tbuckley/cabot-search huggingface dataset:
Abstract 13026: Effects of Dapagliflozin in Heart Failure, Type 2 Diabetes, and Neuropathy - A Patient-Level Meta-Analysis of DAPA-HF and DELIVER
Authors: Jawad H Butt, Pardeep S Jhund, Kieran Docherty, Erasmus Bachus, Brian Claggett, Adrian F Hernandez, Carolyn S Lam, Silvio Inzucchi, Felipe Martinez, Rudolf A de Boer, Mikhail N Kosiborod, Akshay S Desai, Lars Kober, Piotr Ponikowski, Marc S Sabatine, Sanjiv J Shah, Muthiah Vaduganathan, Scott Solomon, John J McMurray
Journal: Circulation (2023)

Introduction: Type 2 diabetes (T2D) is a common comorbidity in heart failure (HF), and neuropathy is a serious complication in patients with T2D that is associated with worse outcomes. Purpose: To investigate the efficacy and safety of dapagliflozin, compared with placebo, according to neuropathy status in patients with HF and T2D. Methods: We conducted a patient-level pooled analysis of the DAPA-HF and DELIVER trials, which evaluated the effects of dapagliflozin, compared with placebo, in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome was a composite of worsening HF or cardiovascular death. Results: Of the 5,274 patients with T2D at baseline, 756 (14.3%) had a history of neuropathy. Compared to patients without neuropathy, those with neuropathy more often had a history of hypertension and PAD and were female. They also had a higher BMI, HbA1c, and LVEF, but a lower eGFR and NT-proBNP. Patients with neuropathy had a longer duration of both T2D and HF, worse NYHA functional class and KCCQ scores and a higher incidence of all outcomes. The benefit of dapagliflozin on the primary outcome was consistent irrespective of neuropathy status: no neuropathy, HR: 0.81 (95% CI: 0.72-0.92); neuropathy, HR: 0.63 (0.46-0.84) (P interaction =0.11). Dapagliflozin reduced the risk of secondary clinical outcomes and increased (improved) mean KCCQ scores from baseline to 8 months in both patients with and without neuropathy. The effects on secondary outcomes appeared larger in those with neuropathy (Table) . Adverse events and treatment discontinuation were not more frequent with dapagliflozin than with placebo irrespective of neuropathy status. Conclusions: Dapagliflozin reduced the risk of worsening HF or cardiovascular death and improved symptoms in patients with HF and T2D, with and without neuropathy, possibly with larger effects in individuals with neuropathy. In addition, dapagliflozin was safe and well-tolerated, irrespective of neuropathy status.
Abstract 16214: Prescription of Teratogenic Medications for Reproductive-Age Women With Heart Failure With Reduced Ejection Fraction in a Safety-Net Health System
Authors: Niharika Neela, Spencer Carter, Nicholas Hendren, Sandeep R Das
Journal: Circulation (2023)

Introduction: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor blocker-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA) have been proven to improve morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF); however, they have known teratogenic effects. It is uncertain how often reproductive-age women are prescribed these medications and whether they are prescribed contraception. Methods: We included all patients in our health system with documented left ventricular ejection fraction ≤45% within the past 2 years. Patients were excluded from the present study if they had a creatinine ≥2.0 mg/dl (women) or ≥2.5 mg/dl (men), as these are contraindications to MRA. Individuals were stratified into reproductive-age women (age ≤45), women age &gt;45, and men (any age). Contraception prescription was queried via chart review for all reproductive-age women. Rates of ACEi/ARB/ARNI, and MRA, were then compared across 4 subgroups. Results: Of 3,003 patients who met the inclusion criteria, 130 were women ≤45y, 709 were women &gt; 45y, and 2164 were men. Among the 81/130 (62%) reproductive-aged women not prescribed contraception, 78% had an active prescription for either an ACEi, ARB, or ARNI and 56% had an active MRA prescription (Figure). Comparing reproductive-age women not on contraception with all other groups, the ACEi/ARB/ARNI prescription rates were 78% vs. 78% (p = 0.36) and the MRA prescription rates were 56% vs 49% (p = 0.16). Conclusions: In a large safety net health system, most reproductive-aged women with HFrEF, were not prescribed contraception, yet they were commonly prescribed teratogenic heart failure medications. This is an important safety concern that should be addressed at the health system level.
Abstract 14855: Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal LV EF: Comparison of CMR With Echocardiography
Authors: Wissam Rahi, Imad Hussain, Miguel A Quinones, Dipan J Shah, Sherif F Nagueh
Journal: Circulation (2023)

Background: Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP) with the best accuracy in mid-rage or reduced left ventricular (LV) ejection fraction (EF). . There is a paucity of data on the accuracy of CMR estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF) or on how CMR compares with echocardiography in these patients. Methods: Stable patients with EF of ≥50%, who underwent right heart catheterization (RHC), CMR, and echocardiographic imaging within one week were included. PCWP was estimated by CMR using a previously validated equation where PCWP is estimated based on the left atrial maximum volume (LAV) and left ventricular mass (LVM) as PCWP=6.1352+ (0.07204*LAV) + (0.02256*LVM). Echocardiographic estimation of PCWP was based on 2016 ASE/EACVI guidelines taking into account the presence of myocardial disease and pulmonary vein atrial velocity. Results: Mean age was (54.6 ± 15.2), 58.2% females. There were 33 patients with PCWP &gt; 15 mmHg by RHC and 46 with a normal PCWP by right heart catheterization. The table shows sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the two imaging modalities. CMR prediction of PCWP had an AUC=0.72. In comparison, echocardiographic prediction of PCWP had significantly higher accuracy (AUC=0.87 vs. AUC=0.72; P- value=0.008). Conclusion: In patients with normal LV EF, CMR estimation of mean PCWP has an acceptable accuracy for detecting patients with mean PCWP&gt;15 mmHg. Echocardiography predicts elevated PCWP with a significantly higher sensitivity, specificity, and overall accuracy in comparison with CMR.
Abstract 13363: Echocardiographic Coronary Flow Velocity Parameters in Assessing Sub-Clinical Atherosclerosis in Inflammatory Bowel Disease Patients: A Meta-Analysis
Authors: Vagisha Sharma, abhigan babu Shrestha, Anureet Malhotra, Siddharth Agarwal, Harendra Kumar, Mansunderbir Singh, Tanvi Grover, Sana Dang, Chandan K Dash, Rohit Goyal, Abhishek Yadav, Samrat Koirala, HITESH BHATIA, Vikash Jaiswal, Sayed T Hussain
Journal: Circulation (2023)

Introduction: Chronic inflammatory diseases are linked to atherosclerosis and cardiovascular events. However, there are conflicting results in the literature regarding differences in echocardiographic Coronary Flow velocity parameters, which serve as markers of subclinical atherosclerosis, between inflammatory bowel disease (IBD) patients and healthy controls. Hypothesis: We aim to assess the Coronary Flow Velocity Reserve (CFVR), baseline Diastolic Peak Flow Velocity (DPFV), and hyperemic DPFV in IBD patients. Methods: We conducted a systematic search of databases, from January 1, 2014, to June 1, 2023, to gather relevant studies. The pooled mean differences in various parameters between IBD patients and controls were calculated using the standard mean difference with 95% confidence interval (CI), and random effect model was used when heterogeneity (I 2 ) crossed 50%. Results: 4 studies with 342 participants were included. The mean age of the IBD group was 39.25 years and of the control group was 41.25 years. Male comprised 51.46% of the study participants. IBD patients had a significantly lower CFVR (SMD; -1.12 95%CI; [-1.62, -0.61], p-value&lt;0.01) and hyperemic DPFV (SMD; -0.68, 95%CI [-1.09, -0.27], p-value&lt;0.01) than healthy controls. Whereas, Healthy controls had a lower baseline DPFV (SMD; 0.69 95%CI; [0.35, 1.04], p-value&lt;0.01) than the IBD group. Conclusions: IBD was associated with Coronary Microvascular Disease assessed as impaired CFVR and hyperemic DPFV. This suggests reduced myocardial perfusion in IBD patients and the need for regular cardiovascular risk assessment and targeted interventions to mitigate the increased risk of cardiovascular events.
Abstract 17098: Detection of Multiple Structural Heart Diseases Using a Novel Artificial Intelligence-Driven Algorithm for Noisy Real-World Single-Lead ECGs
Authors: Arya Aminorroaya, Akshay Khunte, Lovedeep S Dhingra, Veer Sangha, Sounok Sen, Norrisa Haynes, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2023)

Background: Wearable devices capable of ECG acquisition can help scale screening of structural heart disease (SHD) if diagnoses can be made with a single lead ECG. Algorithms for portable and wearable ECG require resilience to noisy acquisition but can enable detecting SHD in a community setting before symptom onset, ideal for public health management. Methods: Using Yale EHR data (2015-2021), we developed an artificial intelligence model to detect the presence of left ventricular systolic dysfunction, severe left-sided valvular disease, or hypertrophic cardiomyopathy using lead I of an ECG, which is commonly captured by wearable devices. We used 563,668 ECGs paired with echocardiograms obtained within 30 days of each other from 131,804 patients to develop the model. The dataset was split into training, validation, and test sets (85:5:10). For individual disease labels, we trained 6 convolutional neural network models using ECG signals augmented with random Gaussian real-world noise within 4 distinct frequency ranges and at 4 signal-to-noise ratios. Then, we included their prediction probabilities and age and sex as inputs to an XGBoost model to predict the composite SHD (Fig). Results: In the development set, the prevalence of composite SHD was 13%, encompassing left ventricular systolic dysfunction (9%), severe valvular disease (4%), and hypertrophic cardiomyopathy (1%). In the held-out test set of 13,181 patients (65±17 years, 49% women, 14% Black), AUROC and AUPRC of the ensemble model for prediction of SHD were 0.92 (0.90-0.93) and 0.61 (0.54-0.68), respectively (Fig). With optimized Youden's index, the model has a sensitivity of 0.83, specificity of 0.87, PPV of 0.41, and NPV of 0.98 to detect SHD. Conclusion: A novel wearable-adapted model demonstrated promising performance for detecting multiple SHD using single-lead ECG. This can enable community screening for SHD and improve patient outcomes through early initiation of guideline-directed therapies.
Abstract 13286: Co-Morbidities Clustering According to Imaging Diagnostic Criteria in Cardiac Sarcoidosis
Authors: Sakeeb Khan, John Tremblay, Mikhail Torosoff
Journal: Circulation (2023)

Background: Cardiac sarcoidosis (CS) diagnostic guidelines updated in 2006 and in 2017 now include imaging findings of left ventricular (LV) dysfunction (LV EF &lt; 50%) on cardiac MRI and echocardiography as major diagnostic criterion. Limited data is available with regards to co-morbidities clustering in sarcoidosis and CS according to the 2017 updated guideline diagnostic criteria. Methods: A case control, single tertiary medical center study included 558 sarcoidosis patients with documented extracardiac sarcoidosis and completed electrocardiogram and/or cardiac MRI imaging. CS 2006 and 2017 diagnostic criteria and co-morbidity data were extracted from electronic charts and were available for comparison in 540 patients. Results: The total study population was composed of 52.7% (281/540) females, aged 58.9+/-12.6 years old, with diabetes mellitus (DM) present in 29.6% (160/540), HTN in 51.7% (279/540), CAD in 13.3% (72/540), moderate to severe aortic, mitral, or tricuspid valvular disease in 14.8% (80/540), ESRD in 2.4% (13/540), and COPD or asthma in 21.9% (118/540). There was a significant clustering of co-morbidities according to the imaging CS diagnostic criteria. Patients meeting the 2017 CS imaging criteria were found to be older (61.4+/-11.3 vs 58.8+/-12.8 years old in patients not meeting criteria, p=0.085), predominantly male (69.2%, (54/78) vs. 44.4%, (205/462), p&lt;0.001), and demonstrated significantly increased prevalence of DM (39.7%, (31/78) vs. 27.9%, (129/462), p=0.034), and valvular disease (33.3%, (26/78) vs. 11.7%, (54/462), respectively, p&lt;0.001). However, there were no statistically significant difference in the prevalence of HTN (60.3%, (47/78) vs. 50.2%, (232/462), p=0.101), ESRD (3.9%, (3/76) vs. 2.2%, (10/456), p=0.361), and COPD or asthma (19.2%, (15/78) vs. 22.3%, (103/462), p=0.544) in patients meeting 2017 CS criteria compared to those that did not. Conclusion: CS patients meeting 2017 imaging diagnostic criteria were found to have statistically significant clustering of the following co-morbidities: male gender, DM, and valvular disease. These findings underscore importance of comprehensive care in CS patients and warrant caution in assigning LV abnormalities observed on imaging solely to CS etiology.
Abstract 157: Differences in Mid-Term Neurological Changes From 30 to 90 Days According to Age; is Plasticity Following Brain Injury After Cardiac Arrest Observed in Children or Young Adults?
Authors: Hiromi Miyoshi, Mitsuaki Nishikimi, Yuki Masuka, Takeshi Namba, Shinichiro Ohshimo, Nobuaki Shime
Journal: Circulation (2023)

Introduction: In clinical practice, younger patients following cardiac arrest (CA) are usually expected to recover, even though they are at high risk for poor neurological outcome. The aim of this study was to evaluate the differences of mid-term neurological improvements from 30 to 90 days after CA according to age. Methods: A retrospective observational study was conducted using data from the Japanese Association for Acute Medicine (JAAM) out-of-hospital cardiac arrest (OHCA) registry; a nationwide, prospective database including information on OHCA patients. All CA patients of any age except &lt;1years who had recovered spontaneous circulation and survived after 30 days were analyzed. Patients who already showed cerebral performance category (CPC) (or pediatric CPC [PCPC]) of 1 at 30 days were excluded. We evaluated the proportion of patients in each age category (aged 1-17 [children and adolescents], 18-39 [young adults], 40-64 [middle-aged adults], 65-79 [older adults], ≥80 [elderly] years) who improved in either CPC or PCPC between the 30 and 90 days after CA by using a multivariate logistic regression analysis. Results: Of the 68,111 patients in the registry, 1,449 patients for whom 30- and 90-day CPC (or PCPC) data were available were analyzed. Among them, a total of 186 patients (13%) showed improvement in their 90-day CPC (or PCPC). Multivariate logistic regression analysis showed that patients aged 18-39, 40-64 and 65-79 years were more likely to have improved 90-day CPC compared with those aged ≥ 80 years (Odds ratios: 2.67 [1.19-5.96], 2.33[1.37-3.95] and 1.87 [1.13-3.11], respectively). Adjusted spline curve showed that patients ranging from children to middle-aged adults had an expectation of improved neurological changes (Figure). Conclusions: The expectation of improved neurological changes following an OHCA was higher in patient aged 18-39, 40-64 and 65-79 years compared to those aged &gt;80 years, while it was not in patients aged 1-17 years.
Abstract 13402: Outcomes of Cardiac Resynchronization Therapy in Ischemic versus Non-Ischemic Cardiomyopathy: A Patient-Level Meta-Analysis of 7 Randomized Clinical Trials
Authors: Saurabh Sudesh, William T Abraham, John G Cleland, Anne B Curtis, Daniel Friedman, Michael R Gold, Valentina Kutyifa, Cecilia M Linde, Anthony L TANG, Antonio Olivas-Martinez, Lurdes Inoue, Gillian Schmidler, Sana M Al-Khatib
Journal: Circulation (2023)

Background: Data on whether CRT results in better clinical and echocardiographic outcomes in patients with NICM versus patients with ICM are conflicting. Objective: To determine if there are differences in clinical and echocardiographic outcomes of CRT in patients with ICM versus NICM. Methods: We analyzed patient-level data from 7 CRT trials (MIRACLE, MIRACLE-ICD, MIRACLE-ICD II, COMPANION, RAFT, MADIT-CRT, REVERSE) using Bayesian Hierarchical Weibull survival regression modeling, adjusted for baseline characteristics and presence of an ICD, to determine the effect of etiology of cardiac dysfunction on time to all-cause mortality alone and in combination with heart failure hospitalization (HFH). Kaplan-Meier (KM) survival curves were developed with unadjusted frequentist analyses. Linear regression was used to assess the effect of etiology of cardiomyopathy on echocardiographic measurements. Results: Of the 6252 patients included, 1535 (25%) were women, the median age was 66 (IQR 58-73), 3704 (59%) had ICM, and 3778 (60%) received CRT. Of those who received CRT, 2207 (58%) patients had ICM. Overall, CRT increased the time to HFH or death (hazard ratio (HR) 0.67, 95% credible interval (CrI) 0.56-0.82, p&lt;0.001) with no difference by etiology (HR ratio 1.06, CrI 0.87-1.29, p=0.57). CRT increased the time to death (HR 0.71, CrI 0.55-0.93, p=0.019) with no difference by etiology (HR ratio 1.06, CrI 0.80-1.43, p=0.70), although overall event rate was higher in ICM. CRT in ICM increased the median survival and time free of HFH (70 versus 50 months, p=0.0015) and had borderline effect in NICM (p=0.05) (Figure). Echocardiographic data that were available for 2430 (39%) patients showed that CRT improvements in LVEF, LVEDD, and LVESD were larger for patients with NICM. Conclusion: CRT increased the time to HFH or death independent of etiology of cardiac dysfunction. However, CRT led to greater increases in LVEF and reductions in ventricular dimensions for patients with NICM.
Abstract 13142: Prediction of Embolic Stroke in People Without Atrial Fibrillation and Prior Stroke Using Measures of Atrial Myopathy: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ankit Maheshwari, Faye L Norby, Riccardo M Inciardi, Elsayed Z Soliman, Alvaro Alonso, Michelle C Johansen, Rebecca Gottesman, Scott Solomon, Amil M Shah, Lin Y Chen
Journal: Circulation (2023)

Introduction: There is no effective way to predict embolic stroke (ES) in people without atrial fibrillation (AF). Atrial myopathy—characterized by left atrial (LA) remodeling—is associated with ES independent of AF. Hypothesis: An ES prediction model for people without AF or stroke can be developed with measures of atrial myopathy. Methods: ARIC study participants without AF, stroke, or anticoagulation at visit 5 (2011-13) were followed for 5 years. Covariates included CHA 2 DS 2 VASc variables, P-wave indices, echocardiographic measures of LA function and size, and N-terminal B-type Natriuretic Peptide (NTproBNP). The primary outcome was ischemic stroke. A secondary outcome of possible embolic stroke (PES) was defined as non-lacunar strokes and strokes with new AF within 1 year of stroke. Cox proportional hazards models were created for 5-year ischemic stroke (model A) and PES (model B) risk. Stepwise backwards selection (inclusion threshold P&lt;0.20) generated parsimonious models. Model discrimination and calibration were evaluated by the c-statistic and Hosmer-Lemeshow χ 2 statistic, respectively. Results: 91 ischemic strokes (53 PES) were identified in 4154 participants (59.9% female, mean age 75.1(5.0) years). Age, sex, peripheral arterial disease, hypertension, abnormal P-wave axis, and left atrial reservoir strain were included in model A. Model B added NTproBNP. The C-statistics for models A and B were 0.653 (0.596-0.709) and 0.744 (0.680-0.808), respectively. Both models were well calibrated. Conclusions: Prediction of ES may be achieved using measures of atrial myopathy in people without AF and prior stroke. Validation of our model is needed.
Abstract 15958: Obstetrical History That Includes Adverse Pregnancy Outcomes (APO) Are Not Incorporated Into the Creation of Cardiovascular Risk Screening in Adults
Authors: Kerly M Guerrero, Shaun Wesley, Medina Mishiyeva, Weirui Xiao, Diana S Wolfe, Peter Bernstein, Krishna K Patel, Loralei Thornburg
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) is a major contributor to maternal morbidity and mortality and is the leading cause of death for women/assigned female at birth (AFAB) people in the US. People who experience metabolic and hypertensive complications in pregnancy are at an increased risk of hypertension and CVD later in life. ACC/AHA have published clinical guidelines, which includes the use of the ASCVD risk estimator, to identify patients that may benefit from treatment with primary prevention. Our objective was to determine how often OBHx was included in the underlying primary literature that was utilized to create the current CVD screening guidelines. Methods: This is a descriptive study of the cited works, including original research and guidelines, used to develop the 2018 guidelines for the use of risk assessment tools for ASCVD and the 2019 primary prevention of CVD guidelines. Original research citations were analyzed for identification of OBHx. Articles that included OBHx were analyzed for identification of Adverse Pregnancy Outcomes (APO), specific risk factors including preeclampsia/gestational hypertension (GHTN), fetal growth restriction (FGR), preterm delivery (PTD), gestational diabetes (GDM) and peripartum cardiomyopathy (PPCM). We further assessed discussion of OBHx within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (&gt;5 sentences). Results: Of the 58 articles included, more than half included AFAB/women, 37 (63.8%), although how sex/gender was assigned was not delineated. Of these only 3 (5.2% of total) included OBHx. In 2 of the studies OBHx was identified by maternal recall, while 1 study performed a chart review. Of the 3 studies that included OBHx, 2 (66.6%) included history of preeclampsia/GHTN and PTD. FGR and GDM were each identified in 1 article. None of the articles included PPCM. An extensive discussion of APO risk factors was included for 2, while 1 study had a moderate discussion. Conclusions: Most of the data used to create the primary prevention of CVD guidelines provide very little information regarding OBHx. This may lead to an underestimation of CVD risk in AFAB people and potentially fail to identify those that may benefit from treatment for primary prevention of CVD.