tbuckley/cabot-search huggingface dataset:
Abstract 4142845: Efficacy of full petticoat TEVAR in Stanford type B aortic dissection with patent false lumen and computational fluid dynamics analysis of the remodeling mechanism
Authors: Yukiyo Yoshida, Kenji Sakakibara, Shigeaki Kaga, Hiroyuki Nakajima
Journal: Circulation (2024)

Introduction: Uncomplicated Stanford type B acute aortic dissection is traditionally managed with strict blood pressure control. However, many patients who survive the acute phase develop dissecting aortic aneurysms owing to false lumen expansion in the chronic phase. Objectives: This study investigated treatment strategies for Stanford type B aortic dissection, specifically comparing the outcomes of full provisional extension to induce complete attachment (PETTICOAT) thoracic endovascular aortic repair (TEVAR) with those of simple entry closure using TEVAR. This study aimed to elucidate the long-term results of full PETTICOAT TEVAR and the mechanisms underlying false lumen expansion or suppression through computational fluid dynamics analysis. Methods: This retrospective study included 22 patients diagnosed with Stanford type B aortic dissection: 12 in the full PETTICOAT group and 10 in the entry closure group. Computed tomography images were analyzed at various time points till four years postoperatively by measuring the aortic, true lumen, and false lumen diameters at four levels. Statistical analyses were performed using Welch's t-test, and statistical significance was defined as p &lt; 0.05. Additionally, blood flow analysis was performed for one case from each group. We aimed to approximate solutions from the fluid equations, visualize blood flow, and compare hemodynamic parameters, namely wall shear stress and oscillatory shear index. Results: In the fourth postoperative year, there was a significant difference in aortic diameter (p = 0.012) and false lumen diameter (p = 0.001) at level 3 (diaphragm level of the descending aorta), and the full PETTICOAT group showed smaller values indicative of favorable remodeling. Blood flow analysis revealed elevated oscillatory shear index values in the false lumens of the entry closure group, suggesting a correlation with false lumen expansion. Conclusions: Full PETTICOAT TEVAR demonstrated positive long-term outcomes by reducing the false lumen and preventing aortic enlargement. This study provides insights into the underlying hemodynamic mechanisms, emphasizing the potential of computational fluid dynamics analysis in understanding aortic dissection treatment strategies.
Abstract 4142908: Pulsatile perfusion attenuates kidney injury during ECMO
Authors: Xueyang Shen
Journal: Circulation (2024)

Background: Extracorporeal membrane oxygenation(ECMO) is a critical intervention for treating critically ill patients, Kidney injury is a common occurrence during ECMO therapy, and studies indicate that Veno-Arterial ECMO (VA-ECMO) is linked to more severe kidney damage compared to Veno-Venous ECMO (VV-ECMO). This study aims to compare the impact of VV-ECMO and VA-ECMO on the kidneys and explore their potential underlying mechanisms. Methods: Based on our prior research, we established rat models for both VV-ECMO and VA-ECMO. Subsequently, we conducted a comparative analysis to assess the impact of VV-ECMO and VA-ECMO on renal injury. This analysis involved the examination of various data points such as blood urea nitrogen (BUN), creatinine (CR), cystatin C, and Kidney Injury Molecule-1 (KIM-1). Histopathological analysis using HE staining was performed to evaluate the extent of pathological damage. Additionally, we placed particular emphasis on monitoring the pulsatility index in both groups.Furthermore, we employed RNA-Seq on both the VV-ECMO and VA-ECMO rat groups to investigate potential underlying mechanisms. Results: The study demonstrated lower levels of renal injury indicators (e.g., BUN, CR, cystatin C, KIM-1) in the VV-ECMO group compared to the VA-ECMO group. Furthermore, HE staining revealed less severe pathological damage in the VV-ECMO group. VV-ECMO also displayed a higher pulsatility index. Transcriptomic analysis highlighted differentially expressed genes between the VV-ECMO and VA-ECMO groups, primarily associated with angiotensin II. Concurrently, the omics data indicated a milder inflammatory response in the VV-ECMO group. We further validated the more pronounced inflammatory response of VA-ECMO through Western blot and RT-PCR experiments. This suggests that VA-ECMO might activate angiotensin II, inducing inflammation due to the absence of cardiac pulsation. Conclusion: Compared to VA-ECMO, VV-ECMO demonstrates a more favorable effect in mitigating renal injury. The potential mechanism may involve the rhythmic cardiac pulsation provided by VV-ECMO, effectively suppressing angiotensin II and thereby reducing inflammatory responses. This study offers crucial insights for developing rational strategies in the clinical selection of combined cardiopulmonary support systems.
Abstract 4142955: Clinical Outcomes and Healthcare Resource Utilization Following Percutaneous Coronary Intervention for ST-segment-elevation Myocardial Infarction in Adult Patients Treated in US Hospitals
Authors: Shanthi Krishnaswami, Brendan Clark, Manu Tyagi, Meenal Sinha, Bonnie MK Donato, Villum Wittrup-Jensen, Zhun Cao
Journal: Circulation (2024)

Background: ST-segment-elevation myocardial infarction (STEMI) is estimated to affect approximately 250,000 people in the US each year, leading to significant burden of morbidity and mortality. Evidence on long-term outcomes following percutaneous coronary intervention (PCI) for STEMI is limited. Aims: To assess clinical and economic outcomes following PCI among patients with STEMI. Methods: This retrospective study utilizing data from Premier PINC AI™ Healthcare Database was conducted among adult patients (age ≥ 18 years) discharged from US hospitals for PCI with a primary diagnosis of STEMI, between October 1, 2016 and December 31, 2021 (index date). The study included mortality data from an external data source that captures death dates for approximately 85% of the US population. Clinical outcomes, healthcare resource use, and costs (adjusted to 2022 US dollars) following first PCI discharge were assessed for a minimum of 1 year. Outcomes at 3-year follow up were assessed among a subset of patients with an index date on or before December 31, 2019. Multivariable regression was used to identify risk factors for key outcomes. Results: A total of 180,691 patients underwent PCI for STEMI in 633 US hospitals during the study period. Median age of patients was 62 years, with majority being male (71%), White (79.1%), and with Medicare as the primary payor (42.9%). At index visit, 13.8% of patients had ventricular tachycardia, 8.8% had ventricular fibrillation, with a median cost of $17,582, and a mortality rate of 5.5%. Within 1-year, there were 1,966 (1.1%) additional deaths, 16.4% of patients were readmitted, 12.6% newly diagnosed with heart failure (HF), 3.6% with atrial fibrillation, and 1% experienced recurrent STEMI. The median total study cost at 1-year was $21,010. In patients with 3-year follow up data (n=63,469), the mortality rate was 7.5%. Charlson Comorbidity Index (CCI) score ≥4 (vs &lt;4) at index visit was most strongly associated with higher risk of death at follow up periods: 1-year (HR: 4.1, 95% CI: 3.66 to 4.49), 3-year (HR: 3.7, 95% CI: 3.21 to 4.27), higher odds of readmissions (1,3-year: OR: 2.2, 95% CI: 2.08 to 2.37), HF incidence (OR: 3.0 to 3.2, 95% CI: 2.89 to 3.35) and had 74% higher costs (p&lt;0.05). Conclusion: This study highlights the risk factors associated with long-term negative clinical outcomes and higher cost following PCI for the treatment of STEMI.
Abstract 4142839: Modulating the Intestinal Mycobiome Mitigates Pulmonary Arterial Hypertension Severity
Authors: Benjamin Kremer, Elizabeth Ngo, Sasha Prisco
Journal: Circulation (2024)

Introduction: Inflammation is a key driver in the development of pulmonary arterial hypertension (PAH). Recent studies have indicated that modulating the intestinal microbiome may be an innovative approach to mitigate systemic inflammation in PAH. The gut microbiome is a complex ecosystem consisting of trillions of organisms, 0.1% of which are fungi. The role of fungal species, or intestinal mycobiome, is undefined in PAH and is understudied in all diseases. We investigated whether the use of fluconazole, a broad-spectrum antifungal, affects the pulmonary vasculature in the monocrotaline (MCT) rat model. Hypothesis: Fluconazole administration will alter PAH severity in a preclinical PAH model. Methods: Three groups of male Sprague-Dawley rats were investigated: Control, MCT-vehicle (MCT-V), and MCT-fluconazole. MCT was given once subcutaneously at 60 mg/kg. Two weeks after MCT injection, MCT-fluconazole rats were administered fluconazole 20 mg/kg daily via oral gavage for ten days. Echocardiography and invasive hemodynamics defined right ventricular (RV) function and PAH severity. The pulmonary vasculature was evaluated histologically. RV hypertrophy was assessed by weight and cardiomyocyte area. Treadmill exercise testing assessed functional capacity. Results: MCT-fluconazole rats had significantly decreased PAH disease severity with a significant reduction in RV systolic pressure (A), effective arterial elastance (B), and percent pulmonary medial wall thickness (C) compared to MCT-V. Rats administered fluconazole had augmented RV function with increased percent RV free wall thickness change (D), RV ejection fraction (E) and RV-pulmonary arterial coupling (F). Compared to MCT-V, MCT-fluconazole rats had diminished RV hypertrophy with a reduction in Fulton index ( p &lt;0.05), RV/body weight ( p &lt;0.05), and cardiomyocyte area ( p &lt;0.0001). Although MCT-fluconazole rats ran for a similar amount of time compared to MCT-V (6.5±2.6 and 5.2±3.4 seconds, respectively), they had significantly lower respiratory exchange ratios (G) and a trend towards higher maximum oxygen consumption (H) . Conclusion: Modulating the intestinal mycobiome may be a novel approach to diminish PAH severity.
Abstract 4142032: Hospital Discharge Education For Heart Failure Patients Delivered by Conversational Agent Technology Improves Patient Experience and Is Preferred to a Doctor or Nurse
Authors: Abbas Mohammadi, Jamie Barney, Sultana Jahan, Deepu Rathi, Vipindas Chengat, Henry Hodder, brian jack, Leo Spaccavento, Hossein Akhondi
Journal: Circulation (2024)

Introduction: . The hospital discharge process is non-standardized and contributes to post-discharge adverse events, re-hospitalization and high cost. To address this, we developed the Re-Engineered Discharge (RED) program designed to provide high quality discharge education, shown to lower readmission rates and improve patient satisfaction. Integrating digital technologies could facilitate its implementation into hospital workflow. Methods: We designed “MayaRED”, a digital conversational agent that simulates face-to-face human interactions through personalized, conversational dialogue to deliver discharge education. MayaRED employs the “teach-back” method to document patient understanding. Upon completion, a report documents what was taught by MayaRED and understood by the patient. Participants were asked to complete a survey regarding their perceptions of the acceptability and usefulness of MayaRED. Participants were matched to controls subjects to evaluate the comparative effectiveness. Results: HF patients (N=18) using MayaRED averaged 69 years, 13,003 pg/ml pro-BNP, 42% ejection fraction and 3 mg/dl creatinine were compared to 17 matched controls. On a 1 to 7 point Likert scale (1=strongly disagree; 7=strongly agree), patients using MayaRED reported that they had “their questions answered” (mean 6.47 vs. 4.76; P&lt;.0001), “understood their follow-up appointments” (6.73 vs. 5.59; P&lt;.0001), “understood their medicines” (6.87 vs 4.59; P&lt;.0001), and understood “how to care for themselves at home” (6.07 vs 4.65; P&lt;.0001) (Figure 1). Intervention patients reported that they trust MayaRED (6.80), “are likely to follow Maya’s advice” (6.66), and are “confident in Maya’s ability to help me” (6.66). When asked “If you were hospitalized again at SVH, would you like to interact with Maya again?,” all patients responded “yes”. When asked “would you rather have the nurse/doctor or Maya give you your information about your discharge, all 18 responded MayaRED (Figure 2). Preliminary data show the 30 day all-cause readmission rate for those receiving MayaRED was 16.6% vs 29% for controls. Conclusion: The MayaRED conversational agent system is well-accepted by HF patients, demonstrating its feasibility as a tool for delivering discharge education. These findings support the continued implementation and rigorous testing of MayaRED in diverse clinical settings.
Abstract 4142952: Feature Tracking Global Longitudinal Strain in Long-term Risk Stratification of Hypertrophic Cardiomyopathy without Septal Reduction Therapy
Authors: Xuan Ma, Yun Tang, Xingrui Chen, Shujuan Yang, Shihua Zhao
Journal: Circulation (2024)

Background: The significance of left ventricular global longitudinal strain (LV-GLS) for risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) without septal reduction therapy remains to be investigated. Aims: To evaluate the prognostic utility of LV-GLS in a long-term follow-up HCM cohort without septal reduction therapy. Methods: We retrospectively enrolled 871 consecutive patients with HCM (mean age 49±13 years, 71% men) who underwent cardiac MRI in our center between January 2010 and December 2013. All study participants never received alcohol septal ablation or surgical myectomy during follow-up. LV-GLS were derived from cine cardiac MRI by using feature tracking method. The primary endpoint was SCD or SCD-equivalent events. The association between LV-GLS and SCD-related endpoints was evaluated by using time-dependent receiver operating characteristic (ROC) analysis, Kaplan-Meier analysis, and multivariable competing risk regression analysis. Results: During median follow-up of 8.8 years, SCD-related endpoint occurred in 45 HCM patients (5.2%). Patients suffering from SCD had higher European Society of Cardiology (ESC) Risk-SCD score (2.2 ± 0.6 vs. 2.6 ± 0.6, P &lt; .001) and absolute LV-GLS (11.4 ± 3.7% vs. 9.3 ± 3.4%, P &lt; .001). According to time-dependent analysis, 9% is an optimal cut-off value for absolute LV-GLS in predicting the primary outcome after a 10-year follow-up. On competing risk regression analysis, absolute LV-GLS ≤ 9% was associated with a higher rate of primary endpoints (subhazard ratio: 2.66 [95% confidence interval: 1.96 to 3.36]) after adjustment for known risk factors. Finally, LV-GLS provided incremental prognostic value over 2020 American College of Cardiology (ACC)/American Heart Association (AHA) risk model (log-likelihood ratios, -262.2 vs -266.2; P = .003) and 2022 ESC risk model (log-likelihood ratios, -268.4 vs -264.9; P = .009), respectively. In the subgroup with Class 3 of recommendation for implantable cardioverter defibrillator, patients with absolute LV-GLS ≤ 9% showed significantly worse prognosis than those with absolute LV-GLS &gt; 9% (p = .002 and .004 for 2020 AHA guideline and 2022 ESC guideline, respectively). Conclusion: Feature tracking LV-GLS derived by cardiac MRI may enable further risk stratification for the subgroup of HCM patients who never accept septal reduction therapy in their lifetime, especially for those recognized as low-risk for SCD based on current guidelines.
Abstract 4142086: Efficacy And Safety Of Inhaled Nitric Oxide In Pediatric Cardiac Surgery: A Systematic Review And Meta-Analysis
Authors: Abdelraouf Ramadan, Amr Elrosasy, Ahmed Ali, Nour-Aldeen Mahmoud, Hassan Eid, Menna Kamel, Hadeer Abd al-azim, Salomon Chamay, Manoj Ghimire, Sameh Nassar
Journal: Circulation (2024)

Background: Congenital heart diseases affect one in every 100 live births. Surgical intervention is necessary for almost half of these cases, with a significant proportion requiring surgery within the first year after birth. This meta-analysis aims to evaluate the efficacy and safety of inhaled nitric oxide (iNO), selective pulmonary vasodilator, particularly its impact on perioperative clinical outcomes such as low cardiac output syndrome (LCOS), duration of mechanical ventilation, blood and fresh frozen plasma (FFP) transfusion, ICU stay, and hospital stay. Methods: We conducted a comprehensive search of PubMed, Scopus, WOS, and Cochrane databases for relevant studies from inception to April 1, 2024. We included randomized controlled trials (RCTs) comparing iNO with placebo or standard care in pediatric patients undergoing cardiopulmonary bypass. Data extraction and quality assessment were performed according to PRISMA guidelines and Cochrane's risk of bias tool. Mean differences (MD) and their 95% confidence intervals (CI) were calculated using OpenMeta [Analyst]. Results: We included six RCTs in our meta-analysis. Our analysis showed that iNO significantly reduced the duration of mechanical ventilation (MD = -5.733, 95% CI [-10.494; -0.972]). However, no significant differences were observed between the iNO group and the control group for hospital stay, ICU stay, or incidence of LCOS. Safety outcomes showed no significant differences in blood or platelet transfusion rates, though iNO was associated with statistically significant lower FFP transfusion (MD = -5.199, 95% CI [-8.032; -2.366]). Conclusion: our review and meta-analysis highlights the potential benefits of iNO in reducing ventilation time and FFP transfusion in pediatric patients undergoing cardiac surger, while also emphasizing the need for further research to conclusively determine its impact on other clinical outcomes and safety parameters.
Abstract 4142070: Single Ventricle Palliation Pathways: Patient Characteristics and Outcomes
Authors: Michael Kuntz, Steven Staffa, Eleonore Valencia, Viviane Nasr
Journal: Circulation (2024)

Introduction: The choice between conventional surgical (SP) and hybrid (HP) stage 1 palliation for single ventricle heart disease remains debated. Pulmonary artery banding and prostaglandins followed by delayed surgical stage 1 (DSP) remains another option. HP is proposed for high-risk patients. We aimed to describe index hospitalization outcomes for patients undergoing these 3 pathways. We hypothesized that patients undergoing HP and DSP have more comorbid conditions, higher morbidity, and longer length of stay (LOS). Methods: Using the Pediatric Health Information System data, January 2016 – August 2023, we analyzed the characteristics and index hospitalization outcomes for patients with single ventricle disease undergoing SP, HP, and DSP. Results: Our final cohort included 1,872 patients (1,573 SP; 176 HP; 123 DSP). Prematurity was most common (45.5%) in the DSP compared to the HP (27.8%) and SP (9.5%) groups (P&lt;0.001); the rate of small for gestational age birth (SGA, &lt;2.5 kg) was similarly distributed. Non-cardiac comorbidities were most prevalent in DSP (neurologic, gastrointestinal, need home technology) and HP (respiratory). LOS (days) was highest for DSP (median 130, IQR:69–195) compared to HP (median 61, IQR:37–139) and SP (median 45, IQR:29–80)(P&lt;0.001). Disposition varied (P&lt;0.001), with in-hospital mortality highest among HP (25.6%) compared to DSP (13.8%) and SP (11.3%); the rate of index hospitalization heart transplant was 8.5% for HP, DSP 0.8%, and SP 0.9%. Among patients born prematurely or SGA, LOS was longest for DSP (median 143, IQR:88–216) followed by HP (median 72, IQR:52–139) and SP (median 59, IQR:36–124)(P&lt;0.001). Disposition also varied (P=0.004), with higher in-hospital mortality among HP (35.9%) compared to DSP (16.9%) and SP (19.9%); transplant was highest among HP (4.7%) compared to DSP (0%) and SP (0.8%). Adjusted total costs per hospital day did not vary significantly. Conclusions: Patients undergoing DSP and HP are more often premature or SGA. Patients undergoing HP are most likely to have index hospitalization mortality or transplant. While recognizing the limitations of administrative databases, our data does describe the current utilization trend and outcomes for SP, HP, and DSP.
Abstract 4142075: From GPT-4 to GPT-4o: Progress and Challenges in ECG Interpretation
Authors: Vidish Pandya, Alan Ge, Shreya Ramineni, Alexandrina Danilov, Faisal Kirdar, Luigi Di biase, Kevin Ferrick, andrew krumerman
Journal: Circulation (2024)

Background: With the increasing popularity of large language models (LLM), the use of artificial intelligence (AI) for medical diagnostics has garnered significant attention. One area of particular interest is the application of LLMs in the interpretation of electrocardiograms (ECGs). Traditional ECG machines, such as those by General Electric (GE), use established algorithms for analysis. This study explores the potential of AI, specifically OpenAI’s GPT-4 and its latest iteration, GPT-4o, as an aide in interpreting ECGs. Objective: To evaluate the improved capability of GPT-4o in interpreting ECGs, comparing its performance against GE’s algorithm and previous iteration GPT-4, with a focus on identifying both improvements and remaining limitations. Methods: A total of 25 randomly selected ECGs representing both normal and abnormal findings were analyzed using GPT-4o. We prompted GPT-4o to comment on clinically relevant ECG findings, including rate, rhythm, QRS axis, intervals, chamber enlargement, and signs of ischemia. We compared the interpretations of GPT-4o against the GE machine and an older version of ChatGPT, examining diagnostic accuracy, consistency, and reliability. Results: GPT-4o showed marked improvements in detecting critical diagnoses compared to older versions. It successfully identified 4 STEMIs and all ventricular tachycardias (VT) missed by its predecessor. However, GPT-4o continued to struggle with atrial arrhythmias, missing 2 cases of atrial fibrillation, 1 atrial flutter, and 1 supraventricular tachycardia. Interestingly, GPT-4o exhibited a higher tendency to classify nonspecific ST segment and T wave changes as ischemia. Notable limitations included the quality of ECGs, with some having poor baselines, and the resolution of uploaded images. Conclusion: The rapid improvement in ECG interpretation, especially in detecting critical diagnoses previously missed, is very promising for AI and ChatCPT. GPT-4o shows significant advancements over its predecessor, particularly in identifying STEMIs and VTs. However, it still struggles with atrial arrhythmias and tends to overdiagnose ischemic changes, indicating the need for further refinement. While AI advancements are promising, more development is necessary before such technologies can be safely integrated into routine ECG interpretation. Future research should focus on enhancing AI's ability to detect a broader range of arrhythmias and improving efficiency in cardiology diagnostics.