tbuckley/cabot-search huggingface dataset:
Abstract 4142671: Machine-learning versus traditional risk scores for predicting clinical outcomes after coronary artery bypass graft surgery: a systematic review and meta-analysis
Authors: Aashray Gupta, Ammar Zaka, Daud Mutahar, Benjamin Muston, Daksh Tyagi, Maria Farag, Alexander Lombardo, Razeen Parvez, Brandon Stretton, Joshua Kovoor, Naim Mridha, Fabio Ramponi, Justin Chan, Paul Gould, Gopal Sivagangabalan, Sarah Zaman, Aravinda Thiagalingam, Clara Chow, Pramesh Kovoor, Stephen Bacchi, Jayme Bennetts, Guy Maddern
Journal: Circulation (2024)

Background: Coronary Artery Bypass Graft Surgery (CABG) is the most commonly performed operation in cardiac surgery and results from isolated CABG are used as benchmark to rate cardiac surgery programs in the US by the Society of Thoracic Surgeons (STS). Accurate and reliable mortality risk prediction of CABG patients is essential for developing targeted treatment strategies. Traditional risk scores such as the STS score and EuroSCORE II offer moderate discriminative value, and have limited utility in predicting outcomes for high-risk patients. Machine learning (ML) models have emerged as an alternate method that may offer improved risk assessment. This study aims to compare machine learning models with traditional risk scores for predicting all-cause mortality in patients undergoing CABG. Methods: PubMed, EMBASE, Web of Science and Cochrane databases were searched until 18 th May 2024 for studies comparing ML models with traditional statistical methods for event prediction of CABG patients. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality. A secondary aim was to compare model calibration between ML models and traditional risk scores, adhering to guidelines for predictive algorithm comparisons. Results: A total of 27 studies were included (568,190 patients). The summary C-statistic of all ML models across all endpoints was 0.82 (95% CI, 0.78-0.85), compared to traditional methods 0.73 (95% CI, 0.70-0.75). The difference in C-statistic between all ML models and traditional methods was 0.09 (p&lt;0.0001). One model undertook external validation, and calibration was inconsistently reported. Conclusion: ML models demonstrated superior discrimination of all-cause mortality for CABG patients compared to traditional risk scores. Whilst there is great potential for ML models to be integrated into electronic healthcare systems to improve pre-operative risk stratification, and guide clinical decision making, the methodological and validation limitations pose a hurdle for immediate clinical implementation.
Abstract 4142266: Long-term Outcomes and Predictors of Recurrence in Atrial Arrhythmia Ablations Post-Fontan Procedure: A Retrospective Analysis
Authors: Khush Kharidia, Weiyi Tan, Nimesh Patel
Journal: Circulation (2024)

Introduction: Supraventricular tachycardia (SVT) is common and poorly tolerated in patients who have undergone Fontan procedure. Recurrence rates after catheter ablation in these patients are high. Recent data on the outcomes of SVT ablation and the predictors of recurrence in this population is lacking. Objective: Our study aimed to characterize clinical variables in patients with a Fontan undergoing EP ablation, investigate long-term outcomes, and determine factors that are associated with recurrence. Methods: Charts of patients who had undergone Fontan procedure and underwent SVT ablation between January 1, 1995, and October 1, 2023, at a tertiary care center were reviewed. Demographic, clinical, and outcome variables over 5 years were compared between patients with and without SVT recurrence. Results: Mean age of 25 patients (56% male) at time of SVT ablation was 31.5 ± 7.2 years. Ablation success rate was 92%. Recurrence occurred in 12 (48%) patients, with 7 (28%) requiring repeat ablations repeat within 5 years. Rate of recurrence did not differ between those who had the procedure before or after 2018. During the 5-year follow up period, 13 (59%) patients with follow up had cardiovascular (CV) hospitalization and 1 patient died. Atrial Tachycardia (70%) and Typical Atrial Flutter (65%) were the most common SVTs ablated. A trans-baffle puncture during the ablation was performed in 6 (23%) patients. Tricuspid atresia and elevated BNP levels were associated with increased risk of SVT recurrence (Table). Conclusion: Recurrence and cardiac hospitalization rates after SVT ablation in this population remain high. This study underscores the need for risk stratification in patients with Fontan physiology undergoing SVT ablation and informs future research directions for enhancing ablation outcomes.
Abstract 4142206: Shear Stress-based Purification Method for Human Pluripotent Stem Cell-derived Endothelial Cells
Authors: Mosha Abulaiti, Wusiman Maihemuti, Kozue Murata, Laura Gonzalez-Teshima, Yaxiaer Yalikun, Hidetoshi Masumoto
Journal: Circulation (2024)

Background: To apply human pluripotent stem cell-derived endothelial cells (hPSC-ECs) in regenerative medicine, exploring methods for highly purified ECs is desirable. Cell sorting is a versatile technique for isolating and purifying specific cell types, yet mechanical cell loss persists. Previously, we established a differentiation method for human induced pluripotent stem cell-derived ECs (hiPSC-ECs) based on lineage control using vascular endothelial growth factor (VEGF) and 8-Bromo cyclic adenosine monophosphate (cAMP). However, achieving high hiPSC-ECs purity without cell sorting has not yet been possible. Hypothesis: We speculated that applying digital rocker-generated shear stress during a specific period of hiPSC-EC induction would yield highly purified hiPSC-ECs without cell sorting. Methods: We applied cyclic share stress to the cultured cells using a digital rocker. To optimize the frequency and duration of digital rocker application, ECs purity on day 13 of differentiation (d13) was analyzed by flow cytometry for vascular endothelial cadherin (VE-Cadherin). Shear stress was measured using a simulation model. The functionality of ECs was evaluated through reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) for endothelial nitric oxide synthase (eNOS) and angiogenesis assay. Results: The optimized protocol consisted of a rocking period from day 5 (representing the EC progenitor stage) to d13, at 30 cycles/min with 13° tilt (equivalent to 1.09 dyn/cm 2 ), which significantly increased the purity of ECs (Control vs Rocking: VE-Cadherin; 69.25±17.43 vs 86.68±6.023 %, P = 0.0090). Examining the number of cells on d13 revealed rocking stimulation reduced both ECs and non-ECs. Non-ECs were nearly absent, suggesting EC purification occurs by removing non-ECs, indicating ECs are more resistant to being eliminated by the rocking stimulation. The rocking culture also led to increased eNOS mRNA expression on d13 (Control vs Rocking: 0.5574±0.4985 vs 1.056±0.1652, P = 0.0393). The angiogenesis assay showed a longer vascular structure length trend in the rocking group, indicating enhanced angiogenic capacity. (Control vs Rocking: 15407±2929 vs 18335±3568 Pixel, P= 0.4309). Conclusion: In this study, we developed a method where digital rocker-generated shear stress during a specific period of hiPSC-EC induction not only selectively purifies ECs without cell sorting, but also enhances endothelial function, demonstrating their therapeutic potential.
Abstract 4142343: My AI Ate My Homework: Measuring ChatGPT Performance on the American College of Cardiology Self-Assessment Program
Authors: Afif Hossain, Anam Shaikh, sarah hossain, Amina Shaikh, Renjit Thomas
Journal: Circulation (2024)

Background: Artificial intelligence (AI) is a rapidly growing field with promising utility in health care. ChatGPT is a language learning model by OpenAI trained on extensive data to comprehend and answer a variety of questions, commands, and prompts. Despite the promise AI offers, there are still glaring deficiencies. Methods: 310 questions from the American College of Cardiology Self-Assessment Program (ACCSAP) question bank were queried. 50% of questions from each of the following sections were randomly selected: coronary artery disease, arrhythmias, valvular disease, vascular disease, systemic hypertension and hypotension, pericardial disease, systemic disorders affecting the circulatory system, congenital heart disease, heart failure and cardiomyopathy, and pulmonary circulation. Questions were fed into ChatGPT Legacy 3.5 version with and without answer choices and the accuracy of its responses were recorded. Statistical analysis was performed using Microsoft Excel statistical package. Results: Human respondents were 77.86% accurate +/- 16.01% with an IQR of 21.08% on average. Without answer choice prompting, ChatGPT was correct 57.93% and inconclusive 7.77% of the time. When prompted with answer choices, ChatGPT was correct only 20.91% and inconclusive 14.55% of the time. Additionally, an average of 55.47% +/- 35.55% of human respondents with an IQR of 73.19% selected the same answer choice as ChatGPT. Finally, on a scale of 1 to 5, with 1 being the most picked and 5 being the least picked, human respondents selected the same response as ChatGPT an average of 1.66 out of 5. 30.32% or 94 of the 310 questions contained images in the question stem. Only 0.65% or 2 out of the 310 questions contained images in the answer choices. Conclusion: To our knowledge, the performance of ChatGPT in the field of cardiology board preparation is limited. Our analysis shows that while AI software has become increasingly more comprehensive, progress is still needed to accurately answer complex medical questions.
Abstract 4142680: Functional Heterogeneity of Na <sub>V</sub> 1.5 in Mouse Heart
Authors: Bum-rak Choi, Jason Dierdorff, Colin Clark, Peter Bronk, Sade Solola Nussbaum, Jin-Young Yoon, Hannah Choi, Haider Mehdi, Christopher Ahern, Barry London
Journal: Circulation (2024)

Introduction: The voltage-gated sodium channel Na V 1.5 controls cardiac excitability. The mechanisms by which loss of function Na V 1.5 mutations cause diverse pathogenic outcomes (Brugada syndrome, conduction disease, heart failure) are not fully resolved. The physiological significance of non-Na V 1.5 Na + channels in the heart is also uncertain. Methods: We engineered knock-in mice in which Na V 1.5 was modified to contain a high-affinity binding site for acylsulfonamide (GX) drugs, enabling a pharmacological strategy to drive nonconducting channel conformations. We used optical mapping (di-4 ANEPPS) of Langendorff-perfused WT (n=6) and homozygous GX/GX hearts (n=14) to investigate how selective Na V 1.5 blockade influences action potential (AP) propagation and arrhythmogenesis. Results: In the absence of the GX drug (GX-674) in sinus rhythm, action potential duration (APD; 71±7 vs. 68±10 ms), APD dispersion (13±5 vs. 12±3 ms), AP upstroke rise time (6±1 vs. 6±1 ms) and longitudinal (CVL, 0.71±0.16 vs. 0.85±0.16 m/s) and transverse conduction velocity (CVT, 0.43±0.11 vs. 0.49±0.1 m/s) were not statistically different between GX/GX and WT hearts. GX-674 application (0 ~ 300 nM) during optical mapping with S1S2 pacing resulted in loss of excitability (50% loss at 10 nM in GX/GX ; 0% loss up to 300 nM in WT) associated with an increase of AP upstroke rise time (10±3 vs. 5.4±0.5 ms) and conduction slowing mainly along the longitudinal direction (CVL=0.49±0.22 vs. 0.85±0.24 m/s); APD remained relatively stable (85±15 vs. 76±11 ms). The AP upstroke in GX/GX hearts often exhibited 2 steps (Fig-A), leading to frequent premature beats, reentry, and non-sustained ventricular tachycardia (Fig-B,C). The loss of excitability was heterogeneous, with sensitivity to GX-674 being higher in the right versus left ventricle (16% vs. 50% at 10 nM), Purkinje fibers and AV node (100% AV block at 100 nM), and atrial tissue (100% excitable at 100 nM but complete loss at 300 nM). Conclusion: Regional heterogeneities in Na V 1.5 function, along with Na + channels other than Na V 1.5, may contribute to cardiac conduction and arrhythmias in the mouse heart.
Abstract 4142619: Implications of Rate Limiting Medications in Patients with Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction
Authors: Mohamed Abbas, Jonathan Ariyaratnam, Jenelle Dziano, Jackson Howie, John Fitzgerald, Mohanaraj Jayakumar, Shaun Evans, Adrian Elliott, Prashanthan Sanders
Journal: Circulation (2024)

Introduction: Concerns have been raised regarding the potential adverse effect of beta-blockers particularly in limiting chronotropic response in Heart failure with preserved ejection fraction (HFpEF) patients. While beta-blockers are commonly used in Atrial fibrillation (AF) management, their effect in patients with both AF and HFpEF remains uncertain. Methods: In patients undergoing AF ablation, invasive left atrial (LA) hemodynamic measurements were obtained at rest and following 500mL fluid challenge. Patients with HFpEF (baseline mean LA pressure &gt;15 mmHg) and preclinical HFpEF (baseline mean LA pressure &lt;15 mmHg, increasing to &gt;15 mmHg post-fluid challenge) were included for analysis. Two subgroups were identified based on the use of rate-limiting medications (RLM) at the time of recruitment. The validated AF Severity Scale (AFSS) and Minnesota Living with Heart Failure questionnaire (MLHFQ) were utilised to assess AF and HFpEF symptoms respectively. Baseline Pro-BNP level and cardiopulmonary exercise test were also performed. Results: Of the 88 patients (mean age 65.1 ± 10.8 years, 64% males) included for analysis, 63.6% had clinical HFpEF and 36.4% had preclinical HFpEF. Patients on RLM (79.5%) and not on RLM (20.5%) had similar baseline characteristics including age ( p =0.53) sex ( p =0.24) type of AF ( p =0.43) and pacemaker implantation ( p =1.0). Treatment with beta-blockers did not significantly affect quality of life as measured by the AFSS ( p =0.77) reported global wellbeing ( p =0.51) or exercise capacity as assessed by maximum heart rate at peak exercise ( p =0.75) and peak oxygen consumption (VO2ml/kg.min) ( p =0.65). Additionally, there were no differences between groups in self-reported heart failure (HF) symptoms as measured by the MLHFQ ( p =0.69) or in mean Pro-BNP levels ( p =0.63). Results were consistent when groups matched for age and sex. Conclusions: While there is some apprehension regarding the use of RLM in patients with HFpEF, in this observational study, there was no difference in exercise capacity, quality of life, HF symptoms or biomarkers between those using RLM and those not.
Abstract 4142327: Pharmacosurveillance study of FDA Adverse Event Reporting System (FAERS) events of Apixaban and Rivaroxaban
Authors: Ilana Logvinsky, Gautam Maddineni, Malissa Wood, Maja Delibasic
Journal: Circulation (2024)

Background: Apixaban and rivaroxaban are common agents used for anticoagulation to treat and prevent blood clots and to prevent stroke in people with atrial fibrillation. Research question: As anticoagulants, there is a risk of bleeding occurring. The question is, which of these two medications has a higher risk of bleeding from various organ systems. Goals: Using the FAERS database to calculate the reporting odds ratio (ROR) for the risk of ocular, cerebral, gastrointestinal, rectal, and renal hemorrhage in addition to epistaxis and hemoptysis of these medications. Methods: We manually extracted data from the FAERS database owned by the FDA on hemorrhagic events related to Apixaban and Rivaroxaban from January 2012 to March 2024. We calculated the reported odds ratio for both drugs to compare their respective hemorrhagic outcomes. Results: The total AE reported for apixaban and rivaroxaban from 2012 to March 2024 was 87490 and 88026, respectively. Rivaroxaban has an increased risk for cerebral (ROR 1.73, 95% CI 1.60 to 1.86), gastrointestinal (ROR 5.91, 95% CI 5.61 to 6.22), rectal (ROR 4.64, 95% CI 4.21 to 5.12), renal (ROR 3.83, 95% CI 2.87 to 5.11), epistaxis (ROR 2.06, 95% CI 1.93 to 2.20) and hemoptysis (ROR 3.20, 95% CI 2.80 to 3.66) compared to apixaban with a significant p-value. There was no statistical significance in reported cases of ocular hemorrhage in apixaban versus rivaroxaban. Conclusion: Apixaban and rivaroxaban are common medications used in the treatment of people with atrial fibrillation to reduce the risk of clots and stroke. The FAERs database compared the risk of ocular, cerebral, gastrointestinal, rectal, and renal hemorrhage and epistaxis and hemoptysis of these medications. There was no statistical significance in reported cases of ocular hemorrhage in apixaban versus rivaroxaban. Rivaroxaban overall has a significantly higher risk of bleeding in multiple organ systems, especially cerebral, gastrointestinal, rectal, and renal hemorrhage, as well as epistaxis and hemoptysis. Apixaban would be a better option for people at risk for or with a history of these complications.
Abstract 4142661: Comparative Analysis of ECG Processing Software Performance on Traditional vs Patch-Based Lead II Configurations
Authors: Adrian Deery, Danielle Dowie, Jordan Diven, Holly Easlea
Journal: Circulation (2024)

Introduction: Although ECG devices with non-conventional form factors, such as wearable patches, offer enhanced convenience and comfort for users, they can introduce variability in signal characteristics, posing challenges for clinicians and ECG analysis software. To ensure accuracy and support informed decision-making, ECG software must process even the most difficult signals effectively. Aims: To compare the signal characteristics of a standard lead II configuration with those of a modified lead II (MLII) patch configuration and to evaluate the differential impact of these configurations on the performance of ECG processing software. Methods: Five-minute ECGs were recorded on 43 adult participants (63% male, mean age: 34.5 ± 9.1 years) using Bittium Faros cardiac monitors in two configurations: i) standard Einthoven lead II with electrodes placed across the chest cavity, and ii) a MLII patch configuration with electrodes 10 cm apart on the upper left chest. Average QRS amplitudes for both configurations were compared, using a paired T-test to determine statistical significance. ECG signals were processed with HeartKey software, and the accuracy of QRS beat detection was calculated against manual annotations. Heart rate (HR) detection accuracy was assessed using Bland-Altman analysis. Results: The average QRS amplitude was significantly lower in the MLII patch configuration compared to the standard lead II configuration (2.3 ± 1.0 mV vs. 1.2 ± 0.7 mV, p &lt;0.001), with 55% of participants showing a two-fold greater mean QRS amplitude in the standard configuration. Despite the reduced amplitude, HeartKey software achieved high QRS beat detection accuracy, with a mean sensitivity of &gt;99.1% and a mean positive predictive value of &gt;99.9% across both configurations. HR detection accuracy was high across both configurations, with an absolute mean HR difference of 0.4 bpm (95% CI: -0.5 bpm to 1.3 bpm) for the standard lead II and 0.24 bpm (95% CI: -1.4 bpm to 1.9 bpm) for the MLII patch configuration. Conclusion(s): Despite the notable decrease in QRS amplitude with the MLII patch configuration compared to the standard Lead II configuration, HeartKey software maintained high accuracy in detecting QRS beats and analysing heart rate.
Abstract 4142573: Validation of Wrist-Worn Body Impedance Analysis Technology for Cardiovascular Disease Risk Management
Authors: Adrian Deery, Jonathan Francey, Jordan Diven, Stacey McKenna, Holly Easlea, Geraldine Horigan, Ruth Price, Benjamin Sanchez Terrones
Journal: Circulation (2024)

Background: Chronic hypohydration and heightened adiposity are established contributors to CVD risk that are modified by lifestyle behaviours. However, traditional monitoring methods require specialised equipment and are impractical for everyday use. Emerging wrist-worn devices with body impedance analysis (BIA) capabilities offer a non-invasive solution for monitoring body composition to aid in CVD risk self-management. Aims: To validate the accuracy of a wrist-worn BIA device and associated algorithms in measuring body fat percentage (BFP) and total body water (TBW) relative to gold standard measurements. Methods: This cross-sectional, single-centre study recruited healthy participants with diverse demographic and anthropometric characteristics for a single time-point investigation at the Human Interventions Studies Unit, Ulster University. Two-minute BIA recordings were collected from participants on a proprietary wrist-worn device and used to train and validate a predictive BIA algorithm. BFP and TBW metrics were validated against clinical-grade measurements on a GE Lunar DEXA scanner and Impedimed SFB7 device, respectively. Algorithm accuracy was evaluated using the mean absolute error (MAE) between predicted and true values. The R 2 value assessed the predictive model's goodness of fit. Results: A total of 130 participants were recruited (44% male, 82% Caucasian, mean age: 39.8±14.8 years, mean BMI: 25.4±5.5 kg/m 2 ; Figure 1a), 15 of whom were excluded for failing to adhere to the study protocol. The remaining 115 subjects’ data were divided into training (n=100) and test (n=15) sets. On test data, regression analysis indicated a strong relationship between algorithm-predicted values and true values of BFP (R 2 =0.83; Figure 1b) and TBW (R 2 =0.83; Figure 1c). The algorithm accurately measured BFP and TBW, achieving a MAE of 3.4% for BFP and 2.3 L for TBW relative to gold standard measurements. Conclusion: The wrist-worn BIA technology has shown comparable accuracy to gold standard devices in measuring BFP and TBW. These findings suggest that wearable BIA devices could serve as effective, non-invasive tools for body composition monitoring, enabling individuals to better manage their cardiovascular health.