tbuckley/cabot-search huggingface dataset:
Abstract 15176: Artificial Intelligence Model Detecting Acute Myocardial Infarction Requiring Revascularization
Authors: Kyung Hoon Cho, Donghoon Han, Mineok Chang, Seok Oh, Yongwhan Lim, Joon Ho Ahn, Seung Hun Lee, Dae Young Hyun, Namho Lee, Seonghoon Choi, Jung Rae Cho, Min-Kyung Kang, Dong-Geum Shin, Younghoon Ji, Sunghoon Joo, Yeha Lee, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Juhan kim, Young Keun Ahn, Myung Ho H Jeong
Journal: Circulation (2023)

Background: Rapid myocardial revascularization in patients with acute myocardial infarction (AMI) is essential for increasing the chances and extent of myocardial salvage and better clinical outcomes. There still have been largely missed opportunities in the timely diagnosis of AMI. Research Questions: Can artificial intelligence (AI) be helpful in timely diagnosing AMI? Aims: We aimed to develop an AI algorithm for detecting AMI requiring revascularization using electrocardiograms (ECGs). Methods: We developed an AI model detecting myocardial infarction requiring revascularization from a 12-lead ECG. This retrospective cohort study included 17,907 ECGs from 5,872 coronary angiography-validated AMI patients and 705,482 ECGs from 294,755 non-AMI patients at Chonnam National University Hospital between May 2013 and December 2020. External validation was performed at Hallym University Kangnam Sacred Heart Hospital using 357,072 ECGs from 163,870 patients between January 2006 and December 2020. Results: The prevalence rates of AMI-ECGs were 5.29% (1356/25,627) and 0.87% (3089/357,072) in the internal test and external validation set, respectively. The areas under the receiver operating characteristic curves (AUROC) were 0.958 (95% CI, 0.955 to 0.962), 0.988 (95% CI, 0.986 to 0.991), and 0.930 (95% CI, 0.923 to 0.936) in total, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction in the external validation, respectively (Figure 1A). Subgroup analysis assessing the efficacy of subsets of 12-lead ECG revealed that the AUROC were 0.926 (95% CI, 0.920 to 0.931), 0.921 (95% CI, 0.915 to 0.926), and 0.846 (95% CI, 0.839 to 0.854) in 6 limb-lead, lead combining I and II, and lead I, respectively (Figure 1B). Conclusion: Our AI model detecting myocardial infarction can be beneficial in identifying patients with acute myocardial infarction requiring revascularization timely.
Abstract 18453: Giant Right Atrial Lipoma Inducing Atrial Flutter and Tachycardia-Mediated Cardiomyopathy: The Value of Multimodality Cardiac Imaging
Authors: Maedeh Khayyat Kholghi, Karla B Almaraz, Mark E Garcia, Michelle Ratliff, Said Yassin, Carlos A Roldan
Journal: Circulation (2023)

Case Presentation: A 60-year-old male who presented with progressive dyspnea on exertion and atrial flutter with rapid ventricular response. His TTE showed a large (5.1 x 3.9 cm) right atrial (RA) mass occupying 80% of a severely dilated RA attached to the lateral wall (Fig A) and severe global LV hypokinesis with an ejection fraction of 20 - 25%. A TEE was then performed to further characterize this mass and showed a large (6.3 x 5.5 x 3.7 cm), heterogeneously echoreflectant, bi-lobed, and partially mobile RA mass attached to the lateral wall (Fig B,C) just below the superior vena cava and extending near the tricuspid valve annulus with sparing of the leaflets and only mild tricuspid regurgitation. At last, a chest CT scan showed a large (5.5 x 4.5 x 3.3 cm) mass which was tissue characterized as RA lipoma (Fig D). Therefore, patient underwent an uncomplicated surgical resection of the mass with partial removal of RA free wall (Fig D,E) repaired with a pericardial patch. Pathology confirmed a RA lipoma. Patient’s atrial flutter was then ablated, and patient was discharged home in stable condition. Discussion: This case illustrates an unreported cavitary giant RA lipoma inducing atrial flutter and tachycardia-mediated cardiomyopathy and emphasizes the importance of multimodality cardiac imaging in its diagnosis and management. Cardiac lipomas are rare benign tumors usually of small size and therefore mostly incidentally detected. They can rarely lead to embolization, conduction abnormalities, and flow obstruction requiring surgical resection. In this patient, pre-operative echocardiography and CT imaging were critical in the assessment of the tumor size, tissue characterization, location, motion, relation or extension to other cardiac structures, and obstruction or dysfunction of heart valves. Pre-and-intraoperative echocardiography were also essential in planning and performing the successful surgical resection of the RA lipoma.
Abstract 17461: Major Cardiovascular Events and Liver Disease in Patients With Truncating Variants in APOB and PSCK9
Authors: Stacey Knight, Viet T Le, Nephi A Walton, G B Christensen, Jared M Evans, Heidi T May, Jeffrey L Anderson, Lincoln Nadauld, Kirk U Knowlton
Journal: Circulation (2023)

Introduction: Truncated variants in the genes ApoB and PSCK9 have been shown to be associated with low levels of low-density lipoprotein cholesterol (LDL-C), however, there is concern about the increased risk of liver disease. Using Intermountain Health’s HerediGene Population Study, a population-based genetic study, we sought to understand the impact of these variants on major adverse cardiovascular events (MACE) and liver disease. Methods: Of the 32,159 sequenced patients (pts), 58 (0.18%) had a truncating variant in ApoB (n=49) and PCSK9 (n=10). Among those with a truncating variant, we compared the demographics, LDL-C levels, statin use, and disease by MACE (including, myocardial infarction [MI], heart failure (HF) hospitalization, stroke, peripheral artery disease, and carotid artery disease). Results: MACE occurred in 32% of pts, with HF hospitalization followed by MI being the most frequent. The rates of MACE were similar for pts with ApoB (n=15, 30.6%) and PCSK9 (n= 4, 40%). Differences in demographics and clinical characteristics stratified by MACE are shown in the Table. LDL-C levels were low in both groups, with approximately half having an LDL-C &lt;70 mg/dL. Hypertension was more common in the MACE group (95% vs 50%). Both groups had high rates of liver disease (47%) compared to the general patient population (9%). Renal failure was also common among these pts (36%). Only 2 of the deaths (both in the MACE group) were cardiovascular-related, 1 due to stroke and 1 due to heart failure. Conclusion: Low LDL-C was associated with truncated variants in the ApoB and PSCK9 genes. However, these patients still had a high rate of MACE, which was driven mainly by hypertensive diseases. Frequency of liver disease and renal failure was high, which may also be attributed to hypertension. While this is a small sample, these findings suggest that continued screening for cardiovascular disease is needed despite low LDL-C, with liver disease screening also needing to be performed.
Abstract 12875: Echocardiographic Findings Associated With Subsequent Risk of Native Valve Endocarditis
Authors: Juan A Quintero Martinez, Joya-Rita Hindy, Hector R Villarraga, Brian Lahr, Mark J Dayer, Martin Thornhill, John OHoro, Hector I Michelena, Nandan S Anavekar, Parham Sendi, Daniel C Desimone, Larry M Baddour
Journal: Circulation (2023)

Introduction: The association of echocardiographic measurements and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined. Aim: To determine if transthoracic echocardiographic (TTE) measurements are associated with the subsequent development of LS-NVE in patients without recognized cardiac predisposing conditions. Methods: Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and recognized predisposing cardiac conditions were excluded. Patients with a TTE performed 6 months to 3 years before developing LS-NVE were included as cases. Controls were patients within the same Mayo Clinic location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson Comorbidity Index (CCI), and echocardiography date. Multivariate logistic-regression analyses adjusting significant variables between cohort's were performed. A p-value &lt;0.05 was considered significant. Results: There were 148 cases and 431 matched controls. The median age was 63.8 (IQR: 53.6 - 74.6) years, and 329 (56.8%) patients were males. LS-NVE cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) when compared with controls (p&lt;0.001 both). The median CCI score was 3 (IQR: 0-6) for cases and 2 (IQR: 0-6) for controls. After performing adjusted analyses, left ventricular outflow tract velocity (p=0.017), left ventricular ejection fraction (p=0.018), and E: e’ ratio (p=0.050) were associated with the development of LS-NVE ( Figure 1) . Conclusions: Echocardiographic measurements were associated with subsequent LS-NVE development in this preliminary investigation. A larger cohort of LS-NVE patients is needed to validate these findings.
Abstract 13912: Insights From a Multi-Center Consortium for HCV-Viremic Donor Heart Transplant: Outcomes Are Excellent Across Regimens Often Without Major Changes to Statin or PPI
Authors: Dana Farsakh, Ahmad Abdelrehim, Mahmoud Salem, Robert L Gottlieb, Ashwin Ravichandran, Jamie Kennedy, Jennifer Strope, Shin Lin, Jennifer Chow, Peter Eckman, Sapna Desai, Johanna van Zyl, Joost Felius, Shelley Hall
Journal: Circulation (2023)

Introduction: With the availability of pangenotypic direct-acting antivirals (DAA) for facile, curative treatment of hepatitis C virus (HCV) infections, HCV-viremic donors are utilized regularly to partially address the shortage of suitable organs for heart transplant (HT). This multi-center, retrospective registry characterized HT outcomes from HCV-positive donors. Methods: Of 138 isolated HT recipients from 8 sites across the US, the most common DAAs were the pangenotypic antiviral combinations sofosbuvir-velpatasvir (SOF/VEL, n=39) and glecaprevir-pibrentasvir (GLE/PIB, n=76); these 115 cases were analyzed in terms of primary graft dysfunction (PGD), episodes of rejection ≥ pAMR1 and/or Grade 2R, post-transplant infection, sustained virologic response at 12 weeks post-treatment (SVR12), and survival up to 1 year. Results: Comparing these two most common pangenotypic regimens, HT recipients differed in their listing status (p&lt;0.001), hospital stay length (p=0.04), time until HCV+ (p=0.01), DAA payor (p=0.01), induction therapy (p=0.03) and statin therapy (p=0.01). A concurrent open-label trial accounted for up to 13/39 SOF/VEL patients, partially accounting for differences in DAA payor. Despite potential interactions, statin and proton pump inhibitor (PPI) therapy typically continued uninterrupted with minimal dose adjustment. Both treatment groups showed 100% cure (SVR12) of donor-derived HCV. Although not powered for comparative effectiveness of DAA agents, there were no significant differences in study outcomes. SOF/VEL and GLE/PIB-treated patients demonstrated 97% and 96% survival at 1 year, respectively. Conclusions: As utilized to achieve cure of HT donor-derived HCV, two pangenotypic DAA regimens are safe and feasible, with coverage accessed across a variety of DAA payors. SVR12 can be achieved often without major modifications to PPIs or statins with either pangenotypic DAA regimen (with pravastatin most commonly utilized).
Abstract 17774: Utilization of Oral Anticoagulants and Antiplatelets in Nursing Home Residents With Atrial Fibrillation
Authors: Darae Ko, Yoojin Lee, Kim Dae Hyun, Andrew Zullo, Sarah Berry
Journal: Circulation (2023)

Background: Prior research reported underutilization of oral anticoagulants (OAC) in nursing home (NH) residents with atrial fibrillation (AF), but these studies may not have sufficiently addressed whether utilization was appropriate given the multimorbidity and limited life expectancy, and whether these patients are receiving antiplatelet (APT) as the alternative stroke prophylaxis. Methods: We conducted a retrospective cohort study using electronic health records and Minimum Data Set resident clinical assessment from 735 NHs among long-stay NH residents (≥100 days) with a diagnosis of AF. Because there was increased awareness of thrombotic events during the COVID-19 pandemic, we assessed OAC and APT use in 30 days prior to 1/1/2020 and 1/1/2021 was measured from medication order records. Results: Our study sample included 8135 long-stay residents with AF (mean age 78, 58% women, 1.6% American Indian/Asian/Native Hawaiian, 14% Black, 2.4% Hispanic, 80% White, 2% Other). Dementia was the most common comorbidity (51%) followed by diabetes (40%), heart failure (36%), chronic kidney disease (32%), and stroke (19%). One in 3 residents had moderately or severely impaired cognitive function. One third of the residents received APT only (mostly aspirin) and half did not receive APT or OAC in either year. The proportion of patients who did not receive OAC increased in 2021 (Figure). Conclusion: Only 13% of NH residents with AF received OAC and 37% received APT only. Given APT does not reduce the risk of AF-related stroke but has similar bleeding risk as OAC, there is an urgent need to develop anticoagulant standards for NH residents that address multimorbidity, life expectancy and patient preferences.
Abstract 17878: Clinical Profile, Procedure-Related Complications and Long-Term Outcomes in Men and Women With Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From TAVI-NOR Study
Authors: Daanyaal Wasim, Abukar Ali, Oyvind Bleie, Kjetil H Løland, Jon Herstad, Sahrai Saeed
Journal: Circulation (2023)

Introduction: The incidence of aortic stenosis (AS) is increasing. If left untreated, AS progresses to clinical heart failure, reduced quality of life and functional capacity, and ultimately death. Hypothesis: Gender difference in survival benefits of transcatheter aortic valve implantation (TAVI) and frequencies of procedural complications. Methods: We included 600 consecutive, less selected, patients with symptomatic AS who underwent TAVI at our hospital. Clinical and echocardiographic data was analysed in SPSS. Data distribution was checked for normality. The inter-group comparison by Student’s t-test or chi square as appropriate. The association between gender and all-cause mortality assessed by Kaplan-Meier survival analysis with Log-rank test. Results: Mean age was 80.8±6.5 years of the study population. Women (49.3%) were older (82.2 ±5.3 years vs 79.5±7.3 years, p&lt;0.001), had more severe AS and higher left ventricular ejection fraction and more often had basal septal hypertrophy. The prevalence of hypertension and use of antihypertensive medications were higher in women. The prevalence of diabetes mellitus, coronary artery disease, previous stroke, overall abnormal ECG, and atrial fibrillation was higher in men. The severity of symptoms, and prevalence of chronic kidney or lung diseases were comparable. The frequencies of procedure-related paravalvular leakage (PVL) ≥ grade II and endocarditis during follow-up were low, but significantly higher in men than women. No significant difference between genders in procedure-related access site dissection and pseudo-aneurysm, anaemia requiring blood transfusion, or new-onset renal failure. Need of permanent pacemaker implantation following TAVI was also comparable between genders. Mean event-free survival was 59±24 months for men and 66±25 months for women (p&lt;0.001). Most apparent benefits was seen at 3-year follow-up where survival estimate for men was 84% and for women 92%. Conclusions: Results from TAVI-NOR study demonstrates that women with AS were older and had a higher burden of hypertensive heart disease, and showed a significantly better outcome. Men more frequently developed a significant PVL or endocarditis during follow-up.
Abstract 18709: Disparities in Socioeconomic Metrics Associated With Adverse Outcomes Among Medicare Beneficiaries Undergoing Peripheral Endovascular Intervention
Authors: Shantum Misra, Anna Krawisz, Brett Carroll, Eric A Secemsky
Journal: Circulation (2023)

Background Low socioeconomic status (SES) is associated with an increased incidence of peripheral artery disease, however there is a lack of granularity in the specific metrics that contribute to this discrepancy. We examine the association of community-level economic distress with adverse outcomes in patients undergoing peripheral endovascular intervention (PVI). Hypothesis: Socioeconomically distressed communities have non-healthcare-related, structural disparities that contribute to incident PVI and adverse outcomes. Methods: Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine the incidence of femoropopliteal PVI. The Distressed Community Index (DCI) was used to categorize adults as distressed (DCI ≥80) or not distressed (DCI &lt;80). Composite outcome of death and major amputation within 1 year of PVI were examined by level of distress using individual community-level metrics. Results: Socioeconomically distressed adults underwent 158 PVIs per 100000 distressed beneficiaries compared with 109 PVIs per 100000 non-distressed beneficiaries (risk ratio, 1.45 [95% CI, 1.42-1.48]; P&lt;0.001). Distressed adults who underwent PVI were more likely to be female (45.5% versus 43.1%; P&lt;0.001) and Black race (21.9% versus 10.1%; P&lt;0.001) (Table I). There was a strong association between distress and the composite outcome at 1 year (incidence rate ratio, 1.11 [95% CI 1.07-1.16; P=0.0001]). Distressed adults lacked high school diplomas (11.88% versus 11.15%; P&lt;0.001), had higher rates of unemployment (24.11% versus 22.76%; P&lt;0.001), and greater housing vacancy rates (9.74% versus 9.31%; P&lt;0.001). Conclusion: Socioeconomic distress is associated with higher rates of PVI-incidence and post-PVI adverse outcomes. This may be driven by structural inadequacies inherent to low SES communities that need to be addressed in order to narrow the gap in care among distressed adults undergoing PVI.
Abstract 14541: Pericardiocentesis is Associated With Higher Mortality in Patients With Pulmonary Hypertension
Authors: Moises A Vasquez, Juan Quintero Martinez, Mina Iskander, Juan Uribe, Ivan A Mijares, Jose Antonio Luna Alvarez, mohammed mustafa, Joel Mintz, Jose Noy, Eduardo de Marchena, Carlos Alfonso
Journal: Circulation (2023)

Background: Pericardiocentesis in patients with Pulmonary Hypertension (PH) and pericardial effusions has unclear benefits, as it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population is limited. Aims. Describe pericardiocentesis-related patient characteristics and in-hospital outcomes in patients with PH versus without. Methods: The National Inpatient Sample database was used to identify adult patients undergoing pericardiocentesis during hospitalizations between 2016 and 2020. Data were stratified between patients with and without PH. A multivariate regression model was used to estimate the association of PH with pericardiocentesis in-hospital outcomes, adjusting for statistically significant comorbidities. Results: A total of 95,665 hospitalizations with a procedure diagnosis of pericardiocentesis were included, of which 7,770 had PH. Patients with PH tended to be older (67 ± 15.7) and female (56%), had significantly higher rates of hypertension (79% vs 66%, P&lt;0.01), diabetes (26% vs 17%, P&lt;0.01), chronic lung disease (32% vs 23%, P&lt;0.01), chronic liver disease ( 15% vs 12%, P&lt;0.01), CKD ( 44% vs 25%, P&lt;0.01), and chronic heart failure (19% vs 10%, P&lt;0.01). Pericardiocentesis in PH was associated with higher in-hospital all-cause mortality, post-procedure shock, cardiogenic shock, cardiac arrest, and mechanical circulatory support compared to patients without PH. Those presenting with cardiac tamponade had higher odds of mortality, post-procedural shock, and mechanical circulatory support (Figure 1) compared to patients without PH. All P values were &lt; 0.001. Conclusion: PH was associated with higher mortality and a higher rate of cardiovascular complications in patients undergoing pericardiocentesis. Those presenting with tamponade had particularly worse outcomes. Further research on the outcomes of pericardiocentesis in these patients is needed.
Abstract 17035: Relationship Between Neighborhood Level Deprivation and Blood Pressure Among 122,177 Adolescents, Analysis of PEDSnet Data
Authors: Carissa M Baker-Smith, Zugui Zhang, Dan Eckrich, Carol Prospero, Varsha Zadokar, Bonita E Falkner, Robert E Akins
Journal: Circulation (2023)

Introduction: Hypertension (HTN) begins in youth and accounts for ~80% of the cardiovascular disease burden in the US. Socio/environmental factors are critical, and greater knowledge of the relationship between neighborhood level deprivation and blood pressure (BP) in youth is needed. Hypothesis: We hypothesized that greater neighborhood deprivation is associated with intermediate/poor BP status in adolescents even after adjusting for other factors. Methods: Data from 2009 to 2019 were extracted from PEDSnet (a PCORI-funded aggregate of pediatric health data). We modeled the relationship between BP and neighborhood deprivation based on national Area Deprivation index (ADI; scaled 1-100) tertiles (ADI&lt;25=best/low, 25-52, &gt; 52=worst/high). The BP status of each youth was coded as good (BP score: 80-100) or intermediate/poor (BP score: 0-80) where BP score=100 if median BP &lt;120/80mmHg and score=75 if median BP 120-129/&lt;80mmHg. Analyses were carried out using SAS 9.4 with p&lt;0.05 considered significant. The outcome of interest was poor/intermediate BP score. Results: Data from 122,177 youth, 13-17 years of age were analyzed. 51% were female, 58% were non-Hispanic white, and 22% non-Hispanic Black. 24% lived in neighborhoods with ADI &lt;25; 35% lived in neighborhoods with ADI &gt; 52. In a multivariate logistic model, ADI &gt; 52 was associated with a 49% greater odds of intermediate/poor BP score. Due to significant interactions between ethnicity-race and ADI, compared to non-Hispanic Black youth, non-Hispanic White and Other youth had lower odds of intermediate/poor BP score by univariate analysis, but greater odds in the full model (Table). Female sex was associated with lower odds of HTN. The model’s goodness of fit was strong with a ROC, AUC of 0.73 (Figure). Conclusions: Higher neighborhood deprivation is associated with greater odds of hypertension in adolescents. Greater emphasis on measures to mitigate this risk are needed.