tbuckley/cabot-search huggingface dataset:
Abstract 4142146: Disparities in Health Literacy Are Present in Adult Congenital Heart Disease Patients in the Modern Era
Authors: William Porter, Stephen Dolgner, Michael DiLeo, Katherine Salciccioli, Nicolas Flores, Keila Lopez
Journal: Circulation (2024)

Introduction: Health literacy levels (HLL) in adults with chronic diseases correlate with health outcomes, especially in acquired cardiovascular disease. Data demonstrates that lower HLL correlate with lower education, and adult congenital heart disease (ACHD) patients have overall lower educational attainment. Currently, the HLL of ACHD patients is understudied and largely unknown. We hypothesized that adults with lower educational attainment would have a lower HLL. Methods: We conducted a cross-sectional study of health literacy between March and June 2024 in a large tertiary care ACHD outpatient clinic. We included patients ≥18 years old with simple, moderate, or great complexity CHD who spoke English or Spanish. We excluded patients with significant developmental delay and intellectual disability. The primary outcome was the Newest Vital Sign (NVS) Score, a validated 6-point adult health literacy assessment tool, where low HLL is a NVS score of 0-3. Our primary predictor variable was education level. Covariables included age, race/ethnicity, primary language, insurance type, and transition program participation. Analysis was performed using univariable logistic regression (Stata v.17). Results: Seventy-three in-person HLL assessments were completed. One patient was excluded for developmental delays on assessment. The median age was 32 years (25-75% IQR 24.5-46). Most of the cohort was female (58%) and had great complexity CHD (72.2%). Patients were 59.7% non-Hispanic White, 25% Hispanic, and 12.5% Black. 89% primarily spoke English. 72% had private insurance, and 76% had at least a high school education. The median NVS score was 5, with a range of 0-6 (Figure). Logistic regression demonstrated ~4x higher odds of low HLL for Hispanics (OR 3.92, 95% CI 1.07-14.33) and 4.6x higher odds of low HLL for public insurance (OR 4.6, 95% CI 1.23-17.23). There was no HLL association with age, education level, CHD severity, primary language, or transition program participation. Conclusion: This is the largest study assessing the HLL of the ACHD population in the modern era. While education did not correlate with HLL, lower HLL in Hispanic and publicly insured patients underscores a need for further evaluation in these populations.
Abstract 4142101: Preservation of Cardiac Function by Glucagon-Like Peptide-1 (28-36) through Metabolic Modulation and Coronary Vasodilation in a Juvenile Porcine Model of Donation after Circulatory Death
Authors: Sachiko Kadowaki, M. Ahsan Siraj, Mimi Deng, Robert Lao, Manya Lamba, Jing Li, Anita Nagy, Brigitte Mueller, Steve Fan, Marlee Parker, Junko Kobayashi, Mansoor Husain, Osami Honjo
Journal: Circulation (2024)

Purpose and Hypothesis: Despite the increasing number of donation after circulatory death (DCD) heart transplants over the last decade, there is no promising cardioprotective agent to improve DCD heart function in this clinical setting. There is some evidence that glucagon-like peptide (GLP)-1 (28-36), a metabolite of the insulinotropic GLP-1(7-36) incretin hormone, provides cytoprotection to the coronary vasculature without activating the GLP-1 receptor. This study aims to explore the potential benefits of GLP-1(28-36) on DCD hearts in juvenile pigs. Methods and Results: DCD heart procurement was performed on twelve Yorkshire juvenile pigs (9-12 kg) with a 15-min warm ischemic period, followed by reperfusion for 2 hours using ex-vivo heart perfusion (unloaded condition) with either GLP-1(28-36) or scrambled GLP-1(28-36) control (SCRAM) (each N=6, 6-nM), before switching to working mode (loaded condition). Between-group differences were analyzed using Wilcoxon rank-sum tests and linear mixed-effects models. Over the reperfusion period, venous lactate levels trended down in the GLP-1(28-36) group, compared to SCRAM (3.0±1.1 vs. 4.4±0.5, mmol/L at 120min, p=0.01; Figure 1A ), despite no significant difference seen in plasma cardiac troponin I levels in working mode (GLP-1[28-36] vs. SCRAM, 61±20 vs. 83±18, ng/mL, p=0.08). Coronary vascular resistance was lower in the GLP-1(28-36) group vs. SCRAM (0.48±0.11 vs. 0.93±0.51 mmHg*min/mL/100g at 30min, p&lt;0.01; Figure 1B ). During working mode, GLP-1(28-36)-treated hearts showed better diastolic function (dp/dt min: -3357±784 vs. -2372±471 mmHg/sec, p=0.03), with comparable systolic function (p=0.13). Higher levels of cardiac activated endothelial nitric oxide synthase (0.23±0.05 vs. 0.14±0.02, p&lt;0.01) and plasma cyclic guanosine monophosphate (45±22 vs. 23±11, pmol/mL, p=0.03) were observed with GLP-1(28-36) treatment. Conclusion: GLP-1(28-36) preserves diastolic function of DCD hearts during ex-vivo heart perfusion by reducing anaerobic metabolism and maintaining coronary endothelial function.
Abstract 4142895: Artificial Intelligence for Clinical Risk Stratification: Expert Based Risk Scores versus Online Open Source Generative Pre-Trained Transformers
Authors: Marinela Veshtaj, Alaa Omar, Loba Alam, Ga Hee Kim, Sean Pinney, Edgar Argulian
Journal: Circulation (2024)

Background: We explored the potential of cutting-edge open-label artificial intelligence, particularly the unique cognitive capabilities it offers, in modern clinical practice. Our study evaluated the efficacy of online open-source generative pre-trained transformers (ChatGPT) in predicting cardiovascular risk in patients with heart failure and preserved ejection fraction, comparing its performance with expert-based clinical stratification. Methods: Retrospectively, we included 772 patients presenting with heart failure symptoms (mean age: 69±6 years, 56% female, mean ejection fraction: 61±5%, all &gt;50%). They were followed for a median of 3.9 years for occurrences of death and hospitalization due to heart failure (HF). A script incorporating 12 variables (see Figure 1) was generated and submitted to the ChatGPT website, utilizing the returned score. Additionally, the H2FPEF score was computed as per guidelines. We then compared the predictive capabilities of both models for outcomes. Results: During follow-up, 17 patients died, 52 were hospitalized, and 67 experienced the combined outcome. The average ChatGPT score stood at 6.1±1.7, whereas the mean H2FPEF score was 3.1±1.5, exhibiting a modest correlation (r=0.51, p&lt;0.001). Receiver-operator characteristic curve analysis suggested thresholds of ChatGPT of 6 and H2FPEF of 3 [AE1] for predicting the combined outcome, with comparable accuracy (AUC: 0.71 vs 0.72, all p&lt;0.001). Both models similarly accounted for patients' comorbidities, exercise capacity, and baseline and post-exercise diastolic function. Survival curves illustrated the discriminative power of both H2FPEF and ChatGPT scores in predicting death, HF hospitalization, and the combined outcome. While the agreement between the two classifications was modest (Kappa 0.4, p=0.032), ChatGPT facilitated the reclassification of high-risk patients identified by H2FPEF. Conclusions: Open-source large language models such as ChatGPT can contribute to existing methods for predicting cardiac risk, offering the potential for significant cost and expertise savings. Future research endeavors should explore broader applications in diagnosis and management, always prioritizing rigorous ethical and equitable considerations.
Abstract 4142932: Patients with Higher Stage of Cardiovascular-Kidney-Metabolic Syndrome Are More Likely to be Prescribed Antihypertensive Medication, Referred to Dietitians, and have an Echocardiogram among Youth Referred for Hypertension Disorders: A SUPERHERO Analysis
Authors: Andrew South, Carissa Baker-Smith, Jessica Campbell, Giya Harry, John Laisure, Margaret Murphy, Elizabeth Onugha, Ashna Pudupakkam, Sandeep Riar, Sahar Siddiqui, Carol Vincent, Michael Walsh
Journal: Circulation (2024)

Background: Presence of cardiovascular-kidney-metabolic (CKM) syndrome may help guide hypertension (HTN) management. However, whether initial management of youth with HTN disorders differs by CKM syndrome stage is unknown. Methods: Inferential cross-sectional analysis of baseline data from 7 sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data using standardized biomedical informatics scripts validated by manual record review. Inclusion criteria were youth &lt;19 years old who received care from subspecialists for ICD-10 code-defined HTN disorders from 1/1/2016–12/31/2023. Exclusion criteria were ICD-10 code-defined kidney replacement therapy (dialysis or transplantation) or pregnancy. Exposure was CKM syndrome (Stage 0, Stage 1, Stage 2, or Unclassified) defined by ICD-10 codes and recorded blood pressure and BMI. Outcomes were orders for antihypertensive prescriptions ( n =5,766) and for echocardiograms and dietitian referrals ( n =9,356). We used directed acyclic graph-informed generalized linear models adjusted for acute kidney injury, cancer, growth restriction, lower birth weight, preterm birth, and social risk factors by ICD-10 codes and visit season. Results: Of 9,356 participants, 85% had CKM syndrome, 16% were prescribed a medication, 33% had an echocardiogram ordered, and 7% had a dietitian referral ordered. Participants with Stage 2 CKM syndrome were 34% more likely to have an echocardiogram ordered vs. Stage 0 (95% CL 1.16–1.55) and 25% more likely vs. Stage 1 (95% CL 1.14–1.38). Those with Stage 2 were 29% more likely to be prescribed medication vs. Stage 0 (95% CL 1.03–1.62) and 62% more likely vs. Stage 1 (95% CL 1.35–1.94). Compared to Stage 0, dietitian referrals were more common in those with Stage 2 CKM syndrome (RR 1.85, 95% CL 1.28–2.68), Stage 1 (RR 1.79, 95% CL 1.21–2.67), and Unclassified (RR 1.91, 95% CL 1.21–3.02). Discussion: At the first HTN disorder clinic visit, providers were more likely to order echocardiograms, prescribe antihypertensive medication, and refer to dietitians in youth with worse CKM syndrome stage. This supports current guideline recommendations for youth with HTN disorders. Ongoing steps in SUPERHERO are improving the definition of CKM syndrome and outcomes. Future analyses will investigate if presence of CKM syndrome can improve management and health outcomes.
Abstract 4143003: Association of Mitral Regurgitation with Heart Failure Subtypes in Patients with Chronic Kidney Disease: the CRIC Study
Authors: XUANYI JIN, Jing Chen, Hua He, Cong Zhao, Sydney Richardson, Layla Wright, Oygen Suayp, Flor Alvarado, Arnold Alper, Lydia Bazzano, Katherine Mills, Jiang He
Journal: Circulation (2024)

Background: Data on the association between mitral regurgitation (MR) and heart failure (HF) subtypes in participants with chronic kidney disease (CKD) are scarce. Hypothesis: We hypothesized that the worsening of MR severity is associated with the incidence of both HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in participants with CKD. Additionally, these associations may differ by sex, race, or the presence of atrial fibrillation (AF). Methods: We studied participants with CKD who had an echocardiography exam (2013-2015) in the Chronic Renal Insufficiency Cohort (CRIC) study and were free of HF at the time of enrollment in the study. The incidence of HFpEF and HFrEF was determined and classified based on the hospitalization diagnosis and ejection fraction measured by echocardiography during the hospitalization or follow-up visits. The level of MR severity was categorized as absent/trace, mild, and moderate/severe based on visualization and quantification of the effective regurgitant orifice area from an apical-four chamber. Multivariable Cox hazard models were used to examine the association of MR degree with the incidence of overall HF, HFpEF, and HFrEF. Results: Among 2951 participants with CKD (58.9 years, 46.1% women, and 73.4% with MR), 309 incident HFpEF and 322 incident HFrEF were confirmed during follow-up. Worsening MR severity was associated with the incidence of HFpEF (hazard ratio [HR] 1.65, p =0.04) and HFrEF (hazard ratio 1.91, p &lt;0.001), independent of traditional clinical risk factors, ejection fraction, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio ( Table 1 ). In addition, AF accounted for 10.1% and 11.1% of the association of MR severity with HFpEF and HFrEF, respectively. Furthermore, MR severity was associated with HFrEF in women (HR 4.04, p &lt;0.001, p sex- interaction =0.0019), but not in men (HR 1.20, p =0.80). Conclusion: In patients with CKD, worsening MR severity was significantly and independently associated with the risk of HFpEF and HFrEF. These associations are partially explained by the presence of AF.
Abstract 4142098: Clinical Link of Neutrophilia to Neovascularization and Fibrinolysis
Authors: Darwin Eton MD FACS DFSVS
Journal: Circulation (2024)

The anti-angiogenic impact of neutrophil elastase clouded the understanding of the role of neutrophils in promoting neovascularization (NV) and fibrinolysis in patients with chronic limb-threatening ischemia (CLTI). The impact of significant neutrophilia was not studied during clinical trials using Granulocyte Colony Stimulating Factor (G-CSF) to boost the deficient circulating endothelial progenitor cell count. Only recently have activated human neutrophils been documented to release pro-angiogenic factors such as VEGFA, Hepatocyte Growth Factor (HGF), MMP-9, angiopoietin (Ang1). They also stimulate and modulate fibrinolysis through release of proteases, and by promoting endothelial cell release of plasmin. The purpose of this abstract is to link clinical evidence* to these observations. Proteomic and cytometry data were obtained in 14 CLTI patients treated with Filgrastim 7-10 mcg/kg SQ every 72 h for up to a month. The absolute neutrophil count (ANC) increased a mean of 6-fold a day after each injection, returning to baseline within 72 hours. Significant (p &lt; 0.05) increases in the concentration of VEGFA, HGF, MMP-9, Ang1 was measured by ELISA a day after both the 5th and the 10th Filgrastim doses as compared to baseline. The ANC peak was measured at the same time, as well as was the significant (p &lt; 0.01) increases in the plasma concentration of plasmin (&gt;10-fold) and Fibrin Degradation Products (FDP) (&gt;5-fold). Since these patients also wore an infra-geniculate programmed compression pump (PCP) for 3 hours daily, these data were compared to 19 CLTI patients treated with PCP alone. PCP was used to improve the ischemic micro-environment and to provide endothelial shear stress as a strategy to induce arteriogenesis. PCP use did not influence the concentration of any of these proteins and did not induce neutrophilia. Resolution of ischemic rest pain and healing of ischemic ulcers contributed to limb salvage. Arterial hemodynamic improvement was supported by angiographic evidence of NV (enlarged corkscrew collaterals, improved contrast transit through the ischemic tissue). Segmental arterial recanalization indicated fibrinolysis. No hemorrhage occurred over the 30 day course. A prospective investigation of the uncovered link between neutrophilia, NV, and fibrinolysis is justified. * J Tissue Eng Regen Med. 2022 May;16(5):496-510. doi: 10.1002/term.3284
Abstract 4142072: Prevalence of Cardiovascular Risk Factors in Pediatric Patients in a Large Rural Health System
Authors: Catherine Benziger, Stephen Asche, Clayton Allen, Laura Freitag, Claire Holland, Melissa Harry, Brandon Schultz, Heidi Ekstrom, Inih Essien, Abhilash Muthineni, Vijayakumar Thirumalai, Phuong Vo, Kay Kromrey, Elizabeth Ronkainen, Daniel Saman, Patrick Oconnor, Elyse Kharbanda
Journal: Circulation (2024)

Introduction: Cardiovascular (CV) disease risk factors in rural areas are influenced by behavioral, environmental and social factors. Risk factors begin in childhood and contribute to increased morbidity and mortality in adults. Research Questions: What is the difference in burden of CV risk factors among pediatric patients by rural and urban residences? Aims: To describe the CV risk factors among patients 6-17 years of age by rural and urban dwelling in a large, rural health system. Methods: Descriptive cohort study of patients aged 6-17 years in the PedsBP study, a pragmatic, cluster-randomized study in 44 Essentia Health (MN, WI, ND) primary care clinics (3 pediatric, 41 family medicine, 73% rural). Patients were included who had an ambulatory clinic visit and blood pressure measurement at time of index visit and were seen from 8/1/2022-7/31/2023. Patients were separated into groups based on rural vs urban residence (rural urban commuting code [RUCA] 4-10 were considered rural). Primary outcomes include the number of CV risk factors (out of 5): hypertension, obesity, pre-diabetes or diabetes mellitus, hyperlipidemia (all based on problem list, labs and vital signs), and current tobacco smoking or passive smoke exposure (self-reported). Results: Among 33,160 (50.4% female, mean age 11.6 years, SD=3.5 years) eligible patients,18,348 (55.3%) were from a rural residence. The most common CV risk factor was obesity (Rural N=3,888; 21.2%; Urban N=2,890; 19.5%), followed by current smoking/passive smoking (Rural N=3,341;18.2%; Urban N=2,201; 14.9%), hyperlipidemia (Rural N=548; 3.0%; Urban N=750; 5.1%), hypertension (Rural N=415, 2.3%; Urban N=357; 2.4%), and diabetes (or pre-diabetes) (Rural N=215; 1.2%; Urban N=225; 1.5%). Patients in rural areas were more likely to have ≥1 CV risk factors than patients in urban areas (36.1% vs. 33.6%, p&lt;0.001). However, patients in rural and urban areas did not differ in their likelihood of having ≥2 CV risk factors (8.5% vs. 8.1%, p=0.22). Conclusions: 1 in 12 children and adolescents have ≥2 CV risk factors. Obesity and smoking are the most prevalent factors. Differences between rural and urban youth varied by risk factor.
Abstract 4142173: Inpatient Outcomes for Patients with Peripheral Artery Disease Hospitalized for Acute Myocardial Infarction
Authors: Jason Gusdorf, Kamil Faridi, Tracy Wang, Carlos Mena-Hurtado, Kim Smolderen, Jennifer Rymer, Jeptha Curtis, Eric Secemsky
Journal: Circulation (2024)

Background: Patients with peripheral artery disease (PAD) and coronary artery disease (CAD) are at high risk for adverse cardiovascular events. Prior research shows worse clinical outcomes for these patients, but contemporary in-hospital outcomes for PAD patients hospitalized with acute myocardial infarction (AMI) are not well characterized. Objectives: The objective of this study was to characterize in-hospital mortality and major bleeding events in PAD patients hospitalized with AMI in the U.S. We hypothesized that patients with PAD have higher rates of bleeding and mortality during AMI hospitalization. Methods: We assessed characteristics, major bleeding, and mortality of AMI patients with PAD, defined as atherosclerotic disease in peripheral arteries, at 670 hospitals in the NCDR Chest Pain MI Registry between January 01, 2019 and March 31, 2023. Primary endpoints were in-hospital mortality and major bleeding. Exploratory endpoints included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis requirement. Results: Of 493,740 patients, 36,274 (7.4%) had PAD. These patients were older with higher prevalences of comorbidities. In-hospital mortality was 8.2% for patients with PAD vs. 4.9% for those without PAD, while major bleeding occurred in 9.7% of patients with PAD and 6.3% of those without PAD. After multivariable adjustment, PAD was associated with increased mortality (aOR 1.25; 95% CI 1.19 to 1.31) and major bleeding (aOR 1.23; 95% CI 1.17 to 1.28). The elevated risk of in-hospital mortality was driven by patients with PAD who were 65 years of age or older (aOR 1.29; 95% CI 1.22 to 1.37), whereas no significant difference was observed in patients younger than 65 years (aOR 1.00; 95% CI 0.91 to 1.09). No significant interactions for mortality risk were observed based on sex (p=0.98) or race (p=0.84). For major bleeding, no significant interactions were observed based on age (p=0.41), sex (p=0.84), or race (p=0.27). Exploratory endpoints showed poorer outcomes in PAD vs. non-PAD patients regarding cardiac arrest (6.4% vs. 4.6%), cardiogenic shock (6.9% vs. 4.8%), heart failure (2.5% vs. 1.0%), stroke (1.4% vs. 0.9%), and new dialysis requirement (2.5% vs. 1.0%). Conclusions: This large, nationally representative study demonstrates that PAD patients hospitalized for AMI are at increased risk for in-hospital mortality and major bleeding compared to patients without PAD. Improved management strategies in the acute care setting are needed.
Abstract 4143007: Pericoronary fat attenuation index as a Novel Tool to predict the morbidity of new-onset atrial fibrillation in patients with myocardial infarction with nonobstructive coronary artery disease
Authors: Sizhuang Huang, Mengyue Yu, Haobo Xu
Journal: Circulation (2024)

Background: Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. The pericoronary fat attenuation index (FAI) could reflect the local coronary inflammation as a novel imaging marker. This study focuses on the correlation between FAI and the morbidity of new-onset atrial fibrillation (NOAF) in MINOCA patients. Methods: This study was a single-center, observational clinical cohort study. Patients who underwent coronary angiography and diagnosed with MINOCA in Fuwai Hospital from January 2015 to December 2019 and met the inclusion criteria were enrolled. We mainly explored the correlation between the FAI of right coronary artery and left circumflex and morbidity of AF. Kaplan-Meier analyses and Cox regression analyses were performed to evaluated cumulative NOAF hazard ratio during a 77.2-month follow-up. ROC analyses were also adapted in this study to detect the best cut-off value for FAI in predicting NOAF. Results: A total of 592 MINOCA patients with coronary CT angiography were enrolled, including 40 (8.0%) with NOAF. CT was performed within two months before or after the onset of MI. Patients in higher median group of FAI had an apparently higher rate of NOAF (8.8% vs 4.7%; P&lt;0.05) during the follow-up time. After adjusted for multiple clinically relevant variables, higher FAI was still associated with an increased risk of NOAF (HR=1.71; 95% CI: 1.23-2.39 P&lt;0.001). Moreover, AMR had an AUC of 0.722 for NOAF prediction with the best cut-off value of -74.395 HU. Conclusions: FAI score of main atrial coronary artery (RCA and LCX ), which may capture the risk of inflammation, is closely related to the atrial function. Higher FAI was a risk factor for NOAF in patients with MINOCA, which had high specificity and sensitivity for predicting NOAF in MINOCA patients. Assessment of FAI score derived from CCTA may increase predictability for NOAF in this special population.