tbuckley/cabot-search huggingface dataset:
Abstract 11579: In-Hospital Characteristics and Outcomes Among Patients Who Received an Off-Label Tricuspid Clip
Authors: Marissa A Donatelle, Christian Torres, Karthik Vedantam, Nirat Beohar
Journal: Circulation (2021)

Intro: Tricuspid regurgitation has high morbidity &amp; mortality, leading to recurrent hospitalization preventing surgery. Tricuspid valve transcatheter edge-to-edge repair with an off-label clip (TVc) are becoming more common, but data are limited. We examined the National Inpatient Sample (NIS) database to describe demographics &amp; in-hospital outcomes among TVc patients. Methods: The NIS database was queried from 2016-2018 to identify patients that received TVc using ICD-10 codes. Weights were applied to obtain national estimates. Results: All P values were &lt;.05. A total of 485 patients received TVc, 94% at large academic medical centers as elective procedures (73%). Patients were older (78±9 Vs 58±20 yrs) with an equal proportion of males &amp; females (45% vs 55%). They were more likely to have comorbidities, like congestive heart failure (88.6% vs 15%), chronic kidney disease (45.3% Vs 16%), hypertension (72.1% vs 52%), atrial fibrillation (85.5% vs 13%) &amp; pulmonary hypertension (47.4% vs 3%). Concomitant mitral regurgitation was the most common valve disorder (7.2% vs. 0.1%). The most common complication was acute kidney injury (32.9% vs 13%), followed by pericardiocentesis (4% vs 0.06%) &amp; cardiac arrest (1% vs 0.01%). Hospital costs rose by six-fold ($303,222 vs $53.5270) &amp; length of stay (LOS) was longer by 3.5 days in those with a TVc. Half of patients were discharged home (54.6%) but 23% required home health &amp; 19% a skilled nursing facility. Conclusions: TVc patients are more likely to be white, older, with an even division in gender &amp; a significant number of chronic comorbidities. Overall mortality is low &amp; complications are rare. Both hospitalization costs &amp; LOS were higher.
Melanoma-derived small extracellular vesicles induce lymphangiogenesis and metastasis through an NGFR-dependent mechanism
Authors: Susana García-Silva, Alberto Benito-Martín, Laura Nogués, Alberto Hernández-Barranco, Marina S. Mazariegos, Vanesa Santos, Marta Hergueta-Redondo, Pilar Ximénez-Embún, Raghu P. Kataru, Ana Amor Lopez, Cristina Merino, Sara Sánchez-Redondo, Osvaldo Graña-Castro, Irina Matei, José Ángel Nicolás-Avila, Raúl Torres-Ruiz, Sandra Rodríguez-Perales, Lola Martínez, Manuel Pérez-Martínez, Gadea Mata, Anna Szumera-Ciećkiewicz, Iwona Kalinowska, Annalisa Saltari, Julia M. Martínez-Gómez, Sabrina A. Hogan, H. Uri Saragovi, Sagrario Ortega, Carmen Garcia-Martin, Jasminka Boskovic, Mitchell P. Levesque, Piotr Rutkowski, Andrés Hidalgo, Javier Muñoz, Diego Megías, Babak J. Mehrara, David Lyden, Héctor Peinado
Journal: Nature Cancer (2021)
Abstract P423: Nox2 Mediates Increased Oxidative Stress And Ros Production Leading To Atrial Ion Channel And Structural Remodeling In Obesity-induced Af.
Authors: Arvind Sridhar, Liang Hong, Olivia T Ly, Hanna Chen, Srikanth Perike, Mahmud Arif Pavel, Jalees Rehman, Mark McCauley, Dawood Darbar
Journal: Circulation Research (2021)

Background: Inducible atrial fibrillation (AF) in diet-induced obese (DIO) mice is mediated in part by a combined effect of ion channel remodeling and atrial fibrosis. NADPH oxidase 2 (NOX2), a major source of reactive oxygen species (ROS) production in human atria, is increased in DIO mice. Although a mitochondrial antioxidant (MitoTEMPO) reduced AF burden, and reversed ion channel and structural remodeling, the role of NOX2 in increased ROS production and atrial remodeling in obesity-induced AF remains unclear. Objective: To test the hypothesis that increased NOX2 modulates atrial remodeling in obesity-induced AF, we treated DIO mice with apocynin, NOX2 inhibitor, and fed a 60% high fat diet (HFD) to Nox2 -KO mice. Methods: Weight, BP, plasma glucose, trans-esophageal rapid (TE) pacing and F 2 -isoprostanes were measured in DIO mice and compared to controls. Echocardiography, electrophysiology (EP), immunohistochemistry, Western blotting, cellular patch clamping and optical mapping studies were performed. Results: The average weight of DIO mice treated with apocynin (DIO-A) and vehicle control mice was 38.4 ± 3.8 g versus 44.0 ± 7.5 g versus 31.7 ± 1.19 g respectively (P≤0.0001). Both groups of DIO mice displayed progressive increase in weight over 10 weeks of HFD + drug treatment compared to controls (P≤0.0001). After TE pacing, DIO mice treated with apocynin showed significantly reduced pacing-induced AF burden when compared to DIO mice treated with vehicle. DIO mice treated with apocynin displayed 20.2 ± 26.1 sec versus 162.3 ± 133.7 sec and 18.3 ± 18.1 sec in DIO mice treated with vehicle and control mice respectively (P≤0.0001). Western blotting experiments showed that potassium channels, Kv7.1 and Kv1.5 protein expression is restored in Nox2 -KO HFD mice compared to DIO mice thus indicating restoration of ion channel remodeling upon Nox2 inhibition. Conclusions: We showed that genetic and pharmacological inhibition of NOX2 abrogates ion channel remodeling and reverses obesity-induced AF burden. Our findings may have important implications for the management of obesity-mediated AF in patients.
Abstract 11791: Hospitalized Congestive Heart Failure Patients Without SARS-CoV-2 Had Higher Mortality During the COVID-19 Pandemic vs Non-Pandemic Year
Authors: Harjeet P Singh, Manvir Wadhwa, Hyunju S Heinekel, Ayutyanont Napatkamon, Mimi S Biswas, Scott Kubomoto
Journal: Circulation (2021)

Introduction: As COVID 19 swept across the nation, the pandemic imposed many challenges to the United States healthcare system. With limitations in access to care, common conditions including an exacerbation of congestive heart failure (CHF) accounted for a significant proportion of hospitalizations. What remains unclear is the impact that the pandemic had on outcomes including mortality of patients who tested negative for SARS-CoV-2 compared to the year prior. Hypothesis: During the COVID-19 pandemic, COVID 19 negative CHF exacerbations patients had increased mortality than patients from the prior non-pandemic period. Methods: This was a retrospective multi-center study including 37,340 patients admitted in 154 hospitals in the HCA network. The study primarily evaluated the mortality difference between patients hospitalized with congestive heart failure that tested negative for SARS-CoV-2 polymerase chain reaction (PCR) during the pandemic during the months of March through May 2020 (N=15282) and compared to patients hospitalized with congestive heart failure during the same months in 2019, pre-pandemic (N=22058). Results: There was an observed increase in mortality in patients admitted in 2020 when compared to 2019 (2.34% vs 1.98% respectively, p = 0.020). Multivariable logistic regression analysis showed mortality was 24% higher in CHF patients admitted in the studied months March through May 2020 when compared to CHF patients admitted in the same period in 2019 (OR = 1.24, CI [1.07-1.43], p = 0.003), when correcting for age, demographics, comorbidities, and prior beta blocker or diuretic use. Although there was no statistically significant difference in BNP between the two groups as a measure of disease severity, patients that presented to the ED in the studied months in 2020 had higher admission rates (OR = 0.90 CI [0.86-0.95] p&lt;0.001). Conclusions: The study revealed that there was an increased mortality rate in hospitalized CHF exacerbation patients who tested negative for SARS-CoV-2 during the pandemic when compared to those the year prior. This illustrates some of the unforeseen consequences of the pandemic on patient healthcare. Further studies are needed to determine the effects of the pandemic in COVID-19 negative patients.
Abstract 9987: Relation of Body Mass Index to Outcomes Among Patients Hospitalized for Heart Failure
Authors: Abdul Minhas, Abu Baker Sheikh, Waqas Ullah, Stephen J Greene, Erin Michos, Marat Fudim
Journal: Circulation (2021)

Background: Variable associations have been reported between obesity and clinical outcomes among patients with heart failure (HF), including a potential obesity paradox. The aim of the study is to evaluate the association between body mass index (BMI) and clinical outcomes in patients hospitalized for HF. Methods: We conducted a retrospective analysis of adult discharges from the U.S. National Inpatient Sample (NIS) between 2016 and 2018. ICD codes were used to identify primary HF hospitalizations. BMI&lt;20 kg/m 2 , 25.0-29.9 kg/m 2 , and ≥ 30 kg/m 2 patients were further identified by their respective ICD codes. The remaining cohort was assumed to have normal BMI of 20-24.9 kg/m 2 . We used weighted multivariable logistic regression adjusted for patient-level and hospital-level characteristics to compare outcomes across BMI groups. Prevalence estimates were weighted using NIS-provided discharge-level weights to reflect national estimates. Results: Among 3,489,634 weighted primary HF hospitalizations, 59,175 (1.7%) had BMI&lt;20 kg/m 2 , 2,519,179 (72.2%) had BMI 20-24.9 kg/m 2 , 31,680 (0.9%) had BMI 25.0-29.9 kg/m 2 , and 879,599 (25.2%) had BMI ≥ 30 kg/m 2 . On multivariate analysis, compared with individuals with a BMI of &gt;20-24.9 kg/m 2 , those with BMI&lt;20 kg/m 2 and BMI ≥ 25.0-29.9 kg/m 2 had higher inpatient mortality, mechanical circulatory support use, cardiogenic shock, invasive mechanical ventilation, pressors use, gastrostomy, length of stay and inflation-adjusted cost. BMI ≥ 30 kg/m 2 had lower in-hospital mortality, mechanical circulatory support use, cardiogenic shock and higher invasive mechanical ventilation, tracheostomy, acute kidney injury, length of stay and inflation-adjusted cost (Figure). Conclusion: Among patients hospitalized for HF, patients who were underweight and overweight had worse outcomes compared with normal weight patients, whereas patients who were obese tended to have variable outcomes, including lower in-hospital mortality.
Abstract 6982: PCI Appropriateness of Use: Trends Over the Last Decade
Authors: Harsh Rawal, Tung Nguyen, Lloyd W Klein
Journal: Circulation (2021)

Introduction: The Appropriate Use Criteria (AUC) for coronary revascularization have undergone 2 revisions, reflecting improved understanding of which situations percutaneous coronary intervention (PCI) optimizes patient care. Over this time, PCI appropriateness and volumes have changed with increased compliance. Accordingly, we analyzed these changes in detail. Methods: PubMed and Embase libraries identified 9 national studies evaluating appropriate use of PCI. Case appropriateness was classified as appropriate, inappropriate/rarely appropriate, uncertain/may be appropriate and unmappable. Temporal trends for each category were determined from linear regression. Student-t-test was used to compare groups using Graphpad Prism 8.0 software. Results: The total number of PCIs decreased 14.1% over the study period. This diminished volume was associated with reductions in both non-acute (from 22.5% to 16.3%, p &lt;0.01) and non-mappable PCIs (from 17.6% to 5.0%, p&lt;0.001), while acute PCIs increased (from 65.7% to 81.2%, p&lt;0.001, figure). In non-acute PCIs, appropriate PCIs increased (from 42.8% to 68.4%, p&lt;0.001) while both inappropriate (from 18.9% to 11.6%, p&lt;0.01) and uncertain (from 38.2% to 20.0%, p&lt;0.001) were reduced. Reclassification as defined in the 2017 Revision led to significant decrease in appropriate (56.8% to 48.0%, p&lt;0.01) and an increase in uncertain class (32.7% to 50.1%, p &lt;0.01). Acute PCIs showed no overall change in appropriateness. Conclusions: These findings demonstrate: 1) the overall volume of PCIs is decreasing, 2) revised classification led to more uncertain PCIs, and 3) the percent of appropriate non-acute PCIs is increasing with a decline in inappropriate and uncertain PCI. The AUC have successfully decreased the performance of inappropriate/rarely appropriate PCIs. These trends suggest either that more appropriate non-acute PCIs are being performed or better documentation has led to more accurate classification.
Abstract 13625: Association of Antiphospholipid Antibodies With Venous Thromboembolism in COVID-19
Authors: Prerna Sharma, Victor Popoola, Aditya Sharma, Dana Albon
Journal: Circulation (2021)

Introduction: Coagulation abnormalities leading to arterial and venous thrombotic events have been described in patients with COVID-19 and studies have reported an overall pooled incidence of venous thromboembolism (VTE) of 17%, however little is known regarding VTE association with antiphospholipid antibodies in patients with COVID-19. Hypothesis: Antiphospholipid antibodies are associated with VTE events in COVID-19. Methods: This is a retrospective cohort study of COVID-19 patients hospitalized at the University of Virginia Medical Center (UVA). Serum samples were collected and stored in the UVA COVID-19 biorepository. Anti-cardiolipin (aCL) and anti-b2glycoprotein1(ab2GLP1), IgM/IgG titres, were measured from stored samples, using the enzyme-linked immunosorbent assay (ELISA). Specimens were analysed at two distinct time-points/days during the patient’s hospitalization for COVID-19. VTE incidence was collected retrospectively by chart review. The study was approved by the Institutional Review Board at UVA. Two-tailed Mann-Whitney two-sample rank-sum tests were conducted to examine whether there were significant differences in APS antibody levels, and mean change in APS levels between the two time points analysed, and VTE events. Additionally, logistic regression models were constructed to examine whether APS antibody levels and mean change in APS levels had a significant effect on the odds of observing a case of VTE. Results: There were 53 patients included in the study. The mean age of participants was 57.2 years (SD 13.9). VTE did not corelate with the levels of APS at studied time points, or the mean change in APS levels during the disease course. aCL IgM (p = 0.24), aCL IgG (p = 0.92), ab2GLP1 IgM (p = 0.79), and ab2GLP1 IgG (p = 0.79). Changes in the APS antibody levels during the course of the disease were not predictive of the odds of having VTE. Similarly, these changes did not predict the need for ICU care. Conclusions: This study shows that neither the presence of antiphospholipid antibodies nor the change in APS levels during the course of COVID-19 correlated with VTE events.
Abstract 10954: Quantification of Myocardial Perfusion Reserve Using a Cardiac-Centered Camera: First Comparison with Invasive Indexes of Coronary Microvascular Disease
Authors: loic djaileb, Olivier Phan Sy, Nicolas De Leiris, Marjorie Canu, Alexandre Seiller, Alexis Broisat, Gerald Vanzetto, Catherine GHEZZI, Daniel Fagret, Laurent Riou, Gilles Barone
Journal: Circulation (2021)

Introduction: – The invasive quantification of coronary flow reserve (CFR), the index of microcirculatory resistance (IMR), and fractional flow reserve (FFR) allows to assess coronary physiology. Although semi-conductor (CZT) SPECT myocardial perfusion reserve (MPR) has been previously compared with FFR, there are no data documenting the relationships between CZT SPECT MPR on one hand and CFR and/or IMR on the other hand. We assessed the performances of noninvasive CZT SPECT MPR in comparison with invasively determined FFR, CFR, and IMR. Methods: – Rest and dipyridamole-induced stress myocardial blood flow and MPR were quantified using 99m Tc-SestaMIBI and a Discovery NM 530c camera in 26 patients with suspected or known coronary artery disease who underwent conventional invasive coronary angiography. Thermodilution-derived resting and adenosine-induced hyperemic mean transit times, distal intracoronary pressures, and mean aortic pressures were assessed for the quantification of FFR, CFR, and IMR values. Results: – Only 2/35 vessels presented with a pathological (&lt;0.8) FFR. A moderate yet significant correlation was observed between regional CZT SPECT MPR and CFR (r=0.40, P =.02). The sensitivity, specificity, positive and negative predictive value, and accuracy of regional CZT SPECT MPR vs CFR were 69% [44-86%], 94% [74-100%], 91% [65-100%], 77% [56-90%], and 82% [65-93%], respectively. In territories without underlying CAD (n=32), CZT SPECT MPR values were significantly higher in those with CFR≥2 and IMR&lt;25 (negative composite criterion, n=14) than in those with CFR&lt;2 and IMR≥25 (positive composite criterion, n=8, CZT SPECT MPR, 2.6 [2.1-3.6] vs 1.6 [1.2-1.8]), P &lt;.01). Regional CZT SPECT MPR displayed sensitivity, specificity, positive and negative predictive value, and accuracy of 87% [53-99%], 100% [78-100%], 100% [64-100%], 93% [70-99%], and 95% [77-99%] for the diagnosis of a positive composite criterion, respectively. Conclusions: – CZT SPECT MPR presented a moderate, significant correlation with thermodilution CFR and good diagnostic performances for the detection of patients at high risk of cardiovascular events (low CFR and high IMR) in the absence of obstructive CAD.
Abstract 13015: Rates and Predictors of Treatment With Oral Anticoagulant in Patients Newly Diagnosed With Atrial Fibrillation at High-Risk for Stroke
Authors: Evan Manning, Kelley Burns, Melissa Laurie, Patten Luke, Michael Ho, Amneet Sandhu
Journal: Circulation (2021)

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and increases risk of stroke. Guidelines recommend treatment with oral anticoagulants (OACs) for those at high risk of stroke associated with AF, yet many patients do not receive OAC therapy. Methods: Using University of Colorado’s multi-institutional electronic health records (EHR) database, patients newly diagnosed with AF (by ICD-9/10 codes) and CHA 2 DS 2 -VASc score ≥ 2 between 2013-2018 were identified and prescription of an OAC during the first 6 months after AF diagnosis was determined. Logistic regression was used to compare baseline characteristics to the odds of being prescribed an OAC. Results: We identified 18,404 newly diagnosed AF patients with a CHA 2 DS 2 -VASc score of ≥2 (mean age 74; 46.6% female; 88.6% white). Of these 18,404 patients, 7,604 (41.3%) were prescribed an OAC in the follow up period and 10,800 (58.7%) were not. The Figure below displays a forest plot of patient-level factors correlating with OAC and lack of OAC prescription. This analysis demonstrated that patient sex, race, comorbidities, risk of stroke/bleeding and other prescriptions may influence the prescribing an OAC. Conclusions: Most newly diagnosed AF patients with a CHA 2 DS 2 -VASc score of ≥ 2 were not prescribed an OAC in the first 6 months after diagnosis. Understanding factors associated with not being prescribed an OAC may help efforts to improve anticoagulation rates in those with AF at high risk of stroke.
Are Delays in the Diagnosis and Treatment of Acute Leukemia in a Middle-Income Country Associated with Poor Outcomes?
Authors: Yadith Karina López García, Mayra Valdez-Carrizales, Jorge Adrian Nuñez-Zuno, Elia Ixel Apodaca, Juan Rangel-Patiño, Roberta Demichelis
Journal: Blood (2021)
NICE recommends progesterone to prevent early miscarriage
Authors: Jacqui Wise
Journal: BMJ (2021)

Progesterone should be offered to women who experience bleeding in early pregnancy and have previously had a miscarriage, the National Institute for Health and Care Excellence (NICE) has recommended.1

The new recommendation follows a Cochrane network meta-analysis of progestogens for preventing miscarriage. The committee found evidence of no benefit in women with early pregnancy bleeding but no previous miscarriage, nor in women with previous miscarriage but no early pregnancy bleeding in the current pregnancy. However, further research has been recommended in these two areas.

Miscarriage is a common complication of early pregnancy, affecting about 20% of all pregnancies. It can have serious consequences for patients, including psychological harm and mental health …
NCOG-39. EXPLORING PATIENT REPORTED OUTCOMES (PROS) ACROSS ETHNORACIAL GROUPS IN PRIMARY BRAIN TUMOR (PBT) PATIENTS: DIFFERENCES IN THE ILLNESS EXPERIENCE
Authors: Amanda King, Julianie De La Cruz Minyety, Alvina Acquaye, Nicole Briceno, Anna Choi, Alexa Christ, Ewa Grajkowska, Varna Jammula, Heather Leeper, Jason Levine, Matthew Lindsley, Jennifer Reyes, Kayla Roche, James Rogers, Michael Timmer, Lisa Boris, Eric Burton, Nicole Lollo, Marissa Panzer, Lily Polskin, Marta Penas-Prado, Valentina Pillai, Brett Theeler, Jing Wu, Mark Gilbert, Terri Armstrong, Elizabeth Vera
Journal: Neuro-Oncology (2021)

Abstract SIGNIFICANCE AND AIMS Past research in PBT patients has demonstrated that minorities may have a survival advantage compared to Whites for high-grade tumors, though little is known about their illness experience given their underrepresentation in clinical trials. This study explored differences in PROs across race-ethnicity within a large PBT cohort describing associated burden and risk for minority populations where data is scarce. METHODS Demographic, clinical characteristics, MDASI-Brain Tumor, PROMIS Depression and Anxiety Short-Forms, and Neuro-QoL Cognitive Function were collected from the most recent timepoint for PBT patients enrolled on the Natural History Study. Descriptive statistics, one-way ANOVA, and linear regression were used to report results. RESULTS The sample included 562 PBT patients (58% male, median age = 50 [18-85]) comprised of 79% White, 6% African American (AA), 10% Hispanic, and 5% Asian patients per self-report. Most patients had a high-grade glioma (60%), with 28% on active treatment and 44% with good KPS (90-100). Among the most commonly reported moderate-severe symptoms were fatigue ( &amp;gt; 40% in all groups), difficulty remembering (30-40% of Asians, AAs, and Whites), and disturbed sleep (44% in Asians, 29% in Hispanics), while hemiparesis was common only for AA patients (37%). There were no differences between groups with respect to symptom burden and interference, mood disturbance, or cognitive function. Race/ethnicity group was not predictive of overall symptom burden or interference, but for all groups, higher KPS predicted lower symptom and interference scores (p &amp;lt; .001 and p = .004, respectively). CONCLUSION While some symptoms were common across ethnoracial groups, there were differences in symptom patterns, suggesting there may be other factors driving their illness experience. Future exploration of socioeconomic and cultural factors that might contribute to the symptom burden of minorities is warranted, which may allow development of targeted interventions to improve clinical outcomes in these groups.
Back Pain, Fever, and Cough in a 46-Year-Old Man
Authors: Aaron Richterman, Melissa Richard-Greenblatt, Kathryn Whitaker
Journal: JAMA (2021)

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