tbuckley/cabot-search huggingface dataset:
Abstract 18718: A Deep Learning Model for Classifying Left Ventricular Enlargement Using Transthoracic and Point-of-Care Echocardiograms
Authors: Jeffrey G Malins, DM Anisuzzaman, John Jackson, Eunjung Lee, Jwan Naser, Behrouz Rostami, Jared Bird, Paul Friedman, Francisco Lopez-Jimenez, Zachi Attia, Sorin Pislaru, Garvan Kane
Journal: Circulation (2023)

Background: Enlargement or dilation of the left ventricle (LV) is associated with increased cardiovascular morbidity and mortality, and is an established precursor of ventricular dysfunction and heart failure in almost all major cardiovascular conditions. Although there are existing artificial intelligence frameworks that make use of deep learning to detect LV enlargement, many entail LV segmentation, which can be error-prone especially for point-of-care ultrasound (POCUS) images. Goal: To develop a fully end-to-end deep learning framework that takes as input either transthoracic echocardiographic (TTE) or POCUS 2D image clips, and classifies directly (i.e., without first segmenting the LV) whether a patient has an enlarged LV. Methods: Using a sample of retrospective TTE data enriched for LV enlargement (out of 13,868 patients total, 3,351 had an enlarged LV defined using sex-specific guideline-directed criteria), we trained a classifier that takes as input apical 2-chamber and parasternal long axis videos, and provides as output a binary label denoting whether a patient has an enlarged LV. Then, we evaluated the trained model using a holdout testing dataset of retrospective TTE data (2,087 patients) as well as data from a prospective cohort of 428 patients from whom TTE and POCUS were collected simultaneously. Results: For the retrospective TTE testing dataset, the AUC was 0.851 (95% confidence interval (CI) of 0.830-871). For the prospective cohort, the model performed comparably for both TTE and POCUS video clips (TTE: AUC of 0.865, 95% CI of 0.823-0.906; POCUS: AUC of 0.840, 95% CI of 0.797-0.883). Conclusions: The current deep learning model performed comparably well for both TTE and POCUS echocardiograms. We regard these results as a proof-of-concept of the potential utility of this model in helping point-of-care clinicians make decisions regarding whether patients should receive further evaluation for LV enlargement and associated conditions.
Abstract 15785: Effects of Empagliflozin on Fatty Acid Binding Protein 4 and Body Composition in Patients Without Diabetes but With Risk Factors for Adverse Cardiac Remodeling From the Empa-Heart 2 Cardiolink-7 Randomized Clinical Trial
Authors: Ning-i Yang, Chao-Hung Wang, David Mazer, Subodh Verma
Journal: Circulation (2023)

Background: Prevention of the progression from stage B to C heart failure is an unmet need. Increased fat composition in skeletal muscle is one of the mechanisms associated with heart failure with preserved ejection fraction. Fatty acid binding protein 4 (FABP4) is known to facilitate the transport of fatty acid to tissue mitochondria for lipid oxidation. Knockdown of FABP4 gene is associated with increased body weight and fat mass in animal models. We sought to determine if Sodium-glucose co-transporter 2 (SGLT2) inhibition with empagliflozin leads to change in blood FABP4 levels and improvement in body composition in patients without diabetes and significant heart failure but with risk factors for adverse cardiac remodeling. Hypothesis: Empagliflozin increases blood FABP4 concentration and lowers body fat composition without changes in skeletal muscle mass. Methods: A total of 42 individuals between 40 and 80 years of age without diabetes but with risk factors for adverse cardiac remodeling were randomized to empagliflozin (10 mg/day; n=21) and placebo (n=21) groups for 6 months. Body composition parameters measured by bio-impedance analysis (InBody-720) included body weight (BW), skeletal muscle mass (SMM) and body fat mass (BFM) at baseline and 6 months follow up. Blood FABP4 concentrations were measured at the same time points. Results: There were no significant differences between two groups in baseline characteristics, BW, SMM, BFM, or FABP4. From baseline to 6 months, empagliflozin compared to placebo significantly increased blood FABP4 concentrations (6067.3 ± 7591.4 pg/ml vs 2714.9 ± 11232.6 pg/ml, p = 0.002), but decreased BW (-1.19 ± 1.01 kg vs 0.34 ± 2.59 kg, p = 0.018) and BFM (-0.68 ± 1.27 kg vs 0.53 ± 2.01 kg, p = 0.024). However, empagliflozin did not significantly affect changes in SMM from baseline to 6 months (-4.01 ± 0.70 kg vs -0.17 ± 0.96 kg, p = 0.387). Conclusions: SGLT2 inhibition with empagliflozin, in patients with neither diabetes nor significant heart failure but with risk factors for adverse cardiac remodeling, increased blood FABP4 concentrations and ameliorated BW and body fat composition with no effect on skeletal muscle mass following 6 months of treatment.
Abstract 14843: Unveiling the Phenotype of Smooth Muscle Foam Cells in Human Atherosclerotic Lesions: Insights From Bulk and Single Cell RNA Sequencing
Authors: Sima Allahverdian, Pinhao Xiang, Valentin Blanchard, Basak Sahin, Teddy Chan, Gordon A Francis
Journal: Circulation (2023)

Background and Aims: Our previous studies of human coronary atherosclerosis and ApoE-/- mice indicated that at least 50% and ~70% of foam cells are of smooth muscle cell (SMC) origin, respectively. We also found that SMCs generate a distinct class of foam cells, due to several gene expression and regulatory differences compared to macrophage foam cells. In the current investigation we utilized transcriptomic approaches to identify and characterize the phenotype of SMC foam cells of human coronary plaques and in SMCs treated with aggregated LDL (ag-LDL). Methods: Sections of fresh human coronary artery were subjected to gentle digestion and the isolated cells used for single-cell RNA Sequencing (scRNA-Seq) (n=3) using 10X Genomics Chromium Single Cell 3’ Reagent Kits v3 Technology. Human vascular SMCs were treated with 100 μg/mL ag-LDL for 24 h (n=3) and stained with the fluorescent lipid probe BODIPY493/503. BODIPY high SMCs were collected and subjected to bulk RNA sequencing along with non-treated SMCs as control. Results: Single cell RNA sequencing of cells isolated from human coronary arteries followed by unsupervised Seurat-based clustering (R version 4.2.0) identified 15 distinct clusters including 8 SMC clusters with varying degrees of differentiation and macrophage foam and non-foam cells. The top 70 upregulated genes in ag-LDL treated SMCs were used to identify clusters corresponding to SMC foam cells in the scRNA-seq dataset. We found that these genes are mostly enriched in 2 clusters of less differentiated SMCs. SMC and macrophage foam cell clusters display distinct characteristics. SMC foam cell clusters exhibit upregulation of complement and coagulation cascades, as well as ECM-receptor interaction genes. In contrast, the macrophage foam cell cluster shows enrichment of proinflammatory genes, genes involved in the response to unfolded protein, and both pro- and anti-apoptotic genes. Conclusion: Our studies provide novel tools to investigate the nature of SMC foam cells in human atherosclerosis and may provide unique markers for SMC foam cells. Gaining a comprehensive insight of the significance and characteristics of SMC foam cells is crucial in elucidating their ultimate role and potential as a therapeutic target in atherosclerosis.
Abstract 15801: Nighttime Hypertension is a Risk Factor for Cardiovascular Events in Stage B Heart Failure Patients
Authors: Takahiro Komori, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2023)

Background: Nighttime blood pressure (BP) was reported to have a stronger association with cardiovascular outcome and hypertensive organ damage than clinic BP, 24-hour BP, and daytime BP in hypertensives. However, the significance of nighttime BP was not established in stage B heart failure (HF) patients. We hypothesized that nighttime BP measured by home BP monitoring device was associated with cardiovascular outcome in stage B HF patients. Method: We used the dataset of Japan Morning Surge-Home Blood Pressure study (J-HOP study), and selected 417 of stage B HF patients. The definition of stage B HF was based on Universal definition of HF. The patients with history of HF hospitalization were excluded. BP was measured on waking, before bedtime and during the night. The cardiovascular event was followed. Result: Mean follow-up period was 6.6±3.8 years, and 59 cardiovascular events were occurred. When nighttime hypertension was defined as nighttime BP &gt;120mmHg, nighttime HT group showed higher BMI, serum creatinine, HbA1c, and higher prevalence of diabetes, atrial fibrillation, and chronic kidney disease, and lower HDL-cholesterol than nighttime normotension (NT) group. With regard to BP, nighttime HT group, clinic BP, home morning BP, home evening BP, and home nighttime BP were higher in nighttime HT group than in nighttime NT group. In Kaplan-Meier analysis, nighttime HT group had a higher incident of cardiovascular event than nighttime NT group (P&lt;0.01). In Cox multivariate analysis, nighttime HT was significant predictor for cardiovascular event adjusting by significant variables (Hazard ratio 1.84, 95% Confidence interval: 1.01-3.36, P=0.046). Conclusions: Nighttime HT was a prognostic factor in stage B HT patients. Nighttime BP was a therapeutic target to improve the outcome in stage B HT patients.
Abstract 17475: Intravascular Ultrasound versus Angiography in Percutaneous Coronary Interventions: A Meta-Analysis Unveiling Compelling Evidence of Ultrasound's Superiority
Authors: Mohamed R Abouzid, Karim Ali, Ahmed Ali, Khaled Ali, Mohamed El-Helw
Journal: Circulation (2023)

Objective: This meta-analysis aims to compare the effectiveness of intravascular ultrasound (IVUS) versus angiography alone in percutaneous coronary intervention (PCI) procedures. Methods: A comprehensive literature search was conducted to identify relevant studies comparing IVUS-guided PCI with angiography-guided PCI. The primary outcome measure was major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization. Secondary outcomes included all-cause mortality, stent thrombosis, and angiographic outcomes. Results: A total of 41 eligible studies involving 712635 patients were included in the meta-analysis. IVUS-guided PCI was associated with a significantly lower risk of MACE compared to angiography-guided PCI (pooled odds ratio [OR] 1.38, 95% confidence interval [CI] 1.24-1.53, p&lt;0.00001). The use of IVUS also resulted in a lower risk of all-cause mortality (pooled OR 1.61, 95% CI 1.41-1.83, p&lt;0.00001) and reduced rates of stent thrombosis (pooled OR 2.28, 95% CI 1.82-2.86, p&lt;0.00001) and TVR (pooled OR 1.31, 95% CI 1.21-1.42, p&lt;0.00001). Conclusion: This meta-analysis provides evidence supporting the use of IVUS-guided PCI over angiography-guided PCI. IVUS-guided procedures were associated with reduced MACE rates, improved procedural success, decreased stent thrombosis, and superior angiographic outcomes. The findings suggest that incorporating IVUS into PCI procedures may lead to improved clinical outcomes and more optimal stent deployment. However, further studies are warranted to explore potential subgroup differences and to evaluate the cost-effectiveness of IVUS-guided PCI.
Abstract 18374: Effective Atomic Number and Electron Density Number Acquired Using Latest Spectral CT Enable the Differentiation of Infarcted Myocardium and Hypertrophied Myocardium From Normal Myocardium
Authors: Nobusada Funabashi, Shin Akaza, Atsushi Shukuya, Hiroki Asano
Journal: Circulation (2023)

Introduction: Spectral CT can acquire effective atomic (EAN) and electron density number (EDN). Hypothesis: EAN and EDN using spectral CT enable the differentiation of infarcted myocardium and hypertrophied myocardium from normal myocardium. Methods: We analyzed 146 patients (73 males; mean age 55 ± 14 years old) who had no significant coronary stenosis on CT (7500; Philips) and normal ECG (normal group), 20 patients with previous myocardial infarction (MI) (12 males; mean age 73 ± 7 years old) (MI group), and 10 patients with hypertrophic cardiomyopathy (HCM) (5 males; mean age 66 ± 15 years old) (HCM group). On CT, we measured EAN and EDN in the interventricular septum (IVS), left ventricular (LV) anterior wall (LVAW), and lateral wall (LVLW) within a 1.0 mm2 circle at LV inflow level in the non-contrast and early contrast phase. In MI and HCM groups, EAN and EDN were also measured in the infarcted and hypertrophied myocardium, respectively. Results: In the non-contrast and early contrast phase, the EAN was significantly lower in the infarcted myocardium group than in the normal group (p &lt; 0.01), in the non-infarcted myocardium than in the MI group (p &lt; 0.05) and non-hypertrophied myocardium in the HCM group (p &lt; 0.05), and in the hypertrophic myocardium in the HCM group than in the normal group (p &lt; 0.05) and non-hypertrophic myocardium in the HCM group (p &lt; 0.05). In the non-contrast and early contrast phase, the EDN was also lower in the infarcted myocardium than in the normal group (p &lt; 0.01), non-infarcted myocardium in the MI group (p &lt; 0.05), hypertrophied and non-hypertrophied myocardium in the HCM group (p &lt; 0.05). Conclusion: The use of EAN and EDN enables the differentiation of infarcted myocardium (EAN and EDN) and hypertrophied myocardium (EAN) from normal myocardium even on non-contrast CT alone. The use of EAN and EDN enables the detection of abnormal myocardial characteristics (blood flow decrement, fibrotic change, hypertrophy, and inflammation) on non-contrast CT alone.
Abstract 18273: Mitral Annular Calcification is Associated With Higher Operative Risks and Worse Survival in Hypertrophic Cardiomyopathy
Authors: Changrong Nie, Zining Wu, Changsheng Zhu, Zhengyang Lu, Shuiyun Wang
Journal: Circulation (2023)

Background: Mitral annular calcification (MAC) is common in hypertrophic cardiomyopathy (HCM), usually accompanied by mitral leaflet calcification, subvalvular apparatus calcification, and mitral valve dysfunction. However, the impact of MAC on surgical strategy and clinical outcomes in HCM is not fully understood. Methods: This cohort enrolled 1035 consecutively recruited patients diagnosed with HCM between January 2016 and December 2021. All patients received a computed tomographic scan prior to surgery. Results: Of the 1035 patients, 112 (10.8%) had MAC, including 39 patients with moderate or severe MAC (calcification area greater than one-third of the annulus). Patients with MAC were significantly older (59.6±8.2 years vs. 47.5±12.3 years, p&lt;0.001) and more likely to be female (61.8% vs. 35.4%, p&lt;0.001). Echocardiography showed a higher proportion of mitral leaflet thickening (17.9% vs. 6.0%, p&lt;0.001) in patients with MAC. Moreover, patients with MAC had a higher rate of annular reconstruction (1.79% vs 0.11%, p=0.002), plastic ring implantation (5.36% vs 1.84%, p=0.017), chordae release (12.50% vs 5.09%, p=0.002), artificial neochordoplasty (2.68% vs 0.54%, p=0.015), and fibrous membrane removal (8.93% vs 4.12%, p=0.022), as well as longer ventilation time [19 hours, interquartile range (IQR) 17.0-26.0 vs. 18 hours, IQR 14.0-20.5, p&lt;0.001], intensive care unit stay [61 hours, IQR 36.5-96.0 hours vs. 48 hours IQR 24.0-72.0 hours, p&lt;0.001] and postoperative hospital stay [8days, IQR 7-11 days vs. 7 days, IQR 6-8 days, p&lt;0.001]. During a median follow-up time of 26.2 months (IQR, 17.0 to 39.5 months), 5 death and 158 major adverse cardiovascular events (MACE) were observed. Kaplan-Meier survival curves showed that patients with MAC had a higher cumulative rate of all-cause mortality (p=0.026) and MACE (p=0.003) compared to their counterparts. On multivariable Cox regression analysis, moderate or severe MAC was an independent risk factor for MACE (Hazard ratio =2.38, 95% confidence interval: 1.31-4.32). Conclusions: The prevalence of MAC was 10.8% in this study. The presence of MAC was associated with a higher rate of concomitant operations, longer hospital stays, and worse survival.
Abstract 13192: Anti-Factor Xa Activity in Patients With Chronic Thromboembolic Pulmonary Disease With or Without Pulmonary Hypertension Treated With Factor Xa Inhibitors
Authors: YOSHIHISA NAKANO, Shiro Adachi, Hiroki Kondo, Miku Hirose, Takeshi Adachi, Itsumure Nishiyama, Kenichiro Yasuda, Masahiro Yoshida, Hiroshi Yatsuya, Toyoaki Murohara
Journal: Circulation (2023)

Introduction and Hypothesis: Data on the efficacy and safety of factor Xa (FXa) inhibitors in chronic thromboembolic pulmonary disease (CTEPD) patients, especially in chronic thromboembolic pulmonary hypertension (CTEPH) patients, remain limited. Here, we aimed to evaluate the effect of FXa inhibitors by measuring anti-factor Xa activity (AXA) in both patients with CTEPD without pulmonary hypertension (PH) and CTEPH. Methods: Twenty-five CTEPD patients without PH and 52 CTEPH patients, treated with either of the FXa inhibitors were enrolled. AXA was measured by using HemosIL heparin calibrator. Blood samples were collected two times at the same day: immediately before the drug administration (trough) and 2-3 h after drug administration (peak). Results: In all 77 patients, median age was 66 (Interquartile range [IQR] 51–73) years, and 43% were male. In addition, 47% of the patients received rivaroxaban of 15 mg/day, 27% received apixaban of 10 mg/day, 14% received edoxaban of 60mg/day, and 12% received edoxaban of 30 mg/day. The median peak AXA of all 77 patients was 1.92 IU/mL and was comparable between CTEPD without PH and CTEPH patients. Significant difference of trough and peak AXA was shown among four different prescribed drugs (P &lt; .001 and P = .006, respectively). During the observational period of median 519 (IQR 364–1118) days, major and clinically relevant non-major bleeding occurred in six patients. ROC analysis to predict bleeding events revealed that the sensitivity and specificity of the cutoff point of a peak AXA of 2.1 IU/mL were 67% and 66%, respectively (AUC 0.66). The cumulative rate of major and clinically relevant non-major bleeding tended to be higher in patients with peak AXA ≥ 2.1 IU/mL than in patients with values below this point (p = .092, Figure). Conclusion: Measuring AXA could be a useful method to evaluate the effect of FXa inhibitors in CTEPD with or without PH patients.
Abstract 14644: Healthcare Resource Utilization and Economic Burden Due to Atrial Fibrillation in Patients With Symptomatic Obstructive Hypertrophic Cardiomyopathy: Real-World Analysis of 2016-2021 Claims Data
Authors: Michael Butzner, Sounok Sen, John C Stendahl, Eros Papademetriou, Ravi Potluri, Xing Liu, Stephen B Heitner, Daniel L Jacoby, Sanatan Shreay, Regina L Sohn, James V Freeman
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is common among patients with symptomatic obstructive hypertrophic cardiomyopathy (soHCM), but the impact of AF on healthcare resource use (HCRU) and cost is not well studied. Hypothesis: Comorbid AF increases HCRU and cost among patients with soHCM. Aims: To assess HCRU and charges (per person per year [PPPY], in USD) for patients with vs without comorbid AF. Methods: Symphony medical and pharmacy claims data were assessed from 2016-2021 to identify (by ICD-10 code) adult patients with treatment-naïve soHCM in the United States. We defined symptomatic as fatigue, chest pain, syncope, dyspnea, heart failure, or palpitations within 3 months of index date and comorbid AF as AF within 3 months of index date. Patients entered the cohort once they received their index soHCM pharmacotherapy or soHCM surgery treatment; and were required to be on soHCM pharmacotherapy (beta-blockers, calcium channel blockers, or disopyramide) or to have had a procedure for soHCM (septal reduction therapy, pacemaker, or implantable cardioverter defibrillator). Results: Of 9490 patients with soHCM, 2681 (28.3%) had AF. For patients with vs without AF, median age was 68 years vs 63 years ( p &lt;0.0001), 48.0% vs 42.5% ( p &lt;0.0001) were male, and mean (SD) Charlson Comorbidity Index was 2.4 (2.0) vs 1.5 (1.8). Patients with vs without AF had ~44% more outpatient (OP) visits (14.75 vs 10.22), more urgent care visits (5.95 vs 4.88), and higher charges ($50,936 vs $32,254) PPPY (Table). Total all-cause charges were ~60% higher for those with vs without AF ($70,902 vs $44,035 PPPY) (Table). Conclusions: In this large, US-based cohort of patients with symptomatic oHCM, those with vs without comorbid AF had substantially more OP visits and charges PPPY. Our data show that comorbid AF in patients with soHCM is associated with a significantly greater healthcare resource use and economic burden, emphasizing the need for new treatments to prevent or improve AF.
Abstract 17187: The Relationship Between N-Terminal Pro-Brain Natriuretic Peptide Levels and Poor Outcomes in Covid-19 Patients
Authors: Hywel Soney, Manavjot S Sidhu
Journal: Circulation (2023)

Introduction: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker reflecting increased cardiac stress. It is a key variable in assessing patients with various pathologies. However, assessment of NT-proBNP as a variable in the prognostication of poor outcomes in COVID-19 patients is lacking. In addition, COVID-19 has brought its own variables and sequelae along with overlapping pathologies in a variety of systems. Hypothesis: With the systemic impact that COVID-19 can have, NT-proBNP represents a variable that will aid in identifying patients at higher risk of poor outcomes. We aim to assess the utility of NT-proBNP to help predict the incidence of major adverse cardiovascular events (MACE) and mortality in patients hospitalized with COVID-19. Methods: Using a multi-center observational database, we analyzed 1,692 hospitalized COVID-19 PCR-positive patients at Methodist Health System from March to July 2020. We examined NT-proBNP levels, in-hospital death or hospice referral rates, and incidence of MACE in the cohort. MACE was defined as congestive heart failure (CHF) exacerbation, pericardial effusion, cardiac tamponade, myocarditis, pericarditis, myocardial infarction (MI), stroke, pulmonary embolism/deep vein thrombosis, or shock. The incidence of mortality and MACE were compared between patients with and without elevated NT-proBNP levels. Elevated NT-proBNP levels were those &gt;900 pg/mL. A chi-square ( X 2 ) and odds ratio (OR) test were used to analyze observed variables. Results: Of the 1,692 hospitalized patients, 576 patients (34.0%) arrived with elevated NT-proBNP levels. Patients with elevated NT-proBNP had a higher incidence of mortality (OR=3.2559, 95% CI=2.522-5.203, p&lt;0.0001) and MACE (OR=6.564, 95% CI=5.255-8.199, p&lt;0.0001) compared to patients with NT-proBNP levels &lt;900 pg/mL. Additionally, the elevated NT-proBNP patients had a higher incidence of CHF exacerbation, MI, and shock compared to patients with NT-proBNP levels &lt;900 pg/mL. Conclusions: NT-proBNP levels can be a vital tool in recognizing COVID-19 patients who are at higher risk of poor outcomes. The use of NT-proBNP can further aid in prognostication in patients presenting to the hospital with COVID-19.