tbuckley/cabot-search huggingface dataset:
Abstract 18615: Utilizing Deep Learning Network for Analyzing National Health and Nutrition Examination Survey Data: Investigating the Association Between Self-Reported Sleep Duration and Hypertension
Authors: Dr Debbie Chung, April Rogers, Azizi A Seixas, Ferdinand Zizi, Girardin Jean Louis
Journal: Circulation (2023)

Introduction: Epidemiological evidence consistently demonstrates significant links between self-reported sleep duration and hypertension (HTN). However, traditional logistic regression models may not capture the full complexity of these associations. Therefore, in this study, we employed a Deep Learning Network to model the intricate relationships between sleep duration and HTN. Methods: Data were extracted from participants (n=38,540) in the National Health and Nutrition Examination Survey (2006-2016), a nationally representative study of the US civilian non-institutionalized population. Self-reported demographic, medical history and sleep duration were determined from household interview questions. HTN was determined as SBP ≥ 130 mmHg and DBP ≥ 80mmHg. We used a deep neural network architecture with three hidden layers with two input features and one binary output to model associations of sleep duration with HTN. The input features are the hours of sleep (limited to between 4 and 10 hours) and its square; and the output variable HTN. Probability predictions were generated 100 times from resampled (with replacement) data and averaged. Results: Participants ranged from 18 to 85 years old; 51% Female, 41% white, 22% black, 26% Hispanic, 46% married, and 25% &lt;high school. The model showed that sleeping 7 hours habitually was associated with the least observed HTN probabilities (P=0.023%). HTN probabilities increased as sleep duration decreased (6hrs=0.05%; 5hrs=0.110%; 4hrs=0.16%); HTN probabilities for long sleepers were: (8hrs=0.027; 9hrs=0.024; 10hrs=0.022). Whites showed sleeping 7hrs or 9hrs was associated with lowest HTN probabilities (0.008 vs. 0.005); blacks showed the lowest HTN probabilities associated with sleeping 8hrs (0.07), and Hispanics showed the lowest HTN probabilities sleeping 7hrs (0.04). Conclusions: We found that sleeping 7 hours habitually confers the least amount of risk for HTN. Probability of HTN varies as a function of individual’s sex and race/ethnicity. Likewise, the finding that blacks experience the lowest HTN probability when they sleep habitually 8 hours is of great public health importance. Support: R01HL142066, R01AG067523, R01AG075007
Abstract 13614: Nationwide Trends in Transcranial Doppler Utilization During Acute Ischemic Stroke Hospitalizations
Authors: Dhaivat Shah, Nishitha Sai Sreeni, Karishma Patil, Anchu Thomas, Aagam Jain, Rajkamal Pandya, Abdiwahid adam, Pooja Sekar, Ramit Singla, Urvish K Patel
Journal: Circulation (2023)

Background: Trans-cranial Doppler (TCD), diagnostic ultrasound of the head and neck is a non-invasive, safe, and portable tool to assess dynamic cerebral blood flow. TCD allows us to explore the patient's neurocritical pathological features without invasive testing. Although TCD is portable and inexpensive compared to CT/MR angiograms, its utilization during AIS hospitalization is nonfrequent and unknown. Aim: The aim of the study was to evaluate the patterns of TCD use during AIS hospitalizations. Design/Methods: Data from the Nationwide Inpatient Sample (NIS-2003-2014) for adults (≥18 yr) were analyzed. Primary discharge diagnoses of AIS and TCD were identified using ICD-9-CM codes 433-436, 437.1, and 88.71, respectively. Cochran-Armitage trend test and multivariable survey logistic regression were utilized to evaluate TCD use and predictors. Results: Of 4,224,924 patients identified with AIS 93,673 (2.22%) had TCD examination. There was a significant decline in utilization of TCD (3.84% in 2003 to 1.34% in 2014, p&lt;0.0001). The patients with TCD utilization had a higher mean length of stay (6 vs 5 days; p&lt;0.0001) and cost of hospitalization ($39,270 vs $38,100; p=0.0007) than non-TCD utilization. In multivariate regression analysis, age group 50-64 (aOR:1.55; 95%CI:1.28-1.88), 65-79 (1.66; 1.32-2.08), ≥80 (1.68; 1.29-2.18), African American (1.51; 1.45-1.58), Hispanic (1.63; 1.55-1.72), Asian/Pacific Islander (1.36; 1.26-1.47), zip income 76-100th percentile (1.24; 1.19-1.30), large bed size hospitals (1.44; 1.36-1.52), hypertension (1.05; 1.01-1.09), hypercholesterolemia (1.23; 1.18-1.29; p&lt;0.0001), alcohol abuse (1.09; 1.00-1.18), anticoagulant use (1.47; 1.39-1.56), ischemic heart disease (1.05; 1.01-1.09), and ventricular septal defect (2.69; 1.31-5.52) have higher odds of TCD utilization. We have noticed lower odds of TCD utilization in elective admissions (0.65; 0.59-0.72). (c-statistic: 0.71) Conclusions: Over the last decade, there has been a slight but steady decrease in the use of TCD during AIS hospitalizations in the US. Future studies should examine the cost-utility of TCD, especially with the advent of endovascular stroke treatment systems.
Abstract 15527: Cardiac Magnetic Imaging-Derived First-Pass Perfusion Parameter: New Marker for Cardiac Involvement and Prognosis in Light-Chain Amyloidosis
Authors: Keying Bi, Ke Wan, Yuanwei Xu, JIE Wang, Weihao Li, Yucheng Chen
Journal: Circulation (2023)

Introduction: The clinical value of cardiac magnetic resonance (CMR) imaging-derived first-pass perfusion parameters in patients with light-chain (AL) amyloidosis remains unknown. Methods: This prospective study included 226 patients with biopsy-proven AL amyloidosis who underwent CMR between November 2011 to June 2021, with 43 healthy volunteers as normal controls. pulmonary transit time (PTT), Corrected PTT (PTTc), and pulmonary transit beats (PTB) were quantified and calculated from first-pass perfusion image. All-cause mortality was defined as the primary endpoint. Receiver operating characteristic curve, Kaplan-Meier analysis and Cox regression were used for statistical analyses. Results: PTT [area under the curve (AUC) 0.84], p&lt;0.001, PTTc (AUC 0.84, p&lt;0.001), and PTB (AUC 0.81, p&lt;0.001) were sensitive to identified cardiac involvement in patients with AL amyloidosis. Amongst 226 patients [143 men, 58.80 years ± 9.86], all-cause death occurred in 166 patients (73.5%) during a median follow-up of 35 months (interquartile range, 25-51 months). In multivariable-adjusted cox regression analysis, PTT was an independent predictor of mortality after adjustment for known clinical [HR 1.061, 95% confidence interval (CI) 1.021-1.102, p=0.003], biochemical (HR 1.055, 95% CI 1.014-1.097, p&lt;0.008), and CMR (HR 1.077, 95% CI 1.034-1.123, p=0.002) risk factors, respectively. In the Kaplan-Meier analysis, PTT cutoff value provided further risk stratification in the subgroup of NYHA class III (p=0.039), Mayo stage 2004 III (p&lt;0.001), and transmural late gadolinium enhancement (LGE) pattern (p&lt;0.001). Conclusions: CMR Imaging-derived First-Pass Perfusion Parameters were sensitive for the diagnosis of cardiac amyloidosis and aid for further risk stratification in patients with advanced cardiac amyloidosis.
Abstract 15011: Recent Trends in Interventional Treatment of Acute Pulmonary Embolism and Their Implications for a National Healthcare System
Authors: Katharina Mohr, Ioannis T Farmakis, Stefano Barco, Richard N Channick, Konstantinos Christodoulou, Jay S Giri, Lukas Hobohm, Brent Keeling, Karsten Keller, Michelle Lanno, Robert A Lookstein, John M Moriarty, Jamie Reed, Rachel P Rosovsky, Kenneth Rosenfield, Eric A Secemsky, Thomas M Todoran, Harald Binder, Stavros V Konstantinides
Journal: Circulation (2023)

Introduction: Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is gaining popularity in Europe, following a trend that originated earlier in the US. For healthcare systems, reimbursement of CDT depends on their clinical benefits along with assessing the impact on hospital costs. Hypothesis-Aims: To estimate how increasing use of CDT, as reflected by prospective US data, may affect costs of PE treatment in the German hospital remuneration system (G-DRG). Methods: We analyzed data from the German nationwide inpatient sample (Federal Statistical Office), covering all hospitalizations for PE, for the years 2018-2019. For the same period, we analyzed prospective patient-level data from the multicenter US registry of the Pulmonary Embolism Response Team (PERT) Consortium. Results: During the study period, 196,167 patients were hospitalized for acute PE in Germany. Of these, 64,056 (33%) had intermediate-risk or high-risk PE, but overall ≤ 1% received CDT. Median reimbursement was є3,572 (IQR, 2,804-5,869), corresponding to є4,088 in inflation-adjusted 2022 currency ($5,678, adjusted for purchase parity power). Of 1,349 patients with intermediate- or high-risk PE included in the US registry in 2018-2019, 284 (21%) received CDT, mostly aspiration thrombectomy (63/1,349; 4.7%), ultrasound-assisted catheter thrombolysis (151; 11.2%), or non-assisted catheter thrombolysis (47; 3.5%). Median length of stay was 4.5 (2.8-8.2) days. Based on current reimbursement rates in the G-DRG, fees for PE treated with aspiration thrombectomy amount to є12,179-15,753, and for catheter-directed thrombolysis (with or without ultrasound) to є9,858-13,829. Considering, (a) the shorter length of stay; (b) the proportion of patients receiving CDT in the elevated-risk US cohort in 2018-19; and (c) that of intermediate- and high-risk PE in the German PE inpatient sample, average remuneration per patient would rise from currently є4,088 to є4,724 ($6,552). Conclusions: CDT for PE patients at elevated risk would currently lead to a 16% increase in average per-patient hospital costs in Germany. Together with clinical validation of CDT in ongoing studies, these estimates may inform decision making on reimbursement of interventional treatment options.
Abstract 201: 3D-Printed Automated Pressure-Cycled Resuscitator Maintains Respiratory Homeostasis in Swine With Normal to Moderately Low Lung Compliance
Authors: Brian K Walsh, Evan Mullen, Eliauria R Martins, Álvaro J de Andrade Dantas, Caio da Costa, João Barbosa Roberto, Luiz Alberto G de Oliveira Filho
Journal: Circulation (2023)

Background: During resuscitation, manual ventilation is commonly used. However, the effectiveness of this approach heavily relies on the skills of the individuals performing, often leading to inconsistent tidal volumes and respiratory rates. Such variations in ventilation can disrupt the removal of CO 2 resulting in altered pH. To address this problem, we leveraged advancements in fluidics and 3D printing to develop a miniature, automated, pressure-cycled resuscitator (inVent) that operates without any moving parts or settings. Hypothesis: The inVent will be able to maintain a pH of 7.2 or higher in swine with a dynamic compliance (Cdyn) of 25-50 ml/cmH 2 O. Goals/Aims: To assess the inVent’s performance in an animal model with normal to severe lung injury. Methods: Hybrid Landrace swine were studied under a protocol approved by the Institutional Animal Care and Use Committee. All swine were anesthetized, and underwent oral intubation. Breath by breath measurements were obtained using the NM3 Monitor (Phillips). All 3 inVent (fluidIQ) resuscitators pressure modules were used pre and post lung injury to fully characterize how each of the modules would react in different lung conditions. Lung injury was induced through a repeated bronchoalveolar lavage. ABG analysis was performed using the epoc system (Siemens). pH values 7.2 or less were considered acidotic while those over 7.2 were considered acceptable. Results: 8 swine with an average weight of 36 (5.8) Kg were studied. 7 swine contributed to 39,770 breaths of pulmonary mechanics and 33 ABGs recorded. Mean Cdyn was lower than anticipated at 25.8 (14.7) mL/cmH 2 O and a pH 7.32 (0.16). Figure 1 demonstrates a linear relationship with compliance and pH. Conclusions: The inVent resuscitator was able to maintain a pH of at least 7.2 in moderate compliance ranges, however struggled to maintain pH of 7.2 or higher in the severely injured. Higher lung compliance ranges are needed to explore possible hyperventilation events.
Abstract 18180: Contemporary Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events in Young Hospitalized Adults With Dependent Cannabis Use in Absence of Concomitant Tobacco, Alcohol or Cocaine Use Disorder, 2016-2019
Authors: Priyatham Gurram, Adil S Mohammed, Sandeep Guntuku, Vikas Yadav, Ravi Venkata Sai Krishna Medarametla, Shanmukh sai pavan Lingamsetty, Rishabh Baskara Salian, Shariq Nawab, Zaki Ur Rahman Mohammed, ERUM SAEED, IRFAN SAEED, Rawnak Jahan, Akhil Jain, Rupak Desai
Journal: Circulation (2023)

Introduction: Recreational cannabis use has been on the rise among young adults in recent years. Dependent cannabis use disorder (CUD) has been linked to various cardiac events, but its impact on young adults in the absence of concomitant substance abuse remains unclear. We aim to analyze the nationwide trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this specific population. Methods: We identified hospitalized young adults (18-44 years) using National Inpatient Sample (2016 -2019), excluding those with concomitant substance abuse (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD- groups. We assessed the trends in hospitalizations for MACCE, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS), using ICD 10 codes. Results: Of 27.4 million hospitalizations among young adults without other substance abuse, 4.2% (1.1 million) had CUD. The rates of hospitalizations for MACCE (1.71% vs. 1.35%), AMI (0.86% vs. 0.54%), CA (0.27% vs. 0.24%), and AIS (0.27 vs. 0.24%), were higher in the CUD+ group compared to the CUD- group (P &lt; 0.001). However, the rate of ACM hospitalizations (0.30% vs. 0.44%) were lower in the CUD+ group. From 2016 to 2019, the CUD+ group exhibited a relative increase of 5% in MACCE and 20% in AMI hospitalizations, which were lower compared to the respective increases of 22% and 36% in the CUD- group (Ptrend&lt;0.05). Additionally, there was a relative decrease of 13% in ACM hospitalizations among the CUD+ group, whereas the CUD- group experienced a relative increase of 10% (Ptrend&lt;0.05). Conclusion: The CUD+ group had higher rates of MACCE admissions, but the growing trends were more pronounced in the CUD- group through the years. Interestingly, the CUD+ group exhibited lower rates of ACM compared to the CUD- group. Further research is needed to better understand this complex relationship.
Abstract 16820: Outpatient Intravenous Diuresis in Decompensated Heart Failure: A Systematic Review
Authors: Roshni S Kalkur, John P Hintz, Girish Pathangey, Katharine A Manning
Journal: Circulation (2023)

Introduction: Heart failure (HF) burdens the US healthcare system, with persistent 30-day readmission (25%) and mortality rates (10%), and annual costs exceeding $30 billion. Outpatient intravenous (OP IV) diuresis in clinic or home settings may potentially improve outcomes and reduce costs, though limited data exist. This systematic review evaluates the safety, efficacy, and outcomes of OP IV diuresis in managing decompensated HF as a hospitalization alternative. Methods: Following PRISMA 2020 guidelines, this systematic review used MeSH terms in MEDLINE, SCOPUS, CINAHL Complete, and Cochrane Central. From 16 selected studies, 15 were single-center; 6 prospective, 9 retrospective; and 1 was a randomized trial comparing OP IV diuresis to oral home regimen. Demographics, visit data, and outcomes were collected, and 30-day outcomes were compared to inpatient IV (IP IV) diuresis from 2021 Medicare HF hospitalizations. Results: The review included 2088 unique patients, with a mean age of 69±6 years, 62% male, and 75% NYHA III-IV. Minimal adverse post-diuresis events such as hypokalemia, hypotension, and worsening renal function occurred (4.3%, 0.7%, and 2.2% respectively). Post-visit mean weight loss was -2.2±1.1 kg. The 30-day readmission rate for OP IV diuresis was comparable to IP IV diuresis (22.6 % vs. 22.6%; p=0.995), while 30-day mortality was lower (5.6% vs. 10.7%; p&lt;0.001). In addition, mean 1-year mortality for OP IV diuresis was under 20%, compared to 25-30% for IP IV diuresis. Estimated cost savings per patient ranged from $1,632-10,395. Conclusions: OP IV diuresis is a safe and effective treatment for decompensated HF with minimal risk of adverse events. Data demonstrates comparable readmission rates to IP IV diuresis with significantly lower mortality rates and costs. These findings highlight the potential of OP IV diuresis as an enhanced alternative for HF care; however, further randomized control trials are needed to evaluate long-term outcomes.
Abstract 18175: LncRNA in Monocytes of Patients With Type 2 Diabetes and Established Cardiovascular Disease Modulate the Expression of Protein-Coding Genes
Authors: Najeeb Halabi, Binitha Thomas, Jassim Al Suwaidi, Jayyousi Amin, Martina Bradic, Charbel Abi Khalil
Journal: Circulation (2023)

Introduction: Monocytes contribute to cardiovascular complications of type 2 diabetes (T2D) through various mechanisms. Objectives: We investigated diabetes-induced changes in long non-coding RNAs (lncRNA) from monocytes of patients with T2D and established cardiovascular disease. Methods: We performed polyA capture and paired-end RNA sequencing of monocytes from 120 patients with T2D and 37 non-diabetes controls. Monocytes were sorted using FACSAria2 flow cytometer. Alignments and gene counts were done with STAR to reference GRCh38 using Gencode (v41) gene annotations. The batch correction was done with CombatSeq and differential expression analysis with EdgeR. The false discovery was controlled with the Benjamini-Hochberg procedure. Pathway analysis was done with the IPA software using differentially expressed genes (DEGs) with a p-value &lt; 0.05. Co-expression analysis was done with cdsR and Cytoscape. Results: We found two significantly upregulated lncRNAs in monocytes from diabetes patients (ENSG00000287255 and ENSG00000289424, FDR = 0.035). Pathway analysis on DEGs revealed a network affecting cellular movement, growth, and development that includes directly interacting plasma membrane genes ITGB4 and CDH1, nuclear genes HIF1a, ZEB1, ETS1, TWIST1, SNAI2, NFKB complex, and lncRNA genes SNHG29 and FBXL19-AS1 (p &lt; 1*10^ -25 ). Analysis within T2D patients revealed one lncRNA upregulated only in monocytes from patients with microvascular disease (ENSG00000261654 on chr1, FDR =0.022). Interestingly, co-expression analysis uncovered correlated expression clusters between lncRNAs and protein-coding genes, with one interesting interaction identified between the highly connected MCR1 and SNHG7, a lncRNA shown to respond to IGF-1 (insulin-like growth factor 1) . Conclusion: Monocytes from patients with diabetes have differentially expressed lncRNA genes that potentially impact diabetes-related pathways.
Abstract 13343: Left Ventricular Noncompaction Cardiomyopathy in a Family With Dolichol Kinase Congenital Disorder of Glycosylation
Authors: Eric T Xia, Iva Minga, Catherine Lazarus, Jose Nazari
Journal: Circulation (2023)

Introduction: During embryogenesis, failure of spongy, sinusoidal myocardium to condense results in left ventricular noncompaction cardiomyopathy (LVNC). The resulting LV is hypertrophic but loosely organized. LVNC is associated with heart failure (HF), arrhythmias, and thromboembolic events. Case: A 41 year old man with a history of non-ischemic HF with recovered ejection fraction associated with signs of LVNC, LV thrombus, and ischemic stroke while compliant with rivaroxaban has been known to cardiology services for years. His brother who also exhibited LVNC and suffered thrombotic events died at age 31 from advanced HF. Uniquely, EKG for both brothers showed exceptionally low ventricular voltage, with P waves of higher amplitude than R waves. Genetic testing revealed a homozygous variant of unknown significance (VUS) in dolichol kinase (c.863_865del)(p.Leu288del) establishing a diagnosis of congenital disorder of glycosylation (DOLK-CDG). Metabolic testing was abnormal and, given phenotypic overlap of the brothers, it is likely that the VUS caused this clinical presentation. Discussion: LVNC has never previously been linked with DOLK-CDG. In the literature, 27 patients with DOLK-CDG have been described ranging from 3 days to 16.5 years old at time of death. Nearly all patients expressed dilated cardiomyopathy, while others expressed a combination of ichthyosis, dysmorphism, and neurological dysfunction. Our patient reported good health until presentation with chest pain at age 35 when he was discovered to have ejection fraction of 40% and LV thrombus. The most curious finding was the paradoxically low ventricular EKG voltage in both brothers, dissimilar to the hypertrophic pattern commonly seen in LVNC. Yet all common MR criteria were met, strongly suggesting LVNC. Given the similarities in the presentation between brothers, this patient was preemptively referred for transplant.
Abstract 14954: Disaggregating the Burden of Cardiovascular Risk Factors and Disease Among Asian Subpopulations in the United States
Authors: Sudheesha Perera, ZhaoNian Zheng, Rishi K Wadhera
Journal: Circulation (2023)

Background: Asian Americans are the fastest growing racial group in the US, and represent a highly heterogeneous population. However, little is known about how the burden of all cardiovascular risk factors and diseases varies among Asian American subgroups on a national scale. Methods: We identified all Asian adults in the National Health Interview Survey (NHIS) database from 2013 to 2018, and fit survey-weighted logistic regression models to examine the association between each Asian subgroup (Chinese, Asian Indian, Filipino, Other Asian) and outcomes after adjustment for age and sex. We also evaluated how social determinants (education, insurance status, poverty) contributed to any observed associations. NHIS survey weights were used to generate nationally representative estimates. Results: The weighted study population included 12,984,588 Asian adults. After adjustment for age and sex, Filipino, Asian Indian, and Other Asian adults were all significantly more likely to have hypertension, diabetes, hyperlipidemia and obesity than Chinese adults (Figure). For cardiovascular diseases, Filipino adults were significantly more likely to have a history of heart attack (2.76% vs 0.51%; adjusted RR 2.73, 95% CI 1.42-5.22), coronary artery disease (5.00% vs. 1.37%; RR 2.16, 95% CI 1.30-3.55), and stroke (2.71% vs. 0.90%; RR 2.41, 95% CI 1.35-4.26) than Chinese adults, while prevalence rates were similar for other groups (Asian Indian, Other Asian). Differences across Asian subgroups were not attenuated after also including social determinants in our models. Conclusions: In this national study, the burden of cardiovascular risk factors and diseases varied significantly across Asian subpopulations. These findings highlight the importance of disaggregating Asian adults in national public health surveillance efforts, to inform targeted initiatives that address inequities in cardiovascular health.