tbuckley/cabot-search huggingface dataset:
Abstract 15001: Radial Access Has No Impact on Medications Adherence Post Coronary Intervention: A Retrospective Observational Cohort Study Using Real-world Data
Authors: Nawaf Okleh, Jasim Swedee, Awad AL Qahtani, Salaheddin Arafa, Ala A Rahhal, Ahmed S Mahfouz, Sumaya A Al Yafei, Amer H Aljundi, Yousra R Hamid, Osama N Al Khalaila, Fadi K Khir, Maha K Al-Amri, Abdul Rahman Arabi
Journal: Circulation (2020)

Introduction: The Transradial artery access for Primary Percutaneous Coronary Intervention (PCI) is the preferred access for coronary interventions in ST Elevation Myocardial Infarction STEMI due to less complications post intervention and it has been shown to improve quality of life of patients post intervention. This decrease in complications may give the patient sense of ease and underestimation of disease severity, and hence worsen the patient’s compliance with medications. This retrospective observation study aimed to assess the impact of radial versus femoral access coronary interventions on adherence to post-PCI medications. Methods: We conducted a retrospective analysis for all patients who presented with STEMI and underwent primary PCI in a tertiary cardiac hospital in Qatar between January 1, 2016 and December 31, 2018. Adherence was assessed by refilling the first prescription post discharge. Adherence rates were compared between the patients who underwent PCI with radial versus femoral access using the Chi square test. Results: A total of 1339 patients who presented with acute STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with mean age of 51 years. The majority of patients (1082; 81%) underwent radial access, while 257 (19%) underwent femoral access. The two groups were comparable in terms of age, nationality, the presence of full versus partial insurance, and using medications before admission. The patients adherence to medications post-PCI, including aspirin, P2Y12 inhibitor, statin, beta-blocker, angiotensin converting enzyme (ACE) inhibitor/ angiotensin II receptor blocker (ARB) was comparable between the radial versus femoral access ( aspirin: 78% vs. 74%; p-value= 0.16, P2Y12 inhibitor: 81% vs. 79%; p-value=0.45, statin: 80% vs. 76%; p-value= 0.15, beta-blocker: 72% vs. 70; p-value= 0.51, ACE inhibitor/ARB: 79% vs. 74%; p-value= 0.09). Conclusion: In comparison to femoral access in primary coronary intervention in STEMI, the radial access resulted in similar adherence to post-PCI medications assessed by refilling of first prescription post discharge. Therefore, the radial access is a safe approach in terms medications adherence.
Reply to Letter to the Editor, Reply to Yasri &amp; Wiwanitkit
Authors: Nikolaos Lazaridis, Alexandros Skamnelos, Alberto Murino, Rocio Chacchi Cahuin, Nikolaos Koukias, Edward J. Despott
Journal: Endoscopy (2020)

See also:Double-surgical-mask-with-slit and COVID-19 preventionEndoscopy eFirstDOI: 10.1055/a-1293-8107
Abstract 16712: Safety &amp; Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients
Authors: Tauseef Akhtar, Usama A Daimee, Bhradeev Sivasambu, Erica Hart, Joseph E Marine, Ronald D Berger, Hugh G Calkins, David D Spragg
Journal: Circulation (2020)

Introduction: Catheter ablation (CA) for atrial fibrillation (AF) is widely performed, with a rising proportion of patients of advanced age receiving the procedure. There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for AF among elderly patients in the United States. Hypothesis: CB ablation is associated with better outcomes in elderly patients. Methods: We conducted a retrospective analysis of patients &gt; 75 years undergoing index AF ablation between January 2001 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after 1 year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1year follow-up were also evaluated. Results: In our cohort of 194 patients, the mean age was 78 + 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 + 0.7, while mean CHA2DS2-VASc score was 3.5 + 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of major complications, including bleeding and cardiac tamponade, was similar in the two sub-groups (RF: 2% vs. CB: 0%, p=0.63). No significant difference in success rate at 1year follow-up was found between patients receiving RF vs. CB ablation (57.7% vs. 64.4% Figure, p=0.94). In a multivariable model adjusting for the age, sex, CHA 2 DS 2 -VASc score, AF type, and index RF vs CB ablation, only LA size was associated with ATA recurrence at 1 year follow-up with each increment of 1 cm in LA size was associated with 1.6-fold greater risk of recurrence [HR=1.59, CI: 1.05-2.41, p=0.02]. Conclusion: In elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was the significant predictor of ATA recurrence at 1year independent of index ablation modality.
Abstract 13475: Stress Perfusion Cardiovascular Magnetic Resonance Provides Strong Long-term Prognostic Value to Cardiac Events Irrespective of Patient Sex
Authors: Theo Pezel, Philippe Garot, Marine Kinnel, Valentin Landon, Thomas Hovasse, Marie Claude Morice, Thierry Unterseeh, Solenn Toupin, Stephane Champagne, Yves Louvard, Francesca Sanguineti, Jerome Garot
Journal: Circulation (2020)

Introduction: Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men. Hypothesis: To test the hypothesis that stress CMR can provide robust prognostic value in women to the same extent as in men. Methods: Consecutive patients referred for stress CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE): cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. Results: Of 3436 patients referred for stress CMR in a single French center, 3322 completed the CMR protocol (60±12yrs, 57%men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4±0.2 years). Reasons for failure to complete CMR included renal failure (n=29), claustrophobia (n=26), poor gating (n=22), intolerance to stress agent (n=19) and declining participation (n=18). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95% CI[1.54-3.62]; p &lt;0.001) and men (HR 3.57; 95% CI[2.75-4.64]; p &lt;0.001). Moreover, inducible ischemia was associated with cardiovascular death for both women (HR 1.92; 95% CI[1.12-2.74]; p =0.04) and men (HR 2.71; 95%CI[1.98-4.41]; p &lt;0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR, inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95% CI[1.18-2.92]; p =0.008) and men (HR 3.55; 95% CI[2.73-4.63]; p &lt;0.001). Conclusions: Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE and cardiovascular mortality in patients of either sex presenting with inducible ischemia.
Abstract 251: Characterizing Bystanders and Their Actions in Response to Out of Hospital Cardiac Arrest
Authors: Kristopher Torossian, Mina Altwail, Ryan Paternoster, Eddie Ford, Robert A Swor
Journal: Circulation (2020)

Background: Bystander actions upon witnessing a cardiac arrest are crucial to improving patient survival. Bystander perceptions and actions when witnessing a cardiac arrest are complex and not well understood. Our study has three primary aims: 1) To characterize CA bystanders demographics, 2) To understand the events from patient collapse until EMS arrival, with a focus on telecommunicator or dispatcher-assisted CPR (T-CPR), and 3) Bystander knowledge/ training in CPR and their actions at the time of CA. Methods: This is a prospective observational study conducted on bystanders of out of hospital cardiac arrests (OHCA) serviced by EMS agencies in southeast Michigan. OHCA patients were identified from 3/2018- 12/2019, and bystanders of these events surveyed. Surveys were mailed to non-medical addresses with an introductory letter and paper survey. A phone interview was conducted to describe bystander demographics, events from collapse to EMS arrival, and their actions including CPR performance. We inquired regarding telecommunicator CPR instructions (T-CPR), and if CPR was not performed what were the barriers. Results: During our study period, 126 surveys were mailed, and of these 47 bystander surveys were completed. The majority of events occurred in private homes (37/47,78.7%). Few patients (10, 21.2%) survived to discharge. The bystander and patient age were (mean, range)were 62.9 (30-91 ) and 69.3 (30-100) respectively. The majority were female 27/47(57.4%), most 43/47 (91.4%) knew the patient and were family (34/47,72.3%). Bystanders knew the patient a median(range) of 32 (0-68) years. A majority of bystanders (31/47,66.0%) had CPR training and 19 performed CPR. Of the 14/47 (27.8%) that received T-CPR instructions, 9 performed CPR. CPR trained bystanders that did not perform CPR(8/31), identified panic, assessment barriers and physical reasons for not performing CPR. Conclusion: In this preliminary work, we identify that bystanders to OHCA are most often family, of similar age to the patient and knew the patient for decades. CPR educational programs should prepare trainees to know that they may well respond to loved ones. Further researcher characterizing bystanders and their actions are needed to improve cardiac arrest outcomes.
Continuous ST-Segment Monitoring in Contemporary Acute Coronary Syndrome Patients: The Magic of MERLIN–TIMI 36**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.
Authors: Dan Tzivoni, Mitchell W. Krucoff
Journal: Journal of the American College of Cardiology (2009)
Abstract 13864: In-hospital Management and Outcomes of Acute Myocardial Infarction Before and During the Coronavirus Disease 2019 Epidemic
Authors: Bing Huang, Hui Yan, Guiqiu Cao, Jing Chen, Hong Jiang
Journal: Circulation (2020)

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) before and during the COVID-19 epidemic. Methods and Results: We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (case group), and from January 1, 2019, to December 31, 2019 (control group) and conducted a 1:1 ratio-matched case-control study. Fifty-three AMI (31 STEMI, 22 NSTEMI) patients during the COVID-19 epidemic were matched to 53 AMI patients before the epidemic. Baseline characteristics were comparable between the groups. STEMI patients in the case group had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those in the control group. Less coronary angiography and stenting were performed in AMI patients in the case group than in the control group. Although there were no statistically significant differences in clinical outcomes between the two groups, STEMI patients in the case group had more than a three-fold increase in mortality rates. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. Conclusions: The COVID-19 epidemic has resulted in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. This epidemic also results in more than a three-fold increase in mortality rates in STEMI patients, although the differences were not statistically significant.
Abstract 15049: Prognostic Implications of Outpatient N-terminal Pro-b-type Natriuretic Peptide Changes in Patients With Left Ventricular Assist Devices
Authors: Abbas Ali, suchith shetty, Rupesh Kshetri, Alexandros BRIASOULIS, Ernesto Ruiz dubuque, Emmanuel Akintoye, Umesh C Sharma, Paulino Alvarez
Journal: Circulation (2020)

Objective: Evaluate the prognostic implications of N-terminal Pro-B-type Natriuretic Peptide measurements in ambulatory patients with continuous flow left ventricle assist devices (CFLVAD). Methods: We performed a retrospective study of consecutive patients that had an LVAD implantation at our institution and were discharged from their index hospitalization. Results: Between January 31 st , 2006 and August 21 st , 2019, 139 patients received a continuous flow left ventricle assist device implant at our institution and survived beyond their index hospitalization. 127 patients (56.2±12.5 years, 78.7 % male) had NT pro BNP measured at 1- and 3-months post discharge in ambulatory settings. The median (IQR) NT-pro BNP levels were 1661 pg/mL (921-2558 pg/mL) at 1 month and 1094 pg/mL (673-2089 pg/mL) at 3 months post discharge. After a median follow up of 17 months, a total of 53 (41.7%) incidents event occurred. Of these, 37 (69.8%) were heart failure hospitalizations and 16 (30.2%) were deaths. For each 1000-unit increase in NT-pro BNP level at 3 months, there was a 17% increase in the risk of heart failure hospitalization or death (HR=1.17, 95% CI=1.04-1.32, p=0.007)). Also, for each 1000-unit decline in NT-pro BNP level between the 1 st and 3 rd months, there was an 11% decrease in the risk of heart failure hospitalization or death (HR=0.89, 95% CI=0.77-0.98, p=0.04). Conclusion: In ambulatory patients with CFLVAD, increase in NT pro BNP value from one to three months is associated with a significantly increased risk of heart failure hospitalization and death.
Contribution of biofilm formation genetic locus, <i>pgaABCD</i>, to antibiotic resistance development in gut microbiome
Authors: Dachuan Lin, Kaichao Chen, Jiubiao Guo, Lianwei Ye, Ruichao Li, Edward Wai Chi Chan, Sheng Chen
Journal: Gut Microbes (2020)

The human gut microbiome is the presumed site in which the emergence and evolution of antibiotic-resistant organisms constantly take place. To delineate the genetic basis of resistance formation in gut microbiome strains, we investigated the changes in the subpopulation structure of Escherichia coli in rat intestine before and after antimicrobial treatment. We observed that antibiotic treatment was selected for an originally minor subpopulation E. coli carrying the biofilm-forming genetic locus pgaABCD and the toxin-antitoxin system HipAB. Such strains possessed dramatically enhanced ability to withstand the detrimental effects of antibiotics, becoming a dominant subspecies upon antibiotic treatment and eventually evolving into resistant mutants. In contrast, E. coli strains that did not carry pgaABCD and HipAB were eradicated upon antibiotic treatment. Our findings, therefore, suggested that genes encoding biofilm-forming ability played an important role in conferring specific gut E. coli strains the ability to evolve into resistant strains upon a prolonged antibiotic treatment, and that such strains may therefore be considered bacterial antibiotic resistance progenitor cells in the gut microbiome.
Abstract 13016: Percutaneous Coronary Intervention versus Optimal Medical Therapy for Coronary Chronic Total Occlusion: A Meta-Analysis
Authors: Jayakumar Sreenivasan, Mohammad S Khan, Noman Lateef, Mohammad M Memon, Nisar Asmi, Muhammad Hassan, Ankur Kalra
Journal: Circulation (2018)

Introduction: The role of percutaneous coronary intervention (PCI) in the management of coronary chronic total occlusion (CTO) remains controversial. We conducted a systematic review and meta-analy...
Abstract 17261: Maintenance of Sinus Rhythm After His Bundle Pacing and AV Nodal Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation
Authors: Amrish Deshmukh, Puspha Khanal, Amlish Gondal, Mary Romanyshyn, Pramod Deshmukh
Journal: Circulation (2020)

Background: Catheter ablation (CA) is the most effective means of rhythm control for atrial fibrillation (AF) but is not curative. Irregular and rapid ventricular activation by AF begets AF. Cardiac resynchronization and atrioventricular nodal (AVN) ablation have been associated with favorable atrial remodeling and spontaneous reversion to sinus rhythm in patients with longstanding atrial fibrillation. Hypothesis: We hypothesized that in patients with longstanding persistent AF who had failed CA, AVN ablation and His bundle pacing (HBP) may improve maintenance of sinus rhythm. Methods and Results: A total of 13 patients (5 female, age 69±8.7 years, 8 with HFrEF, BMI 29 ±5 kg/m 2 ,LVEF 38±15%, NYHA 3±0.6) underwent simultaneous AVN ablation and HBP an average of 531 days (Range 1-2158 days) after CA for AF with recurrent AF. Prior to AVN ablation and HBP these patients had a median 9-year history of AF (IQR: 5-15 years) with a median of 2 prior cardioversions (IQR: 1-4) and 2 prior CA. All patients had failed at least 1 antiarrhythmic drug. In 3 patients HBP induced cardiac resynchronization of pre-existing bundle branch block and in 8 patients HBP was fused with ventricular pacing to optimize QRS duration. 12 of 13 patients had an atrial lead. All patients underwent cardioversion at the time of the procedure. In a median of follow up of 21 months (IQR:4-74 months), 7 of the 13 patients (54%) had no device detected or clinical recurrence of AF. In follow up LVEF increased to 46±12.7% and NYHA class to 2 ±0.2. Of patients with recurrence, 3 underwent CA and had no recurrence of AF in subsequent follow up. Conclusion: In patients with advanced longstanding persistent AF, a strategy of AVN ablation and HBP allowed for ventricular rate control with a narrow QRS. This approach resulted in a lower than expected rate of AF recurrence.
Abstract 364: Continuous Electrocardiogram Classification During Resuscitation Using Transfer Learning
Authors: Jason Coult, Diya Sashidhar, Thomas Rea, Jennifer E Blackwood, Peter Kudenchuk, J. Nathan Kutz, Heemun Kwok
Journal: Circulation (2020)

Introduction: Cardiac arrest resuscitation requires CPR interruption for ECG rhythm analysis, but pausing CPR is adversely associated with survival. Ideally, automated rhythm analysis would occur agnostic of CPR state throughout resuscitation and discriminate non-shockable from shockable rhythms. Transfer learning of pre-trained deep convolutional neural networks (CNNs) may enable accurate ECG analysis when applied to time-frequency representations of the ECG. We designed and evaluated a transfer learning algorithm to identify ventricular fibrillation (VF), asystole (AS), and organized (OR) rhythms agnostic of CPR. Methods: In this observational study of out-of-hospital cardiac arrest, rhythms were manually diagnosed in continuous defibrillator ECG recordings. Non-overlapping adjacent 2-s ECG segments were extracted from the first 30 min of each case regardless of CPR during VF, AS, and OR. Each segment was represented by an intrafrequency-normalized Morlet wavelet transform from 4-40 Hz. Using a 2/3 subset of patients for training, a series of two ResNet-101 CNNs were retrained to perform a shock decision (VF vs. non-shockable) followed by a specific non-shockable prediction (AS, OR, or Indeterminate). Performance was evaluated in a 1/3 validation subset of patients using a range of probability decision thresholds to predict the class of each segment. Results: In total, 275100 segments were collected from 461 patients. Of 90962 segments from 152 validation patients, using a 0.7 probability threshold for class prediction, 21% (18930/90962) were indeterminate, shock vs. no-shock sensitivity and specificity were 90% (19702/21930) and 97% (48421/50102), and specificities among non-shockable rhythms for AS vs. OR were 84% (5032/5998) and 86% (37760/44104), respectively (Fig 1). Conclusion: Transfer learning may enable shock/no-shock and rhythm-specific ECG classification continuously throughout resuscitation regardless of CPR.
Abstract PO-038: Activation of Kras and loss of <i>Pten</i> induces pancreatic ductal adenocarcinoma from pancreatic acinar cells in mice
Authors: Wesley J. Hunt, Claire L. Dubois, Atefeh Samani, Farnaz Taghizadeh, David F. Schaeffer, Maike Sander, Janel L. Kopp
Journal: Cancer Research (2020)

Abstract Cellular origin has an impact on tumorigenesis of pancreatic ductal adenocarcinoma (PDAC). We have previously demonstrated the effects of Pten loss and/or Kras activation in adult pancreatic ductal cells and their involvement in PDAC tumorigenesis. However, mature acinar cells have not been studied in this genetic context before. We used adult Ptf1aCreER;KrasG12D mice with homozygous (Ptenf/f (KPf/f)) or heterozygous (Ptenf/+ (KPf/+)) loss of Pten to specifically express KrasG12D and reduce Pten in the acinar cell lineage to examine this phenotype. We found that KPf/f mice reach humane endpoint much faster than KPf/+ or KP+/+ mice do, suggesting Pten limits tumor development and progression. Upon morphological examination, we found that most tumors develop as moderately or well differentiated or a mixture of both with cystic lesions and gastric-type glands dominating tumor architecture. Morphologically, no differences were found between KPf/f and KPf/+ mice. Tumors have large areas of Alcian Blue and PAS positivity that vary between tumors but not between genotypes. We characterized the tumors by immunohistochemistry (IHC) and found that they are Mucin 1 positive and Mucin 2 negative, regardless of their genotype. Additionally, we stained them for Mucin 5AC, Keratin 20, and Claudin 18 and found variable patterns of positivity amongst tumors regardless of genotype. In summary, our data shows that loss of Pten in acinar cells in context of Kras activation can promote PDAC. In contrast, our previous data demonstrates that loss of Pten alone can predispose ductal, but not acinar cells to tumorigenesis, and activation of Kras further synergizes with Pten reduction. These data suggest that ductal cells are more sensitive than acinar cells to Pten perturbation. Citation Format: Wesley J. Hunt, Claire L. Dubois, Atefeh Samani, Farnaz Taghizadeh, David F. Schaeffer, Maike Sander, Janel L. Kopp. Activation of Kras and loss of Pten induces pancreatic ductal adenocarcinoma from pancreatic acinar cells in mice [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2020 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2020;80(22 Suppl):Abstract nr PO-038.