tbuckley/cabot-search huggingface dataset:
Abstract 227: Cover Up- It's a Code Blue: Protecting Staff without Compromising Patient Outcomes
Authors: Shae Saint Amour, Brigid Kiley, Matthew DeMarco, Jane Sederstrom, Ayan Sen, Kai Singbartl, Bhavesh Patel
Journal: Circulation (2020)

Introduction: During the COVID-19 pandemic, hospitals across the globe have been challenged with following the chain of survival with Get With The Guidelines (GWTG) metrics of time to epinephrine, CPR and early defibrillation while ensuring resuscitation teams are protected with recommended PPE. Healthcare organizations are seeking innovative processes to implement PPE during resuscitation events (codes) while maintaining a timely response. Hypothesis: Utilization of for PPE for Airborne Precautions for all resuscitation events can be achieved without compromising patient outcomes or GWTG metrics. Methods: In collaboration with Infection Prevention and Control (IPAC), the Resuscitation Subcommittee at an academic medical center developed a modified airborne PPE workflow for both inpatient and outpatient resuscitation events. For staff safety, all patients are considered as COVID-19 positive during a code response. Identifying timely donning and doffing techniques of PPE as paramount for maintaining GWTG metrics, a Safety Officer was implemented as an additional member of the code team. The role of the Safety Officer is to assist with the PPE process and to monitor code team compliance. Other measures implemented included attaching PPE supply bags to all code carts for easy access, adding viral filters on the bag valve masks, conducting educational mock code events, and providing online resources for staff. To measure process outcomes, pre COVID-19 pandemic GWTG metrics, mortality, and survival to discharge rates were compared with COVID-19 metrics utilizing the modified airborne PPE workflow. Conclusions: Despite additional use of PPE, the hospital has maintained patient outcomes and adhered to the GWTG resuscitation measures of time to epinephrine, CPR and defibrillation while ensuring the utmost safety of the code team during the COVID-19 pandemic. Table 1: GWTG-Award Measures *Preliminary Results
Abstract 17053: Cardiac AKAP12 Signalosome Overexpression Exacerbation of Heart Failure and Cardiac Calcium Handling
Authors: Hanan Qasim, Bradley K McConnell
Journal: Circulation (2020)

Introduction: Heart failure (HF) is responsible for 1 out of 8 deaths per year in the U.S.A. and is the major cause of death globally. Calcium cycling is crucial for proper signaling processes and efficient cardiac contraction. In failing hearts, remodeled calcium handling contributes to cardiac dysfunction. Previously we reported enhanced cardiac function in mice lacking a functional A-Kinase Anchoring Protein 12 (AKAP12). In this study, we aim to investigate the role of AKAP12 overexpression (oxAKAP12) on heart failure progression through assessing Sarco/Endoplasmic Reticulum Ca2+-ATPase (SERCA2) and its regulatory protein Phospholamban (PLN). Hypothesis: Cardiac AKAP12 overexpression potentiates HF development through its action on SERCA2. Methods: HF was developed in WT and oxAKAP12-Tg mice of 8-10 weeks old males and females, through chronic Isoproterenol (ISO) administration (60 mg/kg/day for 14-days). Left ventricular homogenates were used for gene expression analysis. Furthermore, AKAP12 was transiently overexpressed in AC16 cells (human cardiomyocytes cell line), to assess protein expression levels upon treatment with 100 nM of ISO for 12-hrs. Results: Cardiac oxAKAP12 in both males and females reduced left ventricular ejection fraction (EF) by 14.5±2.5% and fractional shortening (FS) by 22.7±2.0% after 14-days of chronic ISO treatment when compared to control groups. Both RNA sequencing and RTqPCR analysis showed a significant reduction of SERCA2 and PLN mRNA levels, respectively, in left ventricular homogenates of male (53.5±2.0%, 39.0±2.5%) and female (50.0±2.5%, 45.0±2.0%) groups overexpressing AKAP12 treated with ISO (14-days) compared to control groups (p&lt;0.005). In AC16 cells overexpressing AKAP12 and treated with ISO, SERCA2 protein expression was reduced by 37% (p=0.0413) while PLN protein expression was not significantly reduced compared to control groups. Conclusions: Cardiac oxAKAP12 negatively influences systolic function in both male and female mice, potentially through affecting calcium handling, which will be assessed in future experiments by evaluating calcium transients and sarcomere shortening in isolated primary cardiomyocytes from oxAKAP12 and control mice.
Abstract 17340: Pre-LVAD QRS as an Independent Predictor of Myocardial Recovery in Chronic Heart Failure Patients Supported With Left Ventricular Assist Device
Authors: Muhammad S Khan, Iosif Taleb, Elizabeth Dranow, Christos Kyriakopoulos, Omar W Pinzon, Ravi Ranjan, Stephen H MCKELLAR, Craig Selzman, Abdallah G Kfoury, William Caine, Stavros G Drakos, Derek J DOSDALL
Journal: Circulation (2020)

Introduction: Left ventricular assist device (LVAD) therapy aims to improve LV reverse remodeling, but still &gt;50% of chronic heart failure (CHF) patients show ‘no’ recovery. The current clinical paradigm to assess post-LVAD myocardial recovery relies on ventricular rotational and deformational mechanics. Investigating the role of a pre-LVAD QRS as a potential indicator for post-LVAD LV recovery in CHF patients may help clinicians develop optimal care plans for LVAD patients. Hypothesis: Pre-LVAD short QRS has potential value to be useful as an independent predictor for early myocardial recovery following LVAD implantation. Methods: Chronic and dilated cardiomyopathy patients (n=315) undergoing LVAD implantation were retrospectively studied. Acute HF etiology and post-LVAD follow up (&lt;3 months) were exclusion criteria. Post-LVAD myocardial recovery criteria for responders (R) is defined as post-LVAD implant follow-up LVEF ≥40% and LVIDd ≤6 cm. Non-recovery (NR) criteria is defined as follow-up LVEF &lt;40% and LVIDd &lt; or &gt;6 cm. From 315 LVAD patients, 39 fulfilled the criteria of myocardial recovery as ‘R’. Results: Based on univariate logistic regression, pre-LVAD QRS duration is found to be a predictor of myocardial recovery following LVAD implantation (OR:0.986, 95% CI:0.976-0.996, p=0.005) in LVAD patients. QRS duration is 14.5% longer in the ‘NR’ group as compared with the ‘R’ group (145±36 ms vs 124±37 ms). In multivariate logistic regression, after adjusting for previous thoracotomy, beta-blockers, and a previously evaluated composite score (UCARS) including age, HF duration, and LVEDD, pre-LVAD QRS remains a significant predictor of ‘R’ status (OR:0.983, 95% CL:0.973-0.994, p=0.003). The model shows an accuracy of 0.74 with a p-value of &lt;0.001. Conclusions: Pre-LVAD short QRS interval is associated with post-LVAD LV reverse remodeling in the ‘R’ group, and thus could be of use in a clinical setting for predicting post-LVAD early myocardial recovery.
Abstract 17298: Validation of Beat-to-Beat Blood Pressure and Left Ventricular Ejection Time by the Caretaker Physiological Monitor Against Invasive Central Aortic Measurement
Authors: Evan Harmon, Younghoon Kwon, Patrick Stafford, Martin Baruch, Sung-Hoon Kim, Sula Mazimba, Lawrence W Gimple
Journal: Circulation (2020)

Objective: There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. We examined the accuracy of noninvasive Caretaker device against invasively measured central aortic BP. Methods: Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. We derived correlations and Bland-Altman comparisons, after calibrating the Caretaker with 20 seconds of the initial catheter readings, as well as trend analyses for both systolic (SBP) and diastolic BP (DBP). We also measured left ventricular ejection time (LVET) from both aortic pressure tracing and Caretaker and compared the two. Results: A total of 47 patients were included in the study. A total of 31,369 beats obtained during the diagnostic portion of coronary angiogram were used for analysis. The correlations for SBP and DBP were 0.89 and 0.78, respectively (p &lt; 0.001 for both). The Bland-Altman comparison yielded overall mean differences of 2.11 mmHg (SD 7.40) for SBP and 1.46 mmHg (SD 6.12) for DBP respectively (p &lt;0.001 for all comparisons). The trend analysis yielded concordances of 86% and 85% for SBP and DBP, respectively. The correlation and Bland-Altman analyses for the LVET comparison yielded 0.89 (p&lt; 0.001) with a mean difference of 13.9 ms (SD 14.4 ms). Conclusion: Beat-to-beat BP by Caretaker showed excellent agreement and high concordance in the direction and the degree of BP change with central aortic BP. This study supports the satisfactory performance of the Caretaker device in continuous tracking of beat-to-beat BP and LVET measurements.
Hypodermic Injection Device
Authors: Robert A. Hingson
Journal: JAMA (1963)

<h3>To the Editor:</h3> —An injector which circumvents many of the disadvantages of the standard conventional needle and syringe is a pre-filled disposable hypodermic device containing a sterile solution. A one-piece 23-gauge 7/16-in stainless-steel needle is mounted within a sealed polyethylene container which holds one exact dose (0.7 to 1.4 cc) of parenteral medication. A hermetically sealed aluminum overpack container is used to prevent transmission of moisture vapor and exposure to ultraviolet, and to minimize transfer of oxygen. When the bottom of the injector is placed in firm contact with the skin and pressure is applied to the top, the needle pierces a thin polyethylene membrane and enters the tissues. Application of continued mechanical pressure by the spring-activated metal plunger of the injector applicator causes the side walls to collapse and telescope. The medicament is thereby forced continuously through the cannula and is dispersed evenly through the tissues until the needle
Abstract 14910: Role of 3.3fr Mapping Catheters in Defining and Ablating Mechanisms of Ventricular Arrhythmias: A Multicenter Experience
Authors: Albert J Rogers, Shana Greif, Alexander C Perino, Rajan L Shah, Mohan N Viswanathan, Venkatakrishna N Tholakanahalli, David Singh, Nitish Badhwar
Journal: Circulation (2020)

Introduction: Ventricular arrhythmia (VA) mechanisms arising from the crux, summit, and epicardium are often not accessible from the endocardium. The 3.3Fr multipolar mapping catheters (3FMC) (Map-iT, Access Point Technologies, Rogers, MN) can be used to map deep within the coronary sinus (CS) branches and other locations difficult to access with standard catheters. Objective: We present a case series of and techniques for VA ablations guided by the 3FMC. Methods: We retrospectively reviewed VA ablations at 3 centers to describe the utility of the 3FMC in diagnosis and ablation of the arrhythmia. Results: We reviewed 33 patients who underwent VA ablations guided by the 3FMC. Patients (age 59.0 ± 15.4 years, 72% male, LVEF 41.5 ± 10.3%, 93% non-ischemic) had ventricular tachycardia (32%) or high-burden PVCs (68%). The 3FMC was used to interrogate the epicardium via the coronary sinus branches allowing interrogation of the LV crux (Fig. A) and LV summit (Fig. B). Early potentials in the poster-septal branch of CS guided alcohol ablation to focal site in septum not reachable by traditional catheters. Continuous signal on the 3FMC in the posterolateral branch of CS elucidated microreentry and guided more extensive epicardial ablation. Overall, the 3FMC measured signals 18.7 ± 11.3ms early and diagnosed 75% focal, 10% micro-reentrant, and 15% macro-reentrant VAs. Ablation was successful in 76% of cases. Conclusions: High definition mapping with the 3FMC allows diagnosis of VA mechanisms in locations not easily reachable by traditional catheters. Improved mapping of the CS branches enables interrogation and ablation planning of epicardial, summit, and crux VAs and may increase the likelihood of successful VA ablation.
Abstract 15129: Outcomes Related to Age of Elective Surgery and Age of Dissection Within Genetically Triggered Aneurysm Conditions: The Gentac Experience
Authors: Kathryn W Holmes, Scott A Lemaire, Richard B Devereux, William J Ravekes, Shaine A Morris, Siddharth K Prakash, Jonathan W Weinsaft, Howard Song, Kim A Eagle, Sheila Markwardt, Michael M SILBERBACH, Rita C Milewski, Mary J Roman
Journal: Circulation (2020)

Introduction: The GenTAC Registry ( G enetically Triggered T horacic A ortic Aneurysms and Cardiovascular C onditions) followed patients with aortopathies over 8 years among 8 centers with the goal of evaluating cardiovascular outcomes. Methods: Enrollment initiated in 2007, and data were collected until 2015. We included diagnoses with &gt;100 participants: Bicuspid aortic valve with aneurysm (BAV, n=879), Marfan syndrome (MFS, n=861), Familial thoracic aortic aneurysm or dissection (FTAAD, n=378), Other thoracic aortic aneurysm at &lt; 50 years of age (Other&lt;50, n=524), Turner syndrome (TS, n=298), Vascular Ehlers Danlos syndrome (VEDS, n=149), and Loeys-Dietz syndrome (LDS, n=121). We identified patients who underwent elective ascending aortic replacement, total unique dissections, and time to first dissection. With MFS as a reference population and adjusted for sex, endpoints were analyzed by a Firth penalized Cox-PH regression model to account for diagnosis groups with low event numbers. Results: LDS participants at a mean age of (24.5 ± 15.0y) were youngest at elective aortic surgery followed by MFS (32.3 ±12.3y), TS (37.6 ±13.6y), VEDS (35.0 ±SD 7.4y), Other&lt;50 (40.3 ±SD 10.3y), FTAAD (42.9 ±14.2y), and BAV(49.4 ± 13.8 y). Dissections were reported in all diagnosis groups with a total of 472 unique dissections in 3210 patients (14%). Mean age at first dissection was in the third decade for LDS, TS, MFS, VEDS and in the fourth decade for BAV, FTAD, and Other&lt;50. Adjusted hazard ratio for time to first dissection was higher in LDS, 1.77 (95%CI 1.14- 2.77), compared to MFS and other diagnosis groups (Figure 1). Conclusions: Reported aortic dissections were prominent in the GenTAC cohort. Despite elective surgery at a younger age, LDS patients had a higher hazard risk of dissection compared to other diagnosis groups.
Abstract 17208: Successful Implementation of Grip Strength Measurement as a Frailty Screening Tool
Authors: Gloria Y Kim, Arati A Gangadharan, Craig S Brown, Nicholas H Osborne, Matthew Corriere
Journal: Circulation (2020)

Introduction: Objective screening for frailty is seldom performed because existing tools are time consuming and usually applied post-hoc. Implementation of efficient and feasible frailty screening approaches within clinic is needed. Purpose and hypothesis: We implemented grip strength measurement as a frailty screening tool in a cardiovascular clinic setting and compared this to existing frailty assessment tools, including the modified frailty index-5 (mFI-5) and -11 (mFI-11). We hypothesized that grip strength would be comparable to the mFI-5 and -11, associated with common adverse events including urinary incontinence (UI) and falls, and increased diagnosis of frailty would occur as a result implementation. Methods: Grip strength measurement was integrated into clinic intake to screen for weakness, a frailty component. Measurements were performed routinely for cardiovascular clinic visits and entered into the EMR data field. Categorical frailty was assessed based on 20 th percentile for grip strength (kg) adjusted for gender and BMI. A “dotphrase” statement was built to streamline clinical documentation, and quarterly newsletters were used to disseminate coding and other related information. Categorical tests were used to evaluate associations between grip, weakness, and other measures of frailty. Results: A total of 4,447 unique patients had grip strength measured. Mean age was 63.3±15.6, BMI 29.6±7.0, 47.6% (n=2,115) were female, and 86.5% were Caucasian/White. Based on grip strength, 34.6% (n=1,538) were weak, and 22.0% (n=980) and 16.9% (n=754) were frail based on mFI-5 and mFI-11, respectively. Less than 10% (n=408, 9.25%) had a history of falls and 39 (0.88%) had UI. Falls were associated with weakness (P&lt;0.001) but UI was not. Only 45 (1.01%) had a coded frailty diagnosis in the EMR. Among those with a frailty diagnosis, 35 (77.8%) were considered frail by grip. The negative predictive value (NPV) of the grip strength when mFI-5 is used as the gold standard is 0.84. Conclusions: Grip strength is both feasible and practical for frailty screening in clinical environments. Mismatch between screening-based and coding-based frailty prevalence suggests an opportunity to improve risk screening through routine grip strength assessment.
Abstract 13924: Covid-19 Registry to Assess Frequency, Management, and Outcomes of Arterial and Venous Thromboembolic Complications (CORONA-VTE)
Authors: Gregory Piazza, Umberto Campia, Julia Snyder, Samantha Rizzo, Mariana Pfeferman, Orly Leiva, John Fanikos, Victor Nauffal, Zaid Almarzooq, Samuel Z Goldhaber
Journal: Circulation (2020)

Introduction: Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in COVID-19. Hypothesis: Arterial and venous thromboembolic complications are a common complication in COVID-19, especially in the cirtically ill and hospitalized populations. Methods: We analyzed a retrospective cohort of 1114 patients with COVID-19 diagnosed through our healthcare network. The total cohort was analyzed by site of care: intensive care (170 patients), hospitalized non-intensive care (229 patients), and outpatient (715 patients). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism. Results: Patients with COVID-19 were ethnically (22.3% Hispanic/Latinx) and racially (44.2% non-white) diverse. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized non-intensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized non-intensive care cohort (2.6%, 6.1%, and 2.2%, respectively). The frequency of adverse events in the outpatient cohort was low. Conclusions: Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.
Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research
Authors: Katherine Schaumberg, Erin E. Reilly, Sasha Gorrell, Cheri A. Levinson, Nicholas R. Farrell, Tiffany A. Brown, Kathryn M. Smith, Lauren M. Schaefer, Jamal H. Essayli, Ann F. Haynos, Lisa M. Anderson
Journal: Clinical Psychology Review (2020)
Abstract 12873: Clonal Hematopoiesis With JAK2V617F Promotes Pulmonary Hypertension Through ALK1
Authors: Yusuke KIMISHIMA, Tomofumi Misaka, Tetsuro Yokokawa, Kento Wada, Koki Ueda, Koichi Sugimoto, Keiji Minakawa, Kazuhiko Nakazato, Takafumi Ishida, Motohiko Oshima, Shuhei Koide, Kotaro Shide, Kazuya Shimoda, Atsushi Iwama, Kazuhiko Ikeda, Yasuchika Takeishi
Journal: Circulation (2020)

Rationale: Pulmonary hypertension (PH) is associated with hematological disorders by unclear multifactorial mechanisms. JAK2 V617F is the most frequent driver mutation among the myeloproliferative neoplasms and is recently identified in clonal hematopoiesis. However, the impact of clonal hematopoiesis on PH remains unknown. Objectives: To elucidate the mechanistic relevance of hematopoietic JAK2V617F in the development of PH. Methods: We applied experimental mouse models, mimicking hematological clinical scenarios using Jak2 V617F-transgenic (JAK2 V617F ) mice and recipient mice transplanted with JAK2 V617F bone marrow cells (JAK2 V617F recipients), exposed to chronic hypoxia to induce PH. The presence of JAK2 V617F was also examined prospectively in PH patients. Measurements and Main Results: Increases in right ventricular systolic pressure and right ventricular hypertrophy accompanied by pulmonary arterial structural remodeling after exposure to chronic hypoxia were significantly exacerbated in both JAK2 V617F mice which showed a myeloproliferative neoplasm-phenotype and JAK2 V617F recipients which modeled clonal hematopoiesis compared to corresponding controls. JAK2V617F-expressing neutrophils were specifically accumulated in pulmonary arterial regions, accompanied by increases in neutrophil-derived elastase activity and chemokines. RNA sequencing identified progressive upregulation of Acvrl1 (encoding ALK1) during the differentiation from bone marrow stem/progenitor cells peripherally into mature neutrophils of pulmonary arterial regions in the enrichment of JAK-STAT-related molecules by JAK2V617F. JAK2V617F-mediated STAT3 phosphorylation upregulated ALK1-Smad1/5/8 signaling. Strikingly, ALK1 inhibition completely rescued the development of PH in JAK2 V617F mice. Furthermore, clonal hematopoiesis with JAK2 V617F was significantly more common in PH patients than in healthy subjects. Conclusions: Our study reveals clonal hematopoiesis with JAK2V617F as a crucial factor that causally leads to PH through ALK1.
<i>CDK12</i> Deficiency and the Immune Microenvironment in Prostate Cancer
Authors: Tamara L. Lotan, Emmanuel S. Antonarakis
Journal: Clinical Cancer Research (2020)

Abstract CDK12 inactivation in prostate cancer is associated with tandem genomic duplications that may generate fusion-associated neoantigens and elicit immune responses amenable to checkpoint blockade. In the first study to comprehensively characterize the T-cell immune microenvironment of CDK12-deficient prostate cancers, subsets of immunosuppressive CD4+FOXP3− T cells were increased compared with CDK12-proficient controls. See related article by Rescigno et al., p. 566
Abstract 15160: Atrioventricular and Ventricular Functional Interdependence in the Community
Authors: Yuriko Yoshida, Koki Nakanishi, Masao Daimon, Jumpei Ishiwata, Naoko Sawada, Megumi Hirokawa, Hidehiro Kaneko, Tomoko Nakao, Yoshiko Mizuno, Hiroyuki Morita, Marco Di Tullio, Shunichi Homma, Issei Komuro
Journal: Circulation (2020)

Introduction: Left atrial (LA) and right ventricular (RV) performance play an integral role in the pathophysiology and prognosis of heart failure (HF). However, the alteration of atrioventricular and ventricular functional interdependence in a preclinical setting is unclear. We aimed to investigate the association between LA/RV functional remodeling and subclinical left ventricular (LV) dysfunction. Methods: LV global longitudinal strain (LVGLS), RV free wall longitudinal strain (RVLS) and LA reservoir strain were assessed by speckle-tracking echocardiography in 1,080 participants (600 men; 62±12 years) without cardiac disease. Results: A hundred and forty-three participants (13.2%) had an abnormal LVGLS (&gt;-18.6%). LA reservoir strain and RVLS were significantly decreased in abnormal LVGLS group compared with normal LVGLS group (both p&lt;0.001). LA and RV dysfunction (LA reservoir strain &lt; 31.4% and RVLS &gt; -19.2%) were present in 18.9% and 19.6% of participants with abnormal LVGLS, respectively (Figure). Decreased LVGLS was significantly associated with worse LA reservoir strain and RVLS (standardized β=-0.20 and 0.11 respectively, both p&lt;0.01) independent of cardiovascular risk factors, pertinent biomarkers and LV geometry and diastolic dysfunction. Conclusions: In the general population without overt cardiac disease, approximately 20% subjects with impaired LVGLS exhibited LA/RV dysfunction, and LVGLS was independently associated with both LA and RV strain. Our findings may provide valuable insights for a better understanding of HF pathophysiology and possibly preventive strategies.