tbuckley/cabot-search huggingface dataset:
Abstract 13601: Distinct Proteomic Profiles in Human Thoracic Aortic Aneurysm by Segment May Drive Prognostic Differences: Conventional &amp; Machine Learning Analysis
Authors: Malak Elbatarny, Uros Kuzmanov, Daniella Eliathamby, Vivian Chu, Rashmi Nedadur, Cristine Reitz, Omar Hamed, Craig A Simmons, Jennifer Chung, BO WANG, Maral Ouzounian, Anthony Gramolini
Journal: Circulation (2023)

Background: Acute Type A Aortic Dissection (ATAD) is a surgical emergency with 18% mortality. Anatomic segment (root, ascending, arch, descending) impacts aneurysm natural history but mechanisms remain unclear. Aim: To compare proteomic profiles of human thoracic aortic segments that could account for distinct phenotypes and clinical outcomes; to analyze the largest cohort to date with enhanced depth of coverage. Methods: Aortic tissues were collected (N=148) from 82 unique individuals and analyzed using our customized proteomics protocol ( Figure 1A ). Conventional statistics, machine learning (t-distributed Stochastic Neighbour Embedding, t-SNE), and functional enrichment analyses were used to characterize significant phenotypic differences by segment. Differential protein expression was validated using immunofluorescence. Results: From all samples, 7251 proteins were identified (5660 quantified), exceeding literature (by 100s-1000s). Significant differences were greatest in comparisons of root, ascending, and descending aorta ( Figure 1B-C ). Root vs descending and ascending vs descending comparisons had clear separation in t-SNE analysis; root and ascending samples also clustered modestly ( Figure 1D ). MFAP4, a cellular-binding protein previously associated with descending thoracic dissection in Marfan patients, was significantly elevated in ascending aortic segments compared to root and descending. This was validated by immunofluorescence ( Figure 1E ). Conclusions: We extensively profiled thoracic aneurysm tissue using enhanced coverage, customized proteomics from the largest known cohort of human samples. Thoracic aneurysm phenotype differs by aortic segment as a function of intrinsic biochemical (proteomic) processes. Potential thoracic aneurysm biomarkers likely must account for aortic segment. Multiomic integrative analysis (DNA, RNA, post-translational data) are underway.
Abstract 16487: Implementation of a Web-Based Cardiac Rehabilitation Program in Rural Australia Improves Access
Authors: Katie Nesbitt, Stephanie Champion, Jonathon Foote, Lemlem G Gebremichael, Robyn A Clark, Alline Beleigoli
Journal: Circulation (2023)

Introduction: Involvement in cardiac rehabilitation (CR) programs reduces death, reoccurring cardiac events, also improving quality of life. Globally, CR attendance and completion is poor, with referral and non-attendance rates ranging from 20-50%. Hypothesis: To evaluate the effectiveness of an interactive web-based CR program as an alternative mode of delivery, to improve access and attendance. Methods: The RE-AIM implementation framework. Patients eligible for CR, residing in a rural and remote areas between July 2021-June 2022 Results: A total of 828 rural patients participated, 50 choosing the web-based mode of delivery. Web patients were younger, (60, SD 11.9 vs 68.5 years, SD 11.9; p&lt;0.001). Sex distribution did not differ between web and non-web, 17 (34%) males in web and 195 (23.5%) non-web (p=0.167). Myocardial infarction was the predominant reason for referral in both groups (64.3% vs 35.6%, p=0.049). Mean BMI was higher in the web compared to non-web (33.6, SD 8.0 vs 29.8, SD 6.0; p=0.025). Program completion was higher for non-web than for the web-based patients (17; 34% vs 553;71.4% p=&lt;0.001). Web-based patients reported overall program satisfaction (77.8%). Clinicians reported the web-based program as high quality (71.4%). There was an increase in web-based enrolments with concurrent reduction in usual care resulting from COVID pandemic restrictions. Patient fidelity to entry of self-reported data was high in the web-based with all patients completing a pre-assessment and 50% a post-assessment. Change in risk factor control did not differ between the groups. There was no significant difference in patients’ preference by age or gender for web-based or other modes of CR. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.100, 0.372; p&lt;0.001) after adjustment for age and gender. Conclusions: The web-based program provides an alternative flexible mode to complete CR, having met the demands of COVID pandemic restrictions. It has been integrated and successfully used by patients and clinicians, capturing a cohort who fit into the 20-50% not attending a CR program. Strategies for improving completion of web-based programs need further investigation.
Abstract 15293: Impact of Catheter on Central Venous Catheter Associated Right Atrial Thrombosis in Systemic Cancer Patients
Authors: Michael Park, Raina Jain, Nicole Liberman, Hannah Agoglia, Jiwon Kim, Jennifer Liu, Jonathan W Weinsaft, Angel T Chan
Journal: Circulation (2023)

Introduction/Background: Central venous catheters (CVC) are commonly utilized in cancer patients for prolonged systemic anti-cancer treatments but increased the risk of right atrial thrombosis (C THR ). Cardiac MRI (CMR) tissue characterization is commonly performed to identify C THR based on absence of vascularity. Research Questions/Hypothesis: How do catheters affect thrombus formation? Goals/Aims: To evaluate predictors of thrombus formation in cancer patients with CVC. Methods/Approach: The population comprised of adult (≥18yo) systemic cancer pts with indwelling CVC who underwent contrast-enhanced CMR (0.2 mmol/kg gadolinium). C THR were defined using the reference of LGE-CMR via established criteria (absence of contrast enhancement). CVC depth was measured from CXR/CT. Clinical follow-up was obtained via chart review for embolic events. Results/Data (descriptive and inferential statistics): 157 cancer pts with CVC (52±17 yo; 47% M; heme 29%
Abstract 18926: Skeletonization Mitigates Risk of Deep Sternal Wound Infection in Patients With Diabetes Undergoing CABG With Bilateral Internal Mammary Arterial Grafting
Authors: Ifeanyi D Chinedozi, Sari D Holmes, Fayyaz Hashmi, Nikhita Athipathy, Thomas Matthew, Ralf Martz Sulague, Jin Kook Kang, Shuait Nair, Janelle J Sangalang, Clifford Edwin Fonner, Diane Alejo, Jennifer S Lawton
Journal: Circulation (2023)

Background Bilateral internal mammary artery (BIMA) grafting may provide benefits compared to single artery coronary artery bypass grafting (CABG). However, many surgeons cite deep sternal wound infections (DSWI) as a deterrent for use of BIMA in patients with diabetes (DM). Aim To evaluate the effect of DM and skeletonization on the incidence of DSWI in patients with BIMA grafting. Hypothesis Skeletonization reduces risk of DSWI in DM patients with BIMA. Methods A retrospective analysis from 11 hospitals in the Maryland Cardiac Surgery Quality Initiative was performed. Of 27,930 adult non-emergent CABGs between 2017 and 2022, 2,010 patients (7%) received BIMA grafting among whom 764 (38%) had DM. Effect of DM and skeletonization of ≥ 1 IMA on DSWI in BIMA patients was evaluated by chi-square analyses and multivariable logistic regressions adjusting for DSWI-specific STS risk score. Results There was no significant difference in preoperative glycosylated hemoglobin (HgbA1c) level for DM patients with and without BIMA (7.2 [6.5-8.4] vs 7.2 [6.5-8.5], P=0.842. BMI was significantly higher in DM vs non-DM patients (30 [27 - 33] vs 28 [25 - 31], respectively, P&lt;0.001]. Skeletonization of ≥ 1 IMA in DM patients reduced DSWI vs. no skeletonization (0.3% vs 4.1%, respectively, P=0.023) but did not alter DSWI in non-DM patients (0.4% vs 1.2%, P=0.280). In patients with skeletonization of ≥1 IMA, there was no difference in DSWI between patients with and without DM (0.3% vs 0.4%, respectively, P&gt;0.999; Figure 1). After adjusting the DSWI-specific STS risk scores, skeletonization remained independently associated with reduced DSWI risk in DM patients with BIMA (OR=0.09, P =0.044). Conclusions Skeletonization of ≥1 IMA was associated with lower risk of DSWI in BIMA patients with DM. This supports the use of BIMA with skeletonization in patients with DM barring other prohibitive risk factors, and may encourage its increased usage in skeptical surgeons.
Abstract 14789: Atrial Anatomical Variations Between Atrial Fibrillation Patients Compared to Other Subjects Without Atrial Fibrillation
Authors: Rami Abazid, Jonathan Romsa, James Warrington, Cigdem Akincioglu, Nikolaos Tzemos, William Vezina, Habib Khan
Journal: Circulation (2023)

Introduction: In this study, we evaluated the anatomical atrial variations using gated cardiac computed tomography (CCT) between patients with and without atrial fibrillation (AF). Hypothesis: The aim of the study is to evaluate if there are specific anatomical characteristics that are associated with poor clinical outcomes following ablation in patients with AF. Methods: We retrospectively included 502 CCT scans of patients with AF prior to their pulmonary vein isolation procedure, and 1058 CCT scans of patients without AF performed to evaluate pulmonary vein anatomy and to rule out coronary artery disease between 2014 to 2017. Anatomical variations of the atria and interatrial septum included the Bachman bundle shunt (BBS - defined as a vascular channel crossing between the atria through the Bachman bundle), and atrial diverticulae. Results: Five-hundred and two patients with AF were older (67±14 vs. 63±13 years, P = 0.039), had a higher prevalence of diabetes mellitus (24.4% vs 14.7%, p = 0.006), and cerebrovascular disease (3.8% vs. 0.9%, p = 0.044) compared to patients without AF. Furthermore, CCTs analysis of AF patients demonstrated a significantly higher prevalence of BBS: (11% vs 4.1%, p &lt;0.0001, left atrial diverticula (19% vs 7.7%), p &lt;0.0001, and right atrial diverticula (9.8% vs 2.1%), P &lt;0.0001 compared to patients without AF. Conclusions: This study is the first to analyze BBS and atrial diverticular prevalence in patients using CCT. We found that patients with AF are associated with a higher prevalence of structural atrial abnormalities including BBS, left and right atrial diverticula in comparison to individuals with no previous history of AF. Whether these anatomical variations influence AF incidence or AF recurrence after catheter ablation is yet to be determined.
Abstract 16145: Statin Prescription and Cholesterol Control Among Persons With HIV Without Existing Atherosclerotic Cardiovascular Disease
Authors: Megan M McLaughlin, Matthew S Durstenfeld, Monica Gandhi, Meredith Greene, Yifei Ma, Alexis Beatty, Priscilla Hsue
Journal: Circulation (2023)

Introduction: Persons with HIV (PWH) have significantly increased risk for atherosclerotic cardiovascular disease (ASCVD) including acute MI. The REPRIEVE trial recently demonstrated that statins reduce cardiac events in PWH at low-intermediate ASCVD risk. However, statins are underutilized even among PWH who are at high ASCVD risk. Accordingly, we sought to characterize current gaps in cholesterol management in a population of PWH and identify factors associated with statin prescription. Methods: We conducted a retrospective study of PWH 40 years and older without existing ASCVD at three HIV clinics in San Francisco, U.S. from 2019-2022. We used ICD-10 codes and electronic health record data to assess cholesterol screening and treatment. Multivariable logistic regression models evaluated clinical factors associated with statin prescription among those eligible. Results: The clinical cohort included 2,567 PWH, of which 14% were female, 54% White, 24% Hispanic, and 18% Black, with a median age of 55 years. Among those with complete data on the components of the ASCVD Risk Estimator, the median 10-year ASCVD risk was 7.6%. The majority of PWH (87%) had undergone cholesterol screening, and 43% were eligible for statin therapy based on current guidelines (Figure 1). Of the 1,097 PWH eligible for statins, only 478 (44%) were prescribed statins. Among statin-eligible PWH, statin prescription was positively associated with older age, antiretroviral therapy, undetectable viral load, and chronic kidney disease and negatively associated with hepatitis C. Cholesterol control (non-HDL cholesterol &lt;130 mg/dL) was achieved in 47% of the study population. Conclusions: PWH in this study demonstrate suboptimal rates of statin prescription and cholesterol control. Identification of PWH eligible for statin therapy, prescribing statins, and ensuring lipid control are opportunities for improving primary prevention of ASCVD among PWH at heightened risk.
Abstract 17781: Spironolactone Improves Left Atrial Function and Atrioventricular Coupling in Resistant Hypertension
Authors: Andrew A Girard, Thomas S Denney, Oleg F Sharifov, Steven G Lloyd
Journal: Circulation (2023)

Purpose: To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN). Methods: Patients with RHTN (N=36, 55±7 years) were prospectively recruited. Spironolactone was initiated at 25 mg/day and increased to 50 mg/day after four weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after six months of spironolactone treatment and changes in LA functional metrics were assessed (Figure 1). The statistical analysis was conducted using two-sided tests of significance. Results: LA size and function parameters improved from baseline to month-six: LA volumes indexed to body surface area (LAVI) were reduced (LAVI max 41.4±12 vs 33.2±9.7 ml/m 2 ; LAVI pre-A 32.6±9.8 vs 25.6±8.1 ml/m 2 ; LAVI min 18.5 [13.9 - 24.8] vs 14.1 [10.9 - 19.2] ml/m 2 ; all p &lt; 0.05); left atrioventricular coupling index was reduced (28.2±11.5 vs 22.7±9.2 %, p &lt; 0.05); LA emptying fractions (LAEF) were increased (total LAEF 52.4 [48.7 - 60.3] vs 55.9 [50.3 - 61.1] %; active LAEF 40.2±8.6 vs 43.1±7.8 %, both p &lt; 0.05). There was a substantial increase in reservoir strain (29.1 ± 8.5 % vs 30.9 ± 5.5 %, p = 0.068) whereas active strain was significantly increased from baseline (16.3 ± 4.1 % vs 17.8 ± 4.2 %, p &lt; 0.05). Changes in passive strain and strain rates were not statistically significant (p &gt; 0.1). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-hour urine aldosterone). Conclusion: Treatment of RHTN with spironolactone is associated with improvements in LA size and function regardless of whether aldosterone levels were normal or high. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.
Abstract 14815: Sex Differences in Transcatheter Aortic Valve Replacement Outcomes Among Patients With Bicuspid Aortic Stenosis: Insights From the National In-Patient Sample
Authors: Frederick B Rivera, Sonny Redula, Mara Bernadette Liston, Erika Ong, Nathan Ross Bantayan, Sarang Choi, Vikram Sharma, Gurleen Kaur, Fareed Moses M Collado, Annabelle S Volgman, Mamas Mamas
Journal: Circulation (2023)

Introduction: Studies have shown higher in-hospital mortality and complications among women who underwent transcatheter aortic valve replacement (TAVR) compared to men. However, most of these studies excluded patients with bicuspid aortic stenosis (BAS). Our aim is to determine if there are sex differences in outcomes among patients with bicuspid AS who underwent TAVR. Methods: This analysis was performed using the National Inpatient Sample (NIS) database. Multivariable regression analyses were performed to adjust for anticipated confounders for in-hospital outcomes. The main multivariable model (model A) included variables on patient demographics and comorbidities. Model B further adjusted for history of myocardial infarction (MI), prior percutaneous coronary intervention (PCI), and prior coronary artery bypass grafting (CABG). The main outcome is in-hospital mortality. ( See figure 1B) Results: More TAVR were performed in men (61.1%) than women (38.9%). Men were more likely to have coronary artery disease, carotid artery disease, and peripheral vascular disease. (See table 1) There was no difference in in-hospital mortality between sexes (1.5 versus 2.4, adjusted odds ratio (aOR) 1.521, 95% confidence interval (CI) 0.523 - 4.424; p&lt; 0.44. Furthermore, there was no sex difference in secondary outcomes. Conclusions: A significantly higher proportion of men undergo the procedure as compared to women. There was no sex difference in in-hospital mortality and other secondary outcomes. More research is needed to address this sex gap in the performance of TAVR in BAS.
Abstract 14367: Multimodal Artificial Intelligence Algorithm to Distinguish Paroxysmal versus Persistent Atrial Fibrillation and Predict Outcomes After Ablation
Authors: Hannah Bernstein, Wesley Brooks, Padmini Sirish, Oliver Kreylos, Nipavan Chiamvimonvat, Alexandra McCann, Vladimir Filkov, Uma N Srivatsa
Journal: Circulation (2023)

Introduction: We aimed to develop effective multimodal machine learning (ML) techniques to predict: 1) duration of AF; 2) arrhythmia recurrence after ablation. Methods: Clinical data, intracardiac EGMs and metabolomic samples were obtained from patients undergoing AF ablation. Patients were prospectively followed to assess for recurrence after a 90-day blanking period with monitors every three months and if symptomatic. A prototype model was implemented via projection onto latent structures (PLS) logistic regression (LR), which accounts for collinearity in the predictors by estimating a small number of latent vectors that are aligned with the binomial response. PLS LR was used to estimate models for distinguishing paroxysmal from persistent AF and predicting recurrence. The latent structures identified by PLS LR combine strength from measurements of multiple correlated features. We generated a reference distribution to assess whether the model is better than chance by permuting the responses while keeping the inputs fixed. Models were compared based on the Akaike Information Criterion. Results: Three models were compared: EGM data (n=39), metabolomic data (n=29), multimodal approach on the combined two datasets (n=23). The multimodal model consistently produced a better fit despite smaller sample size. Only the model based on EGMs was significantly better than chance at distinguishing PAF from PeAF (p=0.03). The models based on EGMs and the combined data were significantly better than chance at predicting recurrence (p=0.02, p=0.04, respectively). Predictor EGM and metabolomics variables are shown in tables. Conclusion: Multimodal ML algorithm is promising to effectively combine multidimensional data for clinical use. The combined model consistently produced a better fit compared to the others, indicating that multimodal approaches are promising. According to AIC, the fit was better when the datasets were combined.
Abstract 13901: Deep Learning-Based Digital Biomarker to Diagnose Hypertension and Stratify Cardiovascular Risk From the Electrocardiogram
Authors: Mostafa A Al-Alusi, Samuel Friedman, Shinwan Kany, Joel Ramo, Daniel Pipilas, Pulkit Singh, Christopher Reeder, Shaan Khurshid, James Pirruccello, Mahnaz Maddah, Jennifer E Ho, Patrick T Ellinor
Journal: Circulation (2023)

Background/Aim: Hypertension affects nearly half of US adults and is a major modifiable risk factor for cardiovascular disease (CVD). Guidelines recommend serial blood pressure (BP) measurement under controlled conditions or ambulatory BP monitoring, but BP is often measured intermittently under suboptimal conditions, leading to underdiagnosis and undertreatment. We developed a deep learning model (HTN-AI) to identify hypertension and stratify risk of hypertension-associated CVD from 12-lead ECGs. Methods: HTN-AI is a convolutional neural network trained to detect prevalent hypertension or elevated baseline BP (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg) using 747,992 ECGs from 106,879 adults receiving primary or cardiology care at Massachusetts General Hospital (MGH). Associations between HTN-AI-predicted risk of hypertension and CVD (all-cause mortality, heart failure [HF], myocardial infarction [MI], stroke, and aortic dissection) were assessed in 56,730 primary care patients at Brigham and Women’s Hospital (BWH) with cumulative incidence analysis and cause-specific hazard regression. Results: In an MGH test sample and the BWH sample, HTN-AI discriminated prevalent hypertension or elevated baseline BP (AUC 0.791 and 0.762, respectively). Quintiles of HTN-AI risk stratified cumulative incidence of mortality (Figure), HF, MI, stroke, and aortic dissection (p &lt; 0.001 for all). HTN-AI risk was significantly associated with age- and sex-adjusted risk of incident mortality (HR per SD: 1.85 [95% CI: 1.77-1.92], p&lt;0.001), HF (3.55 [3.25-3.88], p&lt;0.001), MI (2.33 [2.20-2.47], p&lt;0.001), stroke (1.74 [1.64-1.86], p&lt;0.001), and aortic dissection (1.80 [1.41-2.31], p&lt;0.001). Conclusion: A deep learning model, HTN-AI, discriminates patients with hypertension and stratifies risk of incident CVD using 12-lead ECGs. HTN-AI has the potential to facilitate diagnosis of hypertension and serve as a novel digital biomarker for hypertension-associated CVD.
Abstract 15100: Long-Term Clinical Outcomes Following Percutaneous Coronary Intervention in the Super Elderly Patients Aged Over 90 Years
Authors: KOTARO TOKUDA, Akihito Tanaka, Toyoaki Murohara, Hideki Ishii, Naoki Yoshioka, Miho Tanaka, Hiroshi Tashiro, Naoki Shibata, shogo yamaguchi, makoto iwama, Luka Yoshida, Yosuke Tatami, Norio Umemoto, Yusuke Uemura, Teruhiro Sakaguchi, Yosuke Negishi
Journal: Circulation (2023)

Background: In aged society, percutaneous coronary intervention (PCI) for super-elderly patient is not rarely performed in clinical practice. However, data regarding the clinical features and outcomes among the population are still limited. Aim: To investigate the patient characteristics and long-term clinical outcomes in nonagenarians who underwent PCI. Methods: This was a multicenter observational study, enrolling 402 nonagenarian patients who underwent PCI across 10 hospitals between 2011 and 2020. This study included the patients presented with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Clinical outcomes including the occurrence of all-cause and cardiac deaths were investigated. Results: In overall 402 patients (mean age 91.9±2.0 years, 48.3% male), regarding coronary risk factors, 74.6% had hypertension, 25.4% diabetes mellitus, and 56.7% dyslipidemia. Majority of patients (77.9%) were ACS, mainly ST-segment elevation myocardial infarction (53.2%), and 22.1% CCS. During hospitalization [median 14 days (interquartile range, 6-25 days)], in-hospital death occurred in 12.4%. The rate was significantly higher in ACS patients than CCS patients (15.3% vs. 2.2%, p&lt;0.001). The cause of death was mainly cardiac death (96.0%). The median follow-up period was 544 days (interquartile range, 72-1171 days). The estimated cumulative incidence rates of all-cause death were 24.3%, 39.5% and 60.4% at 1-year, 3-years, and 5-years respectively. The rates of cardiac death were 18.0%,26.5% and 39.2% at 1-year, 3-years, and 5-years, respectively. No significant difference was observed in the occurrence of all-cause death between the patients with ACS and CCS. Regarding causes of death after discharge, 44.1% were cardiac causes mostly account for heart failure and sudden death, and 55.9% were non-cardiac causes mainly account for infection and cancer. Conclusion: This study highlights the clinical features and long-term clinical course of nonagenarian patients who underwent PCI in the real-world setting. The patients presented with ACS had higher rate of in-hospital death than CCS, and the cumulative mortality increased approximately linearly after discharge, regardless of ACS or CCS.