tbuckley/cabot-search huggingface dataset:
Abstract 14748: Unheard Voices: The Burden of Ischemia and No Obstructive Coronary Artery Disease in Women
Authors: Marah Maayah, Nazar Chowdhury, Kristie Walenczyk, Carolyn M Mazure, Matthew Burg, Erica S Spatz, Michelle Bernabeo, Jessica Ritchie, Samit Shah
Journal: Circulation (2023)

Introduction: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in women. Up to two-thirds of women with IHD suffer from ischemia with no obstructive CAD (INOCA), which includes endotypes such as microvascular dysfunction and vasospasm. Due to a lack of clear prognostic data, INOCA has historically been viewed as a benign condition, and many women have been dismissed from cardiovascular care despite refractory symptoms and a risk for adverse outcomes. Hypothesis: Women with INOCA have a high burden of symptoms and significant functional limitation due to poorly controlled symptoms, which can be characterized with a structured interview. Methods: We enrolled 41 women with INOCA who underwent clinically-indicated invasive coronary physiology testing. Structured interviews were performed to elicit symptom characteristics, limitations, and perception of illness. Data extracted from the interviews was analyzed using the constant comparison method to determine common themes among women with INOCA. Results: The most common symptoms in our sample included chest pain (n=38, 93%), dyspnea (35, 85%), fatigue (32, 78%), and abnormal heart rhythms (27, 66%). Most patients experienced symptoms daily (24, 59%) and reported that their symptoms were severe (33, 80%). They expressed limitations to instrumental activities of daily living (25, 61%), hobbies (23, 56%), work (19, 46%), and travel (11, 27%). Many reported a sense of foreshortened future (26, 63%), a feeling of invalidation by providers and loved ones (25, 61%), and difficulty getting a diagnosis (31, 76%). After receiving a diagnosis, they reported positive outcomes such as reduced stress and better understanding of disease management (38, 93%). Conclusions: Women with INOCA have significant impairment in quality of life due to frequent anginal symptoms. Feelings of invalidation were common, and many patients reported multiple incorrect diagnoses. After receiving a diagnosis, they reported reduced stress, improvement in illness perception, and hope for improved health in the future. These findings demonstrate the importance of recognizing INOCA and incorporating advances such as physiology-guided medical therapy into routine practice.
Abstract 16652: Cardiovascular Outcomes of Renin-Angiotensin System Inhibition Amongst Non-Proteinuric Chronic Kidney Disease Patients in the Chronic Renal Insufficiency Cohort
Authors: Rachel Shulman, Jordana Cohen, Wei Yang, Debbie L Cohen, Peter Reese, Raymond R Townsend
Journal: Circulation (2023)

Introduction: Chronic kidney disease is a leading cause of CVD morbidity and mortality. The majority of CKD patients do not have proteinuria. Current therapies, including renin-angiotensin system (RAS) blockers, are only known to be beneficial in proteinuric CKD. Our goal was to evaluate the association of RAS blockade with long-term CVD outcomes and survival among those with non-proteinuric CKD. Methods: The cohort included subjects in the prospective Chronic Renal Insufficiency Cohort Study without proteinuria at study entry. Non-proteinuric CKD was defined as urine protein &lt;0.5g/day. We excluded subjects with heart failure or not on hypertension treatment. We used Cox proportional hazards regression to evaluate the association of RAS blockade vs. other antihypertensive therapy with CVD outcomes and death. The primary outcome was a composite of physician-adjudicated CVD events, including MI, stroke, heart failure hospitalization and death. Baseline covariates were adjusted through inverse probability of treatment weighting including: age, sex, race, education, smoking, BMI, diabetes, blood pressure, eGFR, and statin use. Results: A total of 2,825 of subjects met inclusion criteria. There were 2,068 subjects using vs 757 not using (73% vs 27%) RAS blockade at entry. Users had a similar age (61 vs 62 years) and eGFR (50 vs 51ml/min/1.73m 2 ) to non-users. Users were more likely to be male (66% vs 46%), to have diabetes (59% vs 30%), and to be on a statin (61% vs 50%). No significant association was found between RAS blockade and CVD events (adjusted HR 0.90, 95% CI 0.76-1.07) or mortality (adjusted HR 0.84, 95% CI 0.68-1.04) compared to other antihypertensive therapy. Conclusions: Among adults with non-proteinuric CKD, baseline use of RAS blockade was not associated with a lower risk of long-term events or mortality. Further studies are needed to determine if RAS blockade may play a role in high-risk patients with non-proteinuric CKD.
Abstract 13427: Incidence and Causes of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-year Study
Authors: Bradley J Petek, Timothy Churchill, Nathaniel Moulson, Stephanie A Kliethermes, Aaron L Baggish, Jonathan A Drezner, Manesh R Patel, Michael J Ackerman, Kristen L Kucera, David M Siebert, Monica L Zigman Suchsland, Lauren Salerno, Irfan Asif, Joseph J Maleszewski, Kimberly G Harmon
Journal: Circulation (2023)

Background: The incidence and causes of sudden cardiac death (SCD) among young competitive athletes impact prevention strategies yet remain incompletely understood. Methods: National Collegiate Athletic Association (NCAA) athlete deaths from 7/1/2002-6/30/2022 were identified through 4 independent databases/search strategies. Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. Poisson regression was used to calculate incidence rate ratios (IRR) for 5-year intervals over the 20-year study. Results: A total of 143 SCD cases were identified among 1102 athlete deaths and 9,106,516 athlete-years (AYs). The incidence of SCD among NCAA athletes was 1:63,682 AYs [95% CI 1:54,065, 1:75,010]. Incidence was higher in males compared to females (1:43,348 vs. 1:164,504 AYs) and Black compared to White athletes (1:27,217 vs. 1:74,581 AYs). The highest incidence of SCD was among Division 1 male basketball players (1:8,188; White 1:5,848; Black 1:7,696 AYs). The incidence rate for SCD decreased over the study period (5-year IRR 0.71 [95% CI 0.61,0.82]), whereas the rate of non-cardiovascular deaths remained stable (5-year IRR 0.98 [95% CI 0.94,1.04]; Figure 1A ). Autopsy-negative sudden unexplained death (AN-SUD, 19.5%) was the most common post-mortem exam finding, followed by idiopathic left ventricular hypertrophy/possible cardiomyopathy (CM, 16.9%) and hypertrophic CM (12.7%) in cases with enough information for adjudication (118/143, Figure 1B ). There were 8 cases of myocarditis, with none attributed to COVID-19 infection. SCD events occurred most commonly during exertion among athletes with coronary artery anomalies (100%) and arrhythmogenic CM (83%), whereas AN-SUD and hypertrophic CM had a higher proportion of non-exertional SCD (44% and 40%, respectively). Conclusions: The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.
Abstract 14549: Body Mass Index Shift and Associated Cardiometabolic Risk Factors in People With Obesity or Overweight: A Post Hoc Analysis From SURMOUNT-1
Authors: Naveed Sattar, Reshmi Srinath, Xuanyao He, Beverly L Falcon, Clare J Lee, Adam Stefanski, Arian Plat
Journal: Circulation (2023)

Introduction: In SURMOUNT-1, treatment with once weekly GIP and GLP-1 receptor agonist tirzepatide resulted in substantial body weight reductions in people living with obesity. Hypothesis: This post hoc analysis assessed whether participants with obesity (body mass index [BMI] ≥30 kg/m 2 ) or overweight (BMI ≥27 kg/m 2 with at least one weight-related comorbid condition) who shifted to a lower BMI category had improved cardiometabolic factors. Methods: Change in BMI category (&lt;25 kg/m 2 , 25 to &lt;30 kg/m 2 , 30 to &lt;35 kg/m 2 , 35 to &lt;40 kg/m 2 , and ≥40 kg/m 2 ) from baseline to week 72 was assessed in participants from SURMOUNT-1 (N=2539) treated with tirzepatide or placebo. BMI shifts were grouped into “improved” (shift to at least one lower BMI category) or “stable” (no change) or “worse” (shift to a higher BMI category). Cardiometabolic parameters included waist circumference, fasting insulin, fasting glucose, HbA1c, blood pressure, and lipid profile. Results: In SURMOUNT-1, most participants demonstrated improved BMI with tirzepatide treatment (N=1457, 76.8%) while some had stable BMI (N=422, 22.3%) or worsened BMI (N=5, 0.3%) (Table). Furthermore, 38.1% improved by ≥2 BMI categories. Most placebo-treated participants had stable BMI. Compared to those with stable or worsened BMI, participants with improved BMI demonstrated greater improvement in cardiometabolic risk factors, including decreases from baseline in waist circumference, fasting insulin, fasting glucose, HbA1c, systolic and diastolic blood pressure, triglycerides, and cholesterol (non-HDL-c, and LDL-c) and increases from baseline in HDL-c. Conclusions: Substantial shifts to lower BMI categories were observed among tirzepatide-treated people living with obesity or overweight in SURMOUNT-1. Improved BMI and accompanying cardiometabolic risk factors with tirzepatide may lower further cardiovascular outcomes. Relevant outcomes trials are ongoing.
Abstract 13745: Exploring the Segment-Wise Explainability of Electrocardiogram on Deep Learning-Based Models for Acute Myocardial Infarction
Authors: Younghoon Ji, Kyung Hoon Cho, Mineok Chang, Sunghoon Joo, Minje Park, Kyung Geun Kim, Yeha Lee, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Juhan kim, Young Keun Ahn, Myung Ho Jeong, Dong-Geum Shin, Jung Rae Cho, Min-Kyung Kang, Choi Seonghoon, Namho Lee, Donghoon Han
Journal: Circulation (2023)

Background: While DL models for AMI detection using ECGs have advanced, their 'black box' nature hinders seamless integration into clinical practice, as it limits our understanding of their decision-making process. Research Questions: Which specific ECG segments (P, QRS, T) are considered important by the DL model for the detecting AMI, and does it fit into the ECG criteria of AMI? Aims: We aimed to examine the importance of each ECG segment in the detection of DL model for AMI. Methods: We examined the impact of various ECG segments by replacing their values with Gaussian noise and verify the decrease in AUC of a DL model for detecting AMI. The importance of each ECG segment in diagnosing AMI using a DL model was assessed by observing the performance drop in AUC of the model. DL-based model detecting AMI trained with 17,907 ECGs from 5,872 coronary angiography-validated AMI patients and 705,482 ECGs from 294,755 non-AMI patients at Chonnam National University Hospital (May 2013 - December 2020). External validation was performed at Hallym University Kangnam Sacred Heart Hospital using 357,072 ECGs from 163,870 patients (January 2006 - December 2020). For ECG segmentation, a U-Net architecture trained on LUDB was employed. Results: The test set was divided into STEMI and NSTEMI groups within internal and external sets. The occurrence rates of events in ECGs were 0.498% (1895/380149) for STEMI and 0.67% (2550/380804) for NSTEMI. In the STEMI group, the AUC values were as follows: 12-lead raw ECG - 0.988, P-wave masking ECG - 0.986, QRS-complex masking ECG - 0.943, and T-wave masking ECG - 0.939. In the NSTEMI group, the AUC values were 0.943, 0.936, 0.835, and 0.867, respectively. Conclusion: The DL model assigns varying degrees of importance to individual ECG segments when determining AMI. The results show that the AMI model effectively utilizes ECG characteristics such as QRS and T waves, which are also highly valued in clinical practice, to determine the presence of AMI.
Abstract 15779: A Comparison of Survival Outcomes in Ischemic Cardiomyopathy Following Heart Transplantation Under 2018 Allocation Criteria
Authors: Talha Chaudhry, Zahra Aryan, Julius Gardin, Juan Bello
Journal: Circulation (2023)

Introduction/Background: The adult heart transplant allocation system was changed from a 3-tiered to a 6-tiered system in 2018, prioritizing unstable patients on temporary mechanical circulatory support and patients with non-ischemic cardiomyopathies on the waitlist. Research Questions/Hypothesis: This study aims to compare post-heart transplantation survival rates and all-cause mortality of ischemic and non-ischemic cardiomyopathies in the United States before and after the implementation of the current 6-tiered heart allocation system. Methods/Approach: The United Network for Organ Sharing registry was queried from 2011 to 2021 for all adults listed for isolated heart transplantation for the first time. The Kaplan-Meier method and Cox proportional hazards regression modeling were used to compare the post-transplantation outcomes between ischemic and non-ischemic cardiomyopathies. Results: A total of 21,104 cases were included in the final analysis. The 1, 5, and 10-year survival rates of ischemic versus non-ischemic cardiomyopathies were 89.7% vs. 92.1%, 76.5% vs. 81.5%, and 48.5% vs. 62.4%, respectively (p&lt;0.001). The risk of all-cause mortality was greater in patients with ischemic cardiomyopathy (Hazard Ratio: 1.368, 95% CI, 1.285 - 1.457, p&lt;0.001). Post heart transplant survival rate has decreased by approximately 2% since 2018 compared to the era of the prior allocation system (p&lt;0.001). Conclusions: The gap between the survival rate of ischemic and nonischemic cardiomyopathies has not improved since 2011. The one-year survival rate has dropped by ~2% since 2018, partly due to the new heart allocation system prioritizing clinically unstable patients.
Abstract 18128: How Long Should We Tilt?: Challenging the 10-Minute Cutoff in the Diagnosis of Postural Tachycardia Syndrome (POTS)
Authors: Mohak Gupta, Bianca Honnekeri, Ramya Vajapey, Erika Hutt, Kenneth Mayuga
Journal: Circulation (2023)

Background: Postural tachycardia syndrome (POTS) is defined by symptoms of orthostatic intolerance (OI) that correlate with an orthostatic tachycardia response. Current diagnostic criteria require a sustained increase in HR by ≥30 bpm [accentuated postural tachycardia (APT)], without a concurrent BP drop, within 10 minutes of standing or head-up tilt testing (HUTT). In many centers, the HUTT duration is predetermined to be 10 mins. However, many patients may exhibit APT after this cutoff. Research Question: How many patients with symptoms consistent with POTS demonstrate APT during HUTT after the 10-min cutoff, and what factors influence onset time? Methods: Using a cohort of 255 patients with OI, we characterized the temporal distribution of APT onset time during 45-minute HUTT at our referral center. We used multivariate linear regression to identify predictors influencing onset time, and plotted Kaplan-Meier failure function stratified by predictors. Results: The cohort's mean age was 33 years, 91% were female, 16% were obese, 13% had hypertension, 1.6% had diabetes, and 26% were smokers. Mean APT onset time was 17.5 mins (SD 10), and median onset time was 13 mins (IQR 11-22). About 15% had APT onset within 10 min, 60% in 15 mins, 75% in 20 mins, 90% in 30 mins, and 95% in 40 mins. Increasing age and BMI were associated with later APT onset time, whereas sex, diabetes, hypertension, and smoking were not influential Conclusion: The 10-min cutoff captured only 15% of patients with APT; extending the cutoff just 5 minutes longer captured an additional 60% patients. Our findings suggest that the current 10-min cutoff for POTS diagnosis is likely too restrictive, as a significant proportion of patients exhibit APT after this period but otherwise fit the clinical scenario of POTS. Increasing age particularly ≥40 yrs, and obesity were associated with a later APT response. Future definitions should consider extending the testing duration and cutoff time in the evaluation of POTS.
Abstract 15690: The Impact of Frailty on 6-12 Months Adverse Outcomes Following Left Atrial Appendage Closure
Authors: Simon Liu, Zaid Zayyad, Pranati Sreepathy, Siddharth Bhayani, Manoj Ambalavanan, Helena Dickens, David Tiu, Daniel Tiu, Bayan Hammad, Azmer Khan, Mayank M Kansal, Khalil Ibrahim, Adhir R Shroff
Journal: Circulation (2023)

Introduction: Frailty is a syndrome of functional decline characterized by an increased risk for adverse health outcomes. The association between frailty and left atrial appendage closure (LAAC) outcomes has not been extensively studied yet. This study aims to analyze the impact of frailty on adverse health outcomes following LAAC. Method: Retrospective review of electronic medical records from June 2016 to December 2021 at the University of Illinois, Chicago identified LAAC patients, who were included if they were followed-up within 6 and 12 months of the procedure. Patients were stratified into frail and non-frail groups based on the Johns Hopkins Claims-based Frailty Indicator, an externally validated index. Outcomes included 6- and 12-months major bleeding event defined by VARC, death, and hospitalization indexes. Two-sample t-tests and chi-squared tests were used to compare continuous and categorical variables, respectively. Results: Our cohort included 101 patients (age 72 ± 9 years, 75% male, 24% white): frail (N=34) and non-frail (N=67) groups. There were no statistically significant differences in baseline demographics, comorbidities, and medication except for older age in frail patients (79.6 vs 68.3 years, p=0.000). Although frail patients had higher mortality rate at 6 months (8.82% vs 0%, p=0.014), no differences were seen for nonhome discharges (6.67% vs 1.54%, p=0.184), 6-months major bleeding events (2.94% vs 2.99%, p=0.990), 6-month emergency department visits (38.2% vs 28.4%, p=0.313), and 6-month hospital admission (20.6% vs 25.4%, p=0.593). There were also no differences seen for mortality rate at 12 months (11.8% vs 5.97%, p=0.308), length of hospital stays (1.35 vs 1.37 days, p=0.966), 12-months major bleeding event (2.94% vs 4.48%, p=0.708), and 12-months hospital admission (29.4% vs 31.3%, p=0.842). Conclusion: Our results suggest that frail patients are at a higher risk for death within 6 months following LAAC despite no observable differences in comorbidities, medications, other adverse events, and hospitalization indexes, including nonhome discharges. Additional analysis is needed to determine factors that may preclude frail patients from hospital admissions or precipitate earlier death.
Abstract 16870: Short-Term Risk Prognostication for All-Cause Mortality After Endovascular Revascularization in the Medicare Claims-Linked VQI Registry
Authors: Jacob Cleman, Gaelle Romain, Santiago Callegari, Lindsey Scierka, Francky Jacque, Jeremy B Provance, Kim G Smolderen, Carlos Mena-Hurtado
Journal: Circulation (2023)

Background: Patients with chronic limb-threatening ischemia (CLTI) have high mortality rates after revascularization. Balancing short-term mortality risk against limb salvage gains is important when triaging patients with CLTI to revascularization. Data for risk stratification is limited. We aimed to develop machine learning models to rank predictive variables for 30-day and 90-day all-cause mortality for CLTI after peripheral vascular intervention (PVI). Methods: Patients undergoing PVI for CLTI between 2017 and 2018 in the Medicare-linked Vascular Quality Initiative (VQI) were included. Sixty-six preprocedural variables were included in random survival forest (RSF) models. RSF models were constructed for 30-day and 90-day all-cause mortality in the training sample (80% of data) and evaluated in the validation sample (20% of data). Predictive variables were ranked based on frequency that they caused branch splitting nearest the root node. Goodness of fit was assessed by Harrell’s C-index. Results: A total of 10,114 patients (mean age 72 ± 11, 59% male, 74% white) were included. The mortality rate was 4.4% at 30 days and 10.6% at 90 days. The RSF model for 30-day mortality identified stage 5 chronic kidney disease (CKD), dementia, and urgent procedures as the most predictive variables. For the 90-day mortality prediction model, the most important variables were stage 5 CKD, dementia, and poor functional status (Figure) . For both models, 8 of the top 10 variables were either medical history or functional status variables. The C-index was 0.72 for the 30-day model and 0.73 for the 90-day model. Conclusion Using data from the claims-linked VQI registry, medical comorbidities and functional status variables were identified as the most predictive variables for 30-day and 90-day all-cause mortality using RSF models. Results may help guide individualized risk conversations regarding PVI versus conservative therapy for the highest risk patients.
Abstract 13428: Validation of the Tri-Score for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asians
Authors: Dae-Young Kim, Jihoon Kim, Iksung Cho, Eun Kyoung Kim, Geu-Ru Hong, Jong-Won Ha, Sung-ji Park, Chi Young Y Shim
Journal: Circulation (2023)

Introduction: TRI-SCORE was recently developed in Europe as a risk model for predicting in-hospital mortality after isolated tricuspid valve surgery (ITVS). Hypothesis: This study aimed to validate TRI-SCORE in an Asian population and investigate its value for predicting long-term outcomes. Methods: The TRI-SCORE was calculated for 186 patients (65 ± 12 years, 62% female, 88% functional tricuspid regurgitation [TR]) who underwent ITVS for severe TR at two Korean centers and was based on eight parameters: age, New York Heart Association class, right-sided heart failure signs, furosemide daily dose, glomerular filtration rate, bilirubin, left ventricular ejection fraction, and moderate/severe right ventricular dysfunction. The primary outcome was all-cause death during follow-up; the secondary outcome was in-hospital mortality. Results: During a median follow-up duration of 50 months after ITVS (interquartile range 22-82), 21 patients (11.3%) experienced the primary outcome, and six patients (3.2%) experienced the secondary outcome. Observed all-cause death and in-hospital mortality increased by up to 50% in those with higher scores. Patients with the primary outcome had a higher TRI-SCORE (4.4 ± 2.5 vs. 2.9 ± 2.1, p = 0.003) than those without. The TRI-SCORE showed a significant association with the primary outcome (concordance index: 0.76, cut-off value: 4) and in-hospital mortality (concordance index 0.84, cut-off value: 5) (Figure). Using the Kaplan-Meier analysis, patients with a high TRI-SCORE exhibited a poor clinical outcome for all-cause death at follow-up (log-rank p = 0.001) and in-hospital mortality (log-rank p = 0.003). Conclusions: TRI-SCORE was validated in an Asian population and helped predict long-term outcomes after ITVS.