tbuckley/cabot-search huggingface dataset:
Abstract 16836: A View-Invariant Deep Learning Model for Estimating Ejection Fraction From Any Valid Echocardiogram Videoclip, Including Point-of-Care Ultrasound (POCUS)
Authors: DM Anisuzzaman, Jeffrey G Malins, John I Jackson, Eunjung Lee, Jwan Naser, Behrouz Rostami, Jared G Bird, Paul A Friedman, Francisco Lopez-Jimenez, Sorin V Pislaru, Garvan C Kane, Zachi Attia
Journal: Circulation (2023)

Background: Recently, our team developed an end-to-end artificial intelligence (AI) framework that can successfully estimate left ventricular ejection fraction (LVEF) from echocardiogram videos. However, this framework requires specific views (A2C and PLAX), and cannot estimate LVEF for studies from which these views are missing. Goal: To develop a deep learning model to estimate LVEF from any type and number of echocardiogram video(s). Methods: We built a deep learning model for B-mode echocardiogram videos of the left ventricle (A2C, A3C, A4C, or PLAX views), using retrospective transthoracic echocardiography (TTE) data. The model was evaluated with two test datasets: one with random valid (i.e., showing the left ventricle) views, and one with preselected views (both having 433 patients). Later, the model was tested with a prospective patient cohort that had both TTE and point-of-care ultrasound (POCUS) data collected simultaneously (393 patients). Results: On the retrospective TTE test set, we observed excellent performance (five random valid views per study: RMSE of 6.87% and Pearson correlation (PC) of 0.82 on LVEF estimation, and an AUC of 0.96 (95% CI: of 0.94-0.98) on low LVEF classification (&lt;=40%); preselected views: RMSE of 6.75%, PC of 0.83, and an AUC of 0.96 (95% CI: 0.94-0.98)). For both TTE and POCUS data from the prospective cohort, we also observed strong performance (TTE: RMSE of 5.62%, PC of 0.87, and an AUC of 0.97; POCUS: RMSE of 6.12%, PC of 0.84, and an AUC of 0.96). For the prospective test sets as well as for the retrospective TTE test set with preselected views, results reflect the estimated LVEF average of A2C, A3C, A4C, and PLAX videos from each patient. Conclusions: For both TTE and POCUS data, the current model showed strong performance which was comparable to that of our previously established view-specific model. Alongside this comparable performance, the current model surpasses our previous model in terms of flexibility, as it isn't dependent on view classification and allows a broader selection in terms of the number and types of videos per study or patient. This innovative approach could prove particularly beneficial in point-of-care situations in which it may not be feasible to obtain high-quality, view-specific videos.
Nanomaterials as Microglia Modulators in the Treatment of Central Nervous System Disorders
Authors: Matteo Battaglini, Attilio Marino, Margherita Montorsi, Alessio Carmignani, Maria Cristina Ceccarelli, Gianni Ciofani
Journal: Advanced Healthcare Materials (2023)

Abstract Microglia play a pivotal role in the central nervous system (CNS) homeostasis, acting as housekeepers and defenders of the surrounding environment. These cells can elicit their functions by shifting into two main phenotypes: pro‐inflammatory classical phenotype, M1, and anti‐inflammatory alternative phenotype, M2. Despite their pivotal role in CNS homeostasis, microglia phenotypes can influence the development and progression of several CNS disorders such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, ischemic stroke, traumatic brain injuries, and even brain cancer. It is thus clear that the possibility of modulating microglia activation has gained attention as a therapeutic tool against many CNS pathologies. Nanomaterials are an unprecedented tool for manipulating microglia responses, in particular, to specifically target microglia and elicit an in situ immunomodulation activity. This review focuses the discussion on two main aspects: analyzing the possibility of using nanomaterials to stimulate a pro‐inflammatory response of microglia against brain cancer and introducing nanostructures able to foster an anti‐inflammatory response for treating neurodegenerative disorders. The final aim is to stimulate the analysis of the development of new microglia nano‐immunomodulators, paving the way for innovative and effective therapeutic approaches for the treatment of CNS disorders.
Abstract 246: Consumptive Coagulopathy is Associated With Poor Neurological Outcome in Patients With Refractory VT/VF Cardiac Arrest Requiring Extracorporeal Cardiopulmonary Resuscitation
Authors: Nelly C Rojas-Salvador, Rajat Kalra, Marie E Steiner, Alexandra M Marquez, Tamas Alexy, Andrea M Elliott, Demetris Yannopoulos, Jason Bartos, Alejandra Gutierrez
Journal: Circulation (2023)

Introduction: Post cardiac arrest syndrome is associated with altered hemostasis. This is aggravated further by the foreign surface in the extracorporeal circuit leading to a coagulofibrinolytic imbalance. Aim: We examined the serial changes of consumptive coagulopathy markers and their association with neurologic outcomes. Methods: A single-center, retrospective cohort study of consecutive patients with VT/VF cardiac arrest meeting criteria for ECMO-facilitated resuscitation (ECPR) between December 2015 and January 2023 were included. Consumptive coagulopathy markers (INR, D-dimer, platelet count, antithrombin III and fibrinogen) were obtained after VA ECMO cannulation and serially on day 1, 2 and 3. We compared the coagulation profiles of patients who had a neurologically favorable outcome (defined as Cerebral Performance Categories (CPC) 1-2) and those with a neurologically unfavorable outcome (CPC 3-5). Results: Of 258 patients, 82 (32%) survived to hospital discharge. Of these, 87% (71/82) survived with favorable neurological outcome. Prolonged INR, elevated D-dimer levels and decreased ATIII levels were associated (p&lt;0.05) with neurologically unfavorable survival and decreased over time (p&lt;0.05)(Figure1). Platelet count and fibrinogen levels were not associated with neurological outcomes. In adjusted analysis (including age, lactate, CPR time and use of dual antiplatelet therapy), each point increase in the INR on day 1, 2 and 3 was associated with neurologically unfavorable survival (OR 4.4, p=0.01; OR 7.14, p=0.04; OR 8.5, p=0.03 respectively). Conclusion: Markers of consumptive coagulopathy with a prolonged INR are associated with unfavorable neurological outcome.
Abstract 13054: Predictive Utility of a CAD Polygenic Risk Score in a Low-Risk Primary Prevention Cohort
Authors: John H Bertot, Giorgio Melloni, Patrick T Ellinor, Marc S Sabatine, Christian Ruff, Nicholas A Marston
Journal: Circulation (2023)

Background: Statin initiation is not recommended for individuals at low clinical risk of ASCVD as defined by the Pooled Cohort Equations (PCE). We sought to evaluate whether CAD PRS can be used to reclassify low ASCVD risk to a range in which a statin should be considered. Methods: We performed a longitudinal cohort study of low-risk participants from the UK Biobank excluding those on lipid-lowering therapy. The PCE was used to identify participants with low risk for ASCVD. We evaluated the actual 10-year ASCVD event rate as a function of the PCE risk score and a previously validated 2.3 million-SNP CAD PRS. The top 10%, 5%, and 1% of CAD PRS were used to depict estimates across PCE predicted risk and the Net Reclassification Index (NRI) was calculated for risk thresholds ≥5% and ≥7.5%. Results: 294,371 participants were included with mean age of 56 ± 8 years and 56% female. High CAD PRS elevated a subset of clinically low-risk individuals to higher risk categories ( Figure ). The top 10% of CAD PRS reclassified individuals with a PCE estimated risk of ≥3.7% to ≥5% risk (borderline risk). For the top 5% and top 1% of CAD PRS, the PCE estimated risk thresholds to be reclassified to ≥5% risk dropped to ≥2.9% and ≥1.3%, respectively (p&lt;0.001). Patients in the top 5% and 1% CAD PRS cross into intermediate risk (≥7.5% risk) at PCE risk estimates of ≥4.2% and ≥2.7%. In these low-risk individuals, the addition of the CAD PRS resulted in a NRI of 0.12 (CI 0.11-0.14) with 14% (CI 0.13-0.16) correctly upclassified to risk ≥5% and 5% (CI 0.04-0.06) correctly upclassified to risk ≥7.5%. Based on the 2021 US census, this corresponds to ~10.4 and ~3.7 million people reclassified, respectively. Incorrect upclassification occurred in 2% (CI 0.02-0.02) and 0.6% (CI 0.005-0.006) at these risk thresholds. Conclusion: In low-risk individuals, a CAD PRS can be used to identify individuals with a higher ASCVD risk than expected based on conventional clinical risk stratification who may merit consideration of statin initiation.
Abstract 14664: Integrated Atherosclerotic Cardiovascular Disease Lipid Management Initiative
Authors: Roseanne Hemmitt, Rebecca Alicki, Liz Olson, Katherine Overton, Chiadi E Ndumele
Journal: Circulation (2023)

Introduction: In the US, 48.6% of adults ≥40 years of age are eligible for statin therapy. Since the release of updated ACC/AHA guidelines in 2018, statin use and mean low-density lipoprotein cholesterol (LDL-C) levels remained unchanged, suggesting that enhanced efforts to understand and implement guideline-directed therapies are needed. Objective: The ASCVD Lipid Management Initiative’s primary goals are to increase the proportion of very-high risk ASCVD patients achieving LDL-C levels &lt; 70 mg/dl and to increase appropriate referrals to lipid management clinics. Methods: The AHA has engaged a cohort of six diverse health systems (caring for 40,000 patients) to characterize current clinical lipid management care pathways, identify barriers to treatment and to partner to refine lipid management strategies. The methods of the 3-year intervention focus on implementation science, peer-to-peer learning, and patient engagement. Results: In the first 12 months of the intervention, health systems collectively identified several common barriers and developed corrective actions to promote standardization of lipid management ( Table ). Organizations are participating in regular quality improvement discussions with an AHA consultant and attending quarterly ASCVD Learning Collaborative calls to share insights and strategies. This initiative has implemented a Referral to Lipid Management measure in the Get With The Guidelines(R) - Stroke and Coronary Artery Disease registries and piloted an outpatient registry with a focus on ASCVD and risk factor related measures. A unique identifier system is being developed to follow patients from inpatient to outpatient settings, as well as an app to facilitate patient activation. Conclusion: Together, AHA and health systems are identifying barriers to lipid management and implementing strategies to optimize ASCVD care pathways. We will evaluate the impact of the intervention on LDL-C and referrals for lipid management.
Abstract 104: Photoplethysmogram Signal Characteristics as a Non-Invasive Surrogate of Diastolic Blood Pressure During Cardiopulmonary Resuscitation
Authors: Dieter Bender, Grace Sutoris, Marc Hershey, Kathryn Graham, Vinay M Nadkarni, Robert A Berg, Ryan W Morgan, Robert M Sutton, C. Nataraj
Journal: Circulation (2023)

Background: During cardiopulmonary resuscitation (CPR), diastolic blood pressure (DBP) is a key driver of coronary perfusion pressure and thereby, blood flow during CPR. Although resuscitation guidelines advise measuring DBP as an indicator of CPR quality, the need for an invasive arterial catheter to measure DBP limits scope of patients for whom a BP-directed CPR strategy can be implemented. Aims and Hypothesis: We aimed to study the photoplethysmogram (PPG) signal acquired from pulse oximetry monitoring as a non-invasive indicator of CPR quality. We hypothesized that a machine learning algorithm using dynamic PPG features would accurately classify CPR segments according to whether they met established pediatric DBP thresholds associated with improved outcomes (≥25mmHg in infants and ≥30 mmHg in older children). Methods/Approach: This was an NHLBI-funded ancillary study of the ICU-RESUScitation clinical trial (NCT02837497). This initial pilot study included 12 children who received CPR for an IHCA and had both arterial BP and pulse oximetry monitoring in place. Physiologic data were summarized into five-second epochs and DBP for each epoch was dichotomized by whether it met age-based DBP thresholds. Time-domain features ( k =25) were systematically engineered from the PPG signal, and a Support Vector Machine (SVM) model with a Gaussian kernel was trained to classify the CPR quality samples. Results: The analysis yielded n= 268 five-second CPR epochs, of which 147 (55.9%) met DBP thresholds. In the testing set of 134 previously unseen samples (50% of n , n low =59, n high =75), the SVM model achieved a classification accuracy of 91% with 100% precision and specificity, 79.7% sensitivity, and a negative predictive value of 86.2% only influenced by false negatives. Throughout development, six features describing the dicrotic notch characteristics reflected in the PPG waveform were empirically observed as significant CPR quality indicators. Conclusion: In this multicenter pilot investigation, the PPG waveform derived from pulse oximetry readings showed promise as a non-invasive surrogate of invasively measured DBP during pediatric CPR. This has the potential to greatly broaden the population for whom physiologic monitoring during CPR is possible.
Abstract 14127: Differential Stroke Volume Between Left and Right Ventricles as Predictor of Clinical Outcomes: The MESA Study
Authors: Ashkan Abdollahi, Yoko Kato, Hooman Bakhshi, Vinithra Varadarajan, Omar Chehab, Ralph Zeitoun, Mohammad R Ostovaneh, Collin Wu, Alain G Bertoni, Sanjiv J Shah, Bharath Ambale Venkatesh, David A Bluemke, Joao AC Lima
Journal: Circulation (2023)

Background: Valvular heart diseases and intra-cardiac shunts associated with congenital heart disease can cause persistent disruption in the balance between left (LV) and right (RV) ventricular stroke volumes (SV). However, the prognostic value of such imbalances has not been established among asymptomatic individuals in the general population. Methods: 4,058 participants from multi-ethnic study of atherosclerosis who had a cardiac MRI at cohort inception were included in this study. ΔSV was calculated as LVSV-RVSV, and participants were classified as: Balanced ΔSV: -30 mL ≤ ΔSV ≤ 30 mL; Negative ΔSV: ΔSV &lt; -30 mL; and Positive ΔSV: ΔSV &gt; 30 mL. Multivariable Cox proportional hazard regression models were applied to compute hazard ratios for the association between ΔSV and mortality, heart failure (HF), and atrial fibrillation (AF). Results: The average age of participants was 61±10 years, with women making up 52% of the cohort. Participants were followed for a median of 17 years (IQR, 16.9-17.1) for AF, and 18.4 years (IQR, 18.3-18.5) for other outcomes. At baseline 1.2% of participants (n=47) had ΔSV &gt; 30 mL, 2% (n=80) had ΔSV &lt; -30 mL, and 96.8% (n=3931) had ΔSV between -30 and 30 mL. During follow up, 1,006 participants died, 235 incurred HF, and 764 developed AF. After adjusting for demographics and baseline cardiovascular risk factors, ΔSV &gt; 30 mL was associated with increased mortality (HR 1.73; 95% CI 1.12-2.67; p=0.01), HF (HR 2.40; 95% CI 1.11-5.20; p=0.02), and AF (HR 1.89; 95% CI 1.16-3.08; p=0.01). These relationships were independent of LV and RV function at baseline. ΔSV &lt; -30 mL solely linked to HF (HR 2.09, 95%CI 1.09-3.99; p=0.02) and lost significance after adjusting for baseline LV function. Conclusions: In a multi-ethnic cohort of participants free of cardiovascular disease at baseline, LVSV exceeding RVSV by at least 30 mL was independently associated with lower long-term survival and greater risk of HF and AF.
Cancer survivorship—a framework for quality cancer care
Authors: Bradley Zebrack
Journal: JNCI Journal of the National Cancer Institute (2023)

Abstract When diagnosed with cancer or any other life-threatening condition, people must negotiate 2 once-separate but now integrated realms—a medical care industrial complex and an everyday life now lived in conscious awareness of mortality—a state of being subject to death. Life becomes a series of challenges and disruptions to relationships, body image and integrity, autonomy and independence, life goals, hopes, and dreams for the future. Whether one physically, emotionally, or spiritually survives, thrives, or succumbs to cancer is dependent on a treatment plan that accounts for the multiple and varied ways in which people experience dual citizenship in the realms of the well and the sick. A theory of cancer survivorship that integrates both medical and patient perspectives into a cogent and coherent framework has the potential to enhance the quality of cancer care and the patient experience. “Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.… Although we prefer to use the good passport, sooner or later each of us is obliged … to identify ourselves as citizens of that other place” (1).
Abstract 16851: Tricyclic Antidepressant Induced Wide Complex Tachycardia With Brugada Pattern
Authors: Chandra Chhetri, Shahan Haseeb, Umair A Ansari, Rajat Goyal
Journal: Circulation (2023)

Case Description: A 52-year-old male with bipolar disorder and depression was brought to the ED after he was found confused following an episode of syncope. He reported taking 5 pills of his new dose of Nortriptyline 75mg instead of 5 pills of his previous dose of Nortriptyline 25mg. ECG from the field showed a wide complex tachycardia (WCT) with a rightward axis and a Brugada pattern in V1 and V2 at a rate of 120-130s. Upon arrival in the ED, he continued to have WCT, and was treated with Amiodarone, Magnesium Sulfate, and Sodium Bicarbonate. Following treatment, his heart rate improved and the QRS duration shortened with a gradual loss of Brugada pattern (Figure 1). Six hours from initial presentation, his QRS completely normalized. Transthoracic echocardiogram (TTE) showed normal LV function. His presentation was consistent with tricyclic antidepressant (TCA) overdose. Discussion: The cardiotoxic effects of TCAs are mediated through their behavior as class IA antiarrhythmic drugs. This results in lengthening of both depolarization and repolarization of the cardiac action potential resulting in a widened QRS complex and QT prolongation. Sodium channel blockade can precipitate a Brugada phenotype which resolves after Sodium Bicarbonate administration. Similar to class IA agents, TCAs also exhibit use dependence and in our patient, the Brugada pattern began to resolve soon after presentation, possibly due to slowing of the tachycardia. Recognition of TCA toxicity is important to allow for timely administration of bicarbonate which facilitates prompt reversal.
Abstract 347: Artificial Intelligence for Targeted and Personalized Prediction of Sudden Cardiac Death in the General Population: A Machine Learning Study Based on Electronic Health Records
Authors: Younes Youssfi, Wulfran Bougouin, Frankie BEGANTON, Jean-Philippe Empana, Nicolas Chopin, Xavier Jouven
Journal: Circulation (2023)

Background: Identification of subjects from the general population with an increased risk of Sudden Cardiac Death (SCD) remains highly challenging, particularly at an individual level. Methods: Every case of SCD + 18 y.o. that occurred since 2011 in Paris and its inner suburbs was prospectively included in the Paris Sudden Death Expertise Center (SDEC) registry (6.7M inhabitants). SCD cases were matched by age, sex, and residence area with a control group (70000) sampled from the general population. All data from the French National Health Insurance database (SNDS) were collected: prescribed drugs, examinations and diagnoses that occurred up to 10 y. before the event, including cardiovascular and non-cardiovascular variables (10000). We provide a detailed explanation of the prediction at the individual level. For each subject, we computed the Shapley scores from the supervised learning model (CatBoost) to evaluate the contribution of variables to its predicted risk. The model used was derived from 12338 SCD cases and matched controls cohort (2011-15) and validated on 11620 cases cohort (2016-20). Results: A total of 23958 equations have been built with personalized variables and coefficients, achieving an AUC of 0.80 in the derivation cohort (with a PPV=77%, sensitivity=68%). One example is shown below, with an individual predicted risk of SCD at 3 months (89.3%), and the most important factors that increase (red) or decrease (blue) the risk of SCD. Conclusions: For the first time, we provide a personalized prediction model of SCD, which explains the predicted risk at the individual level. These findings offer a new step toward personalized prevention and global public health interventions
Abstract 13562: Calcium Supplementation to Prevent Pre-Eclampsia and Hypertensive Disorders of Pregnancy: A Meta-Analysis of Randomized Controlled Trials
Authors: Vikash Jaiswal, Akash Jaiswal, Jillian Reeze Medina, Kriti Kalra
Journal: Circulation (2023)

Background: Pre-eclampsia and eclampsia are common causes of morbidity and mortality, especially in low-income countries. Reducing adverse outcomes associated with hypertensive disorders of pregnancy has been the ultimate priority in recent years. Objective: We aim to evaluate the association between calcium supplements and the risk of preeclampsia and gestational hypertension among pregnant women. Methods: A systematic literature search was performed in electronic databases from inception to 15th May 2023, including only randomized controlled trials involving pregnant women, with one group on calcium supplements and another with a placebo. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of &lt;0.05 was considered statistically significant. Results: A total of 27 studies with 28,660 patients (14319 patients with calcium supplements and 14341 patients with placebo group) were included in the analysis. The Pooled analysis shows that calcium supplements reduce the risk of preeclampsia by 44% (OR, 0.56(95%CI: 0.45-0.70), P&lt;0.001) compared to placebo. Similarly, calcium supplements were found to significantly reduce the risk of gestational hypertension by 20% (OR, 0.80(95%CI: 0.70-0.91), P&lt;0.001). Conclusion: Our study shows that calcium supplements are associated with a significant reduction in preeclampsia and gestational hypertension which can lead to a reduction in associated morbidity and mortality.