tbuckley/cabot-search huggingface dataset:
Abstract 15503: Biophysical Indicators of Acute Pulmonary Vein Isolation With a Novel Cryoballoon
Authors: Ante Anic, Andrew Martin, Toni Breskovic, Alexandre Ouss, Lukas Dekker, Matthew Sulkin, Binh Tran, Sing-Chien Yap, Rohit E Bhagwandien, Nigel Lever, Niraj Varma
Journal: Circulation (2020)

Introduction: Low nadir temperature (N T ) and long thaw times with cryoballoon ablation are associated with successful PVI. Recently, a cryo-system was designed to improve catheter stability during ablation via a balloon (CB, POLARx™, Boston Scientific) that maintains uniform pressure and size. The purpose of this study was to evaluate whether the CB biophysical parameters, including time to -40 o C (TT40), N T , time to thaw (iTT0), and time to 15 o C (iTT15), are associated with acute PVI success in paroxysmal AF patients. Methods: Ablation was delivered for 180s if isolation was achieved in ≤ 60s or 240s if isolation occurred after 60s. PVI was confirmed via entrance and exit block. Biophysical parameters were evaluated for 3 groups: block with 180s ablation, block with 240s ablation, and for unsuccessful initial treatments (gap veins). The diagnostic accuracy for predicting PVI was assessed using area under (AUC) the receiver operator characteristic (ROC) curve for ablations &gt; 120s. Results: Forty-six consecutive de novo PVI procedures at 4 centers were analyzed (n=234 ablations). All PVs were isolated using the CB alone, with the vast majority within 60s. During freeze, TT40 and N T were significantly shorter and colder for isolated veins compared to gap veins (Table). During thaw, iTT0 and iTT15 were significantly longer for isolated veins compared to gap veins (Table). ROC analysis found iTT15 had the highest diagnostic accuracy for isolation (AUC: 0.85) followed by N T (AUC: 0.81), iTT0 (AUC: 0.77), and TT40 (AUC: 0.72). Optimal cutoff values for iTT15 and N T were 33.5s and -48 o C, which had positive predictive values for acute block of 96.6% and 93.5%. Conclusions: When using the novel CB, ablations reaching &lt; -48 o C and having thaw times to 15 o C &gt; 33.5s were predictive of acute block in PVI, providing guidance toward improved workflow and potential reduction in procedural time.
Single cell and spatial transcriptomics in human tendon disease indicate dysregulated immune homeostasis
Authors: Moeed Akbar, Lucy MacDonald, Lindsay A N Crowe, Konstantin Carlberg, Mariola Kurowska-Stolarska, Patrik L Ståhl, Sarah J B Snelling, Iain B McInnes, Neal L Millar
Journal: Annals of the Rheumatic Diseases (2021)

Figure 1 The frequency and OR of ultrasound power Doppler signal in tender vs non-tender non-swollen wrists.
Abstract 13030: Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial
Authors: Mandeep S Sidhu, Karen P Alexander, Zhen Huang, Sean M O’Brien, Bernard R Chaitman, Gregg W Stone, Jonathan D Newman, William E Boden, Aldo P Maggioni, Philippe Gabriel Steg, T Bruce Ferguson, Marcin Demkow, Jesus Peteiro, Gurpreet S Wander, Mark A de Belder, Hanna Szwed, Rolf Doerr, Erick Alexanderson, Carisi Polanczyk, Peter Henriksen, Dwayne Conway, Vicente Miro, Tali Sharir, Yves D Rosenberg, Sripal Bangalore, Harmony R Reynolds, Judith S Hochman, David J Maron
Journal: Circulation (2020)

Background: In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, all-cause mortality was similar in patients with stable ischemic heart disease (SIHD) randomized to invasive (INV) and conservative (CON) management strategies. This analysis details specific causes of cardiovascular (CV) and non-CV mortality by treatment group. Methods: In ISCHEMIA, 289 deaths occurred after a median follow-up of 3.2 years; 145 (5.6%) in INV and 144 (5.6%) in CON (HR 1.05, CI 0.83-1.32). Deaths were adjudicated by an independent Clinical Events Committee as CV, non-CV with or without a CV contributor or undetermined. The protocol defined CV death as deaths from CV causes, non-CV causes with CV contributor, and cause undetermined; non-CV death was defined as death from non-CV causes without a CV contributor. Multivariable analyses were used to identify factors associated with cause-specific death. Results: CV death was similar between groups [INV 92 (3.6%), CON 111 (4.3%); HR 0.87 (CI 0.66, 1.15)], but INV had more non-CV death [INV 53 (2.0%), CON 33 (1.3%); HR 1.63 (CI 1.06, 2.52)]; fewer undetermined deaths [INV 12 (0.5%) and CON 26 (1.0%); HR 0.48 (0.24, 0.95)] and more malignancy deaths [INV 41 (1.6%), CON 20 (0.8%); HR 2.11 (1.24, 3.61)]. In multivariable analysis, risk factors associated with CV death were age [HR 1.42 (CI 1.19-1.70) per 10-year increase], diabetes [HR 1.39 (CI 1.03-1.87)], history of heart failure [HR 1.96 (CI 1.33-2.91)], and eGFR [HR 1.18 (CI 1.11-1.26) per 5-ml/min decrease below 80ml/min]. Factors associated with non-CV death were age [HR 2.31 (CI 1.75-3.03) per 10-year increase] and randomization to INV [HR 1.76 (CI 1.13-2.75)]. Conclusions: In ISCHEMIA, all-cause mortality was similar for the INV and CON strategies. Excess non-CV deaths in INV with a higher number of deaths from malignancy but a higher number of undetermined deaths in CON requires further evaluation.
Abstract 12957: Delay in Qrs Interval Predicts Risk of Heart Failure and In-hospital Mortality in Patients Admitted With Atrial Fibrillation With Rapid Ventricular Response
Authors: Belal Kaseer, Bassman Tappuni, Ali AlKhayru, Awfa Zain Elabidin, Vahid Namdarizandi, Gitanjali Lobo, Sai Hanumanthu, Marshall W Winner, Stephanie Kovalchik v, Dominique Brandt, Kamal Shemisa
Journal: Circulation (2020)

Introduction: Atrial fibrillation is associated with increased risk of heart failure and mortality. The association of QRS duration (QRSd) with morbidity and mortality is understudied in patient with atrial fibrillation (AF) Hypothesis: We sought to investigate the association of prolonged QRSd (≥120 ms) and risk of heart failure and in-hospital death in patients admitted for AF with rapid ventricular response (RVR) Methods: A retrospective study in a community hospital using EPIC database analyzed 1637 patients from 2013-2018 with admission codes of AF with RVR. The cohort was then stratified based on QRSd ≥120ms vs &lt;120ms. A p-value of &lt;0.05 was considered significant Results: Among the 1637 patients who were admitted with AF with RVR, 233 (14%) had QRS ≥120ms. Patient’s characteristics with QRSd≥120 compared to those with QRSd&lt;120ms were mean age [75.9 (11.8) vs 70.9 (13.6), (P&lt;.0001)], history of CAD [41% vs 28%, odds ratio (OR)= 1.78, 95% confidence interval (CI): 1.3-2.3 (P&lt;.0001)], history of PVD [15% vs 7%, OR=2.38, 95% CI: 1.58-3.59 (P&lt;.0001)], history of acute MI [50% vs 33%, OR=1.99, 95% CI:1.5-2.6 (P&lt;.0001)] and CHA2DS2Vasc score [median (IQR) 5(3, 6) vs 4(3, 5) (P&lt;0.001). QRSd≥120ms was associated with higher BNP value [median (IQR) 537(305, 862) vs 371(186, 655) (P&lt;0.001)] and an increased risk of heart failure [(70% vs 55%, OR=1.93, 95% CI:1.43-2.6 (P&lt;.0001)]. Additionally, higher in-hospital mortality rate was observed in patients with QRSd≥120ms [4.3% vs 1.3%, OR=3.11, 95% CI:1.44-6.75 (P=0.006)] Conclusions: In patients who were admitted with AF with RVR, QRSd≥120ms was associated with a higher burden of cardiovascular disease, CHA2DS2Vasc score and an increased risk of heart failure resulting in worse clinical outcomes. Higher median BNP values suggest that worsening heart failure contributed to higher in-hospital mortality. Heart failure associated mortality could be alleviated with medical management or cardiac resynchronization therapy.
Pretreatment metastatic growth rate determines clinical outcome of advanced melanoma patients treated with anti-PD-1 antibodies: a multicenter cohort study
Authors: Nikolaus B Wagner, Max M Lenders, Kathrin Kühl, Lydia Reinhardt, Fiona André, Milena Dudda, Natalie Ring, Chiara Ebel, Ramon Stäger, Caroline Zellweger, Roland Lang, Michael Paar, Philipp Gussek, Georg Richtig, Suzan H Stürmer, Susanne Kimeswenger, Angela Oellinger, Andrea Forschner, Ulrike Leiter, Benjamin Weide, Maximilian Gassenmaier, Amadeus Schraag, Bernhard Klumpp, Wolfram Hoetzenecker, Carola Berking, Erika Richtig, Mirjana Ziemer, Johanna Mangana, Patrick Terheyden, Carmen Loquai, Van Anh Nguyen, Christoffer Gebhardt, Friedegund Meier, Stefan Diem, Antonio Cozzio, Lukas Flatz, Martin Röcken, Claus Garbe, Thomas K Eigentler
Journal: Journal for ImmunoTherapy of Cancer (2021)

Checkpoint inhibitors revolutionized the treatment of metastatic melanoma patients. Although tumor burden and lactate dehydrogenase (LDH) are associated with overall survival (OS), the impact of tumor growth kinetics remains elusive and in part contradictory. The aims of this study were to develop a novel simple and rapid method that estimates pretreatment metastatic growth rate (MGR) and to investigate its prognostic impact in melanoma patients treated with antiprogrammed death receptor-1 (PD-1) antibodies.MGR was assessed in three independent cohorts of a total of 337 unselected consecutive metastasized stage IIIB-IV melanoma patients (discovery cohort: n=53, confirmation cohort: n=126, independent multicenter validation cohort: n=158). MGR was computed during the pretreatment period before initiation of therapy with anti-PD-1 antibodies nivolumab or pembrolizumab by measuring the increase of the longest diameter of the largest target lesion. Tumor doubling time served as quality control. Kaplan-Meier analysis and univariable as well as multivariable Cox regression were used to examine the prognostic impact of MGR.Pretreatment MGR >3.9 mm/month was associated with impaired OS in the discovery cohort (HR 6.19, 95% CI 2.92 to 13.10, p<0.0001), in the confirmation cohort (HR 3.62, 95% CI 2.19 to 5.98, p<0.0001) and in the independent validation cohort (HR 2.57, 95% CI 1.56 to 4.25, p=0.00023). Prior lines of systemic treatment did not influence the significance of MGR. Importantly, the prognostic impact of MGR was independent of total tumor burden, diameter of the largest metastasis, number of prior lines of systemic treatment, LDH, as well as liver and brain metastasis (discovery and confirmation cohorts: both p<0.0001). Superiority of MGR compared with these variables was confirmed in the independent multicenter validation cohort (HR 2.92, 95% CI 1.62 to 5.26, p=0.00036).High pretreatment MGR is an independent strong prognostic biomarker associated with unfavorable survival of melanoma patients receiving anti-PD-1 antibodies. Further investigations are warranted to assess the predictive impact of MGR in distinct systemic therapeutic regimens.
Abstract P186: “It Was Just For Us”: Qualitative Evaluation Of An Exercise Intervention For Older African-american Couples
Authors: Lyndsey M Hornbuckle, Cristina S Barroso, Amy Rauer, Chloe S Jones, Kerri M Winters-Stone
Journal: Circulation (2021)

Introduction: Promoting long-term exercise adherence should be a key focus for health and fitness professionals working to reduce obesity and cardiometabolic health disparities, and all-cause mortality in inactive African-American (AA) adults. Data have suggested that romantic partners can improve long-term exercise adherence and that this dyadic approach should be examined in exercise interventions. Therefore, the purpose of this study was to conduct a qualitative process evaluation of a pilot exercise intervention conducted in older AA couples. The intervention itself examined whether exercising together influenced exercise adherence and cardiometabolic risk. Methods: Two semi-structured focus groups were utilized to compare experiences across two randomly assigned treatment conditions (exercising together with partner [ET: n=8] versus exercising separately [ES: n=6]). Participants (mean age: 64.7±6.8 years; body mass index 30.4±4.8 kg/m 2 ) of a previous 12-week pilot exercise intervention (walking ≥3 days/week, 30 minutes/day plus supervised resistance training 2 days/week) were interviewed. Investigators used guidelines for process evaluation and the context of the intervention to design the focus group guide. Verbatim transcripts were coded using an open coding approach. Results: Three key themes emerged (Table 1). Although all couples identified health and relationship benefits of the intervention, some differences surfaced within themes across the two intervention groups. Conclusions: These data will help investigators continue to develop the intervention, which is ultimately designed to promote long-term exercise adherence to reduce cardiometabolic health disparities in the AA community.
Abstract 17063: Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure
Authors: Finnian R Mc Causland, Marty Lefkowitz, Brian Claggett, Nagesh Anavekar, MICHELE SENNI, Mauro Gori, Pardeep S Jhund, Martina McGrath, Milton Packer, Victor SHI, Dirk van Veldhuisen, Faiez ZANNAD, Josep Comin-Colet, Marc A Pfeffer, John J McMurray, Scott Solomon
Journal: Circulation (2020)

Background: In patients with heart failure, chronic kidney disease (CKD) is associated with a higher risk of renal events than in patients without CKD, irrespective of the ejection fraction. We assessed the renal effects of angiotensin/neprilysin inhibition in patients with heart failure in a pooled analysis of 13,195 patients with reduced and preserved ejection fraction. Methods: We combined data from PARADIGM-HF (LVEF eligibility≤40%; n=8,399) and PARAGON-HF (LVEF eligibility≥45%; n=4,796) in a prespecified pooled analysis. We assessed the effect of treatment (sacubitril/valsartan compared with enalapril or valsartan) on the renal composite outcome, defined as the time to first occurrence of either: ≥50% reduction in eGFR, end-stage renal disease, or death from renal causes. We also assessed the influence of therapy on eGFR slope. Results: At randomization, eGFR was 68±20 ml/min/1.73m 2 in PARADIGM-HF and 63±19 ml/min/1.73m 2 in PARAGON-HF. The composite renal outcome occurred in 70 of the 6594 patients (1.1%) in the sacubitril/valsartan group and 123 of the 6601 patients (1.9%) in the valsartan or enalapril group, with a risk reduction of 44% (HR 0.56, 95%CI 0.42-0.75; P&lt;0.001). The treatment effect on the composite renal endpoint did not differ according to the baseline eGFR (&lt;60 vs ≥ 60 ml/min/1.73 m 2 ; P-interaction=0.46) or baseline ejection fraction (P-interaction=0.35). From randomization, the mean decline in eGFR was -1.8 (95%CI -1.9 to -1.7) ml/min/1.73 m 2 per year for the sacubitril/valsartan group, compared with -2.4 (95%CI -2.5 to -2.2) ml/min/1.73 m 2 per year for the valsartan or enalapril group, with an adjusted mean difference of 0.6 (95%CI 0.4 to 0.7; P&lt;0.001) ml/min/1.73 m 2 per year. Conclusions: In patients with heart failure, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, compared with valsartan or enalapril, across the spectrum of ejection fraction.
Abstract 16545: Sinus Rhythm Dynamics and Ventricular Ectopy in an Experimental Model of Aging
Authors: Martina Comelli, Emanuele Pizzo, Marianna Meo, Daniel O Cervantes, Aaron Plosker, Bridget Faltas, Jason T Jacobson, olivier meste, Marcello Rota
Journal: Circulation (2020)

Aging is coupled with alterations of heart rate and heart rate variability (HRV), together with increased incidence of arrhythmias and sudden cardiac death. But whether changes of sinus rhythm properties of the aged heart correlate with enhanced occurrence of ventricular ectopic discharge remains unclear. Thus, we studied the effects of aging on heart rate, HRV, and occurrence of premature ventricular complexes (PVCs) in aging C57Bl/6 mice. Electrocardiograms (ECG) were obtained in male and female conscious mice at ~4, ~12, ~18, and ~24 months of age (n=37-66). Heart rate was preserved at ~4, ~12, and ~18 months (729±30, 730±22, and 725±20 bpm) and reached a minimum at ~24 months (708±37 bpm). Standard deviation of RR intervals, an indicator of HRV, was maximal at ~4 months (3.5±1.7 ms) and was reduced at ~12, ~18, and ~24 months (2.6±1.5, 2.5±1.3, and 2.6±1.3 ms). By frequency domain analysis, high-frequency components of RR interval variations, indicative of parasympathetic influence, were preserved with aging. In contrast, low frequency components, comprising the influence of sympathetic and parasympathetic axis, were maximal in young animals and progressively decrease at ~12, ~18, and ~24 months. PVCs were observed in only 3% of mice at ~4 months, a fraction that increased to 11%, 10%, and 22% at ~12, ~18, and ~24 months, respectively. For each age interval, heart rate and HRV parameters for animals with PVCs were distributed within the range observed in mice not experiencing ventricular ectopy. Moreover, for animals with PVCs, parameters of HRV before the occurrence of ectopic beats were comparable to those observed during undisturbed sinus rhythm, although a tendency for lower heart rate was seen. To address the role of the autonomic nervous system on incidence of ectopic events, ECGs were collected before and after block of the sympathetic and parasympathetic axis in mice at ~4 months (n=30) and ~24 months (n=26). This intervention reduced heart rate in both groups of animals and attenuated HRV exclusively in young. Moreover, combine autonomic block decreased incidence of PVCs by 50% and 57% in young and old animals, respectively. Collectively, these results suggest that occurrence of ventricular ectopy does not correlate with heart rhythm dynamics.
Abstract 16146: Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover - <i>Topical Nitroglycerine to Prevent Radial Artery Spasm</i> (TNTRASP) <i>Study</i>
Authors: Prabhakaran P Gopalakrishnan, Manova David, Pradeep Manoharan, Sharan Rufus Ponniah, Brendan Duffy
Journal: Circulation (2020)

Background: Radial to femoral access crossover has been reported as high as 7.6%. Access site failure, radial spasm and tortuosity are potential reasons. Methods: Patients undergoing radial catheterization were randomly assigned to 30 mg of topical nitroglycerine (NTG, n =48) or placebo ( n =52) at least one hour before access. Both groups received 40 mg of topical lidocaine. Radial artery dimensions were measured before drug application and immediately before access. RASP score (Forearm discomfort + Difficult catheter manipulation + Additional intraarterial NTG + Sheath removal difficulty) &gt;0 indicates radial spasm. Results: Radial artery cross sectional area (CSA) increased significantly in NTG group (30% vs. -3%, p &lt;0.001). Radial artery was smaller than the sheath at time of access in fewer patients in NTG group (10% vs. 27%, p &lt;0.05). Fewer patients had spasm in NTG group (17% vs. 29%, p =0.14). Average RASP score was lower in NTG group (0.2 vs. 0.6, p =0.10). No crossover to femoral access in NTG group compared to 4 crossovers in control ( p &lt;0.05). Femoral crossover was 10 times more likely if radial diameter &lt; 2 mm ( p &lt;0.05). Risk of radial spasm was higher with multiple arterial sticks ( p &lt;0.01); arterial tortuosity ( p &lt;0.05); intraarterial heparin ( p &lt;0.01), use of multiple wires ( p &lt;0.001); use of multiple catheters ( p &lt;0.01) and nonhydrophillic catheter use ( p =0.001). Preprocedural valium reduced risk of radial spasm. Radial spasm was associated with 5 fold risk of hematoma ( p =0.01) and higher radiation dose ( p &lt;0.001). Discussion: Pre-dilation with topical NTG reduced access site failure and risk of femoral crossover. Radial spasm incidence was lower in NTG but not statistically significant. Radial spasm was influenced by several factors like choice of wires and catheters. Radial spasm increased risk of hematoma as well as radiation exposure. Conclusion: Topical nitroglycerine to predilate radial artery reduces risk of femoral crossover and may reduce radial spasm.
Abstract 17083: SARS-CoV-2 Dramatically Decreases Healthcare Access for Patients With Cardiovascular Disease
Authors: Josephine L Harrington, James G Jollis, Manesh R Patel, Anjni Joiner, Christopher B Granger
Journal: Circulation (2020)

Background: In the setting of SARS-CoV-2 the public has sought to avoid any unnecessary contact, leaving their homes only when absolutely necessary. Hypothesis: We hypothesized that patients largely stopped seeking care for their acute CV conditions as they sheltered in place in the setting of Covid-19. Methods: We assessed changes in access to CV medical care at multiple levels, including Emergency Medical Services (EMS) call volumes in local Durham and Orange County (population 469,000), as well as for CV clinic appointments, inpatient CV census, ST elevation myocardial infarction (STEMI) activations and Emergency Room (ER) visits for a CV complaint at Duke University Hospital, which provides care for a catchment area of about 3.9 million residents, between the first and second half of March 2020. Results: Interactions for CV conditions dropped significantly at almost every level of entry into the healthcare system between the first and second half of March 2020 (Table, Figure). Conclusions: During the current pandemic, CV patients appear to have a significantly higher threshold to seek medical care. The older population of patients with CV disease may be particularly predisposed to remain in isolation due to the higher risk. Patients not receiving medical care may be continuing to decompensate. They may be more likely to die at home, or when they do present for care it may be at a later stage, leading to increased morbidity and mortality. Understanding and addressing the profound change in acute CV care may be almost as important as controlling the virus and its direct consequences, especially as the healthcare systems begin to evaluate how to best re-engage with their patients.
Abstract 15983: New Left Ventricular Systolic Dysfunction in Hospitalized Patients With Covid-19
Authors: Celeste S Witting, Jayson Baman, Eric Cantey, Baljash Cheema, Arvind Nishtala, Nausheen Akhter, James Flaherty
Journal: Circulation (2020)

Introduction: Left ventricular systolic dysfunction (LVSD) has been observed in COVID-19 and is thought to be multifactorial. The epidemiology of stress cardiomyopathy in these patients has not been studied. Methods: Transthoracic echocardiograms (TTE) were evaluated in consecutive COVID-19 patients admitted to a large tertiary care center in Chicago, Illinois. Subjects with new LVEF ≤50% with prior normal LVEF or unknown baseline LVEF were compared to those with LVEF &gt;50% or previously known LVSD. InterTAK scores were calculated for all patients with new LVSD, and a cutoff of 50 was used to delineate the likelihood of stress-induced cardiomyopathy. Two-tailed student t-test of unequal variance and Chi-squared testing were used for analysis of continuous and categorical variables, respectively, with p&lt;0.05 considered statistically significant. Results: Of hospitalized patients with COVID-19 (n=982), 231 (23.5%) underwent TTE. Thirty patients (13.0%) were found to have new LVSD. Patients with new LVSD had higher peak troponin and rates of ICU admission and incidence of in-hospital mortality compared to patients without new LVSD (Table). Ten patients (33%) with new LVSD had InterTAK scores ≥50. Compared to those with low InterTAK scores, these patients were more likely to be female, have lower peak d-dimer, and a trend towards lower troponin as well as rates of ICU admission and mortality. Only two patients with new LV dysfunction were noted to have Takotsubo patterns on TTE. Conclusions: In hospitalized patients with COVID-19, new LVSD was rare but associated with an increased risk of critical illness requiring intensive care, intubation and in-hospital mortality. The etiology of new LVSD in COVID-19 is likely multifactorial, but those with LV dysfunction likely secondary to stress-induced cardiomyopathy have a trend towards improved mortality.