tbuckley/cabot-search huggingface dataset:
Abstract 12190: Cardiovascular Disease Mortality Trends Among Native Hawaiian and Pacific Islander Adults—United States, 2018 to 2022
Authors: Rebecca C Woodruff, Joseph K Kaholokula, Lorinda Riley, Fleetwood V Loustalot, Adam Vaughan, Kotryna Diktonaite, LaTonia C Richardson, Xin Tong
Journal: Circulation (2023)

Introduction: Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in US mortality surveillance, potentially masking important differences between these two populations. In 2018, US death certificate race categories were modified, enabling the disaggregation of NHPI national CVD mortality surveillance data from the Asian population. Methods: Using National Vital Statistics System mortality data from 2018 to 2022, we identified CVD deaths among adults aged ≥35 years with ICD-10 codes I00-I99 listed as the underlying cause of death. Of all CVD decedents with non-Hispanic origin and NHPI listed alone or in combination with other race groups on the death certificate, we classified those with NHPI listed as the only race group as NHPI (60.1%). Rate ratios (RR) and 95% confidence intervals (CI) compared age-standardized mortality rates (ASMR) among NHPI adults compared to non-Hispanic Asian adults and US adults overall. Results: From 2018 to 2022, 6,088 CVD deaths (72.0% heart disease, 19.8% stroke) occurred among NHPI adults of Hawaiian (24.5%), Samoan (24.3%), Guamanian (11.0%), or other Pacific Islander (40.2%) descent. The NHPI ASMR was 464.5 CVD deaths per 100,000 (95% CI: 452.4-476.6), second only to the non-Hispanic Black ASMR (590.3 CVD deaths per 100,000, CI: 588.7-591.8; Figure). The ASMR among NHPI adults was significantly higher than non-Hispanic Asian adults (RR: 1.86, CI: 1.81-1.91) and US adults overall (RR: 1.07, 95% CI: 1.04-1.10). Conclusions: Single-race NHPI adults had the second-highest CVD death rate in the US from 2018 to 2022, second only to Black adults, and significantly higher than Asian adults. Surveillance using broader multi-race definitions to identify the NHPI population, further disaggregate by NHPI subgroup, and explore geographic variation is needed to better understand potential health disparities and target interventions to reduce CVD mortality disparities among NHPI adults.
Abstract 13945: Evaluation of a Deep Neural Network for Detection of D-Transposition of the Great Arteries on Fetal Echocardiograms
Authors: Alisa Arunamata, Marilyne LEVY, Bertrand stos, Eric Askinazi, Valentin Thorey, Christophe Gardella
Journal: Circulation (2023)

Introduction: While prenatal detection of congenital heart disease (CHD) has improved over the years, a significant proportion of CHD remains unrecognized on fetal ultrasound. Prenatal identification of d-transposition of the great arteries (d-TGA) in particular would significantly alter delivery planning and postnatal course. Research Questions: We investigated whether a deep neural network (DNN) can accurately detect d-TGA on fetal echocardiograms. Aim: To evaluate a DNN for detection of d-TGA on second (2T) or third (3T) trimester fetal echocardiograms. Methods: Patients with a singleton pregnancy with a 2T or 3T fetal echocardiogram performed between Jan 1, 2022 and May 1, 2023 at one center were retrospectively evaluated. Cases of d-TGA and negative cases referred for family history of CHD or increased nuchal translucency were included. Cases were reviewed by 3 pediatric cardiologists to confirm that the recorded ultrasound clips were sufficient to diagnose the presence or absence of d-TGA, and were excluded otherwise. The DNN was trained on patients not included in the evaluation to detect the absence of the great artery cross-over pattern, a distinct finding in d-TGA. The DNN outputs the presence or absence of this finding using all recorded video clips of an examination. Results: We included 18 positive and 99 negative cases. The DNN detected suspicion for d-TGA with an AUC of 91.4%, sensitivity of 83.3% (60.8-94.2, 95%CI) and specificity of 92.9% (86.1-96.5, 95%CI). Conclusions: D-TGA can be accurately detected on fetal echocardiograms using a DNN. These promising results lay the foundation for reliable, computer-aided detection of CHD on screening fetal ultrasounds.
Abstract 12321: Discordant Association of Nonalcoholic Fatty Liver Disease With Lipoprotein(a) and Markers of Atherogenic Dyslipidemia
Authors: Terence Lee, Gowtham R Grandhi, Pamela Alebna, Amon Asgharpour, Dave L Dixon, Fadi N Salloum, Arun J Sanyal, Mohammad Siddiqui, Anurag Mehta
Journal: Circulation (2023)

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with atherogenic dyslipidemia and an increased risk of cardiovascular events. Previous studies have suggested a paradoxical inverse relationship between NAFLD severity and Lp(a) level, an independent cardiovascular risk factor. However, contemporary data in patients with biopsy-proven NAFLD in the U.S. are lacking. Hypothesis: NAFLD severity on liver biopsy has a discordant association with Lp(a) and other markers of atherogenic dyslipidemia. Methods: Lp(a), traditional lipid profile, apolipoproteins, and nuclear magnetic resonance-based lipoprotein particle concentration were measured in 151 patients with NAFLD. Levels were compared between those with nonalcoholic fatty liver (NAFL) on histology and non-alcoholic steatohepatitis (NASH), the clinically aggressive NAFLD variant. Results: Median age was 55 [48, 62] years, 67% of patients were women, 83% were White, 43% had NAFL, and 57% had NASH. Demographic characteristics were similar among those with NAFL and NASH. Triglyceride level was higher and High-Density Lipoprotein-cholesterol (HDL-C) was lower among those with NASH as compared with NAFL. Circulating concentration of two key markers of atherogenic dyslipidemia, Apolipoprotein-B (apoB) and Low-Density Lipoprotein particle concentration (LDL-P) was 9% and 17% higher in the NASH group as compared with NAFL, respectively. Contrastingly, Lp(a) concentration was 50% lower in NASH relative to NAFL group (Figure). Hepatocyte ballooning, lobular inflammation, and fibrosis on histology were inversely associated with Lp(a) concentration, while steatosis severity was not. Conclusions: NAFLD severity has a discordant association with Lp(a) and markers of atherogenic dyslipidemia. The mechanistic basis of this relationship may have implications for prognosticating cardiovascular disease risk and determining the safety of targeted Lp(a) lowering in patients with NAFLD.
Abstract 13913: Value of Ischemia and Coronary Anatomy for Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease
Authors: Krishna K Patel, poghni A peri-Okonny, Leslee J Shaw, alessia gimelli
Journal: Circulation (2023)

Aims: To assess the value of ischemia versus coronary anatomy for prognosis and to guide revascularization. Methods: A total of 1764 patients who had rest-stress SPECT MPI and angiography (invasive or CT) were prospectively enrolled and followed for cardiac death/non-fatal MI. CAD prognostic index (CADPI) was used to quantify extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pre-test risk, known CAD, stressor, LVEF, %ischemia and infarct, CADPI, early (90 day) revascularization. Incremental prognostic value was evaluated using net reclassification indices (NRI). Results: Mean age was 69.7±9.5 years, 24.4% were women and 29.3% had known CAD. Ischemia was present in 90.9%; &gt;10% in 28.4%. Non-obstructive, single, and multi-vessel disease was present in 256 (14.5%), 772 (43.8%) and 736 (41.7%) respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/MI occurred in 148 (8.4%) over 4.6 year median follow-up. Both % ischemia and CADPI provided incremental prognostic value over pre-test clinical risk (p&lt;0.001, Table ). In a model containing both ischemia and anatomy, ischemia was prognostic (HR per 1% ↑=1.06, 95% CI:1.02, 1.10,p=0.02), but CADPI was not (HR=1.01 (1.00, 1.02),p=0.07). Early revascularization modified the risk associated with %ischemia (interaction p=0.003, Figure ), but not with CADPI (interaction p=0.6). % Ischemia and SPECT variables added incremental prognostic value over clinical risk and CADPI (NRI=20.3%, 95%CI: 9%, 32%, p=0.01); however CADPI was not incrementally prognostic over pre-test risk, %ischemia and SPECT variables (NRI=3.1%, 95% CI: -5%, 15%, p=0.21; Table ). Conclusion: Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. Anatomic extent of disease has limited incremental benefit for prognosis and guiding revascularization beyond ischemia.
Abstract 12617: Predictors of Mortality in African Americans Requiring Intra-Aortic Balloon Pump for Cardiogenic Shock Following Acute Myocardial Infarction
Authors: Abhimanyu Ravalani, Rahat A Memon, Kamleshun Ramphul, Jasninder Dhaliwal, Nomesh Kumar, Shaheen Sombans, Petras Lohana, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: Past studies have linked African Americans(AA) to disparities in care and outcome. We aim to improve the care of AA by evaluating the predictors of mortality in AA requiring an intra-aortic balloon pump(IABP) for cardiogenic shock(CS) following acute myocardial infarction (AMI). Methods: Variables influencing mortality among AA adults with CS from AMI using intra-aortic balloon pump (IABP), were studied via the 2016-2020 National Inpatient Sample. Results: Our study found 9050 cases of AMI with CS among AA that required IABP and 3100 (34.3%) of them died. Odds of mortality were higher in those ages ≥60(aOR 1.356, p&lt;0.01), using mechanical ventilation (aOR 2.725, p&lt;0.01), with ventricular tachycardia (aOR 1.231, p&lt;0.01), ventricular fibrillation (aOR 2.215, p&lt;0.01), prior stroke (aOR 1.319, p&lt;0.01), Chronic Kidney Disease (aOR 1.387, p&lt;0.01), cirrhosis (aOR 2.581, p&lt;0.01), hypertension (aOR 1.29, p&lt;0.01), peripheral vascular disease (aOR 1.218, p =0.031), acute kidney injury (aOR 1.281, p&lt;0.01), and females (aOR 1.111, p=0.042). Lower odds were reported in those with lipid disorders (aOR 0.713, p&lt;0.01), alcohol abuse (aOR 0.549, p&lt;0.01), depression (aOR 0.676, p&lt;0.01), drug abuse (aOR 0.483, p&lt;0.01), events of supraventricular tachycardia (0.438, p&lt;0.01), atrial fibrillation (aOR 0.88, p=0.042), smoking (aOR 0.727, p&lt;0.01), obesity (aOR 0.843, p=0.011), and weekend admissions (aOR 0.867, p&lt;0.01). Furthermore, Medicaid (aOR 0.705, p&lt;0.01) and Private Insurers (aOR 0.550, p&lt;0.01) showed reduced risk compared to Medicare-covered patients. Urban non-teaching (aOR 0.52, p&lt;0.01) and Urban teaching(aOR 0.526, p&lt;0.01) centers also had reduced mortality rates (vs. Rural hospitals). Conclusions: We found several patient and hospital characteristics that can influence the survival of AA using IABP for CS following AMI. Further research to improve the impact of these factors and alleviate their negative roles on survival should be encouraged.
Abstract 12000: Prolonged Arterial Phase is Caused of the Chest Pain in Takotsubo Cardiomyopathy A Dynamics Angiography and Artificial Intelligence Analysis
Authors: LOC Vu, Dung Ho, Vu H Vu, Duc Chinh D Nguyen, Duc M Tran, Anh D Le, Hien Q Nguyen, Trang Le, Minh Q Mai, Thach N Nguyen
Journal: Circulation (2023)

Introduction: Takotsubo Cardiomyopathy (TCM) known as “Broken Heart Syndrome” is triggered by extreme emotional or physical stress. The typical TCM patient features chest pain, ST elevation, elevated troponin, reduced ejection fraction (EF), patent coronary artery, and apical ballooning. Hypothesis: Could abnormal coronary flow explain chest pain in Takotsubo patients? Methods: The patient with severe chest pain, elevated troponin, ST change, patent coronary arteries, and apical ballooning underwent angiography and review with a new dynamic recording technique. Ten patients without ACS, normal EF, and no coronary artery disease served as control. At first, the angiographic recording started when the contrast was injected into the coronary artery. Then the recording continued with the blood in white color moving in until all contrast disappeared from the arteries. The angiogram was recorded at 15 images per second. The review of coronary images focused on the blood flow in white on top of a background of black contrast. The arterial phase (AP) calculation began when the blood moved in and ended when all the contrast was flushed out of the distal arterial vasculature. The two-layer artificial intelligence program was built based on U-net and Densenet-121. The first layer, with a segmentation model and Convolutional neural network is responsible for detecting the starting frame of AP with a full index of contrast. The second layer with a segmentation model will detect the ending frame of AP. All TCM patient was followed up in one year. Results: Fifteen TCM patients met the criteria (12/15 female). The AP in the TCM group was 3.17 +/- 0.53 seconds compared with 1.62 +/- 0.26 seconds in the control group (P&lt;0.001). The TCM group had a mean EF 33.9 +/- 7.6 %, and all recovered to 58.8 +/- 12.6 % after two weeks. At one year follow-up, all patients had no chest pain and no re-admission, except for one case of non-cardiovascular mortality associated with septic shock from pneumonia 3 months after the index event. Conclusions: Chest pain in TCM was caused by slow flow (measured as prolonged arterial phase) which was detrimental to myocardial contraction. Their prognosis was benign because all patients recovered.
Abstract 11597: A Rare Cause of an NSTEMI: Left Main Coronary Artery Compression in a Patient With Pulmonary Hypertension
Authors: Kayla M Secrest, Scott W Ketcham, Michael P Thomas
Journal: Circulation (2023)

Background: Pulmonary hypertension has varying effects on cardiac function. Though uncommon, a dilated pulmonary artery can cause decreased coronary perfusion through extrinsic compression of the left main coronary artery (LMCA). While the most common presentation of LMCA compression is angina, acute coronary syndrome is rare. Case Summary: An 81-year-old female with a history of group 3 pulmonary hypertension presenting with neck and shoulder pain was found to have elevated cardiac biomarkers and EKG findings remarkable for isolated ST elevation in aVR with diffuse ST depressions in all other leads, consistent with a non-ST elevation myocardial infarction. Coronary angiography revealed left main coronary artery compression that was successfully intervened on with placement of a single drug eluding stent. Right heart catheterization was remarkable for evidence of severe pulmonary hypertension with a mean pulmonary artery pressure of 60 mmHg. Discussion: Given the patient’s past medical history, presenting symptoms, coronary and right heart catheterization findings the etiology of her acute coronary syndrome presentation was thought to be driven by left main coronary artery compression from pulmonary artery dilation. Pulmonary artery dilation in individuals with a history of pulmonary hypertension is common, with several modalities available to evaluate for this anatomic compensatory measure. Management for left main coronary artery compression in this patient population is percutaneous coronary intervention. Future studies to determine if routine screening for coronary compression in patients with pulmonary hypertension is needed.
Abstract 12214: Large Left Atrial Infected Myxoma in a Healthy Patient With Intermittent Fever
Authors: Karla M Asturias, Cara Pietrolungo, Colin Craft
Journal: Circulation (2023)

Introduction: Infected myxomas represent a rare subset of cardiac myxomas. The diagnosis is classified as definite, probable, or possible based on microbiological and pathological findings. Prognosis is often favorable with early diagnosis and intervention. Case description: A 39-year-old female with a history of iron-deficiency anemia presented with three months of fever, poor exercise tolerance, 15-lb unintentional weight loss, and episodes of amaurosis fugax associated with upper extremity paresthesias. Her physical exam revealed tachycardia and a grade 3/6 apical holosystolic murmur. Her laboratory workup was notable for microcytic anemia, elevated inflammatory markers, and Streptococcus sanguinis bacteremia . Echocardiography showed left ventricular and left atrial dilation with normal systolic function and a 6.4x4.3 cm heterogenous left atrial mass adherent to the interatrial septum with prolapse across the mitral valve plane (Figure 1, panel A-B) associated with eccentric mitral regurgitation. She was managed with surgical resection and antibiotics. Pathology revealed myxomatous tissue and prominent plasma cell infiltrates, confirmatory of definite infected cardiac myxoma. Follow-up echocardiography showed residual mitral regurgitation due to mitral annular stretch from myxoma for which surgical intervention was deferred in the acute setting. Discussion: A definite diagnosis of infected myxoma is established with biopsy-proven myxoma, along with microorganism visualization or positive blood cultures with inflammatory cells on histopathology. Rare in occurrence, infected myxomas have been associated with a higher incidence of embolic events, sepsis, and shock compared to uninfected myxomas. Prognosis is favorable with prompt intervention. Increased awareness leading to earlier diagnosis and management is a priority for this subset of patients.
Abstract 11818: The Beneficial Effects of Ceramide on Human Microvascular Endothelial Function is Dependent on S1P/S1PR1 Signaling Axis
Authors: Gopika SenthilKumar, Zachary Zirgibel, Brian J Lindemer, Henry Bordas-Murphy, Julie K Freed
Journal: Circulation (2023)

Despite the known damaging effects of elevated intracellular ceramides on human microvascular function, our recent work showed that loss of ceramide-formation through neutral sphingomyelinase (NSmase) promotes endothelial dysfunction in arterioles from healthy adults. This presents as a switch in the endothelial-derived mediator responsible for eliciting dilation to flow (flow-induced dilation; FID), from the vasoprotective nitric oxide (NO) to pro-inflammatory hydrogen peroxide (H 2 O 2 ). The mechanism through which ceramide exerts beneficial effects on the vasculature remains poorly understood. One of ceramide’s metabolites, sphingosine-1-phosphate (S1P), has been shown to stimulate NO production through the activation of S1P receptor 1 (S1PR1). Thus, we hypothesize that ceramide promotes NO-mediated FID through its metabolism to S1P and activation of S1PR1. Arterioles (100-250μm) from healthy adults were dissected from discarded surgical adipose tissue. Vessels were cannulated in organ chambers, pre-constricted with endothelin-1, and changes in internal diameter in response to increases in flow or C2-ceramide was measured via videomicroscopy. Difference between mean % dilation ±SE with two-way ANOVA is reported. Agonism of S1PR1 (CYM5442, 1μM, 30min) during NSmase inhibition (GW4869, 4μM, 30min) restored dependency on NO for FID, as L-NAME (100μM; NO synthase inhibitor) diminished FID (GW+CYM, n=4 vs GW+CYM+L-NAME, n=4: -70.3±20.0, p=0.01). A similar switch to NO-mediated FID was seen with C2-ceramide (10μM)+GW4869 treatment (GW+C2, n=5 vs GW+C2+L-NAME, n=4: -52.5±5.9, p&lt;0.001). Inhibition of S1PR1 (W146, 10μM, 30min) induced a switch from NO to H 2 O 2 mediated FID, as catalase (500U/ml; W146, n=5 vs W146+Catalase, n=4: -34.0±7.9; p=0.01) but not L-NAME (W146, n=5 vs W146+L-NAME, n=4; -1.4±9.9, p=0.89) impaired FID. Acute ceramide-induced dilation (1min) was diminished in the presence of L-NAME (C2, n=5 vs C2+L-NAME, n=4: -33.40±10.06, p=0.02) and W146 (C2, n=5 vs C2+W146, n=4; -39.7±5.9, p=0.01). Together, these data suggest that ceramide induces NO-signaling through the activation of S1PR1 and provide mechanistic insight into how ceramide may exert beneficial effects within the human microvascular endothelium.
Abstract 12413: Arrhythmia Burden, Associated Outcomes, and Cost Implications in Patients Hospitalized With Idiopathic Pulmonary Fibrosis
Authors: Patrick Benjamin, Olamide Oyenubi, Bernard Gitler, Andreea-Constanta Stan, JULIAN ROBLES
Journal: Circulation (2023)

Introduction: Arrhythmias are a common cardiovascular manifestation of idiopathic pulmonary fibrosis (IPF), however, associated costs and hospital outcomes are unknown. We aim to determine the impact of cardiac arrhythmias on outcomes and costs among hospitalized IPF patients. Methods: A retrospective cohort analysis was conducted using the National Inpatient Sample from 2017-2019. IPF-associated hospitalizations with and without concurrent arrhythmia were compared and identified by appropriate ICD-10 CM codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were the duration of hospitalization and associated costs. Results: Among 92,125 IPF patients, 28.5% (n=26,235) were diagnosed with 29,885 arrhythmias. The most frequent (65%) form of arrhythmias was atrial tachyarrhythmias of which atrial fibrillation was the most predominant (88%). The frequency of bradyarrhythmias, ventricular tachyarrhythmias, and unspecified arrhythmias were 10%, 8%, and 17%, respectively. The IPF-arrhythmia group was predominantly male (64% vs 36%, P &lt; 0.001) and significantly older (76 vs 69 years, p&lt;0.001) with a higher number of comorbidities (3 or more Charlson comorbidity index score: 52% vs 40%, p&lt;0.001). All-cause mortality was significantly higher in the IPF-arrhythmia cohort (12.3% vs. 9.5%, p&lt;0.001) and the odds of in-hospital death remained significantly higher among the IPF-arrhythmia cohort after adjusting for sociodemographic and hospital-level factors (AOR 1.30, 95% CI 1.17-1.44, P &lt;0.001). The hospital length of stay was longer (8.4 vs. 6.7 days, p&lt;0.001), and costs were higher ($123,185 vs. $88,073, p&lt;0.001) among the IPF-arrhythmia cohort. Conclusions: Concurrent arrhythmias are associated with worse survival outcomes and costs for patients with IPF. Future studies are needed to confirm the benefits of treatment and elucidate the appropriateness and cost-effectiveness of screening for arrhythmias among IPF patients.