tbuckley/cabot-search huggingface dataset:
Abstract 4144536: Predicting Intramyocardial Hemorrhage Following Reperfusion Therapy for Acute MI with Coronary Biomarkers and Hemodynamic Modeling
Authors: Gabriel Gruionu, Keyur Vora, Khalid Youssef, Rohan Dharmakumar
Journal: Circulation (2024)

Introduction: Emergency PCI has reduced immediate death in STEMI patients. However, reperfusion therapy can cause intramyocardial hemorrhage (IMH) in 40% of STEMI patients and has emerged as a major predictor of adverse CV events. The mechanisms contributing to the development of IMH, however, are not understood. Research Hypothesis: We hypothesize that hemodynamic forces (pressure variation and blood flow redistribution) influenced by the topological organization of coronary vasculature plays a major role in IMH development. Goal: We tested our hypothesis by developing a computational model of the coronary vasculature to determine patient-specific coronary network topology biomarkers and hemodynamics associated with IMH. Methods: Pre- and post-PCI coronary angiograms from STEMI patients (n=17) were stratified into 4 groups (IMH:H; Collaterals: C): H-/C+; H+/C-, H-/C-, and H+/C+). T2* MRI was used to identify IMH. Vascular topology and hemodynamics of the main branches of LCx and LAD and associated collaterals (if present) were determined. Computational model used input pressure of 100mmHg, 40mmHg threshold for IMH in microvasculature, and pressure-flow relationships. Results: A higher density of vessels on angiograms in the H-/C+ group (91±15) vs H+/C- (47±19) with smaller vessel diameters (1.2±0.2mm (H-/C+) vs 1.6±0.4mm (H+/C-)) of shorter length (7.4±1.1mm vs 11±3.5mm) were observed. There were more 3 rd or 4 th order arterioles (41±6.7 vs. 21±8) with smaller diameters (0.72±0.6 vs. 0.9±0.2mm) in H-/C+ vs H+/C-. The Junctional Exponent (JE, a coronary network biomarker) was significantly lower in the H-/C+ vs other groups in pre-PCI (1.48±0.1 vs 1.74±0.02 H+/C- p=0.021; 1.79±0.12 H-/C- p=0.021; 1.6±0.12 H+/C+ p=0.008) and post PCI (1.44±0.11 vs 1.87±0.19 H+/C- p=0.02; 1.64±0.07 H-/C- p=0.04) except H+/C+ (1.58±0.11 H+/C- p=0.46) suggesting hemodynamically efficient branching structure in the H-/C+ group. Hemodynamic simulations indicated that prior to PCI, collaterals provide some tissue perfusion to the MI area whereas, after PCI, collaterals play minimal role in flow redistribution. Mean segment pressure was lower in the H-/C+ vs. H+/C- groups (55.6±4.2 vs. 60.8±7.7mmHg, p=0.41) whereas the terminal arterial flows were not different (p=0.94). Conclusions: Our early findings support the notion that coronary network topology influences hemodynamic factors and contributes to the development of hemorrhagic MI.
Abstract 4144376: Applying artificial intelligence chatbot to increase heart disease awareness and knowledge in women
Authors: Yoshimi Fukuoka, Diane Kim, Holli Devon, Jingwen Zhang, Thomas Hoffmann, Kenji Sagae
Journal: Circulation (2024)

Introduction: Heart disease is the leading cause of death (LOCD) in women in the United States. Despite public campaigns, women's awareness of heart disease as the LCOD of death for women significantly decreased from 65% in 2009 to 44% in 2019. Significant declines were observed in Black, Hispanic, and young women. Aims: This pilot trial aims to evaluate the acceptability/usability and potential efficacy of the fully automated artificial intelligence (AI) HeartBot program to increase awareness and knowledge of heart attacks in women. Methods: In this pre-and post- trial, 102 women were asked to complete the baseline survey and then interact with the HeartBot. The HeartBot is an AI-based text-driven conversational agent, available 24 hours a day, 7 days a week, and fully automated (Figure 1). After 4 weeks of the interaction, women were asked to complete the post-survey. The primary outcomes include four questions (recognizing the signs and symptoms of a heart attack, telling the difference between the signs or symptoms of a heart attack and other medical problems, calling an ambulance or dialing 911, and getting to an emergency room within 60 minutes after the onset of your symptoms of a heart attack). Wilcoxon signed rank tests and ordinal logistic regression models were used to evaluate the HeartBot program. Results: The mean (SD) age was 46 (12) years; 60.6% of the sample was women with racial/ethnic backgrounds; 41.3% reported commercially available chatbot use (i.e. Siri) in the past 30 days. 88.5% of the sample completed the trial and the majority accepted HeartBot use. The mean (SD) length of the HeartBot interaction was 13 (11) minutes. Overall, the Wilcoxon signed-rank test indicated a significant increase in all outcomes of heart attack awareness and knowledge from the baseline and the post-Heartbot interaction ( p &lt; 0.05) (Figure 2). In the ordinal regression model, this significance of the outcomes remains even when controlling for potential confounding factors ( p &lt; 0.05). Conclusion: To the best of our knowledge, this was the first pilot trial to demonstrate the potential efficacy of the HeartBot program in the short term in women with diverse racial/ethnic backgrounds. However, a full-scale randomized controlled is warranted.
Abstract 4144305: Comparison of Transradial Versus Transfemoral Access in Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Authors: Laveeza Fatima, Mushood Ahmed, Eeshal Zulfiqar, Muhammad Daoud Tariq, Sonia Hurjkaliani, Fiza Mushtaq, Adeel Ahmad, Asad Rahman, Raheel Ahmed
Journal: Circulation (2024)

Background and Purpose: Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool. Results: The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27]. Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36]. Conclusion: TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.
Abstract 4144404: Efficacy of Mavacamten on Echocardiographic Parameters and Cardiac Biomarkers in Hypertrophic Cardiomyopathy Patients: A Systematic Review and Meta-Analysis
Authors: Zina Otmani, Noura Abdrabou, Hazem Ayman Elsayed, Mahmoud Diaa Hindawi, Ahmed K. Awad
Journal: Circulation (2024)

Introduction: Mavacamten, a cardiac myosin inhibitor, distinguishes from other pharmacological interventions by addressing not only symptomatic treatment but also targeting the underlying pathophysiological mechanisms in Hypertrophic Cardiomyopathy (HCM). Therefore, we aimed in our meta-analysis to evaluate the impact of mavacamten on echocardiographic parameters and cardiac biomarkers in HCM patients. Methods: We searched different databases such as PubMed, SCOPUS, WOS, and Cochrane from inception until February 20, 2023, for any randomized controlled trials (RCTs) that compare mavacamten to placebo in HCM patients and report the echocardiographic parameters. Our outcomes of interest were diastolic function parameters [lateral and septal early diastolic mitral annular velocity (lateral e’ and septal e’), lateral and septal ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity of the septum (E/e’ lateral and septal ratio)], left ventricular parameters [left ventricular ejection fraction (LVEF) and left ventricular outflow tract (LVOT) valsalva gradient ], as well as cardiac biomarkers [NT-proBNP and troponin]. We used the mean difference (MD) for continuous outcomes with the corresponding 95% confidence interval (CI). Results: Four RCTs with a total of 503 patients were included. Mavacamten led to a significant improvement in lateral e’ and septal e’, (MD=1.43, 95% CI [1.06, 1.79]), (MD=0.78, 95% CI [0.51, 1.05]) respectively compared to placebo. Furthermore, mavacamten was superior to placebo in reducing E/e’ lateral ratio, (MD=-3.05, 95% CI [-5.05, -1.05]) E/e' septal ratio (MD=-3.38, 95% CI [-4.50, -2.25]), LVEF, and LVOT valsalva gradient, (MD=-3.52, 95% CI [-4.76, -2.27]), (MD=-51.02, 95% CI [-69.66, -32.38]), respectively. Regarding to cardiac biomarkers, mavacamten demonstrated substantial efficacy in reducing NT-proBNP (MD=-557.14, 95% CI [-685.59, -428.68]), and troponin (MD=-8.47, 95% CI [-12.73, -4.21]). Conclusion: Our meta-analysis reveals that mavacamten significantly enhanced echocardiographic outcomes for diastolic function and left ventricular parameters. Also, mavacamten led to a significant reduction in cardiac biomarkers.
Abstract 4144306: Relation Between Periprocedural Acute Myocardial Infarction And Coronary Microcirculation In Elective Percutaneous Coronary Intervention
Authors: Pedro Jallad, Danilo Maksud Maksud, Bruno Alves, Jean Carlos Calderon, ROGER GODINHO, Brunna Pileggi, Neuza Lopes, Luis Henrique Gowdak, Alexandre Abizaid, CARLOS CAMPOS
Journal: Circulation (2024)

Background: Coronary microvascular dysfunction in patients with stable coronary artery disease (CAD) predicts worse long-term clinical outcomes. Whether the dynamic changes of the microcirculation during elective percutaneous coronary intervention (PCI) might be associated with the occurrence of periprocedural acute myocardial infarction (pMI) is still unknown. Objective: In this study we aimed to investigate the impact of pre and post-PCI angiographic-derived index of microcirculatory resistance (AMR), coronary flow velocity ratio (CFVR) and μFR on periprocedure myocardial infarction (pMI). Methods: Between June 2021 and December 2023, patients with CAD who underwent elective PCI at a tertiary hospital in Brazil, were considered for inclusion; patients with side branch occlusion were excluded. All eligible patients underwent microcirculation analysis using AngioPlus Core (Shanghai Pulse Medical Technology Inc). The primary outcome was the incidence of pMI, as defined by the Fourth universal Definition (4thU) and by the Society for Cardiovascular Angiograph&amp;Interventions (SCAI) criterias. Results: 330 patients were included into the analysis. Figure 1 (A-D) shows the behavior of epicardial pressure and flow and, the microvascular resistance according to the occurrence of pMI. Dynamic changes in coronary microcirculation, lead to differences between the delta of μFR, AMR and CFVR pre and post-PCI, which are correlated with pMI in patients undergoing elective PCI. The best parameter to predict pMI was delta AMR (4thU AUC 0.64; SCAI AUC 0.68; Figure 1A). Patients who developed pMI, presented significantly higher values of delta μFR (4thU p&lt; 0.001; SCAI p 0.04; Figure 1B) and delta AMR (4thU p &lt; 0.001; SCAI p = 0.005; Figure 1C). There is a tendency for CFVR to decrease in pMI population, as seen in delta CFVR value (4thU p = 0.03; SCAI p = 0.007; Figure 1D). Conclusion: Computational angiographic-derived indexes were able to identify patients with pMI undergoing elective PCI irrespective of the pMI definition. These indexes have potential utility in clinical practice for patient’s risk stratification.
Abstract 4144271: AI-Assisted Transseptal Puncture: Visual-Prompt Fine-Tuning of Foundation Models on Low-Dose X-RAY Images
Authors: Xiuyu QI, Xingyao Wang, Chang Cui, WEIZHU JU, Minglong Chen
Journal: Circulation (2024)

Background: Transseptal puncture (TSP) is a critical step allowing access from right atrium to left atrium in cardiac interventions. The operation relies heavily on real-time X-ray imaging and often involves subjective decision-making needing experience. Recent advancements in artificial intelligence (AI), particularly visual foundation model offer promising solutions to enhance the precision and consistency of TSP. Research questions: We hypothesize that a foundation model fine-tuned on real TSP images and expert annotations, can accurately predict the optimal puncture site on imaging. Aims: This study aims to develop and validate an AI method that automatically identifies the ideal TSP site using only the CS catheter as a reference in X-RAY image. This approach seeks to replicate the decision-making process of experienced clinicians, thereby improving the accuracy and safety of the procedure. Methods: A pilot study enrolled 101 patients in one center. Three experienced senior practitioners are responsible for labeling these images. To learn information from limited X-RAY images, we design a co-training framework based on Segment Anything Model (SAM) to fine-tune the decision module for TSP by combining visual prompts of the three bounding boxes (heart edge, spine, and coronary sinus electrode). The input images are captured before puncture and resized to 512*512. The candidate puncture area is set as a circle centered at actual puncture point with a radius of 10 pixels. Results: Images from 80 patients were used to fine-tune the decision module, while 21 for validation. The Intersection over Union (IoU) on validation set is 70.22% for the pre-defined candidate TSP circle. In validation, the success rates of the predicted TSP point (the center of the predicted area) falling within radii of 5, 10, 15 pixels cantered on the actual TSP site are 56.30%, 72.01% and 83.54%, respectively. Conclusions: In this study, we introduce an AI-assisted visual prompt for TSP using SAM-based fine-tuning. With the limited samples, the performance of puncture-site prediction underscores the potential of our framework as an efficient solution for TSP guidance and assistance. The future works include expanding the sample size and testing whether visual prompts can enhance TSP quality and clinical training.
Abstract 4144471: Addition of Malignancy into the CHADS2/CHADS2VASc Score: Better prediction of stroke risk in cancer patients with atrial fibrillation.
Authors: Zoha Majeed, Rochell Issa, Ahmad Safdar, Rohan Prasad, Patrick Collier, Arianne Clare Agdamag, David Kaelber, Diego Sadler, Alok Khorana, Mohamed Kanj, Rohit Moudgil
Journal: Circulation (2024)

Introduction: The CHADS2 and CHADS2VASc scoring systems are used to determine thromboprophylaxis indication in patients with atrial fibrillation (AF). While these scoring systems include multiple independent risk factors for the development of ischemic stroke, their overall predictive performance is poor when applied to cancer populations. Research Question: To identify whether cancer serves as an independent risk factor for ischemic stroke in AF. Methods: TriNetX, a global health research database, was utilized to identify AF patients with and without malignancy from 2015 to 2022, excluding patients with prior cerebrovascular disease. Propensity score matching was conducted to control for demographic variables, heart failure, type 2 diabetes, hypertension and anticoagulation. Propensity matching yielded two cohorts consisting of 45,339 patients each. Risk and survival analyses were then run at 3 months, 6 months, 1 year, and 5 years after the index event. The primary outcome was stroke and secondary outcomes were mortality and major bleeding events. Results: At 3 months, our study showed that the incidence of stroke was higher in patients with AF and malignancy when compared to AF alone, with an odds ratio (OR) of 2.773 (p &lt; 0.001). A Kaplan-Meier curve analysis revealed a hazard ratio (HR) of 2.683 with a confidence interval of 2.564-2.807. These results were consistent at the 6-month, 1-year and 5-year intervals, with an OR of 2.737, 2.685 and 2.167, respectively (p-value &lt;0.001), and an HR of 2.659, 2.628 and 2.267, respectively. The results also revealed higher rates of mortality among the AF and malignancy cohort, along with elevated major bleeding events across all intervals. Conclusion: Patients with malignancy had a significantly higher risk of stroke compared to patients without malignancy, despite controlling for other CHADS2 and CHADS2VASc variables. This defines malignancy as an independent risk factor with an HR of at least 2 across all intervals. Additionally, there was a higher incidence of mortality in patients with AF and malignancy. However, this cohort also had higher rates of major bleeding. Therefore, future studies should investigate incorporating malignancy into the CHADS2VASc score.
Abstract 4144492: Association of the Intermountain Risk Score with Major Adverse Cardiovascular Events in Patients Assessed for Renal Transplantation
Authors: Benjamin Horne, C Minder, Viet Le, Donald Morris, Sanjiv Anand, Sean Dow, Steve Mason, Jeffrey Anderson, Tami Bair, Stacey Knight
Journal: Circulation (2024)

Background: In patients with end-stage kidney disease, assessment of cardiovascular (CV) risk is difficult due to a lack of analytical decision tools to guide care. The Intermountain risk score (IMRS) is a well-validated sex-specific risk prediction tool calculated from weightings of age and components of the complete blood count and basic metabolic profile that was originally derived to predict mortality. IMRS also predicts major CV events. This study evaluated the association of IMRS with major adverse CV events (MACE) in patients listed for renal transplantation (Tx). Methods: Patients evaluated for renal Tx between June 2015-April 2024 and subsequently listed were assessed using cardiac PET/CT, echocardiography, and other risk measures. MACE was defined as pre-Tx all-cause mortality, acute MI, or Tx de-listing. IMRS was computed using the 2009 1-year mortality approach and pre-defined sex-specific risk categories were used. Other data included demographics, comorbidities, CV risk factors, mode of dialysis, and a previously-derived 1-year PET risk score (using ischemic burden, coronary artery calcium, myocardial blood flow, transient ischemic dilation, smoking, obesity, diabetes and inpatient). Association with MACE-free survival was evaluated by Cox regression. Results: Among 691 patients with IMRS data (200 were missing labs for IMRS), age averaged 55.9±12.0 years (range 20.9-81.0 years) and 34.3% were female. MACE was found in 171 patients. IMRS was associated with MACE (Figure) in univariable analysis (high vs. low IMRS: HR=2.50, 95% CI: 1.44, 4.32, p=0.001; moderate vs. low: HR=1.55, CI: 0.99, 2.42, p=0.055). For high vs. low IMRS, females had HR=2.26 and males had HR=2.61. Analysis showed that 24.7% of the predictive ability of IMRS was explained by the PET risk score, MI and COPD history, and mode of dialysis. IMRS was independently associated with MACE when adjusted for those factors (high vs. low: HR=1.99, CI: 1.14, 3.49, p=0.016). Conclusions: IMRS was associated with long-term pre-Tx MACE outcomes in patients assessed for renal Tx. A quantitative tool computable from objective, standardized, and common electronic health record elements, IMRS may be useful alone as a low-cost, low-touch clinical decision tool to evaluate risk in early screening or together jointly as part of a more complete risk assessment with other factors such as the PET risk score, comorbidities, and dialysis data.
Abstract 4144537: Recurrent Myocarditis and Ventricular Arrhythmias Associated with Vascular Endothelial Growth Factor Inhibitor Use and Rechallenge
Authors: Jacob Roberts, Lizette Garcia, Eric Yang, Duc Do, Olcay Aksoy, Ali Salavati, Houman Khakpour, Bartosz Chmielowski, Ashley Stein-Merlob
Journal: Circulation (2024)

Introduction: Vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) therapy has been associated with cardiotoxicity, particularly hypertension. Cardiomyopathy and ventricular arrhythmias (VA) have rarely been reported. Case Report: A 51-year-old male with metastatic sarcoma on pazopanib, a VEGFR-TKI, for the past 4 years presented with 1 month of increasing palpitations and lightheadedness leading to a fall. On arrival, telemetry showed paroxysmal AF with RVR rates to 120 bpm followed by incessant runs of NSVT with rates 200-240 bpm. Initial labs included BNP 191 pg/mL and HS troponin-I 6 ng/L (&lt;5 ng/L). Lidocaine infusion, amiodarone infusion, and metoprolol were required to reduce NSVT burden. Initial TTE revealed LVEF of 30-35% from baseline 55-60%. Coronary angiography showed no significant CAD. Cardiac MRI was negative for LGE or metastatic involvement. Cardiac PET-CT revealed moderate diffuse FDG uptake with focal enhancement suggestive of an inflammatory process. Pazopanib was stopped and the patient started on GDMT and prednisone taper for treatment of myocarditis. At 2 months follow up, TTE revealed LVEF improved to 45-50% and ambulatory rhythm monitoring showed rare PVCs and few NSVT episodes. Repeat cardiac PET-CT revealed resolution of myocardial inflammation. Due to sarcoma progression, the patient started on regorafenib, another VEGFR-TKI, 3 months after initial hospitalization. About 3 weeks later, he presented with frequent NSVT which required lidocaine and amiodarone infusions for arrhythmia control. Repeat cardiac PET demonstrated myocarditis recurrence. He received intravenous pulse dose steroids followed by prednisone taper and was transitioned to oral mexiletine and amiodarone with resolution of VA. Review of ambulatory rhythm monitoring 1 week following regorafenib initiation already showed 20.6% burden of ventricular ectopy and &gt;8000 NSVT episodes. Discussion: This patient had an unusual, delayed presentation of VEGFR-TKI induced myocarditis presenting with significant VA. Although TKI induced myocarditis is rare and the mechanism is not well understood, recurrence of myocarditis in this case with an alternative agent indicates a possible medication-class effect.