tbuckley/cabot-search huggingface dataset:
Abstract 16284: Patient Derived Endothelial Progenitor Cells as a Model to Unravel New Mechanisms of Coronary Artery Disease
Authors: Meghan Finemore, Christine Yu, Kristen J Bubb, Katherine Kott, Belinda Di Bartolo, Marie Besnier, Gemma A Figtree
Journal: Circulation (2020)

Introduction: Endothelial colony forming cells (ECFCs) are progenitor cells that can differentiate into mature endothelial cells. Ability to culture these cells from peripheral blood mononuclear cells (PBMCs) make them a suitable tool for investigation into individual susceptibility to coronary artery disease (CAD). We hypothesise that patient-derived ECFCs provide a model to study endothelial cell signalling in patients with CAD. Here we aim to identify biasing factors in spontaneous growth of ECFCs, and confirm whether they retain an “imprint” of patient disease burden. Methods: ECFCs were purified from patient samples in the BioHEART-CT biobank. Mitochondrial ROS assays (MitoSOX) were performed and protein lysate was collected to determine expression of redox signalling proteins by immunoblotting. CT coronary angiograms were analysed using Gensini scores to determine the burden of disease. Results: Spontaneous growth of ECFCs occurred in 178 of the 828 patients (21.50%). Spontaneous growth was lower in those with obesity (BMI ≥ 30: 15.7%, n = 30/191 vs BMI &lt; 30: 23.2%, n = 148/637, p = 0.03) and higher in hypertensive patients (25.4% n = 81/319 vs normotensive 19.1% n = 97/509, p = 0.03), although growth was not affected by presence of CAD (21.0% n = 59/281 vs CAD- 21.8% n = 119/547, p = 0.8). ECFCs expressed endothelial markers such as CD31 and eNOS, validating their differentiation into endothelial cells. However, ECFCs of patients with CAD expressed higher NADPH oxidase-2 protein level (1.9±0.4 fold-change vs CAD-, n = 13, p = 0.02) and were associated with higher mitochondrial superoxide production (Pearson correlation= 0.66, n = 18, p = 0.003). Conclusion: Spontaneous growth is affected by obesity and hypertension however the impact of this is reasonably small. The biochemical characteristics identified in these cells correlate with the patient’s disease state indicating that they are a helpful tool to further investigate individual susceptibility to CAD.
Older lives are valuable but not equal
Authors: Simon Kenwright
Journal: BMJ (2020)

Salisbury wants her older patients—at least those who have no problem with taking up her time—to leave with the feelgood factor.1 Elsewhere in The BMJ Kar mentions a need for patients to know resources are finite.2

Older people are unlikely to have paid for their care in full (through taxes) if we allow for increases in treatment costs and longer survival with …
Abstract 15393: Automatic Multi-structural Cardiac Segmentation of 2d Echocardiography With Convolutional Neural Networks
Authors: Xiaoyan Zhang, Joshua V Stough, Sushravya M Raghunath, Alvaro Ulloa Cerna, David vanMaanen, Brandon Fornwalt, Christopher M Haggerty
Journal: Circulation (2020)

Introduction: The use of convolutional neural networks (CNN) to automatically segment the heart from echocardiography images has garnered recent attention, but generalizable performance segmenting multiple cardiac structures has not been demonstrated. The objective of the present work was to develop a 2D CNN model to automatically and accurately segment the left ventricular (LV) endo- and epicardial and left atrial (LA) endocardial surfaces from an independent, external clinical dataset. Methods: A modified U-net CNN was trained using 10-fold cross-validation and augmentation within the published CAMUS echocardiography dataset to segment the LV and LA from apical 2- and 4-chamber images. For external validation, this model was applied to 3,087 echocardiograms from Geisinger for which the physician-reported LV ejection fraction (EF) was within 10% of the reported bi-plane EF, signifying confidence in quality of the underlying images. LV end-diastolic and end-systolic volumes (EDV, ESV), LA volume (LAV), and LV mass (LVM) were estimated using Simpson’s bi-plane summation. We compared performance against two published segmentation models. Results: Our model agreed well with clinically-reported values, based on small median absolute errors in percent of clinical measures (MAE; Table 1) and biases, and narrow limits of agreement (mean bias/coefficient of variation (%): LV EDV 10.3/10.6, ESV 6.3/13.1, EF 0.5/6.3, LVM 13.9/10.1, and LAV 3.1/9.5). Moreover, the observed MAE for each metric was within the previously reported limits of inter-observer variability for 2D echo. Compared to two previously published models, our model exhibited smaller MAE in all measures tested (Table 1). Conclusions: Our model exhibits accurate, generalizable performance in multi-structural echocardiography segmentation, with accuracy meeting or exceeding current leading models. Such models hold great promise for translational research and precision medicine efforts.
It's distributions all the way down!: Second order changes in statistical distributions also occur
Authors: Mark T. Keane, Aaron Gerow
Journal: Behavioral and Brain Sciences (2014)

Abstract The textual, big-data literature misses Bentley et al.’s message on distributions; it largely examines the first-order effects of how a single, signature distribution can predict population behaviour, neglecting second-order effects involving distributional shifts, either between signature distributions or within a given signature distribution. Indeed, Bentley et al. themselves under-emphasise the potential richness of the latter, within-distribution effects.
Abstract 14483: Association Between Four Selected Social Determinants of Health and Readmissions for Patients in the Grady Heart Failure Program, 2018-2019
Authors: Ashley Marshall, Jasmin Minaya-Junca, Rashon Lane, Kara Macleod, Diane Wirth, Anekwe Onwuanyi
Journal: Circulation (2020)

Introduction: African Americans have a higher prevalence of heart failure (HF) than white Americans due in part to social determinants of health (SDOH). The Grady Heart Failure Program (GHFP) at Grady Memorial Hospital (GMH) in Atlanta aims to reduce readmissions for primarily low income, underinsured, African American patients with congestive HF. The GHFP addresses barriers to access to care through a community health worker, mobile health visits, transportation support, and low-cost medication. This study examines whether four key SDOH variables from Healthy Planet, a population health module in GMH’s electronic medical record, are associated with readmissions for GHFP patients. Methods: We analyzed data on demographics (race, sex, ethnicity) and SDOH variables (homelessness, financial resource strain, inability to afford medications, and issues with transportation to medical appointments) from Healthy Planet linked to HF-related readmissions from the GHFP’s dashboard. A total of 420 patients in the GHFP were included in this analysis from May 2018-April 2019. We evaluated the relationship between SDOH variables and any HF-related readmission and any 30-day HF-related readmission within the 12-month study period using Fishers exact tests. Results: Of the 420 patients, 92% were non-Hispanic African American, 62% were male, and 22% were uninsured. In the year prior to their first GHFP consult, 22% experienced homelessness, 49% had financial resource strain, 30% were unable to buy needed medications, and 46% had difficulty with transportation to medical appointments. A total of 76 patients (18%) were readmitted (range 1-5 readmissions), and 26 (6.2%) were readmitted within 30 days (range 1-4 readmissions within 30 days) over 12 months. No SDOH variables were associated with any 30-day HF-related readmission. Transportation issues were associated with any HF-related readmission ( P =0.04). Conclusions: While the majority of GHFP patients experienced SDOH-related barriers to care, none were associated with any 30-day readmissions and only transportation issues were associated with any readmissions. Future studies and models will examine whether the GHFP’s efforts to address social needs have led to a decline in 30-day readmission rates.
Amyloid Fibril Formation of Immunoglobulin Light Chain Peptide from IHC-Negative AL Amyloidosis and Its Inhibition By Doxycycline and Epigallocatechin
Authors: Hiroyuki Hata, Toshiya Sugimoto, Mitsuharu Ueda, Nao Nishimura, Shinya Endo, Yutaka Okuno, Taro Yamashita, Konen Obayashi, Masayoshi Tasaki, Eri Fujii, Yuuki Inada, Misaki Kakoki, Yukio Ando
Journal: Blood (2017)
Real World Treatment Patterns and Survival in Patients with Multiple Myeloma (MM) in Taiwan
Authors: Hsin-An Hou, Chao-Hsiun Tang, Hung-Yi Liu, Hong Qiu, Sarah Siggins, Lee Anne Rothwell, Ya-Wen Yang, Sung-Nan Pei, Yongjing Zhang, Yanfang Liu
Journal: Blood (2017)
Helen Salisbury: Pandemic stress
Authors: Helen Salisbury
Journal: BMJ (2020)

England is now in a second lockdown, this time for four weeks. Some patients with the virus in our local hospital require ventilation, but at much lower numbers than reported in the north of England.1 At our surgery we’re bracing for the new wave of coronavirus patients, but it hasn’t yet arrived—perhaps because most of the recent cases are in young people, many of them students who have limited interactions with vulnerable adults.

I have no illusions that this will be anything other than a brief reprieve. Meanwhile, our mental health workload is growing. Patients are increasingly anxious—about their own health, or that …
Abstract 156: Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests
Authors: Robyn McDannold, Chengcheng Hu, Daniel W Spaite, Annemarie E Silver, Margaret Mullins, Terry Mullins, Vatsal Chikani, Gail Bradley, Joshua B Gaither, Amber D Rice, Bentley J Bobrow, Melody Glenn, Samuel M Keim, Bruce J Barnhart
Journal: Circulation (2020)

Background: Little is known about the ventilatory aspects of overdose-related OHCA (OD-OHCA). We compared maximum ETCO2 (mETCO2; each patient’s highest CO2 level) and mean for each recorded minute of CPR in OD-OHCA to that of respiratory (R-OHCA) and cardiac (C-OHCA) arrests. Methods: Continuous CO2 data (Zoll E/X series monitors) were obtained from 3 Arizona EMS agencies. Cases had at least 3 min of recorded CO2 during CPR. Arrests were classified as OD-OHCA by EMS and/or hospital documentation. Any drug OD was included (e.g., opioids, mixed). C-OHCA and R-OHCA cases were randomly chosen for comparison. The groups were compared using Fisher’s exact test or Chi-squared for categorical and Kruskal-Wallis for continuous variables. Results: Included were 263 subjects (37 OD-OHCA, 157 C-OHCA and 69 R-OHCA; median age 61, 64% male, 1/10-12/18) with 10,271 min of data [median resuscitation interval 37 min (IQR 29, 47)]. Mean ETCO2 (SD): OD-OHCA [41 mmHg (24)]; R-OHCA [40 (23)], C-OHCA [30 (13); p&lt;0.01]. Median mETCO2: OD-OHCA [57 mmHg (95CI: 50, 77)]; R-OHCA [61 (50, 73)], C-OHCA [48 (44, 50); p&lt;0.001; Fig 1]. While mean ETCO2 and mETCO2 were similar for OD-OHCA and R-OHCA, they were both significantly higher than C-OHCA (p&lt;0.01 for all comparisons). ETCO2 waveforms in OD-OHCA resembled the very high, full waveforms typical of R-OHCA while those in C-OHCA tended to be low and blunted. Conclusions: We believe this is the first report of continuous capnography during resuscitation of OD-OHCA. The mean ETCO2 and median of mETCO2 of OD-OHCA and R-OHCA imply similar physiology (hypoventilation and hypercapnia leading to arrest). Both etiologies had much higher ETCO2 values compared to C-OHCA, where low blood flow delivers minimal CO2 to the lungs and yields low, and morphologically different, waveforms. Future studies assessing OD arrest physiology and various approaches to resuscitation and pharmacological reversal are needed.
Abstract 17275: The SGLT2 Inhibitor Empagliflozin Ameliorates Left Atrial Dilatation in Non-Diabetic Patients With Heart Failure With Reduced Ejection Fraction: A Secondary Analysis of the EMPATROPISM Trial
Authors: Carlos G Santosgallego, Juan Antonio Requena-Ibanez, Ariana Vargas, Alvaro Garcia-Ropero, Anderly Rodriguez-Cordero, Sean Pinney, Donna M MANCINI, Anuradha Lala, Johanna P Contreras, Pedro R Moreno, Javier SANZ, Valentin Fuster, Juan J Badimon
Journal: Circulation (2020)

Background: SGLT2 inhibitors (SGLT2i) improve prognosis in HFrEF patients. We recently demonstrated in a porcine model of non-diabetic HFrEF that empagliflozin (EMPA) ameliorates adverse cardiac remodeling and improves LV systolic function. However, the effect of EMPA on left atrial (LA) dilatation has not yet been studied Hypothesis:: Empagliflozin ameliorates left atrial dilatation in non-diabetic HFrEF patients Methods: The EMPATROPISM clinical trial investigated the efficacy and safety of EMPA in non-diabetic HFrEF patients. 84 patients were randomized to EMPA 10mg daily for 6 months or placebo on top of optimal medical treatment, and were evaluated with cardiac magnetic resonance (CMR). LA Volumes were quantified by CMR using the Simpson method (the number of slices in the usual short axis SSFP cine sequence was increased to cover both LV and the whole of LA. The primary endpoint was change in LVEDV. Prespecified secondary endpoints were changes in maximal and minimal LA volumes (ΔMax LA Vol and ΔMin LA Vol) at the end of 6 months between both arms Results: 80 patients completed the follow up period. There were no differences at baseline in LVEDV (220±75 vs 209±68mL for EMPA vs placebo, p=0.5) or LVEF (36±8 vs 37±8%, p=0.7). There were no differences at baseline in both groups in either maximal or minimal LA volume (Table). In the primary endpoint, EMPA-treated patients showed decrease in LVEDV and increase in LVEF (ΔLVEDV -25±25 vs -1±25mL, p&lt;0.001; and ΔLVEF 6±4 vs 0±4%, p&lt;0.001 for EMPA vs placebo). EMPA-treated patients exhibited a reduction of both maximal LA volume (ΔMax LA Vol -16.2±17.8 vs 11.4±25.9mL for EMPA vs placebo, p&lt;0.001) and minimal LA volume (ΔMin LA Vol -11.3±13.3 vs 6.4±19.3mL for EMPA vs control, p&lt;0.001) Conclusions: In HFrEF patients without diabetes, treatment with empagliflozin ameliorates left atrial dilatation. As LA volume is a surrogate for chronic filling pressures, this reduced LA volume suggest improved diastolic function with EMPA
Abstract 13653: Physical Activity and Arterial Stiffness in Black Adults
Authors: Shabatun Islam, Nour Beydoun, Anurag Mehta, Jeong Hwan Kim, Yi-An Ko, Qingchun Jin, Peter Baltrus, Matthew L Topel, Chang Liu, Viola Vaccarino, Mario Sims, Kiran Ejaz, Charles D Searles, Sandra B Dunbar, Tene T Lewis, Herman A Taylor, Priscilla E Igho-Pemu, Arshed A Quyyumi
Journal: Circulation (2020)

Introduction: Arterial stiffness is a precursor for development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Blacks remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Blacks in two independent cohorts. Methods: In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 458 Black adults (age 53 ± 10, 39% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV) using applanation tonometry (Sphygmocor Inc). Total and domain specific physical activity (work, active living, household, and sport/exercise) were assessed by self-report using the Jackson Heart Study Physical Activity Questionnaire. Multiple linear regression models were used to investigate differences after adjusting for age, gender, blood pressure, diabetes, and smoking. Change in the Framingham Risk Score (FRS) was tested as a potential mediator. Findings were validated in the Emory-Morehouse Partnership to Reduce Cardiovascular Health Disparities (META-Health) --another independent cohort of Black adults (n=60, age 50 ± 10, 25% male). Results: Lower arterial stiffness was associated with higher self-reported levels of sport/exercise (Beta = -0.54 [-1.03, -0.05], p=0.03, highest versus lowest quartile), but not work, active living, household-related physical activities, or the overall physical activity scores. 26.9% of this improvement appeared to be mediated through changes in FRS factors. These findings were confirmed in an independent group of Blacks in META-Health where higher levels of sport/exercise remained associated with lower arterial stiffness (Beta = -1.46 [-2.80, -0.12], p=0.03, highest versus lowest quartile). Conclusion: Higher sport/exercise related physical activity is associated with lower arterial stiffness in Blacks, an association that is only partially attributable to a lower traditional CVD risk factor burden.
Immunostimulatory nanoparticle incorporating two immune agonists for the treatment of pancreatic tumors
Authors: M.E. Lorkowski, P.U. Atukorale, P.A. Bielecki, K.H. Tong, G. Covarrubias, Y. Zhang, G. Loutrianakis, T.J. Moon, A.R. Santulli, W.M. Becicka, E. Karathanasis
Journal: Journal of Controlled Release (2020)
Abstract 17172: Pre Ablation Voltage Mapping Can Alter VT Inducibility
Authors: Asad A Al Aboud, Travis Richardson, Oluwaseun G Adeola, Benjamin B HOLMES, McHugh Julia, Ikutaro Nakajima, Gregory Michaud, William G Stevenson, Arvindh KANAGASUNDRAM
Journal: Circulation (2020)

Introduction: VT inducibility is often used to assess the efficacy of VT ablation. Sinus rhythm voltage maps (VMs) are used to guide ablation of VT substrate, but catheter manipulation may mechanically traumatize critical sites, altering VT inducibility. We prospectively evaluated the effect of VM on VT inducibility. Methods: Twenty-nine patients (mean age 62, 70% ischemic cardiomyopathy) with planned VT ablation underwent initial programmed electric stimulation (PES). Fifteen patients then underwent VM followed by repeat PES and 14 patients underwent a waiting period with ICE imaging and transseptal puncture but no VM (imaging group) before repeat PES. Responses to repeat PES were categorized as type I if the same VT was induced, type II if a different VT was induced, and type III if no VT was inducible. Results: In the VM group, the same VT was inducible in 3 patients, a different VT in 9, and no VT in 3 patients (figure). In contrast, those in the imaging group had the same VT induced in 10 patients, a different VT in 3 and no VT in 1 patient. There was no difference in the number of extrastimuli needed to induce VT between the two PES in either group. VT cycle length in the VM group was shorter after mapping (295 vs 331ms), although this was not statistically significant. There was no difference between the groups in anesthesia method, time between initial and second PES, type of cardiomyopathy, or ejection fraction. Conclusions: The mechanical effects of VM can alter inducibility of VT independent of ablation. This may contribute to late recurrences of VT by preventing mapping of clinically relevant VT circuits, or falsely indicating effective ablation when PES is repeated only after ablation.
Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women
Authors: Harmony R. Reynolds, Akiko Maehara, Raymond Y. Kwong, Tara Sedlak, Jacqueline Saw, Nathaniel R. Smilowitz, Ehtisham Mahmud, Janet Wei, Kevin Marzo, Mitsuaki Matsumura, Ayako Seno, Anais Hausvater, Caitlin Giesler, Nisha Jhalani, Catalin Toma, Bryan Har, Dwithiya Thomas, Laxmi S. Mehta, Jeffrey Trost, Puja K. Mehta, Bina Ahmed, Kevin R. Bainey, Yuhe Xia, Binita Shah, Michael Attubato, Sripal Bangalore, Louai Razzouk, Ziad A. Ali, Noel Bairey Merz, Ki Park, Ellen Hada, Hua Zhong, Judith S. Hochman
Journal: Circulation (2020)

Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6% to 15% of myocardial infarctions (MIs) and disproportionately affects women. Scientific statements recommend multimodality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) imaging to assess mechanisms of MINOCA.
Abstract 13500: Association Between Breast Cancer and Cardiac Autonomic Function as Measured by Heart Rate Variability in the Women’s Health Initiative
Authors: Mary Branch, Christopher L Schaich, Daniel Beavers, Elsayed Z Soliman, Kerryn Reding, Aladdin Shadyab, Tochi M OKWUOSA, Gretchen L Wells, Celina Valencia, Ana Barac, Mara Vitolins
Journal: Circulation (2020)

Background: Autonomic dysfunction (AD) as measured by heart rate variability (HRV) is associated with increased risk of cardiovascular disease (CVD) and breast cancer. No study has utilized a large prospective multi-center cohort of diverse women to assess differences in HRV associated with incident breast cancer. Objectives: To identify heart rate variability changes in women with breast cancer compared to controls in the Women’s Health Initiative (WHI). Methods: In a retrospective cohort study, we utilized 5,031 women in the WHI CT cohort who were breast cancer free at baseline and compared 1) those with incident breast cancer v. 2) those who were breast cancer free during the ECG follow-up period as controls. HRV was calculated utilizing 10-second ECG with two measures of two-domain HRV: standard deviation of all normal-to-normal RR intervals (SDNN) and the root mean square of successive differences in normal-to-normal RR intervals (rMSSD). HRV was measured from ECGs collected at baseline, years 3, 6, and 9 in the comparison groups. An adjusted mixed linear model was used to evaluate the differences in SDNN and rMSSD comparing women with incident breast cancer to controls. Cardiovascular risk factors utilized in the adjusted model were determined via questionnaire at baseline. Results: At baseline, women with incident breast cancer diagnosed by years 3, 6, or 9 were significantly older (median age 63 vs. 61, P&lt;0.0001) and had a higher prevalence of hypertension (35% vs. 32%, P=0.02). SDNN at years 3 and 6 in women with breast cancer compared to controls was significantly lower (P=0.0002, P=0.03 respectively). As well, rMSSD was significantly lower at year 3 compared to controls (P&lt;0.0001) ( Figure 1 ). Conclusions: HRV as a measure of AD is significantly lower in women with incident breast cancer compared to women without breast cancer. Reduction in HRV is associated with CVD outcomes in the literature. Our study suggests HRV may predict CVD in breast cancer patients.