tbuckley/cabot-search huggingface dataset:
Abstract Su801: Use of Large Language Models to Optimize Clinical Text Analysis for In-Hospital Cardiac Arrest Identification
Authors: Aarthi Kaviyarasu, Ugurcan Vurgun, Sy Hwang, Ana Acevedo, Benjamin Abella, Danielle Mowery, Oscar Mitchell
Journal: Circulation (2024)

Introduction/Background: In-hospital cardiac arrest (IHCA) is experienced by approximately 300,000 patients annually in the US. While individual care teams can readily identify IHCA at the bedside, the reporting of these events after the event often lacks consistency and poses a major challenge for hospitals across the US. Accurate and timely reporting of IHCA events is crucial for facilitating QI initiatives, such as CPR quality review, optimizing team performance, and benchmarking IHCA outcomes. Hypothesis: Large language models (LLMs) can be used to identify IHCA events at the patient encounter-level by analyzing targeted note types from the inpatient record with high performance. Methods: Adult (≥18 years old) inpatient encounters at the Hospital of the University of Pennsylvania from 06/2018 to 03/2022 with a reported clinical emergency were identified from a QI database. Discharge summaries and notes associated with the encounters of interest were extracted from the EHR and deidentified using a natural language processing tool. Notes were reviewed by research staff to ascertain true IHCA events. Positive IHCA was defined as the loss of pulses followed by the delivery of CPR. An LLM, GPT4 v. 32K-Chat, was employed on the Penn Medicine Microsoft Azure Databricks environment to compare zero- and few-shot prompting methods to identify IHCA. Model performance was measured using accuracy, precision, recall and F1 scores. Results: Manual chart review determined 96.8% and 3.2% of cases to be IHCA+ and IHCA-, respectively. A balanced pilot dataset of positive and negative cases was created and the accuracy values across strategically sampled note types was checked. Using zero-shot learning with Chain-of-Thought (COT) prompting, the LLM performed with an accuracy of 86%, precision of 77%, recall of 100%, and F1-score of 87%. Using three-shot learning with COT, the LLM performed with an accuracy of 90%, precision of 83%, recall of 100%, and F1-score of 91%. Conclusions: This study demonstrates the potential efficacy of leveraging LLMs to automatically classify IHCA from strategically sampled note types using both zero and few-shot learning approaches. In the future, we will implement temporal sampling of note types and refine model parameters such as output token size and temperature. These findings suggest that such technologies can be effective in real-world clinical settings, providing a scalable solution to improve patient outcomes and quality improvement efforts.
Abstract 4144548: High Morbidity and Mortality in Adults With Turner Syndrome and Aortic Dilation: A Retrospective Cohort Study from the Healthy Heart Project
Authors: Rakesh Kathiresan, Nikhil Vj, Deborah Rios, Emilio Quezada, Michael Silberbach, Siddharth Prakash
Journal: Circulation (2024)

Introduction: Turner syndrome (TS) is caused by the partial or complete absence of one sex chromosome and affects 1 in 2500 liveborn infants. Hypertension, bicuspid aortic valve (BAV), and thoracic aortic aneurysms (TAAs) are more prevalent in TS compared to the general population and predispose to aortic dissections, which may occur in young adults with TS. We hypothesize that adults with TS who have TAAs experience a high rate of adverse cardiovascular outcomes. Methods: Adults with TS who had Healthy Heart Project (HHP) echocardiograms at national conferences between 2003 and 2023 were contacted for enrollment in descending order of the aortic size index (ASI, cm/m 2 ), defined as the ratio of the maximum ascending aortic diameter to body surface area. After informed consent, clinical characteristics and outcomes (as numbers of participants or median and interquartile range) were abstracted from questionnaires and medical records. Results: Sixty-four of 704 total HHP participants were contacted and 19 (with 10 of the 20 highest ASI values) were enrolled with complete data. The baseline ASI was 2.19 (0.48), compared to 1.51 (0.36) for all other HHP participants. The median age was 59 (13) years. The most prevalent characteristics were 45,X (10) or 45,X/46,XX (6) karyotypes; BAV (9), coarctation (4), or no congenital lesions (6); and hypertension (12). A mean of 10 serial aortic images were available for each participant over a follow up period of 14 (9.8) years. The median increase in aortic diameter was 0.09 (0.29) mm/yr at the sinuses of Valsalva and 0.26 (0.44) mm/yr at the ascending aorta. Seven participants underwent aortic operations due to enlarging TAAs when the median ascending diameter was 3.83 (0.67) cm (ASI 2.58 (0.11) cm/m 2 ). In 3 cases, operations were urgent due to cardiovascular symptoms or rapid aortic dilation, but there were no acute aortic dissections. The median time between the index image and subsequent repair was 3.5 (7.0) years. Three HHP participants with the 8th, 15th, and 42nd largest ASI values died prior to follow up. One death was caused by complications after surgical aortic valve replacement at age 20. Conclusions: In a cohort of adults with TS and TAAs, 40% (7/19) developed progressive aortic enlargement requiring aortic repairs and there were 3 deaths. These observations underscore the importance of lifelong surveillance and timely intervention to prevent deaths due to cardiovascular disease in TS.
Abstract 4114705: Clinical Predictors of Stress Induced Cardiomyopathy
Authors: Bharat Marwaha
Journal: Circulation (2024)

Introduction: Stress Induced Cardiomyopathy is increasingly becoming more prevalent with increasing awareness about disease condition with annual incidence of 30 cases/100000 per year and an incidence of 1-2% in the patients presenting with acute coronary syndrome.[1] Physical and emotional triggers have been linked with occurrence of Stress induced Cardiomyopathy. Methods: We have obtained the National Readmission database for the year of 2020. We have used the ICD 10 code I51.81 for stress induced cardiomyopathy and found 10450 patients in the data base. Total 494 patients had cardiac arrest and 191 patients out of this 494 had died. We have used Binary logistic regression methods to find the odd ratio for physical and emotional risk factors for stress induced cardiomyopathy. Results: Grief disorder with an odd ratio of 7.2, followed by female gender with an odd ratio of 4.1, septic shock with an odd ratio of 3.3, Hemorrhagic stroke with an odd ratio of 1.73, ischemic stroke with an odd ratio of 1.72, depression with an odd ratio of 1.5, followed by asthma exacerbation with an odd ratio of 1.35 and seizure disorder with an odd ratio of 1.34 were among the few predictors for stress induced cardiomyopathy. Incidence of Cardiac Arrest was 4.7% and mortality rate of 1.8% was observed in the patients with stress induced Cardiomyopathy. Discussion: Extreme emotional and physical triggers like stroke, septic shock are among few significant risk factors for the stress induced cardiomyopathy.
Abstract 4134308: Re-evaluating the safety profile of Semaglutide: An updated meta-analysis
Authors: Frederick Rivera, GERARD FRANCIS MANGUBAT, John Magalong, Marie Francesca Ansay, Nenad Zelenkov, krishnaswami vijayaraghavan, Jade Monica Marie Ruyeras, John Andrew Amigo, Kenneth Ong, Mer Lorraine Mahilum
Journal: Circulation (2024)

Background: Semaglutide is increasingly used in the management of type 2 diabetes mellitus and obesity. Ensuring safety of this medication is crucial for its clinical use. This meta-analysis evaluates the safety profile of semaglutide across patient populations and treatment durations. Methods: Randomized controlled trials assessing the safety of semaglutide versus placebo, with specified treatment durations were identified. The primary outcome was occurrence of any cardiovascular adverse events. Secondary outcomes included sudden cardiac death, adverse events leading to death, adverse events, gastrointestinal side effects, occurrence of hypoglycemia and new-onset neoplasm. Results: A total of 23 studies met the inclusion criteria with a combined sample size of 57,911 participants. The meta-analysis revealed that the adverse event associated with semaglutide is gastrointestinal in nature (nausea and vomiting). No significant differences were observed between semaglutide and comparator groups. (See Figure 1) Conclusion: Semaglutide appears to have a favorable safety profile across diverse patient populations and treatment durations, supporting its continued use in the management of type 2 diabetes mellitus and obesity. It is generally well-tolerated, with a low incidence of adverse events. Clinicians should be aware of these findings and monitor patients accordingly. Further long-term studies are warranted to assess the safety of semaglutide in clinical practice.
Abstract 4141448: Evaluation of cardiac amyloidosis with cardiac MRI and association with endomyocardial biopsy findings
Authors: Nicholas Huerta, Taha Khalid, Yakubu Bene-Alhasan, Adhvithi Pingili, Bethel Woldu
Journal: Circulation (2024)

Introduction: Late gadolinium enhancement (LGE) observed on cardiac magnetic resonance imaging (CMR) has emerged as a potential indicator of myocardial involvement in cardiac amyloidosis (CA). However, discerning which LGE patterns in amyloidosis distinguish it from other cardiomyopathies remains unclear. This study aims to compare LGE characteristics in a predominantly African American cohort who underwent endomyocardial biopsies. Despite advancements in cardiac imaging techniques, the endomyocardial biopsy remains the gold standard for amyloidosis diagnosis. Insights garnered from this analysis could enhance diagnostic precision and facilitate earlier detection. Methods: In this retrospective study at MedStar Union Memorial Hospital in Baltimore, MD, patients who underwent both endomyocardial biopsy and CMR were included. The study compared individuals with biopsy-proven amyloidosis (both AL and ATTR) to those with negative biopsy results. LGE patterns were selected based on their frequent use in CMR interpretation. Statistical analysis employed Pearson chi-square and t-tests. Results: The cohort comprised 42 patients who underwent biopsy, with 13 patients (31%) with positive biopsy results. Among them, 24 were men (57%), and 81% identified as African American. Demographic, anthropomorphic, and objective clinical findings are detailed in Table 1. The average age of the cohort was 68 years, with those with biopsy-proven amyloidosis significantly older (75 vs. 61 years, p = 0.002). Although the biopsy-positive group exhibited a lower absolute NT-pro-BNP, the difference was not statistically significant. The most prevalent LGE patterns among the biopsy-positive group were diffuse (62%) and basal (31%). Notably, 69% of biopsy-positive patients exhibited an LGE pattern described as infiltrative. However, 38% of the biopsy-negative group also manifested infiltrative patterns on LGE, a difference not statistically significant compared to the biopsy-positive group. The positive predictive value of an infiltrative LGE pattern was low (45%). Conclusion: This study compares CMR LGE patterns in biopsy proven CA. Despite findings of an infiltrative LGE pattern on CMR, when using endomyocardial biopsy as the gold standard, the positive predictive value of LGE in differentiating CA patients was low. Further research and larger studies are warranted to explore additional imaging modalities or biomarkers that may complement or refine the diagnostic algorithm for CA.
Abstract 4144503: Association of Granular Sleep Health Metrics with Arterial Stiffness in the Community
Authors: Hassan Alhassan, Mawra Jha, Ramachandran Vasan, Gary Mitchell, Robert Thomas, Connie Tsao
Journal: Circulation (2024)

Introduction: Poor sleep is a risk factor for cardiovascular disease and all-cause mortality; however, the mechanisms underlying this relationship remain poorly understood. Since sleep health is a complex construct extending beyond mere sleep duration, we aimed to examine the relationship between granular sleep health indicators and arterial stiffness. Methods: We analyzed Framingham Offspring cohort (Exam 9) and OMNI cohort 1 (Exam 4) participants with sleep study and applanation tonometry data (n= 847, 56.6% females). Participants wore an M1 device to obtain ECG-derived sleep spectrograms to assess sleep quality and the Nonin WristOx device for oximetry data over two consecutive nights. Sleep variables of interest included total sleep time, duration of stable and unstable NREM, duration of elevated low-frequency coupling (e-LFC), and duration and number of nocturnal hypoxia events. Measures of aortic stiffness and pressure pulsatility included carotid-femoral pulse wave velocity (PWV), and central pulse pressure (CPP). Results: Characteristics of the sample are presented in Table 1. Several sleep measures were associated with PWV in univariable analysis, but significance attenuated after age/sex adjustment (Table 2). After adjusting for cardiovascular risk factors and sociodemographics, duration of e-LFCnb remained associated with CPP (β = 0.036, p = 0.02) Conclusion: Sleep measures associated with aortic stiffness are closely tied to age and sex. Longer duration of e-LFCnb, a hallmark of carotid body-driven elevated sympathetic tone and periodic breathing, is associated with greater pressure pulsatility. Longitudinal studies are needed to fully elucidate the role of e-LFCnb in vascular health
Abstract 4142783: Association of Body Roundness Index and Cardiovascular Disease among US Adults
Authors: Kang Wang, Pengfei Chen, Bohao Tan, Cheng Wei, Jianjun Tan, Zhen-fei Fang, Qiming Liu, Shenghua Zhou, Zhangling Chen
Journal: Circulation (2024)

Background: Obesity is one of the major risk factors for cardiovascular disease (CVD), body roundness index (BRI) is more comprehensive in assessing fat distribution than traditional measurements. However, evidence regarding the association between BRI and the risk of CVD was limited, particularly in American people. This current study aimed to investigate the association between BRI and the risk of CVD among US adults. Hypothesis: We hypothesized that higher BRI was associated with a higher risk of CVD. Methods: A total of 21,852 participants were included in the National Health and Nutrition Examination Surveys from 6 survey cycles (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Weighted multivariate logistic regression was carried out to examine the relationship between BRI and the risk of CVD. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships. Results: Among 21,852 US adults, the mean (SD) age was 47.5 (17.3) years, 10,669 (48.8%) were female, and 1886 were diagnosed with CVD. In the weighted multi-variable logistic regression model with adjustment for demographics, lifestyle, economic status and dietary factors, higher BRI was significantly associated with a substantially higher risk of CVD. Compared with the participants in the lowest quartile of BRI, those in the highest quartile of BRI had a higher CVD, with OR and 95%CI of 2.47 (1.92-3.17). Furthermore, the RCS demonstrated a linear dose-response relationship between BRI and CVD (P non-linearity =0.29). Conclusion: This national cohort study found a higher BRI was associated with a higher risk of CVD among US adults. BRI may provide a new perspective for CVD prevention among adults.
Abstract 4144567: Prevalence of Atrial Fibrillation in Amyloidosis and Their Association: A 5-Year Nationwide Analytical Cross-Sectional Study
Authors: Aliza Khatiwada, Viet Nghi Tran, Doan Ngoc Chau Nguyen, Thanh Bilo, Hoang Nhat Pham, Thoai Hoang Phu, Tahira Qadeer, Phillip Tran
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with significant morbidity and mortality. Amyloidosis (AM) is characterized by the accumulation of amyloid protein in various anatomical sites, including the heart, atria, and ventricles. This amyloid infiltration leads to adverse chamber remodeling, predisposing patients to tachyarrhythmias such as atrial fibrillation/flutter. This study aims to re-evaluate the association of AM with AF by using the large nationwide inpatient database over a total duration of 5 years. Methods: An analytical cross-sectional study was conducted utilizing the data from a survey-weighted national inpatient sample database covering admissions from Jan 2017 to Dec 2021. A total of 147,015,073 admissions of patients aged 18 years and above were included. Descriptive statistics and univariate logistic regression models were used to calculate prevalence rates and odds ratios (OR), respectively. The multivariate logistic regression model was then used to adjust various potential confounders, including age, gender, race, income, hypertension, diabetes, stage 3 or above chronic kidney disease (CKD), Charlson comorbidity index, and hospital-related factors. Results: The 5-year prevalence of AF was 36.73% and 15.42% in admissions with and without AM, respectively. Significant differences between the with AM and without AM groups were in mean ages (72.40 vs. 58.08), female (41.83% vs. 56.92%), race of Black (24.57% vs. 15.40%), and CKD stage 3+ (44.83% vs. 16.65%), respectively. The univariate logistic regression analysis showed an OR for AF of 3.18 (95%CI: 3.102 - 3.267, P&lt;0.000) in admissions with AM compared to those without. After adjustment for the potential confounders, the OR for AF decreased to 1.64 (95%CI 1.597- 1.686; P&lt;0.000) in patients with Amyloidosis compared to those without. Conclusion: This study confirms a significant association between amyloidosis and atrial fibrillation, demonstrating that patients with amyloidosis have a markedly higher prevalence of atrial fibrillation compared to those without. Univariate analysis showed an odds ratio of 3.18 for atrial fibrillation in amyloidosis patients, which remained significantly elevated at 1.64 after adjusting for confounders. These findings indicate the need for a comprehensive workup of suspected atrial fibrillation in amyloidosis patients. Further research should investigate the mechanisms behind this association and potential prevention.
Abstract 4148085: Transfer to ‘Hub’ Hospitals and Outcomes in Cardiogenic Shock
Authors: Shubhadarshini Pawar, Kannu Bansal, Van-Khue Ton, Manreet Kanwar, Jinnette Abbott, Navin Kapur, Saraschandra Vallabhajosyula
Journal: Circulation (2024)

Introduction: Patients with cardiogenic shock (CS) have high mortality. Many CS patients present to non-tertiary care centers. Limited data exist on outcomes for patients transferred to “hub” CS centers for both acute myocardial infarction (AMI) and non-AMI etiologies. This study sought to compare the characteristics and outcomes of transferred CS patients compared to patients presenting to a hub center. Methodology: Adults (≥18 years) with a primary or secondary diagnosis of CS were identified from the National Readmissions Database (2016-2020) and stratified by transfer status. Overlap propensity score (PS) weighting was performed to assess the association between in-hospital mortality, length of stay (LOS) and transfer status. Results: Of 314,098 CS patients (AMICS 27%, non-AMICS 73%), 30,630 (9.8%) were transferred. Compared to non-transferred patients, transferred patients were on average younger (65 [interquartile range {IQR} 55-73] vs. 68 [IQR 58-77] years), more likely to be female (34% vs. 37%), less frequently with Medicare as primary payor (55% vs. 62%), and with higher comorbidity (Elixhauser index 8 [IQR 6-9] vs. 6 [IQR 5-8]) (all p &lt;0.001). Transferred patients had higher rates of respiratory failure (70% vs. 64%), renal failure (71% vs. 60%), hepatic failure (25% vs. 17%), bleeding complications (28% vs. 17%), and arrhythmias (59% vs. 52%) (all p &lt;0.001). Transferred patients were also more likely to undergo percutaneous coronary intervention (22% vs. 19%), coronary artery bypass grafting (13% vs. 8%), pulmonary artery catheter insertion (36% vs.16%), placement of intra-aortic balloon pump (25% vs.13%), percutaneous left ventricular assist device (13% vs. 7%), and extracorporeal membrane oxygenation (7% vs. 2%), receive invasive mechanical ventilation (3% vs. 2%), and undergo hemodialysis (17% vs. 11%) (all p &lt;0.001). In-hospital mortality was significantly lower in transferred patients – 39% vs. 47.1%; unadjusted odds ratio 0.71 (95% confidence interval 0.70-0.73); adjusted PS weighting odds ratio 0.73 (95% confidence interval 0.71-0.76), p &lt;0.001. Transferred patients had a longer median LOS (13 [IQR 7-22] vs. 6 [IQR 3-11] days, p &lt;0.001). Conclusion: Transferred CS patients had higher use of cardiovascular procedures and organ support therapies and lower in-hospital mortality suggesting patients were appropriately selected for transfer.
Abstract 4139148: Mechanisms of Maternal Cardiovascular Disease Development in a Novel Mouse Model of Pregnancy-Induced Diabetes
Authors: Olufunto Badmus, Erin Taylor, Gertrude Arthur, Lucy Taylor, Karis McGowan, Andrew Wasson, Isabela Cucolicchio, David Stec
Journal: Circulation (2024)

Background: Women with gestational diabetes mellitus (GDM) are more likely to develop cardiovascular disease (CVD) within 3 to 10 years following pregnancy. Endothelial dysfunction is a mechanism implicated in both hyperglycemia and CVDs, and it may constitute the missing link in this interaction. One reason for the lack of progress into the cardiovascular complications of GDM is the need for appropriate preclinical models that mimic human GDM. Also, the exact mechanisms mediating increased future cardiovascular risk in maternal with pregnancy-induced diabetes is unclear. Aim: To determine the mechanisms underlying cardiovascular disease in hormonal model of GDM. Methods: Sixteen week-old C57BL/6J female mice were treated with insulin receptor antagonist (S961) or saline (n=4) from the second trimester of pregnancy until delivery to develop a model of GDM. Glucose tolerance test was determined by glucometer and fasting insulin by colorimetry. Cardiac structure and function were measured by echocardiography (VEVO 3100) and pulse wave velocity was measured by Pulse Wave Doppler. Exercise tolerance test was performed on treadmill. Plasma endothelin-1 and nitrite were measured by ELISA and colorimetric assay. Aortic SIRT-1 was determined by western blot and aortic vascular reactivity was determined by wire myograph. Results: S961-induced GDM mice exhibit hyperglycemia (169.2 ± 3.6 vs. 105.5 ± 10.8mg/dL, P&lt;0.004 ) and hyperinsulinemia (1.9 ± 0.2 vs. 0.8 ± 0.1ng/ml , p&lt;0.01 ) which mimics the condition observed in human GDM. Interestingly, S961-induced GDM mice went on to develop systolic and diastolic dysfunction, vascular stiffness (3.7 ± 0.1 vs. 3.1 ± 0.08m/s, p&lt;0.005 ), exercise intolerance and increased thickness of the cardiac wall at 10 weeks post-delivery. Plasma ET-1 was elevated in our model during pregnancy (28.1 ± 1.7 vs. 5.2 ± 0.2pg/ml, p&lt;0.002 ) and at 10 weeks post-delivery (19.9 ± 2.9 vs. 6.7 ± 0.7pg/ml, p&lt;0.05 ). Circulating NO and aortic expression of sirtuin-1 (SIRT 1), that is involved in endothelial longevity is reduced in GDM mice. Additionally, vascular relaxation to acetylcholine was attenuated in S961-induced GDM mice. Conclusion: We have developed a novel mouse model of GDM similar to that observed in pregnant women by treatment with S961. Moreover, S961 treated mice develop cardiac dysfunction and vascular stiffness at 10 weeks post-delivery. Alterations in ET-1, SIRT 1, and NO levels may be responsible for the development of CVD in this model.