tbuckley/cabot-search huggingface dataset:
Abstract 4144907: Left ventricular-arterial coupling and mortality in the cardiac intensive care unit
Authors: Mitchell Padkins, Luca Fazzini, Kristoffer Berg, MAURO GORI, Jae Oh, Garvan Kane, Dustin Hillerson, Guido Tavazzi, Jacob Jentzer
Journal: Circulation (2024)

Background: Ventricular-arterial coupling (VAC) refers to the ratio of afterload (effective arterial elastance) to contractility (left ventricular (LV) end-systolic elastance) as an integrated marker of cardiac performance. Echocardiography might be used to evaluate VAC through a simple time-efficient bedside evaluation. Hypothesis: VAC is useful for mortality risk stratification in an unselected cardiac intensive care unit (CICU) cohort. Aims: We sought to determine whether the VAC ratio, defined using the ratio of LV end-systolic volume (LVESV) to stroke volume (SV), predicted mortality in the CICU. Methods: Consecutive patients admitted to the Mayo Clinic CICU between 2007 and 2018 were included. The simplified VAC ratio was calculated as the LVESV calculated from 2D measurements using the Teichholz formula divided by the SV calculated from the LV outflow tract pulsed wave Doppler measurement, with values &gt;1 reflecting ventricular-arterial uncoupling. The main outcome was all-cause in-hospital mortality. Results: We included 4685 patients with a median age of 69 (58-79) years; 37% were females. The median VAC ratio was 1.0 (0.7 to 1.8) and 21% of patients had a VAC ratio &gt;2. Most clinical and echocardiographic variables differed in patients with higher VAC ratio, reflecting greater severity of illness with worse cardiac systolic and diastolic function. A total of 329 (7.0%) patients died during hospitalization. An incremental association was observed between a higher VAC and in-hospital mortality (unadjusted OR 1.22, 95% CI 1.16-1.29, p&lt;0.001). Patients with a VAC ratio &gt;1 (unadjusted OR 2.85, 95% CI 2.22-3.69, p &lt;0.001) and especially those with VAC ratio &gt;2 (unadjusted OR 4.28, 95% CI 3.24-5.69, p&lt;0.001) had higher in-hospital mortality overall and in each admission diagnosis subgroup of interest ( Figure ). After multivariable adjustment, patients with a VAC ratio &gt;2 remained at higher risk of in-hospital mortality (adjusted OR 1.63, 95% CI 1.17-2.28, p = 0.01). Conclusions: Ventricular-arterial uncoupling was associated with worse outcomes in an unselected CICU cohort. The echocardiographic VAC ratio is a simple non-invasive bedside measure that can be used for risk prediction in the CICU.
Abstract 4145231: Immuno-Hematologic Aging and Resilience: Novel Markers of Cardiovascular Risk
Authors: Arion Yu, Anoop Titus, Khurram Nasir, David Zidar, Sadeer Al-Kindi
Journal: Circulation (2024)

Background: Aging is a complex process that affects various organ systems, including the cardiovascular (CV) and immune systems. Chronologic age does not fully capture the heterogeneity in biological aging, and studies suggest that the immuno-hematologic (IH) systems play a critical role in the aging process and may contribute to CV disease. However, the relationship between IH aging and CV risk is not well characterized. Routine complete blood count with differential (CBC-diff) is a widely available test that assesses blood components. Its utility in capturing biological age and association with CV risk has not been explored. Methods: Using data from adult participants in NHANES 1999-2018, we trained an XGBoost model to predict chronologic age using 20 variables obtained from CBC-diff. The model was trained on 50% of the data (n=26,677), and the remaining 50% (n=26,677) was used to predict age (IH AGE ). We calculated the difference between IH AGE and chronologic age (ΔAge), and categorized it into 3 groups: proportionate IH aging (ΔAge -10 to 10 years), accelerated IH aging (ΔAge &gt;10 years), and resilient IH aging (ΔAge &lt;-10 years). We then examined the association between IH groups and CV mortality using Cox regression models (model 1 adjusted for chronologic age and model 2 additionally adjusted for sex, race, body mass index, blood pressure, history of diabetes, kidney disease, heart failure, coronary disease, myocardial infarction, stroke, smoking and serum cholesterol). Results: A total of 10,621 (39.8%) had proportionate IH aging, 7,953 (29.8%) had resilient IH aging, and 8,103 (30.4%) had accelerated IH aging (figure). In model 1, accelerated IH aging was associated with near doubling of CVM risk (adjusted hazard ratio [aHR] 2.28, 95% CI [1.66-3.13], P&lt;0.001), while IH resilience was associated with a near half the risk of CVM (aHR 0.54, 95% CI [0.47-0.62], P&lt;0.001). In model 2, resilient aging was associated with 32% lower risk of CV mortality (aHR 0.68, 95% CI [0.58-0.80], P&lt;0.001), while accelerated aging had a 75% higher risk of CV mortality (aHR 1.75, 95% CI [1.22-2.51], P&lt;0.001), figure. The leading contributors to IH AGE were RDW, MCV and Absolute Lymphocyte Count. Conclusions: We introduce a new concept, IH AGE , which captures IH biologic aging from CBC-diff. IH aging is independently associated with CV mortality, providing a novel tool for risk stratification and personalized prevention strategies in cardiovascular disease.
Abstract 4144884: Optimizing Large Language Models for Interpreting American Heart Association Dietary Guidelines in Nutrition Education for Cardiovascular Disease Prevention: A Retrieval-Augmented Generation Framework
Authors: Vijaya Parameswaran, Jenna Bernard, Alec Bernard, Neil Deo, David Bates, Kalle Lyytinen, Rajesh Dash
Journal: Circulation (2024)

Introduction: Large language models (LLMs) show proficiency in clinical capabilities such as responding to medical inquiries, and summarizing information, but their application in patient education requires evaluation. This study optimizes LLMs' interpretation of dietary guidelines for nutrition education using a framework that integrates American Heart Association (AHA) guidelines with Retrieval Augmented Generation (RAG), outperforming the baseline models. Methods: Analyzing 105 dietitian-authored visit notes (623,214 words) with Latent Dirichlet Allocation revealed two themes (coherence score 0.9). We posed 30 questions on these themes, along with the prompt, “Answer the following question as if you were a dietitian and cite sources from AHA,” three times to the baseline Perplexity (perplexity.ai), GPT-4o (OpenAI) models, and a customized LLM framework using RAG with formatted guidelines and citations applied to the Llama 3 70B model (Meta). Three expert reviewers evaluated the responses, scoring 0 or 1 for reliability, appropriateness, guideline adherence, and harm (Figure 1). Mean scores across groups were compared using analysis of variance. Results: Our LLM framework scored higher than baseline Perplexity and GPT-4o models on reliability (0.57±0.45 vs. 0.24±0.42, 0.11±0.25; p&lt;.001, 95% CI [.07, .25]), appropriateness (0.83±0.28 vs. 0.62±0.34, 0.57±0.37; p&lt;.001, 95% CI [.06, .23]), guideline adherence (100% vs. 47.5%, 80%; p&lt;.001, 95% CI [.21, .41]), readability using the Flesch-Kincaid grade level (11.1±2.4 vs. 9±2.1, 9.4±1.8; p&lt;.001, 95% CI [.07, .25]), and showed no harm (0 vs. 0.23±0.43, 0.26±0.44; p&lt;.001, 95% CI [.02, .17]). Cohen’s kappa coefficient (k&gt;70%, p&lt;.001) indicates high reviewer agreement. Conclusion: The baseline models scored lower across all measures and included Type 2 errors. While the optimized model shows promise, improvements in reliability, readability, and inclusivity of dietary restrictions, preferences, and cultural considerations are needed for ethical and equitable clinical use. Future steps include refining model capabilities, building a comprehensive knowledge base, and field testing to assess impact of these improvements on clinicians' educational and documentation tasks.
Abstract 4144490: Impact of Transient Conduction Disturbances on Long-term Outcomes Following Transcatheter Aortic Valve Implantation
Authors: shogo okita, Hideki Kitahara, Kaoru Matsuura, Goro Matsumiya, Yoshio Kobayashi
Journal: Circulation (2024)

Background: Conduction disturbances (CD) following transcatheter aortic valve implantation (TAVI) are well known as one of the important predictors of poor post-TAVI prognosis. Although persistent CD are evidently associated with poor prognosis, data on transient CD are limited. The aim of this study was to investigate the prognostic impact of transient CD on long-term clinical outcomes after TAVI. Methods: Patients with severe aortic stenosis (AS) undergoing TAVI between February 2017 and October 2022 were retrospectively enrolled. CD were defined as any of the following: 2nd- or 3rd-degree atrioventricular block, right or left bundle branch block, and intraventricular CD with QRS duration ≥120 ms. Transient CD were defined as CD that appeared after TAVI but improved either before discharge or within 7 days. Persistent CD were defined as CD that appeared after TAVI and presented at hospital discharge or &gt;7 days after TAVI. The primary endpoint was cardiovascular adverse events (CAE) after discharge, defined as a composite of cardiovascular death, heart failure hospitalization, and new pacemaker implantation. Results: Of 412 enrolled patients, transient CD occurred in 81 patients (19.7%), persistent CD in 72 patients (17.5%), and no CD in 259 patients (62.9%). In comparison between the transient and no CD groups, membranous septum length was significantly shorter in the transient CD group (5.0 mm vs. 6.1 mm, p=0.005). For a maximum of 2,000 days follow-up (the median follow-up period was 569 days), the transient CD group showed a significantly higher incidence of CAE compared with the no CD group (18.5% vs. 9.3%, p=0.012) (Figure). Although there was no significant difference in cardiovascular mortality (11.1% vs. 8.5%, p=0.48), the incidence of heart failure hospitalization tended to be higher in the transient CD group (6.2% vs. 2.3%, p=0.091), and new pacemaker implantation was more frequent in the transient CD group (4.9% vs. 0.0%, p&lt;0.001) compared with the no CD group. Conclusions: Post-TAVI transient CD were associated with a higher risk of long-term adverse events. Even though CD were transient and no longer present at discharge, careful outpatient follow-up may be necessary after TAVI.
Abstract 4144738: Change in Valve Function During Pediatric Heart Transplant Graft Rejection May Shed Light on Immunosuppressive Strategies for Partial Heart Transplantation
Authors: Addison Gearhart, Gianna Dafflisio, Stuart Lipsitz, Sitaram Emani, Tajinder Singh
Journal: Circulation (2024)

Introduction: Partial heart transplant (HT), the transplantation of living/growing heart valve implants, has emerged as a novel solution for children with complex CHD and semilunar valve dysfunction. Management of immune suppression following partial HT is unclear, and may be aided by understanding how valve function changes during full HT graft rejection. Aims: To compare semilunar and atrioventricular (AV) valvular function before and during biopsy-proven rejection by echocardiogram imaging in pediatric HT recipients. Methods: Single institution retrospective study including all pediatric HT recipients during 2005-2023 with biopsy diagnosed rejection, a preceding biopsy with no rejection (baseline), and available echo within 24 hours of each biopsy. All echos were reviewed by a pediatric imaging cardiologist to qualitatively grade valvular and ventricular function. Change in valvar/ventricular function was assessed by McNemar’s and Fischer’s exact tests. Results: The cohort comprised 87 patients (43.7% female, mean age 14.2 years [SD +/-6.5], 60% with acute cellular rejection and 40% with antibody mediated rejection, median time between baseline and rejection diagnostic biopsy/echo pairs 6.5 months [SD +/-3.9]). At baseline, 99% of patients had no/mildly depressed left and right ventricular systolic function. During rejection 18%(17) patients had progressed to moderate or greater LV dysfunction and 15%(13) had moderate or greater RV dysfunction (p-value &lt;0.001 for both). There were no instances of aortic, pulmonary, mitral, or tricuspid stenosis. No patients had more than trivial aortic regurgitation (AR) at baseline or during rejection. At baseline 1%(1) of patients had mild PR versus 6%(5) during rejection (p=0.103). The proportion of those with mild or greater MR increased from 17% at baseline to 39% during rejection (p=0.0003). Worse MR during rejection was seen in a higher proportion of those who developed &gt; mild LV dysfunction during rejection compared to those who did not (82% vs. 22%, p&lt;0.001). Those with mild or more TR increased from 39% to 52% during rejection (p=0.068). Conclusion: There was no significant semilunar valve dysfunction during graft rejection in pediatric HT recipients using contemporary immune suppression. This suggests that less immunosuppression may be sufficient to preserve the longevity of semilunar valve transplants. Mitral valve dysfunction was worse during rejection, but was related to LV dysfunction and warrants further study.
Abstract 4144621: Intensive Risk Factor Modification for Secondary Prevention of Ischemic Stroke – a Feasibility Study
Authors: John Fitzgerald, Elnaz Shahmohamadi, Mehrdad Emami, Melissa Middeldorp, Mohanaraj Jayakumar, Adrian Elliott, Celine Gallagher, Timothy Kleinig, Prashanthan Sanders
Journal: Circulation (2024)

Background: Secondary prevention targets for embolic stroke or transient ischemic attack (TIA) are clearly described in guidelines, but many patients do not achieve consistent follow-up or adequate cardiovascular risk factor control. Aim: This study evaluated the feasibility of an intensive risk factor modification clinic model following embolic stroke compared to usual care. Methods: Eligible participants 18 to 85 years old with embolic stroke were randomly allocated to 3-monthly physician-led multi-disciplinary risk factor clinic (RFC) review or to standard follow-up for up to 3 years. Lifestyle and cardiovascular risk factors were evaluated including hypertension, hyperlipidemia, diabetes or impaired fasting glucose, physical activity, obesity, sleep apnea, alcohol and tobacco use. In the RFC group, structured advice and medication titration were provided to achieve the secondary prevention targets for each risk factor in accordance with stroke guidelines. Results: A total of 140 participants were enrolled (39% female, mean age 71±9 years), at 100±70 days post embolic stroke. Mean follow-up was 545±264 days. Risk factor clinic intervention was associated with greater likelihood of control to target for blood pressure, low density lipoprotein cholesterol (LDL-C) and achievement of target exercise volume. Average percentage weight change in participants with a body mass index (BMI) &gt;27kg/m 2 was 7.5±5.4% in the treatment group compared with 1.3±4.9% in the control group (p&lt;0.001). Differences in blood sugar control, alcohol intake and tobacco use did not reach statistical significance. Moderate or severe sleep apnea was diagnosed in 37% of those tested, with 50% acceptance of continuous positive airways pressure. Achievement of all risk factors to target including a BMI ≤27kg/m 2 (47% versus 0%) was significantly more likely in the risk factor intervention group, compared to the control group. Conclusions: The structured risk factor modification in this study was feasible and led to greater risk factor control than standard follow-up. Adopting this approach routinely following embolic stroke has the potential to reduce cardiovascular adverse outcomes and should now be tested in a large, randomized trial.
Abstract 4144624: Clinical Outcomes of Postoperative Atrial Fibrillation Following Non-Cardiovascular Procedures: A Three-Year Study
Authors: Sittinun Thangjui, Basel Abdelazeem, Mohamed Al Hajji, Gregory Perkowski, HangYu Watson, Matthew Santer, Harshith Thyagaturu, sudarshan balla, Sandeep Arora
Journal: Circulation (2024)

Background: Postoperative atrial fibrillation (AF) is common, often brief, and may recur, with some studies reporting a recurrence rate lower than 30% at one year. The initiation of anticoagulation (AC) in these patients, particularly those at lower stroke risk, remains debatable due to insufficient evidence. This study aims to assess outcomes in postoperative non-cardiovascular procedures with acute AF, focusing on patients at lower stroke risk, comparing those treated with and without AC. Method: Using the TriNetX database, we identified patients aged 18 to 64 years with new-onset AF following non-cardiovascular procedures, excluding those with a history of stroke or other indications for anticoagulation. Patients were divided into AC and Non-AC groups based on AC initiation within two weeks of AF onset, then followed for three years. Propensity score matching (PSM) balanced confounders between groups. Thromboembolic and bleeding outcomes were assessed. Results: Among 10,108 patients, 734 (7%) received anticoagulation within two weeks of postop AF. After PSM, mean ages were 53.7±7.6 years for the AC group and 54.2±7.17 years for the Non-AC group. At 3 years, the incidence of composite thromboembolic events did not significantly differ between AC and Non-AC groups (5.8% vs. 4.1%, OR 0.70 (95% CI: 0.43-1.14)). Most thromboembolic events occurred within one month of AF onset. There were no significant differences in the composite of intracranial bleeding, gastrointestinal bleeding, retroperitoneal bleeding, or need for blood transfusion between the AC and Non-AC groups at 3 years (OR 1.04 (95% CI 0.72-1.50)). Conclusion: At three years, there is no significant difference in thromboembolic and bleeding outcomes in patients undergoing non-cardiovascular procedures who develop new-onset AF. Further randomized controlled trial is needed to determine the necessity of anticoagulation in this patient population.
Abstract 4144617: Disparities in Mortality Following Stroke with Atrial Fibrillation Among Older Adults in the United States: A CDC WONDER Database Analysis
Authors: M Danial Ali Shah, Muhammad Faiq Umar, Iram Malik, Fomengia Nkeangu, Zeeshan Sattar, Saad Ur Rahman, Ali Jafry, Hassan Mehmood Lak, Uqba Awan, Abdul A Ameen, Mohammad Khan
Journal: Circulation (2024)

Introduction: Over the past two decades, treatment advances for atrial fibrillation (AF) and stroke have improved overall survival (OS). However, a significant proportion of the population still faces high mortality, suggesting an uneven distribution of improvements. This study analyzes mortality after stroke in older adults with AF in the United States (US), highlighting disparities and trends. Method: A retrospective analysis was conducted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 code I48, I63.1, I63.2, I63.4, I63.5, I63.8, I63.9, I64, I69.4, to find stroke-related deaths among people diagnosed with AF, aged ≥65 years old from 1999 to 2019. We examined demographic disparities in mortality rates by age, gender, race, geographic region, rural/urban classification, and place of death. Results were reported as age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI). Joinpoint regression assessed trend changes and average annual percentage change (AAPC). Results: Between 1999 and 2019, 398,571 individuals aged 65 and older died from AF and stroke in the US, with an AAMR of 45.6 per 100,000 (95% CI: 45.5-45.8). The AAMR declined from 47.0 in 1999 to 45.7 in 2019. Mortality rates showed disparities: females had a higher AAMR than males (46.4 vs. 43.4), non-Hispanics higher than Hispanics (46.7 vs. 27.9), and Whites higher than Blacks (48.5 vs. 32.8). The West was the most affected region (53.9), while the Northeast was the least affected (42.1). State variations were most pronounced in Vermont and Oregon (84.9 and 78.6) and lowest in Louisiana and Nevada (28.3 and 27.0). Rural areas had higher AAMR than urban areas (51.1 vs. 44.4). Most deaths occurred in inpatient settings (39.3%), followed by nursing homes (32.6%). The age group 85 years and older accounted for the majority of deaths (56.5%). Conclusions: Overall mortality due to stroke and AF has decreased, yet disparities persist. Focused action is needed to mitigate these deaths. Expanding access to healthcare in rural areas and promoting stroke prevention programs are vital for improving survival rates.
Abstract 4144486: Early versus Delayed Left Atrial Appendage Occlusion After Left Atrial Appendage Electrical Isolation
Authors: FENGWEI ZOU, Vincenzo Mirco La Fazia, Michael Freilich, Giuseppe Ammirati, Nicoletta Ventrella, Juan Cedeno Serna, Jacopo Marazzato, Aung Lin, Xiaodong Zhang, Sanghamitra Mohanty, Andrea Natale, Luigi Di biase
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) causes significantly increased risk of stroke and patients often need to be on lifelong anticoagulation. Left atrial appendage occlusion (LAAO) device is an alternative approach to prevent strokes in patients who cannot tolerate anticoagulation. Patients undergoing LAA electrical isolation (LAAEI) as part of their ablation strategy are at increased risk of stroke due to the loss of LAA contractility. In patients with prior LAAEI, the optimum timing of LAAO is unknown. Objective: The aim of this study is to investigate whether early versus delayed LAAO impacts risk of stroke in patients with prior LAAEI adherent to anticoagulation. Methods: Patients who received both LAAEI and LAAO were included in this analysis. Demographics, co-morbidities, anticoagulation adherence, timing between LAAEI and LAAO, and occurrence of stroke between LAAEI and LAAO were summarized. Patients who received LAAO ≤6 month of LAAEI were designated as the early group, and those &gt;6 month the late group. Results: A total of 171 patients were included in this study with 135 in the early group and 36 in the late group and all patients were adherent to oral anticoagulation. Patients in the early vs late group had similar age (69.8 vs 70.7 yr), BMI (28.8 vs 27.3 kg/m 2 ), CHA 2 DS 2 -VAS C score (2.19 vs 1.83), left ventricular ejection fraction (57.9% vs 57.9%), diabetes (88.9% vs 87.4%), LAA maximum orifice width (18.1 vs 18.5 mm) and percentage of paroxysmal AF (25.0% vs 25.9%). Patients in the early group were more likely to be male but did not reach statistical significance (83.3% vs 71.8%, p=0.161). During a mean follow up duration of 18.6 ± 5.5 months after LAAEI, no stroke events occurred in either group between the date of LAAEI and date of LAAO. Conclusion: Delayed LAAO after &gt;6 month of LAAEI is not associated with increased risk of stroke compared to early LAAO (≤6 month) in patients adherent with oral anticoagulation. Delayed occlusion allows for the opportunity to confirm LAAEI and reisolate if needed as the effectiveness and technical difficulty of LAA ablation significantly increases after LAAO.