tbuckley/cabot-search huggingface dataset:
Abstract 4144603: Artificial Intelligence Tool Accurately Predicts Occlusion Myocardial Infarction And May Reduce False-Positive Cath Lab Activations
Authors: Samantha Harris, FREDRICK BROWN, Adam May, Richard Bach
Journal: Circulation (2024)

Introduction: An early and accurate diagnosis of occlusion myocardial infarction (OMI) by an electrocardiogram (ECG) is critical for prompt catheterization lab activation (CLA) for primary percutaneous coronary intervention (PCI). Objective: To evaluate the predictive accuracy of a new mobile application, utilizing an artificial intelligence (AI) deep learning algorithm, for distinguishing cases of OMI from non-OMI among actual Emergency Department (ED) patients assessed for potential CLA. Methods: We conducted a retrospective analysis of adult patients assessed for potential CLA in the ED at Barnes Jewish Hospital, St. Louis, MO, from August 22, 2023 to April 6, 2024. Patients arriving post-cardiac arrest were excluded. The ECG obtained immediately prior to each CLA was re-analyzed using a mobile device application with the OMI ECG AI algorithm, known as the Queen of Hearts (QoH) model. Each ECG was then categorized as either OMI or non-OMI. Coronary angiograms were reviewed blinded to the ECG results. Results: Out of 102 CLAs, 57 patients were accepted for emergent coronary angiography. The QoH model predicted 54 patients (52.9%) as having an OMI. Patients predicted to have an OMI were more likely to be accepted for coronary angiography (94% vs. 17%), have primary PCI performed (85% vs. 2.1%), and have acute coronary thrombosis detected (74.1% vs. 0.0%) on coronary angiography compared to non-OMI patients. All 46 patients fulfilling STEMI ECG criteria were correctly identified as having an OMI. Two patients predicted to have OMI without STEMI ECG criteria were found to have acute coronary occlusion. Patients with OMI had higher peak high-sensitivity troponin values. Among the 55 patients predicted to have non-OMI, 41 of 45 (91.1%) were not accepted for emergent coronary angiography and 6 of 10 (60.0%) patients accepted for emergent coronary angiography did not have obstructive coronary artery disease. Conclusions: The AI-based QoH model was highly predictive of OMI confirmed at coronary angiography. Implementation of this model may help clinicians identify the risk of OMI in patients triggering a CLA, and utilization of the AI-model could have led to potential reduction of false-positive CLAs.
Abstract 4144676: Leveraging AI to Identify ECG Indicators of Ventricular Dysfunction
Authors: Hisaki Makimoto, Takayuki Okatani, Masanori Suganuma, Tomoyuki Kabutoya, Takahide Kohro, Yukiyo Ogata, Kenji Harada, Alexandru Bejinariu, Obaida Rana, Asuka Makimoto, Malte Kelm, Kazuomi Kario
Journal: Circulation (2024)

Introduction: Recent studies have demonstrated that artificial intelligence can effectively identify ventricular dysfunction using electrocardiograms (ECGs). However, the specific ECG waveforms indicative of left ventricular dysfunction remain poorly understood. This study aims to identify the ECG leads and segments that most accurately signal left ventricular dysfunction. Methods: We utilized ECG and echocardiography datasets comprising 17,422 cases from Japan and Germany. Convolutional neural networks with ten layers were developed to detect left ventricular ejection fractions below 50%. The models were trained and validated through 4-fold cross-validation using the Japanese dataset. The performance of the models was evaluated and compared among various ECG configurations (3-second strips, single-beat, and adjacent 2-beat overlay) and ECG segments (PQRST, QRST, P, QRS, PQRS). In addition to internal validation using Japanese data not employed during training, external validation was conducted with the German dataset. Results: Models based on 2-beat ECGs significantly outperformed the other models. Models with single-beat ECGs showed at least equivalent to superior performance compared to the 3-second models in both internal and external validations (AUC 0.908±0.001, 0.863±0.001 vs 0.826±0.016, respectively for 2-beat, single-beat, and 3-second models, P&lt;0.0001, external validation). Employing single-beat models, our analysis found that limb leads, particularly leads I and aVR, were more indicative of left ventricular dysfunction. Furthermore, within the single-beat ECGs, the segments from QRS to T-wave were most revealing, while the addition of P segments significantly augmented the models’ performance ( Fig.1 ). Conclusions: This study confirms that using ECG segments from the P to the T-wave is more effective for assessing ventricular dysfunction than 3-second ECG strips, with performance further enhanced by multiple heartbeats. Notably, signals indicating ventricular dysfunction were predominantly distributed within the QRS to T-wave segments, while the P-segment also showed some significance. The concentration of dysfunction signals varied by lead, with leads I and aVR providing higher diagnostic utility. Further research is needed to identify specific ECG signals or waveforms for ECG-based diagnostics of ventricular dysfunction.
Abstract 4144702: Gender Disparities in Outcomes of Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI) who have also received Chemotherapy: An Analysis of National Inpatient Sample (NIS) Data from 2016-2021
Authors: Kanishka Uttam Chandani, Siddharth Agrawal, Maharshi Raval, Sahil Bhargava, Yug Patel, Sajid Siddiq
Journal: Circulation (2024)

Background: Gender disparities in outcomes for patients undergoing Transcatheter Aortic Valve Implantation (TAVI) with concomitant chemotherapy remain under-explored. This study investigates these disparities, focusing on mortality, procedural complications, and baseline characteristics. Methods: We conducted a retrospective analysis using data from the National Inpatient Sample (NIS) from 2016 to 2021. Gender differences in outcomes were examined in patients undergoing TAVI who have also received chemotherapy. Multivariate logistic regression was utilized for outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with statistical significance determined by P-values. Results: The study included 7,275 patients, comprising 3,375 males and 3,900 females. The mean age was similar between males (76.19 years) and females (75.81 years). Outcome analysis revealed no significant gender difference in in-hospital mortality (OR: 1.63, 95% CI: 0.464-5.725, P = 0.445), heart block (OR: 1.061, 95% CI: 0.849-1.326, P = 0.6) or vascular injury (OR: 1.065, 95% CI: 0.572-1.981, P = 0.841). However, females had significantly higher odds of bleeding (OR: 1.601, 95% CI: 1.161-2.207, P = 0.004) and respiratory failure (OR: 1.792, 95% CI: 1.028-3.126, P = 0.04). Additionally, females had higher odds of sudden cardiac arrest (OR: 8.181, 95% CI: 1.092-61.26, P = 0.041) but lower odds of atrial fibrillation (OR: 0.689, 95% CI: 0.543-0.875, P = 0.002) and arrhythmia (OR: 0.537, 95% CI: 0.344-0.837, P = 0.006). Length of stay was longer for females (Coefficient: 0.515, 95% CI: 0.137-0.893, P = 0.008), but total charges did not differ significantly between genders (Coefficient: 2321, 95% CI: -10371.11-15013.54, P = 0.72). Conclusions: Significant gender disparities exist in specific procedural outcomes for patients undergoing TAVI who have also received chemotherapy. Females were at higher risk for bleeding, respiratory failure, and sudden cardiac arrest, while having lower rates of atrial fibrillation and arrhythmia compared to males. These findings highlight the necessity for gender-specific risk assessment and management strategies to improve outcomes for patients undergoing TAVI with chemotherapy.
Abstract 4144639: Electrocardiographic Right Ventricular Hypertrophy As a Predictor of Mortality in Mitral Transcatheter Edge-to-Edge Repair
Authors: Felix Wangmang, Donald Richards, Manvir Dhillon, Tina Torbati, Alon Shechter, Danon Kaewkes, Vivek Patel, Ofir Koren, Sabah Skaf, Moody Makar, Tarun Chakravarty, Raj Makkar, James Mirocha, Robert Siegel, Meshe Chonde, Kuang-Yuh Chyu
Journal: Circulation (2024)

Background: M-TEER is an option for patients with severe mitral regurgitation (MR). Long-standing severe MR may lead to RVH; however, the clinical significance of RVH on ECG in patients undergoing M-TEER in relation to mortality is not known. Methods: A single-center, observational, prospective cohort of 443 adults with severe MR and a representative ECG from within 12 months prior to procedure date who underwent M-TEER between January 2018 and July 2020 was analyzed. Patients were assessed for paced rhythm (n=109), RAD only (n=28), and RVH (n=23) diagnosed by expert consensus. The rest of patients (n=283) served as control group. All-cause in-hospital mortality was evaluated as the primary outcome using log binomial regression models. The secondary outcome was one-year mortality calculated with multivariate Cox regression models. Results: The prevalence of electrocardiographic RVH is low (5.2%). RVH was associated with increased in-hospital mortality (RR 6.15, 95% CI 1.64-23.01, p 0.007, Table 1). A total of 71 (16%) patients experienced a one-year mortality (Figure). Several variables including RVH, RAD, a history of smoking, and prior cardiogenic shock were identified as each having association with one-year mortality. A multivariable analysis adjusting for these covariates demonstrated that RVH still was associated with increased one-year mortality (HR 2.53, 95% CI 1.06-6.03, p 0.036, Table 2). Paced rhythm on ECG was not associated with in-hospital mortality or at one-year. Conclusions: Electrocardiographic RVH is associated with an increased risk of in-hospital and 365-day mortality in patients with severe MR undergoing M-TEER.
Abstract 4144266: Transcription factor LITAF orchestrates pericyte-mediated vascular inflammation via modulation of protein trafficking pathways in pulmonary hypertension
Authors: Prakash Chelladurai, David Condon, Stuti Agarwal, Ankita Mitra, Kian Shamskhou, Abinaya Nathan, Andrew Sweatt, Ananya Chakraborty, Roham Zamanian, Ke Yuan, Vinicio Dejesus
Journal: Circulation (2024)

Introduction: Vascular inflammation is a major component in the pathogenesis of pulmonary arterial hypertension (PAH). Inflammatory mediators initiate a pro-inflammatory state in capillary-resident pericytes resulting in dysfunctional endothelial-pericyte interactions, reduced pericyte coverage, and microvessel loss in severe PAH. However, molecular mechanisms driving excessive proinflammatory responses in pericytes remain elusive. Hypothesis: Lipopolysaccharide-induced tumor necrosis factor (TNF)-α factor ( LITAF ) perpetuates pro-inflammatory state in pericytes that consequently exacerbate tissue inflammation, reduces pericyte coverage, compromises vascular integrity leading to loss of microvasculature in PAH. Methods: Transcriptomic and mechanistic studies were conducted on isolated human pericytes from healthy donors and patients with PAH. Impact of LITAF ablation and overexpression on the secretion of proinflammatory mediators was assessed using cytokine arrays, and protein interactions using mass-spectrometry. Pericyte-specific Litaf deletion was generated using NG2-CreERT2 and Litaf flox/flox transgenic mouse lines . Results: LITAF transcription and protein levels are significantly elevated in PAH pericytes, which correlated with the increased levels of cytokines including TNFα and monocyte chemoattractant protein-1 (MCP1) as compared to healthy pericytes. Comparatively, PAH pericytes exhibited rapid stabilization and increased nuclear translocation of LITAF and MCP1 upon exposure to cytokines (TNFα, IL1β, IL6). LITAF proteins also colocalized to late endosomes and lysosomes. Secretome analysis from PAH pericytes confirmed increased LITAF and MCP1 secretion, and coregulation of ALG-2-Interacting Protein-X (ALIX), which is a bona fide marker of exosomes. Our observations confirm the positive feedback loop between TNFα signalling in the transcriptional activation of LITAF promoter, and the function of LITAF as a proinflammatory transcription factor in the regulation of TNFA transcription. Pericyte-specific LITAF deletion protects against development of chronic hypoxia-induced PH via reduction in the serum levels of proinflammatory cytokines, inflammatory cell infiltration, capillary loss, and vascular remodeling in vivo . Conclusions: LITAF activation mediates pro-inflammatory state in pericytes via regulation of endolysosomal and secretory pathways that amplifies pro-inflammatory mediator release, endothelial dysfunction, and vascular inflammation in PAH.
Abstract 4144431: Machine Learning to Differentiate Myocardial Infarction with Obstructive versus Non-Obstructive Coronary Artery Disease
Authors: Shubh Patel, Jiawen Deng, Marinda Fung, Barry Rubin, Bo Wang, Todd Anderson, Vallijah Subasri
Journal: Circulation (2024)

Background: Myocardial infarction (MI) can occur with or without coronary artery disease, classified as myocardial infarction with non-obstructive coronary artery disease (MINOCA) and MI with obstructive coronary artery disease (MICAD), respectively. Differentiating between these conditions is important as they require potentially different diagnostic and therapeutic approaches. No pre-test probability score currently exists to aid in this differentiation. This study aims to develop and validate machine learning (ML) models to predict whether a patient with suspected MI has MINOCA or MICAD. Methods: Data from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database, including patients who underwent their first cardiac catheterization for chest pain or an anginal equivalent from 2002 to 2017, was used. We analyzed a cohort of 53,348 patients suspected of having myocardial infarction. For machine learning model development, 20 demographic and clinical features were selected using the Boruta algorithm. The dataset was divided into training (80%) and testing (20%) sets. Model performance was evaluated using 5-fold cross-validation, and the area under the receiver operating characteristic curve (AUROC) was the primary metric for model evaluation. Results: Among the five machine learning models trained, the XGBoost model showed superior performance, achieving an AUROC of 0.76 [95% CI: 0.76–0.77] and an accuracy of 0.86 during internal validation. Logistic regression achieved an AUROC of 0.74 [95% CI: 0.74–0.74]. Calibration of the XGBoost model was assessed via a calibration plot, which showed good agreement between predicted probabilities and observed event probabilities, with a Brier score of 0.10. Conclusions: The developed ML models demonstrated moderate accuracy for predicting MICAD versus MINOCA using clinically relevant features. Implementing such models in clinical practice could guide alternative diagnostic approaches for patients with suspected MINOCA.
Abstract 4144754: Comparing Combined Pneumococcal and Influenza Vaccines to Influenza Vaccine Alone in Coronary Artery Disease Patients: A Propensity Matched Analysis
Authors: Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, FNU Sundas, FNU Danisha, Novonil Deb, Ibadete Bytyci
Journal: Circulation (2024)

Background: Pneumococcal and influenza vaccination have shown cardioprotective effects by reducing adverse cardiovascular events among high-risk patients. However, the effectiveness of combined pneumococcal and influenza vaccinations compared to influenza vaccination alone in patients with coronary artery disease (CAD) has not been thoroughly established to date. Objective: This study aims to investigate the cardiovascular events in patients with CAD following combined pneumococcal and influenza vaccination compared to influenza vaccination alone. Method: The TriNeTX US Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2005 to April 2021. Patients were divided into two groups, one with pneumococcal and influenza vaccination and a control group with influenza vaccination only. Patients were followed for one year. Propensity score-matched analysis (1:1, Figure 1) was conducted based on age, sex, race, body mass index, hypertension, diabetes mellitus, and chronic kidney disease. The main outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, heart failure and ischemic stroke. Secondary outcomes included all-cause mortality, acute myocardial infarction, heart failure and ischemic stroke. Results: After propensity score matching, the study cohort comprised 132,646 patients in the pneumococcal and influenza vaccination group and 132,646 patients in the influenza alone group. The mean age of patients was 79.2 years. Patients who received pneumococcal and influenza vaccinations had a significantly lower risk of MACE (RR, 0.925 (95%CI: 0.896-0.955), P&lt; 0.001), all-cause mortality (RR, 0.947 (95%CI: 0.916-0.979), P= 0.001), acute myocardial infarction (RR, 0.946 (95%CI: 0.897-0.997), P= 0.039), and heart failure (RR, 0.937 (95%CI: 0.903-0.973), P= 0.001) when compared with CAD patients with influenza vaccine alone. However, the risk of ischemic stroke was comparable between both groups (RR, 0.943 (95%CI: 0.893-1.004), P =0.067). Conclusions: In patients with coronary artery disease, those who received both pneumococcal and influenza vaccinations showed significantly lower risk of MACE and all-cause mortality compared to those who received only influenza vaccine.
Abstract 4144752: Endothelial and microvascular dysfunction in adults with congenital heart disease: a systematic review and meta-analysis
Authors: Amalia Baroutidou, Theodoros Dimitroulas, Alexandra Arvanitaki, Triantafyllia Grantza, Nikolaos Otountzidis, Ioannis Farmakis, Vasileios Kamperidis, Antonios Ziakas, George Giannakoulas
Journal: Circulation (2024)

Background: Adults with congenital heart disease (ACHD) are lifelong at high risk for premature cardiovascular events and life-threatening complications, suggestive of early or accelerated cardiovascular disease. Endothelial and microvascular dysfunction as well as arterial stiffness play a key role in the emergence and progression of cardiovascular complications. As vascular dysfunction may precede the occurrence of adverse events, early identification of endothelial damage markers in ACHD is crucial. Aim: This is the first systematic review and meta-analysis of studies investigating the endothelial and microvascular function in ACHD patients versus healthy controls. Methods: We systematically searched four major electronic databases (PubMed, CENTRAL, Scopus, Web of Science), ClinicalTrials.gov and grey literature. We included studies evaluating endothelial and microvascular function with any semi- or non-invasive method in adult patients with and without ACHD. Studies exploring arterial stiffness indices were also investigated. Results: In total, 31 studies (1118 ACHD patients, 794 controls) were included in this systematic review. Branchial arterial endothelium-dependent (assessed via flow-mediated dilatation, FMD) and -independent vasodilation (assessed via nitroglycerine-mediated dilatation, NMD) were impaired in ACHD patients versus controls (mean difference [MD] -2.5, 95% confidence intervals [CI] -3.7; -1.3 and MD -3.9, 95%CI -6.8; -1.0, respectively). Microvascular dysfunction was also evident; significantly lower reactive hyperemia index and peripheral arterial tonometry (PAT) ratio were found in ACHD patients compared with controls (MD −0.26, 95%CI −0.48; −0.04 and MD −0.26, 95%CI −0.5; −0.4, respectively). Regarding arterial stiffness, pooled analysis revealed non-significant differences in pulse wave velocity between the study groups (standardized MD 0.2, 95%CI -0.2; 0.6). However, augmentation index was significantly higher in ACHD (standardized MD 1.6, 95%CI 0.8; 2.4). Conclusions: ACHD patients have impaired endothelial and microvascular function and increased arterial stiffness, factors that may be responsible for the increased adverse cardiovascular events in this population.
Abstract 4144459: Sex Differences in Lipid Measurement, LDL-C Goal Attainment, and Prescribing Practices
Authors: Natasha Vartak, Spencer Weintraub, Xueqi Huang, Caroline Ong, Joanna Fishbein, Nisha Parikh, Stacey Rosen, Eugenia Gianos
Journal: Circulation (2024)

Background: ASCVD is the leading cause of death in women worldwide. Historically, lipid lowering therapy (LLT) and LDL-C goal attainment have been suboptimal in women. Aim: We aim to investigate sex differences in lipid measurement, LDL-C goal attainment, and prescribing practices within our health system. Methods: We performed a retrospective chart review of adult patients with lipid panels performed between 2022 and 2023 in a large health system. We abstracted demographics, comorbidities, lipid levels, LLT, and prescriptions from the electronic health records. Optimal LDL-C was defined as &lt;70 mg/dL for high-risk patients with ASCVD and &lt;100 mg/dL for the rest of the population. Results: Among 364,021 patients, 57% were female, 60% were White, 10% Black, 6% Asian, 14% Other, and 10% unknown; 12% were Hispanic or Latino with ASCVD noted in 7% of women and 13% of men. Mean LDL-C was 108 mg/dL ± 35 in women vs. 102 mg/dL ± 37 in men. Overall optimal LDL-C was achieved in 41% of women vs. 47% of men; 31% women vs. 47% men with ASCVD achieved goal LDL-C. LDL-C was ordered primarily by primary care (74% and 69%) and cardiology (12% and 17%), in men and women respectively, compared to other specialties. Statins were most often prescribed by primary care (61%) and cardiology (31%). Cardiology prescribed more frequently to men compared to women (55% vs. 45%); primary care prescribed more often to women compared to men (53% vs. 47%). Non-statin prescriptions were more common by cardiology (57%) and primary care (34%). Overall, men were more frequently prescribed statins than women (33% vs 26%) and amongst ASCVD patients, men had higher prescriptions rates of high intensity statins compared to women (31% vs. 24%) (Figure 1A-D). Results were statistically significant (p&lt;0.01) for all comparisons between men and women. Conclusions: In our study, women had higher mean LDL-C and suboptimal LDL-C levels compared to men. Women with ASCVD were less frequently prescribed high intensity statins. Most LDL-C orders and statin prescriptions were by primary care, but women experienced treatment disparities even when treated by cardiologists, highlighting the need for increased awareness and education around sex disparities in lipid management.