tbuckley/cabot-search huggingface dataset:
Abstract 15811: Prevalent Pharmacotherapy in United States Children and Adolescents After Fontan Completion
Authors: Michael L Obyrne, Jen Faerber, Hannah Katcoff, Jing Huang, Jonathan Edelson, David Finkelstein, Catherine Avitabile, Andrew C Glatz, David J Goldberg
Journal: Circulation (2020)

Background: Patients who have undergone Fontan palliation are at life-long risk of significant morbidities including thrombosis, heart failure, and arrhythmia. At present there is limited evidence to guide pharmacotherapy and no recent studies have evaluated US pharmaceutical practice in this population. Methods: A retrospective observational study evaluating the prevalent use of prescription medications in children and adolescents with hypoplastic left heart syndrome or tricuspid atresia after Fontan completion (identified using ICD9/10 codes) was performed using data from the Marketscan® Commercial and Medicaid databases. Cardiac pharmaceuticals were divided by class and function. Anticoagualants, other than aspirin, which is not uniformly a prescription medication, were also studied. Associations between increasing age and the likelihood of a filled prescription for each class of drug were evaluated. Results: A cohort of 4056 subjects [median age 12 years (IQR: 8-16), 61% male, 60% commercial insurance] was identified. The most common medication classes were angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), diuretics, cardiac glycosides, and pulmonary vasodilators (Table), although 50% received no prescription medications. Older age was associated with increased likelihood of receiving anticoagulants (p=0.008), antiarrhythmic agents, digoxin, ACEI/ARB, and beta blockers (each p &lt;0.0001 ), but also lower likelihood of receiving pulmonary vasodilators, diuretics (both p &lt;0.0001), and potassium sparing diuretics ( p =0.02). Conclusion: Pharmacotherapy typically used to treat adult heart failure and pulmonary hypertension are the most commonly prescribed medications following Fontan palliation. Determining the optimal regimen for individual patients and the population at large is an important knowledge gap for future research.
Abstract 17229: Predictors of 30 and 180 Days Readmissions After Transcatheter Aortic Valve Replacement in the United States
Authors: Irfan Shafi, Tushar Mishra, Tanveer Mir, Katherine Akers, Omid Yazdanpanah, Joseph Sebastian, Mohamad Alkhouli
Journal: Circulation (2020)

Background: Readmission rates are a widely accepted quality indicator. Our objective was to study characteristics of readmissions at 30 and 180 days after Transcatheter Aortic Valve Replacement (TAVR). Methods: Patients undergoing TAVR between 2016 and 2017 in the U.S. Nationwide Readmission Database were evaluated for the rates, causes, predictors, and mortality of readmission at 30 and multiple readmission within 180 days after index discharge. Results: This analysis included 89601 hospitalizations; 13% were readmitted within 30 days and 8.7% were readmitted multiple times within 180 days. Most important predictors of readmissions, were Length of stay &gt;5 days during index hospitalization (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.47-1.71 at 30 days &amp; HR 1.72; 95% CI 1.58-1.87 at 180 days), &gt; 4 Charlson comorbidities (HR 1.27; 95% CI, 1.19-1.34 at 30 days &amp; HR, 1.54; 95% CI, 1.44-1.65 at 180 days), discharge to skilled nursing facility (HR, 1.34; 95% CI, 1.24-1.44 at 30 days &amp; HR, 1.49; 95% CI, 1.36-1.65 ), atrial fibrillation (HR, 1.25; 95% CI, 1.18-1.32 at 30 days &amp; HR, 1.35; 95% CI, 1.26-1.45 at 180 days), Transapical TAVR approach (HR, 1.21; 95% CI, 1.04-1.42 &amp; HR, 1.20; 95% CI, 1.01-1.43 at 180 days), and acute kidney injury (HR, 1.22; 95% CI, 1.12-1.32 at 30 days &amp; HR, 1.1; 95% CI, 1.01-1.21 at 180 days)(Figure 1 A,B). 67% patients were readmitted at least 1 time within 180 days, 22% were readmitted 2 times within 180days and 11% were readmitted more than 3 times within 180 days. Readmissions were because of noncardiac causes in 67.8% of cases and because of cardiac causes in 32.2% of cases. Conclusion: The study demonstrates that baseline comorbidities alongside non-cardiac causes contributed significantly to readmissions after TAVR at both 30 days and 180 days. The results help to target the susceptible patients in both short as well as long term and to provide evidence-based interventions to reduce the risk and financial burden associated with readmissions.
Abstract 14297: Potential Role of the Tumor Suppressor WWOX in Mediating Skeletal Muscle-Lung Vasculature Crosstalk in PH-HFpEF
Authors: Gunner Halliday, Yang Bai, Marta T Gomes, Dmitry Goncharov, Elena Goncharova, Mark T Gladwin, Roberto F MacHado, Yen Chun Lai
Journal: Circulation (2020)

Introduction: Pulmonary hypertension due to left heart disease (PH-LHD; Group 2), particularly in the context of heart failure with preserved ejection fraction (HFpEF), is the most common cause of PH worldwide. At present, no specific effective therapy has been identified mainly due to the fact that major pathways involved in the regulation of PH-HFpEF are still not well understood. Results: We have recently reported on a role of skeletal muscle sirtuin-3 (SIRT3) in modulating PH-HFpEF. Using skeletal muscle-specific SIRT3 knockout mice ( Sirt3 skm-/- ), we showed that absence of SIRT3 in skeletal muscle drastically reduced the pulmonary vascular tree accompanied by vascular proliferative remodeling. Interestingly, we found that expression levels of the tumor suppressor WW domain-containing oxidoreductase (WWOX) were decreased in pulmonary arterial smooth muscle cells (PASMCs) obtained from Sirt3 skm-/- mice, while no changes in SIRT3 activation levels were detected. Reduced WWOX expression levels were also found in PASMCs isolated from SU5416/Obese ZSF1 (Ob-Su) rat model of PH-HFpEF, in which the levels of SIRT3 activation were found to be decreased in skeletal muscle, but not in the lungs and PASMCs. No changes of WWOX levels were observed in skeletal muscle of Ob-Su rats or in pulmonary artery endothelial cells (PAECs) treated with plasma obtained from Ob-Su rats. Conclusions: Since reduction of WWOX in PASMCs has been shown to promote cell proliferation, HIF1α stabilization and pulmonary arterial hypertension (PAH; Group 1), our data suggest a potential role of WWOX in mediating skeletal muscle SIRT3 deficiency-associated remote pulmonary vascular remodeling in PH-HFpEF.
Inhibition of p62-ZZ Domain-Mediated Signaling Overcomes Bortezomib Resistance in Multiple Myeloma Cells Independent of Their p53 Status
Authors: Silvia Marino, Daniela Nicoleta Petrusca, Rebecca Silberman, Denise Toscani, Judith L Anderson, Nicola Giuliani, Xiang-Qun Xie, Noriyoshi Kurihara, G David Roodman
Journal: Blood (2017)
Abstract 13948: Deep Learning Identification of Brain Structural Atrophy Associated With Heart Failure With Preserved Ejection Fraction Among Patients With Preexisting Dementia Using Clinical Imaging
Authors: Camilo Bermudez Noguera, Cailey I Kerley, Karthik Ramadass, Eric H Farber-Eger, Ya-Chen Lin, Hakmook Kang, Warren D Taylor, Quinn Wells, bennett landman
Journal: Circulation (2020)

Background: Heart failure with preserved ejection fraction (HFpEF) and dementia share several cardiovascular risk factors and have been independently associated with brain atrophy. However, it is unclear how HFpEF affects brain morphology in patients with preexisting dementia. Advances in bioinformatics data extraction pipelines, quantitative neuroimaging, and deep learning, have made possible the analysis of the effects of cardiovascular disease on clinical neuroimaging in large datasets. Hypothesis: We hypothesized that HFpEF in the setting of dementia would be associated with distinct brain morphology imaging changes compared to dementia in the absence of HFpEF. Methods: We used the bioinformatics tools at Vanderbilt University Medical Center to extract and analyze deidentified clinical neuroimaging from patients with a diagnosis of dementia with and without coexisting HFpEF from the electronic health record. We identified a total of 30 patients with HFpEF and dementia who had high-resolution, clinical neuroimaging as well as 301 age- and sex-matched controls. We used an automated pipeline to segment the brain into 132 distinct brain regions and estimate their volume to find structural differences associated with HFpEF. Results: We found six regions with significant atrophy associated with HFpEF: accumbens area, amygdala, posterior insula, anterior orbital gyrus, angular gyrus, and cerebellar white matter. There were no regions with atrophy inversely associated with HFpEF (Figure 1). Conclusions: Here, we show that patients with HFpEF have a distinct neuroimaging signature on patients with preexisting dementia. A possible mechanism of injury for this region and the subsequent atrophy has been linked to high aortic stiffening secondary to chronic cardiovascular disease and its risk factors, resulting in end-organ damage due to barotrauma and shear forces.
Abstract 17100: Effects of Electronic Cigarette Solvents on Endothelial Dysfunction
Authors: Lexiao Jin, Jordan Lynch, Andre Richardson, Daniel J Conklin
Journal: Circulation (2020)

Introduction: After a decade of electronic cigarettes (E-cig) in the U.S., 3 elements remain: 1) E-cigs evolve; 2) E-cigs use propylene glycol (PG) and vegetable glycerin (VG); and, 3) uncertainty about E-cig use and CVD risk. Because all E-cigs use PG:VG, we tested for vascular effects of PG:VG-derived aerosol alone. Methods: Female C57BL/6 mice were exposed by inhalation (6h/d*4d) to filtered air (n=10) or to PG:VG-derived aerosol (n=10). After exposures, blood and aortas were examined for changes in: circulating immune and stem cells and platelets by flow cytometry, and vascular function by isometric myography. Results: PG:VG exposure significantly decreased WBC (-47±7%); increased RBC (+6±1%) and hemoglobin (+4±1%), but had no effect on circulating angiogenic cells or platelet-leukocyte aggregates. In aorta, vascular smooth muscle (VSM) function measured as aortic contractility to phenylephrine (PE) was unaltered. However, acetylcholine (ACh)-induced, endothelium-dependent relaxation was significantly decreased (air: -75.5±4.2%; PG:VG: -61.8±4.2%; P&lt;0.05), whereas sensitivity of ACh-induced relaxation was variably depressed (air EC 50 : 166±54nM; PG:VG EC 50 : 1020±435nM; 0.05&lt;P&lt;0.10). Because loss of ACh-induced relaxation may reflect VSM desensitization to NO, we measured relaxation of NO donor, sodium nitroprusside (SNP). Both sensitivity and efficacy of SNP-induced relaxations were unchanged in the PG:VG group (EC 50 : 8.8±0.8nM; % relaxation: -99.0±0.3%) vs air group (EC 50 : 11.1±1.0nM; % relaxation: -99.1±0.3%) indicating a loss of ACh responsiveness was independent of VSM. To test whether eNOS was altered by PG:VG, PE response was done in presence of eNOS inhibitor (LNAME). The ‘PE contraction ratio’ (i.e., Tension PE+LNAME / Tension PE alone ) was significantly decreased in PG:VG group (1.28±0.03) vs air group (1.39±0.20; P&lt;0.05) re-enforcing that PG:VG depressed eNOS function and/or NO bioavailability. Conclusions: Acute exposure to E-cig solvent aerosol alone led to endothelial dysfunction and immune cell changes suggesting that E-cig use may increase CVD risk independently of nicotine and flavor constituents. Perhaps thermal degradation of PG and VG into aldehydes may contribute to endothelial dysfunction.
Abstract 15516: Predicting Heart Failure Hospitalization in Type 2 Diabetes Mellitus: Validation of the TRS-HFDM Score in the ACCORD Trial
Authors: Malik Elharram, Thao Huynh, Jiayi Ni, João P Ferreira, Abhinav Sharma
Journal: Circulation (2020)

Background: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk for developing heart failure (HF), and clinical models are needed to identify patients with a greater risk for HF hospitalization (HHF). The Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HFDM) was recently developed and validated to predict HHF in patients with T2DM in two large clinical trials (SAVOR-TIMI 53 and DECLARE-TIMI 58). We aimed to validate the TRS-HFDM in another cohort of patients with T2DM. Methods: We validated the TRS-HFDM score in 5,123 patients with T2DM for fatal or non-fatal HHF in the placebo arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes Study Group). The TRS-HFDM included: prior HF, history of atrial fibrillation, coronary artery disease, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio. We evaluated discrimination with the Harrell C index, and calibration by comparing observed event rates for HHF with predicted risk, and the Nam-D’Agostino statistic. Results: During a mean follow up of 4.8 years, 212 patients (4.14%) experienced at least one HHF. The mean age was 63 ±6.7 years, and 38% were female. The baseline hemoglobin A1C was 8.3%, and 36% were on insulin. The ACCORD patients had less comorbidities with a lower proportion of patients with renal dysfunction (8% vs. 16% vs. 17%), established cardiovascular disease (35% vs.79% vs. 41%) and pre-existing HF (5% vs. 13% vs. 10%) compared to patients enrolled in the SAVOR-TIMI 53 and DECLARE TIMI-58 trials respectively. In our cohort, the TRS-HFDM score predicted well HHF events with a Harrel C index of 0.78. The integer-based score was well calibrated, with the observed Kaplan-Meier HHF rates closely predicting the Kaplan-Meier event rates at the end follow up (Nam D`Agostino test: 65.39 (p&lt;0.0001). Discussion: Our findings confirm the applicability of the TRS-HFDM in a large cohort of patients with T2DM with less high-risk features than the SAVOR-TIMI 53 and DECLARE-TIMI 58 populations. Future validation of this risk score in observational cohort studies is needed to evaluate its external validity in a general clinical setting.
Abstract 13510: Impact of Adverse Pregnancy Outcomes on Indication for Lipid Therapy in Women
Authors: Sarah Sherman, Nik Kaufman, Ki Park
Journal: Circulation (2020)

Introduction: Lifetime risk for cardiovascular disease (CVD) is higher in women who experience adverse pregnancy outcomes (APOs) including pre-eclampsia, preterm birth, gestational hypertension, and gestational diabetes. APOs are risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD) in contemporary cholesterol guidelines. Hypothesis: History of APOs impacts consideration for lipid therapy in a significant proportion of women with borderline to intermediate CVD risk . Methods: A single center retrospective chart review of new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019 was performed. New female patients were routinely screened for pregnancy history with an obstetrics questionnaire, and cardiovascular history and lipid profiles were collected where available. Patients were stratified by age and calculated 10-yr risk of a cardiovascular event using the ACC/AHA Pooled Cohort Equation. APO history within age and risk categories in addition to pregnancy history documentation in electronic health records were then assessed. Results: Of the 182 new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019, average age was 49 years old and 71.3% were Caucasian. 25% of the study population had history of APO, and of patients with history of APO, only 55% had documented lipid profiles, 46% had pregnancy history documented in the obstetrics section of the electronic health record, and 17% had pregnancy history documented in their past medical history section. For patients aged 40-75 y/o with borderline-intermediate 10-yr CV event risk, risk-enhancing factors influenced consideration of potential statin therapy, with 20% of patients in the intermediate risk group having history of APO. Conclusions: Pregnancy history impacts potential statin therapy in a significant percentage of women aged 40-75 y/o with borderline-intermediate 10-yr ASCVD risk. However, APOs are often under-recognized and poorly documented as non-traditional CVD risk factors in women. Efforts to improve recognition of APOs in clinical practice should be promoted to improve CVD risk reduction efforts, particularly in young women.
Venous Air Embolism Identified by 18F-Fluorocholine Dual-Phase PET/CT
Authors: Francisco M. Cañete-Sánchez, Leonardo G. Romero Robles, Xavier L. E. Boulvard Chollet, María Mangas Losada, Patrick M. Colletti, Domenico Rubello, Rafael Ramírez Lasanta, Roberto C. Delgado Bolton
Journal: Clinical Nuclear Medicine (2020)

A 60-year-old woman with primary hyperparathyroidism with previous nonconclusive imaging studies was referred for 18F-fluorocholine (18F-FCH) PET/CT as part of the preoperative diagnostic imaging workup to localize the adenoma before minimally invasive surgery. 18F-FCH PET/CT with dual time point was performed, acquiring immediately and 60 minutes after 18F-FCH administration. The early images demonstrated possible hyperfunctioning parathyroid tissue in the mediastinum, located in the right upper paratracheal space (region 2R), with an incidental iatrogenic subclavian venous air bubble embolism presenting as high uptake in the early images that disappeared in the late images. No symptomatology was reported during the examination.
Abstract 13530: A Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Ed-vad Risk Score
Authors: Jonathan B Edelson, Jonathan J Edwards, Hannah Katcoff, Antara Mondal, Feiyan Chen, Nosheen Reza, Thomas C Hanff, Heather M Griffis, Jeremy A Mazurek, joyce Wald, Danielle Burstein, Pavan Alturi, Matthew J O'Connor, Carol Wittlieb-Weber, Lee R Goldberg, Payman Zamani, Peter W Groeneveld, Joseph W Rossano, Kimberly Y Lin, Edo Birati
Journal: Circulation (2020)

Introduction: The past decade has seen tremendous growth in ambulatory ventricular assist device (VAD) patients. We sought to identify patients that present to the emergency department (ED) who are at the highest risk of death. Methods: We performed a retrospective analysis of ED encounters of VAD patients using data from the Nationwide Emergency Department Sample (NEDS) from 2010-2017. Demographic and clinical variables significantly associated with mortality (p &lt; 0.2) in a univariate analysis were evaluated in a multivariate model. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality, which were weighted using integer-normalized beta coefficients. Each patient encounter was assigned to one of three groups based on risk score. Results: A total of 44,042 ED encounters of VAD patients were included in the study. The majority of patients were male (73.6%), &lt;65 years old (60.1%), and 29% presented with bleeding, ischemic/hemorrhagic stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (OR 1.8, 95% CI 1.3, 4.6), primary diagnoses [stroke (OR 19.4, 95% CI 13.1, 28.8), device complication (OR 10.1, 95% CI 6.5, 16.7), cardiac (OR 4.0 95% CI 2.7, 6.1), infection (OR 5.8, 95% CI 3.5, 8.9)], and blood transfusion (OR 2.6, 95% CI 1.8, 4.0), while history of hypertension was protective (OR 0.69, 95% CI 0.5, 0.9)]. The risk score predicted mortality with an area under the curve of 0.78 and 0.71 for development and validation, respectively. Encounters in the highest risk score strata tertile had a 16-fold higher mortality compared to lowest risk tertile (15.8% vs 1.0%). Conclusions: We present a novel risk score and its validation for predicting mortality of VAD patients who present to the ED, which can serve as useful tool for clinicians caring for this high-risk, and growing, population.
Abstract 16352: Baseline Comorbidities and Cardiac Biomarkers are Associated With In-hospital Mortality of Covid-19 Patients
Authors: Efstratios Koutroumpakis, Tariq Thannoun, Jason Pang, Ritesh Patel, Cullen Grable, Sarita Damaraju, Shamim B Mawji, Messan Folivi, Siddharth Chauhan, Mariya Fatakdawala, Christopher Powell, Muhammad A Shabbir, Edward Philbin, Radmila Lyubarova, Shikanth Damaraju, Nicolas L Palaskas, Anita Deswal, Heinrich Taegtmeyer, Enrique Garcia-Sayan
Journal: Circulation (2020)

Introduction: In a time span of 6 months, COVID-19 has infected more than 7 million and cost the lives of more than 400,000 people worldwide. Cardiovascular involvement is associated with adverse clinical outcomes. Hypothesis: Increased plasma troponin and brain natriuretic peptide (BNP) or NT-proB-type natriuretic peptide (NT-proBNP) levels are associated with the presence of underlying cardiovascular disease and predict increased in-hospital mortality. Methods: Here we present a multicenter observational study of patients diagnosed with COVID-19, who were hospitalized in 5 hospitals (4 in Texas and 1 in New York) between March 16 th and May 22 nd , 2020. Demographic and clinical characteristics were abstracted after patient’s discharge or death. To address the non-standard troponin and BNP/NT-proBNP assays across institutions we used the upper 99th percentile as the cut-off for abnormal on each test. Results: We identified 297 consecutive patients hospitalized with COVID-19. Troponin levels were available in 84% and BNP/NT-proBNP levels in 47% of patients. Troponin levels were increased in 14% and BNP/NT-proBNP in 46% of patients. In multivariate Cox analysis, history of coronary artery disease was independently associated with elevated troponin levels (Hazard Ratio [HR]: 5.24; 95% confidence interval [CI]: 1.37-19.97; p=0.015), while history of congestive heart failure was independently associated with elevated BNP/NT-proBNP levels (HR: 2.58; 95% CI: 1.05 6.31; p=0.038). Older age, history of hypertension, dyslipidemia, or stroke, were associated with elevated troponin or BNP/NT-proBNP levels only in the univariate analysis. Other demographic and clinical characteristics were not significantly associated with cardiac biomarker elevation. Collectively, elevated troponin or BNP/NT-proBNP were significantly associated with in-hospital mortality (HR: 3.47 95% CI: 1.90-6.35 and HR: 3.56; 95% CI: 1.44-8.77, respectively; both p&lt;0.01). Conclusions: Increased levels of cardiac biomarkers were associated with a 3-fold increase of in-hospital mortality among patients with COVID-19. Troponin or BNP/pro-BNP testing has a prognostic value and may guide treatment.