tbuckley/cabot-search huggingface dataset:
Abstract 4140118: Identification of Obstructive and Non-Obstructive Hypertrophic Cardiomyopathy Patients Using Natural Language Processing in a Large Integrated Healthcare System
Authors: Ann Sheridan, Jane Liu, Grace Tabada, Thida Tan, Anand Dubey, Matthew Lucas, Yue Zhong, Gary Okano, Matthew Solomon
Journal: Circulation (2024)

Introduction: Accurately identifying and characterizing patients with hypertrophic cardiomyopathy (HCM) is critical for population management and care optimization. Research Question: To develop natural language processing (NLP) algorithms to identify and characterize obstructive (oHCM) and non-obstructive (nHCM) HCM patients directly from echocardiograms, and to compare with the presence or absence of HCM-related diagnosis codes. Methods: We developed and validated NLP algorithms to identify HCM from all adult (age≥18yrs) echocardiograms performed from 2010-2019 in Kaiser Permanente Northern CA (KPNC), capturing measures of any HCM, HCM subtype, hypertrophy subtype, septal and posterior LV wall thickness, resting and stress/Valsalva LVOT gradients, and systolic anterior motion. We developed a rules-based algorithm (following AHA/ACC criteria) to classify patients as having HCM, including oHCM or nHCM subtypes, and possible HCM (defined as wall thickness ≥2cm without other criteria meeting an HCM definition). We evaluated the presence of HCM-related ICD-9/10 diagnosis codes among patients classified as HCM/non-HCM from echocardiograms using NLP, and linked baseline demographics and clinical parameters from our integrated electronic medical record. Results: Among 472,405 adults with echocardiograms, we identified 2,892 patients with HCM based upon NLP-derived measures (all NLP measures achieved &gt;95% positive predictive value and &gt;95% negative predictive value), including 1,585 (55%) with oHCM, 1,145 (40%) with nHCM, and 162 (6%) which could not be classified (Figure). Among those 2,892 patients, 1,283 did not have any associated HCM ICD-9/10 diagnosis codes (Table). Among 469,513 patients with no identified HCM from NLP-based algorithms, HCM ICD-9/10 diagnosis codes existed in 1,567 patients (Table). We also identified 4,593 patients with possible HCM by NLP, only 4.5% of whom had an associated HCM code. Among confirmed HCM patients by NLP, oHCM patients were slightly older (66 vs 61 yrs), more likely female (53% vs 43%), had similar mean septal wall thickness (1.7cm vs 1.7cm), but were more likely to have a septal hypertrophy subtype (46% vs 28%) compared to nHCM patients. Conclusions: Echocardiogram-based NLP methods can improve the identification of and care for HCM patients. Many patients with possible HCM may be underdiagnosed, representing an opportunity for quality improvement.
Abstract Sa1104: Head and Pulmonary Artery Chest CT Detect Most but Not All Causes of Sudden Death and Resuscitation Injury Compared to Head to Pelvis CT Angiography in Survivors of Out of Hospital Circulatory Arrest
Authors: Xavier Sendaydiego, Khoi Ha, Peter Kudenchuk, Martin Gunn, Nicholas Johnson, Medley Gatewood, Charles Maynard, Michael Sayre, Catherine Counts, Kelley Branch
Journal: Circulation (2024)

Introduction: Head-to-pelvis “sudden death computed tomography” angiography (SDCT) has a high diagnostic yield to identify causes and complications of out-of-hospital cardiac arrest (OHCA). The differences in yields of non-contrast head CT (H-CT) and pulmonary embolism chest CT (CT PE) angiography alone or in combination is not clear. Methods: Our prospective observational cohort enrolled patients that survived OHCA resuscitation and had a SDCT (H-CT, ECG-gated chest CT, and non-ECG gated venous phase abdomen/pelvis CT) within 6 hours of arrival (December 2015 – February 2018). For this sub-study, we assessed the same scans for diagnoses obtainable from routine H-CT and CT PE axial coverage alone, excluding any added (SDCT) findings from ECG-gating and abdomen/pelvis assessment. The primary outcome was the difference in diagnostic yield of time-critical and non-time-critical diagnoses by CT PE with or without H-CT compared to SDCT. Results: SDCT identified 86 time-critical diagnoses in 104 enrolled patients, including 39 pneumonias (45% of diagnoses), 13 myocardial infarctions [MI] (15%), 8 pulmonary embolisms (9%), 8 pneumothoraces (9%), 8 abdominal catastrophes (9%), 3 intracranial hemorrhages (3%), and 1 vascular access hemorrhage (1%) [ Table ]. CT PE alone identified 61 of the 86 time-critical diagnoses (71%), missing 25 diagnoses (29%) compared to SDCT. Missing diagnoses included MI (13/13), abdominal catastrophe (8/8), and active vascular access hemorrhage (1/1). H-CT diagnosed all 3 intracranial hemorrhages. Of the 208 non-time-critical diagnoses identified by SDCT, CT PE identified 183 non-time critical diagnoses (88%), missing 25 diagnoses (12%). H-CT did not identify any non-time-critical diagnoses. Conclusions: CT PE imaging with H-CT identifies a majority—but not all—time-critical and non-time-critical diagnoses in OHCA patients, mainly failing to capture coronary and intra-abdominal pathologies. SDCT, which includes ECG-gated chest CT and abdomen/pelvis CT, improves total diagnostic yield, but its incremental utility requires further study.
Abstract 4147623: PORTAL VEIN PULSATILITY INDEX, INDEPENDENT OF INFERIOR VENA CAVA DILATATION, PREDICTS ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE HEART FAILURE
Authors: Eder Gonzalez Macedo, Ximena Latapi Ruiz Esparza, Sarai Hernandez Pastrana, Braiana Diaz, Mariana Garcia Villarejo, Raul Rodrigo Neri Bale, Alberto Santiago Hernández, Rodrigo Gopar-Nieto, Jorge Daniel Sierra Lara Martinez, Alexandra Arias-Mendoza, Diego Araiza
Journal: Circulation (2024)

Background: The VExUS score is a useful tool for assessing systemic venous congestion that has shown the ability to predict acute kidney injury (AKI) in various populations (post cardiac surgical, CKD&amp;ACS patients). Among the variables included in VExUS, inferior vena cava diameter (IVCD) is of particular importance, as the finding of a non-dilated IVCD (&lt;20 mm) assigns a VExUS score of 0 (indicating no venous congestion). However, multiple factors in addition to congestion status may affect the IVCD, which may result in an errouneous assessment of congestion. Previous studies have suggested that portal vein pulsatility index (PVPI) and renal vein doppler are associated with volume status; however, no previous studies have assessed the PVPI, independently of IVCD, in the prediction of AKI. Hypothesis: We hypothezise that PVPI may predict AKI independently of the IVCD in patients with AHF. Methods: A prospective, single-center study was conducted, including patients admitted to the emergency room from July 2023 to January 2024 with the diagnosis of AHF, and in whom VExUS evaluation was performed during the first 8 hours of admission. For the analysis of the primary endpoint, patients were divided into four groups based on the presence or absence of a dilated inferior vena cava (cutoff &lt;20 mm) and a PVPI ≥30%. We calculated the differences in time to the development of AKI for each group using survival analysis, Log-rank test and depicted the results using Kaplan-Meier curves. All statistical analyses were conducted using STATA v14.1. Results: A total sample of 189 patients was available for analysis (Figure 1). The mean age was 58.3 years (45.7–70.9), and the proportion of men was 73.6% (137), 5.9% patients had CKD stage IV (n = 11) and 18.8% CHF (n = 35). The median of serum creatinine at admission was 1.1 mg/dL (0.8 – 1.56) and NT-proBNP 4422 (1266 – 10783). Conclusion: PVPI, independent of dilatation of IVC, is a predictor of AKI in patients with AHF.
Abstract 4145896: Terminal Rhythm of the Worldwide First Genetically Modified Porcine-to-Human Xenotransplantation
Authors: Justin Brilliant, Mahdokht Parsirad, Bartley Griffith, Oneib Khan, Ubaid Khan, Manjula Ananthram, Susie Hong-Zohlman, Erika Feller, Alison Grazioli, Richard Amara, Stephen Shorofsky, Muhammad Mohiuddin, Timm Dickfeld
Journal: Circulation (2024)

Background: The worldwide first genetically modified porcine-to-human cardiac xenotransplantation was successfully performed in January 2022 at the University of Maryland with the recipient surviving 60 days. Aim: Assess the ECG parameters and cardiac rhythm during the death of the worldwide first porcine-to-human xenotransplant. Methods: Continuous 6-lead ECG telemetry was used to analyze ECG parameters and cardiac rhythm during the final 9 minutes after withdrawal of life support. Results: At the time of withdrawal (W), the patient was in sinus rhythm (70bpm, PR interval 280ms, right bundle branch block (RBBB) with QRS 140ms, QT 400ms; Figure). PR prolongation up to 360ms with loss of P wave was noted at W+2:55min. Irregular junctional rhythm with blocked PACs and bradycardia (23 bpm) occurred around W+3:25min. At that time, widening of RBBB to 160ms with non-specific repolarization abnormalities and QT prolongation were observed. At W+4:30min, increasing pauses of up to 8.5s with mild QRS axis shift occurred. At W+6min, asystole (up to 20s) with rare PVCs from the left anterolateral LV base were seen. Final rhythm at W+6min consisted of ventricular escape beats from the infero-basal LV before electrical activity ceased at W+6:45min. No other atrial or ventricular arrhythmias were noted. Conclusion: The porcine-to-human cardiac xenotransplant showed a terminal rhythm of bradycardia, sinus arrest, and junctional and ventricular escape beats. This is consistent with ischemia-related failure of impulse generation, slowing intra-atrial/AV-conduction delay, and failure of impulse propagation. Notably, no tachyarrhythmias were seen despite ectopic atrial and ventricular beats with prolongation of depolarization and repolarization. This is similar to traditional terminal rhythms observed in humans and does not suggest unexpected arrhythmic proclivities between pig myocardium and the human environment (“pig heart in human body”).
Abstract 4140139: Cardio-ankle vascular index (CAVI) in prediction of chronic coronary artery disease: risk, coronary artery lesions, and cardiovascular disease events
Authors: Le Van Dung, Pham Nguyen Son, Dinh Cong Pho, Pham Truong Son
Journal: Circulation (2024)

Introduction: The cardio-ankle vascular index (CAVI) is a significant metric for evaluating arterial function. The test measures the stiffness of the arteries from the beginning of the aorta to the ankle, and the algorithm used is not influenced by blood pressure. Recent statistics indicate that a high CAVI score has the potential to predict future cardiovascular disease (CVD) occurrences. However, no research has been conducted in Vietnam to investigate this matter. Methods: A prospective study was conducted on 222 patients. Out of these, 162 patients had chronic coronary artery disease (CAD), while the remaining 62 patients were free of CAD. The study took place between October 2019 and December 2022. Participants who fulfilled the criteria were evaluated using the CAVI baseline measurement and clinical and paraclinical parameters. A total of 162 patients with chronic coronary artery disease (CAD) were monitored for cardiovascular disease (CVD) events over a period of 2 years. Results: CAVI in chronic CAD patients (9.21±0.79) was significantly higher compared to those in free-CAD patients (8.48 ± 0.62) with p&lt;0.001. CAVI with a cut-off point ≥ 8.83 was a significant predictor for chronic CAD (OR = 9.6; 95%CI: 4.0-18.8). The Area under the curve (AUC) of CAVI for chronic CAD was 0.796 (95% CI: 0.736-0.856 ; p&lt;0.001). In addition, CAVI has a statistically significant increase in severe stenosis (≥75%) and multivessel coronary artery disease. CAVI in the CVD events group (9.77±1.06) was significantly higher than CAVI in the free–CVD events group (9.13±0.72) group (p=0.009). The patients with CAVI ≥9.63 have significantly higher CVD events (HR=6.4 ; 95% CI: 1.9-21.9, p=0.046). Conclusion: CAVI is higher in chronic CAD and can predict chronic CAD with a cut-off point ≥ 8.83. In chronic CAD, CAVI is higher in severe stenosis and multivessel coronary artery disease. Increased CAVI was significantly associated with CVD events.
Abstract 4112926: Echocardiography in Hypertrophic Cardiomyopathy: Virtual Continuing Medical Education Advances Physician Knowledge and Confidence
Authors: Margaret Harris, Margie Stefan, Anne Sendaydiego
Journal: Circulation (2024)

Purpose: This study examined whether online CME could improve the knowledge and confidence of cardiologists regarding the use of echocardiography for HCM diagnosis and management. Methods: The CME intervention comprised of a series of 6 online interviews between 1 moderator and 2 expert faculty. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, and 1, rated on a Likert-type scale, assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (significance level, P &lt; .05). Data were collected August 8-September 8, 2023. Results: 165 cardiologists answered all assessment questions during the study period. Analysis of pre- vs. post-intervention responses demonstrated a significant improvement in overall knowledge; average correct responses increased from 48% pre-assessment to 74% post-assessment ( P &lt;.001). Specific areas of improvement include: Knowledge of the quantification of LVOT gradients, MR, and LVEF in the echocardiographic workup of HCM: 21% improved and 62% reinforced; the correct response increased (P&lt;.001) from 65% (pre) to 84% (post). Knowledge of the utility of echocardiography for follow-up and monitoring response to HCM treatment: 48% improved and 35% reinforced; the correct response increase (P&lt;.001) from 39% (pre) to 70% (post). Post-education, 48% of cardiologists had a measurable increase in their ability to diagnose HCM using echocardiographic parameters, resulting in 43% who were mostly or very confident after education (24% pre vs 43% post; P&lt;.001). Conclusion: This study demonstrated the success of online CME at improving the knowledge and confidence of cardiologists related to the use of echocardiography to identify and manage HCM.
Abstract 4136938: Autonomous Personalized Dynamic ECG Analysis Predicts 1-hour Incidence of Sudden Cardiac Arrest
Authors: Debapriya Hazra, Steven Jones, Swati Dey, Deeptankar DeMazumder
Journal: Circulation (2024)

Background: Sudden cardiac arrest (SCA) is a leading cause of death in the USA. Defibrillators prevent SCA by delivering shocks for sustained ventricular tachyarrhythmias (VT). However, current clinical methods for predicting SCA are limited. We have shown that distinct nonlinear fluctuation patterns “hidden” within normal-appearing ECG waveforms have unique prognostic value. Hypothesis: Autonomous personalized dynamic ECG analysis predicts the 1-hour incidence of SCA. Methods: In an established pressure-overload model that exhibits key features of human VT and SCA (e.g., cardiac restitution properties), 30% of 37 freely ambulating animals had spontaneous SCA in 4 weeks. The exposures included a rolling 1-hour window of time, frequency and nonlinear domain measures of heart rate and QT time series during sinus rhythm, and EntropyX QT , a higher-dimensional machine learning-based nonlinear measure of cardiac repolarization dynamics. Results: In multivariate analyses, the major independent predictors of 1-hour incidence of SCA were (1) high EntropyX QT ; (2) high parasympathetic tone, as indexed by the high-frequency component of the heart rate power spectral density; and (3) the degree of coupling between RR and QT intervals. The baseline values of EntropyX QT and parasympathetic tone increased by 3.6-fold and 46.5-fold, respectively, during the hour preceding SCA. The adjusted ROC curve area was &gt; 89%. Conclusion: Continuous autonomous analysis of cardiac repolarization and autonomic dynamics strongly and independently predicts the subacute incidence of SCA. Incorporation of these measures into current strategies of SCA risk stratification has potential to save many lives and warrants further evaluation.
Abstract 4139191: ETX-258 - A GalOmic™ siRNA for the Treatment of Heart Failure Following Myocardial Infarction
Authors: Alexander Fischer, Natalie Pursell, Alan Whitmore
Journal: Circulation (2024)

Introduction: Heart failure with reduced ejection fraction (HFrEF) remains a significant clinical challenge, evidenced by high hospitalization rates and five-year mortality. Current treatments are limited by side effects, poor patient compliance, and the necessity for gradual drug titration. These challenges highlight the need for new therapies that are both safe and effective in targeting the structural remodeling pivotal to disease progression post-myocardial infarction (MI). e-therapeutics (ETX) uniquely combines computation and RNAi to discover life-transforming medicines. ETX’s RNAi platform, GalOmic™, enables generation of specific, potent, and long-acting siRNA therapies that effectively silence novel gene targets in hepatocytes. This highly specific mechanism of action limits unwanted side effects, positioning it as a promising approach to HFrEF treatment. Methods: Potent siRNAs against a hepatic target with cardioprotective potential were designed in silico. Candidate siRNAs were screened in vitro in HEK293 cells and in vivo in C57BL/6J mice to select the lead GalOmic™ siRNA, ETX-258. MI was induced by ligation of the left anterior descending artery in C57BL/6J mice after which ETX-258 was injected subcutaneously weekly for 6 weeks. Eplerenone, a mineralocorticoid receptor antagonist which is part of the current treatment regimen for HFrEF, was used as a comparator. Cardiac function was assessed by echocardiography at 2-, 4- and 6-weeks post-MI. Cardiac damage and structural remodeling were evaluated using circulating biomarkers of cardiac function and histological assessment. Results: ETX-258 was selected as a highly active siRNA for the treatment of heart failure with a long duration of action. Post-MI treatment with ETX-258 significantly improved key echocardiographic parameters of cardiac function, including ejection fraction and total cardiac output, achieving results comparable to eplerenone. Additionally, both structural cardiac parameters and markers of damage and remodeling showed significant improvements, reaching similar levels in both ETX-258 and eplerenone-treated mice. Conclusions: High unmet need remains for HFrEF patients despite existing therapies. These results highlight the potential of ETX-258 to improve cardiac function and pathogenic structural remodeling post-MI. This, paired with the long duration of action and favorable safety profile of GalOmic™ siRNAs, makes ETX-258 a promising candidate for further clinical development.
Abstract 4140154: Highly Sensitized Heart Transplant Recipients Who Have Undergone Pre-Transplant Desensitization Therapies Demonstrate Acceptable Medium-Term Outcomes
Authors: Rashmi Jain, Andriana Nikolova, Evan Kransdorf, Michelle Kittleson, David Chang, Jignesh Patel, Jon Kobashigawa
Journal: Circulation (2024)

Introduction/Research Question: Allosensitization, the presence of circulating anti-HLA antibodies, is a barrier in heart transplantation (HT), restricting the donor pool size, and leading to increased waitlist mortality and rejection risk post-HT. Desensitization therapies can be used to broaden the donor pool in highly sensitized patients, defined as pre-HT calculated panel reactive antibodies (cPRA)≥50%, for antibodies with mean fluorescence intensity (MFI)&gt;10,000. There is paucity of data on longer-term outcomes in such high-immunological risk patients. Methods: Sensitized patients with pre-HT cPRA&gt;50%, who were treated with desensitization and then received HT between 2011-2022 at Cedars-Sinai Medical Center were included. Desensitization therapies included bortezomib, rituximab, tocilizumab, obinutuzumab, intravenous immunoglobulin (IVIG), and plasmapheresis. cPRA, donor-specific antibody (DSA) levels, and post-HT clinical outcomes were assessed up to 5-year follow-up, loss to follow-up, or death. Results: 40 patients were analyzed. 77.5% of patients were female, and all had at least 1 risk factor for sensitization. cPRA decreased from 84.5±13.5% at baseline to 74.1±22.4% after completion of desensitization therapy, prior to transplant (p=0.005). Mean follow-up time post-HT was 4.3±2.9 years. 45.0% of patients had antibody-mediated rejection (AMR), 12.5% had CAV. Overall survival was 94.9%, 92.1%, and 87.5% at 1, 3, and 5 years respectively. All patients except 1 had normal left ventricular function at last follow-up. 72.5% of patients were transplanted in the presence of DSA, and 60.0% underwent post-HT induction with eculizumab in addition to antithymocyte globulin (ATG)/IVIG, while the remaining received ATG/IVIG alone. Among HT recipients with pre-formed DSA, 41.4% had high-level DSA (MFI &gt; 10,000) at time of HT. At 6-12 months post-HT, only 17.2% had high-level DSA, and 41.4% had resolution of DSA. Conclusion: Highly sensitized HT candidates who underwent pre-HT desensitization had comparable survival and CAV rates as compared to the general HT population reported in the literature. However, sensitized patients experienced higher rates of AMR which were not associated with graft dysfunction or mortality.
Abstract 4124966: Trends and Gender Differences in Stroke Mortality Rates Among Patients with Atrial Fibrillation/Flutter from 1999 to 2020
Authors: Issam Motairek, Chadi Tabaja, Astefanos Al-Dalakta, Abdel Hadi El Hajjar, Osamah Badwan, Besir Besir, Medhat Farwati, Ayman Hussein, Arwa Younis, Tyler Taigen, John Rickard, Mandeep Bhargava, Mohamed Kanj, Bryan Baranowski, Shady Nakhla, Pasquale Santangeli, Mina Chung, Walid Saliba, Oussama Wazni
Journal: Circulation (2024)

Background: Atrial fibrillation (AFib) and atrial flutter (AFL) are common arrhythmias associated with increased stroke risk. This study examines stroke mortality trends and gender differences among AFib/AFL patients in the United States over a 22-year period. Research Question: Do stroke mortality rates among patients with AFib/AFL show significant trends and gender differences from 1999 to 2020? Aims: The primary aim is to analyze trends in crude and age-adjusted stroke mortality rates and determine gender-specific differences over the 22-year period. Methods: We conducted a retrospective analysis using CDC multiple causes of death files from 1999 to 2020. Stroke deaths (ICD-10 codes I60-I69) with AFib/AFL (ICD-10 code I48) as contributory factors were identified. Crude and age-adjusted mortality rates were calculated annually. Joinpoint regression calculated annual percentage change (APC) and assessed trend significance (p &lt; 0.05). Poisson regression was used for rate comparisons. Gender-specific trends highlighted differences between males and females. Results: The analysis included 204,127 stroke deaths with AFib/AFL. Both crude and age-adjusted mortality rates increased. The crude mortality rate rose from 3.3 per 100,000 in 1999 to 4.9 per 100,000 in 2020, APC 1.8% (p &lt; 0.01). The age-adjusted rate increased from 3.4 to 4.0 per 100,000, APC 1.2% (p &lt; 0.01). Females had higher crude mortality rates, increasing from 4.3 to 5.5 per 100,000, APC 1.3% (p &lt; 0.01), while males rose from 2.3 to 4.2 per 100,000, APC 2.2% (p &lt; 0.01). Age-adjusted rates: females increased from 3.4 to 3.9 per 100,000, APC 0.8% (p &lt; 0.01), and males from 3.3 to 4.2 per 100,000, APC 1.6% (p &lt; 0.01). Poisson regression indicated these differences were significant (p &lt; 0.05). Age adjustment narrowed gender disparity. Conclusion: Increasing stroke mortality rates among AFib/AFL patients highlight a growing public health concern in the United States. Females have higher crude stroke mortality rates than males, but age adjustment reveals a more balanced trend. More work is needed to understand influencing factors, including anticoagulation rates, healthcare access, and AFib/AFL management strategies.