tbuckley/cabot-search huggingface dataset:
Abstract 4146129: Global, National and Regional Burden of Cardiovascular Disease in Women in 204 Countries and Territories and its Trend from 1990-2021: A Global Benchmarking Analysis.
Authors: Saif Syed, Paritaben Bhalodia, Shruthi Katam, nimrat dhillon, Ashwinikumar Shandilya, Danish Ahmed, Mohit Lakkimsetti, VISHRANT AMIN, Rabia Islam, Hamza Islam, HARDIK DESAI, kamal sharma, JUHI PATEL
Journal: Circulation (2024)

Introduction: Cardiovascular Disease (CVD) is the primary cause of death and disability among women worldwide. Despite its escalating impact, there remains a significant gap in consistent and comparative global data on the burden of CVD in women. This groundbreaking study provides the first estimates of the CVD burden in women over the past three decades, including the first two years of the COVID-19 pandemic. Method: Using the Global Burden of Disease 2021 framework, we estimated the prevalence, incidence, deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) due to cardiovascular disease (CVD) in women. This analysis spans ages, years, and locations across 204 countries and territories from 1990 to 2021. Results: From 1990 to 2021, the total percentage change (TPC) in prevalence of the condition increased by 108%, followed by a 91% increase in incidence, and a 47% increase in deaths. Regionally, the highest TPC in age-standardized incidence rate (ASIR) was observed in Central Asia at 14%, while the highest mortality rate (ASMR) was in Southern Sub-Saharan Africa at 15%, and the highest YLD rate (ASYLDR) was in Australasia at 8% from 1990 to 2021. Nationally, Uzbekistan saw the largest increase in ASIR at 69%, and the United Arab Emirates had the highest increase in ASMR at 82%. In terms of socio-demographic index, the highest ASYLDR was observed in middle SDI regions with a 1% increase, while other regions saw decreases. Regarding age, individuals aged 55 and over recorded the highest deaths at 8.4 million, followed by the 20-54 age group with 659,296, and under 20s at 37,034 in 2021. Ischemic heart disease constituted 43.46% of all CVD-related deaths in 2021. Conclusion: Deaths due to cardiovascular disease (CVD) in women attributable to metabolic risk factors accounted for 70.75% of all CVD-related fatalities. This was followed by behavioral risk factors at 34.64% and environmental risk factors at 31.62%. The disproportionate impact of metabolic, behavioral, and environmental risk factors on cardiovascular disease-related deaths in women highlights the critical need for targeted intervention strategies. Addressing these risk factors through comprehensive public health initiatives could significantly reduce the global burden of CVD in women.
Abstract 4146403: Direct Oral Anticoagulants vs Vitamin K Antagonists for Cardiovascular Interventions: A Systematic Review and Meta-Analysis
Authors: Ernesto Calderon Martinez, Jonathan Victor Salazar Ore, Carla Isabella Miret Durazo, Noe Alejandro Zuniga Gonzalez, Yuriana Zurita Salas, Evelyn Mabel Navarro, Clara Betances, Ernesto Enrique Garcia Rodriguez, Lautaro Floridia, Gabriela Navarrete Gutierrez, Sabia Afreen, Victor Arruarana
Journal: Circulation (2024)

Introduction: Anticoagulation therapy is crucial in enhancing perioperative outcomes, yet uncertainty persists regarding the optimal use of Direct Oral Anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) in cardiovascular interventions. Key outcomes such as bleeding, thromboembolic events, and mortality are critical. Conducting a thorough review is essential to make well-informed decisions that improve patient quality of life and mitigate complications. Hypothesis: This meta-analysis aimed to investigate whether Direct Oral Anticoagulants (DOACs) reduce perioperative complications such as bleeding, thromboembolic events, and mortality compared to Vitamin K Antagonists (VKAs) in patients undergoing cardiovascular procedures. Methods: The present study was conducted in accordance with PRISMA guidelines. A systematic search was conducted in PubMed, MEDLINE, Scopus, Web of Science, Cochrane, and EMBASE databases on 05/14/2024. Data extraction was rigorously performed, and a random-effects model was used for data synthesis. Results: The review included 25 studies involving a total of 25,754 patients. For bleeding risk, the meta-analysis showed that DOACs are associated with a lower risk compared to VKAs, with a relative risk (RR) of 0.69 (95% CI: 0.51 to 0.94, p = 0.0457, I 2 = 60%). Thromboembolic events showed no significant difference between DOACs and VKAs (RR: 1.13, 95% CI: 0.74 to 1.73, p = 0.5313, I 2 = 15%). Mortality outcomes also showed no significant difference (RR: 0.53, 95% CI: 0.20 to 1.43, p = 0.1622, I 2 = 68%). Conclusion: The systematic review and meta-analysis demonstrate that DOACs are associated with a lower risk of bleeding compared to VKAs, with no significant difference in thromboembolic events and mortality. This evidence supports the substantial benefit of DOACs in cardiovascular interventions. Further research is needed to consolidate these findings and improve patient outcomes. PROSPERO registry— CRD42024547465
Abstract 4146406: Association of Pulmonary Function with Right Ventricular Function and Longitudinal Change: The Echocardiographic Study of Latinos (ECHO-SOL) and Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
Authors: Priscilla Duran Luciano, Juan Cedeno Serna, Yawen Yuan, Cristian Zamora, Ayana April-Sanders, Mayank Kansal, Gregory Talavera, Sanjiv Shah, Martha Daviglus, Franklyn Gonzalez, Robert Kaplan, Barry Hurwitz, Carlos Rodriguez
Journal: Circulation (2024)

Introduction: Right ventricle (RV) changes secondary to severe lung disease are well described, but the association of pulmonary function tests (PFTs) and subclinical airflow obstruction with RV function is unexplored. Methods: Serial echocardiograms conducted 4.3 years apart on 1643 adults (mean age 56.4 years, 41.5% female) during ECHO-SOL visits 1 (2011-2014) and 2 (2015-2018) were analyzed. RV baseline function and change over time (from visit 1 to 2) were assessed by echocardiographic outcomes: RV fractional area change (RVFAC, %), tricuspid annular plane systolic excursion (TAPSE, mm), peak S’ velocity (cm/sec), tricuspid regurgitant maximum pressure gradient (TR max PG, mmHg), and RV velocity-time integral (RV VTI, cm). PFTs assessed by spirometry during HCHS/SOL visit 1 (2008-2011) included forced expiratory volume in 1 second (FEV1) in liters, forced vital capacity (FVC) in liters, and FEV1/FVC ratio. Regression models were utilized. All analyses were weighted to account for complex survey design. Results: Greater baseline FEV1 and FVC volumes were associated with more favorable RV systolic function at visits 1 and 2 evidenced by greater TAPSE, higher peak S’ velocity (only visit 1), and lower RV pulmonary flow (TR max PG, RV VTI). However, an inverse association was seen between FEV1 and RVFAC at visit 2. Greater baseline FEV1/FVC was also associated with higher peak S’ velocity at visit 1, lower TR max PG at visit 2 but less favorable TAPSE at visit 2. ( Table ) Conclusion: Better lung function was associated with healthier RV function at baseline and over time among Hispanic/Latino individuals, highlighting the association of pulmonary function with RV function.
Abstract 4145990: Time Trend Analysis of Clinical Outcomes for Drug-Coated Balloon versus Drug-Eluting Stent among Patients with Coronary In-Stent Restenosis: A Meta-Analysis of Randomized Controlled Trials
Authors: Arman Soltani Moghadam, Sina Kazemian, Shayan Shojaei, saman soltani moghadam, Reza Hosseini Dolama, Rasoul Ebrahimi, Fatemeh Ojaghi Shirmard, Seyed Morteza Ali Pourfaraji, Mohammad Sadeq Najafi, Sara Hobaby, Hamidreza Soleimani, Behnam Tehrani, Islam Elgendy, Salman Allana, Claire Raphael, Sandeep Basavarajaiah, Kaveh Hosseini
Journal: Circulation (2024)

Background: Coronary in-stent restenosis (ISR) secondary to neointimal hyperplasia or neoatherosclerosis remains a significant challenge following percutaneous coronary interventions (PCI), with no consensus on the optimal revascularization strategy. We compared the outcome of PCI for ISR using drug-coated balloons (DCB) and drug-eluting stents (DES) and investigated the time trends in their clinical outcomes. Methods: PubMed, Embase, Scopus, and the Cochrane Library databases were searched through May 2024. We included randomized controlled trials (RCTs) comparing DCB versus DES among patients with coronary ISR. The primary outcome was target lesion revascularization (TLR). Secondary outcomes included all-cause mortality, myocardial infarction (MI), stent thrombosis, and late lumen loss (LLL). Random-effects models were employed to analyze outcomes within 1-year and beyond 1-year intervals. Meta-regression analysis was used to investigate the effect of age, sex, history of diabetes, hypertension, dyslipidemia, smoking, and ejection fraction on all outcomes by applying mixed-effect models. Results: We included 10 RCTs (1034 patients in the DCB group and 943 patients in the DES group). We found similar incidence of 1-year TLR (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.86, 2.14; P 0.194; I 2 43.3%) and &gt;1-year TLR (OR 0.94; 95% CI 0.57, 1.56; P 0.817; I 2 0%) with the use of DCB versus DES. The risks of all-cause mortality, MI, and stent thrombosis were comparable between DCB and DES in 1-year and beyond 1-year follow-ups. At 6-9 months angiographic follow-up, DCB was associated with non-significantly lower LLL compared to DES (standardized mean difference [SMD] -0.12 millimeters; 95% CI -0.29, 0.05; P 0.170; I 2 71.7%). Meta-regression indicated that higher prevalence of diabetes was associated with an increased risk of 1-year revascularization after DCB compared to DES (Estimate 0.07; P 0.003; I 2 0%). Additionally, male sex was associated with an increased LLL in DCB versus DES (Estimate 0.034; P 0.001; I 2 41.8%). No association was found between other baseline characteristics and measured clinical outcomes. Conclusion: DCB demonstrated comparable PCI outcomes compared to DES in patients with coronary ISR.
Abstract 4146465: Development and Multinational Validation of an Ensemble Deep Learning Algorithm for Detecting Structural Heart Diseases Using Noisy Single-lead Electrocardiograms
Authors: Arya Aminorroaya, Lovedeep Dhingra, Akshay Khunte, Veer Sangha, Aline Pedroso Camargos, Sumukh Vasisht Shankar, Sounok Sen, Norrisa Haynes, Luisa Brant, Sandhi Barreto, Antonio Ribeiro, Harlan Krumholz, Evangelos Oikonomou, Rohan Khera
Journal: Circulation (2024)

Background: While portable devices capable of single-lead ECG acquisition have the potential to enhance the scale of structural heart disease (SHD) screening, noise during the acquisition of portable ECGs decreases the performance of deep learning models. Here, we developed and multi-nationally validated a noise-adapted artificial intelligence (AI) model to detect the presence of SHD from single-lead ECGs. Methods: We developed ADAPT-HEART (AI Deep learning for Adapting Portable Technology in HEART disease detection) using lead I ECGs paired with echocardiograms within 30 days from 110,228 patients at Yale New Haven Hospital during 2015-2023. We validated the model in five community hospitals and practices in the Northeastern US (N=65,988), and the population-based cohort of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (N=3,014). SHD was defined by the presence of LVEF &lt;40%, moderate or severe left-sided valvular disease, or severe LVH (IVSd &gt;15 mm + moderate or severe LV diastolic dysfunction). We developed label-specific convolutional neural networks (CNN) using ECG signals augmented with random Gaussian noise to make models resilient to noisy ECG acquisition. The CNN output probabilities and the patient’s age and sex were ensembled using extreme gradient boosting to detect SHD. Results: In the development set, 32% had SHD compared with 31-56% across the community hospital sources and 3% in ELSA-Brasil. ADAPT-HEART achieved an AUROC of 0.88 (95% CI, 0.87-0.89) for detecting SHD. With optimized Youden's index, the model has a sensitivity of 86%, specificity of 82%, PPV of 54%, and NPV of 96% for detecting SHD in the held-out test set. The model performed consistently across US data sources (AUROC: 0.81-0.89) and ELSA-Brasil (AUROC: 0.86) with comparable performance across key demographic subgroups. The model showed better discrimination in detecting a composite SHD that encompasses severe valvular disease, rather than moderate or severe valvular disease (AUROC, 0.91). Conclusion: ADAPT-HEART, a noise-adapted AI model for 1-lead ECGs, is able to detect a composite of several treatable SHDs with consistent performance across multinational data sources. By integrating outputs from a growing number of wearable/portable devices with ECG capabilities, ADAPT-HEART can enable low-cost, large-scale screening for SHDs in the community.
Abstract 4146037: Navigating the Diagnostic Challenges and Therapeutic Landscape of Giant Cell Myocarditis: A Compelling Case Study of Survival and Recovery
Authors: Neria Bitton, Alex Caplan, Favour Nelson, Gregory Olenginski, Aric Gonter, Gustaaf de Ridder, Brendan Carry, Lucie henry
Journal: Circulation (2024)

Introduction: Giant cell myocarditis (GCM), a rare and often fatal heart disease, presents diagnostic challenges due to its varied symptoms mimicking other cardiac conditions. Treatment can involve medical management and heart transplant. Early diagnosis and targeted therapy can improve survival without transplant. Case presentation: A 66-year-old female with type II diabetes, obesity, and coronary artery disease (CAD), presented with dyspnea, orthopnea, epigastric pain, and hypotension. Laboratory findings showed troponin at 2301 ng/L and lactic acidosis, with nonspecific ST changes on EKG prompting treatment for acute coronary syndrome (ACS). She was started on dobutamine and admitted to the cardiac ICU for cardiogenic shock. An echocardiogram revealed left ventricular ejection fraction (LVEF) of 25% with diffuse hypokinesis. She underwent coronary angiography which showed no significant obstructive CAD. She remained in cardiogenic shock despite inotropic support, prompting placement of an Impella and endomyocardial biopsy. Pathology revealed diffuse interstitial giant cells and multifocal cardiomyocyte necrosis, consistent with GCM. She was treated with pulse-dose steroids, tacrolimus, and placed on the heart transplant list. After 14 days with Impella 5.5 support, her LVEF improved to 45%. She has since been managed with mycophenolate, prednisone, and guideline-directed medical therapy for heart failure. Discussion: Without treatment, GCM has a median survival of 3 months. Early diagnosis is often challenging as symptoms can mimic acute coronary syndrome. Refractory cardiogenic shock with myocardial injury in the presence of benign coronary angiography should prompt an endomyocardial biopsy to investigate uncommon etiologies such as GCM. While treatment primarily involves immunosuppressive therapy and heart transplantation, not all patients are eligible candidates for transplant. In this case, mechanical support stabilized the patient's hemodynamics, allowing immunosuppression to reverse myocardial inflammation, potentially improving survival, and reducing the need for a transplant. We highlight the diagnostic challenges of GCM and the critical role of medical and mechanical therapy in improving outcomes.
Abstract 4146115: Contribution of Preload Elevation vs. Ischemia to Pro-Fibrotic Signaling and Interstitial Collagen Deposition in Swine with Chronic Coronary Artery Disease
Authors: Emily Hudson, Alexandra Wadhwani, Beth Palka, John Canty, Brian Weil
Journal: Circulation (2024)

Introduction: We recently observed that transient elevations in preload are common in swine with multi-vessel coronary artery disease (MV-CAD), presumably due to intermittent demand-induced ischemia of a large perfusion territory. Based on evidence that repetitive preload elevation can lead to fibrosis in the absence of ischemia, we hypothesized that mechanical stretch, rather than ischemia, maybe a key mechanism underlying extracellular matrix (ECM) remodeling in chronic CAD. To test this hypothesis, we compared regional pro-fibrotic gene expression and interstitial collagen in swine with MV-CAD to that observed in swine with single-vessel CAD (SV-CAD) in which the size of the culprit artery perfusion territory is insufficient to cause preload elevation during acute ischemia. Methods: Juvenile swine were instrumented with fixed 1.5 mm stenoses on the left anterior descending and left circumflex (LCx) coronary arteries (MV-CAD; n=6) or the LCx only (SV-CAD; n=6). Three months later, LV tissue was collected from the free wall (ischemic region) and posterior wall (non-ischemic region) to quantify pro-fibrotic gene expression (qPCR) and interstitial collagen (picrosirius red staining) vs. controls (n=11). Results: LCx stenosis severity was similar between MV-CAD and SV-CAD groups (90±4 vs. 82±7%; p=0.4). Pro-fibrotic gene expression was significantly elevated in both ischemic and non-ischemic regions within the MV-CAD group but was generally absent in animals with SV-CAD ( A ). This corresponded with a significant increase in interstitial collagen in ischemic and non-ischemic regions of the LV in animals with MV-CAD ( B ). In contrast, the SV-CAD group did not exhibit increased interstitial collagen in either the ischemic or non-ischemic region of the LV vs. controls. Conclusion: Pro-fibrotic gene expression and interstitial collagen are not altered in swine with chronic LCx stenosis, suggesting that ischemia alone may not be sufficient to elicit ECM remodeling. Conversely, swine with MV-CAD exhibit an increase in pro-fibrotic gene expression and interstitial collagen that is not restricted to the ischemic area of the LV, implicating repetitive preload elevation as a potential mechanism underlying ECM remodeling in CAD.
Abstract 4146032: Routine stress testing in diabetic patients after coronary intervention: a systematic review and single arm meta-analysis
Authors: Juan Peres de Oliveira, RAMON HUNTERMANN, Caroline De Oliveira Fischer Bacca, Franciani da Rocha, Raissa de Oliveira
Journal: Circulation (2024)

Background: Stress testing is a well-established non-invasive method commonly used in clinical practice for patients with angina. However, its benefit in diabetic patients after coronary intervention remains unclear. This systematic review aims to address this knowledge gap by evaluating the impact of routine stress testing in this specific patient population. Research Question: Does routine stress testing improve outcomes in diabetic patients with prior revascularization? Goals: We aimed to perform a systematic review and meta-analysis of studies that evaluated death, MACE and repeated revascularization episodes in diabetic patients who have prior coronary intervention. Methods: We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCT) and cohort studies evaluating diabetic patients who underwent cardiac revascularization and reporting the following outcomes: (1) Myocardial Infarction (MI) and Cardiovascular Death; (2) Ischemia; and (3) Repeat Revascularization. Statistical analysis was performed using Open Meta and heterogeneity was assessed with I 2 statistical. Results: We included 16924 patients from 16 studies, of which 15 were observational cohort studies and 1 was a RCT. All patients were diabetics and had a history of revascularization. Follow-up ranged from 1 to 5.2 years. The mean patient age was 60.8±9.5 years and 75% were male. MI and cardiovascular death was found in 9.8% (95% CI; range 6.8-12.8%; p&lt;0.01; (figure 1A), ischemia was found in 36.5% (95% CI; range 28.7-44.3%; p&lt;0.01; (figure 1B) and revascularization was repeated in 16.3% (95% CI; range 4.9-27.7%; p&lt;0.01; (figure 1C). Conclusion: Routine stress testing in diabetic patients with prior coronary intervention may not significantly alter the outcomes. These findings suggest that, while routine stress testing is a common practice for monitoring heart diseases in diabetic patients, its impact on improving clinical outcomes requires further investigation through controlled studies.
Abstract 4146204: Quantification of Atrioesophageal Fistula Morbidity and Mortality Reports Following Left Atrial Catheter Ablation
Authors: William Zagrodzky, Julie Cooper, Christopher Joseph, Natalie Putzel, Jacob Sherman, Catherine Lazarus, Tiffany Sharkoski, Erik Kulstad, Mark Metzl, Steven Girouard, James Daniels, Jose Nazari
Journal: Circulation (2024)

Introduction: Atrioesophageal fistulas (AEF) are severe life-threatening complications that can occur after left atrial ablation for the treatment of atrial fibrillation (AF). Although new ablation modalities promote a non-thermal mechanism of action, uncertainty remains surrounding their ability to reduce AEFs when implemented at scale. The international POTTER-AF survey found that AEFs continue to occur despite traditional preventative efforts, but trends in the U.S. are less clear. However, data from the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database can provide insight. Research Question: What are the recent trends in AEF reporting following left atrial ablation? Aim: To determine the number of AEFs and patient outcomes reported using the FDA’s MAUDE database over the last 5 years. Methods: Reports were reviewed from the FDA’s MAUDE database for entries filed from January 1st, 2019 through January 1st, 2024. Product codes LPB, OAE, and OAD, representing cardiac ablation catheters and radiofrequency generators, were reviewed for reports of AEFs. Each report was reviewed to remove duplicate reports and to verify patient outcomes. Results: A total of 202 reports of AEF were identified, with 128 non-fatal fistulas, and 74 reported deaths. Of the 202 reports, 110 were reported under the code LPB, 66 under OAE, and 26 under OAD. Reports generally increased over the analysis time frame, with 30 reports in 2019, 28 in 2020, 45 in 2021, 45 in 2022, and 54 in 2023 (Figure 1). Esophageal protective methods were reported to be luminal esophageal temperature (LET) monitoring in 61 cases, esophageal deviation in 3 cases, no protective method in 10 cases, and not mentioned in the remaining 128 cases. Conclusion: Despite widespread AEF awareness and adoption of traditional preventive efforts the annual rate of reported AEFs in the United States continues to grow, and fatality rates remain high, suggesting the need for improved preventative efforts.