tbuckley/cabot-search huggingface dataset:
Abstract 4146180: HFpEF in Space: The Influence of Weightlessness on Cardiac Filling Pressure in Obese Heart Failure with Preserved Ejection Fraction
Authors: Giorgio Manferdelli, James MacNamara, Christopher Hearon, Aman Shah, Kevin Tayon, Ambarish Pandey, Satyam Sarma, Benjamin Levine
Journal: Circulation (2024)

Introduction: Heart failure with preserved ejection fraction (HFpEF) and obesity are often co-morbid, with obesity being associated with greater left ventricular (LV) filling pressures. Obesity may contribute to LV filling pressure by increasing external constraint due to the weight of the lungs and chest wall compressing the heart. The magnitude of the contribution of external constraint to LV filling pressure in HFpEF is unknown. We investigated the influence of chest weight on pulmonary artery systolic, diastolic, and mean pressures in two patients with obesity and HFpEF during acute exposure to weightlessness. Methods: One female (participant 1; age: 62 years; BMI: 41.2 kg/m 2 ) and one male (participant 2; age: 72 years; BMI: 46.8 kg/m 2 ) patient with HFpEF, obesity, and previously placed CardioMEMS device (Abbott), completed a parabolic flight consisting of repeated parabolas with ~30 seconds of 0G, and ~30 seconds of 1.8G, with level flying (1G) between sets (Figure 1A). Pulmonary artery systolic, diastolic and mean pressures were measured using a CardioMEMS console in the supine position and 10-second waveforms were recorded for analysis (Figure 1C). Spontaneous end-expiratory pressures were corrected for barometric pressure. Results: Pulmonary diastolic pressures during flight are shown in Figure 1B and 1C. Removal of gravity immediately and significantly decreased pulmonary pressures in both participant 1 (1.8G: 61/36 (46), 1G: 59±4/34±3 (45±3), 0G: 52±3/26±1 (37±2) mmHg) and participant 2 (1.8G: 41/27 (32), 1G: 38/24 (30), 0G: 29±1/15±1 (21±1) mmHg). The absolute change in pulmonary artery diastolic pressure from 1G to 0G was -8 mmHg and -9 mmHg, while between 1.8G and 0G was -10 mmHg and -12 mmHg for participant 1 and 2, respectively. Conclusion: Acute exposure to weightlessness profoundly reduced pulmonary artery pressures in patients with the obese phenotype of HFpEF. The magnitude of the decrease was greater than nitrates and left atrial shunt devices. Our results suggest that the weight of the lungs and chest wall contribute mechanically to LV filling pressures in HFpEF, and that weight loss may lower LV filling pressures by reducing external constraint.
Abstract 4146187: Ivabradine Associated Atrial Fibrillation Incidence Over 1 Year
Authors: Jasmeen Kaur, Halie Anderson, KIBUM KIM, Przemyslaw Radwanski, Mark Munger
Journal: Circulation (2024)

Objective: Ivabradine (IVBD) is a hyperpolarization-activated cyclic nucleotide-gated channel blocker that inhibits the pacemaker I f current causing spontaneous depolarization in the sino-atrial node thereby regulating heart rate in patients with heart failure (HF). Previous reports state that IVB use is associated with an increase in risk of atrial fibrillation (AF). This study aims to determine the incidence of ivabradine-associated AF over 1 year in a real-world database of AF naïve patients with HF. Methods: Rates of incident AF were determined using Merative Health MarketScan ® Commercial Claims and Medicare Supplemental Database. Using ICD codes and outpatient medication dispensing records, we extracted HF patients who filled a prescription for IVBD between 01/2015 and 12/2021. Patients with a prior diagnosis of AF before starting IVBD were excluded. The study endpoint was the first diagnosis of AF, defined by ICD 9 and 10 codes, after the index IVBD dispensing. The time to AF was projected using cumulative incidence calculation. We used Kaplan-Meier product limit estimator to calculate AF outcomes at 30, 90, 180, and 365 days from the index IVBD, where patients were censored at the end of enrollment or end of the one-year follow up. Results: The analytic cohort at first IVB dispensing included 498 patients with mean (SD) age of 52.27 (12.47). Analytic cohort was slightly more weighted by male with a proportion of 53.2%. The cumulative incidence of AF at 30, 90, 180 and 365 days after the IVB use was 4.91%, 12.16%, 19.24%, and 28.11%, respectively. (Figure) Conclusions: Cumulative incidence of AF after IVBD was higher than the published AF incidence among commercially insured HF patients. A comparative safety assessment is warranted to quantify the measure of association for the AF incidence and exposure to IVBD.
Abstract 4146140: An Artificial Intelligence Machine Learning Algorithm Approach Using Segmental ECG Analysis to Distinguish Long QT Syndrome from Acquired QT Prolongation
Authors: Johan Bos, Kan Liu, Zachi Attia, Peter Noseworthy, Paul Friedman, Michael Ackerman
Journal: Circulation (2024)

Background: Many medications, electrolyte perturbations, and several diseases can prolong the QTc beyond its 99 th percentile value resulting in acquired QT prolongation (AQTP). In contrast, approximately 1 in 2,000 people have congenital long QT syndrome (LQTS) hallmarked by pathological QT prolongation. Recently, we developed an AI-ECG model to distinguish these two groups, however this model does not elucidate which ECG segments distinguish LQTS from AQTP. Methods: Using the cohort from our previous study, all patients with LQTS evaluated in the Mayo Clinic Genetic Heart Rhythm Clinic and controls were included. Next, every patient/control with ≥1 ECG above age- and sex-specific 99 th percentile for QTc was selected and matched at 1:100 ratio. Subsequently, 5 ML algorithms (logistic regression, Naïve Bayes, random forest, Gradient boosting and XGBoost) were trained using 52 features representing segments of the 12-lead ECG (e.g. wave peak times, amplitudes, areas under wave, duration; 52x12 features). Training and testing sets were spilt at 80:20 ratio and 5-fold cross validation was performed to prevent overfitting. Following analysis, the top 100 features were re-analyzed to refine results. Results: Among &gt;1,600 patients with LQTS, 690 had ≥ 1 ECG with a QTc above the established threshold compared to 28,186 controls. Following age- and sex-matching and splitting, 22,410 (training), and 5,776 (testing) ECGs were used. Of the 5 ML algorithms, XGBoost demonstrated best performance (AUC 0.913, accuracy 0.836, sensitivity 0.857, specificity 0.835) to distinguish LQTS from AQTP. Following filtering for the top 100 features, performance of the algorithm remained high with AUC of 0.912 (accuracy 0.84, sensitivity 0.841, specificity 0.84). The features with the greatest impact on classification output included time from T wave onset to T wave peak (leads V1, V4, V4), QRS interval duration (leads V1, V3, V4, aVR), and amplitude at end of ST segment (aVF). Conclusions: Distinguishing monogenetically driven LQTS from multi-factorial AQTP is critical in clinical practice for proper management, mitigation of offending QT-prolonging factors, and treatment. Building on our previously developed AI-ECG-LQTS ‘mutation detector’, this model identifies some of the elements within the ‘black box’ that distinguish an ECG and QTc stemming from a patient with LQTS compared to a similar prolonged QTc value that is arising due to non-genetic, acquired QT-prolonging factors.
Abstract 4146217: Validation of an Unsupervised Cluster Model of Clinical and Echocardiographic characteristics for Natural Unbiased Stratification of Risk In Heart Failure with Preserved Ejection Fraction
Authors: Juan Arango, Alaa Omar, Loba Alam, Ga Hee Kim, Sean Pinney, Edgar Argulian
Journal: Circulation (2024)

Background: We previously reported computational clustering to describe clinically distinct phenotypes of heart failure with preserved ejection fraction (HFpEF). We aimed to validate our prior model exploring the clinical and echocardiographic variations in HFpEF on unseen dataset. Methods: Retrospectively, 556 HFpEF patients previously reported [exploration group, Age: 66±17years , 56%females, EF: 63±6%, DOI:10.1016/s0735-1097(19)31580-3] and a new unseen dataset of 1055 HFpEF patients [validation group, Age: 58±17years , 56% females, EF: 60±6%] were studied and followed for a median of 4.7 years for death and cardiac hospitalization. A 2-step unsupervised cluster model previously applied to the exploratory group and composed of 11 echo and clinical variables (age, sex, diabetes, hypertension, hematocrit, creatinine, pulmonary functions, E/A ratio, E/e’ ratio, left atrial volume index, tricuspid regurgitation velocity) was saved and applied to the unseen validation dataset. Clusters were described based on echo and clinical domains. Results: The analysis in the exploratory group yielded 8 different clusters with increasing distinct clinical, structural, hemodynamic, as well as adverse event risks as previously reported [low risk females (lowest risk), low risk males, hypertensive females, hypertensive males, multiple risk factor group, diabetes group, pulmonary group, and renal group (highest risk), figure 1 A,B,C]. When applied to the exploratory group, similar clinical, echocardiographic and event rate risk criteria were noted (figure 1 D,E,F). The diagnostic performance of both exploratory and validation models were comparable (AUC=0.724, 0.721, respectively). In the validation group, the clusters also differentiated brain natriuretic peptide and troponin concentration and had progressively worsening H2FPEF score, exercise capacity and exercise induced diastolic dysfunction. Conclusion: The current study validates our previous model and confirms the previously reported heterogeneous clinical and echocardiographic phenotypes. Next, computational models such as the one reported should be applied to clinical trials to discover new therapeutic approaches unique to each phenotype.
Abstract 4146142: Constrictive Pericarditis Due to Sarcoidosis: Role of Multimodality Imaging in a Patient with a Metal Jacket Full of Calcification
Authors: Alveena Syed, Abdel Hadi El Hajjar, Farah Abdulhai, Ushasi Saraswati, Ahmad Safdar, Jaideep Singh Bhalla, Tom Kai Ming Wang, Jay Ramchand, Allan Klein, Issam Motairek
Journal: Circulation (2024)

Clinical Presentation: A 62-year-old male with a complex medical history, including pulmonary sarcoidosis, diabetes, constrictive pericarditis post partial pericardial stripping, cirrhosis, and congestive heart failure, presented with signs and symptoms of volume overload. Despite increasing diuretics and previous paracentesis, his condition continued to deteriorate. There were raising concerns for constrictive pericarditis due to cardiac sarcoidos. Echocardiography (TEE) showed pericardial thickening and calcification adjacent to the left ventricle and dilated IVC 2.4 cm (TTE). Cardiac magnetic resonance imaging (CMR) demonstrated conical deformity of the ventricles, thickened pericardium with signal void suggestive of calcification. Computed Tomography (CT) showed significant near circumferential pericardial calcifications. Subsequent catheterization confirmed constriction and identified a right coronary artery lesion. Following this, the patient underwent a redo pericardiectomy and coronary artery bypass grafting, at the Cleveland Clinic. However, his post-operative course was marked by complex challenges, including multi-organ dysfunction, the need for tracheostomy, feeding tube, renal replacement therapy, and recurrent ascites. Despite intensive care, his condition did not improve, leading to a transition to comfort care and eventually the patient passed away in December 2023. Discussion: This case highlights the intricate management of a patient with a myriad of underlying health issues. While multimodality imaging is pivotal in ensuring accurate preoperative diagnosis and guiding surgical interventions, it is important to acknowledge that challenges may persist in the postoperative phase. This case study underscores the vital role of multimodality imaging, irrespective of post-surgical outcomes, in facilitating precise diagnosis and delivering optimal patient care. The subsequent referral to the Cleveland Clinic for redo surgery, followed by a challenging and ultimately palliative care journey, shows the complexity of her clinical course and the importance of multimodality imaging and comprehensive care strategies.
Abstract 4146152: Young Onset Stroke in Young Asian American and Pacific Islanders and Associated In-hospital Mortality Using National Inpatient Sample 2016-2020
Authors: Mansi Patel, Samyuktha Prabu, Hemanth Dhananjaya, Himanshu Jog, Arankesh Mahadevan, Ninia Goyal, Rashmi Gawde, Rupak Desai
Journal: Circulation (2024)

Background: Exploring the risk of young-onset stroke (YOS) in Asian Americans and Pacific Islanders (AAPIs), our study helps fill a critical gap in medical literature. By identifying unique risk factors and trends, the findings can guide early identification and targeted interventions for young AAPI individuals at high risk of stroke. Method: AAPIs aged 18-44 with and without YOS hospitalization were retrospectively identified from the National Inpatient Sample (2016-2020). Study population, comorbidities, and outcomes were queried using ICD-10-CM codes. All-cause in-hospital mortality (ACIHM) was the primary outcome and secondary outcomes were measures of healthcare resource utilization. Multivariable regression analysis was performed to analyze cardiovascular disease risk (CVD) factors as predictors of YOS and associated all-cause in-hospital mortality (ACIHM). Linear-by-linear trend analysis was performed. Statistical significance was defined at p&lt;0.05. Result: Of 1,629,064 young AAPIs hospitalized between 2016 and 2020, 9325 had YOS (0.6%), with an overall increasing prevalence year by year (0.5% in 2017 to 0.7% in 2020). Demographically, the YOS had a higher average age (38 vs. 32 years) and a male majority. YOS hospitalizations had the highest prevalence of comorbidities (hypertension, hyperlipidemia, obesity, diabetes mellitus, and smoking). Based on sex, females had an upward trend in YOS admissions (0.3% in 2016 to 0.4% in 2020) while nonsignificant in males. Trends in ACIHM were nonsignificant (p=0.279) overall, but by sex, it showed an overall decrease in males (11.1% in 2016 to 0.5% in 2020) and an overall increase in females (4.5% in 2016 to 11.5% in 2020). ACIHM was higher in the YOS cohort (9.4% vs. 0.3%), with a longer stay (5 vs 2 days) and more expense (94,712 USD vs. 25,637 USD). Comorbidities of hypertension, both complicated and uncomplicated, hyperlipidemia, and peripheral vascular disease significantly predicted the odds of stroke by 7.14, 6.29, 1.85, and 5.94. Hyperlipidemia was protective against ACIHM in YOS hospitalizations (OR: 0.24 [0.13-0.43]). Conclusion: Young AAPIs have an increasing risk of YOS each year, with higher rates and odds seen with certain CVD risk factors.
Abstract 4146172: Gender Differences in Outcomes of Leukemia Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): 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: Transcatheter Aortic Valve Implantation (TAVI) is increasingly used to treat severe aortic stenosis in patients who are at high risk for conventional surgery. Patients with leukemia represent a unique subset, often presenting with additional comorbidities and a higher susceptibility to complications. Gender differences in clinical outcomes following TAVI in leukemia patients remain under-explored. Understanding these differences is crucial for optimizing patient care and improving procedural outcomes in this vulnerable population. Methods: A retrospective analysis using the National Inpatient Sample (NIS) data from 2016 to 2021 compared male and female leukemia patients undergoing TAVI. Multivariate logistic regression was utilized to analyze variables such as in-hospital mortality, transfusion requirements, bleeding, and other complications. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and statistical significance was determined by P-values. Results: The study included 2,175 male and 1,055 female leukemia patients undergoing TAVI. The majority of patients were White, with 91.92% of males and 92.12% of females. Black patients constituted 2.14% of the male and 2.46% of the female groups.The mean age of male patients was 79.25 years, while female patients were slightly older, with a mean age of 80.66 years. Total charges were comparable between genders, with males incurring $217,554.6 and females $224,248.3. The length of stay was also similar, with males staying an average of 3.48 days and females 3.82 days. Mortality was significantly higher in females compared to males, with an odds ratio (OR) of 8.824 (95% CI: 1.415-55.017, P=0.02). Females also had higher odds of requiring transfusions (OR=2.049, 95% CI: 1.052-3.989, P=0.035) and experiencing bleeding complications (OR=2.039, 95% CI: 1.17-3.555, P=0.012). Other complications, such as vascular injury, permanent pacemaker (PPM) insertion, arrhythmias, and respiratory failure, did not show significant gender differences. Conclusion: Female leukemia patients undergoing TAVI are at a significantly higher risk of mortality, requiring more transfusions, and experiencing increased bleeding compared to their male counterparts. These findings underscore the urgent need for gender-specific management strategies and further research to enhance outcomes for this high-risk population.
Abstract 4146225: Stress Perfusion Cardiac Magnetic Resonance Imaging for Pediatric Patients with Repaired Transposition of the Great Arteries
Authors: Devin Chetan, Subin Thomas, Hanan Smaili, Navjot Gill, VIvian Tassos, Christopher Lam, Shi-Joon Yoo, Israel Valverde, Mike Seed
Journal: Circulation (2024)

Introduction: Patients who underwent arterial switch operation (ASO) for d-transposition of the great arteries (TGA) are at increased risk for early myocardial ischemia. Stress perfusion cardiac MR (SPCMR) is used as a non-invasive tool for risk stratification but interpretation is often challenging. Hypothesis: There is significant interobserver variability in SPCMR image interpretation in patients with repaired TGA. Aims: 1. Determine incidence and severity of adverse effects of stress agents. 2. Evaluate incidence of positive SPCMR. 3. Assess agreement amongst reviewers in image interpretation. Methods: Patients with repaired TGA with SPCMR imaging from 2013 to 2024 were reviewed. Three patients with previous coronary intervention and one with severe chest pain after adenosine, unable to complete SPCMR, were excluded. 61 studies were performed in 56 patients. Images were independently reviewed by two investigators blinded to initial interpretation and clinical outcome. Perfusion defects were displayed on a circumferential polar plot using standard LV segmentation. Results: Median (IQR) age was 15 (11-17) years, weight 55 (36-68) kg, and BSA 1.6 (1.2-1.8) m2. Max heart rate was 110 (100-125) and systolic BP 127 (116-138). Eleven (20%) patients had cardiac symptoms, chest pain in 9 (16%), syncope in 1 (2%), pallor and distress in 1 (2%) infant. Adverse effects from SPCMR in 8/52 (15%) adenosine, 2/4 (50%) dobutamine, and 0/6 (0%) regadenoson were minor and resolved on stress completion. Six (10%) studies were initially interpreted as suspicious (n=5) or definitive (n=1) perfusion defect (Figure). No LGE was detected. Original interpretation did not match blinded reviews for 6 cases (Figure). Blinded reviewers agreed on 3 negative cases but interpretation differed in the other 3 cases (Figure). Conclusions: SPCMR is safe and feasible. Significant interobserver variability highlights the challenges in qualitative SPCMR interpretation for TGA. Quantitative perfusion may reduce interobserver variability. Larger multicenter studies would be helpful in further elucidating the risk profile of patient characteristics and coronary artery arrangements to determine whether routine use of SPCMR is warranted for TGA patients.
Abstract 4146177: Oxygen uptake kinetics are not a specific marker of peripheral limitations to exercise among adults with heart failure with preserved ejection fraction.
Authors: Michael Zuazua, Michael Leahy, Joseph Campain, Denis Wakeham, Tiffany Brazile, Mitchel Samels, James Macnamara, Satyam Sarma, Christopher Hearon, Benjamin Levine
Journal: Circulation (2024)

Introduction: Oxygen uptake (VO 2 ) and cardiac output (Q C ) kinetics describe the time required for oxygen delivery and blood flow to match metabolic demand during exercise and reflect the efficiency of peripheral oxygen utilization. Individuals with heart failure with preserved ejection fraction (HFpEF) have slow VO 2 kinetics, potentially due to peripherally limited skeletal muscle or a blunted Q C response. We characterized cardiovascular kinetics to determine whether the mechanisms of VO 2 kinetics are differentially regulated in adults with HFpEF with peripheral or non-peripheral limitations to exercise. Methods: We studied 44 adults with HFpEF (62% female, age: 70 ± 7 [55-83] years, BMI: 38 ± 7 kg/m 2 [26-50]) during submaximal and maximal exercise. The Q C response normalized to metabolic demand (Q C /VO 2 slope; Direct Fick) assessed from rest to maximal exercise was used to characterize the cardiac output response to exercise. Participants were classified as either peripherally (slope: &gt;6 or stroke volume reserve &gt;50%) or non-peripherally limited (slope: &lt;6 or stroke volume reserve &lt;50%). Kinetics were measured as the mean response time (MRT) to steady-rate exercise during a 6-minute sub-maximal (20 Watts) effort on a semi-recumbent cycle ergometer. We measured VO 2 (indirect calorimetry), heart rate (HR; electrocardiography) and Q C (Modelflow analysis of radial arterial catheter waveforms) and compared groups using unpaired t-tests. Results: The Q C /VO 2 slope was higher in peripherally (n=28, 6.3 ± 2.0) versus non-peripherally limited participants (n=16, 5.2 ± 0.6; p=0.035). There was no difference in VO 2 MRT in peripherally limited (60 ± 20 sec) and non-peripherally limited participants (55 ± 20 sec; p=0.438, Panel A). There were no differences in Q C MRT (peripheral: 48 ± 23 sec; non-peripheral: 41 ± 15 sec, p=0.374) or HR MRT (peripherally: 53 ± 21; non-peripheral: 56 ± 20 sec, p=0.708) (Panels B&amp;C). Conclusion: There was no difference in oxygen uptake or cardiovascular kinetics between adults with HFpEF with peripheral or non-peripheral limitations to exercise. Our findings indicate that differences in VO 2 kinetics are not a specific marker of peripheral limitations to exercise in adults with HFpEF.