tbuckley/cabot-search huggingface dataset:
Abstract 4146532: Human Induced Pluripotent stem Cell Derived Nanovesicles for Cardiomyocyte Protection
Authors: Xiaoxiao Geng, Yuhua Wei, Jianyi Zhang, Lei Ye
Journal: Circulation (2024)

Introduction: It is well-known that reactive oxygen species (ROS) play important roles in myocardial ischemia reperfusion (I/R) injury. Exosomes have shown great potential and application in mitigating I/R induced cell and tissue damage. However, the clinical translation of exosomes has been limited by deficiencies in the yield of exosomes from cultured cells. Instead, nanovesicles (NVs), products manufactured directly from cells, can be easily scaled-up which facilitates translation into clinic. Methods: NVs were manufactured from human induced pluripotent stem cells (hiPSCs) using an extruder and with a 0.2-μm filter membrane. The size and number of hiPSCs derived NVs (hiPSC-NVs) were measured by a Nanosight, and morphology of NVs were visualized with an electron microscope. The potency of hiPSC-NVs on protection of hiPSCs derived cardiomyocytes (hiPSC-CMs) against hypoxia and H 2 O 2 were assessed in culture and in a mouse model of I/R injury. Proteomic analysis was performed to identify proteins that have ROS scavenger properties in hiPSC-NVs. Results: About 9,500 NVs can be manufactured per one hiPSC. hiPSC-NVs starting 6.25x10 8 /mL concentration effectively reduced lactate dehydrogenase leakage and apoptosis in hiPSC-CMs cultured in HBSS for 24 h in a hypoxia incubator, and protected cultured hiPSC-CMs from 200 µM H 2 O 2 induced damage. When hiPSC-NVs or 0.9% NaCl was intramyocardially injected into C57BL mice hearts after cardiac I/R, measurements of cardiac function and infarct size conducted 4 weeks later were significantly better in the hiPSC-NV treatment group and were accompanied by increases in recipient mouse CM survival. Notably, proteomic analyses indicated that compared to hiPSCs, hiPSC-NVs were enriched in numerous proteins that scavenge ROS, including NUDT2, PRDX2, PRDX4, PRDX5, PRDX6, and GSR. Thus, through all these proteins in NV cargos, hiPSC-NVs exert CM protection activity against ROS injury after I/R. Conclusions: The use of hiPSCs as parental cells for manufacturing NVs, can easily scale-up production, and have great potential for cardiac protection after I/R.
Abstract 4146507: Sex-Based Disparities in Atrial Flutter Outcomes: An Analysis of the National Readmission Database
Authors: Anne Marie Arcidiacono, Lauren Klei, Vera Hapshy, James Arcidiacono, Steven Imburgio, Swapnil Patel, Mohammad Hossain, Joseph Heaton
Journal: Circulation (2024)

Background: Atrial flutter (AFL) is a common supraventricular tachyarrhythmia characterized by a rapid and regular atrial rate. Although the global burden of atrial flutter on the general population has risen dramatically over the past four decades, the impact of sex on clinical outcomes for these patients is poorly characterized. This study aims to investigate sex disparities in clinical outcomes over recent years for patients admitted with atrial flutter. Methods: In this large scale, retrospective cohort study, adult patients who were admitted with AFL were analyzed from 2016 to 2021 using the National Readmissions Database. The study population was divided into male and female groups. Diagnoses were classified using the International Classification of Diseases, 10th edition codes. The primary outcome was 30-day readmissions. Secondary outcomes included inpatient mortality and length of stay. Results: A total of 132,027 patients with AFL meeting inclusion criteria were included in the study. Of these, 82,988 (62.9%) were male and 49,040 (37.1%) were female. The mean age was 63.0 ± 11.5 for males vs 67.2 ± 11.4 years for females. Readmissions were higher in females (10% vs 9%) than males. Cox regression analysis showed higher readmission events in females (HR: 1.07, 95% CI: 1.01-1.13, p &lt; 0.010) when compared to males. Multivariate regression analysis for inpatient mortality and length of stay was higher for females than males (p &lt; 0.01 for both). Conclusion: Women experienced higher readmission rates and had worse outcomes including inpatient mortality and higher length of stay compared to their male counterparts. These findings suggest that female patients may require closer monitoring and targeted intervention to improve these outcomes.
Abstract 4146070: <u>A</u> rtificial intelligence for the prediction of all-cause mortality and readmission in heart failure: a meta-analysis of twenty studies
Authors: Aashray Gupta, Ammar Zaka, Daud Mutahar, Cecil Mustafiz, James Gorcilov, Johayer Abtahi, Harish Kamalanathan, Sheryn Tan, Lewis Hains, Prakriti Sharma, Srishti Sharma, Priyyanca Ragunath, Joshua Kovoor, Brandon Stretton, Naim Mridha, Stephen Bacchi
Journal: Circulation (2024)

Background: Accurate risk prediction of heart failure patients is essential for identifying high risk patients, developing targeted treatment strategies and prognostication. Existing traditional risk scores offer modest discriminative value, and rely on rigid predictor variables. A form of artificial intelligence, machine learning (ML) models provide alternate risk stratification that may improve predictive accuracy. This systematic review and meta-analysis compared machine learning models with traditional risk scores for predicting all-cause mortality and readmission in patients with heart failure. Methods: PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1st May, 2024 for studies comparing ML models with traditional statistical methods for prediction of all-cause mortality and hospital re-admission following an index admission with CHF. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality and hospital readmission at 30 days. Results: Twenty observational studies were included (558,233 patients). The summary C-statistic of the top-performing ML models for all-cause mortality was 0.76 (95% CI, 0.72-0.80), compared to traditional risk scores 0.71 (95% CI, 0.68-0.74). The difference in C-statistic between ML models and traditional methods was 0.05 (95% CI 0.04-0.06, p&lt;0.05). Of all included studies, 6 models were externally validated. Calibration was inconsistently reported. Conclusion: ML models demonstrated superior discrimination of 30-day all-cause mortality and hospital readmission for heart failure patients when compared to traditional risk scores. Before integrating into clinical practice, further research is required to overcome methodological and validation limitations.
Abstract 4146487: Prediction of New-onset Structural Heart Disease and Cardiovascular Risk Using Ensemble Deep Learning Applied to Electrocardiographic Images
Authors: Lovedeep Dhingra, Arya Aminorroaya, Aline Pedroso Camargos, Veer Sangha, Luisa Brant, Sandhi Barreto, Antonio Luiz Ribeiro, Harlan Krumholz, Evangelos Oikonomou, Rohan Khera
Journal: Circulation (2024)

Background: Despite the availability of effective pharmacological and procedural interventions, risk stratification strategies for structural heart disorders (SHDs) remain elusive. We developed an ensemble deep learning model for ECG images that predicts the development of future SHD and the risk of major adverse cardiovascular events (MACE). Methods: In Yale New Haven Health System (YNHHS), UK Biobank (UKB), and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included adults without baseline cardiomyopathy or heart failure. In YNHHS, where serial echocardiogram data were available, we identified the first transthoracic echocardiogram (TTE) with SHD (LVEF &lt; 40%, moderate-to-severe left valve diseases, or severe LVH [IVSd &gt; 15mm and LV diastolic dysfunction]). Across all cohorts, we followed individuals till the first MACE (HF/acute MI/stroke/all-cause death). We developed an ensemble convolutional neural network model that detects cross-sectional SHD from images of ECGs. We assessed the association of this model’s output probability with future risk of SHD or MACE using adjusted Cox models and discrimination using Harrel’s c-statistic. Results: Among 213,652 YNHHS patients, 11,695 developed SHD and 21,929 had MACE over 4.5 years (IQR 2.5-6.6). In UKB and ELSA-Brasil, among 42,147 and 13,454 people, 768 and 338 had MACE over 3.1 (2.1-4.5) and 4.2 (3.7-4.5) years. In YNHHS, a positive AI-ECG screen portended 2.5-fold higher risk of developing SHD (age-, sex-adjusted HR: YNHHS, 2.46 [95% CI, 2.35-2.57]) in those with serial TTEs. The association was consistent after accounting for comorbidities (aHR: 2.42 [2.32-2.54]) and the competing risk of death (aHR: 2.27 [2.17-2.38]). In YNHHS, model discrimination for new-onset SHD was 0.811 (0.807-0.814). Across cohorts, a positive AI-ECG screen portended a significantly higher risk of MACE (aHR: YNHHS, 1.86 [1.80-1.93]; UKB, 2.00 [1.62-2.46]; ELSA-Brasil, 3.01 [2.16-4.20]). Model discrimination for MACE was 0.763 (0.760-0.766) in YNHHS, 0.667 (0.646-0.688) in UKB, and 0.723 (0.695-0.751) in ELSA-Brasil. Conclusion: Across multinational cohorts, an ensemble AI model applied to a 12-lead ECG image identified those at elevated risk of SHD and MACE. This approach represents a digital biomarker to enable scalable cardiovascular risk stratification using ECG printouts or digital images, especially in low-resource settings.
Abstract 4146480: Implementation and Evaluation of an Electronic Health Record Rule-Based System to Identify Heart Failure Patients Eligible for Guideline-Directed Medical Therapy
Authors: Shahzad Hassan, Samantha Subramaniam, Sanjay Kumar, Ozan Unlu, David Zelle, John Ostrominski, Hunter Nichols, Marian McPartlin, Megan Twinning, Emma Collins, Christian Figueroa, Ryan Ruggiero, Echo Fridley, Matthew Varugheese, Dan Gabovitch, Christopher Cannon, Akshay Desai, Alexander Blood, Benjamin Scirica, Kavishwar Wagholikar
Journal: Circulation (2024)

Background: Despite well-established benefits on morbidity and mortality, implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) population remains suboptimal. Quality improvement interventions to improve GDMT uptake often necessitate labor-intensive manual chart reviews to identify eligible patients. To automate this process, we implemented and evaluated a Rule-Based System (RBS) designed to identify HF patients eligible for remote medication optimization program. Methods: To identify symptomatic HF patients for enrollment in our Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT-HF), an RBS was hierarchically developed to first identify HF patients meeting program criteria (Figure 1A), then exclude those with contraindications or at increased risk of adverse drug reactions. The RBS processed structured data from electronic health records (EHR) from Mass General Brigham’s enterprise data warehouse to compile a list of potentially eligible patients as per program criteria. This list was then reviewed by program staff, who manually verified patient eligibility. Results: A total of 5,460 patients were identified by the RBS as potentially eligible, of whom 1,754 (32.1%) were confirmed as eligible on manual chart review with positive predictive value of 47.3%. Among the false positives, 25% did not meet the program criteria for symptomatic HF, 12.4% with LVEF &gt; 50% were already on SGLT2i, 11.0% were too medically complex for our program, 9.8% did not have a recorded echocardiogram within 2 years, 6.6% were receiving anticancer therapies, 4.0% had outside cardiologist, 3.9% with LVEF &lt;50% were either on GDMT or intolerant and 23.3% had other reasons for exclusion (Figure 1B). Discussion: These findings suggest that RBS may be a useful tool for modeling and applying guideline logic in comparison to the traditional method of querying institutional health record repositories. While the RBS demonstrated acceptable performance in mass screening for remote GDMT optimization program, future efforts should focus on improving coding and integrating the natural language processing tool for processing of clinical notes to enhance screening accuracy and efficiency.
Abstract 4146478: Women with Acute Heart Failure Have Lower Intracardiac Pressures than Men Despite Similar Symptoms, Physical Findings, and Biomarkers
Authors: Prerna Gupta, David Kao
Journal: Circulation (2024)

Background: Sex differences in physiology and presentation have been well established across the heart failure (HF) spectrum. Sex differences in presentations of acute decompensated heart failure (ADHF) have not yet been well described. Hypothesis: Women hospitalized with ADHF present with different hemodynamic profiles than men. Methods: Through the NHLBI BioLINCC resource, we obtained publicly available data via the NHLBI BioLINCC resource for the ESCAPE trial, which evaluated the potential benefit of pulmonary artery catheterization (PAC) in managing ADHF. We compared \ characteristics at enrollment between men and women with respect to symptoms, physical exam, biomarkers, imaging, and hemodynamics. Results: Women were more likely than men to be non-white (52% vs. 36%, p=0.02) with a non-ischemic etiology (69% vs. 44%, p&lt;0.001). Women had a worse Minnesota Living with Heart Failure physical subscore (34.6±5 vs. 32.6±6.7, p=0.008) and more physical signs of congestion (10.7±2.3 and 10.1±2.5, p=0.03). On PAC, right atrial pressure (11.1±5.8 v. 13.0±5.8 mm Hg, p=0.08), mean PA pressure (35±10 v. 38±11 mm Hg, p=0.03), pulmonary capillary wedge (22±8 vs. 25±8 mm Hg,p=0.07) were all significantly lower or trended lower in women despite similar cardiac index, and mixed venous oxygen saturations between men and women ( Image 1 ). Echocardiographic correlates including right and left atrial area, mitral inflow deceleration time (161±74 vs. 138±50 ms, p=0.04) and estimated right atrial pressure (40% vs. 60% &gt; 15 mm Hg, p=0.02) were concordant with PAC findings and consistent with lower intracardiac filling pressures in women ( Image 2 ). Conclusions: Despite similar physical and symptomatic features on presentation, women with ADHF appear to have lower intracardiac filling pressures. This suggests that women may develop increasing symptoms with less absolute fluid retention, which could have implications for ambulatory monitoring of HF for impending decompensation.
Abstract 4146289: Electronic device use and cardiovascular disease risk in middle-aged and elderly people: evidence from two prospective cohorts
Authors: Yidan Zheng, Xu Jingyu, Xingyu Qian, Shiyan Hu, Zihao Zhou, Yuqi Liu, Fuqiang Tong, Pengning Fan, zhe chen, Da Zhu, Xiangbin Pan, Nianguo Dong, Li Xu, Fei Li
Journal: Circulation (2024)

Background: The usage of electronic device has two-sided effects on the health of middle-aged and elderly people. Its protective effects on cardiovascular disease (CVDs) and specific mechanisms are rarely reported. Hypothesis: Moderate electronic device usage can reduce the risk of CVDs, with the possible mechanisms of cognitive function and personal well-being. Method: Participants from the UK Biobank and CHARLS cohort who were free of the 11 CVDs at recruitment were included. Restricted cubic spline (RCS) analysis was employed to investigate the association between electronic device usage time (not for work reasons) and the hazard ratios (HRs) of CVDs, determining the optimal protective time for grouping. Propensity score matching (PSM) of 1:1 and robust estimation of Cox proportional hazards regression models were utilized to analyze the association between electronic device usage and the risk of CVD incidence, all-cause mortality, and CVD-specific mortality in the UK Biobank, and to reveal the association between internet usage and the risk of CVD in the CHARLS cohort. Mediation analysis and mediation Mendelian randomization (MR) were utilized to screen for potential mediators. Results: Total 479,975 participants from two cohorts were included for final analysis. Among the participants recruited from the UK Biobank, RCS analysis indicated that using electronic devices for exactly 1 hour daily received the lowest HRs of general CVDs (HR: 0.984, P&lt;0.001) and specific subtypes. One hour daily electronic device users exhibited reduced risks of all-cause and CVD-specific mortality. Cox analysis validated that internet usage contributes to the prevention of CVDs after PSM in CHARLS cohort (HR: 0.510, P=0.032). Mediation analysis suggested that protective effect of electronic device usage on CVDs was mediated through promoting health satisfaction, enhancing cognitive function, and reducing depression and anxiety (mediating effect: 12.6%, 19.5%, 7.1%, respectively, all p-values&lt;0.001). The mediating effects were further verified by MR. Conclusion: No working electronic devices usage for one hour a day contributed to CVDs prevention, which might be mediated by cognitive function improvement in middle-aged and older adults.
Abstract 4146526: Impella in Myocardial Infarction Complicated by Cardiogenic Shock: A Meta-Analysis
Authors: Mobeen Haider, Ryan Berry, Mohammad Hamza, Prakash Upreti, junaid Mir, Hamza Naveed, Usman Naseer, Krutarth Pandya, Khaled M. Harmouch, Munis Ahmed, Mubashar Karamat Karamat, Yasar Sattar, M Chadi Alraies
Journal: Circulation (2024)

Background: Despite recent technological advancements, myocardial infarction complicated with cardiogenic shock is associated with high mortality. Impella has been advocated as an adjunct to the standard of care, but conflicting data has hindered greater utilization. We performed an updated meta-analysis with the recent data. Methods: We searched PubMed and Embase, screened 787 articles, and identified twelve studies that met eligibility criteria; these randomized controlled trials and cohort studies compared Impella to other mechanical circulatory support systems in patients with myocardial infarction complicated by cardiogenic shock. We evaluated groups with twenty-three metrics related to adverse events and clinical outcomes. A random effects model assessed heterogeneity between studies. Results: We did not find a statistically significant difference between groups across all twenty-three included metrics: in-house mortality, 30-day mortality, 6-month mortality, brain death, cardiovascular death, non-cardiac mortality, myocardial infarction, need for repeat percutaneous coronary intervention, need for left ventricular assist device, coronary bypass artery graft, stroke, limb ischemia, hemolysis, major bleeding, thrombosis, and sepsis. Table 1 Our subgroup analyses for intra-aortic balloon pump, extracorporeal membrane oxygenation, and medical management revealed similar results for mortality. In terms of bleeding, IABP was associated with better outcomes whereas ECMO was associated with worse outcomes than Impella. Impella was also associated with an increased risk of thrombosis as compared to IABP. Table 2,3,4 Conclusions: Our updated meta-analysis did not relate Impella use to better outcomes. Heterogeneity in the timing of device implantation calls for stricter reporting in subsequent larger, randomized controlled trials.
Abstract 4146475: Impact of Cancer on Atherosclerotic Burden and Coronary Anatomical Complexity in the Presence of Acute Coronary Syndromes: A Comparative Analysis from the BRAVADO Registry
Authors: Vinicius Seleme, Brunna Pileggi, Isabela Costa, Carlos Branco, Stephanie Itala Rizk, Maria Antonieta Lopes, Diego Carter Borges, Rodrigo Campos, Fabio de Brito Junior, ROGER GODINHO, Bruno Faillance, DALTON BERTOLIM PRECOMA, Marcelo Ribeiro, Juliane Seabra Garcez, Roberto Kalil Filho, Alexandre Abizaid, Ludhmila Abrahao Hajjar, CARLOS CAMPOS
Journal: Circulation (2024)

Background: The interaction between cancer and coronary artery disease (CAD) significantly impacts cardiovascular outcomes and disease progression. However, the impact of cancer on atherosclerotic plaque burden and coronary lesion complexity in acute coronary syndrome (ACS) have not yet been studied. Objective: The aim of this study is to correlates the presence of cancer e atherosclerotic plaque burden Methods: This is a multicenter, ambispective, observational study, based on the analysis of coronary angiographies. Data was collected between September 2016 to December 2022. Patients were categorized into three study groups: ACSC (ACS with a history of cancer), ACSNC (ACS without a history of cancer), and CCAD (chronic coronary artery disease). Patients with ACS were consecutively included while those with CCAD were randomly included. Propensity score matching between ACSC and ACSNC groups was performed. Results: 618 patients were included, and 3,752 coronary lesions were analyzed. The mean age of the patients was 68 years, with more than 74% diagnosed with hypertension. The most common types of cancer were prostate, hematological, and colorectal cancer ( Figure 1 ). Patients with acute presentations had more eccentric and ulcerated lesions, with lumen obstructions greater than 90%, involving bifurcations and resulting in worse SYNTAX and Leaman scores compared to chronic coronary artery disease (p values &lt; 0.01 for all). Post-matching, 234 ACSC and ACSNC patients were compared, revealing heightened atherosclerotic burden in ACSC, evidenced by elevated SYNTAX scores and complex lesions (p &lt; 0.01). This group also showed a higher prevalence of complex lesions in the proximal thirds of the vessels, with statistical correlation (p = 0.003), as shown on Figure 2 . Conclusion: Cancer was associated with a greater atherosclerotic burden and greater complexity of coronary lesions in patients with ACS when compared to those without history of cancer. These findings underscore the impact of cancer on exacerbating cardiovascular complexity in ACS individuals, emphasizing the need for comprehensive management strategies in this population.
Abstract 4146441: Non-invasive Algorithmic Hemodynamic Measurements Using Wearable Cloth-based Nanotechnology: Alternative to Invasive Right Heart Catheterization
Authors: Ameesh Isath, Shazli Khan, Arjun Kanwal, Vasiliki Gregory, Prashanth Shyam Kumar, Mouli Ramasamy, Venk Varadan, John Zimmerman, Vijay Varadan, alan gass
Journal: Circulation (2024)

Background: SimpleSense (Nanowear, New York, NY) is an FDA-cleared artificial intelligence (AI) based wearable diagnostic platform with multiparametric monitoring including 2-leads of ECG, thoracic impedance, heart sounds, blood pressure, posture and activity (Fig. 1 A). We explored the correlation between SimpleSense-derived and invasive hemodynamics (HD) parameters during right heart catheterization (RHC). The SimpleSense parameters assessed included amplitudes and width of heart sounds S1 and S2, ECG amplitudes, R to S1 and S2 times (Fig. 1 B), and pulse ejection period (PEP). PEP is a surrogate measurement that combines the pre-ejection period and left ventricular ejection time (Fig. 1 C). Methods: A single-center prospective feasibility study was conducted after IRB approval. Adult patients &gt;18 yrs undergoing RHC were screened and enrolled after informed consent (NCT05629533). SimpleSense recorded data on the patients throughout the RHC procedure. We performed an exploratory analysis to identify potential correlations between the SimpleSense data and HD parameters utilizing maching learning. Results: Data from 11 subjects (8 Males, age:64.3 ± 10.23 yrs.) included 39 thermodilution cardiac outputs (CO) and 11 pulmonary artery pressures (PAP). The mean ± SD values of CO, cardiac index (CI), Systolic PAP, Diastolic PAP, and mean PAP were 4.4±1.9 l/min, 2.19±0.96 L/min/m 2 , 37.27±17.32 mmHg, 12.09±5.03 mmHg, and 22.72±8.42 mmHg respectively. Multiple SimpleSense derived data show statistically significant correlations with HD parameters (Fig. 2). The PEP metric exhibited the highest correlation with mean PAP and systolic PAP. Conclusion: The results highlight SimpleSense’s potential as a non-invasive AI tool that could revolutionize management by offering a reliable alternative to traditional invasive RHC. With further validation, SimpleSense may provide continuous, real-time hemodynamic information, significantly enhancing patient care and outcomes.