tbuckley/cabot-search huggingface dataset:
Abstract 4148181: Neutrophil and Leucocyte Ratio and LDL to HDL ratios as predictors of Hemorrhagic transformation in ischemic stroke patients : A systematic review
Authors: Harendra Kumar, Vagisha Sharma, Saurabh Sharma
Journal: Circulation (2024)

Background: Following an ischemic stroke, a serious complication known as hemorrhagic transformation (HT) might jeopardize patient outcomes. Inflammatory indicators, such as the neutrophil-to-leukocyte ratio (NRR), and lipid markers, such as the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, have been investigated as HT predictors. Recent research has delved further into the predictive significance of these biomarkers for ischemic stroke outcomes. Objectives: To systematically review the literature on the predictive value of NLR and LDL to HDL ratios for HT in ischemic stroke patients, incorporating recent findings that enhance our understanding of these biomarkers. Methods: A detailed search of electronic databases was conducted to gather studies focusing on NLR and LDL to HDL ratios as predictors for HT in ischemic stroke. The selection process followed strict inclusion criteria, and the quality of studies was rigorously assessed. Results: The paper discusses new findings that emphasize the impact LDL and NLR play in influencing HDL ratios and, hence, HT prediction. Following an ischemic stroke, an increased incidence of HT, especially parenchymal hematoma (PH), has been associated with greater NLR. A high neutrophil-to-HDL ratio (NHR) has also been identified as a possible predictor of poor prognosis in ischemic stroke, underscoring its significance in predicting HT. Furthermore, the LDL-to-HDL ratio has been connected to long-term clinical outcomes like death and recurrent myocardial infarction, which may be associated with HT risk. Conclusions: In individuals with ischemic stroke, NLR and LDL-to-HDL ratios are potential HT indicators. The addition of current data underscores the potential of these ratios not just as HT indicators but also as markers for broader stroke-related effects. More studies are needed to validate these results and provide consistent recommendations for their use in clinical practice.
Abstract 4147674: Real world analysis of adverse events with implantation of aveir leadless pacemaker in comparison to micra leadless pacemaker: a food and drug administration MAUDE database study
Authors: Sahith Reddy Thotamgari, Aakash Sheth, Jake Smith, CALEB PHILLIPS, Harsh Patel, Ashritha Penagaluri, Vijaywant Brar
Journal: Circulation (2024)

Background: Leadless pacemaker (LP) is a novel pacemaker offering an innovative approach to bradyarrhythmia treatment. Aveir LP and Micra LP are the two leadless pacing systems available in the United States. Aveir LP was approved by the Food and Drug Administration (FDA) in April 2022. Data regarding the adverse events (AE) following implantation of Aveir LP is scarce, largely limited to single centers, and no real-world comparative analyses were done previously. Methods: We queried the FDA Manufacturer and User Facility Device Experience (MAUDE) database between April 2022 and December 2023 to assess the safety and AE following implantation of Aveir LP. "AVIER" and "MICRA" were the key terms used to search the MAUDE database. The event types "death" and "injury" were included in our search to capture major clinical events related to the patient. Disproportionality analysis was performed using the reporting odds ratio (ROR) to compare the adverse events of Aveir LP with Micra LP. A signal to noise ratio was considered to be significant if the confidence interval (CI) did not cross the number "one". Results: Our search resulted in 207 event reports for Aveir LP and 1969 event reports for Micra LP. Major device related adverse events with Aveir LP were capturing problem (33.8%) followed by dislodgement (16.9%), and sensing problem (7.2%). Most encountered device related AE with Micra LP were capturing problem (37.8%), pacing problem (11.5%), and sensing problem (9.3%). Frequencies of all the analyzed AE are shown in Figure 1. The reporting of pericardial effusion (ROR 2.84, 95% CI 2.18-3.71), and dislodgment (ROR 1.85, 95% CI 1.26-2.73) were significantly higher with Aveir, whereas cardiac arrest (ROR 0.18, 95% CI 0.04-0.74) was disproportionately lower. Overall, patient related AE were significantly higher (ROR 1.53, 95% CI 1.20-1.95) and device related events were significantly lower (ROR 0.65, 95% CI 0.51-0.83) with Aveir LP compared to Micra LP (Figure 2). Conclusion: This is the first real-world comparative analysis of two leadless pacing systems available in the United States. Our analysis showed that, when compared to Micra LP, the newer Aveir LP had lower device related events but higher patient related events, largely driven by pericardial effusion. These events could be attributed to the operator learning curve and long-term data are needed to further verify these findings.
Abstract 4147060: Artificial Intelligence-based improvement of smartwatch detection of AF
Authors: Elaine Wan, Taya Glotzer, Suneet Mittal, Oceane Senepart, Baptiste Lefebvre
Journal: Circulation (2024)

Introduction: Cardiac arrhythmias, such as atrial fibrillation (AF), are a common health problem. Standard 12-lead electrocardiograms (ECGs) and Holter monitors may not detect them due to their brief recording duration. There is increasing consumer use and demand for Smartwatch (SW), and herein we investigate the use of an AI algorithm (Philips Cardiologs) on the Apple Watch to improve detection of AF. Hypothesis/Objective: Evaluate the performance of the AI algorithm on a SW in detecting AF in comparison to physician interpretation on the 12-lead ECG among patients undergoing cardioversion. Methods: 220 patients from 3 different US hospitals undergoing a cardioversion were included in the study. A SW single lead and a standard 12-lead ECGs were obtained before and after the procedure. 12-lead ECGs were annotated and adjudicated by three expert electrophysiologists as 91.3% AF before the procedure, 4.1% after the procedure and 49.3% of total ECGs were AF. The study design allowed us to reach a high AF:Sinus Rhythm (SR) ratio for the total ECGs dataset. The Apple ECG App 2.0 and the AI algorithm both processed the SW-ECGs to classify them as AF, SR or inconclusive and their performances were compared. Results: Among the 383 simultaneous combinations of single and 12-lead ECGs, the algorithm obtained a sensitivity of 91.21% (95% CI, 86.12%-94.89%) and a specificity of 91.48% (95% CI, 86.33%-95.15%) for AF detection. Among the same dataset, the ECG App 2.0 from Apple Watch yielded inconclusive diagnoses for 12.5% (48/383) of all SW-ECGs while the AI algorithm reduced that number to 6.5% (25/383) and reached a sensitivity and specificity of 82.9% (95% CI, 76.44%-88.12%) and 95.6% (95% CI, 91.19%-98.22%) for AF detection. Conclusions: The Philips Cardiologs AI algorithm has demonstrated strong performances in the detection of AF and SR. In comparison to the Apple Watch, the AI algorithm significantly reduced the number of inconclusive diagnoses by half (p=0.0023, Z-test), thereby significantly improving diagnostic outcomes. This AI driven ECG analysis could enhance detection of AF in SW. Further efforts are warranted to extend the achieved performance to encompass the detection of additional types of arrhythmias.
Abstract 4147282: Systemic inflammation after STEMI – impact on infarct size and outcome –
Authors: Christian Graesser, Johannes Krefting, Felix Voll, Teresa Trenkwalder, Sebastian Kufner, Erion Xhepa, Michael Joner, Salvatore Cassese, Moritz Von Scheidt, Heribert Schunkert, Gjin Ndrepepa, Adnan Kastrati, Thorsten Kessler, Hendrik Sager
Journal: Circulation (2024)

Background: Systemic inflammation due to acute myocardial infarction (MI) leads to leukocyte accumulation inside cardiac tissue. Three days after MI the reparative phase is initiated, where cardiac macrophages adopt anti-inflammatory phenotypes and support scar formation and cardiac healing. Delayed resolution of inflammation leads to adverse cardiac remodeling after MI. Objective: To correlate persistent inflammation and delayed resolution of inflammation with infarct size and mortality in patients with ST-elevation myocardial infarction (STEMI). Methods and Results: This retrospective study, included data of STEMI patients treated with primary percutaneous coronary intervention (PPCI) from a historical (n=1155, 2002-2007) and contemporary (n=698, 2014-2022) cohort. Patients were grouped in tertiles according to leukocyte counts on day 3 after MI, as a surrogate parameter for delayed resolution of inflammation. In the historical cohort Serial single-photon emission computerized tomography imaging was available on admission and 7 to 14 days. Patients with elevated leukocyte counts after 72 h (T3 group) showed greatest area at risk (AAR) before PPCI (T1, AAR (median): 20.0% (IQR 11.0–36.0%); T2, AAR (median): 25.0% (IQR 14.0–40.0%), T3, AAR (median): 27.4% (IQR, 15.0–51.0%) and final infarct size (FIS) after 7 to 14 days after MI (T1, FIS (median): 7.0% (IQR 1.0–17.0%); T2, FIS (median): 12.0% (IQR 3.0–24.7%); T3, FIS (median): 13.0% (IQR 5.0–30.0%)) of the left ventricle. In line with these scintigraphic findings, peak creatine kinase myocardial band (CK-MB) values, as an enzymatic estimate of the infarct size, were also highest in T3. Additionally left ventricular ejection fraction (LV-EF) was lowest in the T3. At one year, 8 patients in T1, 7 patients in T2, and 22 patients in T3 had died (Kaplan–Meier estimates of 1-year mortality: 2.6%, 2.3%, and 7.3%, respectively (log-rank test: T1 vs. T3: p=0.01; T2 vs. T3: p=0.03). In the contemporary cohort we also found that patients with elevated leukocyte counts after 72 h (T3 group) showed greatest enzymatic infarct size, estimated by peak CK-MB values and reduced LV-EF. At one year, 6 patients in T1, 13 patients in T2 and 25 patients in T3 had died (Kaplan–Meier estimates of 1-year mortality: 3.8%, 8.3%, and 15.9%, respectively (log-rank test: T1 vs. T3: p&lt;0.005, T2 vs. T3: p=0.004). Conclusion: Delayed resolution of inflammation following MI, is associated with poorer outcomes at one year in STEMI patients.
Abstract 4147523: Bonnie and Clyde: Pulmonary artery aneurysm with concomitant ascending aortic aneurysm
Authors: Hasnoor Sandhu, Areeba Marrium, Alyson Shadrix, Amit Kumar, Omar Hamoui
Journal: Circulation (2024)

Background: Pulmonary artery aneurysms (PAAs) are rare with an incidence of 1 in 14,000. While rare, they are very critical conditions with a mortality rate of 50-100%. PAAs may be congenital or acquired via infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, inflammatory lung disease, neoplasm, or iatrogenic. The risk of PAA is due to respiratory compromise, compression of other structures, and dissection. We describe the rare presentation of a PAA with a concomitant ascending aortic aneurysm. Case Description: 75-year-old woman with a PMH of hypertension, Group I pulmonary artery hypertension, HFpEF, non-obstructive CAD, aortic insufficiency s/p mechanical aortic valve replacement on warfarin since 02/2014, hyperlipidemia who was admitted due to altered mental status. Physical exam was remarkable for 4/6 diastolic murmur, 3/6 aortic murmur, prominent P2, and parasternal lift and no JVD or lower extremity edema. CXR incidentally showed enlarged pulmonary artery and CT chest showed PAA at 6.6 cm. Echocardiogram confirmed moderate to severe pulmonary hypertension and a markedly dilated PAA with pulmonary valvular insufficiency. In addition, she had an ascending aortic aneurysm with moderate aortic insufficiency. The two coinciding aneurysms could be distinct in etiology due to sequela of high pressure vessel wall degradation from pulmonary artery hypertension and systemic hypertension or related due to vasculitis or cystic medial necrosis/connective tissue disease. Due to multiple concomitant aneurysms, the patient is pending further workup. Discussion: Aneurysms are focal dilations with PAA larger than 29 mm and ascending aortic aneurysm larger than 44 mm. Common etiologies include vasculitis, connective tissue disease, and high vessel pressure. Due to the risk of fatal pulmonary hemorrhage, PAAs are critical. Diagnosis of PAA is via CTA and of aortic aneurysm is via TTE with annual monitoring. Surgical intervention is greater than 45-55 mm depending on risk factors for ascending aortic aneurysm and greater than 55 mm for PAA. Surgical interventions for PAAs include stent graft, aneurysmorrhaphy, lobectomy, aneurysmectomy, and pneumonectomy. Surgical resection comes with high risk in patients with severe pulmonary hypertension. Treating the underlying pulmonary artery hypertension is crucial to long term management along with determination and treatment of underlying cause.
Abstract 4147342: Beat-to-beat Blood Pressure Variability, Cerebrovascular Reactivity, and White Matter Lesion Volume In Older Adults
Authors: Trevor Lohman, Isabel Sible, Allie Engstrom, Arunima Kapoor, Fatemah Shenasa, John Paul Alitin, Aimée Gaubert, Amy Nguyen, Xingfeng Shao, Danny Wang, Daniel Nation
Journal: Circulation (2024)

Introduction: Brain health is dependent upon maintenance of stable cerebral blood flow in part through the interplay of blood pressure variability (BPV) and cerebrovascular reactivity (CVR). Consistent with this conceptualization, both BPV and CVR have been separately implicated in cerebral hypoperfusion and white matter lesion (WML) burden. However, the interactive effect of BPV and CVR on WML burden has yet to be investigated. Hypothesis: Older adults with elevated BPV and deficient CVR will exhibit greater WML volume. Aims: Determine the relationship between elevated beat-to-beat BPV and WML volume across varying levels of whole brain CVR. Methods: Independently living older adults without history of major neurological/psychiatric history were recruited from the community and underwent continuous blood pressure monitoring and pseudo-continuous arterial spin labeling MRI. Whole brain perfusion was quantified during 5 minutes of rest with simultaneous monitoring of end-tidal CO 2 ( ET CO 2 ) levels. BPV was quantified as beat-to-beat systolic average real variability and spontaneous CVR was quantified as %change in CBF/change in ET CO 2 at rest. WML volume was quantified from T1-weighted fluid attenuated inversion recovery and segmented with the lesion growth algorithm implemented in the LST toolbox version 3.0.0 for SPM12. Results: Eighty-five older adults were studied (mean age = 69.3 years; SD = 6.56; age range 55–89 years; 61.4% female). Resting whole brain CVR moderated the relationship between BPV and WML volume ( B= - .12 , P= .01). Specifically, in individuals with impaired whole brain CVR, elevated BPV was independently associated with increased white matter lesion volume ( Fig. 1 ). Conclusion: The present findings show that the relationship between BPV and WML volume is dependent upon whole brain CVR. This suggests that the cerebral vasculature’s ability to respond to vasoactive stimuli determines whether elevated BPV is associated with white matter lesions. Future studies of blood pressure variability and cerebral small vessel disease should account for this interactive effect.
Abstract 4147021: Atorvastatin Therapy for Prevention of Anthracycline-Induced Cardiotoxicity in Cancer Patients: A Meta-Analysis
Authors: Elisio Bulhoes, Carlos Farias, Mayara Florindo, Gustavo Fernandes da Silva, Oscar Holmvard, Ana Laura Soares Silva, Andre Carvalho Ferreira, Gabriel Sales, Andre Schneider, Heveline Rayane Moura Roesch, Camila Guida
Journal: Circulation (2024)

Introduction: Cancer therapy-induced cardiac dysfunction is a significant adverse effect of chemotherapeutic agents, particularly anthracyclines (ANT). High-potency statin therapy, such as atorvastatin, appears to exert a protective effect against this condition. Objective: We aimed to perform a meta-analysis to evaluate the effect of atorvastatin therapy in preventing anthracycline-induced cardiotoxicity in cancer patients. Methods: We searched PubMed and Web of Science for randomized controlled trial (RCT) studies comparing atorvastatin prophylactic use to placebo in patients with cancer undergoing anthracycline-based chemotherapy. Outcomes were: mean change in left ventricular ejection fraction (LVEF), LVEF final, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), LDL-c, cancer treatment related cardiac disease (CTRCD) and heart failure symptoms. A random effects model was used to calculate the risk ratios (RRs) and mean difference (MDs) with 95% confidence intervals. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. Results: Five RCTs with 831 participants were included. The median follow-up ranged from 1 to 24 months. The dose used in all studies was 40 mg. Breast cancer was present in 77% of the patients. In our analysis, atorvastatin prophylactic use was associated with a statistically significant lower LVEF final (MD 2.31 %; 95% IC [0,78; 3,84]; p&lt;0.01; I2 =65%), LVESV (MD -4.50 mL; 95% IC [-7,57; -1,44]; p&lt;0.01; I2 =0%), LVEDV (MD -6.08 mL; 95% IC [-11,27; -0,90]; p=0.02; I2 =0%), LDL-c (MD -38.11 mg/dL; 95% IC [-55,01; -21,20]; p&lt;0.01; I2 =89%) and CTRCD (RR 0.42; 95% CI 0.28 - 0.65; p&lt;0.001; I2 =0%). In addition, atorvastatin prophylactic use was associated with a statistically significant increased LVEF final (MD 2.31 %; 95% IC [0,78; 3,84]; p&lt;0.01; I2 = 65%). There was no significant difference between groups in terms of mean change LVEF (MD 2.56 %; 95% IC [-0,20; 5,32]; p=0.07; I2 =89%) and heart failure symptoms (RR 0.40; 95% CI 0.14 - 1.18; p=0.097; I2 =0%). Conclusion: In conclusion, atorvastatin prophylactic use to placebo in patients with cancer undergoing anthracycline-based chemotherapy was associated with a reduction in LVESV, LVEDV, CTRCD and an increase in LVEF final. There was no difference between groups regarding mean change LVEF and heart failure symptoms.
Abstract 4147013: Impact of Obstructive Sleep Apnea on Mortality Patterns in COPD: A Comparative Analysis Across Age, Sex, and Racial Groups
Authors: Aryan Zahergivar, Swetha Mynedi, Fatemeh Homayounieh, Alem Mehari
Journal: Circulation (2024)

Introduction/Background: Chronic Obstructive Pulmonary Disease (COPD) is a major health issue characterized by long-term breathing problems and poor airflow, leading to significant morbidity and mortality. Obstructive Sleep Apnea (OSA) is a prevalent condition that can exacerbate complications in patients with COPD. The coexistence of COPD and OSA, known as "overlap syndrome," has been linked to worse patient outcomes, including higher cardiovascular morbidity and all-cause mortality. Research Question: How does the presence of OSA affect mortality patterns in COPD across different age, sex, and racial groups? Goals/Aims: To analyze mortality patterns in COPD with and without the presence of OSA. Methods/Approach: This retrospective study used CDC’s public mortality data from 1999 to 2020 to identify patients aged 35 and older with COPD (ICD-10 codes J40-J44) and those with OSA (ICD-10 code G-47.3). Mortality patterns were assessed across different age ranges, genders, and races. Statistical analyses included an independent two-sample t-test (Welch’s t-test) to compare average ages of death and Chi-Square Tests to assess differences in mortality patterns due to specific causes. Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were calculated, with statistical significance set at p &lt; 0.05. Results/Data: The study identified 5,952,368 deaths in patients with COPD, including 68,935 deaths in patients with both COPD and OSA. Leading causes of death were chronic lower respiratory diseases and diseases of the heart. The highest mortality in COPD-only cohort occurred in the 80-84 age group, while in COPD+OSA group was in the 70-74 age group. The weighted average age of death was 76.56 years for the COPD-only group and 69.34 years for the COPD + OSA group (p &lt; 0.001). Chi-square analysis revealed significant differences in mortality patterns across age groups, with higher heart disease mortality risk in the older (i.e.,55+) COPD+OSA population. Men showed higher crude death rates in both groups. COPD + OSA mortality odds were higher in American Indian or Alaska Native and African American populations compared to Whites. Conclusion(s): OSA significantly impacts cardiac-related mortality in patients with COPD, evidenced by a lower average age of death and increased cardiovascular mortality risk in higher age groups. Early diagnosis and effective management of OSA in COPD patients are crucial for reducing premature mortality and improving outcomes.
Abstract 4147347: The value of Coronary Artery Disease Polygenic Risk Score (CAD PRS) and Coronary Artery Calcium Score (CACS) in the prediction of Atherosclerotic Cardiovascular Diseases (ASCVD)
Authors: Natale Wasef, Patrick Biskupski, Mahmoud Alsaiqali, Krystina Stys, Catherine Hajek, Shubhi Bartaria, SHAOPENG GU, Xiuqing Guo, Jerome Rotter, Eric Larson, Adam Stys, Naveen Rajpurohit, Marian Petrasko, Tom Stys
Journal: Circulation (2024)

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a complex disease process, and an early diagnosis of high-risk patients will decrease morbidity and mortality. In our study, we evaluated Coronary Artery Disease Polygenic Risk Score (CAD PRS) and Coronary Artery Calcium Score (CACS) and their combination in the prediction of ASCVD, represented by peripheral vascular disease, aortic sclerosis, severe aortic stenosis, and stroke. Method: Our population was individuals enrolled in the Sanford Heart Screening Program and genotyped using the Illumina Global Screening Array version 1. CAD PRS was calculated using a literature-derived list of 180 single nucleotide polymorphisms (SNP). Patients were classified into two groups based on CAD PRS: High PRS (&gt;=85 th percentile) or low/intermediate PRS (&lt;85 th percentile). CACS was classified as high risk with a value of ≥ 300 and a non-high score when &lt;300. We used hierarchical logistic regression to assess CAD PRS, CACS, and their combination in predicting ASCVD. Results: In a sample of 689 patients, CACS was associated with sclerosis (OR=2.29 [1.18, 4.30], p&lt;.05), aortic stenosis (OR=10.0 [2.14, 70.6], p&lt;.01), PVD (OR=2.52 [1.23, 4.97], p&lt;.01) but not a stroke (OR=1.63 [0.62, 3.87], p=.3). A high PRS was shown not to be significantly associated with aortic sclerosis (OR=1.23 [0.52, 2.60], p=.60), PVD (OR=1.09 [0.40, 2.52], p=.8), or stroke (OR=1.5 [0.49, 3.84], p=.4), but was marginally associated with aortic stenosis (OR=4.31 [0.84, 19.8], p=.058). When holding a high CACS constant, a high PRS failed to show any significant hierarchical utility in predicting aortic stenosis (OR=3.10 [0.59, 14.7], p=.20). Conclusion: The combination of high CAD PRS to high CACS was not clinically significant in improving predictive value for atherosclerotic cardiovascular diseases, although was noted to be marginally significant for aortic stenosis. Increasing sample size might increase the power and show clinical significance in future assessment