tbuckley/cabot-search huggingface dataset:
Abstract 4146785: A Six-Year Analysis of In-Hospital Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Valve in patients with dementia: Insights from the National Inpatient Sample Data (2016-2021)
Authors: Siddharth Agrawal, Maharshi Raval, Aalesh Shah, Labdhi Sanghvi, Yug Patel, Sajid Siddiq
Journal: Circulation (2024)

Background: Dementia is a prevalent comorbidity in patients undergoing the transcatheter edge-to-edge repair (TEER) procedure of the mitral valve. This study compares outcomes of mitral valve TEER in patients with and without dementia, utilizing data from the National Inpatient Sample (2016-2021) Methods: We conducted a retrospective cohort study on 48,085 patients without dementia and 3,125 with dementia undergoing mitral valve TEER. Multivariate logistic regression was employed to compare outcomes, adjusting for potential confounders. Primary outcomes included mortality and major complications, while secondary outcomes encompassed specific procedural complications. Results: Patients with dementia were older (mean age: 80.896 vs. 76.69 years, p-value &lt;0.001) and exhibited differences in gender distribution (male: 49.92% vs. 54.24%, female: 50.08% vs. 45.76%, p=0.0356).Patients with dementia had a longer LOS (coefficient: 1.64 days, 95% CI: 0.85-2.43, p&lt;0.001) and higher total hospitalisation cost (coefficient: $19,868.97, 95% CI: $302.45-$39,435.49, p=0.047). Patients with dementia exhibited a higher prevalence of mortality (OR: 1.677, 95% CI: 1.049-2.68, p=0.031), bleeding (OR: 1.4807, 95% CI: 1.156-1.896, p=0.002), PPM insertion (OR: 3.351, 95% CI: 1.463-7.674, p=0.004), post-procedure shock (OR: 2.027, 95% CI: 1.478-2.779, p&lt;0.001), intra-procedure stroke (OR: 1.971, 95% CI: 1.438-2.701, p&lt;0.001), mechanical ventilation (OR: 3.088, 95% CI: 2.172-4.389, p&lt;0.001), and cardiogenic shock (OR: 1.949, 95% CI: 1.418-2.678, p&lt;0.001). Additionally, they had increased odds of sepsis (OR: 1.974, 95% CI: 1.125-3.466, p=0.018) and stroke (OR: 1.987, 95% CI: 1.007-3.923, p=0.048), as well as a higher likelihood of pleural effusion (OR: 2.167, 95% CI: 1.501-3.128, p&lt;0.001). Odds of arrhythmia and post-procedure deep vein thrombosis did not significantly differ between groups. Conclusion: Patients with dementia undergoing mitral valve TEER procedure face elevated risks of mortality, bleeding, PPM insertion, post-operative shock, stroke, and other major complications compared to those without dementia. Clinicians should consider these heightened risks when evaluating the appropriateness of mitral valve TEER in dementia patients. Further research is warranted to explore strategies for risk mitigation in this population.
Abstract 4146852: Impact of Left Ventricular Diastolic Function in Pulmonary Arterial Hypertension Outcomes
Authors: Alexandria Miller, Scott Visovatti, Rebecca Vanderpool
Journal: Circulation (2024)

Introduction: The demographics of patients with pulmonary arterial hypertension (PAH) is shifting towards older age, increased comorbidity burden, and an increase in the risk of left ventricular (LV) diastolic dysfunction. The H 2 FPEF score and probability were developed to assist in heart failure with preserved ejection fraction (HFpEF) diagnosis. We evaluated the utility of the H 2 FPEF score as well as echocardiographic measures of LV diastolic function in PAH. Hypothesis: Development of left-sided heart failure in a population of patients diagnosed with PAH may affect outcomes for those treated with PAH based therapies. Methods: Participants with an inpatient admission and a prostacyclin order at the Ohio State University Medical Center between Jan 2020 and Dec. 2022 were included. Chart review was performed to obtain clinical and echocardiographic data. The H 2 FPEF score and probability were calculated at the time of the Echo. Survival analysis was performed (Outcome: PAH related-hospitalization or death). Significant predictors of outcomes were identified using Cox logistic regression analysis. Data are presented as mean ± standard deviation or mean [interquartile range]. Results: Overall, 140 participants were identified (age: 56±16 years; BMI: 30.04±8.04 kg/m 2 ; 74% female) with normal left ejection fraction (LVEF: 63±9%). The majority were on prostacyclin therapy or no therapy at the time of the echo. Median H 2 FPEF score was 3[2-4] and median H 2 FPEF probability was 88[67-95%]. High H 2 FPEF probability was driven by high systolic PA pressure (70±22 mmHg) in the continuous equation ( Fig 1A ). The H 2 FPEF score and probability did not associate with outcomes. However, E/A ratio (HR:0.49(0.26-0.92), p=0.03) and estimated RA pressure (HR:1.1(1-1.1), p=0.02) did significantly associate with outcomes individually and in a multivariable assessment with adjusting for age and BMI ( Fig 1B ). Conclusions: The continuous H 2 FPEF probability did not perform well in this inpatient PAH cohort primarily on prostacyclin therapy. Notably measures of right and left atrial function (E/A and estimated RA pressure) did significantly associate with hospitalization and mortality. Future studies in a broader cohort of PAH patients are needed to better understand how diastolic function parameters may impact outcomes.
Abstract 4147913: Factors Associated with Activation to Perform Self-care among Rural Caregivers of Patients with Chronic Diseases and the Association of Activation to Perform Self-care with Adherence to Cardiovascular Disease Risk Reduction Measures
Authors: Muna Hammash, Terry Lennie, Martha Biddle, Misook Chung, Debra Moser
Journal: Circulation (2024)

Introduction: Caregivers are at high risk of cardiovascular disease (CVD), depression, and mortality compared to non- caregivers. Patient activation- one's knowledge, skills and confidence to manage their own health-is associated with improved self-management behaviors for several chronic conditions. Studies exploring patient activation among rural caregivers of patients with chronic diseases are lacking. Aims: To determine 1) demographic, socio-economic, and psychological characteristics associated with activation in rural caregivers, and 2) association between activation and reported adherence to recommended CVD risk reduction measures and affective symptoms in rural caregivers of patients with chronic diseases. Method: In this cross-sectional study, 277 rural caregivers were included (mean age 54 ± 14 years; 76% were female; and 70% were married). We measured sociodemographic factors using a standardized survey, activation using patient activation measure (PAM), caregiver burden using the Zarit Burden Interview, social support using the Medical Outcomes Study Social Support Survey, depression using the Patient Health Questionnaire-9, anxiety using the Brief Symptom Inventory– Anxiety subscale, and adherence to recommended CVD risk reduction measures using the Medical Outcomes Study (MOS) Specific Adherence Scale. Hierarchical regression analysis was performed. Results: In this study, patient activation was high (mean PAM 69 ± 26). Caregivers who reported low activation had significantly poorer social support, more depressive symptoms, higher anxiety level, and scored higher on food insecurity ( p &lt;.05). High patient activation was associated with better adherence to recommended CVD risk reduction measures ( β = 0.17; p &lt;.01), less depressive symptoms ( β = -0.2; p &lt;.001), lower anxiety level ( β = -0.23; p &lt;.001), and lower caregiver burden ( β = -0.15; p &lt;.01) compared to those with the lowest scores. Conclusion: In rural caregivers, higher activation was associated with better adherence to health behavior recommendations and favorable self-reported outcomes. Greater attention should be given to patient activation and psychosocial factors to reduce CVD risk in this population.
Abstract 4147419: EKG Abnormalities and Homozygous Embryonic Lethality in Gene-Targeted Mice Mimicking K1479 Acetylation of the Cardiac Na <sup>+</sup> Channel Na <sub>v</sub> 1.5
Authors: Joseph Kaesbauer, Jason Dierdorff, Alexander Greiner, Jin-Young Yoon, Kaikobad Irani, Barry London
Journal: Circulation (2024)

Introduction: Na v 1.5, the predominant Na + channel in cardiac myocytes, is encoded by SCN5A and is essential for depolarization and impulse propagation in the heart. Loss of function mutations of Na v 1.5 can lead to tachyarrhythmias, conduction disease and dilated cardiomyopathy by altering channel expression, kinetic properties, and/or membrane trafficking. We previously reported that amino acid K1479 of Na v 1.5 is acetylated, that K1479 acetylation or mutation to the acetylation mimic glutamine (K1479Q) decreases inward Na + current (I Na ) in heterologous expression systems by decreasing membrane trafficking, that cardiac myocytes from mice lacking the deacetylase Sirt1 (Sirt1 -/- ) are hyperacetylated and have less I Na , and that Sirt1 -/- mice have conduction disease and arrhythmias. Here, we studied the effect of the K1479Q mutation that mimics acetylation in-vivo . Methods: K1479Q knock-in mice were engineered via CRISPR/Cas9 on a C57BL6 background and backcrossed 4 times with C57BL6 wild type (WT) mice. Na v 1.5 WT/Q heterozygous (het) mice were mated, and male (M) and female (F) gene-targeted offspring and littermate controls were studied by electrocardiograms (EKGs) and echocardiograms (Echos) at 3 and 6 months of age. Data is shown as mean±SEM. Results: The K1479Q mutation was homozygous (hom) embryonic lethal (Na v 1.5 WT/Q x Na v 1.5 WT/Q crosses: WT, n=23; Het, n=49; Hom, n=0). On EKG (WT: n = 5M, 3F; Het: n = 6M, 5F), Na v 1.5 WT/Q mice had a prolonged PR interval at 3 months (42±1 vs. 36±1 ms, p=0.0003) and at 6 months (46±1 vs. 39±1 ms, p=&lt;0.0001) compared to WT (Figure). Na v 1.5 WT/Q mice also showed a prolonged QTc interval (72±1 vs. 65±2 ms, p=0.007) compared to WT controls at 6 months. No significant differences were identified in cardiac size or function between Na v 1.5 WT/Q and WT mice at 6 months. Conclusions: The K1479Q Na v 1.5 mutation, which mimics the acetylation post-translational modification at K1479, leads to homozygous embryonic lethality and a heterozygous electrophysiological phenotype as severe as targeted deletion of the channel. These findings suggest that Na v 1.5-K1479Q and acetylated Na v 1.5-K1479 do not produce I Na in-vivo in cardiac myocytes, in part due to failure to traffic to the surface membrane.
Abstract 4147426: Intravascular Lithotripsy vs Rotational Atherectomy in Calcified Left Main Coronary Artery Disease: A Systematic Review and Meta-analysis
Authors: Shanmukh sai pavan Lingamsetty, Harshith Thyagaturu, Matthew Santer, Mohamed Abugrin, Maan Awad, Vikram Padala, Mohammed Saifuddin
Journal: Circulation (2024)

Background: Calcified left main disease is a high-risk and procedurally complex subset of coronary artery disease. So, adequate lesion preparation before stenting is crucial in achieving a favorable outcome. We performed a meta-analysis to compare the safety of intravascular lithotripsy (IVL) and rotational atherectomy (RA) in preparation of calcified left main coronary artery disease. Hypothesis: We hypothesize that there are no significant differences in angiographic and in-hospital outcomes between RA and IVL while treating calcified left main coronary disease. Methods: We systematically searched PubMed, Embase, and Cochrane databases until May 2024 for studies comparing IVL and RA in calcified left main coronary disease. A random-effects model was used to pool risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical analyses were performed using software R and heterogeneity was assessed using I 2 statistics. Results: We included 3 studies comprising 276 patients undergoing PCI for calcified left main disease, of whom 109 (39.5%) underwent lesion preparation with IVL. The mean age was 72.9 years and 73.1% were males. In the pooled analysis, there were no significant differences between the IVL and RA treated groups in terms of in-hospital mortality (RR 0.30; 95% CI 0.08 to 1.13, p=0.07, I 2 =0%; Figure 1A) and in-hospital myocardial infarction (RR 0.85; 95% CI 0.17 to 4.11, p=0.83, I 2 =0%; Figure 1B). There was also no significant difference in angiographic outcomes such as coronary perforation (RR 0.56; 95% CI 0.15 to 2.04; p=0.37, I 2 =0%; Figure 2A) and slow-flow/no-reflow (RR 1.43; 95% CI 0.22 to 9.51; p=0.70, I 2 =0%; Figure 2B). Conclusion: This meta-analysis showed that both IVL and RA were comparable in terms of in-hospital and angiographic outcomes while treating calcified left main coronary disease.
Abstract 4146850: Expectant Management versus Ibuprofen Treatment for Preterm Infants with PDA: A Meta-Analysis of Randomized Controlled Trials
Authors: Meghna Joseph, Mrinal Murali Krishna, Chidubem Ezenna, Shelby Kutty
Journal: Circulation (2024)

Introduction: Ibuprofen is used to induce closure of patent ductus arteriosus (PDA) in preterm infants due to its fewer side effects compared to other nonsteroidal anti-inflammatory drugs. However, ibuprofen treatment has not improved survival or decreased morbidity in this population. Objective: To compare expectant management vs. ibuprofen treatment in preterm infants with PDA. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing expectant management versus treatment with ibuprofen in preterm infants with PDA. Outcomes of interest included all-cause mortality, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), sepsis, surgical or transcatheter PDA ligation, cystic periventricular leukomalacia (CPL), pulmonary hemorrhage, impaired renal function, composite outcome of BPD or death, duration of ventilator support and duration of supplemental oxygen therapy. Random effects models were used to generate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I 2 statistics. Analysis followed the PRISMA guideline. Results: The meta-analysis consisted of 5 randomized controlled trials including 1,536 infants. All-cause mortality, BPD, NEC, IVH, ROP, sepsis, PDA ligation, pulmonary hemorrhage, composite of BPD or death, duration of ventilator support and duration of supplemental oxygen therapy did not show any significant differences between the groups. CPL (RR 0.50; 95%CI 0.27-0.92; p=0.02) and impaired renal function (RR 0.64; 95%CI 0.51-0.81; p&lt;0.001) were significantly lower with expectant management. Conclusion: In preterm infants with PDA, expectant management did not show any difference in all-cause mortality and adverse clinical outcomes compared with ibuprofen treatment. However, there was a lower risk of CPL and impaired renal function with expectant management.
Abstract Sa1203: Application of a Centralized Media-Based Strategy for Exception from Informed Consent Community Consultation and Public Disclosure in the Pediatric Prehospital Airway Resuscitation Trial
Authors: Henry Wang, Shannon Stephens, Kammy Jacobsen, Brittany Brown, CARA ELSHOLZ, Jennifer Frey, John VanBuren, Marianne Gausche-Hill, Manish Shah, Nichole Bosson, Julie Leonard, Caleb Ward, Daniel Nishijima, Kathleen Adelgais, Katherine Remick, Joshua Gaither, Riccardo Colella, Doug Swanson, Sara Goldkind, Matthew Hansen
Journal: Circulation (2024)

Background: In the United States, enrollment in clinical trials that involve emergency care may require compliance with federal regulations for Exception from Informed Consent (EFIC), including Community Consultation and Public Disclosure (CCPD). The most effective methods for CCPD in studies of emergency care in children are not known. Aim: To describe the results of a centralized media-based CCPD outreach effort for the Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART), a multicenter trial testing paramedic airway management strategies in critically ill and injured children. Methods: During a three-month window, across 10 participating US communities, we deployed social media (SM - Facebook and Instagram) advertisements of the study, targeting users within Emergency Medical Services service regions and zip codes with high anticipated need for pediatric airway management. The SM advertisements hyperlinked to study websites and surveys. We also solicited survey completion using a marketing research platform (Qualtrics Marketing Research Services), targeting the same communities. We determined the extent of SM exposure (impressions), interactions (shares, reactions, saves, comments, likes and clicks), and referrals to study website. For each site, we determined the number of completed surveys and the time required to achieve 200 surveys as required by the Institutional Review Board. We determined the demographics of survey respondents and the percentage with supportive responses. Results: The SM campaign resulted in 23.3M advertisement impressions (range 1.8-2.7M per site) reaching 3.4M unique users (range 239,494-439,360 per site), 13,873 engagements (range 828-1,656 per site) and 10,154 click-throughs to the study website (range 760-1,589 per site). There were 6,771 completed community surveys (range 531-914 per site). Across the sites, time to 200 completed surveys ranged from 5-28 days. Survey respondents were: 54.1% &lt;45 years old, 61.9% female, 27.0% minority race, 14.2% Hispanic ethnicity, and 40.8% household income &lt;$50,000. A total of 6,144 (90.7%; range 88.6-92.6% per site) survey respondents supported trial deployment in their communities. Conclusions: In Pedi-PART a centralized media-based outreach campaign efficiently reached and engaged a vast and diverse population, and yielded key community feedback. This strategy illustrates one robust approach to facilitate CCPD in pediatric emergency care trials.
Abstract 4147530: Artificial Intelligence Predicted Age using the Electrocardiogram Predicts Mortality in Adults with Congenital Heart Disease.
Authors: Scott Anjewierden, Malini Madhavan, Zachi Attia, Francisco Lopez-Jimenez, Paul Friedman, Alexander Egbe, Heidi Connolly, Samuel Asirvatham, Luke Burchill
Journal: Circulation (2024)

Background: Artificial intelligence (AI) can be used to predict a person’s age from the electrocardiogram (ECG) (AI-ECG age) and has been proposed as a measurement of biological age. The difference between AI-ECG age and chronological age (defined as delta-age) is an independent predictor of mortality in the general population. This study assessed the relationship between AI ECG estimated age and mortality among adults living with congenital heart disease (CHD). Methods: A previously validated neural network to estimate AI-ECG age was used to analyze standard digital 12-lead ECGs in a cohort of subjects aged &gt;18 years seen in the adult CHD (ACHD) clinic between 1992 to 2023. A single ECG, collected during the year of the first visit to the ACHD clinic was analyzed to compute the delta-age.. A positive delta-age indicates an AI ECG estimated age higher than the subject’s chronological age. The relationship between the delta-age and mortality was evaluated using Cox proportional hazard models adjusting for influential clinical factors including chronologic age, sex, ACHD severity, NYHA class and history of arrhythmia. Results: Of 5,780 subjects tested (50% females), the mean chronological age was 39.1 ± 15.0 years. AI ECG estimated age was 52.3 ± 16.6 years. Complexity of CHD was classified as mild, moderate, and severe in 7.4%, 73.9% and 18.7% of patients respectively. Patients with severe CHD had the highest delta-age of 17.1 (±18.2) years followed by moderate 12.7 (±13.6) y and simple 7.7 (±11.5) y. Patients with single ventricle had the highest deviation in AI estimated age [median delta-age 21.0 (IQR 28.6) y] followed by those with a systemic right ventricle [median delta-age of 16.3 (IQR 29.3) y]. During a median follow-up of 6.4 y (25th – 75th centile 1.58 – 13.7 y), mortality occurred in 839 (14.5%) patients. After adjusting for chronological age, CHD severity, and other clinical variables, delta-age gap was associated with increased mortality risk (HR 1.06 (1.03 – 1.09) per 5-year increment in delta-age, p&lt;0.005), Table 1. Conclusion: The difference between AI ECG and chronological age is an independent predictor of all-cause mortality in ACHD patients.
Abstract 4147468: Using Structured Queries versus Retrieval Augmented Generation Enabled GPT-4 to Phenotype Atherosclerotic Cardiovascular Disease
Authors: Ozan Unlu, Jiyeon Shin, David Zelle, Kavishwar Wagholikar, Shahzad Hassan, Lee-Shing Chang, Caitlin Colling, Dan Gabovitch, Michael Oates, Matthew Varugheese, Fei Wang, Charlotte Mailly, Benjamin Scirica, Samuel Aronson, Alexander Blood
Journal: Circulation (2024)

Background: Using Electronic Health Record (EHR) data to accurately phenotype patients for atherosclerotic cardiovascular disease (ASCVD) is crucial for clinical decision-making and research. Traditional methods using structured queries often lack specificity or sensitivity. We developed RECTIFIER, an AI-based clinical phenotyping tool. This study compares the performance metrics of structured queries against RECTIFIER in determining types of ASCVD. Methods: We conducted an analysis using EHR to compare the performance of structured queries with RECTIFIER for identifying various ASCVD types. The dataset included 998 patients with diabetes. Structured queries identified ASCVD types using ICD, CPT, and HCPCS codes, while RECTIFIER analyzed unstructured clinical notes within the previous year to identify the same components. Three expert clinicians adjudicated each ASCVD component by reviewing patients’ charts. Performance metrics, including sensitivity, specificity, and accuracy, were calculated for both methods. Results: Structured queries demonstrated similar or lower sensitivity in identifying ASCVD types compared to RECTIFIER (Figure). The sensitivity of structured queries to determine any ASCVD was significantly lower than that of RECTIFIER (Structured: 67.8%, RECTIFIER: 87.3%). Conversely, structured queries exhibited similar specificity with RECTIFIER except for greater performance in PCI and coronary revascularization which showed small but statistically significant differences (Structured: 100% and 95.1%, RECTIFIER: 98.1% and 90.1%, respectively). Conclusion: The higher sensitivity of RECTIFIER in identifying ASCVD components suggests its potential for improving patient phenotyping. However, the greater specificity of structured queries underscores its utility in specific procedural identification. An integrated approach, using RECTIFIER for general phenotyping and structured queries for procedure-specific components, may enhance the accuracy and efficiency of ASCVD identification. Future studies should explore optimized prompting strategies to further refine structured queries' performance and validate these findings in larger, diverse populations.