tbuckley/cabot-search huggingface dataset:
Abstract 4145772: Evaluation of the AHA PREVENT Models in a Diverse US Veteran Population Among Race and Ethnic Groups
Authors: Roy Mathew, Sadiya Khan, Josef Coresh, Chiadi Ndumele, Janani Rangaswami
Journal: Circulation (2024)

Background: The AHA recently developed the Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) equations. PREVENT estimates risk for total cardiovascular disease (CVD: a composite of atherosclerotic cardiovascular disease [ASCVD] and heart failure [HF]), includes kidney function (eGFR) as a predictor, and did not include race as a predictor. Aim: We evaluated model performance of the PREVENT equations and the pooled cohort equations (PCEs) in a large multi-ethnic sample of US Veterans and compared accuracy of PREVENT and PCEs among self-identified race and ethnic groups. Methods: The Loma Linda VA IRB provided ethical approvals. Data were accessed through the Veterans Integrated Networking and Computing Infrastructure, with death data provided through the VA Information Resource Center. Individuals aged 30-79 with available risk factor data between 1/1/2007 and 12/31/2009 and without baseline CVD were eligible for inclusion. For PREVENT, we evaluated the base models predicting total CVD and ASCVD. For PCEs, we evaluated model performance predicting ASCVD. We assessed model discrimination with the C-statistic and calibration with observed vs. predicted curves. All analyses were stratified by self-reported race and ethnicity and utilized R statistical software. Results: Among 2,500,291 adults, mean age was 60.3 years and 1.2% were Asian/Native Hawaiian/Pacific Islander (AANHPI), 5.2% Hispanic, 15% non-Hispanic Black (NHB), and 70% non-Hispanic White (NHW). Over a median follow-up of 8.7 years, the incident CVD rate was 16.5%. The C-statistic (95% CI) for PREVENT for total CVD was 0.70 (0.69-0.71) in AANHPI, 0.70 (0.69-0.70) in Hispanic, 0.68 (0.68-0.69) in NHB, and 0.65 (0.64-0.65) in NHW individuals. Similar C-statistics were observed for PREVENT-ASCVD and PCEs. Calibration curves demonstrated accurate prediction with PREVENT for CVD and ASCVD across the range of predicted risk. In contrast, PCEs overpredicted ASCVD at high predicted risk for all race and ethnic groups ( Figure ). Conclusion: The AHA PREVENT equations more accurately and precisely estimates risk across race and ethnic groups. This demonstrates that removing race as a variable from outcomes prediction does not diminish predictive performance.
Abstract 4145579: Comparing 1-Year and 3-Year Outcomes of Atrial Fibrillation Ablation
Authors: Viren Srivastava, Brototo Deb, Hui Ju Chang, Prasanth Ganesan, Kelly Brennan, Ruibin Feng, Albert Rogers, Tina Baykaner, Paul Wang, Paul Clopton, Chad Brodt, Sanjiv Narayan
Journal: Circulation (2024)

Background: A major challenge in improving atrial fibrillation (AF) ablation is understanding variability in patient’s response to ablation. While some are long-term responders, others recur within a month. Some of this variability may be attributed to progression of AF despite short-term success manifested by acute termination. Our objective was to use our rich clinical database to identify predictors of differential response to ablation. Method: We studied 597 consecutive patients with drug-refractory AF, enrolled prospectively for a uniform AF ablation strategy at Stanford Health. We applied logistic regression to 73 clinical variables to identify features associated with freedom from AF or atrial tachycardia (AT) at 1-3 years. Results: Patients (N=597) were 65.4±10.4 years, 29.0% female, BMI 29.6 kg/m2, 60.1% with non-paroxysmal AF, and 68.8% at de novo ablation. N=253 (42.4%) recurred at 1 year, N=101 (16.9%) within 1-3 years, and N=243 (40.7%) were free of AF beyond 36 months. One year success in adjusted analyses was associated with fatigue, prior ablation, PVI approach, beta-blocker usage, digoxin usage, and GDMT usage. AF progression at 3 years was associated in adjusted analyses with post-ablation asthma and post-ablation usage of direct oral anticoagulants. In addition, pre-ablation stroke and presenting rhythm was associated with both outcomes. Conclusion: In a large prospective AF registry, we identified features which differed between patients with 1-year success and 3-year success, as well as factors shared between endpoints. This data may provide mechanistic insights and help to guide and personalize ablation.
Abstract 4145344: Outcomes of Early Rhythm Control versus Rate Control Strategies for Atrial Fibrillation in Elderly Patients: A Systematic Review and Meta-Analysis
Authors: Soban Ahmad, Muhammad Ahsan, Kathryn Kim, Hafiz Muhammad Fazeel, Huzaifa Ahmad Cheema, Amman Yousaf, Laraib Khalil, Sundus Ikram, Michael Kim
Journal: Circulation (2024)

Background: The prevalence of atrial fibrillation (AF) increases with age. However, limited data are available regarding the prognostic implications of rhythm versus rate control strategies for AF in the elderly. We have conducted this systematic review and meta-analysis to explore the effects of early rhythm control strategy in elderly (age &gt;65 years) AF patients. Methods: A literature search was conducted for relevant studies using MEDLINE (PubMed), EMBASE, Scopus, Cochrane CENTRAL, Conference Abstracts, and ClinicalTrials.com through March 19th, 2024. The primary outcome was all-cause mortality. Meta-analysis was performed using the random-effects Mantel-Haenszel method, and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) were calculated using RevMan 5.4. Results: Six studies with 39,181 patients (rhythm control 11,446; rate control 27,735) were included. The mean age was 79 years in the rhythm control and 81 years in the rate control cohort. Females were 52% in rhythm control and 55% in the rate control group. The rhythm control strategy was associated with a lower risk of stroke (RR 0.73, 95%CI 0.66-0.81, p&lt;0.0001, I 2 =44%) but had a higher risk of permanent pacemaker (PPM) implantation (RR 2.54, 95%CI 1.04-6.23, p=0.04, I 2 =29%). Rhythm control did not improve all-cause mortality (RR 0.90, 95%CI 0.72-1.11, p=0.32, I 2 =96%) or cardiovascular mortality (RR 0.87, 95%CI 0.62-1.23, p=0.43, I 2 =75%) in elderly AF patients. Conclusion: Rhythm control strategy in elderly patients is associated with a lower risk for stroke but has a higher risk for PPM implantation. Additionally, there is a comparable risk for all-cause mortality and cardiovascular mortality between rhythm and rate control treatments for elderly AF patients.
Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations
Authors: Cathryn Sawalski, Michelle Seu, Amir Darki
Journal: Circulation (2024)

Description of Case: A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations. Urgent angiography revealed complete occlusion with thrombus of the proximal left anterior descending (LAD) coronary artery. The patient underwent aspiration thrombectomy, followed by intracoronary vasodilators, without improvement of flow. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus. Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved. The patient was placed on an integrilin drip with plans to reevaluate in 24 hours. While preparing for transport to the cardiac ICU, the Impella device malfunctioned, and function could not be restored. With ongoing hemodynamic collapse, a second Impella device was placed, but it malfunctioned almost immediately, and the patient suffered a pulseless electrical activity arrest. Advanced Cardiac Life Support was initiated, but the patient ultimately expired. Abiomed's investigation following the case identified an unknown biological material obstructing both Impella devices. In light of a leukocytosis of 14,000 and a recent urine sample positive for E. coli, there is a high suspicion that the patient suffered from recurrent infective endocarditis causing septic embolization and subsequent Impella device failure from aspiration of bacterial vegetations. Discussion: This is the first known reported case of Impella device failure resulting from the aspiration of vegetation in a patient with infective endocarditis of a bioprosthetic aortic valve. The case highlights the challenges of diagnosing endocarditis in bioprosthetic valves and emphasizes the importance of transesophageal echo in cases with high clinical suspicion. Additionally, considering the recent FDA recall of Impella devices in patients who have had transcatheter aortic valve replacement (TAVR) procedures due to the risk of motor damage after contact with TAVR stents, this case calls attention to a need for further research of the use and safety of Impella devices in patients with non-native aortic valves.
Abstract 4145979: Rising Burden of Ischemic Heart Disease Attributable to High Fasting Plasma Glucose in the United States: A Three-Decade Trend Analysis (1990-2019)
Authors: Anushka Chokshi, Saif Syed, Muhammad Waqas, Ashwinikumar Shandilya, Paritaben Bhalodia, Mohit Lakkimsetti, VISHRANT AMIN, Darshine Venugopal, JUHI PATEL, HARDIK DESAI, kamal sharma
Journal: Circulation (2024)

Introduction: Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies. Method: Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019. Results: Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019. Conclusion: IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.
Abstract 4145609: The Cardiac Conundrum of Cannabis: A Case of Junctional Bradycardia Triggered by Cannabis Use
Authors: Devi Parvathy Jyothi Ramachandran Nair, SMIT SHAH, Aniruddha Singh
Journal: Circulation (2024)

Introduction: Cannabis has been increasingly used as a recreational drug. Its cardiovascular effects depend on several factors, including the exact composition, route of administration, dose, and duration of use. Here we report a case of cannabis induced junctional bradycardia in a patient with cardiovascular comorbidities. Case description: A 68-year-old male with history of chronic systolic heart failure, coronary artery disease, diabetes, hypertension and chronic kidney disease was referred to the hospital from outpatient clinic for bradycardia with heart rate 25-35. Patient did not report any symptoms and was hemodynamically stable. He was euvolemic on physical exam. Electrocardiogram (ECG) and telemetry revealed junctional bradycardia with heart rate in 30s and sinus pauses (5-7 seconds). Initial laboratory analysis was unremarkable. He was admitted for further workup of bradycardia. His home medications included metoprolol succinate 25mg daily which was held given bradycardia. Urine drug screen was positive for cannabis. Patient endorsed that he had recently started smoking marijuana to help him with sleep and anxiety. Echocardiogram was unchanged from baseline. He was monitored on telemetry and the heart rate improved to 60-70s in about 24-48 hours without any other intervention. The temporal relationship between cannabis initiation and spontaneous resolution of bradycardia favored a potential causal link for cannabis- induced mechanism for the junctional bradycardia. Patient was resumed on metoprolol prior to discharge and tolerated it well without any bradycardic episodes establishing further that this was not iatrogenic bradycardia. He was counseled to abstain from cannabis use. Conclusion: At low to moderate doses, cannabis can lead to a surge in sympathetic activity causing tachycardia and hypertension, while parasympathetic activity is predominant at higher doses, causing bradycardia and hypotension. Understanding these nuanced effects is crucial for clinicians when evaluating patients especially those with pre-existing cardiovascular conditions. Guidelines should be refined for safer use as the landscape of cannabis legislation evolves.
Abstract 4145541: The Association Between Leisure Time Physical Activity and Atrial Fibrillation Risk
Authors: Achsah Varghese, Danny Varghese, Djhenne Dalmacy, Raul Torres-Heisecke, Nina Radford, Beth Wright, Andjelka Pavlovic, kerem Shuval, David Leonard, Laura DeFina, Jarett Berry
Journal: Circulation (2024)

Background: While physical activity (PA) is associated with a lower risk of atrial fibrillation (AF), prior studies have observed a higher prevalence of AF among athletes. Therefore, we sought to characterize the association between PA and the risk for AF in a large cohort of healthy adults with relatively high levels of self-reported leisure time PA levels. Methods: Individual participant data from the Cooper Center Longitudinal Study were linked to Medicare administrative claims files. PA volume (MET-min/wk), duration of moderate (&lt; 6 METs), and duration of vigorous PA (≥ 6 METs) PA were measured by self-report at study entry. Other risk factors such as age, current smoking status, weekly alcohol consumption, BMI, blood glucose, systolic blood pressure, and cholesterol were measured using a standard approach. AF was identified using Medicare claims. A proportional hazards illness-death model was used to estimate hazard ratios for incident atrial fibrillation and multivariable-adjusted for all measured baseline covariates.PA was evaluated as an ordinal variable (&lt; 500, 500-1499, 1500-3000, and ≥ 3,000 MET-min/week). In analyses for subtype of activity, moderate and vigorous activity were mutually adjusted and evaluated as a continuous covariate (per hour). Results: We included 26,549 participants (71.9% men, mean age 54 years at baseline), who received Medicare coverage from 1999 to 2019. After 195,343 person-years of Medicare follow-up time, we observed 3,939 cases of AF. Higher PA was associated with a modest increase in the risk for AF above 1,500 MET-min/week, but with less precision at PA above 3,000 MET-min/week (Figure 1). We also observed vigorous activity, but not moderate activity, was associated with higher risk of AF (Figure 2). Conclusion: After accounting for covariates, higher PA volume was associated with increased risk of AF at doses more than 3x the guideline-recommended amount. These associations appear to be more apparent for vigorous exercise intensity.
Abstract 4145660: Limitations of the Generalizability of Semaglutide Trials Evaluating CV Outcomes
Authors: Ivy Shi, Robert Yeh, Sadiya Khan, Chiadi Ndumele, Susan Hennessy, Joanne Penko, Dhruv Kazi
Journal: Circulation (2024)

Introduction: In the SUSTAIN-6, SELECT, and FLOW clinical trials, semaglutide improved CV outcomes for primary and secondary prevention among those with poor cardiovascular-kidney-metabolic (CKM) health. However, whether trial participants are representative of the treatment-eligible U.S. population is uncertain. Research Question: How well do the SUSTAIN-6, SELECT, and FLOW trial populations each represent their respective treatment-eligible U.S. populations? Methods: We identified U.S. adults eligible for semaglutide by applying key inclusion and exclusion criteria of the SUSTAIN-6, SELECT, and FLOW trials to the 2015 to March 2020 cycles of the National Health and Nutrition Examination Survey (NHANES). We compared baseline demographic and clinical characteristics of treatment-eligible NHANES populations (“real-world”) with those of their corresponding clinical trial populations using standardized mean differences (SMD). An absolute SMD ≥ 0.10 represents an imbalance in a given demographic or clinical characteristic between the trial and U.S. population. Results: Across the 3 trials, 39 of the 50 characteristics had an absolute SMD value ≥ 0.10 (Table). Trial participants were younger (SMD &lt; -0.2) than the real-world populations. Women were significantly underrepresented in the SELECT and FLOW trials (SMD &lt; -0.2). Self-reported race/ethnicity representation was imbalanced in all studies, with underrepresentation of Black (SMD &lt; -0.2) individuals and Hispanic individuals in FLOW (SMD = -0.11). Trial subjects had higher diastolic blood pressure and HgbA1C. The greatest imbalance was that SELECT enrolled a lower proportion of patients with a history of stroke compared with the real-world population (a subgroup in which semaglutide showed equivocal CV benefit). Conclusion: Of the three semaglutide CV outcome trials that have been published, all were not representative of the treatment-eligible U.S. population. The underrepresentation of women and Black and Hispanic individuals is notable because of the disproportionate burden of poor CKM health in these groups. Evaluation of semaglutide in representative, diverse US populations is needed to examine safety, effectiveness, and cost-effectiveness in the real-world.
Abstract 4145524: Artificial Intelligence-Based Screening for Blood Pressure Phenotypes of White-coat and Masked Hypertension in Outpatient Settings
Authors: MING HUI HUNG, Chun-Hung Chen, Yu-Hsuan Tseng, Chin-Chou Huang
Journal: Circulation (2024)

Introduction: White-coat hypertension (WCH) and masked hypertension (MH) complicate accurate blood pressure (BP) monitoring. While ambulatory BP monitoring (ABPM) is effective, its high cost and limited availability are significant barriers. Hypothesis: We hypothesized that a machine learning (ML) model using clinical data from a single outpatient visit could accurately predict WCH and MH. Aims: This study aimed to develop and validate ML-based prediction models for WCH and MH using accessible clinical data to improve diagnostic efficiency and accessibility. Methods: We enrolled patients from two hypertension cohorts, after excluding those with incomplete data. Patients were classified by office BP and ABPM readings per American Heart Association guidelines. ML models, including Multi-layer Perceptron （MLP）, Support Vector Machine (SVM), and Tabular Prior-Data Fitted Network (Tab-PFN), were developed. Input parameters included demographic data (age, gender, height, weight, smoker), and office BP (OBP) and heart rate measurements. Principal Component Analysis (PCA), kernel PCA (kPCA), or t-distributed stochastic neighbor embedding (t-SNE) were used to improve class separability. Results: The study population comprised 1481 participants with a mean age of 47.6 years (SD 13.6), 65% of whom were male and 20.1% were smokers. OBP measurements showed a mean systolic BP (SBP) of 128.7 mmHg (SD 15.4) and a mean diastolic BP (DBP) of 84.2 mmHg (SD 11.6). ABPM showed a mean 24-hour systolic BP of 122.5 mmHg (SD 11.8) and diastolic BP of 79.3 mmHg (SD 10.1). The inclusion of demographic and OBP data, along with advanced resampling and dimensionality reduction techniques, significantly improved the model’s predictive ability. The final TabPFN model achieved the best performance with recall, precision, F1 score, and accuracy of 0.747, 0.931, 0.829, and 0.807 for WCH, and 0.713, 0.954, 0.816, and 0.907 for MH. Conclusion: Our ML-based model effectively predicts WCH and MH using accessible clinical data, offering a cost-effective alternative before applying ABPM.
Abstract 4146046: A Chemical Language Model for the Design of De Novo Molecules Targeting the Inhibition of TLR3
Authors: Juan Velasco
Journal: Circulation (2024)

Background: Toll-like receptor 3 plays a role in the development of calcific aortic valve disease (CAVD). However, there are currently no pharmacological treatments for CAVD, and the discovery of de novo molecules targeting a specific protein is a time-intensive and financially demanding process. It is hypothesized that language models, trained on encodings of molecular graphs, can tailor the design of novel molecules with specific molecular and pharmacological properties. Objective: This study aims to develop a chemical language model tailored for designing novel molecules that target the inhibition of TLR3. Methods: A language model was pre-trained on 25,000 chemical structures sourced from the ChEMBL database. Each chemical structure was represented through Simplified Molecular Input Line Entry System (SMILES) strings, which were subsequently tokenized into discrete atomic and functional group tokens. The model leverages an Average-Stochastic Gradient Descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) architecture. Transfer learning was employed for domain-specific fine-tuning of the pre-trained language model on the target chemical structures. Results: The model achieved strong performance by unfreezing the pre-trained language model’s parameters for fine-tuning in all layers. Specifically, it achieved an accuracy of 85.49%, a weighted F1-score of 83.28%, and a perplexity of 1.44. This approach yielded better results compared to partially freezing the model’s parameters, where only the latter layers were fine-tuned. The partial freezing approach resulted in an accuracy of 85.06%, a weighted F1-score of 82.44%, and a perplexity of 1.44. Conclusion: A chemical language model was developed for designing novel molecules that target the inhibition of TLR3. This provides an efficient and automated method for developing novel molecules with specific molecular and pharmacological properties.