tbuckley/cabot-search huggingface dataset:
Abstract 13692: Cardiorespiratory Fitness and Atrial Fibrillation Risk in African American Veterans
Authors: Apostolos Tsimploulis, charles faselis, Eric J Rashba, Hans Moore, Pamela Karasik, Peter F Kokkinos
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting &gt;10 million in the USA. The beneficial effects of cardiorespiratory fitness (CRF) on cardiovascular (CV) diseases are well-documented. Interestingly, African American (AA) individuals are less prone to develop AF. Little is known about the association between CRF and AF in AA men. Hypothesis: CRF-AF risk association in AA men. Methods: We identified 11,216 AA Veterans with a mean age (±SD) 58±11 years who completed a symptom-limited exercise treadmill test at the VAMCs in Washington DC and Palo Alto CA. None exhibited evidence of ischemia or AF during and prior to it. We established four fitness groups based on age-specific quartiles of peak metabolic equivalents (METs) achieved: Least-Fit: 4.4 ±1.2 METs (n=2,530); Moderate-Fit: 6.6±1.3 METs (n=3,361); Fit: 8.1±1.4 METs (n=2,719) and High-Fit: 11.2±2.4 METs (n=2,606). AF was identified by a search of the medical records CPRS (database) using ICD coding and verified by 2 investigators. Cox proportional hazard models adjusted for age, CV disease, CV medications and risk factors were constructed to assess the CRF-AF association. P-values &lt;0.05 using two sided tests were considered statistically significant. Results: During a mean follow-up period of 10.7±6.2 years, 1,423 patients developed AF; 421(16.6%) in the Least-Fit, 366 (10.9%) in Moderate-Fit, 323 (11.9%) in Fit and 313 (12%) in the High-Fit group. The CRF-AF association was inverse and graded. When compared to the patients in the Least-Fit group, the AF risk in the Moderate-Fit group was 29% lower (HR=0.71; 95% CI: 0.62-0.82, p&lt;0.001). For Fit and High-Fit patients, the risk was 37% (HR=0.63; 95% CI: 0.54-0.73, p&lt;0.001) and 51.0% lower (HR=0.49; 95% CI: 0.42-0.57, p&lt;0.001), respectively. Conclusion: In this cohort, higher fitness levels reduced and delayed the risk of atrial fibrillation. The CRF-AF association was inverse, graded and independent of comorbidities.
Abstract 14989: Failure to Rescue After Transcatheter Aortic Valve Replacement: Does Experience Matter?
Authors: Lise Tchouta, Hechuan Hou, Karen Kim, Mike Thompson
Journal: Circulation (2020)

Introduction: Volume-outcome relationships are well defined in transcatheter aortic valve replacement (TAVR), but little is known about how hospital experience in aortic valve replacement (AVR) informs processes of care to rescue patients once a complication occurs after TAVR. Hypothesis: Increasing AVR experience improves post-TAVR rates of failure to rescue (FTR) - defined as in-hospital mortality after major treatable post-procedural complications. Methods: Statewide Inpatient Databases from seven diverse states were queried from 2011 to 2017 for patients who underwent TAVR. Hospitals were stratified as low vs high-volume by mean annualized SAVR and TAVR volume using the median as cutoff: SAVR = 43 cases/year, TAVR = 28 cases/year. Crude rates of complications, in-hospital mortality, and FTR were estimated for the overall sample and stratified by SAVR and TAVR volume (low vs high). Logistic regression was used to estimate the adjusted odds ratio of SAVR and TAVR volume, independently, on the outcomes above, adjusting for patient demographics and comorbid conditions. Results: A total of 42,025 TAVR patients were identified and categorized as low (N = 2,946) or high-volume (N = 39,079) SAVR centers, and low (N = 7,183) or high-volume (N = 34,842) TAVR centers. Within the high-volume SAVR centers, 84.8% were also high-volume TAVR centers. Low SAVR or TAVR volume was associated with a marginal increase in the risk of developing complications after TAVR (OR 1.26; P &lt; 0.001 and OR 1.14; P &lt; 0.001) as show in Table 1. There was no statistically significant difference in risk-adjusted in-hospital mortality rates (OR 1.10; P = 0.499 and OR 1.10; P = 0.273) or FTR rates (OR 0.97; P = 0.816 and OR 1.03; P = 0.732) after TAVR between low- and high-volume SAVR or TAVR centers, respectively. Conclusion: Undergoing TAVR at a high-volume SAVR or TAVR center was associated with lower rates of complications, but volume was not an independent predictor of in-hospital mortality or FTR.
Abstract 15783: A Simplified Machine Learning Algorithm for Identification of Patients At-risk for Wild-type Transthyretin Amyloid Cardiomyopathy
Authors: Stephen B Heitner, Ahmad Masri, Miriam R. Elman, Birol Emir, Kim D. Nolen, Jennifer Schumacher, Veena Calambur, Ahsan Huda, Marianna Bruno, Adam Castano
Journal: Circulation (2020)

Introduction: Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is a progressive, life-threatening, increasingly recognized but underdiagnosed cause of heart failure (HF). A previously validated machine learning (ML) model trained on medical claims data from 300 million US patients predicted wtATTR-CM among individuals diagnosed with HF with high sensitivity and specificity. Here, we simplified the ML model by reducing the number of predictive variables and tested it in a cohort of patients with confirmed wtATTR-CM at a large academic amyloid referral center. Methods: A retrospective, case-control study was conducted using electronic health records (EHR) from a random 1:1 sample of patients diagnosed with wtATTR-CM (cases) and non-amyloid HF (controls) at OHSU (Jul 2005-Nov 2019). Inclusion criteria were age ≥50 years; HF diagnosis (based on ICD-10 codes/SNOMED CT); and ≥1 of the following: ≥12 months of medical history, ≥5 clinical visits, or ≥10 documented diagnosis codes. The original 1,871 variables were systematically reduced to 15 based on recursive feature elimination and clinical relevance to ATTR-CM. After confirmation of the full ML model algorithm performance, the simplified model, validated against Optum EHR, was applied to the OHSU cohort of patients with wtATTR-CM. Results: Of 25,233 patients who met study criteria, 38 (0.2%) had wtATTR-CM and were evaluated along with 38 patients with non-amyloid HF. Performance of the simplified ML model was consistent with the previously validated model, with an ROC AUC of 0.812 and 0.804, respectively, and improved at lower thresholds (Table). Conclusions: A simplified ML algorithm to estimate the empirical probability of wtATTR-CM in patients with HF performed well at an academic amyloid referral center. This may serve as a practical approach to aid physicians in identifying HF patients who may be at-risk for wtATTR-CM. Additional studies are needed to confirm these findings in larger cohorts.
Abstract 11535: The Impact of Heart Rate Reserve at Discharge on Prognosis in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Masato Okada, Toshinari Onishi, Koichi Inoue, Katsuomi Iwakura, Yasumura Yoshio, Takahisa Yamada, Uematsu Masaaki, Shunsuke Tamaki, Yoshiharu Higuchi, Nakagawa Yusuke, Fuji Hisakazu, Masami Nishino, Shungo Hikoso, Daisaku Nakatani, Yasushi Sakata
Journal: Circulation (2019)

Introduction: The prognostic value of resting heart rate (HR) and HR reserve (HRR) at discharge is incompletely understood in patients with heart failure with preserved ejection fraction (HFpEF). M...
Identification and Characterization of Patients With Rapid Progression of Diabetic Retinopathy in the Danish National Screening Program
Authors: Jakob Grauslund, Anne S. Thykjær, Ryo Kawasaki, Kurt Højlund, Nis Andersen, Jens Andresen, Toke Bek, Morten la Cour, Steffen Heegaard, Line Kessel, Caroline S. Laugesen, Katja C. Schielke, Katrine H. Rubin, Lonny Stokholm
Journal: Diabetes Care (2020)

Screening for diabetic retinopathy (DR) is needed for identification and treatment of patients with sight-threatening stages prior to irreversible visual loss. For avoidance of unnecessary screening, prolonged screening intervals have been proposed and implemented in Denmark and other countries (1). A potential argument against extended screening intervals is the risk of rapid progression of DR, which has been described anecdotally. Kohner coined the term “florid DR” as rapidly developed advanced stages of proliferative DR (PDR) and reported unfavorable clinical outcomes in 34 patients identified during an 8-year span (2). While individualized screening with prolonged screening intervals might serve the vast majority of patients, it would be important not to risk irreversible visual loss in the minority at risk for rapid progression. Hence, we aimed to quantify the risk of rapid progression of DR and evaluate associated risk factors in a national screening program of DR.

In Denmark, screening for DR is nationally implemented and offered for free for all patients with diabetes. According to national guidelines, screening is predominantly performed by fundus photography and level of DR is given by the International Clinical Retinopathy Disease Severity Scale as levels 0 (no …
Sequential FDG-PET in the management of multiorgan sarcoidosis
Authors: Alan Kelly, Michael P Keane, David Keane, Jonathan D Dodd, David J Murphy, Cormac McCarthy
Journal: Thorax (2020)

A 32-year-old man presented with palpitations and central chest pain, examination was unremarkable and chest radiograph was normal. ECG demonstrated right axis deviation and inferolateral T-wave inversion; cardiac enzymes were normal. Cardiac MRI demonstrated multifocal, patchy subepicardial and mesocardial left ventricular late gadolinium enhancement, suggestive of cardiac sarcoidosis. Whole body and dedicated cardiac fluorodeoxyglucose (FDG)-positron emission tomography (PET) was performed 60 min after radiotracer injection following a special patient preparation to suppress physiological myocardial uptake of glucose. This consists of a high-fat, low-carbohydrate diet the day before scanning followed by a 15 hours fast. The PET revealed multifocal metabolically active cardiac inflammation, corresponding to the areas of late gadolinium enhancement on MRI and extensive sites …
Abstract 14115: A Multimorbidity-based, Risk-stratified Reanalysis of the Affirm Trial
Authors: Mohammed Ruzieh, John Mandrola, Anne Marie Dyer, Vernon M Chinchilli, Gerald V Naccarelli, Andrew J Foy
Journal: Circulation (2020)

Introduction: Multimorbidity is common in patients with cardiovascular disease. Clinical trials in cardiovascular medicine mostly enroll patients who are younger, healthier and more affluent than average patients with the condition of interest. These trials rarely account for patient-level multimorbidity in a systematic fashion. Further, treatment effect heterogeneity is usually tested across subgroups of patients based on the presence or absence of individual variables, not on the basis of summative risk scores which account for multimorbidity. Objectives: To describe the distribution of multimorbidity using a modified version of the Charleson comorbidity index (mCCI), scale 0-14, and to assess its impact on the original primary endpoint of all-cause mortality. Methods: We performed a multimorbidity-based risk-stratified reanalysis of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Trial. To do this, we created a mCCI risk score based on inclusion of patient clinical parameters documented at the time of trial enrollment. The variables included in our score are: Age, ischemic heart disease, heart failure, symptomatic bradycardia, stroke or TIA, peripheral vascular disease, diabetes, hepatic or renal disease, pulmonary disease, and polypharmacy. Results: We found that the majority of patients in the AFFIRM Trial had a mCCI score of ≤4 (55.5%) and there was no statistically significant difference in the risk of death for rate vs rhythm control in these patients (7.9% vs 8.8%; p=0.44 ). However, for patients with a mCCI ≥5 (44.5%), there was a strong trend toward a reduction in death with rate control that nearly reached statistical significance despite being underpowered (24.5% vs 28.3%; p=0.07 ), figure. Conclusion: This proof-of-concept study supports the idea that clinical trials in cardiovascular medicine should systematically assess for multimorbidity and investigate its potential impact on treatment effects.
Counseling Patients (pts) with Higher-Risk Myelodysplastic Syndromes (HR-MDS) Regarding Expected Survival with Azacitidine (aza) Therapy: Are We Using Accurate Estimates?
Authors: Michelle Deveaux, Maximilian Stahl, Smith Giri, Rong Wang, Nikolai A. Podoltsev, Xiaomei Ma, Amer M. Zeidan
Journal: Blood (2017)
Abstract 16355: Impact of Renal Dysfunction on Outcomes After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis
Authors: Michel Ibrahim, Sandrine Lebrun, Garly Rushler Saint Croix, Michael Fattouh, Sandra V Chaparro
Journal: Circulation (2020)

Background: Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from left ventricular assist device (LVAD) therapy. The effect of preoperative renal dysfunction on clinical outcomes after LVAD implantation remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes post-LVAD in patients with and without renal dysfunction. Methods: PubMed, Medline, and EMBASE databases were searched for studies comparing outcomes in patients with and without renal dysfunction who underwent LVAD implantation for advanced heart failure. The primary outcome of all-cause mortality was reported as random effects risk ratio (RR) with 95% confidence interval. Results: Our search yielded 5,229 potentially eligible studies. We included 7 studies reporting on 26,652 patients. Patients with renal dysfunction (glomerular filtration rate (GFR) &lt;60) (n=4,630) were found to have increased risk of all-cause mortality 2.21 (95% CI 1.39-3.51, p &lt;0.01) when compared to patients with normal renal function (GFR &gt;60) (n=22,019). Conclusion: Patients with renal dysfunction have increased mortality after LVAD implantation when compared to patients with normal renal function. GFR can be used to risk stratify patients and guide decision making prior to LVAD therapy.
The diagnosis of testicular torsion
Authors: B. E. Haynes
Journal: JAMA (1983)

Prompt diagnosis of testicular torsion remains difficult. Since warning symptoms occur in one third of patients and salvage rates correspond to the interval between symptom onset and operation, higher salvage rates should be achievable. Separating torsion from epididymitis is complicated by overlapping ages of peak incidence, shared symptoms, and the need for rapid distinction of the two. Doppler studies (88% accuracy) and nuclear scans (95% accuracy) help confirm the diagnosis, but correct technique is essential, and their use should not delay prompt operation. The diagnosis of epididymitis should be made cautiously in persons younger than the age of 35 years. (<i>JAMA</i>1983;249:2522-2527)
Abstract 14969: A Four Week Exercise Intervention in a Cohort of Young Army Recruits is Associated With Anti-inflammatory and Pro-antioxidant Responses
Authors: James N Tsoporis, Alex Drosatos, Shehla Izhar, George Tsirebolos, Elefterios Sakadakis, Thomas G Parker, LOUKIANOS RALLIDIS, Ioannis C Rizos
Journal: Circulation (2020)

Introduction: Regular physical activity is considered a cornerstone of cardiovascular disease prevention and is therefore strongly encouraged by most medical societies. Apart from its beneficial effects on classical cardiovascular risk factors, an anti-inflammatory effect is strongly implicated based on results from observational studies. Hypothesis: Data regarding the effect of an exercise intervention on healthy individuals are limited and contradictory. The present study aimed to investigate the effects of a physical activity intervention on the inflammatory marker S100A8/A9, the soluble form of the receptors for advanced glycation end products (sRAGE) and the anioxidant DJ-1. Methods: 332 young army recruits volunteered and 169 completed the study. The participants underwent the standard basic training of Greek army recruits which includes 2 hours of aerobic exercise, 5 times a week. Plasma S100A8/A9, sRAGE and DJ-1 were measured at the beginning and at the end of the training period. Results: At the end of the training period we observed a statistically significant reduction of S100A8/A9 (630.98 vs 472.12 ng/ml, p=0.001) and soluble RAGE (416.21 vs 225.19 pg/ml, p=0.001) while DJ-1 was significantly increased (62.48 vs 74.45 ng/ml, p&lt;0.05). S100A8/A9 reduction was positively correlated with body weight (r=.238 [.106, .375], p=0.002), indicating that heavier individuals could benefit more from an exercise intervention. Conclusions: A 4 weeks military exercise training intervention resulted in a reduction of the pro-inflammatory S100A8/A9 complex as well as an increase of the anti-oxidant DJ- 1 protein, supporting the anti-inflammatory and anti-oxidant effects of physical activity. The observed reduction of sRAGEs was interpreted as a sign of diminished AGE-RAGE axis activation.
Prognosis and Application of Day 14 Bone Marrow Results in Acute Myeloid Leukemia Induction
Authors: James England, Lalit Saini, Donna Hogge, Artur J Szkotak, Joseph M. Brandwein, Monika Hudoba, Nadejda Medvedev, Tyler Smith, Roland Kristine, David Sanford
Journal: Blood (2017)
Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients
Authors: Yusuke Mukai, Hisayoshi Murai, Tadayuki Hirai, Takuto Hamaoka, Yoshitaka Okabe, hideki tokuhisa, Hiroyuki Sugimoto, Masayuki Takamura
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients. Purpose: The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD. Methods: This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and &lt;11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA. Results: 28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p&lt;0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P&lt;0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p&lt;0.01 respectively). In the patients without DD (the group of E/e’&lt;11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P&lt;0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p&lt;0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P&lt;0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity. Conclusion: CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.
Abstract 15954: <i>Arriba Por La Vida Estudio</i> : A Randomized Trial Promoting Standing Behavior to Reduce Sitting Time Among Postmenopausal Latinas
Authors: Gregory A Talavera, Sheila Castaneda, Maria Lopez-Gurrola, Ana Rebeca Alvarez-Malo, Johanne Hernandez, Dorothy Sears, Chase Reuter, Loki Natarajan, Michelle Takemoto, Ya-Ju Chang, yesenia avitia, Areilia Haimovich, Luis Ornales, Andrea De La Torre, Matthew Allison
Journal: Circulation (2020)

Introduction: Increased sedentary behavior is independently associated with increased risk of cardiometabolic diseases. There are few community-based RCTs designed to address this behavior, and none among Latinas, who are particularly at risk for cardiometabolic diseases. This study presents the results of an intervention to reduce sitting time among postmenopausal overweight Latina women. Hypothesis: Participants randomized to the standing intervention arm will have a greater reduction in sitting time compared to those in the comparison arm. Methods: A total of 254 overweight, sedentary postmenopausal Latinas in San Diego were enrolled in a 12-week trial, and randomized to either an intervention to replace sitting time with standing bouts or a comparison group that received heart healthy information. The intervention, based on social-cognitive behavior change, included culturally-tailored coaching. Intervention participants received three in-person health-counseling sessions, one home visit, and five telephone calls using motivational interviewing; the comparison group received an equal number of contacts to discuss topics on healthy aging. The primary outcome was change in sitting time at 12 weeks measured via thigh-worn inclinometers (ActivPAL microTM). Group differences in outcomes were analyzed using linear mixed-effects models. Results: The trial arms were comparable at baseline with mean (SD) age 65 (6.5) years, education 10.7 (4.4) years, 32.4 (4.8) kg/m2 BMI, sitting time 540 (86) minutes/day. Significant differences between control and intervention groups were observed in change in sitting time (p&lt;0.001), standing time (p&lt;0.001), and stepping time (p=0.016). For control and intervention groups, mean (SE) in minutes/day of sitting time change was -7.5 (9.1) and -71.0 (9.8); standing time change was 2.5 (6.5) and 49.6 (7.0); stepping time change was 4.7 (2.4) and 13.2 (2.6), respectively. Conclusions: The findings demonstrate that our intervention was successful at reducing sitting time and increasing standing time and step counts. Results demonstrate that it is feasible and effective to implement sitting time reduction interventions among older, predominately Spanish-speaking postmenopausal Latinas.