tbuckley/cabot-search huggingface dataset:
Abstract 4136394: Elucidation of a novel genetic substrate responsible for genetically elusive ring-like arrhythmogenic cardiomyopathy
Authors: David Tester, Matteo Castrichini, Michael Ackerman, John Giudicessi
Journal: Circulation (2024)

Background: Arrhythmogenic cardiomyopathy (ACM) is a genetic heart disease characterized by fibrofatty replacement of ventricular myocardium. Arrhythmogenic left ventricular (LV) cardiomyopathy (ALVC) is a phenotypic variant of ACM predominantly involving the LV. Mutations in genes encoding for desmosome proteins and filamin C have been implicated in ALVC, especially in the setting of a ring-like late gadolinium enhancement (LGE) imaging pattern. Objective: To identify the underlying genetic substrate responsible for genetically elusive ring-like ALVC in a patient with seemingly sporadic/recessive disease. Methods: A 38-year-old male was referred for genetic investigation to determine the underlying genetic substrate responsible for his ALVC phenotype. The patient fulfilled both electrocardiographic (low voltage in the limb leads and anterolateral T-wave inversions) and imaging (&gt;1 segment of subepicardial LGE) criteria for ALVC. Additionally, the patient experienced unexplained episodes of tachycardia, shakiness, sweating, and nausea prompting concern for an underlying neuromuscular disease. Genome sequencing (GS) was performed on DNA isolated from the affected patient and both of his unaffected parents. Variants were filtered assuming either a sporadic de novo occurrence or an autosomal recessive inheritance pattern. Results: GS identified compound heterozygous GNPTAB variants in the affected patient. A previously reported maternally derived p.Leu257Leu (c.771G&gt;A) variant involving the last nucleotide of exon 7 of the GNPTAB gene and a novel paternally inherited Lys834fs*5 frame-shift variant were identified. The p.Leu257Leu variant has been reported to cause aberrant splicing and exon skipping of the GNPTAB mRNA transcript. Pathogenic variants in the GNPTAB encoded N-acetylglucosamine-1 (GlcNAc)-phosphotransferase subunits alpha/beta cause mucolipidosis type III, a rare recessive lysosomal storage disease characterized by coarse facial features, developmental delay, short stature, skeletal deformities, and cardiac involvement including valvular thickening and cardiomyopathy. Conclusions: Here, using a genome sequencing trio analysis we identified a compound heterozygous GNPTAB pathogenic variants as the underlying genetic substrate in a patient with ring-like ALVC and concomitant neuromuscular disease manifestation. Genome sequencing may identify the genetic etiology responsible for an otherwise undifferentiated diagnosis of cardiomyopathy.
Abstract 4136013: Pre-operative Frailty Status and Short-term Complications Among Adults Undergoing Transcatheter Aortic Valve Replacement
Authors: Jasninder Dhaliwal, Nomesh Kumar, parampreet johal, Kamleshun Ramphul, Rahul Singla, Kanwar Bir Singh Dhaliwal, Renuka Verma, Manraj Sekhon, Arush Rajotia, Hemamalini Sakthivel
Journal: Circulation (2024)

Introduction: The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further. Methods: Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them. Results: Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p&lt;0.001, HFR: aOR 13.303, p&lt;0.001), acute kidney injury(MFR: aOR 9.737, p&lt;0.001, HFR: aOR 26.685, p&lt;0.001 ), use of invasive mechanical ventilation(MFR: aOR 10.763, p&lt;0.001,HFR: aOR 39.432, p&lt;0.001), events of acute myocardial infarction(MFR: aOR 3.32, p&lt;0.001, HFR: aOR 6.021, p&lt;0.001), need for transfusion of blood products(MFR: aOR 3.027, p&lt; 0.001, HFR: aOR 5.938,p&lt;0.001), post-procedural bleeding(MFR: aOR 2.475, p&lt;0.001, HFR: aOR 3.277, p&lt;0.001), IABP use(MFR: aOR 4.942, p&lt;0.001, HFR: aOR 9.703, p&lt;0.001), and need for pericardiocentesis(MFR: aOR 3.804, p&lt;0.001, HFR: aOR 4.217, p&lt;0.001). Moreover, patients with MFR and HFR reported higher mortality risks than those with LFR(MFR: aOR 6.375, p&lt;0.001, HFR: aOR 16.035, p&lt;0.001 )(Table 1). Conclusion: Our study confirms the higher odds of various complications with increasing frailty status, including all-cause in-hospital death. A careful assessment of pre-operative frailty status along with close monitoring of pre-, peri-, and post-operative status will help improve the outcomes and provide care in a timely fashion.
Abstract 4136550: In-hospital cardiac arrest can be detected by Innovative smart healthcare syste
Authors: Wei-Chun Huang, Wang-chuan Juang, Huang-Jeng Chao, Kun-Chang LIN, Wei-Hsin Chen, Chien-Wei HSU, Man-Ling Liao, Hsiao-Wen Huang, Shu-Shong HSU
Journal: Circulation (2024)

Background: Predicting in-hospital cardiac arrest (IHCA) is crucial for preventing patient fatalities. However, it remains challenging due to the irregularities in time series data across various features. Previous studies relied on traditional medical scoring systems, but their accuracy was limited as the models were overly simplistic. Recent research using machine learning methods has shown improved results. In our work, we employ deep learning and time series approaches, which are considered the most powerful models for addressing complex problems in recent years. Method/Research Design: The cohort study took place in a hospital in Taiwan from January 2016 to August 2022, involving 252,000 patients in general wards. Input data encompassed basic information, vital signs, Glasgow Coma Scale scores, medication, etc., to predict IHCA occurrences within 24 hours. Given the immediacy of IHCA events, we utilized left alignment to handle time series. Evaluation metrics included the area under the receiver operating characteristic curve (AUROC). Results: We compared three types of settings. The first was based on scoring systems, where the national early warning system (NEWS) achieved an AUROC of 0.756, and the modified early warning score (MEWS) reached 0.653. In the next setting, based on the data summary within a given time interval, the machine learning models XGBoost and deep learning model TabNet achieved AUROCs of 0.863 and 0.839, respectively. This indicates that machine learning outperforms traditional medical methods. The final setting involved time series analysis, where XGBoost and the Gate Recurrent Unit (GRU) network achieved 0.848 and 0.904, respectively, surpassing all previous settings. Conclusion: Our study demonstrates that learning-based methods outperform rule-based methods in predicting IHCA events. Machine learning algorithms offer more possibilities and have the potential to address complex problems effectively. Moreover, considering time series data rather than summarizing within fixed intervals preserves information and leads to better scores. Leveraging the time series deep learning method, GRU shows promising potential in significantly reducing the risk of IHCA events.
Abstract 4136355: Investigating Changes in Hazardous and Harmful Drinking Among Young Adults Through Zoom Intervention
Authors: Sangeun Lee, Ruth Adomah, HAGAR HALLI HAN
Journal: Circulation (2024)

Introduction/Background: Hazardous drinking is a major adverse factor for young adults’ health. This study investigates the efficacy of an integrated contingency management and problem-solving Zoom intervention in addressing hazardous and harmful drinking among young adults. Research Questions/Hypothesis: Participants who receive the 8-session integrated Zoom CM-PST intervention will demonstrate a significant reduction in hazardous and harmful drinking behaviors compared to baseline measurements. Goals/Aims: The aims of this study were to evaluate the effectiveness of 8-session integrated Zoom contingency management and problem-solving Zoom intervention in reducing hazardous and harmful drinking reduction and abstinence. Methods/Approach: This pilot randomized controlled trial study employed a single-arm design with post-intervention and follow-up assessments at 12 weeks. The study targeted young adults aged 18-24 in Chicagoland who regularly consume alcohol at least once a week and have alcohol use disorder. Participants completed the Alcohol Use Disorders Identification Test (AUDIT), Drinking Motives Questionnaire-Revised (DMQ-R), and the 90-day Timeline Follow-back (TLFB) at baseline and 12 weeks after the intervention. The Zoom CM-PST intervention was administered to the participants, and a self-reported questionnaire was utilized to evaluate participants’ drinking use, severity, motivation, and hazardous drinking behavior at baseline and at the 12-week follow-up. A paired t-test, correlation, and multiple regressions were performed to investigate changes in hazardous and harmful drinking among 20 young adults aged 18-24. Results: A paired t-test showed that the participant’s level of alcohol use problem and social, coping, and enhancement motivation for alcohol use decreased from pre- to post-intervention. High drinking behaviors accounted for 40% at baseline, while 35% at post-intervention assessment. Over 12 weeks, 45% of participants demonstrated an improvement in hazardous drinking behaviors. Motivation at baseline was a significant factor affecting post-intervention alcohol use problems at 12 weeks. Conclusions: The results showed notable enhancements in alcohol use problem reduction and motivation for alcohol use at 12 weeks. The study provides useful insights into the effectiveness of web-based integrated contingency management and problem-solving Zoom interventions in mitigating hazardous and harmful drinking among young adults.
Abstract 4136403: Impact of Coronary Artery Calcium Scores on Cardiovascular Risk and Preventive Therapies: A Systematic Review and Meta-Analysis
Authors: Angad Bedi, Hussam Al Hennawi, Muhammad Khuzzaim Khan, Shehroze Tabassum, Rachel Ramirez, Robert Watson
Journal: Circulation (2024)

Introduction: Coronary artery calcium (CAC) serves as a key marker of atherosclerosis and is widely utilized in the noninvasive evaluation of coronary artery disease. We aim to compare cardiovascular risk outcomes and the likelihood of initiating or continuing pharmacological and lifestyle preventive therapies in asymptomatic and symptomatic patients with a CAC score greater than zero and those with a CAC score of zero with no established diagnosis of coronary artery disease. Methods: We performed systematic searches of PubMed, Scopus, Google Scholar, Cochrane Central, and ClinicalTrials.gov from inception to May 2024. Our search focused on randomized controlled trials and observational studies comparing outcomes between patients with a CAC score greater than zero and those with a CAC score of zero. Results: We included 53 observational studies, incorporating data from 210,672 asymptomatic and 32,477 symptomatic patients. Over a mean follow-up duration of 8.6 years, we observed that a CAC score greater than zero significantly correlated with an elevated risk of major adverse cardiovascular events (MACE) (OR: 5.58; 95% CI: 4.05–7.69; P &lt; 0.00001). This association extended to all-cause mortality (OR: 3.90; 95% CI: 2.78–5.48; P &lt; 0.00001), myocardial infarction (OR: 4.01; 95% CI: 3.45–4.65; P &lt; 0.00001), and the need for revascularization (OR: 11.90; 95% CI: 6.82–20.78; P &lt; 0.00001). Patients with a CAC score greater than zero were more likely to commence and continue aspirin therapy (OR: 2.45; 95% CI: 1.56–3.83; P &lt; 0.0001 for initiation and OR: 1.71; 95% CI: 1.31–2.23; P &lt; 0.0001 for continuation). Similar trends were noted for lipid-lowering medications (OR: 2.44; 95% CI: 1.57–3.79; P &lt; 0.0001 for initiation and OR: 2.48; 95% CI: 1.53–4.01; P = 0.0002 for continuation), as well as the initiation of blood pressure medications (OR: 1.94; 95% CI: 1.61–2.33; P &lt; 0.00001). Furthermore, a CAC score greater than zero was linked to increased adoption of lifestyle modifications, including enhanced physical activity (OR: 1.84; 95% CI: 1.41–2.41; P &lt; 0.00001) and dietary changes (OR: 1.94; 95% CI: 1.52–2.49; P &lt; 0.00001). Conclusion: Patients with elevated CAC scores are more likely to initiate and continue preventive pharmacological therapies and adopt beneficial lifestyle modifications. These findings underscore the importance of CAC scoring in guiding the management and prevention of cardiovascular disease in both asymptomatic and symptomatic populations.
Abstract 4135899: Large-Scale Investigation on the Outcomes of Atrial Fibrillation Ablation in Liver Cirrhosis Patients
Authors: Soumiya Ravi, Ajit Brar, Ayushi Garg, Aalam Sohal
Journal: Circulation (2024)

Background: Catheter-based atrial fibrillation(AF) ablation is amongst the most commonly done EP procedures that have evolved over decades, improving patient outcomes and quality of life. Atrial fibrillation is seen in 5% of patients with cirrhosis and studies have shown AF in cirrhosis to be associated with increased mortality and adverse hospital outcomes. Aim: There is scarce literature on the outcomes of AF ablation in patients with cirrhosis. Our study aimed to study the safety and efficacy of catheter-based AF ablations in this population group and to ascertain if there is a difference compared to the general patient population. Methods: We used the Nationwide Inpatient Sample Database 2016-2020, the largest openly accessible inpatient healthcare database in the United States. Patients with a primary diagnosis of AF were identified using ICD-10 codes. We excluded patients with a secondary diagnosis of other arrhythmias, missing demographics, mortality, or age&lt;18. The study population was divided into patients with and without cirrhosis. Information was collected regarding various patient demographic characteristics and comorbidities (comorbidity burden captured via Elixhauser Comorbidity Index). The primary endpoint was in-hospital mortality. The secondary endpoints were total complications, length of stay, and hospitalization charges. Results: A total of 23,905 patients underwent ablation, with 23,800 being non-cirrhotic, and only 105 presenting with cirrhosis. This signifies a relatively low proportion of cirrhotic patients undergoing ablation procedures, approximately 0.6% (105 out of a total of 17,600 cirrhotic patients). Additionally, the Elixhauser comorbidity index is significantly higher in cirrhotic patients (6.62) compared to non-cirrhotic patients (3.65) with a p-value &lt;0.001, indicating a higher burden of comorbidities in the cirrhotic group. Patients with cirrhosis undergoing ablation procedures exhibit a notably higher risk of major bleeding compared to those without cirrhosis (14.3% vs. 4.06%, p-value = 0.02). Furthermore, the incidence of bleeding requiring transfusion is significantly elevated in cirrhotic patients (4.8%) in contrast to non-cirrhotic patients (0.2%) (p-value &lt; 0.001). Conclusion: Although the risk of major bleeding is high, overall mortality and other complications are comparable to those without cirrhosis. We believe that this can be mitigated by carefully selecting the patients with cirrhosis for this procedure.
Abstract 4135480: Effect of Time Since Heart Failure Diagnosis or Hospitalization on the Cost-effectiveness of Dapagliflozin in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction
Authors: Ankeet Bhatt, Rudolf De Boer, David Booth, Jason Davis, Jieling Chen
Journal: Circulation (2024)

Background: Previous studies have shown dapagliflozin, a sodium-glucose co-transporter-2 inhibitor (SGLT2i), to be a cost-effective treatment option for patients with heart failure (HF) with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) in multiple European settings. Research question: Is the cost-effectiveness of dapagliflozin treatment in HFpEF/HFmrEF modified by either the time since HFpEF/HFmrEF diagnosis or the time since the last hospitalization for heart failure (HHF) event? Methods: A Markov cohort transition model was built for the UK setting, informed by patient-level data from the randomized, placebo-controlled DELIVER trial. The patient population was subset according to categories of time since last HHF event (including no prior HHF) and time since HF diagnosis (further subset to those with no prior HHF). For each subgroup, disease evolution was characterized by transitions among health states defined by quartiles of the Kansas City Cardiomyopathy Questionnaire Total Symptom Scale. The risk of fatal (cardiovascular and non-cardiovascular) and non-fatal events of worsening HF were modelled, adjusting for baseline characteristics and time-updating health state. Incremental costs and quality-adjusted life-years (QALYs) were calculated for each subgroup to yield incremental cost-effectiveness ratios (ICERs). Results: The lowest ICERs were observed for subgroups with the shortest time from HF diagnosis (with and without prior HHF) or last HHF event (Figure 1). Across all subgroups, the calculated ICERs were below the UK willingness-to-pay (WTP) threshold of £20,000/QALY gained. Conclusions: In patients with HFpEF/HFmrEF, the cost-effectiveness of dapagliflozin improved (via lower ICERs) in the subgroups corresponding to earliest disease (least time since an HHF event or HF diagnosis) compared with groups of later disease and potentially delayed treatment initiation. These findings suggest early optimization of HF therapy with implementation of guideline-directed medical therapy, including SGLT2is, may improve economic value.
Abstract 4135726: Prospective validation and implementation pilot study of an emergency department heart failure risk stratification tool: STRIDE-HF
Authors: Dana Sax, Jie Huang, Dustin Mark, Jamal Rana, Mathew Solomon, Robert Norris, Mary Reed
Journal: Circulation (2024)

Background: We previously found the STRIDE-HF emergency department (ED) risk tool accurately predicted risk of a 30-day serious adverse event (SAE), including 30-day mortality, cardiopulmonary resuscitation, intra-aortic balloon pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization. Research question: We sought to prospectively validate STRIDE-HF and describe safety of the deployed model in a clinical pilot. We hypothesized that performance would decrease slightly with prospective evaluation and that real-time risk display would contribute to safe disposition decisions. Goals: 1) To prospectively validate KPCARES-HF across 21 community EDs among ED patients with acute heart failure (AHF) from January 1, 2023 – December 31 st , 2023; and 2) to describe outcomes among patients predicted to be very low risk and discharged home in the clinical pilot. Methods: For prospective validation, we report 30-day mortality rates by risk strata. We assess model performance using area under the receiver operator curve (AUROC) and sensitivity at a key clinical threshold. We describe rates of 30-day SAE among patients predicted to be very low risk and discharged after ED or observation unit care in the clinical pilot. Results: There were 13,274 ED patients in the prospective validation; median age was 76, 50.8% were female, and 44.5% were non-White. We found 11.4%, 24.8%, 31.9%, and 31.9% of patients were very low, low, moderate, and high risk, respectively, while 21.6%, 15.2% and 63.0% were discharged, observed, and admitted, respectively. Among discharged patients, 29.2% and 13.3% were moderate or high risk, respectively, and 30-day mortality rates among these patients were 2.2% and 8.4%, respectively. Among 8,363 admitted patients, 27.7% were very low or low risk. Conclusions: STRIDE-HF maintained high predictive accuracy with prospective validation in this diverse, multi-center cohort. Our findings suggest that use of STRIDE-HF might help better align risk with admission decision and can be safely used to assist providers in identifying patients who may be stable for outpatient care.
Abstract 4136442: Efficacy and Safety of Paclitaxel-coated balloons versus Uncoated balloons in the Management of Coronary in-stent restenosis: a Meta Analysis of Randomized Controlled Trials
Authors: Hala Najeeb, Javeria Malik, Carol Christina, Sakina Aquil, Muhammad Aamir, Mutiba Aslam, Ayesha Rasheed, Muhammad Khalid, Malaika Butt, Wajiha Gul, Hamna Kashif, Beena Muntaha Nasir, Abdul Moeed, Mahboob Alam, Courtney Bennett
Journal: Circulation (2024)

Introduction: Coronary in-stent restenosis (ISR) remains challenging despite stent technology advancements. Paclitaxel-coated balloons (PCB) offer a promising non-implant approach to deliver antiproliferative agents directly to the vessel wall. This meta-analysis aims to evaluate the comparative effectiveness of PCB versus uncoated balloons (UCB) in managing coronary ISR to address emerging safety concerns. Methodology: Medline, Scopus and Embase were searched until April 2024 for randomized controlled trials (RCTs) comparing PCB versus UCB in patients undergoing coronary ISR. Primary outcomes were in-segment late lumen loss (LLL), binary restenosis, target lesion revascularization (TLR), major adverse cardiac events (MACE), and mortality. Secondary outcomes included in-stent LLL, in-stent binary restenosis, myocardial infarction (MI), cardiac death, target vessel MI, and target vessel revascularization (TVR). Results: This meta-analysis includes seven RCTs with 1,408 patients (PCB = 864, UCB = 544). PCB significantly reduced in-segment LLL (MD= -0.50, 95% CI [-0.67, -0.33]; P &lt; 0.00001), in-segment binary restenosis (RR= 0.25, 95% CI [0.14, 0.45]; P &lt; 0.00001), target lesion revascularization (RR= 0.43, 95% CI [0.32, 0.58]; P &lt; 0.00001), mortality (RR=0.56, 95% CI [0.39, 0.80]; P=0.001), and MACE (RR= 0.36, 95% CI [0.25, 0.51]; P &lt; 0.00001). PCB also significantly decreased in-stent LLL (MD= -0.52, 95% CI [-0.72, -0.32]; P &lt; 0.00001), in-stent binary restenosis (RR = 0.19, 95% CI [0.11, 0.35]; P &lt; 0.00001), and TVR (RR = 0.45, 95% CI [0.29, 0.70]; P = 0.0003). PCB showed a short-term reduction in MACE and target lesion revascularization at 6 months, 1 year and 3 years of followup. No difference was observed in MI, cardiac death, or target vessel MI. Conclusion: In patients with coronary ISR, PCB are associated with reduced in-segment LLL, in-segment binary restenosis events, target lesion revascularization, mortality, MACE, in-stent LLL, in-stent binary restenosis and target vessel revascularization.