tbuckley/cabot-search huggingface dataset:
Abstract 13708: Right Ventricular Strain Comparison Between Quantification Software in Pediatric Normal and Pulmonary Hypertension Patients
Authors: Lisa Le, Dunbar IVY, Pei-ni Jone
Journal: Circulation (2020)

Background: Right ventricular (RV) free wall longitudinal strain (FWLS) is a functional assessment in pediatric pulmonary hypertension (PH). RV FWLS analysis requires study transfer to an offline software which can hinder clinical use. Autostrain RV (AS-RV) uses an automatic recognition and speckle tracking that allows for an efficient tool in routine clinical use. We evaluated the feasibility and reproducibility of AS-RV FWLS in controls and PH patients, and compared the timing of AS-RV to the offline analysis. Methods: Two and 3-dimensional echocardiography 4-chamber RV images were obtained in 32 PH patients and 33 controls. RV FWLS was analyzed by AS-RV software on the EPIQ machines and offline by TomTec 4D RV strain software. AS-RV timing with and without RVFW adjustments were compared to TomTec. Adjusted AS-RV and TomTec RVFWLS were compared between controls and PH patients using paired T-tests, Intraclass correlation (ICC), and Bland-Altman. Results: Controls and PH patients were not statistically different in age, body surface area, or heart rate. PH patients had decreased RV FWLS than controls (-24.1 ± 5.2 vs -28.3 ± 3.6; p&lt;0.001). AS-RV was feasible in all controls and 31/32 PH patients. However, 72% of controls and 75% of PH patients required contour adjustments for accurate tracking. There were significant differences in timing between AS-RV, adjusted AS-RV, and TomTec in controls (4.3 ± 1.0 seconds, 26.5 ± 25.7 seconds, 50.4 ± 6.9 seconds; p&lt;0.0001 respectively) and PH patients (4.4 ± 1.3 seconds, 42.4 ± 29.7 seconds, 52.7 ± 5.5; p&lt;0.0001). ICC of adjusted AS-RV and TomTec showed strong correlation in controls and PH patients (0.70 and 0.78 respectively). Bland-Altman analysis shown in Figure 1. Conclusion: RV FWLS evaluation is feasible and reproducible using AS-RV, but frequent adjustments need to be made for data accuracy. Adjusted AS-RV can be incorporated into clinical use with less time, making quantification of RV easier in clinical practice.
Acute targeting of pre-amyloid seeds in transgenic mice reduces Alzheimer-like pathology later in life
Authors: Ruth E. Uhlmann, Christine Rother, Jay Rasmussen, Juliane Schelle, Carina Bergmann, Emily M. Ullrich Gavilanes, Sarah K. Fritschi, Anika Buehler, Frank Baumann, Angelos Skodras, Rawaa Al-Shaana, Natalie Beschorner, Lan Ye, Stephan A. Kaeser, Ulrike Obermüller, Søren Christensen, Fredrik Kartberg, Jeffrey B. Stavenhagen, Jens-Ulrich Rahfeld, Holger Cynis, Fang Qian, Paul H. Weinreb, Thierry Bussiere, Lary C. Walker, Matthias Staufenbiel, Mathias Jucker
Journal: Nature Neuroscience (2020)
Abstract 13103: Nourin-dependent <i>Mirna-106b</i> : A Novel Early Inflammatory Diagnostic Biomarker for Cardiac Injury
Authors: Salwa A Elgebaly, Robert H Christenson, Hossam Kandil, Nashwa Elkhazragy, Laila Rashed, Beshoy Yacoub, Roshanak Sharafieh, Ulrike Klueh, Donald L Kreutzer
Journal: Circulation (2020)

Introduction: Nourin is an inflammatory mediator rapidly released by ischemic myocardium “before” necrosis, and by necrotic cells . It stimulates leukocyte “ chemotaxis ” and “ activates ” leukocytes and vascular endothelial cells to release several “ cytokine storm ” mediators. Using Nourin amino acid sequence, Bioinformatics analysis indicated that Nourin is likely regulated by miRNA-106b ; an inflammatory-signaling pathway linked to myocardial ischemia. Hypothesis: As an "initial" inflammatory marker, the Nourin-dependent miR-106b can early diagnose ischemia-induced injury in UA patients when Troponin levels are below the decision limit, and in STEMI patients. The underlying regulatory mechanism involves lncR-CTB89H12.4 and mRNA-ANAPC11; associated with ischemia. Methods: Gene expression of lncR-CTB89H12.4 / miR-106b and mRNA-ANAPC11 were measured in serum samples from UA (n=30 - confirmed by invasive coronary angiography and negative Troponin) and STEMI (n=16) patients at presentation, and healthy volunteers (n=16). Results: Gene expression of miR-106b was up-regulated by 150-fold in UA compared to healthy, and by 4.6-fold in STEMI compared to UA (Fig. 1). Receiving Operator Characteristics (ROC) analysis revealed a statistically significant difference in miR-106b that discriminated UA from healthy controls with a test sensitivity of 87% sensitivity &amp; specificity of 88%. Diagnostic sensitivity was 86% and specificity was 90% for discriminating UA from STEMI. Additionally, Spearman’s correlation analysis revealed a significant association of miR-106b with lncR-CTB89H12.4 and mRNA-ANAPC11. The down regulation of lncR-CTB89H12.4 after ischemia resulted in the up-regulation of miR-106b and activation of mRNA-ANAPC11 . Conclusions: The Nourin-dependent miR-106b is a promising early inflammatory biomarker indicating UA patients and discriminating between UA and STEMI. Regulations appears to be from lncR-CTB89H12.4 and mRNA-ANAPC11 .
Abstract 14173: Emailing is an Economical Way to Recruit Participants
Authors: Kirsten Raby, Karen Blinson, David M Herrington, David X Zhao, Gary Rosenthal, Schuyler Jones, Li Zhou
Journal: Circulation (2020)

Introduction: To produce results from clinical trials that are statistically significant, researchers must enroll enough participants; however, it is difficult to recruit sufficient participants. The ADAPTABLE trial is a pragmatic randomized controlled trial designed to compare two aspirin doses in patients with cardiovascular disease. Methods: We used eligibility criteria set forth by the ADAPTABLE study protocol. We then put patients into two groups. Patients with email addresses were group one, and sent an email weekly. Patients without an email address were in group two, and a letter was mailed to their home address. Eligible patients who had a clinic appointment scheduled were also recruited approached in clinic. Most of these patients had already been stratified into the email or letter group, but there was the possibility that they had a new diagnosis and had not been contacted. All were given a link to the ADAPTABLE trial portal with an access code to enroll. An explanatory video about the study and electronic informed consent were on the trial website. Results: As shown in Table 1, four hundred and nine patients enrolled in our trial over a 10-month period. Three hundred and ninety-seven (97.06%) patients enrolled in the study via email. Letters were sent to 7,226 patients and four (0.98%) enrolled in the study. Eight (1.96%) of the patients who were approached in person enrolled in the study. The cost of email campaign was $1.44/patient and the cost per enrollment was the least expensive, at $95.71. In person enrollment cost $23.34/patient and the total cost per enrollment was $417.12. The letter recruitment cost $0.30/patient, however, the cost per enrollment was the highest, at $542.26. Conclusion: Email is an effective and economical way to recruit patients for clinical trials. Email allows researchers to contact more patients about proposed studies promptly and facilitates pragmatic research trials that achieve results in a timely and cost-efficient manner.
Abstract 15173: Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis
Authors: Neal I Olarte, Manuel Rivera, Alexander Toirac, Louis Vincent, Igor Vaz, Marcelo Fernandes, Tanira Ferreira, Carlos Alfonso, Mauricio G Cohen, Eduardo de Marchena
Journal: Circulation (2019)

Introduction: Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment for severe aortic stenosis (AS) in patients who are at intermediate and high surgical risk. TAVR has no...
Abstract 14982: Paravertebral Block With a Paravertebral Catheter May Improve Outcomes After Minimally-invasive Cardiac Surgery
Authors: Diane Kim, Monica Hsieh, Travis Schisler, Richard Cook
Journal: Circulation (2020)

Background: Postoperative (post-op) pain following minimally-invasive cardiac surgery (MICS) may complicate outcomes in patients having surgery performed through a right mini-thoracotomy. Regional anaesthesia, by delivery of local anaesthetic agents to the paravertebral space using a paravertebral catheter (paravertebral block, PVB) may be useful to reduce post-op pain, however, few studies have reported outcomes on patients undergoing MICS with the use of a PVB. Methods: Ninety consecutive patients who underwent MICS at Vancouver General Hospital between January 2016 and May 2019 were included in this retrospective study. Data were collected for 53 patients who only had routine pain control (control) and 37 patients who had a PVB (PVB). Primary outcomes were post-op opioid use and hospital length of stay (LOS). Peri-operative (peri-op) death and stroke were secondary outcomes. Statistical analyses were performed using ANOVA single factor and t-tests. Results: Patient demographics and operative times were comparable between the two groups. The average total amount of opioid consumed in the PVB group was lower at 155.3 mg morphine equivalents, compared to 193.9 mg in the control group, however, the difference was not statistically significant (p=0.39) (Figure 1). However, the percentage of patients who did NOT receive any oxycodone was almost double in the PVB group (43.2% vs 24.5%, PVB vs control, respectively. p=0.06). The average LOS for the PVB group was significantly lower than the control group (5.4 vs 8.3 days, PVB vs control, respectively. p=0.006) (Figure 1). There were no peri-op deaths or strokes. Conclusion: In our experience, addition of a regional anesthetic was associated with ~20% reduction in the amount of opioid narcotic required. Although not statistically significant, this may be a clinically important difference, as the LOS was significantly lower in the PVB group. Outcomes in patients undergoing MICS may be improved with the addition of a PVB.
Abstract 13621: Predictors of Short-term and Long-term Clinical Outcomes After an Acute Atrial Fibrillation or Flutter Admission
Authors: Jia Yi Anna Ne, Tu Nguyen, Stuart Thomas, Joanne Han, Emma Charlston, Clara K Chow
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) is a major cause of mortality and morbidity globally. This study aims to identify predictors of AF-related rehospitalization following an acute AF/flutter admission. Methods: Patients admitted to Westmead Hospital with a primary diagnosis of AF/flutter from 1 May 2014 to 31 May 2018 were included and followed up until 31 May 2019. We defined AF-related rehospitalization as an admission due to recurrent AF/flutter, congestive heart failure, stroke and/or myocardial infarction. Multivariable logistic regression was used to identify independent predictors of 30-day outcomes. Cox regression was used to identify independent predictors of long-term outcomes: first AF-related rehospitalization or all-cause mortality. Results: Of 1664 consecutive patients admitted with AF/flutter, 55.8% were male and the median age was 68.0. At 30 days, 123 (7.4%) had an AF-related readmission (110 for AF/flutter and 13 for other cardiovascular outcomes). During a mean follow-up period of 2.1 ± 1.5 years, 683 (41.0%) of patients had at least one AF-related rehospitalization (38.1%, n=634) or died (2.9%, n=49). Chronic kidney disease (CKD) (OR 1.94, 95% CI 1.07 - 3.50) was an independent predictor of 30-day AF-related rehospitalization. Age (HR 1.01, 95% CI 1.01 - 1.02 for each additional year), initial admission via emergency (HR 1.29, 95% CI 1.08 - 1.54), CKD (HR 1.64, 95% CI 1.24 - 2.18), chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.09 - 1.83) and the presence of additional comorbidities (HR 1.38, 95% CI 1.04 - 1.83) were independent predictors of first AF-related rehospitalization or death (all p &lt;0.05). Conclusion: AF-related rehospitalization is common following an acute AF/flutter admission. AF/flutter patients with comorbidities, particularly renal and pulmonary diseases, are at high risk of readmission. Such patients could be targeted for increased surveillance and additional post-discharge support to prevent readmission.
Abstract 14047: Novel Noninvasive Risk Stratification Method Using Control-and-stability-theory Applied to 12-lead-ECG Repolarization Patterns in Brugada Type1 Subjects
Authors: Antonella Sabatini
Journal: Circulation (2020)

Background: Brugada syndrome (BrS) risk stratification in asymptomatic subjects and its underlying pathophysiological dynamics is complex. Purpose: This study aims to analyze, from alternative standpoints, superficial 12-lead ECG V2 repolarization patterns (repol.). This method diverges from ECG pattern characterization (patterns, angles, shapes, intervals, waves); it rather exploits nonlinear dynamics and stability of ECG repol. to assess stability driving cardiac dynamics: basal, after flecainide, during RF ablation, after 2nd flecainide test and post procedure. Target: to lower the number of invasive electrophysiology studies, furthering knowledge and applications of control-and-stability-theory applied to ECG. Methods: A stability control closed loop system has been designed to model electrophysiology dynamics of cardiac conduction: ECG segments being the input-output of the system. (Figure). A sequence of V2 repol. have been scanned, digitized and quantitatively processed yielding stability parameters (poles in S-plane). Scanning by Digitizeit - Digital River GmbH. S-plane computation by Microsoft Office, Wolfram Demonstrations Project &amp; Contributors, https://demonstrations.wolfram.com Results: Figure. Conclusions: Based on our data, 1) 12-lead-ECG repol. are associated with increasing stability (parameter values b), denoting underlying nonlinear dynamics, trending to incremental stability from basal to end of procedure.2) The incremental stability associated with all the process phases, from basal to end of procedure, indicates a potential use of this methodology to BrS risk stratification. Unstable repol. may be classified as high VT risk. In conclusion, furthering control-and-stability-theory applied to 12-lead ECGs aims to deeper comprehension of physiological and pathological substrates of malignant arrhythmias, and to focus on noninvasive risk stratification strategies for ICD implantation indication in BrS.
Chromosomal instability in urothelial bladder cancer is multimodal, predicts metastatic death, and indicates susceptibility to telomerase inhibitor treatment
Authors: Yuesheng Jin, Ylva Stewenius, David Lindgren, Tord Jonson, Mattias Hoglund, David Gisselsson
Journal: Cancer Research (2007)

136  Background: Genomic instability contributes to tumor development, but little is known about its underlying mechanisms and clinical implications.  Material and Method: We developed techniques to follow chromosome movement at mitosis in urothelial cancer cells. In the present study, six bladder cancer cell lines and 52 tumor samples were investigated.  Result and Significance: We have identified three distinct mitotic segregation errors leading to chromosomal instability in urothelial carcinomas: (1) telomere dysfunction, triggering structural rearrangements and loss of chromosomes through breakage-fusion-bridge events, (2) sister-chromatid non-disjunction generating discrete chromosomal copy-number variations, and (3) supernumerary centrosomes causing dramatic shifts in chromosome copy-number through multipolar cell division. Mitotic segregation errors were present already in pre-invasive tumors and a high frequency of telomere-dependent instability was an independent predictor of poor survival. Growth of cells with this instability could be specifically inhibited by a telomerase inhibitor, suggesting that the mode of genomic instability could be a potential indicator for response to targeted therapy.  We also showed that mitotic instabilities are active in vivo at frequencies increasing with tumor grade and stage, and that they independently can predict metastatic death. The instability with the closest association to poor patient survival was telomere dysfunction. A small molecule telomerase inhibitor induced dramatic growth reduction of tumor cells with this, but not with other types of mitotic instability. Taken together, our data show that several mechanisms may concurrently generate chromosome instability in urothelial cancer cells, and that these mechanisms may have fundamental biological and clinical implications.
Abstract 15961: Multicenter Prospective Prevention of Sudden Death in High Risk Patients Utilizing Enhanced ACC/AHA Risk Model
Authors: Ethan J Rowin, Martin S Maron, Arnon Adler, Alfred Albano, Armanda Varnava, Kevin Leong, Stephen Heitner, Stephen L Winters, Matthew Martinez, Dana Marsy, Emilie Cohen, Dana Spears, Adaya Weissler Snir, Harry Rakowski, Barry J Maron
Journal: Circulation (2020)

Introduction: Strategies for reliable selection of high-risk hypertrophic cardiomyopathy (HCM) patients for prevention of sudden cardiac death (SCD) with implantable cardioverter-defibrillators (ICDs) continue to be debated. Objective: Assess the sensitivity of sudden death risk strategies in predicting SCD events (appropriate ICD shocks, sudden death or out of hospital cardiac arrest) among a large multicenter cohort of high-risk HCM patients. Methods: Observational longitudinal study from 6-HCM centers in North America and Europe to determine outcomes in consecutive HCM patients considered high risk for sudden death based on an enhanced ACC/AHA (U.S./Canada) guidelines-based risk factor algorithm with primary prevention ICD placement. ESC risk score was retrospectively calculated in this cohort and compared to ACC/AHA risk factor method for predicting SCD events. Results: Of 1185 patients with primary prevention ICDs implanted based on ≥ 1 major risk marker, 162 (14%) experienced device therapy terminating VT/VF episodes at 49 ± 18 years of age and 4.6 ± 4.2 years after device implant. Within the 6 HCM centers, only 28 other patients not implanted with ICD died suddenly or had resuscitated cardiac arrests, including 19 (68%) with risk-markers who declined ICDs. Of these 190 high risk patients with SCD or SCD events, 67 (35%) had ESC risk-scores scores ≥6%/5-years, considered sufficient to recommend a prophylactic ICD, while 83 (44%) had low risk scores (&lt;4%/5-years) that likely would have excluded an ICD recommendation. Compared to enhanced ACC/AHA risk factors, the ESC risk-score was less sensitive than ACC/AHA (35% vs. 95%, p&lt;0.01), consistent with identifying fewer high-risk patients with events. Conclusion: In this large multicenter study of high-risk HCM patients, an enhanced ACC/AHA risk factor strategy was superior to the ESC risk score in identifying patients at greatest risk for SCD events.
Abstract 319: A Multi-faceted Programmatic Approach Associated with Over 50% Reduction in In-hospital Mortality
Authors: Amrita Mukhopadhyay, Wai Sha (Sally) Cheung, Eugene Yuriditsky, Karsten Drus, Quyen Wong, James Horowitz, Martha J Radford
Journal: Circulation (2020)

Introduction: In the United States, the chance of dying in the hospital widely varies by hospital, with bottom-decile hospitals having twice the rates of risk-adjusted mortality when compared to top-decile hospitals. This suggests a need for improvement in health systems nationwide. Here, we describe the implementation of, and associated outcomes for a multi-faceted, evidence-based approach to reducing in-hospital mortality. Methods: This is a retrospective interrupted time-series conducted at a large, urban, academic health system. Specifically, we describe the implementation of the following evidence-based methods: 1) escalation of communication guidelines, 2) proactive rounding with nurse response teams, and 3) rapid response teams with dedicated staff. We then quantify the associated observed-to-expected (O:E) in-hospital mortality over a 12-year period at our main hospital, and subsequently over a 3-year period at an affiliated hospital where the same interventions were later implemented. Results: Over 12 years, 445,308 patients were discharged from our main hospital, with 3,948 (0.9%) being discharged to an acute care facility, 4,558 (1.0%) discharged to hospice, and 4,648 (1.0%) expiring in the hospital. Patients had an average age of 53.1 years (std.dev 22.8 years), with the majority being female (59.0%), non-Hispanic white (66.1%), and admitted from the outpatient setting (93.3%). From the years 2010 to 2013, there was decline in O:E mortality by 59.0% (Figure 1A). This effect was sustained from 2014-2018. At the affiliate hospital, there was a similar decline in O:E mortality after implementation of the same interventions (60.5%, Figure 1B). Conclusion: Our multi-faceted, programmatic approach was associated with over 50% reductions in in-hospital mortality that were sustained for several years after implementation, and were reproduced at an affiliated hospital.
Abstract 16297: Persistent and Delayed Depression Predict All-cause Unplanned Rehospitalisations Following Acute Myocardial Infarction
Authors: Samia R Toukhsati, David L Hare
Journal: Circulation (2020)

Introduction: Depression following acute myocardial infarction (AMI) is a risk factor for future events and mortality. The aim of this study was to explore the post-AMI trajectory of depression as a risk factor for all-cause unplanned rehospitalisations. Methods: A total of 118 adults (101 men; mean±SD age = 64.76±11.16 years) completed the Cardiac Depression Scale (CDS) during and one month following AMI admission. On the basis of their CDS scores during index admission and 30 days post-AMI (≥ 95 = probable major depression) patients were categorized as having chronic; absent; recovered; or delayed depression. All-cause, unplanned rehospitalisations were sourced from electronic hospital databases (Cerner and TrakCare) from the time of the enrolment admission to census (11 th Dec 2019). Time in the study ranged from 61 days to 4.8 years. Results: A total of 41% of the sample (n = 48) had ≥ 1 all-cause unplanned rehospitalisation following their index AMI admission. Kaplan Meier Survival analyses revealed that worsening or persistent depression trajectories had earlier unplanned rehospitalisations (p &lt; .05). Pairwise Log Rank tests showed that patients with delayed depression had significantly less time to their first all-cause unplanned rehospitalisation compared to those with absent or recovered depression (p &lt; .05). Patients with chronic depression had significantly earlier unplanned rehospitalisations than those with recovered depression (p &lt; .05). Cox Regression analyses revealed that chronic (HR = 9.62109 [95% CI 2.53, 36.62] and delayed depression (HR = 2.94 [95% CI 1.08, 7.97] significantly increased the risk of all-cause unplanned rehospitalisations, after adjusting for time in the study, demographic factors, illness severity, heart disease knowledge, state anxiety and psychological resilience. Conclusions: Persistent or delayed trajectories of depression from admission to 30 days following AMI independently increases the risk of all-cause unplanned hospital readmissions. Patients should be screened for depression during AMI admission and throughout the early adjustment period (2-3 months post-AMI). Further research to increase capacity to predict post-AMI depression trajectories is warranted.