tbuckley/cabot-search huggingface dataset:
Abstract 17842: 3D Visualization and Quantitative Assessment of the Pulmonary Arteries on CT Using Deep Learning Segmentation
Authors: Jessica Kim, Diviya Gupta, Matthew LeComte, Albert Hsiao, Lewis Hahn
Journal: Circulation (2023)

Introduction: Assessment of the pulmonary arteries (PA) on CT scan is typically qualitative and requires review of hundreds of images. PA segmentation would enable creation of 3D reconstructions that visualize the entire pulmonary arterial tree in a single image, similar to catheter angiography, and also enable quantification of pathophysiologic changes. Manual segmentation is very time-consuming, but deep-learning (DL) can automate the process. Hypothesis: A DL segmentation algorithm can be used to automatically generate 3D reconstructions of the PAs and quantify morphologic changes seen in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Pulmonary Arterial Hypertension (PAH). Methods: A DL algorithm based on a 3D U-Net architecture which segments PAs larger than 2 mm was trained and validated on a total of 250 contrast-enhanced CT chest. The study group included 15 CTEPH and 15 PAH patients seen consecutively in pulmonary hypertension (PH) clinic in 2022 with prior CT chest and right heart catheterization, and 10 additional patients with prior CT chest and no evidence of PH on same day echo (normal). After running the DL algorithm on CTs, 3D renderings were created from segmentations and the relative volume of the central, interlobar, and segmental/subsegmental PAs was derived. Results: 3D renderings of PAH and CTEPH patients showed larger central and interlobar PAs compared with those of normal patients, whereas segmental and subsegmental PAs were smaller and pruned in CTEPH patients (Figure). Quantitatively, the volume of the central and interlobar PAs was higher in CTEPH and PAH compared to normal (p &lt; 0.05). The combined volume of segmental/subsegmental PAs was smaller in CTEPH patients relative to normal and PAH patients (p &lt; 0.005). Conclusions: DL segmentation enables intuitive visualization and quantification of the morphologic changes to the PAs seen in conditions causing PH. This method may improve diagnosis and assessment of PH on CT.
Abstract 14693: Combined Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data From the PROVAR+ Study
Authors: Clareci S Cardoso, Isabely S Ribeiro, gabriela silva, Allan M de Morais Bessa, Wanessa C Vinhal, Mariela M da Mata Coimbra, Cássia Aparecida Silva, Maria D Nunes, Lucas L Fraga, Marina G Diniz, Alexandre M Ferreira, Mauro Henrique A Silva, Marcia Barbosa, Beatriz Costa, Henrique L Fava, Lucas C Diamante, Antonio L Ribeiro, Craig A Sable, Bruno R Nascimento
Journal: Circulation (2023)

Introduction: Tele-cardiology tools are valuable strategies to improve risk stratification, especially in low-resourced settings. We aimed to evaluate the accuracy of tele-electrocardiography (ECG) in remote sites to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 healthcare workers at 16 PC units were trained on simplified handheld (GE VSCAN) echo protocols. Tele-ECGs were recorded with dedicated software with measurement and magnification tools, with final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:3 sample of individuals without abnormalities underwent a clinical questionnaire and screening echo interpreted remotely. Major heart disease (HD) was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression, in 4 models: 1): unadjusted, 2): model 1 adjusted for age and sex; 3): model 2 plus cardiovascular risk factors (hypertension and diabetes); 4: model 3 plus history of cardiovascular disease (Chagas, Rheumatic Heart Disease, ischemic heart disease, stroke and heart failure). Results: At total 1,411 patients underwent echo; 1,149 (81%) with major ECG abnormalities. Mean age was 67 (IQR 60-74) years, 51.4% were males; 76.3% had hypertension, 37.7% diabetes and 22.3% ischemic heart disease. Among those with major ECG abnormalities, 78% had abnormal echo. Major ECG abnormalities were associated with a 2.2 higher chance of major HD in echo in bivariate analysis: OR=2.15; (95%CI: 1.76 - 3.39), and remained significant after adjustments in models (p&lt;0.001) 2: OR=2.57 (95%CI 1.84 - 3.65), model 3 (OR=2.52 (95%CI 1.80 - 3.58), and model 4 (OR=2.23 (95%CI 1.59 - 3.19). Age (OR=1.07 (95%CI 1.06 - 1.09), p&lt;0.001) and heart failure (OR=5.18 (95%CI 2.43 - 11.87), p&lt;0.001 were also independent predictors of major HD on echo. Conclusions: Tele-ECG abnormalities increased likelihood of major HD on screening echo, even after adjustments for demographic and clinical variables. The combination of tele-cardiology tools and clinical data may improve risk stratification in PC.
Abstract 14745: Stem Cell Factor Associated With Critical Limb Ischemia in Patients With Peripheral Artery Disease
Authors: Marc P Bonaca, David Morrow, Robert Giugliano, Benjamin Scirica, Mark A Creager, Petr Jarolim, Andrea Bellavia, Sabina A Murphy, Marc S Sabatine
Journal: Circulation (2023)

Introduction: Critical limb ischemia (CLI) and related amputation (AMP) are severe manifestations of peripheral artery disease (PAD). The pathobiology of CLI/AMP is multifactorial including chronic ischemia in the context of large vessel and microvascular disease. Novel biomarkers may identify potential pathways for new therapies to prevent and treat CLI. Hypothesis: Exploration of the proteome will yield insights into new proteins and hence pathways relevant in the pathogenesis and complications of PAD. Methods: A nested case-control study including 50 patients with CLI/AMP and 83 without was assembled from patients with PAD in the TRA2P-TIMI 50 trial for proteomic exploration using the Olink CVDII panel. Candidate markers were identified based on a false discovery rate (FDR) p-value &lt;0.05 and then validated among 7,077 patients with PAD from TRA2P-TIMI 50 and FOURIER trials. Biomarkers were evaluated continuously &amp; by quartile and analyses adjusted for age, sex, diabetes mellitus, and prior peripheral revascularization. Results/Data: A total of 12 protein biomarkers were significantly associated with CLI/AMP in the case-control sample at an FDR of 5% (Fig-Panel A). Three remained significantly associated with CLI/AMP in the validation step, the strongest of which was stem cell factor (SCF), a cytokine expressed by endothelial cells and involved in vasculogenesis. There was a significant inverse association between SCF and CLI/AMP (p-Bonferroni 0.00047). Examined by quartiles and adjusting for baseline differences (Panel B), a graded inverse association between SCF and CLI/AMP was observed (Q4 vs Q1 Adjusted OR 0.52, 95% CI: 0.34, 0.77; p=0.002). Conclusions: A proteomic approach to identifying novel biomarkers associated with CLI/AMP revealed a strong inverse risk relationship with SCF levels. These data suggest that SCF and its effects on vasculogenesis warrant further investigation as a pathway to prevent and treat CLI/AMP in patients with PAD.
Abstract 15054: Impact of Sarcoidosis-Related Admission in Patients With Heart Failure: A Nationwide Readmissions Database Analysis (2017-2020)
Authors: Qi Xuan Ang, Min Choon Tan, Jia Yi Tan, Jian Liang Tan
Journal: Circulation (2023)

Background: Sarcoidosis is an infiltrative systemic disorder that commonly involves the heart. Despite a higher prevalence of herat failure (HF) among patients with cardiac sarcoidosis (CS), data on these patients’ outcomes remain scarce. Objective: This study aimed to assess the impact of concomitant CS in patients admitted for HF on in-hospital outcomes and 30-day readmission rates. Methods: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who were admitted with a primary diagnosis of HF between 2017 and 2020. We stratified the cohort into two groups depending on the presence of sarcoidosis diagnosis. The in-hospital outcomes of both groups were assessed with weighted propensity score matching and multivariable analyses. Results: Our analysis included 1,902,068 patients with a primary diagnosis of HF, whereby 9,343 (0.49%) patients had sarcoidosis. Via multivariable analysis, sarcoidosis was associated with an increased risk of prolonged hospital stays (aOR: 1.15 [95% CI: 1.08 - 1.23], p&lt;0.01), 30-day readmission (aOR: 1.18 [95% CI: 1.11 - 1.25], p=0.01), and higher cumulative cost of hospitalization ($16,179 vs $13,421, p&lt;0.01) among HF cohort. Sarcoidosis was not associated with an increased risk of early mortality. Among HF patients with sarcoidosis, the most common cause of 30-day readmission was cardiovascular causes (59%), where decompensated HF accounted for 50% of the readmission, followed by ischemic heart disease (2%), valvular heart disease (1%), and pulmonary embolism (1%). Conclusion: In conclusion, our study suggests that HF patients with sarcoidosis had poorer in-hospital outcomes with prolonged hospital stays, higher 30-day readmission rates, and increased cumulative hospitalization costs. These findings merit increased effort in the early diagnosis and treatment of CS to improve outcomes in HF patients with sarcoidosis.
Abstract 14082: Evans Syndrome Post Transcatheter Aortic Valve Replacement: A Rare Presentation
Authors: Jie Ren, KaChon Lei, Hazem Aboaid, Neilmegh Varada, Russell Gollard, Chowdhury Ahsan
Journal: Circulation (2023)

Description of Case: Evans Syndrome is a rare hematologic condition. Here we present a patient who developed Evans Syndrome post TAVR. A 63-year-old male with history of HFrEF and aortic stenosis presented with 2-week history of worsening shortness of breath and bilateral lower extremity swelling. He was found to be in cardiogenic shock. TTE showed (LFLG) aortic stenosis (AS). Due to concomitant cardiogenic shock and tachyarrhythmias, we were unable to perform dobutamine stress echo. A cardiac CT was performed which revealed an aortic valve calcium score of 2761 (Figure 1). The diagnosis of severe AS was confirmed, and patient underwent TAVR. Postprocedural TTE showed significant improvement in EF. Patient’s complete blood count on admission was remarkable for Hgb of 12.5 g/dL and PLT of 148 k/mm 3 . Both Hgb and PLT began to drop significantly following TAVR. We ruled out vascular access site bleeding, mechanical complication from paravalvular leak, nutritional deficiencies, disseminated intravascular coagulation, heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, myelodysplastic syndrome, HIV, hepatitis C. Autoimmune hemolytic anemia was identified given elevated lactate dehydrogenase, low haptoglobin, and positive IgG direct antiglobulin test. We started steroids and treat the case as Evans syndrome. PLT count improved from 67 to 117 k/mm 3 within 2 days of steroids initiation. The bone marrow biopsy was deferred to outpatient follow up given the response to steroids. Patient was discharged on oral prednisone. Three-month follow up showed Hgb and PLT with normal limits. Discussion: Anemia and thrombocytopenia are common complications post TAVR. Both anemia and thrombocytopenia are suggested to be excellent markers for clinical outcomes, morbidity and mortality after TAVR. It is crucial to keep a broad differential for post TAVR anemia and thrombocytopenia. Less common causes should be evaluated and addressed to improve prognosis.
Abstract 19038: Insights of Optical Coherence Tomography Into the Safety and Efficacy of Coronary Intravascular Lithotripsy for Calcified Nodule Modification During Percutaneous Coronary Intervention
Authors: Sanya Chhikara, Mahesh N Kumar, Abhinav Shrivastava, Ankush Gupta
Journal: Circulation (2023)

Background: Among calcified lesions, nodular calcium is the most challenging subset to deal with during percutaneous coronary intervention (PCI), as there are limited options available for its modification. This study was done to assess the safety, efficacy and impact of coronary intravascular lithotripsy (IVL) on calcified nodule (CN) using optical coherence tomography (OCT). Methods: A total of 17 patients with 40 CN undergoing PCI using coronary intravascular lithotripsy were prospectively enrolled in the study. OCT parameters studied were pre-IVL minimum lumen area (MLA), calcium (Ca) score, number of CN, proximal and distal reference diameter, post-IVL gain in MLA, calcium fracture, major dissection, post-PCI minimum stent area (MSA), stent expansion, apposition, edge dissection and spherical index at CN. Spherical index was calculated by dividing the shortest and longest diameter at CN after stent placement. The primary safety endpoint was freedom from major adverse cardiovascular events (death, MI and target vessel revascularization) during hospitalisation and at 30 days. Primary efficacy endpoints were gain in MLA after stent placement and stent expansion. Results: Pre-IVL mean MLA at CN was 3.87±2.25mm 2 , Ca score was 3.94±0.24, Ca arc 190.59±54.02 o , Ca depth 0.97±0.31mm, Ca length 22.73±9.87mm and CN height-1.04±0.30 mm. All 17 (100%) patients developed Ca fractures, post-IVL MLA at CN was 5.20±2.31mm 2 , CN height 0.83±0.19mm and luminal gain at CN was 0.76 ± 1.71mm 2 . 10 (58.8%) patients developed fractures at base of CN and rest developed fractures at apex. Patients with fractures at base showed decrease in luminal area after IVL due to luminal shift of nodule, but all these patients had good stent expansion, likely due to Ca softening. Post-IVL OCT showed minor dissections in 5 (29.4%) and major in 3 (17.6%) patients. There was no perforation, slow flow or abrupt vessel closure. Stent expansion and MSA at CN was 107.12 ± 18.98% and 8.57±2.54 mm 2 respectively with spherical index of 0.83±0.12. All patients were free of MACE during hospitalization and at 30 days. Conclusion: Coronary intravascular lithotripsy is safe and effective for modification of coronary calcified nodules during percutaneous coronary intervention.
Abstract 15437: Use of Artificial Intelligence to Decrease Data Deluge From Remote Monitoring of Cardiac Implantable Electronic Devices
Authors: Danish Bawa, Rajesh Kabra, Adnan Ahmed, shanti l bansal, Rachad Ghazal, Nicholas Pham, Ilyas Colombowala, Eric Olsen, Douglas J Darden, Naga Venkata Pothineni, Rakesh Gopinathannair, Dhanunjaya R Lakkireddy
Journal: Circulation (2023)

Background Remote monitoring (RM) has become the standard of care for follow up of patients with cardiac implantable electronic devices (CIED). Data deluge from RM of CIEDs is one of the major challenges faced by the cardiac device clinics. This study explores the role of a novel artificial intelligence (AI) algorithm in reducing the data deluge from CIED. Methods: The study included remote transmissions from CIEDs being monitored at 78 clinics across USA from Jan 2023 to April 2023. De-identified data was obtained from the data repository of Octagos Health. The transmissions were initially processed by AI algorithm and were either dismissed, forwarded to the device technician (DT) for review or forwarded directly to the device clinics. The main reasons for dismissals were redundant data or clinically non-actionable and non billable information. After initial triage by AI algorithm, the DT served as the second checkpoint who either dismissed or forwarded the transmissions to the device clinic with and without alerts. Results: A total of 42,534 patients with CIEDs were included in this study. There were 19,895 (46.8%) patients with pacemakers, 8,858 (20.8%) with ILRs, 7,012 (16.5%) with ICDs, 5,028 (11.8%) with CRT-D and 1,741 (4.1%) with CRT-P. Over a period of 4 months of RM, 273,435 transmissions were received. Of these, 57,345 (21%) transmissions were dismissed by AI and 118,546 (43.4%) were dismissed by the device technician team. As such only 97,544 (35.7%) transmissions were sent to the clinicians, of which 37,627 (13.8%) had alerts while 59,917 (21.9%) were routine transmissions. For quality control, about 15% (11,324) transmissions were randomly verified by EP for accuracy and were found to be 99% (11,193/11,324) accurate. Conclusion In our study, the use of AI algorithm significantly decreased data deluge by appropriate triaging of RM data from CIEDs. This has a potential to streamline the workflow of cardiac device clinics and improving efficiency and patient care.
Abstract 15662: Age-Adjusted Premature Cardiac Mortality Rate Among United States Counties by Social Vulnerability Index From 2018 to 2021
Authors: Mohamed R Abouzid, Mohammed Ghanim, Maha Almohamad, Odai Alhasanat, Own Khraisat, Ahmad Ebeidat, Shaden Ebeidat, Dania Mofleh
Journal: Circulation (2023)

Background: Considerable differences in premature cardiovascular disease (CVD) mortality rates exist across counties in the United States. Ecological examination and the association with county-level social vulnerability Indices (SVI) are limited. Aims: This study provides an updated analysis of age-adjusted premature CVD mortality rates and association with county-level SVI from 2018 to 2021. Methods: In this ecological cross-sectional study, we used United States county-level CVD mortality data from the Centers for Disease Control and Prevention (CDC) WONDER database (2018-2021) for non-elderly adults (&lt;65 years) and CDC SVI classified into quartiles (1st least vulnerable and 4th most vulnerable). We calculated age-adjusted CVD mortality rates per 100,000 persons including Ischemic heart disease (IHD), stroke, heart failure, and hypertension ICD-10 codes: I20-I25, I60-I69, I50 and I10-I13, I15 respectively. A multivariable mixed negative binomial regression model with county intercept examined the association between SVI and CVD mortality rate adjusted for gender, and ethnicity. Results: Overall, the age-adjusted CVD mortality rate per 100,000 persons was 111.0 (IHD 68.1 (95% CI:67.8-68.4), stroke 8 (95% CI: 7.9-8.0), heart failure 3.7 (95% CI:3.6-3.8), and hypertension 26.3 (95% CI 26.1-26.5)), increasing in a stepwise manner from the 1st to 4th SVI quartile. Counties in the 4th quartile had significantly higher mortality compared to the 1st quartile for CVD IRR=2.5 (IHD IRR=2.27 (95% CI:1.65-3.11), stroke IRR=2.72 (95% CI: 1.84-4.02), heart failure IRR=2.84 (95% CI:1.74-4.62), and hypertension IRR=2.83 (95% CI 1.79-4.45)). Conclusions: We observed a higher premature CVD mortality rate in the most vulnerable compared to the least vulnerable counties, adjusting for demographic characteristics. Targeted public health interventions are needed to effectively mitigate the growing burden of premature CVD in vulnerable populations.
Abstract 17708: Cardiac Nut-Cracker: Paroxysmal Left Main Coronary Compression by Inducible Pulmonary Trunk Dilatation in Pulmonary Hypertension
Authors: Andrew O Suen, Anna Beale, John T Granton, Piroze Davierwala, Elmari Neethling, Adam Snyman, Sanjog Kalra
Journal: Circulation (2023)

Case Presentation: A 56yo woman with a 12-year history of idiopathic pHTN and severe RV dysfunction presented with worsening exertional angina (CCS III). Perfusion imaging demonstrated a large apical-septal defect, corresponding to an 80% eccentric stenosis of the LMCA on angiography ( Fig 1AB ) due to compression on ostium and shaft by a severely dilated pulmonary trunk ( Fig 1C ). Right heart catheterization revealed pulmonary artery pressures (PAPs) of 90/40/68mmHg. Operative risk for CABG was deemed prohibitive, thus the patient underwent high-risk PCI of the LMCA under IV conscious sedation. Initial angiography confirmed a patent LMCA with minimal longitudinal compression. Opening PAPs (102/37/64mmHg) with supplemental oxygen (FiO 2 /PaO 2 0.76/168mmHg) were similar to preop findings ( Fig 1D ). To replicate her symptomatology, supplemental oxygen was discontinued, resulting in rapid worsening of LMCA compression with severe reduction in LMCA cross-sectional area at room air conditions (FiO 2 /PaO 2 0.21/70mmHg), with corresponding suprasystemic PAP (122/44/73mmHg) ( Fig 1E) . Under IVUS guidance, a preselected stent was deployed producing complete LMCA patency without evidence of dynamic compression; minimal stent areas were unchanged at supraphysiologic and physiologic conditions: 19 vs 20mm 2 , FiO 2 0.73 vs 0.21 ( Fig 1F ). Discussion: LMCA stenosis from extrinsic compression of the vessel by an enlarged pulmonary artery is a rare etiology of acute coronary syndromes. Treatment options include PCI, CABG, reimplantation, or PA reduction plasty. While preop imaging clearly demonstrated LMCA compression by a dilated PA, during PCI true and dynamic severity of LMCA compression was revealed only under “normoxic conditions” (FiO 2 0.21). This paroxysmal “nut-cracker” phenomenon from inadvertent reversal of dynamic LMCA compression highlights the importance of normoxia in making the diagnosis of such anomalies in susceptible individuals with pHTN.
Abstract 13947: Racial Differences in Peripheral Microvasculature's Association With Mild Cognitive Impairment
Authors: Matthew E Gold, Steven C Rogers, Ambar Kulshreshtha, Yuxuan Chen, Michael Cheng, Daniel Gold, Nishant Vatsa, Vardhmaan Jain, vardhmaan jain, Shivang Desai, Yi-An Ko, Kasra Moazzami, Tiffany Thomas, Maureen Okafor, James Lah, Felicia C Goldstein, Arshed A Quyyumi, Ihab Hajjar
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) and Alzheimer’s Dementia (AD) share numerous risk factors, with vascular dysfunction a common underlying mechanism. Individuals with mild cognitive impairment (MCI) have a high likelihood of developing AD in their lifetime. The link between microvascular dysfunction (MVD) and AD has yet to be fully established. Hypothesis: We examined the contribution of MVD to MCI with the hypothesis that Black Americans, who have a higher prevalence of MVD, will have higher rates of MCI. Methods: Participants &gt;50 years with MCI or with normal cognition (NC) were enrolled for neuropsychological and microvascular function testing using peripheral arterial tonometry. Microvascular function was measured as the reactive hyperemia index (RHI) and calculated as the ratio of the post- to pre-occlusion pulse volume in the fingertip (EndoPAT). Multivariate analyses, adjusting for demographic and CVD risk factors associated with MCI, evaluated the relationship between RHI and MCI in Black and White participants. Causal mediation analysis, using the Monte Carlo approach, was performed to investigate whether the effect of RHI on MCI was mediated through plausible mediators, including risk factors. Results: Of 152 participants (NC=104, MCI=48), 41.4% were Black and 33.6% male. Participants with MCI were more likely to be Black (58.3% vs 33.7%%, p=0.007) and have lower RHI (1.93 vs 2.27, p=0.004) compared to NC. RHI was an independent predictor of MCI with a 96% adjusted greater odds of MCI per unit reduction in RHI. Black race remained an independent predictor of MCI (OR 2.90, 95% CI [1.16, 7.56]). RHI was lower in Black compared to White participants (1.86 vs 2.37, p&lt;0.001). There was no heterogeneity in the impact of RHI on MCI. In a casual mediation analysis, MCI was mediated via RHI more in Black than in White participants (proportion mediated 24.2% vs 18.4%, p=0.034) after multivariate adjustment. Conclusions: Peripheral MVD, measured as RHI, was independently associated with MCI. Furthermore, Black participants exhibited lower RHI levels, a higher prevalence of MCI, and potentially mediated MCI through RHI to a greater extent compared to their White counterparts.