tbuckley/cabot-search huggingface dataset:
Abstract 4145588: Evaluating the Cardioprotective Effects of Sodium-Glucose Cotransporter-2 Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis of Recent Studies
Authors: Sudeep Nugooru, Prerana Sevella, Shravya Ginnaram, Sai Sri Harsha Rallabhandi, Chaitra Janga, Enad Haddad, Kavya Sudireddy, Shayan Qadir, Shreeja Shah, Robert Watson
Journal: Circulation (2024)

Background: Cancer therapies, including anthracyclines and tyrosine kinase inhibitors, can induce cardiotoxic effects, increasing the incidence of heart failure (HF). With improvements in cancer survival rates, the focus has shifted towards minimizing non-cancer-related morbidities and improving overall quality of life. SGLT2 inhibitors (SGLT2i) have demonstrated efficacy in reducing cardiovascular events, particularly HF, in patients with and without diabetes. Given their dual cardioprotective and anticancer properties, these drugs present a promising therapeutic option in the cardio-oncology field. Preclinical studies have shown that SGLT2i, especially canagliflozin, can impede tumor growth in various cancer models. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. Four studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The SGLT2i used in these studies included canagliflozin, dapagliflozin, and empagliflozin. The total sample size was 10,775 patients, with 1,649 in the SGLT2i group and 9,126 in the control group. Outcomes analyzed were hospitalizations for HF, total adverse events, and all-cause mortality using R/R Studio. Results: SGLT2i significantly reduced the risk of hospitalizations for HF compared to control (OR: 0.50; 95% CI: 0.38–0.66, p &lt; 0.01), with significant heterogeneity observed (I 2 = 71%, p = 0.02). The incidence of total adverse events was lower in the SGLT2i group (OR: 0.99; 95% CI: 0.84–1.16, p &lt; 0.01), with high heterogeneity noted (I 2 = 98%, p &lt; 0.01). SGLT2i showed a trend towards reduced all-cause mortality but was not statistically significant (OR: 1.01; 95% CI: 0.87–1.18, p &lt; 0.01), and high heterogeneity was present (I 2 = 98%, p &lt; 0.01). Conclusions: SGLT2i use in cancer patients is associated with a significant reduction in hospitalizations for HF. While there is a trend towards reduced all-cause mortality and total adverse events, the results are not statistically significant. The high heterogeneity in the analyzed studies suggests variability in patient populations and study designs, indicating a need for further research to confirm these findings.
Abstract 4145933: Short-Term Outcomes After Temporary Mechanical Circulatory Support Escalation From Intra-Aortic Balloon Pump to Impella in Patients With Cardiogenic Shock: Insights From the J-PVAD Registry
Authors: Masashi Yokoi, Tsuyoshi Ito, Yu Kawada, Tatsuya Mizoguchi, Shohei Kikuchi, Shuichi Kitada, Toshihiko Goto, Yoshihiro Seo
Journal: Circulation (2024)

Introduction: Cardiogenic shock (CS) remains a clinical challenge with a high mortality rate. An escalation strategy from intra-aortic balloon pump (IABP) to Impella has been proposed for patients with CS refractory to IABP therapy, but clinical data on this approach are lacking. This study aimed to elucidate the short-term clinical outcomes after IABP-Impella escalation in patients with CS. Methods and Results: From the Japanese nationwide registry of Impella (J-PVAD) database between 2020 and 2022, a total of 2,578 patients with CS who received Impella support were classified into the IABP-Impella group (n=189) or the Primary Impella group (n=2,389). We applied a 1:3 propensity score matching, selecting 180 patients in the IABP-Impella group and 540 patients in the Primary Impella group. Before matching, the IABP-Impella group presented significantly longer shock-to-Impella time, worse laboratory data indicating multiorgan damage, and more frequent inotrope use compared to the Primary Impella group. After matching, the baseline characteristics were well-balanced between the two groups. The clinical outcomes within 30 days after the initiation of Impella were compared between the matched groups. The IABP-Impella group showed a significantly higher rate of additional mechanical circulatory support (MCS) use than the Primary Impella group (33.9% vs. 25.6%, p=0.034). Although the incidence of mortality was similar between the two groups (30.6% vs. 30.9%, p&gt;0.99), the incidence of major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) tended to be higher in the IABP-Impella group (43.0% vs. 36.3%, p=0.053). Notably, the incidence of infection was significantly higher in the IABP-Impella group than in the Primary Impella group (10.0% vs. 4.8%, p=0.018). Kaplan-Meier estimates revealed that infection occurred more frequently in the IABP-Impella group during the 30-day follow-up period (log-rank p=0.016). Conclusions: Patients undergoing the IABP-Impella escalation strategy showed poorer baseline clinical conditions in baseline and were associated with a higher likelihood of further MCS upgrade and an increased risk of infection.
Abstract 4146436: Echocardiography Analysis of Anabolic-Androgenic Steroids Effects on Cardiac Structure and Function in Athletes: A Systematic Review and Meta-Analysis
Authors: Douglas Cavalcante, Gustavo Eduardo Fante, Altair Melo, Livia Romariz, Caroline De Oliveira Fischer Bacca
Journal: Circulation (2024)

Introduction: Anabolic-androgenic steroids (AAS) have been used for performance enhancement by athletes, exposing them to potential cardiovascular effects and structural changes. Some athletes also present cardiac structural or functional changes secondary to resistance training. Therefore, the true effect of AAS in echocardiographic parameters among athletes remains unclear. Research Question: What are the changes in echocardiographic parameters in athletes who use AAS compared with those who do not use AAS. Objective: We aimed to perform a systematic review and meta-analysis comparing use with no use of AAS in athletes for echocardiography parameters. Methods: PubMed, Embase, and Cochrane were systematically searched for studies that assessed echocardiographic changes in athletes who used AAS compared to non-users. We computed mean differences (MD) for all continuous outcomes, with 95% confidence intervals (CI) pooled under a random-effects model. Heterogeneity was assessed with I 2 statistics. Statistical analysis was performed using Review Manager (Cochrane Collaboration). Results: We included 13 studies with 742 male athletes (401 AAS vs 341 control; mean age 33.4 and 32.4 years respectively). AAS was associated with a decrease left ventricular (LV) ejection fraction (MD -3.17%; 95% CI -5.51, -0.83%; p=0.008; Figure 1A) and global longitudinal strain (MD 3.58%; 95% CI 2.95, 4.20%; p&lt;0.001; Figure 1B) when compared to no use. Athletes who used AAS also had an increased septal wall thickness (MD 0.98 mm; 95% CI 0.06, 1.9 mm; p=0.04; Figure 2A.), posterior wall thickness (MD 1.16 mm; 95% CI 0.57, 1.75 mm; p&lt;0.01; Figure 2B) and LV mass (MD 42.9g; 95% CI 23.2, 62.5g; p&lt;0.0001; Figure 2C) when compared to non-user athletes. LV end-diastolic diameter (MD 1.26mm; 95% CI 0.00, 2.51mm; p=0.05; Figure 2D) showed a tendency to increase in AAS users, but with no significant difference. Conclusion: AAS use among athletes is associated with reduced LV function and increased LV hypertrophy and overload, compared with athletes who do not use AAS.
Abstract 4146391: Multinational Validation of Fully Automated Diagnostic Reports using Artificial Intelligence-enabled Application for ECG Images
Authors: Akshay Khunte, Veer Sangha, Evangelos Oikonomou, Lovedeep Dhingra, Arya Aminorroaya, Andreas Coppi, Sumukh Vasisht Shankar, Bobak Mortazavi, Deepak Bhatt, Harlan Krumholz, Girish Nadkarni, Akhil Vaid, Rohan Khera
Journal: Circulation (2024)

Background: Accurate ECG interpretation is critical for triaging, diagnosis, and managing patients with cardiovascular conditions. Current computerized methods have limited accuracy and are often proprietary algorithms based on raw signal data. We sought to evaluate ECG-GPT, a novel vision-text transformer model capable of generating free-text diagnosis statements from images of ECGs. Methods: ECG-GPT was developed with 3 million ECGs at Yale and validated in 2 large and geographically distinct populations: (1) 1.4 million ECG images with diagnosis statements from Mount Sinai Health System (MSHS), NY, and (2) 45,389 ECG images with 6 diagnostic labels from UK Biobank (UKB). We employed 2 metrics: (A) a rule-based approach to evaluate diagnostic accuracy for 19 rhythm and conduction disorders on MSHS ECGs and 6 key conditions on UKB ECGs, and (B) semantic similarity (similar meaning) using a fine-tuned DistilBERT model. Using semantic similarity methods, we assessed the quality of generated text across the full range of ECG diagnoses by computing similarity both for all model-generated and reference statements and for subsets specific to ECGs flagged for each of the 19 extracted conditions. To establish baseline similarities, we also computed semantic similarities between random combinations of model-generated and reference statements within each of these sets. Results: The model performed well across multiple key labels, spanning rhythm and conduction disorders, including an AUROC of 0.92 for atrial fibrillation, 0.95 for left bundle branch block, and 0.90 for atrioventricular block (Table A). More importantly, in addition to the labels, ECG-GPT identified the full context of the diagnosis statements with allied conditions. It had a median pairwise cosine similarity of 0.86 (IQR 0.78-0.94), significantly greater than the median baseline similarity of 0.73 (IQR 0.66-0.79, p&lt;0.001) (Table B). This separation between median pairwise and baseline similarity remained consistent across all 19 condition-specific subsets. Results were comparable in the UKB dataset, with AUROCs of 0.95, 0.92, and 0.95 for AF, ST, and SB, and AUROCs of 0.99, 0.99, and 0.95 for LBBB, RBBB, and AVb (Table C). Conclusion: Our model represents a scalable and accessible strategy for generating accurate, expert-level reports from photos of ECGs, validated across large, multinational datasets using both individual diagnostic labels and the comprehensiveness of the diagnostic statement.
Abstract 4146361: Patients demonstrate hesitancy to participate in cognitive assessments in an international coronary bypass surgery graft (CABG) surgery trial
Authors: Stephanie Ninode Rivera, Sarah Eslami, Richard Swartz, Ruth Masterson Creber
Journal: Circulation (2024)

Introduction: Coronary artery bypass surgery (CABG) is the most common cardiac surgery in adults, yet it is associated with a range of complications including stroke, cognitive impairment, and dementia. Despite the critical importance of cognitive outcomes, cognition remains understudied in CABG surgery trials, and recruitment for cardiac-related cognitive studies faces substantial challenges. Objective: Identify barriers to recruitment in a cognitive auxiliary study in the international Randomized Comparison Of The Clinical Outcome Of Single Vs Multiple Arterial Grafts (ROMA) trial. Methods: Semi-structured interviews were conducted with research staff (n=12) involved in the ROMA trial to explore themes related to recruitment barriers into ROMA:Cognition. The average interview length was approximately 25 minutes. Qualitative data were analyzed using a directed content analysis approach, and inter-rater reliability was assessed with Cohen's kappa score based on the five most frequently applied codes. Results: Twelve participants were recruited, with a mean age of 48 years. Of these, 90% were female, 60% were from North America, and 30% were from Europe. Key themes identified included: (1) misconceptions of cognition as equivalent to psychiatric disorders, (2) gaps in understanding the importance of measuring cognition for a cardiac-related study, (3) distrust in international data sharing practices, and (4) stigma and apprehension surrounding cognitive decline and mental health issues (Table 1). Conclusion: Educational interventions are crucial to improve patient understanding of the importance of cognitive assessments in the context of cardiac surgery. Addressing misconceptions and reducing stigma related to cognitive testing can enhance patient recruitment and engagement in cognitive auxiliary studies. Emphasizing the brain-heart connection and distinguishing cognitive assessment from psychiatric evaluation are essential steps to ensure comprehensive postoperative care and improve outcomes for CABG patients.
Abstract 4146377: Association of Socioeconomic Disadvantage with Coronary Artery Disease on Coronary CTA and Subsequent Major Adverse Cardiovascular Events: The Mass General Brigham CCTA Registry
Authors: Camila Veronica Souza Freire, Adam Berman, Stephanie Besser, Arthur Shiyovich, Brittany Weber, Rhanderson Cardoso, David Biery, Joanne Miao, Jon Hainer, Sumit Gupta, Ayaz Aghayev, Michael Steigner, Cian McCarthy, Michael Lu, Sandeep Hedgire, MARCELO DI CARLI, Brian Ghoshhajra, Ron Blankstein, Daniel Huck
Journal: Circulation (2024)

Background: Socioeconomic disadvantage is associated with worse CV outcomes. However, whether living in a disadvantaged neighborhood is associated with both the presence of coronary plaque identified by Coronary CTA (CCTA) and subsequent MACE is not well defined. Aims: To assess whether residence in a disadvantaged neighborhood predicts (1) plaque presence and stenosis severity and (2) long-term MACE after adjusting for plaque burden. Methods: We included patients who underwent clinically indicated CCTA from 2006 to 2021. Home addresses were geocoded and mapped to their census block groups. The Area Deprivation Index (ADI) was used to assess neighborhood-level socioeconomic disadvantage from 1 to 10. Based on ADI, patients were grouped into low (1-2), medium (3-5), and high neighborhood deprivation (6-10). The presence of plaque (present vs absent) and severity (no plaque or stenosis [0%], nonobstructive [1-49% stenosis], and obstructive [≥50% stenosis]) were categorized on CCTA. We used logistic regression to assess the association of plaque burden and ADI, and Cox regression to assess the association of ADI and MACE, adjusting for CAD severity and risk factors. Results: We included 26,165 patients with a median age of 58 years (IQR 49-67). Of these, 44.5% were female, and 57.8%, 52.8%, and 16.7% had a history of hypertension, dyslipidemia, and diabetes, respectively. The median follow-up after CCTA was 3.9 years (IQR 1.7-7.4). Living in highly disadvantaged neighborhoods was significantly associated with presence of plaque (OR 1.20 [95% CI 1.11-1.30] p&lt;0.001) and obstructive stenosis (OR 1.20 [95% CI 1.11-1.30] p&lt;0.001). Over follow-up, individuals living in medium ADI neighborhoods had a 16% increased hazard of MACE [adjusted HR 1.16 (95% CI 1.02-1.31) p=0.019], and those living in highly disadvantaged neighborhoods had a 20% increased hazard of MACE [adjusted HR 1.20 (95% CI 1.05-1.37) p=0.007] compared to individuals living in the most advantaged neighborhoods. Conclusion: Residence in medium and highly disadvantaged neighborhoods was associated with an increased prevalence of plaque and obstructive stenosis on CCTA as well as higher rates of MACE, even after adjusting for traditional CV risk factors.
Abstract 4145701: The Impact of Mechanical Circulatory Support on Vasoactive Inotropic Score in Patients with Cardiogenic Shock
Authors: Manvir Dhillon, Donald Richards, Felix Wangmang, Tina Torbati, Patrick Botting, Kuang-Yuh Chyu, Joseph Ebinger, Meshe Chonde
Journal: Circulation (2024)

Background: The Vasoactive-Inotropic Score (VIS) quantifies vasopressor and inotropic use in cardiogenic shock (CS), with higher VIS indicating greater severity and mortality. This study examines VIS changes within 48 hours post-Mechanical Circulatory Support (MCS) implementation and their correlation with mortality. Methods: We retrospectively analyzed 2,261 CS patients admitted from Jan 1, 2013, to Dec 31, 2023. Primary outcome is the mean change in VIS score at designated time intervals in the 48 hours after receiving MCS or medical treatment alone. A multivariable Cox proportional hazard regression model was used to evaluate the independent relationship between VIS change and in-hospital mortality. Results: Patients were categorized into the strategy they received in the first 72 hours of shock onset: medical treatment (n=2044) IABP (n=146), Impella (n=33), or ECMO (n=39). A total of 534 patient died within the index hospitalization. A decrease in the change of the mean VIS score was observed at various time intervals within the first 48 hours (Figure 1). The mean change in VIS score incorporates patients who had a decrease, no change or increase in score in the first 48 hours. Therefore, a hazard ratio &lt;1 in a Cox model would indicate that a more negative mean VIS values correlates with lower mortality. A multivariable Cox model assessing for in-patient mortality incorporated the strategies that patients received (medical treatment, IABP, etc.), age, gender, race medical history, left ventricular ejection fraction, serum creatinine, lactate &gt; 4.5 or pH &lt; 7.2. Our model suggests that a decreased need in the vasoactive medication requiring in the first 48hrs is associated with a reduction in mortality (Figure 2). Conclusion: All device strategies effectively reduce VIS within 48 hours. The change in mean VIS score within the first 48 hours is independently associated with lower mortality, regardless of the strategy patients received, their past medical history or other clinical covariates.
Abstract 4145905: NLRP3 signaling in rodent and human right ventricular failure is sexually dimorphic and regulated by 17β-estradiol via estrogen receptor α
Authors: Rafael Sobrano Fais, Erica Das Neves Palotta, Katrina Kopf, Karina Mora Massad, Christopher Hoffer, Avram Walts, Todd Cook, Amanda Fisher, Andrea Frump, Sophie Givens, Alice Bourgeois, KC Woulfe, Soni Savai Pullamsetti, Olivier Boucherat, Brenda Ogle, Sebastien Bonnet, Tim Lahm
Journal: Circulation (2024)

Introduction: Estrogen receptor α (ERα) promotes cardioprotective signaling in right ventricle cardiomyocytes (RVCMs). NLRP3 inflammasome activation in macrophages contributes to RV failure (RVF) development in pulmonary hypertension (PH). However, NLRP3 signaling in RVCMs has not been studied. We hypothesized that NLRP3 inflammasome activation mediates RVCM contractile dysfunction and is attenuated by 17β-estradiol (E2) via ERα. Methods: RVs from male or female PH patients with RVF were assessed for NLRP3 activation by analyzing RNA-seq and proteomics data, plus staining for NLRP3 and its binding partner ASC. Male or female human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) were treated with endothelin-1 (ET1) ± E2. RVCMs were isolated from male or female monocrotaline (MCT) or pulmonary artery banding (PAB) rats. RVCMs were also isolated from healthy rats and treated with ET1 ± E2 in vitro. Male or female ERα loss-of-function mutant (ERα mut )] rats were employed to study effects of ERα. NLRP3 activation in RVCMs and iPSC-CMs was assessed by NLRP3-ASC colocalization and activation of downstream targets. RVCM contractility and cytosolic calcium (c-Ca 2+ ) were evaluated via IONOPTIX system. P&lt;0.05 was considered significant. Results: RNA-seq, proteomics, and immunofluorescence studies revealed that upregulation of NLRP3 activity and signaling in human RVF are more pronounced in males (p&lt;0.05 for all comparisons). In male patients, NLRP3 activation was inversely correlated with cardiac index (p&lt;0.05). In pilot studies, NLRP3 was more activated in male vs female ET1-treated iPSC-CMs. RVCMs from male, but not female, MCT- or PAB-rats demonstrated increased NLRP3-ASC colocalization (p&lt;0.05). RVCMs treated with ET1 exhibited more NLRP3 activation and contractile dysfunction than female RVCMs (p&lt;0.05). E2 treatment in male WT RVCMs reduced NLRP3-ASC co-localization and increased Ca 2+ dependent contractility (p&lt;0.05). E2 treatment in male iPSC-CMs trended to prevent ET1-induced NLRP3 activation. E2’s inhibitory effects on NLRP3 activation, NLRP3-induced contractile dysfunction, and c-Ca 2+ in male WT RVCMs were abrogated in ERα mut RVCMs (p&lt;0.05). Conclusion: NLRP3 activation in human and rat RVF as well as NLRP3-induced contractile dysfunction in human iPSC-CMs and rat RVCMs exhibit a male bias. E2, via ERα, prevents NLRP3 activation and NLRP3-induced contractile dysfunction. Inhibiting NLRP3 via E2-ERα may be a novel treatment strategy for RVF.
Abstract 4146270: Real-World Performance of the Artificial Intelligence-Enabled Electrocardiogram to Detect Increased Left Ventricular Filling Pressure to Predict Incidence of Heart Failure
Authors: Sri Charan Bhyravajosyula, Jose Medina-Inojosa, Betsy Medina-Inojosa, Eunjung Lee, Kathryn Mangold, Paul Friedman, Zachi Attia, Jae Oh, Francisco Lopez-Jimenez
Journal: Circulation (2024)

Background: Our team recently developed an Artificial Intelligence model that enables the identification of increased left ventricular filling pressures using a single-lead electrocardiogram (AI-ECG) with excellent performance (AUC 0.91). However, its ability to predict incident heart failure (HF) in the community is yet to be evaluated. Hypothesis: We tested the hypothesis that the output from the AI-ECG will predict the long-term incidence of heart failure (HF) and HF with preserved ejection fraction (HFpEF), and would refine the HF predictive capabilities of the AHA Predicting Risk of Cardiovascular Disease EVENTs (PREVENT TM ) Equations. Methods: Leveraging the resources of the Rochester Epidemiology Project (REP) we analyzed data from patients who sought primary care in Olmsted County, MN, between 1997-2003 with passive follow-up until April 2024. We included those with a digital ECG at baseline and excluded those who were part of the original algorithm development or history of heart failure. The diagnosis of heart failure was ascertained by using ICD codes (ICD9-428,ICD10-I.50) and a word search for the terms related to heart failure. HFpEF was ascertained using the Ejection Fraction (EF) data closest to the heart failure diagnosis date, using EF more than 40% as the criterion. We tested the association between AI-ECG predicted probabilities and new-onset HF and HFpEF using Cox proportional hazard models. These models were also adjusted for cardiovascular risk factors and were stratified to evaluate the effect of the AI-ECG output on PREVENT TM -predicted HF at 10 years. Results: We included 20,276 subjects, mean age 55±14.03, 52% women, 92% non-Hispanic white. After 18.2±8.5 years of follow-up, 4,008 (19.76%) were diagnosed with HF and 3,812 (18.8%) HFpEF. Risks of HF and HFpEF significantly increased in patients with increased left ventricular filling pressures by AI-ECG, independent of risk factors, all p for trend &lt;0.001, see Fig A-B , respectively. AI-ECG enhanced the prediction capabilities of the PREVENT TM score across all risk groups, see Fig-C. Conclusions: AI-ECG-Derived increased left ventricular filling pressure is associated with new-onset HF and HFpEF in the community and was associated with incidental heart failure at any PREVENT TM risk category. Those results suggest a potential role of AI ECG in predicting heart failure.