tbuckley/cabot-search huggingface dataset:
Abstract 12815: The Effect of Altitude on Cardiovascular Disease Mortality: Insights From a National Database in Ecuador
Authors: Bryan Nicolalde, Frans Serpa, Deisy Muriel Velez Arteaga, Angelo Nicolas Caputi Zuniga, Ximena Arias, Diego Anazco
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) is a leading cause of mortality worldwide. European population studies have shown a protective effect of high altitude on CVD mortality, but the applicability of these findings to Latin population remains to be explored. We aim to compare the mortality rates from ischemic heart disease (IHD), heart failure (HF), and cardiac arrhythmias between low- and high-altitude regions in Ecuador. Hypothesis: CVD mortality might be influenced by altitude Methods: We collected nationwide mortality data on different CVDs for each canton in Ecuador from 2017 to 2021 by using pre-defined ICD-10 codes. Then, we collected the mean altitude in meters above sea level (ASL) for each specific canton and classified them into low-(&lt;2500 meters ASL) and high-altitude (&gt;2500 meters ASL) cantons. We estimated the aggregated mortality rates per 100.000 persons and 95% confidence interval for high- and low-altitude regions at each timepoint. Results: From 2017 to 2021, 69.002 deaths due to CVDs occurred in Ecuador (IHD: 77.0%, HF:19.8% and cardiac arrhythmias: 3.2%). Mean age at death across different pathologies ranged between 76 and 81 years old, and most participants identified as multi-ethic (Table 1). There was a significantly higher mortality rate for HF and cardiac arrhythmias in high-altitude cantons than in low-altitude cantons at almost all timepoints (Figure 1). The mortality rates for IHD were lower for high-altitude cantons than low-altitude cantons at all timepoints. Conclusions: High-altitude cantons in Ecuador had higher mortality rates for HF and cardiac arrhythmias, but lower mortality rates for IHD when compared to low-altitude cantons.
Abstract 16187: COVID-19 and Outcomes of Acute Ischemic Stroke - A Nationwide Cross-Sectional Study
Authors: Urvish K Patel, Emad Singer, Sai Niharika Tammineedi, Deen Tar, Mamadou Diallo, Leslie Kapil, Tarsha Intsiful, Huy Le Duc, Sindu Mukesh, Neel Patel, Fathi Abusharkh, Juan Fernando ortiz, Ramit Singla, Smit Patel, Kogulavadanan Arumaithurai
Journal: Circulation (2023)

Introduction: Acute ischemic stroke (AIS) is thesecond leading cause of death globally, accounting for approximately 11% of alldeaths, long-term disability, and functional impairments in survivors. TheCOVID-19 pandemic has raised concerns about its impact on AIS patients. Aim: This study aimed to assess the outcomes,including mortality and severity of disability in AIS hospitalizations withCOVID-19. Methods: We performed a retrospective cross-sectionalanalysis of the Nationwide Inpatient Sample (NIS-2020) in adulthospitalizations for AIS to compare the outcomes [death &amp; APRDRGseverity/disability] in COVID-19 patients using ICD-10 codes. We performedweighted analyses using chi-square, unpaired t-test, and multivariate logisticregression models to evaluate COVID-19-associated poor outcomes amongst AISpatients. Results: Out of 504,460 AIS patients, 7,590 had AIStriggered by COVID-19. Amongst AIS hospitalizations, COVID-19 was more frequentin age group &gt;65 year old 63.2%, male 52.6%, White race (51.4%), patientwith Medicare (58.7%), median household income 0-25 percentile (33.6%), Southzone (43.4%), and hypertensives (83.7%). AIS patients with COVID-19 had ahigher mortality (10.93% vs 3.8%) and severe/extreme disability (93.21% vs37.43%) rates in comparison to patients without COVID-19. (p&lt;0.0001) Inregression analysis COVID-19 was associated with 213% higher odds of mortality(aOR: 3.13, 95% CI: 2.90-3.38, p&lt;0.0001, c:0.671) and higher odds of severe/extreme disability(26.85, 24.53-29.39, p&lt;0.0001, c:0.686) compared to AIS patients withoutCOVID-19. Conclusion: These findings emphasize the substantialimpact of COVID-19 on AIS patients by elevating mortality and risk of severedisability compared to their counterparts. Efforts should be directed towards earlyidentification of stroke population that is at higher risk ofCOVID-19-associated poor outcome and prompt management tomitigate the burden of the both diseases.
Abstract 14627: Machine Learning Based Models for Imputing Heart Failure on First Medical Contact From the Get With The Guidelines®- Coronary Artery Disease (GWTG-CAD) Registry
Authors: Haoyun Hong, Remy Poudel, Shen Li, Kathie Thomas, Asishana Osho, Abhinav Goyal, Jennifer L Hall, Juan Zhao
Journal: Circulation (2023)

Introduction: The American Heart Association Get With the Guidelines - Coronary Artery Disease (GWTG-CAD) Registry is a quality improvement program with over 2600 participating U.S. hospitals. Among the collected data elements is the yes-no variable “Heart failure documented on First Medical Contact” (HF-FMC), an important clinical predictor of in-hospital mortality. Before 2018, the missing rate of HF-FMC exceeded 60% in some years, significantly limiting its utility as a predictor of in-hospitality mortality. We compared machine learning (ML)-based with traditional statistical methods to accurately impute missing HF-FMC values. Methods: We utilized admission records from the GWTG CAD Registry data from 2018 to 2021, including both STEMI and NSTEMI patients. We removed missing HF-FMC, using complete data as ground truth. The data was split into training and test datasets in a 3:1 ratio. Imputation was framed as a prediction task. For evaluation, we masked HF-FMC in the test set and compared the imputed values against the ground truth. For traditional methods, mode imputation, K-nearest neighbor imputer (KNN), and Multiple Imputation by Chained Equations (MICE) were applied. For ML models, we applied logistic regression, random forest and XGBoost. Shapley Additive exPlanations (SHAP) values were utilized to identify key features contributing to the ML models. Results: The study included 223,074 individuals (12.2% HF-FMC = “yes”), with mean (SD) age 64.9 (13.4) years (33.8% Female; and 77.3% White and 13.8% Black). Machine Learning models achieved higher AUROC scores compared to traditional models in imputing HF-FMC (Table 1). Top features for predicting HF-FMC are shown (Figure 1). Conclusions: Machine learning models outperformed traditional methods in imputing missing HF-FMC, a critical predictor of in-hospital mortality. SHAP values can identify key features in imputing clinically important variables with high degree of missingness.
Abstract 17978: Validation of Contemporary Administrative Codes for Identifying Pulmonary Vein Isolation Procedures
Authors: Enrico G Ferro, Matthew R Reynolds, Jiaman Xu, Yang Song, Andre d'Avila, peter zimetbaum, David J Cohen, Robert W Yeh, Daniel B Kramer
Journal: Circulation (2023)

Introduction: Use of pulmonary vein isolation (PVI) to treat atrial fibrillation continues to grow. Despite great interest in leveraging administrative data for real-world analyses, contemporary procedural codes for identifying PVI have not been validated. Methods: Inpatient PVIs were identified among US Medicare fee-for-service beneficiaries using Current Procedural Terminology (CPT) code 93656 in the Carrier Line Files. Each patient was cross-matched by procedure date with claims from Medicare Provider Analysis and Review Files (MedPAR), in order to compare CPT claims with International Classification of Diseases-10 th Revision Procedure Coding System (ICD-10 PCS) claims submitted by healthcare facilities to bill for each PVI. We performed the reverse for commonly matched ICD-10-PCS codes, to identify their corresponding CPT-billed procedures. Results: We identified 20,388 inpatient PVIs from 1/2017 to 12/2020, of which 14,468 (71%) were linked to MedPAR by same-day procedure date. Of these, 13,156 (91%) were billed as ICD-10 02583ZZ “ Destruction of Conduction Mechanism, Percutaneous Approach ”, with lower use of other codes. However, the reverse process yielded heterogeneous results: among 75,003 procedures billed as ICD-10 02583ZZ, only 15,691 (21%) matched with CPT 93656 (PVI), as several other procedures were interchangeably billed under this same ICD-10 code (Figure). Conclusions: Compared with CPT codes as a gold standard, the ICD-10-PCS code most commonly associated with CPT-billed PVI procedures actually refers to ablation of the atrio-ventricular junction. Yet this same ICD-10-PCS code also matches with a wide range of other procedures distinct from PVI. We conclude that ICD-10-PCS codes alone are not sensitive or specific for identifying PVI in claims, and cannot be reliably used in isolation for health services research on this important procedure.
Abstract 14394: Complete Atrioventricular Block in a Young Patient With Alport Syndrome: A Case Report
Authors: Zuoyi Zhou, Long ZHANG, Yanjun Gong, Jianping Li
Journal: Circulation (2023)

Background: Atrioventricular block (AVB) in young adults is rare, and the etiologies and mechanisms in most cases remain uncertain. Alport syndrome is a heterogeneous, hereditary disorder characterized by nephropathy, hearing loss, and ocular abnormalities. Complete AVB has never been reported in Alport syndrome patients with normal kidney function. Case report: A 20-year-old male patient was admitted to hospital with “asymptomatic bradycardia for years”. On admission, the patient’s blood pressure was normal and electrocardiogram (ECG) showed third-degree AVB with atrial rate of 63 bpm and ventricular rate of 36 bpm. He was diagnosed with Alport syndrome at the age of 10. Genetic testing at that time showed single nucleotide variants (c.2372T&gt;C, c.2072T&gt;G) and deletion (c.1781-1949(Exon25)) in COL4A5 gene. During the subsequent 10-year follow-up, the patient was presented with consistent hematuria and proteinuria, but his renal function has never been found impaired. He denied other medical history as well as family history of arrhythmia. Laboratory tests indicated hypoproteinemia, hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. The 24-hour ambulatory ECG revealed a heart rhythm consisting of sinus rhythm with second-degree AVB (2:1 downward transmission) and complete AVB with junctional escape. The mean ventricular rate was 36 bpm (ranged 25-60 bpm). Neither echocardiography nor cardiac magnetic imaging with delayed gadolinium enhancement found any significant abnormality. We then did whole exome sequencing (WES), which did not identify specific pathogenic variant (Table1). 3mg atropine was admitted to the patient for an atropine test to rule out the possibility of vagally mediated AVB and the pacemaker implantation was then performed. Conclusion: We report a case of complete AVB with unknown etiology in a young patient with Alport syndrome.
Abstract 18371: Evaluation of the Atrial Fibrillation Better Care Pathway in Patients With Atrial Fibrillation: A Machine Learning Cluster Analysis
Authors: Jingyang Wang, Haiyang Bian, Yanmin Yang, Zhang Xuegong
Journal: Circulation (2023)

Background: Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF) and exerts a protective role against adverse outcomes of AF patients. We hypothesize that cluster analysis, an unsupervised machine learning technique, could comprehensively evaluate multiple clinical characteristics of patients, and define clusters of ABC criteria efficacy in patients with AF. Methods: We used data from an observational cohort that included 2,016 patients with AF. We utilized 46 baseline variables for cluster analysis and got the optimal clusters through the K-prototypes algorithm. We evaluated the management patterns and adverse outcomes of identified phenotypes. We assessed the effectiveness of the ABC criteria in reducing adverse outcomes of these phenotypes. Results: Cluster analysis identified AF patients into three distinct groups with markedly different clinical characteristics and outcomes. The clusters were as followed: Cluster 1, old patients with atherosclerotic-comorbidities (n = 964); Cluster 2, young females with valve-comorbidities (n = 407), and Cluster 3, paroxysmal AF patients with low comorbidities (n = 644). The clusters showed significant differences in MACNE, all-cause death, stroke, cardiovascular death, and hospital readmission for heart failure. All clusters showed that full adherence to the ABC pathway was associated with a significant reduction in the risk of MACNE (all P&lt; 0.05). Adherence to the different ‘A’/’B’/’C’ criteria alone showed differential clinic impact for three clusters. Conclusion: Cluster analysis of the Chinese AF cohort further elucidated the heterogeneity of AF. We proposed suggestions for optimizing risk stratification and integrated management of AF patients.
Abstract 18791: Sex Differences in the Phosphorylation of Argonaute 2 Result in Reduced Translocation of Micro RNA-181c Into the Mitochondria and Cardioprotection in Pre-Menopausal Females
Authors: Diego T Quiroga, Barbara Roman, Haley Garbus, Obialunanma Ebenebe, Brian O'Rourke, Mark J Kohr, Samarjit Das
Journal: Circulation (2023)

Introduction: MicroRNAs (miRNAs) play a crucial role in regulating gene expression and have been implicated in various aspects of cardiovascular health and disease. miR-181c is known to be upregulated in obesity, and its translocation into cardiomyocyte mitochondria leads to excessive production of Reactive Oxygen Species(ROS). ROS-mediated degradation of Sp1, a transcription factor for MICU1, results indecreased MICU1 expression and subsequent mitochondrial [Ca2+] accumulation, leading to heart failure. We hypothesized that phosphorylation of Argonaute 2 (pAGO2) at Ser 387could inhibit the translocation of miR-181c into mitochondria by enhancing the stability of the RNA-induced silencing complex in the cytoplasm. Estrogen (E2) could provide cardioprotection in pre-menopausal women against the consequences of mitochondrial miR-181c upregulation by phosphorylating AGO2. Hypothesis: We hypothesize that sex differences in pAGO2 levels lead to reduced translocation of miR-181c into mitochondria, thereby influencing the cardiac response observed in pre-menopausal females compared to males. Methods: This study utilized male, female, and ovariectomized (OVX) mice as in vivo model. AC16 cardiomyocyte cell line was treated with E2 and transfected with miR-181c to mimic conditions of miR-181c upregulation. qRT-PCR was performed to assess miR-181c, SP1, and MICU1 expression levels. Western blot analysis was employed to detect protein levels. Results: Our results revealed significantly higher levels of pAGO2 in pre-menopausal female mice compared to males. This increased pAGO2 phosphorylation was associated with decreased translocation of miR-181c into mitochondria in pre-menopausal females, and this condition was reversed in OVX mice. In AC16 cells, E2 treatment normalized the aberrant degradation of Sp1 and the dysregulation of MICU1 induced by miR-181c overexpression. Conclusion: This study provides evidence of sex differences in pAGO2 levels, suggesting that reduced translocation of miR-181c into mitochondria contributes to the observed cardiac effects in pre-menopausal females.
Abstract 18671: Cardiac Magnetic Resonance Radiomics Characterization of Myocardial Extracellular Matrix in Dilated Cardiomyopathy
Authors: Amine Amyar, Shiro Nakamori, Ahmed S Fahmy, Long H Ngo, Masaki Ishida, Satoshi Nakamura, Taku Omori, Keishi Moriwaki, Naoki Fujimoto, Kyoko Imanaka-Yoshida, Hajime Sakuma, Kaoru Dohi, Warren J Manning, Reza Nezafat
Journal: Circulation (2023)

Introduction: Current CMR sequences cannot discriminate between different myocardial extracellular space (ECS), including collagen, non-collagen, and inflammation. We sought to investigate if CMR radiomics analysis can distinguish between non-collagen and inflammation from collagen in dilated cardiomyopathy (DCM). Methods: 132 DCM patients were scheduled for an invasive septal biopsy and underwent CMR at 3T incorporating native and post-contrast T1 mapping and late gadolinium enhancement (LGE). The radiomic features were computed from the mid-septal myocardium, near the biopsy region, on native T1, extracellular volume (ECV) map, and LGE images. Principal component analysis was used to reduce the number of calculated radiomic features to five. These features were then used in a regression model to discriminate between non-collagen and collagen ECS. Biopsy samples were used to quantify ECS, myocardial fibrosis, and inflammation. Results: Four histopathological phenotypes were identified as normal (G1, n=20), non-collagenous ECS expansion (G2, n=49), collagenous ECS expansion (G3, n=42), and severe fibrosis (G4, n=21). G2 was associated with the highest risk of myocardial inflammation (65%). While native T1 and ECV provided high diagnostic performance in differentiating G4 (AUC= 0.90 and 0.90), their performance in differentiating between G2 and G3 decreased (AUC= 0.59 and 0.55, respectively). Integration of ECV radiomics provided better discrimination and reclassification between G2 and G3 (AUC= 0.79, net reclassification index 0.83; 95% CI 0.45-1.22, p&lt;0.001). A similar trend was observed with the addition of native T1 radiomics and LGE radiomics. Conclusions: The radiomic features extracted from native T1, ECV, and LGE provided incremental information that may improve our capability to discriminate non-collagenous ECS from collagen and could be useful for detecting subtle chronic inflammation in DCM patients.
Abstract 14370: Educate: A Randomized Controlled Trial of Education Curriculum Assessment for Teaching Electrocardiography
Authors: Anthony H Kashou, Peter A Noseworthy, Thomas Beckman, Nandan S Anavekar, Michael W Cullen, Kurt Angstman, Benjamin Sandefur, Brian P Shapiro, Brandon Wiley, Andrew Kates, Justin Sadhu, Prashanth Thakker, david Huneycutt, Andrew Braisted, Stephen W Smith, Adrian Baranchuk, Ken Grauer, Kevin O'Brien, Viren Kaul, Harvir Gambhir, Stephen Knohl, Daniel Restrepo, Adam May
Journal: Circulation (2023)

Background: Gaps in ECG interpretation competency among medical professionals exist, with a need for practical, evidence-based, and accessible learning solutions. We conducted an international, prospective, randomized controlled trial to assess the effectiveness of web-based, self-directed ECG learning. Methods: A total of 1206 diverse medical learners and professionals underwent an initial test, followed by random assignment to one of four groups: (i) online question-bank (questions), (ii) online lectures (lectures), (iii) online, question-bank and lectures (hybrid), or (iv) no resources (control). After 4 months, a post-test was administered to evaluate the overall change in performance. Results: Of all participants, 863 (72%) completed the trial. After the 4-month follow-up, all three online, self-directed intervention groups (questions, lectures, and hybrid) showed significant improvement in overall performance (P&lt;0.001), while the control group did not (P=0.544). The questions, lectures, and hybrid interventions demonstrated score improvements of +11.4% (95% CI, 9.1-13.7; P&lt;0.001), +9.8% (95% CI, 7.8-11.9; P&lt;0.001), and +11.0% (95% CI, 9.2-12.9; P&lt;0.001) respectively, compared to +0.8% (95% CI, -1.2-2.8; P=0.544) for the control group. These improvements were consistent across medical professional groups (Figure 1) . Conclusions: Web-based, self-directed learning resources effectively improved ECG interpretation proficiency for diverse medical learners and professionals.
Abstract 17912: Late Potential and the Risk of Major Arrhythmic Events in Brugada Syndrome Patients: A Systematic Review and Meta-Analysis
Authors: Pattara Rattanawong, Wasawat Vutthikraivit, Jakrin Kewcharoen, Chanavuth Kanitsoraphan, Narut Prasitlumkum, Prapaipan Puttapiban
Journal: Circulation (2023)

Introduction: Brugada syndrome is an inherited arrhythmic disease associated with fatal ventricular arrhythmias. However, ventricular arrhythmia risk stratification remains challenging and controversial. Hypothesis: The late potential may be useful as a predictor of major arrhythmic events in Brugada syndrome patients. Aims: We aimed to assess the association between late potential and risk of major arrhythmic events by a systematic review and meta-analysis. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2023. The included studies were cohort and case-control studies that reported the relationship between late potential and major arrhythmic events. The included studies were selected to yield a maximum total number of sample sizes without population duplications across the studies. Data from each study were combined using the random-effects model to calculate pooled odds ratio and 95% confidence intervals. The late potential was defined as RMS40 &lt;20 μV and/or LAS40 &gt;38 ms on signal-averaged ECG. Results: Five studies were included in this meta-analysis involving 743 Brugada syndrome patients (438 with late potential and 743 without late potential). The mean age was 47.3 ± 14.1 years. The patients were predominately men (61.6%). The late potential was not associated with major arrhythmic events (pooled odds ratio 1.17, 95% confidence intervals: 0.62-2.21, p=0.63, I 2 =21.3%). Conclusions: Our study demonstrated that late potential is not associated with a higher risk of major arrhythmic events in Brugada syndrome populations. To our knowledge, our study is the first meta-analysis of late potential in Brugada syndrome patients.
Abstract 16364: Presence of Ramus Intermedius Artery is Associated With Higher Atherosclerotic Plaque Burden in the Left Main Stem in Coronary CT Angiography
Authors: Leili Pourafkari, April Kinninger, Hooman Fazlalizadeh, Venkat Sanjay Manubolu, Sion Roy, Matthew J Budoff
Journal: Circulation (2023)

Introduction: Ramus intermedius (RI) is a variant vessel arising from left main (LM) bifurcation that supplies the lateral wall. It is thought that presence of RI would result in increased coronary turbulence in LM which in return could affect atherosclerotic plaque formation process. We aimed to investigate the association of presence of RI with presence of atherosclerotic plaque and stenosis in left main (LM). Hypothesis: Presence of RI artery associates with higher frequency of atherosclerotic plaque formation in LM Methods: We performed a large retrospective single-center study, including consecutive subjects who completed a CTA exam from October 2006 to December 2022 in Los Angeles, California to determine if presence of RI associated with higher LM coronary plaque burden. Chi-Square test was used to examine level of left main plaque burden and percent stenosis in subjects where the Ramus is present versus absent. Results: Among the 11,497 subjects, the average age was 62.0±12.4 years, 64% male, and 11% had the Ramus segment present. Those with a Ramus segment present were more likely to have mild, moderate or severe plaque burden (41% versus 26%, p=&lt;0.0001) in their left main. (Table 1). Additionally, subjects with RI has higher prevalence of any degree of LM stenosis compared to those without RI (P-Value&lt;0.0001). Conclusions: Our results suggest that the presence of RI is associated with higher prevalence of atherosclerotic plaques and higher degree of stenosis in LM stem.