tbuckley/cabot-search huggingface dataset:
Abstract 4144844: Comparison of Adjunctive Strategies Beyond Pulmonary Vein Isolation for Persistent Atrial Fibrillation: Cryoballoon-Based Left Atrial Modification vs. Posterior Left Atrial Box Isolation.
Authors: Shuhei Yamashita, Seiji Takatsuki, Yukihiro Himeno, shuhei yano, KOKI YAMAOKA, Susumu Ibe, Yoshinori Katsumata, Takahiko Nishiyama, TAKEHIRO KIMURA, Masaki Ieda
Journal: Circulation (2024)

Background: To improve outcome of catheter ablation for persistent atrial fibrillation (AF), adjunctive strategies targeting non-pulmonary vein triggers and atrial substrate modification were pursued. Objectives: To investigate the efficacy of cryoballoon left atrial roof ablation as an adjunctive ablation for persistent AF. Methods: This retrospective study included 448 consecutive patients who underwent their first ablation procedure for persistent atrial fibrillation at Keio University Hospital from January 2016 to May 2023. Using propensity score matching, we extracted 79 pairs who underwent cryoballoon left atrial roof ablation (CB-RA) or BOX posterior wall isolation (BOX-PWI) using radiofrequency. We evaluated procedural characteristics and the recurrence incidence of atrial arrhythmia after a 90-day blanking period within one year. Results: In the matched cohort of 158 patients (median age 64 [58-70], 88% male, 30.4% with longstanding persistent AF), 25 patients (15.8%) experienced atrial arrhythmia relapse after the blanking period within one year. CB-RA was successfully completed in 55 patients (69.6%), and touch-up radiofrequency roof line ablation was required in 24 patients (30.4%). Additional bottom linear ablation was performed with cryoballoon or radiofrequency in 22 patients (27.8%) in the CB-RA group, based on the physician’s decision during the procedure. Freedom from atrial arrhythmia recurrence was comparable between groups over one year of follow-up (83.5% for CB-RA vs. 84.8% for BOX-PWI; hazard ratio (HR) 1.34, 95% confidence interval (CI) 0.61–2.94, P=0.48). Conclusion: In Japanese clinical practice, cryoballoon-based left atrial modification as an adjunctive therapy for persistent atrial fibrillation demonstrated acceptable outcomes comparable to those of posterior left atrial box isolation using radiofrequency.
Abstract 4145242: Beta-Blocker Efficacy in Acute Myocardial Infarction: A Machine Learning Approach using the KAMIR-NIH Dataset
Authors: Seung-Woon Rha, Jinah Cha, Woo Jin Ahn, sujin hyun, Se Yeon Choi, Byoung Geol Choi, Markz Sinurat, Soohyung Park, Cheol Ung Choi, Chang Gyu Park, Dong Joo Oh
Journal: Circulation (2024)

Background: Acute myocardial infarction (AMI) is a critical global health issue requiring effective secondary prevention strategies. Current guidelines advocate for beta-blockers (BB) in STEMI and NSTEMI cases due to their mortality benefits. However, these guidelines often overlook individual patient variability, necessitating personalized treatment approaches. This study aims to develop a machine learning (ML) model to predict individualized mortality in AMI patients and evaluate the relative benefits of BB across diverse patient profiles to enhance clinical outcomes. Methods: We analyzed 12,599 AMI patients in the Korea AMI Registry (KAMIR)-National Institutes of Health (NIH) dataset. Patients were randomly divided into a training set (n = 8,467) and a testing set (n = 4,132) by a 2:1 ratio. Patients were categorized into four quartiles based on Mortality Risk Differences determined by our ML model, indicating increasing benefits from BB therapy. Quartiles Q1 and Q2 (Low-Risk group) showed smaller differences in mortality risks, while Q3 and Q4 (High-Risk group) showed larger benefits. Results: Among various ML models, Binary GLM Logistic Regression performed best, achieving an AUC of 0.8428. Our evaluations focused on patients with anemia, those aged over 65, eGFR below 60 and eGFR below 90. These factors were selected because they demonstrated the greatest information gain according to the 'information gain attribute evaluation' in the high-risk group. when analyzing the total test group within these groups, there was a noticeable survival advantage for patients in the BB group compared to those not on BB. (p = 0.009, p &lt; 0.001, p = 0.003, p &lt; 0.001). However, there was no significant difference noted among the groups within the low-risk group. Conclusion: This study highlights the potential of ML to enhance personalized medicine in AMI management, particularly in optimizing BB treatment. By utilizing detailed patient data, our model facilitates more personalized treatments that are specifically aligned with individual patient needs, thereby improving clinical outcomes. This approach not only enhances the effectiveness of interventions but also embodies the principles of precision medicine, adapting treatment strategies to optimally suit each patient's unique clinical profile.
Abstract 4145292: DERIVATION OF AN ARTIFICIAL INTELLIGENCE - BASED ELECTROCARDIOGRAPHIC MODEL FOR THE DETECTION OF ACUTE CORONARY OCCLUSIVE MYOCARDIAL INFARCTION
Authors: Braiana Diaz, Carlos Alan Castro García, Karen Gissel Velez Talavera, Edgar Roman-Rangel, Pilar Espinosa, Santiago March, Alexandra Arias, Diego Araiza
Journal: Circulation (2024)

INTRODUCTION: Current ACS guidelines suggest classifying patients according to the presence of persistent ST segment elevation, as a finding suggestive of acute thrombotic coronary occlusion. However, large series have documented that up to 15% of patients initially classified as NSTEMI will show evidence of total coronary occlusion on index angiography, increasing the length of stay, use of hospital resources, and short-term and long-term mortality. Therefore, prompt detection of Acute Coronary Occlusion Myocardial Infarction (ACOMI) is paramount. AIMS: We aimed to assess the performance of an AI-ECG based model capable of detecting ACOMI in the setting of patients with ACS. Methods: This is a prospective study based on the development of an AI-ECG based model capable of detecting ACOMI. A publicly available dataset (PTB-XL ECG) of 21,837 12-lead ECGs was used for training in recognizing ST-segment elevation. Regarding the detection of ACOMI, 12-lead ECGs from 361 patients who presented to the ED with an ACS (2017-2023) at our center were digitized with phone cameras of varying quality. ECGs were independently evaluated by two expert cardiologists blinded to clinical outcomes; each was asked to determine a) whether the patient had an STEMI, based on universal criteria or b) if STEMI criteria was not met, to identify any other ECG finding suggestive of ACOMI. ACOMI was defined as the presence of one of the following: TIMI V thrombus, TIMI thrombus grade 2 or higher + TIMI grade flow 1 or less, or the presence of a subocclusive (&gt;90%) lesion. Patients were classified into four groups: STEMI + ACOMI, NSTEMI + ACOMI, STEMI + non-ACOMI and NSTEMI + non-ACOMI. Performance of the AI model was evaluated using a comparison of multiple areas under the receiver operating characteristic curve (AUC-ROC). Sensitivity, specificity, positive and negative (PPV, NPV) predictive values and F1-score were also calculated. Results: The AI model accomplished an AUC of 0.8667 in identifying ACOMI, outperforming ECG experts (AUC: 0.3333) and the use of universal STEMI criteria (AUC: 0.5095). It also accomplished a sensitivity of 1, specificity of 0.733, a PPV of 0.846, an NPV of 1 and an F1-score of 0.92. Conclusion: Our AI-ECG model demonstrated a higher diagnostic precision for the detection of ACOMI compared with experts and use of STEMI criteria. Further research and external validation is needed to understand the role of AI-based models in the setting of ACS. :
Abstract 4145086: Determining the Prevalence of Genetic Cardiomyopathies in Non-Ischemic Cardiomyopathy Patients Undergoing Cardiac Positron Emission Tomography-Computed Tomography: A Single Institution Experience
Authors: Jacob Roberts, Ali Salavati, Yuliya Krokhaleva, Martin Allen-Auerbach, Justin Hayase, Jessica Wang, Marmar Vaseghi
Journal: Circulation (2024)

Introduction: Inflammatory cardiomyopathies such as sarcoidosis are associated with increased focal 18F-FDG uptake on cardiac positron emission tomography-computed tomography (PET-CT). It has been reported that patients with genetic cardiomyopathies with desmosomal mutations may also have abnormal cardiac PET scans. The incidence and type of genetic cardiomyopathies with abnormal cardiac PET imaging remains unclear. Objective: To determine the prevalence of genetic cardiomyopathies in patients with abnormal cardiac PET imaging. Methods: Data from patients who underwent cardiac PET imaging at our institution between 2018-2024 were analyzed. Those who completed genetic testing were further identified and evaluated for mutation variant type and imaging findings. Results: Of 605 patients with non-ischemic cardiomyopathy referred for cardiac PET scans, 67 (11%, mean age 51.8 ± 15.4 years, 69% male, mean LVEF 46.5 ± 15.1%) had undergone genetic testing. Of these, 21% (n = 14) had evidence of focal inflammation and 15% (n = 10) had indeterminate PET results with assessment of focal inflammatory findings limited by incomplete suppression of physiologic metabolism at the time of imaging. Of patients with focal inflammation, 36% (n = 5) tested positive for known pathogenic gene variants: DSP (n =1), FLNC (n = 1), LMNA (n = 1), and MYH7 (n = 2). An additional 4 patients with evidence of focal inflammation had variants of uncertain significance (VUS). Among the 10 patients with indeterminate cardiac PET findings, 3 had pathogenic mutations: DSP (n = 1), HFE (n = 1), and TTN (n = 1). There was no difference in the cardiac PET imaging findings of patients with versus without genetic cardiomyopathies with regard to focality or location of FDG uptake. Conclusion: Pathogenic mutations beyond desmosomal gene variants can present with evidence of inflammation on cardiac PET. Genetic testing amongst non-ischemic cardiomyopathy patients with abnormal cardiac PET scans should be considered to evaluate for other etiologies beyond sarcoidosis.
Abstract 4145118: The Association Between Obstructive Sleep Apnea and Major Adverse Limb Events in Patients with Peripheral Arterial Disease
Authors: Omair Ahmed, Shahan Haseeb, Harjinder Singh, Muhammad Ahmad Qureshi, Shafia Munir, Ehimen Aneni
Journal: Circulation (2024)

Background: Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD. Methods: National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p&lt;0.05 was considered statistically significant. Results: Our sample consisted of 1,947,125 patients with PAD with a mean age of 74 (57-91) and 56% were male. Patients with OSA had higher incidence of hypertension, diabetes, congestive heart failure, obesity and pulmonary circulation disorders compared to those without OSA and similar rates of ESRD, valvular heart disease and cardiac arrythmias (Table). On unadjusted analysis, patients with OSA had lower odds of composite outcome of MALE (OR: 0.65 p&lt;0.05) which persisted after propensity matching (OR: 0.68 p&lt;0.05) (Table). The incidence of myocardial infarction was the same between the two groups. Conclusion: Patients with OSA had lower rates of MALE compared to patients without OSA in PAD cases. It remains unclear if this paradoxical effect is due to biological factors such as intermittent nocturnal hypoxia promoting angiogenesis or is the result of unmeasured confounders such as OSA severity, positive airway pressure therapy and healthier lifestyle habits. Nonetheless, our findings highlight the need for well-designed prospective studies to further investigate this relationship.
Abstract 4145176: Prices for Transcatheter Aortic Valve Repair Vary Significantly by US Insurance Company
Authors: Chen Wei, Ishan Paranjpe, Pranav Sharma, Nancy Song, Kevin Schulman, Alexander Sandhu
Journal: Circulation (2024)

Background: Transcatheter aortic valve replacement (TAVR) is a crucial procedure for managing aortic stenosis (AS). Despite its widespread adoption, substantial price differences exist between hospitals and insurance companies. This study aims to analyze these variations across major insurers using new pricing data. Hypothesis: We hypothesize significant variation in TAVR prices across insurance plans, influenced by plan type and hospital characteristics. Methods: TAVR prices for Diagnosis Related Group (DRG) code 267 (TAVR without major cardiac complications) were analyzed using the Turquoise Health database. Prices from Aetna, Blue Cross Blue Shield, Cigna, Humana, Medicare, and United Healthcare were compared across HMO/Managed Care, Medicare Advantage, Medicaid, and Other plan types. Outliers beyond the 95th and below the 5th percentiles were excluded. Results: The median commercial price for TAVR was $71,312, about 1.88 times the Medicare rate. In comparison, the median cash price was $78,000. List prices were the highest, with a median of $166,714 and a substantial standard deviation of $83,534. Price variation between hospitals (2.6 times) was greater than within hospitals (2.0 times). Geographic differences significantly influenced prices, with median TAVR prices ranging from $54,915 in New England to $105,538 in the Pacific region (Fig 1A). Aetna had the highest median TAVR price at $84,190, with a standard deviation of $53,186. Medicare had the lowest median price at $37,865 and the least variability, with a standard deviation of $7,566. HMO/Managed Care plans showed the highest prices and variability, with an average median price of $78,725 and a standard deviation of $54,082 (Fig 1B). Medicare Advantage plans had substantially lower rates, with an average median price of $38,044 and a standard deviation of $14,890. Conclusion: This study highlights substantial TAVR price variation across major insurers and plan types. Aetna had the highest prices and variability, particularly in HMO/Managed Care plans, while Medicare Advantage plans had lower prices and variability compared to HMO/Managed Care plans. These findings emphasize the need for greater transparency and standardization in TAVR pricing to reduce disparities and control healthcare costs.
Abstract 4145239: Perinuclear puncta concentrate newly synthesized SERCA2a, Na,K-ATPase, and Phospholemman before cardiomyocyte-wide distribution
Authors: Kazuhiro Aonuma, Jin Guo, Steven Cala, Zhenhui Chen
Journal: Circulation (2024)

Introduction: Distribution of newly synthesized proteins is vital for the maintenance of healthy cardiomyocytes (CMs), but is poorly understood. We previously reported that multiple newly made sarcoplasmic reticulum (SR) proteins first concentrated in the perinuclear endoplasmic reticulum (ER) puncta of CM, before their transition to transversely oriented SR z-tubules (zSR), aligned with T-tubules (TTs) (the NEST pathway). We now study the initial trafficking steps of newly made sarcolemma (SL) proteins Na, K-ATPase (NKA) and its phosphoprotein regulator phospholemman (PLM), which we recently reported to have a unique uneven steady state distribution to lateral, transverse SL TTs, and intercalated discs (IDs), key to cardiac conduction. Hypothesis: Newly synthesized SL proteins sort through NEST pathway in CMs. Methods: Confocal immunofluorescence assay was performed on adult rat CMs 12-48h post infected with adenoviruses encoding dog isoform of NKA-Flag, PLM (dPLM) ± SR protein dSERCA2a (&gt; 10 CMs at each condition), as indicated by corresponding affinity purified dog–specific monoclonal antibodies, which do not detect endogenous rat proteins. Results: Fig. A, newly made NKA-Flag proteins were concentrated in a punctate pattern within perinuclear ER at ~2µm intervals (18h, NE), and then spread distally from perinuclear ER puncta into zSR 24h post infection (zSR). Fig. B, Dual immunostaining also showed overlapping fluorescence of dPLM and co-expressed dSERCA2a in these perinuclear ER puncta and into zSR. Thus, morphologically, the same pathways were initially used for the trafficking of newly made SR protein SERCA2a, SL proteins dPLM and NKA. dPLM and NKA ultimately diverge from SERCA2a to localize to IDs, which occurs at 24 h and 30 h post infection, respectively. Anti-dPLM B8 and anti-Flag fluorescence intensity ratios of ID/TT were 2.6 ± 0.1 and 2.2 ± 0.5 at 30 h post infection, respectively, paralleling its steady state distribution in heart tissue. Conclusions: Newly made SL proteins PLM and NKA co-localize with SR protein SERCA2a in a series of organized perinuclear ER puncta, revealing a key CM-specific trafficking step that appears to “presort” SR and membrane proteins by aligning their transport with zSR.
Abstract 4145119: Implementation and Evaluation of a Life’s Essential 8 Risk Factor Screening Tool in a Public HIV Clinic in Tanzania
Authors: Nicholas Roberts, Gloria Manyangu, Godfrey Kisigo, Megan Willkens, Bernard Desderius, Robert Peck
Journal: Circulation (2024)

Background: The burden of cardiovascular disease (CVD) is increasing among people with HIV (PWH) in sub-Saharan Africa. Integrating CVD screening into routine HIV care represents an opportunity to diagnose CVD at an earlier stage in a potentially high-risk population. Research questions Is integrating CVD risk factor screening feasible and sustainable in a public HIV clinic in Mwanza, Tanzania? What is the magnitude of CVD risk of the general adult PWH population? What is the unmet need for blood pressure (BP) and diabetes management? Methods: We adapted the AHA Life’s Essential 8 (LE8) into a rapid questionnaire that was administered to every PWH in a large public adult HIV clinic. Questions included demographics; LE8 risk factors (BMI, diet, physical activity, sleep, and smoking); and the hypertension and diabetes continuum of care. Every patient had their BP measured; BP was measured two additional times for those with an initial BP &gt;140/90 mmHg. We administered random blood glucose screening to anyone with a high BP, obese BMI, current smoking, or history of diabetes. Implementation and effectiveness were evaluated using the RE-AIM framework. Results: In 3 months, 1072 PWH were screened at least once. Mean age was 50 years and 72% were female. On average, PWH had a nutritious diet and received adequate physical activity per AHA guidelines. The prevalence of hypertension was 34%; the continuum of care is shown in Figure 1. Of those screened, 21% had diabetes or pre-diabetes. Evaluation via the RE-AIM framework is shown in Table 1. Successes included the reach and effectiveness of screening in only 3 months. Adoption was the biggest challenge due to staffing and supply constraints. The intervention was feasible, implemented with fidelity, and is ongoing. Conclusions: Integrating CVD risk screening into routine HIV care in a busy Tanzanian clinic was feasible and demonstrated a high magnitude of undiagnosed and untreated hypertension among the general PWH population.
Abstract 4144797: Interaction of Multiorgan Reserve Components Contributing to Exercise Intolerance in Heart Failure Patients: A Clinical Profiling Study
Authors: Isabela Landsteiner, Joseph Campain, Catharine Griskowitz, Rajeev Malhotra, Gregory Lewis
Journal: Circulation (2024)

Background: In heart failure patients, the multiorgan system reserve capacity required to meet physiologic demands of exercise can be impaired at multiple levels. Cardiopulmonary exercise testing (CPET) with invasive hemodynamics can help dissect contributions of different organ systems to exercise intolerance. Aims: To map exercise limitations in patients with exertional dyspnea, comparing reserve capacities between HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF). Methods: From a cohort of patients undergoing invasive CPET, we included an “overt” HFpEF group defined by hemodynamic criteria (LVEF≥0.5 and PCWP rest supine≥15 mmHg) and a HFrEF group (LVEF≤0.4). We defined 7 exercise performance limitations: pulmonary mechanical impairment (VE/MVV&gt;80% with FEV1&lt;80% predicted [pred.]); exercise-induced steep elevation in cardiac filling pressures (PCWP/CO slope&gt;2 mmHg/L/min); chronotropic incompetence (&lt;80% pred. peak heart rate); reduced peak Fick stroke volume (&lt;80% pred.); abnormal pulmonary vascular response (PVR&gt;1.5WU at peak exercise); peripheral impairment (arteriovenous oxygen content difference&lt;80% pred.); high metabolic cost of initiating exercise observed with excess body weight (internal work&gt;30 watts). Results: Among 1,207 patients undergoing invasive CPET, 351 met criteria for "overt" HFpEF (mean age 60.0±14.5 years, 190 female [54%]) and 92 for HFrEF (mean age 57.9±12.9 years, 15 female [16%]). Compared to HFpEF, patients with HFrEF had more prevalent exercise-induced steep elevation in cardiac filling pressures (70% in HFrEF vs. 49% in HFpEF), chronotropic incompetence (74 vs. 48%), and deficient peak exercise stroke volume (49 vs. 12%) ( Figure ). Conversely, HFpEF patients exhibited higher peripheral impairment contributing to exercise limitation, with 45% of patients vs. 24% in HFrEF. Conclusions: This study highlights the distribution of physiologic deficits contributing to exercise intolerance in HFpEF and HFrEF patients that frequently extend beyond elevation in cardiac filling pressure and cardiac output reduction, especially in HFpEF. Mapping abnormal physiologic responses to exercise and their rank order may inform strategies to optimize functional capacity in HF.