tbuckley/cabot-search huggingface dataset:
Abstract 4128187: Does Health-related Quality of Life Differ by Race over time in Older Patients with Heart Failure from Before to After Heart Transplantation or Long-term Mechanical Circulatory Support?
Authors: Jerian Dixon-Evans, Adin-cristian Andrei, Tingqing Wu, Shondra Clay, Kathryn Mazurek, Kathleen Grady
Journal: Circulation (2024)

Background: Minority patients are disproportionately affected by heart failure. Therefore, we aimed to determine the impact of race on health-related quality of life in three groups of older patients (60-80 years) with heart failure who underwent advanced surgical therapies (within race and by surgery group): (1) heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS]), (2) HT without pre-transplant MCS (HT Non-MCS), or (3) long-term MCS, if ineligible for HT. Methods: Secondary analyses were conducted using data from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support study. From 10/1/15 to 12/31/18, 396 patients with heart failure were recruited at 13 U.S. medical centers, of which 305 patients underwent HT (n=161 [68 HT MCS and 93 HT Non-MCS]) or long-term MCS (n=144) and had data through 1 year follow-up. Analysis included non-inferiority testing (Long-term MCS vs HT MCS; Long-term MCS vs HT Non-MCS). To demonstrate non-inferiority, the surgical strategies by race needed to show a difference of at least 5 percentage points, with a 95% lower confidence boundary and a two-tailed p-value&lt;0.05 in health-related quality of life, using the Kansas City Cardiomyopathy-12 Questionnaire Overall Summary Score at baseline and 3-, 6-, and 12 months. Results: The entire cohort was on average 66.2±4.7 years, 78% male, and 84% White. All three surgical groups experienced improved health-related quality of life from before to 1 year follow-up; with the largest gain through 3-months. Using non-inferiority testing, the long-term MCS minority group did not demonstrate non-inferiority when compared to both the HT MCS minority group and HT Non-MCS minority group confidence limits above the non-inferiority margin of -5 (Figure). Also, the White long-term MCS group did not demonstrate non-inferiority when compared to the White HT MCS and White HT Non-MCS groups. Conclusion: Differences in health-related quality of life among groups based on race were not statistically significant. Per non-inferiority testing, HT is superior to long-term MCS for health-related quality of life, regardless of race.
Abstract 4132217: Comorbidities Associated with One Year Mortality and Hospital Readmission After Ventricular Tachycardia Ablation
Authors: Peter Brodeur, Enrico Ferro, Timothy Maher, Shu Yang, Jonathan Waks, Patricia Tung, Eduardo Saad, Andre d'Avila, peter zimetbaum, Daniel Kramer, Robert Yeh, Andrew Locke
Journal: Circulation (2024)

Introduction: Many studies have evaluated outcomes after ventricular tachycardia (VT) ablation though few studies have evaluated outcomes past thirty days. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after VT ablation, including socioeconomic disadvantage (SED) via the Area Deprivation Index (ADI). Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2020 ADI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for VT and VT ablation were used. Patients undergoing pacemaker placement or with other arrhythmias were excluded. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models. Results: 1,798 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 18.5%, 27.4%, 41.4% and 3.5%, 4.1%, 6.5%, respectively. Common diagnoses for readmission were VT (24.8%) and dyspnea/chest pain (10.7%). After adjustment, African American race, federal insurance, heart failure (CHF), vascular disease, renal disease (CKD), severe liver disease (SLD), and higher ADI were associated with increased risk for twelve-month readmissions. Federal insurance, CHF, cerebrovascular disease, dementia, peptic ulcer disease, CKD, and SLD were associated with increased risk for twelve-month mortality. Conclusion: CHF and CKD increased the risk of readmission and mortality. Recurrent VT was the most common cause of readmission. Patients of SED are at increased risk of readmissions within one year.
Abstract 4131445: The Effects of Percutaneous Pulmonary Valve Implantation (PPVI) or Stenting on RV Diastolic Relaxation
Authors: Kiyoshi Uike, Dariusz Mroczek, Zarmiga Karunanithi, Christopher Lam, Lee Benson, Rajiv Chaturvedi
Journal: Circulation (2024)

Introductions: Pulmonary regurgitation is a diastolic phenomenon but little is known of the impact of RV-PA conduit interventions on RV diastolic function. We measured the acute effects of PPVI or stent implantation on RV diastolic relaxation with high-fidelity pressure catheters. Methods: Right and left heart pressure measurements with Millar Mikro-Cath pressure catheters in children undergoing RV-PA conduit intervention, who had also had an MRI. The relaxation time constant (RV-tau) was calculated as the time constant of the monoexponential pressure decay in the interval between the pressure at dP/dt min (P 0 ) to when the pressure fell to 10% of P 0 . Result: The age for PPVI (n=29) or stent (n=21) implantations were (mean ± sd): 14 ± 2.8 and 11.8 ± 4.2 years, respectively. RV-tau decreased 33% in the PPVI group and increased 11% in the Stent group (Table 1). The absolute value of RV dP/dt min decreased 9% in the Stent but not the PPVI group. The absolute value of LV dP/dt min increased 12% in the PPVI but not the Stent group. There was a small increase in peak VO 2 at the last follow-up (median 1.04 years, range 0.15-4.69 years) in the PPVI but not the Stent group compared to baseline (from 27.1 to 31.6 ml/kg/min, p = 0.01). The Δpeak VO 2 correlated with ΔRV-tau (r = 0.75, p = 0.01, n = 10) but not with ΔRV-PA gradient or pre pulmonary regurgitation fraction. Conclusions: PPVI results in faster RV diastolic relaxation. This may contribute to post-procedure enhanced exercise capacity more than either RV pressure and volume unloading alone.
Abstract 4129397: Cardiovascular Risk Models Using Large-Scale Physical Examination Data
Authors: Jintao Fei, Shuhan Ding, Minghui Li, Yifang Yuan, Jiangying Luo, Guoxin Wang, Jun Zhao, Xuyang Cao, Minyu Gao, Yang Yao, Ping Zhang, Zhaoji Xu, Mingxue Liu, Xinyue Wu, Ding Wang
Journal: Circulation (2024)

Background: Physical examination (PE) data offer more potential key risk factors that can enhance the development of risk models. Additionally, the latest CVD risk model, PREVENT, developed from an American population, necessitates validation within China. Objectives: This study aimed to develop CVD risk models based on large-scale PE records and compare them with PREVENT model in Chinese adults. Methods: Data were collected from a China national database (2016-2024), including 929682 participants aged 30-79 years without previous CVD (Table I). The variables covered demographics, comorbidities, and PE items, resulting in 59 features as input. The endpoint events were defined as total CVD and its subtypes, ASCVD and heart failure (HF). Sex-specific survival analysis was developed based on age-scale, utilizing Cox Proportional Hazards and Random Survival Forests (RSF). Feature importance was assessed using the average minimal depth in RSF. The performance was evaluated by the Harrell C-statistic in the validation set. Results: The results showed that our RSF model achieved the best performance in total CVD, with the highest C-index of 0.82 (Table II). The top 15 predictive risk factors for each gender are presented in Figure 1. Additionally, validation of the PREVENT model in our Chinese population dataset showed its great generalizability, particularly for HF events. Conclusions: Overall, this research underscores the importance of leveraging large-scale PE data and advanced modeling techniques to improve CVD risk prediction. Beyond traditional risk factors, greater emphasis should be placed on more demographic characteristics, comorbidities, urinalysis, and ECG features.
Abstract 4129273: Severe Mitral Regurgitation from Impella-associated Mitral Chordae Rupture with Successful Transcatheter Edge-to-edge Repair
Authors: Felix Wangmang, Tatsunori Takahashi, Pooja Desai, Priya Bansal, Sabah Skaf, Mamoo Nakamura
Journal: Circulation (2024)

Background: Limited data exists describing Impella-related mechanical mitral valve complications. Diagnosis and management can be challenging due to potential underestimation of mitral regurgitation severity from Impella and acute clinical deterioration upon removal. We present a case of successful mitral transcatheter edge-to-edge repair (TEER) for acute severe MR secondary to Impella-related mitral chordae rupture resulting in acute pulmonary edema post-Impella removal. Case Summary: A 37-year-old male smoker presented with chest pain complicated by cardiac arrest due to ventricular fibrillation. Spontaneous circulation could not be restored, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Coronary angiography revealed total occlusion of the proximal left anterior descending artery, which was successfully stented. Transfemoral Impella CP was placed for left ventricular venting under fluoroscopy (Panel A) with TTE showing no complications. In the intensive care unit, the Impella was advanced under TTE guidance; its tip was found to be positioned deep at the base of the posteromedial pupillary muscle without suction alarms or ventricular arrhythmias on the following day (Panel B). Several days later, TTE revealed new eccentric MR with hyperdynamic left ventricular motion (Panel C). The patient remained hemodynamically stable after VA-ECMO decannulation with Impella at P4. Following Impella removal, he developed repeated flash pulmonary edema despite aggressive fluid removal attributed to acute severe MR secondary to a flail P3 leaflet with ruptured chordae tendineae confirmed by transesophageal echocardiography (Panel D). Given the patient's poor surgical candidacy with a STS score of 13.2%, the team proceeded with mitral TEER, successfully reducing MR severity from severe to mild with a single NT Mitraclip ® across the medial commissure (Panel E). His post-operative cardiac course was uneventful without recurrence of pulmonary edema. Discussion: Irreversible mechanical damage to the mitral valve apparatus caused by Impella placement and repositioning is a rare, potentially fatal complication requiring emergent intervention. Mitral TEER can be a viable salvage option for poor surgical candidates.
Abstract 4132062: Early changes in albuminuria and their interaction with eplerenone treatment in patients hospitalized for acute heart failure: findings from the EARLIER trial
Authors: AYAKO TEZUKA, Masatake Kobayashi, Akira Yamashina, Kazuhiro Satomi, Shin Ito, Masanori Asakura, Masafumi Kitakaze
Journal: Circulation (2024)

Background: Patients hospitalized for acute heart failure (AHF) have high degrees of congestion, which may be associated with albuminuria. Mineralocorticoid receptor antagonists (MRAs) have natriuretic effects, possibly diminishing the degree of albuminuria. However, early changes in albuminuria, their prognostic value and interaction with MRA therapy remain unclear in AHF. Methods: The EARLIER trial included patients with AHF who were randomized to receive eplerenone or placebo over 6 months. Urine albumin-to-creatinine ratio (UACR) at admission and week 1 were measured, and Cox proportional hazards models were used for analyses. Results: Among 296 patients (mean age, 67±13years; 72% male), median B-type natriuretic peptide was 386 (190-660) pg/ml, and mean left ventricular ejection fraction was 30±8%. Patients with an UACR of ≥30 mg/g at admission had more severe congestion and poorer exercise capacity compared to those without (all-P&lt;0.01). From admission to week 1, UACR levels significantly decreased (P&lt;0.01), without significant differences between treatment groups (P&gt;0.10). UACR levels at both admission (adjusted-HR [95% CI]=1.23 [1.03-1.47]) and week 1 (adjusted-HR [95% CI]=1.23 [1.01-1.50]) were associated with the risk of cardiovascular death and hospitalization. Additionally, eplerenone vs. placebo reduced the risk of a composite of all-cause mortality, HF re-hospitalization, investigator-reported worsening HF, and/or out-of-hospital diuretic intensification (HR [95% CI]= 0.53 [0.29-0.97]), irrespective of the severity of albuminuria (P-for-interaction&gt;0.10). Conclusion: In patients with AHF, the degree of albuminuria at both admission and week 1 was associated with post-discharge prognosis. Although eplerenone did not reduce albuminuria levels, the benefit from eplerenone was consistent regardless of the albuminuria severity.
Abstract 4128377: Association between Mean Platelet Volume (MPV) and coronary artery disease: An analysis of NHANEs 2017-2020
Authors: Phuuwadith Wattanachayakul, Adivitch Sripusanapan, Evan Isaacs, Abiodun Idowu, Thitiphan Srikulmontri, Narathorn Kulthamrongsri, Chalothorn Wannaphut, John Malin, Pojsakorn Danpanichkul, Natchaya Polpichai, Lucas Pereira, Pakin Lalitnithi, Sakditad Saowapa, Nisha Wanichwecharungruang, Carlo Gabriel Casipit, Napat Suriyathumrongkul, Wasawat Vutthikraivit, Aman Amanullah
Journal: Circulation (2024)

Background: Recent data showed that mean platelet volume (MPV) is linked to mortality after myocardial infarction and restenosis following coronary angioplasty. However, its association with coronary artery disease (CAD) remains unclear. Therefore, we aim to investigate the association between MPV and CAD using a nationwide database. Methods: We analyzed retrospective cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, including participants aged 18 years and older. The data on MPV were classified into three groups: below the 10th percentile (P10), between the 10th and 90th percentiles (P10 to P90), and above the 90th percentile (P90). Univariable and multivariable logistic regression models were utilized to identify the association between MPV and CAD. Results: A total of 12,156 patients with MPV results were identified. Their mean age was 37 ± 24 years, with females constituting 51.0% of the population. The racial distribution was primarily White at 33.8%, Black at 25.7%, Mexican American at 13.2%, Asian at 10.7%, and other races at 16.6%. The participants were categorized into three MPV groups: below P10 (11.2%), P10 to P90 (77.3%), and above P90 (11.5%), with median MPV values of 6.8, 8, and 9.7 fL, respectively. In a univariable analysis using participants with MPV in the P10 to P90 as a reference, those with MPV above the 90th percentile had a significantly higher risk of CAD, with an OR of 1.39 (P90-MPV: 95% CI 1.05, 1.83; P=0.021). No significant association was found between participants with MPV below the 10th percentile and risk of CAD (P10-MPV: OR 0.91, 95% CI 0.59, 1.41; P=0.684). After adjusting for age, gender, smoking status, blood pressure (SBP &gt;130 vs &lt;130 mmHg), type 2 diabetes, urine albumin creatinine levels, serum creatinine, heart failure, and stroke history, the association between those with MPV above P90 and increased CAD risk remained significant (P90-MPV aOR 1.65; 95% CI 1.16, 2.34; P=0.005). Gender and race did not modify this effect. Conclusion: Our findings indicate that high MPV (above the 90th percentile) is positively associated with the risk of CAD in the general population. Further longitudinal cohort studies are necessary to explore this relationship and its clinical implications thoroughly.
Abstract 4129520: The mechanism of cardiac hypertrophy induced by testosterone in postmenopausal women through the activation of the mTORC2/Atg9a
Authors: Wenting Wang, Jing Yu
Journal: Circulation (2024)

Objectives: The estrogen level of postmenopausal women decreased sharply, while the androgen level did not decrease significantly, which was characterized by the inversion of estrogen / androgen ratio. Therefore, it could be observed that relative excess androgen in the circulation of postmenopausal women, which may be one of the reasons for the increase of cardiovascular disease in postmenopausal women. In this study, the model of postmenopausal hypertension was established by bilateral ovariectomy in spontaneously hypertensive rats (SHR), and the specific mechanism of testosterone-induced myocardial hypertrophy in ovariectomized SHR was explored. Methods: 24 SHR were randomly divided into four groups: WKY group (n=6), sham operation group (Sham group, n=6), bilateral ovariectomized group (OVX group, n=6) and testosterone propionate intervention group (OVX+T group, 6mg/kg/Weekly, im for 4 weeks, n=6). Western Blot was used to detect the protein expression of β-MHC, ANP, Androgen receptor, Akt, p-Akt, mTORC2 and its subunits Rictor. Moreover, the expression of autophagy-related proteins LC3 was observed. Results: 1. The study revealed that the expression of β-MHC and ANP was significantly increased in both the OVX and OVX+T groups when compared to the WKY and Sham groups. Remarkably, testosterone induced a more significant cardiac hypertrophy response than observed in the OVX group alone. Additionally, the expression of androgen receptors was markedly upregulated in both the OVX and OVX+T groups. These findings strongly suggest that testosterone primarily induces myocardial hypertrophy in SHR after ovariectomy through androgen receptors. 2. Although no significant difference in mTORC2 expression was noted between the WKY, Sham, and OVX groups, testosterone exhibited a notable capacity to activate mTORC2 expression and the p-Rictor subunit in the OVX+T group. 3. The expression of LC3II/LC3I and mitochondrial fission protein DRP1 were increased in the OVX+T group when compared to the WKY, Sham, and OVX groups. While the expression of MFN2 in the four groups shows no significant difference. Meanwhile, the expression of Atg9a was increased in OVX+T group. The results indicate that testosterone might activate mitophagy via inducing the expression of Atg9a. Conclusions: In bilateral ovariectomized SHR, testosterone has the potential to activate mitophagy by activating the mTORC2/Atg9a pathway, which, in turn, leads to cardiac hypertrophy.
Abstract 4130756: Two Leads are All We Need: Optimizing Choice of Electrocardiogram Leads for Artificial Intelligence-based Based Detection of Left Ventricular Systolic Dysfunction
Authors: Masamitsu Nakayama, Ryuichiro Yagi, Rahul Deo, Calum Macrae, Shinichi Goto
Journal: Circulation (2024)

Introduction: Artificial intelligence (AI) models built with convolutional neural networks (CNN) accurately detect left ventricular systolic dysfunction (LVSD) from 12-lead electrocardiogram (ECG). While AI models can also detect LVSD from 1-lead (but with lower accuracy), the optimal numbers and combinations of the leads remain unclear. Aims: To identify the optimal numbers and combinations of ECG leads for detecting LVSD. Methods: A total of 75,033 ECGs recorded within 14 days of an echocardiogram were collected. The data was randomly divided into derivation, validation, and test sets in a 5:2:3 ratio without patient overlap. The same split was used throughout the study. While all available ECGs were included in derivation and validation sets, the test set included 1 ECG per patient closest to the echocardiogram. CNN models were trained to detect LVSD, defined as left ventricular ejection fraction &lt;40%, using all possible combinations of 1-, 2-, and 3-lead extracted from 12-lead ECG. The final model for each lead combination was chosen according to the area under the receiver operating curve (AUROC) on the validation set across the 20 epochs. The models were trained 4 times to evaluate the variance caused by initialization vectors. Results: The 12-lead model showed AUROC of 0.893 (95%CI, 0.887-0.899). Multiple models trained with 2-lead achieved similar performance, with aVR-V4 displaying the highest AUROC (0.892; 95%CI, 0.889-0.895), followed by I-V4 (0.889; 95%CI, 0.883-0.895) and I-II (0.888; 95%CI, 0.884-0.893). The results were similar for 3-lead (aVR-aVL-V4: AUROC 0.895; 95%CI, 0.893-0.897, I-aVR-V4: 0.892; 95%CI, 0.889-0.896, and I-II-V4: 0.891; 95%CI, 0.886-0.895). The choice of leads greatly affected the performance. For the 1-lead models, aVR showed the highest AUROC (0.876; 95%CI, 0.873-0.879), but III only achieved an AUROC of (0.766; 95%CI, 0.761-0.772). The combinations, including a chest lead and a limb lead (especially aVR), tend to achieve higher performance (Fig 1). Conclusion: A combination of 2-lead was sufficient to achieve comparable accuracy as the 12-lead for the AI model to detect LVSD. Wearable devices collecting a combination of a limb and a chest lead may enhance the detection of LVSD.
Abstract 4130368: Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective
Authors: Frederick Rivera, John Paul Aparece, Jade Monica Marie Ruyeras, Rajiv Hans Menghrajani, Emily Grace Honorio, Alok Dwivedi, Rachel Anne Puentespina, Nathan Ross Bantayan, Sarang Choi, Drashti Desai, GERARD FRANCIS MANGUBAT, Edgar Lerma, Fareed Moses Collado, Kenneth Ong, krishnaswami vijayaraghavan, Amir Kazory
Journal: Circulation (2024)

Background: Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. Objectives: We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI. Methods: We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2016-2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay (LOS), and total hospital charges. Multivariable logistic regression was performed to adjust for covariates. Results: A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had a higher in-patient mortality (OR 1.68, CI, 1.17-1.68, p &lt; 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p&lt;0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p&lt; 0.001) and major bleeding (OR 1.12, 95% CI 1.05-1.19, p&lt;0.001). Patients with CKD underwent conservative (31.08% vs 36.73%, p&lt;0.0001) and invasive procedures (14.73% vs 23.55%, p&lt;0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p&lt;0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p&lt;0.0001) amputations more often. Conclusion: Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation