tbuckley/cabot-search huggingface dataset:
Abstract 4145934: Racial Disparities in Knowledge of Cardiovascular Disease by Chat-Based Artificial Intelligence Models
Authors: Oseiwe Eromosele, Kelechukwu Ughagwu, Ayodeji Johnson, Herlyne Das, Temitope Sobodu, David Ouyang
Journal: Circulation (2024)

Background: Patients and their families often explore the information available online for information about their health status. Dialogue-based artificial intelligence (AI) language models (ChatGPT, Perplexity, Bing AI and Google Bard AI) havebeen developed for complex questions and answers even while still constantly evolving. We sought to assess whether AI model had knowledge of cardiovascular disease (CVD) racial disparities, including disparities associated with CVD risk factors and associated diseases. Methods: To assess the responses of various AI models to topics in cardiovascular disease disparities, we created twelve questions, with each question having varying topics and patient demographics. Each question was input into 4 different AI models and was asked three times to assess for variability in responses, and the application closed after each attempt. Results: A total of 144 responses were tabulated from ChatGPT, Google Bard, Perplexity, and Bing AI answers to 12 questions in triplicate to assess for consistency. Most responses to the same prompt were consistent across different question-and-answer sessions. ChatGPT’s responses to 75% of the questions (9 out of 12 questions) were appropriate, 25% (3 out of 12 questions) were inappropriate and none were unreliable. Google Bard's responses to 91.7% of the questions (11 out of 12 questions) were appropriate, 8.3% (1 out of 12 questions) were inappropriate and none were unreliable. Perplexity responses to 66.7% of the questions (8 out of 12 questions) were appropriate, 25% (3 out of 12 questions) were inappropriate and 8.3% of the questions (1 out of 12 questions) were unreliable. Bing AI responses to 75% of the questions (9 out of 12 questions) were appropriate, 16.7% (2 out of 12 questions) were inappropriate and 8.3% of the questions (1 out of 12 questions) were unreliable. Of the 144 prompt entries into ChatGPT, Google Bard, Perplexity, and Bing AI; 122 (84.7%) were correct, 11 (7.64%) were hedge responses and could not be binarized into a correct or incorrect response, and 11 (7.64%) were incorrect. Conclusion: Our study showed that online chat-based AI models have a broad knowledge of CVD racial disparities, however persistent gaps in knowledge about minority groups. Given that these models might be used by the general public, caution should be advised in taking responses at face value.
Abstract 4145382: Sex Differences in Clinical Outcomes Among Patients with Myocarditis Complicated by Cardiogenic Shock: A Retrospective Multi-Center Cohort Study
Authors: Gina Josey, Vibhu Parcha, John Scheinuk, Usman Hasnie, Ahmed Saleh, Ammar Hasnie, Samuel McElwee, Stephen Clarkson
Journal: Circulation (2024)

Introduction: Myocarditis is more commonly reported among young males and may be complicated by cardiogenic shock. Animal models and clinical studies demonstrate that myocardial fibrosis after myocarditis disproportionately impacts males. There is limited contemporary data on sex-specific clinical outcomes among patients with myocarditis complicated by cardiogenic shock. Methods: This retrospective cohort study used an EHR-based data platform from large academic medical centers across the United States (TriNetX, Inc.) to identify patients diagnosed with cardiogenic shock secondary to myocarditis between January 2012 and January 2024. Baseline demographics, clinical characteristics, medication use, and outcomes were defined using standardized ICD codes. The primary study outcome was all-cause mortality at 6 months. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF). The study population was stratified based on sex. Propensity score matching (1:1), incorporating demographic factors, comorbidities, and medication usage, was employed to compare the risk of primary and secondary outcomes between groups. Results: We identified 3,048 individuals (1,857 males, 60.9%) with myocarditis complicated by cardiogenic shock. After propensity-score matching, there were 1,072 individuals in each group ( Table ). Females had a higher risk of all-cause mortality (HR: 1.27, 95%CI: 1.06-1.52), but a lower risk of AKI (HR: 0.83, 95% CI: 0.74-0.92) and VT/VF (HR: 0.74, 95%CI: 0.60-0.92). The risks of atrial fibrillation (HR: 0.88, 95% CI: 0.70-1.09) and cardiac arrest (HR: 1.04, 95% CI: 0.85-1.27) were similar between the two groups. Conclusion: Significant sex-based differences in clinical outcomes exist among patients with myocarditis complicated by cardiogenic shock. Further studies are warranted to investigate the pathophysiological basis of the higher risk of all-cause mortality, and lower risk of AKI and ventricular arrhythmias among females with myocarditis complicated by cardiogenic shock compared with males.
Abstract 4145988: Individual- and Community-level Socioeconomic Differences in Use of GLP-1 Receptor Agonists in Diabetes
Authors: Richard Chaudhary, Sergio Decker, Yang Song, Sadiya Khan, Chiadi Ndumele, Dhruv Kazi
Journal: Circulation (2024)

Introduction: Cardiovascular-kidney-metabolic (CKM) syndrome disproportionately affects individuals with adverse social determinants of health (SDOH). While glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve outcomes in CKM syndrome, inequitable access (e.g., coverage, supply constraints) may worsen health disparities in CKM syndrome. Aims: To characterize the association of individual- and community-level SDOH with GLP-1RA use among Medicare beneficiaries with diabetes. Methods: Cross-sectional study using 100% Medicare claims linked with the Social Vulnerability Index and the US Department of Agriculture Rural-Urban Commuting Area Codes. We evaluated Medicare Advantage and fee-for-service beneficiaries ≥65 years with diabetes enrolled in Part D in 2021 (last year available). Filled prescriptions for GLP-1RAs were identified using National Drug Codes. Baseline characteristics were compared using standardized mean differences. Associations between SDOH (self-identified race and ethnicity, insurance status, social vulnerability index, median household income, rurality, US census region) and GLP-1RA use was evaluated using multivariate logistic regression adjusted for age, sex, and clinical characteristics. Results: Of 13,429,963 adults with diabetes included in the analysis, mean age was 77y and 54.6% were female. During the 1-year study period, 8.5% (475,719) filled ≥1 GLP-1RA prescriptions and were more likely to be younger, have obesity and chronic kidney disease. After adjustment, race and ethnicity were associated with GLP-1 RA use (Compared with non-Hispanic pregnancy: Black race, OR 0.74 (95% CI: 0.73– 0.75); Asian American race, OR 0.80 (0.78– 0.81); Native American, OR, 1.56 (1.50 –1.62); and Hispanic ethnicity 0.91 (0.89–0.93). Medicare Advantage enrollees had lower odds of use than fee-for-service Medicare: OR, 1.18 (1.17 – 1.19). Dual enrollee status, higher median household income, rurality, and higher social vulnerability were associated with greater use. Conclusions: There is substantial variability in the use of GLP-1RAs by individual-level and community-level SDOH factors. Determining the drivers of differential access is urgently needed to enhance equitable use.
Abstract 4145409: Detection and Significance of Nonsustained Ventricular Tachycardia in a Post-stroke Population
Authors: Pranav Rekapalli, Alireza Oraii, Sanjay Dixit, Andrew Epstein, David Frankel, Matthew Hyman, David Lin, Timothy Markman, Steven Messe, Saman Nazarian, Robert Schaller, Vincent See, Wei Yang, Scott Kasner, Francis Marchlinski, Rajat Deo
Journal: Circulation (2024)

Introduction / Background: Clinical guidelines emphasize cardiac rhythm monitoring in post-stroke patients (pts) for detecting atrial fibrillation. Limited studies have evaluated other arrhythmias in this population. Objective: We sought to assess the prevalence and significance of nonsustained ventricular tachycardia (NSVT) in pts who have had an ischemic stroke or TIA. We hypothesize that pts who have NSVT will have a higher risk of cardiovascular events and recurrent stroke than those who do not have NSVT on monitoring. Methods: In a large, quaternary academic health system, we evaluated 563 consecutive, post-stroke pts, who did not have a history of MI or heart failure (HF) and underwent routine, mobile cardiac outpatient monitoring (MCOT, Phillips Biotelemetry, Malvern, PA) between 2019 and 2023. We evaluated all episodes of NSVT, defined as a ventricular rhythm with a wide QRS complex for at least 3 beats and a rate faster than 100 beats per minute. We collected all NSVT episodes during the wear period. For each episode, we also collected the total duration and maximum heart rate. We also calculated the NSVT burden by summing the duration of NSVT episodes and dividing by the total monitoring time. The electronic health record was utilized to identify incident MI, heart failure and/or recurrent stroke. Cox proportional hazard models were used to determine the risk of developing a cardiovascular event across the follow-up period. Results: Of 563 patients, the mean duration of MCOT monitoring was 19±7 days. NSVT was observed in 113 pts (mean 1.8±2.5 episodes per patient). Compared to pts who did not have NSVT, those with NSVT were older, more likely to be male, and more likely to smoke. No differences were observed in the prevalence of hypertension, diabetes, or hyperlipidemia. After a median follow-up of 920 days [IQR 844], there were 123 cardiovascular events. Patients with NSVT had higher risk of incident HF (HR 4.7, 95% CI [1.8, 12.1]; p = 0.002), incident MI (HR 4.2, 95% CI [1.8, 10.0]; p = 0.001) or recurrent stroke (HR 2.1, 95% CI [1.2, 3.7]; p = 0.007). Among those with NSVT, a higher NSVT burden was associated with a greater risk of cardiovascular events (p=0.004). Conclusion: In post-stroke patients, the presence and burden of NSVT are associated with a higher risk of incident cardiovascular events and recurrent stroke. Future studies should evaluate whether NSVT is a modifiable marker of cardiovascular risk in these pts.
Abstract 4145955: In An Experimental Type 2 Diabetes Mellitus Model Induced With Streptozotocin, The Combined Use of Finerenone and Exenatide Reduced Inflammation and Oxidative Stress In The Heart and Kidney Tissues and Improved The Health of The Heart
Authors: emirhan gunek, Elif Aydin, Meliha Koldemir Gunduz, Gullu Kaymak, Ayse Kocak
Journal: Circulation (2024)

Introduction: Cardiovascular problems are the primary cause of morbidity and death in people with diabetes mellitus.The whole nature of diabetic cardiomyopathy(DCM) is yet unknown.In order to investigate the pathogenesis of DCM and find possible treatment targets,animal models have proven invaluable.It has been common practice to create experimental models of type 2 diabetes(T2DM) using streptozotocin (STZ).Finerenone(F) is a selective mineralocorticoid receptor antagonist and reduces cardiovascular and adverse renal outcomes in diabetes.Exenatide(E) has been approved by the FDA to improve glycemic control in T2DM. Aim: The aim of this study is to investigate the possible cardiorenal protective effects of potential heart failure and chronic kidney injury associated with T2DM and to assess the potential therapeutic roles of Finerenone and Exenatide.To understand the interactions on cardiorenal outcomes of heart failure and diabetes and to effectively manage these two conditions. Methodology: Wistar male rats with streptozotocin-induced T2DM were used.Five different groups were established as 1)Control,2)STZ,3)STZ+F,4)STZ+E,5)STZ+F+E groups. During the 21-day experiment, blood glucose concentrations were measured in all animal experimental groups. The kidney, heart tissues, and blood serum were collected. Serum urea and creatinine were exanimated.Total antioxidant status(TAS) and total oxidant status(TOS) were examined from blood serum,kidney,heart tissues by spectrophotometric assays. Kidney, heart tissues and blood IL-6, IL-1β, TNF-α gene expressions were examined by qPCR. Cardiac troponin T(cTnT) and troponin I(cTnI) gene expressions were examined by qPCR.p-STAT3 and p-NRF2 protein expressions in heart tissue were assessed by western blotting. Results: Serum urea and creatinine were significantly lower in STZ+E+F group than control group. TAS were significantly higher in STZ+E+F group than control group in serum,heart and kidney tissues. TOS, IL-1β, IL-6, and TNF-α gene expressions were lower in STZ+E+F groups than control group significantly in serum, heart and kidney tissues.cTnT and cTnI gene expressions and p-STAT3 and p-NRF2 protein expressions were lower in STZ+E+F groups than control group significantly in heart tissues. Conclusion: This study demonstrates the potential beneficial effects of Finerenone and Exenatide on cardiorenal complications in T2DM. Evaluation of these drugs in treatment strategies and further clinical trials are recommended.
Abstract 4145760: Impact of the liver fibrosis scoring on prognosis after coronary artery bypass grafting in patients with prediabetes or diabetes
Authors: Zhongchen Li, Juntong Zeng, Runze Chen, Zhe Zheng
Journal: Circulation (2024)

Background: Previous studies have suggested a strong association of liver fibrosis scores with cardiovascular outcomes in patients with different cardiovascular diseases, especially in people with abnormal glucose metabolism. However, the prognostic implication of liver fibrosis scores in patients with prediabetes or diabetes undergoing coronary artery bypass grafting (CABG) has not been investigated yet. Purpose: This study aimed to investigate the impact of liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index on clinical outcomes following CABG in patients with prediabetes or diabetes. Methods: Adult patients with stable coronary artery disease and prediabetes or diabetes undergoing isolated CABG from a large prospective registry-based cohort between January 2013 and December 2018 at our center were consecutively included. Patients with missing detailed data, hepatitis B/C virus infection, autoimmune hepatitis, hereditary liver disease, secondary causes of fatty liver, drug-induced liver disease, active infections, or severe liver insufficiency were excluded. The primary outcome was all-cause death. The secondary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of all-cause death, myocardial infarction, cerebrovascular accidents, or repeat revascularization. Survival was summarized using Kaplan-Meier curves and compared by log-rank test, followed by multiple adjustments. Results: A total of 14,253 patients were included. According to clinical guidelines, a FIB-4 score of ≤1.3 is considered indicative of a low risk for liver fibrosis. Of all patients, 8,888 (47.9%) were identified as having a high FIB-4 (&gt;1.3) level. During a median follow-up of 3.4 years, a high FIB-4 level was associated with an increased risk of all-cause death (adjusted hazard ratio [aHR]: 1.405, 95% confidence interval [95% CI]: 1.205-1.698, P＜0.001), as well as MACCEs (aHR: 1.142, 95% CI: 1.039-1.256, P=0.006). Conclusion: Almost half of the patients with prediabetes or diabetes undergoing CABG were exposed to high FIB-4, which might be associated with poor prognosis.
Abstract 4145915: Postoperative Pericarditis after Cardiac Surgery in Adult Congenital Heart Disease
Authors: Sinan Khor, Ralph Mosca, TK Kumar, Brittany Weber, Adam Small, Dan Halpern, Michael Garshick
Journal: Circulation (2024)

Background: Advances in diagnosis and treatment have led to improved congenital heart disease (CHD) outcomes with more adults undergoing operations into adulthood. Cardiac surgery is associated with post-surgical inflammatory conditions including postoperative pericarditis that confer morbidity and are understudied in the adult CHD (ACHD) population. Goals/Aims: To evaluate the incidence and risk factors for developing postoperative pericarditis in ACHD surgical operations. Methods: This is a retrospective study of all adult patients with CHD who underwent cardiac surgery between 2015 and 2023 at a major New York medical center. Pericarditis diagnosis required 1) documentation of pericardial inflammation as meeting 2/4 criteria for acute pericarditis (chest pain, friction rub, non-localizing ST-elevations or PR depressions, and new/worsening pericardial effusion) and 2) treatment of pericarditis (NSAIDS, colchicine, steroids, IL-1 inhibition). Surgical data and lesion classification was collected. Results/Data: Out of 214 ACHD patients undergoing cardiac surgery (median age 36, IQR [26-53] years, 49% male [Table 1]), 47 patients (22%) developed postoperative pericarditis. The majority (&gt;75%) of cases occurred within the first 7 days, with clinical resolution within 2-4 weeks. Four patients developed recurrent episodes of pericarditis, and no patients experienced clinical tamponade or required urgent pericardial drainage. Those who developed pericarditis were younger and more commonly Asian (33%) or African American (33%) compared to Hispanic (23%) or White (12%) (Table 1). Pericarditis occurred most frequently with shunt repairs (27/73, 37%, p&lt;0.001) and aortic valve replacement (10/29, 34%, p=0.016). Those who underwent septal defect (ASD) repairs (24/61, 39%, p&lt;0.001) with autologous pericardium (16/36, 44%, p=0.001) represented the highest risk group. Conclusions: Postoperative pericarditis develops in roughly one in five ACHD cardiac surgical cases, most frequently in those who required autologous patch repair, yet only rarely had long-lasting complications. Our study suggests the need to further understand the natural history, treatment, and prevention of pericarditis in those with ACHD requiring surgery.
Abstract 4145438: Pharmacological Targeting of FAS Attenuates Macrophage-Derived Foam Cell Formation
Authors: Dina Ibrahim, Shahab Hafezi, Larisa Belaygorod, Batool Arif, Clay Semenkovich, Mohamed Zayed
Journal: Circulation (2024)

Introduction: Fatty acid synthase (FAS), a key enzyme in de novo lipogenesis, may contribute to the pathogenesis of atherosclerosis. Notably, the circulating form of FAS (cFAS) is a potential biomarker for peripheral arterial disease and carotid artery stenosis, particularly in patients with diabetes. Within the atherosclerotic lesion, macrophage-derived foam cells (MDFc) play a crucial role in disease pathogenesis. Research question: This study addressed the role of cFAS in macrophage-derived foam cell formation and the efficacy of FAS inhibitors in mitigating this process. Methods: Cell culture: U937 monocytes were differentiated into macrophages using PMA (200ng/mL) for 24h. Foam Cell Assay: Differentiated macrophages were cultured under various conditions. The RPMI1640 media supplemented with 5% FBS used as a negative control. To induce MDFc, some cultures used 5% human serum containing high FAS/low LDL levels as a positive control. Other cultures combined human serum containing low FAS with high, medium, or low LDL levels. Additionally, the effects of FAS inhibitors were tested by adding PTM (20μM), TVB-2640 (100nM), or GSK2194069 (10nM) to the media for 48h, both with and without high FAS/low LDL levels. Oil-O-Red Staining: Lipid droplets were quantified after neutral lipid staining with Oil-O-Red. Results: Our findings reveal a notable increase in the formation of MDFc when macrophages were cultured with high FAS/low LDL levels as compared to the low FAS/low LDL condition (P=0.00082) and as compared to the negative control using 5% FBS (P=0.0001). Furthermore, we observed a significant reduction in lipid droplets within MDFc following treatment with FAS inhibitors. Both the selective FAS inhibitors TVB2640 and GSK2194069 led to significant reductions in MDFc (P&lt;0.0001). Conclusion: Our findings underscore the potential role of FAS in promoting the formation of MDFc. Pharmacological inhibition of FAS can mitigate foam cell formation, which represents a potential novel avenue for clinical management of atherosclerosis. Further exploration of the mechanism of action of pharmacological targeting of extracellular cFAS versus intracellular FAS in pre-clinical in vivo models is warranted.
Abstract 4145424: 30-Day Outcomes of Dual vs Triple Antithrombotic Therapy After PCI
Authors: William Meeks, Sarah Slone, Kurt Barringhaus
Journal: Circulation (2024)

Introduction: Dual therapy with clopidogrel and an anticoagulant has become the standard of care for patients on long-term anticoagulation following PCI. However, the impact of initial triple therapy and the selection of optimal P2Y12 inhibitor on ischemic and bleeding events is ambiguous during the first 30 days after PCI. Aim: Explore prescribing patterns and outcomes of patients discharged on dual therapy versus triple therapy post PCI. Methods: We performed a retrospective chart review of all patients receiving PCI at a single institution over a 12-month time frame who were discharged on an anticoagulant. The exposure variable was type of therapy (dual vs. triple) prescribed at discharge as well as anticoagulants and P2Y12 inhibitors prescribed. The outcome was any 30-day event defined as death, stent thrombosis, major bleeding events, and composites of ischemic and bleeding events. Differences were explored using Fisher’s exact test due to the low number of types of events. Results: The study included 124 patients. 41% patients were treated with immediate dual therapy, and 59% were discharged on triple therapy. A greater proportion of patients undergoing non-elective PCI received triple combination therapy (58% vs 31%; P=0.004; Table 1). There was no statistically significant difference in death or composite outcomes between groups (Table 2). Two stent thrombosis events occurred, both in patients receiving dual antithrombotic therapy with clopidogrel ( P=0.09 ). No stent thrombosis events occurred in patients initially started on triple therapy or in patients receiving dual therapy utilizing a more potent P2Y12 inhibitor. Four major bleeding events were noted in patients on triple therapy, and 1 major bleeding event occurred in a patient on dual therapy ( P=0.31 ; Table 2). Conclusion: In this retrospective analysis of patients, a trend toward higher albeit not statistically significant 30-day stent thrombosis event rate was noted in patients started on dual therapy using clopidogrel for P2Y12 inhibition. These findings should be cautiously interpreted, and analysis is ongoing in a larger dataset to better define the relationship between type of therapy and ischemic and bleeding events.