tbuckley/cabot-search huggingface dataset:
Abstract 4146053: Global Burden and Trend of Cardiomyopathy and Myocarditis in G20 Countries from 1990-2021: A secondary analysis from the Global Burden of Disease Study 2021.
Authors: Ragavendar Saravanabavanandan, Darshine Venugopal, Ratan Pal Yadav, Saif Syed, Mohit Lakkimsetti, Harsha Choudary Pudhota, Ashwinikumar Shandilya, VISHRANT AMIN, JUHI PATEL, Paritaben Bhalodia, HARDIK DESAI, kamal sharma
Journal: Circulation (2024)

Introduction: Cardiomyopathy (CM) and myocarditis rank as the fifth leading cause of death and disability in G20 countries amongst all cardiovascular disease related (CVD) deaths. Despite their escalating burden, there is a notable lack of consistent data across these nations. This study is the first to estimate the burden of these cardiac conditions over the last three decades, including the initial two years of the COVID-19 pandemic, highlighting the urgent need for improved surveillance and specific healthcare strategies to manage these critical health issues. Method: We estimated incidence, prevalence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs) due to CM and myocarditis by age, sex, year and location across the G20 countries from 1990-2021 using global burden of disease 2021 methodology. Results: From 1990 to 2021, the total percentage change (TPC) in prevalence counts increased by 64% (95% Uncertainty Interval: 53% to 75%), incidence by 57% (47% to 68%), and deaths by 37% (26% to 49%). Japan had the highest age-standardized incidence rate (ASIR) at 19.84 (16.38-24.21) cases per 100,000, closely followed by Sweden at 19.74 cases per 100,000. The highest mortality rate (ASMR) was observed in Latvia at 27.95 (23.89-31.99) cases per 100,000, with Russia following at 26.3 cases per 100,000 in 2021. Poland recorded the highest YLD rate (ASYLDR) at 16.13 (11.05-22.86), with Sweden next at 15.67 per 100,000 in 2021. The highest incidence occurred in the 70-74 age group with 76,173 cases (46,415-113,840), with the most deaths in the 80-84 age group at 31,289 (27,390-33,741), and the highest DALYs in the 55-59 age group at 750,723 (680,540-814,890) in 2021. Regarding gender, the TPC in incidence for males was 55% compared to 61% for females, in deaths 57% for males versus 16% for females, and in YLDs 67% for males versus 54% for females from 1990 to 2021. Conclusion: Deaths due to CM and myocarditis accounted for 2.04% of all CVD deaths in G20 countries in 2021. The increasing burden highlights the need of proactive initiatives, including tailored health education and advanced screening programs. It should be prioritized to address the needs of the most affected demographics and regions. Integrating technology and cross-border healthcare collaborations could play a pivotal role in mitigating the impact of this condition and enhancing overall public health resilience.
Abstract 4145721: Diagnosing Hemorrhagic Myocardial Infarction with 3D Cardiac MRI Under 15 minutes
Authors: Xinheng Zhang, Xingmin Guan, Hsin-jung Yang, Yuheng Huang, Ghazal Yoosefian, Anthony Christodoulou, Debiao Li, Rohan Dharmakumar
Journal: Circulation (2024)

Background: Hemorrhagic myocardial infarction (hMI) has emerged as the most serious form of reperfusion injury in MI patients. Cardiac MRI (CMR) is the gold standard for characterizing hMI. Given the challenges in imaging these patients (difficulty with breath-holding and patient discomfort with long scans), we developed a free-breathing, non-ECG gated, motion-resolved whole LV 3D CMR to integrate multiple quantitative measurements to limit acquisitions to be within 15 min. Method: A free-running 3D Cartesian readout with IR preparation and multiple readouts were used to collect image data interleaved with subspace training data. Images were represented as a 6-way tensor with a combined spatial and 5 temporal dimensions and then were jointly reconstructed. The post-Gd acquisition was time-resolved to trace the Gd kinetics (last time point used to determine LGE). The time-resolved images were assigned to 15 bins (~1 min/bin) and the temporal coefficients were estimated from subspace training data. Data Acquisition: Canines with reperfused MIs were imaged at weeks 1 (n=12) and 8 (n=9), post MI. Reference 2D CINE, T2* and LGE images were acquired at diastole during end-expiration breath-holds. Data Analysis: Left Ventricle Ejection Fraction (LVEF), MI size and transmurality, microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) size were computed from conventional CINE, (Early Gadolinium Enhancement) EGE, LGE, T2*-weighted (T2*-w) images (TE=11.42 ms), respectively and compared with those determined using the proposed 3D method. Trichrome and Prussian Blue staining were used to validate MI and IMH, respectively. Results: Representative CINE, T2*-w and LGE images obtained using conventional and proposed methods are shown in Fig. 1A&amp;B. There was excellent agreement in LVEF, IMH size, extent of MI (Fig. 1C-F), as well as early and late enhancement (Fig. 2) between the approaches. Conclusion: Accurate characterization of hMI can be performed under 15 minutes without gating. Patients studies are needed for clinical validation.
Abstract 4146190: Multinational Clinical and Community-based Validation of PRESENT-SHD, an Ensemble Deep Learning Approach for the Detection of Multiple Structural Heart Disorders Using Electrocardiographic Images
Authors: Lovedeep Dhingra, Arya Aminorroaya, Aline Pedroso Camargos, Veer Sangha, Luisa Brant, Sandhi Barreto, Antonio Luiz Ribeiro, Harlan Krumholz, Evangelos Oikonomou, Rohan Khera
Journal: Circulation (2024)

Background: Screening for structural heart disorders (SHDs) requires cardiac imaging, which has limited accessibility and requires clinical expertise. We report the multinational validation of PRESENT-SHD, an artificial intelligence-based approach for detecting multiple SHDs from a single image of a 12-lead electrocardiogram (ECG) across clinical settings in the US and a community-based cohort from Brazil. Methods: Using paired ECG images and transthoracic echocardiograms (TTEs) from the Yale New Haven Hospital (2015-2023) from 110,228 patients, we developed PRESENT-SHD, an ensemble deep learning approach combining CNN probabilities for individual SHDs with a person’s age and sex, as a single screen for multiple SHDs. SHD was defined as any LV systolic dysfunction (LVEF &lt; 40%), moderate-or-severe left-sided valve disease, or severe LVH (IVSd &gt; 15mm and LV diastolic dysfunction). We validated PRESENT-SHD across patients from 4 distinct hospitals and an outpatient medical network (Northeast Medical Group [NEMG]) in the US and in a large prospective population-based cohort study, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), who underwent protocolized ECGs and TTEs concurrently. Results: We evaluated the model on a single ECG drawn from 8921 individuals at Bridgeport Hospital, 2507 at Greenwich Hospital, 17,856 at Lawrence + Memorial Hospital, 3638 at Westerly Hospital, 21,055 at NEMG, and 3014 in ELSA-Brasil. SHD prevalence ranged from 20-23% at the hospital sites and 22% at the outpatient NEMG. It was 3% in the population-based ELSA-Brasil. In the hospital-based sites, PRESENT-SHD had an AUROC ranging 0.847-0.899, with sensitivities and specifities of 81-85% and 72-80%, respectively. In the outpatient NEMG, the performance was also consistent (AUROC, 0.815 [95% CI, 0.808-0.822], sensitivity 61%, specificity 84%). In ELSA-Brasil, the model had an AUROC of 0.853 (95% CI: 0.808-0.890) with sensitivity and specificity of 63% and 90%, respectively. Model performance was consistent across demographic subgroups. Conclusion: PRESENT-SHD maintained excellent performance in identifying SHD on ECG images across diverse populations and clinical settings in the US and Brazil. This demonstrates strong potential as a scalable and accessible tool for SHD screening using digital or printed versions of 12-lead ECGs.
Abstract 4145908: Early Pregnancy Blood Pressure Trajectory Predicts Diagnosis of Hypertensive Disorders of Pregnancy: an External Validation Study
Authors: Megan Sheehan, Manyun Zhao, Stacey Alexeeff, Baiyang Sun, Erica Gunderson, Lisa Levine, Jinbo Chen, Jennifer Lewey
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and contribute to cardiovascular disease later in life. Early identification of patients at highest risk of HDP may improve targeting of preventive therapies. Prior work within the Kaiser Permanente Northern California (KPNC) cohort demonstrated that early pregnancy blood pressure trajectories (BPT) improved HDP prediction compared to clinical factors alone. Our objective is to assess the performance of BPT models in a racially diverse patient population. Methods: We identified patients within Penn Medicine with a delivery from 2012-2020 and ≥3 outpatient BP measurements between 0 to 20 weeks gestation. Patients with pre-existing hypertension (HTN) or serious medical conditions were excluded. Covariates were obtained from the electronic medical record (EMR). Each patient was assigned one of six BPT groups based on KPNC latent class growth models. The primary outcome of HDP diagnosis, including preeclampsia and gestational HTN, was identified using ICD codes. Multivariable logistic regression was used to model the relationship between patient factors and HDP diagnosis. Predictive models were compared using the C-statistic. Results: Among 26,430 patients, the mean age was 30.8 years, 23% had Medicaid insurance, and 32% identified as Black. Overall, 22% of patients developed HDP and incidence varied by BPT group (Figure). After adjusting for age, race/ethnicity, parity, BMI, and diabetes, the moderate-stable group (aOR 5.42, 95% CI 3.7-8.3) and the elevated-stable group (aOR 10.2, 95% CI 6.9-15.8) had the strongest associations with HDP compared to the ultra-low-declining group. The prediction model including patient factors and BPT groups had better discrimination for HDP compared to patient factors alone (C-statistic 0.71 vs 0.66). Overall, models including BPT groups performed similarly to those from the KPNC cohort. Conclusions: Compared to the KPNC cohort, the Penn cohort had higher prevalence of patients with HDP, who identified as Black and had Medicaid insurance. Despite these differences, early pregnancy BPT groups demonstrated a similar improvement in HDP prediction compared to patient risk factors alone.
Abstract 4146021: Post transcatheter aortic valve replacement outcomes among patients with heart failure with preserved ejection fraction versus heart failure with reduced ejection fraction.
Authors: Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, Adriana Mares, FNU Sundas, Ramesh Daggubati, Kendra Grubb
Journal: Circulation (2024)

Background: Heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) is a common comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR). However, post-TAVR outcomes among HFpEF and HFrEF patients have not been well studied. Objective: This study aims to investigate the clinical outcomes post-TAVR among patients with HFrEF vs. HFpEF. Methods: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2005 to May 2023. Patients were categorized into two groups: HFpEF and a control group with HFrEF, with both groups of patients undergoing TAVR and followed for 1-month and 1-year. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, low density lipid (LDL) level, and various drugs including ACEi, ARBi, beta-blockers, SGLT2i and statins. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, major bleeding and major adverse cardiovascular event (MACE) (composite of ACM, AMI and ischemic stroke). Results: After 1:1 propensity score matching ( Figure 1 ), the study cohort comprised of 11, 982 patients in HFpEF with TAVR and 11, 982 patients in the control group. The mean age of patients in HFpEF and HFrEF was 81.7 and 81.5 years, respectively. PSM analysis showed that post-TAVR outcomes among HFpEF patients were significantly associated with lower risk of ACM after 1-month (RR, 0.88 (95%CI: 0.707-0.953), P =0.009), and after 1-year (RR, 0.93 (95% CI: 0.87-0.99), P =0.041) compared with the HFrEF group. A similar trend was observed with a significant reduction in the risk of MACE after 1-month (RR, 0.86, (95% CI: 0.74-0.99), P =0.043), however, it was non-significant after 1-year (RR, 0.942 (95% CI: 0.881-1.007), P =0.077). However, the risk of AMI, ischemic stroke, hemorrhagic stroke, major bleeding both at 1-month and 1-year follow up were comparable between the HFpEF and HFrEF post-TAVR. Conclusion: In patients with HFpEF post-TAVR, there was a significant decrease in ACM at 1-month and 1-year, while there was a significant reduction in MACE only at 1-month. Further investigation is warranted to determine whether HFpEF has better clinical outcomes than patients with HFrEF.
Abstract 4146005: Cardiogenic Shock secondary to Acute Structural Valve Dysfunction of an Avalus Bioprosthesis in a Patient with Two Prior Valve Replacement Surgeries - Third Time’s the Charm
Authors: Carlos Matute-Martinez, Anu Radha Twayana, PRASHANTH GUMPU SIVASHANKAR, GODFREY TABOWEI, Hanieh Tabatabaei Yeganeh, Abi Watts, Fernando Boccalandro
Journal: Circulation (2024)

Aortic valve replacement (AVR) with biological valve prostheses (BV) avoids long-term anticoagulation compared with mechanical vale prostheses. Their durability is limited due to structural valve dysfunction (SVD). Valve degeneration is gradual, leading to bioprosthetic valve failure (BVF). We present the first case reported of acute aortic Avalus bioprosthesis SVD with severe aortic regurgitation (AR) secondary to flail leaflet. A very active 52-year-old male with CAD, atrial fibrillation/flutter, and bicuspid aortic valve (AV) with symptomatic severe aortic stenosis treated with a 25 mm Abbott St. Jude/EPIC TM Supra valve 16 years ago required a redo surgery for infective endocarditis with an aortic root abscess treated with a 25 mm Medtronic Avalus BV 5 years prior and aortic root reconstruction. He presented with a 3-day history of chest pain and severe dyspnea. On arrival, cardiogenic shock and respiratory failure ensued, requiring vasopressors and endotracheal intubation. CXR revealed pulmonary edema. Coronary angiogram revealed non-obstructive CAD. TEE revealed preserved LV function with severe acute AR. He underwent emergent AVR. Surgery revealed a sterile flail prosthetic valve leaflet with complete prolapse of the noncoronary cusp. A 27-mm Medtronic Evolute BV was placed. His course was complicated by transient complete heart block. He continued improving and was then discharged. Acute AR should be suspected in patients with acute hemodynamic instability and history of AVR. TTE or TEE are crucial for the assessment of BV and diagnosis of AR. The only effective treatment for acute severe AR is emergent AVR. Newer generation BVs offer the possibly of not requiring long-term anticoagulation and enhanced durability. The PERIGON trial evaluating the Avalus bioprosthesis in AVR showed no cases of SVD with excellent durability and hemodynamic profile during the 5-year follow-up, being this the first case reported in the literature of acute catastrophic failure of this valve. Our case highlights the importance of rapid diagnosis and intervention in acute aortic BVF. While newer BVs offer improved durability and hemodynamic properties, clinicians must remain vigilant for acute complications secondary to SVD. Studies with longer follow-up are needed to better characterize the safety and performance of the Avalus bioprosthesis. The lack of standardized definitions for SVD may have led to underreporting and underestimation of its incidence.
Abstract 4146010: Does Pre-eclampsia Heighten the Risk of Future Cardiovascular Events? Insights from a Retrospective Study
Authors: Usman Akbar, Fnu Muhibullah, Nouman Shafique, Ahmed Muaaz Umer, Muhammad Aslam Khan, Saad Malik, Urooj Rehman, Besham Kumar, Faizan Ahmed, Umer Rizwan, Michael Cheshire, Sourbha Dani
Journal: Circulation (2024)

Background: Pre-eclampsia (PE) affects approximately 4 million women annually, characterized by sudden-onset hypertension (&gt;20 weeks gestation) and proteinuria. It is a leading cause of maternal and perinatal morbidity and mortality and increases long-term cardiovascular risks for mothers and infants. This study examines the long-term risk of arrhythmias in women with PE to improve future cardiovascular outcomes. Methods: This observational cohort study utilized the US Collaborative Network to analyze electronic medical records from 64 healthcare organizations. We identified 7,463 women with PE and 7,463 matched women without PE, following them from their first pregnancy to the incidence of arrhythmia, death, or study end. Primary outcomes included heart failure, cardiac arrhythmias, atrial fibrillation/flutter, supraventricular tachycardia, and ventricular fibrillation. Incidence rates and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models over a median follow-up of 1 year. Results: Women with PE had significantly higher risks of heart failure (HR 6.39, 95% CI: 3.48–11.74, p = 0.007), cardiac arrhythmias (HR 1.70, 95% CI: 1.35–2.13, p &lt; 0.001), and atrial fibrillation/flutter (HR 2.73, 95% CI: 1.22–6.13, p = 0.011). No significant difference was observed for supraventricular tachycardia (HR 0.93, 95% CI: 0.44–1.98, p = 0.116), while the risk of ventricular fibrillation was 49% higher in the PE cohort (HR 1.49, 95% CI: 1.01–2.19, p = 0.044). Conclusion: Women with pre-eclampsia have significantly higher risks of developing heart failure, cardiac arrhythmias, and atrial fibrillation/flutter compared to those without PE. No significant difference was found in the risk of supraventricular tachycardia, while the risk of ventricular fibrillation was moderately higher. These findings underscore the need for targeted cardiovascular monitoring in women with a history of PE.
Abstract 4145771: Association Between Sleep Quality Parameters and Risk of Stroke: A Meta-Analysis of Mendelian Randomization Studies
Authors: Arankesh Mahadevan, Samyuktha Prabu, Mansi Patel, Hemanth Dhananjaya, Himanshu Jog, Ninia Goyal, Rashmi Gawde, Rupak Desai
Journal: Circulation (2024)

Background: Sleep quality has emerged as a potential contributor to ischemic stroke risk, and genetic associations have been increasingly investigated for this association. Our analysis aims to elucidate the current understanding of the genetic basis linking sleep quality parameters to ischemic stroke through four distinct exposure groups: short sleep duration, long sleep duration, total sleep duration, and the presence of insomnia. Method: The PubMed database was searched to find Mendelian randomization studies reporting the association between ischemic stroke and associated sleep durations and parameters using title abstract keywords and medical subject headings. The initial search yielded 76 results, of which 62 underwent title abstract screening, and nine studies were identified for full-text screening. Eight studies were included in the final analysis. The random effects model was used to pool binary outcomes as odds ratios (OR) with 95% confidence intervals (CI), and the results were presented on forest plots. P value &lt; 0.05 was considered for statistical significance. Results: Our pooled analysis revealed a statistically significant association between insomnia and higher odds of ischemic stroke (1.11 [95% CI 1.01-1.22, p=0.03]). However, this finding was limited by high heterogeneity (I2 = 77%, p&lt;0.01). Short sleep vs. normal sleep duration, long sleep vs. normal sleep duration, and total sleep duration did not show statistically significant associations with ischemic stroke (OR: 1.06 [1.00-1.12], 1.01 [0.94-1.08], and 0.99 [0.98-1.00], respectively). Conclusion: Our pooled analysis of Mendelian randomization studies finds a positive association between insomnia and the odds of ischemic stroke. However, the associations between sleep duration and ischemic stroke cannot be ruled out. Suggesting potential genetic underpinnings between sleep quality parameters and cerebrovascular events.
Abstract 4145774: Clinical Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair in Cancer Survivors: A Systematic Review and Meta-Analysis
Authors: Thomaz Costa, Nicole Felix, Mariana Clemente, Bruno Costa, Neiberg Lima, Avirup Guha, Guilherme Silva
Journal: Circulation (2024)

Introduction: Little is known about the outcomes of cancer survivors versus patients without a history of cancer undergoing Transcatheter Edge-to-Edge Mitral Valve Repair (TEER) for mitral regurgitation (MR). Moreover, recent publications retrieved conflicting results on the safety and efficacy of TEER in cancer survivors. Hypothesis: Performing TEER in cancer survivors produces similar outcomes when compared to patients with no history of cancer. Aims: Conduct a systematic review and meta-analysis to evaluate clinical outcomes after TEER for MR in patients with versus without a history of cancer. Methods: From inception to December 2023, we systematically searched PubMed, Web of Science, and Embase for studies comparing the safety and efficacy of TEER for MR in cancer survivors versus in patients without a history of cancer. Outcomes of interest were 30-day and 1-year all-cause mortality, incidence of post-procedural MR grade ≥ 3, post-procedural stroke, and 30-day readmissions. Statistical analyses were performed using R software version 4.3.2. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. Results: We included six observational studies comprising 25,334 patients, of whom 6.1% were cancer survivors. Cancer survivors and controls had comparable rates of 30-day all-cause mortality (OR 1.15; 95% CI 0.55 to 2.39; p=0.71), 1-year all-cause mortality (OR 1.61; 95% CI 0.93 to 2.79; p=0.09), post-procedure severe MR (OR 1.49; 95% CI 0.67 to 3.30; p=0.33), post-procedural stroke (OR 1.25; 95% CI 0.47 to 3.27; p=0.66), and 30-day readmission (OR 1.16; 95% CI 0.92 to 1.46; p=0.19). Conclusion: This meta-analysis suggests that cancer survivors with symptomatic MR have similar outcomes after TEER as compared with patients who do not have a history of cancer. Future multicenter studies are warranted to confirm and expand these findings in larger populations and with multivariable-adjusted analysis.