tbuckley/cabot-search huggingface dataset:
Abstract 16768: Blood Pressure Responses to Exercise in Patients With Heart Failure With Preserved Ejection Fraction: The Importance of Normalizing Blood Pressure to Workload
Authors: Diana De Oliveira Gomes, Denis J Wakeham, Tiffany M Brazile, Joetsaroop Bagga, Matthew M Howrey, James P Macnamara, Benjamin D Levine, Christopher Hearon, Satyam Sarma
Journal: Circulation (2023)

Background: Exaggerated exercise blood pressure (EEBP) is assessed using systolic blood pressure (SBP) thresholds at peak exercise (&gt;210 [men], &gt;190 [women] mmHg), which is confounded by the presence of hypertension. However, SBP-workload slopes are independent of resting SBP and predict future cardiovascular events in those at high-risk for and those diagnosed with heart failure and preserved ejection fraction (HFpEF). Thus, we compared the two methods of EEBP assessment between normotensive high-risk individuals and hypertensive patients with HFpEF. Methods: We studied 71 individuals at high-risk for HFpEF (obesity and elevated cardiac biomarkers; 58% Female; age: 49±6 years, BMI: 39.0±5.7 kg/m 2 ) and 42 patients with HFpEF (67% Female; age: 71±6 years, BMI: 40.0±6.4 kg/m 2 ) during cycle ergometry. Blood pressure was measured via Brachial electrosphygmomanometry. SBP/Watts slopes were constructed using data from rest, 2 sub-maximal, and peak exercise workloads. To index central arterial stiffness we calculated the SBP/cardiac output (Q˙c; acetylene rebreathing) slope and systemic arterial compliance (SAC; stroke volume / pulse pressure). Results: Resting SBP was higher in HFpEF compared to high-risk (132±23 vs 120±19 mmHg, P =0.001). Peak workload ( P &lt;0.001), oxygen uptake (1.284±0.420 vs 2.016±0.453 L/min; 11.7±3.3 vs 18.2±4.1 mL/min/kg, both, P &lt;0.001), and Q˙c ( P &lt;0.001) were lower in HFpEF. Peak exercise SBP was not different between HFpEF (189±28) and high-risk groups (180±33 mmHg, P =0.104), but the SBP/Watts slope was higher in HFpEF (0.9±0.7 vs 0.4±0.2 mmHg/Watt, P &lt;0.001). In patients with HFpEF the SBP/Q˙c slope was higher (9.8±6.7 vs 5.6±2.8 mmHg/L/min, P &lt;0.001) and SAC was lower (1.2±0.4 vs 1.7±0.5 mmHg/ml , P &lt;0.001). Conclusion: Only reporting peak SBP masks the greater SBP response to exercise in HFpEF when compared to younger high-risk individuals; a difference likely mediated by higher arterial stiffness. Thus, the slope method may be more appropriate for quantifying BP responses to exercise as it more accurately reflects the physiology of EEBP in patients with HFpEF.
Abstract 16400: Development of Deep Neural Network Models for Identification of Pulmonary Vein Potentials From Body Surface Electrocardiograms of Patients With Atrial Fibrillation
Authors: Munekazu Tanaka, Hirohiko Kohjitani, Tomoyuki Inoue, Akifumi Morinaga, Fumiya Yoneda, Shushi Nishiwaki, Satoshi Shizuta, Yasushi Okuno, Koh Ono
Journal: Circulation (2023)

[Background] Pulmonary vein (PV) potential is essential as the origin of atrial fibrillation (AF). However, no established method exists to evaluate PV potentials on a body surface ECG (BS-ECG). [Objective] To develop a method to identify PV potentials from BS-ECGs using state-of-the-art deep neural network (DNN) technology. [Methods and results] A cohort of 799 consecutive paroxysmal AF patients, who underwent Pulmonary Vein Isolation (PVI), were enrolled, and pre- and post-PVI 12-lead ECGs (12ECGs) were collected, amounting to a dataset of 1598 ECGs. Four DNN models were constructed, each employing distinct architectures: 1D-ResNet, 1D-DenseNet, 1D-EfficientNet-b3, and 1D-ViT (Vision Transformer). These models were rigorously trained and evaluated for the identification of PV potentials. The 1D-EfficientNet-b3-based model exhibited optimal performance, achieving an accuracy of 89.4% in the training set and 89.1% in the test set. The Gradient-weighted Class Activation Mapping (Grad-CAM) effectively demonstrated that the segments 200-300ms before the P-wave is crucial for identifying PV potentials. Furthermore, DNN models were developed for each single-lead ECG. While there were variations in the accuracy of PV potential identification among single-lead models, the V6-lead model demonstrated superior performance with an accuracy of 83.2%. [Conclusions] The findings of this research strongly suggest that our DNN-based model can accurately differentiate PV potentials from BS-ECGs. Additionally, Grad-CAM visualizations indicate that pertinent features for the identification of PV potentials are predominantly clustered in the P-wave frontal region. This signifies a promising advancement in the non-invasive detection and analysis of PV potentials, paving the way for improved management of paroxysmal AF.
Abstract 16742: Deep-Learning-Derived Retinal Cardiovascular Risk Predictor (Reti-CVD) and 14 Cardiovascular Conditions in UK Biobank
Authors: Hyun Goo Kang, Tyler H Rim, Geunyoung Lee, Marco Yu, Yih-Chung Tham, Ching-Yu Cheng, Chan Joo J Lee, Sung Soo Kim, Sung Ha Park
Journal: Circulation (2023)

Introduction: The advent of sophisticated deep learning algorithms has now made it possible to predict the risk of cardiovascular diseases (CVDs) using retinal images. We had previously developed a retina-based deep learning model, Reti-CVD, trained on coronary artery calcium (CAC) data, which successfully predicted future CVD incidents in a longitudinal study. Hypothesis: This study aims to investigate the cross-sectional association between Reti-CVD and 13 distinct CVDs, alongside arterial hypertension. Methods: Our cross-sectional analysis involved 45,980 participants from the UK Biobank at baseline. To discern the differential cardiovascular risk associated with Reti-CVD, we studied a wide array of CVDs. These included cerebrovascular diseases, aneurysms, thrombo-embolic diseases, other CVDs (coronary artery disease, aortic valve stenosis, atrial fibrillation, heart failure, and peripheral vascular disease), and arterial hypertension. We defined CVD outcomes based on the international classification of disease codes. We used logistic regression, adjusted for hypertension, diabetes, dyslipidemia, and smoking, to estimate the correlations between Reti-CVD and the defined CVD outcomes. Results: In the cross-sectional study, after adjusting for CVD risk factors, we found the highest tertile of Reti-CVD scores to be significantly associated with 11 outcomes in comparison to the first tertile (adjusted Odds Ratio [OR], 95% Confidence Interval [CI]). These include: Coronary artery disease (OR=10.37, 95% CI, 7.58-14.18), peripheral vascular disease (9.65, 2.94-31.64), atrial fibrillation (9.36, 6.51-13.45), aortic valve stenosis (8.13, 1.87-35.35), heart failure (7.33, 3.64-14.77), ischemic stroke (4.70, 2.30-9.59), transient ischemic attack (4.17, 2.07-8.40), arterial hypertension (3.17, 2.78-3.61), pulmonary embolism (3.00, 1.86-4.84), deep vein thrombosis (2.54, 1.70-3.80), and cerebrovascular diseases (2.36, 1.63-3.42). Notably, we found suggestive evidence of an inverse association of Reti-CVD tertiles with subarachnoid haemorrhage. Conclusions: This study demonstrates that higher Reti-CVD scores correlate with an elevated risk across a broad range of cardiovascular conditions.
Abstract 18220: Does Mineralocorticoid Receptor Blockade Affect the Occurrence of Perioperative Atrial Fibrillation in Cardiac Surgery Patients? - A Systematic Review and Meta-Analysis
Authors: Kripa Rajak, Anupam Halder, Manoj Ghimire, Seema Sharma Gautam, Resha Khanal, Vikash Jaiswal, Anas Atrash, Rohan Goswami
Journal: Circulation (2023)

Background: Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to prevent atrial fibrillation (AF). However, inconsistent results of MRAs effect on perioperative AF have been reported in the literature in patients undergoing cardiac surgery. To our knowledge, this is the first metanalysis to assess the effect of MRAs on occurrence of perioperative AF in patients undergoing cardiac surgery. Method: We searched different electronic databases from inception to April 30th, 2023, for randomized controlled trials (RCTs) and observational studies that evaluated the use of MRAs in patients with heart failure and left ventricular ejection fraction (LVEF) 30-50% who were referred for Coronary Artery Bypass Grafting (CABG) and/or valve surgery without any AF history. Primary outcome was occurrence of perioperative AF. Three independent reviewers selected and appraised the data. A random-effects meta-analysis was performed to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Result: We included 4 studies, 1 RCT and 3 observational cohorts, with a cumulative number of 1,128 patients with mean age 65.15 years. 412(36.5%) received an MRA (spironolactone or eplerenone). The follow up duration was 5 days to 1 month. During follow-up, 118 (28.64%) patients treated with MRAs, developed AF, compared to 224 (31.28%) patients, without MRA treatment. However, metanalysis showed that there is no significant reduction in occurrence of perioperative AF in MRA treated patients (OR: 0.88 CI: 0.58-1.33 p=0.55), I2 53%; Figure] Conclusion: Experimental data have shown that MRA blockade prevents perioperative AF in animal models but our metanalysis demonstrated that MRAs were not protective for perioperative AF in patients undergoing cardiac surgery. Larger trials in humans are warranted to evaluate its efficacy, particularly in patients undergoing cardiac surgery.
Abstract 432: Temporal Trends in End Tidal Capnography and Outcomes in Out of Hospital Cardiac Arrest
Authors: Michelle Nassal, Andoni Elola, Elisabete ARAMENDI, Xabier Jaureguibeitia, Ahamed Idris, Ashish R Panchal, Henry E Wang
Journal: Circulation (2023)

Background: While widely measured and used to direct resuscitation, the time-varying relationship between exhaled end-tidal CO2 (ETCO2) and out-of-hospital cardiac arrest (OHCA) outcomes is unclear. We sought to determine the association between temporal trends in ETCO2 and return of spontaneous circulation (ROSC) in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed data from the PART Trial, which tested endotracheal intubation or laryngeal tube strategies in OHCA resuscitation. Emergency medical services collected continuous ETCO2 recordings using defibrillator monitors. We identified maximal ETCO2 values for each ventilation using previously validated automated signal processing. We determined mean ETCO2 in one-minute(min) epochs from advanced airway insertion through ROSC or end of event. We included all cases with interpretable ETCO2 signal in at least one of the epochs. We compared discrete time points between ROSC and non-ROSC using one way Mann-Whitney and determined the association between temporal trends in ETCO2 comparing the slopes of ETCO2 over time. Results: We included 1147 of 3004 patients with available ETCO2 data. There were 225(20%) ROSC and 923(80%) non-ROSC cases. Mean duration of resuscitation was 16 and 27 minutes for ROSC and non-ROSC cases, respectively. In ROSC cases, ETCO2 increased from 26.8 to 48.9 mmHg over 20-min prior to ROSC. In non-ROSC cases, ETCO2 declined from 30.6 to 21.7 mmHg over the 20-min. Mean ETCO 2 between ROSC and non-ROSC cases did not differ at t-10 (30.6 mmHg vs 26.1 mmHg, p=0.07) or t-20 min (26.8 mmHg vs 30.6 mmHg, p=0.71). However, ETCO 2 changes over time differed between ROSC and non-ROSC (p&lt;0.01, figure 1). Conclusions: Upward temporal increases in ETCO 2 are associated with ROSC. Dynamic time-varying changes in ETCO2 may indicate OHCA outcomes.
Abstract 14942: Austrian Syndrome Complicated by Purulent Pericarditis
Authors: Rohan Umrani, Nicholas Mason, Hiral Amin
Journal: Circulation (2023)

Introduction: Austrian syndrome is a triad of pneumonia, endocarditis, and meningitis due to S. pneumoniae . First characterized by Robert Austrian in 1956, it is a rare condition with an unknown incidence since the advent of the antibiotic age and introduction of the pneumococcal vaccine. Case Presentation: A 69-year-old female with a history significant for alcohol abuse presented with shortness of breath, productive cough and encephalopathy. The patient was septic with concurrent NSTEMI. She was emergently intubated for hypoxia and CT chest revealed multifocal pneumonia with a pericardial effusion. Echocardiogram (TTE) demonstrated a mitral annular calcification extending into the ventricle and confirmed a small fibrinous effusion without tamponade physiology. Infectious workup revealed S. pneumoniae bacteremia and pneumonia and he was initiated on ceftriaxone. The patient remained encephalopathic despite antibiotic treatment. Lumbar puncture revealed S. pneumoniae meningitis. The patient’s mentation continued to decline. MRI brain revealed an embolic shower. Repeat echocardiogram showed worsening pericardial effusion and the patient suffered a cardiac arrest due to pericardial tamponade resolved with emergent pericardiocentesis. Pericardial fluid was noted to be serofibrinous with predominance of leukocytes albeit culture negative. Unfortunately the patient succumbed to her illness and passed. Conclusions: Males, alcoholics, the immunocompromised, or those with a history of heart valve surgery are at risk for Austrian Syndrome. Mortality is as high as 60%-75%. This patient was at risk due to her history of alcoholism. Her presentation is unique in that she had concurrent purulent pericarditis, which is rarely attributed to S. pneumoniae. The condition is fatal if untreated and mortality ranges from 15%-40%. Treatment entails prompt drainage and appropriate antibiotic coverage. The advent of pneumococcal vaccination has significantly reduced the incidence of S. pneumoniae infection. This case represents the widespread effects of this organism if left unrecognized and untreated. Clinicians should have a high index of suspicion in any patient with pneumococcal infection and underlying predisposing factors.
Abstract 15183: Diabetes is Associated With Worse Postoperative Mortality and Morbidity in Bariatric Surgery, Regardless of the Procedure
Authors: Omar Khalil, Soha Dargham, Amin Jayyousi, Jassim Al Suwaidi, Charbel Abi Khalil
Journal: Circulation (2023)

Introduction: Bariatric surgery is an efficient treatment for obesity. Objectives: We aimed to assess the impact of diabetes on postoperative outcomes of bariatric surgery. Further, we compared the outcomes of different techniques in patients with diabetes. Methods: We used data from the National Inpatient Sample (2015-2019) to identify patients who underwent either sleeve gastrectomy, Roux-en-Y, or gastric banding. Outcomes included postoperative mortality (primary outcome), major bleeding, atrial fibrillation, and acute renal failure. Results: Patients with diabetes had an overall increased risk of perioperative complications when compared to non-diabetic ones for all three types of bariatric surgery. Among patients who underwent sleeve gastrectomy, diabetes was associated with a higher adjusted risk of mortality [aOR 2.07 (1.36-3.16)], atrial fibrillation [aOR 1.07 (1.02-1.11)], and acute renal failure [aOR 1.51 (1.39-1.64)] but a similar risk of major bleeding. Among patients who underwent Roux-en-Y, diabetes did not increase the risk of mortality and bleeding. Still, it was associated with a higher risk of atrial fibrillation [aOR 2.24 (1.25-4.02)] and acute renal failure [aOR 1.36 (1.21-1.62)]. Among patients who underwent gastric banding, diabetes was only associated with a higher risk of major bleeding [aOR 2.94 (1.42-5.88)]. When comparing the 3 techniques in diabetes patients, Roux-en-Y was significantly associated with a higher mortality rate (1.05%, 0.06%, 0%), atrial fibrillation (7.04%, 3.35%,3.48%), and acute renal failure (6.32%, 1.29%, 3.48%) (Roux-en-Y, sleeve, gastric banding; respectively). Major bleedings were more common in Roux-en-Y (1.05%) than in Sleeve (0.5%) (p&lt;0.001). Conclusions: Diabetes is associated with worse postoperative outcomes regardless of the type of bariatric surgery performed. Among diabetes patients, Roux-En-Y was associated with higher mortality and morbidity.
Abstract 18151: Impact of Socioeconomic Disparities in Women With Peripartum Cardiomyopathy
Authors: Somin Lee, Nisha Ali, Sachin Bhandari, Sridhar Chilimuri, Jonathan N Bella, Preeti Jadhav
Journal: Circulation (2023)

BACKGROUND Peripartum cardiomyopathy(PPCM) is a rare cardiomyopathy associated with pregnancy. Recently there is increased awareness of social determinants and health impact on cardiovascular disease. Hypothesis: We aim to investigate incidence, complication, and prognosis of PPCM in socioeconomically vulnerable South Bronx community and compare it with contemporary data. METHOD A retrospective cohort study was performed from 2009 to 2023 at a single center, BronxCare Health System in United States. A community hospital is located in South Bronx, a low socioeconomic neighborhood where median income is 57th percentile($15,398). South Bronx ethnicity was reported as 34% Black, 60% Hispanic. Statistics for numerical variables were presented as mean±SD and categorical variables were presented as count. Total subjects 52 were identified. After adopting criteria of systolic dysfunction with left ventricular ejection fraction(EF)&lt;45%, 27 patients were included in PPCM group in our study consisting of 14 Black and 13 Hispanic women. RESULT The incidence of PPCM in our study was 1 in 622 live births compared to the incidence of PPCM in the United States 1 in 3,186 live births.(RR=5.12) MAE defined as mortality, heart transplant, mechanical circulatory support, pulmonary edema, thromboembolism, implantable cardioverter defibrillator implantation and cardiogenic shock, occurred in 29.6% compared to 13.5% of patients in a nationwide population-based study.(RR= 6.985) Follow-up echocardiogram in 5 years, 5 patients(18%) recovered their ejection fraction&gt;45%, 11 patients (40%) did not recover, and the other 11(40%) were lost to follow-up, and repeat EF is unknown. 17 patients (62.9%) were counseled contraception. 4 patients had subsequent pregnancy, only 2 had recovered EF prior to subsequent pregnancy. CONCLUSION We observed the significant burden of PPCM in low-socioeconomic South Bronx community, higher incidence, and greater risk of adverse events compared to the nationwide population-based study. Healthcare professionals should be alert and emphasize the importance of close follow-up, patient education, and social support for PPCM patients to prevent complications and improve prognosis to decrease socioeconomic disparity impact on PPCM.
Abstract 18472: Plasma Proteome Changes in Heart Failure and Non-Heart Failure Patients Undergoing Cardiac Surgery
Authors: Jhana Parikh, Matthew Foster, Kamrouz Ghadimi
Journal: Circulation (2023)

Introduction: Patients with and without heart failure display different clinical courses after cardiac surgery. Hypothesis: Unbiased analyses of the plasma proteome from extreme phenotypes in myocardial function may identify differences in candidate proteins differentially modified by cardiac surgery using cardiopulmonary bypass (CPB). Methods: We combined two prospectively-collected datasets: Left ventricular assist device (LVAD) recipients from the INSPIRE-FLO trial (N=94, NCT03081052) and coronary artery bypass graft (CABG) surgery patients with normal biventricular function (N=50). For each population, we obtained EDTA-plasma from arterial blood sampling in the operating room and on postoperative day 1. Including quality control pools, 304 total samples were digested in a 96-well format with trypsin. Peptides were analyzed by microflow liquid chromatography coupled to tandem mass spectrometry using data-independent acquisition. Proteins were identified and quantified at a 1% false discovery rate (FDR) in Spectronaut. Statistical analyses utilized a t-test with FDR correction (significance defined by log2FC&gt;1 and q&lt;0.05). Results: There were 943 protein groups quantified in at least one plasma sample. Patients undergoing LVAD surgery had significantly higher levels of 135 proteins including acute phase reactants (CRP, SAA1, SAA2), putative neutrophil-derived proteins (S100A8/9) and markers of renal insufficiency (B2M and REG3A) (Figure 1). Cardiac surgery using cardiopulmonary bypass increased acute phase and inflammatory markers, and cardiac proteins (ENOB, MYG and KCRM), with NGAL, TIMP1 and PAI1 among proteins with higher absolute increase after LVAD implantation versus CABG surgery ( Fig.1 ). Conclusions: Unbiased analyses of the plasma proteome identifies baseline and postoperative differences associated with extreme phenotypes of myocardial function undergoing cardiac surgery using CPB.
Abstract 15342: Outcomes of High-Intensity Interval Training Are Superior to Moderate Exercise Training Among Post-Heart Transplant Patients
Authors: Ralf Martz Sulague, MARIA-KASSANDRA CORONEL, Pia Gabrielle Alfonso, Thea Danielle Cartojano, Nikki Cruz, EDWARD DANIEL MORTALLA, Carl J LAVIE
Journal: Circulation (2023)

INTRODUCTION: Heart failure patients who underwent heart transplantation (Htx) need to undergo cardiac rehabilitation (CR) to regain and improve their physical ability and functional capacity. To date, there is no established exercise regimen that optimizes this recovery. This study aims to compare the outcomes of High-Intensity Interval Training (HIIT) versus Moderate Exercise Training (MT) among Htx patients. Hypothesis: The outcomes of HIIT are superior to MT among Htx patients. Methods: A systematic review was conducted in multiple databases including PubMed, Embase, and Google Scholar from inception to 2022 following the PRISMA guidelines to look for randomized controlled trials that directly compare clinical outcomes of HIIT versus MT. Joanna Briggs Institute (JBI) critical assessment tool was used to assess the risk of bias. A meta-analysis was performed using a random effect model to calculate mean differences with 95% confidence intervals (CI). This study is registered on Prospero (CRD42023403954). Results: This study included four clinical trials (n=177 patients). The average age was 51 years ± 10.57, with a majority male (73%). On average, patients were overweight (BMI = 25.78 ± 4.08) with comorbidities including hypertension (81%) and diabetes (12%). Compared to baseline levels, the peak oxygen consumption (VO2 peak), maximal muscle strength extensors, maximal muscle endurance, body mass index, and FEV1 were statistically significantly increased after the intervention of either HIIT or MT. Of these, HIIT had higher percent changes in VO2 peak at 0.205 (95% CI: 0.007 to 0.417, p=0.0578), maximal muscle strength extensors at 0.100 (95% CI: 0.059 to 0.141, p&lt;0.001), and maximal muscle endurance at 0.263 (95% CI: 0.185 to 0.341, p&lt;0.001) compared to MT. CONCLUSION: Both exercise CR regimens significantly improved the physical ability and functional performance of Htx patients. However, HIIT was superior to MT in terms of VO2 peak, maximal muscle strength extensors, and maximal muscle endurance, which may be associated with higher survival.