tbuckley/cabot-search huggingface dataset:
Abstract 4145944: Disparities in Cardiovascular Multimorbidity and Mortality among Dual Medicare-Medicaid Beneficiaries: A Nationwide Cohort Study of &gt;2 Million Patients
Authors: Jay Lusk, Cheryl Kalapura, Robert Mentz, Stephen Greene, Bradley Hammill, Brian Mac Grory, Fan Li, Ying Xian, Emily Obrien
Journal: Circulation (2024)

Introduction/Background: Patients dually eligible for Medicare and Medicaid have higher mortality rates and disparate outcomes for acute cardiovascular conditions. However, the association between dual eligibility and cardiovascular multimorbidity and associated mortality is not well-established. Goals/Aims: To understand differences in cardiovascular disease (CVD) outcomes among patients dually eligible for Medicaid and Medicare. Methods/Approach: We analyzed Medicare claims data from a 5% random sample of fee-for-service beneficiaries (2010-2019). The exposure was Medicaid dual eligibility. The primary outcomes were the development of incident cardiovascular disease or cardiovascular multimorbidity (defined as &gt;=2 of the following conditions: stroke/TIA, myocardial infarction, atrial fibrillation, heart failure, and ischemic heart disease). The secondary outcome was death. Multistate survival models were used to estimate hazards of progression from no CVD to incident CVD, CVD multimorbidity, and death before and after adjustment for demographics and medical comorbidity burden defined using a 1-year lookback window. Results/Data: In total, 2,189,382 patients (12.9% dual-eligible for Medicaid) were included. Compared with non-dual eligible beneficiaries, dual-eligible beneficiaries were more likely to have at least one cardiovascular condition at baseline (23.6% vs. 15.0%). Over a median 5 years of follow-up, dual-eligible beneficiaries spent approximately 1 less year alive and free from CVD than non-dual eligible beneficiaries (4.89 years vs. 5.95 years). Dual-eligible beneficiaries were more likely to develop CVD and multimorbidity and had higher mortality rates before and after adjustment (Table 1 and Figure 2). Conclusions: Dual-eligible beneficiaries had higher rates of incident CVD, cardiovascular multimorbidity and associated mortality, illuminating the critical need for primary and secondary prevention of CVD in this vulnerable population.
Abstract 4146002: Advancing Cardiac Function Assessment with a Real-Time, Lightweight Deep Learning Network for Precise Left Ventricular Internal Diameter Measurement
Authors: Teddy Red, Chao Tian
Journal: Circulation (2024)

The purpose of this study is to develop a real-time, lightweight deep learning network to accurately detect the Left Ventricular Internal Diameter (LVID) for enhanced precision and efficiency in cardiac function assessment. Our approach redefines the task of locating LVID endpoints by framing it as a classification problem along two axes, thereby significantly reducing the computational burden. This novel approach ensures high accuracy and enables real-time deployment in clinical settings. We conducted extensive training using EchoNet-LVH, a primary dataset comprising 12,000 meticulously labeled echocardiogram videos sourced from diverse patients exhibiting various cardiac conditions. Furthermore, we evaluated our model on two external datasets and collected specialized datasets to assess its generalizability: a pediatric dataset consisting of 892 key frames from 138 children to evaluate accuracy in young patients with distinct cardiac dynamics, and an adult dataset encompassing 298 key frames from 39 adults representing a wide range of cardiac health statuses for testing effectiveness across diverse demographics. On the EchoNet-LVH dataset, the model exhibited exceptional accuracy by achieving a mean absolute error (MAE) of 2.39mm and a mean absolute percentage error (MAPE) of 6.5%, thereby establishing a new benchmark for precision in left ventricular internal diameter (LVID) measurement. Notably, the model also demonstrated excellent generalizability across diverse patient populations in external datasets, yielding MAPEs of 6.4% in the pediatric dataset and 5.6% in the adult dataset. Moreover, its efficiency was underscored by an impressive forward inference speed of up to 401.82 FPS on advanced GPU, representing a substantial improvement over previous approaches. This accelerated processing capability enables real-time analysis, which is crucial for clinical applications as it facilitates immediate diagnostic feedback essential for effective patient management and care. The proposed model significantly enhances the efficiency of LVID measurements while maintaining a high level of precision, enabling real-time and automated assessments of cardiac function that are highly suitable for clinical application. In addition, its robust performance suggests a strong potential for widespread adoption in routine cardiac evaluations. Our approach provides rapid, accurate assessments of LVID makes it an invaluable tool for cardiac function evaluation.
Abstract 4145862: Prognostication Of Cardioembolic Stroke Due To Underlying Atrial Fibrillation With Serum Troponin Levels
Authors: Hamza Maqsood, Alamdar Hussain, siddhant solanki, Muhammad Furqan, MUHAMMAD SIDDIQUE KARIMI, Shifa Younus, muhammad khaliq, Shahzad Zafar
Journal: Circulation (2024)

Introduction: The association between elevated levels of high-sensitivity cardiac troponin I (cTnI) and clinical outcomes in stroke patients has been documented. Nevertheless, the precise significance of cTnI and its potential as a biomarker in ischemic stroke (IS) remains unclear. Our study sought to evaluate the correlation between serum cTnI levels and early neurological deterioration (END) in individuals experiencing stroke related to atrial fibrillation (AF). Methods and Materials: In this multicentric study, we enrolled consecutive patients with stroke related to atrial fibrillation (AF) from 2020 to 2023. Exclusion criteria for this study comprised large vessel stenosis/occlusion and previously identified etiologies upon admission. All patients underwent a comprehensive etiological assessment. Early neurological deterioration (END) was defined as a rise in the NIHSS score of at least 2 points from baseline to the 48-hour assessment. Results: A total of 1611 patients with stroke related to atrial fibrillation (AF) were assessed. In the multivariable analysis, cTnI (odds ratio [OR] = 1.32, 95% confidence interval [CI] 0.96–1.62; P &lt; 0.005) remained statistically significant after controlling for confounding factors. The initial NIHSS score (OR = 0.98, 95% CI 0.92–1.11; P &lt; 0.005) showed a positive association with early neurological deterioration (END), whereas the utilization of anticoagulants (OR = 0.61, 95% CI 0.51–0.74; P &lt; 0.001) and new oral anticoagulants (OR = 0.71, 95% CI 0.37–1.36; P &lt; 0.005), exhibited a negative association. Conclusion: Our study concluded that troponin elevation in patients with AIS may be attributed to the cumulative impact of comorbidities alongside neurological status, thereby highlighting the prognostic importance of troponin assessment.
Abstract 4146447: Deficiency of Mitochondrial Serine Hydroxymethyltransferase Impairs Endothelial Cell Phenotype and Function
Authors: Xiaoxiao Geng, Yuhua Wei, Jianyi Zhang, Lei Ye
Journal: Circulation (2024)

Introduction: Our previous study showed that endothelial cells (ECs), differentiated from human induced pluripotent stem cells (hiPSCs) derived from patients with type 2 diabetes (dia-hiPSCs), displayed impaired phenotypes and function, including lower intracellular glycine content, increased senescence and inflammation, and impaired mitochondrial function. Furthermore, of the four molecules that regulate glycine homeostasis (glycine transporter 1 and 2 and the cytoplasmic and mitochondrial serine hydroxymethyltransferases [cSHMT and mSHMT, respectively]), only mSHMT was downregulated in dia-hiPSCs derived ECs (dia-hiPSC-ECs). Thus, we aim to determine whether deficiency of mSHMT protein expression will impair EC phenotype and function due to increased oxidative stress. Methods: hiPSCs reprogrammed from the cells of healthy human subjects (nor-hiPSCs) were differentiated into ECs (nor-hiPSC-ECs), and transduced with adenoviral vectors carrying shRNA targeting mSHMT (Ad-shRNA/mSHMT) or Scramble (Ad-Scramble) for 48 hours, and cultured in endothelial growth medium for 14 days. Intracellular glycine content and ROS were measured by liquid chromatography and MitoSOX, respectively, cell senescence was assessed by β-galactosidase staining, mitochondrial membrane potential was visualized using JC-1 dye, and expression of intercellular adhesion molecule-1 (ICAM-1, an indicator of inflammation) protein was evaluated via Western blot. Results: Ad-shRNA/mSHMT starting 25 infectious unit/EC dramatically inhibited mSHMT protein expression, which was accompanied with significantly reduced glycine content in nor-hiPSC-ECs. Compared to Ad-scramble transduced nor-hiPSC-ECs, down-regulation of mSHMT, caused by Ad-shRNA-mSHMT, resulted in significant increase of senescence (increased abundance of β-gal and P53 expression) and inflammation (increased ICAM-1 protein expression), and significant decline in mitochondrial membrane potential (reduced red fluorescence intensity) in nor-hiPSC-ECs. Although low intracellular cellular glycine level can lead to oxidative stress as it is required for glutathione synthesis, increased oxidative stress, by MitoSOX labeling, was not found in nor-hiPSC-ECs with mSHMT knockdown. Conclusion: Deficiency of mSHMT impairs nor-hiPSC-EC phenotype and function, which is independent of oxidative stress.
Abstract 4145759: Guideline Directed Medical Therapy and the Impact of Sex on Patient Reported and Clinical Outcomes in a Specialized Heart Failure Clinic
Authors: Chen Hsiang Ma, Arthur Qi, Luke Gagnon, Chandu Sadasivan, Gavin Oudit
Journal: Circulation (2024)

Introduction: Despite new advances in heart failure (HF) management, underutilization of guideline-directed medical therapy (GDMT) persists. In addition, contemporary data on GDMT utilization and whether sex differences exist is unclear. We aim to characterize GDMT use across HF subtypes, investigate sex-based disparities in utilization, and explore these impacts on patient quality of life markers and clinical outcomes. Methods: Patients with HF were enrolled in the heart function clinic (HFC) in Edmonton, Alberta, from Feb 2018 to Nov 2022. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i], and glucagon-like peptide 1 receptor agonist [GLP-1 RA]) over 3 years and clinical comorbidities using ICD-10 codes were obtained. We administered the Kansas City Cardiomyopathy Questionnaire Score (KCCQ-12) at enrolment and 6—or 12-month follow-ups, with changes ≥5 defined as clinically significant. We assessed the association between GDMT and sex to changes in KCCQ-12 scores and clinical outcomes. Results: Our HFC cohort of 1431 HF patients (median age 68, 29% female) included 52% with reduced (HFrEF), 20% with mildly reduced (HFmrEF), and 28% with preserved (HFpEF) ejection fraction. Median baseline KCCQ-12 score was 75 (IQR 33) and was similar between HF subtypes. ARNI, SGLT2i, and MRA use in HFpEF remains lower compared to HFrEF/HFmrEF (p&lt;0.001), with gaps in treatment persisting over 3 years. Across HF subtypes, GDMT utilization rates were similar between sexes except for SGLT2i in HFmrEF (19.1% male vs. 7.5% female, p=0.02). Controlling for clinical covariates, RAASi (aHR 0.54, 95% CI 0.41-0.70), ARNI (aHR 0.58, 95% CI 0.43-0.80), GLP-1 RA (aHR 0.43, 95% CI 0.19-0.97), and females (aHR 0.72, 95% CI 0.58-0.91) were associated with lower all-cause mortality. ARNI use was also associated with improved follow-up KCCQ12 scores (aOR 1.57, 95% CI 1.00-2.45). Conclusion: Despite evidence of improved KCCQ-12 scores and reduced all-cause mortality, GDMT remains underutilized, particularly in HFpEF patients. While we found no sex-based disparities in GDMT utilization, females showed better clinical outcomes in our HF cohort. To improve patient outcomes, further research is needed to address barriers to implementing new GDMT across the heart failure spectrum.
Abstract 4145764: Mitral Annular Calcification (MAC) and Stroke Risk: A Single Center Cohort Analysis of stroke outcomes across the spectrum of MAC Severity
Authors: Akiva Rosenzveig, Osamah Badwan, Mohammad Alamer, Ahmad Gharaibeh, Habib Layoun, Ahmad Safdar, Saeid Mirzai, Ian Persits, Warren Skoza, heba wassif
Journal: Circulation (2024)

Background: Stroke is one of the leading causes of long-term disability and mortality worldwide. Of ischemic stroke etiologies, cardio-embolism both causes more severe strokes and is responsible for an increasing share of the ischemic stroke etiologies in the developed world. Mitral annular calcification (MAC), chronic degeneration of the fibrous base of the mitral valve, has been implicated by association with increased stroke risk. However, there has been conflicting evidence regarding the causative relationship between MAC and stroke risk. Although the 2008 CHEST guidelines recommended antithrombotic therapy with aspirin to mitigate stroke risk, the updated 2012 CHEST guidelines question the role of antithrombotic therapy since stroke may be due to embolized calcific spicules. 2020 American College of Cardiology / American Heart Association guidelines do not make recommendations regarding stroke prevention in MAC. Our study sought to assess the association of MAC and its severity with stroke outcomes. Hypothesis: We hypothesize an association between MAC and stroke which increases with increasing MAC severity Methods: We retrospectively studied patients undergoing transthoracic echocardiography in a single center cohort from 2005 through 2017. MAC severity was determined based on documented echo reports. Multivariable cox regression analysis was used to assess for correlation with stroke and was adjusted for diabetes, hypertension, hyperlipidemia, infection, endocarditis, lupus, prior MI, mitral disease, OSA, PAD, and prosthetic valves. Results: The cohort included 2,837 patients. Of the full cohort, 393 had no MAC, 1686 had mild MAC, 537 with had moderate MAC, and 221 had severe MAC. Mean age (57.2 to 68.6) and female gender rates (49.4% to 71%) significantly increased with increasing MAC severity. At median follow up of 73 months (IQR 6.1,103.7) there were a total of 92 stroke events. Cox regression analysis found aHR of 1.45 (0.74-2.84, p=0.28), 1.16 (0.52-2.59, p=0.72), and 1.23 (0.44-3.44, p=0.69), for mild, moderate, and severe MAC, respectively, when compared to patients without MAC. Conclusion: In a large single center cohort, there was no association found between MAC and stroke outcomes, regardless of severity.
Abstract 4146376: Efficacy of Early Vs Delayed Catheter Ablation in Atrial Fibrillation: an Updated Meta-analysis
Authors: Sahib Singh, Udaya Tantry, Kevin Bliden, Syed Ishaq, Mohammed Abuzahra, Paul Gurbel, Mohammed Kanjwal, Scott Lundgren, Niyada Naksuk
Journal: Circulation (2024)

Background: Although observational studies have shown a higher rate of atrial arrhythmia recurrences in patients with atrial fibrillation (AF) undergoing delayed catheter ablation as compared with early ablation, a recent randomized controlled trial (RCT) did not show any such difference. We aimed to perform an updated meta-analysis of the available studies. Methods: Multiple online databases were searched for studies comparing early ablation (&lt; 1 year) to delayed ablation (&gt; 1 year) in patients diagnosed with AF. The outcome of interest was atrial arrhythmia recurrence at the longest follow up available. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Results: A total of 8 studies (1 RCT and 7 observational) with 5,171 patients (early ablation n=1,636, delayed ablation n=3,535) were included. Around 70% patients were men, mean age was 61 years and mean duration of follow up was 28 months. Patients with AF undergoing early catheter ablation had a lower rate of atrial arrhythmia recurrence when compared with the delayed ablation group (OR 0.57, 95% CI 0.44 to 0.73, p &lt; 0.0001). Substantial level of heterogeneity was present between the studies (I2 = 67%). Conclusion: Performing catheter ablation early (within 1 year of diagnosis) in patients with AF may lead to significant reduction in atrial arrhythmia recurrence as compared with delayed ablation. The results of this meta-analysis, however, are subject to potential bias and heterogeneity.
Abstract 4146112: Colchicine for secondary prevention in patients with Acute Coronary Syndrome (ACS). A systematic review and meta-analysis.
Authors: Safia Shaikh, Mohammad Hamza, Ahmed Muaaz Umer, Manish KC, Sivaram Neppala, Sahib Singh, Jawad Basit, Krutarth Pandya, yasar sattar, M Chadi Alraies
Journal: Circulation (2024)

Background: Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern in the United States. The literature increasingly acknowledges the role of inflammation in the development of atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout and pericarditis, is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS). Methods: We searched PubMed and Embase to find studies up to April 2024 that compared colchicine to placebo in patients with ACS. The primary outcomes were major adverse cardiovascular events (MACE), stroke, recurrent ACS, and recurrent hospitalizations. Secondary endpoints consisted of cardiovascular death and the incidence of congestive heart failure (CHF). We also examined the gastrointestinal effects of colchicine in all subjects. To combine the data, we used the random-effects model. Results: We included ten studies with a pooled sample size of 7,260 patients. The mean age was 60.1 (±11.8) years, with 19.3% females and an average follow-up duration of 8.5 (±6) months. Patients who received colchicine treatment demonstrated a reduced risk of MACE (OR: 0.72, 95% CI: 0.59-0.88, p- 0.001), stroke (OR: 0.41, 95% CI: 0.20-0.84, p- 0.01), recurrent ACS (OR: 0.73, 95% CI: 0.57-0.93, p- 0.01), and hospitalization (OR: 0.52, 95% CI: 0.34-0.81, p- 0.003). However, there was no significant difference in cardiovascular death (OR: 1.01, 95% CI: 0.60-1.72, p- 0.95) and the incidence of CHF (OR: 1.04, 95% CI: 0.64-1.69, p-0.89) between patients treated with colchicine and those without. Notably, patients treated with colchicine experienced more gastrointestinal effects than those without colchicine treatment (OR: 1.16, 95% CI: 1.02-1.32, p-0.02). Conclusion: Adding colchicine to standard medical therapy in ACS patients significantly reduced the incidence of major adverse cardiovascular events, stroke, recurrent ACS events, and hospitalizations. Further prospective trials are required to validate these findings and determine if early intervention with colchicine treatment improves clinical outcomes in ACS patients.
Abstract 4145765: Interstate And Age Group Stratified Variability In The Incidence, Prevalence And Mortality Of Maternal Hypertensive Disorders In The United States: A 1990–2021 Analysis Using The Global Burden Of Disease Database
Authors: Vidit Majmundar, Shreyash Parajuli, Aangi Shah, Marina Byer, Rosario Colombo, Rhea Sancassani
Journal: Circulation (2024)

Background: The incidence burden of maternal hypertensive disorders has increased by 30% globally. This study analyzed the trends in prevalence and death rates from maternal hypertensive disorders across various states in the United States from 1990 to 2021. Methods: Using the Global Burden of Disease (GBD) database, we compared the following levels, stratified by state, between the beginning of 1990 and the end of 2021: hypertensive disorders of pregnancy, percentage prevalence change, mortality percentage change by age-standardized rates per 100,000 population, and age-stratified changes in the rate of incidence and mortality. The analysis was conducted using Microsoft Excel (16.7). Results: The analysis revealed notable interstate variability in the prevalence and death rates of maternal hypertensive disorders (Figure 1). Nevada exhibited the highest increase in prevalence (0.87%), followed by Hawaii (0.65%) and Idaho (0.54%). In contrast, Mississippi experienced the largest decrease in prevalence (-0.22%), followed by Louisiana (-0.20%) and Maine (-0.19%). Regarding death rates, the District of Columbia saw the most significant decrease (-0.67%), followed by New York (-0.45%) and New Jersey (-0.42%). Conversely, West Virginia had the highest increase in death rates (0.89%), followed by Alaska (0.52%) and Kentucky (0.51%). The analysis of Age stratified subgroups in each state showed the maximum increase in mortality change in the age group of 40–44 years, followed by 35–39 years, with West Virginia having the highest percentage change mortality rates (2.55%; age group 40–44 years) and District of Colombia showing a sharp decrease in the percentage mortality rates (-0.72%; age group 30-34 years). Incidence percentage changes showed similar patterns, with Virginia showing a (3.41%; 40–44 years), closely followed by New York (3.31%; 40–44 years). Conclusion: The data reveal significant disparities in both the prevalence and death rates of maternal hypertensive disorders across different states. Additionally, an increase in mortality and incidence rate changes of hypertension in pregnancy was observed in higher age groups, particularly among women aged 35–39 and 40–44. These findings highlight the need for tailored, state-specific public health strategies to effectively address targeted interventions for older age groups and mitigate the impact of maternal hypertensive disorders.