tbuckley/cabot-search huggingface dataset:
Abstract 13640: Effects of Influenza Vaccine on Mortality and Cardiovascular Outcomes Ii Patients With Cardiovascular Disease: A Systematic Review and Meta-analysis
Authors: Siva Harsha Yedlapati, Safi U Khan, Swapna Talluri, Ahmad Naeem Lone, Muhammad KHAN, Mohammad S Khan, Ann M Navar, Martha Gulati, Heather M Johnson, Seth J Baum, Erin D Michos
Journal: Circulation (2020)

Introduction: Influenza infection is associated with increased morbidity and mortality in patients with cardiovascular disease (CVD). We assessed the effects of influenza vaccine on mortality and cardiovascular outcomes in patients with CVD. Hypothesis: Influenza vaccination in those with CVD is associated with a reduction in mortality and major adverse cardiovascular events (MACE). Methods: We searched PubMed, EMBASE, and Cochrane library through January 2020 for randomized-controlled trials (RCTs) and observational studies assessing effects of influenza vaccine on mortality and cardiovascular outcomes in patients with CVD. Estimates were reported as random effects risk ratios (RR) with 95% confidence intervals (CI). Analyses were stratified by study design into RCT and observational studies. Results: Overall, 16 studies (n=237,058) encompassing 4 RCTs (n=1,667) and 12 observational studies (n=235,391) were included. The mean age was 69.2±7.01; 36.6% were female, 65.1% had hypertension, 31.1% had diabetes, and 23.4% were smokers. The median follow-up duration was 19.5 (IQR, 12, 43.3) months. Influenza vaccine was associated with a lower risk of all-cause mortality (RR, 0.72 [95% CI, 0.59-0.89], p&lt;0.001) ( Figure 1A ), cardiovascular mortality (RR, 0.82 [95% CI, 0.80-0.84], p&lt;0.001), and MACE (RR, 0.87 [95% CI, 0.80-0.94], p&lt;0.001) ( Figure 1B ), though the association with myocardial infarction was not statistically significant (RR, 0.73 [95% CI, 0.50-1.07]; p=0.10). These finding were consistent across randomized and observational studies. Conclusions: This meta-analysis suggests that both randomized and observational data support the use of influenza vaccine in adults with CVD to reduce mortality and MACE events. Efforts to improve utilization of influenza vaccine in this population should continue to reap survival benefits.
Abstract 283: Repolarization Heterogeneity and Torsades De Pointes: A Case Control Study
Authors: Keith Marill, Samantha Lopez, David Hark, Jennifer Spahr, Ketaki Muthal
Journal: Circulation (2020)

Introduction: Torsades de Pointes (TdP) is a potentially lethal ventricular tachydysrhythmia associated by definition with prolonged myocardial repolarization. However, prolonged myocardial repolarization is not specific for TdP. Our primary objective was to determine if heterogeneous myocardial repolarization manifested by corrected QT (QTc) and T wave variation is necessary and predictive of TdP. Methods: We performed an IRB approved case control study of TdP at a large urban hospital. We identified cases based on a MUSE ECG database search for tracings from 1/05 to 6/19 with QTc&gt;500, QRS&lt;120, and HR&lt;60, and a subsequent natural language search of electronic health records for the terms: TdP, polymorphic ventricular tachycardia, sudden cardiac death, etc. Controls were drawn in a 2:1 ratio to cases from a similar pool of ECGs, and matching for sex, age, QTc, and heartrate. We abstracted historical, laboratory, ECG, and telemetry data using detailed written instructions and an electronic database. Groups were compared using unpaired and paired nonparametric and parametric statistics as appropriate. Results: We included 75 cases and 150 controls. We found no significant difference in measures of QTc or T wave repolarization heterogeneity, QTc prolonging medications, or serum electrolytes between the two groups. However, 35 cases had brief telemetry strips demonstrating TdP and a median of four beats prior to TdP onset. Ectopy was present in 25 (71%) strips prior to TdP. Heartrate in these cases was also 17 beats per minute (BPM) (95% CI 7 to 27) higher at an average 87 BPM just prior to TdP as compared to their index ECG. Conclusions: Repolarization heterogeneity is not greater in patients with QTc prolongation who suffer TdP. It doesn’t appear mechanistically necessary or predictive of TdP. Ventricular ectopy, possibly triggered from early after depolarizations, but not bradycardia, is common before TdP and may be usefully predictive.
Delivery mode and gut microbial changes correlate with an increased risk of childhood asthma
Authors: Jakob Stokholm, Jonathan Thorsen, Martin J. Blaser, Morten A. Rasmussen, Mathis Hjelmsø, Shiraz Shah, Emil D. Christensen, Bo L. Chawes, Klaus Bønnelykke, Susanne Brix, Martin S. Mortensen, Asker Brejnrod, Gisle Vestergaard, Urvish Trivedi, Søren J. Sørensen, Hans Bisgaard
Journal: Science Translational Medicine (2020)

Cesarean section delivery is associated with gut microbiota differences and an increased risk of asthma by age six.
Abstract 15486: Subclinical Hypothyroidism and Left Heart Strain in the General Population
Authors: Koki Nakanishi, Masao Daimon, Yuriko Yoshida, Naoko Sawada, Jumpei Ishiwata, Megumi Hirokawa, Hidehiro Kaneko, Tomoko Nakao, Yoshiko Mizuno, Hiroyuki Morita, Marco Di Tullio, Shunichi Homma, Issei Komuro
Journal: Circulation (2020)

Background: Although subclinical hypothyroidism (SCH) is a common clinical entity and carries independent risk for incident heart failure (HF), its possible association with subclinical cardiac dysfunction has not been extensively evaluated. Left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic strain can unmask subclinical left heart dysfunction and are excellent predictors for HF. This study aimed to investigate the association between the presence of SCH and subclinical left heart dysfunction in a sample of the general population without overt cardiac disease. Methods: We examined 1,078 participants who underwent extensive cardiovascular health check-up including laboratory tests and 2-dimensional speckle-tracking echocardiography to assess LVGLS and LA reservoir, conduit and pump strain. SCH was defined as an elevated serum thyroid stimulating hormone level with normal concentration of free thyroxine. Results: Mean age was 62±12 years, and 56% were men. Seventy-eight (7.2%) participants exhibited SCH. Individuals with SCH had significantly reduced LA reservoir and conduit strain (both p&lt;0.05) compared with those with euthyroidism, whereas there was no significant difference in LV ejection fraction, LA volume index, LVGLS and LA pump strain between the 2 groups. In multivariable analyses, the presence of SCH was significantly associated with impaired LA reservoir strain, independent of age, traditional cardiovascular risk factors and pertinent laboratory and echocardiographic parameters including LVGLS. Conclusions: In an unselected community-based cohort, individuals with SCH had significantly impaired LA function. This association may be involved in the higher incidence of HF in subjects with SCH.
Abstract 13943: Elevated Natriuretic Peptides in Covid-19 Patients With Severe or Critical Illness
Authors: Benjamin Benhuri, Tadao Aikawa, Hisato Takagi, Daniel Benhuri, Toshiki Kuno
Journal: Circulation (2020)

Introduction: The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an extraordinary increase in the number of severe and critically ill patients in a relatively short span of time. Cardiovascular risk factors and outcomes are noted as being key contributing features of many patients who ultimately develop severe illness. As such, laboratory markers for cardiac damage and failure have been described as being elevated in this subset of patients. Hypothesis: The purpose of this meta-analysis is to identify and compare the values of natriuretic peptides in severely ill patient infected with the SARS-CoV-2 compared to those who are identified as being not severe. Methods: PUBMED and Medrxiv were searched through April 15th 2020. The outcome of interest is the difference of BNP or NT-pro BNP in severe versus non-severe Results: We identified 9 eligible retrospective cohort studies that observed a total of 1,575 patients that had their natriuretic peptides measured and who were classified by disease severity. Patients who were identified as having a non-severe status with the SARS-CoV-2 infection had a mean difference of -69.56 (95% CI) [-137.35, -1.77, P =0.04, I2=83%) in B-type natriuretic peptide (BNP) levels compared to those with severe status. Similarly, patients who had their N-terminal-pro BNP (NT-proBNP) levels measures had a mean difference of -518.65 (95% CI) [ -884.90, -152.40, P=0.006, I2=86%) when compared to those whom NT-proBNP levels were measured with severe status. Conclusions: In conclusion, patients infected with the SARS-CoV-2 virus and were classified as severe had higher levels of natriuretic peptides than patients who were classified as not severe.
Association of Cardiovascular Health Metrics With Subsequent Cardiovascular Disease in Young Adults
Authors: Hidehiro Kaneko, Hidetaka Itoh, Tatsuya Kamon, Katsuhito Fujiu, Kojiro Morita, Nobuaki Michihata, Taisuke Jo, Hiroyuki Morita, Hideo Yasunaga, Issei Komuro
Journal: Journal of the American College of Cardiology (2020)
Abstract 14148: Local Aldosterone Production via StAR in PAH and in Human IPS Cell-derived Cardiomyocytes: Efficacy of Spironolactone in Cardiac Remodeling and Mitochondrial Dynamics Under Hypoxic Stress
Authors: Itsumi Murai, Anyu Kaiami, Ryuji Kato, Hideki Imano, Hirofumi Morihara, Kiichiro Tomoda, Michio Asahi, Yoshio Ijiri, Takehiro Yamaguchi, Yasukatsu Izumi, Minoru Yoshiyama, Keiko Ohta-Ogo, Hatsue Ishibashi-Ueda, Tetsuya Hayashi
Journal: Circulation (2020)

Objective: Pulmonary arterial hypertension (PAH) is a progressive disease that frequently leads to right ventricular (RV) remodeling. Increased plasma aldosterone levels have been reported in patients with PAH. The aim of this study was to examine the expression of steroidogenic acute regulatory protein (StAR) in patients and animal model of PAH, and in the human iPS cell-derived cardiomyocytes (hiPSC-CMs). Furthermore, we evaluated therapeutic effects of mineralocorticoid receptor (MR) antagonist, spironolactone (SPL) on mitochondrial dynamics in the RV myocardium. Methods: Autopsied heart samples (n=20) were obtained from patients with or without PAH. PAH model rats (n=46) were injected with Sugen5416 (20 mg/kg) and then exposed to hypoxia and reoxygenation for 4 weeks with/without treatment with SPL (25 mg/kg/day). Human umbilical vein endothelial cells (HUVECs) and hiPSC-CMs were cultured under hypoxic conditions (37 °C, 1% O 2 , 5% CO 2 ) with/without treatment with SPL (10 μM). In addition, we applied the Clustered Regularly Interspaced Short Palindromic Repeats interference (CRISPRi) technology and repressed StAR gene expression in hiPSC-CMs under hypoxic conditions. Results: In PAH patients, the expression of StAR and MR was significantly increased in cardiomyocytes and endothelial cells in the RV myocardium. In PAH rats, RV systolic pressure elevated over 60 mm Hg with deteriorated RV function. Under electron microscopy, severe degeneration of mitochondria and capillaries with myofibrillar lysis in the RV myocardium were observed, which were compatible with those findings in PAH patients. Hypoxic stress significantly increased the StAR and phosphorylated JNK, ERK-1/2, and NF-kB proteins in hiPSC-CMs as well as in HUVECs. Furthermore, we established the CRISPRi-hiPSC cell lines where StAR gene was successfully knockdown. Treatment with SPL decreased the phosphorylation of JNK, ERK-1/2, NF-kB, and Smad3 in HUVECs and hiPSC-CMs. Strikingly, SPL attenuated mitochondrial degeneration and increased mitophagy, suppressing the RV remodeling under hypoxic stress. Conclusion: SPL might regulate mitochondrial dynamics and attenuates RV remodeling in PAH via StAR/JNK signaling pathway.
Abstract 153: Non-invasive Measurement of Cerebral Tissue Oxygen Extraction Fraction is Correlated with Microdialysis Brain Injury Biomarkers During Extracorporeal Cardiopulmonary Resuscitation
Authors: Tiffany S Ko, Julia Slovis, Lindsay Volk, Constantine D Mavroudis, Ryan W Morgan, Jake Breimann, Jonathan P Starr, William P Landis, Emilie Benson, Thomas Hallowell, Nile Delso, Kristen Andersen, Anna Roberts, Jharna Jahnavi, Jonah Padawer Curry, Yuxi Lin, Kathryn Graham, Robert A Berg, Wesley B Baker, Daniel J Licht, Todd J Kilbaugh
Journal: Circulation (2020)

Introduction: Extracorporeal membrane oxygenation (ECMO) assisted CPR (ECPR) can improve outcomes after prolonged or unsuccessful resuscitative efforts, but neurological injury remains common in survivors. The lack of routine neuromonitoring during ECPR and ECMO prohibits brain-targeted management to help improve neurological outcomes. In this study, we examine the association of non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) measurements of cerebral tissue oxygen extraction fraction (OEF), an indicator of metabolic stress, with invasively collected brain injury biomarkers to explore the utility of this monitoring modality during ECPR. Hypothesis: FD-DOS measurement of cerebral OEF is positively correlated with biomarkers of brain injury (lactate-pyruvate ratio, LPR; glycerol). Methods: Cerebral OEF was continuously monitored by FD-DOS in nine pediatric swine (8-11 kg) who underwent 30-60 minutes of manual CPR, were cannulated for ECMO, and remained on ECMO for 22-24 hours. Cerebral pyruvate, lactate, glycerol and glucose content were measured from cerebral microdialysate samples collected hourly. The correlation between OEF and microdialysis parameters were assessed using a linear mixed-effects model incorporating subject-specific random slope and intercept effects. Significance was determined at p&lt;0.05. Results: Microdialysis parameters from 192 samples were compared against non-invasive OEF values. OEF was significantly correlated with LPR (p=0.001), and relative change in glycerol (p=0.005) and glucose (p=0.020) concentrations from baseline. Conclusions: Non-invasive FD-DOS neuromonitoring of OEF demonstrated significant correlations with invasive brain injury biomarkers; increasing OEF was associated with elevated LPR and glycerol, and diminished glucose. FD-DOS detection of critical neurometabolic stress at the bedside may facilitate brain-targeted ECMO management after cardiac arrest.
Correspondence on ‘Impact of the COVID-19 pandemic on the disease course of patients with inflammatory rheumatic diseases: results from the Swiss Clinical Quality Management cohort’
Authors: Adeline Ruyssen-Witrand, Martin Soubrier, André Basch, Marie-Elise Truchetet, Raphaèle Seror
Journal: Annals of the Rheumatic Diseases (2020)

<i>Introduction:</i> Erythema migrans (EM) is an annular, erythematous, expanding rash that is characteristic of early Lyme disease. In the southern United States, however, many cases of EM seem to have an etiology different from that of Lyme disease. This little-understood condition is called Southern tick-associated rash illness. <i>Methods:</i> With the goal of obtaining biological specimens and clinical histories from 12 to 20 STARI patients for use in etiologic research, microbiologists from the Centers for Disease Control and Prevention contacted the North Carolina Network Consortium, a statewide consortium of practice-based research networks. This article describes the methods by which the North Carolina Network Consortium successfully identified and enrolled Southern tick-associated rash illness patients into a primary care-based research protocol. <i>Results:</i> A total of 23 patients were enrolled, with 100% attainment of the desired specimens. After an initial lack of success, the revised protocol identified and trained physicians practicing in endemic areas for the illness, used a coordinator with 24-hour availability, recruited participants using newspaper notices and medical providers, and provided regular reminders and progress updates. <i>Conclusions:</i> A practice-based research network can help basic scientists identify patients and collect specimens for clinically relevant research.
Abstract 15622: Progression of Calcific Aortic Valve Sclerosis in WHHL Rabbits, an Animal Model of Aortic Valve Stenosis
Authors: Tetsuya Hara, Norie Tsukada, Tatsuro Ishida, Ken-ichi Hirata, Masashi Shiomi
Journal: Circulation (2017)

Introduction: Recent development of transcatheter aortic valve implantation (TAVI) improved the therapeutic strategy of aortic valve stenosis (AS). However, the pathogenesis of calcification in aor...
Abstract 15562: Incidence and Risk Factors of Device-related Infection in <i>De Novo</i> Transvenous Implantable Cardiac Defibrillator Medicare Patients
Authors: Mikhael F El-Chami, Caroline M Jacobsen, Robert I Griffiths, Linda K Hansen, Nicholas Wold, Stacey L Amorosi, Timothy M Stivland, Bradley P Knight, Raul Weiss, George E Mark, Mauro Biffi, Vincent Probst, Pier D Lambiase, Marc A Miller, Larry M Baddour
Journal: Circulation (2020)

Introduction: Practice guidelines recommend use of subcutaneous implantable cardioverter-defibrillators (ICD) in patients (pts) at risk of sudden cardiac death and high risk for infection. This has prompted a need to better identify pts at high risk of infection to assist in de novo device selection. The objective of this study is to estimate infection incidence in de novo transvenous (TV) ICD implants and assess risk factors associated with infection in a large Medicare population. Methods: A retrospective cohort study was conducted using 100% Medicare administrative and claims data to identify pts who underwent de novo TV-ICD implantation between 7/2016 and 1/2018. Device-related infection within 2 years of implantation was identified using ICD-10 diagnosis and procedure codes. Baseline pt factors associated with infection were identified by univariable logistic regression analysis of all variables of interest, including factors in Charlson and Elixhauser comorbidity indices, followed by stepwise selection criteria with a p≤0.25 for inclusion in a multivariable model and a backwards, stepwise elimination process with p≤0.1 to remain in the model. A time-to-event analysis was also conducted. Results: Among 26,742 pts with de novo TV-ICD, 519 (1.9%) had a device-related infection over 2 years. The mean pt age with and without infection was 68 and 71 years, respectively. While more than half (54%) of infections occurred within 90 days post implant, infections continued to be diagnosed with 16% of infections occurring between years 1 and 2. Multivariable analysis revealed several significant predictors of infection (Figure) including age &lt;70 years, end stage renal disease with chronic dialysis and diabetes with complications. Conclusion: The rate of de novo TV-ICD infection in a large real-world Medicare population is clinically significant. The factors associated with increased infection risk identified here can be used to help determine device selection.
Abstract 14140: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Left Main Disease in Very Elderly Patients Suffering Acute Myocardial Infarction
Authors: Derek Phan, Ara ROSTOMIAN, Mingsum Lee, naing a moore, prakash mansukhani, vicken aharonian, Somjot Brar, Ray Zadegan
Journal: Circulation (2020)

Introduction: The optimal revascularization strategy for left main disease in very elderly patients is unclear given under-representation in randomized trials. Therefore, we sought to compare percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for left main disease in very elderly patients presenting with acute myocardial infarction (AMI). Methods: Retrospective study of patients aged ≥ 80 years undergoing invasive coronary angiography (ICA) for AMI at Kaiser Permanente Los Angeles Medical Center between June 2009 and February 2019. Patients were grouped by treatment decision: PCI, CABG, or medical therapy. Inverse Probability Treatment of Weighting (IPTW) was used to balance baseline characteristics. All-cause mortality and non-fatal myocardial infarction (MI) was evaluated. Results: A total of 172 patients (average age 84.4 ± 3.6 years, 37% female) were analyzed. Of these 54 (31.4%) underwent PCI, 67 (39%) underwent CABG, and 51 (29.7%) were treated with medical therapy. Compared to CABG, the PCI group was significantly older, with more history of CAD, COPD, previous CABG, and previous PCI. Median follow-up was 22.4 months (interquartile range 5.1-46.8 months). After IPTW adjustment, there were no differences in mortality between PCI vs CABG (Hazard Ratio [HR] 1.40, 95% Confidence Interval [CI] 0.97-2.01), but an increase in non-fatal MI with PCI (HR 2.6, 95% CI 1.02-6.69). Both PCI and CABG reduced mortality (PCI: HR 0.46, 95% CI 0.32-0.66; CABG: HR 0.71, 95% CI 0.52-0.96) and non-fatal MI (PCI: HR 0.22, 95% CI 0.11-0.41; CABG: HR 0.09, 95% CI 0.4-0.23) compared to medical therapy. Conclusion: In very elderly patients with left main disease presenting with AMI, there was no difference in mortality between PCI and CABG, but an increased risk for non-fatal MI with PCI. However, both PCI and CABG were superior to medical therapy. Either revascularization strategy may be reasonable in this population.
A deep learning system for differential diagnosis of skin diseases
Authors: Yuan Liu, Ayush Jain, Clara Eng, David H. Way, Kang Lee, Peggy Bui, Kimberly Kanada, Guilherme de Oliveira Marinho, Jessica Gallegos, Sara Gabriele, Vishakha Gupta, Nalini Singh, Vivek Natarajan, Rainer Hofmann-Wellenhof, Greg S. Corrado, Lily H. Peng, Dale R. Webster, Dennis Ai, Susan J. Huang, Yun Liu, R. Carter Dunn, David Coz
Journal: Nature Medicine (2020)
Abstract 14949: Influence of Myocardial Bridge on Atherosclerotic Plaque Distribution and Characteristics Evaluated by Near Infrared Spectroscopy
Authors: Kan Saito, Hideki Kitahara, Takaaki Matsuoka, Naoto Mori, Kazuya Tateishi, Yoshihide Fujimoto, Yoshio Kobayashi
Journal: Circulation (2020)

Introduction: Myocardial bridge (MB) has been reported to be associated with developed atherosclerosis in the segment proximal to MB. Near-Infrared Spectroscopy (NIRS) identify the lipid content of atherosclerotic plaque as lipid core burden index (LCBI) but little is known about the influence of MB on characteristics of atherosclerosis assessed by NIRS imaging. Methods: 116 consecutive patients who underwent percutaneous coronary intervention using NIRS were included. MB was defined as an echo-lucent band surrounding left anterior descending artery (LAD) which could be detected by gray-scale intravascular ultrasound (IVUS). In MB patients, LAD was divided into 3 segments: proximal segment, MB segment, and distal segment. In non-MB patients, corresponding 3 segments were defined based on the average length of the above segments. Segmental maximum plaque burden and lipid content derived from NIRS-IVUS imaging in the section of maximum plaque burden were evaluated in each segment. Results: MB was identified in 42 patients. MB was not associated with maximum plaque burden in the proximal segment. Whereas MB was negatively correlated with both LCBI and max LCBI 4mm in the proximal segment. Multivariable analysis demonstrated both MB and maximum plaque burden in proximal segment to be independent predictors of LCBI or LCBI 4mm in proximal segment. Conclusions: MB was negatively correlated with both LCBI and max LCBI 4mm in the proximal segment and could be considered as an independent predictor of lipid content of atherosclerotic plaque assessed by NIRS-IVUS imaging.