tbuckley/cabot-search huggingface dataset:
Abstract 16207: Deep Learning-Based Natural Language Processing of Discharge Summaries for Automated Identification of Heart Failure With Reduced Ejection Fraction
Authors: Arash Aghajani Nargesi, Philip Adejumo, Benjamin Rosand, Lovedeep S Dhingra, Astrid Hengartner, Sounok Sen, Tariq Ahmad, Faraz S Ahmad, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2023)

Background: Implementation of a national program to improve guideline-directed care in heart failure with reduced ejection fraction (HFrEF) has been limited by the lack of automated tools to measure care quality. A key challenge for this approach is to identify patients with HFrEF at hospital discharge, an opportunity to evaluate and improve care. Methods: We developed a novel deep-learning language model to detect patients with HFrEF from discharge summaries using a semi-supervised learning framework. Hospitalizations with heart failure (HF) at Yale New Haven Hospital between 2015-2019 were labeled as HFrEF if left ventricular ejection fraction was under 40% on antecedent echocardiography. The model was internally validated with model-based net reclassification improvement (NRI) assessed against chart-based diagnosis codes. We externally validated the model on discharge summaries from hospitalizations with HF at Northwestern Medicine, community hospitals of Yale Health, and MIMIC-III database, confirmed with chart abstraction. Results: A total of 13,251 notes from 5,392 individuals (age 73 ± 14 years, 48% female), including 2,487 (46.1%) patients with HFrEF were used for model development (train/validation/test: 70/15/15%). The model achieved an AUROC 0.97 and AUPRC 0.97 in detecting HFrEF on the test set. In external validation, the model had high performance in identifying HFrEF with AUROC 0.91-0.95 and AUPRC 0.91-0.96 among 19,242 discharge summaries at Northwestern Medicine, 139 notes from Yale community hospitals, and 146 notes from MIMIC-III. Model predictions corresponded to an NRI of 28 ± 7% compared to chart diagnosis (p&lt; 0.001) and identified significant gaps in the use of guideline-directed therapies (Figure). Conclusions: We developed and validated an NLP model that automates the identification of HFrEF from clinical notes with high precision and accuracy, representing a key element to automate quality-of-care measurements in HFrEF.
Abstract 13713: Coronary Endothelial Dysfunction and Microvascular Vasospasm in Patients With Postural Orthostatic Tachycardia Syndrome
Authors: Rebecca S Steinberg, Anamaria Dragan, Puja K Mehta, Alexis Cutchins, Olga Toleva
Journal: Circulation (2023)

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by autonomic dysfunction-related symptoms such as orthostatic intolerance, palpitations, dizziness, and chest pain. The mechanisms driving chest pain in POTS are unclear. Hypothesis: We hypothesized that coronary endothelial dysfunction (ED) and abnormal microvascular reactivity may be a contributor to chest pain in POTS. Methods: Patients (n=6) were diagnosed with POTS or had significant tachycardia despite medical therapy out of 67 patients in our cohort. All patients reported persistent chest pain and were referred for coronary function testing (CFT) to test macro- and micro-vascular function. CFT was performed to test endothelium-dependent and non-endothelium dependent function using graded doses of intracoronary acetylcholine (ACH), and intravenous adenosine (ADO). Coronary Flow Reserve&lt;2.0 and Index of Microvascular Resistance&gt;25 diagnosed coronary microvascular dysfunction. Coronary artery diameter narrowing to ACH (100 mcg) was used to diagnose ED. Epicardial coronary spasm was defined as &gt;90% constriction to ACH. Microvascular spasm was diagnosed by ACH provoked-chest pain and EKG changes in the absence of epicardial spasm. Results: Mean age was 44.1 ± 15.2 years, 67% were female, and all tolerated CFT without complications. POTS symptoms, baseline medications, and CFT results are shown ( Table ). All had an abnormal response to ACH, indicating ED and microvascular spasm. Non-endothelium function was normal in all patients. Anti-anginal medications were changed based on CFT information, with improvement in chest pain with calcium channel blocker use. Conclusion: In all 6 pts, CP was associated with ED and microvascular spasm. Mechanistic links between ED and POTS need further investigation. Given that ED is a prognostic marker associated with recurrent angina hospitalization and events, investigation of therapies that target ED in POTS may be warranted.
Abstract 13356: Get the Strips: Bridging the Gap Between First-Responders and Hospital Care After Cardiac Arrest
Authors: Carmel Ashur, Kelby Kuo, Paul D Varosy, John West, Amneet Sandhu, Alexis Tumolo, Lohit Garg, Michael Rosenberg, Syed Rafay Ali Sabzwari, Christopher Barrett, Lukasz Cerbin, Matthew Zipse, Wendy Tzou, Ryan Aleong
Journal: Circulation (2023)

Introduction: Following a cardiac arrest, rhythm strips stored on an automated external defibrillator (AED) can help guide medical decisions, including the need for an implantable cardioverter defibrillator. However, this information is often lost or difficult to obtain in the transfer of patient care. Objective: Highlight the utility of obtaining AED rhythm strips and illustrate current practice and potential pitfalls from a first-responder’s perspective. Methods: Distributed a survey to emergency medical service (EMS) agencies in the Denver area. Results: A total of 25 EMS providers responded from Denver (28%) and the surrounding area (72%). Direct transfer of rhythm strips to hospitals after an arrest was felt to be either very important (20%) or extremely important (80%), while 24% responded that rhythm strips were unlikely to be transferred into a patient’s electronic medical record (EMR). Over half (52%) of respondents do not consider the possibility of an inappropriate shock or inappropriately withheld shock from an AED, while 88% recognized that the type of shockable rhythm affected medical decisions. Of the 18 who reported a system for uploading rhythm strips, half directly scanned paper rhythm strips while half uploaded data using a cloud-based software. Finally, 80% felt that a system of wireless transmission to an online server would improve transfer of rhythm strips to receiving hospitals. A rhythm strip obtained from an AED interrogation (Figure 1) showed an appropriate shock for polymorphic VT in an otherwise healthy 30-year-old male that did impact clinical decision making. Conclusions: Rhythm strips stored on an AED should be reviewed at the time of hospitalization as this information may affect medical evaluation. Despite first responder appreciation, there remain gaps in this process, with the use of direct wireless upload from an AED to a patient’s EMR offering a potential solution.
Abstract 15438: Cardiovascular Diseases Are Associated With an Increased Incidence of Cancer Metastasis
Authors: Tal Caller, Alexander Fardman, Nili Naftali Shani, Jonathan Leor, Elad Maor
Journal: Circulation (2023)

Background: While heart diseases are associated with an increased incidence of cancer, the association between cardiovascular diseases (CVD) and cancer metastasis, the primary determinant of cancer prognosis, has never been studied. We aimed to determine the association between CVD and cancer metastasis. Methods: We evaluated 21,952 self-referred adults, free of cancer and CVD (ischemic heart disease/stroke) at baseline, who were screened in our preventive healthcare. Next, we implicated a 1-year blanking period at the start of the follow-up. Then, a Cox regression model with CVD as a time-varying covariate was used to evaluate the association between CVD and metastatic cancer. Finally, we implicated the same models in evaluating the risk of young (ages Q1-3) and old adults (ages Q4). Results: During a median follow-up of 7 years (IQR 3-13 years), 1359 subjects developed CVD, and 920 subjects developed metastatic cancer. Subjects who developed CVD were 71% more likely to develop cancer metastasis by a univariate model (HR= 1.33, 95% CI 1.05-1.69, p=0.02). The risk persisted after adjustment for risk factors by a multivariate model (95% CI 1.33-2.20, p&lt;0.001), as well as landmark analysis (HR=1.84 95%CI 1.42-2.34, p&lt;0.001) ( Fig-1) . The association of CVD with the risk of metastatic cancer was age-dependent (p for interaction = 0.035): significant among younger adults (43±6 years, HR=1.57,95% CI 1.02-2.42, p=0.040), compared with older adults (60±6 years, HR=1.12, 95% CI 0.80-1.56, p=0.522). Notably, CVD emerged as a risk factor for metastatic cancer in younger adults despite a lower rate of common risk factors. Conclusions: We show, for the first time, that cardiovascular diseases are associated with an increased and independent risk of cancer metastasis. The risk is age-dependent and more significant among young adults. Understanding this association could promote early diagnosis, risk stratification, and better treatment of cardiovascular diseases and cancer.
Abstract 18495: Right and Left Ventricular Starling Function in Heart Failure With Preserved Ejection Fraction
Authors: Joetsaroop Bagga, Denis J Wakeham, Seamus Hughes, Matthew Howrey, Tiffany Brazile, Bryce Balmain, Andrew R Tomlinson, Christopher Hearon, James P Macnamara, Tony Babb, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2023)

Background: Efficient conversion of cardiac filling pressure to stroke volume (SV) is described by the Frank-Starling mechanism. Our group has previously characterized dynamic Starling mechanisms (DSM) in the frequency domain using respiratory mediated changes in beat-by-beat SV as a function of changes in pulmonary artery diastolic pressures (PAD) and shown this to be impaired in heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is common in HFpEF but efficiency of the RV Starling mechanism is unknown. The goal of this study was to characterize RV and LV DSM in patients with HFpEF. Methods: We studied 16 HFpEF patients (10 females; age: 68 ± 6 years) at seated rest following the placement of a radial arterial and right heart catheter. DSM was quantified by transfer function (input/output frequency) analyses of beat-by-beat changes in PAD (for LV) and A wave right atrial pressures (for RV) as input variables. Output variable was SV (Modelflow from radial arterial line waveform) and normalized for LV DSM using direct-Fick derived SV and for RV DSM using acetylene rebreathing derived SV as a measure of pulmonary blood flow. Results: The power spectral density (PSD) was higher for LV compared to RV filling pressure (521 ± 446 vs 125 ± 111 mmHg 2 , P = 0.001); there was no difference for adjusted SV PSD (819 ± 764 vs 808 ± 765 ml 2 , P = 0.232). DSM gain was higher for LV compared to RV for all but 1 subject (0.58 ± 0.29 vs 0.30 ± 0.16 ml/mmHg, P = 0.002; Figure). Conclusions: RV DSM gain was significantly worse than LV DSM gain suggesting decreased RV contractile and/or compliance reserve in patients with HFpEF. These results highlight the utility of RV DSM gain to characterize RV dysfunction in patients with HFpEF.
Abstract 15402: Anatomic and Physiologic Classification of Adults With Congenital Heart Disease Using International Classification of Diseases (ICD) Coding
Authors: Lindsey C Ivey, Joy Chen, Attila Ahmad, Cheryl L Raskind-Hood, Fred H Rodriguez, Wendy M Book
Journal: Circulation (2023)

Background: The 2018 Adult Congenital Heart Disease (ACHD) Anatomic Physiologic (AP) classification scheme encompasses both anatomy and physiology to guide care management. To utilize the ACHD AP classification system in population-based research, an International Classification of Diseases (ICD) code-based classification is needed. Methods: AP classification of 240 cases, 18-65 years, with an encounter between 1/1/2010 - 12/31/2019 identified by at least one of 90 CHD codes (41 ICD-9-CM, 49 ICD-10-CM) in a tertiary adult healthcare system was performed by two methods - medical record review and a novel code-based AP classification. Cases were assigned one of four mutually exclusive AP classification categories based on complex vs. non-complex (simple plus moderate) anatomy and combined AB physiology (no/mild physiologic comorbidities) vs. CD physiology (moderate/severe physiologic comorbidities). A composite outcome of death, emergency department visit and/or hospitalization at 1-year after AP classification was evaluated. Results: Both record review and ICD code-based physiology classification methods demonstrated significant differences in 1-year outcomes between AB and CD physiology regardless of anatomic classification (Table 1), with CD physiology experiencing more adverse outcomes. Performance of AP classification by record review [PPV: 85.1% (97/114)] and ICD code-based classification [PPV: 80.7% (92/114)] (p=0.38) was similar. No differences were revealed by comparing outcome prediction within physiologic group by method, (AB by record review vs. AB by ICD codes: p=0.98; CD record review vs. CD by ICD codes: p=0.16). Conclusion: An ICD code-based classification of the ACHD AP guidelines is feasible, predictive of future adverse outcomes, and a reliable tool to use in administrative data. ICD code-based AB and CD physiology classifications are a good differentiator of outcomes for both complex and non-complex anatomic groups.
Abstract 17923: Acute Limb Ischemia Due to Dissection and Thrombosis of Anomalous Right Subclavian Artery: A Rare Complication of Trans-Radial PCI
Authors: Waseem Farooq, Raheel Khan, Brian Page
Journal: Circulation (2023)

Introduction: Right subclavian artery (RSA) normally originates from brachiocephalic artery, but in 0.4-1.8% of the general population it may arise directly from the aortic arch distal to the left subclavian artery. We present a case of acute limb ischemia due to dissection and thrombosis of anomalous right subclavian artery (ARSA) following transradial PCI. Case: A 60-year-old female presented with anterior STEMI. Coronary angiogram was performed via right transradial approach. During the procedure the aortic arch was noted to be exceedingly tortuous and coronary artery catheterization was difficult. Post-procedure, patient reported right arm pain. Her right hand was cold with bluish discoloration, nonpalpable right radial, ulnar and brachial artery pulses which prompted a CTA of the chest and right upper extremity. Imaging revealed ARSA with dissection and thrombosis of the RSA extending to mid-brachial artery and absent opacification of radial/ulnar arteries. The patient underwent right brachial artery cutdown, axillary artery thrombectomy and stenting of ARSA dissection. Post procedure, her pulses were palpable with triphasic doppler signals in the radial and ulnar artery. Four months later, surveillance CTA of chest showed patent stent without additional evidence of dissection (Figure 1). Discussion: ARSA is a rare anatomical variation of the origin of the RSA but also the most common abnormality of the aortic arch. ARSA anomaly is often asymptomatic, but approximately 10% is associated with tracheo-esophageal symptoms; the most frequent among them is dysphagia. Only 60% of coronary procedures using transradial approach are successful in the presence of ARSA. This congenital variant makes it difficult to approach the ascending aorta by the right transradial route, as it requires the catheter to curve back to reach the aortic root. Prompt recognition of this anomaly during the procedure and alternate access routes can avoid these severe complications.
Abstract 18136: Efficacy and Safety of Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis - A Systematic Review and Proportional Meta-Analysis
Authors: Jawad Basit, Zaofashan Zaheer, Farah Yasmin, Usman A Akbar, Mohammad Hamza, Khawar Abbas, Umer Irshad, kuldeep dhama, Shanjeev Kumar K Rajeshkumar Chitra, Majd Al Ahmad, Mohammad E Rehman, Sajeel Saeed, yasar sattar, Gary Tse, M Chadi C Alraies
Journal: Circulation (2023)

Background Cardiac amyloidosis (CA) is a restrictive cardiomyopathy characterised by amylin deposits in the heart muscle. While the prevalence of atrial arrhythmias in CA is high, the data regarding the outcomes of catheter ablation in these patients is limited. Our current study aims to elucidate the safety &amp; efficacy of catheter ablation for treating atrial arrhythmias in patients with CA. Methods: We conducted a comprehensive literature search across MEDLINE &amp; Scopus from inception till May 2023 for randomized control trials &amp; observational studies reporting catheter ablation (cryoablation or radiofrequency ablation) for the treatment of atrial arrhythmias (AAs) (atrial flutter, atrial fibrillation, atrial tachycardia) in patients with cardiac amyloidosis (transthyretin or light-chain). The primary outcomes of interest were pooled recurrence &amp; re-ablation rates. The secondary outcome was all-cause mortality. All data was analyzed using the Hedges-Olkin random-effects model &amp; presented as percentage proportions. Results: A total of 6 cohort studies with 154 cardiac amyloidosis patients with atrial fibrillation were included. The pooled incidence of repeat ablation was 16.4% [(6.2%, 26.7%), p=0.002)] &amp; recurrence rate was 47.9% [(25.2%, 70.5%), p&lt;0.001)]. The pooled incidence of all-cause mortality in these patients was 37.1% [(25.1%, 49.1%), p&lt;0.001)]. Conclusion High rate of recurrence &amp; need for re-ablation coupled with high mortality demands better patient selection. Prospective &amp; randomized controlled data is needed to better study the outcomes of catheter ablation in these patients.
Abstract 11432: Association of Cardiac Biomarkers With Long-Term Cardiovascular Events in the Community
Authors: Robert A Churchill, Benjamin R Gochanour, Christopher Scott, Vlad C Vasile, Allan S Jaffe
Journal: Circulation (2023)

Introduction: Biomarkers can facilitate the prediction of events in primary prevention. Few studies have been conducted in the community setting with analyses that incorporate many biomarkers. Hypothesis: We tested whether a multi biomarker model would outperform clinical factors and individual biomarkers for predicting MACE and Stroke/MI in subjects without known CAD. Methods: A retrospective cohort study assessed composite outcomes MACE (MI, CABG, PCI, stroke, and death) and Stroke/MI. Cox proportional hazard models were fit for individual biomarkers, adjusted for age, gender, BMI, hypertension, CAD, and GFR. Multi biomarker models were developed based on AIC values from the single-biomarker models. Bootstrap tests compared survival C-statistics and relative Integrated Discrimination Index (IDI). Results: 1131 patients in Olmsted County, MN were studied. Median age was 63.1 years, 97.5% were Caucasian, and 52.2% were female. Median BMI was 27.8. Kaplan Meier rates of MACE and Stroke/MI were 29.2% (CI = 26.5-31.8%) and 12.3% (CI = 10.3% - 14.3%), at 10 years. Adjusted NT proBNP models showed a 31% increased risk of MACE/death (HR = 1.31; CI = 1.17-1.46) and a 31% increased risk for stroke/MI (HR = 1.31; CI = 1.08-1.58). Adjusted Ceramide score models showed a 13% increased risk of MACE/death (HR = 1.13; CI = 1.04-1.24) and a 29% increased risk for stroke/MI (HR = 1.29; CI = 1.11-1.51). NT proBNP and the Ceramide score with clinical factors was better than clinical factors alone for MACE/Death (Relative IDI = 29.7%; p = 0.003) and Stroke/MI (Relative IDI = 36.1%; p = 0.034). This combined model did not outperform the strongest single biomarker model for Stroke/MI or MACE/Death. Other biomarkers were not significant when added to the combined model. Discussion: Ceramide score and NT proBNP alone and together improve the prediction of MACE and Stroke/MI in a community primary prevention cohort.
Abstract 16629: Comparison of Clinical and Genetic Risk Model for Ischemic Stroke After Atrial Fibrillation Catheter Ablation
Authors: Je W Park, Daehoon Kim, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Hui-Nam Pak
Journal: Circulation (2023)

Introduction: CHA 2 DS 2 -VASc score (CVS) is used to estimate risk of stroke in atrial fibrillation (AF) patients. But, CVS does not include genetic risk. We explored clinical and genetic risks for ischemic stroke (IS) after AF catheter ablation (AFCA). Methods: We used genome-wide association study (GWAS) data in European (34217 IS, 406111 controls) and Asian (22664 IS, 152022 controls) to develop polygenic risk score (PRS) for IS in 2897 independent Korean AF patients (Median 60 years, male 74.0%, paroxysmal AF 66.3%, anticoagulation rate 60% in 1367 patients with CVS ≥ 2 who underwent AFCA. Patients with IS within 2 weeks after AFCA were excluded. In the independent AF cohort during median 50 [IQR 28-94] months follow-up, 48 experienced IS after AFCA. We developed two different CVS-combined PRS models in the independent cohort using European and Asian GWAS data. Using p-value &lt;5e-8, rs635634 and rs671 were used in CVS-combined European PRS (CVS-EPRS) and CVS-combined Asian PRS (CVS-APRS) model, respectively in the independent cohort. We compared C index of risk models to investigate prediction power for IS. Results: CVS was higher in patients with IS than in their counterparts (3.0 IQR [1.0, 4.0] vs. 1.0 [1.0, 2.0], p&lt;0.001). Overall C index was 0.716 in CVS model, 0.711 in CVS-EPRS model, and 0.725 CVS-APRS model. For 1-year IS after AFCA, CVS-APRS model improved C index as compared to CVS model (0.834 vs. 0.813, p=0.037). For 3-year IS after AFCA, C index was higher in CVS-APRS model rather than CVS-EPRS model (0.746 vs. 0.721, p=0.030). In patients with CVS &lt; 2, both CVS-APRS (0.849, p=0.013) and CVS-EPRS (0.766, p=0.027) models showed better prediction for 1-year IS compared to CVS model (0.523). Conclusions: In AF patients with AFCA, genetic polymorphism with clinical risk factors contributed to predict 1-year IS. Genetic contribution was more obvious in AF patients with CVS &lt;2. However, ethnicity might be an important factor in adapting genetic contributions to predicting IS.