tbuckley/cabot-search huggingface dataset:
Abstract 13327: Worse Cerebral Blood Flow in Single Right verses Left Ventricle After Fontan Completion
Authors: Nancy A PIKE, Bhaswati Roy, Nancy J Halnon, Alan B Lewis, Mary A Woo, Danny JJ Wang, Rajesh Kumar
Journal: Circulation (2020)

Introduction: Single ventricle heart disease (SVHD) adolescents with a single right ventricle (RV) have worse cognition and mood function compared to single left ventricle (LV) which may result from variability in ventricular function or structure related sequela after Fontan completion. However, it is unclear whether RV SVHD has worse cerebral blood flow (CBF) in cognitive and mood regulatory areas over LV SVHD compared to healthy controls. Methods: Cross-sectional, comparative design, 14 adolescents with RV SVHD (age 16.1±1.5 years; 7 male), 6 LV SVHD (age, 16.3±1.0 years; 4 male), and 25 healthy controls (age, 15.9±1.4 years; 13 male) were studied. SVHD participants were recruited who have undergone surgical palliation with Fontan completion from local pediatric cardiology clinics. Self-reported healthy controls were recruited from the community. Brain MRI studies were performed using a 3.0-Tesla MRI scanner and 3D pseudo-continuous arterial spin labelling data were collected. We calculated whole-brain CBF maps, normalized to a common space, and assessed brain changes between RV and LV SVHD and controls [ANCOVA; covariates, age and sex; p&lt;0.005]. Region of interest analyses were performed in cognitive and mood control brain sites. Results: Regional brain CBF was reduced in single RV over LV SVHD. Multiple brain sites showed more widespread reduced CBF values in RV over LV SVHD compared to controls (Figure 1, p&lt;0.005), including the prefrontal cortices, caudate, insula (a, f), anterior (b, g), mid (c, h), and posterior (d, i) cingulate, and hippocampus (e, j). Conclusion: Single RV adolescents show more widespread reduced CBF than single LV in cognitive and mood regulatory sites, which may result from variable function or structure related sequela between ventricle types. The findings indicate that the therapeutic approach should recognize the differences in CBF based on ventricle type and investigate interventions to optimize CBF in single RV SVHD.
Abstract 12986: Geriatric Nutritional Risk Index Provides the Additional Long-term Prognostic Information to Gwtg Heart Failure Risk Score in Acute Decompensated Heart Failure Patients With and Without Reduced LVEF
Authors: Takahisa Yamada, Tetsuya Watanabe, Takashi Morita, Yoshio Furukawa, Shunsuke Tamaki, Masato Kawasaki, Atsushi Kikuchi, Tsutomu Kawai, Masahiro Seo, Jun Nakamura, Kiyomi Kayama, Masatsugu Kawahira, Kumpei Ueda, Takanari Kimura, Daisuke Sakamoto, Masatake Fukunami
Journal: Circulation (2020)

Backgrounds: The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and has been recently reported to be associated with post-discharge long-term outcomes. Malnutrition is associated with poor outcome in ADHF patients. However, there is no information available on the long-term prognostic significance of the combination of GWTG-HF risk score and malnutrition in patients admitted for ADHF, relating to reduced left ventricular ejection fraction (LVEF). Methods: We studied 303 ADHF patients discharged with survival (HFrEF(LVEF&lt;40%); n=180, HFpEF(LVEF≥40%;n=123). At the admission, we evaluated GWTG-HF score and nutritional status. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 · serum albumin (g/dl) + 41.7 · BMI/22, and malnutrition was defined as GNRI&lt;92. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. Results: During a follow-up period of 4.2±3.3 yrs, 86 patients had CVR. At multivariate Cox analysis, GWTG-HF risk score and GNRI were significantly and independently associated with CVR, in both HFrEF and HFpEF groups. The patients with both greater GWTG-HF score (&gt;median value=35) and malnutrition had a significantly increased risk of CVR than those with either and none of them ([HFrEF] 60% vs 32% vs 16%, p&lt;0.0001, [HFpEF] 45% vs 18% vs 12%, p&lt;0.0001, respectively) Conclusion: Malnutrition assessed by GNRI would provide the additional long-term prognostic information to GWTG-HF risk score in patients admitted for ADHF, irrespective of the presence of reduced LV function.
Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial
Authors: Shukui Qin, Qiu Li, Shanzhi Gu, Xiaoming Chen, Lizhu Lin, Zishu Wang, Aibing Xu, Xi Chen, Cuncai Zhou, Zhenggang Ren, Lin Yang, Li Xu, Yuxian Bai, Lei Chen, Jun Li, Hongming Pan, Bangwei Cao, Weijia Fang, Wei Wu, Ge Wang, Ying Cheng, Zhuang Yu, Xu Zhu, Da Jiang, Yinying Lu, Huaming Wang, Jianming Xu, Li Bai, Yunpeng Liu, Hailan Lin, Changping Wu, Yang Zhang, Ping Yan, Chunlei Jin, Jianjun Zou
Journal: The Lancet. Gastroenterology & hepatology (2021)
Abstract 16649: Natural History of Ascending Aortic Aneurysms With Bicuspid and Tricuspid Aortic Valves
Authors: Serena Tharakan, Christopher Bellaire, Jordan Roy, Miguel Bravo, John Puskas, Gabriele Di Luozzo
Journal: Circulation (2020)

Introduction: Patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) with ascending aortic aneurysms (AAA) are at risk for aortic complications. Meticulous follow-up and assessment of risk factors can mitigate the adverse aortic events. Hypothesis: We hypothesized that BAV and TAV with AAA can be managed conservatively with acceptable survival, low aortic complication rate, and timely surgery. Methods: From 2016 to 2018, 188 patients were seen for an isolated AAA. 147 patients had two or more CT scans (631-patient-years) which allowed measurement of aortic growth. We used a 1:1 greedy matching algorithm in R to identify similar cohorts of BAV and TAV patients matched by age, sex, hypertension, family history of aortic disease, coronary artery disease, and hyperlipidemia. Univariate and multivariate analysis of the unmatched cohorts were performed. Echocardiogram data was evaluated for each patient. Results: Initial mean AAA diameter was 4.3±0.58 cm (Table 1). The mean time between scans was 4.2 ± 3.3 years. 20 patients had an ascending aortic aneurysm ≥ 5cm with mean diameter 5.2 ± 0.23 cm (range 5.0-6.0 cm). Five patients had an aortic event (1 BAV and 4 TAV). Three of these aortic events lead to patient deaths (1 BAV and 2 TAV), in addition to one death (TAV) unrelated to aortic pathology. From time of enrollment, survival at 10 years was 90 ± 32%. Our model suggests that given the absence of known high risk factors, BAV patients do not have an accelerated ascending or root growth rate in comparison to their TAV counterparts. BAV patients do have higher rates of aortic stenosis (p &lt;.05), a factor that influenced the need for aortic repair. Conclusion: In conclusion, regardless of aortic valve type, the associated AAA has a similar natural history and low adverse event rate. In the absence of risk factors, conservative management of AAA can be accomplished with minimal risk to the patient.
Abstract P171: A Longitudinal Study Of Maternal Thyroid Hormone Trajectories And Neonatal Anthropometric Measures
Authors: Shristi Rawal, Lauren Berube, Stefanie Hinkle, Jing Wu, Cuilin Zhang
Journal: Circulation (2021)

Introduction: Maternal thyroid hormones (TH) are essential for fetal growth and development. While prior studies have examined associations of TH with birthweight (BW), data on other neonatal anthropometric measures are scarce. Here we aimed to examine relations between TH and its trajectory across pregnancy with neonatal anthropometrics in a multi-racial pregnancy cohort. Hypothesis: We hypothesized that distinct TH trajectories across gestation would explain differences in neonatal anthropometrics including BW, length and sum of skinfolds (SSF). Methods: We used longitudinal data from 321 women who were included in a gestational diabetes (GDM) case-control study nested within the NICHD Fetal Growth Studies-Singletons Cohort (n=2802). Plasma free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were measured, and fT3/fT4 ratio was derived, using blood samples collected at gestational weeks (GW) 10-14, 15-26, 23-31 and 33-39. TH trajectories were identified using a latent class trajectory approach. BW was abstracted from medical records. Neonatal length and SSF were measured. To examine associations between TH levels and neonatal outcomes, we used weighted linear regression models, adjusted for maternal age, race/ethnicity, GW at blood collection, pre-pregnancy BMI, education, parity, infant sex, GDM diagnosis (33-39 GW only) and number of days post-delivery (length and SSF only). Results: Overall, neonates of women in the highest fT3 tertile at 33-39 GW had marginally higher BW (β: 205.5 g, 95% CI -23.4, 434.4) and BW z-score (β: 0.4, 95% CI 0.0, 0.8) than neonates of women in the lowest tertile. Significant interactions were observed by infant sex for associations of fT4 and BW, BW z-score and neonatal length (all p for interactions &lt;0.05). Specifically, female neonates of women in the highest fT4 tertile had lower BW, BW z-score and length than those in the lowest tertile at 15-26 (β BW -416.3 g, 95% CI -753.7, -79.0; β BW zscore -0.5, 95% CI -0.9, -0.1; β length -1.5 cm, 95% CI -2.8, -0.1, respectively) and 23-31 GW (β BW -357.0 g, 95% CI -635.6, -78.4; β BW zscore -0.7, 95% CI -1.3, -0.1; β length -1.8 cm, 95% CI -3.3, -0.2, respectively). Across gestation, a low fT3 trajectory (class size 5.5%) was associated with lower neonatal SSF (β: -3.2 mm, 95% CI -6.0, -0.5) than an intermediate/referent trajectory (60.1%). A high fT3/fT4 ratio trajectory (16.2%) was associated with higher BW (β: 300.5 g, 95% CI 41.7, 559.4), BW z-score (β: 0.6, 95% CI 0.3, 0.8), and neonatal SSF (β: 3.3 mm, 95% CI 0.7, 5.9) than an intermediate/referent trajectory (44.3%). Conclusions: Our study suggests that both overall TH trajectory across gestation and TH levels at specific timepoints in pregnancy may be related to neonatal anthropometrics, with associations varying by infant sex. These novel data support the significance of monitoring thyroid hormones longitudinally in pregnancy.
Abstract P224: Does Cognitive Function And C-reactive Protein Produce A Combined Effect On All-cause Mortality Risk? An Analysis Of Older Adults In The 1999-2002 NHANES
Authors: Madeline B Zipperer, James R Churilla, Michael R Richardson
Journal: Circulation (2021)

Introduction: There is limited evidence examining the combined effects of cognitive function and C-reactive protein (CRP) on mortality risk using a large nationally representative sample of U.S. adults. Hypothesis: We assessed the hypothesis that cognitive function and CRP produce a combined effect in predicting all-cause mortality risk. Objective: Examine the combined effects of cognitive function and CRP in predicting all-cause mortality in a large nationally representative sample of U.S. adults. Methods: The study sample (n=2,111) included older adults (≥ 60 years of age) who participated in the 1999-2002 National Health and Nutrition Examination Survey. A four-level variable was created based on CRP concentration and cognitive function (high cognitive function and low to average CRP; high cognitive function and high CRP; low cognitive function and low to average CRP; low cognitive function and high CRP). Results: Compared to a referent group with low to average CRP and high cognitive function, analysis revealed a statistically significant increase in risk of all-cause mortality in adults with high CRP and low cognitive function (Hazards Ratio [HR] 1.97; 95% Confidence Interval [CI], 1.52-2.55, p&lt;0.0001) and in adults with low to average CRP and low cognitive function (HR 1.76; 95% CI, 1.44-2.15, p&lt;0.0001). Similar relationships were not revealed in adults with high cognitive function, regardless of CRP concentration. Conclusions: In a large nationally representative sample of older U.S. adults, low cognitive function was associated with increased all-cause mortality risk independent of CRP concentration.
Abstract 13048: Do Anti-HLA Antibodies Pre-heart Transplant Truly Impact Post-transplant Outcomes?
Authors: Timothy Ho, Jignesh K Patel, Keith Nishihara, Michelle M Kittleson, David H Chang, Evan P Kransdorf, Lawrence S Czer, Xiaohai Zhang, Jon A Kobashigawa
Journal: Circulation (2020)

Introduction: Antibody-mediated rejection (AMR) continues to be a major barrier to favorable long-term outcomes and long-term survival. Sensitized pre-heart transplant (HTx) patients, those with anti-HLA antibodies, have previously demonstrated increased post-HTx rejection risk as well as increased mortality. In the current era, there is contention as to whether pre-HTx antibodies result in poor outcome after HTx. Methods: Between 2010 and 2015, 580 HTx patients were assessed for pre-HTx panel reactive antibodies (PRA). PRA levels were measured by the Luminex Single Antigen assay. Patients were divided into 5 groups of PRA levels including 0%, n=423 (Control); PRA 1-10%, n= 21; PRA 11-25%, n=24; PRA 26-50%, n=49; PRA 51-75%, n=32; and PRA &gt;75%, n=35. Endpoints included 5-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE), freedom from donor specific antibody (DSA) development, and freedom from LV dysfunction (LV ejection fraction ≤40%) and 1-year freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), AMR). Results: All groups with PRA &gt;10% had significantly lower 1-year freedom from AMR and 5-year freedom from DSA compared to the control, worsening with higher the PRA group. There was no significant difference in 5-year survival, 5-year freedom from CAV, NF-MACE, or LV dysfunction and 1-year freedom from ATR or ACR. Conclusions: Patients with increased anti-HLA antibody levels pre-HTx do not appear to have lower 5-year survival compared to patients without anti-HLA antibody levels. However, the development of 1-year AMR and 5-year DSA increased progressively with higher the PRA group. Further studies and longer follow-up are needed to better understand the effects of elevated pre-HTx PRA, immune therapies (desensitization) and post-HTx outcomes.
Abstract 15733: CD34 <sup>+</sup> Cell Therapy is Associated With Improved Right Ventricular Function in Heart Failure With Preserved Ejection Fraction
Authors: Sabina Frljak, Gregor Poglajen, Gregor Zemljic, Andraz Cerar, Francois Haddad, Bojan VRTOVEC
Journal: Circulation (2020)

Introduction: Right ventricular (RV) dysfunction is an important predictor of adverse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Hypothesis: We sought to investigate the effects of transendocardial CD34 + cell therapy on RV function in HFpEF patients. Methods: We enrolled 30 patients with HFpEF who underwent transendocardial CD34 + cell transplantation. At baseline, all patients received granulocyte-colony stimulating factor; cells were collected by apheresis and immunomagnetic selection and injected transendocardialy in the left ventricle targeting the areas of local diastolic dysfunction. Patients were followed for 6 months and changes in RV function were assessed by tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (St), and fractional area change (FAC). Impaired RV function was defined as TAPSE&lt;1.8 cm. Results: At baseline, RV function was impaired in 11 (37%, Group A), and preserved in 19 (63%, Group B) of patients. The groups did not differ in age (64±6 years in Group A vs. 61±11 years in Group B, P=0.37), gender (male: 82% vs. 74%, P=0.61), or left ventricular E/e' (17.7±2.3 vs. 17.3±3.4, P=0.74). Patients in Group A had lower LVEF (55.6±5.1% vs. 61.3±6.5% in Group B, P=0.02), and higher NTproBNP levels (1750±1139 pg/ml vs. 1038±658 pg/ml, P=0.05). At 6 months after cell transplantation we found an overall improvement in all parameters of RV function (TAPSE: +0.21±0.37 cm, P=0.01; St: +0.7±2.1 cm/s, P=0.03; FAC: +8.5±1.9%, P=0.02). However, RV function improvement was significant in Group A (TAPSE: +0.43±0.37 cm, P=0.004; St: +1.4±2.3 cm/s; P=0.01; FAC: +9.8±2.0%, P=0.01), but not in Group B (TAPSE: +0.04±0.27 cm, P=0.65; St: +0.4±1.3 cm/s, P=0.32; FAC: +7.1±3.7%, P=0.08). In both groups we found comparable changes in E/e' (-5.1±3.0 in Group A vs. -5.9±3.2 in Group B, P=0.53), LVEF (1.2±5.7% vs. 1.9±6.5%, P=0.45) and NTproBNP (-462±410 pg/ml vs. -390±398 pg/ml, P=0.64) at 6 months after cell transplantation. Conclusions: Transendocardial CD34 + cell therapy appears to be associated with improvement of right ventricular dysfunction in patients with HFpEF.
Abstract 16113: CT Pulmonary Angiography Yield in Patients With an Active Malignancy: Lack of Non-invasive Screening
Authors: Olivia Lamping, Pradeep Yarra, Austin Stratton, John Pidakala, Vikas Bhalla
Journal: Circulation (2020)

Patients with an active malignancy are at increased risk of venous thromboembolism due to the production of pro-coagulant factors causing a hypercoagulable state. Providers must keep their index of suspicion high for a pulmonary embolism in these patients because of the high prevalence and often vague symptoms. This is a retrospective study of 2226 patients who underwent CT pulmonary angiography (CTPA) in the emergency department. We compared the diagnosis of PE in patients with and without an active malignancy within the past 6 months. Of those patients without an active cancer, 133/1788 (7.4%) patients were diagnosed with a PE. This is not significantly different from the cohort with cancer where 37/437 (8.5%) patients were diagnosed with a PE (p=0.468). During diagnosis, patients with a history of cancer were less likely to have a chest x-ray, d-dimer or troponin performed prior to the CTPA scan (Table 1). These tests are less invasive and much cheaper than the CTPA and can help identify other pathologies that a patient may be experiencing. Not surprisingly, patients with a malignancy have a higher Wells’ score, revised Geneva score and PERC rule (Table 2), leading providers further down diagnostic algorithms towards CTPA. While many of these high-risk patients should immediately undergo CTPA, patients at low or moderate risk of PE should first be evaluated with less invasive testing such as a chest x-ray or d-dimer. In conclusion, in order to decrease the number of patients unnecessarily undergoing CTPA, patients with an active malignancy should be risk stratified in a similar manner as those patients without a malignancy, including the use of non-invasive testing where appropriate.
Abstract 16983: Validation of 3D Volume Measurement Technology to Assess Body Fat Content Using Biplane Imaging From Mobile Devices
Authors: Jose R Medina-inojosa, Audry Chacin Suarez, Farzane Saeidifard, Smitha Narayana Gowda, Justin Robinson, Kalkidan Aseged, Johnson Lynne, Jennifer Zundel, Amanda Bonikowske, Francisco Lopez-jimenez
Journal: Circulation (2020)

Introduction: Body fat (BF) content better predicts adiposity-related cardiovascular risk than the body mass index (BMI). Accurate and accepted methods to assess BF are complex, expensive, and accessible only in clinical settings. Multi-sensor 3D body volume (3D-BV) measurement technology has been shown to accurately estimate BF. We assessed the hypothesis that 3D models generated from biplane imaging (i.e., front and side facing photographs) using mobile devices (App), could be used to predict body volume measurements and derive BF. Methods: We prospectively enrolled 196 subjects, who underwent 3D-BV (gold standard for body volume) within 24 hours, dual-energy X-ray Absorptiometry (iDEXA) (gold standard for BF) and photographs taken with an Ipad® App at a predefined distance and pose. These photos were post-processed with a computer-assisted algorithm to estimate body length, girth, and volume. These were used to calculate body density (BD) using the bicompartmental principles of body composition (BD=Body Mass/Volume) and derive BF% using the Siri equation [(4.95/BD-4.50) X 100]. Correlation indexes and residual plots were created to compare 3D-BV and iDEXA with the App. Mean differences were compared using a paired t-test. Results: Mean ±SD age was 31.9±9.15 years, 53% were women, weight 72.8±14.1 kg, BMI was 25.5±4.5 kg/m 2 .The App volume correlated with 3D-BV (R 2 =0.95,95%CI 0.90,0.95, p&lt;.0001, Figure 1-A ) ; average difference between App volume vs 3D-BV volume was -1.2 Liters, 95%CI,0.03, 2.42, p=0.06, ( Figure 1-B ). App BF% correlated with iDEXA BF% (R 2 =0.92, 95%CI 0.90,0.94, p&lt;.0001, Figure 1-C ) ; while average difference between App BF% vs iDEXA BF% was -0.13 %, 95%CI -0.6,0.4, p=0.6, ( Figure 1-D ). Conclusion: BF can be estimated using volume measurements obtained by biplane imaging from mobile devices and could serve as a home-based, portable, scalable, cost-effective, and convenient measure to assess BF and track changes in body composition over time.
Neuromelanin-Sensitive Magnetic Resonance Imaging as a Proxy Marker for Catecholamine Function in Psychiatry
Authors: Guillermo Horga, Kenneth Wengler, Clifford M. Cassidy
Journal: JAMA Psychiatry (2021)

This article describes the use of neuromelanin-sensitive magnetic resonance imaging for the monitoring of the catecholamine neuromodulators dopamine and norepinephrine in the brains of individuals with mental illness.
Abstract 14780: Developing a Model for Abdominal Aortic Aneurysm in Swine
Authors: Nicholas De Leo, Atlee Melillo, Jeremy Badach, Henry Miller, Andrew Lin, John Williamson, Ping Zhang, John Gaughan, Spencer Brown, Jeffrey P Carpenter
Journal: Circulation (2020)

Introduction: Abdominal aortic aneurysms (AAA) are responsible for over 150,000 deaths worldwide annually. Attempts at producing a reliable large-animal model of AAA have proven challenging. We sought to create a reproducible swine model of AAA using enzymatic degradation of the aortic wall. Methods: A total of 9 male Yorkshire swine received periadventitial injections of type 1 collagenase (23.5 mg) and porcine pancreatic elastase (500 mg) into a 4 cm segment of infrarenal aorta. Aortic diameter growth was monitored at POD 7 and 14 using ultrasound. The animals were euthanized on POD 21, and the suprarenal (control) and infrarenal (treated) aorta was harvested for analysis, after gross measurement of aortic diameter under physiologic blood pressure. Sections of control and treated aorta were used to obtain tensile strength using a tensiometer. Additional segments of the aorta were collected for histopathological analysis (H&amp;E, elastin, alpha smooth muscle actin). PCR of matrix metalloproteinases (MMP9) was conducted. Groups were compared with paired t-tests, or ANOVA for repeated measures, where appropriate. Results: Average percent growth of aortic diameter at POD 21 for treated segments was 27% +/- 16.5% versus 4.5% +/- 4% for control tissue. The average difference in aortic growth by subject, was 26.7% [14.6%-38.8%]; (p&lt;0.001). Aortic medial thickness was decreased in treated tissue; 235 um +/- 208 um versus 645 um +/- 191 um (p&lt;0.0001). Quantity of both medial elastin fibers, and vascular smooth muscles cells was decreased in treated tissue; 1.8% +/- 3.16%, compared to 9.9% +/- 6.85% (p&lt;0.0001), and 24% +/- 6.8% versus 37.4% +/- 6.9%, respectively. Tensile strength was also decreased in treated tissue; 16.7 MPa +/- 7 MPa versus 29.5 MPa +/- 10.7 MPa (p=0.0002). A 12-fold increase in expression of MMP9 mRNA was also demonstrated in aneurysmal tissue (p=0.002) Conclusion: A reproducible, large-animal model of AAA, with anatomical, histopathological, and biomechanical properties that are clinically translatable, can be achieved with extraluminal enzymatic degradation.