tbuckley/cabot-search huggingface dataset:
Abstract 16813: The Prevalence and Predictors of Pacing-Induced Cardiomyopathy (PICM) in Younger Patients
Authors: Dan L Li, Zachary Yoneda, Tariq Z Issa, Jay A Montgomery, Ben B Shoemaker
Journal: Circulation (2020)

Background: Pacing-induced cardiomyopathy (PICM) has been increasingly recognized as a cause of heart failure in patients with pacemakers. Thus far, clinical trials and observational studies of PICM have largely included elderly patients with mean age &gt; 70 years. The prevalence and predictors of PICM in younger patients (age ≤ 59 years) after pacemaker implantation are not known. Methods: We retrospectively studied the prevalence and predictors of PICM in younger adults (18-59 years) who received single ventricular chamber or dual chamber pacemakers at Vanderbilt University Medical Center from 1986-2015. Patients without documented ventricular pacing burden, and patients with baseline left ventricular ejection fraction (LVEF) &lt; 30% were excluded. PICM was defined as LVEF drop of ≥ 10% and LVEF &lt; 50% during follow up in the setting of significant right ventricular pacing (≥ 20%), without alternative explanations for cardiomyopathy. Univariate and multivariable Cox proportional hazards regression models were utilized to study the factors associated with hazard of developing PICM. Results: A total of 325 patients were included in the study. 182 patients had high ventricular pacing (≥ 20%), which was associated with pre-existing atrial fibrillation (AF) and reduced baseline LVEF in addition to atrioventricular block (AVB) in the multivariate analysis. During the median follow up duration of 11.5 (Interquartile range 7 - 17) years, 38 patients (11.7%) developed PICM (1.3 per 100 patient-year). The median time to the development of PICM was 5 (Interquartile range 2 - 10) years. Older age (HR 2.5 for age ≥ 50 years, P = 0.013), reduced baseline LVEF (HR 2.4, P = 0.022), and AVB (HR 2.7, P = 0.007) were associated with an increased risk of PICM in the multivariate analysis. Furthermore, pre-existing AF was associated with an increased risk of PICM in patients without pre-implant AVB (HR 8.8 compared to the absence of both AF and AVB, P = 0.039). Conclusion: The incidence of PICM in young patients was low in this cohort of younger patients. Older age, baseline reduced LVEF, and AVB were associated with an increased risk of PICM in the young patient cohort. AF was associated with an increased risk of PICM in a subset of patients without pre-existing AVB at implant.
Abstract 9041: Cost Effective Risk Assessment of Asymptomatic Wolff Parkinson White Syndrome Patients
Authors: Christopher Snyder, Joan Steinberg
Journal: Circulation (2012)

Background: Asymptomatic ventricular pre-excitation (aVPE) is a conduction abnormality that may result in sudden death resulting from rapid conduction down the accessory pathway during atrial fibrillation (AFib). The purpose of this study was to identify the most cost effective approach to risk assessing aVPE patients. Methods: A cost effectiveness analysis was performed using a decision tree model (TreeAge Pro software) comparing aVPE patients undergoing a transvenous electrophysiology study (TVEPS) vs. step wise risk assessment consisting of exercise stress test(EST), transesophageal electrophysiology study (TEEPS) and TVEPS if risk could not be determined. A TEEPS followed EST when VPE did not disappear in a single beat and TVEPS followed TEEPS when not effective inducing Afib or was risky (shortest preexcited RR interval &lt; 250 msc). Efficacy of EST was 15% and the ability of TEEPS at inducing Afib was 88%; with 78% having no risk (published results.) Sensitivity analysis investigated the impact of changes in the efficacy assumption on the cost effectiveness results. Costs were 2009 Medicare reimbursement rates with cost of EST $ 277, TEEPS $990, and TVEPS $4035. Results: The step wise approach involving EST, TEEPS and TVEPS when necessary is the most cost-effective method of identifying aVPE patients at risk with an expected cost of $2,174 compared to $4,035 for those initially undergoing TVEPS. Combining efficacy and cost data on these patients, this approach (EST- TEEPS - TVEPS) results in an average savings of $1,861 per patient. This step wise approach remained cost effective as long as TEEPS efficacy rate is &gt; 31% on patients not screened out at EST. Conclusions: This step wise approach (EST-TEEPS-TVEPS) is the most cost effective way to risk assessment of aVPE patient. This approach yields an average savings of $1,861 per patient.
Interventions to reduce infections caused by multidrug resistant Enterobacteriaceae (MDR-E): A systematic review and meta-analysis
Authors: Heyam Atamna-Mawassi, Maayan Huberman-Samuel, Shimrit hershcovitz, Nitzan Karny-Epstein, Axel Kola, Luis Eduardo López Cortés, Leonard Leibovici, Dafna Yahav
Journal: Journal of Infection (2021)
Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum
Authors: Robert F. Krueger, Kelsey A. Hobbs, Christopher C. Conway, Danielle M. Dick, Michael N. Dretsch, Nicholas R. Eaton, Miriam K. Forbes, Kelsie T. Forbush, Katherine M. Keyes, Robert D. Latzman, Giorgia Michelini, Christopher J. Patrick, Martin Sellbom, Tim Slade, Susan C. South, Matthew Sunderland, Jennifer Tackett, Irwin Waldman, Monika A. Waszczuk, Aidan G.C. Wright, David H. Zald, David Watson, Roman Kotov
Journal: World Psychiatry (2021)

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within dis­orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.
Abstract 17331: Elevated Troponin Levels Predict Major Adverse Cardiovascular Outcomes and Mortality in COVID-19 Patients
Authors: Chirag Patel, Farukh Ikram, Nicholas Nguyen, Hao Nguyen, Priyanka Acharya, Manavjot S Sidhu
Journal: Circulation (2020)

Introduction: Measurement of cardiac biomarkers such as troponin-I (TnI) are useful in assessing for the presence of cardiovascular events. Chest pain is often not a presenting complaint of COVID-19 patients, yet there have been many cases of patients experiencing possible cardiovascular complications. We sought to examine the value of elevated TnI in predicting the occurrence of major adverse cardiovascular events (MACE) and mortality in COVID-19 patients Methods: A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at our quaternary care hospital. Baseline characteristics and clinical outcomes of their disease course were identified. During the chart review, we documented the admission and peak TnI levels available in the medical record, and noted the occurrence of MACE (a composite of myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock requiring vasopressor support) or death. Data were analyzed using Pearson’s chi square test and logistic regression to adjust for age. Results: Of the 225 hospitalized patients, only 31(14.83%) complained of chest pain on admission. Among patients with elevated TnI, 49.15% had MACE/ Mortality, compared to 21% with non-elevated TnI. Patients with elevated TnI were nearly 4 times more likely to have MACE/Mortality than patients with non-elevated TnI (p = 0.0001; OR = 3.97; 95% CI [1.88, 8.41]). They were also 3.63 times more likely to have MACE alone (p &lt; 0.0001; OR = 3.63; 95% CI [1.70, 7.79]). Median peak TnI values were higher in patients who had a MACE compared to those who did not (0.0275 ng/mL [IQR 0.012-0.152] vs 0.012 ng/mL [IQR 0.012-0.152], p &lt;0.05). For every one-unit increase in peak TnI levels, the age-adjusted odds of having MACE increased by a factor of 4468.37 (95% CI [9.07 2200316.00]; p = 0.008). Conclusions: Based on our data, elevated troponin-I levels predict the occurrence of MACE in patients who are hospitalized with COVID-19. Furthermore, there is an association between elevated troponin-I and eventual MACE, mortality, or both. This suggests that checking troponin-I levels in COVID-19 patients holds prognostic value, irrespective of the presence of chest pain as a presenting complaint.
Abstract 21217: Cardiovascular Impact of Obesity Epidemic on Children with Congenital Heart Disease
Authors: David I Crowley, Philip R Khoury, Holly M Ippisch, Elaine M Urbina, Thomas R Kimball
Journal: Circulation (2010)

The prevalence of overweight and obese children has tripled in one generation's time; 31.9% of US children and adolescents are overweight. Higher body mass index (BMI) is associated with higher lef...
Caloric Restriction Enhances Cardiomyocyte Autophagy via AMPK and ULK1 Pathways to Ameliorate Postinfarction Cardiac Remodeling
Authors: Watanabe Takatomo, Takemura Genzo, Kanamori Hiromitsu, Tsujimoto Akiko, Gotou Kazuko, Ogino Atsushi, Morishita Kentaro, Fujiwara Hisayoshi, Fujiwara Takako, Mikami Atsushi, Minatoguchi Shinya
Journal: Circulation (2013)
Abstract 15645: The Prognostic Impact of Left and Right Atrial Segmental Strain Analysis in Cardiac Amyloidosis Patients
Authors: Yuko Soyama, Kathleen Zhang, Peter Huntjens, Maria Karmpalioti, Daniel Lenihan, John Gorcsan
Journal: Circulation (2020)

Introduction: Little is known about global and segmental atrial function in cardiac amyloidosis. Atrial function plays an important role to maintain adequate ventricular filling. Hypothesis: We hypothesized left atrial (LA) and right atrial (RA) segmental strain analysis is prognostic in patients with cardiac amyloidosis. Methods: We studied 121 patients with biopsy-proven cardiac amyloidosis and speckle-tracking strain echocardiography. The LA and RA were divided into 6 segments each (basal, mid, and apical segments of free wall and septum). We determined LA and RA free wall/septal wall peak strain ratios. The primary outcome was all-cause mortality (median follow-up; 5.0 years). Results: Regional LA strain analysis was feasible in 104 patients (86%) and RA in 92 patients (76%). Average LA global peak strain was 18.3±12.1% and RA global peak strain was 20.0±15.0%. We compared LA and RA strain free wall and septal wall segments. Atrial septal strain was significantly reduced compared to free wall strain in RA (10.8±9.9 % vs 30.7± 23.8%, p&lt; 0.01). Free wall/septal wall strain ratio of LA was significantly reduced compared with the ratio of RA (p&lt; 0.01). During the follow up, 60 patients died. All atrial regions showed reduction in peak strain in non-survivors compared with survivors. When dividing patients into 2 groups using LA free wall strain and RA free wall strain median values, low atrial free wall strain was associated with worse prognosis (Log-rank p &lt; 0.001, HR 4.9, 95% CI= 2.6-9.3). Conclusions: LA and RA atrial strain have significant prognostic value in patients with cardiac amyloidosis. Free wall/septal wall strain ratio in LA was significantly reduced compared with RA. Assessment of atrial dysfunction has promise for clinical applications cardiac amyloidosis patients.
Abstract 12972: Serum-induced Expression of Brain Natriuretic Peptide Contributes to its Increase in Patients With HFpEF
Authors: Ryuji Okamoto, Ryotaro Hashizume, Noboru Suzuki, Hiroshi Kiyonari, Kaoru Dohi
Journal: Circulation (2020)

Introduction: Brain natriuretic peptide (BNP) levels are relatively higher in patients with heart failure with preserved ejection fraction (HFpEF) than heart failure with reduced ejection fraction (HFrEF); however, the mechanism remains unclear. BNP is induced by undetermined stretch-activated receptors including mechanically gated channels, which can be activated by a mechanical stimulus alone, and mechanically modulated channels, which require nonmechanical stimuli such as agonists. Thus it is possible that serum-induced expression of BNP may contribute to the increase of BNP in patients. Purpose: Our purpose is to examine whether serum-induced BNP expression (iBNP) partly contributes to the increase in BNP in patients with HFpEF. Methods: We generated the BNP reporter mice by knocking luciferase cDNA in the initiation site of NPPB . Neonatal cardiomyocytes were isolated and cultured from 2-day-old neonates. These cardiomyocytes were stimulated for 24 hours with 20% serum from patients with HFpEF or HFrEF (n=114 and 82, respectively) and the luciferase activity was examined as iBNP and the ratio of iBNP to BNP was measured. The patients’ characteristics and clinical parameters were compared and multivariate regression analysis was performed using SPSS version 25. Results: The mean ages were 71 yrs in HFpEF and 67 yrs in HFrEF. The female gender was higher in HFpEF (46% vs 32%). The prevalence of atrial fibrillation and hypertension and the use of calcium channel blocker (CCB) were higher in HFpEF than in HFrEF (31 vs 17%, 66 vs 43%, 28 vs 18%). The prevalence of coronary artery disease, chronic kidney disease and diabetes mellitus were lower in HFpEF than HFrEF (21 vs 42%, 44 vs 74%, 25 vs 44%). The ratio of iBNP to BNP was significantly higher in HFpEF than in HFrEF (26.9 vs 16.1, P&lt;0.001). Multivariate regression analysis showed the existence of HFpEF was an independent predictor for the ratio of iBNP to BNP after adjusting all other measurements (β=0.154, P=0.032). Age, hemoglobin, the use of CCB and the deceleration time were also independent predictors (β=0.167, P=0.025; β=0.203, P=0.006; β=0.138, P=0.049; β=0.143, P=0.049, respectively). Conclusions: These results indicate the elevation of BNP in patients with HFpEF is partly due to the iBNP from heart.
Abstract 16594: Clinical Outcomes in Digital Electrocardiography: Evaluation of Mortality in Atrial Fibrillation (Code Study)
Authors: Gabriela Paixao, Luis Gustavo Silva e Silva, Paulo Gomes, Milton Ferreira, Derick Oliveira, Manoel Ribeiro, Antonio Ribeiro, Jamil Nascimento, Gustavo Cardoso, Rodrigo Araujo, Bruno Santos, Jessica Canazart, Leonardo Ribeiro, Antonio Ribeiro
Journal: Circulation (2018)

Introduction: Telehealth system is an important tool to improve access and quality to health assistance.Large electrocardiogram (ECG) databases, linked to mortality or hospitalization data, can be useful in determining the prognostic value of ECG markers. Atrial fibrillation (AF) is a public health problem with increasing prevalence as the population ages, associated with cardiovascular mortality and morbidity. Hypothesis: Evaluate the association between the presence of AF with overall and cardiovascular mortality in a large electronic cohort of primary care patients of Minas Gerais. Methods: This is an observational retrospective study. Patients over 16 years old who performed digital electrocardiograms by Telehealth Network of Minas Gerais from 2013 to 2016 were assessed. A probabilistic linkage between data from the national mortality information system and our ECG database was made. Clinical data were self-reported, and ECGs were interpreted by a team of trained cardiologists and automatic software (Glasgow and Minnesota).The diagnosis of AF was considered if there was concordance between the cardiologist′s report and one of the automatic systems. In cases of disagreement, ECGs were reviewed manually.Only the first ECG made was analysed. To assess the relation between AF and mortality, Cox regression was used, adjusted by age, sex and clinical conditions. Results: From a dataset of 1,773,689 patients, 1,075,531 were included. The mean age was 51.4 years, 40.5% male.The prevalence of AF was 1.15%. There were 2.9% deaths for all causes in 2.69 years of mean follow up. In univariate analysis, AF was a risk factor for death from all causes (HR 6.98, 95%CI 6.68-7.28). After adjustment for age, sex and comorbidities, AF remained an independent risk factor for all-cause mortality (HR 2.49; 95% CI 2.39 - 2.61). AF was also a predictor of risk for cardiovascular mortality after adjustment for age, sex and clinical conditions (HR 2.35, 95% CI 2.01-2.73). In multivariate analysis by sex, adjusted for age and comorbidities, AF women had higher risk of death for all causes (HR 3.06; 95% CI 2.86-3.26) than men (HR 2.18; 95% CI 2.06-2.32). There were no difference between sex in cardiovascular mortality (HR 2.34; 95% CI 2.01-2.73 for male sex e HR 2.49; 95% CI 2.14-2.90 for female). Conclusions: AF was a strong predictor of mortality for all causes and cardiovascular mortality in primary care population with increased risk in women for deaths for all cause.
Evaluating the morphology of the degradation layer of pure magnesium via 3D imaging at resolutions below 40 nm
Authors: Berit Zeller-Plumhoff, Daniel Laipple, Hanna Slominska, Kamila Iskhakova, Elena Longo, Alexander Hermann, Silja Flenner, Imke Greving, Malte Storm, Regine Willumeit-Römer
Journal: Bioactive Materials (2021)

A C T Magnesium is attractive for the application as a temporary bone implant due to its inherent biodegradability, non-toxicity and suitable mechanical properties.The degradation process of magnesium in physiological environments is complex and is thought to be a diffusion-limited transport problem.We use a multi-scale imaging approach using micro computed tomography and transmission X-ray microscopy (TXM) at resolutions below 40 nm.Thus, we are able to evaluate the nanoporosity of the degradation layer and infer its impact on the degradation process of pure magnesium in two physiological solutions.Magnesium samples were degraded in simulated body fluid (SBF) or Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS) for one to four weeks.TXM reveals the three-dimensional interconnected pore network within the degradation layer for both solutions.The pore network morphology and degradation layer composition are similar for all samples.By contrast, the degradation layer thickness in samples degraded in SBF was significantly higher and more inhomogeneous than in DMEM+10%FBS.Distinct features could be observed within the degradation layer of samples degraded in SBF, suggesting the formation of microgalvanic cells, which are not present in samples degraded in DMEM+10%FBS.The results suggest that the nanoporosity of the degradation layer and the resulting ion diffusion processes therein have a limited influence on the overall degradation process.This indicates that the influence of organic components on the dampening of the degradation rate by the suppression of microgalvanic degradation is much greater in the present study.
Abstract 16239: Skeletal Muscle Mass Recovery Early After Left Ventricular Assist Device Implantation in Patients With Advanced Systolic Heart Failure
Authors: Amanda R Vest, Joronia Chery, Alexandra Coston, Laura Telfer, Matthew Lawrence, Abbey Haynes, Pascaline Karanja, Arnav Singla, Michael S Kiernan, Gregory Couper, Edward Saltzman
Journal: Circulation (2020)

Introduction: Patients with advanced systolic heart failure (HF) are at risk of unintentional weight loss and muscle wasting. It has been observed that left ventricular assist device (LVAD) recipients gain weight after device implantation, although it is unknown whether this represents skeletal muscle or fat mass gains. Hypothesis: We hypothesized that LVAD recipients would gain skeletal muscle mass during the first 6 months of LVAD support. Methods: We prospectively recruited 28 adults with systolic HF ±21 days from LVAD implantation. Participants underwent whole-body dual X-ray absorptiometry (DXA) to calculate fat free mass (FFM, representing all lean mass), appendicular lean mass (ALM, lean mass in the arms and legs) and fat mass (FM). DXA was repeated at 3 and 6 months after LVAD implantation (±14 days), with study participation ending after either the 6 month visit or heart transplantation, whichever occurred first. Paired t-testing and mixed effects models were used to evaluate changes over time each for FFM, ALM and FM. Results: The cohort was 86% (24/28) male, with mean age 56 ±12 years and mean BMI 26.6 ±5.5 kg/m 2 at baseline. The median Intermacs class was 2 and duration of HF 50 months. Per European Working Group on Sarcopenia in Older People (EWGSOP) criteria, 41% of participants had muscle wasting at baseline. There was a significant increase from baseline to 3 months and then 6 months of LVAD support for FFM (Fig 1A; baseline: 56.6 ±11.8 kg, n=27; 3 months: 57.9 ±11.3 kg, n=23; 6 months: 62.7 ±11.1 kg, n=17; p-value for change=0.025) and for ALM (Fig 1B; 22.2 ±5.6 kg; 23.2 ±5.0 kg; 25.4 ± 4.5 kg; p&lt;0.001). There was no increase in FM over the same period (p=0.36). Amongst 22 participants with comparison DXAs, 81% had a ≥5% ALM gain by either 3 or 6 months. Conclusions: Among patients with advanced systolic HF and a high baseline prevalence of muscle wasting, there was a significant gain in skeletal muscle mass, as represented by both FFM and ALM, over the first 6 months of LVAD support.