tbuckley/cabot-search huggingface dataset:
Abstract 4146008: Association of Pre-operative Neutrophil to Lymphocyte Ratio (NLR) and Post-operative AKI in Patients Undergoing CABG: A Meta-Analysis
Authors: Bhavin Patel, Boney Lapsiwala, Prayag Jariwala, Aditya Suresh, Samir Vanani, Shaurya Patel, Aayushi Rajani, Rupak Desai
Journal: Circulation (2024)

Objective: Inflammation is associated with pathologies including post operative acute kidney injury (AKI). AKI is one of the common post operative conditions which prolongs hospitalization, intensive care unit stay and causes higher health costs and mortality. Pre-operative neutrophil to lymphocyte ratio (NLR) has predictive value for post-operative AKI after coronary artery bypass grafting (CABG). Hence, we aimed to evaluate the association of pre-operative NLR and post-operative AKI in patients undergoing CABG. Methods: A comprehensive literature review was conducted using PubMed, Google Scholar and SCOPUS databases from 2000 until 2024 using related keywords to identify studies reporting association of pre-operative NLR and post-operative AKI in patients undergoing CABG. The data was extracted and independently reviewed by four authors using standard forms. A random-effects model was used to calculate odds ratios (OR) and heterogeneity was assessed using I2 statistics. The sensitivity analysis was performed using the leave-one-out method. Results: Our final analysis included 6 retrospective studies which included 1757 patients with CABG. The mean age of the included patients was 64 years and 63.4% were males. Initial unadjusted analysis showed higher odds of post-operative AKI in patients having higher pre-operative NLR values with unadjusted OR 1.67, 95% CI 1.20-2.34, p &lt;0.001 with high heterogeneity (I2=94.89%). After adjusting for baseline characteristics and comorbidities, odds for post-operative AKI increased to aOR 1.69, 95% CI 1.03-2.79, p &lt;0.001 with high heterogeneity (I2=85.16%), which indicates stronger association after adjusting for confounders. Leave-one-out sensitivity analysis confirmed the robustness of these findings. Conclusion: Our meta-analysis suggests that higher pre-operative NLR is associated with 69% higher risk of post-operative AKI in patients undergoing CABG. This warrants more prospective studies to validate these findings. Moreover, better prediction of AKI can help to establish preventive measures to avoid adverse outcomes including the need for renal replacement therapy or hemodialysis in high-risk patients.
Abstract 4146340: Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Patients with and without Iron Deficiency Anemia: An Analysis of the National Inpatient Sample (NIS) Data from 2016-2021
Authors: Siddharth Agrawal, Maharshi Raval, Labdhi Sanghvi, Sahil Bhargava, Sajid Siddiq
Journal: Circulation (2024)

Background: Iron deficiency anemia (IDA) is a common comorbidity in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). This study investigates the differences in outcomes between TAVI patients with and without IDA, focusing on mortality, procedural complications, and baseline characteristics. Methods: A retrospective analysis was conducted using data from the National Inpatient Sample (NIS) from 2016 to 2021. The outcomes for patients undergoing TAVI with IDA were compared to those without IDA. Multivariate logistic regression was employed to analyze outcomes. Results: The study included 367,440 patients without iron deficiency anemia and 16,030 patients with iron deficiency anemia. Baseline characteristics showed a significant difference in gender distribution, with 47.15% of IDA patients being male compared to 56.4% in the non-IDA group (P &lt; 0.0001). Racial distribution varied significantly (P &lt; 0.0001), with a higher % of Black patients in the IDA group (6.16% vs. 3.97%).Patients with IDA had higher odds of heart block (OR: 1.146, 95% CI: 1.061-1.238, P = 0.001), bleeding (OR: 1.229, 95% CI: 1.115-1.355, P &lt; 0.001), transfusion (OR: 2.487, 95% CI: 2.209-2.800, P &lt; 0.001), prosthetic dysfunction (OR: 1.377, 95% CI: 1.053-1.801, P = 0.02), post-procedure shock (OR: 1.450, 95% CI: 1.180-1.782, P &lt; 0.001), intra-procedure shock (OR: 1.562, 95% CI: 1.264-1.931, P &lt; 0.001), dialysis (OR: 1.450, 95% CI: 1.044-2.015, P = 0.027), atrial fibrillation (OR: 1.115, 95% CI: 1.033-1.204, P = 0.005), cardiogenic shock (OR: 1.587, 95% CI: 1.283-1.963, P &lt; 0.001), sepsis (OR: 1.541, 95% CI: 1.122-2.117, P = 0.008), respiratory failure (OR: 1.635, 95% CI: 1.462-1.828, P &lt; 0.001), and myocardial infarction (OR: 1.684, 95% CI: 1.421-1.996, P &lt; 0.001). Patients with IDA had a longer length of stay (Coefficient: 2.067, 95% CI: 1.798-2.337, P &lt; 0.001) and higher total hospital charges (Coefficient: $23,107, 95% CI: $16,471-$29,742, P &lt; 0.001) compared to those without IDA. Conclusions: Patients with IDA undergoing TAVI are at higher risk for several complications, including heart block, bleeding, transfusion, prosthetic dysfunction, post-procedure and intra-procedure shock, dialysis, atrial fibrillation, cardiogenic shock, sepsis, respiratory failure, and myocardial infarction compared to those without IDA. These findings underscore the need for targeted management strategies and further research to optimize outcomes for TAVI patients with iron deficiency anemia.
Abstract 4146434: Factors Associated with Subsequent Catheterization and Identification of High-Grade Obstructive Coronary Artery Disease in Patients Without Known Coronary Disease and a Low to Moderate Short-Term Risk PET/CT Stress Test
Authors: Kirk Knowlton, Viet Le, Steve Mason, Kent Meredith, Peter Hu, Stacey Knight
Journal: Circulation (2024)

Background: PET/CT stress test may be performed to risk stratify patients including those without known coronary artery disease (CAD) who may be at risk for short-term adverse cardiac events. In patients with low- to moderate (LTM) risk for short-term MACE and without a known history of CAD, a small percentage of these patients will undergo a coronary angiogram within 90-days, of which some will be diagnosed with high-grade stenosis. The purpose of this study is to determine factors associated with this approach and findings. Methods: Patients without a history of known CAD (n=43,271) undergoing a PET/CT from 2018-2023 at Intermountain Health, with scan interpreted clinically as LTM short-term risk for adverse cardiac events, and ischemic burden &lt;10% (n=38,388) were studied. To determine factors associated with a decision to proceed with a coronary angiogram and the presence of high-grade CAD (&gt;70% stenosis in any vessel), an a priori list of clinical data and PET/CT results were examined. Results: Within 90 days of the LTM risk PET/CT, 3,163 (8.2%) had a coronary angiogram. Of these, 806 (25.5% of angiograms and 2.1% of total LTM) had high-grade CAD. The PET/CT ancillary findings were associated with the largest odds of performing an angiogram and the presence of high-grade CAD (Tables). Factors most likely to be associated with performing an angiogram were an ischemic burden of 7.5-10% (adjusted-OR [adj. OR]=11.54), coronary artery calcification (CAC) score of &gt;300 (adj.-OR =1.62), and myocardial blood flow (MBF) of &lt;1.5 (adj. OR=2.25 compared to &gt;MBF 2.3). Other clinical parameters associated, after adjustment, with an angiogram were age, male sex, hypertension, elevated troponin, and inpatient status. Many of the same factors were found to be associated with the identification of high-grade CAD. However, being an inpatient was associated with increased odds of angiogram but a decrease in odds of high-grade CAD. Conclusions: In patients without a known history of CAD who underwent PET/CT clinically adjudicated as LTM short-term risk and ischemic burden &lt;10% of cardiac events, subsequent coronary angiograms and high-grade CAD were not common. High-grade CAD was associated with PET/CT findings of ischemic burden of 7.5%-10%, CAC, and MBF. This indicates that attention to these findings may have a role in the decision to perform catheterization to identify high-grade CAD despite an interpretation of LTM short-term risk.
Abstract 4145626: Comparative Bleeding Risks Following Acute Myocardial Infarction: Clopidogrel and Ticagrelor, with Consideration for Clopidogrel Resistance
Authors: Nikita Gupta, Anderson Anuforo, Pratyaksh Vaishnav, Rohan Kumar Ochani, Dr. Avi Harisingani, Sahana Devakumar, Debanik Chaudhuri
Journal: Circulation (2024)

Various studies have shown higher bleeding risks with ticagrelor in comparison to clopidogrel in acute myocardial infarction (AMI). The literature also reveals significant variability in Clopidogrel resistance and consequent efficacy in patients. Our study compares the post-AMI bleeding risks and outcomes of patients on Clopidogrel with confirmed inhibition of platelet aggregation via P2Y12 platelet reactivity assay, compared to Ticagrelor. We queried the TriNeTX Global collaborative network for adults diagnosed with AMI between 01/01/08 to 12/31/23 and created two cohorts: one on Clopidogrel for at least one month post-AMI, after confirmed ADP-mediated P2Y12 inhibitor effect, and the second cohort was on Ticagrelor for at least one month post-AMI. We conducted propensity score matching(PSM) for around 35 variables, including race, age, sex, medications, and other comorbidities. Logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) at one year. Upper Gastrointestinal (GI) bleeding and hemorrhagic stroke at one year were the primary outcomes. Secondary outcomes included 4-point major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, cardiac arrest, heart failure, and ischemic stroke. The sample population had 1,460 post-AMI patients in the Clopidogrel cohort (Cohort 1) and 17,686 post-AMI patients on Ticagrelor (Cohort 2). After PSM both cohorts had 1,296 patients. The Clopidogrel cohort had significantly increased odds of upper GI bleeding (OR 1.656, 95% CI, 1.092-2.511) and hemorrhagic stroke (OR 2.119, 95% CI, 1.110 - 4.044) compared to Cohort 2 at one year. Among secondary outcomes, there was increased odds of heart failure (OR 1.565, 95%CI, 1.118-2.190), ischemic stroke (OR 1.745, 95%CI, 1.098 - 2.775), and 4-point MACCE (OR 1.549, 95%CI, 1.110 - 2.160) in the clopidogrel group compared to ticagrelor. There was no significance noticed in cardiac arrest and all cause-mortality. In our study, post-AMI patients on Clopidogrel with confirmed in-vitro platelet aggregation effect had significantly higher odds of bleeding and MACCE than those on Ticagrelor. However, Ticagrelor use did not show any mortality benefit.
Abstract 4145650: Development and Validation of a Pediatric Cardiology-Specific Large Language Model Chat Interface using Retrieval Augmented Generation
Authors: Doaa Aly, Liliam Aquino, Geetha Haligheri, khaled Elmeleegy
Journal: Circulation (2024)

Introduction: Generative Pretrained Transformers (GPTs) utilize extensively pre-trained large language models (LLMs) to generate text that resembles human language. Commercially available GPTs are not optimized for medical use and are prone to generating hallucinatory information. Retrieval-augmented generation (RAG) is a novel technology that allows embedding of customized knowledge bases for more enhanced performance of GPTs in specific domains. We aimed to validate the performance of a novel RAG empowered specialized GPT in Pediatric Cardiology. Methods: We developed "PedheartVersa," a pediatric cardiac disease-specific GPT, by using our institution's HIPAA-compliant text embedding and LLM platform, "Versa Chat". We conducted RAG on a custom knowledge base which we generated from 6 recent pediatric and fetal cardiology textbooks and 30 AHA/ACC guideline statements (Fig1). We applied prompt engineering through zero shot, few shot and chain of thought learning. We evaluated the performance of PedsheartVersa by comparing its outputs for 75 deidentified real-life fetal, pediatric and ACHD cases to those of trainees, OpenAI's ChatGPT 4, and Meta AI 2. Outputs were rated by expert pediatric Cardiologists on a detailed rubric (scientific consensus, reading comprehension, knowledge depth, reasoning, citation, hallucination, bias, and likelihood of harm). Results: 94% of the tested cases were correctly answered by PedsheartVersa vs 78% by trainees, 84% by ChatGPT 4 and 76% by Meta AI, P= 0.027(Fig 2). PedsheartVersa had significantly less demographic bias and likelihood of harm, and higher reading comprehension, reasoning, and depth of knowledge scores than trainees and rest of commercial unspecialized GPTs (Fig 2). Conclusion: Our novel customized GPT demonstrated high performance on a wide range of pediatric cardiology-based problems. This lays a groundwork for future applications of customized models in pediatric cardiology education, training and overall decision making.
Abstract 4146216: Sex Differences in Cardiogenic Shock: A Meta-Analysis of Outcomes per Etiology (Myocardial Infarction versus Heart Failure)
Authors: Aniket Jaimalani, Darshine Venugopal, Ragavendar Saravanabavanandan, OGECHUKWU OBI, Saqlain Rasheed, Mohammed Raake, Maham Tabassum, Mohammed Al-Tawil, Assad Haneya
Journal: Circulation (2024)

Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) and acute heart failure with cardiogenic shock (AHFCS) are associated with high morbidity and mortality. While women are underrepresented in clinical trials and observational studies of these conditions, emerging evidence suggests potential sex-based differences in presentation, management, and outcomes. Understanding these differences is crucial for tailoring treatment strategies and improving outcomes for both men and women. Methods: We conducted a systematic review and meta-analysis of studies reporting sex-specific outcomes in patients with AMICS and AHFCS. A comprehensive search of PubMed, Scopus, and Embase was performed using relevant keywords. 20 Studies reporting outcomes stratified by sex were included. Pooled effect sizes for outcomes were calculated using random-effects models, and heterogeneity was assessed. Subgroup analyses were performed. Results: In this study of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and acute heart failure with cardiogenic shock (AHFCS), men had a significantly lower risk of mortality compared to women (AMICS: RR 0.82, 95% CI 0.74-0.91; AHFCS: RR 0.84, 95% CI 0.75-0.94). In the AMICS group, men were more likely to undergo revascularization (RR 1.15, 95% CI 1.08-1.23) and receive mechanical circulatory support (RR 1.26, 95% CI 1.19-1.34). However, there was no statistically significant difference in tMCS use between male and female patients with AHFCS (RR 0.98, 95% CI 0.83 - 1.16). Men in the AMICS group also experienced a lower risk of major bleeding (RR 0.78, 95% CI 0.54-1.13) but a slightly higher risk of major adverse cardiovascular events (MACE) (RR 1.04, 95% CI 0.96-1.12). Conclusion: Our meta-analysis reveals significant sex-based differences in outcomes and treatment patterns among patients with cardiogenic shock. Men consistently demonstrate a lower in-hospital mortality risk across both AMICS and AHFCS, despite a slightly higher risk of MACE in AMICS. This survival advantage may be partially attributed to increased utilization of revascularization and mechanical circulatory support in men. These findings emphasize the need for further research to elucidate the underlying mechanisms driving these sex-based disparities.
Abstract 4146183: Rheumatoid arthritis is Associated with Sub-Clinical Abnormalities in Myocardial Energetics, Left Ventricular Remodelling, and Increased Fibrosis
Authors: Chin Yit Soo, Nicholas Jex, Laurence Duquenne, Lucy Elizabeth Thornton, Thomas Anderton, Raluca Tomoaia, May Lwin, Christel Kamani, Amrit Chowdhary, Sharmaine Thirunavukarasu, Henry Procter, Sindhoora Kotha, Marilena Giannoudi, Eylem Levelt, Lesley-Anne Bissell, Paul Emery, Benazir Saleem, Richard Wakefield, Kulveer Mankia, Sven Plein
Journal: Circulation (2024)

Background: Patients with rheumatoid arthritis (RA) display around 20% increased risk of heart failure, even after adjusting for traditional atherosclerotic risk factors. The reasons behind this are not fully understood. Analogous states of chronic inflammation such as type two diabetes have been shown to be associated with deleterious effects on myocardial metabolism and energetic depletion which predispose to systolic dysfunction. The impact of RA on myocardial energetics and cardiac phenotype in individuals at risk of RA has yet to be established. Aims: Using 31 Phosphorous magnetic resonance spectroscopy ( 31 P MRS) and cardiovascular magnetic resonance (CMR), we aimed to establish if myocardial energetics, measured as phosphocreatine (PCr) /ATP ratio and quantitative myocardial perfusion were reduced in individuals at risk with isolated anti-CCP positivity (CCP+ve) and those with refractory RA (RRA) compared to healthy volunteers (HV). Methods: A total of 30 age and sex matched participants were recruited (11 CCP+ve, 9 RRA and 10 HV). All subjects underwent 31 P MRS and comprehensive CMR protocol including volumetric analysis, quantitative myocardial perfusion and T1 mapping. Results: Table-1 shows clinical and CMR / 31 P MRS data. Groups were matched for age, sex, body mass index (BMI) and systolic blood pressure. Left ventricular volumes, bi-ventricular systolic function, maximal LV wall thickness and left atrial function were similar between groups. Native T1 values and LV mass were increased in both CCP+ve and RRA versus controls. PCr/ATP was significantly reduced in both CCP+ve and RRA groups compared to healthy controls. No significant difference was observed in either stress myocardial blood flow (MBF) or myocardial perfusion reserve (MPR). Conclusions: This is the first-time energetic impairment has been reported in both patients with anti-CCP positivity and refractory RA. Our findings also demonstrate increased LV mass and diffuse fibrosis in these groups compared to age, sex and BMI matched controls. These findings may provide a mechanistic insight to the increased incidence of heart failure in individuals with rheumatoid arthritis.
Abstract 4146173: Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Atrial Fibrillation Recurrence Post-Ablation: A Systematic Review and Meta-Analysis
Authors: Sudeep Nugooru, Shravya Ginnaram, Chaitra Janga, Prerana Sevella, Hamza Muhammadzai, Shreeja Shah, Muhammad Sabri, Zaineb Alhassani, Tyler Lee, Robert Watson
Journal: Circulation (2024)

Background: Recurrent atrial fibrillation (AF) occurs in approximately 20 to 40% of patients following catheter ablation. SGLT2 inhibitors (SGLT2i), known for their cardiovascular benefits beyond glycemic control in type 2 diabetes, exhibit multiple pleiotropic effects. These effects offer glucose-independent and direct cardiac protection, potentially enhancing atrial remodeling. Studies suggest that SGLT2 inhibitors may also reduce atrial tachyarrhythmia and lower the risk of recurrence after the initial ablation procedure. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. Studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Primary outcomes included AF recurrence with secondary outcomes of left ventricular ejection fraction (LVEF) improvement, hospitalizations and adverse events. Data was extracted and analyzed using R/R Studio. Random effects model was utilized to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Six studies were included with 5,456 participants (2,514 in SGLT2i group, 2,942 in control group). SGLT2i significantly reduced AF recurrence (OR = 0.44, 95% CI: 0.29-0.67, I 2 = 65%, p = 0.01). Four studies with 1,044 participants showed a non-significant trend towards LVEF improvement with SGLT2i (OR = 1.99, 95% CI: 0.99-3.99, I 2 = 0%, p = 0.88). Hospitalization rates from five studies (5,184 participants) showed no significant difference between groups (OR = 1.07, 95% CI: 0.63-1.82, I 2 = 46%, p = 0.12). Adverse events in four studies (734 participants) were not significantly higher in the SGLT2i group (OR = 1.19, 95% CI: 0.56-2.52, I 2 = 0%, p = 0.53). Conclusions: The results suggest that SGLT2i use significantly reduces AF recurrence following catheter ablation, with a trend toward LVEF improvement, though not statistically significant. Hospitalization rates and adverse events did not significantly differ between the SGLT2i and control groups, indicating a favorable safety profile. These findings support the potential benefit of SGLT2i in post-ablation management. Further large-scale randomized controlled trials are needed to confirm these results.
Abstract 4145416: Geographic Variation in the Impact of Rurality on Hospitalization for Acute Myocardial Infarction Among Medicare Beneficiaries
Authors: Nitin Kanneganti, Djhenne Dalmacy, Abdullah Rabah, Fayz Quadri, Yordanos Tiruneh, Jarett Berry
Journal: Circulation (2024)

Background: Prior research has observed a higher cardiovascular mortality rate in rural vs. urban counties. However, rural counties exhibit significant heterogeneity both within and across geographic regions. Therefore, we sought to characterize the association between rurality and hospitalization for acute myocardial infarction (AMI) across rural vs. urban zip codes and across US Census regions. Methods: We included fee-for-service Medicare beneficiaries with prevalent hypertension (HTN) or diabetes (DM), followed from 2017-2021. Participants were categorized at the residential zip code level as metropolitan, micropolitan, small town, and rural using Rural Urban Commuting Area Codes. Census geographic regions were categorized at the state level into Northeast, South, Midwest, and West. First hospitalization for AMI was determined from Medicare claims. The association between rurality and AMI hospitalization was estimated using Cox models adjusted for age, race, and sex. Additional models were stratified by census regions. Results: We included 25,915,862 participants (age 73; 45% male; 97.6% HTN; 41.6% DM; 75.5% metropolitan). HTN prevalence was similar across RUCA codes (98%), but DM prevalence was slightly lower (42% vs. 39%, metropolitan vs. rural). After mean follow-up of 3.9 years, we observed 1,395,853 first AMI events (14.3 per 1,000 person-years. Rates were higher in rural vs. metropolitan zip codes (15.6 vs. 13.8 per 1,000 p-years). AMI rates also varied by census region (Northeast: 16.3; Midwest: 15.9; South: 15.5; Midwest: 13.4 per 1,000 p-years). In adjusted models, more rural zip codes were associated with a higher risk of AMI (see Table). However, this association appeared to vary by US census region (see Table). Conclusion: Medicare beneficiaries residing in rural communities have a higher risk for AMI compared to those in metropolitan areas. However, these associations do not appear uniform across geographic regions, indicating heterogeneity in the impact of rurality on AMI hospitalization. Further research is needed to understand the factors contributing to this variation.