tbuckley/cabot-search huggingface dataset:
FRI0117 Neuropsychiatric disorders in children with systemic lupus erythematosus
Authors: OV Shpitonkova, NS Podchernyaeva, TV Riabova
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Neuropsychiatric symptoms of systemic lupus erythematosus (SLE) are one of the more common features and are the least understood. <h3>Objectives</h3> To clarify the association of clinical manifestations and instrumental investigation findings in children with neurolupus. <h3>Methods</h3> 20 children (aged 5–15 years) that met 4 or more ARA criteria of SLE were examened. Investigations included immune system changes indicating increased lupus activity, lupus anticoagulant, anticardiolipin antibodies by ELISA, electroencephalogram (EEG), in 10 patients magnetic resonance imaging (MRI). <h3>Results</h3> The clinical manifestations of neurolupus were transient ischaemic attack (2), epilepsy (3), chorea (1), coordination disturbance (4), low extremity paresis (1). Eighteen children demonstrated psychiatric disturbances (psychosis, hysteria, fobia, anorexia, behavioural abnormalities). In all 20 children intensity of neuropsychiatric symptoms correlated with lupus activity. The most severe neuropsychiatric clinical manifestations were associated with the presence antiphospholipid antibodies. Instrumental assessment revealed pathologic abnormalities in both: children with subtle clinical symptoms and children with severe brain damage. EEG demonstrated diffuse abnormalities in 12 patients, epilepsy in 3, but not sensitive enough for diagnosis. MRI visualised diffuse and focal changes in 10 children: widening subarachnoid space and cortex atrophy. <h3>Conclusion</h3> MRI can visualise diffuse and focal changes even in children with no history of overd symptoms of neurolupus and seems to be of real help in diagnosis. Antiphospholipid antibodies appeared to be the laboratory parameter most frequently relied apon in the diagnosis of neuropsychiatric SLE and in decision regarding treatment.
Abstract 12973: Atrial Fibrillation is Associated With Increased Central Blood Pressure and Arterial Stiffness
Authors: Priit Pauklin, Jaan Eha, Kaspar Tootsi, Rein Kolk, Rain Paju, Priit Kampus
Journal: Circulation (2020)

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, yet there is a lack of information about the hemodynamic profile and arterial stiffness of these patients. Purpose: The purpose of this study is to describe the differences in arterial stiffness and central blood pressures in patients with paroxysmal/persistent AF compared to a healthy control group. Methods: We included 76 patients with paroxysmal and persistent AF who underwent electrical cardioversion or pulmonary vein isolation (PVI) for AF. Carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) and central blood pressure (cBP) were measured by applanation tonometry. All measurements were done in sinus rhythm (SR). We compared the results with 75 healthy age matched individuals. Results: Patients with a history of AF had higher cfPWV compared to the control group (8,0 m/s vs 7,2 m/s, p&lt;0,001). AF patients also had higher central systolic blood pressure (cSBP) (118 mmHg vs 114 mmHg, p=0,03) and central pulse pressure (cPP) (39 mmHg vs 37 mmHg, p=0,03), without differences in peripheral systolic pressure (pSBP) (127 mmHg vs 123 mmHg, p=0,13), peripheral diastolic blood pressure (pDPB) (78 mmHg vs 76 mmHg, p=0,14) and peripheral pulse pressure (pPP) (48 mmHg vs 47 mmHg, p=0,37). There was no difference in heart rate (HR) (58 vs 61 bpm, p=0,08) (Table 1). In a multiple regression analysis (adjusted R 2 = 0,37) where cfPWV was set as the dependent variable and adjusting for age, sex, HR, weight, mean central arterial pressure (cMAP), estimated glomerular filtration rate (eGFR), the AF group remained to be an independent predictor for cfPWV (p=0,016). Conclusions: Patients with atrial fibrillation have a higher cSBP, cPP and cfPWV compared to healthy subjects without differences in peripheral blood pressure and HR. These findings support the hypothesis that arterial stiffness may play an important role in the development of atrial fibrillation.
Abstract 14896: Air Embolism and St Elevation Myocardial Infarction: A Systematic Review
Authors: Tayyab Ali Waheed, Usama Nasir, ANTHONY DONATO, SALIK NAZIR
Journal: Circulation (2020)

Introduction: Air embolism has rarely been associated with ST- elevation myocardial infarction (STEMI). Limited data exists on the risks, management and outcomes of this phenotype of STEMI to guide clinicians. Method: We queried EMbase, PubMed and Cochrane database for cases of air embolism associated with STEMI to better understand this association, its complications and outcomes. Results: We identified thirty-six cases of systemic air embolism events associated with STEMI. A mean age of fifty-nine with male predominance was identified. Patent foramen ovale was identified in 22%. Periprocedural air emboli occurred 66% (24/36) and miscellaneous causes including scuba diving and positive pressure ventilation accounted for 33% (12/36). Six patients reported chest pain, eleven developed shock and four suffered cardiac arrest. Neurological symptoms were reported in eighteen patients (50%). ST elevations were noted in all cases. CT angiography detected air bubbles in ten patients and seven were detected via cardiac catheterization. Transthoracic echocardiography detected air bubbles in a ventricular cavity in seven patients, and thirteen had air bubbles demonstrated on CT brain. Hyperbaric oxygen was delivered to eleven patients, nine of whom also received high flow oxygen. Seven were placed in Trendelenburg position and two had catheter aspiration of air bubbles. All patients received supportive treatment. Thirteen (36%) patients died. Conclusion: Patients with periprocedural STEMI and unexplained neurological symptoms should have air embolism considered in the differential. If identified, patients should be treated as per STEMI guidelines along with early delivery of 100% oxygen, in hyperbaric setting if available. If patient is hemodynamically unstable for catheterization, CT and echocardiographic imaging are reasonable alternatives to establish the diagnosis.
Abstract 16894: Utilization of H2FPEF to Predict One-Year Mortality in Decompensated Heart Failure With Preserved Ejection Fraction
Authors: Sunil Saith, anuragh trikha, Tamta Chkhikvadze, Ciril Khorolsky, June Ha, J. D Chuquin
Journal: Circulation (2020)

Background: The H2FPEF score is a validated scoring system to determine whether dyspnea may be due to heart failure with preserved ejection fraction (HFpEF). Recent evidence has suggested that H2FPEF scoring system may correlate with outcomes in established HFpEF. Its utilization for estimating mortality in patients who die within one year of discharge is not known. Methods: We collected clinical demographics and echocardiographic parameters from reports to calculate H2FPEF scores for 301 patients admitted with decompensated HFpEF between August 2016 and 2017. Patients were included if an echocardiographic report was available within 3 months, confirming an ejection fraction &gt; 50%. E/E’ and filling pressures were scored as 0 if not recorded in the echocardiographic report. Results: Median age was 81 years (IQR: 71-89), with 62.9% female. One-year follow-up was confirmed for 268 patients, with 56 deaths (20.9%). Receiver operating curve analysis suggest borderline significance of H2FPEF in predicting one-year mortality (area under curve, 0.576, 95% CI: 0.493-0.658, p=0.073). Optimal H2FPEF cutpoint score was 4.5 (73% sensitivity, 50% specificity). On univariate analysis, body mass index (BMI) &gt; 30, hypertension, atrial fibrillation (p&lt;0.001) and pulmonary artery systemic pressure &gt; 35 mmHg (p=0.038) were associated with one-year mortality. On stepwise logistic regression, only BMI &gt; 30 and atrial fibrillation remained associated with mortality in multivariate analysis. Conclusion: The utilization of H2FPEF in established HFpEF might confer some ability to predict one-year mortality, driven by obesity (2 points) and atrial fibrillation (3 points). Validation in larger cohorts with longer follow-up is necessary to establish its potential role in discharge planning and transitions of care of decompensated HFpEF.
Real-Time Conformational Dynamics of SARS-CoV-2 Spikes on Virus Particles
Authors: Maolin Lu, Pradeep D. Uchil, Wenwei Li, Desheng Zheng, Daniel S. Terry, Jason Gorman, Wei Shi, Baoshan Zhang, Tongqing Zhou, Shilei Ding, Romain Gasser, Jérémie Prévost, Guillaume Beaudoin-Bussières, Sai Priya Anand, Annemarie Laumaea, Jonathan R. Grover, Lihong Liu, David D. Ho, John R. Mascola, Andrés Finzi, Peter D. Kwong, Scott C. Blanchard, Walther Mothes
Journal: Cell Host & Microbe (2020)
Abstract 17118: Myocarditis in Multisystem Inflammatory Syndrome in Children (MIS-C) Temporally Related to COVID-19
Authors: Supriya Jain, anthon fuisz, Heather Cowles, Michael H Gewitz
Journal: Circulation (2020)

Background: Little is know about the pathophysiology of Multisystem Inflammatory syndrome in Children (MIS-C) temporally associated with COVID-19 Hypothesis: Patients with MIS-C may present with myocarditis. Cardiac magnetic resonance (CMR) may help in its diagnosis. Methods: Nine children and adolescents were identified to have clinically suspected myocarditis based on their clinical presentation, abnormal cardiac enzymes and evidence of ventricular dysfunction on echocardiogram. 5 patients underwent CMR. Results: All patients had evidence of current/recent SARS-COV-2 infection. Five were PCR+, 7 were IgG+. On echocardiogram at presentation, all the patients had mild-severe left ventricular dysfunction (EF: 25%-53%). Three had left ventricular dilation, 7 had evidence of valvulitis presenting as mitral regurgitation, 4 had pericardial effusion with no evidence of tamponade and 3 patients had associated coronary dilation. Seven patients presented in cardiogenic shock requiring inotropic support. Out of the 5 patients who underwent CMR, 2 had evidence of early and late gadolinium enhancement. Small focal area of late gadolinium enhancement was noted in the inferolateral segment of the subepicardial region of the left ventricle. There was evidence of myocardial edema in the other 3 patients. Conclusions: Children with Multi system Inflammatory Syndrome in Children can present as myocarditis. Cardiac magnetic resonance has a role in its diagnosis, prognosis, better understanding of this disease and may be useful for the long term follow up of these children. Table 1: Patient characteristics, labs, imaging findingsAbbreviations:-BNP: Brain natriuretic peptide, CRP:C-reactive protein, LV EF: Left ventricular ejection fraction, CAs: Coronary abnormalities, Valvar R: valvar regurgitation, EGE: Early gadolinium enhancement, LGE: Late gadolinium enhancement
Abstract 14082: The Effect of Diagnostic Ultrasound Mediated High Mechanical Impulses on Cardiac Output During an Ultrasound Enhancing Agent Infusion
Authors: Swethika Sundaravel, Jessica Roettger, Arif Albulushi, Joan Olson, Feng Xie, Thomas R Porter
Journal: Circulation (2020)

Introduction: Diagnostic ultrasound high mechanical index (MI) impulses are used during an ultrasound enhancing agent (UEA) infusion to improve endocardial border resolution and study myocardial perfusion. They have also been shown to cause endothelial shear, resulting in prolonged increases in ATP release and augment microvascular flow. The potential for these high MI impulses to alter cardiac output (CO) are unknown. Hypothesis: To study the impact of high MI impulses on CO Methods: Fifty one patients (mean age 63±15 years; 41% female) referred for contrast echocardiography underwent very low MI imaging with intermittent high MI impulses (1.6-1.7 Megahertz) in three different apical windows during either a Definity (Lantheus Medical) or Lumason (Bracco Diagnostics) infusion or bolus. CO was determined from Doppler measurements of left ventricular outflow tract stroke volume and heart rate. Mean contrast enhanced biplane left ventricular ejection fraction (LVEF) was 53±15%; (range 10-75%). CO from baseline without contrast (COwoC) and baseline after contrast (COwC) before high MI impulses were compared to CO after contrast and after high MI impulses (COaHMI). All CO measurements were made by an independent reviewer blinded to time of measurement (before or after high MI impulses). Results: Although heart rate did not change before and after intermittent high MI impulse administration, COaHMI increased significantly when compared to COwoC and COwC (p&lt; 0.001 for both comparisons; Figure). In nine patients (18%), CO increased by more than 20%. In patients with LVEF &lt; 40% COwC was 2.4±0.8 liters per minute (LPM) and COaHMI increased to 2.7± 0.8 LPM (p=0001). In patients with LVEF≥40%, COwC was 3.4±1.06 LPM while COaHMI increased to 3.8± 1.2 LPM (p=0.00001). Conclusions: Application of diagnostic guided high MI impulses during a commercially available microbubble infusion significantly increases CO irrespective of underlying left ventricular systolic function.
Abstract 13514: Gender-Stratified Difference in the Association Between Coronary Artery Calcium and Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Hooman Bakhshi, PRAMITA BAGCHI, Zahra Meyghani, Behnam N Tehrani, Parveen K Garg, Bharath Ambale Venkatesh, Yoshiaki Ohyama, Colin Wu, Matthew J Budoff, Michael H Criqui, David A Bluemke, Joao Ac Lima, Christopher DEFILIPPI
Journal: Circulation (2020)

Introduction: Coronary artery calcium score (CACs) measured by non-contrast cardiac CT has a strong correlation with coronary atherosclerotic burden. Although CACs predicts incident coronary heart disease, its gender-specific association with incident peripheral artery disease (PAD) is not clear. Methods: The multi-ethnic study of atherosclerosis (MESA) is a prospective population-based cohort consisting of 6814 men and female free of overt cardiovascular disease at enrollment. In this study we included MESA participants with baseline CACs and at least one ankle brachial index (ABI) measured at follow up exams. We excluded participants with baseline ABI≤ 0.9 or&gt; 1.4. Incident PAD was defined as a follow up ABI≤ 0.9 and decline of ≥15%. Multivariable logistic regression models were deployed to evaluate the association between baseline CACs and incident PAD in female and male. Results: The mean age (SD) was 61.29 (9.96) years and 52.6% (3013/5725) were female. Female had lower baseline ABI [1.10 (0.08) vs 1.15 (0.09); p &lt; 0.001]. Over a median (IQR) of 9.23 (8.22-9.60) years, 113(4%) female and 85(3%) male developed PAD. Every one unit increase in log (CACs+1) was associated with 1.11-fold higher odds of incident PAD in male (p=0.001). This association remained significant after adjustment for demographics, traditional cardiovascular risk factor and baseline ABI. Male participants with CACs&gt;300 showed 1.94-fold higher odds of incident PAD compared to participant with CACs=0 (p=0.005). In female there was no statistically significant association between CACs and incident PAD in multivariable analysis. Conclusions: Baseline CACs is associated with future PAD independent of traditional cardiovascular risk factors in male participants of a multi-ethnic cohort. Disclaimer statement: The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry
Authors: Nobuaki Tanaka, KOICHI INOUE, Atsushi Kobori, Kazuaki Kaitani, Takeshi Morimoto, Toshiya Kurotobi, Itsuro Morishima, Yumie Matsui, HIROSUKE YAMAJI, Yuko Nakazawa, Kengo F. Kusano, Masato Okada, Koj Tanaka, Yuko Hirao, Yasushi Koyama, ATSUNORI OKAMURA, Katsuomi IWAKURA, Kenshi Fujii, Takeshi Kimura, Satoshi Shizuta
Journal: Circulation (2020)

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p&lt;0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p&lt;0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p&lt;0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.
Abstract 14083: Implantable Loop Recorders Change Management in Patients With Cryptogenic Stroke With or Without Atrial Fibrillation
Authors: Danni Fu, Richard Jones, Xing Dai, Michael Wu, Tina Burton
Journal: Circulation (2020)

Introduction: Implantable loop recorders (ILR) are widely used for long term arrhythmia monitoring in patients with cryptogenic stroke (CS). Single center study has shown that some patients with incidental arrhythmias found by ILR, aside from atrial fibrillation (AF), resulted in changes in clinical management. Unfortunately, a large portion of the patients had premature ILR explantation before the end of battery life and other studies on incidental arrhythmias are limited. Hypothesis: We sought to determine the rate of occurrence of incidental arrhythmias other than AF on ILR monitoring among patients with CS and to characterize the rate of these incidental arrhythmias that result in a change in clinical management. Methods: All adult patients with ILR for CS at Rhode Island Hospital between 1/2015-1/2019 were included. Demographics, cardiac risk factors and structural features, and ILR tracings were reviewed. Results: Three hundred and twelve patients were identified with a median follow up time of 27.9 months (IQR 18.5-35.8 months). Incidental arrhythmias were identified in 110 patients (35.2%) with a median of 7.8 months (IQR 4.4-16.2 months) at a rate of 20.1 per 100 person-years. AF was detected in 51 patients (16.3%) with a median of 3.9 months (IQR 1.3-12.3 months). Eighteen patients had both AF and incidental arrhythmias and incidental arrhythmias were found after AF in 8 of those patients. Premature explantation occurred in 9.3% of patients with the most common reason being patient preference. Twelve patients with incidental arrhythmias (10.9%) had a resultant change in management; 9 with procedural interventions and 3 with medication adjustments. Overall, the rate of actionable incidental arrhythmias is 2.2 per 100 person-years. Conclusions: Other than AF detection, long term EKG monitoring in patients with CS with ILR allows for detection of other arrhythmias. These incidental findings can result in changes in management and potentially favorable clinical outcomes.
Clinical Impact of Cytokine Release Syndrome on Outcomes of Peripheral Blood Stem Cell Haploidentical Hematopoietic Cell Transplantation with Post-Transplant Cyclophosphamide
Authors: Salman Otoukesh, Hany Elmariah, Dongyun Yang, Sally Mokhtari, Madiha Siraj, Haris Ali, Krishnakar Mogili, Shukaib Arslan, Taiga Nishihori, Chatchada Karanes, Joseph Pidala, Ryotaro Nakamura, Claudio Anasetti, Stephen J. Forman, Monzr M. Al Malki, Nelli Bejanyan
Journal: Blood (2020)
The Efficacy of Systemic High Dose Methotrexate As Central Nervous System Prophylaxis in Patients with High Risk Diffuse Large B-Cell Lymphoma: A Propensity Score-Matched Analysis
Authors: Kyoungmin Lee, Dok Hyun Yoon, Jung Yong Hong, Jung Bok Lee, Shin Kim, Jung Sun Park, Jooryung Huh, Sang Wook Lee, Cheolwon Suh
Journal: Blood (2017)
Abstract 16396: The Anti-inflammatory Role of Chronic Maintenance Statin Therapy in Hospitalized Coronavirus Disease 2019 (covid-19) Patients: An Exploratory Assessment
Authors: Mohsin S Mughal, Ali R Jaffery, Ikwinder P Kaur, Chang Wang, Hasan Mirza, Denise Dalmacion, Isaac Tawfik, Mohammed Usman, Kenneth M Granet
Journal: Circulation (2020)

Introduction: The role of inflammation in the spectrum of COVID-19 disease is well documented. Statins are one of the most commonly used prescription medications for the treatment of hyperlipidemia. Additionally, statins have been shown to decrease intracellular pro-inflammatory compounds and thus reduce overall inflammation in the vasculature and myocardium. Limited information is available about their anti-inflammatory role in COVID-19. Hypothesis: We hypothesize that chronic maintenance statin therapy can prevent cardiac complications (acute cardiac injury) and mitigate the hyper-inflammatory state in COVID-19. Methods: In this single-center study, adult patients who were hospitalized from March 1 to April 20, 2020, with RT-PCR confirmed SARS-CoV-2 infection were included. Patients were divided into two cohorts; cohort 1 included the patients who were on maintenance statin therapy (regardless of dosage) and cohort 2 included patients who were not on statins. We retrospectively analyzed lab findings and compared clinical outcomes among the two cohorts. Median two-sample test (for continuous variables), chi-square test, and Fisher's exact test (for categorical variables) were utilized for statistical analysis. Results: Out of 120 patients, 44 patients were on statin therapy. Acute cardiac injury, defined as an elevation of cardiac biomarkers, was seen in 13.64% and 2.63% of patients in cohorts 1 and 2, respectively. Median values of peak inflammatory markers (LDH, CRP, Ferritin, and IL-6) were higher in cohort 1. Conclusion: Chronic maintenance statin therapy showed no additional benefit in hospitalized COVID-19 patients. We suspect that the higher median age and underlying vascular disease in cohort 1 likely played a significant role in worse clinical outcomes. However, we speculate that statin therapy should be investigated while adjusting for age and comorbidities to understand their anti-inflammatory role in COVID-19.