tbuckley/cabot-search huggingface dataset:
Abstract 18025: Does Co-Morbid Depression Predict Worse In-Hospital Outcomes in Elderly Patients Primarily Hospitalized With Atrial Fibrillation?: A Nationwide Sex and Race Stratified Analysis
Authors: Vibhor Garg, Jyoti Verma, Hansika Sharma, Nikhil Sai Vasireddy, Harroop Singh Klair, Shrenil Kavathia, Shruti Bodhankar, Kumar Anmol, Dhanush Kolli, Sobya Hashmi, Jithin Teja Kolli, Rupak Desai
Journal: Circulation (2023)

Introduction: Depression is an established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the association between depression (DP) and all-cause mortality, as well as stroke in atrial fibrillation (AF) patients, remains understudied. We aim to establish a relationship between depression and MACCE in AF patients. Methods: Using the National Inpatient Sample (2019) and relevant international classification of disease (ICD-10) codes, we identified hospitalizations with AF among elderly patients (age &gt;65) and categorized them into groups with and without depression (DP vs nDP). The primary outcome was all-cause inpatient mortality and stroke in AF-related hospitalizations. Results: The overall prevalence of depression (DP) among elderly patients hospitalized for AF was 10.6% (32810/310,005). The DP cohort contained less number of males (30.4% vs 44.38%), Blacks ( 2.91% vs 5.77%), Hispanics (4.11% vs 4.68%) while more females (69.59% vs 55.62%) and Whites ( 88.7% vs 83.82%). Stroke prevalence was not significantly different (0.8% vs 0.8% OR:0.97, CI:0.85-1.1 p=0.701) whereas all-cause mortality prevalence was lower in the DP cohort (0.9% vs 1%, OR: 0.85, CI:0.75-0.97 p=0.015). Surprisingly, the subgroup analysis revealed that depressed males exhibited significantly higher odds of stroke, and this association persisted even after multivariable analysis (aOR 1.184, CI: 1.12-3.02, p= 0.016)[Fig 1]. All-cause mortality was higher in depressed blacks(2.6% vs 1.4%, OR:1.84, CI:1.21-2.79, p=0.004) and lower in depressed females (0.8% vs 1.1%, OR:0.78 CI:0.67-0.91, p=0.001). Adjusted multivariable analysis revealed no significant all-cause mortality and stroke in depressed vs non-depressed except for subgroup analysis for elderly depressed males. Conclusion: Depression independently associated with stroke in elderly males hospitalized for AF.
Abstract 15947: Cracking the Code of Cardiovascular Risk: Cardiac Troponin I vs. T in Community Dwelling Adults. Is Specificity at Stake?
Authors: Yashika Parashar, Aya Awwad, Soahum Bagchi, Saman Asad Siddiqui, Ogheneochuko Ajari, Christopher deFilippi
Journal: Circulation (2023)

Introduction. High sensitive cardiac troponin I and T (hs-cTnI and T) are detectable in most adults. Several studies have identified that hs-cTnI and T perform differently for long-term prediction of incident myocardial infarction (MI). Furthermore, in adults with myopathies, hs-cTnT can lose cardiovascular (CV) specificity which may be more relevant to MI prediction vs heart failure (HF) and CV death (CVD). We hypothesized that a meta-analysis of ambulatory adult studies would demonstrate hs-cTnI is a superior predictor of incident MI, but similar for HF and CVD. Methods. Research articles on hs-cTnI or T for longitudinal outcomes in ambulatory adults were screened from PubMed, EMBASE, and Web of Science inclusive of incident MI, HF or CVD and reporting hazard ratios (HR) and 95% confidence intervals (CI) for hs-cTn on a continuous log scale. Two reviewers evaluated the studies for inclusion, removing overlapping populations and extracting the most adjusted model HR. Pooled effect sizes were calculated with a random-effects model, and heterogeneity was assessed using the I 2 statistic. Subgroup analyses based on hs-cTn type were conducted. Results. A total of 3092 studies were screened and 44 met inclusion criteria. There were 109,553, 80,597, and 141,389 participants for HF, MI, and CVD with hs-cTnI measured, and 90,012, 81,259, and 73,977 participants for HF, MI, and CVD with hs-cTnT measured with a mean age of 61 ± 10 years and a median follow-up of 2.1 – 20 years. The pooled effect size estimate (HR) for HF, MI and CVD was 1.57(1.47, 1.66), 1.27(1.18, 1.37) and 1.41(1.32, 1.50) respectively. Subgroup analyses showed similar HR values for HF (I: 1.49 (1.37, 1.62) and T: 1.64 (1.51, 1.78)), MI (Figure) and CVD (I: 1.32 (1.21, 1.44) and T: 1.49 (1.36, 1.63)). Conclusion. hs-cTnI and T are prognostically similar for incident MI, as well as HF and CVD in ambulatory adults, suggesting similar cardiac specificity, though substantial heterogeneity exists between individual studies.
Abstract 13273: APOLLO-B, a Study of Patisiran in Patients With Transthyretin Cardiac Amyloidosis: Primary Long-Term Results From the Open-Label Extension Period
Authors: Rebecca R Hung, Edileide d Correia, John L Berk, Brian Drachman, Marianna Fontana, Julian D Gillmore, Claudio T Mesquita, Marcus V Simoes, Elena Yureneva, Matthew T White, Marianne T Sweetser, Patrick Y Jay, John Vest, Mathew S Maurer
Journal: Circulation (2023)

Introduction: The Phase 3 APOLLO-B study evaluates patisiran in patients (pts) with transthyretin (ATTR) cardiac amyloidosis over a 12-month (M) double-blind (DB) period, followed by an open-label extension (OLE) period when all pts receive patisiran (NCT03997383). Hypothesis: Patisiran provides long-term benefit in pts with ATTR cardiac amyloidosis. Aims: Describe safety and efficacy of patisiran during the APOLLO-B OLE (18M+). Methods: Pts (18-85 yrs) with ATTR cardiac amyloidosis and heart failure history were randomized 1:1 to patisiran or placebo (pbo). Pts completing DB period were eligible to receive patisiran in the OLE for ≤36M. Results summarized based on DB treatment arm. Exploratory assessments include change from study baseline (CFB) in 6-minute walk test (6MWT), KCCQ-OS, NT-proBNP, and troponin I. Results: In the DB period, 359 pts (pbo n=178; patisiran n=181) received study drug (median [range] age, 76.0 [41, 85] yrs; male, 89%; wtATTR, 80%; tafamidis at baseline, 25%); 334 (93%) entered the OLE. In patisiran arm, M12 and M18 results, respectively, were similar for each endpoint: 6MWT and KCCQ-OS (mean [SEM] CFB) –8.09 [5.73] vs –9.21 [6.04] meters (m) and 0.60 [1.36] vs 0.22 [1.48]; NT-proBNP and troponin I (geometric mean fold-CFB [95%CI]) 1.10 [1.03, 1.17] vs 1.17 [1.07, 1.27] and 1.11 [1.05, 1.18] vs 1.09 [1.01, 1.17]). In pbo arm, patisiran initiation in OLE was associated with a slower rate of worsening or relative stability across endpoints; CFB at M12 vs M18, respectively: 6MWT, –25.43 [5.61] vs –31.08 [5.45] m; KCCQ-OS, –3.41 [1.33] vs –4.02 [1.49]; NT-proBNP, 1.39 [1.28, 1.51] vs 1.53 [1.38, 1.71]; and troponin I, 1.29 [1.21, 1.38] vs 1.21 [1.13, 1.30]. Patisiran had an acceptable safety profile; no new concerns. OLE analyses are ongoing; updated data to be presented. Conclusions: The M18 results provide evidence that beneficial effects observed in DB period on functional capacity, health status, and quality of life were maintained by continued treatment with patisiran during the OLE. Pbo-treated pts initiating patisiran at M12 showed slowed worsening or stabilization in most endpoints at M18. Early treatment initiation is important: pbo-treated pts did not recover functional capacity or health lost prior to initiating OLE patisiran.
Abstract 13148: Sex Difference and Right Ventricular Global Longitudinal Strain in Prognosis of Malignancy-Related Submassive Pulmonary Embolism
Authors: Shunsuke Eguchi, Yoshiyuki Orihara, Ayumi Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, Zhaohui Gao, John Boehmer, John Gorcsan, Ryan Wilson
Journal: Circulation (2023)

Introduction and Hypothesis: The risk of pulmonary embolism (PE) increases in patients with malignancy. It was reported that malignancy-related PE had significantly higher mortality compared to PE without malignancy. The aim of this study was to identify predictive factors for mortality in patients with malignancy-related submassive PE. Methods: Retrospective cohort study of patients with submassive PE between 2010 and 2018. Echocardiograms were obtained within 48 hours of PE. Strain parameters were retrospectively applied using TomTec®. The primary outcome was all-cause mortality at 30 days. Univariable and multivariable analysis, receiver operator characteristic (ROC) curve and Kaplan-Meier curves were used for evaluation. Results: 82 patients were analyzed. Among patients (mean age: 65.0 ± 13.3 years, 51.2 % female), mortality at 30 days occurred in 17.1 %. In univariable analysis, sex, left ventricular diastolic diameter, right to left ventricular diastolic diameter ratio, right ventricular global longitudinal strain (RVGLS), RV free wall strain and right atrial strain were associated with 30-day mortality (p &lt; 0.05). Multivariable analysis revealed sex and RVGLS independently associated with 30-day mortality (p = 0.007 and p = 0.036, respectively). ROC curve indicated that the best cutoff value for the absolute RVGLS to predict 30-day mortality was 17.7 % (area under the curve 0.827, sensitivity 0.917, specificity 0.672). Kaplan-Meier curves showed that male patients had higher risk of 30-day mortality compared with female patients (p = 0.029. Figure A). Patients with absolute RVGLS less than 17.7 % had 18 times higher risk compared to the other patients (p = 0.006. Figure B). Conclusions: Sex and RVGLS predicted short-term mortality in malignancy-related submassive PE more accurately. Further study is needed to validate these findings and determine the role of sex difference and RVGLS in malignancy-related submassive PE.
Abstract 18100: Comparative Analysis of Right Ventricular (RV) Apical Pacing versus Physiologic Left Bundle Branch Area Pacing (LBBAP) in Hypertrophic Cardiomyopathy With Left Ventricular Outflow Tract Obstruction (LVOTO): A Case Study
Authors: Kofi M Osei, George Wuni, Nikhil Mehta, Sanjaya K Gupta
Journal: Circulation (2023)

Introduction: AV dyssynchrony is considered advantageous in HoCM patients requiring pacemaker therapy. The impact of physiologic pacing, particularly LBBAP, on LVOTO in HoCM remains unexplored. We present a patient highlighting the effect of LBBAP on LVOTO. Case: A 69-year-old female with HoCM (resting gradient ~130mmHg) and asymmetric septal hypertrophy (17mm), managed conservatively due to high surgical risk. She had persistent AF, accompanied by debilitating fatigue and palpitations. Due to unsuccessful treatment with sotalol, dofetilide, and 5 DCCV procedures, other treatment options were discussed. She opted for LBBA pacing and AV node ablation. Dual chamber device was implanted utilizing a Medtronic 3830 lead. Within 48 hours of discharge, she came to the ER with exertional dyspnea and lightheadedness, indicating ambulatory cardiogenic shock (BP: 78/66 mmHg). A stat echo showed LVEF of 75%, severe SAM, LVOT gradient of 179 mmHg, and severe MR. No pericardial effusion. Phenylephrine was initiated, and VVIR rate was decreased from 90 bpm to 60 bpm, but no BP improvement. Obstructive cardiogenic shock from worsened LVOTO was likely caused by physiologic LBBAP. To objectively demonstrate this, she underwent a brief study in the lab after informed consent. We inserted a temporary RV apical pacing lead and assessed LVOT gradients at rest and during exercise for both physiologic pacing and RV apical pacing. RV apical pacing had lower LVOT gradient at rest and exercise compared to LBBA pacing (Figure 1). LBBA lead was extracted and a CRT-P device implanted and programmed for optimal dyssynchrony. Discussion: Traditional RV apical pacing is superior to physiologic LBBAP in HoCM. Limited studies suggest biventricular pacing reduces LVOT gradient, but CRT is not superior to RV pacing. LBBA pacing may be contraindicated in LVOTO patients. Conclusion: In HCM patients with LVOTO, RV apical pacing appears superior to LBBAP, reducing LVOT gradient at rest and during exercise.
Abstract 17037: Validation of Deep Learning System for Comprehensive 12-Lead ECG Interpretation
Authors: Robert Herman, Anthony Demolder, Boris Vavrik, Michal Martonak, Vladimir Boza, Davide Fabbricatore, Leor Perl, Jozef Bartunek, Robert Hatala
Journal: Circulation (2023)

Introduction: The electrocardiogram (ECG) is a widely available diagnostic tool for evaluating cardiac patients. Although automated ECG interpretation has made significant progress, it has yet to match the accuracy demonstrated by physicians. Hypothesis: In this study, we hypothesized that an artificial intelligence based ECG system can achieve comparable performance to physicians in accurately identifying 20 essential ECG patterns. Methods: An AI-powered system comprising six deep neural networks (DNNs) was trained to identify 20 diagnostic patterns from 12-lead ECGs categorized into six groups: rhythm, infarction, conduction abnormalities, ectopy, chamber enlargement, and axis. An independent test set with the consensus of two expert cardiologists was used as a reference standard. We compared the system's performance to that of three General Practitioners (GPs) and six individual cardiologists, using F1 scores as the evaluation metric. Results: The AI system was trained on 932,711 standard 12-lead ECGs from 173,949 patients. The independent test set comprised 11,932 annotated ECG labels. Figure 1 shows the respective F1 scores of the DNNs, average GP and average cardiologist as follows: Rhythm: 0.957 vs. 0.771 vs. 0.905; Infarction: 0.925 vs. 0.780 vs. 0.852; Conduction abnormalities: 0.893 vs. 0.714 vs. 0.851; Ectopy: 0.966 vs. 0.896 vs. 0.951; Chamber enlargement: 0.972 vs. 0.562 vs. 0.773; Axis: 0.897 vs. 0.601 vs. 0.685. The AI system's diagnostic performance exceeded that of GPs and was on par with cardiologists for all individual diagnostic patterns. Conclusions: The AI-powered ECG system is able to accurately identify electrocardiographic abnormalities from the 12-lead ECG, highlighting its potential as a clinical tool for healthcare professionals.
Abstract 13531: Uptake of SGLT2i and Outcomes in Patients With Diabetes and Chronic Heart Failure: A Community-Based Cohort and a Specialized Clinic Cohort
Authors: Luke R Gagnon, Deepan Hazra, Kevin Perera, Kaiming Wang, Niharika Kashyap, Chandu Sadasivan, Luan Manh Chu, Doug Dover, Padma Kaul, Scot Simpson, Aminu Bello, McAlister Finlay, Gavin Y Oudit
Journal: Circulation (2023)

Introduction: Sodium/glucose cotransporter 2 inhibitors (SGLT2i) have an established benefit in people with diabetes mellitus (DM) and chronic heart failure (HF). We aimed to evaluate the uptake and impact of these agents in two cohorts: a community-based cohort of all adults with DM and HF in Alberta who had an echocardiogram and a cohort of people with DM and HF being cared for in a specialized heart failure clinic (HFC). Methods: We identified the community-based cohort using validated ICD code-based case definitions for DM and HF (physician claims, outpatient, hospitalization databases) with an echocardiogram study (available from two major centres) from 2015 (when SGLT2i were available provincially) to March 2022. In addition, we identified the HFC cohort by chart review of patients seen in the Mazankowski Alberta Heart Institute HFCconsented between February 2018 and August 2021 with HF and DM and followed them until August 2022. We examined the association between SGLT2i use and all-cause mortality and/or cardiovascular (CV)-related hospitalizations using Cox proportional hazard models adjusted for clinical covariates and time-varying SGLT2i use. Results: In 12,150 people with DM and HF in the community-based cohort, 2,321 (19.1%) were dispensed an SGLT2i compared to 208 (39.2%) of the 530 patients with DM and HF followed in the HFC. SGLT2i was associated with less CV-related hospitalization and all-cause mortality (the composite outcome) (aHR 0.65 [95%CI 0.58 - 0.73]) in the community but no difference (aHR 0.88 [95% CI 0.64 - 1.21] in the HFC. SGLT2i use was associated with less all-cause mortality (aHR 0.50 [95% CI 0.44 - 0.57]) in the community but no difference (aHR 0.81 [95% CI 0.54 - 1.20]) in the HFC. Conclusion: Despite robust randomized trial evidence of clinical benefit, the uptake of SGLT2i even in people with DM and HF remains low. Although uptake is higher in a specialized HFC overall the rate is below optimal. Multifaceted Strategies (targeted to healthcare professionals, patients, and policymakers) to guide risk identification and raise awareness on the clinical benefits of these agents are warranted.
Abstract 13982: Ischemic Heart Disease Burden in the United States: Prevalence, Mortality, and Regional Differences From 1990-2019
Authors: Saeed Abughazaleh, Omar Obeidat, Mohammad Tarawneh, Yaman Mkhaimer, Khalid Abdalla
Journal: Circulation (2023)

Background: Understanding the burden of IHD in the United States is crucial for informed decision-making and targeted interventions aimed at reducing morbidity and mortality. Aim: To understand the burden of IHD, identify gender disparities and risk factors, explore the relationship between socioeconomic growth and IHD, and analyze risk factor distribution across states. Method: utilizing data from the GBD Study 2019. The study assessed the relationship between IHD and socioeconomic development using SDI and measured the overall impact of IHD using DALYs, considering premature death and disability. Data analysis involved comparing prevalence, mortality, SDI, DALYs, attributable burden, and risk estimation among states. Results: Between 1990 and 2019, there was an improvement in socioeconomic development in all states. Age-standardized rates of disease burden for IHD decreased by 50% with the most significant decline observed in Minnesota. Males had higher burden rates than females in all states, and the southeast region had the highest mortality rates. The prevalence of IHD showed a declining trend with a 37.1% decrease in ASPR from 1990. Metabolic risks were the leading contributors to the disease burden, accounting for 50% of cases, with Mississippi having the highest attributable risk. Arkansas had the highest attributable risk for high cholesterol and smoking. Conversely, Minnesota had the lowest burden of IHD among all states. Conclusion: This study highlights variations in the burden of IHD across US states and emphasizes the need for tailored prevention programs to address specific risk factors and gender differences.
Abstract 18196: Relationship Between Napping with Brachial-Ankle Pulse Wave Velocity (BAPWV) and Coronary Heart Disease in a Chinese Community Prospective Cohort Study
Authors: Xiaolei Zhao, Qiujing Cai, Tao Tian, Xian-Liang Zhou, Yuqing Zhang, Weiguo Zhang, Lisheng Liu, Aihua Hu
Journal: Circulation (2023)

Introduction: To this date, many studies have proposed an association between napping and multiple cardiovascular events. The brachial-ankle pulse wave velocity (baPWV) level can be used as an indicator of vascular stiffness and is becoming a non-invasive indicator of diseases such as atherosclerosis and coronary artery disease (CAD). However, few associations between napping and baPWV levels combined with cardiovascular disease are known. Therefore, we investigated the association of napping with baPWV and CAD in a prospective cohort study. Hypothesis: To study the association of napping with baPWV and CAD in a prospective cohort study, and to guide the lifestyle of the population. Methods: Interviews, physical examinations, laboratory tests, and bapwv testing were part of baseline assessments of 3636 participants who were continuously followed from 2012 to 2018. The population was divided into three groups based on nap frequency that non-siesta group, intermittent siesta group and continuous siesta group. The association of napping with baPWV and CAD were determined using survival curve, COX regression models and multivariate linear regression. Results: Among all participants, the different groups have a significant difference of baPWV and the highest was in the continuous siesta group (2012: 1668.59cm/s, 2019: 1723.69cm/s). After χ2 test, the incidence of abnormal baPWV showed an ascending trend as the frequency of napping increased, siesta was positively correlated with baPWV (P&lt;0.001). Of the participants, 45, 97 and 47 (6.4% vs 5.5% vs 4.0%) persons in three groups newly found CHD after baseline (P&lt;0.001). According to Cox regression analysis, in the fully controlled model, participants in the continuous siesta group [ HR 1.519 (95%CI 1.004-2.296); P&lt;0.05] exhibited a 1.519-fold risk of CAD occurrence when setting the non-siesta group as reference. After adjusting for multiple variables in multiple linear regression analysis, we found the positive relationship between nap frequency and baPWV values (P=0.008) Conclusions: An elevated baPWV and danger of CAD were shown to influenced by increased frequency of siestas. These results need to be verified by additional lab work.
Abstract 18707: Concomitant Occurrence of Takotsubo Cardiomyopathy and Posterior Reversible Encephalopathy Syndrome: An Uncommon Encounter With Shared Pathophysiology
Authors: Mohan Chandra Vinay Bharadwaj Gudiwada, Miguel Treminio Quezada, Abdulkareem Lukan, Pooja Singh, Ankit Sahni, Ajay Baddi
Journal: Circulation (2023)

CASE PRESENTATION: A 61-year-old African American woman presented in an unconscious state after a seizure. She was febrile, tachycardic, tachypneic alongside elevated lactate, leukocyte counts, and procalcitonin levels. Initial high-sensitivity troponin I was notably raised at 4,217 ng/l, with ekg revealing a new onset left bundle branch block (LBBB). Patient was intubated and needed pressor support. Echocardiogram revealed hypokinesis in the basal-mid left ventricle, with a significantly decreased ejection fraction (EF) of 40%. Chest imaging showed a consolidation in the left lower lobe, and Hemophilus influenzae was identified in the sputum culture. A subsequent lumbar puncture yielded elevated leukocytes and proteins, suggesting a secondary meningitic process. DISCUSSION: She was started on antibiotic therapy for pneumonia and meningitis. LV hypokinesis was thought to be due to Takotsubo cardiomyopathy (TTC) or myocardial infarction. Although uncommon LBBB can be seen in TTC. Her clinical presentation, echocardiogram findings further points her LBBB and troponinemia towards TTC than Myocardial infarction. Patient was managed conservatively. Neuroimaging later on revealed restricted diffusion in bilateral occipital and parietal lobes, consistent with Posterior Reversible Encephalopathy Syndrome (PRES). A delayed coronary angiogram after clinical stabilization ruled out obstructive atherosclerotic disease. Weakness and ataxia improved over the course. EF at discharge was 80%.This case illustrates the possibility of concomitant TTS and PRES, conditions hypothesized to arise following intense physical or emotional stress, in this case, likely triggered by pneumonia and meningitis. This clinical scenario underscores the importance of awareness and understanding of these two entities and their potential for simultaneous presentation, providing valuable insights for clinical decision-making in such complex cases.