tbuckley/cabot-search huggingface dataset:
Abstract 4120990: Classification of Echocardiography Videos Using TimeSformer for Detecting Incipient Heart Failure in Asymptomatic Patients with Normal Ejection Fraction and Patients with Heart Failure
Authors: Srilakshmi Adhyapak, Prahlad Menon
Journal: Circulation (2024)

Background: Recent advancements have seen deep learning models help differentiate echocardiography images of patients with heart failure with preserved ejection fraction (HFpEF) from normal controls. Our aim was to develop a model capable of detecting early signs of heart failure in asymptomatic patients with a normal ejection fraction. Methods: We employed the TimeSformer, a video transformer model that classifies video data using a novel attention-based mechanism. This self-attention mechanism that diverges from traditional convolutional neural networks (CNNs). It focuses on relevant parts of the video across both space and time, split into spatial attention, which processes each frame individually, and temporal attention, which integrates information across different frames. The training and validation of the TimeSformer model were conducted on the same dataset of echocardiography videos from 50 normal controls and 50 patients diagnosed with HFpEF, employing 5-fold cross-validation to ensure robust performance evaluation. Results: The TimeSformer model effectively identified HFpEF in patients, as all diagnosed with HFpEF were flagged as abnormal. The echocardiography assessment, along with NT pro BNP levels, supported the diagnoses, with patients showing NT pro BNP levels of 1016±32 pg/ml. Conversely, 46 out of 50 normal controls were correctly identified, with their NT pro BNP levels averaging 52±12 pg/ml. These controls remained asymptomatic. Conclusions: The TimeSformer model demonstrated capability in identifying subtle deviations indicative of incipient heart failure in videos of normal controls, despite normal NT pro BNP levels. This suggests potential for early detection of heart failure in asymptomatic individuals. Further longitudinal studies are necessary to determine whether individuals identified as abnormal develop heart failure symptoms subsequently.
Abstract 4119116: Percutaneous Aspiration of Mitral Valve Endocarditis using the AngioVac Device
Authors: Jenny Jia Ling Cao, Charanjit Rihal, Arashk Motiei, Bastiaan Kietselaer
Journal: Circulation (2024)

Case Description: A 68-year-old man with end-stage renal disease on dialysis, peripheral vascular disease with metatarsal amputations, atrial fibrillation and type 1 diabetes was admitted for foot osteomyelitis secondary to MSSA bacteremia. Transesophageal echocardiogram revealed mobile mitral valve vegetations up to 1.8cm on the atrial aspect of the posterior mitral valve leaflet which prolapsed through the mitral valve during diastole. Ejection fraction was 60% and there was trivial-mild mitral regurgitation without valvular destruction or peri-annular extension into the mitral annulus. MRI brain showed bilateral cerebral and cerebellar hemispheric infarcts, consistent with acute embolic stroke. He was at high risk for both recurrent embolism and operative mortality (STS risk score 51%) due to his comorbidities and risk of hemorrhagic conversion of stroke. After shared decision making, percutaneous aspiration of the mitral vegetation was performed with AngioVac (Fig). Cerebral embolism protection devices were deployed prior to AngioVac evacuation of the mass. There was no residual mitral regurgitation and only a small vegetation strand remained (Fig). Surgical pathology confirmed MSSA endocarditis. Blood cultures remained negative, and the patient did not suffer from recurrent embolic events. The patient underwent revision metatarsal amputation and was discharged with a 6-week course of IV cefazolin. Discussion: Infective endocarditis with high embolic risk is life-threatening and challenging to treat in patients with high surgical risk. We illustrate a case of percutaneous vegetation aspiration using the AngioVac device in our patient who suffered from embolic strokes due to MSSA mitral valve endocarditis. Meta-analyses have shown clinically successful debulking in 90% of cases, with 82% of patients able to clear bacteremia with AngioVac. Although most commonly used in right-sided lesions, percutaneous debulking of left-sided endocarditis with AngioVac and cerebral protection can be considered as a treatment strategy in select patients with prohibitive surgical risk.
Abstract 4118451: A Real-world Evaluation of Longitudinal Healthcare Expenses in a Health System Registry of Type-2 Diabetes Mellitus and Cardiovascular Disease Enabled by the 21 <sup>st</sup> Century Cures Act
Authors: Lovedeep Dhingra, Arya Aminorroaya, Aline Pedroso Camargos, Jigar Rajpura, Sherif Mehanna, IVY TONNU-MIHARA, Rohan Khera
Journal: Circulation (2024)

Background: An evaluation of the longitudinal burden of healthcare expenses in type-2 diabetes mellitus (T2DM) is limited to self-selected cohorts and claims-based or self-reported spending. Leveraging the 21 st Century Cures Act rule that made reporting hospital-level service prices mandatory, we demonstrate healthcare spending in T2DM with and without cardiovascular disease in a diverse multisite EHR-based T2DM cohort. Methods: Patients with T2DM seeking regular care (≥ 1 visit/2 years) across 5 hospitals and a large outpatient network (2013-2023) in the Yale New Haven Health System (YNHHS). Cohorts were defined by the presence of atherosclerotic cardiovascular disease (ASCVD) and/or heart failure (HF) before or up to 1 year after the T2DM diagnosis. We used the YNHHS chargemaster file to extract Medicare and insurance-negotiated cash prices. We linked census data using residential zip codes to estimate household income, used multivariable logistic regression to identify factors associated with financial hardship (health expenses &gt;20% of income), and evaluated expenses during the last year of life. All values were inflation-adjusted to 2023 US$. Results: Overall, 106881 patients with T2DM followed for 5.4 years (3.1-7.5) had 147919 hospitalizations, representing $3.41B in expected healthcare expenses. 8% of patients with T2DM without ASCVD/HF, 14% with ASCVD, 23% with HF, and 28% with ASCVD and HF had a financial obligation for healthcare above the threshold for financial hardship. Compared with White patients, Black and Hispanic patients were more likely, and Asians were less likely to have financial hardship (OR: Black, 1.81 [1.73-1.91]; Hispanic, 1.39 [1.31-1.48]; Asian, 0.46 [0.37-0.57]), after accounting for age, sex, and comorbidities. Comorbid HF at baseline portended 2x higher odds of financial hardship (OR: HF, 2.20 [2.00-2.42]; ASCVD and HF, 1.98 [1.84-2.14]) compared with T2DM alone. Care in the last year of life represented 72-80% of overall health expenses, with 55-61% of patients at risk for financial hardship across cohorts. Conclusion: A digital individualized expense-linked registry of patients enabled by recent US price transparency rules defined that annually, one-fifth of patients with T2DM and cardiovascular disease had healthcare events exceeding 20% of their annual income, and vulnerable racial/ethnic minorities were at high risk for financial toxicity.
Abstract 4119072: When is the Broken Heart Most Dangerous? Assessing Risk Factors to Predicting Mortality in Takotsubo Cardiomyopathy: Analysis of The National Inpatient Sample 2021
Authors: Kayode Ogunniyi, Toluwalase Awoyemi, Derek Ugwendum, Inderbir Padda, Arun Mahtani, Meena Farid
Journal: Circulation (2024)

Introduction: Takotsubo Cardiomyopathy often presents very similarly to acute coronary syndromes (ACS). Although the gravity of the condition is being increasingly recognized, prognostic factors have been hardly established. We applied known near-term ACS mortality risk factors to determine their prognostic value in takotsubo cardiomyopathy. Methods: We analyzed the National Inpatient Sample database for 2021. Inclusion criteria were Principal Diagnosis of Takotsubo Syndrome (ICD 10 code "I5181") and age 18 years or more. Different comorbidities, age, and gender were analyzed in these patients, and the primary outcome was inpatient mortality. Univariate logistic regression was used to test the association of each factor with mortality, and multivariate logistic regression was then used to test for independent predictive value. Analyses were performed using STATA/BE 18.0. Significance was set at 0.05. Results: 9109 admissions for takotsubo syndrome were identified (10.3% males and 89.7% females) with a mean age of 67 years and an inpatient mortality rate of 2.31%. On univariate regression, age (OR 1.04; p=0.013), heart failure (OR 3.2; p&lt;0.001), atrial fibrillation (OR 3.12; p&lt;0.001) and chronic kidney disease (OR 3.54; p&lt;0.001) were significant predictors of mortality while gender(0.389), diabetes(0.132), hypertension (0.052), smoking (0.617), nicotine dependence (0.075), hypercholesterolemia (0.686), obesity (0.728), history of stroke (0.068) and history of myocardial infarction (0.613) were not significantly associated with mortality. On multivariate regression, only heart failure (OR 2.8; p=0.007) and chronic kidney disease (OR 2.34; p=0.032) were independently associated with inpatient mortality. Conclusion: Our findings are mostly congruent with the existing literature regarding this condition. Pre-existing heart failure and a history of chronic kidney disease are poor prognostic factors in patients presenting with Takotsubo cardiomyopathy. Further large-scale studies are required to validate our findings.
Abstract 4119073: Zaza: A New Etiology of an Acquired Brugada-Pattern ECG
Authors: Taimur Bayar-Masood, Nwando Tony-Onugu, AIMEN KHAN, Shawn Shaikh, Ethan Keller
Journal: Circulation (2024)

Introduction: Tianeptine, an unregulated supplement, adds a new problem to the ever-growing drug epidemic. We describe a case of Tianeptine overdose presenting with acute agitation and an acquired Brugada-pattern ECG. Case Description: A 26-year-old male presented with acute agitation after bystanders witnessed the patient ingest 15 capsules of “Zaza Silver”. Initial ECG showed a type I Brugada pattern with coved ST-elevations in V1 and prolonged QRS and QTc. Previous ECGs on record were negative for evidence of a hereditary Brugada pattern. His urine toxicology was positive for THC. Troponins, echocardiogram and CT head were unremarkable. The patient was treated with Diazepam and a sodium bicarbonate drip with close monitoring of arterial blood pH, maintaining a goal between 7.50-7.55. After resolution of his symptoms and ECG findings, he was discharged home. Discussion: Patients with a Brugada pattern ECG are at increased risk of fatal arrhythmias. Classified as both inherited and acquired, this unregulated supplement presents a new etiology of an acquired Brugada-pattern ECG. Tianeptine is a non-FDA approved tricyclic antidepressant that is marketed as a supplement under the brand name “Zaza” at gas stations and convenience stores. Currently approved for the treatment of depression in Europe, it is solely distributed in the US as an unregulated health supplement. We hypothesize that Tianeptiene’s Tricyclic Antidepressant properties can affect the myocardial voltage-gated sodium channels leading to the Brugada pattern on EKG with a similar mechanism as has been previously described in cases of Tricyclic Antidepressant overdoses. Early identification of EKG findings, coupled with a detailed history can be instrumental in early diagnosis and critical treatment with bicarbonate therapy. This case also demonstrates the dangers of the non-FDA marketing of tianeptine and underscores the urgent need to regulate such supplements.
Abstract 4120274: Symptom cluster profiles predict all-cause mortality among U.S. community-dwelling older adults with heart failure
Authors: Zequan Wang, Stephen Walsh, Sangchoon Jeon, Samantha Conley, Deborah Chyun, Nancy Redeker
Journal: Circulation (2024)

Background: Individual symptoms are predictors of mortality in adults with heart failure (HF). However, symptom clusters may be more predictive of future risks than isolated symptoms, yet research on these symptom clusters in older adults with HF is limited. Aims: To explore the extent to which symptom cluster profiles predict all-cause mortality among community-dwelling older adults with HF, while adjusting for known risk factors. Methods: We conducted a secondary analysis of data of the 2008 to 2016 surveys of the U.S. Health and Retirement Study using latent class analysis to identify baseline cluster profiles, and survival analysis for time to death with Cox proportional hazard (Cox PH) models, and Kaplan Meier survival analyses. Results: We included 684 participants [mean age=74.9, (SD=10) years, 56.6% female, 16.2% Black/African American]. Three baseline symptom cluster profiles were identified: high-burden (pain, shortness of breath, fatigue, swelling, depressive symptoms, dizziness), low-burden, and cardiopulmonary-depressive (shortness of breath, pain, and dizziness). The estimated median time-to-death was 71 (95% CI=64, 79) months. Of the 364 participants in the cardiopulmonary-depressive profile, 240 (65.9%) died (median time= 65 months, 95% CI= 55, 73) compared to those in the low-burden profile, of which 49% died. Approximately 61% in the high burden profile died (median time=67 months, 95% CI= 51, 90). A significant difference in survival times between the 3 cluster profiles was found (Log-rank= 9.13, p = 0.01). In the adjusted Cox PH model, participants in the high symptom burden and respiratory-depressive distress profiles had adjusted HR of 1.48 (95% CI=1.15, 1.94) and 1.44 (95% CI=1.14, 1.80) compared to those in the low burden symptom cluster profile, after controlling for age, gender, smoking, and comorbidities. Conclusions: The identified symptom cluster profiles predict 8-year all-cause mortality in older adults with HF, after controlling for known risk factors. An evaluation of symptom clusters, rather than individual symptoms, may provide additive prognostic information.
Abstract 4120929: Silent Myocardial Infarctions in Women with Ischemic Sudden Cardiac Death
Authors: Ida Hookana, Anette Eskuri, Lauri Holmstrom, Lasse Pakanen, Jani Tikkanen, Juha Perkiomaki, Heikki Huikuri, Juha Vahatalo, Juhani Junttila
Journal: Circulation (2024)

Background: Sudden cardiac death (SCD) is a significant mode of death in both sexes, with most cases attributed to coronary artery disease (CAD). In women, ischemic SCD seems to occur more often without previously diagnosed CAD, but the prevalence and characteristics of silent myocardial infarctions (SMI) in women are not known. Aim: This study aimed to investigate the prevalence and characteristics of women with silent myocardial infarction (SMI) and ischemic SCD. Methods: The Fingesture study consists of 5,869 autopsy-verified SCD cases (21.1% women) in Northern Finland 1998-2017. In this study, we investigated women with ischemic SCD without previous CAD diagnosis (N=660). SMI was defined as a myocardial infarction (MI) scar at autopsy in the absence of CAD history in medical records. As a control group, we used women with ischemic SCD without MI scar and previous CAD diagnosis. Coronary artery stenosis, myocardial fibrosis, and MI scars were evaluated through macroscopic assessment during autopsy, with further histological verification for myocardial fibrosis and MI scars. Results: Among 660 ischemic SCD subjects without prior CAD diagnosis, 220 (33.3%) had SMI. Women with SMI were older compared to those without SMI (73.4 vs. 71.4 years in subjects without SMI, p=0.03), and SMIs became more prevalent with advancing age (+4.4% per decade, p&lt;0.01). Women with SMI had higher heart weight (411 vs. 386 g in subjects without SMI, p&lt;0.01) and a higher prevalence of left ventricular hypertrophy (LVH) (73.6% vs. 64.5% in subjects without SMI, p=0.02). The average body mass index was 27.1 kg/m 2 in subjects with SMI and 27.6 kg/m 2 in subjects without SMI (p=0.34). Subjects with SMI were more likely to have severe coronary artery stenosis with &gt;90% occlusion (37.3% vs. 22.5% in subjects without SMI, p&lt;0.01). Severe (15.0% vs. 3.0% in subjects without SMI, p&lt;0.01) and moderate (69.1% vs. 39.4% in subjects without SMI, p&lt;0.01) degrees of myocardial fibrosis were more prominent among subjects with SMI. Conclusions: One-third of ischemic SCD cases without prior CAD diagnosis in women had findings of SMI at autopsy. Women with SMI were slightly older and exhibited more severe coronary disease, LVH and myocardial fibrosis at autopsy. These findings underscore the importance of earlier diagnosis and treatment of CAD in SCD prevention in women.
Abstract 4119189: Imaging practices prior to cardioversion in patients presenting post percutaneous left atrial appendage occlusion.
Authors: Ali Bahbah, Dawn Witt, Melanie Kapphahn-Bergs, Edwin Zishiri, Susan Casey, Emily Halvorson, Raed Abdelhadi, Jay Sengupta
Journal: Circulation (2024)

Background: Direct current cardioversion (DCCV) carries a risk for stroke in AF patients, for that reason there are guidelines for mitigating this risk in AF patients on oral anticoagulation (OAC). Meanwhile, no consensus on the best approach for cardioverting patients with an appendage occlusion device in situ. This led to a very wide variation in pre and post DCCV practices in these patients. Aims: We aim to explore different factors that might be associated with the variation seen in pre-DCCV imaging practices in patients presenting post- percutaneous LAAO. Methods: This was a multi-center retrospective cohort study of patients who received DCCV for AF or AFL during follow up after LAAO procedure within a single healthcare system from 2016-2024. Results: A total of 119 patients were included, there were more females 70 (59%), with more than half (64 (54%)) receiving a first-generation WATCHMAN™ 2.5, while the rest had WATCHMAN FLX™. Median age at presentation was 77 years (72,82), BMI of 31 kg/m 2 (26,37), average CHADSVASC score of 4.5 and HASBLED score of 3. A median duration of 10 months (3,21) between LAAO to presentation for DCCV . Forty-four (37%) patients had pre-DCCV imaging (imaging cohort). Number of males was significantly higher in the imaging cohort (24 (54.5%) vs 25 (33.3%), p=0.038), compared to those without imaging. There was a significant difference (p&lt;0.001) between the two cohorts in the location (center) where DCCV was done. The site with the highest number of pre-DCCV imaging cases had an equal gender ratio of patients presenting for DCCV. Patients who received imaging presented earlier (11.2 months vs 15.8 months, p=0.068) compared to those without imaging, though the difference was not significant. Between the two groups, there was no significant difference in OAC (VKA-antagonist/DOAC) usage prior to presentation (8 (18.6%) vs 12 (16.4%), P=0.9). There was no significant difference in baseline CHADSVASC score, HASBLED score, age, LVEF. Higher percentage of patients were discharged on OAC post DCCV in the imaging arm (13 (30.2%) vs 14 (19.4%), p=0.27), but the difference was non-significant. No Device related thrombus nor significant PDL was detected on imaging. Conclusion: There was male preference in providing pre-DCCV imaging for ruling out DRT. Location of care was also associated with the variation in pre-DCCV protocols. Additional research is needed to understand other factors associated with variation seen in pre-DCCV practices.
Abstract 4121530: Comparison of Drug-Coated Balloon Versus Drug-Eluting Stents in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Authors: Hritvik Jain, Ramez Odat, Aman Goyal, Neha Pervez, Jyoti Jain, Nandan Patel, Eeshal Fatima, Ancy Jenil Franco, Janhvi Shah, Jagriti Jha, Siddhant Passey
Journal: Circulation (2024)

Background: Percutaneous coronary intervention (PCI) is the preferred revascularization strategy for acute myocardial infarction (AMI). Drug-eluting stents (DES) are linked to higher risks of stent restenosis and stent thrombosis when implanted for AMI. Drug-coated balloons (DCB) provide a high concentration of anti-proliferative drugs over the target lesion without using the polymeric stent structures. The current literature comparing DCB to DES for AMI PCI is limited. Methods: A systematic literature search was performed on the major electronic databases for studies comparing DCB to DES for AMI PCI. Mean difference (MD) and odds ratio (OR) with their corresponding 95% confidence intervals were pooled using a random-effects model, and a p-value of &lt;0.05 was considered statistically significant. Results: A total of 8 studies with 1401 AMI patients were included (545: DCB and 856: DES). The pooled analysis demonstrated that DCB was associated with significantly lower mean lumen diameter on follow-up [MD: -0.26; 95% CI: -0.47, -0.05; p=0.02] compared to DES. However, there was no statistically significant difference in mean in-stent late lumen loss [MD: 0.07; 95% CI: -0.03, 0.18], cardiovascular mortality [OR: 0.90; 95% CI: 0.35, 2.34], all-cause mortality [OR: 0.80; 95% CI: 0.25, 2.63], myocardial infarction [OR: 0.94; 95% CI: 0.36, 2.45], major adverse cardiovascular events [OR: 0.97; 95% CI: 0.47, 2.00], target lesion revascularization [OR: 1.59; 95% CI: 0.52, 4.87], and stent thrombosis [OR: 0.48; 95% CI: 0.05, 4.94]. Conclusion: In patients with AMI, PCI using DCB leads to a significant reduction in the minimum lumen diameter on follow-up compared to DES. No statistically significant difference was noted in mean in-stent late lumen loss, cardiovascular mortality, all-cause mortality, myocardial infarction, major adverse cardiovascular events, target vessel revascularization, and stent thrombosis. Further trials are warranted to confirm these findings.