tbuckley/cabot-search huggingface dataset:
Abstract 4144205: Diagnostic accuracy of artificial intelligence-based electrocardiogram algorithm to predict heart failure with reduced ejection fraction: a systematic review and meta-analysis
Authors: Andre Carvalho Ferreira, Vanio do Livramento Junior Antunes, Camila Guida, Luciana Vergara Ferraz de Souza, Maria Luiza Rodrigues Defante, Elisio Bulhoes, Edin Begic, Buena Aziri, Roberto Mazetto, Sarah Monteiro, Luanna Garcez, Maria Benitez
Journal: Circulation (2024)

INTRODUCTION: AI-based EKG has shown good accuracy for diagnosing heart failure. However, due to the heterogeneity of studies regarding cutoff points, its precision for specifically detecting heart failure with reduced ejection fraction (LVEF &lt;40%) is not yet well established. Research question: What it is the sensitivity and specificity of artificial-based electrocardiogram to diagnose heart failure with low ejection fraction(cut-off of 40%) Aims: We conducted a meta-analysis and systematic review to evaluate the accuracy of artificial intelligence electrocardiograms in predicting an ejection fraction below 40%. METHODS: We searched PubMed, Embase and Cochrane Library for studies evaluating the performance of AI EKGs in diagnosing HFrEF. We computed true positives, true negatives, false positives and false negatives events to estimate pooled sensitivity, specificity and area under the curve, using R software version 4.3.1, under a random-effects model. RESULTS: We identified 8 studies,including 136151 patients with a paired artificial intelligence enabled electrocardiogram with an echocardiography. 9349(6.8%) patients had an ejection fraction below 40% according to the echocardiogram. The AI-ECG data yielded areas under the receiver operator of, sensitivity of 0.861(0.815-0.897), and specificity of 0.874(0.834-0.905) , and area under the curve of 0.929(0.876-0.949). Mean/median age ranged from 60±9 to 67.8±14.4 years. CONCLUSIONS: In this systematic review and meta-analysis, the use of electrocardiogram-based artificial intelligence models demonstrated high sensitivity and specificity for the diagnosis of heart failure with an ejection fraction below 40%
Abstract 4144258: Clinical value of bioactive adrenomedullin and proenkephalin A in patients with left ventricular assist devices
Authors: Rachad Zayat, Leyla Dogan, Deborah Bergmann, Aileen Hill, Mohammed Shoaib, Assad Haneya, Alish Kolashov, Mohammad Khattab, Jan Spillner, Andreas Goetzenich, Christian Stoppe
Journal: Circulation (2024)

Introduction: In an acute heart failure setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting acute kidney injury (AKI) while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. Research questions: This raises the question of whether they can serve as predictive indicators for risk assessment in patients receiving left ventricular assist device (LVAD) implantation. Aims: we aimed to study whether pre- and postoperative bio-ADM and penKid levels could predict clinical outcomes in LVAD patients. Methods: This observational study prospectively enrolled patients who were undergoing LVAD implantation. Routine laboratory, Plasma levels of PenKid and bio-ADM were assessed at five-time intervals, spanning from pre-induction of anesthesia to 48 hours postoperatively. clinical data and patient outcomes were recorded, with a particular emphasis on right heart failure (RHF) and AKI. Results: In 20 patients undergoing LVAD implantation, the bio-ADM levels increased and the penKid levels decreased significantly over time. Preoperative PenKid was a predictor of postoperative AKI (OR: 1.04, 95%-CI: 1.0-1.09; p =0.035). Bio-ADM was a predictor of postoperative RHF (OR: 1.10, 95%-CI: 1.01-1.20; p =0.025) and early mortality (OR: 1.02, 95%-CI: 1.0-1.03; p =0.039). In the ROC analysis bio-ADM as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.83. Adding bio-ADM to accepted clinical scores for post-LVAD RHF prediction (CRITT-Score and RV-Michigan score) the AUC reached 0.93. Preoperative bio-ADM was also a useful predictor of early mortality and added prognostic value to the HeartMateII risk score and EuroSCOREII reaching an AUC of 0.96. Conclusion: In the present study, the biomarkers penKid and bio-ADM correlated with clinically significant patient outcomes after LVAD implantation, such as AKI and RHF. Adding Bio-ADM to well-established risk scores increased the prognostic value in the prediction of RHF. Preoperative penKid is a helpful marker to predict post-LVAD AKI.
Abstract 4144157: Coronary microvascular disease has subtypes with distinct wave intensity profiles as measured with intra-coronary provocation agents
Authors: Justin Carrington, Amir Lerman, Claire Raphael
Journal: Circulation (2024)

Background: Coronary microvascular disease (CMD) may be endothelium-independent (coronary flow reserve, CFR&lt;2.5) or endothelium-dependent (&lt;50% increase in coronary blood flow in response to acetylcholine). Endothelium-independent CMD has been subclassified into structural and functional groups based on hyperemic microvascular resistance (hMR, mmHg/cm/s). We hypothesized that endothelium-dependent CMD also has these subtypes. Methods: Patients with non-obstructive coronary artery disease who underwent coronary catheterization of the left anterior descending artery were included (n=112). Pressure and flow were recorded at rest, with adenosine, and with acetylcholine. Patients were classified by endothelial type and functional CMD (hMR&lt;2.5) or structural CMD (hMR&gt;2.5). Wave intensity analysis was performed and cumulative separated wave intensity (Joules/m 2 ) was calculated by standard formulae. Three dominant waves were analyzed (forward compression wave, FCW; backward compression wave, BCW; backward expansion wave, BEW). Results: Seventy-four of 109 patients had CMD, of which 59 had endothelium-independent and 38 had endothelium-dependent CMD (23 had both). Functional and structural subgroups were identified (Figure 1). All CMD subtypes had significantly different wave intensities at rest, adenosine, and acetylcholine (p&lt;0.05). Comparing subtypes, there was no difference in wave intensities at rest. However, wave intensities significantly differed between all CMD subtypes with adenosine and acetylcholine, with higher energy waves in the endothelium-independent and functional groups (p&lt;0.05, Figure 2). Conclusions: CMD is a heterogenous condition with distinct subtypes. Functional and structural groups exist in both endothelium-dependent and endothelium-independent CMD. These subgroups have distinct hemodynamic profiles as measured by wave intensity. A patient-specific approach to first line medical therapy may be improved by subgroup classification.
Abstract 4144101: Variation in Vasoactive Treatments for Cardiogenic Shock: Insights from the Critical Care Cardiology Trials Network
Authors: David Hamilton, Jackson Shriver, Jeong-Gun Park, Zoe Michos, Scott Ketcham, Sarah Adie, Michael Mathis, Siddharth Patel, David Morrow, Andrea Thompson
Journal: Circulation (2024)

Introduction: The paucity of data to guide selection of specific vasoactive agents in patients with cardiogenic shock (CS) may lead to variability in practice patterns. Hypothesis: Variation in the utilization of inodilators to treat CS is associated with both institution- and patient-level factors. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in North America coordinated by the TIMI Study Group. This analysis cohort includes patients with CS from 2018-2023. Shock was defined as systolic blood pressure less than 90 mmHg with end-organ dysfunction ascribed to the hypotension. Shock type was classified by site investigators. Multivariable linear mixed-effect modeling was used to evaluate patient- and institutional-level variation associated with the use of inodilators treatment (milrinone, dobutamine). Results: A total of 3,282 patients from 37 CICUs were in the study cohort. The rate of utilization of specific vasoactive medications and MCS varied substantially across institutions (Fig 1). For inodilators, rates of dobutamine use varied by institution from 10% to 82%, while milrinone use varied from 6% to 71%. Patient-level variables that were associated with the use of inodilator treatment included male sex (OR 1.24 [95% CI 1.03-1.49]), history of heart failure (1.98 [1.61-2.43]), SCAI class D vs. B/C (1.35 [1.08-1.69]), and BiV failure vs. LV failure (1.59 [1.27-1.99). Variables less likely to be associated with inodilator use included age (0.97 [0.97-0.98] per year increase), cardiac arrest (0.34 [0.27-0.42]), and acute coronary syndrome presentation (0.72 [0.57-0.91]). MCS use within 36 hours of CICU admission and pulmonary hypertension were not associated with variability in inodilator use. In multivariable linear mixed-effect modeling, 45.9% of variation in inodilator use was attributed to patient-level factors and 21.8% of variation was attributed to the institution. Conclusion: There is substantial variation in vasoactive treatment and inodilator use related to patient- and institution-level factors. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.
Abstract 4144103: Circulating miRNAs are Differentially Expressed in Pediatric Dilated Cardiomyopathy Patients with Favorable vs. Poor Outcomes
Authors: Scott Stuart, Shelley Miyamoto, Steven Lipshultz, Ana Laura Hernandez, Taye Hamza, James Wilkinson, Anis Karimpour-Fard, Steven Colan, Carmen Sucharov
Journal: Circulation (2024)

Introduction: microRNAs (miRs) are small single stranded RNAs capable of targeting expression of several genes. Circulating miRs can be important biomarkers of disease progression. Children with dilated cardiomyopathy (DCM) experience multiple outcomes including recovered-normalization, stable disease, and progression to death/ need for transplant. We hypothesized that circulating miRs are differentially expressed among these cohorts and may serve as useful prognostic biomarkers in pediatric DCM patients. Methods: RNA-sequencing was used to detect and quantify circulating miRs. Samples were collected within 3 months of a new diagnosis of DCM. Inclusion criteria included &lt;18 years of age at diagnosis of idiopathic or familial DCM (LVEF&lt;50% or left ventricular end-diastolic dimension [LVEDd] z-score ≥+2). Primary outcomes within 1 year of enrollment were defined as: [1] Death, cardiac transplant, or initiation of mechanical circulatory support; [2] Recovered-normalization of LVsize and function (LVEF≥50% and LVEDd z-score &lt;+2) or [3] Stable-persistent DCM with LVEF&lt;50% or LVEDd z-score ≥+2. Statistical analysis included random forest and hierarchical clustering (HC). Results: Sequencing was performed on 76 patients: death/transplant (n=35), recovered (n=20), or stable DCM (n=21). The top three differentially expressed miRs between the death/transplant and recovery group were miR-424-5p, miR-335-5p, and miR-503-5p (Figure A). HC based on expression of these 3 miRs identified an expression pattern associated with death/transplant outcome (Figure B). miR-503-5p was also among the top 3 miRs most differentially expressed between the stable and the recovery group. Conclusions: These results indicate circulating miRs can predict recovery in the pediatric DCM population. Importantly, miR-503-5p was more highly expressed in the recovery group when compared to both the stable and transplant groups, suggesting expression of this miR may be associated with favorable outcomes. A unique biomarker signature of miRs specific to children with DCM who have the potential to recover would improve risk stratification of this population.
Abstract 4144191: The effect of sacubitril/valsartan on epicardial adipose tissue in patients with chronic heart failure and reduced left ventricular ejection fraction
Authors: Hiroki Mori, Shiro Nakamori, Naoki Fujimoto, Hana Mizutani, Takanori Kokawa, Yuichi Sato, Itaru Goto, Masaki Ishida, Takashi Tanigawa, Hajime Sakuma, Kaoru Dohi
Journal: Circulation (2024)

Background: Natriuretic peptides (NPs) have been reported to have beneficial effects on adipose tissue, as well as the cardiovascular system and kidneys. Epicardial adipose tissue (EAT) has been recognized as an important target for the treatment of heart failure. Sacubitril/valsartan (ARNI) increases NPs by inhibiting neprilysin, but its effect on EAT has not been reported. We evaluated the impact of ARNI on EAT in patients with heart failure and compared this impact in patients with ischemic cardiomyopathy (ICM) to patients with non-ischemic cardiomyopathy (NICM). Methods: This study was a secondary analysis of patients enrolled in the open-label, standard treatment-controlled, randomized clinical trial (SAVE-HF) investigating the effect of ARNI in 59 stable patients with chronic heart failure and reduced left ventricular ejection fraction. Cardiovascular magnetic resonance (CMR) was performed at baseline and after 9 months. EAT was measured as the thickness of adipose tissue situated between the outer wall of the right ventricular myocardium and the visceral layer of the pericardium at a mid-ventricular level on end-diastolic short-axis cine images. Results: We identified 36 ICM patients and 19 NICM. There was a trend of higher prevalence of diabetes mellitus in the ICM cohort (p=0.08). Baseline EAT was similar in ICM patients (4.9 ± 1.7 mm) and NICM patients (5.1 ± 1.9 mm). In the ICM cohort, EAT was significantly reduced in the ARNI group compared with the standard treatment group (p=0.04), with an EAT reduction of 7.1%. There was an inverse relationship between the changes in EAT and atrial NP (ANP) (r=-0.39, p=0.02). After accounting for the usage of the inhibitors of the sodium-glucose cotransporter-2 receptor (SGLT2-i), the benefit of ARNI on reducing EAT remained unchanged. In contrast, ARNI was not associated with EAT reduction in the NICM cohort (p=0.9). Conclusion: ARNI reduced epicardial adiposity by significantly increasing circulating ANP in ICM patients, even after accounting for the usage of SGLT2-i, but it did not reduce EAT in NICM patients. These findings may suggest differential pathophysiological mechanisms of EAT adipocytes depending on the cause and pathology of heart failure.
Abstract 4144092: Dysregulation of DSCAM and Sclerostin Signaling in Down Syndrome Associated Congenital Heart Disease and Other Phenotypes
Authors: Vi Tang, Qi Zhang, Sarah Morton, David McKean, Priyanka Narayan, Olivia Layton, Ananya Sharma, Jonathan Seidman, Christine Seidman
Journal: Circulation (2024)

Introduction: Trisomy 21 (T21) is the most common genetic cause of congenital heart disease (CHD) with a preponderance of atrioventricular canal defects (AVCD), a type of malformation that is uncommon in euploid CHD patients. Mechanisms that cause CHD and AVCD in T21 are unknown. We recently reported an 11-fold increase in levels of SOST which resides on chromosome 17 and encodes sclerostin, a secreted Wnt inhibitor, in T21 CHD tissues compared to euploid CHD controls. Further investigations revealed that SOST is primarily expressed in cardiac endothelial cells and genetic inactivation of DSCAM on chromosome 21 in T21 endothelial cells derived from human induced pluripotent stem cells (iPSC-ECs) diminishes sclerostin secretion. Methods and Results: DSCAM is a transmembrane cell adhesion molecule that is involved in neuronal synapse formation. Recent studies suggest that the DSCAM intracellular domain (ICD) can translocate to the cell nucleus to regulate gene expression in HEK293 cells. To test whether the DSCAM ICD can function as a transcription regulator in endothelial cells, we overexpressed DSCAM-ICD-GFP fusion protein in T21 iPSC-ECs and euploid human aortic endothelial cells (HAECs) using lentiviral vectors. We observed a discrete nuclear localization pattern of DSCAM-ICD-GFP compared to a more diffused cytoplasmic localization of GFP alone. Overexpression of DSCAM-ICD-GFP also resulted in a modest increase in sclerostin secretion in HAECs as compared to GFP controls. Ongoing experiments will measure sclerostin secretion in T21 iPSC-ECs that overexpress DSCAM-ICD-GFP. To test whether increased sclerostin secretion can lead to CHD, we obtained mice carrying a human SOST transgene ( SOST Tg ) that exhibit osteopenia, consistent with Wnt inhibition by sclerostin. As cardiac phenotype has not been assessed, we will report cardiac structure and function using echocardiography and histology to determine the consequences of SOST overexpression. Conclusions: An increase in DSCAM gene dosage in T21 leads to increased sclerostin secretion in endothelial cells. The localization of DSCAM ICD in the cell nucleus indicates potential direct or indirect regulatory activities on SOST and other genes. Defining these effects and the consequences of sclerostin-inhibition of Wnt signaling may indicate the mechanisms for CHD in approximately half of patients with T21.
Abstract 4144053: Age- and Sex- Differences in the Accuracy of Rule-based Natural Language Processing Models for Identification of Pulmonary Embolism
Authors: Darsiya Krishnathasan, SINA RASHEDI, Candrika Khairani, Antoine Bejjani, Ying-Chih Lo, Mehrdad Zarghami, Shiwani Mahajan, Cesar Caraballo, jose victor jimenez ceja, David Jimenez, Manuel Monreal, Eric Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad Hussain, Abena Appah-Sampong, Sanjay Aneja, HAMID MOJIBIAN, Samuel Goldhaber, Liqin Wang, Li Zhou, Harlan Krumholz, Gregory Piazza, Behnood Bikdeli
Journal: Circulation (2024)

Background: Presentation, treatment and outcomes of pulmonary embolism (PE) in adults varies by age and sex. Recently, some rule-based natural language processing (NLP) tools have been developed to detect PE from radiology reports. It is unknown whether variations in age and sex influence the accuracy of the NLP models to detect PE in radiology reports. Methods: We used patient data from the Mass General Brigham (MGB) Health System between 2016 and 2021. The NLP models developed by Verma et al. and Johnson et al. were applied to radiology reports to determine PE among a randomly selected sample of 1,712 patients (52.3% female and 45.3% ≥65 years old). Two independent physicians conducted a manual chart review of patient records with predefined criteria, serving as the reference standard. Accuracy metrics were ascertained across age (≥65 vs. &lt;65 years) and sex (female vs. male) subgroups. Weighted estimates were established based on the total number of hospitalizations at MGB (n=381,642, 54.0% female and 47.2% ≥65 years old). Results: In the weighted sample, the prevalence of PE was 2.0% (7,708/ 381,642). The weighted estimates of the NLP models resulted in high sensitivity (range 71.0% to 89.3%) and specificity (range 96.8% to 98.6) for patients ≥65 and &lt;65 years of age (Table, Part A). Similarly, both models resulted in high sensitivity (range 76.9% to 88.2%) and specificity (range 96.6% to 98.7%) for females and males (Table, Part B). However, positive predictive values were low for both models in the two age categories (range 36.8% to 51.0%) and sex groups (range 35.1% to 54.7%) (Table, Parts A and B). Conclusions: Despite some variations in the accuracy of the rule-based NLP models, positive predictive values across age and sex groups were low. Further improvements are necessary before rule-based NLP tools can be reliably utilized for PE identification from imaging reports.
Abstract 4144104: Intramyocardial Hydrogel Injections in Porcine Model of Infarction Remodeling Demonstrates Improved Left Ventricular Performance on Pressure-Volume Analysis Associated with Decreased Matrix Metalloproteinase Activation
Authors: Olivia Porcaro, Stephanie Thorn, Shawn Ahn, Supum Lee, Selen Uman, Taras Lysyy, Rachel Burns, nicole guerrera, Billy Vermillion, Francis Spinale, James S Duncan, Paul Heerdt, Jason Burdick, Albert Sinusas
Journal: Circulation (2024)

Introduction: Following myocardial infarction (MI), extracellular matrix (ECM) degradation significantly contributes to adverse left ventricular (LV) remodeling mediated by the activation of matrix metalloproteinases (MMPs). Intramyocardial injection of hydrogels that locally release MMP inhibitors are designed to modulate MMP activation, increase wall thickness, reducing wall stress, resulting in improved regional mechanics and function. Pressure-volume (PV) analysis is an established approach for evaluation of cardiac performance. Methods: Chronic reperfused MI was created by a 90-min LAD occlusion in swine (n=16). PV loop analysis was performed using simultaneous 3D echocardiography and invasive LV pressures at baseline and 5 weeks post-MI. Therapeutic hydrogels were delivered by direct intramyocardial injection (9x100 μl) at 7 days post-MI using hyaluronic acid hydrogels alone (HA-Only) (n=4) or hyaluronic acid that releases an MMP inhibitor doxycycline (HA-DOX) (n=5) into the MI region. Outcomes were compared to control MI pigs (n=7) at 5 weeks post-MI to assess therapeutic benefits. MMP inhibition was measured by uptake of the SPECT MMP targeted radiotracer, 99m Tc-RP805 in the infarct region. Results: Quantitative indices of remodeling from representative PV loops are shown in Figure 1 A-C. LV end-diastolic volume (LVEDV) corrected for body weight (BW) was significantly greater in the MI-controls at 5 weeks post-MI compared to the HA-DOX group (Fig 1D, p=0.035, t-test). There was a statistically significant difference in LV end-diastolic pressure (LVEDP) (Fig 1E) between MI-controls and HA-DOX (p=0.025, ANOVA). There was a trend for decreased LV compliance (Fig 1F) in MI-controls based on the EDPVR V30. These changes correlated with a significant decrease in 99m Tc-RP805 in the MI region of HA-DOX animals compared to controls (Fig 1G). Conclusion: LV PV analysis demonstrated significant adverse remodeling in control pigs that was reduced by early intramyocardial delivery of a DOX releasing hydrogel post-MI. Delivery of both hydrogels prevented some measures of adverse LV remodeling, with prevention of LV dilatation and reduction in LVEDP and correlated with a decrease in MMP activation by SPECT 99m Tc-RP805.