tbuckley/cabot-search huggingface dataset:
Abstract 4144649: Severity of Tricuspid Regurgitation and Its Impact on Long-Term Clinical Outcomes in Heart Failure: A Meta-Analysis of 456,353 Patients
Authors: Sachin Singh, Adil Mohammed, Ramya S D Kanagala, Ali Danish, Lovekumar Vala, Riya Dhadhal, Joanne Mathew, Hafeezuddin Ahmed, Neha Kanthala, Ankit Vyas, paritharsh ghantasala, Ihsan Al-Sabbagh, Rupak Desai
Journal: Circulation (2024)

Introduction: Tricuspid regurgitation (TR) can have detrimental effects on heart failure (HF) patients clinically, and there is growing evidence supporting this association. We aim to study the impact of the severity of TR on the long-term outcomes in patients with HF. Methods: We systematically screened PubMed, SCOPUS, and Google Scholar databases up to May 2024 using appropriate keywords. The outcomes studied included 1-year mortality, 2-year mortality, HF hospitalizations, cardiovascular deaths, and composite events (HF hospitalization and mortality). The majority of studies included Journal of the American Society of Echocardiography 2017 guidelines to assess the severity of TR. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a binary random effects model. Heterogeneity was assessed using I2 statistics, and a leave-one-out analysis was performed. A p-value of &lt;0.05 was considered significant. Results: A total of 10 studies with 456,353 HF patients were included. The mean age of the included population was 71.2 years, with 59.4% of male participants having a median follow-up of 2 years. Severe TR showed a significant association with higher odds of 1-year mortality (OR=1.25 [1.02-1.52], p=0.03; I2=78.15%), 2-year mortality (OR=1.63 [1.28-2.09], p&lt;0.01; I2=0%), HF hospitalization (OR=1.39 [1.14-1.71], p&lt;0.01; I2=61.58%), and composite events (OR=1.44 [1.10-1.88], p&lt;0.01; I2=73.46%). However, it showed no association with cardiovascular deaths (OR=1.35 [0.82-2.24], p=0.24; I2=78.31%). Upon performing a leave-one-out sensitivity analysis, we found that excluding Adamo's study changed the overall OR to 1.34 (95% CI: 1.29, 1.39), indicating its influence on the estimate. The narrower CI and increased OR suggest Adamo's study has a relatively lower effect on overall mortality risk compared to the pooled effect of the other studies. Conclusion: Severe TR is associated with a higher risk of 1-year and 2-year mortality, HF hospitalizations, and composite events among heart failure patients. Therefore, HF patients with comorbid TR should be promptly screened and managed, as increasing severity is linked to a higher risk of adverse outcomes.
Abstract 4144458: Cardiometabolic Risk during the Venezuelan Humanitarian Crisis: Insights from the EVESCAM Study on Crisis Indicators.
Authors: Ramfis Nieto-Martinez, Diana De Oliveira Gomes, Juan Gonzalez Rivas, Eunice Ugel, Maritza DURAN, Maria Marulanda, Luis Franceschi-Jimenez, Jeffrey mechanick, Goodarz Danaei
Journal: Circulation (2024)

Introduction: Social vulnerability is linked to increased cardiovascular morbimortality. Venezuela faces a severe humanitarian crisis –rated 4.2/5 on the INFORM Severity Index-, marked by hyperinflation, healthcare collapse, and mass migration (&gt;7.2 million by 2023), with poverty escalating from 48% in 2014 to 96.2% by 2020. This study aims to examine the association between crisis indicators—food insecurity, stressful life events (SLEs), and family separation—and cardiometabolic risk factors (CMRF). Methods: This analysis uses follow-up data (2018-2020) from 1,257 individuals in the Venezuelan Study of Cardiometabolic Health (EVESCAM,2014-2017). The distribution of CMRF (adiposity, dysglycemia, dyslipidemia, anxiety/depression symptoms, diet, physical activity, alcohol intake, and smoking) by three crisis indicators (food insecurity, SLEs—including financial difficulties, accidents, family deaths, health issues, and violence—and family separation) was analyzed. Logistic regression determined the associations. Results: Table 1 illustrates the relationship between crisis indicators and CMRF. Food insecurity was prevalent in 60.2% of participants, especially those with low SES, and was associated with higher odds of being underweight (OR:2.0[1.1-3.6]), anxiety (OR:2.9[2.3-3.7]), depression (OR=3.2[2.5-4.1]), and reduced fruit/vegetable intake. SLEs affected 67.2% of participants, linked to higher odds of diabetes (OR:1.6[1.1-2.3]), anxiety (OR: 2.2[1.7- 2.9]), depression (OR: 2.0[1.5- 2.6]), and poor dietary habits. Family separation, with a prevalence of 49.2%, was more common in older adults and females and linked to depression (OR: 1.4[1.1- 1.8]), low adherence to the Mediterranean diet, high triglycerides (OR:1.3[1.01-1.7]), and high risk of a fatal cardiovascular event (OR: 1.6 [1.1 – 2.5]). Conclusion: The Venezuelan humanitarian crisis has severely impacted adults, with high prevalence rates of food insecurity, SLEs, and family separation, while increasing CMRF, especially among vulnerable groups. Food insecurity rates in Venezuela were aligned with crisis-hit countries like Yemen. This study underscores the urgent need for targeted interventions to support the most affected populations.
Abstract 4144421: Factors Associated with Delay Presentation of Acute Ischemic Stroke to Emergency Department in Oman
Authors: Fatma AL Hadabi, Mohammed AL Hadhrami, Ahmed Al Saidi, Raheela AttaUllah, Muna Alshahri, Amal AL-Hashmi
Journal: Circulation (2024)

Abstract Background: Stroke is a leading cause of death and disability worldwide and a significant burden on healthcare systems globally. Despite the effectiveness of tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke (IS), many patients arrive at the emergency department beyond the window to perform intravenous thrombolysis. Study objectives: This study investigated factors contributing to the delayed presentation of acute patients with stroke to emergency departments across governorate hospitals in Oman and assessed neurological function at 90 days using the Modified Rankin Scale. Methods: A prospective observational cohort multi-center study was conducted involving 512 participants with acute ischemic stroke symptoms who arrived at the emergency departments more than 4.5 hours after symptom onset. Data were collected using questionnaires administered to participants or their relatives to identify reasons for delayed arrival. Key variables included socio-demographic characteristics, symptom type, mode of arrival, and follow-up outcomes. Statistical analysis was performed to assess associations between these variables and participant outcomes. Results: The mean age of the participants was 61.96 years, with a majority being male (65.2%) and Omani nationals (81.3%). The most common symptoms were upper limb weakness (67.8%), lower limb weakness (60.4%), and inability to speak (56.7%). The primary mode of transfer to the hospital was by a relative (62.3%). Significant findings included; Delayed Arrival: Confusion, falls, and facial weakness were associated with the fastest median arrival times, while memory loss, loss of facial sensation, and abnormal eye movements were associated with the longest delays. Reasons for Delay: Common reasons for delay included lack of awareness of stroke symptoms (36.7%), believing symptoms would self-resolve (29.7%), and not knowing the importance of timely hospital arrival (31.9%). Outcomes: At 90 days, 36.3% had mild disability, 50.0% had moderate to severe disability, and 13.7% had died. Conclusion: Delayed hospital arrival in participants with stroke is influenced by various factors, including symptom type, mode of arrival, and socio-demographic characteristics. Enhancing public awareness about stroke symptoms and the importance of timely medical intervention could improve outcomes. This study provides valuable insights for improving stroke management and patient education in Oman.
Abstract 4144774: Machine Learning-Based Clinical Predictive Models for Early Readmission in Patients with Cardiogenic Shock
Authors: Xiarepati Tieliwaerdi, Abulikemu Abuduweili, Erasmus Mutabi, Kathryn Manalo, Matthew Lander
Journal: Circulation (2024)

Background/Purpose: Cardiogenic shock (CS) affects up to 50,000 people annually in the United States, with high in-hospital mortality rates of 40%-67%. About 18.6% of CS survivors are re-admitted. This study aims to predict 7-day and 30-day readmissions in CS patients using machine learning (ML) algorithms to guide targeted interventions and improve healthcare outcomes. Methods: This retrospective study used the 2019 National Readmissions Database (NRD). CS hospitalizations were identified using ICD-10 code R57.0. Welch’s t-test compared continuous variables. The dataset was split into training and testing sets with a 7:3 ratio. Commonly used ML models, including XGBoost, Adaboost, decision tree, and random forest, were compared with logistic regression (LR). The primary outcome was CS readmission within 7 or 30 days of discharge. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used for performance measurement. Results: Among 97,653 CS patients, 32,881 (33.7%) died during their initial hospitalization. Index hospitalizations were 51,976. We excluded hospitalizations where patients died during their initial stay, as these cases would not contribute to readmission data. Additionally, we only considered hospitalizations from January to November, excluding December hospitalizations since their 30-day readmissions would occur in the following year. The 7-day readmission rate was 4,317 (8.3%), and the 30-day readmission rate was 10,927 (21.02%). Significant predictors for both readmission periods (p value &lt;0.05) included lower mean age, lower income, higher Medicaid coverage, lower private insurance coverage, higher rates of CKD3, chronic pulmonary disease, drug abuse, and diabetes with complications as shown in Table 1. Figure 1 shows the performance of various ML models, with XGBoost being the best model in both tasks, achieving an AUC of 0.65 for 7-day and 0.67 for 30-day readmissions, indicating less than a 70% chance of accurately predicting readmission. This performance was similar to that of LR (AUC of 0.61 and 0.67). Conclusion: ML models have poor capacity for early CR readmission prediction and perform similarly to logistic regression (LR) when developed using large administrative datasets. To enhance future model development, incorporating electronic health records (EHRs) with more detailed and clinically relevant data should be considered.
Abstract 4144534: Sex Differences in Onset of New Cognitive or Psychological Complaints Following Acute Coronary Syndrome in Older Adults
Authors: Shivani Priyadarshni, Ritika Saxena, Hani Jneid, Diann Gaalema
Journal: Circulation (2024)

Background: Anxiety, depression, and cognitive changes are common adverse outcomes after acute coronary syndromes (ACS). These challenges also predict increased risk of adverse cardiac outcomes. While it is known that females have higher rates of psychological symptoms generally, data on sex differences in onset following an acute cardiac event are scarce, especially among older adults. Goal: Our goal was to determine if sex differences exist in mental health and cognitive outcomes after acute coronary syndrome in older adults. Hypothesis: Females are more likely to have new psychological and cognitive issues within one year of ACS compared to male patients. Methods: We conducted a retrospective analysis using Texas Medicare claims data from 2017-2020. The study population consisted of those 65 and older, diagnosed with ACS (either STEMI or NSTEMI). Eligible participants had continuous enrollment in Medicare Part A and B for at least one year before and after the index event, were not part of any Health Maintenance Organization, and had no prior diagnosis of the outcomes of interest (anxiety, depression, amnesia, and dementia). Data were extracted on demographic characteristics, clinical variables, and intervention (i.e. PCI/CABG). Descriptive statistics were used to summarize the data. Results: Our study included 56,325 patients (23,911, 42.4% female), 13,078 with STEMI and 43,247 with NSTEMI. In STEMI and NSTEMI patients respectively, the prevalence of onset of the following outcomes was significantly higher among females compared to males: anxiety (14.8% vs. 9.3%; 16.2% vs. 11.3%), depression (11.5% vs. 7.9%; 14.1% vs. 9.9%), and dementia/Alzheimer's (2.5% vs. 1.7%; 3.5% vs. 2.5%). No differences were observed in amnesia by sex. Differences by sex persisted by treatment type for anxiety and depression (Table). Additionally, rates of new diagnoses were higher across sexes for CABG compared to PCI. Conclusion: Significant sex differences exist in cognitive and mental health outcomes after ACS. Females are more likely to have worse outcomes following ACS as compared to men. Additionally, across sexes, psychological outcomes are worse following CABG as compared to PCI.
Abstract 4144388: Impact of Left Atrial Myopathy and Post-Ablation Remodeling on Quality of Life: A DECAAF II Subanalysis
Authors: ghassan bidaoui, Han Feng, Nour Chouman, Ala' Assaf, Hadi Younes, Mayana Bsoul, Francisco Tirado Polo, Chanho Lim, Yishi Jia, Yingshuo Liu, William Rittmeyer, Mario Mekhael, Charbel Noujaim, Amitabh Pandey, Swati Rao, Omar Kreidieh, Nassir Marrouche, eoin donnellan
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is associated with adverse remodeling of the left atrium (LA). The impact of the extent of atrial myopathy and post-ablation remodeling on quality-of-life (QoL) outcomes have not been studied. Objective: The aim of our study was to investigate the association between atrial myopathy and post-ablation remodeling on quality-of-life outcomes in patients with persistent AF. Methods: We conducted an analysis of DECAAF II participants who underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. We assessed atrial myopathy and post-ablation atrial remodeling, scar formation, and fibrosis coverage with ablation. QoL metrics were assessed using the Short Form Survey (SF-36) and Atrial Fibrillation Severity Scale (AFSS). Uni- and multivariable regression models were developed for this analysis. Results: 613 patients with persistent AF were included in our analyses. At baseline, AFSS burden and total AFSS score were 18.94±7.35 and 12.24±8.17, respectively. Following ablation, all QoL and AFSS metrics improved in both the pulmonary vein isolation (PVI) and MRI-guided fibrosis ablation groups. On average, one unit of post-ablation reduction in left atrial volume index (LAVI) was associated with an improvement of 0.085 in total AFSS score (p=0.001), 0.01 in shortness of breath with activity (p&lt;0.001), 0.15 in AF burden (p&lt;0.001), -0.016 in global well-being (p=0.018), 0.519 in health change (p&lt;0.001), 0.19 in vitality (vitality (p=0.01), and 0.27 in physical functioning (p=0.001). Baseline fibrosis and residual fibrosis post-ablation were associated with improved vitality and general health. Conclusion: Atrial myopathy and post-ablation atrial remodeling significantly impact QoL in patients with persistent AF undergoing ablation.
Abstract 4144277: Analysis risk factors of long-term adverse outcomes and construction of nomogram based on fractional flow reserve for coronary artery disease patients with an intermediate stenosis
Authors: Fan Qi Li, Qiming Liu, Yichao Xiao
Journal: Circulation (2024)

Background: The role of fractional flow reserve (FFR) in intermediate lesions has been widely demonstrated and recommended by guidelines. However, the long-term outcomes in patient with an intermediate stenosis received FFR have not yet been investigated comprehensively. Methods: We retrospective included 558 patients underwent both coronary artery angiography (CAG) and FFR. All patients were randomly divided into a training set containing 390 individuals and a validation set of 168 individuals at a ratio of 7:3. Valuable predictors were screened for constructing nomogram by statistical and clinical significance. The prediction efficiency of nomogram was evaluated by multiple methods, including C-index, area under the curve (AUC), calibration curves and decision-curve analysis (DCA). Results: During a median follow-up of 6.2 years, 87 (15.59%) adverse events were documented. The nomogram consists of age, smoking, hypertension, diabetes mellitus (DM), hyperuricemia, and FFR≤0.8 six factors. The C-index in the training and validation sets were 0.807 and 0.832. The AUC of 3-year, 5-year, 7-year receiver operating characteristic (ROC) curves of training set were 0.697, 0.823, 0.854, and of validation set were 0.845, 0.824, 0.856. The calibration curves and DCAs illustrated the ability of the nomogram to predict long-term adverse outcomes and its net benefits in clinical practice. Conclusions: Age, DM, and hyperuricemia were independently associated with longterm adverse outcomes, and the constructed nomogram based on FFR may be used as a visible tool to predict long-term adverse outcomes for coronary artery disease (CAD) patients with an intermediate stenosis.
Abstract 4144298: Structural Remodeling of Coronary Microvasculature in Hypertrophic Obstructive Cardiomyopathy
Authors: Mohamed Roshdy, Ayman Ibrahim, Eslam Soror, Mina Azer Gayed, Manar Osman, Padmini Sarathchandra, Laura Nicastro, Danika Hayman, Mohamed Hosny, Amany Elaithy, Yasmine Aguib, Cesare Terracciano, Magdi Yacoub
Journal: Circulation (2024)

Background: Microvascular dysfunction is a hallmark of hypertrophic obstructive cardiomyopathy (HOCM). Factors modulating myocardial microcirculation in response to disease phenotype require further studies. This study aims to investigate microvascular remodeling in HOCM patients using a quantitative imaging toolset that combines classical histological screening, ultrastructure assessment, 3D molecular imaging and automated segmentation of myocardial tissue specimens. Methods: Microvascular remodeling was studied in a cohort of 20 consecutive HOCM patients who underwent septal myectomy, and 6 normal controls. Myectomy specimens were examined using histopathological staining, immunofluorescence and electron microscopy. Molecular 3D visualization was conducted using Free of Acrylamide SDS-based Tissue Clearing (FASTClear) protocol of 300 µm thick myocardial slices. Cleared slices were examined using immunostaining targeting microvascular markers; Isolectinβ4 and CD31. Reconstructed images of stained slices were analyzed using ImageJ and Python-based algorithm. Transcriptome data from HOCM patients’ myocardial tissues was analyzed to investigate angiogenesis and hypoxia-related gene expression. Gene and protein expression was validated using RT-PCR and immunohistochemical staining. Results: Histopathological examination demonstrated a significant increase in perivascular fibrosis around intramural vessels in HOCM myocardial tissues, compared to controls, associated with a significant increase in vascular wall thickness, which led to a reduction in luminal area. Electron microscopy analysis revealed, for the first time, ultrastructural changes in the microvasculature in HOCM, including irregular microvessels, disorganized perivascular collagen fibres and abnormal endothelial cell morphology. Increased Aurora and Caspase 3 levels in the endothelial cells of myocardial microvessels were observed. 3D molecular imaging of myocardial slices showed a significant reduction in microvascular density, length, and number of microvascular branches in HOCM, which correlated to LVOT. Microvascular orientation was significantly altered throughout slices of HOCM myocardium. Transcriptome data analysis and protein examination revealed that angiogenesis and hypoxia-related markers elevate in HOCM patients’ myocardial tissues. Conclusion: Structural alterations of coronary microvasculature delineate the clinical presentation and myocardial functional response in HOCM patients.
Abstract 4144751: Relationship between abnormal conduction area detected by isochronal late activation mapping in sinus rhythm and arrhythmogenicity of atrial fibrillation
Authors: Tomonori Watanabe, Takafumi Okuyama, Hiroaki Watanabe, Masashi Kamioka, Hisaki Makimoto, Ayako Yokota, Takahiro Komori, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
Journal: Circulation (2024)

Background: The arrhythmogenic substrate in atrial myocardium could contribute the trigger of atrial fibrillation (AF) except pulmonary vein (PV). This study was conducted to investigate the arrhythmogenic substrate using an isochronal late activation mapping (ILAM) related with the trigger of AF. Methods: Forty-five AF patients (age 65±9 years old,35 Males,17 non-paroxysmal AF,11 patients with 2 nd -session procedure) who underwent the catheter ablation for AF were enrolled. The high-density activation mapping of left atrium (LA) was obtained by in sinus rhythm or atrial pacing with a cycle length of 600ms. ILAM was retrospectively constructed and deceleration zone was defined as abnormal conduction area with ≥3 isochrones within a 1cm radius along with a discontinuity of conduction zone. Relationship between the AF arrhythmogenicity and ILAM deceleration zone was investigated. Results: Patients with non-paroxysmal AF has larger number of ILAM deceleration zone in LA than those with paroxysmal AF (median [interquartile], 4.0[2.5-7.5] vs.0[0-5], p=0.028). Of all, 15 patients had a trigger of AF except pulmonary vein (non-PV foci) in the LA (10: posterior wall, 6: anterior wall, 2: septum, 1: roof). Patients with non-PV foci had a larger number of ILAM deceleration zone in LA than those without (median [interquartile], 6.0[4.0-8.0] vs.0[0-4], p&lt;0.001). Furthermore, 15 patients with non-PV foci had 35 deceleration zones in sinus rhythm, 26 of them were associated with non-PV foci. On the other hand, of total 87 deceleration zones in all patients, 61 deceleration zones had no contribution to the non-PV foci. Conclusion: ILAM deceleration zone with ≥3 isochrones within a 1cm radius along with a discontinuity of conduction zone obtained in sinus rhythm may be useful to assess the atrial myocardial arrhythmogenic substrate related with non-PV foci.