tbuckley/cabot-search huggingface dataset:
Abstract 16796: Machine Learning-Based Hepatic Fat Assessment in Low-Dose Coronary Artery Calcium Scans is Correlated With Human Reader Assessment
Authors: Gourav Modanwal, Jonathan R Walker, Sadeer Al-Kindi, Sanjay Rajagopalan, Anant Madabhushi
Journal: Circulation (2020)

Introduction: Hepatic attenuation on computed tomography (CT) is a surrogate marker for cardiometabolic risk, including Type 2 diabetes and its progression. Coronary artery calcium (CAC) screening for assessment of cardiovascular risk often includes portions of the liver and provides an opportunity for concomitant assessment of liver fat. However, the use of lower radiation dose CT and the need for reliable regions of interest (ROI) tracing creates challenges for routine clinical utilization. We present machine learning-based hepatic fat assessment (a) segmentation of liver and spleen and (b) CT attenuation measurement on low dose CT scans performed for CAC screening. Methods: Our approach (Figure 1a) comprises two steps. First, a deep learning-based model is utilized to segment the liver and spleen. Second, CT attenuation is measured on imaged organ volume. The segmentation model (U-Net with an EfficientNetB3 backbone) is trained with 5-fold cross-validation on 35 patients enrolled in the CLARIFY registry (clinicaltrials.gov NCT04075162) and validated on an independent set of 21 patients. The ground truth for segmentation is generated using Slicer 3D. Further, mean liver and mean liver-to-spleen CT attenuation is automatically measured on these scans and compared with manual ROI based assessment. Results: The segmentation model achieved a dice coefficient of 0.91 on the validation (Figure 1b). The automated volumetric assessment of liver and liver-to-spleen attenuation estimation showed a strong correlation with manual ROI assessment (Pearson correlation coefficient R=0.89 and R=0.88, respectively; Figure 1c). Conclusions: The presented machine-learning-based methods enable accurate estimation of liver and liver-to-spleen attenuation ratio on low-dose CAC CT scans. The approach needs to be further validated on larger, multi-institutional datasets to analyze its generalizability for hepatic fat assessment.
Risk of Severe COVID-19 Among Workers and Their Household Members
Authors: Thomas M. Selden, Terceira A. Berdahl
Journal: JAMA Internal Medicine (2020)

supply-side mechanisms, including patient fear of exposure and effects of infection control measures on faciliy capacity and nonessential care. 3 The findings of this study do not reflect intensified COVID-19 testing or pent-up demand from deferred care.As incidence fell after our study period, outpatient utilization rebounded but remained below prepandemic levels through mid-June 2020, 4 even for older adults for whom pent-up demand should be greater.Our findings suggest that subsequent COVID-19 surges that started in late June should be associated with corresponding spending reductions.For commercial insurers, the prospect of net gains in 2020 raises questions about optimal use of unspent premium dollars 5 ; rebates mandated by medical loss ratio regulations are partial and delayed by design.For Medicare Advantage plans, our findings suggest potentially substantial cumulative savings.Medicare could remand these savings to preserve the Trust Fund as tax revenue falls.
Effects of empagliflozin on first and recurrent clinical events in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a secondary analysis of the EMPA-REG OUTCOME trial
Authors: Darren K McGuire, Bernard Zinman, Silvio E Inzucchi, Christoph Wanner, David Fitchett, Stefan D Anker, Stuart Pocock, Stefan Kaspers, Jyothis T George, Maximilian von Eynatten, Odd Erik Johansen, Waheed Jamal, Michaela Mattheus, Ulrich Elsasser, Stefan Hantel, Søren S Lund
Journal: The Lancet Diabetes & Endocrinology (2020)
ONSET OF PRIMARY BILIARY CHOLANGITIS ASSOCIATED TO GUILLAIN-BARRE SYNDROME DURING SARS-COV-2 INFECTION
Authors: A. Bartoli, T. Alicandro, M. Rivi, P. Sighinolfi, P. Andreone
Journal: Hepatology (2020)

Background: In December 2019, a novel coronavirus caused a series of acute atypical respiratory diseases in Wuhan, China COVID-19, now called SARS-COV-2, has spread worldwide leading the World Health Organization to declare a pandemic on 11 March 2020 The majority of patients experiences a self-limiting disease characterized by fever, cough, ageusia and anosmia;the minor part develops dyspnoea and severe respiratory illness The involvement of other organs has been described, particularly for nervous system Guillain-Barre syndrome (GBS) is an immune-mediated disease characterized by acute polyneuropathy, ascending paralysis and post-infectious polyneuritis, predominantly targeting motor fibres  Primary biliary cholangitis (PBC) is a progressive chronic cholestatic liver disease characterized by the immune-mediated destruction of intrahepatic bile ducts resulting in chronic liver injury, and presence of antimitochondrial antibody (AMA) in serum Methods: A 44-years old woman, already suffering from hypertension, obesity and hypothyroidism, hospitalized because of Sars-CoV-2 severe infection, with subsequent ICU admission and mechanical ventilation underwent different therapies at the same time: Tocilizumab, Hydroxychloroquine, Ceftriaxone, Azithromycin, Darunavir/Cobicistat, Anakinra, Remdesivir and Fluconazole During hospital stay the patient developed proximal hyposthenia at the four limbs without sensitive alterations;for this reason a neurological examination, EMG, lumbar puncture and blood tests were performed During ICU stay an important rise of gamma-glutamyl-transpeptidase (GGT;peak 1524 U/L 40XULN) and alkaline phosphatase (AP;peak 413 U/L, 3XULN) was also observed Total bilirubin and transaminase were always in range or slightly augmented Family history was positive for alcohol abuse liver cirrhosis (father) but negative for biliary tract or auto-immune hepatobiliary diseases;the patient was completely asymptomatic and no alterations were observed at the objective examination An abdominal ultrasound, liver fibroscan, blood exams and liver biopsy were performed Results: The hypothesis of a Guillain-Barre syndrome was advanced and the patient was treated with intravenous immunoglobulins with progressive regression of neuropathy Concerning the liver tests, anti-nuclear and antimitochondrial antibodies tested positive and liver biopsy was consistent with PBC in stage 2 The patient started treatment with ursodeoxycholic acid obtaining a substantial reduction of GGT and AP Conclusion: To the best of our knowledge, no other cases of PBC subsequent to Covid-19 infection have been described in literature up to now We cannot rule out the role of immunoactivation following viral infection, as well as the use of immunomodulating drugs in inducing the onset of biliary disease, but we think that AMA determination should be performed in subjects affected by Sars-Cov2
Abstract 13391: Cardiomyocyte Cell Cycling, Maturation, and Growth by Multinucleation in Postnatal Swine
Authors: Nivedhitha Velayutham, Christina M Alfieri, Emma J Agnew, Kyle W Riggs, Richard S Baker, Sithara Raju Ponny, Farhan Zafar, Katherine E Yutzey
Journal: Circulation (2020)

Background: Rodent cardiomyocytes (CM) undergo mitotic arrest and decline of mononucleated-diploid population post-birth, which are implicated in neonatal loss of heart regenerative potential. However, the dynamics of postnatal CM maturation are largely unknown in swine, despite a similar neonatal cardiac regenerative capacity as rodents. Here, we provide a comprehensive analysis of postnatal cardiac maturation in swine, including CM cell cycling, multinucleation and hypertrophic growth, as well as non-CM cardiac factors such as extracellular matrix (ECM), immune cells, capillaries, and neurons. Our study reveals discordance in postnatal pig heart maturational events compared to rodents. Methods and Results: Left-ventricular myocardium from White Yorkshire-Landrace pigs at postnatal day (P)0 to 6 months (6mo) was analyzed. Mature cardiac sarcomeric characteristics, such as fetal TNNI1 repression and CX43 co-localization to cell junctions, were not evident until P30 in pigs. In CMs, appreciable binucleation is observed by P7, with extensive multinucleation (4-16 nuclei per CM) beyond P15. Individual CM nuclei remain predominantly diploid at all ages. CM mononucleation at ~50% incidence is observed at P7-P15, and CM mitotic activity is measurable up to 2mo. CM cross-sectional area does not increase until 2mo-6mo in pigs, though longitudinal CM growth proportional to multinucleation occurs after P15. RNAseq analysis of neonatal pig left ventricles showed increased expression of ECM maturation, immune signaling, neuronal remodeling, and reactive oxygen species response genes, highlighting significance of the non-CM milieu in postnatal mammalian heart maturation. Conclusions: CM maturational events such as decline of mononucleation and cell cycle arrest occur over a 2-month postnatal period in pigs, despite reported loss of heart regenerative potential by P3. Moreover, CMs grow primarily by multinucleation and longitudinal hypertrophy in older pigs, distinct from mice and humans. These differences are important to consider for preclinical testing of cardiovascular therapies using swine, and may offer opportunities to study aspects of heart regeneration unavailable in other models.
Abstract 15809: 68 Gallium Fibroblast Activating Protein Inhibitor Positron Emission Tomography is Able to Diagnose Checkpoint Inhibitor-induced Myocarditis
Authors: Daniel Finke, Markus B Heckmann, Esther Herpel, Hugo A Katus, Uwe Haberkorn, Florian Leuschner, Lorenz H Lehmann
Journal: Circulation (2020)

Introduction: Checkpoint inhibitors (ICIs) have gained importance in recent years regarding the treatment of a variety of oncologic diseases. The possibilities of diagnosing cardiac adverse autoimmune effects of ICIs are still limited. We aimed to implement FAPI PET/CT imaging in detecting ICI-induced myocarditis. Methods: In a retrospective study, FAPI PET/CT scans of 26 patients who received ICIs from 01/2017 to 10/2019 were analyzed. We compared tracer enrichment in the heart of patients without any signs of a cardiac disease (n=23) to three patients with suspected ICI-induced myocarditis. To exclude any significant coronary heart disease, cardiac catherization was performed. Myocardial biopsies were examined, especially in regard to the infiltration of immune cells. Results: Three patients showed clinical manifestations of an ICI syndrome including myocarditis with elevated levels of hsTnT (175 pg/ml, 1771 pg/ml, 157 pg/ml). Further cardiological assessments revealed ECG abnormalities, lymphocyte infiltration of the myocardium in the biopsies or wall motion abnormalities in echocardiography. These patients’ FAPI PET/CTs showed a locally defined cardiac enrichment of the marker which was absent in patients receiving ICIs without any signs of immunological adverse effects and cardiac impairment (n=23) (Median SUV myocarditis patients: 1.79 (IQR: 1.65, 1.85), median SUV non-myocarditis patients: 1.15 (IQR: 0.955, 1.52)). Conclusions: Myocardial biopsy, the current gold standard of the diagnosis of ICI-induced myocarditis, is susceptible to sampling errors and results arrive within a few days. We provide first evidence that FAPI PET/CT is able to diagnose ICI-induced myocarditis and can demonstrate locally enhanced manifestation of ICI-induced myocarditis on time.
US election: Biden announces covid-19 task force, promising “compassion, empathy, and concern”
Authors: Joanne Silberner
Journal: BMJ (2020)

In his victory speech on Saturday night the US president elect, Joe Biden, said he felt called on to "marshal the forces of science and the forces of hope in the great battles of our time," and he specifically mentioned the climate emergency, healthcare, and covid-19."Our work begins with getting covid under control," he said, promising a plan "constructed out of compassion, empathy, and concern."On 9 November, with President Donald Trump continuing to challenge the election results, Biden announced the formation of a covid-19 task force.Trump, who is challenging the election results with court actions, has underplayed the impact of covid-19 since its start.During the campaign he made fun of Biden for wearing a mask and has for the most part left interventions up to individual states.By the end of last week the US had nearly 10 million total confirmed cases and nearly 238 000 deaths, shows Johns Hopkins University's tracker.
Abstract 15919: Latent Trajectory Patterns of Left Ventricle Ejection Fraction Among Heart Failure Patients With Chronic Inflammatory Disease: Longitudinal Analysis of Electronic Health Records
Authors: Adovich S Rivera, Arjun Sinha, Anna Pawlowski, Donald M Lloyd-jones, Matthew J Feinstein
Journal: Circulation (2020)

Background: Immune regulation and inflammation play a role in the pathogenesis and progression of acute and chronic heart failure (HF). While overt inflammatory cardiomyopathy is a well-described clinical entity marked by acute cardiac dysfunction and relatively high rates of recovery, trajectories in cardiac function among people with chronically heightened systemic inflammation are less clear. We hypothesized that there are differences in trajectories of left ventricular ejection fraction among HF patients with different chronic inflammatory diseases (CIDs): human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis. Methods: We analyzed serial echocardiographic data from people with CIDs and HF who had at least three echocardiograms (n=974) at a large academic medical center. We identified latent trajectories patterns of LVEF using latent class trajectory models, then described clinical differences across the different trajectories. We then used multinomial regression to test if CID type and other baseline variables were associated with different trajectories. Results: We observed three major LVEF trajectories which paralleled known HF subtypes: preserved/intermediate EF (HFp/iEF, 687, 70.5%), reduced EF (HFrEF, 255, 26.2%), and recovered EF (HFrecEF, 32, 3.3%). These trajectories corresponded closely to accepted clinical definitions. For example, 30/32 (94%) patients in the HFrecEF trajectory had LVEF &lt;40% at baseline that increased ≥15% on ≥1 follow-up. We observed significant differences in associations of CID type, age, sex, and diabetes with a specific LVEF trajectory (Figure) that remained even after regression. Conclusions: Among people with HF and CIDs, different trajectories of LVEF are associated with different CIDs and clinical characteristics. This may have implications for therapy and prognosis of HF in CIDs.
Abstract 13124: Physiologic Oxygen Tension Enhances Proliferation, Resistance to Hypoxic Stress, Telomerase Activity and Telomere Length of Mouse Cardiac Mesenchymal Cells (CMCs)
Authors: Robi Bolli, Dinesh Devadoss, Chandrashekhar Dasari, Asma Arshia, Amr M Alkasir, Yibing Nong, Yiru Guo, Marcin Wysoczynski, Qianhong Li
Journal: Circulation (2019)

CMCs, a newly-discovered and promising type of progenitor cells, are highly effective in improving LV function in rodents after myocardial infarction. Stem/progenitor cells are usually cultured at ...
Abstract 14611: Indices of Myocardial Work is an Independent Predictor of Exercise Capacity
Authors: Henry H Chen, Aditya Bhat, David Chandrakumar, Fernando Fernandez, Gary C Gan, Timothy C Tan
Journal: Circulation (2020)

Introduction: Exercise capacity has been shown to be an independent determinant of cardiovascular outcomes and prognosis. Conventional measures of left ventricular (LV) diastolic dysfunction, including E/e’ and left atrial (LA) metrics, have been shown to be independent predictors of exercise capacity however little is known about its relationship to myocardial energy utility and expenditure. Myocardial work (MW) is a novel non-invasive modality for assessment of myocardial efficiency and may serve to better define this relationship. Hypothesis: Greater wasted myocardial work is associated with reduced exercise capacity. Methods: Patients without prior cardiac disease referred to our echocardiography service for stress echocardiograms were prospectively recruited. These patients underwent comprehensive baseline transthoracic echocardiography (TTE) followed by exercise stress echocardiography. Only patients without structural heart disease on TTE and without ischaemia on stress testing were included. Myocardial work was assessed using EchoPac (v2.2, Chicago Illinois). Reduced exercise capacity was defined as METS achieved of ≤7. Results: 100 consecutive patients meeting inclusion criteria were analysed (45% male, age 56.0±15.7), of which 67% had diabetes and 44% had hypertension. The mean METS achieved was 8.5±3.7. Thirty-nine patients had a poor exercise capacity defined as METS achieved of ≤7. These patients were of older age, had greater indexed LV mass, higher E/e’, larger indexed left atrial volume, greater constructive work, greater wasted work, greater work index and lower work efficiency. On logistics regression, age (p&lt;0.001), and myocardial wasted work (p=0.02) were independent predictors of poor exercise capacity after adjusting for the other clinical and echocardiographic variables. Conclusions: Reduced exercise capacity is independently associated with greater wasted work. Larger studies will be required to validate our findings.
Abstract 16794: Characteristics, Trends, Outcomes, and Costs of Stimulant-Related Acute Heart Failure Hospitalizations in the United States
Authors: Suchith Shetty, Aaqib h Malik, Abbas Ali, Ying Chi Yang, Alexandros BRIASOULIS, Paulino Alvarez
Journal: Circulation (2020)

Introduction: Heart failure hospitalizations remains significant burden on the health care system. Simulants including cocaine and methamphetamine are amongst the most used illegal substances in the United States. The information regarding stimulant related heart failure hospitalizations is scarce. Hypothesis: We sought to evaluate the characteristics and trends of stimulants-related heart failure hospitalizations in the United States and their associated outcomes and resource utilization. Methods: Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of heart failure hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts. Results: We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant related ACHF hospitalization is on the rise (1.1% to 1.9%) as the mean age of these stimulant related ACHF hospitalizations (from 49.9 to 52 years). Stimulant related ACHF hospitalization mostly affects African Americans and the proportion of ACHF is highest amongst the age group of 30-39 years. It is associated with increased incidence of in-hospital complications but lower mortality and length of stay. These patients have more than 7-fold higher discharge against medical advice. Conclusions: Stimulant related heart failure hospitalizations have been increasing. Evaluation of in-hospital outcomes is limited by a high proportion of patients leaving against medical advice.
The Paradox of STEMI Regionalization: Widened Disparities Despite Some Benefits
Authors: Robert O. Roswell, Rachel-Maria Brown, Safiya Richardson
Journal: JAMA Network Open (2020)

Disparities in health care and health outcomes are largely the consequences of historical and contemporary structural inequities, which act in complex, mutually reinforcing ways upon communities and individuals.The implementation of clinical protocols holds potential to standardize medical care and treatment for all.However, the true impact of such policy changes can be known only through ongoing assessment.In this issue of JAMA Network Open, Hsia et al 1 sought to determine whether efforts to improve access, treatment, and outcomes for patients with ST-elevation myocardial infarction (STEMI) by means of cardiac care regionalization were associated with widened or narrowed disparities between minority and nonminority communities at the zip code level across the state of California.Access was defined as admission to a hospital with percutaneous coronary intervention (PCI) capability; treatment was defined as receiving coronary angiography or PCI (as clinically indicated) the day of admission or at any time during hospitalization; and outcomes were defined as all-cause mortality at 30, 90, or 365 days.Minority communities were defined as those zip codes wherein the share of
Abstract 16185: Biomarker-based Heart Failure Risk Stratification in Patients With Atherosclerotic Cardiovascular Disease: Observations From HPS-3/TIMI-55-REVEAL
Authors: David Berg, Stephen D Wiviott, Eugene Braunwald, David A Morrow
Journal: Circulation (2020)

Background: Circulating biomarkers reflecting pathways implicated in heart failure (HF) may improve HF risk assessment in patients with stable atherosclerotic cardiovascular disease (ASCVD). Hypothesis: We aimed to evaluate the performance of circulating biomarkers of hemodynamic stress, myocardial injury, and inflammation for the prediction of hospitalization for HF (HHF) in a large well-characterized cohort with stable ASCVD followed for a median of 4.1 years. Methods: HPS3/TIMI 55-REVEAL was a randomized, double-blind, placebo-controlled trial of the CETP inhibitor anacetrapib in patients with stable ASCVD. We performed a nested prospective biomarker study, measuring high-sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) (all Roche Diagnostics) at randomization (n=29,673). Hazard ratios were adjusted for covariates of a priori clinical relevance to HHF risk: age, prior HF, hypertension, diabetes mellitus, eGFR &lt;60, body-mass index, and polyvascular disease. Discrimination was assessed using Harrell’s c-index. Results: A significant graded risk of HHF was observed with increasing deciles of hsTnT, NT-proBNP, and GDF-15 (p-trend &lt;0.001 for each) ( Figure ). These associations remained significant after multivariable adjustment for clinical risk factors (p&lt;0.001 for each). When added to a multivariable Cox regression model of clinical risk indicators (c-index 0.74), these 3 biomarkers significantly improved the prognostic performance of the model (c-index 0.85; p&lt;0.001). There was no treatment interaction with anacetrapib. Conclusions: In patients with stable ASCVD, biomarkers of myocardial injury, hemodynamic stress, and inflammation provide incremental information for prediction of HHF. Future studies should address whether these patients are more likely to benefit from emerging HF preventive therapies.
Submissions and Downloads of Preprints in the First Year of <i>medRxiv</i>
Authors: Harlan M. Krumholz, Theodora Bloom, Richard Sever, Claire Rawlinson, John R. Inglis, Joseph S. Ross
Journal: JAMA (2020)

This study describes submissions, postings, abstract views, downloads, comments, and withdrawals on the medRxiv preprint server from June 2019 to June 2020 and compares submissions and postings before and after COVID-19.