tbuckley/cabot-search huggingface dataset:
Abstract 11170: In an Aortic System of Care Model, Adherence to Guideline Based Care is Hampered by Gaps in the Collection, Reporting, and Communication of Echocardiogram Data
Authors: Lucia Gordon, Terreal Rogers, Laney Solsbery, Katy Wirtz, Michelle Scharnott, Gary W Myers
Journal: Circulation (2021)

Introduction: Aortic Stenosis (AS) is one of the most common and serious valve diseases, affecting 5% of Americans age 65 or older. Currently, there lacks a national system of care addressing the AS care continuum. The American Heart Association (AHA) has a history of success in systems of care and seeks to apply this experience to create similar for the AS patient through the program, Target: AS. Hypothesis: A key step in an Aortic Stenosis system of care is the identification of the patient’s diagnosis echocardiogram (echo). In some cases, the echo is initially performed at a location other than the tertiary hospital, and a consistent method of reporting the results to valve center does not currently exist. This inconsistency impacts guideline-based care. Methods: Target: AS pilot measures, following current guidelines, were developed with guidance from the AHA’s aortic stenosis scientific advisory group. Hospitals entered 2020 baseline data into the Target: AS data collection tool. Data elements were collected towards the measure: “Percentage of moderate aortic stenosis patients receiving a follow-up echocardiogram during the measurement period that is within 24 months of prior echocardiogram.” Sites reviewed data 24 months prior to the baseline year for the initial echo data. Results: 123 patients in 8 pilot hospitals met inclusion criteria. Overall performance - 53% of patients had a follow-up echo with 24 months. Range was 0% - 65%. All but one patient that failed the measure was due to missing or unavailable prior echo. Engagement with sites through 1:1 interviews, data abstractor calls, and quarterly learning collaboratives revealed that hospitals are not able to find initial echo data in medical records, or that the information is not provided in a discrete manner. Conclusions: The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease states that patients diagnosed with moderate aortic stenosis should have a follow-up echo within 24 months of the diagnostic echo. Early data demonstrates that in all but one case, when hospitals cannot meet this guideline, it is due to not having the initial echo results. A hospital cannot monitor its adherence with guideline-based care when it does not have access to necessary data.
Soluble ICAM-1 As Effective Serologic Marker to Predict Clinical Outcome for Early -Stage I/II Nasal Natural Killer /T-Cell Lymphoma
Authors: Juan J Gu, Paola Ghione, Shiyu Jiang, Cory Mavis, Francisco J. Hernandez-Ilizaliturri, Dongmei Ji, Junning Cao, Xiaonan Hong, Xuejun Ma, Qunling Zhang
Journal: Blood (2021)
ITVT-08. Combined use of awake surgery and intraoperative MRI augments extent of resection in eloquent gliomas without neurological impairment
Authors: Christine Jungk, Philip Dao Trong, Christoph Eisner, Stefan Haehnel, Andreas Unterberg
Journal: Neuro-Oncology (2021)

Abstract Maximizing the extent of resection (EOR) while preserving functional integrity is a mainstay of glioma surgery. Intraoperative MRI (iMRI) helps to augment the EOR. However, in eloquently located gliomas the significance of iMRI is controversial since the EOR is limited by functional rather than image-based boundaries. Thus, we sought to determine the impact of iMRI in our institutional series of awake glioma resections within or adjacent to eloquent (language, motor, sensory) areas since the implementation of a 1.5 Tesla iMRI in 2009. Tumor- and procedure-related data and functional outcome were assessed through medical charts review. The EOR was determined volumetrically on pre-, intra- and postoperative T1 contrast-enhanced (CE) and FLAIR MR images. 131 of 166 awake surgeries (79%) were performed under iMRI-guidance with concurrent language (n=72) and/or motor (n=50) mapping. iMRI was done when functional boundaries were reached (62%), for resection control (28%) or for other reasons (10%). Additional resection after iMRI (AR) was performed in 63 cases (73%); otherwise resection was terminated because the targeted EOR or functional boundaries were reached. New or deteriorated neurological deficits occurred in 20 patients prior and 15 patients post iMRI; however, all but 3 resolved within 6 months. Median EOR significantly increased after AR from 92.6% to 98.4% (∆5.8%; p&amp;lt;0.0001) in CE tumors and from 64.5% to 85.8% (∆21.3%; p&amp;lt;0.0001) in non-enhancing tumors. Remarkably, the reason to perform iMRI (resection control or functional limitations), did not affect the frequency of AR, deficits acquired post iMRI or the increase in EOR after AR. In conclusion, iMRI is a valuable adjunct to maximize the EOR in awake glioma resections without increasing the risk for functional impairment, particularly in non-enhancing tumors. Importantly, iMRI contributes to a maximized EOR even in cases where the resection had to be stopped because functional boundaries were reached.
Abstract 11742: Knowledge on Anticoagulation Use in Atrial Fibrillation With Left Atrial Appendage Thrombus Among Medicine Residents
Authors: Milos Brankovic, Nebojsa Markovic, Markovic Nikolina, Hyoeun Kim, Emad Aziz
Journal: Circulation (2021)

Introduction: Left atrial appendage (LAA) thrombus increases thromboembolic risk in patients with atrial fibrillation (AF). Importantly, 40% of LAA thrombus patients will have an inadequate response to anticoagulation during follow-up. Of note, these patients are frequently followed by medicine residents in the clinic. Therefore, we aimed to explore residents' knowledge on anticoagulation use for the treatment of LAA thrombus. Hypothesis: Insufficient knowledge on anticoagulation for the treatment of LAA thrombus could contribute to inadequate treatment response during patients' follow-up. Methods: All medicine residents (n=96) at Rutgers University New Jersey Medical School were emailed a 26-question survey on the indication, dosing, pharmacokinetics and clinical experience using direct oral anticoagulants (DOACs) and vitamin-K-antagonists (VKA) in AF patients with LAA thrombus. Results: Of 62 responders, 42 (68%) have been prescribing DOACs in the clinic with apixaban being most commonly prescribed. Thirty-seven (61%) indicated DOACs as the first-line agents for LAA thrombus whereas 24 (39%) chose VKA. Nineteen (33%) responders indicated apixaban dosing correctly, and 51 (84%) indicated appropriately relation of apixaban with meals. If follow-up imaging reconfirmed LAA thrombus, 54 (89%) would switch to VKA whereas 7 (11%) would use other DOACs. Nineteen (32%) responders indicated rivaroxaban dosing correctly and only 10 (16%) indicated appropriately how to administer rivaroxaban with meals. If follow-up imaging reconfirmed LAA thrombus, 43 (71%) would switch to VKA whereas 18 (29%) would use other DOACs. Forty-one (72%) responders indicated dabigatran dosing correctly and 36 (58%) indicated no relation to food intake. If follow-up imaging reconfirmed LAA thrombus, 40 (65%) responders would switch to VKA whereas 22 (35%) would use other DOACs. For VKA, 51 (88%) indicated therapeutic INR range of 2-3 and 7 (12%) chose 2.5-3.5. If follow-up imaging reconfirmed LAA thrombus, 38 (61%) would increase INR goal whereas 24 (39%) would switch to DOACs. Conclusions: This survey identified knowledge gaps in dosing and pharmacokinetics of DOACs among medicine residents despite being more likely to prescribe DOACs over VKA to treat LAA thrombus.
NCOG-20. LONGITUDINAL ASSESSMENT OF SUBJECTIVE COGNITIVE FUNCTION IN ADULTS WITH LOW GRADE GLIOMA TREATED WITH PROTON RADIATION THERAPY
Authors: Giuliana Zarrella, Michael Parsons, Janet Sherman, Jorg Dietrich, Helen Shih
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION Our group previously demonstrated stability in neurocognitive function (NCF) over a 5-year period after proton radiation therapy (PRT) in low grade glioma (LGG) patients. Subjective cognitive function (SCF) had not been previously explored, nor had individual analyses of cognition, which can detect variability in trajectory. We used the newly derived Functional Assessment of Cancer Therapy-Brain Cognitive-Index (FACT-Br-CI) to examine SCF in LGG patients after PRT and compare longitudinal changes in SCF and NCF. METHODS 20 LGG patients (M age =37.5) treated with PRT completed NCF tests and self-report measures annually for 5 years or until tumor progression. Group change in SCF was examined with paired t-test (baseline vs final FACT-Br-CI). Individual change scores were calculated for FACT-Br-CI and NCF tests (clinical trials battery composite; CTBC). Individual deterioration in NCF was defined by reliable change index (RCI) on CTBC, and in SCF was defined as decline of &amp;gt;/=1 SD in FACT-Br-CI. Relationships between change in SCF and NCF were explored with correlations. RESULTS At the group level, no change was observed in FACT-Br-CI between baseline and last follow-up (t(19)=-.91;p=ns). Individual SCF analyses at last follow-up found the number of patients reporting decline=3 (15%), improvement=5 (25%), and no change=12 (60%). Individual changes were observed in SCF in 20% of patients at 3 months, 5.9% at 6 months, 12.5% at 12 months, 13.3% at 24 months, and 11.1% at 36 months. Median time to any deterioration in SCF was 36 months and for NCF was not reached. Correlation between CTBC and FACT-Br-CI change scores did not reach statistical significance (r=.41;p=ns). CONCLUSION Consistent with previous research, group analyses of LGG patients did not show cognitive decline after PRT. However individual analyses of SCF showed variability within the group: some patients experienced cognitive decline during follow up. Consideration of individual differences may yield additional information.
Abstract 12774: Effects of Interleukin-1β on Cardiac Reserve and Exercise Capacity in the Mouse
Authors: Habeebah Z Vohra, Eleonora MEZZAROMA, Antonio Abbate, Stefano Toldo
Journal: Circulation (2021)

Introduction: Heart failure (HF) is characterized by dyspnea, fatigue, and exercise intolerance. Clinical evidence points to increased interleukin-1β (IL-1β) activity in patients with HF, with IL-1 blockade improving the exercise capacity in HF patients. In healthy mice, recombinant-mouse IL-1β (rmIL-1β) induces acute systolic dysfunction, peaking 4 hours after administration. However, the direct effects of rmIL-1β on exercise capacity are unknown. Hypothesis: rmIL-1β diminishes the exercise capacity in the mouse. Methods: Adult mice were trained to run on a treadmill and exercise capacity was assessed before, 4, and 96 hours after intraperitoneal rmIL-1β (3 μg/kg) or vehicle (0.9% NaCl) administration (N=7-10/group). In separate groups of mice, left ventricular ejection fraction (LVEF) was assessed at baseline, 4, and 96 hours after stimulation using transthoracic echocardiography. The ultrasound operator was blind to treatments. The cardiac reserve was measured by calculating the difference in LVEF before and after β-adrenergic stimulation using isoproterenol (10 ng/mouse) in IL-1β or vehicle-treated mice (N=5-11/group). Results: Treatment with rmIL-1β significantly reduced exercise capacity measured at 4 and 96 hours (32% reduction at 4 hours and 33% reduction at 96 hours, P&lt;0.01 vs baseline for both time points), whereas no effect was observed in the vehicle-treated group (P&lt;0.05 for IL-1β vs vehicle). LVEF was significantly reduced 4 hours after treatment with rmIL-1β (29% reduction, P&lt;0.01 vs baseline at 4 hours), without any significant changes after vehicle. After 96 hours, LVEF had recovered to pre-treatment values. Cardiac reserve was significantly reduced at 4 and at 96 hours after IL-1β group (7% LVEF change at 4 hours and 2% at 96 hours P&lt;0.05 vs baseline for both time points) and not after vehicle (P&lt;0.05 for IL-1β vs vehicle). Conclusions: Administration of exogenous IL-1β reduces exercise capacity through an impairment in cardiac reserve.
Abstract 11494: Patient Characteristics, Management and Outcomes of Acute Heart Failure Hospitalizations in Japan
Authors: Jung Hyun Kim, Jenny Jiang, Sophie Shen, Anuj Chaudhary, Soko Setoguchi
Journal: Circulation (2021)

Introduction: In Japan, the prevalence of heart failure (HF) was approximately 0.8% in 2005 and is projected to increase. Yet, studies of real-world HF patients are limited. Thus, using a large multi-institutional database, we described in-hospital management and outcome of acute HF hospitalizations. Methods: We conducted a retrospective cohort study of adult patients (age ≥18) using the Medical Data Vision (MDV) database in Japan. MDV consists of ~ 35million medical records from &gt; 400 hospitals across all regions in Japan providing data on diagnosis, procedures, pharmacy claims, and laboratory data. Acute HF hospitalizations were defined as primary HF diagnoses + use of intravenous diuretics within 48 hours. We described patient characteristics, in-hospital management, length of stay (LOS), in-hospital death, and 30-day all-cause readmissions. We included published results from AHA’s Get With The Guidelines (GWTG)-HF for benchmarking. Results: Table includes results from 120,921 hospitalizations in Japan and GWTG-HF publications. Mean age was higher but weight and BMI were lower in Japan. Laboratory values were similar but Hemoglobin A1c, B-type natriuretic peptide, and creatinine levels were lower in Japan. Mean LOS was 24 in Japan vs.4 in the US but 44% had cardiac rehab during hospitalization. In-hospital mortality was &gt; 3 times higher but the 30-day readmission rate was lower in Japan. Conclusion: In a large multi-institutional real-world data of acute HF hospitalizations, compared to published US GWTG-HF data, Japanese patients were older but had less comorbidities. They had longer LOS and lower readmission rates. While hospital death was higher in Japan, this is not directly comparable to the US data due to the large LOS difference. Further studies to understand the reasons for the population and practice differences may generate hypotheses for potential interventions to improve HF outcomes.
Abstract 12598: Association Between Insurance Type, Clinical Characteristics, and Healthcare Use in Adults With Congenital Heart Disease
Authors: Evan F Shalen, Lidija B McGrath, Katrina Ramsey, Abigail Khan
Journal: Circulation (2021)

Introduction: Adults with congenital heart disease (CHD) represent a heterogeneous and growing population with high healthcare utilization. We sought to understand the association between insurance type, healthcare use, and outcomes among adults with CHD in Oregon. Methods: The Oregon All Payers All Claims database from 2010-2017 was queried for adults aged 18-65 in 2014 with ICD-9 or 10 codes consistent with CHD; patient demographics, comorbidities, healthcare use, and disease severity were identified. Insurance type was categorized as either public (Medicare and Medicaid) or private (commercial or self-pay). Descriptive statistics were used to compare groups. Use rates and odds ratios were calculated representing probability of at least one event per person-year using logistic regression with clustering on patients. Results: Of 12,978 adults with CHD, 53% were privately insured. More publicly insured patients had moderate-severe anatomic complexity (29.5% vs 22.9%; p &lt; 0.0001), drug and alcohol use (22.4% vs 4.9%; p &lt; 0.0001), and mental health diagnoses (66.6% vs 50.7%; p &lt; 0.0001). They were more likely to reside in a rural area (24.7% vs 16.0%; p &lt; 0.0001), and less likely to be within an hour of an adult congenital heart disease center (46.7% vs 57%; p &lt; 0.0001). Adjusted for age and CHD diagnosis, publicly insured patients were more likely to use ambulatory (aOR 1.71; 99% CI 1.60, 1.83), emergency (aOR 3.44; 99% CI 3.22, 3.69), and inpatient (aOR 2.63; 99% CI 2.42, 2.85) care ( Table ). Differences in use were more pronounced among patients with higher anatomic complexity. Conclusions: Our study shows that publicly insured adults with CHD in Oregon have more anatomically complex disease, more comorbidities, and higher healthcare use despite controlling for CHD diagnosis. Adults with CHD with public insurance represent a population that may benefit from targeted interventions addressing social determinants of health to improve outcomes and decrease healthcare use.
Abstract 8880: Utility of Telemedicine 3d Transesophageal Echocardiography in Interventional Procedures in Covid-19 Pandemic and Its Impact on Physician Learning
Authors: Lisa Le, Jesse Aguilar, Tracy Hill, Carlie Brewer, Cesar Gonzalez de Alba, Richard Friesen, Benjamin S Frank, Dale Burkett, Pei-ni Jone
Journal: Circulation (2021)

Background: Three-dimensional transesophageal echocardiography (3DTEE) is a diagnostic tool in cardiac procedures, but COVID-19 has made utility challenging. Training junior (JR) attendings and fellows in 3DTEE guidance cases in procedural rooms make it tough to maintain adequate social distance. Collaboration Live (CL) is an application on the ultrasound machine that allows for live communication and access to real time images with a remote user. The study aims were to assess the usefulness of CL during 3DTEE guided procedures and its impact on physician learning. Methods: 3DTEE was obtained in 8 cohorts ranging 4 - 52 years of age on the EPIQ ultrasound machine. CL was used in transcatheter atrial/ventricular septal defect closures, transvenous pacemaker lead placement, and Fontan fenestration closure. 3DTEE was directed by a senior (SR) 3D attending over CL at a remote workstation while a JR attending, cardiac fellow, and echocardiographer performed 3DTEE in the procedural room. A CL post survey was given . Wait time from received page to the start of TEE, TEE duration, fluoroscopy time, absorbed X-ray dose, and saved amount of personal protective equipment (PPE) was noted. Results: A JR attending was in 8/8 cases. CL decreased reliance on SR attending and improved independence in 86% of cases, and no change in 14%. A fellow was in 6/8 cases. CL decreased reliance on SR 3D attending and increased independence in 67% of cases, and no change in 33%. A SR attending was remotely present in all cases. CL allowed flexibility for SR attending in 89% of cases and no flexibility in 11%. Preferred learning skill, comfort performing/giving results over CL, learning/teaching impact, remote user wait time, reduced radiation exposure, and saved amount of PPE are shown in Table 1. Conclusions: CL is valuable in 3DTEE guidance procedures. It increases cost savings by reducing PPE and promotes learner independence. CL allows flexibility and reduces radiation exposure for remote users.
Abstract P421: Analysis Of The Functional Relevance Of Human Beta-myosin Heavy Chain Post-translational Modifications
Authors: Maicon Landim-Vieira, Matthew C Childers, Amanda Wacker, Michelle C Rodriguez Garcia, Rakesh Singh, Bryan Whitson, Elizabeth Brundage, Paul M Janssen, P B Chase, Brandon Biesiadecki, Michael Regnier, J Renato Pinto, Michelle S Parvatiyar
Journal: Circulation Research (2021)

Sarcomeric proteins have been shown to be a target of post-translational modifications (PTMs). Phosphorylation and acetylation of several sarcomeric proteins have been reported to be important for fine-tuning of myocardial contractility. Given the emerging importance of understanding the potential role of PTMs on cardiac muscle performance in healthy and diseased states, we sought to identify novel PTMs on human cardiac beta-myosin heavy chain (beta-MHC). We found several high confidence beta-MHC peptides modified by K-acetylation and S- and T-phosphorylation found in non-diseased, ischemic, and non-ischemic human heart samples. Using bottom-up proteomics and label-free quantification, we identified seven high-confidence peptides (K34, K58, S210, T215, K429, K951, K1195) with K951 displaying significant reduction in acetylation levels in both ischemic and non-ischemic failing hearts compared to donor hearts. Molecular dynamics simulations were performed to better understand the functional significance of the beta-MHC PTMs. Focus was placed on modifications in the regions with greatest potential functional significance as well as modified residues with significantly altered abundance in diseased states (K951-Ac at the myosin tail nearby a binding site for myosin heads in the super-relaxed state). K951 is located in the myosin tail (S2) at the C-terminal end of simulated structure. In both unmodified and modified simulations, the tail fragment showed significant flexibility and partial unfolding at the C-terminus. In the unmodified simulations, the inter- and intra-helical contacts were maintained. However, when beta-MHC is acetylated at residue 951, these helical contacts were altered as the uncharged acetylated residue no longer formed strong hydrogen bonds with a residue of the opposite chain. This facilitated changes increase in inter-helical contacts, an increase in inter-helical distance, and disruption of the coiled-coil tail domain structure. Our study suggests that there are distinct differences in beta-MHC acetylation levels that appear to be influenced more by location of the modified residues than the type of heart disease (ischemic- and non-ischemic heart failure). Additionally, we speculate that these PTMs have the potential to modulate the interactions between beta-MHC and other regulatory sarcomeric proteins, as well as ADP-release rate of myosin, flexibility of S2 fragment, and cardiac myofilament contractility under normal and heart failure condition.
NCOG-12. COGNITIVE FUNCTION (CF) &amp; QUALITY OF LIFE (QOL) IN PATIENTS TREATED WITH PROCARBAZINE, CCNU, &amp; VINCRISTINE (PCV) + RADIOTHERAPY (RT) VS. RT FOR ANAPLASTIC OLIGODENDROGLIOMA (AO) ON NRG RTOG TRIAL 9402
Authors: Laura Donovan, Minhee Won, J Gregory Cairncross, Fabio Iwamoto, Jan Buckner, Karen Fink, Jean-Paul Bahary, Alan Hartford, Luis Souhami, Timothy Nguyen, Terrence Cescon, Mark Mishra, Igor Barani, Anthony Pu, Wilson Roa, Jiayi Huang, Mei Polley, Minesh Mehta
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND PCV+RT substantially prolongs survival in AO patients, but long-term CF and QOL implications are unclear. We compared CF and QOL by treatment arm in RTOG 9402 participants and evaluated the impact that baseline characteristics had on CF, QOL, and survival. METHODS CF and QOL were evaluated using the Mini Mental State Exam (MMSE) and Brain-Quality of Life (B-QOL) scale at baseline and annually. Scores were analyzed between treatment arms at each time point for patients with ≥ 10 years of follow-up data. Shared parameter models evaluated MMSE and B-QOL scores and survival for all patients. RESULTS 42/148 (28.4%) participants in PCV+RT and 20/143 (14%) in RT alone arms survived ≥ 10 years. 35/42 and 39/42 (PCV+RT) and 18/20 and 17/20 (RT) participants completed baseline B-QOL and MMSE assessments, respectively. B-QOL scores did not differ between treatment groups at any time-point. Among 16 patients (10 PCV+RT, 6 RT) who completed year 10 MMSE evaluations, mean MMSE score at 10 years was higher in the RT arm (29.83 [95% CI 22.1, 30.0] vs. 26.50 [95% CI 29.4, 30.0], P= 0.04). Change in MMSE and B-QOL scores from baseline did not differ significantly between treatment groups at any time. In shared parameter models including all patients with baseline assessments, MMSE and B-QOL scores decreased over time (MMSE P= 0.0189, B-QOL P= 0.0005), but this did not differ by treatment group (MMSE P= 0.5727, B-QOL P= 0.3592). Younger age and higher KPS predicted better scores (MMSE P &amp;lt; 0.0001, P = 0.0002; B-QOL P = 0.0043, P = 0.0007). PCV+RT predicted better survival in both models. CONCLUSIONS PCV+RT improves survival in AO. Shared parameter models show decrease in MMSE and B-QOL over time. However, relative to RT alone, the addition of PCV did not impact change in CF and QOL over time.