tbuckley/cabot-search huggingface dataset:
Abstract 11574: Clinical Changes and Predictors of Health Status in Patients With Atrial Fibrillation
Authors: Hiroshi Miyama, Nobuhiro Ikemura, Takehiro Kimura, Yoshinori Katsumata, Takahiko Nishiyama, Yukihiro Himeno, Shuhei Yano, Shuhei Yamashita, Kouki Yamaoka, Susumu Ibe, Otoya Sekine, Ikuko Ueda, Shun Kohsaka, Seiji Takatsuki
Journal: Circulation (2023)

Background: Recent clinical trials have shown the health status benefit of rhythm control, including catheter ablation (CA) over rate control for patients with atrial fibrillation (AF). However, the trials show population-averaged benefits, which complicates clinical interpretation; in reality, some patients may not benefit or even experience worsening health status after treatment. This study aimed to examine changes in patients' health status and identify predictors in a multicenter outpatient registry (KiCS-AF). Methods: KiCS-AF was a multicenter, prospective registry of patients with newly diagnosed AF collecting baseline and 1-year patient-reported health status. We examined changes in the Atrial Fibrillation Effect on QualiTy-of-life overall summary (AFEQT-OS) score over 1 year across different treatment strategies in patients with paroxysmal or persistent AF. We defined clinically important improvement and deterioration of health status as ≥5 points increase and decrease in AFEQT-OS score and no change as -5 to 5 points based on previous reports. Results: Overall, 1,960 patients were enrolled in this study, with mean AFEQT-OS scores of 76.7±17.7 and 85.4±14.8 at baseline and 1-year follow-up, respectively. The majority of patients (53.9%) experienced a clinically important improvement in health status, albeit a substantial number of patients experienced no change (28.7%) or worsening health status (17.4%). The proportion of patients with no change or worsening health status differed by treatment strategy (59.9%, 53.9%, and 32.0% in the rate control, antiarrhythmic drugs, and CA groups, respectively). After adjustment for baseline characteristics and AFEQT-OS scores, preserved baseline health status, older age (≥65 years), female sex, heart failure, and coronary artery disease were independent predictors of worsening health status in the overall cohort and the CA subgroup. Conclusion: In contemporary practice, a large proportion of patients showed improvement in health status, while a considerable number of patients experienced worsening or no change after intervention. Patient-centered care is essential to prevent the worsening of health status even after CA in high cardiovascular-risk, elderly, and female populations.
Abstract 12454: Weak Supervision Enables Scalable Post-Market Surveillance on Medical Wearables
Authors: Richard M Yoo, Ben T Viggiano, Krishna N Pundi, Jason A Fries, Aydin Zahedivash, Tanya Podchiyska, Natasha Din, Nigam H Shah
Journal: Circulation (2023)

Introduction: With the advent of consumer-facing devices that can render atrial fibrillation (AF) pre-diagnosis, medical wearables now have the potential to affect diagnosis rates and medical care. Post-market surveillance is necessary to understand the impact of wearables on patient outcomes and health care utilization, but is hindered by the lack of codified terms in EHR that capture wearable use. Research Questions: Constructing a post-market surveillance system therefore requires a classifier that identifies mentions of AF pre-diagnosis in unstructured EHR data. However, fine-tuning classifiers require large, hand-labeled training sets that can be costly to generate. It is unclear whether a scalable surveillance system could be built for wearables. Methods: Two weakly-supervised approaches were evaluated to reduce clinical note labeling overhead: one using programmatic codes, and the other using prompts to large language models (LLMs). Probabilistically labeled notes were then used to fine-tune a classifier, which identified patients with AF pre-diagnosis mentions. A retrospective cohort study was conducted, where the characteristics and care patterns of patients identified by the classifier were compared against those who did not receive pre-diagnosis. Results: Label model derived from prompt-based labeling heuristics using LLMs (precision = 0.67, recall = 0.83, F1 = 0.74) nearly achieved the performance of code-based heuristics (precision = 0.84, recall = 0.72, F1 = 0.77), while cutting down the cost to create a labeled training set. The classifier learned on the labeled notes accurately identified patients with AF pre-diagnosis (precision = 0.85, recall = 0.81, F1 = 0.83). Those patients who received pre-diagnosis exhibited different demographic and comorbidity characteristics, and were enriched for anticoagulation and eventual diagnosis of AF. At the index diagnosis, existence of pre-diagnosis did not stratify patients on clinical characteristics, but did correlate with anticoagulant prescription. Conclusion: Our work establishes the feasibility of an EHR-based surveillance system for wearable devices that render AF pre-diagnosis. Weakly-supervised approaches can be effective in reducing test set labeling costs.
Abstract 12263: Inflammation and Cholesterol as Predictors of Cardiovascular Events and Risk Reduction With Bempedoic Acid Among Statin Intolerant Patients: An Analysis of the CLEAR Outcomes Trial
Authors: Paul M Ridker, Lei Lei, Michael J Louie, Tariq M Haddad, Stephen J Nicholls, Abraham M Lincoff, Peter Libby, Steven E Nissen
Journal: Circulation (2023)

Introduction: Among contemporary statin-treated patients, residual inflammatory risk assessed by high-sensitivity C-reactive protein (hsCRP) is a stronger predictor of future cardiovascular (CV) events and all-cause mortality than residual cholesterol risk assessed by low density lipoprotein cholesterol (LDLC). Whether these relationships are present among statin-intolerant patients is unknown but has implications for the choice of preventive therapies including bempedoic acid, an agent that reduces both LDLC and hsCRP. Methods: In the multi-national CLEAR-Outcomes trial, 13,970 statin-intolerant patients were randomly allocated 1:1 to 180 mg oral bempedoic acid daily or matching placebo and followed for incident myocardial infarction (MI), stroke, coronary revascularization, CV death, and all-cause mortality. Quartiles of increasing baseline hsCRP and LDLC were assessed as predictors of future adverse CV events after adjustment for traditional risk factors and treatment (bempedoic acid vs. placebo). Results: Baseline hsCRP was significantly associated with incident composite endpoint of MI, stroke, coronary revascularization, and CV death (highest vs lowest hsCRP quartile, HR=1.43, 95% CI 1.24-1.65), CV mortality (HR=2.00, 95% CI 1.53-2.61), and all-cause mortality (HR=2.21, 95% CI 1.79-2.73). By contrast, the relationship of baseline LDLC quartile (highest vs. lowest) to future CV events was smaller for the composite endpoint (HR=1.19, 95% CI 1.04-1.37) and neutral for CV mortality (HR 0.90, 95% CI 0.70-1.17) and all-cause mortality (HR 0.95, 95% CI 0.78-1.16) such that risks were high for those with elevated hsCRP irrespective of LDLC level. Compared to placebo, bempedoic acid reduced median hsCRP by 21.6% and mean LDLC levels by 21.1% at 6 months and demonstrated similar efficacy in reducing major adverse CV events across all levels of hsCRP and LDLC. Interpretation: Among contemporary statin-intolerant patients, inflammation assessed by hsCRP was a stronger predictor of risk for future CV events and death than was hyperlipidemia assessed by LDLC. Compared to placebo, bempedoic acid had similar efficacy for reducing CV risk across hsCRP and LDLC strata.
Abstract 11627: Association of Cardiac Power Output Index With PET Glucose Metabolism and Prognosis in Pulmonary Arterial Hypertension Patients. Two-year Follow-Up
Authors: Remigiusz Kazimierczyk, Lukasz Malek, Stephan Nekolla, Piotr Szumowski, Piotr Blaszczak, Bozena Sobkowicz, Janusz Mysliwiec, Karol Kaminski
Journal: Circulation (2023)

Introduction: In pulmonary arterial hypertension (PAH) there is still a need for new prognostic markers to precisely identify the patients before clinical deterioration. We investigated cardiac power index (CPi) as a tool to assess right ventricular (RV) function and overall prognosis. Hypothesis: Hemodynamic changes occurring in PAH assessed with CPi are related with cardiac metabolism alterations in PET imaging what affects prognosis. Methods: Twenty-eight stable (WHO class II or III) patients (49.9±15.9 yo) had hybrid PET/MRI scans and heart catheterization performed during baseline and after 24-months. SUV RV/LV ratio was used to estimate cardiac 18-fluorodeoxyglucose uptake. Clinical endpoints (CEP - death or clinical deterioration) were assessed between visits. CPi was defined as the cardiac index х mean pulmonary artery pressure x 2.22 х 10-3. Results: Baseline CPi was 0.28±0.09 W/m2 and it correlated significantly with PET-derived SUV RV/LV ratio (r=0.55, p=0.002), confirming relationship between RV hemodynamics and cardiac metabolism. After 24 months of PAH specific therapy, we observed significant improvement in follow-up CPi - 0.23±0.04 W/m2 (p=0.04). Interestingly, baseline CPi predicted follow-up SUV RV/LV ratio. During 2-year observation, 16 patients (57%) had experienced CEP (including 4 deaths). Patients with CEP had higher baseline CPi than stable patients (0.32±0.09 vs 0.21±0.05, p=0.0006), as well as increased SUV RV/LV. CPi cut-off value to predict worse prognosis was 0.24 W/m2 (log-rank test, p=0.003, Figure) and CPi was also a significant predictor of CEP in multivariate analysis (R2 = 0.69; p=0.001). Conclusions: Indexed cardiac power output parameter is related with RV metabolism alterations in PAH and may help to identify stable patients at higher risk of death or clinical deterioration.
Abstract 12374: Machine Learning-Based Evaluation of Elevated Left Ventricular End-Diastolic Pressure
Authors: Michelle Z Fang, Bo Xu, Yadi Zhou, Krishna Sanaka, Lars Svensson, Richard A Grimm, Brian P Griffin, Zoran B Popovic, Feixiong Cheng
Journal: Circulation (2023)

Background: Left ventricular end-diastolic pressure (LVEDP) is clinically relevant due to its association with diastolic dysfunction and other outcomes. The gold-standard method of measuring LVEDP is invasive intra-cardiac catheterization. Echocardiography is routinely used for non-invasive estimation of left ventricular (LV) filling pressures; however, correlation with invasive LVEDP is variable. Goal: We sought to use machine learning (ML) algorithms to predict elevated LVEDP (&gt; 20 mmHg) using clinical, echocardiographic, and biochemical parameters. Methods: We used a cohort of 460 consecutive patients without atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography within 24 hours of elective heart catheterization. We included patients’ clinical (e.g. age), echocardiographic (e.g. left ventricular ejection fraction), and biochemical (e.g. N-terminal brain natriuretic peptide) data. We fit logistic regression, random forest, gradient boosting, and support vector machine algorithms in a 20-iteration train-validate-test workflow and measured performance using average area under the receiver operating characteristic curve (AUROC). We also performed multi-class classification of the patients’ cardiac conditions and predicted elevated tau (&gt; 45), the gold-standard parameter for LV diastolic dysfunction. For each outcome, logistic regression weights were used to identify clinically relevant variables. Results: ML algorithms predicted LVEDP &gt; 20 mmHg with good performance (AUROC = 0.779). ML models showed excellent performance predicting elevated tau (AUROC = 0.830) and classifying a variety of cardiac conditions (AUROC = 0.837 - 0.973). We identified several clinical variables (e.g. BMI, heart rate) relevant to LVEDP prediction. Conclusion: Our study shows ML approaches can robustly predict elevated LVEDP and tau. ML may assist in the clinical interpretation of echocardiographic data.
Abstract 11443: Metabolic Profile Signature of Obesity in Heart Failure With Preserved Ejection Fraction
Authors: Chang Liu, Eisha Udeshi, Dean Jones, Arshed A Quyyumi, Alanna A Morris
Journal: Circulation (2023)

Introduction: Heart failure (HF) affects an estimated 6.2 million people in the US, with at least 50% of patients having HF with preserved ejection fraction (HFpEF). Obesity is a risk factor for HFpEF, however the association of obesity with metabolic signatures in HFpEF remains unclear. We aimed to identify unique metabolic profile of obesity among patients with HFpEF. Methods: A total of 41 participants from the Metabolomics, Oxidative Stress and Vascular Function (MOV) in HF study formed the discovery cohort, and 40 participants from the Atlanta Cardiomyopathy Consortium (TACC) study formed the validation cohort. All patients had HFpEF with left ventricular ejection fraction ≥ 50%. Untargeted high-resolution plasma metabolomic profiling identified 1,986 metabolic features. Partial least squares-discriminant analysis (PLS-DA) was performed separately in two cohorts to find the differently expressed metabolic features among obese (body mass index [BMI] ≥ 30 kg/m 2 ) vs. non-obese (BMI &lt; 30 kg/m 2 ) patients with HFpEF. Variable Importance in Projection (VIP) score &gt; 1 was used for feature selection. Annotation was performed by matching to an in-house library of previously confirmed metabolites. All features with VIP &gt; 1 were used to explore pathway enrichment using Mummichog. Results: The MOV and TACC cohorts included 68.3% and 42.5% obese patients, respectively. The PLS-DA identified 23 metabolic features with confirmed annotations associated with obesity in the MOV, and 9 metabolic pathways were represented. Ten metabolites were validated in TACC, including 2,6-dihydroxypyridine, l-proline, taurine, l-methionine, guanine, 4-coumarate/phenylpyruvate, pyridoxamine, 1-methyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline, ll-2,6-diaminoheptanedioate, and linoleate. One metabolic pathway, di-unsaturated fatty acid beta-oxidation, was validated. Conclusions: In two cohorts of HFpEF patients, by comparing the metabolic profiles of obese vs. non-obese patients, we identified alterations in amino acids, fatty acids, alkaloids, and vitamins. Moreover, pathway analysis confirmed alterations in the metabolic pathway of beta-oxidation of unsaturated fatty acids such as linoleate are also associated with obesity.
Abstract 11905: Real-World Clinical Impact of High-Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department
Authors: Jacob A Martin, Archana Saxena, Olumide Akindutire, Nicholas Genes, Nathan Gollogly, Nathaniel R Smilowitz, Adriana Quinones Camacho
Journal: Circulation (2023)

Background: The impact of high-sensitivity cardiac troponin (hs-cTn) implementation on clinical practice in emergency departments in the United States is not well characterized. Research Questions: We sought to assess the effect of hs-cTn on length of stay, hospital admissions, and utilization of cardiac testing and consultations. Methods: Adult patient visits to the emergency department (ED) for chest pain with ≥ 1 troponin result were identified in electronic health record data from a large academic health system encompassing one suburban hospital and two urban hospitals including a quaternary referral center. Patients were included 15 months before and 11 months after the implementation of hs-cTn on April 6, 2022. Associations between hs-cTn implementation and clinical metrics were evaluated using both univariable and multivariable linear models. Results: Among 27,313 unique patients, there were 17,267 and 14,809 encounters before and after the implementation of hs-cTn, respectively. Using hs-cTn, a greater proportion of patients were discharged from the ED (59.5 % vs. 64.9 %, p &lt;0.0001), and total length of stay ( Figure 1 ) was shorter (6.6 h, IQR 3.9 - 29.5 vs. 6.0 h, IQR 4.0 - 27.1, p = 0.039). Similar results were observed in urban vs. suburban settings and in quaternary care vs. lower levels of care. There were lower rates of cardiology consults (-1.2 per 100 patient visits, adjusted odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.86 - 0.97), echocardiograms (-2.8 per 100 patient visits, adjusted OR: 0.86, 95% CI: 0.82 - 0.91), stress tests (-1.9 per 100 patient visits, adjusted OR: 0.74, 95% CI: 0.67 - 0.81), and coronary angiograms (-2.0 per 100 patient visits, adjusted OR: 0.77, 95% CI: 0.70 - 0.83) after hs-cTn implementation. Conclusions: In real-world data, implementation of hs-cTn was associated with a higher rate of discharges from the ED and shorter total length of stay with small reductions in utilization of cardiac testing.
Abstract 11983: Biomarker Profile of Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction or Reduced Ejection Fraction: Insights From the ARISTOTLE Trial
Authors: Tymon Pol, Johan Lindbäck, John H Alexander, Christopher Granger, Renato D Lopes, Agneta G Siegbahn, Lars C Wallentin, Ziad Hijazi
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a poorly understood entity with phenotypic differences to heart failure with reduced ejection fraction (HFrEF). To shed light on the potential pathophysiological difference between HFrEF and HFpEF, multiplex screening of plasma proteins was performed. Methods: From the ARISTOTLE trial with atrial fibrillation (AF) patients, 562 patients with HFrEF and 562 with HFpEF at randomisation were included. Heart failure status at baseline was defined according to systolic left ventricular function; for HFrEF ≤40% and for HFpEF &gt;40%. Plasma samples were analysed with conventional immunoassays and OLINK proximity extension assay panels; CVDII, CVDIII and the inflammation panel. Associations between biomarkers and HF subtype was evaluated with Wilcoxon–Mann–Whitney test with Bonferroni-Holm adjustment for multiplicity. Results: Out of 269 biomarkers, 53 biomarkers differed between the HF subtypes. After adjustment for multiplicity, nine biomarkers had the strongest associations with difference between HFrEF and HFpEF (Figure). In HFrEF, the proteins levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), cardiac troponin-T (cTnT-hs), renin, growth differentiation factor-15 (GDF-15), angiotensin-converting enzyme 2 (ACE-2) and interleukin-6 (IL-6) were higher than in HFpEF, whereas levels of stem cell factor (SCF) and leptin were higher (Figure) in HFpEF. Conclusions: HFrEF was more strongly associated with elevated markers of cardiorenal dysfunction, the renin-angiotensin-aldosterone system and oxidative stress/inflammation while HFpEF was more strongly associated with higher levels of adipose tissue metabolism and vasculogenesis and tissue repair proteins. These findings add valuable knowledge to the understanding of the underlying differing biological mechanisms in the HF subtypes HFrEF and HFpEF in an AF population.
Abstract 11982: Bariatric Surgery is Associated With Lower Odds of Cardiovascular Diseases and Cardiac Arrhythmias Among Hospitalized Patients With Non-Alcoholic Fatty Liver Diseases: A National Inpatient Sample Study
Authors: ali esparham, Saeed Shoar, Ali Mehri, venkat modukuru
Journal: Circulation (2023)

Introduction: Morbid obesity has shown a strong association with nonalcoholic fatty liver disease (NAFLD), both of which convey significant risk for the development of cardiovascular diseases (CVD). Bariatric surgery (BS) has proved to improve NAFLD and mitigate the severity of different CVD subgroups. Research Question: What are the odds of having different CVDs among morbidly obese patients with NAFLD who have undergone BS compared to those who have not. Methods: Using multivariate logistic regression, national inpatient sample (NIS) databased was analyzed from 2016 to 2019 to compare the odds of having CVD among NAFLD patients who have undergone BS and those who NAFLD patients with no prior BS. Results: The BS and non-BS groups consisted of 27,865 and 315,300 NALFD patients, respectively. BS group was significantly younger with a higher frequency of female patients.The white race, in contrast to the black race, was more frequently in the non-BS group. In addition, Medicare was significantly higher in the non-BS group compared to the BS group. BS was independently associated with lower odds of having HFpEF, HFrEF, AMI, stroke, CAD, peripheral vascular diseases, heart valve diseases, cardiac arrest, cardiogenic shock, AF, VF, VT, RBBB, LBBB, first-, second-, and third-degree heart block, complete heart block, and fascicular block (p-value&lt;0.001 for all). After adjusting for demographics and medical comorbidities, BS was independently associated with 18% lower odds of in-hospital mortality (OR:0.82, CI 95% 0.69-0.97, p-value=0.018). The BS group had a significantly lower length of hospital stay (8.7 days vs. 10 days) (p-value&lt;0.001). Conclusion: Bariatric surgery is associated with significantly lower odds of having cardiovascular diseases in-hospital mortality, and length of stay among hospitalized morbidly obese patients with NAFLD.
Abstract 12686: Serious Complications Occur in Patients With Transcatheter Aortic Valve Replacement Who Develop In-Hospital Infective Endocarditis
Authors: Juan A Quintero Martinez, Moises Vasquez, Joel Mintz, Mina Iskander, Jose Luna-Alvarez-Amezquita, mohammed mustafa, Jose Noy, Juan Uribe, Joaquin Espinoza, Paola Lecompte, Carlos Alfonso, Eduardo de Marchena, Larry M Baddour
Journal: Circulation (2023)

Introduction: Transcatheter aortic valve replacement (TAVR) is a well-recognized treatment for severe aortic stenosis. One potentially life-threatening complication of TAVR is infective endocarditis (IE). There is limited contemporary data on the clinical characteristics and outcomes of patients undergoing TAVR who develop in-hospital IE. Aim: Describe the clinical characteristics and outcomes of patients undergoing TAVR who develop in-hospital IE. Methods: The National Inpatient Sample Database was queried from 2016 to 2020 for relevant ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes of adult (≥18 years) patients undergoing TAVR who developed in-hospital IE were compared to that of patients who did not develop IE. Multivariate logistic-regression analyses adjusting for age, race, gender, and statistically significant comorbidities between cohort's were performed. A p-value &lt;0.05 was considered significant. Results: A total of 314,250 hospitalizations for patients undergoing TAVR were identified. Of them, 1065 (0.3%) developed in-hospital IE. Overall, mean age of IE patients was 70.3 ± 15.0. Patients were predominantly (62%) males and white (79.5%) ( Table 1) . IE patients had a higher risk of in-hospital all-cause mortality (adjusted odds ratio [95% CI]: 2.07 [1.50-2.86]), septic shock (3.73 [2.71-5.13]), acute respiratory failure (2.59 [2.19-3.06]), ischemic stroke (4.4 [3.48-5.51]), acute kidney injury (3.05 [2.61-3.57]), cardiac arrest (2.82 [1.83-4.37] and cardiogenic shock 3.70 [2.98-4.57]). All p values were &lt;0.01. Conclusion: Patients undergoing TAVR who develop in-hospital IE had higher in-hospital complications when compared to those of patients who did not develop IE. Although the rate of in-hospital IE was low, the number of patients identified in the NIS database was sizable and the syndrome deserves investigation due to its associated complications.