tbuckley/cabot-search huggingface dataset:
Abstract 4145451: Efficacy of Left Atrial Appendage Occlusion with Watchman Device in the Population with BMI&gt;25
Authors: junaid Mir, M Chadi Alraies, Majd Al-Ahmad, Anas Al-Ahmad
Journal: Circulation (2024)

Background: Left atrial appendage closure (LAAC) with Watchman device is an alternative strategy to oral anticoagulation for decreasing ischemic stroke risk in selected patients with non –valvular atrial fibrillation (AF). There is a paucity of data about the efficacy of watchman device in overweight/obese population. Methods: We queried the National Inpatient Sample of the years 2016 to 2020. We identified patients who were admitted for Watchman procedures using ICD10-PCS codes. The risk of mortality and in-hospital complications in overweight/obese group was compared to the non–overweight/non obese group using multivariate logistic regression analysis. Results: During 2016-2020, there were a total of 90060 patients who were admitted for Watchman procedure, of which 15765(17.5%) patients were overweight or obese while 74295 (82.5%) were neither obese nor overweight. After adjusting for demographics, watchman procedure in overweight/obese population had higher odds of arrhythmia (aOR (adjusted odds ratio) 1.19; 95% CI 1.08–1.31 p &lt;0.001), AKI (aOR 1.32; 95% CI 1.03–1.68p =0.026), respiratory failure (aOR 1.52; 95% CI 1.16–1.98 p =0.02), and non-invasive ventilation (aOR 1.9; 95% CI 1.33–2.7 p&lt;0.001). There were no differences in mortality, GI bleed, Length of stay (LOS) and mean total cost of care between the two groups. Conclusion: Left atrial appendage occlusion with Watchman device in overweight /Obese population has higher odds of arrhythmia, AKI, respiratory failure, and non –invasive ventilation compared to non-overweight/non obese population. Further studies are needed to elucidate the benefit of Watchman device in the overweight/obese population.
Abstract 4145506: Cardiac Myosin Inhibitors Improve Hemodynamics and Symptom Burden in Symptomatic Hypertrophic Cardiomyopathy: An Updated Meta-Analysis
Authors: Mahad Raheel, Akash Goyal, Sakima Smith, Vaiibhav Patel, Rami Kahwash, Brent Lampert, Indra Bole, Beth Foreman, Garrie Haas, Veronica Franco, ayesha hasan, Ajay Vallakati
Journal: Circulation (2024)

Introduction: Cardiac myosin inhibitors (CMI), including mavacamten and more recently aficamten, are emerging therapies in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) that facilitate ventricular relaxation by reducing myosin-actin crossbridge formations. We performed an updated, contemporary pooled analysis to study to study the clinical efficacy of CMI in patients with HCM. Methods: We searched PubMed database from its inception to May 25, 2024 using the search terms “mavacamten” or “aficamten” and “hypertrophic cardiomyopathy” for literature search. Random effects model with Mantel–Haenszel method was used to pool data. The following outcomes were analyzed: change in peak VO 2 , valsalva LVOT gradient, Kansas City Cardiomyopathy questionnaire (KCCQ) clinical summary scale (CSS), improvement in NYHA functional class (FC), and LVEF decline. Results: We identified five randomized controlled studies which compared CMI with placebo. Pooled analysis included 741 patients of whom 389 received either mavacamten or aficamten and 352 received placebo. Median follow up time was 24 weeks. When compared to placebo, CMI decreased valsalva LVOT gradient (mean difference -41.08 mmHg, 95% CI -48.41 – -33.75 mmHg, p&lt;0.001), improved KCCQ CSS (mean difference 6.83, 95% CI 3.59-10.06, p&lt;0.001), increased peak VO 2 (mean difference 1.19 mL/kg/min, 95% CI 0.21-2.17 mL/kg/min, p=0.02). Patients receiving CMIs were more likely to experience ≥1 NYHA FC improvement (RR 2.18, 95% CI 1.67-2.84, p&lt;0.001) (Figure 1). CMIs were associated with a temporary decline in LVEF (RR 3.30, 95% CI 1.25-8.73, p=0.02). However, LVEF normalized in all patients with temporary decline by the end of follow-up. Conclusion: This is the largest pooled analysis assessing the efficacy of CMI in patients with HCM. Evidence from this analysis suggests that CMIs improved hemodynamic measures and symptom burden in patients with HCM.
Abstract 4146565: Evolving Burden of Cardiovascular Disease Attributable to High Body Mass Index in the United States and its Trend from 1990-2021: A Comparative and Consistent Analysis
Authors: KRISHNA sajeev, Gunjan Kochhar, Jobby John, Dhruvi Modi, Praveena Suppala, Rutvij Patel, Paritaben Bhalodia, Vishwesh Patel, Lalitkumar Patel, Venkata Ramana Katikala, HARDIK DESAI
Journal: Circulation (2024)

Introduction: Cardiovascular Disease (CVD) remains the primary cause of death and illness in the United States, incurring annual costs of $219 billion. Modifiable risk factors significantly contribute to the prevalence of CVD. This study is the first to estimate the burden of CVD attributable to high body mass index (HBMI) on CVD in the US over the past three decades, including the initial two years of the COVID-19 pandemic. Method: Using global burden of disease study 2021 standardized methodology, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CVD attributable to HBMI by age, sex, year and location across the US from 1990-2021. Results: From 1990-2021, the total percentage change (TPC) in deaths attributable to CVD linked to HBMI increased by 54% (95% Uncertainty Interval: 36% to 92%), and YLDs soared by 159% (128% to 207%). In 2021, the highest number of deaths was recorded from ischemic heart disease at 85,522, followed by hypertensive heart disease at 43,430, stroke at 13,886, atrial fibrillation and flutter at 5,278, lower extremity peripheral arterial disease at 3,098, and aortic aneurysm at 1,295. Oklahoma exhibited the highest age-standardized mortality rate (ASMR) due to CVD from HBMI at 49.46 (33.57-68.08) per 100,000 person-years, with the lowest in Massachusetts at 16 (8.16-25.32) in 2021. Louisiana reported the highest YLDs rate at 72.58 (31.04-120.32). The age group 70-74 years old saw the highest number of deaths at 17,997, with the most years of life lost in the 60-64 age group at 430,068 and the highest YLDs in the 70-74 age group at 49,054. Males showed a greater increase in burden compared to females, with TPC in deaths at 65% vs. 42%, DALYs at 59% vs. 43%, and YLDs at 193% vs. 130% from 1990-2021. Conclusion: Deaths due to CVD attributable to HBMI accounted for 16.83% of all CVD related deaths in US in 2021. To combat this trend, it is essential to launch comprehensive health campaigns that leverage the power of e-health and mobile health technologies. These platforms should be utilized to disseminate evidence-based healthcare strategies and preventive measures. Furthermore, engaging influencers and celebrities in these campaigns can amplify the reach and impact, encouraging broader public adoption of healthier lifestyles. Such innovative and inclusive public health initiatives are crucial for reversing the rising trend in CVD-related health burdens.
Abstract 4146616: Incidence of ventricular tachycardia and fibrillation detected by an insertable cardiac monitor in a large real-world cohort of heart failure patients with reduced and preserved ejection fraction.
Authors: Rami Kahwash, Michael Zile, Mohammad Khan, Shantanu Sarkar, Brian Van Dorn, Bart Gerritse, Javed Butler
Journal: Circulation (2024)

Background: Subcutaneous insertable cardiac monitors (ICM) have the capability to detect tachycardia (tachy) which are occasionally ventricular tachycardia and fibrillation (VT/VF). Objective: We investigated the incidence of spontaneous VT/VF in patients (pts) implanted with an ICM and clinical history (Hx) of heart failure (HF) with reduced or preserved left ventricular ejection fraction (LVEF). Methods: Pts with Hx of HF admissions who were implanted with an ICM were identified from the aggregated and de-identified Optum ® electronic health record (EHR) database during 2007-2021. The ICM collected data were merged with EHR data to create a de-identified database of real-world patients. Pts were included if they had ≥180 days of device follow-up. ICMs detect tachy if 30 of 40 recent intervals are shorter than 260 ms or if 16 consecutive intervals are shorter than tachy interval (nominally 340 ms) that is adjusted with age. Tachy episodes were first classified as VT/VF, SVT, or oversensing using an artificial intelligence (AI) model that was pre-trained using over 50K manually adjudicated ICM detected tachy episodes. If the AI model output probability for VT/VF was greater than 0.2, then those episodes were manually adjudicated for true incidence of non-induced spontaneous VT/VF. The Kaplan-Meier incidence curves for VT/VF incidence are reported as a function of reduced vs preserved ejection fraction. Results: A total of 1020 ICM pts with Hx of HF admission were identified from the real-world dataset. In 889 pts (87%) with available LVEF, 394 (44%) had EF&lt;50%, and 495 (56%) had EF≥50%. In 296 pts (29%) with available NYHA class, 13%, 43%, 38%, 6% were class I, II, III, and IV respectively. Pts had an avg. age of 68±13 yrs with 52% being males and Hx of hypertension in 95%, diabetes in 56%, coronary artery disease in 75%, atrial fibrillation in 57%, stroke/TIA in 51%, and renal dysfunction in 53%. A total of 911 pts with an average follow-up of 25.8 months were included. A total of 90 tachy episodes (41 pts) were adjudicated as true VT/VF. Incidence of true VT/VF, as detected by an ICM over 36 months of follow-up, was estimated to be 5.6% with VT/VF incidence being 8.2% vs 3.8% in HF pts with reduced versus preserved LVEF (Figure). Conclusion: Incidence of VT/VF over 3 years of follow-up was estimated to be more than 5% in pts with ICM and Hx of HF events. VT/VF incidence was higher in HF pts with reduced versus preserved LVEF in this real-world cohort.
Abstract 4145480: Acute Pulmonary Edema in Peripartum Period: An Unusual Presentation of Takotsubo Cardiomyopathy
Authors: Chinmaya Sharma, Aditya Bhave, Pratima Bajaj, Stephanie Dunlap, Gyanendra Sharma
Journal: Circulation (2024)

Introduction: Acute respiratory distress in the peripartum period can occur from a variety of reasons including pulmonary or cardiac causes. Careful integration of the history, physical examination and imaging studies is crucial to make a definitive diagnosis. Case presentation: The patient is a 22-yr-old G1P0 African American woman with no significant medical history who had two unsuccessful external cephalic versions and required Cesarean section. Intraoperatively, she became dyspneic and hypoxic. She had labored breathing, tachycardia, scattered wheezes and hypotension. She had acute pulmonary edema, requiring endotracheal intubation. PA catheter placement revealed cardiac output of 3.7 L/min, Pulmonary artey pressure was 37/27 mmHg and SPO2 of 80% on 100% FiO2. Transthoracic echocardiogram (TTE) revealed moderately reduced left ventricular ejection fraction, (LVEF) 30-35% and moderate mitral regurgitation. She had preserved apical LV function with reduced contractility in the basal segments suggestive of reverse Takotsubo syndrome. RV size and function were normal, making significant pulmonary embolism less likely. CXR revealed interstitial edema. EKG had sinus tachycardia. Peak troponin I was 3.3ng/mL and Lactic acid 4.2 mmol/L. Patient received IV diuretic and inotropic support with Norepinephrine, Epinephrine and Milrinone. She was extubated after 2 days. TTE four days later revealed recovery of LVEF to 53%. Three weeks later, she was asymptomatic. Cardiac MRI showed normal LVEF 58% and no wall motion abnormalities. Discussion: The patient had acute pulmonary edema and systolic dysfunction . In the absence of chest pain or ST elevation on EKG, spontaneous coronary dissection was unlikely. Takotsubo cardiomyopathy (TMC) is an acute but transient cardiac dysfunction following significant physical or emotional stress. Attempted external cephalic version may have triggered TMC. It is important to distinguish between TCM and Peripartum cardiomyopathy (PPCM) in these patients as it may prevent the continuation of long term medical therapy for heart failure. PPCM has a more gradual onset. Quick normalization of her LV function strongly favors that she experienced Takotsubo, not Peripartum cardiomyopathy. Conclusion: Making an accurate diagnosis of Takotsubo cardiomyopathy by serial echocardiography to demonstrate quick improvement in LV function has long-term implications regarding future pregnancies and prognosis.
Abstract 4145452: A platelet biosignature in psoriasis associates with enhanced cardiovascular risk
Authors: Kamelia Drenkova, Filipp Kazatsker, Matthew Muller, Florencia Schlamp, Elliot Luttrell-Williams, Sarah Liberow, Siobhan McGirl, Lauren Kennedy, Jessica Garelik, Kristen Lo Sicco, Jeffrey Berger, Michael Garshick
Journal: Circulation (2024)

Introduction: Studies display an increased cardiovascular (CV) risk in psoriasis, but the underlying mechanisms and prevention strategies are not known. We investigated platelet aggregation and the platelet transcriptome as one potential mechanism to explain CV risk in psoriasis. Methods: Recruited psoriasis and controls (from the community) underwent platelet aggregation studies with light transmission aggregometry, and a subset underwent bulk platelet RNA sequencing with downstream analyses in R Studio. Results: Psoriasis subjects (n=75, age 47 ± 15 years, percent body surface area of psoriasis 6%) compared to controls (n=44, age 41 ± 15 years) were older ( p =0.02), overweight, (BMI [kg/m 2 ] 28 ± 6 vs. 26 ± 5, p &lt;0.01), more often carried a diagnosis of dyslipidemia (35% vs. 16% p =0.03) and had higher high-sensitivity C-reactive protein values ([hsCRP in mg/L 3.1 ± 4.5 vs. 1.8 ± 2.5, p =0.02). Platelet aggregation was significantly higher in psoriasis vs. controls with collagen (86.6% vs. 72.0%, p =0.03) and ADP (88.2% vs. 75.7% vs. p =0.03). Platelet RNA sequencing revealed in psoriasis vs. control 384 genes upregulated and 414 genes downregulated ( p &lt;0.05). Hierarchical clustering of the differentially expressed platelet RNA genes allowed a natural separation into three groups including one predominantly encompassing controls (18/20), a middle group (psoriasis = 24, controls = 20), and a third group of predominantly psoriasis (psoriasis = 25/26). Pathway analysis showed dysregulated TNF, interferon, and VEGF signaling pathways. Using penalized lasso regression, a psoriasis platelet RNA signature comprised of 400 differentially expressed platelet genes correlated with arterial stiffness ( r =0.3, p =0.02), coronary plaque ( r =0.5, p =0.02), and coronary calcium ( r =0.5, p =0.02) burden. Conclusion: Platelet aggregation is significantly increased in psoriasis with the platelet transcriptome associated with pro-inflammatory pathways and CV risk. Our results warrant further investigation of platelet involvement driving the heightened CV risk observed in psoriasis.
Abstract 4145423: Antiphospholipid Antibodies and Risk of Atherosclerotic Cardiovascular Disease
Authors: Alleh Nogueira, Lucas Tramujas, Nicole Felix, Thomaz Costa, Pedro Carvalho
Journal: Circulation (2024)

Background: Antiphospholipid antibodies (aPL) trigger inflammation, vasculopathy, and thrombosis, sharing pathophysiological mechanisms with atherosclerosis. However, their association with incident cardiovascular events has not been defined and may impact predicting cardiovascular disease risk and guiding therapy intensity. Hypothesis: aPL predict the risk of all-cause mortality and cardiovascular disease in primary prevention, independent of traditional cardiovascular risk factors and their therapy. Aim: To determine the association between single-time-point measurement of aPL and atherosclerotic cardiovascular risk in a diverse population without established cardiovascular disease or antiphospholipid syndrome. Methods: This retrospective cohort study included patients from 2004 to 2024, measuring nine aPLs using solid plasma assays: anticardiolipin IgM, IgG, IgA; anti–β2-glycoprotein I IgM, IgG, IgA; and lupus anticoagulant IgM, IgG, IgA. Data were sourced from the TriNetX Global Collaborative Network, a centralized database of deidentified electronic medical records from 120 healthcare organizations. Eligible patients had aPL measurements and no history of cardiovascular disease or antiphospholipid syndrome. In accordance with the 2023 ACR/EULAR laboratory criteria, the group of interest was defined by the presence of high-positive aPL (&gt;80 U), with individuals having negative aPL levels serving as the reference group. Associations between aPL and future cardiovascular events were assessed using Cox proportional hazards models, adjusted for known risk factors, medications, and multiple comparisons. Results: After nearest-neighbor matching for demographics, diagnoses, and medication use, there were 2,801 patients in each group. Over a median follow-up of 3.0 years, patients with high-positive aPL levels were at increased risk for the composite of all-cause mortality, cerebrovascular events, or coronary artery disease (HR 1.15 [95% CI 1.01–1.32]). These patients had higher risks for all-cause mortality (HR 1.25 [95% CI 1.03–1.51]) and cerebrovascular events (HR 1.30 [95% CI 1.02–1.65]), but not for coronary artery disease (P=0.76). The association with cerebrovascular events was primarily driven by stroke (HR 1.36 [95% CI 1.04–1.78]), but not transient ischemic attack (P=0.27). Conclusion: In this cohort study, a single measurement of high-positive aPL was an independent predictor of all-cause mortality and cardiovascular events, particularly stroke.
Abstract 4145446: Scalable Phenotyping of Heart Failure Across Multicenter, Non-Interoperable Health Systems Using Retrieval-Augmented Generation and Large Language Models
Authors: Sumukh Vasisht Shankar, Phyllis Thangaraj, Philip Adejumo, Rohan Khera
Journal: Circulation (2024)

Background: While identifying patient characteristics is critical to all electronic health record (EHR)-based research, the ability to do multicenter studies is impeded by differences in data structures, such that tools don’t generalize across EHRs. Large language models (LLMs) can be optimized with Retrieval-Augmented Generation (RAG) to enable EHR-structure agnostic queries for cohort characterization with minimal a priori knowledge of EHR structure. We develop and validate a tabular RAG model to extract clinical characteristics across multiple domains among patients with heart failure (HF) in 2 distinct health system EHRs. Methods: Our approach employs a novel RAG architecture, combining information retrieval and a generative text model (Llama2-13b) to enhance data extraction from medical records. This identifies data relevant to the query for a clinical feature and then uses the generative model to interpretably synthesize the output. We evaluated this model on 1000 HF patients from the Yale New Haven Health System and 1000 deidentified records from Beth Israel Deaconess Medical Center (MIMIC-IV). Clinical knowledge-based queries extracted patient records, across categorical features (demographics, conditions, and medications) and continuous features (vital signs and labs) [A]. We tested the RAG's performance against manually extracted variables from the tables. Results: The RAG model performed robustly across key variables in both cohorts, with overall extraction accuracy of 81% for Yale cohort and 82.9% for MIMIC cohort. For categorical variables like myocardial infarction, peripheral arterial disease, and medications (beta blockers, ACE inhibitors), Cohen's kappa values indicated strong agreement with ground truth (Yale: 0.8, 0.76, 1.0, and 0.82; MIMIC: 0.66, 0.83, 0.94, and 0.95). Continuous variables like creatinine, heart rate and systolic blood pressure showed high correlations (Yale: 0.99, 0.90 and 0.92; MIMIC: 1.0, 0.87 and 0.51) [B]. No significant statistical difference was found between ground truth and extracted values for all categorical variables (Mcnemar’s p-value &gt; 0.05). Conclusion: LLM-optimized RAGs can accurately extract clinical information across multiple EHRs with varying data architectures. This introduces the potential for phenotype extraction at scale, with applications in federated multicenter research, spanning clinical trials and electronic clinical quality assessment.
Abstract 4145459: Lower Extremity Extracorporeal Distal Revascularization (LEEDR) as a Novel Approach to Limb Salvage with Prolonged Ischemia
Authors: Rebecca Treffalls, Diego Rodrigues, Colin Price, Julia Jacobs, David Stonko, Randall DeMartino, Patrick Walker, Jonathan Morrison
Journal: Circulation (2024)

Background: Acute limb ischemia (ALI) requires prompt revascularization to preserve the extremity and minimize the effects of systemic reperfusion. Once ALI is recognized, delays in revascularization are generally due to system issues (e.g., transfer) and there is a need for a method of temporary extremity perfusion to reduce warm ischemic time. Lower Extremity Extracorporeal Distal Revascularization (LEEDR) is a percutaneous technique that uses a pump and circuit to deliver oxygenated blood into a pedal artery. Hypothesis: Extracorporeal perfusion can improve survival from ALI. Aims: The aim of this study is to use a swine model of prolonged hindlimb ischemia to compare survival and functional outcomes of LEEDR versus control (warm ischemia). Methods: Anesthetized female Yorkshire swine (40-60kg) underwent hindlimb ischemia using endovascular balloon occlusion and were randomized to control (n=6) or LEEDR (n=6). Controls underwent 9 hours of ischemia. LEEDR animals underwent contralateral femoral and ipsilateral posterior tibial artery cannulation followed by 8 hours of extracorporeal perfusion into the ischemic limb. Subjects were revascularized by removing the endovascular balloons, restoring extremity blood flow, and undergoing a 4-hour critical care period before extubation and observation for 48 hours. Primary outcome was survival and secondary outcomes included functional extremity scores (Tarlov Gait Score), compartment pressures (mmHg) and biochemical markers of reperfusion. Results: Survival was higher in animals undergoing LEEDR (83% vs. 0%; p=0.001), with most control animals succumbing to acute lung injury. LEEDR animals had a higher functional gait score (5.9±0.3 vs. 2.5±0.7; p&lt;0.001) and lower compartment pressure (8±2 vs. 28±4; p=0.002) compared to controls. Biochemically, the LEEDR group had lower potassium (4.5±0.3 vs. 5.3±0.4; p=0.001) and lactate (1.2±0.5 vs. 2.0±0.7; p&lt;0.001) measurements compared to controls during reperfusion and recovery. Conclusion: LEEDR can effectively mitigate 8 hours of extremity ischemia in a swine model, reducing mortality from reperfusion, while improving functional gait score and eliminating compartment syndrome. This percutaneous approach to ALI opens a new field of extracorporeal limb salvage, which can temporize extremity perfusion improving outcomes in patients who have traditionally had limited options due to prolonged warm ischemia.