tbuckley/cabot-search huggingface dataset:
Abstract 13608: The Association Between Cardiometabolic Disorders/Cardiovascular Disease and the Distribution of Monocyte Subsets: A Systematic Review and Meta-Analysis
Authors: Ester Oh, Muzi Na, Connie Rogers
Journal: Circulation (2020)

Introduction: Monocytes play a crucial role in the pathology of atherosclerosis, a major cause of cardiovascular disease (CVD). Previous studies in preclinical models report that monocyte subsets (i.e. classical, intermediate and non-classical monocytes) may differently contribute to the pathogenesis of atherosclerosis. However, changes in the distribution and the role of each monocyte subset in cardiometabolic disorders (overweight/obesity, metabolic syndrome, hypercholesterolemia, and type 2 diabetes) and CVD in humans is less clear. Therefore, the aim of the current systematic review and meta-analysis was to evaluate the association between the monocyte subset distribution and cardiometabolic disorders/CVD in humans. Methods: Articles were systematically searched in CINAHL, Cochrane Central Register of Controlled Trials, and PubMed until April 2020. A total of 1592 articles were independently screened by 2 reviewers. A total of 25 studies were selected for qualitative analyses. Among them, 6 studies reported the percentage of each monocyte subset and were included in the meta-analyses. For the meta-analyses, a random-effects model was used to generate pooled standardized mean differences (SMD) between subjects with cardiometabolic disorders and healthy controls. Results: In total, sample size ranged from 22 to 135, and mean age of subjects ranged from 22 to 70 years. The percentage of classical monocytes was lower [SMD = -1.21; 95% CI (-1.92, -0.50); P &lt; 0.001; I 2 = 91%] in subjects with cardiometabolic disorders compared to healthy controls. However, the percentage of intermediate [SMD = 0.56; 95% CI (0.23, 0.88); P &lt; 0.001; I 2 = 65%] and non-classical monocytes [SMD = 1.39; 95% CI (0.59, 2.19); P &lt; 0.001; I 2 = 93%] was higher in subjects with cardiometabolic disorders compared to healthy controls. Conclusions: There may be a shift in the distribution of monocytes from classical to intermediate and non-classical monocytes in individuals with cardiometabolic disorders. This shift may be an underlying cause of chronic low-grade inflammation, exacerbate atherosclerotic risk, and contribute to the development of CVD based on preclinical studies. However, additional mechanistic studies are needed in humans to evaluate this question.
Abstract 12882: Renal Hemodynamics in Chronic Heart Failure With Preserved and Reduced Ejection Fraction
Authors: Susanne Jung, Agnes Bosch, Julie Kolwelter, Kristina Striepe, Dennis Kannenkeril, Tizia Schuster, Christian Ott, Stephan Achenbach, Roland E Schmieder
Journal: Circulation (2020)

Introduction: Chronic heart failure (CHF) and impaired renal function are two co-existing medical conditions and known to be associated with adverse outcome. The cardiorenal interaction has not yet been analyzed thoroughly. The aim of this study was to assess renal and intraglomerular hemodynamics by constant infusion input clearance technique in subjects with CHF compared to healthy controls. Methods: This was a cross-sectional observational study including 85 subjects. The group of subjects with CHF consisted of 27 individuals with HFpEF and 27 individuals with HFrEF, who were compared to 31 controls. All subjects underwent renal clearance examination to determine measured -not estimated- glomerular filtration rate (GFR), renal blood and plasma flow (RBF, RPF) and to calculate renal hemodynamic parameters such as filtration fraction (FF), renal vascular resistance (RVR), intraglomerular pressure (P glom ) and resistances of the afferent (R A ) and efferent arterioles (R E ). Results: GFR was lower in subjects with CHF (88.6±13.1ml/min/1.73m 2 ) compared to controls (108.6±17. ml/min/1.73m 2 ) after adjustment for age and BP (p adj =0.037). There were no significant differences regarding RPF, RBF, FF, RVR, P glom , R A as well as R E after adjustment for age and BP. Similarly, there were no significant differences regarding renal hemodynamic parameters between HFpEF and HFrEF subjects. Bivariate correlation analysis in the group of subjects with CHF revealed an inverse association between NT-proBNP and RPF (R=-0.421, p=0.002), RBF (R=-0.414, p=0.002) and a positive association with FF (R=0.324, p=0.019), RVR (R=0.346, p=0.012) and R E (R=0.318, p=0.022). Conclusions: The findings of this study indicate that in CHF renal function is slightly reduced even though renal perfusion is preserved. With progressive severity of CHF as indicated by increasing NT-proBNP, renal vascular resistance in particular at the postglomerular side increases. Our data are in accordance with neuroendocrine activation in CHF since vasoconstriction at the postglomerular site points towards angiotensin II as mediator. The association between NT-proBNP and renal hemodynamics documents a close cardiorenal interaction in CHF.
Abstract 17185: Burden and Prognostic Significance of Thrombocytopenia in the Cardiac Intensive Care Unit: Insights From the Critical Care Cardiology Trials Network (CCCTN) Registry
Authors: Orly Leiva, Danuzia S Silva, David Berg, Jianping Guo, Vivian Baird-Zars, Michael W Levangie, Erin A Bohula, David A Morrow
Journal: Circulation (2020)

Introduction: Thrombocytopenia is associated with poor outcomes in general medical intensive care unit (ICU) populations; however, the burden and prognostic significance of thrombocytopenia in cardiac ICU (CICU) populations have not been rigorously studied. Methods: The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated multicenter network of CICUs (n=25) in North America. Consecutive admissions to the CICU during annual snapshots (mostly 2 months) were submitted to the coordinating center (TIMI Study Group, Boston, MA) between September 2017 and September 2019. Patients were stratified by platelet counts on admission to the CICU and nadir platelet counts. Thrombocytopenia was classified as mild (100-149 K/uL), moderate (50-99 K/uL), or severe (&lt;50 K/uL). Results: Of 8206 CICU admissions with complete laboratory data, 21.7% had thrombocytopenia (platelets &lt;150 K/uL) on admission and 38.4% had thrombocytopenia at any point during their CICU course ( Fig-left ). Among those with normal platelet counts on admission (n=6423), 21.3% developed thrombocytopenia during their CICU course. Patients with thrombocytopenia on admission were more likely to have active cancer, underlying liver disease, and CKD as compared to those who did not (each p&lt;0.001). Among patients with cardiogenic shock (n=1478), 56.8% had thrombocytopenia (mild: 28.6%; moderate: 19.4%; severe: 8.9%). Among patients managed with mechanical circulatory support (MCS) (n=926), 65.0% had thrombocytopenia (mild: 27.0%; moderate: 24.3%; severe: 13.7%). There were stepwise gradients of increasing CICU and in-hospital mortality associated with lower nadir platelet counts (p-trend &lt;0.001) ( Fig-right ). Conclusions: Thrombocytopenia is common in CICU patients, including more than half of patients with cardiogenic shock and those managed with MCS. Thrombocytopenia is an adverse prognostic marker in CICU patients.
Abstract 13231: Fibromuscular Dysplasia Screening in Patients With Spontaneous Coronary Artery Dissection
Authors: Elizabeth W Thompson, Elliot Fitzsimmons, Tessa Cook, Jennifer Lewey
Journal: Circulation (2020)

Introduction: Spontaneous coronary artery dissection (SCAD) is commonly associated with fibromuscular dysplasia (FMD), a vascular condition that can lead to aneurysm and dissection in any arterial bed. SCAD and FMD are increasingly being diagnosed, especially in women. Our objective is to describe screening patterns of FMD over time among patients with SCAD. Methods: We conducted a retrospective cohort study, identifying patients treated for SCAD in the University of Pennsylvania Health System from 2005-2019 using ICD-9 (414.12) and ICD-10 (I25.42) codes. Charts were manually reviewed and clinical data were abstracted. Screening modalities included CT angiogram (CTA) or MR angiogram (MRA) of the head, neck, or abdomen; carotid or renovascular ultrasound; or renal angiography. Complete screening was defined as having head, neck, and abdominal imaging. We indexed cases by date of SCAD event. Time categories were calculated by quartiles of patients. We used Fisher’s exact test to compare proportions and Cochran-Armitage trend test to compare trends over time. Results: We identified 121 patients with SCAD with ≥ 6 months of follow-up prior to the COVID-19 pandemic. FMD screening rates by any modality were higher among patients with SCAD in 2018-2019 compared to 1993-2011 (62% vs. 28%, p=0.009 for trend), see Figure. Rates of complete screening remained low and did not change over time (p=0.451 for trend). In 2018-2019, only 41% of patients were screened with CTA or MRA of the abdomen, 26% with CTA or MRA of the neck, and 15% with CTA or MRA of the head. Patients undergoing complete screening had higher rates of FMD diagnosis compared to those undergoing any screening (63% vs. 37%, p=0.036). Conclusions: While overall FMD screening in SCAD patients has increased, complete screening rates remain low. FMD was diagnosed more often in patients undergoing complete screening, highlighting the importance of head, neck, and abdominal imaging in all patients with SCAD.
Enabling appropriate use of antibiotics: review of European Union procedures of harmonising product information, 2007 to 2020
Authors: Aleksandra Opalska, Marcel Kwa, Hubert Leufkens, Helga Gardarsdottir
Journal: Eurosurveillance (2020)

IntroductionAntimicrobial resistance (AMR) is one of the most important challenges in modern clinical practice. The European regulatory network has a strategy to support prevention of AMR by applying specific referral procedures.AimThe aim of this study was to evaluate post-authorisation changes made in the product information of key antibiotics that underwent referral procedures between 2007 and 2020.MethodIn a comprehensive analysis of the changes made for antibiotics, we extracted information on changes from the European Commission community register of medicinal products and the European Medicines Agency's database for antibiotics that went through referrals. Changes made in the specific sections of the summary of product characteristics of each referral procedure were scrutinised.ResultsWe identified 15 antibiotics from seven classes of antibiotics during the study period. The outcome of all referrals included the restriction of antibiotic use. Therapeutic indications were revised for all antibiotics, with septicaemia and gonorrhoea most common diseases removed. Posology and/or method of administration was updated for all; the majority of referrals included adjustment of dosage for specific populations. Information on contraindication (most regarding hypersensitivity) and information on warnings was amended for all referrals.ConclusionOur findings highlight the importance of the regulatory actions. The changes made in the product information aim to ensure appropriate use. Ongoing harmonisation activities are likely to lead to further refinements and restrictions on individual antibiotics in support of rational use. However, further research is required to examine the impact of post-referral label changes on the clinical practice.
Abstract 14521: Association of Serum Leptin and Abdominal Aortic Inflammation in Rheumatoid Arthritis
Authors: Abhijit Bhattaru, William Y Raynor, Shivaraj Patil, Chaitanya Rojulpote, Paco E Bravo, Karthik Gonuguntla, Pranav Karambelkar, Kiranmayi Vuthaluru, Siavash M Seraj, Vincent Zhang, Thomas Werner, Joshua F Baker, Abass Alavi
Journal: Circulation (2020)

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease associated with increased risk of atherosclerosis. Leptin may indirectly contribute to atherogenesis, but its role in RA is not clear. Hypothesis: We aimed to study the correlation between leptin and inflammation in the abdominal aorta (AA) assessed by 18F-FDG PET/CT in RA patients. Methods: We retrospectively analyzed the data of 18 RA patients (mean age 56.0±11.9, 14 male). All patients were administered 18F-FDG intravenously, and full-body PET/CT scans were acquired 180 minutes later. Regions of interest were delineated around the wall of the AA, with a superior border at the aortic hiatus of the diaphragm and an inferior border at the bifurcation of iliac arteries. Mean standard uptake values per axial slice were averaged to calculate the average SUVmean (aSUVmean). BMI, visceral fat area (VFA), and serum logarithmically transformed leptin (ln-leptin) were obtained. Patients were divided into low- and high-BMI groups, with a cutoff of 25 kg/m2. Results: Mean BMI (kg/m2) and VFA (cm2) between the low- and high-BMI groups were 21.7 vs. 31.4 (p&lt;0.001) and 72.3 vs. 157.0 (p=0.002), respectively. Serum ln-leptin and aSUVmean were significantly increased in the high-BMI group (7.2±0.9 vs. 9.8±1.1, p&lt;0.001; 1.4 vs. 1.7, p=0.04). On regression analysis, serum ln-leptin correlated positively with aSUVmean (r=0.59, p=0.01). Conclusion: In our study, higher serum leptin levels moderately correlated with 18F-FDG uptake in the AA, which reflects inflammation and atherogenic activity. Future studies are warranted to further elucidate the role of leptin in co-morbid atherosclerosis in patients with RA.
Abstract 139: Understanding Why Differences in the Provision of Bystander Cpr Exist for Women Versus Men: Does the Sex of the Rescuer Matter?
Authors: Sarah M Perman, Shelby Shelton, John D Rice, Christopher Knoepke, Kathryn Rappaport, Kathleen M Adelgais, Dan D Matlock, Edward Havranek, Stacie L Daugherty
Journal: Circulation (2020)

Introduction: Women who suffer an out of hospital cardiac arrest receive bystander cardiopulmonary resuscitation (bCPR) less often than men. We sought to determine if there were differences in potential deterrents to providing CPR if the rescuer was a man or a woman. Methods: We surveyed participants via Amazon’s Mechanical Turk, a national crowdsourcing platform, to query why women receive less bCPR than men based on the sex of the rescuer. We asked participants to rank five themes previously identified. Eligible participants were ≥18 years, US residents, and correctly defined CPR. Participants were asked to rank the 5 following themes if the sex of the rescuer was unidentified sex, male, and female: 1) Rescuers are afraid to injure or hurt women; 2) Rescuers might have a misconception that women don’t suffer cardiac arrest; 3) Rescuers are afraid to be accused of sexual assault or sexual harassment; 4) Rescuers have a fear of touching women or that the touch might be inappropriate; 5) Rescuers think that women are “faking it” or being “overdramatic.” Results: In total, 576 participants were surveyed, and 520 responses were formally analyzed. The respondents were 42.3% female, 74.2% Caucasian, 10.4% African American, and 6.7% Hispanic. To determine a “consensus” ranking, a statistical model that finds the mode of the rankings was used, generating separate results for each of the categories of rescuer. This method determined that the modal ranking for respondents asked about a female rescuer was Hurt/Injure, Touch, Overdramatic, Misconception, Sexual Assault/Harassment. By contrast, when respondents were asked about a male rescuer, the modal ranking was found to be Touch, Sexual Assault/Harassment, Hurt/Injure, Misconception, Overdramatic. When the sex of the rescuer was not identified, the modal ranking was identical to that for the male rescuer question. Conclusion: When querying the public as to why women receive less-bystander CPR than men, there were differences in response based on the sex of the rescuer. Participants reported that a male rescuer would potentially be hindered by fears of accusation of sexual assault/harassment or inappropriate touch, while female rescuers would be more deterred due to fears of causing physical injury or harm.
Health Care Use Before First Heart Failure Hospitalization
Authors: Kim Anderson, Heather J. Ross, Peter C. Austin, Jiming Fang, Douglas S. Lee
Journal: JACC Heart Failure (2020)

This study sought to describe the pattern of health care contacts in patients ultimately presenting with incident hospitalization for acute heart failure (HF) compared with chronic obstructive pulmonary disease (COPD) exacerbation or stable HF. Little is known about how effectively HF is detected before the first acute hospitalization. We compared 79,389 patients divided into 3 matched population cohorts in Ontario, Canada (2006–2013) with incident acute HF hospitalization, incident COPD hospitalization, or stable HF. The outcome of interest was the aggregate number of health care contacts occurring in each of the thirteen 28-day periods in the year preceding the index hospitalization. Health care contacts were defined as the total number of outpatient physician visits, hospitalizations for unrelated conditions, or emergency department visits. Acutely hospitalized patients with HF had a significant increase in health care contacts as time approached the index hospitalization. Patients with acute HF had a 28% increase in health care contacts in the last time period before the index hospitalization (adjusted rate ratio [RR]: 1.28; 95% confidence interval [CI]: 1.25 to 1.31; p < 0.001) compared with matched COPD controls. Compared with stable HF, acutely hospitalized patients had a 75% increase in health care contacts during the same time period (RR: 1.75; 95% CI: 1.71 to 1.79; p < 0.001). HF patients 20 to 40 years of age had an accelerated increase in the rate of health care contacts compared with those ≥65 years of age before index HF hospitalization (RR: 1.18; 95% CI: 1.08 to 1.28; p < 0.001). Patients consulted physicians multiple times before their incident acute HF hospitalization. These health care contacts could represent missed opportunities to prevent hospitalizations for HF.
Abstract 154: Hyperoxemia is Associated with Poor Neurological Outcomes in Patients with Out-of-hospital Cardiac Arrest Rescued by Extracorporeal Cardiopulmonary Resuscitation: Insight From the Nationwide Multicenter Observational JAAM-OHCA (Japan Association for Acute Medicine) Registry
Authors: Masaaki Nishihara, Ken-ichi Hiasa, Nobuyuki Enzan, Kenzo Ichimura, Takeshi Iyonaga, Yuji Shono, Takanari Kitazono, Hiroyuki Tsutsui
Journal: Circulation (2020)

Introduction: Previous studies have shown an association between hyperoxemia and mortality in out-of-hospital cardiac arrest (OHCA) patients after cardiopulmonary resuscitation (CPR); however, the evidence is lacking in patients receiving extracorporeal CPR (ECPR). Hypothesis: To test the hypothesis that hyperoxemia is associated with poor neurological outcome in patients treated by ECPR. Methods: The Japanese Association for Acute Medicine - OHCA (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients who had been resuscitated and survived 24 hours after OHCA and had a PaO 2 levels above 60 mmHg were included. Eligible patients were divided into 2 groups by each 2 definition according to the PaO 2 levels measured from arterial blood gas analysis 24-h after the ECPR, (1) High-level of PaO 2 (H-PaO 2 , n=242) as PaO 2 ≥ 157 mmHg (median) and control (n=211) as 60 &lt; PaO 2 &lt; 157 mmHg, (2) hyperoxemia (HO, n=80) as PaO 2 ≥ 300 mmHg and control (n=373) as 60 &lt; PaO 2 &lt; 300 mmHg. The primary and secondary outcomes were the favorable neurological outcome, defined as Cerebral Performance Categories (CPC) Scale 1-2, and survival at 30 days after OHCA, respectively. Results: Out of 34,754 patients with OHCA, 453 patients with ECPR were included. The number of CPC 1-2 was significantly lower in the H-PaO 2 and HO group compared with each control group (H-PaO 2 : 17.4% vs. 33.2%; Odds ratio [OR] 0.42; 95% confidence interval [CI] 0.27-0.66; P&lt;0.0001, HO: 8.8% vs. 28.2%; OR 0.24; 95% CI 0.11-0.55; P&lt;0.001). The 30-day survival was lower in these high oxygen groups (H-PaO 2 : 39.3% vs. 57.4%; OR 0.48; 95% CI 0.33-0.70; P&lt;0.0001, HO: 25.0% vs. 52.6%; OR 0.30; 95% CI 0.17-0.52; P&lt;0.0001). After adjusting for potential confounders, the H-PaO 2 and HO were associated with unfavorable neurological outcomes (adjusted OR, H-PaO 2 ; 2.71; 95% CI 1.16-6.30; P=0.021, HO; 5.76; 95% CI 1.30-25.4; P=0.021). The H-PaO 2 and HO were also associated with poor 30-day survival (adjusted OR, H-PaO 2 ; 2.28; 95% CI 1.13-4.60; P=0.021, HO; 3.75; 95% CI 1.28-11.0; P=0.016). Conclusions: Hyperoxemia was associated with worse neurological outcomes in OHCA patients with ECPR.
Baseline characteristics from a phase 3, randomized controlled trial (COUGH-1) of gefapixant, a P2X3 receptor antagonist, in refractory or unexplained chronic cough
Authors: D Muccino, A Morice, S S Birring, L Mcgarvey, P V Dicpinigaitis, I D Pavord, C La Rosa, E Urdaneta, C Assaid, J A Smith
Journal: Allergy (2020)
Repurposing the Mammographic Breast Density Category for Predicting Lymphedema Risk in Patients With Breast Cancer
Authors: Maggie Lee DiNome
Journal: JAMA Network Open (2020)

Jennifer Yin Yee Kwan, MD; Petra Famiyeh; Jie Su, MSc; Wei Xu, PhD; Benjamin Yin Ming Kwan, MD; Jennifer M. Jones, PhD; Eugene Chang, MD; Kenneth W. Yip, PhD; Fei-Fei Liu, MD
Abstract 16434: Temporal Metabolomic and Transcriptomic Changes in a Large-Animal Model of Hfpef
Authors: Andrew A Gibb, Emma K Murray, Deborah M Eaton, Anh T Huynh, Dhanendra Tomar, Joanne F Garbincius, Devin W Kolmetzky, Remus M Berretta, Markus Wallner, Steve R Houser, John W Elrod
Journal: Circulation (2020)

Heart failure with preserved ejection fraction (HFpEF) accounts for ~50% of HF cases, with no effective treatments. We previously reported that a feline aortic banding model recapitulates many of the multi-factorial features of HFpEF, including: LV hypertrophy, left atrial enlargement, elevated LV filling pressures, impaired pulmonary mechanics and fibrosis. Importantly, this model lacks obesity and hypertension enabling the discovery of cardiac centric targets independent of comorbidities. We examined early changes in metabolism and transcription to gain mechanistic insight into HFpEF development. Male short-hair kittens (2mo old) underwent aortic banding or sham operation. Cardiac function was assessed at baseline and 1mo post-banding prior to tissue collection and downstream analyses. Following banding, we observed significant cardiac hypertrophy and initiation of LV fibrosis in the absence of changes in cardiac function. We observed LV mitochondrial dysfunction, indicated by impaired complex-I and -II respiration prompting the examination of cardiac metabolism by unbiased metabolomics. 82 metabolites were significantly different (≥ 1.25 fold, p ≤ 0.1) between 1mo banded and sham hearts, with an overrepresentation of amino acid (aa) and lipid species. Pathway enrichment analysis highlighted an increase in aa metabolism (e.g. serine, proline) that is associated with ECM remodeling and tissue fibrosis. Additionally, an increase in lipid species (i.e. acyl-carnitines) suggests reduced fatty acid utilization and a shift towards glycolysis. Correlations of metabolomics data with mitochondrial function and cardiac phenotyping revealed strong associations between mitochondrial function and the cardiac energy state, as well as aa and LV fibrosis. RNA-seq and enrichment analyses revealed a significant inflammatory response early in disease progression and a decrease in protein/histone acetylation. Collectively, this systems-based approach provides new insights into the cellular biology underlying HFpEF-like disease progression. The metabolic and transcriptional signature that precede the clinical features of HFpEF, will provide new pre-clinical research directions and may yield novel therapeutic targets.