tbuckley/cabot-search huggingface dataset:
Abstract 13610: Examining Stroke in Metabolically Healthy Hospitalized Young Tobacco Users With Prediabetes: A Population-Based Analysis in the United States, 2019
Authors: Rupak Desai, Arankesh Mahadevan, Dhayashri Dhavapalani, Srinishant Rajarajan, Kalaivani Babu, Ashley Thompson-Edwards, Nafisa Reyaz, Sushmitha Garikipati, Manisha Jain, Dakshin Meenashi Sundaram, Samir Vanani, Dharshana Prem Anand, Advait Vasavada
Journal: Circulation (2023)

Introduction: Correlation between prediabetes and stroke risk among young, metabolically healthy tobacco users is unknown. Our research aims to explore this association. Methods: We did a retrospective study and extracted data from the 2019 National Inpatient Sample (NIS). Focusing on metabolically healthy (defined as absence of known cardiovascular disease risk factors, hypertension, diabetes mellitus, hyperlipidemia, and obesity) young adults aged 18-44 with tobacco use and prediabetes. Results: Our study of 1,017,540 hospital admissions of young, tobacco-using metabolically healthy individuals, identified 2,390 (0.2%) prediabetic cases. Compared to non-prediabetics, prediabetic patients were older, more often male, less frequently white, and had higher rates of comorbidities such as chronic obstructive pulmonary disease (19.2% vs. 11.7%), previous myocardial infarction (1.5% vs. 0.4%), and chronic kidney disease (2.5% vs. 0.9%). Clinical outcomes showed prediabetes was associated with higher rates of major adverse cardiac and cerebrovascular outcomes (MACE) (2.9% vs. 1.4%, p&lt;0.001) and stroke (1.9% vs. 0.5%, p&lt;0.001). After adjusting for confounders, prediabetes was still associated with increased stroke (aOR: 3.31, 95% CI: 1.67 - 6.55, p&lt;0.001). The odds of MACE were higher but not significant (p=0.078). Stratifying by demographics, both sexes and all races except blacks for MACE (p=0.172) showed statistically significant higher rates of MACE and stroke in prediabetic patients. Those in lower household income with prediabetes also had higher rates of MACE and stroke (p=0.015 and p=0.001, respectively). Conclusion: There is almost a 3-fold escalation in stroke risk among prediabetic young, metabolically healthy tobacco users. These findings highlight the necessity of acknowledging prediabetes as a potent risk factor despite absent metabolic risk factors and prevailing income disparities.
Abstract 16888: Reduced Diastolic Myocardial Strain From Interstitial Fibrosis Dissociates the Myocardial Transcriptional Response to Transient Increases in Left Ventricular End-Diastolic Filling Pressure (LVEDP)
Authors: Luke Graser, Brian R Weil, Rebeccah Young, John M Canty
Journal: Circulation (2023)

Objective: Brief repetitive pressure overload (RPO) in swine leads to interstitial fibrosis and reduced diastolic left ventricular (LV) compliance in the absence of LV hypertrophy. The present study determined whether LV compliance influences the transcriptional response to elevated LVEDP. Methods: Brief pressure overload was produced with phenylephrine (1-2 hours) to elevate LVEDP from 11.4±1.2 mmHg to 30.3±2.4 mmHg in normal hearts (n=6) and from 12.3±0.9 mmHg to 30.0±1.6 mmHg after 2 weeks of daily RPO (n=8). Interstitial fibrosis was quantified using picrosirius red staining. Whole tissue RNA-seq was performed on RNA isolated from LV samples collected 24 hours after increased LVEDP in each group vs. unstressed controls (n=10). Transcripts were mapped to Ensembl Sscrofa 11.1 gene index, aligned with Salmon, and mapped to human homologs using Biomart. Differential expression analysis was performed with DESeq2 package and gene ontology was performed using DAVID. Genes were considered differentially expressed (DEG) if the absolute value of log2fc was &gt; 0.477 (∼33% change) and a p &lt; 0.05. Results: Chronic RPO increased interstitial fibrosis (12.9±1.8% vs. 6.5±1.5% in normals; p&lt;0.05) and markedly reduced diastolic circumferential strain (1.5±2.7% vs. 20.3±4.4% in normals; p&lt;0.05). Stretch activated genes ANP and BNP were significantly upregulated with increased LVEDP in normal hearts (fc 35.8 and 14.3; both p&lt;9x10 – 9 ), but not in hearts after RPO (fc 1.4 and 1.8; both p-ns). Among the 15,133 total genes expressed, increased LVEDP induced 3,534 DEGs in normal hearts. Top gene ontology enriched pathways included ECM, cytoskeleton, cell junction, and microtubules. In contrast, there was a marked reduction in DEGs (117) observed when LVEDP was elevated in the stiff LV after RPO. Conclusions: Elevated LVEDP in the normal heart leads to many DEGs including the ECM and cytoskeleton proteins involved in reducing LV compliance. In contrast, after RPO and the development of interstitial fibrosis, there is a marked attenuation of the transcriptional response to increased LVEDP. These data support the notion that myocardial strain rather than pressure is the primary physiological determinant of the transcriptional response to pressure overload.
Abstract 18640: Universal Interpretation of Electrocardiograms as Plain Language Using Deep Learning
Authors: Akhil Vaid, Girish N Nadkarni
Journal: Circulation (2023)

Introduction: Deep learning models have shown promise in diagnosing diseases using electrocardiogram (ECG) data. However, each condition currently requires a separate model, which increases computational burden and operational complexity while decreasing overall clinical utility. Objective: Development of a unified modeling approach that allows for the interpretation of any ECG as plain language. Methods: We extracted ECG data from five facilities within the Mount Sinai Health System in New York City using the GE MUSE system. These data contained raw ECG waveforms, as well as cardiologist-confirmed diagnoses situated as plain language. Waveform data were plotted to images, and available diagnoses were allotted unique identifiers using Natural Language Processing. We also considered echocardiographically derived parameters such as left ventricular ejection fraction, valvular disease, and hypertrophic cardiomyopathy which were available for a subset of these patients as additional diagnostic endpoints to create a list of diagnoses per ECG.We created an end-to-end transformer based neural network consisting of a pre-trained vision transformer for extracting features from the ECG joined to a generative transformer for predicting associated diagnostic text. Model performance was evaluated by checking for concordance between predicted and actual diagnoses. Results: A total of 8.5 million ECGs were used for pre-training the feature extracting vision transformer. A total of 152 diagnoses were embedded with this corpus of data within the ECG file. We analyzed 406,000 echocardiogram reports to generate additional diagnostic labels for pathologies mentioned above. The model correctly predicted all diagnoses for 86.7% cases, and at least one correct diagnosis for 96.2% cases. Conclusions: A unified deep learning model can effectively interpret a broad range of disease conditions from ECG and echo data. Such an approach can speed up physician workflows, and allow for easier screening for conditions not normally diagnosed from the ECG. Future work will focus on extending the vocabulary of the model.
Abstract 13262: A Self-Administered Home Inotrope Program for Unfunded Patients With End-Stage Heart Failure
Authors: Nicholas Hendren, spencer carter, Chris Mathew, Kristin Alvarez, Lauren K Truby, Maryjane Farr, Sandeep R Das
Journal: Circulation (2023)

Introduction: Uninsured patients with inotrope-dependent end-stage heart failure (HF) pose a formidable challenge to the healthcare system and innovative solutions are required. We created a health system funded home program for palliative and bridge-to-funding inotrope strategies for unfunded patients. Herein, we report our updated experiences. Methods: We reviewed records of all patients enrolled in the home inotrope program since inception in 2019. Patients must have demonstrated a low cardiac index that was stabilized on a single inotrope. Advanced HF and palliative care consultations are mandatory. Next, a multidisciplinary team educates the patient via a teach-teach back method on how to self-administer intravenous inotropes via a provided continuous infusion pump. After discharge, patients attended weekly clinic appointments for assessment and dressing changes. Clinic appointments, supplies, and medications are provided by the health system at minimal cost to the patient. This project was deemed IRB exempt as a quality improvement project. Results: Thus far the program has enrolled 15 uninsured patients through April 24, 2023 (table). The median duration of inotropic support was 70 (32-143) days. Patients remained at home for 90% of the 1500 total supported days. To date, one patient has received a heart transplant and three patients have received LVAD surgery after obtaining health insurance. Three (20%) patients experienced a catheter-associated infection, with two developing bacteremia. All patients endorsed satisfaction with increased time spent outside of the hospital. This was estimated to have saved &gt;$2,363,000 in self-pay discounted charges for a general care telemetry bed and &gt;$586,000 in professional charges (CPT 99233, estimates via price transparency act). Conclusion: A self-administered home inotrope program for select patients is feasible, safe, and cost-effective. It may also serve as a bridge to funding for advanced therapies.
Abstract 12808: Use of Intra-Aortic Balloon Pump in COVID-19 Patients With Cardiogenic Shock and Associated Mortality Risk
Authors: Rahat A Memon, Kamleshun Ramphul, Nomesh Kumar, Jasninder Dhaliwal, Shaheen Sombans, Abhimanyu Ravalani, Fnu Bawna, Yogeshwaree Ramphul, Petras Lohana
Journal: Circulation (2023)

Introduction: While some past studies have hinted that intra-aortic balloon pump (IABP) may not influence mortality in cardiogenic shock(CS) patients, the impact and the predictors of its use among COVID-19 admissions with CS are unknown. Methods: We analyzed COVID-19-positive adults from the 2020 National Inpatient Sample hospitalized between April 1st, 2020, and December 31st, 2020. The presence of CS and the use of IABP were identified. Factors influencing the preference of IABP in CS cases were evaluated via logistic regression models. Results: We found 9665 COVID-19 patients with CS, and 430 patients (4.4%) necessitated the use of IABP. COVID-19 patients with CS requiring IABP were younger (mean age 61.38 years) than those not using IABP(mean age 66.28 years). IABP use was less likely to involve adults with prior MI (aOR 0.549, p=0.031), ages ≥60 years (aOR 0.574, p&lt;0.01), hypertension (aOR 0.638,p&lt;0.01), obesity (aOR 0.474, p&lt;0.01), events of acute kidney injury (aOR 0.626, p&lt;0.01), weekend hospitalizations (aOR 0.724, p&lt;0.01), or females (vs. Males, aOR 0.759, p=0.02). However, higher odds of IABP use in CS were seen among those with complete AV block (aOR 5.581, p&lt;0.01) and smokers (aOR 1.427, p&lt;0.01). No racial differences in use were seen and those covered with private insurances were likelier to use IABP than Medicare-insured patients (aOR 2.077, p&lt;0.01). The mortality rate among CS patients using IABP was 3.0%, while those not using IABP had a worse outcome (mortality rate 6.9%, aOR mortality in IABP users vs. non-users 0.458, 95% CI 0.369-0.569, p&lt;0.01). Conclusions: Our study shows that COVID-19 adults with CS using IABP were younger and had a lower mortality rate. Factors such as past MI, ages ≥60 years, hypertension, obesity, AKI, female sex, and weekend hospitalizations were linked with fewer use. At the same time, those with complete heart block, Private insurance forms, and smokers were more likely to use IABP in CS.
Abstract 15881: Progression of Significant Functional Mitral Regurgitation in Medically Managed High Surgical Risk Patients
Authors: Zeina S Al Ghadban, Hasan Alajmi, Mohamed Elganainy, Loai Abudaqa, Fawaz Alenezi
Journal: Circulation (2023)

Background: Functional mitral valve regurgitation (FMR) remains a clinical challenge in patients with high operative risk. Medical therapy alone in FMR is associated with poor outcomes but data regarding MR and left ventricular (LV) systolic function changes over time are limited. Objective: Study the progression of MR severity and LV function in medically managed MR patients with high surgical risk who survived at least 6 months. Methods: Between Jan 1st, 2000 and Aug 31st, 2010, we identified patients with medically managed moderate to severe MR that fulfilled the EVEREST II High Risk Registry (HRR) criteria. All patients were selected based on optimal propensity matching and were required to have a follow up echocardiogram &gt;6 months from the index study. Demographic, clinical and echocardiographic data was compared between baseline and follow up. Paired measurements of global longitudinal strain (GLS) were obtained in a subset of patients with suitable image quality. Results: 159 patients (mean age 73.5, female 45%) fulfilled the study criteria. 130 patients(81%) had moderate and severe MR. Median STS score was 8.9 (IQR: 5.2-14.8) and betablockers as well as ACEI/ARB was used by 71% and 73% respectively. During a median follow-up of 441 days (IQR: 272-780), MR decreased in severity in 82 patients (51.6%) and remained unchanged or worsened in 77 patients (49.4%) Among patients with moderate MR at baseline, improvement was seen in 62 (47.5%), worsening in 6 (5%), and unchanged severity in 62 (47.5%).Among patients with severe MR at baseline, improvement was seen in 17 (58.5%) and 12 (41.5%) remained unchanged. Median LVEF did not change from baseline to follow-up (45%; IQR: 30-55 vs. 45%, IQR: 30-55, p=0.51). Among 43 patients with evaluable paired GLS measurements, GLS did not significantly change over time (-11.8 to -12.6; p=0.36) Conclusions: Despite the high mortality in medically managed MR patients, a substantial number of survivors improve their MR grade at follow-up.
Abstract 16239: Left Atrial Function by Speckle-Tracking Echocardiography in Mitral Valve Prolapse: Evidence of a Primary Atriopathy and Clinical Implications
Authors: Lionel Tastet, Lisa J Lim, Dwight Bibby, Farzin Arya, Francesca N Delling
Journal: Circulation (2023)

Background: Prior studies support the prognostic role of left atrial (LA) volume in predicting overall mortality in mitral valve prolapse (MVP). However, the prognostic impact of LA function on cardiac outcome as quantified by speckle tracking echocardiography (STE) is unknown. Moreover, whether the mitral leaflet “atrialization” observed in bileaflet MVP with mitral annular disjunction (MAD) affects LA function irrespective of mitral regurgitation (MR) severity remains unclear. We sought to investigate the prognostic role of LA global longitudinal strain (LAGLS) and MVP subtype in a large registry of MVP patients with various degrees of MR. Methods: We identified 411 consecutive patients (59±17 years, 52% women) with MVP and clinical, echocardiographic and outcome data. LAGLS was measured offline using STE. Survival analysis was performed to assess the composite risk of cardiac death, heart failure hospitalization, or new onset of atrial fibrillation. Results: Compared to other MVP subtypes, bileaftlet MVP had lower LAGLS regardless of MR severity ( Fig 1A&amp;1B ). Of note, in the subgroup with no or mild MR, LAGLS was significantly lower in bileaflet compared to posterior MVP (p=0.003). There was a trend toward lower LAGLS according to MVP with vs without MAD (p=0.08) ( Fig 1C ). In multivariable linear regression adjusted for several risk factors, including MR grade, bileaflet MVP remained significantly associated with lower LAGLS (p=0.003). A total of 79 cardiovascular events occurred during a mean follow-up of 4.6±2.9 years. There was a significant increase in the risk of events as LAGLS decreased (log-rank: p&lt;0.001) ( Fig 1D ). Conclusion: Bileaflet MVP is associated with lower LAGLS regardless of MR severity, suggesting a primary atriopathy in this MVP subtype. Abnormal LAGLS is linked to higher risk of cardiovascular events. Hence, assessment of LA function using STE may help improve risk stratification in MVP and could represent a useful tool in clinical practice.
Abstract 13065: Comparative Efficacy of Endovascular Mechanical Thrombectomy With and Without Intravenous Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis of Randomized Trials
Authors: Vibhor Agrawal, Vinay Suresh, Rahul Jena, Dabbara V Ramana, Vikash Jaiswal
Journal: Circulation (2023)

Background: Current guidelines states that intravenous tissue plasminogen activator (tPA) should be administered to eligible acute ischemic stroke (AIS) patients even if endovascular mechanical thrombectomy (EMT) is being considered. However, there is still uncertainty regarding the superiority of EMT with tPA over direct EMT. Aim: This meta-analysis seeks to provide a comprehensive evaluation of the comparative effectiveness of EMT with and without tPA in treating AIS. Methods: We performed a systematic literature search using PubMed, EMBASE, Cochrane, Web of Science, and clincialtrials.gov. Relevant articles from inception until April 10th, 2023, were scrutinized. The primary outcome of interest was functional independence assessed by the modified Rankin Score between 0-2 at 90 days. Secondary outcomes included all-cause mortality within 90 days, successful recanalization defined as extended thrombolysis in cerebral infarction score of 2b to 3, and safety outcome, i.e., the occurrence of symptomatic intracranial hemorrhage (sICH). Results: Our analysis included 6 RCTs involving 2334 patients. The pooled analysis of the primary outcome revealed no significant difference between EMT with tPA and direct EMT [OR, 1.08 (95% CI, 0.87-1.34), p=0.41]. All-cause mortality [OR, 0.93 (95% CI, 0.74-1.16), p=0.42] and sICH [OR, 1.22 (95% CI, 0.91-1.62), p=0.14] also did not significantly differ between the two groups. However, the results for successful recanalization [OR, 1.35 (95% CI, 1.01-1.80), p=0.04] indicate that patients who underwent EMT with tPA had a 35% significantly higher likelihood of achieving successful recanalization. Conclusion: Our meta-analysis found no significant difference in functional outcome, all-cause mortality, or sICH between EMT with tPA and direct EMT. However, EMT with tPA was associated with a higher likelihood of successful recanalization, suggesting its potential benefit in improving recanalization rates in AIS.
Abstract 12998: Preoperative Venous Variability Index Predicts the Need for Pulmonary Venous Reintervention in Total Anomalous Pulmonary Venous Return
Authors: Helen M Stanley, Meryl S Cohen, Jen Faerber, Ryan M Callahan, Stephanie M Fuller, Brian R White
Journal: Circulation (2023)

Background: Postoperative obstruction in total anomalous pulmonary venous connection (TAPVC) is variable. Clinical risk factors are described but the role for preoperative echocardiographic markers in prognostication is unclear. Pulmonary venous variability index (PVVI), a novel metric developed at our center, is shown to better correlate to preoperative catheterization gradient and clinical markers of obstruction than standard echocardiographic measures. We hypothesized that preoperative PVVI is superior to maximum and mean velocity for prediction of outcome in TAPVC. Methods: We performed a retrospective review of TAPVC patients born 1/1/2006-9/30/2022 and repaired at our center. The medical record was reviewed for clinical and surgical risk factors. Preoperative echocardiograms were reviewed for clinical read and PVVI ((maximum velocity - minimum velocity) / mean velocity) was calculated from spectral Doppler of the pulmonary venous pathway. The outcome was time to surgical or catheter-based pulmonary vein reintervention or death. Results: In total, 162 patients were repaired. The outcome was met in 52 (32%). A univariate Cox proportional hazards model was performed for possible predictors (Table). Clinical predictors were single ventricle, heterotaxy, and a vertical vein not ligated during repair. Of echocardiographic metrics, PVVI and minimum velocity had strong associations with outcome (Figure). Conclusion: Preoperative PVVI predicts postoperative obstruction in TAPVC or death, while maximum and mean velocity and qualitative assessment of obstruction do not. Use of this quantitative metric may decrease practice variation and be valuable in prognosis.
Abstract 346: Deep Learning Approach for Predicting Good Neurological Outcome for Out-of-Hospital Cardiac Arrest Patients
Authors: Pavitra K Shah, Martha Razo, Shaveta Khosla, Marina Del Rios, Jing Li, Irina A Buhimschi, Terry L Vanden, Houshang Darabi
Journal: Circulation (2023)

Background: Cardiac arrest continues to pose a significant public health burden, with over 350,000 cases of out-of-hospital cardiac arrests (OHCA) occurring each year in the United States, and nearly 90% of them being fatal. The objective of this work was to develop a deep learning model that can accurately predict the Cerebral Performance Category (CPC) in adult OHCA cases. Methods: Adult OHCA cases at an urban academic emergency department were enrolled between 2018-2023. We evaluated data collected post return of spontaneous circulation (ROSC) at the first hour. Six different groups of data were tested for the prediction of CPC score: (1) Post-Rosc Vitals, (2) Pre-hospital &amp; ED data points, and (3) Hospital Admission data points. The second group of exploratory research variables include: (4) ultrasound variables, (5) biomarkers and (6) Sex steroid hormones. The figure below illustrates the prediction framework for cardiac arrest patients, post ROSC, admitted to the hospital. Results: Of the total of 109 cases that were enrolled, 45% were female and 48% were Black. More than one-third (35%) were discharged alive but only 20% had a CPC of 1-2. While the base model with clinical and demographic variables had an AUC of 0.54, addition of subsequent variables improved the AUC substantially. The AUC improved to 0.59, 0.67 and 0.78 when hormones, ultrasound and biomarker variables were added, respectively, to the base model. However, the optimal model included all variables, resulting in a noteworthy AUC score of 0.861. Conclusion: Our findings emphasize the significance of incorporating novel variables to comprehensively evaluate the outcomes of cardiac arrest patients so that better prediction models can be developed, potentially aiding in modifying procedures and any necessary measures to shift the outcome in favor of preserving patients' lives after OHCA.