tbuckley/cabot-search huggingface dataset:
Abstract 17000: Adipokines and Subclinical Myocardial Injury Following Bariatric Surgery
Authors: Amelia S Wallace, Bige Ozkan, Ebenezer K Aryee, Justin B Echouffo, Gary Gerstenblith, Roger S Blumenthal, Christie ballantyne, Elizabeth Selvin, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Bariatric surgery results in marked weight loss and has many cardiometabolic benefits. Adipokines, proteins secreted by adipose tissue with diverse metabolic effects, are affected by bariatric surgery. Whether favorable changes in adipokines after bariatric surgery are associated with improvements in cardiac biomarkers is unknown. Methods: We studied 294 bariatric surgery patients and 294 controls matched on age, sex, BMI, and diabetes in the Geisinger Obesity Registry. We measured serum markers of subclinical cardiac injury (high-sensitivity cardiac troponin I [hs-cTnI]), cardiac fibrosis (galectin-3), and adipokines (adiponectin, leptin, resistin, visfatin) prior to surgery and 6-18 months post-surgery in bariatric surgery patients and at similar intervals in controls. We used linear regression to evaluate the associations of changes in log-transformed adipokines with changes in log-transformed hs-cTnI and galectin-3. Results: Participants (mean age 45; 83% female; 97% White; mean BMI 47 kg/m 2 ) undergoing bariatric surgery lost 38.5 kg and matched controls gained 0.4 kg on average. Leptin, resistin, visfatin, hs-cTnI and galectin-3 decreased while adiponectin increased in bariatric surgery participants. There were no significant changes in any biomarkers in control participants. Increasing adiponectin and decreasing leptin were associated with decreases in hs-cTnI, but these associations were attenuated by adjustment for weight loss ( Table ). Decreasing resistin was linked to decreasing hs-cTnI and galectin-3, and decreasing visfatin with decreasing galectin-3, independent of weight loss. Conclusion: Bariatric surgery induced weight loss results in favorable changes in adipokines, which are associated with reversal of subclinical myocardial injury, and to a lesser degree, with decreasing myocardial fibrosis. Associations for some adipokines were weight loss-dependent, while others were independent of weight loss.
Abstract 19006: Human Epididymis Protein 4 and Carcinoembryonic Antigen-125: Promising Blood Biomarkers to Identify Diffuse Myocardial Fibrosis in Patients With Severe Aortic Stenosis
Authors: Antonela Zanuttini, Sebastien Hecht, Carlos Giuliani, Jeremy Bernard, Lionel Tastet, Rami Abu-Alhayja'a, Jonathan Beaudoin, Benoit J. Arsenault, Robert De Larochelliere, Jean-Michel Paradis, Marie-Annick A Clavel, Josep Rodes, Nancy Cote, Philippe Pibarot
Journal: Circulation (2023)

Introduction: Cardiovascular magnetic resonance (CMR) T1 mapping, extracellular volume (ECV) and late gadolinium enhancement (LGE) demonstrate strong agreement with endomyocardial biopsy in evaluating myocardial fibrosis. Human epididymis protein 4(HE4) has been shown as a blood biomarker to identify fibrosis, but the relationship with other blood biomarkers is not well established yet. Hypothesis: determine the correlation between different blood biomarkers and myocardial fibrosis by CMR in patients undergoing transcatheter aortic valve implantation(TAVI). Methods: Forty-three patients were included. The cohort was divided into two groups based on the threshold values of HE4(128.5 pmol/l) and/or CA-125 (19.5 U/ml), before TAVI. Native T1 mapping and ECV were measured at 1280 ms and 26%, respectively, corresponding to the median of the population studied. LGE was qualitatively measured. Results: Patients with higher HE4 plasma levels (&gt; 128.25 pmol/l) and/or CA-125 (&gt;19.5 U/ml) prior to TAVI had more comorbidities and had higher median native T1 mapping values, 1278 ms (1239.25-1280.25) vs 1352 ms (1303.50 -1376.00), p &lt; 0.001, and LGE positive, 10 (55.6%) vs 10 (90.9%); p= 0.046, respectively. HE4 (r=0.34, p=0.03) and CA-125 (r=0.371, p=0.034) correlated with prolonged T1 mapping. No significant correlation was found with other biomarkers: troponin T (r = 0.14, p = 0.41), Nt-proBNP (r=0.28, p=0.089), IL-6 (r=0.189, p= 0.250), procalcitonin, (r =0.132, p =0.420). The addition of elevated plasma levels of HE4 and CA-125, provided significant C-statistics for myocardial fibrosis, AUC [95%CI]: 0.74 [0.58- 0.89], p= 0.008, regarding HE4 AUC [95%CI]: 0.69 [0.52- 0.85], p=0.039, and CA-125 AUC [95%CI]: 0.72 [0.57- 0.88], p= 0.014. On univariable analysis, high plasma levels of HE4 and/or Ca-125 were independently associated with diffuse fibrosis by native T1 mapping OR:9.37, [95% CI: 2.07 - 42.33], p = 0.004 and there was a trend toward focal fibrosis by LGE + OR: 8.00, [95% CI: 0.83 - 76.36], p = 0.071. Conclusion: Elevated HE4 and/or Ca-125 plasma levels correlated with prolonged native T1 mapping. The combination of HE4 values ≥ 128 pmol/l and CA-125 ≥ 19.5 U/ml may provide a useful screening biomarker to identify diffuse myocardial fibrosis in AS.
Abstract 15033: Development of an Interpretable Machine Learning Model for Predicting Individual Response to Antihypertensive Treatments
Authors: Jiayi Yi, Lili Wang, Yanchen Liu, Jiamin Liu, Haibo Zhang, Xin Zheng
Journal: Circulation (2023)

Introduction: Accurate prediction of individual response to anti-hypertensive treatment is crucial in enhancing the safety and efficiency of offering appropriate regimens to attain desired blood pressure (BP) goals. Hypothesis: Machine learning (ML) based models could accurately predict the BP reduction of different antihypertensive regimens. Methods: We utilized data from the LIGHT study, a pragmatic, cluster-randomized trial conducted in 94 primary care institutions in China, involving 13146 visits of 5192 patients who were required to attend the clinic for hypertension management every 3 months during an overall study period of 1 year. Clinical and laboratory variables, baseline BP, and anti-hypertensive therapies at baseline and at follow-up were used to develop models for predicting post-treatment individual BP response. Five ML algorithms were applied as candidate models, and mean squared error (MSE) was used to evaluate the model performance ( panel A ). Results: The mean (standard deviation) age of the study population at baseline was 64.2 (14.0) years, and 2207 (42.5%) were female. 29 features selected by the least absolute shrinkage and selection operator method and purposeful selection were used to build the model, including age, sex, weight, waist circumference, BMI, baseline systolic and diastolic BP, smoking status, visit interval, history of coronary heart disease, diabetes, and dyslipidemia, and baseline and prescript antihypertensive drugs. Among all candidate models, the Catboost model had the best performance with a training MSE of 149.6 and a validation MSE of 135.2 ( panel B ). The most important features include baseline BP, age, weight, and BMI ( panel C and D ). Conclusions: We developed an ML-based model for predicting the response to antihypertensive regimens for assisting clinicians to achieve individualized antihypertensive treatment effectively and safely.
Abstract 14148: Left Ventricular Outflow Tract Pseudoaneurysm in a Pediatric Patient: An Unusual Presentation of Endocarditis
Authors: Sara Gungor, Dalia Broadus, Katherine Kosiv, Ruchika Karnik, Jeremy M Steele, Dina Ferdman
Journal: Circulation (2023)

Description of Case: A 12-year-old male with known bicuspid aortic valve presented with one month of progressive weight loss and subjective fevers. Transthoracic echocardiogram was concerning for a new left ventricular outflow tract (LVOT) aneurysm (figure 1). His aortic valve stenosis and regurgitation had notably progressed compared to a prior study one year ago. He was urgently referred for cardiac computed tomographic angiography (CCTA), which demonstrated a pseudoaneurysm of the LVOT inferior to the aortic valve and irregularly thickened aortic valve leaflets with a notable perforation (figure 2). Blood cultures were positive for Viridans streptococci, confirming the diagnosis of infective endocarditis. The patient was referred for a Bentall procedure with LVOT pseudoaneurysm repair. Pre-operative transesophageal echocardiogram demonstrated a communication of the non-coronary cusp of the aortic valve and LVOT. Ultimately, aortic root replacement was performed with a 23mm homograft. Our patient recovered well from surgery and now has excellent clinical status with normal aortic valve function. Discussion: Pseudoaneurysm of the LVOT as a result of infective endocarditis is a rare diagnosis, especially in the pediatric population. Of the case reports published, it is most seen in the setting of infection involving the native aortic valve but has also been reported after aortic valve replacement. As in our patient, the most commonly reported location involves the mitral-aortic intervalvular fossa. Symptoms have insidious onset and the diagnosis requires a high level of suspicion. A multimodal imaging approach is warranted for optimal diagnosis and treatment.
Abstract 15539: Outcomes of a Multidisciplinary Approach to Management of Mavacamten in Obstructive Hypertrophic Cardiomyopathy
Authors: Andrew Willeford, Trina Huynh, Megan Kraushaar, Jorge Silva Enciso
Journal: Circulation (2023)

Background: Mavacamten treats obstructive hypertrophic cardiomyopathy in adults, improving symptoms and functional capacity. Its complex management process involves frequent echocardiograms, dose adjustments based on Valsalva left ventricular outflow tract (VLVOT) gradient changes, and screening for drug interactions. The high cost of mavacamten poses a financial burden to patients, and the management process lacks adequate simplification. Real-world workflow descriptions are needed for successful patient outcomes. Methods: We retrospectively analyzed patients prescribed mavacamten from May 2022 to May 2023 through a multidisciplinary workflow. Patients were referred to a pharmacist after an initial clinic visit with a cardiologist. Pharmacists counseled patients, enrolled them in the online Risk Evaluation and Mitigation Strategies program, and facilitated enrollment in the manufacturer's patient support program for cost reduction options and prior authorization. Echocardiogram dates were determined using a calculator created by the authors and coordinated with the echocardiography staff. Pharmacists adjusted doses based on finalized echocardiogram reports. Outcomes included ejection fraction (EF), LVOT, and VLVOT which were analyzed using a generalized linear mixed model controlling for time. Additional outcomes were out-of-pocket cost, time to approval, and time to first dispense. Results: Among 34 patients considered, 21 received mavacamten. Reasons for non-receipt included cost (6 patients), unwillingness to follow-up (4 patients), drug interactions (1 patient), absence of mavacamten on insurance formulary (1 patient), and awaiting insurance approval (1 patient). Patients on mavacamten received therapy for 2-48 weeks. They experienced significant decreases in average LVOT (P&lt;0.001) and VLVOT (P&lt;0.001) over time. Average EF showed a non-significant decrease (P=0.097), with one patient recovering from a decline below 50% upon discontinuing mavacamten. Conclusion: Mavacamten faces barriers such as echocardiogram follow-up, complex dosing, drug interaction screening, and cost. However, the described workflow effectively addresses many of these barriers, serving as a template for mavacamten management.
Abstract 18591: Can the Clip Restore the Physiological Annular Morphology? Serial Quantitative 4d Echocardiographic Analysis
Authors: Toshiyuki Kimura, Nozomi Watanabe, Yoshisato Shibata
Journal: Circulation (2023)

Background: We sought to seek an answer for the question whether the transcatheter mitral valve edge-to-edge repair (TEER) without annuloplasty can induce chronic positive remodeling of the annulus and restore the physiological saddle-shape morphology after the procedure. Methods: We serially analyzed the 3D echocardiographic images in 20 patients who were successfully treated with MitraClip for symptomatic severe mitral regurgitation (MR) (16 functional, and 8 degenerative). Four patients who had the recurrence of MR greater than moderate at chronic phase (3 functional, and 1 degenerative) were also evaluated. 4D-volumetric transesophageal (TEE) and transthoracic echocardiography (TTE) data were assessed offline by dedicated software at 1) before, 2) 5-day and 3) 1-year after the clipping procedure. Results: Annulus shortened in anterior-posterior (AP) direction in early after the TEER procedure (5-day), with keeping anterolateral-posteromedial (AL-PM) diameter and annulus circumference. Following the initial A-P reshape of the annulus, annular diameters reduced both in AP and ML directions with restoring physiological saddle shape (annulus height/AL-PM diameter) in one-year after the valve leaflet intervention (see figure). Conclusions: Fixing leaflet coaptation by successful TEER could induce chronic positive remodeling of the entire mitral annulus, with restoring its physiological saddle shape. Our results show that simple reduction in MR burden can cause the beneficial restoration of the valve apparatus morphology. Progressive negative annular remodeling was found in patients with recurrent MR.
Abstract 13263: Utilization of Proteomic Surrogates for Early Detection of Unexpected Drug Benefits
Authors: Jessica Chadwick, Michael Hinterberg, Clare Paterson, Sama Shrestha, Missy Simpson, Emma Troth, Stephen A Williams
Journal: Circulation (2023)

Introduction: Detection of benefits and adverse effects of therapies in early clinical trial phases could improve the safety, efficiency, and cost of clinical trials. For example, while SGLT2i and GLP-1 RA drugs are recognized success stories, earlier identification of their benefits beyond improved diabetic control may have had the potential to save loss of patients’ lives and years of sales. Hypothesis: Using the EXSCEL and SUGAR-DM-HF trials as examples to study GLP1-RA and SGLT2i responses, we hypothesized that previously validated proteomic surrogates of cardiovascular (CV) events, and kidney health could have enabled detection of these unexpected drug benefits earlier in development in a smaller number of participants over a shorter follow-up period. Methods: CV risk and kidney prognosis SomaSignal tests (each derived from ~5000 plasma proteins measurements using SomaScan® assay) were applied to paired plasma samples at baseline and 9-months (SUGAR-DM-HF) or 1-year (EXSCEL) in intervention (EXSCEL n=1840; SUGAR-DM-HF n=45) and control (EXSCEL n=1833; SUGAR-DM-HF n=52) participants. Power calculations were performed to determine the minimum number of samples needed to detect a significant change within the treatment period with alpha = 0.05, 80% power using a t-test comparing two-sample means. Results: We demonstrated that the cardiovascular benefits of exenatide were detectable with a proteomic surrogate within 1-year (p=0.002), with power analysis indicating a significant 1-year change is observable with group sizes of n=1368 compared with &gt;7000 participants for up to 6.8 years follow-up. Additionally, kidney protection (p=0.037) and CV protection (p=0.06) impacts of empagliflozin within 36 weeks were detectable using proteomic surrogates in small sample sizes (n ~ 50) compared to published outcomes studies requiring thousands of participants followed for &gt;2 years. Conclusions: SomaSignal tests were able to predict cardiometabolic benefits of GLP-1 RA and SGLT2i drugs within a significantly shortened interval and fewer participants than in the outcome trials. Proteomics may provide a powerful tool for improving the efficacy, and cost of drug development by predicting effects of novel therapeutics in smaller, shorter studies.
Abstract 17598: Low Socioeconomic Status Leads to Higher Cardiovascular Mortality in the United States
Authors: Sri Banerjee, Rafael Gonzales-Lagos, Patrick Dunn
Journal: Circulation (2023)

Introduction: Lower socioeconomic status can lead to chronic disease. However, there is a dearth of information as to how it pertains to organ-specific mortality. Hypothesis: In this study, we determined if there was a connection longitudinally between poverty-income-ratio (PIR) and cardiovascular mortality Methods: We conducted a study which assessed for all adult (≥ 20 years) individuals from the 1999-2010 National Health and Nutrition Examination Survey, which is a population-based survey conducted with cardiovascular mortality data obtained through December 2019. All individuals from this were living in the United States. Socioeconomic status was determined using total family income divided by the poverty threshold (≤1 versus &gt;1). Comparisons were analyzed using Complex Samples Cox regression to determine the relationship of poverty-income-ratio and cardiovascular mortality. Results: Data was available for 13,680 adults in the United States population. Mean time period of males (8.3 years (CI 8.0-8.5) who experienced death was higher than the mean time period among females 8.8 years (CI 8.6-9.0). The overall age-adjusted, sex-adjusted hazard ratio for high PIR to low PIR is 1.73 (1.39-2.16, p &lt; 0.01). The adjusted HR remained strong at 1.98 (CI 1.18-3.33, p &lt; 0.01) among adults after the results were controlled for medical (obesity, depression) and demographic (gender, age, and ethnicity) risk factors. Conclusions: There is a significant relationship between low socioeconomic status and cardiovascular mortality among all adults. Consequently, individuals with cardiovascular disease need to be better screened for social determinants of health.
Abstract 15813: Machine Learning Improves Prediction of Heart Failure and Cardiovascular Death Through a Signal Analytical Approach of Echocardiography
Authors: Jakob O Simonsen, Rune Hoejlund, Daniel Modin, Kristoffer G Skaarup, Jacob Christensen, Mats Lassen, Niklas D Johansen, Sergio Sanchez, Brian Claggett, Jacob Marott, Magnus Thorsten, Gorm Jensen, Peter Schnohhr, Rasmus Mogelvang, Tor Biering-Srensen
Journal: Circulation (2023)

Introduction: Recently, speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) have gained increasing traction as non-invasive tissue characterization methods within cardiology. But until now many patterns from the strain and TDI curves remain uninvestigated. Signal analytical methods like wavelet analysis have shown promising potential in effectively identifying previously unknown pathological patterns present in ECG signals. Therefore, we hypothesized that a signal analytic approach combined with supervised machine learning (ML) on strain and TDI curves could identify unknown pathophysiological deformation drivers of heart failure (HF) and cardiovascular death (CV death) in the general population. Methods: The analysis included 3781 subjects from the general population. In total 720 novel statistical parameters and wavelet signal parameters from 18 strain curves and 6 TDI curves were generated. The parameters were used to train an ensemble decision tree with 20-fold cross-validation and compared to a baseline ML model trained on 22 conventional echocardiographic parameters. Results: Follow up-time was four years. In total 108 subjects (2.9%) met the outcome. By including statistical and wavelet-derived parameters along with 22 conventional echocardiographic parameters in a combined model, the ML model was significantly improved compared to the baseline model (AUC for conventional model: 0.76 vs combined model: 0.825, p = 0.0086). Both statistical parameters, such as the mean and skewness of the TDI curve, as well as wavelet parameters, such as mean on the first decomposition level of the strain curve, were found to be important in the model. Conclusion Adding novel echocardiographic parameters based on signal analytical statistics and wavelet decomposition methods to preexisting conventional echocardiographic parameters significantly improved the prediction of incident HF or CV death in ML models.
Abstract 14117: Home Operated Ultrasound Exam for Detection of Worsening Heart Failure
Authors: Stuart B Prenner, Kevin Dougherty, Frances S Shofer, Lee R Goldberg, Nova Panebianco
Journal: Circulation (2023)

Introduction: Acute Decompensated Heart Failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artifact called B-lines directly correlate with pulmonary vascular congestion (PVC) and can be seen on a limited lung ultrasound. Hypothesis: We assessed the ability of a recently hospitalized patient with ADHF to self-perform a lung ultrasound using a hand-held ultrasound and store images for physician interpretation. Methods: This was a prospective observational convenience sample of patients with known chronic heart failure admitted to an urban academic tertiary care center. The patient was educated on a 6 lung-zone image protocol, how to use the cloud archival system, and given a hand-held ultrasound transducer and iPad. The patients were asked to upload images three times a week, for 3 weeks. A B-line score for each interpretable lung zone was calculated. Results: Fifteen patients were enrolled, all of whom completed 7 or more scans. Average patient age was 60 years (range: 28- 86 years), 73% male, 60% white, and 47% obese. Five patients had ejection fraction &gt;50%, and average length of hospital stay was 6.3 days. Of the 792 potential images, 784 were obtained (99%) and 637 (81%) were interpretable. The right upper zone was most often interpretable (97%), whereas the left lateral zone was least (70%). Median patient B line score when indexed to 6 interpretable scans was 3.00. Indexed B line scores are shown for all 15 patients (Figure 1). Patient survey data identified the left lateral zone as the most challenging to obtain. Conclusions: This pilot study shows that patients with ADHF can be taught how to use a hand-held portable ultrasound device and obtain and upload lung ultrasound images to a cloud. Compliance with the study protocol was excellent. Further studies are needed to determine if patient-performed lung ultrasound can be useful to clinicians to detect and manage PVC in this patient population.
Abstract 17566: Prevalence of Lipoprotein(a) Testing Among Patients With CAD: A 10-year Retrospective Analysis at The University of Pennsylvania Health Systems
Authors: Lakshmi Parvathinathan, Marjorie Risman, Ahmad Alsattari, Daniel J Rader, Archna Bajaj
Journal: Circulation (2023)

Background: Lipoprotein(a) [Lp(a)] is a genetically driven independent risk factor for ASCVD. Aims: To determine the prevalence of Lp(a) testing in patients with CAD across the University of Pennsylvania Health Systems (UPHS) over the last 10 years. Methods: Electronic health record (EHR) data from 2012-2021 was queried to examine prevalence of Lp(a) testing in patients who presented with a diagnosis of CAD based on presence of corresponding ICD-9 or ICD-10 codes. Premature CAD was defined as CAD diagnosis in males age &lt; 55 years or females age &lt; 65 years. Race was self-reported. Results: Of the 173,966 patients with CAD, 2395 (1.4%) had an Lp(a) test result (mean 72.7 nmol/L), compared to 81,058 (46.6%) patients with at least one LDL-C result in the 10-year time period. About 94% of Lp(a) tests were ordered at outpatient visits, and 56.1% of the tests were ordered by Cardiology, 31.6% by Preventive Cardiology, 5.5% by Internal Medicine, and 1.2% by Neurology. Approximately 1.7% of males with CAD had an Lp(a) result (mean 65.9 nmol/L), 4.2% of males with premature CAD (mean 66.9 nmol/L), 1.6% of females with CAD (mean 84.1 nmol/L), and 3% of females with premature CAD (mean 80.9 nmol/L). The mean Lp(a) in Whites with CAD was 69.1 nmol/L compared to 104.3 nmol/L in Blacks and 54.8 nmol/L in Asians. The proportion of Whites with premature CAD who had an Lp(a) test was 3-fold higher than the proportion of Blacks with premature CAD. Conclusions: Although Lp(a) testing has increased over the past decade, it remains widely under-utilized in patients with CAD. Further, there is an apparent gap in the prevalence of testing in Black patients compared to Whites and Asians.