tbuckley/cabot-search huggingface dataset:
Abstract 4143513: ECG-AI to Assist with the Classification of Low Ejection Fraction and Heart Failure with Preserved Ejection Fraction
Authors: Ibrahim Karabayir, Robert Davis, M. Samie Tootooni, Lokesh Chinthala, Elsayed Soliman, John Jefferies, Tina Baykaner, Sanjiv Shah, Alain Bertoni, Dalane Kitzman, David Herrington, Oguz Akbilgic
Journal: Circulation (2024)

Background: There are delays on identification of people with low left ventricular ejection fraction (LVEF) and Heart Failure with preserved EF (HFpEF). There is a need for low cost and accessible tools to identify individuals who can benefit from more comprehensive exams such as echocardiogram (ECHO). Research Goal To develop electrocardiographic artificial intelligence (ECG-AI) models that can classify low EF and HFpEF. Methods: We developed an ECG-AI model using convolutional neural networks to classify 12-lead ECG’s into four categories: rEF( LVEF&lt;40), mEF (40≤LVEF&lt;50), HFpEF (clinical HF diagnosis with EF≥50) and controls with no HF diagnosis within 5-years of the index ECG. For rEF, mEF, and HFpEF categories, ECHO were used to determine LVEF. Patients with clinical HF diagnosis without ECHO data were excluded. In patients with ECHO, only available ECGs within 30-days of the ECHO study was utilized. The ECG-AI models were trained on ~80%, validated on ~10%, and tested on the remaining 10% hold out data from Wake Forest Baptist Health (WFBH) ECG repository and externally validated using data from the University of Tennessee Health Science Center (UTHSC). Results: The ECG-AI model was developed using 1,078,198 digital ECGs, 114,068 ECHO derived LVEF values, and EHR data from 165,243 patients (73% White, 19% Black, 52% female, with a mean age (SD) of 58(15) years). There were 32,962, 40,997, 11,037, and 993,202 ECGs from 8,555 rEF, 13,116 mEF, 3,704 HFpEF, and 139,868 control patients, respectively. The ECG-AI achieved a hold-out AUC of 0.76 (0.74-0.77) in classifying ECGs as HFpEF or not (Table 1). The UTHSC external validation cohort included 273 rEF, 167 mEF, 459 HFpEF, and 35,254 control patients, with 35% White, 62% Black, 60% female, mean age of 51(18) years. Our model identified HFpEF patients with an AUC of 0.75 (0.73-0.76) in the UTHSC cohort. Conclusion: ECG data alone result in moderate, moderately high, and very high accuracies in classifying HFpEF, mEF, and rEF, respectively. This could guide future models with incorporation of simple patient demographics and comorbidities to improve accuracy. Such ECG-AI models can assist with identifying who may benefit from further clinical evaluation and imaging studies.
Abstract 4143538: A Predictive Tool and Diagnostic Screening Algorithm for the Identification of Transthyretin Amyloid Cardiomyopathy in High-Risk Patient Populations
Authors: Jocelyn Chai, Andrew Starovoytov, Christine Campbell, Nathaniel Hawkins, Sean Virani, Michael Luong, Lynn Straatman, Marla Kiess, Daniel Worsley, Janarthanan Sathananthan, Nowell Fine, Margot Davis
Journal: Circulation (2024)

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed disease that may result in heart failure (HF), arrhythmias, and valvular disease. Our aim was to develop (1) screening criteria to identify high-risk patients for ATTR-CM and (2) our own predictive tool of ATTR-CM. Methods: This was a prospective observational registry at 2 academic sites in Canada. We designed screening criteria to identify high-risk patients in HF, atrial fibrillation, transcatheter valve clinics, and in cardiologist’s offices from January 2019-December 2022. Patients &gt;60 years were included if one of several screening criteria was met and they were referred for pyrophosphate scan by the cardiologist. Univariate and multivariate logistic regression were used to identify predictive clinical, imaging, and biochemical characteristics. Results: In total, 2500 patients were screened, and 200 patients were enrolled with a follow-up duration of 3 years. The mean age was 78 years and 65% were male. Forty-six (23%) had a diagnosis of ATTR-CM and 7 (4%) were diagnosed with AL-amyloidosis. ATTR-CM patients were older (83±7 vs. 77±8; p&lt;0.001), predominantly male (80 vs. 60%, p=0.01), symptomatic (NYHA III-IV) (46 vs. 19%; p&lt;0.001) and had higher NT-proBNP (3633 vs. 2018; p=0.01). Fewer were on beta-blocker (p&lt;0.001) and renin-angiotensin inhibitors (p=0.01), and more were on amiodarone (p=0.008). They had larger left ventricular posterior wall diameters (14±3 vs. 11±2; p&lt;0.001). On electrocardiogram, ATTR-CM patients had lower voltages (37 vs. 4%; p&lt;0.001) and more atrioventricular blocks (39 vs. 19%; p=0.02). Tissue doppler (E/e’) was higher in ATTR-CM patients (18±7 vs. 14±6; p=0.001). The positive predictive value (PPV) for our screening criteria ranged from 16-38%, with the highest PPV and negative predictive value (NPV) for age ≥70 years and new HF (PPV 38%, NPV 95%). We identified 5 key predictors of ATTR-CM to develop a practical tool for clinicians with a score of ≥7 meeting criteria for further testing (Figure 1). This tool had a sensitivity of 89%, specificity of 85%, PPV of 64%, NPV of 96%, and an area under receiver operating characteristic curve of 0.9. Conclusion: Broad screening criteria applied to high-risk patient populations yielded new ATTR-CM diagnoses in 23% of patients. Screening tools for ATTR-CM can be used to help clinicians identify patients who should undergo further testing. Further studies are needed to validate our predictive tool.
Abstract 4143622: Efficacy of Semaglutide in Patients with Obesity and Heart Failure With Preserved Ejection Fraction (HFpEF): A Systematic Review&amp;Meta-Analysis
Authors: Maneeth Mylavarapu, Asad Gandapur, Yozahandy Abarca, Prarath Roshni, Husna Fatima, Samantha Contreras Vazquez, OGECHUKWU OBI, Muhammad Areeb Siddiqui, Noor ul Huda, Yuliya Lysak, Adetola Mowo-wale
Journal: Circulation (2024)

Introduction: Obesity-related heart failure in patients is often associated with high symptom burden. However, no treatments have been proven to specifically target obesity-related heart failure with preserved ejection fraction (HfpEF). Objective: The objective of this study is to evaluate the efficacy of semaglutide in patients with obesity and HfpEF. Methods: The study was by the PRISMA guidelines. Studies reporting endpoints of semaglutide in patients with obesity and HfpEF were included. The outcomes included percentage weight change and adjudicated heart failure events. Both random and common effects models were used for the data analysis. The random intercept logistic regression model was used to compute the proportions, and the Peto method was used to compute the odds ratios. A p-value ≤ 0.05 was considered significant. Results: In total, three studies with 1463 patients with obesity and HfpEF were included in the study. The mean age of the patients was 68.8 ± 3.47 years. 50.7% of the patients were females. Patients who received Semaglutide had statistically higher odds of 10% weight reduction (OR 6.35; 1.54-26.21; p&lt;0.00001) and 15% weight reduction (OR 9.44; 2.91-30.60; p&lt;0.0001) when compared to placebo. Additionally, patients who received Semaglutide had lower odds of adjudicated heart failure event (OR 0.32; 0.15-0.67; p=0.35) when compared to patients on placebo. Conclusion: Our study demonstrates that semaglutide is significantly effective in reducing weight and potentially lowering the risk of heart failure events. This suggests that semaglutide could be a promising therapeutic option for managing obesity-related HfpEF. However, we need large-scale studies to confirm these benefits.
Abstract 4143615: Does the Prognostic Value of Zero Coronary Artery Calcium Score Vary by Patient Sex?
Authors: Jeffrey Anderson, Dave Collingridge, Viet Le, Leslie Iverson, Joseph Muhlestein, Tami Bair, Stacey Knight, Steve Mason, Kirk Knowlton, Benjamin Horne
Journal: Circulation (2024)

Background: A coronary artery calcium score of zero (CAC=0) is generally accepted as a marker of a very low 5y risk for coronary events. However, whether the prognostic value of CAC=0 varies by sex is unclear. For example, non-atherosclerotic causes of coronary ischemia present more often in women, including spontaneous coronary artery dissection and microvascular angina, which may be undetected by CAC. Further, CAC is performed at a later age in women. Whether these factors impact the utility of CAC=0 in women vs men is uncertain. Methods: We tested whether the prognostic value of CAC=0 differs by sex. We searched the Intermountain Health electronic medical record (eMR) database for patients (pts) at primary coronary risk who underwent positron emission tomography/computed tomography (PET/CT) stress testing and had a zero CAC score. We assessed coronary prognosis (i.e., coronary death [CD] or non-fatal myocardial infarction [MI]) during follow-up. Primary events were adjudicated by chart review. We compared outcomes in women vs. men. Given the small number of events, chi-square rather than time-to-event analyses were performed. We also compared all-cause death or MI rates in those with CAC=0 vs. CAC&gt;0 by sex. Results: The eMR search identified19,495 women and 20,523 men undergoing PET/CT who were at primary coronary risk. Of these, 7967 (19.9%) had CAC=0 on CT. Of CAC=0 patients, 5400 (67.8%) were women and 2567 (32.2%) were men. Overall age averaged 60.5y (SD 12.0) in women and 53.8y (SD 12.6) in men. In total, 13 events occurred (MI=12, CD=1) over a follow-up of 2.1y (SD 1.6). By sex, 7 events (0.13%) occurred in CAC=0 women and 6 (0.24%) in men (p=0.28). Rates of all-cause death or non-fatal MI comparing CAC=0 to CAC&gt;0 were 3.3% vs 9.5% in women and 3.3% vs 10.2% in men (both p&lt;.0001). MI with no obstructive coronary artery disease (MINOCA) constituted 3/7 MI’s in women and 1/5 MI’s in men. Conclusions: In this large, integrated healthcare system experience of symptomatic pts at primary coronary risk undergoing PET/CT, a zero CAC score predicted an excellent prognosis for coronary death or non-fatal MI in both sexes. CAC=0 was more frequently observed in women despite an older average age. Rates of coronary events were at least as low in women as in men, with a trend to more MINOCA events and fewer obstructive coronary events in women. Further, a zero calcified plaque burden predicted a 3-fold lower risk of all-cause death or MI in both sexes.
Abstract 4143480: The Impact of Cardiac Rehabilitation Completion on Quality of Life, Social Support, Depression, and Chronic Pain
Authors: Timothy van Dover, Michael Farbaniec, Lawrence SINOWAY, Michael Zehner, Matthew Nudy
Journal: Circulation (2024)

Background: Social isolation and loneliness have been found to be associated with many chronic diseases including cardiovascular disease (CVD) and those with both CVD and social isolation may have a worse prognosis. Cardiac rehabilitation (CR) has been shown to improve outcomes following cardiac events. We hypothesize that CR may have beneficial impacts on quality of life, social support, depression, and pain rated via Dartmouth COOP Charts (COOP). Research Question: What is the impact of cardiac rehabilitation on quality of life, perceived social support, depression, and chronic pain? Methods: Data from Penn State Hershey Medical Center’s CR program was extracted pre-and post-CR, including Body Mass Index (BMI), Metabolic Equivalents (METs) performed, and components of COOP (social support, quality of life (QoL), depression, pain), with impairment rated from 1 to 5, with 5 representing worse impairment. Analysis was performed with paired t-test. Sensitivity analysis was performed including only high-risk participants (pre-rehab COOP score ≥ 3) for social support, depression, and pain as well as BMI ≥ 30 kg/m 2 . Results: A total of 743 participants were included with a mean (±SD) age of 66.3 (±11.3) years. CR improved METs performed, QoL, depression, and pain (Table 1). When analyzing all participants, CR did not improve social support or BMI. However, when only analyzing those with higher social support needs at baseline (n= 78) as well as elevated BMI ≥30kg/m 2 , CR was associated with improved social support and BMI. QoL, depression and pain also improved among the higher risk groups (Table 2). Conclusion: CR programs have demonstrated benefits for cardiovascular mortality and may have powerful impacts on patients’ mental health, pain, and social support. Further studies are needed to further elucidate the role CR may have in improving outcomes in participants with social isolation and loneliness.
Abstract 4143511: Association of Triglyceride Glucose-Related Parameters with All-cause mortality and Cardiovascular Disease in Non-alcoholic Fatty Liver Disease Patients
Authors: Yaqin Chen, Yusha Zhang, Fengjiao Wang
Journal: Circulation (2024)

Background: The Triglyceride-glucose (TyG) index , a novel indicator of insulin resistance, has been associated with mortality from non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD). However, the association between the TyG index and the derived index of TyG (TyG-WHtR) and CVD in NAFLD patients remains unclear. Methods: This study enrolled 6627 adults aged 18 and above diagnosed NAFLD from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Binary weighted logistic regression analyses, cox proportional hazards model, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were used to analyze the relationship between TyG and TyG-WHtR and all-cause mortality, CVD mortality and CVD related diseases. Mediation analysis explored the mediating role of glycohemoglobin (HbA1c), insulin and hypertension in the above relationships. Results: Except for no significant association between TyG and all-cause mortality and chronic heart failure (CHF), both TyG and TyG-WHtR exhibited significant positive correlations or trends of positive correlation with all-cause mortality, CVD mortality, total-CVD, CHF, coronary heart disease (CHD) and angina pectoris. For all-cause mortality, CVD mortality and CHF, TyG-WHtR was a better predictor than TyG (HR 1.31, 95%CI 1.03-1.66; HR 2.22, 95%CI 1.42-3.47; OR 3.99, 95%CI 1.79-8.93). However, TyG index demonstrated a stronger association with total-CVD, CHD and angina pectoris (OR 2.00, 95%CI 1.26-3.18; OR 1.85, 95%CI 1.19-2.91; OR 2.93, 95%CI 1.23-7.00). Otherwise, the ROC curve illustrated that, for all-cause mortality, CVD mortality, CHD and angina pectoris, TyG had a higher diagnostic efficacy. For CHF, the diagnostic efficacy of TyG-WHtR is higher. For total-CVD, TyG and TyG-WHtR had approximately equal diagnostic efficacy. RCS analysis showed that after adjusting for covariates, most of the above relationships were linearly correlated (P-overall &lt; 0.0001, P-nonlinear&gt; 0.05), while TyG and TyG-WHtR were non-linearly associated with all-cause mortality and CHF (P-overall &lt; 0.0001, P-nonlinear&lt; 0.05) in NAFLD patients. Conclusions: The predictive value of TyG or TyG-WHtR for mortality and cardiovascular risk in NAFLD patients was significant. The TyG index and TyG-WHtR might be a valid predictor of cardiovascular outcomes of patients with NAFLD.
Abstract 4143384: High Accuracy Diagnostic of 4-Electrodes-12-Leads-Wearable-Smartphone-Based-Electrocardiogram(ECG)-System Tracing in Patients with ST Elevation Myocardial Infarction Compared to Standard ECG Tracing. AngelUS® STEMI Study
Authors: Marco Castagna, Katia Nuic, Bernardo Abreu, Carlos Ornelas, Frederico Toledo Campo Dall Orto, Castagna Ilene, Fabiana Aguiar, Mauricio Cavalieri, Rene Miranda, Thiago Assis, Caiser Teixeira, Pricylla Aparecida da silva, Wille Dingsor Pereira, edouard cheneau, Daniel Ramos, Marcelo Baldo, Andrew Ajani
Journal: Circulation (2024)

Introduction: ST elevation myocardial infarction (STEMI) is associated with a persistent high global mortality rate. Early diagnosis and treatment are essential to improve cardiac outcomes. Wearables may play a key role as promising technology in this clinical scenario. Methods: 70 consecutive patients were referred to coronary angiography (cath) due to typical chest pain and STEMI standard 12-lead ECG tracing. At cathlab, 4-electrodes-12-leads-wearable-smartphone-based-ECG-System(AngelUS®) tracing was performed. ECG tracings interpretations were compared between the 2 groups by independent cardiologists blinded to ECGs and then correlated with cath findings. The Cohen κ statistic was used to measure agreement between the 2 groups. Results: Both cardiologists agreed to include 70 standard ECG tracing and 70 AngelUS® ECG tracing as STEMI. Both cardiologists agreed to exclude 70 standard ECG tracing and 70 AngelUS® ECG tracing as absence of STEMI, showing a perfect agreement with Cohen’s k:1. Correlations with coronary angiography were also performed showing total agreement with both ECG diagnostics. Conclusion: In 70 consecutive patients with typical symptoms and STEMI, standard ECG and the AngelUS®4-Electrodes-12-Leads-Wearable-Smartphone-Based-ECG showed clinical agreement. Correlations with coronary angiography were also performed, showing clinical equivalence between both ECG diagnostics. Analysis of AngelUS® ECG tracing compared to standard ECG is ongoing, extending our investigation into the utility of this technology in preoperative ECGs.
Abstract 4143192: Co-incidence of postoperative delirium and atrial fibrillation is associated with elevated risk of one-year mortality after cardiac surgery
Authors: Mostafa Abbas, ROHIT SHARMA, Thomas Morland, Jeffrey Shuhaiber, H Lester Kirchner, Scott LeMaire, Yasser El-Manzalawy
Journal: Circulation (2024)

Background: Delirium and atrial fibrillation (AF) are two common complications after cardiac surgery. Each of them has been associated with several other adverse outcomes including mortality and prolonged hospital stay. We sought to determine the frequency of the co-incidence of postoperative delirium (POD) and postoperative atrial fibrillation (POAF) and its association with risk of one-year mortality following cardiac surgery compared to POD or POAF alone. Methods: We established a retrospective observational cohort of adult patients who underwent cardiac surgery within our healthcare system between 2014 and 2022. POD was defined as a postoperative positive CAM-ICU test in a patient with a Richmond Agitation-Sedation Scale (RASS) &gt;= -3. POAF was defined as a documented AF event within 30 days after surgery. Patients were stratified into four distinct groups: Co-incidence of POD and POAF, POD only, POAF only, and None (i.e., neither complication). Results: Among 6136 patients, there were 256 (4.2%) patients experienced both POD and POAF, 221 (3.6%) had POD only, 2127 (34.7%) had POAF only, and 3532 (57.6%) had neither complication. The overall one-year mortality rate was 5.8%, with mortality rates of 21.9% for the co-occurrence group, 14.0% for the POD only group, 6.8% for the POAF only group, and 3.5% for the group with neither complication. The differences in one-year survival among the four groups are shown in Figure 1 . Multivariable logistic regression analysis identified the top predictors for one-year mortality as co-incidence of POD and POAF (adjusted odds ratio (OR)=3.98, 95% CI=2.69-5.85, p&lt;0.001), POD only (OR=2.95, 95% CI=1.84-4.61, p&lt;0.001), higher Charlson comorbidity index (OR=2.18, 95% CI=1.00-4.46, p=0.040), longer surgery duration per hour (OR=1.62, 95% CI=1.46-1.79, p&lt;0.001), and POAF only (OR=1.50, 95% CI=1.15-1.97, p=0.003). Conclusions: More than half of the cardiac surgery patients with POD also developed POAF. The co-incidence of POD and POAF was associated with elevated risk of one-year mortality compared to either complication alone. Further research to explore the underlying mechanisms connecting POD and POAF and to identify risk factors specific to their co-incidence is warranted.
Abstract 4143371: Lactosylceramides Impair Cardiac Myocyte Function in HLHS
Authors: Praveen Ramaswamy, Mary Turner, Ashley Pietra, Anastacia Garcia
Journal: Circulation (2024)

Introduction: Hypoplastic left heart syndrome (HLHS) is a cardiovascular malformation that is a leading cause of cardiovascular related infant mortality. The cause of HLHS and the progression of heart failure (HF) in this population remains unclear. Additionally, there are no current medical therapies for the treatment of prevention of HF in HLHS. Our data suggests that the glycosphingolipid lactosylceramide (LacCer) is elevated in the heart of HLHS infants when compared to healthy age-matched controls. Based on this we hypothesize that elevated levels of LacCer contributes to cardiomyocyte dysfunction in HLHS. METHODS: To test the effect of LacCer on myocytes directly, neonatal rat ventricular myocytes (NRVMs) were isolated and treated with liposomes containing 3µM LacCer (C18:0 and C24:0) or vehicle. Global cardiomyocyte proteomics changes were analyzed via mass spectrometry (n=11 for vehicle, n=13 for LacCer). The mitochondrial uptake of long chain fatty acids was examined using a stable-isotope based carnitine palmitoyltransferase (CPT) activity assay (n=4 for vehicle, n=3 for LacCer). Mitochondrial bioenergetics, including fatty acid oxidation +/- etomoxir (CPT inhibitor), were assessed using an Agilent Seahorse Bioanalyzer (n=5 for each treatment). RESULTS: Our proteomics data identified 188 significantly differentially regulated proteins in response to LacCer treatment, with a significant number of proteins involved in glycolysis, oxidative phosphorylation, the tricarboxylic acid cycle, and muscle contraction (Fig A). Additionally, Lacer treatment was also sufficient to impair mitochondrial CPT activity, which is required for the uptake of long-chain fatty acids. Correspondingly, LacCer treatment significantly impaired fatty acid oxidation, illustrated by significantly decreased maximal mitochondrial respiration and energetic reserve capacity (Fig B -C). CONCLUSIONS: Together, these data demonstrate the potential role of LacCer in the pathophysiological remodeling of HLHS cardiomyocyte metabolic function and substrate utilization. Moreover, it also indicates LacCer as a potential target of therapy to halt or delay heart failure progression in HLHS patients.