tbuckley/cabot-search huggingface dataset:
Abstract 14546: Left Ventricular Sphericity Index as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy
Authors: Rahul Myadam, Jason D'Souza, Kensey Gosch, Daniel Steinhaus
Journal: Circulation (2020)

Introduction: We assessed the hypothesis that markers of LV wall stress, such as LV sphericity index (SI), may predict appropriate therapy for ventricular arrhythmias (VA) in patients with primary prevention defibrillators, independent of LV ejection fraction. Methods: We performed a retrospective analysis of consecutive patients with new ICD or CRT-D placement for primary prevention at a single hospital from 01/01/2015 to 06/30/2018. TTE images were used for calculating LV SI, which was defined as the ratio of bi-plane LV end-diastolic volume to the volume of a hypothetical sphere with a diameter of LV end-diastolic length in apical 4-chamber view. Device interrogations were reviewed for appropriate therapy for VA and inappropriate therapy for non-VAs. Kaplan-Meier curves stratified by LV SI tertile were constructed, and Cox proportional hazards models were used to evaluate time to appropriate and inappropriate therapy, and all-cause mortality. Results: A total of 282 patients (ICD 154, CRT-D 128) were included. Baseline characteristics are described in the Table. We found a trend towards increased appropriate therapy as LV SI increased in the ICD but not the CRT-D group, but this was non-significant in both (ICD log-rank 0.63, p-value 0.73; CRT-D log-rank 0.07, p-value 0.96). There was no correlation between LV SI and time to all-cause mortality in the ICD (log-rank 0.53, p-value 0.76) or the CRT-D patients (log-rank 0.51, p-value 0.77). LV SI correlated significantly with time to inappropriate therapy in the ICD (log-rank 8.6, p-value 0.01), but not the CRT-D patients (log-rank 2.4, p-value 0.3). Conclusions: LV SI demonstrated a non-significant trend towards increased appropriate device therapy in the ICD but not the CRT-D group. LV SI predicted inappropriate therapy in the ICD but not the CRT-D group. Study power was limited by lower than expected event rates, possibly due to changes in device programming and improvements in heart failure therapies over time.
Abstract 12820: Beta Blocker Use and Peri-operative Outcomes in Cancer Patients Receiving Immunotherapy
Authors: Ohad Oren, Julian R Molina, Eric H Yang, Michal Oren, Kent Bailey, Stephen R Kopecky
Journal: Circulation (2020)

Introduction: The impact of beta blocker use on surgical outcomes of cancer patients receiving immunotherapy is unknown. Hypothesis: Beta blocker use is associated with lower post-operative mortality in cancer patients on immunotherapy. Methods: We used an institutional Advanced Cohort Explorer to identify all patients who underwent any surgical procedure less than 90 days after receiving immunotherapy. Data on the procedure performed as well as the post-operative outcome were collected and analyzed per the pre-operative beta blocker use status. Results: A total of 233 patients underwent surgery between 09/2011-06/2019. Mean age was 64.7 years (range: 16-92). The most common cancer diagnoses were lung (48, 44.4%), melanoma (49, 45.4%) and kidney (11, 10.2%). Immunotherapy medications were pembrolizumab ( 127, 54.5%), nivolumab (51, 21.9%), ipilimumab (43, 18.5%), atezolizumab (11, 4.7%) and avelumab (1, 0.43%). Pre-operative beta blocker use was documented in 140 (60.1%) patients. Most common surgical procedures were skin resection (75, 32.1%), wound repair (47, 20.2%), vascular procedures (36, 15.5%), urethral procedures 16 (6.9%) and sentinel lymph node biopsies (10, 4.3%). The 30-day mortality rate was 10.3% (24 deaths). In a multi-variable logistic regression analysis, pre-operative use of beta blockers was associated with a lower risk of death within 30 days from surgery (OR 0.34, CI 0.13-0.87, P=0.024). 30-day mortality rates were higher in patients undergoing vascular (50%, 17 of 34) versus non-vascular (3.5%, 7 of 199) procedures (P&lt;0.0001) in a Chi Square test. Conclusions: Beta blocker use is associated with a lower 30-day mortality rate after surgical procedures in cancer patients treated with immunotherapy. Further investigation is warranted.
Abstract 12874: Thebesian Veins Are Common and Progress in Adult Patients Late After Fontan Operation
Authors: Toshikatsu Tanaka, Yasunobu Miki, Yasuharu Ogawa, Sachiko Kido
Journal: Circulation (2020)

Introduction: Thebesian veins (ThVs) are coronary veins that drain directly into the atrial or ventricular chamber. Angiographically detectable ThVs are a rare finding sometimes associated with myocardial ischemia due to coronary steal and volume overload of ventricles in adults. However, there are limited data concerning ThVs in the setting of congenital heart disease. The purpose of this study is to demonstrate presence, character, and changes with growth of ThVs in adult patients late after Fontan operation. Methods: This study is single-center retrospective review of adults with Fontan circulation patients who had undergone cardiac catheterization for routine Fontan surveillance between 2009-2019. We assessed the presence of angiographically detectable ThVs from ascending aortography. After identification of the characteristic cases, we examined the ventricular morphology, the portion of ThVs drainage, and compared with previous findings of angiograms. We also reviewed clinical manifestation and findings of exercise stress ECG of the patients. Pulmonary atresia with intact ventricular septum was excluded because abnormal coronary arterial communications have been well documented in this condition. Results: Among 75 Fontan patients who had undergone catheterization, significant ThVs were observed in a total of 12 cases (16%). There were 6 right-dominant single ventricle, 4 left-dominant single ventricle, and 2 unbalanced two ventricles. In all cases, including left-dominant single ventricle, all ThVs drained into right ventricle cavity, never into left ventricle. The patients who underwent serial catheterizations demonstrated that ThVs dilation and tortuosity progressed over time. Among 6 patients who had underwent exercise stress ECG, only 1 patient showed ST segment depression, however, none had clinical history of chest pain. Conclusions: ThVs are common and progress in adult patients late after Fontan operation. Although the clinical significance of these findings remains uncertain, particular attention should be given to myocardial ischemia and volume overload for the future of adult Fontan patients who have prominent ThVs.
The Relationship Between Coronary Calcification and the Natural History of Coronary Artery Disease
Authors: Han-Young Jin, Jonathan R. Weir-McCall, Jonathon A. Leipsic, Jang-Won Son, Stephanie L. Sellers, Michael Shao, Philipp Blanke, Amir Ahmadi, Martin Hadamitzky, Yong-Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J. Budoff, Ilan Gottlieb, Byoung Kwon Lee, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedio de Araujo Goncalves, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Peter H. Stone, Daniel S. Berman, Jagat Narula, Leslee J. Shaw, Jeroen J. Bax, Kavitha Chinnaiyan, Gilbert Raff, Mouaz H. Al-Mallah, Fay Y. Lin, James K. Min, Ji Min Sung, Sang-Eun Lee, Hyuk-Jae Chang
Journal: JACC. Cardiovascular imaging (2020)
Abstract 14182: Genome Wide Association Study for High Sensitive Cardiac Troponin T Levels Identifies a Novel Gene in Europeans With Type 1 Diabetes
Authors: Tarunveer S Ahluwalia, Frederik Persson, Tine W Hansen, Lise Tarnow, Hans-Henrik Parving, Peter Rossing
Journal: Circulation (2020)

Introduction: Adults with diabetes have a two to four folds increased risk of dying with heart disease compared to those without diabetes. Higher cardiac troponins, especially Troponin T (TnT) is a specific biomarker for cardiac injury also guiding management of chest pain and associated with increased risk of heart failure. Hypothesis: There is limited knowledge on genes regulating cardiac TnT levels. We conducted a genome wide association study (GWAS) for circulating cardiac TnT levels among individuals with type 1 diabetes (T1D). Methods: The study included 849 T1D individuals recruited from the outpatient clinic at Steno Diabetes Center Copenhagen, Denmark. Serum high sensitive TnT (hsTnT) levels were measured and log transformed for normalization after check for outliers (mean ± 4 SD). Genotyping on 538,448 single nucleotide variants (SNVs) was done using Illumina Human Core Exome Chip. After quality control filters: hardy weinberg equilibrium (p &gt;10 -6 ), European ancestry, genotype call rates &gt;95%, common variants were examined in 740 individuals with hs TnT data. We ran linear regression based additive genetic models adjusting for age, sex, diabetes duration and population sub structure using Plink and R statistical programs. P &lt;5 x 10 -8 was genome wide significant (GWS) while 5 x 10 -8 &lt; p &lt; 1 x 10 -6 was considered suggestive. Results: Participants had a mean (SD) age of 43.7 (11.1) years, 57.4% were men, with diabetes duration of 28.0 (9.5) years, HbA1c 8.9 (1.3) % and 50.5% with diabetic nephropathy. Median (IQR) hsTnT levels were 64.7 (29.2-175.6) pg/ml. We identified a GWS missense common variant in the CISD3 gene locus on chromosome 17 (p=1.7 x 10 -8 ) for cardiac hsTnT levels. This gene codes CDGSH Iron Sulfur Domain 3 protein also called Mitochondrial Inner NEET Protein. Two suggestive loci were PTPRD (Protein Tyrosine Phosphatase Receptor Type D; p=4.9 x 10 -7 ) and DCC (DCC Netrin 1 Receptor; 6.6 x 10 -7 ) on chromosomes 9 and 18. PTPRD is a known GWS locus for hsTnT that we reconfirm among T1D individuals. Conclusions: We identify a novel gene locus for circulating cardiac hsTnT levels among T1D individuals of European ancestry. CISD3 is expressed in heart tissue regulating mitochondrial functions. Further validation is suggested.
Abstract 13615: Weekdays versus Weekends: Outcomes of Cardiogenic Shock in the Setting of Acute Myocardial Infarction
Authors: Abel E Moreyra, Deep Vakil, Stavros Zinonos, Nora M Cosgrove, John B Kostis, William J Kostis
Journal: Circulation (2020)

Introduction: Acute myocardial infarction (AMI) accounts for the majority of patients with cardiogenic shock (CS). The high case fatality justifies the need for an optimal hospital care system that is available 24 hours, 7 days a week. It is unclear whether the “weekend effect” has an impact on the outcome of CS associated with AMI. Hypothesis: Weekend CS-AMI admissions have a higher in-hospital case fatality than weekday admissions. Methods: A total of 22,632 patients with ST segment elevation AMI complicated with CS between the years 1986 to 2015 were identified in the Myocardial Infarction Data Acquisition System, a statewide database of all admissions to non-federal hospitals in NJ. Trend analysis was performed using a logistic regression model with admission year as a continuous variable. Case fatality rates between weekend vs weekday admissions were compared using the Cochran–Mantel–Haenszel test, stratifying by admission year. Results: From 1986 to 2015 there was a steady decline in the rates of in-hospital case fatality of AMI complicated with CS, from 79% to 33% (p&lt; 0.001). The overall CS death rate for admissions on weekends was 61% and for weekdays 59% (Common-Odds Ratio = 1.10 (95% CI (1.02-1.17) p= 0.006) (figure). The use of mechanical circulatory support (MCS) was lower on weekends (p&lt;0.001) and was associated with a higher case fatality rate 48 hours from admission (p&lt;0.001). Conclusion: Deaths related to CS complicating AMI have steadily declined and this applies for both, patients admitted on weekends and weekdays. There was a higher hospital death rate in patients admitted over weekends compared to weekdays. The underutilization of MCS devices during weekends likely contributes to the difference in case fatality between weekends and weekdays.
Just an odd rash?
Authors: G Klee, E A Langan
Journal: BMJ (2020)

A woman in her 70s presented to the department of dermatology with an acute, non-painful, pruritic rash on the forehead, which had been present for about three days. The rash had worsened after treatment with topical corticosteroids. Her medical history included breast cancer, which had been treated with surgery, chemotherapy, and radiotherapy eight years previously. Subsequent oncological follow-up had been unremarkable. The patient had no risk factors for HIV infection, was a lifelong non-smoker, and had no respiratory symptoms.

Examination showed multiple monomorphic erosions with surrounding erythema, extending across the midline of the forehead, in a bilateral V1 dermatomal distribution (fig 1). Hutchinson’s sign was negative—that is, no vesicles were seen on the tip or either side of the nose. In addition, isolated urticated plaques, some with blistering, involving several thoracic dermatomes were seen.



Fig 1 
Monomorphic erosions with surrounding erythema, extending across the midline of the forehead in a bilateral V1 dermatomal distribution



Routine physical examination was otherwise unremarkable. Table 1 shows the results of routine blood tests. An autoimmune blistering skin disorder was excluded …
Severe organising pneumonia following COVID-19
Authors: István Vadász, Faeq Husain-Syed, Peter Dorfmüller, Fritz C Roller, Khodr Tello, Matthias Hecker, Rory E Morty, Stefan Gattenlöhner, Hans-Dieter Walmrath, Friedrich Grimminger, Susanne Herold, Werner Seeger
Journal: Thorax (2020)

Various forms of diffuse parenchymal lung disease have been proposed as potential consequences of severe COVID‑19. We describe the clinical, radiological and histological findings of patients with COVID‑19-associated acute respiratory distress syndrome who later developed severe organising pneumonia including longitudinal follow-up. Our findings may have important implications for the therapeutic modalities in the late-phase of severe COVID‑19 and might partially explain why a subgroup of COVID‑19 patients benefits from systemic corticosteroids.
MRI-guided focused ultrasound enhances drug delivery in experimental diffuse intrinsic pontine glioma
Authors: Joji Ishida, Saira Alli, Andrew Bondoc, Brian Golbourn, Nesrin Sabha, Kristina Mikloska, Stacey Krumholtz, Dilakshan Srikanthan, Naohide Fujita, Amanda Luck, Colin Maslink, Christian Smith, Kullervo Hynynen, James Rutka
Journal: Journal of Controlled Release (2020)
Abstract 12688: Age and Sex Disparities in Hypertension Control: The Multi-ethnic Study of Atherosclerosis (mesa)
Authors: Nkiru Osude, Ramon A Durazo-Arvizu, Talar Markossian, Kiang Liu, Erin D Michos, Holly Kramer
Journal: Circulation (2020)

Introduction: Blood pressure (BP) control may decline with age and degree of decline may differ by sex. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women, age 45 to 84 years, from six communities in the U.S. during 2000-2002 and follow-up exams occurred every two years for a total of 6 exams from 2000-2016. We assessed the association of age and sex with hypertension control using MESA data among participants receiving treatment for hypertension at any of the first five exams At each exam, resting BP was measured in triplicate at 1-minute intervals using an automated oscillometric device; we used the mean of last two measurements. Hypertension control was defined as BP &lt; 140/90 mmHg among adults with treated hypertension. Mixed-effects models were used to examine the association of sex with BP control by age group (45-64, 65-84, 85+ yrs) while accounting for the clustering within sites and intra-individual correlation and adjusting for demographics, co-morbidities, smoking, alcohol use, and education. Results: Among the 2,017 adults receiving treatment for hypertension (63.1% controlled), the mean age at exam 1 was 64.0 (9.1) yrs, 43.3% male; race/ethnicity was 33.5% White, 9.2% Chinese, 37.2% Black and 20.1% Hispanic. There was a significant interaction of sex*age group (P &lt; 0.001) in mixed-effects models after adjustment for all covariates. The adjusted probability of BP control was then calculated for each sex and age group. Among women, the probability of BP control declined from 74.6% (95% CI 70.8%, 78.5%) for age 45-64 yrs to 55.9% (50.0%, 61.8%) for age 85+ yrs. Among men, probability of BP control declined from 74.0% (70.0%, 78.0%) for age 45-64 yrs to 70.6% (65.7%, 75.5%) for age 85+ yrs. The figure shows the probability of hypertension control by sex and age at a given exam. Conclusion: Hypertension control differs by sex. Interventions are needed to address age-related sex disparities in hypertension control.
Abstract 16719: Impact of Underlying Cardiovascular Disease for the Hospitalized Covid-19 Patients in Delaware
Authors: Zugui Zhang, Tze Chao Chiam, Bayo Gbadebo, Claudine Jurkovitz, Austin Mount-Campbell, Cecelia Harrison, Melissa Bollinger, Leroi Hicks, Mia Papas
Journal: Circulation (2020)

Background: Patients with cardiovascular disease (CVD) are especially vulnerable to respiratory infections caused by the coronavirus. The underlying effect of cardiovascular comorbidities on patients with COVID-19, however, remains to be sufficiently understood. Methods: Hospitalized COVID-19 patients from a state-wide large health care system with completed historical clinical conditions during March - June of 2020 were included in this study. The impact of CVD on the mortality, resources utility including the uses of intensive care unit (ICU) and ventilator, length of stay (LOS) and financial burden of COVID-19 inpatients were examined. Logistic analysis was applied to analyze the relationship between CVD and mortality, and non-parametric methods were used to evaluate the impact of CVD on resources utility. Random forest method was used to rank the importance of risk factors. Results: Among 811 hospitalized COVID-19 patients, 228 (28.11%) were placed in ICU, 105 (12.95%) spent on ventilators, and there were 94 deaths (11.59%). The mean LOS was 11.93 ± 11.26 (SD, standard deviation), mean time a patient in an ICU was 2.41 ± 5.49 days, and mean ventilator time was 1.29 ± 4.62 days. The mean charge of a patient was $55242 ± 71742) with inter-quarter range of $44124. Age, gender, and race were the top 3 factors of mortality and utilities. Patients who present with heart failure vs. those who do not, have increased mortality (21.47% vs 8.97%; odds ratio [OR], 2.00 (95% CI: 1.25-3.21; P=0.004), longer LOS (12.97 ±10.09 vs. 11.61±11.46), p=0.18), higher ICU usage ( 3.32 ± 6.04 vs. 2.14 ±5.26, p=0.02) and ICU requiring ventilator (1.86 ± 4.90 vs. 1.15 ± 4.56, p=0.09), and significant higher charge ($ 66175 ± 68773 vs $ 50736 ±64142, mean difference $15439± 65193 with 95% CI: $4537-26340, p=0.01). Similar results were shown for patients with coronary artery disease or arrhythmia. Patients with hypertension vs those who do not, have increased mortality (14.81% vs. 4.92%; OR=3.22 (95% CI: 1.76-5.90, p=0.01), but the impact was not significant after adjusted by age, race and gender. Conclusions: Among COVID-19 hospitalized patients with established cardiovascular disease, there was a worse survival and adverse utility outcomes in hospital resources and financial charges.
Abstract 357: Will a College Student Perform Conventional Cardiopulmonary Resuscitation on a Stranger?
Authors: Trevor Short, Trey Baird, Daniela Dluzynski, Rachel Vanscoy, Ashish R Panchal
Journal: Circulation (2020)

Background: For many years, significant effort has been placed on training students in CPR earlyto develop a generation of bystanders willing to act during a cardiac arrest event. This traininghas focused on chest compression only CPR (CCO-CPR) to increase provision and decreasebarriers. More recently, with the increase in opioid overdoses, there is a need for CPR withrescue breathing. It is unclear whether college students are willing to provide compressionswith rescue breaths (conventional CPR). The objective of this study is to evaluate the intentionof college students to perform conventional CPR and determine the characteristics associatedwith CPR performance. Methods: A two-page survey was administered to Ohio State University undergraduatestudents in pre-health and non-health related career paths from Jan 2018-Dec 2019.Respondents’ demographic data were collected including age, sex, CPR training, family risk ofcardiac arrest and the student’s career path. Respondents were asked their attitudes concerningperforming CPR (conventional or hands-only CPR) on strangers. Inclusion criteria were age &gt;17and missing &lt; 10% of survey data. Descriptive statistics were calculated and a multivariablelogistic regression model (OR, 95% CI) was constructed to assess the association between thelikelihood of performing CPR on a stranger and demographic characteristics. Results: Surveys were received from 883 students (response rate 74%). The student populationhad a high rate of CPR training with 57% (482) with either CCO-CPR or conventional CPRtraining. A large number of students were also studying to be in a healthcare related field (529,60%). Overall, college students reported that they would perform CCO-CPR more thanconventional CPR on a stranger (78% vs 56%, respectively). Odds of performing conventionalCPR on a stranger was elevated in college students trained in CPR (5.16, 3.82-6.99), studying in ahealthcare related field (1.78, 1.31-2.43), and with a family member at risk for cardiac arrest(1.49, 1.07-2.07). Conclusion: College students are willing to perform conventional CPR on strangers and thelikelihood of provision increases with CPR training, healthcare field of study, or having at riskfamily members.
Abstract 15465: Upregulation of Mitochondrial Atpase Inhibitory Factor 1 Mediates Increased Glycolysis in Pathological Cardiac Hypertrophy
Authors: Bo Zhou, Arianne Caudal, Xiaoting Tang, Juan D Chavez, Andrew Keller, Outi M Villet, Stephen C Kolwicz, Wang Wang, James Bruce, Rong Tian
Journal: Circulation (2020)

Background: During the development of heart failure cardiac fuel metabolism switches from predominantly fatty acid oxidation (FAO) to increased reliance on glucose, especially glycolysis. Mechanisms responsible for the switch are poorly understood but appear to be coupled with impaired mitochondrial function. We recently demonstrated that increased glucose metabolism is required for cardiomyocytes growth during pathological remodeling. Hypothesis: Upregulation of mitochondrial ATPase inhibitory factor 1 (ATPIF1) in hypertrophied hearts suppresses ATP synthesis and shifts cardiac metabolism from fatty acid oxidation towards glucose metabolism. Methods and Results: We report that ATPIF1 expression is upregulated in cardiomyocytes and mouse hearts undergoing pathological hypertrophy. Using genetic models of ATPIF1 gain- and loss-of-function in cardiomyocytes and in mouse hearts,we find that upregulation of ATPIF1 in cardiac hypertrophy inhibits ATP synthesis. Furthermore, quantitative analysis of chemical crosslinking by mass spectrometry revealed that increased expression of ATPIF1 promoted the formation of F o F 1 -ATP synthase nonproductive tetramer. Impairment of F o F 1 -ATP synthase function in respiring mitochondria increasedROS generation resulting in transcriptional activation of glycolysis. Cardiac-specific deletion of ATPIF1 in mice prevented the switch to glycolysis in pressure overload induced cardiac hypertrophy. Conclusions: We show that upregulation of ATPIF1 drives glucose metabolism at the expense of energy supply during the pathological growth of cardiomyocytes. Our study proposes a central role of ATP synthase in toggling anabolic and catabolic metabolism during pathological remodeling, illustrating a new concept for metabolic reprogramming of the heart.