tbuckley/cabot-search huggingface dataset:
Abstract 4131622: Opportunistic Screening of Chronic Liver Disease With Deep Learning Enhanced Echocardiography
Authors: Yuki Sahashi, Milos Vukadinovic, Fatemeh Amrollahi, Hirsh Trivedi, Justin Rhee, Jonathan Chen, Susan Cheng, David Ouyang, Alan Kwan
Journal: Circulation (2024)

Introduction: Chronic liver disease affects more than 1.5 billion adults worldwide, but the majority of cases are asymptomatic and undiagnosed. Echocardiography is broadly performed and visualizes the liver; however, this information is not diagnostically leveraged. Hypothesis and Aims: We hypothesized that a deep-learning algorithm can detect chronic liver diseases using subcostal echocardiography images that contains hepatic tissue. To develop and evaluate a deep learning algorithm on subcostal echocardiography videos to enable opportunistic screening for chronic liver disease. Methods: We identified adult patients who received echocardiography and abdominal imaging (either abdominal ultrasound or abdominal magnetic resonance imaging) with ≤30 days between tests. A convolutional neural network pipeline was developed to predict the presence of cirrhosis or steatotic liver disease (SLD) using echocardiogram images. The model performance was evaluated in a held-out test dataset, dataset in which diagnosis was made by magnetic resonance imaging, and external dataset. Results: A total of 2,083,932 echocardiography videos (51,608 studies) from Cedars-Sinai Medical Center (CSMC) were used to develop EchoNet-Liver, an automated pipeline that identifies high quality subcostal images from echocardiogram studies and detects presence of cirrhosis or SLD. In a total of 11,419 quality-controlled subcostal videos from 4,849 patients, a chronic liver disease detection model was able to detect the presence of cirrhosis with an AUC of 0.837 (0.789 - 0.880) and SLD with an AUC of 0.799 (0.758 - 0.837). In a separate test cohort with paired abdominal MRIs, cirrhosis was detected with an AUC of 0.726 (0.659-0.790) compared to MR elastography and SLD was detected with an AUC of 0.704 (0.689-0.718). In the external test cohort of 66 patients (n = 130 videos), the model detected cirrhosis with an AUC of 0.830 (0.738 - 0.909) and SLD with an AUC of 0.768 (0.652 – 0.875). Conclusions: Deep learning assessment of clinically indicated echocardiography enables opportunistic screening of SLD and cirrhosis. Application of this algorithm may identify patients who may benefit from further diagnostic testing and treatment for hepatic disease.
Abstract 4127345: National Cohort Study on Hypertensive Disorders of Pregnancy Among Women with Congenital Heart Disease: Insights from Multiple Centers
Authors: Qian Zhang, Fang Zhu, Chunfeng Zhu, Ruixiang Ma, Huixian Miao, huiwen chen
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP) are among the primary reasons for maternal and perinatal deaths globally. Encompassing chronic hypertension, pregnancy induced hypertension (PIH), and preeclampsia, HDP are among the most frequent complications encountered during pregnancy. Considering the emerging congenital heart disease (CHD) population globally, research on HDP in pregnancies with CHD is urgently needed. Methods: Outcomes for 2220 pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. Maternal death, cardiac complications, obstetric and offspring complications of completed pregnancies and their demographics, cardiac characteristics, and comorbidities were collected. To identify the risk factors for HDP, univariate and multivariate analysis were performed through logistic regression. Results: Of 2220 completed pregnancies with CHD from 7 tertiary institutions, 77 women had PIH, and 76 women had preeclampsia. The main CHD diagnosis of patients with PIH was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI, BAV, and COA), and single ventricle (SV). The main CHD diagnosis of patients with preeclampsia was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI and MS/MI), and right heart abnormality (including TOF, PS/PAS/PI, DORV and DCRV). In parturients with PIH, the mortality and incidence of heart failure were 2.60% and 15.58%, respectively. In parturients with preeclampsia, the mortality and incidence of heart failure were 6.58% and 23.68%, respectively. Pregnancies with HDP had a significantly higher incidence of adverse maternal and offspring events than pregnancies without HDP. Independent risk factors for HDP included multiple gestation, use of medically assisted reproduction, having elevated brain natriuretic peptide (BNP) level, delayed first ANC visit, and absence of strict antenatal supervision. Conclusion: In summary, the presence of HDP in women with CHD significantly increased the risk of mortality and morbidity for both the mother and the child, particularly in cases involving preeclampsia.
Abstract 4126971: Advanced Care Planning in the CCU: What are the Numbers?
Authors: Daniel Sweeney, Priya Uppal, Thomas Jamrozik, Paul Hutchison
Journal: Circulation (2024)

Introduction: Advanced care planning (ACP) is an important, though often neglected, part of medicine. It can promote goal-concordant care and improve communication between the medical team and patient. This is especially important in the intensive care unit, where important health decisions are made by patients and families. Previous studies have shown that patients and families are interested in ACP discussions, especially in intensive care units. Studies are limited, however, in analyzing the prevalence of these discussions prior to and during admission to the cardiac intensive care unit (CCU). Methods: This was a retrospective cohort study. Baseline demographics were collected on patients admitted or transferred to the CCU between January 1, 2022- July 1, 2022. The presence of any ACP (documentation including POLST forms, advance directives, or power of attorney forms) filled out prior to and during admission was recorded. Length of stay, outcome of admission, discharge disposition, and baseline comorbidity index using the Charlson Comorbidity Index (CCI) were also recorded. Transplant patients, patients admitted for transplant, and patients who underwent multiple admissions were excluded from the study. Results: Between January and July, 400 patients met criteria for inclusion. The average age was 67, with males accounting for 62% of patients. The average CCI amongst these patients was 6.95. Of the 400 patients, 31 had ACP completed prior to their admission (7.75%). Out of the 369 patients who did not have ACP in place upon admission, 9 had ACP completed during their stay in the CCU (2.44%). There was no difference in CCU hours amongst those who had ACP prior to admission compared to those who did not (p=.9). There was, however, a difference among CCI index: those with ACP prior to admission had an average CCI of 9.94 compared to 6.7 in those without ACP (p&lt;.001). Conclusions: Patients at risk of cardiac-related mortality can benefit from ACP discussions prior to the onset of critical illness; however, only a small fraction of patients admitted to the CCU have proper documentation of this process. Inpatient and outpatient ACP can target at-risk patients to improve both the conversation and documentation of patient values and treatment preferences. Possible interventions to provide this care include physician education, consistent discussion of ACP during rounds, or flagging patients without ACP in the EMR.
Abstract 4131460: Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and Renal Insufficiency
Authors: Jordan Strom, Marnie Bertolet, Brandon Herbert, Shahbaz Malik, Gilles Lemesle, Mina Madan, Philippe Steg, Jay Traverse, Harvey White, Caroline Alsweiler, Rajesh Gupta, Luiz Eduardo Ritt, MARK MENEGUS, John Alexander, Renato Lopes, Bernard Chaitman, Jeffrey Carson
Journal: Circulation (2024)

Background: Chronic kidney disease (CKD) is associated with risk of myocardial infarction (MI) and anemia. Among patients with CKD and anemia who experience MI, it remains uncertain if a liberal transfusion threshold (LTT) strategy (hemoglobin cutoff [Hgb] &lt; 10 g/dL) is superior to a restrictive transfusion threshold (RTT, Hgb 7-8 g/dL) strategy. Objectives: To evaluate outcomes of those with CKD randomized to RTT vs. LTT in the Myocardial Ischemia and Transfusion (MINT) trial (NCT02981407). Methods: Among 3,495 MINT participants with non-missing creatinine (99.7%), we compared the baseline characteristics and outcomes at 30 days post-randomization of those individuals without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m 2 (N = 999), CKD with eGFR &lt; 30 mL/min/1.73 m 2 (N = 802), and CKD requiring dialysis (N = 415), both overall and by randomized transfusion strategy. Interaction terms for eGFR category by treatment assignment on each outcome were assessed. Results: Individuals with CKD compared to those without CKD more frequently presented with NSTEMI (all p &lt; 0.001) and had a greater risk of all-cause death, recurrent MI, rehospitalization, and heart failure (all p &lt; 0.05). Compared to a liberal transfusion strategy, a restrictive strategy among non-dialysis dependent individuals with an eGFR &lt; 30 mL/min/1.73 m 2 was associated with an increased risk of death/recurrent MI ( Figure 1 ) and unplanned rehospitalization ( Figure 2 ). Among individuals with an eGFR 30-60 mL/min/1.73 m 2 , a restrictive strategy was associated with an increased risk of cardiac death ( Figure 1 ). No eGFR category by treatment assignment interaction terms were significant. Conclusions: In this prespecified analysis, individuals with CKD were at greater risk of death, recurrent MI, heart failure, and unplanned rehospitalization at 30 days post-randomization than those without CKD. In individuals with CKD, a restrictive transfusion strategy was associated with increased risk of adverse outcomes.
Abstract 4129036: Air pollution and Cardiovascular Disease Incidence in a Pooled Analysis of 6 U.S. Cohorts
Authors: Claire Leiser, Sabah Quraishi, Mary Lou Biggs, Jaime Hart, Dale Sandler, Eric Whitsel, Alexandra White, Michael T Young, Adam Szpiro, Elizabeth Spalt, Joel Kaufman
Journal: Circulation (2024)

Introduction/Background: Long term air pollution is associated with cardiovascular disease (CVD) incidence, however the effects at low levels in the US are unknown. Research Questions/Hypothesis: To assess the effect of long-term exposure to ambient air pollution CVD incidence (myocardial infarction [MI], stroke, and all CVD) in a pooled analysis of epidemiological cohorts. Materials and Methods: We harmonized data from six cohorts (Cardiovascular Health Study, Nurses’ Health Study II, Multi-Ethnic Study of Atherosclerosis, and Reasons for Geographic And Racial Differences in Stroke Study, Sister Study, and Women’s Health Initiative) with both CVD incidence data and extensive covariate information. We predicted time-varying two-year average concentrations of particulate matter &lt;2.5 microns (PM 2.5 ) and nitrogen dioxide (NO 2 ) from 1990-2019 at participant residential addresses using validated regionalized spatio-temporal models, combining spatio-temporal universal kriging and partial least squares regression with inputs from monitoring data from regulatory and researcher-deployed networks, satellite remote-sensing data and chemical transport modeling. Cox proportional hazards regression models adjusted for individual and area-level information, including smoking status, socio-economic factors, anthropometry, blood pressure, cholesterol, and other clinical variables. Results: Our analysis included over 300,000 participants and 10,229 incident CVD events. The median residential concentration of PM 2.5 was 10.1 µg/m 3 and NO 2 was 9.3 ppb. A 5 µg/m 3 increase in PM 2.5 was not significantly associated with a higher hazard ratio for all outcomes: 1.03 (95%CI: 0.96, 1.10) for CVD incidence, 1.03 (95%CI 0.93, 1.15) for MI, and 1.00 (95%CI 0.90, 1.10) for stroke. We found that a 10ppb increase in NO 2 was associated with a 1.06 (95%CI: 1.01, 1.11) higher hazard ratio for CVD, 1.07 (95%CI: 1.01, 1.11) for MI, and 1.02 (95%CI 0.96, 1.09) for stroke. Conclusions: In this analysis of a large, pooled cohort with excellent exposure, outcome, and covariate information, we found an association of NO 2 exposure—considered a surrogate for traffic-related air pollution—with CVD incidence and MI. Associations with particulate matter were not statistically significant, but could not exclude a small increased risk. We are extending this analysis to include 6 additional cohorts and an additional 700,000 participants to allow for generation of a highly resolved concentration-response function.
Abstract 4131618: Association between Clinical Characteristics and Telomere Length - Factor Analysis of Mixed Data (FAMD)-based Cluster Analysis
Authors: Tadeusz Osadnik, Maciej Banach, Anna Goc, Ewa Boniewska-Bernacka, Anna Panczyszyn, Mateusz Lejawa, Joanna Strzelczyk, Natalia Pawlas, Karol Krystek, Marek Gierlotka, Marcin Golawski, Kamila Osadnik, Martyna Fronczek, Agnieszka Gach, Jacek Jozwiak
Journal: Circulation (2024)

Introduction: Telomere length is a marker of cellular aging and is correlated with various cardiovascular risk factors. Aim: To assess the association between clinical characteristics of patients and telomere length in an unselected cohort of patients under the care of primary care physicians. Methods: The LIPIDOGEN study was carried out in the primary care 2015. Patients recruited to LIPIDOGEN cohort (n=1788) were a random subset of patients of LIPIDOGRAM 2015 (n=13,724) study. Patients for LIPIDOGRAM2015/LIPIDOGEN study were recruited in all 16 administrative regions in Poland. Each patient was asked to fill the questionnaire on risk factors, chronic, treatment and lifestyle and also had saliva secured for DNA analyses. Factor Analysis for Mixed Data (FAMD) based cluster analysis was utilized to discern groups of patients with similar clinical profiles and correlate them with relative telomere length (rTL). RTL was measured using quantitative polymerase chain reaction. Results: DNA quality was sufficient for further analyses in 1606 patients. After outlier exclusion, 1,342 patients (59.3% female, mean age 50.2 years) were analyzed. FAMD revealed two distinct clinical characteristic patterns, explaining 41.6% of the total variance in the clinical variables. The first pattern, correlated with male gender and a higher prevalence of MetS, hypertension, diabetes, obesity, greater waist circumference, elevated non-HDL-C and remnant-C levels, was linked to shorter rTL (r = -0.13, p &lt; 0.001). The second pattern, characterized mainly by lipid parameters, showed no significant association with comorbidities or rTL (r = -0.04, p = 0.14). Conclusions: Pattern of clinical characteristics marked by classical cardiovascular risk factors, is inversely related to telomere length, underlining the potential role of metabolic disturbances in cellular aging. The second lipid-centric pattern without significant comorbidities was not associated with telomere length.
Abstract 4127071: Pulmonary Artery Catheter Utilization in Cardiogenic Shock: Clinical Characteristics and Outcomes
Authors: Ethan Krauspe, Christos Kyriakopoulos, Monte Scott, Eric Sheffield, Iosif Taleb, Sean Selko, Konstantinos Sideris, Eleni Maneta, Zhining Ou, Rana Hamouche, Laura Geer, Josef Stehlik, Matthew Goodwin, Joseph Tonna, Thomas Hanff, Stavros Drakos
Journal: Circulation (2024)

Background: The pulmonary artery catheter (PAC) is used for hemodynamic monitoring, but its impact on patient outcomes, especially in cardiogenic shock (CS), is controversial. Several studies have shown no significant benefits and noted complications, leading to a decline in PAC use. However, PAC use appears to have increased recently in guiding management decisions in CS. Our study aims to assess the clinical characteristics and outcomes of CS patients receiving PACs versus not. Methods: We included patients with CS admitted to a tertiary academic medical center between May 2015 and December 2023. Variables were compared using Kruskal-Wallis, chi-squared, and Fisher's exact tests. Hemodynamic parameters were collected from either right heart catheterization or from a PAC. Endpoints included native heart survival to discharge, durable left ventricular assist device (LVAD) implantation, heart transplant (HTx), and 30-day and 1-year survival from discharge. Results: The study group consisted of 742 patients with CS. Of these, 385 (52%) received a PAC and 357 (48%) did not. The baseline characteristics of the two groups are shown in Table 1A . PAC patients had more severe shock, worse hemodynamics, and higher rates of temporary mechanical circulatory support (MCS) use. Hemodynamic measurements at shock onset differed, with PAC patients having higher right atrial pressures and lower cardiac index by Fick. Clinical outcomes and MCS related complications are shown in Table 1B. There was no significant difference in native heart survival at discharge, but HTx and durable LVAD implantation was higher in the PAC group. PAC placement was associated with longer hospital stays and more MCS related complications, including bleeding and hemolysis. The 30-day survival rate was similar between groups, and 1-year survival was marginally higher in the PAC group. Conclusion: PAC patients exhibited more severe clinical characteristics, longer hospital stays, higher rates of temporary MCS use and complications, durable LVAD implantation, and HTx. Short-term survival rates were similar, but 1-year survival was slightly better for PAC patients. Further studies are needed to provide clearer insights into PAC use in CS.
Abstract 4127681: Neutrophil-lymphocyte ratio as a marker of cardiovascular outcomes in patients with chronic coronary syndrome
Authors: Henrique Trombini Pinesi, Eduardo Moreira, Marcelo Barbosa, Eduardo Martins, FABIO GRUNSPUN PITTA, Eduardo Lima, FABIANA HANNA RACHED, Carlos Serrano
Journal: Circulation (2024)

Background: Inflammation is one of the pathophysiological processes involved in the genesis and progression of atherosclerosis and has been increasingly used as a therapeutic target in recent years. The neutrophil-lymphocyte ratio (NLR) is a promptly accessible inflammatory biomarker strongly associated with prognosis in the acute coronary setting. However, there are few data in patients with chronic coronary syndrome (CCS). Objective: Analyze the association between NLR and cardiovascular outcomes in patients with CCS. Methods: Patients with CCS, defined as a previous revascularization procedure (surgical or percutaneous), previous myocardial infarction (MI) or stenosis &gt; 50% in at least one epicardial coronary artery, were included and followed up on an outpatient basis. The NLR was calculated using the baseline blood count. The main outcome was the composite of death, non-fatal myocardial infarction and non-fatal stroke. Results: The study population consisted of 975 patients, with a median age of 65 years and 30% were women. Previous MI was present in 61%, 30% had undergone previous revascularization surgery and 46% had percutaneous coronary intervention. Diabetes was prevalent in 59% and hypertension in 95%. The median NLR was 2.15 (IQR 1.25 - 2.87). Patients with NLR ≥ 2.15, when compared to those with NLR &lt; 2.15, presented more left ventricular (LV) dysfunction (58% vs. 55%; p=0.003) and lower LDL-C serum levels (81 vs. 88 mg/dL; p=0.004). There was no association between NLR and coronary anatomical severity. NLR correlated with age, LDL-C and LV function (p &lt; 0.05 for all). During follow-up, 152 events of the composite primary outcome were registered, with an estimated 3-year incidence of 15.6% in the overall population – higher within patients with NLR ≥ 2.15 when compared to NLR &lt; 2.15 (20% x 14%, p = 0.002), as shown in the figure. In the multivariate analysis, the 3rd quartile of NLR had a 31% higher risk than the 1st quartile (p &lt; 0.05). Conclusion: In this study, the NLR, an easily available inflammatory biomarker, independently correlates with cardiovascular outcomes in a population with CCS.
Abstract 4131409: Systemic Review and Meta-analysis of Global Longitudinal Strain Changes after Angiotensin Receptor Nephrilysin Inhibitor Initiation in Patients with Heart Failure
Authors: Kristen Carter, Soumya Gupta, Ashish Correa, Kiran Mahmood, Arieh Fox
Journal: Circulation (2024)

Angiotensin Receptor Nephrilysin Inhibitors (ARNi) have been established as a beneficial medication in patients with heart failure (HF). This class of medications has been shown to decrease HF hospitalizations and has been included as one of the pillars in guideline directed medical therapy. Recently, left ventricular (LV) global longitudinal strain (GLS) measurements on echocardiograms have become more common and provide a more precise measurement of LV function than ejection fraction. GLS is now being used as a more intricate way of monitoring improvement in the function of the myocardium, especially in patients with heart failure. This meta-analysis was conducted to determine if treatment with ARNi in HF patients significantly improves myocardial functioning measured by LV GLS. A meta-analysis of 9 studies including observational studies and randomized controlled trials found in a Pubmed search was performed and included patients with heart failure who were initiated on an ARNi for guideline directed medical therapy and had LV GLS measurements taken on an echocardiogram before and after ARNi initiation. The study included patients with heart failure with reduced ejection fraction. Studies were excluded if the patient population did not have a diagnosis of HF and if LV GLS measurements were not available before and after treatment with ARNi. This analysis was performed to determine if initiation of ARNi in patients with HF led to a significant improvement in LV GLS on echocardiography and therefore a significant improvement in myocardial function. There were 9 studies included in the analysis and 879 patients with HF who were treated with ARNi or a control. The change in LV GLS at the conclusion of the study period was measured in both treatment and control groups and the mean difference between the two groups was -1.61 with a 95% confidence interval of (-2.23, -0.98) (p &lt;0.00001). This indicates that the ARNi treatment groups had a significant improvement in GLS compared to the control groups. ARNi initiation was found to significantly improve LV GLS and therefore myocardial function in patients with HF with reduced ejection fraction. LV GLS is a precise measurement of myocardial function. Using this form of measurement in echocardiograms can aid in determining the effect different treatments have directly on myocardial function.