tbuckley/cabot-search huggingface dataset:
Abstract 14756: The Effect of Torsemide vs Furosemide Across the Renal Function Spectrum - Insights From the TRANSFORM-HF Trial
Authors: Pieter Martens, Stephen J Greene, Robert J Mentz, Shuang Li, Daniel Wojdyla, Eric Eisenstein, Kevin Anstrom, Bertram Pitt, Eric J Velazquez, Wai Hong W Tang
Journal: Circulation (2023)

Introduction: Among patients discharged after hospitalization for heart failure (HF), a strategy of torsemide versus furosemide showed no difference in all-cause mortality or hospitalization. Hypothesis: Clinicians may favor torsemide in the setting of renal dysfunction due to better oral bioavailability and longer half-life. However, the impact of baseline renal function on these findings is unknown. Methods: The TRANSFORM-HF trial randomized patients hospitalized for HF to a long-term strategy of torsemide versus furosemide, and enrolled patients across the spectrum of renal function excluding patients on dialysis. In this post-hoc analysis, baseline renal function during the index hospitalization was assessed as tertiles of estimated glomerular filtration rate (eGFR) (using 2021 CKD EPI formula), blood urea nitrogen (BUN), and BUN/creatinine ratio. The interaction between baseline renal function and treatment effect of torsemide vs furosemide was assessed for endpoints of (1) all-cause mortality and (2) all-cause mortality and all-cause readmissions at 12 months. Results: Of 2859 patients randomized, 336 (11.7%) had eGFR&lt;30ml/min/1.73m 2 , 1138 (39.8%) had eGFR 30-60 ml/min/1.73m 2 , and 1385 (48%) had eGFR≥60ml/min/1.73m 2 . Baseline eGFR and BUN did not clearly modify the treatment effect of torsemide vs furosemide for either all-cause mortality (Figure, Panel A) or all-cause mortality and all-cause readmissions at 12 months (Figure, Panel B) . For the composite outcome, BUN/creatinine ratio showed evidence of heterogeneity of treatment effect potentially in favor of torsemide in the middle tertile (interaction p-value&lt;0.01). Conclusion: Across the spectrum of baseline eGFR and BUN, a strategy of torsemide versus furosemide did not significantly impact mortality or readmission outcomes following hospitalization for HF..
Abstract 16178: A Deep Learning Algorithm to Estimate Left Ventricular Mass From Coronary Calcium CT Scans: Association With Incident Heart Failure Events From the Dallas Heart Study
Authors: Shawn Simek, Fernando Kay, Suhny Abbara, MD, Colby Ayers, Sonia Garg, Ambarish Pandey, Anand Rohatgi, Amit Khera, Mark H Drazner, Matthew J Budoff, James A de Lemos, Ronald M Peshock, Parag H Joshi
Journal: Circulation (2023)

Introduction: Coronary artery calcium CT (CAC-CT) scans used for ASCVD risk prediction may contain additional clinical information that is currently underexploited. We developed a novel deep-learning algorithm to estimate LV mass from CAC-CT (CT-LVM) and analyzed associations with cardiac biomarkers and incident CV outcomes in the Dallas Heart Study (DHS). Hypothesis: Higher CT-LVM will be associated with baseline cardiac biomarker elevations (hsTnT and NT-proBNP) and a higher risk of incident CVD (heart failure, MI, stroke, and all-cause death). Methods: We included 1841 DHS phase 2 participants (mean age 50, 59% female, 46% Black race) who were free of baseline CVD and underwent CAC-CT and cardiac MRI. Our novel deep-learning algorithm features automatic cardiac chamber segmentation via a 3D U-Net architecture on CAC-CT, followed by a 3D DenseNet model to predict LV mass, using concurrent cardiac MRI as gold standard. LV mass was indexed to BSA. Statistical analysis included multivariable logistic regression models for baseline biomarker elevation assessment (hs-cTnT &gt; 5ng/L or NT-proBNP &gt; 100pg/mL) and Cox proportional hazards models for clinical outcomes. Models were adjusted for age, sex, ethnicity, BMI, hypertension, blood pressure, diabetes, smoking, creatinine, and CAC score. Results: CT-LVM correlated strongly with MRI defined LV mass (R = 0.87). CT-LVM/BSA was associated with elevated hsTnT (adjusted OR 1.3, 95% CI 1.1-1.6) and NT-proBNP (adjusted OR 1.8, 95% CI 1.5-2.2). There were 172 CVD events over a median follow up of 12.5 years. Higher CT-LVM was associated with higher CVD risk (adjusted HR 1.4, 95% CI 1.2-1.6) and higher risk of incident heart failure (adjusted HR 2.1, 95% CI 1.5-2.9). Conclusions: A novel deep-learning method for estimating LV mass from CAC-CT provided independent risk information from traditional risk factors and CAC score. This represents a novel low-cost approach to improving the risk assessment opportunities from a CAC-CT.
Abstract 17045: Investigating the Causal Relationship Between Glycemic Trait and Great Vessels Structures Using Mendelian Randomization
Authors: Tselmen Daria, Hasan Alkhairo, Michael Levin, Scott M Damrauer, Philip S Tsao, James Priest, James Pirruccello, Justin B Echouffo, Catherine Tcheandjieu
Journal: Circulation (2023)

Introduction: Diabetes has been inversely associated with aortic aneurysm. However, it remains unclear whether this relationship is causal. In this study, we investigated the relationship between diabetes and glycemic traits, and MRI-derived measures of the great vessels (aortic and pulmonary artery) morphologies using Mendelian randomization (MR). Methods: We employed an inverse-variance weighted method to conduct a two-sample MR analysis using summary statistics from genome-wide association studies of glycemic traits (fasting insulin [FI], fasting glucose [FG], glycated hemoglobin [HbA1c], 2-hour glucose after oral challenge [2hGlu], and type 2 diabetes [T2D]) and MRI-derived measures of aortic morphology including ascending and descending aortic diameters (AAoD and DAoD), aortic distensibility (AoDist), aortic strain (AoStr), and pulmonary artery diameter (PAD). Sensitivity analysis was performed using the MR-Egger method, and pleiotropy was assessed using the MR-PRESSO method. Results: We observed evidence for associations between glycemic traits and aortic measures. Regarding aortic diameter, genetically predicted increases levels of 2hGlu, FG, and HbA1c were associated with decreased AAoD (2hGlu β = -0.11, p &lt; 0.05; FG β = -0.15, p = 0.0002; HbA1c β = -0.18, p = 0.01) and DAoD (2hGlu β = -0.09, p &lt; 0.001; FG β = -0.17, p = 0.0002; HbA1c β = -0.09, p = 0.02). No significant associations were observed between FI or T2D and both measures. We found that a genetically predicted increase in FI was associated with decreased AoStr (β = -0.23, p = 0.002) and AoDist (β = -0.18, p = 0.02), while a genetically predicted increase in HbA1c was associated with an increased AoStr (β = 0.18, p = 0.0008) and AoDist (β = 0.12, p = 0.03). Lastly, increased levels of FG and HbA1c were associated with an increase in PAD (FG β = 0.11, p = 0.02; HbA1C FG β = 0.25, p = 0.001). Conclusions: The genetic evidence supports the effects of glycemic traits on the aortic vasculature, providing additional causal evidence to support the epidemiological evidence linking high glucose exposure to aortic aneurysm. Further research is needed to better understand the mechanisms underlying these relationships.
Abstract 16833: Native Pulmonary Valve Infective Endocarditis in the Absence of Typical Risk Factors
Authors: Jake Goldstein, Keaton Wieschhaus, Nicholas Poellinger, Georg Gussak, Kaled Malas, Besher Kashlan, Gabriel Diaz, Timothy Paterick, Waddah Malas, Khaled Dajani
Journal: Circulation (2023)

Introduction: Isolated Pulmonary valve endocarditis (PVE) is a rare subset of right sided endocarditis associated with high mortality. We describe a case of PVE without typical risk factors. Case: A 53-year-old male with a history of controlled type 2 diabetes, coronary artery disease and recent minor trauma to the foot presented with 1 week of intermittent fevers, night sweats, and decreased appetite. Vital signs revealed a temperature of 103°F. Exam was significant for a grade II diastolic murmur best heard on the left sternal border and a healed wound on the left 5th metatarsal. Blood cultures taken grew Methicillin-Resistant Staphylococcus Aureus. A trans-thoracic echocardiogram revealed an echo dense material on the pulmonary valve measuring 1.0 x 0.3 cm. Differential diagnosis included endocarditis, pulmonary fibroelastoma, thrombus, or a cardiac tumor. A trans-esophageal echocardiogram later obtained revealed an echogenic lesion on the pulmonic valve measuring 2.1 x 1.2 cm with severe pulmonic insufficiency. An echodensity adherent to the right ventricular wall was also visualized. Tricuspid valve appeared normal. Due to persistent bacteremia despite appropriate antimicrobial coverage and significant valvular insufficiency, a decision was made to proceed with cardiac surgery. Patient received debridement to both pulmonary valve and right ventricular vegetations and underwent pulmonary valve replacement. Intraoperative pathology was consistent with endocarditis. The nidus for infection was attributed to the patient’s recent traumatic wound. The patient was discharged home with 6 weeks of daptomycin therapy. Conclusion: Right sided endocarditis involving the pulmonic valve is rare but can occur in individuals without an obvious predisposing cardiac structural abnormality. In our case, the patient developed severe valvular insufficiency therefore was successfully treated with surgical intervention and a prolonged course of antibiotics.
Abstract 14410: Hemoglobin A1c and Major Adverse Cardiovascular Events in the VA Million Veteran Program: Evidence-Based Recommendation for Life’s Essential Eight Improvement
Authors: Xuan-Mai T Nguyen, Yanping Li, Yuk-lam Ho, Serena Houghton, Mary Pyatt, Timothy M Treu, Daniel Posner, SRIDHARAN RAGHAVAN, David Gagnon, Saad Ur Rahman, John Gaziano, Luc Djousse, Lawrence Phillips, PETER WILSON, Kelly Cho
Journal: Circulation (2023)

Background: The American Heart Association (AHA) recently proposed the Life’s Essential 8 (LE8) score as an enhanced measurement tool for cardiovascular health. For the blood glucose metric in LE8, persons with diabetes mellitus (DM) and a hemoglobin A1c (HbA1c) &lt;7% receive higher points (40 out of 100) and successively fewer with increasing HbA1c. However, some studies have found that having a HbA1c &lt;6% in DM patients was associated with a higher risk of mortality, especially cardiovascular (CVD) death. Aim: We sought to categorize DM with HbA1c &lt;7% into two groups (&lt;6% vs . 6-6.9%) and compare their associations with risk for a major adverse cardiovascular event (MACE) to better inform DM HbA1c cut points and LE8 scoring. Methods: Prospective cohort study of 213,760 Veterans enrolled in the VA Million Veteran Program (MVP) (2011-2021) who had a HbA1c measurement and were free of 5 point-MACE (fatal CVD, non-fatal myocardial infarction [MI], non-fatal stroke, non-fatal heart failure and non-fatal atrial fibrillation [Afib]) at baseline. Results: During a mean follow-up of 4.9 years, we identified 38,151 instances of MACE, including 9,665 MI, 2,837 stroke, 5,523 fatal CVD, 16,543 heart failure, and 18,114 Afib. Compared to diabetic patients with HbA1c of 6-6.9%, diabetic patients with a very low HbA1c level (&lt;6%) had significantly higher risk of MACE [Hazard Ratio (HR): 1.15; 95%CI: 1.09-1.21], which was comparable to diabetic patients with HbA1c of 7-7.9% [HR: 1.14 (95%CI: 1.09-1.18)]. Similar results were observed for the associations between HbA1c and risk for stroke, heart failure, Afib and fatal CVD (Figure 1). Conclusions: Our results confirm previous findings that a very low HbA1c level among diabetic patients was associated with a higher risk for MACE. Based on our findings, we suggest further categorization of diabetic patients with HbA1c below 7% (i.e., &lt;6% and 6-6.9%) and subsequent adjustment in LE8 scoring (i.e., from 40 to 30 points) for HbA1c.
Abstract 18102: Impact of Regional Cardiac Wall Motion Abnormalities on Ejection Fraction and Mortality: Large Data Enabled by Natural Language Processing
Authors: Albert J Rogers, Neal K Bhatia, James Tooley, Vyom Thakkar, JUSTIN XU, Rayan Ansari, Jessica Torres, Jagteshwar Tung, Mahmood Alhusseini, Paul L Clopton, Reza Sameni, Gari Clifford, Euan A Ashley, Marco V Perez, Matei Zaharia, Sanjiv M Narayan
Journal: Circulation (2023)

Background: Cardiac wall motion abnormalities (WMA) independently predict mortality and other adverse events beyond ejection fraction. The impact on mortality and ejection fraction has not been studied in large cohorts with long term follow up. Aim: We aimed to describe the relationship of specific regional cardiac WMAs with ejection fraction and mortality in a large referral academic center. Methods: We collected echocardiograms, demographics, and follow-up data from 35,210 patients from Stanford University. Specific regional abnormalities were determined by natural language processing (NLP) of clinical reports. WMAs were stratified across 5 anatomic regions and compared. Ejection fraction effect were compared by the Mann-Whitney U test and visualized with violin plots. Mortality between regions was assessed with Cox proportional hazards model and visualized with Kaplan-Meier plot. Results: In the Stanford University cohort, (62.9±16.9 years, 47% female, 58% white), regional WMAs were associated variable reductions in EF with apical, anterior, and septal WMAs resulting in an EF 41.6-42.8 +/- 12.8%, which was greater than lateral (45.4 +/- 10.2%) and inferior/posterior (46.3 +/- 12.1) (p&lt; .01 for all comparisons). Distributions for inferior/posterior and lateral were more left-skewed and apex/septal were more bimodal ( Panel A ). In follow-up, having at least one WMA increased the risk of overall mortality with a hazard ratio of 1.8 (CI: 1.61-2.00) over a &gt; 4 year period ( Panel B ). Conclusion: In a very large population of echocardiograms performed in an academic referral center, wall motion abnormalities in different areas were associated with variable effects on ejection fraction and long-term mortality. Natural language processing enabled analysis of a large database of echocardiogram reports.
Abstract 16646: Evidence of Protein Dysregulation in Patients With Post-Acute COVID-19 Syndrome With- and Without Postural Orthostatic Tachycardia Syndrome
Authors: Allan Zhao, Ali Mahdi, Emelie Fredengren, Artur Fedorowski, Frieder Braunschweig, Petter Brodin, Malin Nygren-Bonnier, Michael Runold, Judith Bruchfeld, Jannike Nickander, Qiaolin Deng, Antonio Checa, Liyew Desta, John Pernow, Marcus Stahlberg
Journal: Circulation (2023)

Introduction: Approximately 30 % of patient with Post-acute COVID-19 Syndrome (PACS) develop postural orthostatic tachycardia syndrome (POTS). The pathophysiological mechanisms behind PACS and associated POTS remain largely unknown. Hypothesis: PACS and POTS-specific phenotype are associated with dysregulation of proteins involved in cardiovascular regulation. Methods: We recruited 20 (19 female) patients with PACS and POTS (age 39±11 years, 18±3 months after SARS-CoV-2 infection) and 22 patients (all female) with PACS without POTS (age 44±11years, 19±3 months after SARS-CoV-2 infection). Head-up TILT test was performed in both groups. Age- and sex matched healthy volunteers (n=21; 20 female, age 43±6 years) without- (n=16) and with (n=5) a history of SARS-Cov-2 infection but without symptoms served as control group. Plasma levels of 700 proteins involved in cardiovascular regulation was analysed using Proximity Extension Assay (Olink® Explore 384 Cardiometabolic Assays I and II). Results: Several proteins were dysregulated both in patients with PACS and POTS (n=206/700, 29%) and in PACS patients without POTS (201/700=29%) compared to healthy controls (figure 1A). Only 13 proteins were uniquely up- and 3 down-regulated in PACS and POTS compared to healthy controls (figure 1B). Gene ontology pathway enrichment analysis revealed upregulation of pathways controlling inflammation, hemostasis, platelet activation and apoptosis in PACS compared to healthy controls (figure 1C). Conclusions: PACS is associated with a substantial protein dysregulation regardless of concomitant POTS up to 18 months after a mild primary SARS-CoV-2 infection. This suggests that PACS-associated POTS exist on a background of protein dysregulation but other pathophysiological mechanisms for PACS-induced POTS need to be established. Whether the dysregulated proteins observed in PACS constitute potential treatment target should be explored.
Abstract 18979: Calm Before the Storm: Exploring the Risk of Torsades De Pointes With Dexmedetomidine Administration
Authors: Aslan Amirian, Bosky Soni, Kripa Rajak, Anupam Halder
Journal: Circulation (2023)

Introduction: Corrected QT interval (QTc) prolongation is the known side effect of multiple medications especially in antipsychotic and antiarrhythmic family. Patients with either inherited or secondary prolonged QTc should be monitored closely as they can develop life threatening complications like Torsades de-pointes and ventricular fibrillation. Here we present a case of cardiac arrest secondary to dexmedetomidine. Case: A 49-year-old female with history of bipolar disorder was admitted to intensive unit for seizure after intentional ingestion of uncounted amount of diphenhydramine pills. Patient was intubated for airway protection and started on propofol. Her vitals at the time of admission included the pulse rate of 76, blood pressure of 102/49 mmHg. Her urine drug screen was positive for TCA and cannabinoids. Her ECG at the time of admission was significant for prolonged QTC of 600msec that improved to 460msec in the consecutive ECGs after administration of total of 4mg intravenous magnesium. Continuous EEG was negative for seizure and she was weaned off sedation. After awakening, she became agitated, after pushes of benzodiazepines, was eventually started on dexmedetomidine. Twenty minutes after starting low dose dexmedetomidine, patient was noted to be in cardiac arrest. Reviewing telemetry prior to event, revealed the R on T phenomenon and Torsades de pointes that lasted for few seconds with progression into ventricular fibrillation. Discussion: Currently dexmedetomidine is labeled with a low to possible risk of Torsade de pointes and QTC prolongation. Dexmedetomidine induced Torsade de pointes might be explained by bradycardia in patients which causes further prolongation of QT interval. Studies have shown that continuous IV infusion of dexmedetomidine at rate of 0.3 mcg/kg/hour can worsen QTC prolongation. Conclusions: In this case we present a case of VFib arrest secondary to Torsade after twenty minutes of infusion of dexmedetomidine without any sign of bradycardia prior to the event. This carries a significant importance as it shows this drug carries a potential risk of QTc prolongation similar to previous studies. Whether this side effect is dose dependent or not requires further investigation.
Abstract 17924: Machine Learning Analysis of the Atrial ECG in Patients With Persistent Atrial Fibrillation Predicts Long-Term Outcomes
Authors: Jorge Bohorquez, Ghaith Zaatari, Patrick Ganzer, Odelia Schwartz, Abhishek Prasad, Raul Mitrani, Jeffrey Goldberger
Journal: Circulation (2023)

Background: The surface Atrial ECG (A-ECG) time and frequency domains features are not currently used clinically in patients with persistent atrial fibrillation (PeAF). Machine Learning (ML) can provide novel insight into various data sources. Research question: Can ML analysis of the A-ECG predict the outcome of catheter ablation (CA) of PeAF? Aim: To use ML Tools to assess A-ECG prediction of CA outcomes in PeAF patients at 1 and 2 years. Methods: Thirty-two patients (age 63±9 years; 71% males) with PeAF underwent two 5-minute epochs of surface ECG; 4 were excluded for significant artifacts and 2 more for unrelated clinical issues. The Pre-CA A-ECG was derived by QRST subtraction and independent component analysis filtering and divided into 50% overlap 10-second windows for spectral analysis. A-ECG mean dominant frequency DF, mean organization index and median amplitude M-AMP were computed for each lead. Freedom from atrial arrhythmia AA (Responders) was assessed at one and two years. The two 5-minute segments per patient were included in the data set. Classification Learner (Mathworks Inc., Natick, MA, USA) was used to train classifiers, looking for the minimum number of features able to explain the outcomes. Once the best (2-3) features were identified, a MATLAB program was used to visualize the decision regions and correlate with ablation outcomes. Results: ML identified A-ECG features DF and M-AMP of V 1 to well explain outcome. Specifically, an Artificial Neural Network (ANN) with 1 fully connected hidden layer of size 7 can explain the data with 90.4% accuracy. The figure shows the datasets for year 1 and year 2 CA outcomes, superimposed with ANN decision regions, for Responders and non-Responders. High DF and high M-AMP are predictors of responders and Low DF low M-AMP for non-Responders. Conclusion: ML analysis of the A-ECG is a promising tool to predict Responders to PVI CA for treatment of PeAF. This predictive algorithm needs to be tested on a prospective cohort.
Abstract 16264: Safety and Efficacy Outcomes of Micra Leadless Pacemakers: An Updated Systematic Review and Meta-Analaysis
Authors: Shahan Haseeb, Umair A Ansari, Chandra Chhetri, Ahmed T. Masoud, Hamza Sohail, Shawal Haseeb, Shafia Munir, Muhammad Zulqarnain, Rajat Goyal
Journal: Circulation (2023)

Background: The Micra leadless pacemaker (LP) is a novel pacing technology that has revolutionized the management of bradyarrhythmias and eliminated the need for intra-cardiac leads. A meta-analysis was performed to assess the long term safety and efficacy outcomes of the LP. Methods: We included a total of 60 studies. Data was analyzed to calculate outcomes in the pooled proportion of patients undergoing LP implant. Primary efficacy endpoints were successful implantation and acceptable capture threshold of &lt;2V at 1 year. Primary safety outcomes were vascular injury, tamponade, device dislodgement, pneumothorax, and major complications (complications resulting in intervention, prolonged hospital stay, readmission or death). Results: Successful LP implantation was found to be 99.4% (Cl [99.1%, 99.6%], (P = 0.95)) and acceptable capture threshold of &lt;2V at 1 year was 97.1% (CI [96%, 98.2%], P = 0.001). Major complications occurred in 2.5% (CI [1.3%, 3.6%], P = 0.001). Infection occurred in 0.5% (Cl [0.0%, 0.9%], P = 0.03) and the analysis was homogeneous (I2 = 45.16%, P = 0.04). Vascular injury occurred in 0.9% (CI [0.4%, 1.3%], P = 0.001), cardiac tamponade in 0.4% (CI [0.2%, 0.7%], P = 0.002)) and device dislodgement in 0.3% (CI [0.2%, 0.4%], P &lt; 0.001). Conclusion: LPs had a high rate of successful implantation and capture threshold at 99.4% and 97.1% respectively, while having low rates of major complications, infections, dislodgement, cardiac tamponade and vascular injury.