tbuckley/cabot-search huggingface dataset:
Abstract 14344: Pitfalls of ICD-10 Codes for Identifying Pulmonary Embolism in Electronic Records: Results From the Multicenter PE-EHR+ Study
Authors: Behnood Bikdeli, Antoine Bejjani, Candrika D Khairani, Ying-Chih Lo, David Jimenez, Stefano Barco, Shiwani Mahajan, Cesar Caraballo, Eric A Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, HAMID MOJIBIAN, Yuan Lu, Zhenqiu Lin, Sanjay Aneja, Rohan Khera, Samuel Goldhaber, Li Zhou, Manuel Monreal, Gregory Piazza, Harlan M Krumholz
Journal: Circulation (2023)

Background: Many research studies from electronic databases and even the American Heart Association annual statistics for pulmonary embolism (PE) rely on the International Classification of Disease, 10 th modification (ICD-10) codes. However, the validity of ICD-10 codes for PE remains uncertain. Methods: Using a pre-specified protocol, we identified three groups of patients in the Mass General-Brigham Health system hospitals (MGB, 2016-2021) in equal distribution: Those with ICD-10 Principal discharge codes for PE, those with ICD-10 secondary codes for PE, and those without codes for PE (N=578 each). The accuracy of ICD-10 codes for identification of PE was assessed in reference to review of each chart by two independent physicians who used pre-specified criteria for presence of PE. Weighted estimates were obtained by considering the total of number of hospitalizations at MGB in each group. Results: After excluding duplicates, 1712 entered the analysis (age: 60.6 years, 52.3% female). Using the ICD-10 PEs only in the Principal discharge diagnosis, sensitivity and specificity were 60.3% and 94.6%, respectively. Although use of Principal-or-secondary ICD-10 PE codes had a sensitivity of 99.8% in the study sample, the weighted sensitivity in the parent cohort was reduced to 83.2%. The positive predictive value of Principal ICD-10 discharge codes and Principal-or-secondary ICD-10 codes were 91.9% and 79.2%, respectively (Table). Conclusions: Although the Principal discharge diagnosis codes for PE have an excellent positive predictive value, they miss nearly 40% of new PE events in hospitalized patients. Integration of secondary discharge codes only partially improves the sensitivity at the cost of reducing the positive predictive value, highlighting the need for modified strategies, such as use combination with procedure codes, or use of natural language processing -when feasible -for identification of patients with PE.
Abstract 17479: Angiographic Factors Influencing Treatment Decisions in Pediatric Brain Arteriovenous Malformation (pAVM): Insights From Cart Analysis
Authors: Miguel Tusa Lavieri, Maria Paula Aguilera-Pena, Miguel D Quintero Consuegra, Benson Joseph, Daniel Chang, Peyton Nisson, Moise Danielpour, Nestor R Gonzalez
Journal: Circulation (2023)

Introduction: Pediatric cerebral AVM (pAVM) are the most common cause of hemorrhagic stroke in children. Their optimal management approach remains controversial. Determining the angiographic factors that impact outcomes for the various treatment strategies is crucial. Hypothesis: To identify angiographic factors for modality-treatment decision-making Methods: Cross-sectional study of patients diagnosed with pAVM at a pediatric stroke center between 2016 and 2021. Patients’ demographics, angiographic characteristics (volume, location, nidal aneurysms, non-plexiform rapid fistulas, venous drainage, and nidus diffuseness), treatment, and clinical outcomes were collected. Classification and Regression Tree Analysis (CART) was used to identify impactful angiographic factors, multivariate regression was applied to evaluate their significance in treatment decision-making. Results: Thirty-seven consecutive patients were included, 25 were male, with a median age of 10.3 years (IQR 7.9-13.3). Median follow-up was 30.3 months (IQR 8.6-53.8). Twenty patients presented with a ruptured pAVM. Endovascular embolization was the most common treatment (19, 51.4%), followed by radiosurgery (14, 37.8%), and observation (8, 21.6%). Twenty-seven patients (81.8%) had improved or stable functional neurologic status at last follow-up, and six (18.2%) declined (none of them by more than one point on the mRS). Only one patient had post-treatment hemorrhage during follow-up.The angiographic features associated with specific treatments were: the presence of non-plexiform rapid fistulas (endovascular in 94.0% of patients p=0.01), basal ganglia or pons location (excluded from endovascular in 86% of patients p=0.30), absence of a nidal aneurysm (radiation in 98% p=0.03). CART did not identify other potentially impactful angiographic factors. Conclusions: Our study shows generally favorable outcomes and low complication rates in pAVM patients who underwent multimodal treatment. The presence of non-plexiform rapid fistulas and nidal aneurysms should be considered when determining the appropriate treatment approach. Further prospective confirmatory analyses are warranted.
Abstract 12756: The Interplay of Self-Care Maintenance, Social Support, Depressive Symptoms and Anxiety in Predicting Quality of Life in Patients With Heart Failure
Authors: Ashmita Thapa, JungHee Kang, Misook L Chung, Jia Rong Wu, Martha J Biddle, Debra K Moser
Journal: Circulation (2023)

Introduction: Depressive symptoms, anxiety, and inadequate social support are predictors of quality of life (QOL) in patients with heart failure (HF), but prediction of QOL is multifaceted and mechanisms underlying association are unknown. Essential to better HF outcomes, self-care maintenance (SCM) may moderate associations among these predictors. The interplay among depressive symptoms, anxiety, social support, and SCM and their influence on QOL remains uncertain. Purpose: To determine whether (1) depressive symptoms and anxiety mediate the association of social support with QOL, and (2) SCM moderates the relationship of social support with depressive symptoms, anxiety, and QOL. Methods: We included 167 patients (61 ± 12 years old, 65% male, 47% NYHA III/IV) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, Brief Symptom Inventory for anxiety, Multidimensional Scale of Perceived Social Support for social support, Self-Care of Heart Failure Index for SCM, and Minnesota Living with Heart Failure Questionnaire for QOL. A moderated mediation model was performed using PROCESS macro. Results: We found an indirect association of social support with QOL, mediated by depressive symptoms and anxiety (Figure). The beneficial impact of social support on depressive symptoms and anxiety varied with SCM, suggesting a dose-response moderation effect, which is attenuated at lower SCM scores (Figure). The indices of moderated mediation via depressive symptoms and anxiety were -.007 (95%CI: -.150, -.002) and -.005 (95%CI: -.010, -.002), respectively. There was no direct nor moderated direct effect. Conclusions: There is a pivotal interplay of SCM, depressive symptoms, anxiety, social support, and QOL in HF. Findings suggest that improvement in depressive symptoms and anxiety may improve QOL in HF. Moreover, good SCM may enhance the positive effect of social support on depressive symptoms and anxiety.
Abstract 14793: Relationship Between Self-Rated Health and Clinical Outcomes in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Richard Kazibwe, Muhammad Ahmad, Parag A Chevli, Juliana H Namutebi, Joseph Kazibwe, Isabella Epiu, Michael D Shapiro, Joseph Yeboah
Journal: Circulation (2023)

Background: Self-rated health (SRH) is a well-known independent predictor of mortality. However, the association of SRH with clinical outcomes in patients with hypertension remains uncertain. SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Objective: To examine the association between SRH and the primary SPRINT outcome, which was defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death. Methods: A trained study personnel administered a questionnaire to assess SRH. Each participant rated their overall health as excellent, very good, good, fair, or poor (E, VG, G, F, P). We categorized SRH into excellent, very good, good and fair/poor. Multivariate Cox regression was used to examine the association of SRH and clinical outcomes in SPRINT. Results: We included 9,319 participants (aged 67.9±9 years, 35.6% women, 57.6% White) who had available data on SRH. After a median follow-up of 3.8 years, 724 and 500 primary outcome and all-cause mortality events occurred, respectively. Relative to SRH of excellent, the risk of the primary outcome (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.11 (0.78-1.56; p=0.555), 1.45 (1.03-2.05; p=0.036) and 1.87 (1.28-2.75; p=0.001), respectively. Similarly, relative to excellent, the risk of all-cause mortality (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.13 (0.73-1.76; p=0.581), 1.72 (1.12-2.64; p=0.014) and 2.11 (1.32-3.38; p=0.002), respectively. Poorer SRH was also associated with a higher risk of each component of the primary outcome and adverse events ( Table). Conclusion: In the SPRINT cohort, SRH was independently associated with the risk of cardiovascular outcomes, mortality, and adverse events. Further studies are needed to explore the utility of incorporating SRH in the assessment of risk in patients with hypertension.
Abstract 17951: Infective Endocarditis of an Amplatzer PFO Occluder: A Rare and Devastating Complication
Authors: Salman Salehin, Shahzad Ahmad, Wissam Harmouch, Maha Yaqub, Claudine Abdou, Mostafa Shalaby, Amer Abdulla
Journal: Circulation (2023)

Introduction: Patent foramen ovale (PFO) closure is indicated for secondary prevention of ischemic strokes in select patients. PFO closure devices are rarely complicated by infective endocarditis (IE). We present the case of a patient with a closure device infected by Methicillin-sensitive Staphylococcus Aureus (MSSA). Case: A 60-year-old woman with a history of ischemic stroke status post transcatheter PFO closure with a 25 mm Amplatzer occluder eight months prior to presentation was admitted for a two week history of lower back pain, bilateral lower extremity weakness, and urinary incontinence. She denied dental procedures following device implantation. MRI of the spine revealed L3-L4 osteomyelitis with an adjacent epidural abscess which was immediately drained. Blood and intra-operative cultures revealed MSSA. There was no evidence of endocarditis on transthoracic echocardiogram (TTE). Given persistent bacteremia, a transesophageal echocardiogram (TEE) was performed, revealing large, highly mobile vegetations measuring up to 3 cm in length, attached to both the left and right atrial surfaces of the Amplatzer occluder. Urgent surgical removal of the Amplatzer occluder and PFO closure was performed. She received a 4-week course of Cefazolin. Discussion: Despite periprocedural antibiotics and prophylaxis for dental procedures for six months after implantation, IE of PFO occluders can rarely occur days to years after implantation. In patients with PFO occluders and persistent bacteremia or fevers, TEE is the diagnostic modality of choice as TTE are often negative. Management consists of urgent surgical excision and long-term antibiotics.
Abstract 101: Prehospital High-Dose Methylprednisolone Treatment Reduces Norepinephrine Need Following Resuscitated Out-of-Hospital Cardiac Arrest
Authors: Laust E Obling, Rasmus P Beske, Martin A Meyer, Johannes Grand, Fredrik Folke, Jacob E Møller, Jesper Kjaergaard, Christian Hassager
Journal: Circulation (2023)

Background: Resuscitated out-of-hospital cardiac arrest (OHCA) patients are hemodynamically unstable and have high mortality. Norepinephrine (NE) is recommended to maintain mean arterial pressure (MAP) above 65 mmHg, but excessive NE use, and a continuously low MAP are both associated with poor outcomes in OHCA. The glucocorticoid methylprednisolone (MP) has anti-inflammatory properties and may increase arterial sensitivity to NE, thereby improving MAP and reducing NE need. Aims: To determine if prehospital anti-inflammatory MP treatment could lower the need for NE without affecting MAP values following OHCA. Methods: The STEROHCA trial was a randomized, blinded, placebo-controlled, multicenter study, including adult comatose patients resuscitated from OHCA due to presumed cardiac etiology, and with a minimum of five minutes of return of spontaneous circulation. The intervention was intravenous MP 250 mg or placebo, administered prehospitally. In this sub-study, we repeatedly measured NE dose and MAP from admission until 48h and compared differences between the two groups at each time point. Results: In the STEROHCA trial, 137 patients were randomized to MP (n=68) or placebo (n=69). Patients were mainly male (85%) with a median age of 66 years (IQR 56, 75). The MP group demonstrated significantly lower NE use (mcg/kg/min) at 24h (0.22 (0.15; 0.31) vs. 0.38 (0.28; 0.49), p=0.02), 42h (0.13 (0.07; 0.20) vs. 0.25 (0.17; 0.35), p=0.03), and 48h (0.08 (0.03; 0.15) vs. 0.23 (0.15; 0.33), p=0.004), Figure 1 . We observed a higher MAP in the MP group with significantly higher MAP values (mmHg) at 6h (75 (72; 78) vs. 70 (67; 73), p=0.03), 12h (75 (71; 78) vs. 69 (66; 72), p=0.01), 18h (76 (73; 79) vs. 69 (66; 72), p=0.003), 24h (77 (74; 80) vs. 71 (68; 74), p=0.01), and 48h (86 (82; 89) vs. 79 (76; 82), p=0.004), Figure 1 . Conclusions: Prehospital treatment with high-dose MP reduced the need for NE while improving MAP values in resuscitated OHCA patients for the initial 48h of admission.
Abstract 14675: The Role of Biomechanics in Diagnosis and Evaluation of Coronary Artery Disease
Authors: Sahar Jalal, Lilia Soriano, Alexander Dornback, Navneet Narula, David Molony, Habib Samady, Fay Lin, Simon Dunham
Journal: Circulation (2023)

While there is a strong need to assess the safety and efficacy of novel therapies prior to evaluation in human patients, the ability to accurately model the complexities of coronary disease in-vitro and/or animal models is somewhat limited. Animal models, even those with genetic predispositions toward coronary disease do not exhibit high grade stenoses, similar to those that require treatment in human patients. At the same time, most in-vitro models and simulations of fluid-structure interactions cannot simultaneously capture the complex geometries, hemodynamics, and biomechanical response of human coronary disease. Here, we introduce a robust workflow to replicate an in-vitro platform incorporating compliant, realistic diseased coronary arteries in a flow loop under physiological conditions. Through ex-vivo imaging of cadaveric specimens, coupled with co-registered measurements of coronary biomechanics, we developed protocols that allow for fabrication and testing of highly realistic 3D printed models. The anatomical and biomechanical features of the coronary arteries, including local variations associated with the observed disease burdens were extracted and 3D printed, in high spatial resolution, using commercially available printers, making this methodology conveniently reproducible. Subsequently, the models were incorporated in a testing platform made of flow loops and valve resistance to mimic circulation and microvascular resistance respectively. Under physiological boundary conditions, we successfully collected measurements along the length of the vessels that exhibit a range of biomechanical characteristics from low to high values of modulus and assessed the impact of biomechanics on gold standard diagnostic and prognostic measures such as Fractional Flow Reserve. We demonstrated that incorporating the effects of local biomechanics significantly improves the predicted hemodynamics metrics with respect to ex-vivo coronaries.
Abstract 18956: Knowledge of and Attitude Towards Clinical Trials Among Women in Rural Areas: A Survey-Based Study
Authors: Moatamn Skuk, May S Al-Jorani, Hasan A Farhan, Farqad R Al-Agele, Zainab A Dakhil
Journal: Circulation (2023)

Introduction: In evidence-based era of cardiology with emerging of potential therapies, it is crucial to include diverse population in terms of (geography, gender, race, and economic status) in clinical trials (CT) to enhance generalizability of trials results. Such inclusion necessitates exploring barriers and motivators of diverse population for participation in CT. There is lack of data from Middle Eastern countries regarding perspectives of population about CT. Furthermore, there is no data about perceptions of Iraqi population in general and women in particular regarding CT. Research question: We aim to explore knowledge and perceptions of female patients about CT. Methods: Paper-based survey was filled by investigators during face-to-face interview with women attending healthcare facilities in a rural area in Iraq. Results: n=50, mean age=28.7 year, 50% had primary education level. 36% defined CT as experiments to test a new drug or procedure. Main concerns to participate in CT was safety 62%. 32% said they would participate in CT if they were asked to. 20% said they will participate in CT involving surgery or procedure if were asked to. 80% reported they would participate in education CT (CT involving telemedicine/video programs as intervention). Although all participants never participated in CT before, 80% had concerns about CT in general. 34% of women thought that family duties could prevent them from commitment with trials. 70% agreed to participate in clinical trials if drug safety was ensured, while 90% refused to participate in trials if the drug had unknown safety. 86% of participants agree to participate in trials if it was open label. Conclusions: Safety was a major concern of respondents for participation in CT. Establishing patient public involvement is essential step towards initiating CT ecosystem in Iraq. Being aware of population perceptions and concerns are critical to include this under-represented population in cardiovascular CT.
Abstract 13210: A Hidden Right Atrial Lipoma in a Patient With Recurrent Sustained Supraventricular Tachycardias
Authors: DaYoung Song, Elias Khazoum, Swati Viswanathan, Maha B Mikhail
Journal: Circulation (2023)

Introduction: Cardiac lipomas, known for their benign nature, compose 8 percent of primary cardiac tumors. Advanced imaging modalities allow improved diagnosis, yet little of their potential complications involving the heart's conduction system is known. Case: A 65-year-old male presented to the Emergency Department with palpitations. History was significant for recurrent sustained orthodromic atrioventricular reentrant tachycardia using a concealed left posterior accessory pathway from a prior EP study. He was treated with ablation twice in the past. The patient was hemodynamically stable on evaluation. ECG showed supraventricular tachycardia (SVT) involving orthodromic re-entry with a ventricular rate of 227 bpm. Computer tomography (CT) of the chest revealed a large, low-attenuated lesion with -102 Hounsfield unit (HU) attached to the right atrial roof, extending to both SVC and IVC. No sparing of foramen ovale was seen. Findings suggest right atrial lipoma. A transthoracic echocardiogram (TTE) visualized the same echo-dense structure without increased vascularity. The patient responded to intravenous Adenosine. We discussed the case with the Cardiothoracic surgery team. Outpatient cardiac MRI and elective surgery were planned. Discussion: The case presented clinically significant atrial arrhythmia in a patient with a massive right atrial lipoma. Although most cardiac lipomas remain asymptomatic, arrhythmias coinciding with the location of involved chambers have been reported. In addition, the recurrence of orthodromic tachycardia despite previous ablation suggests the potential benefit of surgical intervention.
Abstract 17007: Unveiling the Immunological and Endocrine Transformations of Veins in Chronic Kidney Disease Through MYCN-AP1 Signaling Amplification
Authors: Fatma Saaoud, Laisel Martinez, Yifan Lu, Keman Xu, Ying Shao, Jia L Zhuo, Avrum Gillespie, Hong Wang, Marwan Tabbara, Alghidak Salama, Xiaofeng Yang, Roberto I Vazquez-Padron
Journal: Circulation (2023)

Introduction: The predominant selection of hemodialysis as the optimal treatment approach for patients with end-stage renal disease (ESRD) and advanced chronic kidney disease (CKD). Thus, upper extremity veins provide a functioning arteriovenous access to reduce dependence on central venous catheters. However, it is unknown whether CKD reprograms the transcriptome of veins and primes them for arteriovenous fistula (AVF) failure. Hypothesis: we hypothesized that CKD reprograms and transdifferentiates veins into a specialized immune endocrine organ thereby accelerating vascular inflammation. Methods: we performed transcriptomic analyses of bulk RNA sequencing data of veins isolated from 48 CKD patients and 20 non-CKD controls. Results: Our data showed that: 1) CKD induces vein conversion into immune organs through upregulation of 13 cytokine and chemokine genes, along with over 50 canonical and non-canonical secretome gene; 2) Enhancement of innate immune responses in CKD through upregulation of 12 innate immune response genes and 18 cell membrane protein genes, promoting intercellular communication including CX3CR1 chemokine signaling; 3) CKD induces upregulation of 5 endoplasmic reticulum protein-coding genes and 3 mitochondrial genes, resulting in impaired mitochondrial bioenergetics and immunometabolic reprogramming; 4) Altered fibrogenic processes in veins during CKD through upregulation of 20 fibroblast genes and 6 fibrogenic factors, leading to increased susceptibility to AVF failure; 5) Reprogramming of cell death and survival programs in CKD; 6) Reprogramming of protein kinase signal transduction pathways and upregulation of SRPK3 and CHKB in CKD; and 7) Transcriptomic reprogramming of veins and upregulation of MYCN, AP1, and Additional 11 transcription factors in CKD: implications for embryonic organ development, positive regulation of developmental growth, and vein muscle structure development. Conclusion: The findings unveil veins as immune-endocrine organs and illuminate the impact of CKD in upregulation of secretomes, immune cell differentiation, and vascular cell dynamics.