tbuckley/cabot-search huggingface dataset:
Abstract 12644: FlowTriever Percutaneous Aspiration Thrombectomy: A Promising Approach to Catch a (Throm)Bus In-Transit
Authors: Phuong Uyen Vo, Grace Ayafor, Charles Matriano-Lim
Journal: Circulation (2023)

Introduction: Clot-in-transit (CIT) is a life-threatening emergency that occurs in about 25,000 patients annually and is associated with high mortality due to rapid cardiopulmonary collapse. This is a case of right atrial (RA) CIT extending from existing IVC filter in a patient with pulmonary embolism (PE) who underwent successful FlowTriever® catheter-based thrombectomy. Description of Case: A 60-year-old male presented with progressively worsening dyspnea on exertion, generalized weakness and fatigue, intermittent chest pain, and right leg pain with immobility for several weeks. He had a history of deep vein thrombosis (DVT), PE in 2008 treated with 18-month of warfarin. IVC filter was placed at that time for unclear indication. His initial labs showed elevated troponin-I of 34 ng/mL and NT pro-BNP of 3542 pg/mL, atrial flutter with 2:1 conduction, incomplete right bundle branch block, and old inferior infarct on ECG. Imaging revealed an extensive bilateral PE with right ventricle (RV) to left ventricle (LV) ratio of 2.3. Transthoracic echocardiogram (TTE) showed global LV dysfunction with ejection fraction of 44%, RV strain, dilated IVC, and an 8.7-cm mobile CIT in IVC extending into RA. Despite being treated with Heparin infusion, patient remained persistently tachycardic and dyspneic. Given his clinical stagnation due to CIT and submassive PE, he underwent an invasive TTE-guided percutaneous IVC and pulmonary arterial thrombectomy using Inari FlowTriever® catheter. Repeated TTE showed complete resolution of atrial thrombus. There was improvement in pulmonary arterial pressure and symptoms immediately post thrombectomy, but atrial flutter persisted. He was eventually discharged the following day with betablocker and life-long duration of anticoagulation. At follow up, he had complete resolution of symptoms and normal sinus rhythm on ECG. Discussion: Although surgical embolectomy is considered first-line therapy, percutaneous thrombectomy should be considered early for CIT to prevent of cardiopulmonary deterioration and shorter hospital course. FlowTriever® is the first device not requiring a cardiopulmonary bypass circuit to be FDA cleared for RA CIT, particularly benefiting patients who are poor surgical candidates.
Abstract 11784: A Deep-Learning-Based Multi-Modal Phonocardiogram and Electrocardiogram Processing Framework for Screening Left Ventricular Systolic Dysfunction Using a Wearable Cardiac Patch
Authors: Wenli Zhang, Bei Song, Qijia Huang, Xuezheng Qu, Jiwei Yu, Hardwin Mead, Xiaowei Yan, Zhengbin Zhu, weiwei Quan, Ruiyan Zhang
Journal: Circulation (2023)

Introduction: Left ventricular systolic dysfunction (LVSD) is associated with poor health outcomes. Previous study has demonstrated the effectiveness of electromechanical activation time (EMAT) derived from phonocardiography (PCG) and electrocardiography (ECG) signals in identifying LVSD. However, high throughput and well-performed algorithm is needed in automatically detecting LVSD. Hypothesis: An artificial intelligence (AI) algorithm was developed and validated in detecting LVSD. Methods: Using ECG and PCG data collected by wearable patch from 1020 admitted patients in Ruijin hospital, we trained an AI algorithm to detect the LVSD, which was determined by ejection fraction &lt;50% from echocardiogram. A separate 590 patients were taken as independent test set. The AI algorithm followed a two-step detection structure, where the first step is to use LSTM learning to quantify heartbeat and heartbeat interval in ECG, and the second step is to apply convolution neural network (CNN) in estimating optimal EMAT cutoff points in detecting LVSD. To overcome the challenge of multi-modal signal training, we develop an alignment-based contrastive learning approach that generates shared feature space embeddings for ECG and PCG signals. Results: Among training and test sets, 18.2% and 26.1% were LVSD, respectively. The AI algorithm yields an AUROC of 0.92 in detecting LVSD with sensitivity of 85.63%, and specificity of 79.39%. Among the test set, model yielded an AUROC of 0.86, sensitivity of 81.29%, and specificity of 77.13%. Conclusions: A wearable device incorporated with a high performed AI algorithm can be a viable, convenient, cost-effective tool in screening LVSD.
Abstract 15535: SGK1 is a Key Mediator of Pathological Cardiac Fibrosis
Authors: Victoria Murray, Sukriti Bagchi, Scott Hahn, Chris C Glembotski, Erik Blackwood
Journal: Circulation (2023)

Background: Cardiac fibroblasts initially respond to injury adaptively, proliferating and differentiating into myofibroblasts to maintain cardiac structure and function. However, prolonged cardiac stress leads to pathological cardiac fibrosis, ultimately resulting in heart failure (HF). Thus, there is a major interest in developing therapeutic strategies to constrain fibroblast differentiation and sustained activation. We recently identified the cytosolic protein kinase, serum/glucocorticoid regulated kinase 1 (SGK1), as being largely involved with pathological remodeling in the cardiac myocyte. While there have been reports that SGK1 may also play a role in fibrosis, the mechanistic role for SGK1 in cardiac fibroblasts in response to injury remains unknown. Hypothesis: SGK1 promotes pathological cardiac fibrosis and exacerbates progression to HF. Methods: Transforming growth factor beta, (TGFβ) was used in primary cardiac fibroblasts (CFBs), in vitro , and transverse aortic constriction (TAC) was used as a HF model in mice, in vivo . CFBs were transfected with siRNA to knockdown SGK1, in vitro , and SGK1 floxed mice were injected with a novel AAV9 utilizing a myofibroblast-specific promoter to knockout SGK1 specifically in myofibroblasts (SGK1 mfbKO), in vivo . Results: SGK1 signaling was elevated in cardiac explants obtained from ischemic human HF patients which led us to further evaluate SGK1 activity in CFBs. SGK1 knockdown in CFBs attenuated TGFβ-mediated differentiation and fibrotic signaling. SGK1 mfbKO mice subjected to TAC showed preserved systolic and diastolic cardiac function, measured by echocardiography. At the biochemical level, pathological remodeling and gene markers of fibrosis were attenuated in SGK1 mfbKO mice as determined by qRT-PCR of cardiac extracts. Finally, treatment of CFBs with a small molecule SGK1 inhibitor attenuated differentiation and fibrotic signaling in response to TGFβ treatment. Conclusion: SGK1 knockdown is protective against cardiac fibrosis, attenuating differentiation and fibrotic signaling in CFBs. Further, SGK1 mfbKO protected against pathological cardiac remodeling and functional decline in a mouse model of HF, highlighting the specific pathophysiological contributions of CFBs.
Abstract 18470: The Impact of Cardiovascular Health Intervention on Plasma Metabolomic Profiles: Results From the Morehouse-Emory Cardiovascular Center for Health Equity
Authors: Nour Beydoun, Nishant Vasta, Chang Liu, Kimberly Rooney, Yan Sun, Priscilla Pemu, Herman A Taylor, Dean Jones, Arshed A Quyyumi, Charles D Searles
Journal: Circulation (2023)

Introduction: Previously, we used plasma metabolomics profiling to identify metabolites underlying cardiovascular health (CVH) in participants of the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity study, a cohort of Black adults living in the greater Atlanta metropolitan area. To determine whether a health intervention could alter expression of metabolites associated with CVH, metabolomics profiles were assessed pre- and post-intervention in participants with poor CVH. Hypothesis: Metabolites previously shown to be associated with CVH in MECA participants would be altered after the health intervention. Methods: Seventy-one Black adults without known cardiovascular disease and with poor CVH (AHA Life’s Simple 7 [LS7] score &amp;lt;8), used a technology-enabled behavioral intervention platform for 6 months with or without a health coach. Metabolomics profiles were assessed pre- and post-intervention by high-resolution metabolomics profiling. A metabolome wide association study (MWAS) identified differentially expressed metabolites and enriched metabolic pathways. Metabolites were annotated by matching to an in-house library of confirmed metabolites. Changes in clinical metrics after intervention were also explored. Results: Mean age was 55 (standard deviation [SD] 9.0) years, 69% female. Total LS7 scores improved from 6.2 (SD 1.49) to 6.5 (SD 1.74) after the intervention. While total and subcomponent LS7 scores and clinical metrics (BMI, blood pressure, glucose and cholesterol levels) trended toward improvement, the changes were not statistically significant. MWAS identified 18 confirmed metabolites that were significantly changed after intervention, including glutamine and glutamate. Pathway analysis identified 29 enriched metabolic pathways, including those for glutamate, aspartate, asparagine, arginine and proline metabolism. Conclusions: A six-month lifestyle intervention significantly altered activity of select plasm metabolites while only modestly altering clinical metrics. These metabolites appear to be sensitive indicators of a healthier lifestyle, potentially supporting their use as markers of CVH and therapeutic targets.
Abstract 15926: Left Atrial Pressure and H <sub>2</sub> FPEF Score in Patients With Atrial Fibrillation Who Underwent Catheter Ablation
Authors: Jong Sung Park, Daehoon Kim, Moon-Hyun Kim, Je W Park, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Hui-Nam Pak
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a common comorbidity in atrial fibrillation (AF) patients and contributes to AF progression and stroke risk. Hypothesis: We explore the hemodynamic effects of left atrial pressure (LAP), which was directly measured during AF catheter ablation (AFCA), on HFpEF based on the H 2 FPEF score. Methods: We included 1,426 patients (73.3% male, median age, 61.0 [54.0-68.0] years; 45.7% persistent AF) who underwent AFCA, LAP measurements at both AF and sinus rhythm (SR), echocardiogram, and H 2 FPEF score, and excluded the patients with EF &lt;50%. We divided patients into low-risk (&lt; 6 points) and high-risk ( ≥ 6 points) HFpEF groups and measured LAP-mean depending on heart rates 90, 100, 110, and 120 bpm during right atrial pacing (Pace-HR) and isoproterenol (ISO-HR) infusion in all patients. Results: The LAP-mean was sequentially and significantly higher according to the H 2 FPEF score (p&lt;0.001) and had an independent association with the high-risk HFpEF group (OR 1.37 per 10mmHg increase [1.13-1.67], p=0.001). LAP-mean increased significantly with increasing Pace-HR (90-120 bpm, 10.4 to 11.6 mmHg, p&lt;0.001) but decreased with ISO-HR (90-120 bpm, 10.2 to 8.1 mmHg, p&lt;0.001). In patients with paroxysmal AF, LAP-mean[AF] was significantly higher than LAP-mean[SR] (p&lt;0.001), but not in those with non-paroxysmal AF (p=0.557). In patients with paroxysmal AF, ΔLAP-mean[Pace-HR, 120-90bpm] was significantly higher than that of non-paroxysmal AF (p&lt;0.001). Conclusions: LAP is independently associated with H 2 FPEF score and has inverse rate-dependent response depending on pacing or ISO infusion. Higher increase of LAP during AF or higher Pace-HR contributes to more severe symptoms in patients with paroxysmal AF than in non-paroxysmal AF.
Abstract 328: Identification of In-Hospital Cardiac Arrest Using Administrative Billing Codes
Authors: Aarthi Kaviyarasu, Oscar J Mitchell, Sunil Thomas, Ashley Batugo, Danielle L Mowery, Benjamin S Abella
Journal: Circulation (2023)

Introduction: In-hospital cardiac arrest (IHCA) is experienced by approximately 200,000 patients annually in the US. While individual care teams can readily identify IHCA at the bedside, subsequent event identification for research or quality improvement (QI) purposes is challenging and often relies on the use of administrative billing codes. Prior research has shown that the use of administrative codes from International Classification of Diseases-9 (ICD-9) was both insensitive and nonspecific for identification of IHCA events. However, the performance of this approach using updated ICD-10 codes has not been established. Hypothesis: ICD-10 codes can be used to identify IHCAs in a QI database of IHCA events with high sensitivity. Methods: We performed a retrospective cohort study of all adult IHCA patients ( &gt; 18 years old) at the Hospital of the University of Pennsylvania from 06/2018-03/2022. True IHCA events were confirmed by a research coordinator and a physician through detailed encounter-level chart review of clinical records. We searched for four individual ICD-10 diagnostic codes: ICD I46.2 - cardiac arrest due to underlying cardiac condition; ICD I46.8 - cardiac arrest due to other underlying condition; ICD I46.9 - cardiac arrest, unspecified; and ICD I49.01 - ventricular fibrillation. ICD-identified IHCA was defined as the presence of any of these codes from a hospital stay but not present on hospital arrival. Results: Of 466 patients with a confirmed IHCA event contained within the QI database, the median age was 65 (54-73), 43% (199/466) were female, and 69% (323/466) had sustained return of spontaneous circulation (ROSC) at the end of their code. The use of billing codes identified 318 patients as having IHCA, corresponding to a sensitivity of 68%. The most used ICD-10 code in this cohort was ICD I46.9 (141/466, 30%). Conclusions: The use of ICD-10 codes has a low sensitivity for identification of IHCA events. These findings are consistent with previously published work using older ICD iterations and suggests significant limitations with using administrative codes to identify IHCA events. Novel approaches (e.g., natural language processing and machine learning algorithms) to identify IHCA may facilitate more accurate research and QI efforts.
Abstract 15027: Predicting Recurrence of Myocardial Infarction in Post-PCI Patients Using Machine Learning
Authors: Kozo Okada, Kohtaroh Kusu, Shinnosuke Kikuchi, Hijiri Etou, Teruyasu Sugano, Yusuke Seki, Kiyoshi Hibi
Journal: Circulation (2023)

Introduction: While prevention of recurrent myocardial infarction (MI) is important in the management of patients after percutaneous coronary intervention (PCI), risk stratification of MI remains a significant challenge with increasingly diverse and complex patient backgrounds. This retrospective observational study aimed to explore whether machine learning (ML) methods can predict recurrent MI after PCI using a variety of features extracted from electronic medical records (EMRs). Methods: Seven machine learning algorithms were retrospectively applied to predict recurrent MI within two years after PCI (124 cases, 4.2%) from a total of 2984 PCI cases. The imbalance in the proportion of positive and negative data was resolved by introducing misclassification costs. Basic patient information (e.g., age, sex, risk factors) and laboratory test results were used for the analysis. Feature importance was calculated to identify key factors for MI recurrence. Five-fold cross-validation was used to calculate accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for each model. Results: As shown in Figure 1a, several ML models showed excellent diagnostic accuracies in the prediction of recurrent MI, demonstrating high NPV. Although the weighting of feature importance for MI recurrence varied among ML models, infarct size (peak CK levels), increased inflammatory status, acute coronary syndrome, and traditional coronary risk factors were identified as important features for predicting recurrent MI within two years after PCI (Figure 1b). Conclusions: It is suggested that ML using EMR data is promising for predicting recurrent MI within two years after PCI. Further studies are warranted to address whether ML-based risk stratification could lead to improved clinical decision-making after PCI.
Abstract 16967: Effect of Catheter Ablation of Persistent Atrial Fibrillation on Surface Atrial ECG Dominant Frequency
Authors: Ghaith Zaatari, Jorge Bohorquez, Laura McDermott, Raul Mitrani, Catherine Blandon, alex velasquez, Litsa Lambrakos, Jeffrey J Goldberger
Journal: Circulation (2023)

Background: There are no standard techniques to track effects of catheter ablation (CA) of persistent atrial fibrillation (PeAF). The Atrial ECG (A-ECG) derived from the standard ECG provides the atrial dominant frequency (DF), an estimation of atrial rate. Research Question: Does CA for PeAF diminish A-ECG DF? Aims: To evaluate change in A-ECG peak DF pre- and post-CA. Methods: We obtained 1-minute epochs of surface ECG pre- and post-CA in 32 patients (age 63±9 years; 71% males) undergoing CA for PeAF. A-ECG was derived by QRST subtraction and independent component analysis filtering, and divided into overlapping10-second windows, each subjected to Fast Fourier Transform. DF was calculated for each lead as the average DF for all 10-sec segments. Peak A-ECG DF was assessed by regional lead group and among all leads. 10 patients were excluded for significant artifact. Of the 22 analyzed patients, all had pulmonary vein isolation and 3 had posterior wall isolation. Two-year outcomes were available in 20 patients (13 were free from recurrent AF). Results: The figure shows the change in the time-frequency plot (left panel) of DF for one subject and the shift in the spectra (right panel) with CA. A-ECG peak DF was significantly lower post- versus pre-CA: 5.96±0.63 vs 6.16±0.64 Hz, p=0.0009. By lead group, peak DFs were all lower post CA - Anterior (V1-3): 5.94±0.62 vs 6.13±0.64 Hz, p=0.0015; Inferior (II, III, aVF): 5.82±0.63 vs 6.01±0.66 Hz, p=0.0040; Lateral (I, aVL, V5-6): 5.82±0.64 vs 5.99±0.63 Hz, p=0.0015. In this small cohort, there was no significant difference in change of peak DF in those free from AF versus with recurrent AF (-2.4±4.3% vs -4.6±3.7%, p=0.26). Conclusion: The A-ECG provides physiologic information of activation rate in PeAF, but despite current, advanced signal processing techniques is analyzable in only 69% of patients. CA results in a significant reduction in DF. Clinical implications of these CA induced changes require further study.
Abstract 18205: Ethnicity and Aortic Stenosis: Presentation, Management and Outcomes
Authors: Dhruva Biswas, Jack Wu, Apurva Bharucha, Natalie Fairhurst, George Kaye, Max Baghai, Rafal Dworakowski, Jonathan Byrne, Philip MacCarthy, Ajay M Shah, Mehdi Eskandari, Kevin O'Gallagher
Journal: Circulation (2023)

Background: Ethnic disparities exist in the diagnosis and management of aortic stenosis (AS), including decreased rates of transcatheter aortic valve implantation (TAVI) in Black patients. We sought to identify if disparities persist in the setting of universal healthcare and whether they are affected by social deprivation. Methods: A validated natural language processing pipeline was applied to the electronic health records of &gt;1M patients at King’s College Hospital (UK) to identify 6214 patients with AS (4.5% Asian, 7.6% Black, 87.9% White self-reported ethnicity). All analyses are adjusted for age and social deprivation. Results: Black and Asian patients had more comorbidities (P&lt;0.05), while Black patients had more cardiac symptoms compared to White patients (P&lt;0.05). Mean time from first report of breathlessness to AS diagnosis was 2.61 years for Asian patients, 2.93 years for Black patients, and 2.09 years for White patients (P&lt;0.05). For those with severe AS, TAVI was performed in 14.3% of Asian patients, 14.3% of Black patients, and 20.2% of White patients. The mean time from severe AS diagnosis to TAVI was 0.41 years for Asian patients, 0.88 years for Black patients, and 0.52 years for White patients (P= NS). Surgical aortic valve replacement (AVR) was performed in 12.5% of Asian patients, 15.5% of Black patients, and 15.4% of White patients. The mean time to AVR was longer for Black patients (1.07 years) compared to Asian (0.19 years) and White patients (0.35 years, P&lt;0.05). The mortality benefit of TAVI or AVR interventions was similar between race and ethnicity groups in a Cox multivariate analysis. Conclusions: Ethnicity-based differences exist in the presentation, diagnosis and management of AS, despite correction for social deprivation. Further, Black patients with severe AS are less likely to receive TAVI intervention, and wait significantly longer for AVR, despite similar efficacy. These data should stimulate strategies to address inequity.
Abstract 12704: Racial, Ethnic, and Socioeconomic Disparities in Incidence and Survival for Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival (CARES)
Authors: Cody-Aaron Gathers, Maryam Naim, Heather Griffis, Bryan F McNally, Rabab Al-Araji, Robert A Berg, sarita chung, Vinay M Nadkarni, Joseph Rossano
Journal: Circulation (2023)

Introduction: Racial, ethnic, and socioeconomic disparities in pediatric out-of-hospital cardiac arrest (OHCA) exist; however, pediatric OHCA incidence and survival outcomes among race, ethnicity, and socioeconomic status (SES) are unknown. We evaluated the incidence and outcomes of pediatric OHCA among race, ethnicity, and SES, hypothesizing that Black and Hispanic children, and children from a lower SES, would have higher incidence rates and lower survival compared to White children. Methods: We conducted a retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival database, analyzing nontraumatic OHCAs in children&lt;18 years old between 2015 and 2019. A previously validated SES risk score, incorporating race, ethnicity, household income, high school graduation rates, and unemployment rates, was developed on a scale from 0-4, with 4 indicating the highest-risk neighborhood. Results: Among 6945 OHCAs, 33% occurred in Black children, 11% in Hispanic children, 31% in White children, and 41% in the highest-risk neighborhood. Black children had the highest OHCA incidence (15.5 per 100,000 children) compared to White children (3.8 per 100,000 children) and Hispanic children (3.3 per 100,000 children) (p&lt;0.001). OHCA incidence was higher in high-risk neighborhoods (11.6 per 100,000) compared to low-risk neighborhoods (4.3 per 100,000) (p&lt;0.001). In multivariable analysis, Black children had lower odds of survival to hospital discharge (aOR 0.74, CI 0.59-0.92) and neurologically favorable survival (aOR 0.64, CI 0.50-0.82) compared to White children. Hispanic children did not have significantly worse survival outcomes compared to White children. Children from the lowest-risk neighborhoods had higher odds of survival to hospital discharge (aOR 1.45, CI 1.12-1.87) and neurologically favorable survival (aOR 1.65, CI 1.24-2.20) compared to children from the highest-risk neighborhoods. Conclusions: Significant racial, ethnic, and socioeconomic disparities exist in pediatric OHCA. Black children have over four times the incidence of OHCA compared to White and Hispanic children and significantly worse survival outcomes. Children from low-risk neighborhoods have significantly better survival outcomes.