tbuckley/cabot-search huggingface dataset:
Abstract 4133830: Uncovering the Gaps: Analyzing Prescribing Patterns of Combination Therapy with SGLT2-inhibitors and GLP-1 Receptor Agonists in Established Atherosclerotic Cardiovascular Disease (ASCVD) and Type 2 Diabetes (T2DM)
Authors: Sanchaya Khetrapal, Mrudula Gadani, Kathryn Manalo, Andrew Oehler, Yue Yin, Siddarth Pratapneni, Yochitha Pulipati, Aaisha Shah
Journal: Circulation (2024)

Introduction: Combination therapy with SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA) reduces major cardiovascular events (MACE) and improves HbA1c, blood pressure, weight, and renal disease progression. The European Society of Cardiology recommends this therapy for ASCVD and T2DM, independent of HbA1c. This study evaluates prescribing patterns in the Internal Medicine Residency Clinics for patients with ASCVD and T2DM. Aims: To investigate demographic and social determinants of health (SDOH) influencing the prescription of combination therapy versus no therapy in an outpatient population and identify factors affecting prescribing patterns and guideline adherence. Methods: We reviewed 828 electronic records of T2DM and ASCVD patients from March 2024. Patients were grouped into combination therapy (SGLT2i and GLP1RA) and no therapy groups. Data on demographics (Table 1) and SDOH (Table 2) were analyzed. Patients on monotherapy or those who did not complete the SDOH questionnaire were excluded. Descriptive statistics were used to summarize demographics. Welch’s t-test compared continuous variables, and chi-square or Fisher’s exact tests compared categorical variables. Analyses were done with SAS 9.4 with significance at 0.05. Results: Age significantly differed between groups (t = 4.56, p &lt; .05), with older patients less likely to receive therapy. Sex was also significant (p &lt; .05); more females were in the no therapy group. No significant association was found between SDOH and combination therapy (p &gt; .05). Conclusion: Over 90% of patients with T2DM and ASCVD were not on optimal medical therapy to reduce MACE, with nearly half on no medications. This highlights the need for increased awareness and targeted interventions to improve outcomes. Future research will explore insurance status and physician awareness to address prescription discrepancies. Limitations: Patients with a GFR &lt;30 are precluded from SGLT2i usage but were not excluded from this study.
Abstract 4144553: Fully Automated Machine Learning Based Echocardiographic Assessment of Global Longitudinal Strain in Breast Cancer Patients Receiving Cardiotoxic Chemotherapy
Authors: Romil Patel, Kifah Hussain, Thriveni Sanagala, Jason Robin, Ilya Karagodin
Journal: Circulation (2024)

Background: Global longitudinal strain (GLS) is considered the most sensitive echocardiographic marker for detecting cardiotoxicity and subclinical changes in cardiac function in patients receiving cardiotoxic therapies. Despite literature that has shown less inter-observer variability for GLS compared to left ventricular ejection fraction, there remains significant variability in GLS measurement across observers and vendors. US2.AI is a novel, machine learning-based artificial intelligence (AI) algorithm for automated echocardiographic interpretation. We aim to demonstrate the feasibility of AI-based GLS assessment and hypothesize that AI-based GLS measurement is more reproducible compared to human-based measurement Methods: A total of 27 transthoracic echocardiograms were selected at random from a population of female cardio-oncology breast cancer patients and were run through the US2.AI algorithm twice to calculate GLS. The same echocardiograms were then analyzed by two board-certified cardiologists in a blinded fashion to calculate GLS using QLAB software (Philips). The two methods of GLS measurement (AI versus humans) were compared using linear regression, as assessed by the Pearson correlation coefficient. Reproducibility for each method was assessed using the intra-class correlation coefficient (ICC). Results: A total of 27 studies were analyzed with a mean age of 55.6 ± 11.3 and all patients were female. The feasibility of US2.AI for the assessment of GLS was demonstrated with a strong correlation between AI-based and human reads (r = 0.80, p &lt; 0.00001). The reproducibility of AI-based GLS assessment was superior to that of human readers as assessed by an ICC of 1.0 versus 0.52, respectively. Conclusion: AI-based assessment of GLS was shown to be both feasible and more reproducible compared to expert human readers in a population of breast cancer patients receiving cardiotoxic chemotherapy. Given the important clinical implications of GLS in cardio-oncology patients, more widespread implementation of AI-based strain assessment has the potential to significantly improve the reproducibility of GLS measurement in this unique patient population.
Abstract 4139188: Myocardial perfusion, oxidative metabolism and fibrosis in heart failure with preserved ejection fraction
Authors: Ravinder Mallugari, Cassandra Reynolds, JoAnn Gottlieb, Shannon Bozeman, Dana Fuhs, Sean Hughes, William Bradham, Mark Lawson, Marvin Kronenberg, Deepak Gupta
Journal: Circulation (2024)

Background: Cardiac remodeling among individuals with heart failure with preserved ejection fraction (HFpEF) and its risk factors is incompletely understood. Non-invasive cardiac imaging can reliably assess myocardial oxidative metabolism, perfusion, fibrosis, systolic and diastolic function. Nevertheless, the interrelationships between these, particularly with oxidative metabolism, remain unresolved from health to HFpEF as most human studies lack complementary multi-modality imaging. Methods: We performed a cross-sectional study using multi-modality cardiovascular imaging in healthy individuals (n=17), those with hypertension (n=15), and patients with HFpEF (n=8). We quantified myocardial oxidative metabolism (K mono ) with 11 C-acetate positron emission tomography (PET), coronary flow reserve (CFR) with 13 N-ammonia PET, fibrosis (extracellular volume [ECV], LVEF and mass with magnetic resonance imaging (MRI), and LV diastolic filling pressure (E/e’) by echocardiography. The associations between myocardial oxidative metabolism, perfusion, and fibrosis across clinical status (health, hypertension, and HFpEF) were examined in multivariable models. Results: From health to HFpEF, we found significant graded declines in oxidative metabolism indexed to workload (K mono /RPP) (β = -1.66 x 10 -6 [95%CI: -3.12 x 10 -6 to -2.10 x 10 -6 ]; p = 0.027) and CFR (β = -0.76 [95% CI: -1.36 to -0.16]; p = 0.021), along with increased fibrosis (ECV) (β = 2.12% [95% CI: 0.10 to 4.14%]; p = 0.041), independent of LVEF, LV mass, E/e’, age, sex, and body mass index. The decline in oxidative metabolism from health to HFpEF was also independent of ECV and CFR (β = -2.98 x 10 -6 [95% CI: -5.62 x 10 -6 to -3.41 x 10 -6 ], p = 0.015). In contrast, the decline in CFR from health to HFpEF was no longer significant (p = 0.30) with further adjustment for ECV. Conclusions: HFpEF and its development involves progressive declines in myocardial oxidative metabolism and perfusion reserve with increase in fibrosis. The decline in myocardial oxidative metabolism from health to HFpEF is independent of fibrosis and perfusion reserve, suggesting oxidative metabolism may be a target for the prevention and treatment of HFpEF.
Abstract 4144573: Cardiac biomarkers, intensive lifestyle intervention, and risk of heart failure subtypes in type 2 diabetes – a post-hoc analysis of the Look AHEAD trial
Authors: Zainali Chunawala, Kershaw Patel, Matthew Segar, Katelyn Garcia, Deepak Bhatt, Thomas Wang, James Januzzi, Javed Butler, Carolyn Lam, Alain Bertoni, Mark Espeland, Ambarish Pandey
Journal: Circulation (2024)

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) identify subclinical heart failure (HF) in type 2 diabetes (T2D). The contribution of changes in cardiac biomarkers to HF risk, particularly HF subtypes, is unclear. Whether HF risk associated with cardiac biomarkers is modifiable with an intensive lifestyle intervention (ILI) targeting weight loss is unknown. Methods: Adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial without prevalent HF were included. NT-proBNP and hs-cTnT were measured at baseline, 1- and 4-years (Roche Diagnostics). Adjusted Cox models were created to evaluate the associations of baseline, 1- and 4-year change in NT-proBNP and hs-cTnT with risk of HF with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). Interaction testing was performed to evaluate heterogeneous effects of the ILI vs diabetes support and education (DSE) across baseline cardiac biomarkers. Results: Of the 3,959 participants included, 212 had incident HF (108 HFpEF, 84 HFrEF) over 12 years. Higher baseline NT-proBNP and hs-cTnT were each significantly associated with higher risk of HFpEF and HFrEF ( Table) . Increases in NT-proBNP over 1- and 4-years were significantly associated with higher risk of HFpEF and HFrEF with a similar pattern of association for hs-cTnT and HF subtypes. After accounting for risk factor changes, the association of 1- and 4-year changes in NT-proBNP, but not hs-cTnT, with risk of HF subtypes remained significant. There was a significant interaction between NT-proBNP and ILI for risk of HFpEF but not HFrEF (p-int = 0.001). The ILI reduced HFpEF risk among participants with elevated (≥125 pg/mL) but not non-elevated NT-proBNP (&lt;125 pg/mL) (ILI vs DSE HR [95% CI]: 0.48 [0.25-0.93] and 1.67 [0.94-2.94], respectively). No significant treatment group by hs-cTnT interactions were identified. Conclusions: In T2D, longitudinal changes in cardiac biomarkers, particularly NT-proBNP, are significantly associated with HF risk, independent of risk factor changes. In Look AHEAD, elevated NT-proBNP may identify individuals who are more likely to benefit from the ILI for HFpEF prevention.
Abstract 4140111: Impact of Digital Health Tools on Patients Undergoing Cardiac Rehabilitation
Authors: Ming-Tse Tsai, Marissa Dzotsi, Aryana Pazargadi, Tiffany Chin, Jacob Bramwell, Hao-Chun Chang, Pam Taub
Journal: Circulation (2024)

Digital health apps are novel tools that have the potential to enhance patient care. However, their benefits in the context of cardiac rehabilitation (CR) are not well studied. This study aims to examine an app’s effectiveness in enhancing exercise performance. The app (KardioPAC) connects to both Bluetooth and cellular-enabled BP devices, which allows providers to monitor and communicate with patients remotely. We aim to assess the app’s impact on functional capacity (metabolic equivalents /METs) compared to standard of care (SOC) CR. This study took place at UC San Diego. Participants were recruited from CR, and randomized in a 1:1 ratio to the two study arms (KardioPAC+CR vs SOC CR). The intervention group was requested to take BP at home and upload via KardioPAC. They additionally received a BP reminder daily and got an intra-app call from the care team at least every 1-2 weeks and when needed. All patients, including SOC arm, were asked to complete a pre- and post-CR visit. In each visit, several measurements (including blood pressure, METs, and quality of life questionnaires) were recorded. The study was approved by the UCSD IRB. All statistical analyses were performed on Python 3.11.8. From Jan 2023 to Mar 2024, 43 patients were enrolled. Table 1 shows their demographics. The mean METs changes are 3.68 vs 2.97 (Intervention vs Control, p=0.052). The mean METs percent changes are 104.39% vs 81.22% (Intervention vs Control, p=0.042), as plotted in Figure 1. Our study found that digital tools significantly enhance CR patients’ performance, even with a small sample size. Furthermore, we found positive signals of digital tools in reducing patients’ blood pressure and improving their quality of life. Patients’ behavior could be changed by incorporating digital tools into daily practice. Our study warrants large-scale studies to investigate the underlying mechanisms and verify the broader benefits of digital tools, including physical, mental, and social improvements.
Abstract 4143289: Contemporary and Genomic Cardiovascular Risk Factors Have Explanatory Power Similar to Traditional Risk Factors for Incident Myocardial Infarction
Authors: Romit Bhattacharya, Christopher Marnell, So Mi Cho, Satoshi Koyama, Amanda Jowell, Mark Trinder, Sara Haidermota, Kim Lannery, Michael Honigberg, Seyedeh Zekavat, Ida Surakka, Gina Peloso, Pradeep Natarajan
Journal: Circulation (2024)

Background: Modifiable cardiovascular risk factors (CRF) have been proposed to be responsible for 80-90% of the risk for incident coronary artery disease (CAD). However, these studies were conducted prior to the era of preventive medications, novel biomarkers, and genetic risk scores. The relative contributions of traditional and contemporary CRF in light of secular trends in worsening cardiometabolic health globally have not been assessed. Hypothesis: Including genetic risk scores and contemporary biomarkers will enhance discrimination and explainability of myocardial infarction (MI) incidence prediction. Methods: The UKBiobank was used to identify traditional CRF (hypertension, diabetes, dyslipidemia, smoking, waist-to-hip ratio (WHR), diet, exercise, alcohol intake and socioeconomic deprivation), and contemporary/genetic CRF (lipoprotein(a), high-sensitivity C-reactive protein [hsCRP], familial hypercholesterolemia [FH] variants, and polygenic risk score for CAD [PRS CAD ]). Incident MI was defined as first-time MI diagnosis or coronary revascularization. Base model discrimination was assessed using C-statistics from Cox proportional hazards models. Percent contribution of each risk factor was calculated by explanatory power lost via Nagelkerke R 2 after removal of the CRF from the full model. Population attributable risks (PAR) were additionally assessed for each model and CRF individually. Results: Over a median [IQR] follow-up of 11.0 [9.6, 12.5] years, 17409/299707 (5.8%) of participants developed incident CAD. C-statistics sequentially increased from base model to traditional CRF to contemporary/genetic CRF model with PAR of 84.3% (95% CI 82.4%-86.5%) ( Table 1 ). Among CRFs, hypertension (C 0.74, R 2 loss 15.2%, PAR 32.5%) and PRS CAD (C 0.72, R 2 loss 12.4%, PAR 38.4%) most strongly explained MI incidence by all 3 indices. Based on discriminability, ApoB:ApoA1 ratio (C 0.71, R 2 loss 3.4%), presence of diabetes (C 0.71, R 2 loss 2.2%), and log(hsCRP) (C 0.71, R 2 loss 1.82%) were subsequently prioritized. PAR analyses included prevalence in prioritization where WHR, presence of diabetes, and log(lipoprotein(a)) levels rose higher. Conclusions: The addition of genetic risk factors and contemporary biomarkers to explanatory models for CAD shows previously underappreciated importance of contemporary CRFs such as PRS, hsCRP, and lipoprotein(a) alongside traditional CRFs such as hypertension, dyslipidemia and presence of diabetes.
Abstract 4114714: Impact of Cardiology Interest Groups on the Professional Development of Medical Students
Authors: Lina Ayasrah, Abdulkader Mohammad, Adriana Mares, Norma Gamarra, Khristian Burke, Mariana Henry, Sebahat Ulusan, Giuliana Mertz, Tasha Phillips-Wilson, Sean O'Very, Lucia Schroeder, Muhammed Erbay, Nikolaos Pyrpyris, Diane Masket, Aayushi Sood, Rahul Gupta, Zain Ul Abideen Asad, Shady Abohashem
Journal: Circulation (2024)

Background: Launched in 2023, the American College of Cardiology Medical Student Member Community (ACC MSMC) began recognizing Cardiology Interest Groups (CIGs) at medical schools worldwide. This initiative fosters a robust network among ACC medical student members and celebrates their contributions within their institutions and broader communities. We surveyed medical students from 50 recognized CIGs to evaluate the influence of this network on their members' career trajectories. Methods: An anonymous web-based survey was sent to 50 student leaders of CIGs recognized by the ACC from 20 countries and was distributed to their members. The objective was to evaluate the impact of their involvement in these groups on their clinical knowledge, research activities and publications, professional advancement, and the promotion of diversity and equity. Results: Of 215 respondents (71% ACC members), 49.3% identified as female, with significant representation from Asia (35.7%), and the USA (17.6%). The majority joined CIGs to explore cardiology as a career path (61%), build professional networks (60%), and participate in specialized workshops (59.5%). Most rated their access to CIG resources as excellent (73.8%), supporting ACC's mission to enhance diversity and inclusion. Regarding educational outcomes, 48.6% rated their knowledge acquisition in cardiology as excellent, and 41% noted excellent preparation for a cardiology career. Additionally, 26.4% of students published research papers post-CIG involvement, with 39% attending ACC or AHA conferences. Survey feedback also highlighted strong networking (38.6% excellent) and mentoring opportunities (36.2% excellent) provided by CIGs. Conclusions: CIGs significantly enrich medical students' professional development by offering extensive networking, education, research, and mentorship opportunities. They play a crucial role in nurturing a global interest in cardiology, thereby enhancing diversity within the field. This model serves as a valuable blueprint for other scientific societies considering the establishment of student interest groups.
Abstract Sa1103: Utility of early Computed Tomography after out-of-hospital cardiac arrest resuscitation
Authors: Saleem Halablab, Frances Shofer, Aarthi Kaviyarasu, William Reis, Jared McFerran, Anahita Ghorbani, Taylor Brothers, Oscar Mitchell, Benjamin Abella
Journal: Circulation (2024)

Background: Initial care after out-of-hospital cardiac arrest (OHCA) poses major challenges to clinical teams due to diverse arrest etiologies and the potential need for time-sensitive interventions. Emergency department-based evaluation of these patients is crucial for identifying treatable causes of arrest. Recent data from one academic hospital highlights the potential importance of initial broad computed tomography (CT) immediately following resuscitation. Objective: To assess the ability of early post-arrest CT imaging to diagnose potential etiologies and sequelae of OHCA. Methods: We employed a registry of consecutive OHCA cases admitted to 3 hospitals within the University of Pennsylvania Health System between 1/2019-10/2020, collecting demographic, arrest, and post-arrest clinical data. Inclusion criteria included age &gt;18 y, OHCA with return of spontaneous circulation (ROSC). We abstracted CT data including findings, contrast use, and timing, and subsequent clinical notes to assess for interventions performed based on CT findings from the EHR. KDIGO definition was used for acute kidney injury (AKI). SAS software was used for data analysis. Results: A total of 161 OHCA patients were included (mean age 60.8±15.6y; 42% female). Initial shockable rhythms were present in 16%, with 70% witnessed and 39% receiving bystander CPR. 154 patients survived to admission, and 41 survived to discharge. 117 patients underwent CT imaging in the ED: 117 underwent head CT, 87 chest CT, and 64 abdomen/pelvis CT. Median time to any first CT was 2.0h (IQR:1.4,2.8). Intracranial hemorrhage was diagnosed in 5/117 patients (4.3%); 3 received conservative therapy. Cerebral edema was found in 30/117 patients (25.6%), 10 received treatment. Pulmonary embolism was diagnosed in 8/87 cases (9.2%), 7 of which were acute and treated pharmacologically and/or mechanically. Aspiration and/or pneumonia, pneumonitis, bronchitis, bronchiolitis was found on 65/84 cases (74.7%), 30 received antibiotics. Deep venous thrombosis was detected in 3/64 patients (4.7%), 2 received anticoagulation. We found no significant differences in AKI rates with the use of contrast compared to patients receiving no contrast (p=0.93). Conclusion: These results confirm and extend other reports emphasizing the potential value for routine use of CT imaging post-ROSC. Implementing larger scale prospective studies comparing such protocols and standard-of-care is important to determine impact on OHCA outcomes.
Abstract 4144581: Diltiazem, Direct Oral Anticoagulants and Risk of Major Bleeding in Patients with Atrial Fibrillation
Authors: Jia Ee Chia, Song Peng Ang, Chayakrit Krittanawong, Shreya Patel, Debabrata Mukherjee
Journal: Circulation (2024)

Background: Existing research suggests a potential increase in bleeding risk associated with the combined use of calcium channel blockers (CCBs) and direct oral anticoagulants (DOACs). However, the evidence remains inconclusive and conflicting. To clarify this relationship, we conducted a meta-analysis to investigate the risk of major bleeding in patients with atrial fibrillation (AF) using diltiazem. Methods: We conducted a comprehensive search of major electronic databases, including PubMed, Embase, and the Cochrane Library, from their inception through April 20, 2024 for relevant studies. The primary endpoint was major bleeding, defined as a composite of bleeding-related hospitalization, requiring blood transfusion, or fatal bleeding. We conducted a conventional meta-analysis using the Hartung-Knapp-Sidik-Jonkman random-effects model. Endpoints are expressed as hazard ratio (HR) and their corresponding confidence intervals (CI). Results: A total of 5 studies with 488,884 patients with AF were included in our study, of which 23.4% of patients were on diltiazem. All patients were also on DOACs. Results of the meta-analysis showed that there was no statistically significant difference between use of diltiazem and the risk of major bleeding (HR 1.16 ; 95% CI 0.94-1.42). Sensitivity analysis showed that this result remained unaltered in terms of magnitude and direction after excluding one study at a time. When stratified by type of control group, both active comparator (HR 1.09 ; 95% CI 0.92-1.30) and non-use subgroups (HR 1.24 ; 95% CI 0.87-1.77) showed that there was no significant difference in the risk of major bleeding with diltiazem use respectively. Conclusion: We observed that there was no significant difference in the risk of major bleeding in diltiazem use compared to controls in AF patients on DOACs. Further large-scale, longitudinal, and prospective studies are essential to validate these findings.