tbuckley/cabot-search huggingface dataset:
Abstract 17562: Real-World Evidence for Comparative Effectiveness of Antihypertensive Therapeutic Intensification Strategies: Increasing Dose versus Adding a New Medication
Authors: Ben Martin, Susan E Sutherland, Michael Rakotz, Brent M Egan
Journal: Circulation (2023)

Background: Clinical efficacy research indicates a placebo-adjusted 7-11 mmHg reduction in SBP can be expected from adding an antihypertensive (AH) medication class compared to a 2-3 mmHg reduction from doubling the dose of a currently prescribed AH medication. Given the relative dearth of real-world data required for external validity and generalizability, we examined the comparative BP effects of AH class addition vs. dose escalation in electronic health records from adult ambulatory primary care clinics. Methods: Analysis was performed with observational data from five distinct health care organizations in 2020-2022. The BP-lowering effect in patients with existing AH medication (n=10,119) was compared for AH intensification (adding a class), versus a dose increase. One-to-one propensity-score (PS) matching was used to decrease the presence of bias and confounding in effect estimation. Results: After PS matching on 20 different clinical and demographic variables, 6,826 patients were included in the final model. Simple linear regression found a 1.31 mmHg greater SBP reduction (14.02 vs. 12.71 mmHg, p=0.0052) after adding a new medication compared to increasing dose. To control for regression to the mean, each group was compared to another group with no medication changes, and a 2.96 vs 1.50 mmHg difference was detected. Removing instances of class additions that resulted in known less than additive combinations of AH medications led to a more pronounced difference, with class additions having a 1.93 mmHg greater SBP reduction than dose increases (p=0.00003). Conclusion: This study provides quasi-experimental real-world evidence for a greater magnitude of SBP reduction after a new AH class is added than after increasing the dose of existing AH medication, although the magnitude of effect is much less than in efficacy studies. Further research to better understand the nuanced dynamics of dose escalation vs. class addition could improve the AH response to treatment intensification.
Abstract 19206: Race, Ethnicity, Gender, and Age Differences in Covid-19-Related Mortality From Diseases of the Heart
Authors: Carol R Oladele, Tyra Dark, Elizabeth B Pathak
Journal: Circulation (2023)

Introduction: Early evidence showed SARS-CoV-2 infection was associated with increased risk of acute cardiovascular complications. COVID-19 has since been implicated in intermediate and long-term cardiovascular disease. However, the impact of COVID-19 on heart disease mortality for specific demographic groups has not been investigated. Goals: This study aimed to determine whether excess heart disease mortality was COVID-19 related and whether differences existed by race/ethnicity, gender, and age.Research Question: What was the excess heart disease mortality associated with COVID-19 in 2020 and 2021? Methods: Death certificate and population data (2010-2021) for Black, White, and Hispanic adults were analyzed. Deaths with diseases of the heart (DOH) as either underlying or contributing cause were included (ICD-10 I00-I09, I11, I13, I20-I51). We fit a log-linear regression model to annual death rates for 2010-2019. Model coefficients were used to estimate expected DOH death rates for 2020-2021. We then compared observed to expected DOH mortality rate ratios and rate differences by age, sex, and gender for those pandemic years. The proportion of excess DOH deaths which had COVID-19 reported on the death certificate was calculated. Results: From 2010-2019, mortality from DOH was highest among Black men. Ratios of observed to expected DOH mortality rates for 2020-2021 were highest among younger ages (25-44 years), men, and Hispanics and Blacks compared to Whites. The proportion of excess DOH deaths with reported COVID-19 was highest among Hispanics compared to other demographic groups across all ages except those 85+. Seventy-five and 78 percent of excess deaths among Hispanic adults 55-64 years were COVID-19 related. Conclusion: Excess deaths during the COVID-19 pandemic were highest among young Black men and COVID-19 was more often reported with excess DOH deaths among Hispanic adults. Findings are consistent with other evidence of disproportionate negative social and structural impacts of COVID-19 among Black and Hispanic communities.
Abstract 17760: Conversion of Dicom ECG Images to Tabular Format for Building Large Language Model in Diagnoses and Disease Progression of Cardiovascular Conditions
Authors: Sujoy Kar, Shivkumar jallepalli, Bharath Potla, Sai Praveen P Haranath, Sangita Reddy
Journal: Circulation (2023)

Introduction: DICOM Electrocardiography (ECG) images from individuals are routinely stored at the institutional PACS server, including normal and abnormal findings. Hypothesis: The study’s objective is to create a database of ECGs as per Standard Communication Protocol (SCP) and to build an accurate Large Language Model (LLM) across different cardiovascular conditions Methods: DICOM ECGs are retrieved, anonymized and labelled to convert the signals to (x, y) coordinates with the help of PyDicom libraries. The tabular format is then stored with lead definition and dimensions of duration and amplitude, metadata, clinical conditions, and textual diagnoses. Results: In the pilot study, 1308 ECGs from individuals with different age (&lt;45 &amp; &gt;45 years), gender (male &amp; female), binary clinical categories (normal &amp; abnormal) and heart rate (&lt;90 &amp; &gt;90 per min) are selected for analysis and modeling. The DICOM image signal reproducibility following conversion (Figure 1 &amp; 2) shows Cross Correlation Percentage of 0.85 (0.76 - 0.94) (Figure 3). An eXtreme Gradient Boosting (XGBoost) model (6) was trained to predict above variables. The results (Figure 4) show AUC highest for predicting binary clinical categories (normal vs abnormal) at 0.81 (0.7 - 0.9) and lowest for predicting age (&lt;45 &amp; &gt;45 years) at 0.6 (0.46 - 0.7). The accuracies in the leads also show similar trend. The limitations include reproducibility of results in Lead VIII, IX and XI, which are sub average and hence being retrained with optimizers. These are initial results with relatively smaller database where multiclass disease or condition classifications are not performed. Conclusions: To conclude, the methodology possesses opportunities to improve the model with Deep Learning and Entity Disambiguation Techniques (NLP) to build Large Language ECG Models for cardiovascular diagnoses and disease progression trajectories.
Abstract 18595: Predictors of Prolonged Post-Operative Stay in Patients Undergoing Coronary Artery Bypass Grafting: The Impact of Multi-Disciplinary Quality of Care Protocols, a Single Center Experience From the Middle East
Authors: Yazan Aljabery, Yosef Manla, Sama Thiab, GOPAL BHATNAGAR, Umer Darr
Journal: Circulation (2023)

Background: Prolonged postoperative stay (POS) in patients undergoing CABG is associated with increased cost, inefficient utilization of resources, and poor quality of care (QOC). We aim to identify predictors of prolonged POS and evaluate the overtime impact of multidisciplinary team (MDT) QOC protocols on POS at a newly established tertiary care center. Methods: A total of 1168 consecutive patients undergoing isolated CABG between 2015-2022 were evaluated. POS was identified as prolonged (&gt;6 days) and short (≤ 6 days). Short vs. prolonged stay groups were compared by appropriate testing methods. Predictors of prolonged POS were determined by multivariable logistic regression. Trends in prolonged POS were determined using Joinpoint Software to calculate the average annual percentage change (AAPC). Results: Overall, 44.3% (517/1168) of patients had prolonged POS. Patients in the prolonged POS group were older (59.1±10.5 vs. 56.3± 9.5, P&lt;0.001), more likely females (16.6% vs. 9.7%, P&lt;0.001), and had a higher burden of hypertension (88.1% vs. 81.9%, P=0.004), and diabetes (74.8% vs. 62.7%, P&lt;0.001). The prolonged POS group featured worse ejection fraction, higher serum creatinine, and more frequently required preoperative intra-aortic balloon pump insertion (Table) . On multivariable logistic regression, age, female gender, NYHA class ≥II, history of diabetes, preoperative creatinine level, preoperative EF, and preoperative IABP placement were independent predictors of prolonged POS (Figure A) . Between 2015-2022, more QOC protocols were initiated, with a 67% relative reduction in the proportion of patients with prolonged POS (85.7% to 28.3%), with an AAPC of -12.8, 95% CI [-16.3, -9.2], P&lt;0.001 (Figure B). Conclusion: Initiating MDT QOC protocols was associated with a reduction in POS among patients undergoing CABG. Identifying predictors of prolonged POS can help in timely planning of milestones aimed at eliminating unnecessary POS.
Abstract 15572: Assessing the Impact of Renal Denervation on Heart Failure: Results From the Pooled Analysis of Randomized Controlled Trials
Authors: Muhammed K Elfaituri, Alhasan Saleh Alzubi, Ala Khaled, Ahmed BenGhatnsh, Ahmed Elfaituri, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: Renal denervation (RDN), first developed for hypertension management, is currently being investigated as a potential treatment for heart failure (HF). However, its efficacy and safety for these patients necessitate further investigation. Hypothesis: This study aimed to assess the impact of renal denervation on various clinical and hemodynamic parameters in heart failure patients. Methods: A comprehensive search of PubMed, Cochrane Library, and Embase databases was performed for randomized controlled trials (RCTs) comparing RDN with standard care or placebo in HF patients, published until January 2023. Data were pooled using a random-effects model, and results were reported as Mean Differences (MD) with a 95% confidence interval (CI). All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages. Results: The search identified five RCTs involving 208 patients (103 in the RDN group and 105 in the control group). RDN was associated with significant improvements in left ventricular ejection fraction (MD: 4.48%, 95% CI: 0.57-8.4%, P=0.02, I2=77%), 6-minute walk distance (MD: 78.71 meters, 95% CI: 47.01-110.41 meters, P&lt;0.01, I2=0%), left ventricular end-systolic diameter (MD: -3.18 mm, 95% CI: -5.64 to -0.72 mm, P=0.01, I2=24%), and left ventricular end-diastolic diameter (MD: -4.16 mm, 95% CI: -6.04 to -2.29 mm, P&lt;0.01, I2=0%). However, no significant changes were noted in left atrial diameter (MD: -4.49 mm, 95% CI: -9.19 to 0.20 mm, P=0.06, I2=79%), New York Heart Association class (MD: -0.71, 95% CI: -1.65 to 0.24, P=0.14, I2=96%), heart rate (MD: -3.71 beats per minute, 95% CI: -8.45 to 1.03 beats per minute, P=0.12, I2=62%), systolic blood pressure (MD: -0.35 mmHg, 95% CI: -11.51 to 10.79 mmHg, P=0.95, I2=88%), and diastolic blood pressure (MD: -1.46 mmHg, 95% CI: -7.12 to 4.19 mmHg, P=0.61, I2=79%). Conclusions: RDN has shown the potential to improve left ventricular function and exercise capacity in managing heart failure. The results, marked by high heterogeneity in some outcomes and constrained by the limited number of trials and patients, necessitate larger multicenter trials for validation and further exploration of renal denervation's role in heart failure management.
Abstract 15181: Sensitivity and Specificity of the Artificial Intelligence-Based 5-Lead 3D Vectorcardiography in Patients With Suspected or Confirmed Coronary Heart Disease
Authors: Caroline Schmidt-Lucke, Betty Lischke, Eugenia Weber, Daniel Günther, Anne Schomoeller, Henning Steen, André Schmidt-Lucke
Journal: Circulation (2023)

Introduction: Artificial Intelligence-based 5-lead 3D-vectorcardiography (5L3DVCG-AI) offers additional information over 12-lead electrocardiography (ECG) identifying coronary vascular disease (CVD) in need for coronary intervention. Hypothesis: We tested the hypothesis of 5L3DVCG-AI being able to detect patients with mild to overt signs and / or history of CVD. Methods: In this monocentric retrospective study, consecutive data of 331 patients with 5L3DVCG-AI were included. The Perfusion (P)-Factor for cardiac ischaemic pathologies, based on the P-Index including 731 parameters and in-house features calculated in time and frequency domains (e.g. beat moments), classified patients as high, medium or low risk for CVD . Diagnosis of CVD was based upon current guidelines by 2 independent blinded cardiologists and categorised as exclusion of CVD (control), mild signs or overt CVD. The P-Index was validated against clinical CVD. Cardiovascular risk factors (CVRF) were quantified with modified PROCAM score. Results: Of 331 patients (m:w 60:40%, 50.0 ± 19.8 years) of mixed ethnicity and moderate CVRF (2.1 ± 1.2), 71% were controls, 20% had mild signs of CVD and 9% overt CVD. Follow-up period was 16.2 ± 7.5 months. CVRF was significantly higher in CVD compared to controls (2.7 ± 0.5 vs. 2.0 ± 1.2, p&lt;0.05), and P-Factor correlated with number of CVRF (p&lt;0.01), with significantly higher CVRF in higher P-factor (KW p&lt;0.001). P-Factor indicated significantly more often higher risk in CVD compared to controls (0.78 ± 0.4 vs. 0.34 ± 0.48, p&lt;0.01). P-Index from 5L3DVCG-AI at rest differentiated between CVD and controls (Chi2= 6.7, p=0.01). ROC curve showed correlation between P-Index and presence of CVD (R2=0.72, p&lt;0.05). ECG at rest was not able to differentiate between CVD and controls. Conclusions: These data extend the previous findings of 5L3DVCG-AI identifying CVD with cardiac ischaemia from those without to now differentiating healthy controls from CVD and those with higher risk for CVD. 5L3DVCG-AI may thus be a further scalable screening method to identify patients at risk for CVD in need for risk modification or further diagnostic procedures. Ongoing prospective large-scale clinical trials will have to confirm these data to verify diagnostic accuracy.
Abstract 13202: Efficacy and Safety of Combining a Thiazide Diuretic With a Loop Diuretic in Decompensated Heart Failure: A Systematic Review and Meta-Analysis
Authors: Rodrigo B Silveira Filho, Marcelo Antonio Pinheiro Braga, Isadora Mamede, Otavio C Martins, Anne Estefane Oliveira Franchini, Marcel Catao
Journal: Circulation (2023)

Background: Acute decompensated heart failure (ADHF) has several presentations, one of the most common being congestion which is treated by intravenous loop diuretics. However, prolonged use of this therapy may lead to resistance that can be overcome with a sequential nephron blockade by adding a thiazide diuretic. Less is known about the safety of that combination. Research question: Is the combination of a thiazide diuretic and a loop diuretic safe and effective? Goal: To perform a meta-analysis of the association between the combination of loop and thiazide diuretics, their efficacy, and potential adverse effects. Methods: We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials that compared patients with ADHF using only a loop diuretic and patients using a thiazide adjuvant therapy, and reported the outcomes of (1) weight change; (2) hypokalemia (potassium ≤ 3.5 mmol/L or potassium ≤ 3.5 mEq/L); (3) 30-day rehospitalization; and (4) length of stay. Heterogeneity was examined with I2 statistics. A random-effects model was employed. Review manager 5.4 was used for statistical analyses. Results: In 4 studies, among 424 patients with ADHF, 212 (50%) were treated with a combination of loop and thiazide diuretics and 212 (50%) had a loop monotherapy treatment. Overall, individuals receiving the diuretic combination experienced greater weight loss (MD -0.73; 95% CI -1.23, -0.24; p=0.004; Fig. 1A), but had higher incidence of hypokalemia (RR 2.36; 95% CI 1.56, 3.58; p&lt;0.0001; Fig. 1B) compared to those who were not receiving. There was no significant difference between both groups in all-cause 30-day rehospitalization (RR 1.26; 95% CI 0.81, 1.96; p=0.30; Fig. 1C) or length of hospital stay (MD 0.26; 95% CI -1.03, 1.54; p=0.70; Fig. 1D). Conclusions: These findings suggest that the combination of a loop and a thiazide diuretic may lower body weight in patients with ADHF. However, its role in improving clinical outcomes remains unclear.
Abstract 14010: Synergistic Influence of Rivaroxaban on Platelets, Inflammation and Coagulation Biomarkers in Patients With CAD and/or PAD on Aspirin Therapy
Authors: Udaya Tantry, Charles Cummings, Kevin Bliden, Paul Gurbel
Journal: Circulation (2023)

Background: Cardiovascular benefits of 2.5 mg twice daily rivaroxaban plus aspirin therapy (RIV+ASA) has been demonstrated in patients with arterial diseases. Hypothesis: RIV+ASA is associated with reduced platelet activation and plasma inflammation and coagulation activation markers in patients with CAD and/or PAD who were on ASA. Methods: In this open-label biomarker study, patients on 81 mg/day ASA were randomized to continue ASA or RIV+ASA for 12 weeks. We assessed ADP-, α-thrombin-, and tissue factor-induced platelet aggregation (PA) using conventional aggregometry, platelet-fibrin clot strength (PFCS) by INTEM (intrinsic pathway activator) and EXTEM (extrinsic pathway activator) using thromboelastometry, shear-induced PA by platelet function analyzer-100, D-dimer and fibrinogen using coagulation analyzer, hs-CRP and interleukin-6 using ELISA method at baseline, and four weeks and 12 weeks post-randomization. Results: Data was available in 9 patients with RIV + ASA and ten patients with ASA-only therapy. Most patients were male, Caucasians, obese and older. There were no differences in baseline demographics, medications, and laboratory values between groups, except patients in RIV + ASA group had higher white blood cell counts (p=0.028) and lower baseline 2uM ADP-induced PA (p=0.03). There were no differences in other laboratory measurements between baseline and post-randomization time points within the group or at 4- and 12-week time points between groups, except D-dimer values were significantly lower at 12 weeks (p=0.038) in the RIV + ASA vs. ASA-only group. No significant adverse events were observed. Conclusions: Twelve weeks of rivaroxaban plus aspirin vs. aspirin was associated with similar levels of platelet aggregation, platelet fibrin clot strength, fibrinogen and inflammation markers, and lower d-dimer levels.
Abstract 16224: Efficacy of Torsemide versus Furosemide in Heart Failure. A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Mohamed Eid, Kirolos Barssoum, Mostafa R Mostafa, Andrew Takla, Mostafa Najim, Sarah Mohamed, Mohamed Diab, Sarath Lal Mannumbeth Renjithlal, Hani Jneid
Journal: Circulation (2023)

There is conflicting evidence regarding how torsemide and furosemide differ in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure. Methods: MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception through January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change. Results: Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR 0.99; 95% CI, 0.97-1.02; p = 0.66; I2 = 0.03%); heart failure hospitalization (OR 0.96; 95% CI, 0.87- 1.06; p = 0.38; I2 = 89%) and weight change (mean difference -0.15; 95% CI, -0.82-0.52; p = 0.66; I2 = 94%). Conclusion: Furosemide and torsemide have a similar impact on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure
Abstract 15053: Distinct Effects of Sacubitril/Valsartan on Left Atrial Function Between Heart Failure With Preserved and Reduced Ejection Fraction
Authors: Takaaki Hashimoto, Kaho Hashimoto, Aika Iijima, Yuka Karasawa, Kazushige Amano, Tomoaki Hama, Toshiharu Fujii, Youta Kawamura, Akiko Ushijima, Fuminobu Yoshimachi, Norishige Morita, Mitsushige Murata
Journal: Circulation (2023)

Background: Although Sacubitril/Valsartan(S/V) could ameliorate left ventricular (LV) function, it was recently reported that S/V worsened the left atrial (LA) remodeling in pre-heart failure with preserved ejection fraction (pre-HFpEF). However, the effects of S/V on LA function remains controversial in heart failure. Accordingly, this study investigated the effects of S/V on LA function and remodeling in both HFpEF and HFrEF. Methods: This was a single-center retrospective study of patients with HF hospitalized at our hospital. Patients with HF underwent clinical evaluation and echocardiography at baseline and after administration with S/V. LA volume index (LAVI) , LA emptying fraction (LAEF), transmitral peak E wave velocity (E), pulsed-wave TDI e’ velocity (e’), and E/e` were measured by echocardiography. Results: A total of 71 consecutive patients (71 ± 13 years, 70% male) were enrolled in this study. Among them, 29 were patients with HFpEF (LVEF 55 ± 7%), and 42 were HFrEF (LVEF 28 ± 7%). S/V administration significantly reduced the serum brain natriuretic protein level in HFpEF and HFrEF (279 ± 343 to 155 ± 214 pg/ml, 638 ± 642 to. 218 ± 288 pg/ml, p&lt;0.05, respectively). LAVI was also significantly decreased after S/V administration in HFpEF and HFrEF (41 ± 11 to 38 ± 12 ml/m 2 , 50 ± 19 to. 41 ± 21 ml/m 2 , p&lt;0.05, respectively), implicating its effects on LA reverse remodeling. Furthermore, the significant decrease in the velocity of E wave and E/e’ were observed in HFpEF and HFrEF. However, LAEF were significantly improved in HFrEF, but not in HFpEF, while e’ were improved in HFpEF, but not in HFrEF. These results indicated that the effects of S/V might be attributable to LV relaxation in HFpEF and to LA reservoir function in HFrEF. Conclusions: This study demonstrated that treatment with Sacubitril/Valsartan could lead to LA reverse remodeling in both HFpEF and HFrEF, possibly due to the distinct mechanisms of Sacubitril/Valsartan for improving the LA function. Further studies should be needed to be clarified.