tbuckley/cabot-search huggingface dataset:
Abstract 15832: Endothelial Shear Stress Assessment in Coronary Arteries: Comparison Between 3d Reconstructions Based on Invasive and Noninvasive Imaging
Authors: Parastou Eslami, Eline Hartman, Julia Karady, Vikas Thondapu, Mazen Albaghdadi, Zexi Jin, Nicholas Cefalo, Michael T Lu, Peter H STONE, Jolanda J Wentzel, Udo Hoffmann
Journal: Circulation (2020)

Introduction: Endothelial shear stress (ESS) identifies coronary plaques at high risk for progression and rupture leading to a future acute coronary syndrome. We developed an optimized methodology to derive ESS using computational fluid dynamics (CFD) in 3D models of coronaries from noninvasive computed tomography angiography (CTA). We hypothesized that ESS based on CTA has a high correlation with ESS based on the gold standard fusion of intravascular ultrasound (IVUS)/optimical coherence tomography (OCT) and CTA. Methods: In 14 patients, paired patient-specific CFD models based on invasive and CTA imaging of the left anterior descending (LAD) coronaries were created. 10 were used to optimize, and 4 patients to test the methodology. Time averaged ESS (TAESS) was calculated for both coronary models applying physiological data at the time of imaging. Each 3D reconstructed coronary was divided into 2 mm segments and further subdivided into 8 arcs (45 o ). TAESS was averaged per segment and arc. The paired segment and arc averaged TAESS were categorized into patient-specific tertiles (low, medium and high). Results: In the 10 LADs, used for optimization of the methodology, we found high correlations between invasively- and noninvasively-derived TAESS averaged over segments (n=263, r=0.86) and arcs (n=2104,r= 0.85,p&lt;0.001). The correlation was also strong in the 4 test patients with r=0.95 (n=117 segments p=0.001) and r=0.93 (n=936 arcs p=0.001). There was a high concordance of 78% of the three TAESS categories comparing both imaging at the segments and 76% at the arcs in the first 10 patients. This concordance was lower in the 4 test patients (64% and 64% in segment and arc averaged TAESS). Conclusions: We showed that we can accurately assess the TAESS distribution noninvasively from CTA and demonstrated a high correlation with TAESS using IVUS/OCT 3D models. Future studies should prove the prognostic value of CTA-based TAESS for plaque progression and clinical events.
Abstract 17244: Obesity and Serial NT-proBNP Levels in Heart Failure: Insights From the GUIDE-IT Trial
Authors: Vibhu Parcha, Nirav Patel, Rajat Kalra, Sarabjeet Suri, Garima Arora, James L Januzzi, Michael Felker, Thomas J Wang, Pankaj Arora
Journal: Circulation (2020)

Background: The prognostic implications of achieving NT-proBNP concentrations ≤1000 pg/mL among obese patients having heart failure with reduced ejection fraction (HFrEF) are not completely known. We evaluated the prognostic implications of body mass index (BMI), and achievement of target NT-proBNP levels of ≤1000 pg/mL in obese HF patients from the GUIDE-IT trial. Methods: Survival analysis using multivariable-adjusted Cox proportional hazard models was used to evaluate the risk of adverse cardiovascular (CV) events (HF hospitalization or CV mortality) based on the achievement of target NT-proBNP (≤1000 pg/mL), stratified by obesity status (obese [≥30 kg/m 2 ] and non-obese [&lt;30kg/m 2 ]). Achievement of NT-proBNP ≤1000 pg/mL was treated as a time-varying measure. We also assessed the risk of the study outcome stratified by baseline obesity status and across BMI quartiles, taking NT-proBNP as a time-varying covariate. Results: Compared to non-obese patients, obese patients were mostly younger, Black, females with 59% (95% CI: 39.5-83.5%) lower adjusted NT-proBNP levels. The risk of adverse CV outcomes was 55% lower in obese (HR: 0.45 [95% CI: 0.28-0.74]) and 70% lower in non-obese (HR: 0.30 [95% CI: 0.17-0.51]) HF patients who achieved the target NT-proBNP, compared to their counterparts who did not achieve the target NT-proBNP ( Figure 1 ). The was no interaction between obesity and achievement of target NT-proBNP on the study outcome (p&gt;0.10). Obese patients at baseline had a greater risk of developing adverse CV events (HR: 1.52 [95% CI: 1.13-2.03]) compared to non-obese patients. Patients in the third (HR: 1.49 [95% CI: 1.03-2.17]) and fourth BMI quartile (HR: 2.04 [95% CI: 1.36-3.01]) had a higher risk of adverse CV events, compared to those in the first quartile. Conclusion: Achievement of NT-proBNP ≤1000 pg/mL has favorable prognostic implications irrespective of obesity status. Obese HF patients had a greater risk of adverse CV events than non-obese patients.
Abstract 14691: Heart Rate Trajectories and Clinical Correlates in Patients Recovering From Acute Myocardial Infarction: A Longitudinal Analysis of Apple Watch Heart Rate Recordings
Authors: Daniel Weng, Jie Ding, Apurva Sharma, Lisa R Yanek, Helen Xun, Ngozi Osuji, Pauline Huynh, Oluseye Ogunmoroti, Erin Spaulding, Kellen Knowles, Yumin Gao, William Yang, Matthias Lee, Ryan Demo, Francoise A Marvel, Seth S Martin
Journal: Circulation (2020)

Introduction: Vital signs can provide critical details regarding a patient’s health status for clinical decision making, and confirm feedback on treatments. Using mobile health technology, vital signs such as heart rate can be collected in larger quantities without requiring frequent clinic visits. In this study, we characterized HR trends of patients recovering from acute myocardial infarction (AMI) in the subacute period, with the goals of identifying higher risk patient subgroups. Methods: Between Nov. 2017 and Apr. 2019, type 1 AMI patients were enrolled in the Myocardial infarction, Combined device, Recovery Enhancement (MiCORE) study (NCT03760796). Patient information was collected via Research Electronic Data Capture (REDCap), and HRs were recorded using the Apple Watch and Corrie smartphone app between the time of admission to 30 days post-discharge. Associations with clinical covariates were assessed with multivariable linear mixed regression models (Figure 1). Results: We recruited 91 patients (mean age: 57 +/- 10.9, 74% male) who provided 4,447 HR recordings, with an overall mean daily HR of 74.5 bpm. Patients had a 0.168 bpm decrease in mean daily HR for each consecutive day post-discharge; the exception were patients who had a prior CABG before admission, hypertension, or type 2 diabetes, who had an associated elevation in HR across each day (Figure 1). Six of 11 AMI patients who were readmitted within 30 days exhibited at least 1 HR recording greater than 90 bpm within 3 days of readmission. Conclusions: While most AMI patients had a decrease in HR over the subacute period, we identified high-risk subgroups with increasing HRs (patients with prior CABG, HTN, and T2DM), and elevated HRs in patients three days prior to readmissions. This study highlights the potential of using longitudinal, biometric data sets in discerning higher risk patient populations post-AMI that require more targeted therapy.
Abstract 16345: Increase in Serum Chloride Level During Hospitalization Leads to Improved Clinical Outcomes in Patients With Heart Failure
Authors: Shota Shirotani, Kentaro Jujo, Makoto Kishihara, Shounosuke Watanabe, Nana Endo, Takuma Takada, Takuro Abe, Yuichiro Minami, Nobuhisa Hagiwara
Journal: Circulation (2020)

Introduction: Serum chloride levels both at admission and at discharge in patients with heart failure (HF) are independently associated with the incidence of adverse clinical outcomes. However, there has been few reports focusing on the prognostic impact of the change in serum chloride level during the hospitalization on the long-term prognosis after discharge. Hypothesis: We thus hypothesized that changes in serum chloride during the hospitalization is an independent prognostic predictor after discharge in HF patients. Methods: This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis, 1,762 patients were ultimately analyzed. The primary endpoint of this study was death from any cause. Result: Overall serum chloride level was significantly decreased from the admission to discharge (103 [100-106] mEq/L to 102 [99-105] mEq/L, P&lt;0.001). During the observation period with 512 days of median follow-up, 286 patients (16.2%) died. Multivariate Cox regression analysis revealed that increase in serum chloride level during the index hospitalization was independently associated with lower rates of mortality, even after the adjustment of diverse covariates including serum chloride level at admission (hazard ratio (HR): 0.94, 95% confidence interval: 0.90-0.98). When dividing the study population into tertiles by chloride levels at admission, patients with the lower baseline chloride level had the greater reduction in HR of the primary endpoint by the increase of chloride level during the hospitalization (Figure). Conclusion: Increase in serum chloride level during hospitalization may be associated with better post-discharge prognosis in HF patients. This could be a new therapeutic target for heart failure to improve long-term prognosis.
The neocoloniality of who cares: US underinvestment in medical education exacerbates global inequities
Authors: Eric Reinhart, Eram Alam
Journal: BMJ (2020)

The US has chronically underinvested in medical education and relies on the annual recruitment of thousands of foreign trained healthcare professionals from nations with far greater unmet healthcare needs. This bears partial responsibility for the dire situation India finds itself in during the pandemic, write <b>Eric Reinhart</b> and <b>Eram Alam</b>
Replication Gaps Underlie BRCA Deficiency and Therapy Response
Authors: Nicholas J. Panzarino, John J. Krais, Ke Cong, Min Peng, Michelle Mosqueda, Sumeet U. Nayak, Samuel M. Bond, Jennifer A. Calvo, Mihir B. Doshi, Matt Bere, Jianhong Ou, Bin Deng, Lihua J. Zhu, Neil Johnson, Sharon B. Cantor
Journal: Cancer Research (2020)

Defects in DNA repair and the protection of stalled DNA replication forks are thought to underlie the chemosensitivity of tumors deficient in the hereditary breast cancer genes
DIFFERENCES IN SELF-REPORTED QUALITY OF LIFE AMONG PATIENTS WITH AUTOIMMUNE HEPATITIS AND PRIMARY BILIARY CHOLANGITIS DURING CANADA'S STATE OF EMERGENCY RESPONSE TO COVID-19
Authors: C. Plagiannakos, S. B. Roberts, M. Saini, C. Vincent, L. Worobetz, J. A. Flemming, C. Tsien, A. F. Gulamhusein, H. L. A. Janssen, A. L. Mason, G. M. Hirschfield, B. E. Hansen
Journal: Hepatology (2020)

Background: Between March 13th and March 22nd, 2020, a state of emergency (SoE) was declared across Canada due to transmission of COVID-19 We compare self-reported quality of life (QoL) changes between Autoimmune Hepatitis (AIH) and Primary Biliary Cholangitis (PBC) patients during the first 3 months of SoE  Methods: Patients with an AIH or PBC diagnosis from the Canadian Network for Autoimmune Liver disease with completed QoL surveys between July 2019 and June 2020 were included in the analysis Surveys completed after March 17th, 2020 were categorized as during SoE, and data prior to February 1st, 2020 were categorized as before SoE  Domain-specific QoL measurements included the Short-Form 36 (SF-36) and Itch Numeric Rating Scale (NRS) Multiple linear mixed effect regressions and estimated marginal means compared PBC and AIH scores before and during the SoE, adjusting for age at diagnosis, duration of disease, and site Results: Of the total 456 participants included in the analysis, 63 3% had PBC Participants included were from six liver clinics across Canada: Toronto (AIH= 131, PBC =186), Montreal (PBC = 39), Edmonton (AIH= 2, PBC = 24), Saskatchewan (AIH = 13, PBC =17), Ottawa (AIH = 8, PBC = 14), and Kingston (AIH = 12, PBC = 9) Females accounted for 86 2% (n=393) of the cohort, and 78 9% (n=360) of participants were Caucasian Medians for age at diagnosis and age at SoE were 49 2 years [IQR 37 8- 57 8] and 58 3 years [48 7-66 4], respectively AIH patients were on average 7 years younger than PBC patients There were 316 assessment completed before the SoE (65% PBC) and 185 during (62% PBC)  There were no significant differences in estimated mean SF-36 Physical component between diseases across time (Pre: AIH= 40 9 vs PBC= 41 8, p =0 9 vs During: 43 1 vs 40 7, p=0 49)  Similar findings were observed in the SF-36 Mental component pre-SoE (p=0 78) and post-SoE (p=0 9) Overall, QoL scores in AIH remained stable across time Both patients with AIH and PBC reported lower SF-36 scores compared to the general Canadian population (p<0 001) Longer disease duration and older age at diagnosis were associated with better SF-36 scores, regardless of SoE (p<0 001) Estimated mean NRS scores for PBC were significantly worse than AIH, both before SoE (AIH= 1 7 vs PBC=2 63, p<0 05) and during SoE (AIH = 2 26 vs PBC= 3 62, p<0 01) Conclusion: Physical and mental QoL components remain stable for both patients with AIH and PBC, and we observed expected differences in itch between diagnoses
Abstract 13908: Prevalence and Implications of Junctional Rhythm During Transcatheter Aortic Valve Replacement
Authors: Natthapon Angsubhakorn, Maria Anderson, Baris Akdemir, Stefan C Bertog, Santiago Garcia, Selcuk Adabag
Journal: Circulation (2020)

Introduction: Cardiac conduction abnormalities are among the most frequent complications of transcatheter aortic valve replacement (TAVR). A small case series has raised the possibility that junctional rhythm (JR) following TAVR may be associated with poor outcomes. However, the prevalence and implications of JR during TAVR have not been systematically studied. Methods: We retrospectively reviewed intra-procedural continuous 6-lead telemetry of 300 consecutive patients undergoing TAVR between April 2015 and April 2019 to identify JR that occurred after deploying the valve . Forty-two patients with pre-existing permanent pacemaker (PPM) were excluded. JR was defined as regular rhythm without P waves but with QRS morphology that was identical to baseline. Results: A total of 258 patients fulfilled the inclusion criteria (mean age of 77.5±8.5 years and 99% men). During TAVR, 79 (30.6%) patients developed new JR. The mean ventricular rate was 74.6±31.0 bpm. Patients who developed JR had similar baseline characteristics compared to those without JR (Table). After TAVR, 57 (22.1%) patients required PPM for complete atrioventricular block. There was a trend for a higher rate of PPM implantation in patients with rapid JR (39%) vs. slow JR (26%) vs. no JR (19.0%, p=0.10). In logistic regression analysis, patients who had a rapid JR (rate &gt;100 bpm) were 2.71 times (95% CI 0.98-7.52, p=0.055) more likely to require PPM than those without JR. Conclusions: Junctional rhythm after deploying the valve is common in TAVR. There was a trend for higher PPM implantation risk among patients who developed rapid JR. Further investigation of these observations in larger cohorts is needed.
NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression – The debate continues
Authors: Kamran Mushtaq, Muhammad Umair Khan, Fatima Iqbal, Deema Hussam Alsoub, Hammad Shabir Chaudhry, Fateen Ata, Phool Iqbal, Khaled Elfert, Girisha Balaraju, Muna Almaslamani, Khalid Al-Ejji, Saad AlKaabi, Yasser Medhat Kamel
Journal: Journal of Hepatology (2020)
Abstract 14510: Post-traumatic Stress Disorder and Traumatic Brian Injury Are Associated With Increased Incidence of Myocardial Infarction in US Veterans
Authors: Laith Derbas, Vikas Singh, OLURINDE ONI, Garima Thakkar, Hemant Thakur, Mukut Sharma, Ram Sharma, Rishi SHARMA
Journal: Circulation (2020)

Background: We have recently shown that PTSD/TBI takes an especially devastating toll on America’s veterans and their families with mental, physical and financial ramifications and poor clinical outcomes (Thakur et al. Epidemiology (Sunnyvale) 2018; 8:353). Patients with PTSD were found to have higher rates of cardiovascular symptoms, hospitalizations and mortality. Whereas electrocardiographic abnormalities, arrhythmias and ventricular dysfunction have been reported in patients with TBI. Association of PTSD/TBI with Myocardial Infarction (MI) is not well studied; the objective of this study was to examine the relationship between PTSD/TBI and MI in a large patient population. Methods: This retrospective study used national data from Veterans Administrations Informatics and Computing Infrastructure (VINCI). Propensity score analysis was performed to obtain matched pairs of (1) Non-PTSD/TBI vs. PTSD (2) Non-PTSD/TBI vs. TBI. Confounding variables used for matching were patients’ demographics and co-morbidities. Cox proportional hazard regression analysis was conducted on matched pairs to determine the relationship between PTSD, TBI and incidence of MI. Kaplan-Meier curves were plotted to compare the time to development of incident MI among the groups. Relationships between variables were examined using chi-square tests, t-tests and non-parametric tests. Results: The risk of new-onset MI was significantly higher for patients with PTSD/TBI when compared with their counterparts without PTSD/TBI. Risk of MI with TBI (HR=2.687, CI 2.546-2.835, P&lt;0.0001) was higher than with PTSD (HR=1.618, CI 1.574-1.662, P&lt;0.0001). Conclusion: There is a significant increase in the incidence of MI in patients with a diagnosis of PTSD or TBI. Further studies are needed to formulate clinical guidelines to risk stratify and intervene to help reduce the incidence of MI in this patient population.
Abstract 14615: Empagliflozin Provides More Value for Money Than Oral Semaglutide for Prevention of Cardiovascular Mortality in Patients With Type 2 Diabetes Mellitus
Authors: Joseph Azuri, Enis Aboalhasan, Ariel Hammerman, Ronen Arbel
Journal: Circulation (2020)

Introduction: The AHA 2020 strategic goal of reducing CV mortality by 20% was partially achieved (15% reduction 2011-2019). Empagliflozin, an inhibitor of sodium-glucose cotransporter 2 inhibitor and oral semaglutide, the first oral glucagon-like peptide 1 receptor agonist, both significantly reduce the incidence of cardiovascular mortality (CVM) in patients with type 2 diabetes (DM) and established CVD. However, the addition of either drug to current diabetes treatment regimens may impose a significant burden on healthcare systems. Hypothesis: Empagliflozin provides more value for money than oral semaglutide for the prevention of CVM in patients with DM. Methods: We calculated the cost needed to treat (CNT) to prevent one case of CVM using either drug, by multiplying the annualized number needed to treat (NNT) to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published randomized controlled trials (RCT) data. We performed a sensitivity analysis to mitigate the primary differences between the RCTs and other uncertainties. Drug costs were calculated as 75% of the US National Average Drug Acquisition Cost listing in June 2020. Results: The annualized NNT of empagliflozin in EMPA-REG-OUTCOME was 141 (95% CI: 104-230) versus 140 (95% CI: 98-893) for oral semaglutide in PIONEER 6, while the corresponding annual costs are $4,572 versus $6,680. Therefore, the CNT of empagliflozin was $644,652 ($475,488-$1,051,560) compared to $935,200 (95% CI: $654,640-$5,965,240) with oral semaglutide. The lower CNT of empagliflozin was confirmed in a sensitivity analysis. Conclusions: The annualized NNT of empagliflozin and oral semaglutide prescribed for the prevention of CVM in patients with T2DM and established CVD is similar. Therefore, the lower cost of empagliflozin results in a lower CNT and better value for money.
Abstract 13504: Timely Recognition and Successful Clinical Outcome of an Acute Debakey Type I Aortic Dissection
Authors: Dakshin Gangadharamurthy, Muhammad M Furqan, Allan L Klein, Saurabh Malhotra, Rachel Harrison, Likhitesh Jaikumar, Nanni Pidikiti, Theodore Richards, Linnea LeBaron, Mehul Patel, Mandar Jagtap, John Prather
Journal: Circulation (2020)

Background: Acute Aortic dissection is a critical etiology of chest pain with very high mortality. 1% to 2% of patients die per hour during the initial 24 to 48 hours. Case: A 62 year old lady with history of diabetes, hypertension, hyperlipidemia, hypothyroidism, smoking and no pertinent family history presented with atypical chest pain. She remained hemodynamically stable with no discrepancy of BP between arms. Labs: troponin 0.64, 0.63 ng/ml. EKG: sinus bradycardia. Chest x-ray: no mediastinal widening or signs of aortic aneurysm. Coronary angiogram showed 20-30 % stenosis in left anterior descending and right coronary arteries. An aortogram showed dilated aortic root over 6 cm with aortic regurgitation. Decision-making: An emergent echocardiogram confirmed acute aortic regurgitation and dissection. CT angiogram showed DeBakey type I aortic dissection extending from aortic annulus to infra renal aorta, supra aortic great vessels, celiac axis and left renal artery. She had no signs of malperfusion syndrome. She was started on iv Esmolol and emergently airlifted to tertiary care facility for surgical repair. Intra operative TEE showed findings consistent with acute aortic dissection. She had successful modified Bentall procedure with replacement of aortic valve, aortic root, ascending aorta and hemi arch. She had excellent recovery and continues to do well at follow up visits in our clinic. Conclusion: An early diagnosis of acute aortic dissection requires high index of suspicion due to variable symptoms and clinical manifestations. DeBakey type I aortic dissection may have better chance of survival in the absence of malperfusion syndrome if treated early as in this case.
Associations of Antibodies Targeting Periodontal Pathogens With Subclinical Coronary, Carotid, and Peripheral Arterial Atherosclerosis in Rheumatoid Arthritis
Authors: Jon T. Giles, Jesper Reinholdt, Felipe Andrade, Maximilian F. Konig
Journal: Arthritis & Rheumatology (2020)

Both periodontal disease and cardiovascular disease (CVD) are overrepresented in rheumatoid arthritis (RA). This study was undertaken to investigate the contribution of periodontal pathogens to CVD in RA.RA patients underwent assessments of coronary artery calcification (CAC), carotid intima-media thickness and plaque, and ankle-brachial index via computed tomography, ultrasound, and Doppler ultrasound, respectively. Sera were assayed for antibodies targeting Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans serotype B (Aa), and Aa-derived leukotoxin A (LtxA). Associations of antibodies against these periodontal pathogens with measures of atherosclerosis were explored using generalized linear models.Among 197 RA patients, anti-Pg was detected in 72 patients (37%), anti-Aa in 41 patients (21%), and anti-LtxA in 84 patients (43%). Adjusting for relevant confounders and reported tooth loss, the mean CAC score was 90% higher in those with anti-Aa and/or anti-LtxA compared with those without either antibody (19 units versus 10 units; P = 0.033). The adjusted odds of CAC ≥100 units were 2.23-fold higher in those with anti-Aa and/or anti-LtxA compared with those without either antibody (P = 0.040). Anti-Aa and/or anti-LtxA seropositivity was significantly associated with all other assessed measures of atherosclerosis except carotid plaque. Anti-Pg was not associated with any measure of atherosclerosis. Higher swollen joint count was associated with CAC exclusively in the group with anti-Aa and/or anti-LtxA.Immunoreactivity against Aa and/or its major virulence factor LtxA was associated with atherosclerosis in multiple vascular beds of RA patients and amplified the effect of swollen joints on coronary atherosclerosis, suggesting a role for treatment/prevention of periodontal disease in the prevention of CVD in RA.