tbuckley/cabot-search huggingface dataset:
Abstract 4146563: Physician follow up and cardiac testing after a first diagnosis with secondary vs. primary atrial fibrillation in-hospital
Authors: Basma Mohammed, Jiming Fang, Paul Dorian, Douglas Lee, Andrew Ha, Cynthia Jackevicius, Dennis Ko, Peter Austin, Sheldon Singh, Husam Abdel-Qadir
Journal: Circulation (2024)

Background: Secondary atrial fibrillation (AF) is triggered by acute illness and associated with adverse outcomes. Timely follow-up is recommended by the American Heart Association statement on acute AF. Hypotheses: Patients with secondary AF receive less follow-up and cardiac testing than those primarily hospitalized for AF (primary AF). Follow-up is lower for secondary AF patients hospitalized for noncardiac diagnoses. Methods: Population-based cohort study using linked administrative datasets of patients aged ≥66 yrs discharged alive after a new diagnosis of AF while hospitalized in Ontario between Apr 2013 - Mar 2019. Patients were classified as secondary or primary AF using a validated approach based on discharge diagnosis type and followed for 1yr. Outcomes included physician visits (family physicians [FP], internists, cardiologists), and cardiac testing (electrocardiograms [ECG], echocardiograms, ambulatory ECG monitoring). The cumulative incidence function was used to quantify the incidence of outcomes. Cause-specific hazards regression was used to estimate hazard ratios (HR) associated with hospitalization type in secondary AF patients. Regression analyses accounted for competing risks. Results: We studied 13,011 secondary AF (35.2% cardiac surgery, 9.6% cardiac medical, 17% noncardiac surgery, 38.1% noncardiac medical) and 11,065 primary AF patients. Secondary AF was associated with lower age, male sex, less heart failure, and greater prevalence of other comorbidities. Less than 50% of secondary AF patients had visits to internists, cardiologists, echocardiograms or ambulatory ECG monitoring (see Figure). The incidence of all outcomes was significantly lower for secondary than primary AF. Among secondary AF patients, specialist follow-up and cardiac testing rates were lowest after noncardiac diagnoses (see Table). Conclusion: Patients with secondary AF have less specialist follow-up and cardiac testing than primary AF, especially if hospitalized for noncardiac diagnoses.
Abstract 4146587: The Healthy Eating Index as predictor of cardiovascular health among Asian populations in the United States
Authors: Yu Zhou, Nana Gletsu-Miller, Angela Chow, Aurelian Bidulescu, Ines Gonzalez Casanova
Journal: Circulation (2024)

Introduction/Background: The Healthy Eating Index (HEI) is an important tool to assess diet quality in the U.S. Asian American populations (AA) have specific dietary patterns. Limited research exists to determine if HEI can adequately predict cardiovascular (CV) health among AA. Hypothesis: The HEI is with a better predictor of CV risk among non-Hispanic White persons (NHW) than among AA in the U.S. Goals/Aims: To assess if HEI predicts CV risk factors among AA and NHW using the National Health and Nutrition Examination Survey 2017-2020 pre-Pandemic (NHANES). Methods/Approach: We used data from 3,770 adults from NHANES 2017-2020 who identified as race/ethnicity AA (877) or NHW (2,893). The HEI-2015 was calculated from 2-day 24-hour recalls. We used multivariate linear and logistic regression models to test associations between HEI and CV risk outcomes. Outcome variables included Body Mass Index (BMI; kg/m 2 ), overweight status (BMI ≥ 24 kg/m 2 for AA and BMI ≥ 25 kg/m 2 for NHW), hypertension (SBP≥140 mmHg and DBP≥90 mmHg), and dyslipidemia (blood cholesterol &gt; 200mg/dL, triglycerides &gt; 150mg/dL, LDL-cholesterol &gt; 100 mg/dL and/or HDL-cholesterol &lt; 40 mmol/L). Adjusted models included age, gender, education, marital status, and alcohol intake. P-values &lt; 0.05 were considered significant. Results/Data: Asian participants were on average 46.7 (±16.6) years and NHW were 53.7 (±19.9) years. Mean HEI were 58.6 (±14.0) among AA and 51.0 (±13.8) among NHW. Among AA, 61.9% were overweight or obese, and 72.2% among NHW. Approximately 5% had dyslipidemia in both groups. Prevalence of hypertension was 5.0% for AA and 4.0% for NHW. After adjusting for demographic variables, BMI (-0.45, 95% CI -0.62 to -0.29, p&lt;0.001) and overweight status (0.99 95% CI 0.98 to 1.00 vs. normal weight, p=0.01) were significantly associated with HEI scores among NHW, while there were no significant associations among AA. Conclusion(s): Significant associations were observed between HEI scores with BMI and overweight status among NHW, but not among AA. A limitation of these analysis is clustering of various ethnic subgroups and national origins under AAs. Additionally, the effect of diet on weight may be less pronounced among AA compared to NHW particularly due to notable differences in waist circumference. Overall, these findings support the need for diet quality assessment tools that better reflect the dietary patterns associated with CV health among AA in the US.
Abstract 4146592: Device-Recorded Physical Activity and Atrial Fibrillation Burden: A Natural History Experiment from the COVID-19 Pandemic in the TRIM-AF Clinical Trial
Authors: Hyun Su Kim, Han Sun, Sojin Wass, William Telfer, Taylor Schilling, Frances Lissemore, Dimitra Bibidakis, Cheryl Lin, Lucy Yang, Erin Sullivan, Alison Jin, Lydia Guo, Parker Foster, Meghan McHale, Michael Crookshanks, Catherine Cantlay, Paul Cantlay, Ayman Hussein, Leslie Cho, Steven Nissen, sangeeta kashyap, Erik Van Iterson, Dennis Bruemmer, Reena Mehra, Jonathan Smith, Niraj Varma, David Van Wagoner, John Barnard, Mina Chung
Journal: Circulation (2024)

Introduction: Low physical activity (PA) has been identified as a risk factor for development of atrial fibrillation (AF). However, the effect of changes in PA on directly recorded AF burden has not been well studied. The COVID-19 pandemic offered an opportunity to observe whether changes in activity were correlated with changes in AF burden. To determine if reduced PA is associated with higher AF burden, we assessed daily PA and AF burden data from patients with cardiac implantable electronic devices (CIEDs) enrolled in a prospective clinical trial, Targeting Risk Interventions and Metformin for Atrial Fibrillation (TRIM-AF, NCT03603912). Methods: Daily AF burden and activity were determined from implantable cardiac devices with atrial leads. The pandemic lockdown period was analyzed for up to 1 year. Pre-pandemic periods were matched by month to pandemic periods. To test the potential confounding of aging, pre-pre-pandemic periods were matched by month to pre-pandemic periods. To reduce the confounding of study interventions, matched periods were taken on one side of the study enrollment date. For PA and AF burden, Gaussian linear mixed models and a Bayesian mixed effect model were fitted and adjusted for age, sex, and device manufacturers. A Gaussian model was used to correlate daily activity minutes and AF%. Time splines were added to adjust for non-linear time effects. Outcomes are reported as mean activity minutes and daily AF%. Results: Comparing Pandemic vs. Pre-periods (N=82 periods; 55 male, 27 female), daily activity minutes decreased by a mean of 13.16±1.06 minutes/day, and daily AF burden increased by 16% [5%-26%]. Comparing Pre vs. Pre-Pre-Pandemic periods (N=60 periods; 41 male, 19 female), mean activity decreased by 2.28±1.13 mins/day, and AF burden increased by 57% [50%-64%]. A significant negative correlation between activity and AF burden was demonstrated (coefficient -2.0, 95% CI -2.4, -1.6). A decrease in 2.0 activity minutes was associated with a 10% increase in AF burden. Conclusions: This natural history analysis of PA and AF burden demonstrated decreases in activity and increases in AF burden with time and the pandemic. Activity and AF burden were significantly negatively correlated.
Abstract 4146602: Deep Learning-enabled Detection of Aortic Stenosis from Noisy Single-lead Electrocardiograms
Authors: Arya Aminorroaya, Lovedeep Dhingra, Aline Pedroso Camargos, Sumukh Vasisht Shankar, Evangelos Oikonomou, Rohan Khera
Journal: Circulation (2024)

Background: Despite vast improvements in management strategies, aortic stenosis (AS) remains underdiagnosed, posing a substantial healthcare burden. Deep learning algorithms applied to portable ECGs can enable community screening for AS in older adults. However, noise in portable ECGs often hinders model performance. To address this, we developed and validated a noise-adapted AI algorithm to detect AS from 1-lead ECG and compared it against 12-lead ECGs in a large diverse US health system. Methods: Using lead I ECG among individuals with echocardiograms within a 30-day window from 84,438 patients at Yale (2015-2023), we developed a 1-lead AS screening model to detect moderate/severe AS. We validated this in 65,988 patients from 5 geographically distinct affiliated community hospitals and practices. Random Gaussian noise was introduced during training to improve the model’s resilience to noisy acquisition. To enforce learning AS-specific signatures as opposed to confounders, each 1-lead ECG of a patient with AS was matched with 10 controls on age, sex, hypertension, and heart failure. We trained an ensemble deep learning model using 1-lead ECGs, and patients’ age and sex as inputs to detect AS. Using the same strategy, we evaluated the performance of models trained using 12-lead ECGs. Results: In the development set, 5.3% had AS compared with 4.5-9.3% across the validation sites. The ensemble 1-lead model achieved an AUROC of 0.845 (95% CI, 0.829-0.862) for detecting moderate or severe AS with consistent performance across community data sources (AUROC: 0.797-0.835). The discrimination of the 1-lead model was comparable to those achieved by 12-lead models (0.864 [0.848-0.879]). The model probability was progressively associated with a higher prevalence of AS (ORs for Q2 vs Q1, 35 [5-254]; Q3 vs Q1, 91 [13-654]; Q4 vs Q1, 388 [55-2,768]). The model output can be optimized to enable either a high sensitivity of &gt;90% (with corresponding specificity of 63%, PPV of 12%, and NPV of 99%) or for specificity of &gt;90% to reduce false positive results (with sensitivity 53%, PPV of 23%, and NPV of 97%). Conclusion: A noise-adapted AI model can detect clinically significant AS from 1-lead ECGs, with performance similar to models trained on full 12-lead ECGs. Given its ease of deployment on wearable and portable devices, this represents a scalable screening strategy for asymptomatic AS in the community.
Abstract 4146606: Complication Rate of Fractional Flow Reserve-guided Angiography in Comparison to Standard Angiography: A Systematic Review and Meta-Analysis
Authors: Ahmed Abdulelah, Zeina Abu Orabi, Ahmad Toubasi, Manar Hasuneh, Zaid Abdulelah, M. Adnan Nadir
Journal: Circulation (2024)

Background: Intracoronary measurement of fractional flow reserve (FFR) has demonstrated higher sensitivity and better negative predicative value in evaluation of coronary artery disease than visual/angiographic only evaluation. Nonetheless, there is profound lack of evidence in the available literature that discusses the rate of complications when utilizing FFR versus standard angiography. Research Question: Does FFR carry higher or lower risk of procedural complications when compared with standard angiography? Aim: Compare the risk of complications encountered in FFR guidance in comparison to angiography only. Methods: The following databases were searched; PubMed, SCOPUS, CENTRAL, Web of Science. The following keywords were used; ((Fractional flow reserve OR FFR) AND (Adverse effect OR Complication)). The studies were included if they compared Angiography-guided Percutaneous Coronary Intervention (PCI) and Fractional Flow Reserve (FFR)-guided PCI in terms of mortality or Major Adverse Cardiac Events (MACE). Case reports and series, animal studies, reviews and non-English articles were excluded from this study. The exposure of interest was FFR-guided PCI whereas the outcomes of interest were MACE and mortality. Results: A total of 1,822 articles were identified. After removing duplicates, initial screening, and secondary screening, 15 articles were included and the total number of included patients was 421,291. The percentage of patients who underwent FFR guidance was 3.5% whereas the rest underwent angiography only. Male predominance was noted in both, FFR and angiography. The mean age of the patients who underwent FFR and angiography was 64.9 ± 9.1 and 65.2 ± 9.3 years, respectively. The model that compared between angiography only and FFR in MACE (14 studies) showed that FFR was significantly associated with lower risk of MACE compared to angiography (RR=0.62, 95%CI:0.48-0.81); this model also showed significant heterogeneity (P-value&lt;0.001, I2=80%). 14 studies were included in the model comparing between angiography and FFR in terms of death which showed that FFR was significantly associated with a lower risk of death in comparison with angiography only (RR=0.60, 95%CI:0.41-0.89); this model also showed significant heterogeneity (P-value&lt;0.001, I2=72%). Conclusion: The currently available literature demonstrates that, despite the significant heterogenicity, MACE and mortality are substantially lower in FFR in comparison to angiography only guidance.
Abstract 4146556: Stratifin is a critical target in Pulmonary Hypertension
Authors: Joel James, Vinicio Dejesus, Olga Rafikova, Ruslan Rafikov
Journal: Circulation (2024)

Introduction: Pulmonary hypertension (PH) is a fatal cardiovascular disease marked by extensive vascular remodeling. Pericytes, crucial for capillary function and typically associated with endothelial cells (ECs), are dysfunctional in PH and contribute significantly to vascular remodeling. Our research indicates that Aminopeptidase-N (APN) is overexpressed in the lungs of PH patients, contributing to pericyte proliferation, although the underlying mechanisms remain unclear. We recently discovered elevated stratifin (SFN) levels in the ECs of PH patients. SFN is known to interact with proteins like APN and activate downstream signaling pathways. Hypothesis: We hypothesize that elevated SFN binds to pericyte APN, triggering a pathological proliferative response. Methods: We utilized rats with the NFU1 (G208C) mutation, which develop spontaneous PH characterized by severe vascular remodeling and increased right ventricular systolic pressure (RVSP). To analyze cell phenotype shifts, we employed scRNA-seq and confocal imaging. Additionally, we used R18, a peptide that inhibits SFN activation of downstream targets, to explore if targeting SFN reverses PH. Results: We found elevated circulating SFN levels in PH patient plasma and observed high SFN expression and secretion in isolated ECs from PH patients. NFU1 rats mirrored these findings, showing significantly elevated SFN expression and secretion in ECs. Similarly, increased APN was found in both the lungs of PH patients and the isolated pericytes of NFU1 rats. scRNA-seq followed by Cell-Chat interaction analysis revealed that NFU1 pericytes had reduced interactions with ECs. Additionally, scRNA-seq indicated a shift to a "smooth muscle cell-like" phenotype in pericytes, characterized by increased calponin-3 and SMMHC expression. Confocal imaging confirmed significant disruption of pericyte-EC connections in NFU1 rats. Treatment with R18 in NFU1 rats significantly reversed vascular remodeling and RVSP. Echocardiography showed that R18 significantly improved the ratio of pulmonary acceleration to pulmonary ejection time. Furthermore, scRNA-seq demonstrated that R18 treatment improved pericyte-EC connections and regulated the pericyte phenotype shift in NFU1 rats. Conclusions: Endothelial stratifin induces a phenotype shift in pericytes, leading to vascular remodeling and PH. Targeting SFN signaling presents a novel strategy to combat PH.
Abstract 4146609: Evaluating the performance and potential bias of predictive models for the detection of transthyretin cardiac amyloidosis
Authors: Jonathan Hourmozdi, Nicholas Easton, Simon Benigeri, James Thomas, Akhil Narang, David Ouyang, Grant Duffy, Ike Okwuosa, Adrienne Kline, Abel Kho, Yuan Luo, Sanjiv Shah, Faraz Ahmad
Journal: Circulation (2024)

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a highly morbid cause of heart failure (HF). Early detection enables initiation of novel therapies to halt progression and drastically improve outcomes. Current evidence suggests that Black communities are disproportionately impacted by underdiagnosis. Models developed to detect ATTR-CM have been proposed as a screening strategy to address this unmet need, but trust in model outputs and concern for bias remain a barrier to adoption. We externally validated the performance of predictive screening tools and audited the models for bias on a retrospective cohort across a large health system. Methods: We identified patients treated at an integrated health system from 2010-2022 with biopsy or PYP scan-confirmed ATTR-CM and age -and sex-matched them to controls with HF in a 19:1 ratio to target 5% prevalence. We then compared the performance of three publicly available algorithms: a random forest model of claims data, the regression-based Mayo ATTR-CM score, and a deep-learning echo model (EchoNet-LVH). Bias was measured in the best performing models using standard fairness metrics. Results: We identified 245 confirmed cases of ATTR-CM for 4900 patients total in our analytic cohort. We excluded 892 patients (41 cases) in which EchoNet-LVH could not be run due to image quality or other factors. In the remaining 4008 patients, 78.7% of the cohort self-identified as White, 8.8% Black, 4.0% Hispanic and 8.5% Other. ATTR-CM prevalence was highest in individuals who identified as Black. The claims-based model performed poorly with an AUC of 0.48. EchoNet-LVH had higher AUC (0.88 vs 0.78) and average precision (0.62 vs 0.18) compared to the Mayo score. Results from bias auditing of the top performing models are presented in the Table below. Conclusions: In external validation using a large, diverse cohort of patients with heart failure, a deep-learning echo-based model to detect ATTR-CM demonstrated best overall performance compared to two other publicly available models. The results of a bias audit suggest that the model is unlikely to exacerbate existing health disparities through inequitable distribution of error with respect to self-identified Black race.
Abstract 4145490: Direct Oral Anticoagulants versus Low Molecular Weight Heparins for Prevention of VTE in Active Malignancy: Insights from a Pooled Analysis of RCTs
Authors: Mustafa Alam
Journal: Circulation (2024)

Background: Cancer is well known to cause a pro-thrombotic state, however, the pharmacologic therapy for prevention of Venous Thromboembolism (VTE) remains under contention. Direct Oral Anticoagulants (DOACs) and Low Molecular Weight Heparins (LMWHs) remain the mainstay treatment to prevent VTE in active malignancy. The purpose of this pooled analysis is to clarify the safety and efficacy of DOACs and LMWHs in the prevention of VTE and the risk of bleeding. Methods: A systematic search of MEDLINE was conducted using PRISMA guidelines using the search terms “DOAC”, “VTE”, “LMWH” and “Cancer OR Malignancy”. Studies were only included if they were prospective and randomized with a control group. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model using clinical events as dichotomous variables and was utilized to calculate Odds Ratios with 95% confidence intervals. Revman 5.3 was used to aggregate outcomes and statistics. Results: A total of 3880 patients were included in this analysis. Solid organ tumors remained the most enrolled malignancies included in the trials, with gastrointestinal malignancies being the most common. Apixaban, Rivaroxaban, Edoxaban, and Dalteparin were compared in these trials. There was a significant reduction in VTE in favor of the DOACs (OR: 0.64 [0.49, 0.82], P=0.0004). There was no significant difference in major bleeding between DOACs and LMWH (OR: 1.22 [0.80, 1.86], P= 0.36). There was a significant increase in Clinically Relevant Non-Major Bleeding in the DOAC group (OR: 1.68 [1.3, 2.17], P&lt;0.0001). There was no significant difference in All Cause Death (OR: 1.02 [0.88, 1.18], P=0.78). Conclusion: DOACs significantly reduced VTE as compared to LMWHs at the expense of an increase in Clinically relevant Non-Major Bleeding. Shared decision making should be utilized with the patient to balance the risks of VTE versus bleeding. Further trials are needed to confirm the safety and efficacy of anticoagulation with differing types of malignancies to guide VTE treatment.
Abstract 4145488: Unique Presentation of Acute Massive Pulmonary Embolism as Complete Heart Block
Authors: Tasmeen Hussain, Emily Chu, Hoda Sayegh, Stefan Torelli, Emily Keamy-Minor, Ronald Witteles
Journal: Circulation (2024)

Description of Case: An 81-year-old man with left bundle branch block (LBBB) and recent inguinal hernia repair presented with 2 weeks of dizziness and shortness of breath. On presentation, sinus tachycardia was noted with a heart rate of 100 bpm. While in the emergency department, he acutely developed complete heart block, initially with a right bundle branch block (RBBB) pattern escape at a rate of 53 bpm. Gradually, the escape slowed to 20 bpm with vomiting and hypotension so an emergent transvenous pacer was placed; he was paced at VVI 80 bpm with improvement in status. Transthoracic echocardiogram exhibited McConnell’s sign (Figure 1) with severe RV enlargement, severely reduced RV systolic function and normal LV systolic function. Arterial line tracings fluctuated with inspiration/expiration consistent with a pulsus paradoxus pattern (Figure 2) without evidence of pericardial effusion. CT angiography of the chest showed emboli in the bilateral main pulmonary arteries. For treatment, the patient was started on a therapeutic heparin drip, transitioned later to therapeutic apixaban. He did continue to require intermittent pacing and so underwent dual-chamber permanent pacemaker placement on hospital day 3. Discussion: EKG findings in patients with pulmonary emboli can be variable. In one prospective cohort study of 246 consecutive patients suspected to have pulmonary embolism (PE), only tachycardia (p = 0.008) and incomplete right bundle branch block (p = 0.002) amongst 28 total EKG findings evaluated were associated with confirmed pulmonary embolism by imaging. Interestingly, new RBBB may be a sensitive and specific marker for massive PE. In 50 patients with proven pulmonary embolism, all 16 cases with new RBBB on EKG were noted to have massive trunk obstruction (no patients with peripheral PEs had new RBBB). In the several case reports we found of patients with prior/observed LBBB and PEs who subsequently developed CHB, PEs were notably large, described as either bilateral or saddle-shaped, suggesting an association of acquired RBBB with significant PE burden. The cause of new complete heart block should always be acutely sought; in patients with baseline LBBB, a new RBBB leading to complete heart block can occur with massive/submassive PE. Rapid identification and treatment are needed to limit mortality in this often hemodynamically unstable entity.