.1-3.8) However, there was no statistically significant difference in the odds of in-hospital mortality, stroke, AMI or major bleeding. Furthermore, the presence of MM in CHF related hospitalizations was not associated with higher length of stay and adjusted total cost. Conclusion: Our study reveals that MM patients admitted with CHF have an increased risk of cardiac arrest, new hemodialysis, and GI bleeding. To optimize cardiovascular outcomes in this high-risk patient population, a multidisciplinary approach involving hemato-oncologists and cardiologists is necessary.
Abstract 15266: Inhibiting Endothelial Mammalian Sterile 20-Like Kinase 1 Attenuates Acute Lung Injury in Mice
Authors: Nopprarat Tongmuang
Journal: Circulation (2023)

Introduction: Lung endothelium plays a pivotal role in the orchestration of inflammatory and injury responses to acute pulmonary insults. Mammalian sterile 20-like kinase 1 (Mst1), a mammalian homolog of Hippo, is a serine/threonine kinase that is ubiquitously expressed in many tissues and has been shown to play an important role in the regulation of complex biological processes, such as apoptosis, oncogenesis and organ growth. While Mst1 is highly expressed in the lung, its role in the endothelial response to pulmonary insults is largely unknown. Hypothesis: Mst1 regulates inflammatory responses in acute lung injury. Methods: Mst1 activity was assessed in lung endothelium by western blot and immunofluorescent staining. EC activation was measured by nuclear factor kappa B (NF-κB) dependent luciferase assay and the electrophoresis mobility shift assay. Mst1 knockout mice and pharmacological inhibitor were employed to assess the effects of Mst1 on homeostatic and lipopolysaccharide (LPS)-induced endothelial inflammation. Results: In this study, we found that Mst1 activation, as determined by Mst1 phosphorylation and nuclear translocation, was significantly increased in lung ECs after exposure to tumor necrosis factor-alpha (TNF-α) and in lungs of LPS-instilled mice as compared to the vehicle control. Overexpression of either full length Mst1 or its kinase domain promoted NF-κB activation by approximately 6.5-fold and 8-fold, respectively, whereas overexpression of the dominant negative forms of Mst1 attenuated endothelial inflammatory responses to both TNF-α and interleukin-1β stimulation. Consistent with these observations, endothelial specific deletion of Mst1 markedly attenuated LPS-induced acute lung injury in mice. Furthermore, we found that treatment of wild-type mice with Mst1 specific pharmacological inhibitor significantly prevented LPS-induced lung injury. Conclusion: Our findings identified Mst1 kinase as a key regulator in promoting lung EC activation and vascular inflammation, and suggest that therapeutic strategies aimed at inhibiting Mst1 activation might be effective for preventing inflammatory vascular diseases of the lung.
Abstract 13320: Age-Based Trends in Improvement in Door-to-Balloon Time Over 15 Years
Authors: Muddasir Ashraf, Suhail Q Allaqaband, Tanvir Bajwa, Sara Walczak, Kirsten Tunink, Michael Peterson, Christopher Koblosky, M F Jan
Journal: Circulation (2023)

Background: In April 2004, an in-house 24x7 interventional cardiology program was implemented at our center to improve door-to-balloon time (D2BT) in ST-segment elevation myocardial infarction (STEMI). Data on our program published in 2010 showed improved D2BT along with improvement in major adverse cardiovascular events and mortality. Hypothesis: We hypothesized that the median D2BT has further improved over time in both elderly and young patients. Aims: The primary objective was to evaluate aged-based yearly trends in median D2BT in patients with STEMI since the implementation of the 24x7 program. Methods: We collected data on all non-transfer adult patients with STEMI at our center from April 1, 2004, to March 31, 2019. Median two-sample test was used to compare medians. Results: A total of 1,889 patients with STEMI (median age [IQR] of 61 [54-71] years, 31% female) were evaluated. Of these, 221 (11.7%) were aged ≥80 years and 1,668 (88.3%) were aged &lt;80 years. Females made up 60% of the elderly group and 27% in the younger group. In the overall cohort, the median D2BT in patients aged &gt;80 years was significantly higher than in the younger group (54 min vs. 49 min, P = 0.004). Temporal trends in the median D2BT are shown in the figure. There was a decreasing trend in median D2BT in both age groups, but D2BT remained longer for the older patients compared with the young for most of the study period. In patients aged &lt;80 years, the median D2BT decreased from 68 minutes in 2004 to 45 minutes in 2019 (P trend &lt; .001), and in patients aged ≥80 years, the median D2BT decreased from 81 minutes in 2004 to 68 minutes in 2019 (P trend = .016). Conclusion: Even though the national averages are beaten by our 24x7 program, D2BT remains higher in the elderly cohort. This is likely due to atypical presentation in elderly females, complexity of the decision-making process in the elderly, and frailty of elderly patients on presentation.
Abstract 15298: Epidemiology and microRNA Predictors of Infection After Heart Transplantation
Authors: Brendan J Lohmar, PRAMITA BAGCHI, Matthew Dimond, Jason Goldberg, Sajal Tanna, Christopher deFilippi, Hannah Valantine, Sean Agbor-Enoh, Palak Shah
Journal: Circulation (2023)

Background: Infection rates are high in heart transplant (HT) patients due to the need for immunosuppressive medication. MicroRNAs (miR) are non-coding RNAs, that regulate gene expression and are promising biomarkers for identifying patients at risk for infection. Hypothesis: MiR profiles can identify HT patients who are at increased risk for developing an infection. Methods: HT patients who were prospectively enrolled from 2015-2018 had miR-sequencing performed. Incident infection after HT hospital discharge along with the epidemiologic characteristics of the infection were collected from the EMR. An opportunistic infection (OI) is an infection which is less virulent in a healthy host but can cause severe disease in those immunosuppressed. A time-to-event analysis was performed using miR expression at two weeks post-HT in multivariable modeling, and the Benjamini-Hochberg procedure was used to correct for false discovery. Results: The cohort included 46 patients with a median age of 56 years (IQR: 49, 62), 33% (N=15) were Female sex, 41% (N=19) were Black, and 80% (N=37) were supported with an LVAD prior to HT. Post-HT infection occurred in 59% of patients (N=27) and median time to infection was 341 days (IQR: 85, 859). Hospitalization was required in 56% (N=15) of infections. Respiratory tract and OIs were the most common infection type (Figure A). The most common microorganisms implicated were CMV (28%) and SARS-COV-2 (19%) (Figure B). After correction for false discovery, we identified 15 miRs associated with infection risk. The 5 miRs with strongest effect size and their corresponding hazard ratios include: miR-21 2.5(95% CI: 1.3, 4.7), miR-130b 8.6 (95%CI: 1.9, 39.3), miR-192 0.3 (95%CI: 0.1, 0.6), miR-218 2.6 (95%CI: 1.3, 5.1) and miR-484 0.3 (95%CI: 0.1, 0.7). Conclusion: While the burden of post-HT infections is high and contributes to patient morbidity, novel plasma miRs can potentially play a role in identifying patients at risk for infections after HT.