tbuckley/cabot-search huggingface dataset:
Abstract 15856: Peripheral Arterial Tonometry Has Low Sensibility for Cardiac Allograft Vasculopathy Detection
Authors: BRUNO M VEIGA, Marina Lima, Rafael Fontes, Evandro C Brito, Daniella Brandão, Armele Dornelas de Andrade, Rodrigo Carneiro, Fernando Figueira, Verônica Monteiro, Maria Mello
Journal: Circulation (2020)

Introduction: Cardiac allograft vasculopathy (CAV) is the main cause of chronic graft failure in cardiac transplant patients and plays a significant role in overall morbimortality of the post-transplantation population. In spite of the many available exams currently able to detect CAV subclinical development, they generally display important clinical limitations and lack early diagnosis sensibility. Therefore, the investigation of alternative technologies is essential for the better recognition and prevention of such condition. Methods: Exploratory study on the use of peripheral arterial tonometry as assessment of endothelial health of post-transplant patients. Patients were enrolled from Brazil’s 3rd largest heart transplant center, Instituto de Medicina Integral Professor Fernando Figueira, and subsequently evaluated with EndoPAT2000 between August 2019 and February 2020, when COVID-19 pandemic prematurely concluded the study. Eligible patients had at least 2 years of transplant afterlife and were regularly hospital monitored. The patients’ cardiac catheterism records were collected for more accurate comparison with endothelial results. Medications, preexisting conditions, and transplant information were acquired from medical records. The main outcomes consisted of peripheral arterial tonometry detection capability of endothelial abnormality degree and CAV. Results: Sample size of 22 patients (mean age 50.9, 90.9% men) submitted for EndoPAT2000 exam. Of these, 14 had prior catheterism records (3 had confirmed CAV, 2 coronary fistulas, 9 no abnormalities) and 9 didn′t. When compared with the non catheterism group (2.25 ± 0.41, 0.80 ± 0.19, 8.13 ± 12.21, 16.49 ± 13.87) patients who underwent the procedure (1.89 ± 0.56, 0.60 ± 0.28, 0.72 ± 10.78, 8.54 ± 12.69) had reasonably lower RHI, LnRHI, AI, and AI@75 respectively. CAV confirmed patients (1.99 ± 0.69, 0.65 ± 0.34, -2.07 ± 3.72, 4.40 ± 6.74) had no significant RHI differences, yet displayed slightly lower AI values. Conclusion: The findings of this study suggest there was no significant difference of endothelial health per peripheral arterial tonometry examination between the average catheterism population and CAV patients. Larger studies are needed to confirm such findings.
Abstract 15437: Effects of the Adjunctive N-3 Polyunsaturated Fatty Acid Therapy to Strong Statin on Vascular Healing Process in Patients With Acute Coronary Syndrome: An Optical Coherence Tomography Study
Authors: Yoko Kita, Makoto Watanabe, Satoshi Okayama, Daisuke Kamon, Tomoya Ueda, Tsunenari Soeda, Hiroyuki Okura, Shiro Uemura, Yoshihiko Saito
Journal: Circulation (2019)

Introduction: Previous study demonstrated that n-3 polyunsaturated fatty acids (PUFAs) have a preventive effect of cardiovascular events. However, healing mechanism of PUFAs on coronary atheroscler...
Abstract 13933: High Urgency Candidates for Heart Transplantation Does Not Correlate to the Development of Primary Graft Dysfunction
Authors: Rafael Skorka, Keith Nishihara, Adriana Shen, Evan P Kransdorf, Lillian Benck, Jignesh K Patel, Jon A Kobashigawa
Journal: Circulation (2020)

Introduction: Primary Graft Dysfunction (PGD) after Heart Transplantation (HTx) is seen in approximately 7-30% of heart transplant patients as described by the literature. Many of these patients have severe PGD which requires support with ECMO. It has been reported that patients who are severely ill on high dose inotropes or on assists devices have greater propensity to develop severe PGD. Many of these patients have borderline blood pressure due to poor cardiac function which may contribute to PGD with its associated vasoplegia. In order to asses risk for the development of PGD we evaluated our patients in terms of their status at the time of transplant to assess risk. Methods: Between 2010 and 2019 we assessed 44 Heart Transplant patients who developed severe PGD immediately after HTx. The UNOS Status at the time of Transplant was recorded along with the presence of a durable assist device, temporary assist device, or no Inotropes or assist device. 30 Day and 1 Year survival were assessed for all status groups including a control group (no PGD, n=799). Results: High urgency status at the time of transplant was not the overwhelming majority of patients that developed severe PGD. Approximately 32% of these patients were patients who were waiting for transplant at home, who were not on Intravenous Inotropes and not on assist devices. 1 Year survival was compromised in all patients who developed severe PGD with survival rates that were significantly lower than patients without PGD in our program (47.7% vs 93.6%, p&lt;0.001) (see Table). Conclusions: High urgency status is not solely associated with the development of severe PGD. Further assessment into these non-urgent patients who develop severe PGD is warranted and is under investigation. Inflammatory markers should be assessed in all patients who develop severe PGD.
Abstract 13574: A Rare Case of Giant Cell Arteritis With Coronary Artery Involvement
Authors: Christabel E Nyange, Joseph Toole, William Chang, Matthew Snyder, Perry Fisher
Journal: Circulation (2020)

Introduction: Coronary artery involvement in patients with systemic vasculitis is relatively rare, but can be life threatening. There is a well-known occurrence of coronary artery vasculitis in Kawasaki disease and Takayasu arteritis, however, coronary arteritis caused by giant cell arteritis (GCA) has been documented in only a handful of reports. Case report: A 65-year-old woman with a history of GCA complicated by cerebrovascular stenosis s/p bypass and coronary artery disease (CAD) s/p DES to mid-left anterior descending (LAD) 3 years prior, without cardiac risk factors, who presented with shortness of breath and 2-3 hours of progressive non-radiating pressure like midsternal chest pain. Vital signs were stable with an unremarkable physical exam. EKG showed new T-wave inversions in V4-V6, I, II, aVL. Labs were significant for Trop T 0.17 and CRP 2.02. Echocardiogram showed EF 30% with wall motion abnormalities (ECHO 9 months prior showed EF 69% with no wall motion abnormalities). Coronary angiography revealed 99% in-stent-restenosis (ISR) of mid-LAD, 50% tubular OM1 stenosis, and 100% RCA occlusion with right-to-right collateral (figure 2). The patient underwent CABG with a left internal mammary artery graft to LAD and saphenous vein graft to RCA. Post-operative EF was 50%, and she was discharged on post-operative day 5. Discussion: In patients with systemic vasculitis and no identifiable CAD risk factors presenting with acute coronary syndrome, there has to be a high suspicion for coronary arteritis. Our case strongly suggests that GCA can involve the coronary arteries given the rapid progression of ISR with triple vessel disease in the absence of cardiac risk factors. Although advancements in imaging techniques have led to improvements in the diagnosis of systemic vasculitis, standardized imaging for evaluating coronary vasculature is lacking. Larger retrospective case studies are needed in order to clearly delineate the association between GCA and CAD.
The Latin American Association for the Study of the Liver (ALEH) position statement on the redefinition of fatty liver disease
Authors: Nahum Mendez-Sanchez, Marco Arrese, Adrian Gadano, Claudia P Oliveira, Eduardo Fassio, Juan Pablo Arab, Norberto C Chávez-Tapia, Melisa Dirchwolf, Aldo Torre, Ezequiel Ridruejo, Helma Pinchemel-Cotrim, Marlen Ivón Castellanos Fernández, Misael Uribe, Marcos Girala, Javier Diaz-Ferrer, Juan C Restrepo, Martín Padilla-Machaca, Lucy Dagher, Manuel Gatica, Blanca Olaechea, Mario G Pessôa, Marcelo Silva
Journal: The Lancet. Gastroenterology & hepatology (2020)
Abstract 13318: Omega-3 Ethyl Esters and Atrial Fibrillation or Flutter in Patients With Coronary Artery Disease: Results From a Randomized Trial
Authors: Abdul Aziz Asbeutah, Hasan Mirza, Smaha Waseem, Maral Amangurbanova, Francine K Welty
Journal: Circulation (2020)

Introduction: Statins have led to significant reductions in cardiovascular disease (CVD) events; however, a high level of residual cardiovascular risk remains. The REDUCE-IT trial showed additional benefit with icosapent ethyl to statins in reducing CVD morbidity and mortality. However, the safety of omega-3 ethyl esters with regards to atrial fibrillation (Afib) in patients with coronary artery disease (CAD) remains unclear. Hypothesis: We hypothesize that omega-3 ethyl esters may influence the risk of Afib or flutter in patients with CAD. Methods: In total, 285 CAD patients on statins were randomized to high dose omega-3 ethyl esters (1.86 g of Eicosapentaenoic acid [EPA] and 1.5 g of Docosahexaenoic acid [DHA]) or no omega-3 for 30 months. The incidence and recurrence of Afib or flutter was compared in those on EPA/DHA plus statin to statin alone (control). Results: A total of 240 patients were included in the analysis and no difference in baseline characteristics was observed (Table A). In total, 19 patients were in Afib or flutter during the trial: 12 in EPA/DHA and 7 in control (9.5% vs. 6.1%, respectively, p=0.33). The incidence of new onset Afib or flutter within 30 months was 7.2% and 4.9% in patients receiving omega-3 ethyl esters compared to controls, respectively (p=0.48). No significant difference in recurrence of Afib occurred among patients with a history of paroxysmal Afib receiving omega-3 ethyl esters compared to control (26.7% vs. 16.7%, respectively, p=0.53) (Table B). Conclusions: EPA/DHA did not increase the incidence of Afib or flutter in patients with established CAD. Further studies are warranted to better understand the effects of omega-3 ethyl esters on the cardiac conduction system.
Abstract 14093: High-Sensitivity C-reactive Protein Modifies the Effect of Lipoprotein (a) on Cardiovascular Risk: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Wei Zhang, Jaime L Speiser, Miguel Cainzos Achirica, Khurram Nasir, Michael Tsai, David M Herrington, Michael D Shapiro
Journal: Circulation (2020)

Introduction: Lipoprotein (a) (Lp(a)) and inflammation, as represented by elevated high-sensitivity C-reactive protein (hsCRP) concentration, are both considered as risk-enhancers in the 2018 AHA/ACC Cholesterol guidelines. However, little is known as to whether the association of Lp(a) with atherosclerotic cardiovascular disease (ASCVD) risk is modified by inflammation. Objective: We assessed whether hsCRP modifies the association of Lp(a) with ASCVD risk. Methods: MESA participants with baseline hsCRP and Lp(a) levels were included. Incident ASCVD events were ascertained from baseline through 2017. Time to incident ASCVD was analyzed using Kaplan Meir curves. Cox proportional hazards models were used to assess the association between Lp(a), hsCRP, and time to ASCVD events adjusting for covariates. Results: The study included 4,654 participants with mean age of 62 and 52.5% females (1,702 Caucasians, 557 Chinese Americans, 1,336 African Americans and 1,059 Hispanics). With a mean 13.6-year follow-up, 676 ASCVD events occurred among 4,609 participants (Figure 1). In participants with hsCRP &lt;2mg/L, the association of Lp(a) (per 1 Log unit increase) and risk for ASCVD as represented by hazard ratio (HR) and 95%CI was 1.01 (0.79, 1.28). In subjects with hsCRP ≥2mg/L, the risk increased to 1.26 (1.01, 1.58). When compared to the reference group with Lp(a) &lt;50mg/dL and hsCRP &lt;2mg/L, the risk for ASCVD in participants with Lp(a) ≥50mg/dL and hsCRP &lt;2mg/L was 1.13 (0.85, 1.50) and in those with Lp(a) &lt;50mg/dL and hsCRP ≥2mg/L was 1.09 (0.92, 1.31). The risk increased significantly to 1.62 (1.26, 2.07) in participants with Lp(a) ≥50mg/dL and hsCRP ≥2mg/L. Conclusions: Lp(a)-related ASCVD risk is modified by hsCRP levels. The findings of this analysis suggest that Lp(a) may serve as a risk enhancing factor in individuals with hsCRP level ≥2mg/L. Future studies are needed to determine whether Lp(a) is associated with risk of ASCVD in the absence of subclinical inflammation.
Abstract 14730: Oral Semaglutide Provides Less Value for Money Than Subcutaneous Semaglutide for the Prevention of Major Adverse Cardiovascular Events, but Significantly More Value for Money for the Prevention of Cardiovascular Mortality
Authors: Ronen Arbel, Enis Aboalhasan, Ariel Hammerman, Joseph Azuri
Journal: Circulation (2020)

Introduction: Semaglutide, a subcutaneous Glucagon-Like Peptide-1 receptor agonist, reduces the risk of major adverse cardiovascular events (MACE) in patients with Type 2 diabetes mellitus (T2DM). An oral version of semaglutide is now available, and patients may prefer it over a subcutaneous injection. The value for money of the oral version for the prevention of MACE is not clear. Hypothesis: Oral semaglutide provides less value for money than subcutaneous semaglutide for the prevention of MACE, but more value for money for the prevention of the single endpoint of cardiovascular mortality (CVM). Methods: We calculated the cost needed to prevent (CNT) one MACE, by multiplying the one-year number needed to treat to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published RCT data. The CNT to prevent one event of the single endpoint of CVM was analyzed as a secondary outcome. We performed a sensitivity analysis to mitigate primary differences between the RCTs. Drug costs were calculated as 75% of the US National Average Drug Acquisition Cost listing in June 2020. Results: The CNT to prevent one MACE with subcutaneous semaglutide in SUSTAIN-6 is $641,823 ($402,021-$3,533,533) compared to $855,040 (95% CI: $420,840-∞) with oral semaglutide in PIONEER 6. The lower cost of subcutaneous semaglutide was confirmed in a sensitivity analysis simulating the effects of the drugs in both RCTs. The CNT to prevent one CVM with semaglutide is $16,342,560 ($2,020,704.00-∞) compared to $1,315,720 (95% CI: $921,004-$8,392,414) with oral semaglutide. Conclusions: Subcutaneous semaglutide prescribed for the prevention of MACE in patients with T2DM is moderately cost-saving compared to oral semaglutide for the same purpose. However, for the prevention of CVM, the oral version provides significantly better economic value.
Removing the training wheels: embracing the social, contextual and psychological in sports medicine
Authors: Linda K Truong, Sheree Bekker, Jackie L Whittaker
Journal: British Journal of Sports Medicine (2020)

According to the US National Federation of State High School Associations, boys have 1.13 million more sport opportunities annually than girls.1 This number snowballs when the intersectionality of race and socioeconomic status is factored in.1 Similarly, income level, gender and race contribute to healthcare inequity.2 While an athletes’ ability to return-to-sport is influenced by their physical and psychological readiness, this is superseded by the systemic social forces that shape an athlete’s reality and determines their access to sport development, funding and medical resources. Despite these realities, substantial neglect and disparity among how we address these ’non-physical’ factors in the sports medicine field continue to exist. Thus, the idea of biopsychosocial sports medicine is both everywhere and nowhere.

The biopsychosocial approach to sports medicine is not new, with theoretical frameworks existing since the 1990s.3 In sport medicine, non-physical factors are often lumped together and termed ‘psychosocial’. While this broad construct was valuable for laying the foundation for biopsychosocial sports medicine, it provides a false illusion that we understand and address all non-physical …
Routine Vaccination Coverage — Worldwide, 2019
Authors: Anna N. Chard, Marta Gacic-Dobo, Mamadou S. Diallo, Samir V. Sodha, Aaron S. Wallace
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Endorsed by the World Health Assembly in 2020, the Immunization Agenda 2030 strives to reduce morbidity and mortality from vaccine-preventable diseases across the life course (1).This report, which updates previous reports (2), presents global, regional,* and national vaccination coverage estimates and trends as of 2019 and describes the number of surviving infants who did not receive the first dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP1) during the first year of life (i.e., zero-dose children), which serves as a proxy for children with poor access to immunization and other health services.Global estimates of coverage with the third dose of DTP (DTP3), the first dose of measles-containing vaccine (MCV1), and the third dose of polio vaccine (Pol3) ranged from 84% to 86% during 2010-2019.Worldwide, 19.7 million children (15%) were not vaccinated with DTP3 in 2019, 13.8 million (70%) of whom were zero-dose children.During 2010-2019, the number of zero-dose children increased in the African, Americas, and Western Pacific regions.Global coverage with the second MCV dose (MCV2) increased from 42% in 2010 to 71% in 2019.During 2010-2019, global coverage with underused vaccines increased for the completed series of rotavirus vaccine (rota), pneumococcal conjugate vaccine (PCV), rubella-containing vaccine (RCV), Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (HepB), and human papillomavirus vaccine (HPV).Achieving universal coverage with all recommended vaccines will require tailored, context-specific strategies to reach communities with substantial proportions of zero-dose and incompletely vaccinated children, particularly those in remote rural, urban poor, and conflict-affected communities (3).In 1974, the World Health Organization (WHO) established the Expanded Programme on Immunization to ensure that all infants have access to four recommended vaccines (bacillus Calmette-Guérin vaccine [BCG], DTP, Pol, and MCV) to protect against six diseases (tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles).Since then, additional vaccines and doses have been introduced in the first year of life (PCV, rota, RCV, Hib, and HepB) and beyond (MCV2 and HPV) (4).WHO and the United Nations Children's Fund (UNICEF) derive national vaccination coverage estimates through annual country-by-country review of available data, * Based on World Health Organization regional classifications.https://www.who.int/about/who-we-are/regional-offices.
Abstract 14328: Relation of Lipoprotein(a) Levels to Incident Diabetes and Modification by Alirocumab Treatment: An Analysis of the Odyssey Outcomes Trial
Authors: Gregory G Schwartz, Michael Szarek, Marie Baccara-dinet, Vera A Bittner, Deepak L Bhatt, Rafael Diaz, Shaun G Goodman, Robert A Harrington, J Wouter W Jukema, Garen Manvelian, Robert Pordy, Harvey D White, Andreas M Zeiher, Philippe G Steg
Journal: Circulation (2020)

Background: Cohort studies and clinical trials have shown a greater prevalence of diabetes among subjects with lower levels of lipoprotein(a) [Lp(a)]. Some healthy cohort studies have shown a greater incidence of new onset diabetes (NOD) among those with lower Lp(a). It is unknown whether the risk of NOD associates with Lp(a) levels in patients (pts) with established cardiovascular disease or whether pharmacologic reduction of Lp(a) with PCSK9 inhibitors modulates this risk. Objective: Using data from the ODYSSEY OUTCOMES trial that compared the PCSK9 inhibitor alirocumab (ALI) with placebo (PBO) in pts with recent acute coronary syndrome, we examined whether NOD was related to baseline Lp(a) level and whether any such relationship was modified by ALI treatment. Methods and Results: Lp(a) was measured with a mass assay in 13,480 trial pts without diabetes at baseline; median (IQR) baseline Lp(a) was 21.9 mg/dL (6.9-61.1); median follow-up was 2.7 years. Intensive statin therapy was utilized in 89%. In the PBO group, NOD was greatest in Quartile 1 and least in Quartile 4 of baseline Lp(a) ( Figure , 4.6 vs 3.1 cases per 100 pt-years, P trend 0.0003). ALI lowered Lp(a) by a median of 23% from baseline. Absolute median reduction in Lp(a) with ALI ranged from nil in baseline Lp(a) Quartile 1 to 15 mg/dL in Quartile 4. Treatment HR (ALI/PBO) for NOD was neutral overall (0.95, 95% CI 0.85-1.05) but varied across baseline Lp(a) quartiles from 0.79 (0.64-0.96) in Quartile 1 to 1.09 (0.87-1.38) in Quartile 4 ( Figure , P trend =0.025). Conclusion: In pts with recent acute coronary syndrome, there is greater NOD among those with lower baseline Lp(a) levels. ALI has an overall neutral effect on NOD: In pts with low baseline Lp(a), ALI has minimal effect on Lp(a) levels and tends to reduce NOD. In pts with high baseline Lp(a), ALI reduces Lp(a) levels with a non-significant excess of NOD. The findings may have implications for emerging therapies that reduce Lp(a) more substantially than PCSK9 inhibitors.
Abstract 17378: “If My Doctors Had Recommended a Mobile App to Me Back Then, I Wouldn't Have Been in This Situation Today”: Identifying the Barriers and Facilitators to the Utilization of mHealth Apps to Improve Self-Care in Patients With Heart Failure
Authors: Ifeanyi Madujibeya, Salman Alreshidi, Adaze Aroh
Journal: Circulation (2020)

Background: Mobile Health applications (mHealth apps) have been demonstrated as an effective strategy for improving self-care abilities in patients with heart failure (HF). However, the uptake of the apps by patients remains low. Little is known about the patient’s perspectives on the factors that influence their uptake of the apps. This study explored HF patients’ perspectives on the barriers and motivators to the uptake and utilization of mHealth apps. Method: Semi-structure interviews and demographic questionnaires were used to gather data from patients with HF (N= 43) recruited from an academic medical center. An in-depth analysis of the interviews was conducted using a deductive thematic approach with the help of qualitative software, Atias.ti version 8. Results: Among the participants ( median age = 62 [35-92] years, mean±SD ejection fraction = 37.3±17, 41.9% female, 70% smartphone owners), 90.7% (n =39) had no prior use of mHealth apps for self-care. The majority of the participants with no prior use of mhealth (79.5%, n = 31), including 64.7% (n= 17) of participants aged 65yrs and above, expressed an intention to use the apps for self-care. All the participants (100%) stated that their healthcare providers (HCP) had never recommended the use of mHealth apps for self-care. Other barriers included lack of knowledge of the apps, the perceived financial cost of mHealth apps or smartphones, concern for privacy, and security of personal information, resistance to the change of previous self-care strategies, and perceived technology incompetence. Motivators to the uptake of mHealth included perceived usefulness of mHealth apps, mHealth apps’ ease of use, and the belief that the use of mHealth apps may alleviate perceived threat to health, and availability of technical support. Conclusion: This study suggests that patients with HF are willing to use mHealth apps to improve their self-care abilities. Thus, the effort to improve patients’ perceptions of mHealth apps’ usefulness and HCP recommendation of the apps are warranted to turn patients' “intention to use” to actual apps usage.