tbuckley/cabot-search huggingface dataset:
Abstract 15946: The Impact of COVID-19 on Blood Pressure Trends Utilizing a National Remote Monitoring Platform
Authors: Eric D Peterson, Roberta A James, Malcolm Barrett, Jennifer Schnieder, Bimal R Shah
Journal: Circulation (2020)

Background: The Shelter-in-place response to the COVID-19 pandemic has demonstrated the value of telemedicine and remote monitoring platforms like Livongo’s Home Blood Pressure Monitoring Program (HBMP) that utilizes a Bluetooth connected blood pressure cuff and access to coaches. The objective of this study was to understand the HBPM frequency and blood pressure trends during the pandemic for this high-risk group of people. Methods: Utilizing Livongo’s national repository of HBMP participants, we selected members with valid measurements between September 16, 2019 and June 15, 2020. The COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University was used to identify the first date a COVID-19 case was identified in each state and county. The top 9 counties with the highest cumulative COVID-19 cases were selected for further evaluation. Weekly national, regional, state, and county number of BP checks, mean SBP and DBP readings, and percentage of people with BP &gt;= 130/80, &gt;=140/90, and &gt;= 160/100 were evaluated. Results: There were 47,745 HBPM participants, age of 54 year, 47% female, mean baseline BP of 129/79. The national trend showed slight increases in SBP and DBP during March 2020 though BP monitoring frequencies seem unchanged. Figure 1 shows state SBP and DBP trends by region. Some of the variability in the states is due to top counties with cases. Cook County, IL had a mean (95% CI) SBP increase of 6.5 mmHg (7.8, 5.1) resulting in while New York City's mean SBP decresed to -1.4 mmHg (-0.1, -2.7). Conclusion: There is a lot of variation in regional trends on the impact of COVID-19 on BP, even for the 9 selected counties. Further study is required to understand the possible drivers of the trends, such as, medication adherence, exercise, and stress.
Abstract 313: Neuron-specific Enolase and S-100B Protein in Crebrospinal Fluid: A Study of Sequential Analysis in Cardiac Arrest Patients Who Underwent Target Temperature Management
Authors: Changshin Kang
Journal: Circulation (2020)

Background: Neuron-specific enolase (NSE) and S-100B protein have been reported that they are associated with neurological outcome in out-of-hospital cardiac arrest (OHCA) survivors. However, comparing the prognostic performance between NSE and S-100B obtained from cerebrospinal fluid (CSF) has not been assessed yet. Therefore, this study aimed to investigate the prognostic performance of NSE and S-100B obtained from CSF for poor neurological outcomes in OHCA survivors. Methods: This was a prospective single-centre observational study, conducted from November 2018 to February 2019. The CSF samples of NSE and S-100B were serially obtained until 72 h from immediate as possible from return of spontaneous circulation (ROSC), at 24 h interval (NSE i , 24,48,72 and S-100B i , 24,48,72 ). The area under curves (AUCs) were used to identify the sensitivities of two biomarkers for predicting poor neurologic outcomes. The primary outcome was the 3-months neurological outcomes. Results: We enrolled 35 patients (males, 28), and 16 subjects had a poor neurologic outcome. NSE and S-100B levels were significantly higher in the poor outcome group compared to the good outcome group at each time point. The AUCs of NSE and S-100B for poor neurological outcomes were 0.87 versus 0.95 at immediately, 0.96 versus 0.92 at 24 h, 0.99 versus 0.97, and 0.98 versus 0.97 at 72 h after ROSC, respectively. The sensitivities with 100% specificity of NSE and S-100B for poor neurological outcomes were 62.5 versus 33.3 at immediate, 73.3 versus 71.4 at 24 h, 92.9 versus 92.3 at 48 h, and 91.7 versus 88.9 at 72 h after ROSC, respectively. Conclusions: S-100B can be useful for early predicting the neurological outcomes of comatose OHCA patients within 24 hours from ROSC in spite of low sensitivity, whereas NSE need 24 hours at least for prognostication. Further prospective with large sample size in multicenter studies are needed to confirm out results.
Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes
Authors: Kershaw V. Patel, Judy L. Bahnson, Sarah A. Gaussoin, Karen C. Johnson, Xavier Pi-Sunyer, Ursula White, KayLoni L. Olson, Alain G. Bertoni, Dalane W. Kitzman, Jarett D. Berry, Ambarish Pandey
Journal: Circulation (2020)

Intentional weight loss is associated with lower risk of heart failure (HF) and atherosclerotic cardiovascular disease among patients with type 2 diabetes. However, the contribution of baseline measures and longitudinal changes in fat mass (FM), lean mass (LM), and waist circumference (WC) to the risk of HF and myocardial infarction (MI) in type 2 diabetes is not well established. Adults from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. FM and LM were predicted using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate the associations of baseline and longitudinal changes in FM, LM, and WC over 1- and 4-year follow-up with risk of overall HF, HF with preserved ejection fraction (EF; EF ≥50%), HF with reduced EF (EF <50%), and MI. Among 5103 participants, there were 257 incident HF events over 12.4 years of follow-up. Predicted and measured FM/LM were highly correlated (R2=0.87-0.90; n=1369). FM and LM decreased over 4-year follow-up with greater declines in the intensive lifestyle intervention arm. In adjusted analysis, baseline body composition measures were not significantly associated with HF risk. Decline in FM and WC, but not LM, over 1 year were each significantly associated with lower risk of overall HF (adjusted hazard ratio per 10% decrease in FM, 0.80 [95% CI, 0.68-0.95]; adjusted hazard ratio per 10% decrease in WC, 0.77 [95% CI, 0.62-0.95]). Decline in FM was significantly associated with lower risk of both HF subtypes. In contrast, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Similar patterns of association were observed for 4-year changes in body composition and HF risk. Longitudinal changes in body composition were not significantly associated with risk of MI. In adults with type 2 diabetes, a lifestyle intervention is associated with significant loss of FM and LM. Declines in FM and WC, but not LM, were each significantly associated with lower risk of HF but not MI. Furthermore, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
Abstract 14212: Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among Us Adults; Trends From 2008-2017, the Medical Expenditure Panel Survey
Authors: Victor Okunrintemi, Martin Tibuakuu, Salim S Virani, Laurence Sperling, Annabelle S Volgman, Martha Gulati, Leslie Cho, Thorsten M Leucker, Roger S Blumenthal, Erin D Michos
Journal: Circulation (2020)

Introduction: Although data up to 2016 suggests that mortality from cardiovascular disease (CVD) in the US appears to be on a decreasing trend, there is evidence of stagnation in progress among young adults, especially women. Sex differences in the trends for control of CVD risk factors have been described, but the temporal trends in the age at which CVD and its risk factors are diagnosed in the US, and whether there are sex-specific differences in these trends is unknown. Methods: We used the Medical Expenditure Panel Survey (MEPS) 2008-2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease (CHD) or stroke and reported the age at which these conditions were diagnosed were included. The trend in the age at diagnosis was calculated from the annual change overall and by sex, using a linear regression model. Results: There were 100,709 participants (50.2% women), representing 91.9 million US adults with the above disease conditions. The mean age at diagnosis of CVD risk factors has decreased over time, with steeper declines among women [(Hypercholesterolemia: women - annual decrease of 0.31 years, men-annual decrease of 0.24 years, all Ps&lt;0.001); (Hypertension: women - annual decrease of 0.23 years, men - annual decrease of 0.20 years, all Ps&lt;0.001); the annual decrease in the age at diagnosis for CHD was not statistically significant. For stroke, while the age at diagnosis decreased by 0.19 years annually for women (p=0.03), it increased by 0.22 years annually for men (p=0.02) Conclusion: The decreasing trend in the age at diagnosis for CVD and its risk factors in the US appears to be more pronounced among women. While earlier identification of CVD risk factors may provide an opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD at the earliest opportunity and sex-specific interventions may be needed.
Abstract 17158: Patient-Specific Analysis of Pre-Surgical Leaflet Deformations to Predict Outcomes of Surgical Repair for Ischemic Mitral Regurgitation
Authors: Harshita Narang, Bruno Rego, Amir Khalighi, Ahmed Aly, Alison Pouch, Robert Gorman, Joseph H Gorman, Michael Sacks
Journal: Circulation (2020)

Introduction: Ischemic mitral regurgitation (IMR) is a highly prevalent disorder, and current methods of repair have suboptimal rates of failure. Accounting for patient-specific variations in the pre-surgical deformation patterns of the mitral valve (MV) may allow for better prediction of post-surgical outcomes. Methods: Real-time 3D echocardiographic images of the MV were segmented to create geometric representations for 20 patients (10 with and 10 without IMR recurrence) immediately pre- and post-annuloplasty repair as well as for 5 healthy MVs. To build correspondence between the open and closed valve geometries in each state, we morphed the open state geometry to the closed state shape within a finite element framework. Metrics including directional in-plane strains, leaflet area, and orifice dimensions were then computed and compared between the valves with and without recurrent IMR. Results: We found that MVs with IMR had significantly lower magnitudes of compressive circumferential strain in the posterior leaflet and higher radial strains across the whole MV than MVs without IMR (Figure). Patients who would later exhibit MR recurrence were found to have significantly higher circumferential leaflet strain in the anterior commissure prior to surgery than those without recurrence (p = 0.0228). The recurrent MVs also had significantly larger leaflet areas and annuli than the non-recurrent MVs, and their annuli contracted less. Conclusions: Key characteristics of IMR including increased downward leaflet tethering, annular dilation, and reduced ability to contract were most pronounced in MVs with recurrent IMR, suggesting that valves with recurrence may be in a more progressed disease state pre-surgically or may have a different manifestation of the myocardial infarct. Such factors could be used to predict post-surgical IMR recurrence and improve surgical planning.
Abstract 15515: Cardiovascular Phenotyping of the APP23 Overexpressing Mouse Model of Alzheimer’s Disease Reveals Decreased Vascular Contractility
Authors: Jhana O Hendrickx, Sofie De Moudt, Debby Van Dam, Guido De Meyer, Paul Fransen
Journal: Circulation (2020)

Background and Aim: Alzheimer’s disease (AD), the most common form of dementia, is characterized by noticeable neuropsychiatric symptoms and cognitive decline. Increasing epidemiological and experimental evidence highlights the occurrence of cardiovascular (CV) disease in the progression of AD. Therefore, we aimed to investigate the cardiovascular phenotype of the APP23 +/- overexpressing mouse model (APP23 +/- ). Methods: The current study presents the CV characterization of APP23 +/- mice (male, n=10) compared to C57BL/6 (male, n=24) at 6 months of age, including in vivo analysis of blood pressure (BP, CODA), aortic pulse wave velocity (aPWV), and echocardiography (high-frequency echocardiography, VEVO2100). Serum corticosterone levels and vascular smooth muscle cell (VSMC) phenotypic markers were ascertained via ELISA and qPCR. Data are presented as mean ± SEM. Results: At 6 month of age, APP23 +/- mice experience a lower survival rate compared to C57BL/6 littermates (39% vs. 100%, p=0.001) and APP23 +/- mice showed increased corticosterone levels compared to C57BL/6 mice (13.39 ± 5.15 vs. 2.30 ± 2.52 μg/mL, p=0.0025). Peripheral BP was increased (systolic BP: 110 ± 5 vs. 99 ± 3 mmHg, p=0.045; diastolic BP: 81 ± 5 vs. 71 ± 3 mmHg, p=0.09) with unaltered pulse pressure. Echocardiography revealed no differences in systolic and diastolic heart function. In vivo arterial stiffness was elevated in APP23 +/- mice (aPWV: 4.08 ± 0.3 vs. 2.94 ± 0.1 m/s, p=0.0004). Vascular reactivity studies showed decreased (32 %) adrenoreceptor-dependent contractions of the thoracic aorta from APP23 +/- mice. Endothelial-dependent (acetylcholine) and -independent (diethylamine nonoate) relaxations were unaffected. Contractile VSMC markers remained unchanged. Conclusion: In conclusion, APP23 +/- mice present with high serum corticosterone levels, elevated pulse wave velocity and decreased vascular contractility.
Abstract 15876: Tie1 is Essential for Cardiac Repair and Myocardial Regeneration
Authors: Elena Rueda de Leon, kevin tompkins, xiaomin fu, Matthew R Bersi, Harold S Baldwin
Journal: Circulation (2020)

Introduction: Cardiac lymphatics are essential in resolving interstitial fluid and inflammatory infiltrate after a myocardial infarction in adults. Little is known about the role of the lymphatic system during neonatal cardiac regeneration following injury in the perinatal animal with an immature lymphatic system. Hypothesis: Our hypothesis is that TIE1, an endothelial specific receptor tyrosine kinase essential for lymphatic development in mice, is required for myocardial repair following infarction (MI) in both neonatal and adult mice. Methods: Using an inducible and lymphatic specific deletion model, Prox1Cre-ER T2 ;Tie1 fl/fl , both mutant and non-mutant control mice undergo myocardial MI with left anterior descending coronary ligation. Adult surgery is performed at 6-8 weeks of age. Conditional Tie1 deletion is induced by ingestion of tamoxifen enriched chow 48 hours prior to adult ligation and continued until dissection is performed; cardiac function is assessed throughout this time by echocardiogram. Neonatal surgery is performed at postnatal day 2 (P2) and conditional Tie1 deletion induced with intraperitoneal tamoxifen with functional assessment by echocardiogram at P4 and P21. Results: Adult control animals had a robust lymphangiogenic response within the scar infarct border zone at 6 weeks post-MI that was not seen in mutants at 6 weeks. Furthermore, Tie1 deletion following led to a an increase in maximal injury, severe depression of cardiac function, and a blunted myocardial repair response, noted by histological analysis of the scar area. Similarly, Tie1deletion in the neonatal period resulted in markedly attenuated regenerative response with persistent scar function at P21. Conclusions: Lymphatic expression of Tie1 in the adult is required for myocardial repair following injury. In addition, lymphatic expression of Tie1 is required for optimal myocardial regeneration in the neonate even though the cardiac lymphatic system is immature in the postnatal period. Further delineation of the mechanisms involved in Tie1 mediated repair and regeneration may provide novel opportunities for therapeutic intervention following cardiac injury in both neonates and adults.
Comparing Laparoscopic Elective Sigmoid Resection With Conservative Treatment in Improving Quality of Life of Patients With Diverticulitis
Authors: Alexandre Santos, Panu Mentula, Tarja Pinta, Shamel Ismail, Tero Rautio, Risto Juusela, Aleksi Lähdesmäki, Tom Scheinin, Ville Sallinen
Journal: JAMA Surgery (2020)

Diverticulitis has a tendency to recur and affect quality of life.To assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis.This open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018. Exclusion criteria included age younger than 18 years or older than 75 years; lack of (virtual) colonoscopy or sigmoidoscopy data within 2 years, or presence of cancer, contraindication to laparoscopy, or fistula. Outcomes were assessed using intention-to-treat analysis. A prespecified interim analysis was undertaken when 66 patients had been randomized and their 6-month follow-up was assessable. Data were analyzed from June 2018 to May 2020.Laparoscopic sigmoid resection or conservative treatment.The primary outcome was difference in Gastrointestinal Quality of Life Index (GIQLI) score between randomization and 6 months.Of 128 patients assessed for eligibility, 90 were randomized (28 male [31%]; mean [SD] age, 54.11 [11.9] years; 62 female [69%]; mean [SD] age, 57.13 [7.6] years). A total of 72 patients were included in analyses for the primary outcome (37 in the surgery group and 35 in the conservative treatment group), and 85 were included in analyses for clinical outcomes (41 in the surgery group and 44 in the conservative treatment group). The difference between GIQLI score at randomization and 6 months was a mean of 11.96 points higher in the surgery group than in the conservative treatment group (mean [SD] of 11.76 [15.89] points vs -0.2 [19.07] points; difference, 11.96; 95% CI, 3.72-20.19; P = .005). Four patients (10%) in the surgery group and no patients in the conservative treatment group experienced major complications (Clavien-Dindo grade III or higher). There were 2 patients (5%) in the surgery group and 12 patients (31%) in the conservative treatment group who had new episodes of diverticulitis within 6 months.In this randomized clinical trial, elective laparoscopic sigmoid resection improved quality of life in patients with recurrent, complicated, or persistent painful diverticulitis but carried a 10% risk of major complications.ClinicalTrials.gov Identifier: NCT02174926.
Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018
Authors: Xian Shen, Gabriel Sullivan, Mark Adelsberg, Martins Francis, Taylor T Schwartz, Allison A Petrilla
Journal: Circulation (2020)

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A &amp; B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A &amp; B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.
Abstract 12894: Suppressed Local Coagulative Response After Newer-generation Ultrathin Strut SES Implantation Compared to Older-generation SES Implantation
Authors: Koji Yamaguchi, Tetsuzo Wakatsuki, Tomonori Takahashi, Muneyuki Kadota, Yutaka Kawabata, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Takeshi Tobiume, Shusuke Yagi, Hirotsugu Yamada, Takeshi Soeki, Masataka Sata
Journal: Circulation (2020)

Background: We have previously demonstrated local persistent hypercoagulation after durable polymer (DP)-sirolimus-eluting stent (SES) implantation by measuring plasma prothrombin fragment 1+2 (F1+2) levels. The aim of this study is to evaluate local coagulative response after newer-generation ultrathin strut SES implantation. Method: Forty-five patients who were treated about 6-12 months earlier with coronary stenting, with no evidence of restenosis, were studied [DP-SES (Cypher): 26pts, biodegradable polymer (BP)-SES (older BP-SES, Ultimaster): 12pts and ultrathin strut BP-SES (newer BP-SES, Orsiro): 7pts]. We measured plasma levels of F1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V). The transcardiac gradient (Δ) was defined as CS level minus V level. Results: No significant difference was observed in the percent diameter stenosis among DP-SES, older BP-SES, and newer BP-SES groups (10.1 ± 16.5 vs 13.1 ± 12.9 vs 12.1 ± 11.9 %). The ΔF1+2 was significantly lower in the BP-SES groups than in the DP-SES group (8.9 ± 10.1 vs 23.4 ± 21.1 pmol/l, p&lt;0.05). The ΔF1+2 was lower in the newer BP-SES group than in the older BP-SES group, however, significant difference was not observed (7.0 ± 7.0 vs 9.7 ± 12.3 pmol/l). Conclusion: Suppressed local coagulative response after newer-generation ultrathin strut SES implantation was observed. These findings might indicate that lower strut thickness is more important factor than faster polymer resorption in the newer-generation DES era.
Abstract 13807: Prevalence and Control of Primary Severe Hypercholesterolemia in Olmsted County, Minnesota: A Community-Based Study
Authors: Medhat Farwati, Magdi Zordok, Ashwini Bhat, Maya Safarova, Kent Bailey, Tina Wood-Wentz, Carin Smith, Iftikhar J Kullo
Journal: Circulation (2019)

Introduction: Severe hypercholesterolemia (SH), defined as plasma low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dl, is a well-established risk factor for atherosclerotic cardiovascular...