tbuckley/cabot-search huggingface dataset:
Abstract 15133: Topic Models Using Notes From Electronic Medical Records Can Classify Non ST Elevation Myocardial Infarction Patients Based on the Presence of an Occluded Culprit Artery
Authors: Dillon J Dzikowicz, Mehmed Aktas, Linwei Wang, Wojciech Zareba
Journal: Circulation (2023)

Introduction: Approximately 33% of patients with a Non-ST-Elevation Myocardial Infarction (NSTEMI) have an occluded culprit artery which doubles their odds of adverse outcomes. Earlier identification of NSTEMI patients with occluded culprit artery may reduce their odds of adverse outcomes. Notes from the electronic health record (EHR) are rich sources of text data about signs and symptoms. Organizing text data into topics may help providers identify patients with NSTEMI and an occluded culprit artery sooner. Latent Dirichlet Allocation uses a deep-learning network to generate topics that can classify patients. Methods: Notes transcribed during the first 72 hours of hospitalization were extracted from the EHR among NSTEMI patients who presented to a medical center between 2015-2020. The data was preprocessed by removing punctuation, numbers, and stop words. We decided 5 topics based on computed coherence value. Two authors determined whether the first 100 terms were associated with an occluded artery. Analyses were completed in R using packages topicmodels and tidyverse . Results: We examined 45,025 notes from 2,223 patients (age=69 + 14 years old; 57% n=1267 male; 83% n=1,845 White) who experienced 2,685 hospitalizations (17%, n=462 NSTEMI re-hospitalizations). In Topic 1, 70% of the terms were associated with an occluded culprit artery including “chest pain” and “troponin”. In contrast, in Topic 5, 90% of terms were not associated with an occluded culprit artery such as “edema” and “pulmonary”. Figure 1 shows the frequency of terms associated with an occluded artery per topic. Conclusions: Topic 1 is most associated with an occluded culprit artery. Topic 5 is the least associated with an occluded culprit artery, instead associated with heart failure. Our results demonstrate it is feasible to develop topics to differentiate NSTEMI with and without an occluded culprit artery. Future research aims to identify patterns between signs and symptoms within topics.
Abstract 14471: Can Administrative Claims Data Accurately Identify Low-Value Pre-Operative Cardiovascular Testing?
Authors: Rebecca Klahr, Kelly Wu, Michelle Smith, Jessica Han, Paul N Casale, Vinay Kini
Journal: Circulation (2023)

Background: Low-value care is defined as care where harms or costs outweigh the benefits. Low-value care services are often identified using administrative claims data, but the validity of claims-based measures may be limited due to the lack of clinical details. One example of a commonly-used claims-based measure of low-value care is pre-operative stress testing prior to low-risk surgery. Clinical practice guidelines recommend against routine testing since it provides no benefit, but testing may be clinically appropriate in patients with symptoms that warrant further investigation such as chest pain. AIM: To test the validity of a claims-based measure of low-value pre-operative stress testing against a gold standard of chart review. Methods: In this retrospective cohort study, we analyzed Medicare claims data linked to electronic health record data from a large accountable care organization. We applied a currently-used claims-based algorithm to identify patients who received a stress test within 60 days prior to a low-risk surgery (e.g., cataract surgery) in 2021. We then reviewed linked electronic health record data to assess the proportion of tests that were actually low-value or were misclassified (i.e., were clinically appropriate based on patient symptoms). Results: We identified 120 patients (median age 74, 50% female, 78% white) who underwent low-risk surgery and received a pre-operative stress test considered low-value by the claims algorithm. We excluded 35 patients who had insufficient data for chart review. Of the remaining 85patients, we found that 36 (42%) were confirmed low-value while 49 (58%) were actually clinically appropriate due to symptoms that prompted testing. The claims-based algorithm hada positive predictive value (PPV) of 42%. Conclusions: A commonly used claims-based measure for identifying low-value pre-operative CV testing misclassifies a substantial proportion of tests as low-value when they are clinically appropriate. This has significant implications for policy and practice, as it can erode trust in quality reporting systems and discourage clinically appropriate testing.
Abstract 17900: Target Trial Emulation: Evaluating Cardiac Rehabilitation After TAVR
Authors: Merilyn Varghese, Issa Dahabreh, Yang Song, Jiaman Xu, Alexis L Beatty, Kevin McConeghy, Robert W Yeh, Laurence Sperling, Gregg C Fonarow, Steven J Keteyian, Wen-Chih H Wu, Dhruv S Kazi
Journal: Circulation (2023)

Introduction: Effectiveness of cardiac rehabilitation (CR) after transcatheter aortic valve replacement (TAVR) has not been examined in randomized trials. We used a novel causal inference approach called target trial emulation to evaluate whether participation in CR after TAVR reduces all-cause mortality. Methods: We emulated a target trial among Medicare beneficiaries age≥ 65 years who had undergone a TAVR from October 2016 through September 2019. The intervention was starting CR within 90 days of discharge (time 0) and the outcome was death from any cause. We created two exact copies of each patient’s data (“clones”) and assigned one clone to the control arm and the other to the intervention arm. This eliminated baseline confounding and immortal time bias. Each clone was censored when not consistent with the assigned treatment strategy (e.g., when a control clone initiated CR). Inverse probability weights accounted for potentially informative censoring. Falsification endpoints examined residual confounding. Results: Among 62,628 Medicare beneficiaries eligible for CR after TAVR, mean age was 80 years, and 43% were women. Of these, 28% initiated CR within the 90-day grace period. After adjusting for demographic, clinical, social, and economic differences, all-cause mortality at 2 years was lower in the CR arm than in the no CR arm (HR 0.74, 95% CI 0.63-0.87, p&lt;0.01) (Figure). Falsification endpoints suggested some residual confounding but absolute differences between the two groups were small. Conclusion Fewer than 1 in 3 eligible patients receive CR after TAVR. In the first-ever target trial emulation of CR in patients undergoing TAVR, patients who initiate CR had lower rates of all-cause death. Ongoing work will examine additional approaches to account for residual confounding and use alternative quasi-experimental study designs. If replicated, our findings suggest that innovation in CR access and delivery is needed to enhance uptake after TAVR.
Abstract 14180: A Case of Symptomatic Thoracic Aortic Aneurysm After Recent Fluoroquinolone Use
Authors: Naba Farooqui, Sara Inglis, Francisco Lopez-Jimenez
Journal: Circulation (2023)

Background: Thoracic aortic aneurysms (TAAs) can be found in 1-2/1000 individuals in the general population and are commonly associated with genetic disorders of connective tissue and bicuspid aortic valve (BAV). Larger size, distal aneurysms, high DBP and presence of BAV are some factors that can accelerate aneurysm growth. Case: A 37-year-old male without a history of recent trauma or stimulant use presented to the emergency room with 2 days of chest tightness. He had acute worsening overnight and awoke with chest pain, discomfort in the suprasternal notch and between the shoulder blades. He had no other medical history, however, was treated with a 10-day course of Ciprofloxacin for epididymitis 3 weeks prior. On presentation, the patient had active pleuritic chest pain, tachycardia and tachypnea with no abnormalities on cardiac auscultation. EKG showed sinus tachycardia, PVCs, and nonspecific ST elevations in leads II, III and aVF with normal troponins and chest X-ray. CT chest angiogram revealed a 60 mm ascending aortic aneurysm ( Fig. 1a ). Doming of the right cusp of the aortic valve in the parasternal view ( Fig. 1b ) raised suspicion for BAV which was confirmed with the classic fish mouth appearance on the TEE ( Fig. 1c ). The patient underwent successful aortic repair with graft placement. First degree relatives were offered screening for BAV. Ciprofloxacin was replaced with Sulfamethoxazole-Trimethoprim for treating his residual epididymal infection. Discussion: TAA rupture is associated with a &gt;90% mortality rate. It is important to be aware of echocardiographic features of BAV as this can predispose to accelerated aneurysm growth. Additionally, fluoroquinolones (FQs) are a commonly prescribed class of antibiotics that may affect the structural integrity of the aorta, associated with aneurysm enlargement and rupture. This case offers an important example to highlight why the FDA recommends against the use of FQs in patients with known TAA or risk factors for it.
Abstract 13134: Comparative Analysis of Implantable Loop Recorder Devices
Authors: eisha gupta, Atul Prakash, Tarick Hadaya, kartikeya srivastava, Tannavi Prakash
Journal: Circulation (2023)

Implantable loop recorders ILR are used for diagnosis and evaluation of Atrial fibrillation and Syncope. The devices mainly utilize RR variability to determine an episode of AF.Diagnosis of bradycardia is based on rate and absence of any R wave. Presence of a P wave is not a prerequisite.In this Retrospective study we used recorded electrogram characteristics obtained with two ILRs. Hypothesis-The R wave amplitude and clarity of P wave facilitates correct diagnosis of AF and any heart block .This would also infuence any undersensing and oversensing Methods-The two ILRs were Medtronic Reveal I &amp; Biomonitor III.The Biomonitor is 77.5x8.6 x4.4 mm whereas LINQ I is 44.8x7.2x4 mm. Main difference in the two is that BioMonitor III has larger sensing area ( 77.5 vs 44.8). Results 106 patients were included in this analysis 53 patients had Medtronic Reveal I and the remaining 53 patients had a BioMonitor III. We compared the amplitude of the R wave, presence of P wave, Undersensing and Oversensing of recorded events. Group I = patients who had Medtronic reveal I, 19 Males, 34 Females, mean age 74+11 BMI=28.83±6.8 Indication was AF in 38 &amp; syncope in 15. Mean R wave was 0.48 mV±0.38, Clear P waves were noted in 16/53. Oversensing noted in 8/53, Undersensing in 4/53. Group I I = patients with BioMonitor III 27 Males, 26 Females,Mean age 73+10 Mean BMI 29.20±5.35. Indication was AF in 37 &amp; syncope in 16.Mean R wave was 0.65 mV±0.37. Clear P waves noted in 33/53. Oversensing noted in 8/53, Undersensing in 0/53. Group II( BM III) had significantly greater R wave amplitude (p=0.02), the presence of a P wave in sinus rhythm was in significanly greater number of patients (p=0.009) There was no significant difference in proportion of patients with oversensing in the two groups ( p=0.09 ) However undersensing was seen in significanly less No of patients in Group II as compared to Group I ( p= 0.04). The two groups are matched for age sex, BMI , indication for implantation. Conclusions 1 In ILRs the recordings obtained with a Biomonitor III ( larger recording area ) had significantly greater amplitude of R wave and a greater proportion of patients with a clear P wave as compared to a Medtronic Reveal 1 ILR 2. Undersensing is also less seen with the Biomonitor ILR which may be related to the R wave amplitude.
Abstract 12787: Efficacy and Safety of Apixaban versus Low Molecular Weight Heparin for the Treatment of Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Abhigan Babu B Shrestha, Nischal Mainali, Shubham Shrestha, Vikash Jaiswal, Sajina Shrestha, Ashok Adhikari, Sanskriti Chapagain, SHUMNEVA SHRESTHA, Yub Raj Sedhai, Rishikesh Rijal, Dr. Bikash Karki, Suju Bhattarai, Md. Nuruzzaman
Journal: Circulation (2023)

Introduction: Current guidelines recommend the use of low molecular weight heparin (LMWH) for the management of venous thromboembolism (VTE) in cancer patients. However, direct oral anticoagulants (DOACs) have emerged as promising alternative for reducing VTE events. Moreover, apixaban shows a higher safety profile among DOACs. Hypothesis: This study aims to compare the efficacy and safety of apixaban versus LMWH (Enoxaparin or Dalteparin) in the treatment of venous thromboembolism in cancer patients. Methods: A systematic search was conducted in electronic databases (Pubmed, Embase, Scopus, and Cochrane libraries) from inception until June 2023, using appropriate Mesh terms for ‘apixaban’, ‘LMWH’, and ‘VTE’. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of &lt;0.005 was considered statistically significant. Results: Five randomized trials involving 2311 patients (apixaban: 1088 and LMWH: 1223) with mean ages of 64.5±11.45 and 64.2±10.8, respectively, were included in the analysis. At a median follow-up of six months, the occurrence of clinically relevant non-major bleeding (CRNMB) (OR, 1.04, 95% CI: 0.66 - 1.64, I2=37.72%, p=0.87), composite of major and CRNMB (OR, 1.11, 95% CI: 0.84 - 1.46, I2=0.00%, p=0.47), were higher with apixaban treatment. However, the rates of recurrent VTE (OR, 0.72, 95% CI: 0.50 - 1.04, I2=3.91%, p=0.08), major bleeding (OR, 0.83, 95% CI: 0.55 - 1.25, I2=0.00%, p=0.38), and mortality (OR, 0.91, 95% CI: 0.79 - 1.05, I2=0.00%, p=0.19) were lower with apixaban compared to LMWH treatment. However, none of the observed differences reached statistical significance. Conclusions: In cancer patients with VTE, apixaban demonstrates non-inferior efficacy and a comparable safety profile to LMWH. Further randomized trials are warranted to confirm these findings.
Abstract 15294: Preliminary Results of the Sit Less Program for Patients With Coronary Artery Disease: A Pilot Randomized Controlled Trial
Authors: Chorong Park, Abigail Doyle, Jason Jean, Mulubrhan F Mogos, James M Muchira, Soojung Ahn, Han Su, Ying Sheng, Mariann R Piano, Shelagh Mulvaney
Journal: Circulation (2023)

Introduction: Coronary artery disease (CAD) patients spend on average 10-14 hours per day sitting, which is higher than the recommended 8 hours of sitting. Independent of physical activity levels, higher levels of daily sitting are associated with adverse cardiometabolic outcomes. This study evaluated the feasibility and preliminary efficacy of a multi-technology-based Sit Less program in reducing sitting time (ST) and increasing breaks in ST in CAD patients. Methods: CAD patients were randomized to a control (n=8) or a 12-week Sit Less program (n=11). Sit Less included one in-person counseling session, a Fitbit, a smart water bottle (used to break prolonged ST via frequent restroom visits), and tailored weekly text messages. Feasibility was assessed via text message response rate and program satisfaction. Primary outcomes included changes in total daily ST, prolonged ST (total time spent in sitting bouts of &gt;30 mins and &gt;60 mins), and sit-to-stand transitions (all measured using activPAL). Cardiometabolic biomarkers included BMI, blood pressure, insulin, HbA1c, and lipids. Pre-post group differences were examined using independent t-tests. Results: All participants completed the study (15 male, 66±10yrs, mean ST = 10.4 hours/day). Out of the 11 Sit Less participants, 82% responded to all text messages and expressed satisfaction with the program. Significant pre-post group differences were found for total daily ST and prolonged ST (Figure 1). The Sit Less group had 36 minutes reduction in total ST and 3.4 more sit-to-stand transitions, while the control group had 47 minutes increase in total ST and 1 fewer sit-to-stand transitions. No significant differences in cardiometabolic markers were found within or between groups. Conclusion: The Sit Less program was feasible in CAD patients and the intervention reduced total and prolonged ST. Large-scale trials are needed to assess the program's effectiveness in reducing sitting and improving cardiometabolic outcomes.
Abstract 17871: Heterozygous Carriers of KCNQ1 Variants Associated With the Jervell-Lange-Nielsen Syndrome Have a Better Outcome When Compared to Other Type 1 LQTS Patients
Authors: Charles Morgat, Isabelle Denjoy, Veronique Fressart, Nathalie Neyroud, Anne Messali, Yassine Temmar, Alessandra Pia Porretta, vincent Algalarrondo, Elodie Surget, Antoine Leenhardt, Fabrice Extramiana
Journal: Circulation (2023)

Background: KCNQ1 mutations are associated with a risk of life-threatening torsade de Pointes. In the most common presentation, the mutation is heterozygous (type 1 LQTS). The homozygous expression causes type 1 Jervell-Lange-Nielsen syndrome (JLNS) with deafness and higher risk of sudden cardiac death. Hypothesis: Heterozygous carriers of JLN mutations would have different phenotype expression than patients carrying other KCNQ1 variants. Aims: To evaluate QTc duration and incidence of LQTS-related cardiac events according to genetic presentation. Methods: All patients with class 4 or 5 KCNQ1 variants for LQT1 or JLNS followed in our center (September 1993 to January 2023) were included. Lifelong Severe Cardiac events (ACA, SCD, appropriate shocks) and cardiac events (severe event + cardiac syncope) were collected.Quantitative data were compared between groups by ANOVA. Kaplan-Meier survival curves with the log-rank test were used to compare survival between the groups. Results: Three groups were identified among 741 LQT1 patients (55.3% female, age at diagnosis 25.2 years); 30 JLNS (group 1), 557 LQT1 carrying heterozygous mutations not found in the JLNS population (group 2), and 154 heterozygous carriers of mutations found in the JLNS population (group 3). QTc interval duration was different between groups (548±60ms, 467±36ms and 450±31ms in group 1, 2, 3 respectively, p&lt;0.001).Patients carrying heterozygous JLN mutations (group 3) had a lower risk for cardiac events than patients with heterozygous non JLN mutations (group2) (HR 0.36 [0.23-0.57]; p&lt;0.01) (Figure). Four parameters were independently associated with cardiac events: QTc (HR 1.01 [1.01-1.01]; p&lt;0.01, haploinsufficiency (HR 0.57 [0.36-0.92]; p&lt;0.05), pore localization (HR 1.63 [1.16-2.30]; p&lt;0.01), and group (HR 0.50 [0.32-0.81]; p&lt;0.01). Conclusion: Heterozygous carriers of JLNS variants have a lower risk of cardiac arrhythmic events that other type 1 LQTS patients.
Abstract 15651: Astrocytic Chordin-Like 1 Regulates AMPAR Synaptic Content and Motor Recovery in a Mouse Model of Ischemic Stroke
Authors: Elena Blanco Suarez, Eileen Collyer, Bridget Boyle, Yolanda Gomez-Galvez, Lorraine Iacovitti
Journal: Circulation (2023)

Introduction: Ischemic stroke triggers a series of molecular events that impairs receptor levels at excitatory synapses. AMPA receptors (AMPARs), the main excitatory receptors in the mammalian brain, are crucial in maintaining proper brain function. In response to ischemic stroke, their subunit composition and location at the synapse are deeply altered and trigger apoptotic cell death cascades. We previously found that Chordin-like 1 (Chrdl1), an astrocyte-derived protein that regulates AMPARs, is highly upregulated in the peri-infarct region at early stages after stroke (1 and 7 days post-stroke, dps). When Chrdl1 was absent, neurons were protected from stroke-induced structural degeneration. Hypothesis: Elimination of Chrdl1 prevents stroke-induced aberrant AMPAR synaptic levels, limits AMPAR-mediated apoptotic cascades and alleviates behavioral deficits. Methods: We used photothrombosis to model ischemic stroke in the motor cortex of adult male and female WT and Chrdl1 KO mice and performed analyses at 1 and 7 dps in the peri-infarct area. We used fluorescent in situ hybridization to analyze mRNA levels of Chrdl1, immunohistochemistry to determine synaptic AMPAR levels and subunit composition, TUNEL to determine apoptotic cell death, MRI to monitor the progression of injury volume, and adhesive removal and grid walk tests to assess sensorimotor and motor behaviors. Results: WT mice, after photothrombotic injury showed important impairments in the AMPAR synaptic distribution and composition. This aberrant AMPAR subunit composition and location at synapses was abolished in Chrdl1 KO mice. This resulted in reduced apoptotic cell death and faster motor recovery in Chrdl1 KO mice compared to WT in both male and female mice. Conclusions: This study shows that targeting Chrdl1 has therapeutic potential to reduce apoptotic cell death and aid motor recovery after ischemic stroke via synaptic regulation of AMPARs. Astrocyte-derived proteins, such as Chrdl1, may represent new molecular targets that can restore synapses to favor functional recovery after ischemic stroke.
Abstract 18184: Association Between Impaired Global Longitudinal Strain and Long-Term Mortality in Patients With Moderate Aortic Stenosis: A Meta-Analysis
Authors: Maharshi Raval, Nishanth Katukuri, Sruthi Venugopalan, Mounika Reddy Vadiyala, Vidit Majmundar, Akhil Jain, Sajid Siddiq, Rupak Desai
Journal: Circulation (2023)

Background: Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis (AS). However, its prognostic value in patients with moderate AS is still unknown. The aim of this study is to investigate the impact of LV GLS on outcomes of patients with moderate AS. Methods: PubMed/Medline, Scopus, and Google Scholar databases were systematically reviewed to find relevant studies through June 2023 reporting data on the relationship between the LV GLS and long-term mortality in patients with moderate AS. Binary random effects models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). I2 statistics were used to interpret heterogeneity, with I2&gt;75% indicating substantial inter-study variation. Leave-one-out meta-analysis was performed to evaluate the effect of each study on the overall estimate. A p&lt;0.05 was considered statistically significant. Results: A total of 172 studies were reviewed, and 4 studies between 2000-2023 were included in our meta-analysis with a median follow-up of 48.5 months and GLS cut-off varying from 11% to 16%. The pooled univariate analysis revealed a significant association between LV GLS and long-term mortality in patients with moderate AS with a pooled OR of 2.02 (95CI 1.04-3.93) p=0.04, I2=94.25%. The multivariate analysis, after adjusting for overall modifiable risk factors, yielded significant results, with an adjusted odds ratio (aOR) of 1.56 (95CI 1.21-2.01) p&lt;0.01, I2=89.48%. Sensitivity analysis, using leave-one-out method, demonstrated robustness and stability of the results with aOR 1.56 (95CI 1.21-2.01) p&lt;0.01. Conclusions: In patients with moderate AS, impaired LV GLS is associated with an increased risk for all-cause mortality. If further randomized studies confirm the prognostic ability of impaired GLS, moderate AS can be redefined, and GLS can be considered in determining the optimal timing for aortic valve intervention.