tbuckley/cabot-search huggingface dataset:
Abstract 12645: Iron Deficiency in Heart Failure - Screening, Detection, and Prevalence Patterns in a New York Public Hospital
Authors: Shaunak Mangeshkar, Sumant Pargaonkar, Elie Flatow, Pawel Borkowski, Dimitrios Varrias, Robert Faillace
Journal: Circulation (2023)

Introduction: Iron deficiency (ID) is common in patients with heart failure (HF) and has been increasingly recognized as a poor prognostic factor. Objective: The objective of this study was to quantify the prevalence of ID in HF among our patient population, rate of appropriate screening and detection of ID, and rates of IV iron repletion in eligible patients. Methods: This is a retrospective analytical study involving all patients admitted to the floor with acute decompensated heart failure. Data pertaining to demographic variables, comorbidities, patients’ heart failure status such as ejection fraction etc. and iron studies and iron repletion status was obtained. The rates of screening for iron deficiency, appropriate detection using established criteria and iron repletion were calculated followed by data analysis. Results: Out of total 126 patients, 35 (27.7%) had objective evidence of iron deficiency in heart failure, 48 (38.1%) did not have iron deficiency, while 43 patients (34.1%) did not have iron studies ordered during course of admission. White patients had lower odds of having iron deficiency compared to African Americans (OR = 0.32, p =0.013) but there was no significant correlation with age or gender. In our cohort, only 37% of patients with iron deficiency received appropriate repletion with IV iron. There was no racial or gender related bias in prescribing iron repletion. Conclusions: Screening for iron deficiency in patients with heart failure is still not being adequately performed. There is scope for improvement in the repletion rates of intravenous iron in eligible patients.
Abstract 15741: Long-Term Efficacy and Safety of Once-Weekly Semaglutide for Weight Loss in Individuals With Obesity or Overweight but Without Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Areesha Moiz, Jeremy Levett, Kristian B Filion, Katya Peri, Pauline Reynier, Mark J Eisenberg
Journal: Circulation (2023)

BACKGROUND: Randomized controlled trials (RCTs) have demonstrated that semaglutide, a GLP-1 receptor agonist, results in clinically important weight loss among individuals with type 2 diabetes. However, its effect on sustained weight loss among those without diabetes is unclear. Objective: To examine the long-term efficacy and safety of once-weekly semaglutide use for weight loss among individuals with obesity or overweight but without diabetes. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Libraries to identify RCTs that randomized participants with obesity or overweight but without diabetes to a once-weekly 2.4 mg subcutaneous dose of semaglutide versus placebo. Inclusion was restricted to RCTs that reported change in body weight at a follow-up duration of ≥ 68 weeks. The primary outcome was relative change in body weight from baseline to 68 weeks. Random-effects models with inverse variance weighting estimated weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs). Results: Three RCTs (n=2,783, 6.0% overweight [BMI 27 to 29.9 kg/m 2 ] and 94.0% obese [BMI ≥30 kg/m 2 ]) were included. Compared to placebo, once-weekly semaglutide was associated with decreased relative (WMD: -12.0%; 95% CI -13.9%, -10.2%; Table 1) and absolute body weight (WMD: -12.2; 95% CI -13.8, -10.6 kg) at 68 weeks. A total of 86.5% of participants randomized to semaglutide achieved ≥5% weight loss compared to 34.8% with placebo (RR: 2.41; 95% CI 1.26, 4.64). The incidence of gastrointestinal adverse events was higher with semaglutide (RR: 1.45; 95% CI 1.14, 1.84); however, the majority of these events were transient, mild-to-moderate in severity, and did not require treatment discontinuation. A low incidence of serious adverse events was reported (9.5%). CONCLUSIONS: Among individuals with obesity or overweight but without diabetes, semaglutide is efficacious for sustained weight loss.
Abstract 15723: Assessing Revascularization Strategies: The Impact of Heart Flow Analysis on Coronary Computed Tomography Angiography
Authors: Adam M Belcher, Cassidy Crews, Fatima Ahmed, Frank Annie, Jesus G Vazquez Figueroa, Sarah Rinehart
Journal: Circulation (2023)

Introduction: Fractional Flow Reserve (FFR) is a technique used to assess the severity of coronary artery disease. Hypothesis: This study aimed to compare the impact of Heart Flow analysis, a CT-based FFR analysis, on patients who underwent Coronary Computed Tomography Angiography (C-CTA) at an Appalachian hospital. Methods: We collected data from January 2nd, 2019, to March 1st, 2023, from the data warehouse at Charleston Area Medical Center. The study included 5,470 patients with CTA, which were divided into two cohorts: 4,750 patients without Heart Flow analysis and 900 patients with Heart Flow analysis. Propensity score matching (PSM) was used to create two well-matched cohorts for comparative analysis. Results: Out of the total patients, 900 (16.4%) received Heart Flow analysis in addition to C-CTA, while 4,750 (83.6%) had C-CTA alone. The group of patients undergoing Heart Flow analysis had a higher prevalence of key comorbidities, including hypertension, diabetes, and prior history of myocardial infarction. After matching, both groups consisted of 900 patients each. Interestingly, while HDL cholesterol levels were similar between the groups, the Heart Flow group demonstrated lower levels of non-HDL cholesterol (102.0 vs 110 mg/dL, p=0.05), total cholesterol (147.6 vs 156 mg/dL, p=0.01), and LDL cholesterol (74.1 vs 81.8 mg/dL, p=0.05). The all-cause mortality rate was similar between the Heart Flow group and the non-Heart Flow group (2.3% vs 2.3%, p=1.00), as was the rate of myocardial infarction (3.5% vs 3.5%, p=1.00). However, the Heart Flow group exhibited a significantly higher rate of stent implantation (21.0% vs 9.2%, p&lt;0.001) and bypass surgery (31.1% vs 1.3%, p=0.01). Conclusions: Heart Flow analysis integrated with C-CTA provides valuable insights into the selection of revascularization strategies for patients with coronary artery disease. While it did not significantly impact all-cause mortality and myocardial infarction rates compared to C-CTA alone, the utilization of Heart Flow analysis was associated with higher rates of stent implantation and bypass surgery. These findings highlight the potential of Heart Flow analysis in guiding the choice of optimal revascularization methods and improving outcomes.
Abstract 14714: Long-Term Neurocognitive Safety of LDL-C Lowering With Evolocumab: Open-Label Extension Data From FOURIER
Authors: Andre Zimerman, Michelle O'Donoghue, Xinhui Ran, KyungAh Im, Brian F Ott, Francois Mach, Kenton Zavitz, Christopher E Kurtz, Maria L Monsalvo, Bei Wang, Dan Atar, Anthony Keech, Marc S Sabatine, Robert Giugliano
Journal: Circulation (2023)

Background: Concerns have been raised about low LDL-C levels and possible adverse effects on cognition. PCSK9 inhibitors markedly lower LDL-C, yet EBBINGHAUS, a prespecified substudy within the FOURIER trial, did not show adverse cognitive changes with evolocumab over 19 months median follow-up. Purpose: To investigate the long-term effects of evolocumab on cognitive function. Methods: EBBINGHAUS was a substudy of cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB) within the FOURIER randomized trial of evolocumab vs placebo in patients with established ASCVD. Patients in North America and Europe who completed EBBINGHAUS on study drug were eligible for an open-label extension (OLE) study with evolocumab. The primary endpoint was change in spatial working memory strategy index of executive function score (SWMI) from baseline over time. Secondary endpoints were measures of working memory, episodic memory, and psychomotor speed. A paired t-test was used to compare baseline vs post-baseline scores during OLE. Results: Of 1204 patients from EBBINGHAUS, 306 entered the OLE and were treated with evolocumab for a median of 5.1 years. Median achieved LDL-C was 34 mg/dL (IQR 21-50). No significant change in SWMI occurred during the OLE period overall [mean (±SD) change -0.1±2.7, p=0.73] or when stratified by original randomized allocation ( Figure 1A ). For secondary outcomes, one showed no change during the OLE period, two showed small changes (10-15% of SD), but these were directionally inconsistent (one higher, one lower). In 152 patients originally randomized to evolocumab, there was no significant change in SWMI from randomization through long-term follow-up over a median of 6.7 and a maximum of 7.2 years (mean change 0.1±2.6, p=0.66) ( Figure 1B ). Conclusion: Evolocumab did not lead to any apparent long-term decline in cognitive function through follow-up extending up to 7.2 years.
Abstract 15460: Relationship Between Sex and the Effects of Left Atrial Volume Index on Risk of Atrial Fibrillation Recurrence After Ablation
Authors: Kevin Lee, Iva Minga, Allyson Varley, Christopher Thorne, Jose Osorio, Matthew J Singleton, Joshua Silverstein, Mark Metzl
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most common arrhythmia and can be treated with ablation. However, recurrence after ablation remains common. We seek to use a large, real-world population to assess left atrial volume index (LAVi) as a risk factor for AF recurrence in men and women. Methods: The REAL-AF registry is a large, multicenter prospective registry enrolling patients undergoing AF ablation at high volume centers. Data from a total of 2666 patients (mean age 66 ± 11 years) receiving index ablations for both paroxysmal and persistent AF from the REAL-AF registry were separated into male ( n = 1548) and female ( n = 1118). The patients in each group were then divided into quartiles (Q1M, Q2M, Q3M, and Q4M for male and Q1F, Q2F, Q3F, and Q4F for female patients) based on LAVi obtained during ablation mapping. Hazard ratios (HR) were calculated per quartile for the development of AF recurrence within 12 months, controlling for the age of the patient and the physician performing the ablation. Results: Of the male patients, 176 (11%) were found to have a recurrence of AF while this occurred in 146 (13%) of the female patients. Results and quartile cutoffs are shown in table 1. For men and women, those with LAVi in Q4M and Q4F were at significantly higher risk of developing recurrent AF when compared to Q1M and Q4F (HR = 1.99 [1.24 - 3.18] and 1.97 [1.12 - 3.45] respectively). Men in Q4M also had a significantly higher risk of recurrence compared to Q2M (HR = 1.87 [1.20 - 2.92]) and a trend toward higher risk compared to Q3M (HR = 1.4 [0.95 - 2.13]). In contrast, women in Q2F had a significantly higher risk of recurrence (HR = 1.80 [1.08 - 2.99]) and Q3F had a trend toward higher risk (HR = 1.65 [0.95 - 2.87]) when compared to Q1F. Conclusion: There are gender differences in AF recurrence based on LAVi. Men tend to have a higher risk of recurrence only at the highest quartile of LAVi size while women tend to have a higher risk of recurrence at any size LAVi above the smallest quartile.
Abstract 17514: Changing Default Prescription Length to Reduce Barriers to Statin Adherence
Authors: Mili Mehta, Alexander C Fanaroff, Corrine M Rhodes, Aria Xiong, Christopher K Snider, E. Madeline Fagen, Nune Mehrabyan, MaryAnne K Peifer, Kevin Volpp, M. Kit Delgado
Journal: Circulation (2023)

Introduction: Statins substantially reduce cardiovascular risk, yet adherence is suboptimal. 90-day prescription fills are associated with better adherence than 30-day fills, though many prescriptions are not written for 90 days. We evaluated the effect of changing default prescription length to 90 days within the electronic health record (EHR) on the proportion of statin prescriptions written for 90 days. Methods: At a single academic health system, we changed the default duration for statin prescriptions written using the primary care preference list within the EHR to 90 pills with 3 refills, while still allowing providers to make a manual change. We compared the proportion of prescriptions written for 90 days over the 4 months before the change (pre-intervention) and 4 months after the change (post-intervention) using a chi-square test, along with need to change prescription dose or drug during the 90-day period after the prescription was written, a potential unintended consequence. Results: Among statin prescriptions written using the primary care prescription preference list, the rate of prescriptions written for 90 days increased from 70.6% pre-intervention to 90.1% post-intervention (p&lt;0.001). Pre-intervention, patients with Medicaid insurance, median ZIP code household income &lt; $50,000, and Black race were significantly less likely to be prescribed a 90-day statin supply (p &lt;0.05). The intervention increased the proportion of 90-day prescriptions more in these groups (interaction p &lt; 0.01), and they were no longer less likely to be prescribed a 90-day supply in the post-intervention period. Post-intervention, there was no change in the proportion of patients that needed a change in prescription during the active prescription time period (p=0.15). Conclusion: Changing default options significantly increased the proportion of statin prescriptions written for 90 days and closed baseline equity gaps without restricting patient or physician choice.
Abstract 14223: Vector Analysis for Left Ventricular Wall Motion by Optical Flow With Echocardiographic Images in Myocardial Infarction Rat Model
Authors: Miyagi Yasuo, Nari Tanabe, Ryosuke Aminati, Tomohiro Murata, Yousuke Ishii
Journal: Circulation (2023)

Background/Research Questions: Alternative evaluation of cardiac function may be established in echocardiography-based vector analysis of the ventricular wall motion property. Vector acceleration and direction have the potential to assess cardiac kinetic energy and dynamics. Optical flow is suitable for vector analysis, because ventricular wall motion can be estimated as visible and quantitative vectors by optical flow from 2D echocardiographic images. Aims: This study aimed to establish a vector analysis for ventricular wall motion via optical flow with echocardiography. Methods: Coronary artery ligation rat model was used in this study. Before surgery (Pre) and four weeks after surgery (MI), short axis echocardiographic images in mid portion were obtained and analyzed by optical flow for left ventricular regional wall motion. Vector accelerations and directions were measured in both systolic and diastolic phases. Vector directions were classified into inward (ID), outward (OD), and circumferential direction (counterclockwise: CC, clockwise: CW). Following echocardiography, a rat was sacrificed for histological evaluation. Results: Pathological myocardial infarction was noted in the anterolateral lesion. Comparing average vector accelerations, MI had significantly smaller acceleration vectors in both systolic and diastolic phase (Pre vs. MI in systolic: 0.006±0.002 vs. 0.002±0.001 mm/s 2 , P&lt;0.001, Pre vs. MI in diastolic: 0.007±0.002 vs. 0.002±0.001 mm/s 2 , P&lt;0.001). Regarding total vector direction, CC and CW significantly increased in MI (P&lt;0.01). In the anterolateral lesion, ID and OD were the main vector directions in Pre. In contrast, CC and CW vectors significantly increased in MI (P&lt;0.0001). Conclusions: Optical flow effectively visualized cardiac wall motions and quantify them as vectors in echocardiographic images. The technique clarified left ventricular wall vector property alterations between healthy and infarcted hearts.
Abstract 14649: Artificial Intelligence Model Predicts Sudden Cardiac Arrest Manifesting With Pulseless Electrical Activity versus Ventricular Fibrillation
Authors: Lauri Holmstrom, Bryan Bednarski, Harpriya Chugh, Habiba Aziz, Hoang Nhat Pham, Arayik S Sargsyan, Audrey Uy-Evanado, Angelo Salvucci, Jonathan Jui, Kyndaron Reinier, Piotr J Slomka, Sumeet S Chugh
Journal: Circulation (2023)

Introduction: There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electrical activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF) which is treatable by defibrillation. The ability to distinguish individuals presenting with PEA-SCA versus VF-SCA has potential mechanistic and therapeutic importance, but access to the initial SCA rhythm has been a limiting factor. Objectives: We trained and tested an AI model to differentiate PEA-SCA vs. VF-SCA in a novel setting that allows for determination of the initial rhythm. Methods: A subgroup of SCAs are witnessed by emergency medical services (EMS) personnel with zero response time, thereby providing the true initial rhythm. The internal cohort consisted of 421 EMS-witnessed out-of-hospital SCAs with PEA or VF as the initial rhythm in the Portland, OR metro area. Using demographics and clinical variables, we trained and tested an extreme gradient boosting model to distinguish PEA-SCA vs. VF-SCA. External validation was performed in EMS-witnessed SCAs from Ventura, CA. Results: In the internal cohort, the AI model achieved an area under the operating curve (AUC) of 0.68 (95% CI 0.61-0.76). Model performance was similar in the external cohort, achieving an AUC of 0.72 (0.59-0.84). Anemia, older age, increased weight, and dyspnea as a warning symptom were the most important features of PEA-SCA; younger age, chest pain as a warning symptom and established coronary artery disease were important features associated with VF. Conclusions: The AI model identified novel features of PEA-SCA and could distinguish EMS-witnessed individuals presenting with PEA-SCA vs. VF-SCA.
Abstract 14255: Roles of Mitochondrial Ca <sup>2+</sup> in Contractile Properties in Diabetic Rat Myocardium
Authors: Sana Koyama, Tsuyoshi Okumura, Shiori Akazawa, Kao Takeda, Chiyohiko Shindoh, Haruka Sato, Masahito Miura
Journal: Circulation (2023)

Introduction: Diabetes mellitus is an important risk factor for heart failure with reduced relaxation. It has not yet been established how mitochondrial Ca 2+ is involved in the reduced relaxation in diabetic myocardium. Thus, using trabeculae from diabetic hearts, we examined whether mitochondrial Ca 2+ affects contractile properties in diabetic myocardium. Methods: Rats were given a subcutaneous injection of 55 mg/kg streptozotocin (STZ-rats) or solvent (Ctr-rats). Eight weeks after the injection, trabeculae were dissected from rat hearts. Force was measured with a strain gauge, intracellular Ca 2+ (Ca i ) with fura-2, mitochondrial Ca 2+ with rhod-2, and mitochondrial ROS with MitoSox Red (24°C). To evaluate contractile properties of cardiac muscle, the velocities of contraction (dF/dt) and relaxation (-dF/dt) were calculated at 0.7 and 2.0 mM extracellular Ca 2+ . To eliminate the effect of developed force (F dev ), the dF/dt and -dF/dt were normalized by dividing them by their F dev . Results: Blood glucose of STZ-rats was higher than that of Ctr-rats (p&lt;0.01). STZ-rats showed smaller F dev , smaller dF/dt max /F dev , and smaller -dF/dt min /F dev (n=9, p&lt;0.05), suggesting that muscle contraction and relaxation are impaired in STZ-rats. STZ-rats showed lower peak and slower decline of Ca i transients compared to Ctr-rats (n=9, p&lt;0.01). In addition, Ru360 (5 μM), a mitochondrial calcium uniporter (MCU) inhibitor, decreased rhod-2 fluorescence and increased dF/dt max /F dev and -dF/dt min /F dev in STZ-rats (n=7, p&lt;0.05), suggesting that a decrease in mitochondrial Ca 2+ improves muscle contraction and relaxation. On the contrary, spermine (150 μM), a MCU activator, increased rhod-2 fluorescence and decreased dF/dt max /F dev and -dF/dt min /F dev (n=5, p&lt;0.05). In STZ-rats, Ru360 increased MitoSox Red fluorescence (n=5, p&lt;0.05). The spatial distribution of rhod-2 and MitoSox Red imaged with confocal microscopy was similar to that of MitoTracker Green within trabeculae, meaning that rhod-2 and MitoSoxRed are loaded within mitochondria. Conclusions: These results suggest that in diabetic hearts, mitochondrial Ca 2+ is involved in the improvement of muscle contraction and relaxation, probably through changes in ROS production.
Abstract 15253: Phenotyping Sub-Populations of Heart Failure Patients Based on Clinical and Social Determinants of Health Using Unsupervised Machine Learning Models
Authors: Kateri J Spinelli, Hsin Fang Li, deanna Rider, Jacob Abraham, Erica S Spatz, Xiaoyan Huang
Journal: Circulation (2023)

Background: Social determinants of health affect health care utilization, access, and outcomes. When designing population health management strategies, phenotyping sub-populations of patients using both clinical and social risk factors is essential. Aims: Define sub-populations of heart failure (HF) patients using a novel machine learning method based on demographics, comorbidities, and social vulnerability. Compare days alive and out of hospital (DAOH) within 1-year post-discharge. Methods: Retrospective cohort study of patients admitted to 48 hospitals in Providence St. Joseph Health with a primary HF diagnosis from 02/01/2016 - 12/31/2022. CDC social vulnerability index (SVI) was linked to patients’ home address. Thirty-four demographic, clinical, and SVI variables were included in the model. Clusters were defined using hierarchical clustering of principal components (HCPC). Top drivers of cluster formation were assessed by v-test . Due to large sample size, 10 random samples were selected and clusters were assigned by vote. Cluster enriched subgroups (CES) were defined as patients having ≥6 cluster assignments and &gt;80% cluster vote. Results: HCPC analysis grouped 61,126 hospitalizations into 3 clusters (Figure). CES-1 patients (n=25,873) were older, wealthier, White, with multiple comorbidities living in more educated communities. CES-2 patients (n=13,450) were younger with combined systolic/diastolic HF and fewer comorbidities living in crowded, urban communities. CES-3 patients (n=3,787) were non-White, Hispanic with higher cardiometabolic risk factors living in urban, crowded, low-income communities. CES-1 patients had fewer DAOH (230) and higher 1-year (22%) mortality. CES-2 patients had similar DAOH (274) to CES-3 (269), despite younger age and fewer comorbidities. Conclusions: In a large heart failure cohort, unique sub-populations based on clinical and social factors have distinct care needs, utilization, and outcomes.