tbuckley/cabot-search huggingface dataset:
Abstract 14822: Portopulmonary Hypertension Unveiled: Effects of Transjugular Intrahepatic Portopulmonary Shunt Placement
Authors: Eson J Ekpo, Daniel Ng, Malhar Patel
Journal: Circulation (2023)

Introduction: Transjugular intrahepatic portosystemic shunts (TIPS) treat portal hypertension by connecting the portal vein to the hepatic vein in the liver. The resultant shunting of portal venous flow to the systemic circulation helps reduce the portosystemic gradient and is used to treat complications of portal hypertension. Right heart failure and the development of pulmonary hypertension after TIPS are known complications; however, portopulmonary hypertension (POPH) is rare. Description of Case: A 61-year-old male presents to the clinic for six months of exertional dyspnea, weight gain, and lower extremity edema. He has a history of coronary artery disease and nonalcoholic steatohepatitis cirrhosis, with TIPS placement four years prior for esophageal variceal bleeding. An echocardiogram revealed right ventricular (RV) dilatation with moderately reduced function, a flattened left ventricular septum, and an estimated pulmonary artery systolic pressure of 91 mmHg. An echocardiogram and right heart catheterization (RHC) performed before his TIPS showed normal RV function and pulmonary artery pressures (PAP). Decision Making: The patient was promptly started on furosemide and spironolactone, and after adequate diuresis, a repeat RHC was obtained, which showed significantly elevated PAP, and normal left-sided filling pressures and cardiac output. Other causes of pulmonary hypertension were ruled out, and the patient was started on tadalafil monotherapy for severe POPH, with significant improvement in his PAP (Table 1). Conclusion: POPH after TIPS is a rare complication that should be suspected in patients presenting with signs of right-sided volume overload. The mechanism by which TIPS leads to POPH is not entirely understood. The degree of RV dysfunction correlates with mortality, and prompt treatment is warranted.
Abstract 12711: Stent Length as a Predictor of Target Vessel Revascularization in Patients Treated With Drug-Eluting Stents
Authors: Raffael Mishaev, Pablo Codner, Leor Perl, Tamir Bental, abed samara, Gabriel Greenberg, Ran Kornowski, hana vaknin-assa
Journal: Circulation (2023)

Background: While several factors have been shown to increase the risk of stent thrombosis, most cases of target vessel revascularization (TVR) are due to in-stent restenosis (ISR) and have not been fully evaluated. Objectives: Our aims were to identify predictors of early and late TVR after drug-eluting stents (DES) implantation in a large prospective registry, focusing on stent length. Methods and Results: We analyzed rates of TVR according to stent length in a prospective registry of 14,447 all-comers treated with angioplasty and DES implantation in our institution. Patients were divided into quartiles according to stent length - mean 21mm - percentile 25 (Q1) 15mm, 50 (Q2) 18mm, 75 (Q3) 26mm and 100 (Q4) 32mm. At baseline patients had similar rates of diabetes mellitus, congestive heart failure and left ventricular ejection fraction. Patients in the first quartile tend to be older, more commonly of female gender, with higher rates of GFR&lt;60, anemia, and unprotected LM angioplasty. At 4 years follow-up, rates of TVR and MACE were higher in patients with longer stents; 8.5%, 9.8%, 10.4% and 16.1% (p&lt;0.001) and 25.3%, 26.6%, 27% and 28.4% (p=0.031); for TVR and MACE in Q1, Q2, Q3 and Q4 groups of patients; respectively. There were no significant differences in the rates of all-cause death amongst patients in different quartiles. Furthermore, at multivariate Cox-regression analysis length of stent was found to be a significant independent predictor for TVR (OR 1.25 95.0% CI 1.11 - 1.42; p&lt;0.001). Conclusion: From the analysis of a large cohort of all-comer angioplasty patients who were treated with DES, stent length emerged as an independent predictor of TVR and MACE.
Abstract 14613: Sex Differences in Protein Biomarkers and Measures of Fat Distribution
Authors: Abigail S Pan, Mariana Ramirez Fernandez Del Castillo, Juhi K Parekh, Ndidi Owunna, Athar Roshandelpoor, Joanne M Murabito, Daniel Levy, Jennifer E Ho, Emily S Lau
Journal: Circulation (2023)

Background: Sex differences in obesity and fat distribution have been well described and may explain differences in subsequent cardiovascular risk in men vs women. Underlying mechanisms are not fully elucidated and warrant further investigation. Objective: This study aims to examine sex differences in the associations of obesity and fat distribution measures with cardiovascular disease (CVD) protein biomarkers reflecting key pathways including inflammation, adiposity, fibrosis, and neurohormonal regulation. Methods: We measured 71 circulating protein biomarkers in 3,143 participants with available computed tomography measures of adiposity in the Framingham Heart Study. We examined whether sex modified the association of obesity (body mass index [BMI] and waist circumference [WC]) and fat distribution measures (visceral adipose tissue [VAT]) with protein biomarkers using multiplicative interaction terms in multivariable linear regression models. Sex-stratified analyses were performed as appropriate. Results: Among 3,143 participants (mean age 50 years, 48.7% women), we found that sex modified the association of BMI with 8 protein biomarkers including AGP-1, adipsin, IGFBP-1, IGFBP-2, ADM, KLKB1, MCP-1, and ucMGP (FDR-q int &lt; 0.05 for all, Figure 1 ). For example, BMI was associated with higher MCP-1 levels in women, but not in men (ß 0.132, SE 0.025, p &lt; 0.0001 in women vs ß 0.036, SE 0.028, p = 0.20 in men, FDR-q int 0.03). We found that sex also modified the association of WC and VAT with key CVD protein biomarkers including AGP-1 and A1M. Conclusions: We found that sex modified the association of obesity and adipose traits with cardiovascular risk as ascertained using biomarkers of CVD. These findings highlight potential biological pathways that may contribute to obesity-related cardiometabolic disease uniquely in men versus women.
Abstract 15144: The Heartline Experience: Can Digital Health Technology Trials Achieve Long-Term Participant Engagement?
Authors: Janeta Nikolovski, Ann Marie Navar, Steve Steinhubl, Katie Baca-Motes, Anne B Curtis, Eric D Peterson, Dhanunjaya Lakkireddy, Michael Tarino, Stephanie Juan, CV Damaraju, Dereck Wentworth, Mithun Patel, Cammie Tavakoli, Charles M Gibson, John Spertus
Journal: Circulation (2023)

Background: Digital health technologies can potentially streamline clinical research and reach broad and diverse populations, yet they often fall short to achieve long-term participant engagement. Research Question: Can long-term participant engagement in a large, direct-to-participant randomized trial using an entirely decentralized trial platform be achieved? Methods: Heartline (www.heartline.com) was designed to test the impact of a mobile app-based heart health program with the electrocardiogram (ECG) and Irregular Rhythm Notification (IRN) features on Apple Watch for early diagnosis, treatment, and outcomes of atrial fibrillation (AF). The custom app collected electronic patient-reported outcomes (ePROs) and incorporated engagement strategies based on behavioral science principles and features relevant to the target study population, including a simple interface and actions, weekly curated health education, and points-based incentives. Participants who received an IRN from their Apple Watch were prompted to take an ECG and follow up with their healthcare provider (HCP). Results: From 02/2020 to 12/2022, Heartline enrolled 34,245 US participants ≥65 years of age. To date, 80% and 76% of the study population used the app at least monthly after 1 and 2 years, with weekly engagement rates of 68% and 66%, respectively ( Figure ). ePRO response rates were 88% at 1 year and 91% at 2 years. Of those receiving an IRN, 85% took an ECG recording and 71% reported follow up with their HCP. Conclusions: The Heartline study achieved high rates of sustained, longitudinal engagement, with &gt;75% of the study population remaining engaged over 2 years and &gt;90% completing ePROs, representing substantially higher engagement rates than prior remote digital health studies. A combination of strategies was used to promote engagement in Heartline. Further work to identify the key drivers of engagement will inform future decentralized trials and digital therapeutics.
Abstract 17250: It's the Journey, Not the Destination: Demonstration of an Uncommon Variation of Para-Hisian Pacing
Authors: Natasha A Vedage, William H Perucki, Anuj Basil, Joshua M Cooper, Isaac R Whitman
Journal: Circulation (2023)

A 21 year-old college athlete presented with palpitations during exercise. ECG and transthoracic echo were normal. He underwent electrophysiology study. With catheter placement, the patient had atrial fibrillation without preexcitation. On isoproterenol, spontaneous salvos of supraventricular tachycardia (SVT) occurred. Coronary sinus activation was concentric. SVT never sustained, limiting diagnostic maneuvers. In SVT, the ventriculoatrial (VA) time was 145 msec, and there was no decrement of VA conduction with ventricular extrastimuli. Para-Hisian pacing (PHP) was performed. At high output, local myocardial + Purkinje (LM+P) capture was observed, with a VA time of 130 msec; at lower output, selective Purkinje (SP) capture was observed, with a narrower QRS (Figure 1A), and paradoxically longer VA time (160 msec) (Figure 1B). The diagnosis of a retrograde conducting-only accessory pathway (AP) was made, mapped with ventricular pacing, and ablated on the posteroseptum. SVT was no longer inducible. Discussion: PHP is employed to identify presence of a septal retrograde conducting AP based on findings of equal VA times with LM and LM+P capture. Here, the traditional findings of PHP (LM and LM+P capture) were absent because LM capture did not occur, and a third, distinct manner of activating the ventricle (via SP capture) produced unexpected results. In the presence of a retrograde conducting AP, the VA time with narrow-QRS by way of SP capture (sequential activation of the Purkinje system then myocardial conduction) was paradoxically longer than that of wider-QRS LM+P capture (concurrent Purkinje and myocardial conduction), because the path of VA conduction via the AP is “closer” to the site of first ventricular activation. The comparison of SP to LM+P capture may in and of itself declare the presence of an AP; however, LM, LM+P, and SP capture together may be useful to identify a second concealed AP providing incremental diagnostic information to conventional PHP.
Abstract 16657: Prognostic Comparison Between Computer Modelling-Derived versus Conventional H2FPEF Scores
Authors: Swiri Konje, Alaa M Omar, Alba Munoz, Ga Hee Kim, Joseph Elias, Arun Mahtani, Kruti Gandhi, Errol C Moras, Christopher Perez Lizardo, Edgar Argulian
Journal: Circulation (2023)

Introduction: H2FPEF score of 0-1 and ≥6 indicate low and high risks of HFpEF, while scores of 2-5 may require additional testing. We compared the prognostic abilities of unsupervised cluster modeling (USCM) and the conventional H2FPEF score. Methods: Respectively, 532 patients with suspected heart failure (HF) symptoms were included (69±6 years, 57% females, EF: 61±5%, all&gt;50%). H2FPEF score was calculated as recommended: BMI (&gt;30: 2 points), atrial fibrillation (3 points), and 1 point each for age&gt;60, ≥2 hypertension drugs, E/e' ratio &gt;9, and pulmonary systolic pressure &gt;35 mmHg. Using these variables, a 2-step USCM was done and compared to the H2FPEF score for death and cardiac hospitalization. Results: The mean H2FPEF score was 3.2±1.5. During a median follow-up of 3.8 years, 13 patients died, 66 hospitalized (35 HF and 51 non-HF causes), and 76 had the composite outcome. H2FPEF scores of 0-1 and ≥6 had the lowest and highest frequencies of individual and combined outcomes, respectively, while scores of 2-5 was intermediate (Figure 1A). Compared to scores of 0-1, scores of 2-5 (HR: 11, 95% CI: 1.5-78) and ≥6 (HR: 29, 95% CI: 4-219) had a higher risk of outcomes. USCM (Figure 1B) identified three clusters with varying risks: (low: 145 patients, intermediate: 333 patients, and high: 54 patients) (Figure 1C). The mean H2FPEF scores differed significantly between clusters (1±0, 3.3±1.1, 6.6±1, p&lt;0.001). Compared to the low-risk cluster, the intermediate-risk (HR: 3.4, 95% CI: 1.5-8), and high-risk clusters (HR: 7.3, 95% CI: 3-18) had a higher risk of outcomes. Clusters significantly reclassified H2FPEF scores (Figure 1D), particularly those with scores of 2-5 (23% reclassified as low risk, 7% as high risk). Among the reclassified patients with H2FPEF scores of 2-5, there was significant discrimination in outcomes (p=0.02, Figure 1A). Conclusions: Machine learning techniques, can enhance the prognostic accuracy of the H2PEF score, particularly for intermediate scores.
Abstract 13144: High Polygenic Risk Score is a Predictor for Major Adverse Cardiac Event
Authors: Emmanuel Fohle, Ninad Nadkarni, Filip Oleszak, Catherine Hajek, Adam Stys, Marian S Petrasko, Naveen Rajpurohit, Eric Larson, Shubhi Bartaria, SHAOPENG GU, Max Weaver, Jerome I Rotter, Xiuqing Guo, Tom Stys
Journal: Circulation (2023)

Background: The polygenic risk score for coronary artery disease (CAD PRS) is an emerging CAD risk assessment tool. It is unclear if it improves predictive value for major adverse cardiovascular events (MACE). This study aims to investigate the value of PRS as predictor for MACE. Methods: Patients who had coronary calcium score (CAC) within the Sanford Heart Screening Program were enrolled in the study from 2011-2021. They were genotyped using Illumina Global Screening Array version 1. PRS was calculated using a literature derived list of 180 single nucleotide polymorphisms. Patients were classified into 3 groups based on CAD PRS: high PRS (&gt; 85 th percentile), moderate PRS (15 th to 85 th percentile) or low PRS (&lt;15 th percentile). MACE was defined as the composite of death, myocardial infarction, coronary revascularization and heart failure hospitalization. Results: A total of 1,380 patients with mean age of 57.76± 9.76 were analyzed of which 6.6% had MACE. Chi-square test revealed a significant relationship between PRS (low, moderate, high) and a future MACE event, [X 2 (N=1380) = 9.9,p &lt; .01]. Post-hoc testing showed that those with high PRS(standardized residuals = 3.14, p &lt; .01) were more likely to have a future MACE event than those with a moderate (standardized residuals =1.59, p=.68) or low PRS (standardized residuals =1.11, p = 1) (Figure 1). Conclusions: This study shows that high CAD PRS has an added value in predicting future MACE in general population as represented in our Sanford Heart Screening Program.
Abstract 15674: Association of Diastolic Blood Pressure and Coronary Artery Calcium Score in South Asian Adults: The MASALA Study
Authors: Meena Moorthy, Namratha Kandula, Nicola Lancki, Juned Siddique, Neela Thangada, Daichi Shimbo, Havisha Pedamallu, Alka M Kanaya, Nilay S Shah
Journal: Circulation (2023)

Background: Diastolic blood pressure (DBP) is associated with coronary artery calcium (CAC). Prior evaluation of this relationship has not included South Asian populations, who experience a disproportionate burden of cardiovascular disease. Hypothesis: High DBP is associated with CAC independent of systolic BP in South Asian adults. Methods: In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the cross-sectional association of sex-specific DBP quartiles and CAC≥100 with robust Poisson regression adjusted for age, sex, systolic BP, body mass index, smoking, low- and high-density lipoprotein cholesterol, triglycerides, diabetes, lipid-lowering and hypertension (HTN) medication use. Restricted cubic splines examined the continuous association of DBP with CAC probability. Secondary analysis examined the association between baseline DBP quartile and incident CAC over median 4.7 years of follow-up. Results: Among 1164 participants (48% female, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 67% were not on HTN medications, 22% had CAC ≥100. The probability of CAC≥100 across levels of DBP is modeled in the Figure. DBP in quartiles 3 and 4 was significantly associated with CAC≥100 with adjusted prevalence ratio (PR, versus quartile 1) of 1.57 [95% CI, 1.20-2.06] and 1.50 [1.08-2.07], respectively. Among those not on HTN medication, the PR for CAC≥100 for DBP quartiles 3 and 4 was 1.98 [1.29-3.04] and 1.80 [1.00-3.24], respectively. Baseline DBP quartile was not associated with incident CAC, but those in quartile 4 had greater risk of CAC≥100 over follow-up compared to quartile 1 (RR 2.47, 1.17-5.23). Conclusion: Among South Asian adults in MASALA, having DBP in quartiles 3 or 4 was associated with a higher probability of CAC≥100. DBP may be an important clinical risk factor when assessing cardiovascular risk among South Asian adults.
Abstract 16718: Association of Elevated Lipoprotein A With Adverse Cardiovascular Events Following Percutaneous Coronary Intervention
Authors: Walter Oliver, Stephanie A Besser, Adam N Berman, David W Biery, Arthur Shiyovich, Khaled Abdelrahman, Jon Hainer, Shelby Laychak, Daniel M Huck, Brittany N Weber, Marcelo F Di Carli, Christopher P Cannon, Deepak L Bhatt, Ron Blankstein
Journal: Circulation (2023)

Background: Patients who undergo percutaneous coronary intervention (PCI) are at increased risk for subsequent cardiovascular (CV) events. Elevated lipoprotein A [Lp(a)] is associated with atherothrombotic disease; however, its role in risk stratification for patients with prior PCI is unknown. Methods: Patients with prior PCI were identified in the Mass General Brigham Lp(a) Registry, a retrospective cohort that included patients who had Lp(a) measured as part of routine care from 2000-2019 and excluded those with severe renal dysfunction (eGFR &lt; 15 mL/min/m 2 , dialysis, or renal transplant) or a malignant neoplasm diagnosis (excepting non-melanoma skin cancers). Lp(a) percentile groups were derived as follows: 1st-50th (ref), 51st-70th, 71st-90th, 91st-100th. The primary outcome was a composite of CV death or myocardial infarction (MI). Results: A total of 2,389 patients with prior PCI were included with a median follow-up period of 12.8 years. Median age was 60 and 583 (24.4%) were women. Higher Lp(a) percentile group was associated with increased incidence of the primary outcome with patients in the 71 st -90 th percentile (112-215 nmol/L) having a HR of 1.39 (95% CI: 1.15-1.69, p = 0.001) and patients in the 91 st -100 th percentile (≥ 216 nmol/L) having a HR: 1.61 (95% CI: 1.26-2.06, p &lt; 0.001). Findings remained significant after adjustment for age, sex, smoking, diabetes, chronic kidney disease, and insulin use with adjusted HR of 1.25 (95% CI: 1.03-1.53, p = 0.024) and adjusted HR of 1.63 (95% CI: 1.27-2.10, p &lt; 0.001) for the 71 st -90 th and 91 st -100 th percentiles, respectively. A similar magnitude of association was observed in evaluating Lp(a) and CV death alone (Figure). Conclusions: Elevated Lp(a) is strongly and independently associated with increased risk of CV death or MI among patients with prior PCI in a stepwise manner that persists over time. Findings support the use of Lp(a) screening in patients with prior PCI to enhance risk stratification.
Abstract 13921: Automated Estimation of Computed-Tomography-Derived Left Ventricular Mass Using Sex-Specific, 12-lead-ECG-Based Temporal Convolutional Network
Authors: Heng-Yu Pan, Benny Hsu, Chun-Ti Chou, Chih-Kuo Lee, Wen Jeng Lee, Taiming Ko, Tzung dau Wang, Vincent S. Tseng
Journal: Circulation (2023)

Introduction: Increased left ventricular myocardial mass (LVM) is associated with adverse cardiovascular outcomes. Various rule-based criteria using limited electrocardiogram (ECG) features lacks sensitivity for evaluating LVM. Recent studies using deep learning methods have made progress in LVM evaluation taking advantage of ECG amplitude data. Hypothesis: We hypothesized that LVM prediction with deep learning models are improved by adding inter-lead information and building sex-specific models. Methods: This study proposed a novel deep learning-based method, the eLVMass-Net, by using ECG-LVM (n=1,459) paired data. ECG signals, QRS duration and axis, demographic features were used as input data. ECG signals were encoded by a temporal convolutional network (TCN) encoder. We adopted a total of four models (non-lead-grouping v. lead-grouping, non-sex-specific v. sex-specific) for LVM estimation. For lead-grouping models, the encoders were constructed based on segregated limb and precordial leads. For sex-specific models, we constructed models on both genders separately. Encoded ECG features and demographic features were concatenated for LVM prediction. To evaluate the performance, we utilized a 5-fold cross-validation approach with the evaluation metrics, mean absolute error (MAE) and mean absolute percentage error (MAPE). Results: For non-sex-specific models, eLVMass-Net has achieved an MAE of 14.33±0.71 and an MAPE of 12.90%±1.12%, outperforming the best state-of-the-art method (MAE 19.51±0.82; MAPE 17.62%±0.78%; P &lt; 0.01). Sex-specific models achieved even lower MAPE for both males and females respectively (male MAPE 12.55%±0.88%; female MAPE 12.52%±0.34%), which also surpassed state-of-the-art methods. Adding the information of QRS axis and duration did not significantly improve the model performance (P = 0.28). The saliency map showed that T wave in precordial leads and QRS complex in limb leads are important features with increasing LVM. Conclusions: This study proposed a novel LVM estimation method, outperforming previous methods by emphasizing relevant heartbeat waveforms, inter-lead information, and non-ECG demographic features. The sex-specific analysis is crucial in improving LVM prediction.
Abstract 13719: Minimal and Delayed Age-Related Increase of Arterial Stiffness Among Tsimane Forager-Horticulturalists
Authors: Tianyu Cao, Edhitt C Cortez, Michael I Miyamoto, Daniel Cummings, Benjamin C Trumble, Jonathan Stieglitz, Randall C Thompson, Hillard Kaplan, Gregory S Thomas, Daniel A Duprez, David R Jacobs, Michael Gurven
Journal: Circulation (2023)

Background: Tsimane forager-farmers of the Bolivian Amazon exhibit a distinct trajectory of vascular aging, characterized by low age-related increases in BP, the lowest levels of coronary calcification ever reported, and robust VO 2 max. However, the prevalence of arterial stiffness (ArSt) in this population and its association with age and other cardiovascular risk factors are unknown. Methods: Large artery elasticity (LAE) and small artery elasticity (SAE) were measured among 491 Tsimane adults (mean age 55.3±13.0 y, 55% female) using HDI CR-2000 (Eagan, MN). Carotid-femoral pulse wave velocity (cfPWV) was assessed among 89 Tsimane (mean age 53.1±15.7 y, 54% female) using the foot-to-foot method with ECG and carotid/femoral pulse wave data. Results: Compared to previous studies from diverse urban populations, Tsimane show lower indices of ArSt: higher LAE (mean 22.79±12.21 ml/mmHg·10) and SAE (mean 7.57±4.04 ml/mmHg·100), and lower cfPWV (mean 6.34±2.1 m/s). LAE and SAE are 73% and 57% higher for Tsimane men, and 70% and 86% higher for Tsimane women, compared to age-matched US MESA adults. Tsimane demonstrate lower LAE and SAE with age, while higher cfPWV was only evident among Tsimane over 70 years (β=2.26±0.71, P =0.001; reference &lt;40 y). Hypertension is rare in this population, but was associated with having higher ArSt. Conclusion: Tsimane forager-farmers have substantially lower levels of ArSt and fewer age-related differences in ArSt compared to more urbanized and sedentary populations. The minimal and delayed age-related increase of arterial stiffness might contribute to the very low observed levels of coronary atherosclerosis and dementia in the Tsimane.