tbuckley/cabot-search huggingface dataset:
Abstract 4145267: An Unusual Case of Listeria LVAD Infection Complicated by Intracranial Catastrophe
Authors: Julieann Zviman, Gautam Ramani, Niya Jones, Bartley Griffith, Lynn Dees, Amanda Nevin, Leigha Crowell, Cullen Soares, ANTHONY AMOROSO, Mallory Mouradjian, Richard Rovelli, Sarah Leventhal, Manjula Ananthram
Journal: Circulation (2024)

Description of Case: A 56-year-old male with ischemic cardiomyopathy, HeartMate 3 LVAD implantation presented with fatigue and diarrhea after eating expired cheese a week prior. Hypovolemia, AKI, an unremarkable LVAD interrogation and an INR of 3.4 were noted. Blood cultures and infectious work-up including imaging were obtained. Imaging was unremarkable. Over the first 2 hospital days, he was fluid resuscitated. Hemodynamics showed low biventricular filling pressures and adequate cardiac index. On hospital day 3, blood cultures revealed Listeria monocytogenes prompting initiation of IV ampicillin. AKI worsened, associated with altered mentation requiring endotracheal intubation and renal replacement therapy. On hospital day 8, bronchoscopy was performed to address worsening respiratory secretions. An hour after procedural sedation, he never regained consciousness and anisocoria was noted. Emergent cranial imaging revealed multicompartment hemorrhage with midline shift. Neurosurgical intervention was not recommended due to the catastrophic nature of the bleeding. Supportive pharmacologic measures were futile; brain death was declared 48 hours later. Discussion: Listeria monocytogenes is a gram-positive rod which causes gastrointestinal illness in immunocompetent adults. Cases of Listeria bacteremia in patients with indwelling cardiac hardware are rare but have been previously described in the literature. A case of Listeria bacteremia and leukocytoclastic vasculitis in an LVAD patient resulting in AKI has been reported. To our knowledge, this is the first published case of Listeria bacteremia in an LVAD patient complicated by acute intracranial hemorrhage. While the exact mechanism of the brain bleed was not confirmed, it is postulated that the altered mental status and AKI were the products of septic embolization to the brain and kidneys, with ultimate hemorrhagic conversion noted in the setting of therapeutic anticoagulation. A transesophageal echocardiogram had been planned prior to the stroke but not performed due to medical futility. Clinicians should be aware of the more unusual complications of Listeria infection in the setting of indwelling cardiac hardware.
Abstract 4145287: The effects on mortality of statin therapy in patients with heart failure with preserved ejection fraction (HFpEF): An updated systematic review and meta-analysis
Authors: Ana Carolina Coan, Wilson Falco Neto, Eric Katsuyama, Rafael Petri Santos Pinheiro, Alonzo Prata, Julia Fernandes, Pedro Gabriel Scardini, Christian Fukunaga, Naieli Andrade, Luciana Gioli-Pereira
Journal: Circulation (2024)

BACKGOUND: Statins have shown benefits in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). However, the effects of statin in patients with heart failure with preserved ejection fraction (HFpEf) remains unclear. Therefore, we aim to perform an updated systematic review and propensity scores (PS) meta-analysis comparing statin with no statin therapy in this population. METHODS: We searched in PubMed, Embase, and Cochrane Library databases for studies examining the effect of statin use in patients with HFpEF. The primary outcome was (1) all-cause mortality, with secondary outcomes being (1) cardiovascular (CV) mortality and (3) heart failure (HF) hospitalization. We also performed a subgroup analysis for the primary outcome, comparing studies that used PS and studies that did not adjust the baseline covariates. RESULTS: We included in this meta-analysis a total of 17 studies. Our study encompassed 43,911 patients with HPpEF, of whom 19,142 (43.59%) received statin therapy. The mean age was 66.95 years, with a mean follow-up of 3.08 years. In the pooled analysis, statin was significantly associated with reduced all-cause mortality (HR 0.68; 95%CI 0.62-0.76; p&lt;0.01) and HF hospitalization (HR 0.75; 95%CI 0.69-0.81; p&lt;0.01; Fig.1). However, our findings shows no significant change in CV mortality in the statin group (HR 0.84; 95%CI 0.70-1.00; p=0.05; Fig.2A). A subgroup analysis for the primary endpoint reported consistency in the benefits of statin group in patients with HFpEF (HR 0.78; 95%CI 0.74-0.83; p&lt;0.01; Fig.2B) after adjusting the covariates using PS. Moreover, there was a significant difference (p&lt;0.01) between the PS and non-PS results. CONCLUSION: In this updated meta-analysis of patients with HFpEF, statin therapy was associated with decreased all-cause mortality and HF hospitalization. Moreover, this finding was confirmed in a subgroup analysis of PS data. However, these benefits do not translate into CV mortality.
Abstract 4145278: Higher Long-Term Variability In Metabolic Parameters From Childhood Is Associated With Poorer Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Soo Jung Kang, Ileana De Anda-Duran, Eunsun Gill, Camilo Fernández Alonso, XUANYI JIN, Lydia Bazzano
Journal: Circulation (2024)

Background: Metabolic syndrome (MetS), a cluster of risk factors, has been linked to higher risk of dementia in older adults. However, the composite impact of long-term variability of metabolic parameters from childhood on midlife cognitive function is unclear. Methods: We studied 1145 midlife participants of the Bogalusa Heart Study (age at enrollment: 12.2 ± 5.4 years, follow-up: 36.1 ± 3.4 years, age at last exam (midlife): 48.3 ± 5.0 years, 60.9% women, 33.7% Black participants) with ≥3 measurements of metabolic parameters (systolic blood pressure (SBP), fasting blood glucose (FBG), triglyceride (TG), high density lipoprotein (HDL), and body mass index (BMI)) across follow-up. MetS was defined by the National Cholesterol Education Program guidelines, but using BMI &gt;30 kg/m 2 for abdominal obesity. Long-term variability of SBP, FBG, TG, HDL, and BMI from childhood were measured as the residual standard deviation (RSD). Repeated measurements of each parameter were fitted in random-effect models to obtain individual growth curves. Using the growth curves, RSD was obtained as the SD of the difference between each observed and predicted parameter level. A composite variability score (range, 0-10) was defined by 1) assigning 0 points to the lowest tertile of RSD and 2 points to the highest tertile for each parameter, then 2) summing the points for all 5 parameters. Midlife cognitive function was measured by 8 neuropsychological (NP) tests. NP test results were categorized into 3 distinct NP profiles (optimal, average, mixed-low) using cluster analysis. Associations between the composite variability score and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status. Sensitivity analysis excluding participants with MetS at midlife were also performed. Results: A total of 348 (30.4%) participants had MetS at midlife. The odds of having mixed-low cognitive function at midlife increased by 13.3% (OR 1.13, 95% CI 1.03, 1.24) for a 1-unit increase in the composite variability score, compared to optimal cognitive function, adjusted for education status. Sensitivity analysis showed consistent results in participants without MetS at midlife (OR 1.18, 95% CI 1.05, 1.33). Conclusions: A graded association was observed between composite long-term variability in metabolic parameters from childhood and poorer midlife cognitive function. Lowering variability of metabolic parameters may be beneficial to midlife cognitive function.
Abstract 4144833: Large Language Models Improve Readability in Primary Responses to Coronary Artery Bypass Graft Questions for Patient Education
Authors: Venkata Paruchuri, Dhaval Patel, Alexander Fang, Ethan Levitch, Conor Kiely, Karmveer Kaur, Amit Sikder
Journal: Circulation (2024)

Introduction: The advent of Large Language Models (LLMs) such as ChatGPT and Google Gemini yields a new paradigm for patient education. Coronary artery bypass grafts (CABGs) are open-heart surgeries that naturally gives to many questions in potential patients. Prior research suggested that patient education material should be written at a 6 th grade reading level maximally to be comprehended by the majority of the US adult population. However, most education material is written at a much higher literacy level. Now with the increasing use of LLMs, the potential for informing patients at an appropriate readability level exists. Research Question: Can ChatGPT and Google Gemini improve the readability of their primary responses to patient education questions about Coronary Artery Bypass Grafts to a 6 th grade reading level? Methods: We obtained 80 questions from 4 independent participants regarding information they would want to know prior to undergoing a CABG procedure. Questions that could not be answered using public information, required clinician input, and repeats were filtered out leaving 20 questions. These questions were asked to ChatGPT 3.5 and Google Gemini. Then both LLMs were asked to answer the question at a 6 th grade level within the same conversation. A new conversation was created each of the 20 questions. All responses were then evaluated using a Flesch-Kincaid calculator where the Flesch-Kincaid reading ease score (FKRE) and the Flesch-Kincaid grade level (FKGL) were obtained. Data analysis was performed using Microsoft Excel and Graphpad Prism. Results: For the ChatGPT responses, the average FKRE was 31.865 and FKGL was 12.545. Following the 6 th grade level request for ChatGPT, the average FKRE was 74.57 (p &lt; 0.0001) and FKGL was 5.93 (p &lt; 0.0001). For the Google Gemini responses, the average FKRE was 46.395 and FKGL was 10.545. Following the 6 th grade level request for Google Gemini, the average FKRE was 72.945 (p &lt; 0.0001) and FKGL was 6.76 (p &lt; 0.0001). Conclusion: Both LLMs significantly increased the readability of their responses and did so to a 6 th grade level. However, ChatGPT was closer than Google Gemini in reaching the desired FKGL. Nonetheless, our work showed that both LLMs could successfully work with CABG information and yield responses at a readability level befitting the US population. Future studies need to assess the accuracy of this information for LLMs to have practical use in cardiac surgery patient education.
Abstract 4144912: Doing Well, But Can We Do Better? Improving Outcomes and Equity After Stage I Single Ventricle Palliation
Authors: Lydia Wright, Sergio Alejandro Carrillo, Clifford Cua, Jo Ann Davis, Rachel Shustak, Karen Texter, Deipanjan Nandi
Journal: Circulation (2024)

Introduction: Infants with hypoplastic left heart syndrome undergoing single ventricle (SV) palliation may need early heart transplant. We aimed to evaluate predictors of transplant referral (TxR) and death without TxR, with focus on neighborhood opportunity and race/ethnicity, to determine if disparities in TxR contribute to increased mortality seen in certain populations. Methods: Retrospective cohort study of all infants undergoing stage 1 (S1) SV palliation enrolled in the National Pediatric Cardiology Quality Improvement Collaborative from 2016-2022 was performed. Competing risk analysis was used to evaluate predictors of TxR and death without TxR through one year. Results: A total of 3099 infants underwent S1 palliation during our study period. Black children had lower median birth weight compared to non-Hispanic white and Hispanic children (p &lt;0.001) as did those from low compared to higher opportunity neighborhoods (p &lt;0.001). There were no other significant pre-operative or S1 procedure differences. At one year, 79% of children were alive, 16% had died, and 5% had a TxR (Figure). In multivariable analysis, risk factors for TxR included hybrid S1 palliation [sHR 2.43 (95% CI 1.54, 3.81], moderate or greater tricuspid regurgitation (TR) [sHR 3.39 (95% CI 1.80 – 6.40)] and female sex [sHR 1.73 (95% CI 1.24 – 2.40)]. Lower birth weight, genetic syndrome, pre-operative TR, hybrid S1 palliation, and small S1 volume (&lt;8 /yr) center were associated with death without TxR. Neither race/ethnicity nor neighborhood opportunity was associated with TxR or death without TxR when controlling for these risk factors. Among those with pre-operative moderate or greater TR, race/ethnicity was associated with TxR in multivariable analysis, with TxR less likely for Black and Other race children compared to white children (p&lt;0.001 for both). Conclusion: One-year survival after S1 palliation without TxR approaches 80%. No clear disparities in death or TxR by race or neighborhood were seen overall, though lower rates of TxR for Black and Other race children with high-risk cardiac features were present. Standardized guidelines for timely TxR may help further reduce death and mitigate potential disparities in this SV population.
Abstract 4145207: A Comparison Between Global Longitudinal Strain (GLS) Derived with CMR Feature-Tracking (CMR-FT) and 2D Speckle-Tracking Echocardiography (2D-STE) to Monitor Cancer Therapy-Related Cardiac Dysfunction (CTRCD)
Authors: Julia Kar, Michael Cohen, Cherie Revere, Samuel McQuiston, Christopher Malozzi
Journal: Circulation (2024)

Left ventricular global longitudinal strain (GLS) is a critical imaging biomarker for monitoring cancer therapy-related cardiac dysfunction (CTRCD) in patients treated with chemotherapy. This prospective study investigated the interchangeability between GLS monitored with cardiovascular magnetic resonance feature-tracking (CMR-FT) and 2D speckle-tracking echocardiography (2D-STE) in breast cancer patients who received antineoplastic chemotherapy. At baseline and 3- and 6-month follow-ups after chemotherapy initiation, LV images were acquired on 34 breast cancer patients with 2D echocardiography, Steady State Free Precession (SSFP) MRI, and Displacement Encoding with Stimulated Echoes (DENSE) MRI as reference (Fig. 1). For 3D strains, the DENSE images were analyzed with automated Artificial Intelligence pipelines, SSFP images with SegmentCMR, and the echocardiographic images with EchoPAC. The latter two are vendor tools. Tests of equivalence, with two-one-sided t-tests (TOST) for statistical inferences of a large effect, were conducted between pairs of the DENSE, 2D-STE, and CMR-FT data; the interaction between time and modalities was tested with 2-way repeated ANOVA (RANOVA). The results showed TOST effect sizes larger than the equivalence bounds at all time points between GLS analyzed with CMR-FT and 2D-STE (CMR-FT mean = -16.0±1.9 %, 2D-STE mean = -15.1 ± 3.3%, Equiv. bounds, [-1.6%, 1.6%], 95% CI, [0.3%, 1.8%], p = 0.05 at 3-months), and DENSE and 2D-STE (DENSE mean = -15.9 ± 1.7%, 2D-STE mean = -15.1 ± 3.3%, Equiv. bounds, [-1.5%, 1.5%], 95% CI, [0.0%, 1.8%], p = 0.1 at 3-months), but not between DENSE and CMR-FT (DENSE mean = -15.9 ± 1.7%, CMR-FT mean = -16.0 ± 1.9%, Equiv. bounds, [-1.6%, 1.6%], 95% CI, [-1.3%, 1.5%], p &lt; 0.001 at 3-months). Pairwise comparison from the RANOVA methodology*time interaction showed differences between CMR-FT and 2D-STE-derived GLS (ΔGLS = -0.9%, 95% CI, [-1.7%, -0.1%,], p = 0.03), and DENSE and 2D-STE-derived GLS (ΔGLS = -0.8%, 95% CI, [-1.9%, -0.1%], p = 0.04) but not between DENSE and CMR-FT (ΔGLS = 0.1%, 95% CI, [-0.1%, 0.4%], p = 0.33) at 3-months and also baseline. Statistically, the significant differences between the CMR-FT and 2D-STE results show that the two methodologies should not be used interchangeably for GLS evaluation in CTCRD, and further large-scale studies are required to establish the most suitable methodology.
Abstract 4145065: All Things in Moderation: Right Ventricular Moderator Band Induced Ventricular Fibrillation In A Young Male
Authors: Wali Kamran, Bharani Pusukur, Peter Sutton, Yash Rao, Rebecca DeBoer, Talal Al-Mohamad, Sergio Cossu, Kunal Patel
Journal: Circulation (2024)

Idiopathic ventricular fibrillation (VF) arrest can be a challenging diagnosis, especially when the etiology is unclear. We present a case of a young male who was found to have VF originating from the right ventricular (RV) moderator band (MB). A 19-year-old male with a history of idiopathic VF arrest with ICD placement presented with a complaint of sudden dizziness and lightheadedness. Upon device interrogation, he was found to have 17 seconds of fine-VF terminated by one out-of-hospital ICD shock. He reported non-adherence to daily nadolol. He was also noted to have a high burden of unifocal premature ventricular contractions (PVC) on telemetry. On EKG the morphology of PVCs was of a LBBB with a superior axis, suggesting origin from the MB. The patient then underwent an electrophysiological (EP) study, where it was felt that earliest site of activation was identified at the mid-inferior RV along a muscle band extending from mid inferior free wall, superiorly to the interventricular septum. He then had successful radiofrequency ablation at this site, with no post-ablation PVCs or ICD discharge, and was subsequently restarted on his home nadolol. Idiopathic VF is defined as VF in the absence of clinical cause. Our patient’s PVCs and fine-VF were highly suspicious for RV MB origination. We proceeded with EP mapping and identified the earliest site of PVC activation at the MB. Pace mapping revealed 95% matching at this site. Following ablation, no further PVCs were induced even with isoproterenol. Though not fully understood, the MB is becoming increasingly noted as a source for Purkinje-mediated ventricular arrhythmias. Possible mechanisms of arrhythmogenesis include fibrosis, stretching of fibers, and ion channel variations. Arrythmias from the MB are potentially responsive to catheter ablation. Early recognition of typical PVC morphology from the RV MB as the source of VF can provide an opportunity for timely intervention. Younger patients, especially, can be treated with catheter ablation to reduce their risk of sudden cardiac death.
Abstract 4145199: Prevalence and Prognostic Implications of Sleep Disordered Breathing in Hypertrophic Cardiomyopathy
Authors: Shahid Karim, Anwar Chahal, Shreyas Venkataraman, Abhishek Deshmukh, Konstantinos Siontis, meghna mansukhani, Thomas Konecny, Mohammed Khanji, Steffen Petersen, Jeffrey Geske, Virend Somers
Journal: Circulation (2024)

Background: Sleep disordered breathing (SDB) is frequently observed in patients with cardiovascular disease, and is associated with intermittent hypoxia, sympathetic activation, oxidative stress, and endothelial dysfunction, all of which may facilitate the development and progression of cardiovascular disease. Objectives: We sought to determine the prevalence, subtypes, and clinical implications of comorbid SDB in patients with hypertrophic cardiomyopathy (HCM). Methods: In this prospective observational study, patients with HCM without prior diagnosis of SDB were recruited to undergo inpatient polysomnography between May 1 st 2018 and October 31 st 2022. Electrocardiographic and echocardiographic parameters, cardiac biomarkers, and symptoms were comparatively assessed in patients with and without comorbid SDB. Patients were assessed for the development of major adverse cardiovascular events (MACE) during follow-up (median 29, range 3-57 months). Results Among 154 participants, 91 (59.1%) were diagnosed with SDB of whom 38 (41.8%) had mild, 22 (24.2%) moderate, 18 (19.8%) severe obstructive sleep apnea, and 13 (14.3%) had central sleep apnea. SDB was associated with greater left ventricular mass (median [IQR]) (128 [107, 161] vs. 109 [96, 134] g/m 2 , p =0.034) and E/e’ ratio (12.5 [10, 15] vs. 10.0 [8.3, 14.5], p =0.039). Patients with HCM over the age of 50 years, with body mass index ≥ 30kg/m 2 , who described their sleep as “poor” were at particularly high risk of having comorbid SDB, as were those who were diabetic, hypertensive, or described greater exertional limitation (NYHA Class ≥II 53% vs. 27%, p =0.005). Importantly, subjects with SDB had elevated baseline Troponin T levels (14 ng/L vs 11 ng/L, p =0.030), and further substantial overnight troponin increases following untreated apneic sleep (2.1ng/L vs 0.2ng/L, p =0.009). Finally, patients with comorbid SDB experienced a significantly higher proportion of incident adverse cardiovascular events (MACE hazard ratio 5.3, 95% CI, 1.6, 17.2, p =0.006) than those without SDB. Conclusions: We report a particularly high burden of previously undiagnosed SDB in patients with HCM, particularly in older, heavier, male patients. Undiagnosed SDB in HCM is not benign and is associated with symptom progression, comorbidity, and a poorer prognosis, particularly in the case of central sleep apnea. These important new findings provide rationale for heightened vigilance and routine screening for SDB in patients with HCM.
Abstract 4145236: Predictors of Mortality Among Hospitalized Patients with Acute Myocardial Infarction by Systemic Lupus Erythematosus Diagnosis
Authors: Aniekeme Etuk, Louisa George, Inimfon Jackson, Salem Badr
Journal: Circulation (2024)

Introduction: Studies have reported on the prevalence, and associations between acute myocardial infarction (AMI) and systemic lupus erythematosus (SLE), but there is limited data on the predictors of mortality and whether these differ among patients with a diagnosis of SLE. We examined the factors associated with mortality among hospitalized patients with a diagnosis of AMI with or without SLE. Hypothesis: Patient and hospital associated factors can predict mortality among hospitalized patients with AMI and these predictors differ by SLE diagnosis Methods: The National Inpatient Sample (NIS) data collected from 2016 – 2020 was utilized to conduct retrospective cohort analyses. Multivariate logistic regression models were used to examine the factors associated with mortality among hospitalized patients with AMI by SLE diagnosis. Results: Among SLE patients with a diagnosis of AMI, being female (AOR: 1.53; 95% CI: 1.02-1.86) and 65 years and above (AOR: 1.65; 95% CI: 1.20-2.74) was associated with higher odds of mortality compared to being male and younger than 65 years. Elective admission (AOR: 0.59; 95% CI: 0.39-0.85) was associated with lower risk of mortality relative to non-elective admission. Of note, non-Hispanic blacks (AOR: 0.68; 95% CI: 0.39-0.98) had lower odds of mortality than non-Hispanic whites. Patients with length of stay greater than 5 days (AOR: 1.75; 95% CI: 1.18-2.59) were more likely to die than those with hospital stay 5 days or less. Higher comorbidity scores were also associated with higher odds of mortality. Among patients without SLE, non-Hispanic blacks (AOR: 1.68; 95% CI: 1.07–2.48) reported higher mortality compared to their non-Hispanic white counterparts. Additionally, being on private insurance (AOR: 0.75; 95% CI: 0.32–0.99) was associated with lower odds of mortality relative to Medicare insurance. Conclusion: Our study highlights patients and hospital related factors that can predict mortality among patients hospitalized with AMI by SLE. Further studies are needed to explore these factors as it will help physicians identify patients that need closer monitoring.