tbuckley/cabot-search huggingface dataset:
HEPATIC STEATOSIS IS ASSOCIATED WITH INCREASED DISEASE SEVERITY IN PATIENTS WITH NOVEL CORONAVIRUS DISEASE 2019 (COVID-19)
Authors: F. Hawa, I. A. Kassab, J. A. Berinstein, C. A. Steiner, K. D. Platt, J. Louissaint, C. Y. Hsu, C. A. Reddy, N. T. Gunaratnam, V. Chen, P. Sharma
Journal: Hepatology (2020)

Background: Novel coronavirus disease 2019 (COVID-19) is a global pandemic with significant morbidity and mortality  Possible association between hepatic steatosis (HS) and worse COVID-19 disease progression has been suggested but not well described in the United States We investigated whether patients with HS experienced worse disease outcomes from COVID-19 infection than those without Methods: We retrospectively reviewed a cohort of 342 consecutive adult patients treated at the University of Michigan for COVID-19 between March 1 and April 30, 2020  HS was defined as either prior imaging evidence of steatosis or hepatic steatosis index >36 for Asians or >39 for non-Asians  The primary outcome was disease severity based on admission to intensive care unit (ICU), intubation, death, or the World Health Organization (WHO) ordinal scale We used multivariable logistic regression to assess the predictors of ICU admission, intubation rate, or death and multivariable linear regression for disease severity on WHO ordinal scale HS was the primary predictor Results: A total of 342 patients were analyzed Median age was 63 years;53 5% of patients were male and 44 4% Black, 52 6% required ICU admission, 34 2% required intubation, and 16% died A 178 patients (52%) had HS, who were younger (58 5 vs 66 5 years;p < 0 001), had higher body mass index (34 7 vs 26 6;p < 0 001), and had higher prevalence of diabetes (48 3% vs 37 8%;p = 0 06) than those without HS HS was independently associated with increased odds of requiring admission to the ICU (odds ratio [OR] 1 75 [1 09-2 81], p = 0 02) and intubation (OR 2 58 [1 56-4 28], p < 0 001), as well as higher WHO ordinal scale (beta 0 51 [0 11-0 92], p = 0 013)  There was no significant association between HS and death (OR 0 83 [0 42-1 67], p = 0 61) (Table 1) Conclusion: Analysis from our cohort showed that HS is associated with worse disease outcomes, evidenced by increased odds of ICU admission, intubation rate, and WHO ordinal scale in patients with COVID-19(Table Presented)
Incidence of COVID-19 in patients exposed to chloroquine and hydroxychloroquine: results from a population-based prospective cohort in Catalonia, Spain, 2020
Authors: Rosa Maria Vivanco-Hidalgo, Israel Molina, Elisenda Martinez, Ramón Roman-Viñas, Adrián Sánchez-Montalvá, Joan Fibla, Caridad Pontes, César Velasco Muñoz
Journal: Eurosurveillance (2021)

BackgroundSeveral clinical trials have assessed the protective potential of chloroquine and hydroxychloroquine. Chronic exposure to such drugs might lower the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or severe coronavirus disease (COVID-19).AimTo assess COVID-19 incidence and risk of hospitalisation in a cohort of patients chronically taking chloroquine/hydroxychloroquine.MethodsWe used linked health administration databases to follow a cohort of patients with chronic prescription of hydroxychloroquine/chloroquine and a control cohort matched by age, sex and primary care service area, between 1 January and 30 April 2020. COVID-19 cases were identified using International Classification of Diseases 10 codes.ResultsWe analysed a cohort of 6,746 patients (80% female) with active prescriptions for hydroxychloroquine/chloroquine, and 13,492 controls. During follow-up, there were 97 (1.4%) COVID-19 cases in the exposed cohort and 183 (1.4%) among controls. The incidence rate was very similar between the two groups (12.05 vs 11.35 cases/100,000 person-days). The exposed cohort was not at lower risk of infection compared with controls (hazard ratio (HR): 1.08; 95% confidence interval (CI): 0.83-1.44; p = 0.50). Forty cases (0.6%) were admitted to hospital in the exposed cohort and 50 (0.4%) in the control cohort, suggesting a higher hospitalisation rate in the former, though differences were not confirmed after adjustment (HR: 1·46; 95% CI: 0.91-2.34; p = 0.10).ConclusionsPatients chronically exposed to chloroquine/hydroxychloroquine did not differ in risk of COVID-19 nor hospitalisation, compared with controls. As controls were mainly female, findings might not be generalisable to a male population.
Abstract 16754: Novel Characterization of Pulmonary Artery Bending, Rather Than Stenosis, Detects Increased Right Ventricular Afterload and is Associated With Increased Right Ventricular Mass in the Post-Arterial Switch Operation Heart
Authors: Marc A Delaney, Paige Mass, Francesco Capuano, Yue-hin Loke, Laura Olivieri
Journal: Circulation (2020)

Introduction: Surgical treatment of transposition of great arteries involves the Arterial Switch Operation (ASO) and the LeCompte maneuver, where the pulmonary artery (PA) and its bifurcation are translocated anterior to the neoaortic root, creating relative PA stenosis and exaggerated PA bending. Assessment of branch PA dimensions can identify stenosis, however complex 3-dimensional bending without clear stenosis may contribute to elevated right ventricular (RV) afterload. Initial data suggest elevated RV afterload and RV mass are prevalent in these patients but the etiology and associated risk factors remain unclear. Hypothesis: In post-ASO patients, more extreme PA bending, as described by radius of curvature, will be associated with elevated RV afterload and RV mass independently of relative PA stenosis. Methods: Retrospective single-center analysis of 22 post-ASO patients was performed, representing native anatomy of D-TGA with (15, 68%) and without (7, 32%) intact ventricular septum, excluding those with PA stent, pulmonary hypertension, or other anatomical confounders. RV systolic pressure (RVSP) was recorded from echocardiography (11, 50%) or catheterization (11, 50%) and correlated to cardiac magnetic resonance (CMR) imaging measurements including: radius of curvature (Rcw) weighted to differential pulmonary blood flow and RV mass indexed to body surface area. Results: In ASO patients, receiver operating characteristic curve demonstrated Rcw, but not PA stenosis, moderately detected presence of elevated RVSP (&gt;40 mmHg) (respectively: AUC 0.84, p = 0.03 and AUC 0.49, p =0.60). Patients with elevated RV Mass had more extreme Rcw (when normalized to body surface area), but no difference in PA stenosis via Nakata index (respectively: p = 0.10, p = 0.02). Conclusions: Abnormal PA bending as described by Rcw is associated with increased RV afterload and RV Mass. Rcw may serve as a promising future clinical proxy to RV afterload.
Abstract 15815: Left Atrial Strain Characterizes the Atrio-ventricular Substrate Responsive to Cardiac Resynchronization Therapy in Patients With Intermediate Electrocardiographic Criteria
Authors: Peter Huntjens, Masataka Sugahara, Yuko Soyama, Joost Lumens, Mitchell N Faddis, John Gorcsan
Journal: Circulation (2020)

Introduction: Guidelines favor patient selection by left bundle branch block (LBBB) with QRS width ≥150 ms for cardiac resynchronization therapy (CRT). Predicting CRT response in patients with QRS width 120 to 149 ms or non-LBBB remains difficult. Left ventricular (LV) global longitudinal strain (GLS) and systolic stretch index (SSI) have shown to characterize the ventricular substrate responsive to CRT. However, the potential application of longitudinal left atrial (LA) strain remains unclear. Hypothesis: Baseline LA strain has prognostic value in CRT patients with intermediate ECG criteria. Methods: We studied 195 patients who underwent CRT based on routine indications: ejection fraction ≤35% and QRS width ≥120 ms. GLS was assessed using the 3 standard apical views. Radial SSI was derived from the mid LV short axis view. Peak longitudinal LA strain was derived from the 2 and 4-chamber apical view. The predefined combined clinical endpoint was death, heart transplant or left ventricular assist device over 4 years after CRT. Results: LA strain was feasible in 162 (83%) of the CRT candidates: QRS duration 156 ± 26 ms, 39.5% had LBBB with QRS ≥ 150ms, 60.5% had intermediate ECG criteria. High peak longitudinal strain (&gt;median, 10.1%) was associated with favorable event-free survival (p&lt;0.001). Patients with intermediate ECG criteria for CRT and both high peak longitudinal LA strain and high GLS (&gt;median, 8.4%) had similar outcome to those with Class I indications for CRT. Multivariable analysis revealed that LA strain had independent prognostic value (hazard ratio 0.9 per LA strain %, p &lt; 0.001) even after adjusted for other clinical, electrophysiological and echocardiographic covariates including QRS morphology and duration, GLS and SSI. Conclusions: Peak LA strain had important prognostic value in candidates for CRT. Prognostic value of LA strain was additive to LV strain characteristics and most significant in CRT patients with intermediate ECG criteria for CRT.
Abstract 14418: Association Between 2018 Unos Heart Transplant Policy Changes and Likelihood of Transplant for Patients in Rural versus Urban Settings
Authors: Khadijah Breathett, Shannon Knapp, Daniel Addison, Nishaki Mehta, Nancy Sweitzer, Sula Mazimba
Journal: Circulation (2020)

Introduction: United Network for Organ Sharing (UNOS) recently extended the radius for which a heart transplant candidate can be matched with a donor in order to improve transplantation access for the most critically-ill patients. However, this means that smaller transplant centers serving rural populations may not retain the hearts that were donated within their geographic area. It is unknown whether the UNOS policy change of 2018 was associated with differences in likelihood of heart transplantation or death on the waiting list for patients from rural versus urban (metropolitan or micropolitan) settings. Methods: Using the Scientific Registry of Transplant Recipients, we analyzed U.S. adult patients who were listed for heart transplant from January 2017 through January 2020. Patients were stratified by home zipcodes to either metropolitan, micropolitan, or rural settings. Fine and Gray proportional hazard regression models were used to estimate the sub-distribution hazard ratio (SHR) of heart transplantation with death or removal from transplant list as a competing event according to geographic residence with date of UNOS policy change October 18 2018 as a time-varying covariate. Interaction (p-int) tests were performed between geographic setting and time of policy change. Results: Among 8756 patients, 82% were from metropolitan, 9% micropolitan, and 9% rural settings. The 2018 UNOS policy change was associated with increased receipt of heart transplantation within each geographic setting [metropolitan SHR 1.41 (95%CI: 1.33-1.50); micropolitan SHR 1.30 (95%CI: 1.08-1.56); rural SHR 1.33 (95%CI: 1.10-1.62); p-int=0.60]. Policy changes were not significantly associated with death on the transplant list for any geographic setting [metropolitan SHR 0.97 (95%CI: 0.82-1.14); micropolitan SHR 1.25 (95%CI: 0.80-1.96); rural SHR 0.89 (95%CI: 0.55-1.46); p-int=0.52]. Conclusions: Independent of geographic location, the 2018 UNOS policy change for heart transplantation was associated with increased heart transplantation and no significant difference in hazard of death. Additional follow-up is needed to determine whether improvements are sustained.
Abstract 15477: Association With Post Discharge Adherence to Guideline Directed Medical Therapy and Long Term Health Outcome
Authors: Chih-Wei Chen, Chun-Yao Huang, Li-Nien Chien, Yi-cheng Lin
Journal: Circulation (2020)

Introduction: Statin, beta-blocker and Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guideline as secondary prevention medications to improve long term outcome post myocardial infarction for years. However, in reality, adherence to these medications have always been challenging and different treatment regimen adherence might lead to divergent outcomes which remains unclear in current AMI standard care. Hypothesis: To investigate the association between different guideline-directed medication regimen adherence post myocardial infarction and long-term outcomes. Methods: This cohort study used data files from Taiwan National Health Insurance Research Database (NHIRD). A total of 77520 survivors of hospitalization with AMI between 2002 and 2015 were assessed. Base on adherence to individual medications, eight treatment groups were estimated in this study. We investigate the association of adherence to different treatment groups and all-cause mortality in 24 months. Results: 51322 STEMI patients and 26198 NSTEMI patients were included in the study. All treatment groups had significant higher mortality compare with patients who adhered to all 3 medications in 24 months follow-up. Patients not adherence to any medications had the highest mortality in 24 months (adjusted HR: 1.78; 95% CI: 1.64 to 1.93). Conclusions: In this large population base real-world data study, we found that adherence to all 3 secondary prevention medications in post myocardial infarction survivor was associated lower rate of all cause mortality.
Abstract 15395: Immune Checkpoint Inhibitors for Cancer Are Associated With Increased Venous Thromboembolism Events
Authors: Jingyi Gong, Zsofia Drobni, Raza Alvi, Sean Murphy, Sarah Hartmann, Hannah Gilman, Leyre Zubiri, Vineet Raghu, Ryan Sullivan, Amna Zafar, Daniel A Zlotoff, Matthew Frigault, Rebecca Karp-Leaf, Kerry Reynolds, Tomas G Neilan
Journal: Circulation (2020)

Introduction: Immune checkpoint inhibitors (ICI) lead to immune activation, increased inflammation and cancer cell death. Both immune activation and inflammation are critical pathobiological drivers for venous thromboembolism (VTE). There are no robust data testing the effect of ICIs on the risk of developing VTE. Methods: This is a retrospective study of 2854 patients who received ICIs at Massachusetts General Hospital, Boston, MA. VTE events, defined as a composite of deep vein thrombosis (DVT) or pulmonary embolism (PE), were identified by individual chart review and were blindly adjudicated using standard criteria. A case-crossover design was applied with an “at-risk period” defined as the two-year period after and the “control period” as the two years prior to treatment. Incidence rate ratio (IRR) was calculated using Poisson’s regression. Results: Immune checkpoint inhibitor use increased VTE risk by 1.84-fold from 4.85 per 100-person years to 8.91 per 100 person-years (IRR 1.84, 95% confidence interval: 1.54 - 2.19, p &lt;0.001). Of the individual components, there was a 2.44-fold increase in DVT risk (2.30 to 5.58 per 100 person-years) and 1.68-fold increase in PE risk (2.96 to 5.00 per 100 person-years). Comparing patients with and without a VTE event, those with a VTE event after ICI initiation had a higher rate of prior VTE, lung cancer, urothelial cancer, and a higher platelet count and white blood cell count at baseline. At 6 months post ICI initiation, 165 (8.6%) patients had a VTE event and of these patients 136 (7.1%) had no prior VTE. Conclusions: Patients with cancer treated with ICIs are at increased risk of developing VTE. Whether prophylaxis for VTE among patients starting an ICI reduces this risk is unclear.
Abstract 16207: An Uncommon Pathogen Causing Endocarditis and Valve Abscess: Aerococcus Sanguinicola
Authors: Aditi Shankar, James P Macnamara, Andrew D Assaf, Robert Brockie, Carter A King
Journal: Circulation (2020)

Introduction: Aerococcus Sanguinicola is a rare pathogen associated with urinary tract infections (UTI). Widespread use of MALDI-TOF can better differentiate Aerococcus species and has led to the identification of A. Sanguinicola as a source of endocarditis. Case Presentation: A 55-year-old male with a history of diabetes mellitus and recent cystitis presented to the hospital with confusion, back pain, fever, chills and myalgias. The patient was tachycardic and hypotensive on exam. Leukocyte count was at 16 k/ul with elevated inflammatory markers. Blood cultures were obtained and empiric vancomycin and cefepime were initiated. Transthoracic echocardiogram revealed mild mitral regurgitation. On hospital day 3, gram stain demonstrated gram positive cocci in clusters, and physical exam revealed a new 3/6 holosystolic murmur in the left 6th intercoastal space. Transesophageal echocardiogram demonstrated acute severe mitral regurgitation and multiple large vegetations with abscess on the anterior leaflet (Figure). Gentamycin was added to treat presumed Staphylococcus Aureus endocarditis. Subsequent species identification revealed A. Sanguinicola as the blood-based pathogen. He underwent bioprosthetic mitral valve replacement due to acute heart failure. Anatomic pathology of the valve confirmed A. Sanguinicola infection. He completed a 6-week course of antibiotics. On his follow up visit at 3 months, the patient had recovered. Conclusion: This case demonstrates a severe case of A. Sanguinicola endocarditis requiring urgent valve replacement. A. Sanguinicola is known to generate biofilms, which are activated by plasma which contrasts with S. Aureus, for which A. Sanguinicola can be mistaken. Additionally, known case of A. Sanguinicola infection demonstrate B-lactams sensitivity. While the organism has the potential to form abscesses, we present the first reported case of valvular abscess that was successfully cured with antibiotics and surgery.
Abstract 14129: Evaluation of Determinant Factors for Delirium in Patients With Acute Coronary Syndrome
Authors: Yasuko Ono, Yuna Fujita, Yumi Tashiro, Nonami Onishi, Shiho Moriyama, Takeshi Yamada, Yukio Mizuguchi, Akihiko Takahashi
Journal: Circulation (2020)

Background: The development of delirium in the intensive care unit (ICU) is associated with increased mortality, prolonged ICU stays, and the development of post-ICU cognitive impairment. There is a paucity of data on factors contributing to the development of delirium in patients with acute coronary syndrome (ACS), who usually have several comorbidities and are subjected to various treatment-related risk factors with impaired cardiac function. This study aimed to identify factors contributing to delirium among patients with ACS. Methods: We retrospectively investigated 185 patients with ACS who were consecutively hospitalized in coronary care units (CCU) of a hospital between January 2017 and March 2019. We divided the 185 patients into two groups (delirium and non-delirium) according to the presence or absence of delirium. Delirium was defined as experiencing any one of following symptoms: 1) contradictory conversation, 2) self-removal of drip infusion, 3) impaired orientation, 4) restlessness, 5) delusions and hallucinations, and 6) inability to stay quiet. Results: Compared to the non-delirium group, the delirium group was older (80.2±8.8 vs. 65.8±11.0 years old, p &amp;lt;0.001); more likely to be living alone, having cerebrovascular disease, and lower left ventricular ejection fraction (43.2 vs. 22.7 %, p =0.008; 25.0 vs. 10.6 %, p =0.017; 49.8±11.7 vs. 54.7±13.4 %, p =0.022, respectively); and more likely to have any one of the central lines, including central venous line, intra-aortic balloon pump, arterial line, and temporary pacing (31.8 vs. 12.8 %, p =0.004). Multivariate logistic regression analyses indicated that age and living alone were independent predictors of delirium (OR 1.16, 95% CI 1.10-1.23, p&amp;lt;0.001; and OR 2.68, 95% CI 1.05-6.85, p =0.04, respectively). Conclusion: In this study, 23.8% patients with ACS who were hospitalized in CCU suffered from delirium. Results revealed that age and living alone were independent predictors of delirium. However, more attention must be focused on not only physical factors but also social factors to prevent delirium in hospitalized patients with ACS.
Abstract 15415: Trends and Predictors of Cardiogenic Shock and Mortality in Takotsubo Syndrome
Authors: Moinuddin Syed, Muhammad Z KHAN, Sudarshan Balla
Journal: Circulation (2020)

Introduction: There is limited data on trends, predictors and outcomes of cardiogenic shock (CS) and mortality among patients admitted with takotsubo syndrome (TTS). We aim to study these parameters from the national inpatient sample. Methods: We analyzed the National Inpatient Sample (NIS) database from September 2006 to December 2017 to assess the trends and predictors of cardiogenic shock and mortality among patients with TTS. Results: A total of total of 265,423 patients with takotsubo syndrome (TTS) were included in our study, of whom 14703 (5.5%) were diagnosed with cardiogenic shock (CS). TTS Patients with CS were more likely to be younger (67, Interquartile range [IQR] 57-75 vs 68, 58-78), males (20.9% vs 13.8%, P &lt;0.01), with key ethnicities being Asian and Hispanic. TTS patients with CS were also more likely to have multiple medical comorbidities at baseline including congestive heart failure (65.7% vs 40.9%, P &lt;0.01), chronic lung disease (31.1% vs 29.2%, P &lt;0.01) diabetes with chronic complications (7.4% vs 5.6%, P &lt;0.01) and chronic kidney disease (13.2% vs 11.1% P &lt;0.01). TTS patients with CS had a higher incidence of malignant arrhythmias including ventricular tachycardia or ventricular fibrillation (15.0% vs 4.6%, P &lt;0.01) and non-shockable cardiac arrests (12.2% vs 2.3%, P &lt;0.01). In-hospital mortality among patients with TTS-CS was fivefold higher compared to those without CS (22.9% vs 4%, P &lt;0.01). During our study period we also noted a significant increase in trends of cardiogenic shock and mortality among patients with TTS. Conclusions: In hospital mortality among TTS patients with CS was approximately five-fold higher compared to those without CS (22.9% vs 4.0%, P &lt;0.01).Future research should be directed towards management strategies to improve outcomes in patients with TTS.