tbuckley/cabot-search huggingface dataset:
Abstract 18204: Application of Machine Learning in Predicting All-Cause Mortality in Patients With Left Ventricular Assist Device
Authors: Vien T Truong, Binh Nguyen, Alex Xing X Wang, Phan Dai, Vivek Patel, Mansoor Ahmad, Muhammad Saad Siddique, Syed Muhammad Usama, Avilash Mondal, Kevin Quach, Durgesh Agrawal, Syed Fahad Shah, Sonela Skenderi, Thomas Metkus, Sunil Dhar, Eugene Chung
Journal: Circulation (2023)

Introduction: Machine learning has been demonstrated to significantly enhance the accuracy of cardiovascular risk prediction across various cardiac diseases. Hypothesis: This study sought to develop a machine learning (ML) framework to predict all-cause mortality in patients with left ventricular assist device (LVAD). Methods: All patients in INTERMACS registry who received an LVAD from June 2006 to December 2017 were screened. The Light Gradient Boosting Machine (LightGBM) algorithm was used to train an ML model for predicting all-cause mortality. Nested ten-fold cross-validation was performed to optimize the model and estimate its performance on unseen data. Model performance was assessed using the receiver operating characteristics (ROC) curves. Results: The final study group consisted of 22,137 patients, with a mean age of 56±13 years, and 21.3% being female. After a median follow-up of 12.4 months (IQR, 4.7 - 27.1 months). The overall all-cause mortality was reported in 7228 patients (32.7%). The proposed LightGBM-based framework had good performance with an area under the receiver operating characteristic curve (AUC-ROC) of 0.74 ± 0.05 on average over the 10 trials. Furthermore, when stratified by gender, the LightGBM-based framework had good performance (AUC-ROC of 0.73 for males and AUC-ROC of 0.70 for females). Conclusions: A ML model using LightGBM can predict all-cause mortality in LVAD patients with good performance.
Abstract 17997: Contemporary Trends in Coronary Artery Anomalies
Authors: Samuel Tan, Wenchy Siu, Shasawat Kumar, Paulus Adinugraha
Journal: Circulation (2023)

Introduction: Coronary artery anomalies (CAA) are a group of congenital conditions whose prognostic significance is still widely debated. In part, this is due to the limited data on CAA, given its general incidental nature. Data on age, gender, and ethnic disparities is even more scarce. Hypothesis: There is an increase in prevalence of CAA over time with unchanged difference in mortality. Methods: The National Inpatient Sample (NIS) database was queried between 2016-2019 to identify hospitalizations with CAA. The primary outcome was in-hospital mortality. Secondary outcomes included type of hospital, region, age, and complications. Linear regression and Chi-squared were used for analysis. Results: Our study identified 7,821 patients diagnosed with CAA. There was a significant increase in the prevalence of CAA from 1,961 in 2016 to 2,127 in 2019 (p&lt;0.001). However, no significant difference in mortality rate (1.89% to 2.05%) in this time period was identified. The average age of the population diagnosed with CAA was 50.4 years, which was not significantly different between the study time periods. Comparing races, 62.35% of those with coronary anomalies were white, 17.54% were African American, 12.1% were Hispanic, and 3.11% were Asians or Pacific Islanders. Of note, 4.14% of those with CAA were diagnosed in a rural hospital, 14.68% in an urban non-teaching hospital, and 81.18% in a teaching hospital. This is a significant difference compared to the percentage composition of each hospital within the database. Conclusions: With recent advances in imaging technology, CAA has been detected at earlier stages, allowing for early intervention. However, our study suggests that CAA may still be under diagnosed, given that most were diagnosed at resource heavy teaching hospitals. In addition, the number of minorities diagnosed with CAA increased during the study period, suggesting disparities that exist and will continue to be addressed as access to modern medicine improves. Despite having a low mortality rate, the mortality rate did not improve over the study period. This highlights the need for further studies to identify challenges in diagnosis and management of CAA, especially regarding ethnic and racial disparities.
Abstract 16411: Patent Foramen Ovale Combined With Solitary Pulmonary Arteriovenous Malformation
Authors: Manasa Dondapati, Chad Gier, Sayedatun Nessa, Nicholas Koroneos, Kamil Stefanowski, Daniel Ohngemach, Puja Parikh
Journal: Circulation (2023)

Introduction: A transthoracic echocardiogram (TTE) with bubble study is standard during evaluation of patients presenting with cryptogenic stroke to evaluate for the presence of a patent foramen ovale (PFO). However, other uncommon conditions, such as solitary pulmonary arteriovenous malformations (sPAVM), can also present with stroke and abnormal bubble study. We examine a case of a woman who presented with an acute ischemic stroke and was found to have both a PFO and sPAVM. Case: A 64-year-old woman with hypertension presented with acute onset facial droop, left arm paresis, and aphasia. A computed tomography (CT) scan of her head did not show an intracerebral hemorrhage or large vessel occlusion. However, magnetic resonance imaging showed acute infarction of the right thalamus. During initial work up, a chest x-ray was also obtained and there was concern for possible pulmonary malignancy. A subsequent contrast-enhanced CT of her chest revealed a right lower lobe PAVM. A TTE with bubble study showed bubbles in the left atrium, which was attributed to PAVM. Interventional radiology was consulted, and the patient underwent PAVM embolization. TTE was repeated and continued to show bubbles in the left atrium. Transesophageal echocardiogram (TEE) revealed an atrial septal aneurysm with PFO. After interdisciplinary discussion and shared decision making, she eventually underwent successful transcatheter PFO closure with an Amplatzer PFO occluder. Genetic testing for hereditary hemorrhagic telangiectasia was negative. Discussion: This case highlights the importance of evaluating for less common causes of stroke such as sPAVMs and multidisciplinary approach to complex cases. The American Heart/Stroke Associations recommend PFO closure for patients presenting with ischemic stroke and no other identifiable cause. However, there is not clear guidance on the management of patients who present with stroke and have both PFO and PAVMs. Although PFOs are commonly ruled out with TTE/TEE and bubble study, there may be utility in also ruling out PAVMs as they are an important and reversible cause of paradoxical emboli. Further studies should the evaluate the management of patients with both PAVM and PFO with a focus on the optimal strategy for sequence of closure.
Abstract 18004: Impact of a Urine Sodium Guided Treatment Protocol on Acute Heart Failure Length of Stay: A Single Center Quality Improvement Study
Authors: Ross A Okazaki, Karishma Pareek, Kyle Jones, Deepa M Gopal
Journal: Circulation (2023)

Introduction: Inpatient management of acute decompensated heart failure (ADHF) is associated with high costs and in-hospital complications. Traditional methods of assessing response to loop diuretics for ADHF is prone to inaccuracies that may contribute to costs and complications. More objective evidence-based methods of treating ADHF are needed to improve outcomes for these patients. Hypothesis: We hypothesize a treatment algorithm using Una as an objective marker of response to loop diuretics can decrease hospital length of stay (LOS) for patients with ADHF. Methods: This quality improvement study took place at a single urban academic center. 3 plan do study act (PDSA) cycles were performed to study the impact of the intervention on key quality metrics. The first two PDSA cycles took place on two medical teams over the course of two weeks each. The third PDSA cycle took place on all medical teams over the course of 5 months. Median hospital LOS, rates of readmission and acute kidney injury (AKI), and protocol use rates were calculated. Results: An average of 78 patients per month were admitted with ADHF. Protocol implementation rate was 58%. Patients in the first two PDSA cycles with ADHF who were managed with the UNa protocol on average had lower hospital LOS by 1 day and similar rates of acute kidney injury (AKI). Patients in the third PDSA cycle, however, did not experience any change in hospital LOS or AKI. Readmission rates were stable across all PDSA cycles. Conclusions: Protocoling the implementation of spot uNa to diuretic management in a large academic hospital required extensive multi-disciplinary coordination. While there was no observable impact on key quality metrics, maintaining high levels of protocol adherence remains a challenge. The impact of acute and chronic kidney injury on Una-protocol performance should be evaluated. Finally, the efficacy of a Una-based treatment approach across diverse patient demographics must be better understood.
Abstract 15069: Perceived Susceptibility to and Severity of Cardiovascular Disease is Associated With Intent to Change Behavior Among Women 25-55 Years Old
Authors: Lauren Rountree, Yoshimi Fukuoka, Kenji Sagae, Jingwen Zhang, Nancy A Pike, Mary-Lynn Brecht, Mary Rezk-Hanna, Holli A Devon
Journal: Circulation (2023)

Background: Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased while knowledge and awareness of CVD remain low. To reverse these trends, it is important to assess whether knowledge and awareness of CVD are associated with intent to change behavior. Aims: Describe the relationship between stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify the predictors of stage of behavior change. Methods: A cross-sectional, descriptive study of women ages 25-55 living in the United States without a self-reported CVD history was conducted. Participants were recruited through flyers and social media campaigns. Awareness was measured with the question, “What is the leading cause of death for women in the United States?” Knowledge, perceptions, and stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and the Precaution Adoption Process Model surveys, respectively. All data were collected online via REDCap. Results: A total of 149, primarily minority women, were included (mean=37.15±7.86 years). Over half (53.7%) of the sample had not decided to make changes in their behavior to reduce their likelihood of CVD. A binary logistic regression of stage of behavior change on awareness, knowledge, and perceptions of CVD showed that the perception subscales of susceptibility and severity were significantly associated with intent to change behavior (OR 1.247, p&lt;0.001 and OR .809, p=.004 respectively). Awareness and knowledge of CVD were not associated with stage of behavior change. There were no significant sociodemographic and health condition predictors of stage of behavior change, although susceptibility and severity remained significant when controlling for these covariates (OR 1.242, p=.002 and OR=.801, p=.004, respectively). Conclusions: Young and middle-aged women who believed that they were susceptible to CVD and did not perceive CVD as a serious condition were more likely to report an intent to change their behavior to reduce their risk of CVD. These may be key factors to leverage when educating young and middle-aged women on heart disease in order to facilitate heart healthy behaviors.
Abstract 18294: The Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Basel Abdelazeem, Youssef Soliman, Amith Reddy R Seri, Abdelrahman Mahmoud, Shafaqat Ali, Mohamed T Abuelazm
Journal: Circulation (2023)

Introduction: The effect of intensive blood pressure (BP) lowering on cardiac remodeling remains uncertain, with emerging evidence suggesting that it can prevent the development of left ventricular hypertrophy (LVH) in patients with hypertension (HTN). We aim to investigate the effect of intensive BP lowering on LVH and cardiovascular disease (CVD) incidence in HTN patients. Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through June 8 th , 2023. We used the random-effect model to pool dichotomous data using risk ratio (RR) and hazard ratio (HR), with a 95% confidence interval (CI). Trial sequential analysis (TSA) was performed to weigh type I and II errors, estimating if the effect is large enough to be unaffected by further studies. Results: We included four RCTs with a total of 20,747 patients. Two RCTs investigated an intensive target of &lt; 120 mmHg, and another two investigated &lt;130 mmHg. Intensive BP lowering was associated with a decreased risk of LVH incidence (RR: 0.66, with 95% CI [0.56 - 0.77]). Our TSA revealed that the cumulative Z-curve consistently crossed the TSA boundary, indicating a statistically significant effect, signifying that the available evidence has reached a predefined threshold for statistical significance, providing robust evidence. Also, intensive BP lowering was associated with a decreased risk of CVD (HR: 0.71, with 95% CI [0.60 - 0.85]). Conclusion: Intensive BP lowering protects against LVH in HTN patients. TSA suggests that additional RCTs may not be necessary to establish the efficacy of intensive BP lowering on LVH. Also, intensive BP lowering was associated with decreased CVD incidence; however, LVH did not explain this effect in the included RCTs. Therefore, further research is warranted to explore possible mechanisms of decreasing CVD with intensive BP lowering in HTN patients.
Abstract 14947: Opportunities to Address Specialty Care Deserts and the Digital Divide: VA’s Virtual Hub-and-Spoke Cardiology Clinic
Authors: Rebecca L Tisdale, Colin Purmal, Neil M Kalwani, Alexander T Sandhu, Paul A Heidenreich, DONNA ZULMAN, Tanvir Hussain
Journal: Circulation (2023)

Introduction: Access to specialty care, including cardiology, in the Veterans Health Administration (VA) varies widely across geographic regions. VA’s clinical resource hub (CRH) model of care offers mostly-virtual specialty care to individuals in low access regions and has recently been implemented in cardiology. Research Question: How does implementation of a predominantly virtual care cardiology program through CRH affect the reach of cardiology specialty care in the VA? Aims: Describe the association between patient characteristics and use of CRH cardiology care in VA’s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services between 7/15/2021 and 3/31/2023 to non-CRH Sierra Pacific cardiology patients, then used multivariate logistic regression to estimate the association between patient-level factors and odds of being a CRH user. Results: There were 798 CRH users over the study period with a total of 3,662 cardiology encounters, 1,690 of which were CRH encounters. Of these, 8% of CRH users were women and 41% were ≥75 years, compared to 4% and 48% respectively among non-CRH users [n=25,412 with 95,663 encounters]. Similar proportions in both groups were rural (26% CRH, 25% non-CRH), highly-disabled (48% CRH, 47% non-CRH), and low-income (20% in both groups). In multivariate logistic models, adjusted odds of using CRH were higher for women (adjusted odds ratio [AOR] 1.45 [95% CI 1.09-1.92]) and lower for older Veterans (AOR 0.44 for ≥75 [95% CI 0.0.32-0.61]). Conclusions: The Sierra Pacific CRH cardiology program served a disproportionately high number of women and similar proportions of rural, highly-disabled, and low-income Veterans in its first two years of operation. This predominately-virtual model of cardiology care may be an effective strategy for overcoming access barriers for certain individuals, though targeted efforts may be required to reach older Veterans.
Abstract 18286: Histone Acetyltransferase P300/CBP in Pulmonary Arterial Hypertension and Associated Right Ventricular Failure
Authors: Alice Bourgeois, Sarah-Eve Lemay, Yann Grobs, Charlotte Romanet, Charlie Theberge, Melanie Sauvaget, Sandra Martineau, Sandra Breuils Bonnet, Francois Potus, Steeve Provencher, Olivier Boucherat, Sebastien Bonnet
Journal: Circulation (2023)

INTRODUCTION Pulmonary arterial hypertension (PAH) is defined by increased pulmonary artery (PA) pressure and vascular remodeling, partly due to excessive proliferation and survival of PA smooth muscle cells (PASMCs). Initially, RV hypertrophy allows adaptation to increased resistance, but as the disease progresses, maladaptive remodeling takes place, leading to RV failure and death. Current therapies aim to promote vasodilatation, but none of them directly targets pathological lungs or RV remodeling. The histone acetyltransferases P300/CBP have been identified as central players driving gene expression in various cellular processes such as proliferation/apoptosis and hypertrophy/fibrosis, all of which are critical features of pathological lung and RV remodeling in PAH. Given their role in controlling gene transcription programs, we hypothesized that P300/CBP contributes to maladaptive remodeling. METHODS &amp; RESULTS We show by western blot (WB) and immunofluorescence (IF) increased P300 expression in isolated PASMCs and distal PAs from PAH patients compared to controls (p&lt;0.01) as well as in monocrotaline (MCT) and sugen-hypoxia rat models (p&lt;0.05). Similar results are observed in remodeled RV from PAH patients, MCT- and pulmonary artery banding-subjected rats (WB). In vitro, P300/CBP inhibition (CCS-1477 or siRNA) reduces H3K27 acetylation (WB, p&lt;0.05) in PAH-PASMCs and RV fibroblasts (RVFbs). This effect is accompanied by a decrease in PAH-PASMC proliferation and resistance to apoptosis [WB (PCNA, PLK1, Survivin), IF (Ki67, AnexinV), p&lt;0.01]. Similarly, P300/CBP inhibition reduces proliferation (WB, PCNA, Survivin) and activation/extracellular matrix production (WB, pSMAD2/3, aSMA, Fn, Col1, MMP2) in RVFbs. In addition, P300/CBP inhibition prevents phenylephrine-induced hypertrophy in H9C2 cells and adult rat cardiomyocytes (IF, p&lt;0.05). In vivo, administration of CCS-1477 reduces pulmonary vascular remodeling (Elastica Van Gieson, p&lt;0.05), improves pulmonary hemodynamics (p&lt;0.01) and attenuates RV fibrosis (Masson’s Trichrome, p&lt;0.05) in MCT rats with established PAH. Conclusion: We provide evidence that targeting P300/CBP may represent a promising avenue to tackle both lung and RV maladaptive remodeling in PAH.
Abstract 16751: Novel Psoriasis Agents Associated Cardiotoxicity: Analysis of FAERS
Authors: Rahul Vyas, Zaki Al-Yafeai, Manush Sondhi, Kavya Vadlamudi
Journal: Circulation (2023)

Introduction: Psoriasis is a chronic skin condition characterised by hyper-proliferation of epidermal keratinocytes, resulting in erythematous and scaling lesions. The US Food and Drug Administration (FDA) has approved nine biological agents to address the burden of psoriasis, but their cardiovascular risks remain poorly studied. Methods: This retrospective pharmacovigilance study utilised the FDA Adverse Event Reporting System database to analyse adverse events associated with newly approved therapeutic agents for psoriasis. We employed disproportionally signal analysis, calculating the reporting odds ratio (ROR) with a 95% confidence interval. Results: Among the vast FAERS database, which contained more than 25 million adverse events, a total of 334,399 events were associated with newly approved therapeutic agents for psoriasis. Cardiac adverse events accounted for 3,852 cases, including pericarditis, atrial fibrillation, and coronary artery disease. Secukinumab had the highest number of reported adverse events, followed by brodalumab, while tildrakizumab had the lowest. Coronary artery disease was the most reported adverse event (1,438 cases), followed by pericarditis (572 cases) and atrial fibrillation (384 cases). Secukinumab had the highest incidence of coronary artery disease, pericarditis, and atrial fibrillation. Risankizumab showed a significant association with an increased risk of coronary artery disease and atrial fibrillation, while tildrakizumab and Ixekizumab were associated with atrial fibrillation. Secukinumab was associated with an elevated risk of pericarditis. Conclusions: The study uncovers unknown cardiovascular adverse effects related to biologic agents used in psoriasis treatment. These findings emphasise the importance of monitoring and evaluating the cardiovascular safety profiles of biologic agents used in psoriasis treatment.
Abstract 18241: Computational Fluid Dynamics (CFD) Exploration of Heart Rate Influence on Wall Shear Stress (WSS) in Coarctation of the Aorta(CoA): Implications for Beta-Blocker Therapy
Authors: Jie Wang
Journal: Circulation (2023)

Introduction: CoA's complex hemodynamics may lead to post-repair complications such as pseudoaneurysms. Understanding the effects of beta-blockers, successful in adult heart failure and potentially beneficial for children, is critical. We used a high-resolution image-based CFD model to study these effects on aortic WSS and turbulence in CoA patients. Hypothesis: Beta-blocker therapy may favorably influence hemodynamic turbulence stresses. Methods: Patient-specific CT scans informed 3D CoA aorta models. Large eddy simulations were conducted at neonatal heart rates of 100, 120, and 160 bpm. Aortic segments were divided into front and back regions based on jet flow impact. Results: Despite heart rate-induced turbulence, WSS distributions remained consistent across rates. Lower rates notably decreased maximal systolic WSS distal to the coarctation site but reduced localized WSS and its variability (6.49 +/- 3.29Pa) . Both front and back segments showed unique WSS patterns and peak systolic WSS increases with heart rate (0.1Pa per 10BPM &amp; 0.07Pa/ per 10BPM, P&gt;0.05) . Significantly higher stress was experienced by the front region (max: 95.2%, min: 70.4%) . Conclusions: Heart rate changes impact WSS values, indicating heart rate-lowering drugs like beta-blockers may alleviate hemodynamic stress. Despite overall lower WSS, the front region is more susceptible to shear stress at lower rates. This could guide beta-blocker therapy decisions and identify potential beneficiaries.