tbuckley/cabot-search huggingface dataset:
Direct and indirect bronchoprovocation tests in dose‐response studies of inhaled corticosteroids: Past, present, and future directions
Authors: Christianne M. Blais, Beth E. Davis, Parameswaran Nair, Donald W. Cockcroft
Journal: Allergy (2020)

Inhaled corticosteroids (ICS) are a mainstay of treatment in eosinophilic asthma. Many studies have explored the dose-response effect of different formulations of ICS through direct or indirect bronchoprovocation testing. Such studies are important for investigating efficacy and identifying the relative potency between formulations. However, lack of consistency in methods and designs has hindered the comparability of study findings. This review discusses current knowledge of the dose-response, or lack thereof, of different formulations of ICS through direct and indirect bronchoprovocation testing. The strengths and weaknesses of past studies inform recommendations for future methodological considerations in this field, such as utilizing a randomized double-blind crossover design, enrolling participants likely to respond to ICS therapy, and carefully selecting treatment durations and washout periods to assess incremental improvement in airway hyperresponsiveness while reducing the likelihood of a carryover effect.
Abstract 17216: Upright T Wave in Lead AVR and Risk of Mortality: A Systematic Review and Meta-Analysis
Authors: laith A derbas, Raed Qarajeh, Anas Noman, Mohammed Al Amoodi, Ala Mohsen, Kristin Whitehair, Aref A Bin Abdulhak
Journal: Circulation (2020)

Background: Multiple observational studies have shown that positive T wave in lead AVR (PTAVR) on 12-lead electrocardiogram is associated with an increased risk of adverse outcomes including death. We sought to review the literature and conduct a meta-analysis to estimate the risk of mortality in patients with PTAVR. Methods: We searched multiple databases to investigate the association between PTAVR and risk of death. Studies that reported adjusted odds ratio (OR) or hazards ratio (HR) of the association between PTAVR and risk of death (all cause or cardiovascular mortality) were included. We used inverse variance approach to pool adjusted OR /HR and it’s 95 % confidence interval using a random effects model meta-analysis. Results: Out of 140 relevant studies, 17 studies were eligible. Twelve studies reported all-cause mortality and enrolled 4,122 patients, 1976 (47.9%) were males. PTAVR was associated with a significant increase in all-cause mortality, with a pooled adjusted OR 2.44, 95% CI [1.76-3.39], heterogeneity I 2 = 86%. Five studies reported cardiovascular mortality and enrolled 31,713 patients, 27,628 (87.1%) were males. PTAVR was associated with a significant increase in cardiovascular mortality, with a pooled adjusted OR 2.34, 95% CI [1.82-3.0], heterogeneity I 2 = 68%. Conclusion: Our findings suggest that PTAVR is significantly associated with a higher risk of death from any cause as well cardiovascular mortality. Lead AVR, an often neglected lead, should be carefully interpreted as it may provide important prognostic information. Further studies are warranted to examined the prognostic value of PTAVR in risk stratification when added to existing cardiovascular risk scores.
Abstract 16310: Association Between the Use of Antithrombotics and Cardiac Implantable Electronic Device Infections: A Systematic Review and Meta-analysis
Authors: Chol Techorueangwiwat, Chanavuth Kanitsoraphan, Jakrin Kewcharoen
Journal: Circulation (2020)

Introduction: Studies have shown that the use of antiplatelet and anticoagulant increases the risk of cardiac implantable electronic device (CIED) infection following the implantation. However, results were contradicting. In this study, we performed a systematic review and meta-analysis to explore the effect of antiplatelets and anticoagulants and the risk of CIED infection following the implantation. Methods: We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published studies of patients undergoing CIED implantations which reported effect size of the use of either antiplatelet or anticoagulant, or both, on the risk of CIED infections. CIED infection was defined as either device-related local or systemic infection. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate effect size and 95% confidence intervals (CI). Results: Fifteen studies from 2008-2019 involving a total of 72,028 patients were included. In random-effect model, we found that the use of antiplatelet was not associated with an increased risk of CIED infections (risk ratio (RR) =1.13, 95% CI: 0.89-1.44, p=0.314, I 2 =51.3%), while the use of anticoagulant was associated with increased risk of CIED infections (RR =1.50, 95%CI: 1.02-2.21, p=0.038, I 2 =75%). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: Our meta-analysis demonstrated that the use of anticoagulant significantly increases the risk of CIED infection following the implantation by up to 1.50-fold, however, this effect was not observed with antiplatelet use. Our study suggested that patients on anticoagulation considering CIED implantations should proceed with caution.
Abstract 169: Prehospital ECPR : An Organizational Challenge!
Authors: Alice Hutin, Jean Herle Raphalen, Christelle Dagron, Kim An, Anaïs Winchenne, Pierre Carli, Lionel Lamhaut
Journal: Circulation (2018)

Introduction: ECPR, « extracorporeal cardiopulmonary resuscitation » is a second line treatment for refractory cardiac arrest (CA), and low-flow time is clearly identified as a prognostic factor. Our prehospital ECPR team is made of a physician, an anesthetic nurse and a paramedic. During the day (8am to 6pm), the physician, specifically dedicated to the ECPR team, is on site at the EMS call center, where he can have other clinical or research activities; at night and during the weekend, he is on call at home. The nurse and paramedic are on site 24/7, dedicated to the mobile ICU activities, but available for the ECPR team if necessary. Triggering of the ECPR team occurs as early as possible after cardiac arrest, if possible at the same time as the BLS and ALS teams are sent out. Our ECPR team operates inside the city limits but also outside the city in surrounding cities, without access to ECPR. After ECPR team activation, cancellation can occur during transportation or on site of the CA in several situations including return of spontaneous circulation (ROSC), or absence of inclusion criteria for ECPR. Methods: Retrospective monocentric study from January to December 2017. The following data were collected: number of ECPR team activation calls, place and time of intervention, reason for cancellation, number of patients implemented with ECPR. Results: Over the 12 month period, ECPR team was activated 336 times; ECPR triggering occurred during the on call period in 185 cases (55%). Most of the time, interventions were within the city limits (N=209, 62%). Reasons for cancelation were as follows: ROSC (N=116, 34%), no inclusion criteria for ECPR (N=102, 30%), absence of CA (N=25, 7%), unknown (N=42, 12%). All together, 61 patients were actually implemented with ECPR for refractory CA (18%). Conclusion: In the end, 18% of ECPR activation calls lead to actual ECPR implementation. The necessity of early ECPR implementation justifies for early triggering of the ECPR team, despite the high risk of cancellation, whether it be for ROSC or absence of CA. This intense activity justifies for a dedicated complete ECPR team available 24/7. ECPR process requires specific training and precise coordination of personnel in the EMS call center and in the prehospital setting (ALS and ECPR teams).
Abstract 15875: Prediction of Intensive Care Unit Admission Among Patients Hospitalized for COVID-19: The Intermountain Coronavirus ICU Risk Model (CORONA-ICU)
Authors: Heidi T May, Joseph B Muhlestein, Benjamin D Horne, Kirk U Knowlton, Tami L Bair, Stacey Knight, Viet T Le, Ithan Peltan, Jeffrey L Anderson
Journal: Circulation (2020)

Background: Treatment for COVID-19 has created surges in hospitalizations, intensive care unit (ICU) admissions, and the need for advanced medical therapy and equipment, including ventilators. Identifying patients early on who are at risk for more intensive hospital resource use and poor outcomes could result in shorter hospital stays, lower costs, and improved outcomes. Therefore, we created clinical risk scores (CORONA-ICU and -ICU+) to predict ICU admission among patients hospitalized for COVID-19. Methods: Intermountain Healthcare patients who tested positive for SARS-CoV-2 and were hospitalized between March 4, 2020 and June 8, 2020 were studied. Derivation of CORONA-ICU risk score models used weightings of commonly collected risk factors and medicines. The primary outcome was admission to the ICU during hospitalization, and secondary outcomes included death and ventilator use. Results: A total of 451 patients were hospitalized for a SARS-CoV-2 positive infection, and 191 (42.4%) required admission to the ICU. Patients admitted to the ICU were older (58.2 vs. 53.6 years), more often male (61.3% vs. 48.5%), and had higher rates of hyperlipidemia, hypertension, diabetes, and peripheral arterial disease. ICU patients more often took ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, and statins. Table 1 shows variables that were evaluated and included in the CORONA-ICU risk prediction models. Models adding medications (CORONA-ICU+) improved risk-prediction. Though not created to predict death and ventilator use, these models did so with high accuracy (Table 2). Conclusion: The CORONA-ICU and -ICU+ models, composed of commonly collected risk factors without or with medications, were shown to be highly predictive of ICU admissions, death, and ventilator use. These models can be efficiently derived and effectively identify high-risk patients who require more careful observation and increased use of advanced medical therapies.
Abstract 12702: Association of Posttraumatic Stress Disorder With Incident Ischemic Heart Disease in Women Veterans
Authors: Ramin Ebrahimi, Jennifer Sumner, Kristine Lynch, paul dennis, Chi-Hong Tseng, Benjamin Viernes, Laurie Shroyer, jean beckham
Journal: Circulation (2020)

Introduction: Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD). Women veterans represent a growing, yet understudied, population with high trauma exposure and a unique cardiovascular risk profile, but research on the PTSD-IHD relation in this group is lacking. Hypothesis: PTSD is associated with incident IHD in women veterans. Methods: Veterans Administration (VA) electronic medical records (EMR) was used to identify women veterans who received care from any VA from 1/1/2000-12/31/2017. Exclusion criteria included: no VA follow-up(s) after index visit; IHD diagnosis at or before index visit; IHD diagnosis within 90 days of index visit. Propensity score matching on age at index visit, year of index visit, number of visits before index visit, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions was conducted in a 1:2 ratio to identify 129,510 women veterans with PTSD and 259,020 women veterans without PTSD. PTSD was defined by International Classification of Disease (ICD)-9/ICD-10 diagnosis codes and inpatient or outpatient encounters. Incident IHD was defined as new-onset coronary artery disease, angina, or myocardial infarction diagnoses based on ICD-9/ICD-10 diagnosis codes and inpatient or outpatient encounters. Results: The analytic sample was relatively young (mean age=40.3 ( SD =12.5)). Median length of follow-up was 1,921 days (interquartile range=884-3,547 days). In a propensity score-adjusted Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (HR=1.15, 95% CI 1.10-1.19; P &lt;.001). Secondary stratified analyses indicated that women veterans with PTSD who were of younger age (particularly those aged &lt;40 years), Black race, and Hispanic/Latino ethnicity, plus those exposed to military sexual trauma, exhibited some of the greatest elevations in incident IHD risk. Conclusions: Findings demonstrate that PTSD is an independent predictor of incident IHD in women veterans, especially in younger women and racial and ethnic minorities. Results may have implications for IHD risk assessment in these vulnerable populations.
Foreseeing Super-Response to Cardiac Resynchronization Therapy: A Perspective for Clinicians⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
Authors: Kenneth A. Ellenbogen, Jose F. Huizar
Journal: Journal of the American College of Cardiology (2012)
Abstract 14342: Redo Surgical Aortic Valve Replacement versus Valve in Valve Transcatheter Aortic Valve Replacement
Authors: Parth M Patel, Edward Chiou, Jane W Wei, Jose N Binongo, Robert A Guyton, Bradley G Leshnower, Kendra J Grubb, Edward P Chen
Journal: Circulation (2020)

Introduction: There has been a recent trend towards the increased use of biologic valves at the time of surgical aortic valve replacement (SAVR) with an understanding there may be a potential need for future valve intervention. In this study, we compared the clinical outcomes of Redo-SAVR with valve-in-valve transcatheter aortic valve replacement (VIVTAVR) in patients with a prior history of SAVR. Methods: From 2012 to 2019, 263 patients underwent isolated aortic valve reintervention after prior SAVR: VIV-TAVR (n=187) or redo-SAVR (n=86). Multivariable analysis was performed to identify risk factors mortality and aortic reintervention. Sub-analyses were performed to compare VIV-TAVR patients to Redo-SAVR patients undergoing biologic valve explant and implant (Biologic) as well as VIV-TAVR and Redo-SAVR patients matched by STS Predicted Risk of Mortality (STS PROM). Results: Operative mortality for the Redo-SAVR and VIV-TAVR was 1.2% (1) and 1.6% (3) respectively (p=0.92). Redo-SAVR patients had an increased stroke rate (7.0% vs 1.1%, p=0.02) and longer postoperative length of stay (7 vs 2 days, p&lt;0.0001). VIV-TAVR patients had a higher rate of ≥1+ paravalvular leak (PVL) (21.4% versus 3%, p=0.0002) and a lesser reduction in transvalvular gradient (-21.9 ± 17.6mmHg vs -30.3 ± 20.7mmHg, p=0.0038). The difference in PVL was maintained during the Biologic Sub-analysis (p=0.0034). In the STS PROM Sub-analysis, early mortality was the same for each group (1.2%), and the differences in PVL (p=0.0002) and in transvalvular gradient reduction (p=0.005) were maintained. Preoperative renal failure (p=0.006) and cerebrovascular disease (p=0.04) were risk factors for mortality and prior myocardial infarction (p=0.04) was a risk factor for aortic reoperation for VIV-TAVR. No risk factors were identified for Redo-SAVR. Conclusions: Aortic valve reintervention following prior SAVR is associated with outstanding clinical outcomes. Both Redo-SAVR and VIV-TAVR can be performed with lower than expected predicted mortality. Redo-SAVR was associated with increased morbidity compared to VIV-TAVR, but improved valve function and hemodynamics. Differences in long term valve durability and patient survival between these two therapies are yet to be determined.
Abstract 12886: Ten-year Trends in Patient Characteristics, Treatments, and Outcomes in St Elevation Mi Patients in the Us - A Report From NCDR CP-MI Registry
Authors: Sanjay Gandhi, Kirk N Garratt, Tracy Y Wang, Shuang Li, Deepak L Bhatt, Leslie L Davis, Michel Zeitouni, Michael C Kontos
Journal: Circulation (2020)

Introduction: The National Cardiovascular Data Registry affords a 10-year perspective of the landscape of STEMI patient characteristics, management, and clinical outcomes. Methods: Annual trends in patient characteristics and in-hospital treatments of 604,936 STEMI patients treated at 1226 US hospitals between 2009 and 2018 were analyzed. Using the ACTION mortality risk model incorporating cardiac arrest, the trend in in-hospitals risk adjusted mortality rates (RAMR) between 2011-2018 was tested. Results: While patient age (median 61 years) and sex (70.7% male) remained stable over time, the prevalence of diabetes (22.8% in 2009 to 28.3% in 2018) and atrial fibrillation (4.1% to 6.1%) increased, while smoking decreased (43.5% to 37.9%) . Among eligible patients, primary PCI use increased (82.3% to 96.0%) with more rapid door to balloon times for both direct arrival (median 62 min vs 56 min) and transferred-in pts (median 113 min vs 103 min, p for trend &lt;0.001 for all). Thrombolytic use declined (10.1% to 5.0%) with no significant change in door to needle time (median 27 minutes). There was no significant change in RAMR (2.83% to 2.69%, p=0.46) from 2011-2018. (Figure 1). Discharge use of P2Y12 inhibitors (91.5% to 95.6%) and statins (94.9% to 98.5%) increased. Conclusions: Characteristics of patients presenting with STEMI changed over time with improvements in primary PCI use and timeliness. However, there was no significant reduction in risk-adjusted mortality over the past decade.
Abstract 266: Quantifying the Effect of Technological Advancements and Guidelines on Pediatric Extracorporeal Cardiopulmonary Resuscitation Survival Outcomes
Authors: Anish Sangari, Nitish Sood, Joseph Hauger
Journal: Circulation (2020)

Introduction: The 2009 H1N1 pandemic resulted in a substantial increase in the use of extracorporeal cardiopulmonary resuscitation (ECPR). The concurrent release of guidelines by the French Ministry of Health also led to the standardization of ECPR protocol. We conducted a systematic review and meta-analysis to examine if the simultaneous development of guidelines and expanded usage led to an increase in survival to hospital discharge (SHD) in pediatric ECPR and to investigate if predictors of survival have changed since 2009. Methods: PubMed, SCOPUS, Google Scholar, Cochrane, and EMBASE were searched to identify studies examining survival outcome and predictors of survival for pediatric ECPR. A random-effects model was applied. Additional pre-specified subgroup analysis was performed using a fixed-effects model. A univariate meta-regression analysis was conducted. Results: The meta-analysis included 3,454 patients from 30 studies. Total survival rates have not improved in pediatric ECPR between subgroups (Mann-Whitney U test: p &gt; 0.05). Extracorporeal membrane oxygenation (ECMO) duration for survivors was not significantly different than nonsurvivors before 2009 RR -0.02 [95% CI: -0.19 - 0.14], but was significantly lower than nonsurvivors after 2009 RR -0.32 [-0.48 - -0.15, p &lt; 0.05]. Meta-regression analysis revealed the ratio of ECMO duration for survivors compared to non-survivors has significantly decreased from 1998 to 2020 (p &lt; 0.05). Patient age was a significant predictor of survival pre-2009 RR but is not correlated with survival post-2009 (p &gt; 0.05). PaO2 was significantly higher in survivors than nonsurvivors pre-2009 RR 0.15 [0.12 - 0.18, p &lt; 0.05] but was not significantly different post-2009 (p &gt; 0.05). End-tidal CO2, CPR duration, pre-CPR serum lactate, and pre-CPR creatinine were not significantly different (p &gt; 0.05) between survivors and non-survivors in either pre-2009 or post-2009. Conclusion: Pediatric ECPR did not see major improvement in survival rates since 2009. In addition, predictors of survival for pediatric ECPR cases have changed over the last 10 years. As such, clinicians may be advised to rely much more heavily on recent research regarding predictors of survival in pediatric ECPR cases.
Abstract 15036: Artificial Intelligence for Characterizing Heart Failure in Cardiac Magnetic Resonance Images
Authors: Skylar E Stolte, Ruogu Fang, Yonghui Wu, William Hogan, Yan Gong
Journal: Circulation (2020)

Introduction: Congestive heart failure (CHF) increases hospitalization burden and risk of mortality.; However, currently there are no guidelines for preemptive screening for CHF. This study aimed to identify imaging features to classify past CHF in order to predict future CHF in cardiac magnetic resonance images (CMRIs). Hypothesis: Machine learning (ML) may reliably segment the heart chambers from CMRIs and these segmentations yield imaging biomarkers to predict CHF. Methods: This study extracted CMRIs from 350 subjects with and without CHF in the UK Biobank. Participants with no CHF were randomly selected to match those with CHF. Convolutional neural networks (CNNs) segmented the heart in short and long axis CMRIs. Each model was based on VGGNet with added skip connections that perform transposed convolutions. These convolutions upsampled feature maps at each scale and concatenated them at the network’s resolution. The VGGNet learned deep feature representations, while the transposed convolutions compensated for issues underlying network depth. The resulting segmentations and imaging metadata were parsed to extract clinical parameters related to heart measurements and function. Support vector machines (SVM) consistently yielded the highest performance among all ML classifiers. A following step split the data into 80%/20% training/testing and run five-fold cross validation on the training set to select optimal SVM parameters. Linear SVM provided feature weights that corresponded to relative feature importance. Results: The pipeline identified past/current HF with 0.84 accuracy and 0.86 precision. The key features for identifying past/current CHF included left ventricular (LV) end diastolic volume, LV end systolic volume, LV stroke volume, LV ejection fraction (LVEF), LV mass, left atrial volume (LAV) max, and LAV min. Future prediction yielded 0.80 accuracy and 0.80 precision. In comparison, these results resulted in the following key features: LVEF, LV cardiac output, left atrial stroke volume, left atrial ejection fraction. Conclusion: CMRI provides a reliable method of extracting indicators for cardiac measurements and function. These values help capture heart health and predict future heart complications like CHF.