tbuckley/cabot-search huggingface dataset:
Abstract 16599: Impact of Race and Ethnicity on Long Term Outcomes Post Percutaneous Coronary Intervention With Drug Eluting Stents
Authors: Anastasios Roumeliotis, Bimmer E Claessen, Samantha Sartori, Davide Cao, Won-Joon Koh, Johny Nicolas, Hanbo Qiu, Rishi Chandiramani, Mauro Chiarito, Ridhima Goel, Joseph Sweeny, Nitin Barman, Prakash Krishnan, Annapoorna Kini, Samin K Sharma, George Dangas, Roxana Mehran
Journal: Circulation (2020)

Introduction: Cardiovascular disease is the leading cause of mortality worldwide, irrespective of race/ethnicity. Previous studies reported that minority patients with ACS have distinct clinical, genetic and socioeconomic backgrounds that may affect clinical outcomes. Hypothesis: To investigate post percutaneous coronary intervention (PCI) outcomes according to race/ethnicity in a contemporary ACS population. Methods: We included consecutive patients undergoing drug-eluting stent implantation for STEMI, non-STEMI or unstable angina (UA) between 2012-2017. The study population was stratified into Caucasian, African American, Hispanic and Asian. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, spontaneous myocardial infarction or stroke at 1 year. Results: Of the 6800 patients included, 3377 (49.7%) were Caucasian, 1408 (20.7%) Hispanic, 1156 (17.0%) Asian and 859 (12.6%) African American. Caucasians were the oldest, Hispanics and Asians had the highest prevalence of diabetes mellitus (DM) and African Americans had more insulin dependent DM and chronic kidney disease. Hispanics and African Americans had the highest STEMI rate, while Asians were more likely to present with UA, have private insurance and be discharged on aspirin and clopidogrel. Compared to Caucasians, Asians had a lower rate of MACCE at 1 year (3.9% vs. 7.1%; p&lt;0.01) whereas Hispanics (6.2% vs. 7.1%; p-value=0.17) and African Americans (8.0% vs. 7.1%; p-value=0.38) had comparable outcomes. Differences were driven by fewer deaths in the Hispanic (2.1% vs. 4.2%; p&lt;0.01) and Asian (1.7% vs. 4.2%; p&lt;0.01) subgroups. Findings remained unchanged after adjusting for potential confounders [Figure]. Conclusions: Among patients undergoing PCI for ACS, Asian race is associated with favorable cardiovascular outcomes compared to Caucasian. No significant differences were observed for Hispanics and African Americans.
Abstract 15706: Association of Blood Pressure Level With Left Atrial Size and Function in Adolescents (SHIP AHOY)
Authors: Edem Binka, Cedric Manlhiot, Elaine M Urbina, Tarek ALSAIED, Tammy M Brady
Journal: Circulation (2020)

Introduction: Left atrial (LA) enlargement and dysfunction are risk factors for stroke, atrial fibrillation and death in adults, and are associated with hypertension (HTN). In children, left ventricular hypertrophy is the most common manifestation of cardiac-specific organ damage in those with HTN, but gaps in knowledge remain regarding the association of HTN with LA size and function. Hypothesis: Increasing blood pressure (BP) is associated with increased LA volume and abnormal LA strain in children. Methods: Echocardiographic images of youth, aged 11 to 18 yrs from 5 clinical sites were obtained. LA strain and strain rate were analyzed using 2-D speckle tracking imaging with R-R gating in the apical 4 and 2-chamber views and averages of both views were used. Subjects were grouped by SBP as low-risk (L; &lt;80th %ile), mid-risk (M; 80-&lt;90th %ile), or high-risk, (H;≥90th %ile). Linear regression models were used to determine the association between BP z-score and LA size and function adjusting for age, sex, race and ethnicity. Results: N=347 youth (median age 15.7 yrs) 60% (n=208) male and 40% (n=139) non-white were included. BP groups differed by age (L&amp;H&lt;M) and BMI (L&lt;M&amp;H). BP groups did not differ by LA size and strain but differed by left ventricular mass index (H&gt;L), stroke volume (M&amp;H&lt;L), peak global longitudinal strain (L&gt;H), mitral E/e’ (H&gt;L) and pulse wave velocity (H&gt;L), each indicating worse CVD risk in the H vs. L group (Table). Multivariable analyses revealed DBP z-score to be independently associated with LA conduit strain (beta 0.73, 95% CI 0.01, 1.45, p&lt;0.05). No other LA size or function variables were associated with BP. Conclusions: Greater BP is associated with increased CVD risk among youth as assessed by non-invasive measurements of CV structure and function. DBP is independently associated with LA conduit strain, a finding associated with CV events in adults. Future studies to determine the long-term association of abnormal DBP with LA strain are needed.
Abstract 15131: National Rates and Trends of Tobacco and Substance Use Disorders Among Atrial Fibrillation Hospitalizations in the United States
Authors: devina adalja, Rajkumar P Doshi, Mihir Dave, Monil Majmundar, Ashish Kumar, Mariam Shariff, Rupak Desai, Jay Shah, Saraschandra Vallabhajosyula, Nageshwara Gullapalli
Journal: Circulation (2020)

Introduction: Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substance abuse. Hypothesis: The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Methods: The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 427.31 in the primary diagnosis column. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD), and drug use disorder (DUD). We used the Jonckheere-Terpstra trend test to analyze the trend in this study. Results: Out of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The trends of all increased substantially during the study period (Figure) . The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD (0.57 (0.56-0.57), P-value &lt;0.001), SUD (0.27 (0.26-0.27), P-value &lt;0.001), AUD (0.22 (0.22-0.22), P-value &lt;0.001), and DUD (0.51 (0.5-0.52), P-value &lt;0.001). Among AF hospitalizations, the black race was associated with higher odds of SUD (1.12 (1.1-1.14), P-value &lt;0.001), and DUD(1.42 (1.38-1.47), P-value &lt;0.001). The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. Conclusions: Tobacco and substance use disorder among hospitalized AF patients in the US mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands the development of preventive strategies to address multilevel influences.
Effect of Ejection Fraction on Clinical Outcomes in Patients Treated With Omecamtiv Mecarbil in GALACTIC-HF
Authors: John R. Teerlink, Rafael Diaz, G. Michael Felker, John J.V. McMurray, Marco Metra, Scott D. Solomon, Tor Biering-Sørensen, Michael Böhm, Diana Bonderman, James C. Fang, David E. Lanfear, Mayanna Lund, Shin-ichi Momomura, Eileen O'Meara, Piotr Ponikowski, Jindrich Spinar, Jose H. Flores-Arredondo, Brian L. Claggett, Stephen B. Heitner, Stuart Kupfer, Siddique A. Abbasi, Fady I. Malik
Journal: Journal of the American College of Cardiology (2021)

In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) (n = 8,256), the cardiac myosin activator, omecamtiv mecarbil, significantly reduced the primary composite endpoint (PCE) of time-to-first heart failure event or cardiovascular death in patients with heart failure and reduced ejection fraction (EF) (≤35%).The purpose of this study was to evaluate the influence of baseline EF on the therapeutic effect of omecamtiv mecarbil.Outcomes in patients treated with omecamtiv mecarbil were compared with placebo according to EF.The risk of the PCE in the placebo group was nearly 1.8-fold greater in the lowest EF (≤22%) compared with the highest EF (≥33%) quartile. Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE (interaction as continuous variable, p = 0.004). Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased, with a 17% relative risk reduction for the PCE in patients with baseline EF ≤22% (n = 2,246; hazard ratio: 0.83; 95% confidence interval: 0.73 to 0.95) compared with patients with EF ≥33% (n = 1,750; hazard ratio: 0.99; 95% confidence interval: 0.84 to 1.16; interaction as EF by quartiles, p = 0.013). The absolute reduction in the PCE increased with decreasing EF (EF ≤22%; absolute risk reduction, 7.4 events per 100 patient-years; number needed to treat for 3 years = 11.8), compared with no reduction in the highest EF quartile.In heart failure patients with reduced EF, omecamtiv mecarbil produced greater therapeutic benefit as baseline EF decreased. These findings are consistent with the drug's mechanism of selectively improving systolic function and presents an important opportunity to improve the outcomes in a group of patients at greatest risk. (Registrational Study With Omecamtiv Mecarbil/AMG 423 to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329).
Abstract 17500: A Crisis of the Heart
Authors: Joyce Njoroge, Michael H Crawford
Journal: Circulation (2020)

A 59 year old female with past medical history of metastatic neuroendocrine tumor without cardiac involvement was admitted for transarterial catheter embolization (TACE) procedure of liver lesions. During the TACE procedure, she developed hypertensive urgency treated with intravenous beta blocker therapy and continuous octreotide for carcinoid reaction. The following day she developed acute pulmonary edema and labile blood pressures requiring low dose norepinephrine. Octreotide infusion was up-titrated to 500 mcg/hour with concern for carcinoid crisis. On physical exam, she was tachycardic and regular without notable murmurs or extra cardiac sounds, no elevated jugular venous distension, and no lower extremity edema. She had bilateral crackles on pulmonary exam and was diaphoretic and delirious. There were sub-millimeter lateral ST- segment elevations on her electrocardiogram but her troponin levels were elevated to 14 ng/dL. Point of care cardiac ultrasound demonstrated severely impaired left ventricular systolic function without regional wall motion abnormalities. Coronary angiogram revealed diffuse coronary vasospasm and elevated left ventricular end-diastolic pressure. On right heart catheterization, she had elevated filling pressures, pulmonary arterial oxygen saturation of 25%, and cardiac index of 1.42 L/min/m2. Our patient was diagnosed with cardiogenic shock secondary to octreotide mediated coronary vasospasm causing diffuse myocardial injury. Continued multidisciplinary discussions were needed to determine appropriate vasopressor and inotropic agent use to support cardiac function without triggering further hormonal dysregulation during carcinoid crisis. Her cardiac function eventually improved with left ventricular Impella support and gradual down-titration of octreotide dose. Norepinephrine, epinephrine, and phenylephrine were avoided in favor of vasopressin, and dobutamine was switched to milrinone to prevent further sympathetic activation. She was able to wean off Impella and pressor support and had improvement of her left ventricular function on repeat echocardiography one month later. She has not had recurrence of heart failure symptoms and continues to follow up with oncology via tele-visits.
Variation in SARS-CoV-2 Infection Risk and Socioeconomic Disadvantage Among a Mayan-Latinx Population in Oakland, California
Authors: Erin E. Esaryk, Paul Wesson, Jessica Fields, Francine Rios-Fetchko, Christina Lindan, Caryn Bern, Alicia Fernández
Journal: JAMA Network Open (2021)

US Latinx populations are disproportionally affected by the SARS-CoV-2 pandemic, with higher rates of infection and associated morbidity and mortality.1 Although often treated as homogeneous, members of Latinx communities vary by national origin, immigration status, and language.2 Oakland, California, is home to many Latinx individuals and an estimated 10 000 Mayan individuals, many of whom speak Indigenous languages.3 Early in the pandemic, community-based organizations (CBOs) in Oakland, California, observed a high frequency of infections among Latinx individuals in general and even higher frequency among Mayan individuals.4 Local CBOs, the University of California, San Francisco (UCSF), and public health authorities formed a collaborative to offer diagnostic testing in Fruitvale, a diverse neighborhood that has among the highest cumulative infection rates in Alameda County.5 Using data from the resulting SARS-CoV-2 testing event, we examined variation in infection risk and socioeconomic disadvantage within the Fruitvale community.
Abstract P112: Impact Of Look Back Period Length On Associations When Using Electronic Health Record Data For Epidemiologic Research
Authors: Nrupen A Bhavsar, John Pura, Ann Marie Navar, Anne Hellkamp, Paul Muntner, Matthew Maciejewski, Sudha Raman, Brad Hammill, Lesley Curtis, Ebony Boulware
Journal: Circulation (2021)

Introduction: Studies using electronic health record (EHR) data often have a limited number of years available for analysis. There is a trade off between the look back period length used to define baseline characteristics and follow up duration used to define outcomes. Objective: Quantify the impact of 6, 12, and 24 month look back periods on the association between diabetes (DM) and subsequent cardiovascular (CV) events using EHR data alone and in combination with Medicare claims. Methods: EHR data from an academic health system and a federally qualified health center from 2009-2014 were linked to Medicare claims data. Eligibility criteria were age ≥65 years, Durham County address, 24 months of continuous enrollment after first claim, EHR encounter in the 2011 index year, and no history of cardiovascular disease (CVD) in the 24 months prior to the index date (i.e., look back period). DM was defined using EHR ICD-9 codes, HbA1c ≥6.5%, or glucose lowering medication, and using claims based diagnosis codes or glucose lowering medication. The outcome was a major CV event (myocardial infarction, stroke, or cardiac procedure) defined by diagnosis or procedure codes. Hazard ratios (HR) compared time to the outcome between patients with and without DM. Results: In 5473 patients, mean age was 77 years, 67% were female and 28% were Black. The prevalence of DM using EHR data only increased with a longer look back period (6 months [19%]; 12 months [21%]; 24 months [23%]) but was less than the prevalence using all available data from EHRs and claims together (28%) (Table 1A). Shorter look back periods resulted in higher HRs (6 month HR=1.64) as compared to HRs from longer look back periods (24 month HR=1.41) using EHR data alone or all available data from the EHR and claims together (HR=1.43) (Table 1B). Conclusions: To avoid over estimating associations, studies of CVD using EHR data to identify baseline conditions may want to use 12-24 month look back periods in the absence of additional administrative data. This may also lead to a shorter follow-up period.
Abstract MP69: A Proteomic Approach For Investigating The Pleiotropic Effects Of Statins In The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Bruno Bohn, Pamela L Lutsey, Weihong Tang, James S Pankow, Faye L Norby, Christie M Ballantyne, Eric A Whitsel, Kunihiro Matsushita, Ryan Demmer
Journal: Circulation (2021)

Background: Statins are prescribed to reduce LDL-cholesterol (LDL-c) and the risk of cardiovascular disease. Statins may influence other outcomes such as dementia through pleiotropic effects unrelated to lipid metabolism. We compared the proteome of statin users and nonusers. We hypothesized that statin use would be associated with proteins in biological pathways unrelated to lipid metabolism. Methods: Among 11,471 participants enrolled in the ARIC study at visit 3 (1993-95), plasma concentrations of 4,638 proteins were determined using the SOMAlogic DNA aptamer-based capture array. We identified 402 participants who initiated statin use within the 2 years prior. Propensity scores (PS) were calculated based on visit 2 (1990-92) LDL-c levels and visit 3 demographic characteristics, CVD risk factors and medications, kidney function, and prevalent CVD. Statin users were matched to nonusers (controls) based on PS similarity, yielding 382 matched pairs. Log2-transformed and standardized protein levels were compared between statin users and controls using t-tests. The false discovery rate (FDR) adjusted for multiple comparisons. Ingenuity Pathway Analysis (IPA) was used to identify potentially altered biological pathways. Results: After PS matching, LDL-c levels at visit 3 were lower in statin users vs controls (125.4 vs 147.1 mg/dL; p &lt;.0001), but all other covariates were balanced. We identified 344 enriched and 298 depleted proteins in statin users (p &lt;.05). After FDR adjustment, 12 proteins were enriched and 17 were depleted. Proteins involved in lipid metabolism were altered in statin users, including proteins in the mevalonate pathway. Proteins unrelated to lipid metabolism also differed between groups (Figure). IPA analysis suggested 20 pathways were altered among statin users. Conclusion: Several proteins unrelated to lipid metabolism differed by statin use. Pending external validation, exploring the biological functions of these proteins could elucidate pleiotropic effects of statins.
Abstract 15539: Single-cell Analysis of Aortic Tissues From Patients With Marfan Syndrome Reveals Changes in Smooth Muscle Cell Differentiation
Authors: Ashley Dawson, Yanming Li, Pingping Ren, Hernan Vasquez, Chen Zhang, Waleed Ageedi, Wei Luo, Lin Zhang, Yang Li, Mary B Sheppard, Hong S Lu, Lisa A Cassis, Joseph S Coselli, Alan Daugherty, Ying H Shen, Scott A Lemaire
Journal: Circulation (2020)

Background: Thoracic aortic aneurysms associated with Marfan syndrome (MFS) carry a high risk of mortality; however, the molecular and cellular processes leading to aortopathy in this population remain poorly understood. We aimed to use single-cell RNA (scRNA) sequencing to define the non-immune cell populations present within the aortic wall in MFS, hypothesizing that these would differ from those of non-aneurysmal control tissue. Methods: We performed scRNA sequencing of ascending aortic aneurysm tissues from MFS patients (n=3) undergoing aneurysm repair and of age-matched, non-aneurysmal control tissue from cardiac transplant donors and recipients (n=4). The Seurat package in R was used for analysis. Differentially expressed genes were identified using edgeR. Results: Eighteen non-immune cell clusters were identified, with conserved gene expression of the largest of the clusters consistent with smooth muscle cells (SMCs; n=6), fibroblasts (n=3), and endothelial cells (n=3). The SMCs and fibroblasts exhibited graded changes in their expression of contractile and extracellular matrix protein genes, supportive of a phenotypic continuum. Additionally, we identified differences in the proportions of non-immune cells in MFS tissues compared to controls. In control tissues, the most common non-immune cells expressed markers of contractile SMC maturity including CNN1 , MYH11 , and SMTN . In contrast, the largest clusters in MFS tissue were most closely related to SMCs on correlation analysis, but displayed increased expression of cyclin genes as well as immune, endothelial, and fibroblast genes indicative of de-differentiated, proliferative SMCs. Additionally, expression of genes associated with SMC phenotypic maturity, including MYH11 and MYOCD , were significantly downregulated in several of the MFS SMC clusters. Conclusion: Our data demonstrate a phenotypic continuum between fibroblasts and SMCs, with aortas from patients with MFS exhibiting an increased proportion of de-differentiated, proliferative SMCs compared to controls. Additionally, markers of SMC maturity were downregulated in SMCs in MFS compared to controls. This may be due to disruption of signaling pathways that promote differentiation.
Using the NHS App as a covid-19 vaccine passport
Authors: Simon Hodes, Azeem Majeed
Journal: BMJ (2021)

The NHS App is a safe and obvious choice for a vaccine passport, but IT problems and the “digital divide” must be tackled 

The UK transport minister, Grant Shapps, announced on 28 April 2021 that the UK government plans to use the existing NHS App to provide proof of covid-19 vaccination status for international travel. For many years, proof of polio, smallpox, and yellow fever vaccinations has been an entry requirement for many countries. The World Health Organization “yellow card” scheme has been in place since 1969, and proof of ACYW135 meningococcal vaccine is required for Hajj to Saudi Arabia.

So while discussions on “vaccine passports” are old, the scale of the covid-19 pandemic will require a large number of global travellers to use a vaccine passport, which is an unprecedented development; and the technological options are far more advanced than the paper based certificates used for other vaccines. There are arguments for and against vaccine passports. We are facing a global pandemic, with huge variation in disease prevalence and vaccine mobilisation between countries. And, while we watch the tragic scenes in India, many people in the UK are preparing for their first opportunity this year to visit relatives oversees or take an international holiday.

In a statement on 5 February 2021, WHO laid down its reasons (at that time) for not supporting …