tbuckley/cabot-search huggingface dataset:
Abstract 13391: The Natural History of Familial Hypercholesterolemia Diagnosis, Treatment, and Outcomes in Patients With Incidental <i>LDLR</i> Pathogenic Mutation Found in Population Based Sequencing Study
Authors: Stacey Knight, Nephi A Walton, Viet T Le, Jared M Evans, G B Christensen, Kirk U Knowlton, Lincoln Nadauld, Jeffrey L Anderson
Journal: Circulation (2023)

Introduction: The HerediGene Population Study is a collaborative between Intermountain Health and deCODE genetics that seeks to understand the genetics behind diseases to better predict and prevent disease. Here we describe the natural history of familial hypercholesterolemia (FH) diagnosis (dx), treatment, and outcomes in HerediGene patients (pts) with an LDLR gene variant. Methods: From the first 32,159 sequenced pts, 157 (0.05%) had a pathogenic/likely pathogenic variant in LDLR. These LDLR carriers were divided into three groups - pts with no prior FH dx (n=47; 30%), pts with an FH dx made after a major adverse cardiovascular event (including, myocardial infarction, heart failure hospitalization, stroke, peripheral artery disease, and carotid artery disease) (n=41; 26%), and pts with an FH dx made prior to any MACE (n=69, 44%) (this is the referent group). The natural history of FH was examined using pairwise comparisons between the referent group and each of the first two groups. Results: The clinical characteristics, LDL-C values, treatments, and outcomes are shown in the Table. The age at last visit or death was similar for all these groups (median=62). Compared to pts without an FH dx, pts with FH dx prior to a MACE had significantly more LDL-C measurements, increased statin and other lipid-lowering medications, and had a large change in LDL-C measurements. They were slightly, but not statistically, less likely to have subsequent MACE (25% vs 28%; p=0.72). The LDL-C measurements and statin use were similar for those pts with FH dx after MACE and pts with FH dx prior to MACE. However, pts with FH dx after a MACE had higher rates of death (36.6% vs 11.6%; p=0.002). Conclusions: Aggressive treatment for and subsequent decrease in LDL-C following FH dx in pts with LDLR mutation, highlight the need for early diagnosis. Furthermore, if this dx was made prior to MACE the death rate was lower. Larger sized studies are needed, but these findings provide support for early screening for FH.
Abstract 17513: Decreased Sensory Neurotransmission Due to Neuronal Mitochondrial Dysfunction Mediates Sex Differences in Vagal Remodeling After Myocardial Infarction
Authors: Asokan Devarajan, Kerry Wang, Zulfiqar Lokhandwala, Maryam Emamimeybodi, Kassandra Shannon, John Tompkins, Marmar Vaseghi
Journal: Circulation (2023)

Background: Vagal dysfunction after chronic myocardial infarction (MI) exacerbates heart failure and predisposes to ventricular tachyarrhythmias (VT/VF). VT/VF after MI is more common in males than females. The mechanisms behind these sex differences are unknown. Hypothesis: We hypothesized that differences in autonomic remodeling in the vagal ganglia, which in a healthy state, provide beat-to-beat sensory neurotransmission and modulate efferent cardiac vagal tone, may serve as the mechanisms behind the sex differences in the incidence of VT/VF. Methods: MI was created (left anterior descending artery ligation) in male and female mice expressing channel rhodopsin in glutamatergic vagal neurons (VGlut2-ChR2-EYFP mice). Sham animals underwent thoracotomy only. Two weeks post-MI, heart rate (HR) responses were assessed following in vivo vagal afferent nerve activation via optogenetic stimulation (5 sec duration, 20 Hz, 10 ms and 20 ms stimulations). Ventricular fibrosis was quantified. Mitochondrial oxygen consumption rates (OCR), glutamate levels, and the levels of oxidative stress marker, 4-hydroxy nonenal (4HNE), were measured in the vagal ganglia. Results: Male MI animals demonstrated significantly reduced HR responses to optogenetic stimulation than female MI animals. No sex differences in the degree of ventricular fibrosis was observed. A decrease in glutamate content accompanied by decreased mitochondrial OCR and increased 4HNE levels was observed in the vagal ganglia of male infarcted vs. female infarcted mice, figure. There were no differences in the HR responses, glutamate content, mitochondrial OCR, and 4HNE levels between sham males vs. sham females. Conclusion: This study demonstrates significant sex differences in vagal remodeling post-MI, with decreased efferent vagal tone in males mediated at least in part by reduced vagal afferent glutamatergic signaling associated with impaired neuronal mitochondrial function.
Abstract 18890: Outcomes for Patients With STEMI vs NTEMI in COVID-19: A Contemporary National Insight
Authors: Rohan Umrani, Martin Matsumura, Yaser Khalid, Neethi Dasu, Kirti Dasu
Journal: Circulation (2023)

Introduction: The COVID-19 pandemic posed significant challenges to cardiovascular care. Previous studies have shown that patients with NSTEMI type II have worse outcomes than those with NSTEMI type I or STEMI. In 2020, STEMI incidence was disproportionately high compared to NSTEMI. Since there are no ICD 10 codes to differentiate NSTEMI types I and II, we sought to compare patients with COVID-19 admitted for STEMI vs NSTEMI using the NIS database. Hypothesis: Given the initial pandemic response, we expect outcomes for STEMI to be worse than NSTEMI in COVID-19 patients. Methods: A retrospective analysis was completed utilizing the National Inpatient Sample (2020). Patients were identified based on ICD-10 codes corresponding to those with COVID-19 and STEMI vs. patients with COVID-19 and NSTEMI. Primary outcomes were mortality, length of stay (LOS) and total hospital charge (TOTHC). Secondary outcomes were analyzed using multivariate analysis. Results: 1,685,745 patients had COVID-19, of which 39,246 had a STEMI, and 5,818 had a NSTEMI. Average age was 62.. When comparing COVID-19, patients with STEMI vs. NSTEMI, the mortality odds ratio (OR) was 2.5 (95% CI 2.28-3.75, p &lt; 0.001) and LOS was -1.27 days. Primary and secondary outcomes are described in Table 1. Conclusions: STEMI was significantly associated with increased mortality in the setting of COVID-19. This may explain the lower LOS and lack of difference in TOTHC between the two groups. This may be related to the initial pandemic response of strict isolation protocols with closing of catheterization and surgical suites. Patients with STEMI and COVID-19 most likely were medically managed or diagnosed late leading to increased mortality. Intubation, cardiogenic shock and cardiac arrest were all significantly associated with increased mortality, LOS and TOTHC. Future studies may show reversal of these outcomes given a return to standard operations with respect to cardiac catheterization and surgical intervention.
Abstract 17257: Aortopulmonary Collateral Burden in the Fontan Circulation: Longitudinal Changes and Relationship With Clinical Outcomes
Authors: Surachai Kongrat, Ashwin Prakash, David N Schidlow, Nikhil Thatte, Rahul Rathod, Nicole St. Clair, Stuart Lipsitz, Sunil J Ghelani
Journal: Circulation (2023)

Background: Aortopulmonary collaterals (APC) are a common source of volume load in patients with a Fontan circulation and their burden can be quantified by CMR. Longitudinal trends in APC flow and their relationship with outcomes have not been described. Hypothesis: Higher APC flow will be associated with worse clinical outcomes in Fontan patients. Aims: To assess longitudinal changes in APC flow in the Fontan circulation using CMR and their relationship with outcomes. Methods: Single-center retrospective analysis of Fontan patients who had at least 1 CMR with APC flow data. APC flow was estimated as the difference between aortic and systemic venous flows and also expressed as a percent of aortic flow. Primary outcome was a composite of death or heart transplantation; secondary outcomes included protein losing enteropathy, ascites, chylothorax, and hemoptysis. The baseline (time at Fontan=time 0) and trend in APC flow were estimated using a linear mixed model with a random intercept and slope for each patient. Results: Analysis included 758 CMRs from 356 patients; 123 of whom had ≥ 2 CMRs. Median age at first CMR was 14 y (IQR 10-19 y) and median CMRs per patient were 2 (range 1-12). Baseline APC flow was 0.6 (±0.5) L/min/m 2 or 17 (±10) % of aortic flow. Increasing APC flow over time correlated with increasing trend in ventricular dilation and decreasing trend in SaO 2 . Over a median follow-up of 17 years, 22 patients (6%) had the composite outcome. High baseline APC flow as well as an increasing trend in APC flow were associated with clinical outcomes including an independent association with death or heart transplantation (Table). Conclusions: APCs represent a significant hemodynamic burden in functional single ventricle hearts palliated to the Fontan circulation. Higher and increasing APC flow is associated with worse clinical outcomes. Factors contributing to APC development and whether APC occlusion results in a lasting reduction in the burden remain to be elucidated.
Abstract 17970: Incidence and Impact of Contrast-Associated Acute Kidney Injury in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention
Authors: Johny Nicolas, Samantha Sartori, Alessandro Spirito, Kenneth Smith, Birgit Vogel, Frans Beerkens, Madison Edens, Anton Camaj, David Power, Samin K Sharma, Annapoorna Kini, George Dangas, Roxana Mehran
Journal: Circulation (2023)

Introduction: Contrast-associated acute kidney injury (CA-AKI) is associated with increased morbidity and mortality following percutaneous coronary intervention (PCI). The incidence and impact of CA-AKI in high-bleeding risk (HBR) patients undergoing PCI remain unknown. Methods: We included patients who underwent PCI at a tertiary care center (Mount Sinai Hospital, NY) between 2012 and 2019. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR definition. CA-AKI was defined according to the Acute Kidney Injury Network as an increase in serum creatinine by ≥50% or ≥0.3 mg/dL within 48 hours after PCI. The primary outcome was all-cause death within 1 year after PCI. Secondary outcomes included myocardial infarction, stent thrombosis, all-cause stroke, post-discharge and all bleeding. Results: Out of 16,966 patients, 7,295 (43.0%) were classified as HBR. CA-AKI occurred in 10.8% of HBR and 3.0% of non-HBR patients (p&lt;0.001). Among HBR patients, those who had CA-AKI were younger and had a higher prevalence of anemia (81.4% vs. 67.7%, p&lt;0.001), diabetes (66.8% vs. 52.8%, p&lt;0.001), and kidney disease (83.8% vs. 50.8%, p&lt;0.001) than those who did not. In contrast, fewer differences in baseline characteristics were observed in non-HBR patients with vs. without CA-AKI. The occurrence of CA-AKI was associated with an increased risk of all-cause death (HBR: HR 3.13, 95% CI [2.39-4.09]; non-HBR: HR 9.11, 95% CI [4.91-16.9]) and other adverse events in both HBR and non-HBR patients (Figure 1). Interestingly, a significant interaction was noted between HBR status and CA-AKI with respect to all-cause death (p-interaction=0.002). Conclusions: CA-AKI occurred at a significantly higher rates in HBR vs. non-HBR patients undergoing PCI and was associated with a significant increase in adverse events. Nonetheless, the impact of CA-AKI on all-cause death was lower in HBR vs. non-HBR patients.
Abstract 12802: Impact of Atrial Fibrillation on Percutaneous Coronary Intervention With Orbital Atherectomy
Authors: Rahat A Memon, Kamleshun Ramphul, Abhimanyu Ravalani, Nomesh Kumar, Jasninder Dhaliwal, Shaheen Sombans, Fnu Bawna, Balkiranjit Kaur Dhillon, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: Patients with atrial fibrillation risk various complications following cardiovascular procedures. As there is a lack of data on the disparities in outcomes in atrial fibrillation patients undergoing orbital atherectomy (followed by the percutaneous intervention (PCI)), we aim to bridge this knowledge gap via our study. Methods: We queried cases of PCI between 2016-2020 via the National Inpatient Sample. Patients with a code for orbital atherectomy (followed by PCI) were retained as per past studies. We compared patient characteristics between patients with and without atrial fibrillation, and the adjusted odds ratios (aOR) of various complications were studied via logistic regression analysis. Results: Our analysis found 20710 patients (ages 18 and more) who underwent orbital atherectomy between 2016-2020 in the United States, which included 5250(25.4%) of cases with atrial fibrillation. Compared to cases without atrial fibrillation, patients with atrial fibrillation undergoing orbital atherectomy showed higher odds of various complications such as acute ischemic stroke (AIS) (aOR 1.507, p&lt;0.01), sepsis (aOR 1.389, p&lt;0.01), pericardial effusion (aOR 1.931, p&lt;0.01), major bleeding (aOR 1.423, p&lt;0.01), cardiogenic shock (aOR 1.258, p&lt;0.01), acute kidney injury (AKI) (aOR 1.438, p&lt;0.01), and mortality (aOR 1.298, p&lt;0.01). While fewer cases of coronary artery dissections were noted among patients with atrial fibrillation (2.0% vs. 2.3%), the results were not statistically significant (aOR 0.862, p=0.256). Conclusions: Atrial fibrillation predisposed patients undergoing orbital atherectomy to poorer outcomes, including AKI, AIS, sepsis, pericardial effusion, major bleeding, cardiogenic shock, and death. Physicians must therefore address this issue via proper screening for cardiac arrhythmias pre- and post-procedure and maintain a close follow-up in at-risk individuals.
Abstract 13411: Effect of Multilevel, Nurse-Led, Mobile Health Enhanced Intervention on Cardiovascular Disease Risk Reduction Among Patients With Uncontrolled Hypertension in Ghana: Evidence From the ADHINCRA Study
Authors: Thomas Hinneh, Oluwabunmi V Ogungbe, Faith Metlock, Nana Kwasi F Appiah, Yvonne Commodore-Mensah, FRED S SARFO, Cheryl R Dennison Himmelfarb, Lambert T Appiah, Kathryn Carson, Lisa A Cooper
Journal: Circulation (2023)

Introduction: Although cardiovascular disease (CVD) accounts for over two-thirds of premature mortality in Africa, risk assessments to guide preventive interventions for atherosclerotic CVD are rarely performed in many clinical settings. Objective: To investigate the impact of Nurse-led intervention on ASCVD risk reduction in adults with uncontrolled hypertension in Kumasi, Ghana enrolled in the ADHINCRA study. Methods: Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (UC) arm. Two hundred and forty (240) participants were randomized to intervention (120 participants) or enhanced usual care (120 participants). We estimated the 10-year ASCVD risks for adults older than 40 years using Pooled Cohort Equations (PCE). We employed a mixed-effect linear regression model to predict the mean risk score as a function of the treatment group. ASCVD was first modeled as a continuous outcome, then categorized according to the ACC/AHA cut points: low (&lt;5%), Borderline (5%-&lt;7.5%), Intermediate (≥7.5% &lt;20%), and high-risk (≥20%). Result: The mean age (SD) was 53 ± 9.7 years; 117 men [49%]. The mean [SE] ASCVD scores for the intervention and Enhanced Usual group (EUC) arms at baseline were 14.1% (0.93) and 15.4% (1.03) respectively. At Month 12, the mean ASCVD score was 13.8% (0.77) in the intervention group and 15.2% (0.98) in the Enhanced usual group. Using the AAC/AHA risk categorization, 24% of patients in the intervention and 27% in the EUC were in the high-risk category. Relatively, ASCVD risk was 1.27% (95 CI -2.36, -0.17; P = .023) lower in the intervention group compared to the EUC arm at month 12 ( Figure 1 ). Conclusion: The Nurse-Led Multilevel Mobile Health Intervention led to a reduction in ASCVD risk, however, the reduction was not sustained after month 6, a more robust RCT is required to examine intervention sustainability in Ghana.
Abstract 15696: Simultaneous Presentation of ST-Elevation Myocardial Infarction, Ischemic Stroke, and Pulmonary Embolism in a Patient With Thrombus-in-Transit Across a Patent Foramen Ovale
Authors: Richard W Petrella, Colin Martz, Tsuyoshi Kaneko, Richard G Bach
Journal: Circulation (2023)

Case Description: A 70-year-old woman with a history of hypertension, hypothyroidism, and sigmoid colectomy, presented to the ER with altered mental status, slurred speech, and left-sided weakness. She was hemodynamically stable, and exam was notable for dysarthria, left-sided facial droop, and left-sided upper and lower extremity weakness. ECG showed ST-elevation in leads I, aVL, and V1-V3, and ST-depression in II, III, and aVF. CT Head was without intracranial hemorrhage. Emergency coronary angiography showed subtotal thrombotic occlusion of the left main, LAD, and LCX arteries consistent with embolic etiology. Coronary thrombectomy re-established TIMI 3 flow. The patient then underwent CTA of the head and neck, which visualized both right anterior M2 occlusion and large pulmonary emboli in the right and left main PAs. She underwent emergency mechanical thrombectomy of the right MCA. With induction of anesthesia she suffered PEA arrest, for which she received 5 minutes of CPR and epinephrine and ROSC was obtained. She then underwent successful thrombectomy of the right anterior M2. Patient then underwent bilateral pulmonary thrombectomy and IVC filter placement. Over the ensuing 24 hours she weaned from pressors, was extubated, and was alert with only mild left hemiparesis. Bilateral lower extremity venous dopplers were negative for DVT, and an echocardiogram showed a serpiginous echodensity in both atria and across the intra-atrial septum, consistent with a large thrombus-in-transit through a PFO. CT Surgery was consulted, and patient underwent successful bi-atrial thrombectomy with PFO closure. Discussion: Simultaneous thromboembolic MI, stroke and PE is an exceedingly rare and catastrophic clinical presentation. Initial management should involve a promptly-assembled multidisciplinary team to determine if the patient is a candidate for procedural or operative intervention, and, if so, to determine the order in which they should be completed. Subsequently, a workup should be initiated to determine an underlying cause of the presentation, including appropriate thrombophilia workup and imaging. If feasible, surgical thrombectomy and PFO closure may be indicated to prevent further embolic phenomena.
Abstract 16401: Optimizing ChatGPT to Detect VT Recurrence From Complex Medical Notes
Authors: Ruibin Feng, Kelly A Brennan, Zahra Azizi, Jatin Goyal, Maxime Pedron, Hui Ju Chang, Prasanth Ganesan, Samuel Ruiperez-Campillo, Brototo Deb, Paul L Clopton, Tina Baykaner, Albert J Rogers, Sanjiv M Narayan
Journal: Circulation (2023)

Introduction: Large language models (LLMs), such as ChatGPT, have remarkable ability to interpret natural language using text questions (prompts) applied to gigabytes of data in the world wide web. However, the performance of ChatGPT is less impressive when addressing nuanced questions from finite repositories of lengthy, unstructured clinical notes (Fig A). Hypothesis: The performance of ChatGPT to identify sustained ventricular tachycardia (VT) or fibrillation after ablation from free-text medical notes is improved by optimizing the question and adding in-context sample notes with correct responses (‘prompt engineering’). Methods: We curated a dataset of N = 125 patients with implantable defibrillators (32.0% female, LVEF 48.9±13.9%, 61.7±14.0 years), split into development (N = 75) and testing (N = 50) sets of 307 and 337 notes, with 256.8±95.1 and 289.8±103 words, respectively. Notes were deidentified. Gold standard labels for recurrent VT (Yes, No, Unknown) were provided by experts. We applied GPT-3.5 to the test set (N=337 notes), using 1 of 3 prompts (“Does the patient have sustained VT or VF after ablation” or 2 others), systematically adding 1-5 “training” examples, and repeating experiments 10 times (51,561 inquiries). Results: At baseline, GPT achieved an F1 score of 38.6%±19.4% (mean across 3 prompts; Fig B). Increasing the number of examples progressively improved mean accuracy and reduced variance. The optimal result was the illustrated prompt plus 5 in-context examples, with an F1 score of 84.6%±6.4% (p&lt;0.05). Conclusions: ChatGPT can accurately identify VT recurrence from small numbers of complex medical notes with optimal prompt engineering. Future studies should define optimal context for different medical questions and domains. These findings pave the way for automated analysis of large medical repositories to broadly improve decision making.
Abstract 18155: A Rare Case of Acute Purulent Pericarditis Secondary to Invasive Streptococcal Infection (S. Pyogenes) With Cardiac Tamponade in an Immunocompetent 37-Year Old Female: A Case Report
Authors: RAYMOND BANQUIRIGO
Journal: Circulation (2023)

BACKGROUND: Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria with Streptococcus pyogenes (S. pyogenes) being a possible, though very uncommon etiology. It is usually associated with an underlying infection or compromised immune system. Purulent bacterial pericarditis is a high mortality entity and represents only 1% of the causes of pericarditis, among these only a few cases have been reported of Streptococcus pyogenes pericarditis. This is an extremely rare case of acute purulent bacterial pericarditis caused by S. pyogenes in an immunocompetent adult patient with no underlying chronic medical conditions. CASE PRESENTATION: A 37-year-old healthy female with no known comorbidities came in for chills, dyspnea, chest pain radiating to the upper back aggravated by deep breathing and relieved with leaning forward. She initially presented with unstable vital signs (hypotension and tachycardia). Electrocardiography demonstrated diffuse ST-segment elevation and PR segment depression, while chest Xray and CT scan showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance indication infection and workup for autoimmune disease was done which was negative. 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done with drainage of 350cc nonclotting purulent serous fluid. Cultures grew Streptococcus pyogenes (S. pyogenes) confirming the diagnosis of acute purulent bacterial pericarditis. Management for pericarditis including daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics for the pneumonia and the patient had resolution of the pericardial effusion as documented by repeat 2DED upon follow up.