bluuebunny/crossref_metadata_2025 huggingface dataset:
Fine-Needle Aspiration Cytology in Preoperative Diagnosis of Bone Lesions: A Three-Year Study in a Tertiary Care Hospital
Authors: Vangala Navatha , Uppin Shantveer G. , Pamu Pramod Kumar , Hui Monalisa , Nageshwara Rao K. , Chandrashekar P.
Published: November 2020

Aim: The aim is to study the utility of fine-needle aspiration cytology (FNAC) in preoperative diagnosis of bone lesions in correlation with radiological and histopathological findings and to determine the spectrum and morphological features of various bone lesions on FNAC. Materials and Methods: A total of 275 cases of bone lesions were studied by FNAC over a period of 3 years. 196 procedures were performed by pathologists, and 107 procedures were guided. Cytology findings were correlated with that of histology on cellblocks or on subsequent surgical biopsies. Immunohistochemistry (IHC) was done wherever necessary. Results: Of the 275 cases, 49 lesions were inflammatory/infectious (granulomatous inflammation-19, nonspecific osteomyelitis-26, and fungal etiology-4), 16 were tumors of undefined neoplastic nature (aneurysmal bone cysts-12, and Langerhans cell histiocytosis-4), 99 lesions were benign (osteoblastoma-6, enchondroma-3, chondroblastoma-14, chondromyxoid fibroma-2, and Giant cell tumor-74), and 111 lesions were malignant (Osteosarcoma-36, chondrosarcoma-7, Ewing’s sarcoma-28, lymphomas-4, plasma cell neoplasm-6, adamantinoma of long bone-1, and metastasis-29). Male to female ratio was 2:1, and the age range was between 4 and 84 years. Correlation with histology/cellblock was available in 149 tumors. Metastasis and round cell tumors such as Ewing’s sarcoma and lymphoma were differentiated by IHC. The accuracy rate in cytological diagnosis of all bone lesions was 87.9% and for neoplasms was 93%. The discordance in the rest of the cases was due to inadequate cell material, and there were no false positives. Conclusion: We conclude that FNAC is a simple and accurate preoperative diagnostic technique for assessment of bone tumors.
Impact of Confinement on the Burden of Caregivers of Patients with the Behavioral Variant of Frontotemporal Dementia and Alzheimer Disease during the COVID-19 Crisis in France
Authors: Boutoleau-Bretonnière Claire , Pouclet-Courtemanche Hélène , Gillet Aurélie , Bernard Amélie , Deruet Anne-Laure , Gouraud Inès , Lamy Estelle , Mazoué Aurélien , Rocher Laëtitia , Bretonnière Cédric , El Haj Mohamad
Published: November 2020

Introduction: The clinical presentation of the behavioral variant of frontotemporal dementia (bvFTD) differs from that of Alzheimer disease (AD), with major impairments in behavioral functions in bvFTD and cognitive impairment in AD. Both behavioral disturbances in bvFTD and cognitive impairment in AD contribute to caregiver burden. Objective: To investigate the impact of home confinement during the COVID-19 crisis on the burden of caregivers of bvFTD or AD patients. Methods: During the COVID-19 lockdown in France, neurologists and neuropsychologists from the Memory Center of Nantes Hospital conducted teleconsultations for 38 AD patients and 38 bvFTD patients as well as for their caregivers. During these consultations, caregivers were invited to rate the change in their burden during home confinement. They were also invited to rate behavioral or emotional changes in the patients during, compared with before, the confinement. Results: Twenty-two bvFTD caregivers and 14 AD caregivers experienced an increase in burden. For bvFTD caregivers, this increased burden occurred regardless of behavioral changes, while AD caregivers experienced an increased burden related to changes in patients’ neuropsychiatric symptoms. Among the whole cohort, 2 factors were associated with increased caregiver burden: behavioral change and bvFTD. Conclusion: The results demonstrate that during home confinement in the COVID-19 crisis, neuropsychiatric symptoms were the core factor that impacted caregiver burden in different ways depending on the disease.
Hemoperfusion with CytoSorb as Adjuvant Therapy in Critically Ill Patients with SARS-CoV2 Pneumonia
Authors: Rampino Teresa , Gregorini Marilena , Perotti Luciano , Ferrari Fiorenza , Pattonieri Eleonora Francesca , Grignano Maria Antonietta , Valente Mauro , Garrone Alberto , Islami Tefik , Libetta Carmelo , Sepe Vincenzo , Albertini Riccardo , Bruno Raffaele , Belliato Mirko
Published: November 2020

We report a preliminary experience of adjuvant therapy with Hemoperfusion (HP) in patients with Severe Acute Respiratory Syndrome-CoronaVirus 2 (SARS-CoV2) pneumonia. Currently, there are no approved treatments for CoronaVirus Disease 19 (COVID-19); however, therapeutic strategies based on the preclinical evidence include supportive measures, such as oxygen supplementation, antiviral, and anticoagulant agents. Despite these treatments, 10% of patients worsen and develop severe acute respiratory distress syndrome (ARDS). Since the pathogenic mechanism of ARDS is an uncontrolled inflammatory state, we speculate that removing inflammation effectors from blood may contrast tissue injury and improve clinical outcome. In a scenario of dramatic medical emergency, we conducted an observational study on 9 consecutive patients hospitalized in COVID Intensive Care Unit, where 5 of 9 consecutive patients were treated with HP, due to the emergency overload made it impossible to deliver blood purification in the other 4 patients. COVID-19 was diagnosed through the identification of virus sequences by reverse transcription-PCR on respiratory specimens. All patients had severe pneumonia requiring continuous positive airway pressure. HP was started in all patients 6–7 days after hospital admission. The treated patients (T) received 2 consecutive sessions of HP using CytoSorb cartridge. Our results show a better clinical course of T compared to control patients (C), in fact all T except 1 survived, and only 2 of them were intubated, while all C required intubation and died. Lymphocytopenia worsened in C but not in T. C-reactive protein decreased in both patients, but to a greater extent in T. IL-6, IL-8, and TNF-α decreased after HP, IL-10 did not change. Respiratory function remained stable and did not worsen in T compared to C. The limited sample size and observational study design preclude a sound statement about the potential effectiveness of HP in COVID-19 patients, but our experience suggests a potential therapeutic role of adjuvant CytoSorb HP in the early course of CO­VID-19 pneumonia. A randomized clinical trial is ongoing.
Jornais em língua Francesa pela tipografia de Pierre Plancher: (Rio de Janeiro, 1827)
Authors: Dutra Santana Júnior Odair Dutra
Published: November 2020

Pierre Plancher, editor, livreiro e tipógrafo francês, instalou-se no Rio de Janeiro em 1824, após ter saído de seu país por motivos políticos. Durante sua estadia, tendo instalado uma tipografia na cidade com os equipamentos que trouxera da França, e com o apoio do Imperador D. Pedro I, imprimiu livros, documentos oficiais e privados, além de periódicos. Entre esses últimos, duas folhas encontram-se em língua francesa: L’Indépendant, publicado semanalmente, aos sábados, entre 21 de abril e 24 de junho de 1827; e L’Écho de L’Amérique du Sud, biebdomadário, publicado às quartas-feiras e sábados, impresso pela tipografia de Plancher até seu número 22, entre 30 de junho e 15 de setembro de 1827. Neste artigo, apresentamos esses dois jornais, os primeiros publicados em língua francesa no Brasil, destacando suas características, desde sua periodicidade, valores de assinatura e aspectos da composição e materialidade gráfica, até as particularidades de seus conteúdos, salientando os assuntos predominantes em seus intervalos de publicação e rubricas mais frequentes. Por fim, conheceremos as inquietações e os interesses que partilhavam os membros de uma comunidade leitora em língua francesa, que se fazia presente no Rio de Janeiro no início de século XIX.
An autonomous place in the global city: an interpretation of Dionne Brand’s “What we all long for”
Authors: Monteiro Beatriz de Carvalho
Published: November 2020

Dionne Brand creates characters with peculiar aspirations in her novel What we all long for. In Toronto, Quy, Tuyen, Carla, Oku and Jackie have their childhoods and origins shaped by the urban spaces they occupy. The author elaborates the struggles between immigrants in Canada and their children, born in the country, as these young people drift in Toronto. How much are these tensions natural in child-parent relationships? In what ways are they more difficult because of the immigrant experience? In this paper, we focus on Oku to point out that the strain in child-parent relationships resembles the tensions between the diasporic subjects and the global city. We conclude that Oku became more aware of his potential to act upon the development of his identity. The main concept that guided this interpretation was that of reterritorialization, as proposed by Kit Dobson (2006).
Análise do Cordel no ensino de Geografia: visão da periferia e a violência urbana
Authors: Queiroz Julia Gabriela Lessa de , Silva Leandro Vieira Cardoso da , Moreno Kelly Barradas
Published: November 2020

O artigo tem como propósito compreender as dinâmicas que constituem a periferia e a violência construída a partir de oficina de elaboração de cordéis numa turma de 7º ano no CIEP 439 - Luiz Gonzaga Júnior, Luiz Caçador, SG-RJ. Esta dinâmica foi realizada a partir do Projeto de Extensão de Oficinas Escolares de Geografia, a qual é desenvolvida com a temática Geografia, Literatura e Artes. Como resultado, percebemos que a grande maioria dos Cordéis relatara diferentes tipos de violência sofridas no local onde vivem, e com isso, nos motivou a aprofundar no tema para entender este processo.
A Geografia serve, antes de mais nada, para organizar a viagem: real e imaginária
Authors: Silva Valéria Cristina Pereira da
Published: November 2020

Neste artigo retomo a trama essencial entre geografia, viagem e literatura vislumbrando que tal entrelaçamento está presente na origem da Geografia e manteve-se na construção do saber geográfico como um tripé articulado resultando em pontos de força significativos e pujantes. A relação entre, geografia, viagem e literatura também é vista a partir da obra de escritoras, poetas e viajantes como Cecília Meireles, Sophia de Mello B. Andresen e Clarice Lispector, tal convergência teve a finalidade de destacar que, tanto no trabalho de geógrafos como de não geógrafos, o tripé geografia, viagem e literatura consiste e mantém-se numa vinculação essencial, considerando também suas interfaces real e imaginária. Por fim, apresento a experiência pessoal, entre o olhar e a narrativa, que faz da viagem geradora e aglutinadora de sentidos e assim, quando narrada, torna-se um meio de ressignificação e difusão porque a viagem é a experiência de um espaço outro, real e imaginária em si mesma.
Abstract 12824: Higher Prevalence of Qt Interval Prolongation in Infants With Intrauterine Tobacco Smoke Exposure
Authors: Harada Kenji , Harada Yukiko
Published: November 2020

Background:
The association between QT interval prolongation and sudden infant death syndrome (SIDS) has been clearly established. Environmental tobacco smoke (ETS) exposure is also associated with increased risk for SIDS. However, there has been little focus on the relationship between the QT interval and ETS exposure during early infancy. To clarify this, we examined the QT interval with ETS exposure during early infancy.

Methods:
A total of 2168 infants (age:1-4 months), 743 infants who have been exposed to tobacco smoking since intrauterine life and 1425 age-matched children without ETS exposure, underwent electrocardiographic study. QT data were extracted from the electrocardiogram monitor built-in echocardiogram. The QT interval was measured on the first, second, third, and fourth month. The corrected QT interval (QTc) was calculated by dividing the QT interval by the square root of the RR interval (Bazett’s formula). QT interval prolongation was defined as QTc≧440 msec. The data of the number of cigarettes per day were collected by a questionnaire.

Results:
In the total study population, the mean QTc in ETS infants was significantly greater than in infants without ETS (402±21 and 395±20 msec, p<0.01). The absolute risk of QT prolongation was 1.11 % (16/1425) in infants without ETS; by contrast, that of ETS infants with QTc≧440 msec was 3.23% (24/743) (odds ratio, 2.94; 95% confidence interval, 2.30 to 3.58). The mean QTc in ETS infants at the first, second and third month was significantly greater than that in infants without ETS (404±20 vs. 397±21 msec, 407±19 vs. 399 ±17 msec and 404±17 vs. 390±18 msec, p < 0.01, respectively), but the mean QTc at the fourth month was similar in the 2 groups. The odds ratios for QTc≧440msec in ETS infants at the second and third month were 7.15 (95% confidence interval, 6.00 to 8.29) and 4.97 (95% confidence interval, 2.74 to 7.18), respectively. Compared with infants without ETS, ETS infants with the number of cigarettes ≧10 cigarettes per day had a significantly higher risk of QTc≧440 msec(odds ratio: 3.32, 95% confidence interval: 2.67-3.99).

Conclusions:
The present study indicates that environmental tobacco exposure is a risk for QT interval prolongation ≧440msec during early infancy.
Abstract 12877: Magnesium Deficiency Causes Reversible Metabolic Diastolic and Systolic Cardiomyopathies
Authors: Liu Man , LIU Hong , Feng Feng , Xie An , Hou Cody R , Zhou Xiaoxu , Zhao Yang , Dudley Samuel C
Published: November 2020

Introduction:
Low circulating magnesium (Mg) level is associated with increased cardiovascular mortality, and conversely, dietary Mg intake is associated with a decreased risk of developing heart failure.

Hypothesis:
We investigated whether Mg deficiency alone could cause cardiomyopathy.

Methods:
C57BL/6J mice were fed with a low-Mg diet (low-Mg, 15-30 mg/kg Mg) or a normal diet (nl-Mg, 600 mg/kg Mg) for 6 weeks. To test reversibility, half of the low-Mg mice were fed then with normal diet for another 6 weeks (low→nl-Mg group).

Results:
Mg deficiency increased mortality, especially in female mice. After 6 weeks of low-Mg diet, surviving mice showed significantly decreased serum Mg (0.9±0.1 vs. 2.8±0.1 mg/dL for nl-Mg) and a reciprocal increase in serum Ca, K, and Na. Low-Mg mice exhibited a decreased cardiac ejection fraction (EF%, 39.8±1.9% vs. 52.0±1.7% of nl-Mg) and impaired relaxation (E/e’: 21.1±1.1 vs. 15.4±0.4 of nl-Mg) in echocardiography. At the cellular level, ATP, Ca transient amplitude, sarcoplasmic reticulum (SR) Ca load, resting sarcomere length, and sarcomere shortening were all decreased significantly in low-Mg hearts and cardiomyocytes. These changes were accompanied by evidence of mitochondrial dysfunction with significantly increased mitochondrial ROS production and mitochondrial membrane depolarization. Mg repletion normalized electrolytes, contraction, relaxation, and cellular changes. The SR Ca pump (SERCA) was decreased, the SR Ca channel RyR2 oxidized, and cardiac myosin binding protein C S-glutathionylated in low-Mg mouse hearts. These changes were normalized with Mg repletion.
In vivo
, mitoTEMPO treatment during low Mg diet improved the cardiac relaxation and increased cellular ATP levels without improving contraction.

Conclusions:
Mg deficiency caused a reversible diastolic and systolic cardiomyopathy associated with mitochondrial dysfunction. This cardiomyopathy may explain the relationship of hypomagnesemia and worsening heart failure. Mg intake could reverse these changes, reinforcing the known correlation of increased Mg intake and reduced heart failure symptoms and mortality. In deficiency states, Mg supplementation may represent a novel treatment for systolic and diastolic heart failure.
Abstract 12883: Proposed Management Framework for Immune Checkpoint Inhibitor Myocarditis
Authors: Rao Anjali , Zaha Vlad G , Mammen Pradeep P , Garg Sonia , Chandra Alvin , Lohrey John , Hammers Hans , Bermas Bonnie
Published: November 2020

Immune checkpoint inhibitors (ICI) have revolutionized the field of oncology. Although rare (<1%), severe autoimmune myocarditis (AIM) has been reported due to ICI. A consensus treatment strategy for AIM is not available. Therefore, our goal is to propose a systematic, tiered approach to treatment of ICI-induced AIM.We report on the clinical course of 6 consecutive patients with malignancy and ICI-induced AIM diagnosed at our tertiary care center, April 2018-March 2020. Severe cardiac manifestations included left ventricular systolic dysfunction and/or arrhythmias within 1-3 months of first ICI dose. All patients had elevated cardiac blood biomarkers (peak hs-troponin 118—7,500ng/L) and cardiac MRI findings typical of myocarditis. A multidisciplinary team included oncology, rheumatology, cardio-oncology, and advanced heart failure. Initial pulse-dose steroids were followed by escalation therapies if patients did not improve. Escalation therapies included: abatacept (1), rituximab (1), plasma exchange (2), and mycophenolate mofetil (2). After clinical improvement, while on a steroid taper, maintenance immunosuppression with methotrexate (5) or mycophenolate mofetil (1) was initiated between 4 days and 5 months after presentation to care. This approach resulted in improved blood biomarkers and clinical status in all patients. The consistent clinical improvement seen in this case series of AIM due to ICI highlights that a multidisciplinary team familiar with immunomodulatory therapies is key and a tiered approach is successful. Suggested approach in severe cases: 1) acute high dose glucocorticoids as mainstay of treatment, 2) early immunomodulatory escalation therapy if not improving, and 3) early transition to steroid-sparing agents to reduce glucocorticoid therapy. Although further investigations are needed, these data suggest early transition to methotrexate as a valuable approach in the maintenance phase of ICI-induced AIM management.
Abstract 12886: Ten-year Trends in Patient Characteristics, Treatments, and Outcomes in St Elevation Mi Patients in the Us - A Report From NCDR CP-MI Registry
Authors: Gandhi Sanjay , Garratt Kirk N , Wang Tracy Y , Li Shuang , Bhatt Deepak L , Davis Leslie L , Zeitouni Michel , Kontos Michael C
Published: November 2020

Introduction:
The National Cardiovascular Data Registry affords a 10-year perspective of the landscape of STEMI patient characteristics, management, and clinical outcomes.

Methods:
Annual trends in patient characteristics and in-hospital treatments of 604,936 STEMI patients treated at 1226 US hospitals between 2009 and 2018 were analyzed. Using the ACTION mortality risk model incorporating cardiac arrest, the trend in in-hospitals risk adjusted mortality rates (RAMR) between 2011-2018 was tested.

Results:
While patient age (median 61 years) and sex (70.7% male) remained stable over time, the prevalence of diabetes (22.8% in 2009 to 28.3% in 2018) and atrial fibrillation (4.1% to 6.1%) increased, while smoking decreased (43.5% to 37.9%) . Among eligible patients, primary PCI use increased (82.3% to 96.0%) with more rapid door to balloon times for both direct arrival (median 62 min vs 56 min) and transferred-in pts (median 113 min vs 103 min, p for trend <0.001 for all). Thrombolytic use declined (10.1% to 5.0%) with no significant change in door to needle time (median 27 minutes). There was no significant change in RAMR (2.83% to 2.69%, p=0.46) from 2011-2018. (Figure 1). Discharge use of P2Y12 inhibitors (91.5% to 95.6%) and statins (94.9% to 98.5%) increased.

Conclusions:
Characteristics of patients presenting with STEMI changed over time with improvements in primary PCI use and timeliness. However, there was no significant reduction in risk-adjusted mortality over the past decade.
Abstract 13200: Relationship Between Baseline Low-Density Lipoprotein Cholesterol and Percent Low-Density Lipoprotein Cholesterol Reduction With Evolocumab in the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) Trial
Authors: Marcusa Dan P , Giugliano Robert P , Park Jeong-Gun , Sever Peter , Wang Huei , Hamer Andrew , Pedersen Terje R , Keech Anthony C , Sabatine Marc S
Published: November 2020

Introduction:
The FOURIER trial demonstrated that the PCSK9 inhibitor evolocumab robustly reduced LDL-C amongst patients on moderate or high intensity statins. We investigated whether the magnitude of the percentage LDL-C reduction is consistent across baseline LDL-C levels.

Methods:
FOURIER enrolled 27,564 patients with ASCVD and an LDL-C ≥70 mg/dl or a non-HDL-C ≥100 mg/dl on optimized statin therapy at the time of enrollment. The % LDL-C reduction from baseline to 12 wks was examined in patients on study drug through 12 wks (N=25,847) using a quadratic regression model including terms for treatment (evolocumab vs. placebo), baseline LDL-C and [LDL-C]
2
, and interaction terms. Stratified analyses were done for patients on high vs. moderate intensity statin.

Results:
Overall, compared with placebo, evolocumab reduced LDL-C by 61% (95% CI 61-62%). Patients with lower baseline LDL-C had significantly greater % LDL-C reductions (Figure top; P<0.001 for interaction between baseline LDL-C and % LDL-C reduction with evolocumab). Among patients with a baseline LDL-C of 70 mg/dL, LDL-C reduction was 68% (95% CI 67-69%) vs. 54% (95% CI 53-55%) in patients with a baseline LDL-C of 130 mg/dl. When stratified by concomitant statin intensity, similar relationships were observed (Figure middle & bottom).

Conclusions:
The magnitude of % LDL-C reduction with evolocumab is greater in patients with lower baseline LDL-C levels. These data are encouraging for the use of PCSK9 inhibition even for patients at the lower end of LDL-C.
Abstract 13273: Treatment of Sleep Apnea With Positive Airway Pressure and Its Effect on Diastolic Dysfunction: A Systematic Review and Meta-analysis
Authors: AlSadawi Mohammed , Saeidifard Farzane , capric violeta , Erwin Patricia J , Budzikowski Adam
Published: November 2020

Introduction:
This meta-analysis assessed the effect of chronic non-invasive positive airway pressure (> 6 weeks) on moderate to severe OSA with diastolic dysfunction based on echocardiographic parameters.

Hypothesis:
chronic use of non-invasive positive airway pressure (> 6 weeks) on moderate to severe OSA improves diastolic dysfunction based on echocardiographic parameters.

Methods:
We searched the databases for randomized clinical trials including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 20th, 2019. The search was not restricted to time, publication status or language. Two independent investigators screened the identified studies and extracted the data, in duplicate. Risk of bias was assessed using Cochrane collaboration tools.

Results:
A total of 2753 results were identified. A total of 9 studies including 808 participants were included. Results showed improvement in deceleration time (-39.49ms CI[-57.24,-21.74]; p=0.000), isovolumic relaxation time (-9.32 ms CI[-17.08, -1.57]; p=0.02) and the ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/E’) (-1.38 CI[-2.6, -0.16]; p=0.03). However, improvement in left atrial volume index, the ratio of early to late mitral inflow velocities (E/A) was not statistically significant. The risk of bias is mild to moderate.

Conclusions:
Our results suggest that chronic treatment of moderate to severe OSA with non-invasive positive airway pressure is associated with improvement in diastolic dysfunction.
Abstract 13282: Patients With Peripheral Artery Disease Perceptions of an Ankle Foot Orthosis: A Comparison by Physical Activity Level
Authors: Dinkel Danae , Hassan Mahdi , Despiegelaere Holly , Johanning JASON , Pipinos Iraklis I , Myers Sara A
Published: November 2020

Introduction:
Peripheral Artery Disease (PAD) restricts blood flow to the legs. Its most common manifestation is claudication, a severe impairment of physical activity produced by ischemia-related leg pain and tiredness during walking. We are conducting a trial to evaluate the possibility that an ankle foot orthosis could reduce claudication symptoms and increase the physical activity of patients with PAD. The perceptions of patients with PAD on wearing the ankle foot orthosis and how they vary by baseline physical activity level are unknown. Therefore, this study explored the perceptions of patients with PAD while using an ankle foot orthosis and if these perceptions varied by level of physical activity.

Hypothesis:
We hypothesize that those who are more physically active will perceive more benefits as a result of using the ankle foot orthosis.

Methods:
Participants (n=21) wore an ankle foot orthosis for 3 months. Baseline median step count was used to divide patients into high (n=10) or low (n=11) active groups. Semi-structured interviews were conducted at midpoint and post. Data were analyzed using a summative content analysis.

Results:
Patients averaged 3233 ± 1523 steps/day with a median of 3137 steps/day at baseline. 45% of participants’ initial responses described a positive perception of their time wearing the ankle foot orthosis. 71.4% of participants reported an overall positive impact of wearing the ankle foot orthosis, primarily being able to walk further. Comparison by baseline physical activity level revealed 36.4% of participants with low physical activity reported seeing improvements in daily tasks (walking in the grocery store) versus 10% of those with high physical activity.

Conclusions:
In conclusion, our interview data demonstrate that perceived quality of physical activity in patients with PAD improved with the use of the ankle foot orthosis. Contrary to our hypothesis, minimal differences in perceptions of ankle foot orthosis use were found between patients with low versus high baseline physical activity levels.
Abstract 13607: Seasonal Variation in the Attenuation of Epicardial Adipose Tissue on Cardiac Computed Tomography
Authors: Archer John M , Raggi Paolo , Sagar Amin B , Zhang Chao , Gadiyaram Varuna , STILLMAN Arthur E
Published: November 2020

Introduction:
The role of epicardial adipose tissue (EAT) in the development and vulnerability of coronary artery atherosclerosis has been the focus of extensive research for the past several years. EAT is visceral fat that surrounds the coronary arteries and it consists of beige adipose tissue that is functionally similar to brown adipose tissue and has a higher computed tomography (CT) attenuation than subcutaneous white adipose tissue. Given the brown-like composition of EAT, its attenuation may be affected by several factors including seasonal temperature variations and clinical factors.

Hypothesis:
We investigated the effect of season on EAT attenuation and additional clinical factors that may influence attenuation measurements.

Methods:
Single center, retrospective study of 597 cardiac CT exams performed for coronary artery calcium (CAC) scoring obtained on a single CT scanner during winter and summer months. Summer was defined as June, July, and August. Winter was defined as December, January, and February. EAT attenuation in Hounsfield units (HU) was measured in a region of interest near the right coronary artery ostium. Subcutaneous adipose tissue (SCAD) attenuation was measured in the thoracic subcutaneous tissue. Patients’ demographic and clinical characteristics were obtained by questionnaire and chart review.

Results:
The clinical and demographic characteristics of patients scanned during the summer (N=253) and the winter (N=344) months were similar. One third of patients were women, one quarter used statins and anti-hypertensive drugs each and 30% had a BMI>30. There was a significantly lower EAT attenuation measured during the summer than the winter months (-98.17±6.94 HUs vs -95.64±7.99 HUs; P<0.001). Additionally, gender, obesity, treatment with statins and anti-hypertensive agents significantly modulated the seasonal variation in EAT attenuation. SCAD attenuation was not affected by season or any other factor.

Conclusions:
Our study shows that the measurement of EAT attenuation is complex and is likely affected by season, demographics and clinical factors. Attempts to use EAT attenuation as a biomarker for risk of cardiovascular events should take these potential confounders into consideration.
Abstract 13609: Predictors of Treatment of Hospitalized Patients With Atrial Fibrillation in the US
Authors: Deitelzweig Steven B , Dhamane Amol D , Di Fusco Manuela , Russ Cristina , Rosenblatt Lisa , Lingohr-Smith Melissa , Lin Jay
Published: November 2020

Introduction:
While a few studies have been conducted that evaluated anticoagulant (AC) treatment of patients with atrial fibrillation (AF) in the outpatient setting, little is known regarding inpatient AC treatment practices.

Objective:
To identify predictors of AC treatment among patients hospitalized with AF in the US

Methods:
Patients (≥18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were selected from the Premier Hospital database (1/1/2016-9/30/2017). Patients were grouped into 2 study cohorts: 1) Patients who received oral AC (OAC) therapy during hospitalization and 2) Patients who did not receive any AC therapy. Demographics, patient clinical characteristics, and hospital characteristics were examined. A multivariable logistic regression analysis was carried out to evaluate potential predictors of not receiving any AC therapy vs. receiving OACs.

Results:
Of the patients hospitalized with an AF diagnosis, 65.7% (n=205,438; mean age: 74.4 years; 47.1% female) received OAC therapy and 34.3% (n=107,076; mean age: 75.9 years; 46% female) did not receive any AC therapy. The most common OACs received were warfarin (39.4%) and apixaban (34.2%). Key predictors of a greater likelihood of not receiving any AC therapy vs. receiving OACs were greater comorbidity (Charlson Comorbidity Index [CCI] ≥5 vs. 0 odds ratio [OR]: 1.72; 3-4 vs. 0: 1.32; 1-2 vs. 0: 1.11, all p<0.001) and having had prior bleeding (OR: 1.59, p<0.001). Key predictors of receiving OACs, relative to not receiving any AC therapy, were having a AF diagnosis in the first vs. second position on insurance claims (OR: 0.24, p<0.001), chronic (OR: 0.76, p<0.001) or persistent (OR: 0.61, p<0.001) AF vs. paroxysmal, higher stroke risk (CHA
2
DS
2
-VASc=5 vs. 0 OR: 0.48; 3-4 vs. 0: 0.51; 1-2 vs. 0: 0.58, all p<0.001), and a prior stroke (OR: 0.87, p<0.001).

Conclusions:
A substantial portion of hospitalized AF patients in the study did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on insurance claims. The predictors of AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF.
Abstract 13612: Association of Tracheobronchial Calcification With Cardiovascular Events and All-cause Mortality in Multi-Ethnic Study of Atherosclerosis (MESA); the MESArthritis Ancillary Study
Authors: Shabani Mahsima , Pishgar Farhad , Rashidi Ali , Silva Thiago Q , Budoff Matthew J , Post Wendy S , Barr Graham , Wu Colin , Bluemke David A , demehri Shadpour , Lima João A.C.
Published: November 2020

Introduction:
Tracheobronchial calcification (TBC), is a readily available potential biomarker in non-contrast chest CT scans, including cardiac calcium scan CTs. However, there is a paucity in literature investigating how this measure contributes to CVD risk prediction.

Hypothesis:
TBC is associated with CVD and mortality events independent from CAC score.

Methods:
Available non-contrast chest CT images from Johns Hopkins Hospital field center within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The calcifications observed in the wall of tracheobronchial tree were measured from aortic arch to carina, by calcium scoring package (VScore, Vitrea 7.11, Vital Images). Outlier values were excluded using the Interquartile range-based outlier fence estimates. Association of TBC with cardiovascular risk factors was investigated by linear regression models. Cox proportional hazard models were applied for CVD and mortality event prediction by TBC with and without adjustment for age, gender, race, CAC, and Framingham global CVD risk score (FRS).

Results:
After exclusion of 39 outliers, a total of 382 participants (51.2% female) with a mean age of 69.9 (±8.82) were included. TBC was associated with age (β=3.26, p:.002), gender (β=96.30, p<.001), race (β=-28.96, p:.002), and FRS (β=3.57, p<.001). In time-to-event analysis, risk of CHD, CVD, and mortality increased by 1.34, 1.28, and 1.15-fold respectively, by every 100 increase in TBC score adjusted for age, gender, and race. Compared with CAC score (C-index: 0.78) and FRS (0.71) individually, the model with TBC addition to both scores had higher C-index (0.82) for CHD event prediction.

Conclusions:
Quantification of calcifications in tracheobronchial area can be used to predict CHD, CVD and all-cause mortality and augment the predictive power of the highly validated CAC and FRS for CHD events.
Abstract 13613: Combination of Atrial Fibrillation and Frailty: Association With All-cause Mortality in Older Veterans
Authors: Fernandez Marlena , Pitteloud Marie , Torres Angelica , Ruiz Sergio , Cevallos Victor , Mintzer Michael J , Rodriguez Alexis , Ruiz Jorge
Published: November 2020

Background:
Atrial fibrillation (AF), the commonest arrhythmia among older adults, is associated with increased mortality. Frailty constitutes a state of vulnerability to stressors resulting from multisystemic loss of physiological reserve. The study aim was to determine whether concurrent frailty and AF increases all-cause mortality in older Veterans.

Methods:
Retrospective cohort study of community-dwelling Veterans 60 years and older identified as having baseline AF (ICD codes) or frailty through a 30-item VA Frailty Index (VA-FI). The VA-FI was generated as a proportion of morbidity, function, sensory loss, cognition/mood and other variables. The VA-FI categorized Veterans into non-frail (robust FI≤.10, prefrail FI=>.10,<.21) and frail (FI≥.21). The combination resulted in 4 groups: Neither AF nor frailty (NoAF-F), atrial fibrillation (AF), frailty (F), and AF and frailty (AF-F). At the end of follow-up, data on mortality was aggregated and adjusted for age, gender, race, ethnicity, marital status, and BMI, the association of concurrent AF and/or frailty with all-cause mortality was determined using a Cox regression model including testing for interaction effects.

Results:
A total of 16391 Veterans were included, mean age 72.06 (SD=9.23) years 74.2% White, 86.7% non-Hispanic, and 97.9% male. There were 1534 (9.4%) Veterans with AF and the proportion of robust, pre-frail and frail patients was 44.3% (n=7255), 37.2% (n=6095) and 18.6% (n=3041) respectively. The 4 resulting groups were NoAF-F (12357, 75.4%), AF (993, 6.1%), F (2500, 15.3%) and AF-F (541, 3.3%). Over a median follow-up of 2025 days (IQR=245) 3917 deaths occurred. As compared with NoAF-F, AF-F, F and AF in that order had higher all-cause mortality, adjusted hazard ratio (HR)=3.24 (95%CI:2.88-3.66), p<.0005; HR=2.06 (95%CI:1.90-2.22), p<.0005; and HR=1.47 (95%CI:1.31-1.64), p<.0005 respectively. When frailty and AF were considered jointly they did not interact.

Conclusions:
The combination of AF and frailty at baseline represents the group with highest risk for all-cause mortality in older Veterans. Further studies may be needed to assess the impact on mortality of clinical interventions targeting both conditions.
Abstract 13628: Absence of Coronary Artery Calcium in Ruling Out Obstructive Cad on Coronary Computed Tomography Angiography (ccta) Among Patients With Stable and Acute Chest Pain: A Systematic Review
Authors: Agha Ali M , Mszar Reed , Pacor Justin , Grandhi Gowtham R , Parikh Roosha , Agrawal Tanushree , Burt Jeremy , Blankstein Ron , Blaha Michael J , Shaw Leslee J , Al-mallah Mouaz H , Cainzos Achirica Miguel , Nasir Khurram
Published: November 2020

Introduction:
Coronary computed tomography angiography (CCTA) is a class IIA recommendation in low-intermediate risk patients with suspected acute coronary syndrome (ACS) and a normal or nondiagnostic cardiac biomarker and ECG. However, there is little consensus on whether absence of coronary artery calcium (CAC) can safely identify patients with stable and acute chest pain (CP) who can avoid more advanced downstream testing. In this study, we conducted a systematic analysis investigating utility of CAC zero in ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP undergoing coronary CT angiography (CCTA).

Methods:
We searched online databases (PubMed, MEDLINE) for original research articles published between 2005 and 2020 examining the relationship between CAC and significant stenosis on CCTA (defined as >50% coronary luminal narrowing) among patients with stable and acute chest pain.

Results:
A systematic review of published articles revealed 18 studies including 27,719 patients with stable CP and 12 studies including 7,184 patients with acute CP undergoing simultaneous CCTA and CAC scoring. Overall, 12,664 (45%, 95% CI: 39%-50%) patients with stable CP and 4,327 (56%, 95% CI: 48%-64%) patients with acute CP had CAC zero. The pooled prevalence of obstructive CAD among those with CAC=0 was 3% (95% CI: 2%-4%) among stable CP patients and 2% (95% CI: 1%-3%) among acute CP patients. The negative predictive values for any CAC ruling out obstructive disease were 97% (95% CI: 96-98%) and 98% (95% CI: 96-100%), respectively (Figure).

Conclusions:
Among over 34,000 patients with stable and acute CP patients undergoing CCTA, the absence of CAC was associated with a very low likelihood of obstructive CAD. These findings support role of CAC zero in a value-based healthcare delivery model as a gatekeeper for more advanced testing.
Abstract 13631: Improving Cardiac Rehabilitation Attendance Through an Appointment-based Approach
Authors: Xie Catherine , Fournier Sean , Hiller Susan , Oen Hsiao Joyce , Dreyer Rachel P
Published: November 2020

Introduction:
Cardiac rehabilitation (CR) is the pillar of secondary prevention for patients with cardiovascular disease (CVD). Despite its effectiveness, there remain systemic issues with adherence to in-clinic CR sessions, with the median number of CR sessions completed nationwide being 26 (out of a total of 36 sessions). We evaluated pre-post health outcomes for patients participating in a patient-driven appointment-based CR program, reasons for discharge, as well as predictors of total CR sessions attended.

Methods:
We utilized data from the Yale New-Haven Health (YNHH) CR program over a 6-year period (2012-2017). Data was collected on patient demographics, socio-economic status, and clinical characteristics. We evaluated CR outcomes with paired T-tests and conducted logistic regression analysis to determine predictors of CR adherence and completion.

Results:
A total of 2,135 patients were enrolled in CR from 2012 to 2017 (27.9% women, mean age 65±12 years). Patients completed a median of 30 sessions out of a total of 36. The primary reason for discharge was completion of all 36 sessions of CR (46.4%). The appointment-based CR program resulted in significant improvements in physical health outcomes
(Table)
, with matched-subject improvements of 1.42 METs increase, 0.32 kg/m
2
decrease in BMI and a 1.88% decrease in body fat percentage (P<0.001). Patients also demonstrated improvements in blood pressure control, lipid profiles and diabetes management. Logistic regression modeling found that patient-specific medical factors, such as self-reported levels of stress and physical activity were predictive of CR completion.

Conclusion:
We demonstrated that an appointment-based CR program led to an increase in the median number of CR sessions completed versus the nationwide average, and produced significant improvements in health outcomes. Appointment-based CR could aid in optimizing the dose-response benefit of CR for patients with CVD.
Abstract 13658: Factors Associated With the Unnecessary Continuation of Cardiac Telemetry Through Discharge
Authors: Gavin Jordan L , MUTHARASAN Raja K
Published: November 2020

Background:
Inpatient cardiac telemetry remains over-utilized. Even when ordered judiciously, telemetry may be unnecessarily continued through discharge, adding cost, complexity, and inconvenience to care.

Objective:
To determine the rate of continuation of cardiac telemetry through time of hospital discharge, and the factors associated with its prolonged use.

Methods:
We analyzed 37,779 telemetry admissions between January 1 and December 31, 2019 at a 6-hospital healthcare system in the Chicago metropolitan area. We sought to evaluate whether hospital setting, location at time of telemetry order, ICU admission, major diagnostic category, cardiology consultation, or discharge disposition affected telemetry continuation through discharge.

Results:
In total, 47.1% of all telemetry admissions retained an active telemetry order through hospital discharge. The median and mean durations on telemetry were 71 hours and 101 hours, respectively. Patients admitted to a community hospital, hospitalized with a cardiac-related Medicare Severity-Diagnosis Related Group (MS-DRG), consulted on by cardiology, started on telemetry in the cardiac catheterization lab, or discharged home were more likely to be continued on telemetry through discharge. Odds ratios are shown in the figure, with an odds ratio > 1 indicating increased likelihood of being continued on telemetry through time of discharge.

Conclusions:
Once started on cardiac telemetry, nearly half of all patients remained on telemetry until discharge. Those with substantial cardiovascular-related care - as evidenced by procedure in the catheterization lab, cardiology consultation, or a cardiac MS-DRG - were more likely to be continued on telemetry through discharge. Quality improvement interventions aiming to reduce telemetry duration should focus on strengthening daily reviews of telemetry need, perhaps leveraging the electronic health record to link telemetry indications and duration.
Abstract 13662: The Arrhythmogenic Impact of Heart Failure With Preserved Ejection Fraction on Diabetics: Insights From A Nationally Representative Sample
Authors: Mubasher Mahmood , Mohamed Mouhand , hanafi amir , Syed Tausif , Magdi Mohamed , Mohammed Shaban , Abdullah Abdullah S , Danjuma Mohammed , Alweis Richard , McCrea Harry , Rao Mohan C , Hoefen Ryan
Published: November 2020

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is emerging as a significant clinical concern among people with DM with recent studies showing that 45% of patients with HFpEF have DM. Sudden death accounts for around 20% of deaths in the HFpEF population, with diabetics running the highest risk. DM and HFpEF are associated with endothelial dysfunction, interstitial fibrosis, and repolarization changes that may predispose to ventricular arrhythmias (VA). However, the burden of VA in people with DM and HFpEF is not well elucidated.

Hypothesis:
We hypothesize that patients with DM and HFpEF have a higher prevalence of VA than patients with DM only.

Methods:
We queried the national inpatient sample (NIS) from 2012 to 2014 for patients age>=18years. We excluded heart failure with reduced ejection fraction and hypertrophic cardiomyopathy. Subsequently, we used ICD-9-CM codes to identify discharges associated with HFpEF, DM, VT, VF, and QTc prolongation. We divided patients into two groups: DM/HFpEF vs. DM/non-HFpEF. 1ry-outcome was VT Prevalence. 2ry-outcomes are VF prevalence, QTc prolongation, length of stay (LOS), and in-hospital mortality. We used multivariate logistic regression (MLR) to devise the propensity scores. Propensity score matching (PSM) was performed. Standardized mean difference <0.1 indicates covariate homogeneity.

Results:
We Identified 326545 hospitalizations among the HFpEF group and 3625130 among the non-HFpEF group. HFpEF group tended to be older, females, and had higher rates of obesity and other comorbidities and. On PSM+MLR, HFpEF group had higher Odds of VT (2.1% vs. 1.9%; OR, 1.06; 95%CI, 1.03-.10; P, <0.001) and higher LOS. Nonetheless, VF and In-hospital mortality were surprisingly higher in the non-HFpEF group. No difference in QTc prolongation between both groups.

Conclusions:
HFpEF was associated with higher rates of VT among patients with diabetes, although there was no change in in-hospital mortality.
Abstract 13674: Real-world Outcomes Following Fractional Flow Reserve Use
Authors: Sda Cuneyt , NG Chin Chwan , Wong Chris , Ng Martin , Chow Vincent , Brieger David , Kritharides Leonard , Fearon William F , Yong Andy
Published: November 2020

Introduction:
Fractional flow reserve is an established method for assessing coronary artery stenosis severity. However, long-term outcome data in a real-world population is lacking.

Aims:
We aim to determine whether FFR use is superior to angiography alone in relation to cardiac death and all-cause death in a real-world population.

Methods:
Patients undergoing angiography between June-2017 and June-2018 recorded by the Centre-for-Health-Record-Linkage (CHeReL) were included. The CHeReL database captures health data from ≥97% of all healthcare facilities in the state of New South Wales, with a population of 7.5 million people. The cohort was stratified into angiography-FFR group when concomitant FFR was performed, and the angiography-only group which included all patients undergoing angiography without concomitant FFR. The primary and secondary outcomes were cardiac death and all-cause death respectively.

Results:
The study cohort comprised 34,597 patients, in which 32,863 (95%) patients underwent angiography alone and 1,734 (5%) patients had angiography combined with FFR. At 1-year follow-up, the angiography-FFR group had a lower occurrence of the endpoints of cardiac death (0.8% vs 2.3%, P<0.001) and all-cause death (1.7% vs 4.7%, P<0.001) compared to the angiography-only group. Multivariable Cox regression analysis showed FFR use to be associated with lower rates of both cardiac death (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.32-0.93, P=0.025) and all-cause death (HR 0.55, 95% CI 0.38-0.79, P=0.001) independent of age, sex, facility, country of birth, referral source, marital status, Charlson comorbidity index, valvular heart disease, pre-existing atrial fibrillation (AF), presenting illnesses including AF, congestive heart failure or acute coronary syndrome, planned percutaneous coronary intervention or coronary artery bypass graft surgery, and concomitant or subsequent cardiac valve surgery.

Conclusions:
FFR use was associated with a reduction in both cardiac death and all-cause death in this real-world study.