tbuckley/cabot-search huggingface dataset:
Abstract 4148033: Deep Learning Enabled Electrocardiogram Aimed to Detect Coronary Artery Disease to Predict Atherosclerotic Cardiovascular Events in the Community
Authors: Jose Medina-Inojosa, Kathryn Mangold, Samir Awasthi, Betsy Medina-Inojosa, Robert McCully, Amir Lerman, Zachi Attia, Paul Friedman, Francisco Lopez-Jimenez
Journal: Circulation (2024)

Background: We previously developed deep-learning algorithms that identify coronary artery disease (CAD) risk based on (i) coronary artery calcium (CAC), (ii) obstructive CAD by angiography, and (iii) left ventricular akinesis in ≥1 segment by echocardiogram, using a 12-lead electrocardiogram (CAD ECG-AI). We tested the hypothesis that those with increased probability of CAD by CAD ECG-AI algorithms will have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events and would refine the AHA Predicting Risk of Cardiovascular Disease Events (PREVENT TM ) equations’ predictive capabilities. Methods: We assessed a group of consecutive patients who sought primary care in Olmsted County, MN, between 1997 and 2003. Passive follow-up was conducted using the Rochester Epidemiology Project's record linkage system. Patients included met the same criteria of the original PREVENT TM equations. The probability output of each CAD ECG-AI algorithm was used to predict ASCVD (fatal and non-fatal myocardial infarction and ischemic stroke) and ASCVD-Plus [further including percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and all-cause mortality]. Events were validated in duplicate. Cox proportional hazard models adjusted for age, sex, and risk factors while modeling each CAD ECG-AI algorithm as an individual and additive predictor (see footnote). PREVENT TM risk categories stratified analysis to evaluate the effect of the CAD ECG-AI models on predicted ASCVD risk. Results: We included 21,193 patients, with mean ± SD age 51.6 ± 12.0, 54% women and 95% white. After 14.2±12.4 years follow-up, 1,351 (6.4%) developed ASCVD, and 2,808 (13.2%) had ASCVD-Plus. The risk of ASCVD and ASCVD-Plus increased with positivity for the CAD ECG-AI algorithms after adjustments for age, sex, and PREVENT TM equations factors, all p for trend &lt;0.001 (data not shown). In additive analyses, the risk of ASCVD and ASCVD-Plus increased with increased CAD ECG-AI factors, all p for trend &lt;0.001 ( Fig. A-B ). Furthermore, the CAD ECG-AI algorithm enhanced the predictive capabilities of PREVENT TM equations across most risk subgroups ( Fig. C-E ). Conclusions: The deep-learning CAD ECG-AI algorithms displayed an independent and additive association with long-term ASCVD and ASCVD-Plus events in the community and improved the PREVENT TM predicted ASCVD risk. The CAD ECG-AI algorithms could help identify individuals at risk in primary prevention of cardiovascular events.
Abstract 4147947: Social Support and Blood Pressure Control Among Older US Adults (1999-2008)
Authors: Michelle David, Eunhee Choi, Brandon Fernandez Sedano, sumayya shurovi, Fatma Dansoko, Marwah Abdalla
Journal: Circulation (2024)

Background: Blood Pressure (BP) control is less likely among older adults compared to other age groups in the National Health and Nutrition Examination Survey (NHANES). Lack of social support is a growing epidemic among older adults and is associated with a higher prevalence of hypertension. It is unclear whether BP control among older adults with and without social support has changed over time. Aim: To determine if BP control among older adults with and without social support has changed from 1999 to 2008. Methods: We conducted weighted cross-sectional analysis of NHANES data from 1999 through 2008 (5 cycles). BP control was defined as BP &lt;140/&lt;90 mmHg. Having social support was assessed during 5 cycles. The proportion of adults with controlled BP was calculated for adults with and without social support and by demographics. Results: The analysis included 5,351 adults ≥60 years with systolic/diastolic BP ≥140/≥90 mmHg on antihypertensive medication; 45.1% were 60-69 years old, 19.4% were &gt;80 years, 58.8% were female, 80.6% were non-Hispanic White adults. Among adults with social support, the proportion with controlled BP increased from 29.1% (95% CI, 24.3-33.8%) in 1999-2000 to 48.5% (95% CI, 44.1-52.9%) in 2007-2008 (p&lt;.0001 for trend). Among adults without social support, the proportion with controlled BP increased from 13.5% in 1999-2000 and was 51.7% in 2003-2004 and then declined to 46.4% in 2007-2008 (p&lt;.0001 for trend; Table 1). For those with social support, women, non-Hispanic White adults, and college graduates had consistently higher BP control rates compared to their counterparts. For those without social support, men had higher BP control compared to women except in 2005-2006. Non-Hispanic White adults had high BP control rates consistently. The proportion with controlled BP was highest for adults with &lt;high school education in 1999-2000 then declined to 41.4% in 2007-2008. Conclusion: Among older adults with social support the prevalence of BP control increased between 1999-2008. Future research focusing on social support interventions for hypertension management should address possible disparities based on sex, race/ethnicity, and education.
Abstract 4148148: Acute Myocardial Infarction outcomes in patients on single anticoagulation versus combined anticoagulation and antiplatelet therapy
Authors: Manuel Rosario, Moises Vasquez, Gustavo Garcia, Caroline Wojtas, Ian Vargas, Benjamin Behers
Journal: Circulation (2024)

Introduction: Current guidelines recommend single anticoagulation (AC) therapy over combined AC plus anti-platelet (AP) therapy in patients with established cardiovascular disease (CVD) and concomitant indication for AC. Data on the in-hospital outcomes of acute myocardial infarction (AMI) in patients on single versus combined therapy is scarce. Methods: The National Inpatient Sample was used to identify adult patients with established CVD on AC and a primary diagnosis of AMI between 2016 and 2020. Data was stratified between patients on single AC and patients on combined AC and AP therapy. In-hospital outcomes were compared after case-control matching for significant comorbidities. Results: A total of 122,975 patients admitted for AMI were included, of which 57,220 (46.5%) were previously on combined therapy. PCI rates were similar in both groups (34.9% vs 34.6%, P=0.247). After matching (15,140 patients in each group), combined therapy was associated with decreased odds of in-hospital mortality, discharge to skilled nursing facilities (SNF), increased odds of mechanical circulatory support (MCS) use, and similar odds of in-hospital cardiovascular and bleeding complications compared to patients on single AC therapy (Figure 1). Conclusion: Combined AC plus AP therapy was associated with decreased in-hospital mortality, increase MCS use, and less SNF discharges compared to patients on single AC therapy admitted for AMI. There was no difference in in-hospital cardiac or bleeding complications.
Abstract 4147920: Optimal Approach to Generate Patient-Level Decision from Study-Level Predictions Using a Multimodal Deep Learning Model for Detecting Transthyretin Cardiac Amyloidosis
Authors: Joshua Finer, Chris Haggerty, Linyuan Jing, Sneha Jain, Andrew Einstein, Matthew Maurer, Sushravya Raghunath, Daniel Rocha, Pierre Elias, Timothy Poterucha
Journal: Circulation (2024)

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is an underdiagnosed cause of heart failure and early disease detection is essential for improving outcomes. We previously developed a multimodal deep learning model, named ATTRact-Net, leveraging electrocardiogram (ECG) and echocardiogram data that can identify patients with ATTR-CA. Patients at risk for ATTR-CA often have multiple ECGs and echos available for analysis, leading to many different risk predictions by AI models. There is little evidence on how to go from study-level prediction to patient-level decision. We studied varying methods to integrate multiple ECG/echo pair predictions to maximize model performance in the detection of ATTR-CA. We hypothesized that retaining the patient-level mean risk across the prior 2 years would improve model performance compared to using maximum predicted risk. Methods and Results: ATTRact-Net was originally trained on 799 patients with 22,344 ECG/echo pairs completed within 2 years of PYP scan. Previously published performance of the model showed an AUROC of 0.83 in internal testing. For this study, a new test set composed of an outside hospital not used for training, had 422 patients with 12,387 pairs and ATTR-CA prevalence of 23%. In this new hospital’s population, we tested model performance using four patient-level aggregation methods (mean, median, max, and no aggregation) for integrating predictions across multiple ECG/echo pairs. Performance was compared based on the area under the receiver operating characteristic curve (AUROC), Diagnostic Odds Ratio (DOR), and F1 score using the Youden index as the optimal threshold. In the external validation dataset, the model achieved AUROCs of 0.78 (max), 0.82 (mean), 0.82 (median) and 0.82 (none) shown in Figure 1A. Mean and median aggregation outperformed both max and no aggregation by F1-score and DOR (Figure 1B). Conclusion: For a multimodal AI model detecting ATTR-CA, aggregating ECG/echo risk predictions using mean or median from the prior 2 years considerably improved diagnostic yield compared to using patient’s maximum score or no aggregation. A prospective clinical trial is underway using this strategy for early diagnosis of ATTR-CA across our healthcare system.
Abstract Sa804: Brain-Directed Management of Venoarterial Extracorporeal Membrane Oxygenation in a Pediatric Swine Model
Authors: Tiffany Ko, Katsunari Terakawa, Benjamin Smood, Julia Slovis, Rodrigo Menezes Forti, Richard Melchior, Takayuki Sueishi, Nolan Chalifoux, Nicolina Ranieri, Alyssa Seeney, Akshatha Krishna, Rika Goto, Alistair Lewis, April Hurlock, Yuxi Lin, Misun Hwang, Kumaran Senthil, Danielle Aronowitz, Audrey Spelde, Ryan Morgan, Constantine Mavroudis, Wesley Baker, Todd Kilbaugh
Journal: Circulation (2024)

Introduction: We present a novel demonstration of brain-directed management of venoarterial extracorporeal membrane oxygenation (ECMO) using real-time feedback from non-invasive neurometabolic optical monitoring (NOM) of the cerebral oxygen extraction fraction (OEF) in pediatric swine. In our prior work, OEF&gt;0.82 was associated with hypoxic-ischemic brain injury during ECMO. Maintaining OEF below this threshold may prevent injury. Hypothesis: Cerebral OEF levels of 0.8, 0.7, and 0.6 will be achieved during 7 h of brain-directed ECMO after prolonged cardiac arrest. Methods: Continuous cerebral OEF was acquired in a pediatric swine model ( sus scrofa , 8-12 kg) of ECMO-assisted cardiopulmonary resuscitation (CPR) using NOM on the left forehead. Animals had 8 min of ventricular fibrillation followed by 30 min of low-flow ECMO (20 ml/kg/min) with epinephrine (0.02 mg/kg) boluses every 4 min to simulate prolonged CPR. Then, ECMO flow rate was increased to 70-100 ml/kg/min to reflect clinical return of circulation. After 1 h, animals were randomized to a cerebral OEF target of 0.8 (n=11), 0.7 (n=12), or 0.6 (n=12) and brain-directed ECMO management was performed for 7 h; OEF was re-assessed every 5 min. If the OEF target was not achieved (±0.05 of target), first, ECMO flow rate was adjusted between 50-120 ml/kg/min, second, arterial blood pressure (ABP) was modulated using vasoactive infusions. Blood gas, hematocrit, anticoagulation, and anesthesia were otherwise standardized across all subjects. Mitochondrial respirometry assessed maximal oxidative phosphorylation of cortical tissue following ECMO as a metric of brain health which we have shown to correlate with neurologic outcomes across injury models. Associations with mean cerebral OEF, ECMO pump flow, and ABP were examined by linear regression. Results: Brain-directed ECMO achieved and maintained respective OEF targets for 79% [57, 93] of the 7 h period (median [IQR] across animals). 71% (n=25/35) of animals achieved their target within 1 h of initiating brain-directed management. OEF, but not pump flow or ABP, was significantly correlated with maximal oxidative phosphorylation (p=0.005). Conclusion: Our results demonstrate the efficacy and precision of real-time modulation of cerebral OEF during ECMO based on neurophysiologic feedback from the individual patient. The association of OEF with brain health suggests that brain-directed management may provide new opportunities to mitigate neurological injury.
Abstract 4147872: Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve Implantation in Patients With Small Aortic Annulus: An Updated Systematic Review And Meta-Analysis
Authors: Bárbara Mariz Ferreira Passos, David Curi, Lorhayne Kerley Capuchinho Scalioni Galvao, Joao Pedro Costa Esteves Almuinha Salles, Fernanda Zamora, Filippe Filippini, Nicole Pimenta, Ana Clara Felix de Farias Santos
Journal: Circulation (2024)

Introduction: Both self-expanding (SEV) and balloon-expandable (BEV) valves are used in transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and small aortic annulus (SAA). This updated meta-analysis compares the efficacy and safety of SEV versus BEV in TAVI for these patients. Hypothesis: This study investigates whether SEV valves are hemodynamically and clinically superior to BEV valves in patients with small aortic annulus. Methods: PubMed, SCOPUS, and Cochrane Central databases were systematically searched for randomized and observational studies comparing SEV and BEV in TAVI for SAA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model for clinical outcomes (all-cause mortality, stroke, permanent pacemaker implantation [PPI]) and hemodynamic parameters (mean gradient [MG], indexed effective orifice area [iEOA], moderate to severe prosthesis-patient mismatch [PPM], and paravalvular leak [PVL]). Results: A total of 21 studies involving 6,515 patients (58.4% treated with SEV) were included. SEV valves were associated with lower all-cause mortality (OR 0.75; 95% CI 0.60-0.95; p=0.014), lower MG (OR -4.44; 95% CI -5.48-3.39; p&lt;0.01), higher iEOA (OR 0.23; 95% CI 0.13-0.23; p&lt;0.01), and less moderate to severe PPM (OR 0.31; 95% CI 0.22-0.45; p&lt;0.001). However, SEV valves had higher rates of PPI (OR 1.35; 95% CI 1.01-1.80; p=0.042) and PVL (OR 2.69; 95% CI 1.58-4.57; p&lt;0.001). Stroke rates were not significantly different between the groups. Conclusion: In patients with severe AS and SAA, TAVI with SEV valves showed better outcomes in all-cause mortality, MG, iEOA, and moderate to severe PPM. However, BEV valves had advantages in lower PPI and PVL rates. These findings should be interpreted cautiously due to the predominance of observational studies and varying valve types and generations used.
Abstract 4148114: Sequential Radial Artery Grafting Safely and Efficiently Increases Multi Arterial Grafting in Patients Undergoing Coronary Artery Bypass Grafting: A Propensity Score Analysis of Operative Outcomes
Authors: Ifeanyi Chinedozi, Jonathan Mathews, Anson Lee, Emily Larson, Janelle Sangalang, Nivedita Kumar, Hanghang Wang, Jin Kook Kang, Zachary Darby, Puja Kachroo, Jennifer Lawton
Journal: Circulation (2024)

Introduction/Background: Use of the radial artery (RA) is associated with better clinical outcomes compared to the saphenous vein during coronary artery bypass grafting (CABG) and is strongly endorsed by society guidelines. While the safety of using the RA as a sequential T-graft from the internal mammary artery is established, evidence on the safety and efficiency of sequential radial artery grafts directly from the aorta is limited. Research Questions/Hypotheses: The use of a sequential radial artery originating on the aorta is safe and efficient and is associated with an increase in the number of arterial grafts used in patients undergoing CABG. Goals/Aims: To evaluate the safety and efficiency of using the radial artery in a sequential approach directly from the aorta during CABG. Methods: STS database analysis of patients undergoing isolated CABG with ≥1 RA by one surgeon at two centers (2001-2022). Patients with sequential vs. non-sequential RA grafting were compared. Primary outcomes included CPB and cross-clamp time, total number of arterial grafts, and incomplete revascularization. Secondary outcomes were 30-day mortality, reoperation, stroke, renal failure, sepsis, ICU length of stay, and deep sternal wound infection. Statistical methods included Mann-Whitney U test, Chi-Square test, and Optimal Matching Propensity Score analysis (1:3 ratio). Results: Of 503 patients who received an RA graft, 129 (25.6%) were sequential. Before matching, significant differences were noted in median age, BMI, CPB and cross-clamp (XC) time, and elective status between groups. Sequential RA use was associated with a higher median number of arterial grafts and total grafts (3 vs 2, and 4 vs 3, respectively, p&lt;0.001 for both). Following propensity score matching (SMD &lt;0.1, n=125 sequential and 370 non-sequential), baseline characteristics were similar. Matched patients with sequential RA and ≥5 grafts had significantly shorter median CPB and cross-clamp time (142 [135–161] vs. 164 [164–164] min, and 113 [107–122] vs. 137 [124–137] min, p&lt;0.001 for both), higher number of arterial grafts and total arterial grafting (p&lt;0.001 for both), and lower rates of incomplete revascularization (17/125 vs. 83/370, p=0.046). No differences were observed in clinical outcomes between matched groups.
Abstract Sa303: Active Decompression during Automated Head-up Cardiopulmonary Resuscitation
Authors: Pouria Pourzand, Johanna Moore, Mithun Suresh, Bayert Salverda, Hamza Hai, Alexander Kaizer, Sue Duval, kerry bachista, Keith Lurie, Anja Metzger
Journal: Circulation (2024)

Background: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) combined with an impedance threshold device (ITD) and controlled head-up positioning, collectively termed AHUP-CPR, is associated with improved outcomes compared with conventional CPR (C-CPR). Active decompression (AD) forcibly lifts the anterior chest wall with suction after each compression, while the ITD simultaneously impedes airflow into the lungs. AD and ITD synergistically lower intrathoracic pressure during decompression, improving venous return, ventricular refilling and cardiac output. Concurrently, head-up positioning lowers intracranial pressures and improves cardiac preload. This pig study focused on the physiological role of AD during AHUP-CPR, simulating real clinical scenarios. Methods: Ten male and female farm pigs (~40 kg) were anesthetized, intubated and ventilated. Hemodynamic parameters, end-tidal CO2 (ETCO2), and biventricular pressure-volume loops were recorded continuously. Ventricular fibrillation was induced and left untreated for 10 mins. Then, after 2 min of automated C-CPR in the flat position, AHUP-CPR with a 3 cm lift above the neutral position of the chest was performed for 13 min. AD was then abruptly discontinued, restarted 1 min later, and increased incrementally every min to up to 4 cm of active lift. Data were analyzed with a linear mixed-effects model, using random intercepts for individual pigs. Results: Upon cessation of AD, coronary and cerebral perfusion pressures, compression and decompression aortic pressures, compression right atrial pressure, ETCO2, right and left ventricular preload, compliance, stroke volume and cardiac output all decreased immediately and significantly (p&lt;0.01), whereas decompression right atrial and biventricular pressures increased. With restoration of AD, physiological parameters returned to ≥ 90% of pre-AD discontinuation values (Figures 1 and 2). Conclusion: Full chest wall lift, achieved with &gt; 3 cm of AD, was needed to maintain and optimize hemodynamics during AHUP-CPR in pigs. After pausing AD, incremental restoration of AD resulted in nearly complete restoration of peripheral and central hemodynamic measures. These observations support the benefit of and need for ≥3 cm of AD to optimize AHUP-CPR. Effective means to generate ≥3 cm of AD should be considered when implementing and developing AHUP-CPR devices to optimize outcomes.
Abstract Sa1006: Association between Increment of Near-Infrared Spectroscopy-Derived Cerebral Perfusion Index and Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients: A Prospective Observational Study
Authors: NORIHIRO NISHIOKA, Takeyuki Kiguchi, Yuto Makino, Kouhei Ninomiya, Wataru Kamo, tsuyoshi Kamada, Hideki Maeda, Taku Iwami
Journal: Circulation (2024)

Introduction: Maintaining cerebral blood flow during cardiopulmonary resuscitation (CPR) is vital, yet establishing a dynamic indicator of cerebral blood flow during CPR remains challenging. Near-infrared spectroscopy (NIRS) is a non-invasive technique capable of continuously detecting changes in cerebral blood volume and has the potential to assess cerebral blood flow in real-time during cardiac arrest. Despite its potential, limited research exists on cerebral perfusion indexes measured by NIRS during CPR and their clinical outcomes. Research Questions: Can assessing cerebral perfusion indices (CPI) using NIRS during CPR in out-of-hospital cardiac arrest patients serve as a prognostic indicator? Aims: To evaluate the association between increased CPI measured by NIRS during CPR by EMS personnel on-scene and return of spontaneous circulation (ROSC) after adult out-of-hospital cardiac arrest (OHCA). Methods: Between January 2021 and March 2023, we included consecutive out-of-hospital cardiac arrest patients due to internal causes who were attempted resuscitation by emergency medical services (EMS) in Sapporo city, Japan. EMS placed a NIRS monitor probe (NIRO 200-NX; Hamamatsu Photonics, Japan) on the patient's forehead and began measurements simultaneously upon contact with the patient. Patients treated with a mechanical chest compression device were excluded. We focused on the change of NIRS pulse waves during CPR at the scene and analyzed the values of NIRS pulse waves at two points: patient contact and scene departure by EMS. NIRS technology measures changes in total hemoglobin (ΔcHb) and oxygenated hemoglobin (ΔO2Hb) concentrations. Patients were divided into groups based on whether their ΔcHb and ΔO2Hb levels increased or decreased between patient contact and scene departure. The primary outcome was prehospital ROSC, and no cases of ROSC were observed at the scene. Results: During the study period, 91 patients were included. The prehospital ROSC rate was 16.4% (11/67) in the group with an increasing ΔcHb trend, compared to 0% (0/24) in the group with no increasing trend (p = 0.034). Regarding ΔO2Hb, the rate was 14.7% (10/68) in the group with an increasing trend and 4.3% (1/23) in the group with no increasing trend (p = 0.279). Conclusion: The increase in CPI measured by NIRS during CPR on-scene was associated with ROSC. Further research is warranted to determine whether CPI can aid in predicting the prognosis of cardiac arrest patients.