tbuckley/cabot-search huggingface dataset:
Abstract 079: Nebivolol Associated With Reduced Incident Cardiovascular Events In Hypertensive Patients Compared With Non-vasodilatory Beta Blockers
Authors: Daniel M Huck, Michael A Rosenberg, Michael R Bristow, Brian L Stauffer
Journal: Circulation (2021)

Introduction: Beta blockers are not guideline-recommended first-line agents for hypertension, based on evidence that older generation beta blockers such as atenolol are associated with inferior reduction of some cardiovascular events compared to other antihypertensive classes. Vasodilatory beta blockers such as nebivolol have been found to have beneficial effects on peripheral vasculature through nitric oxide, endothelin-1, and tissue plasminogen activator pathways. The objective of this study is to compare longitudinal cardiovascular outcomes of hypertensive patients taking the vasodilatory beta blocker nebivolol with hypertensive patients taking the non-vasodilatory beta blockers atenolol and metoprolol. Hypothesis: Nebivolol will be associated with a reduction in odds of adverse cardiovascular outcomes compared with non-vasodilatory beta blockers. Methods: The study is a retrospective cohort analysis of de-identified data from adults in the University of Colorado health system with hypertension and on the vasodilatory beta blocker nebivolol or the non-vasodilatory beta blockers atenolol or metoprolol, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome is incident cardiovascular hospitalization or diagnosis of cardiovascular event including heart failure, stroke, myocardial infarction, angina pectoris, or coronary revascularization based on diagnosis or procedure codes. Nearest-available propensity matching logistic regression was used, with each patient taking nebivolol matched to two control patients taking a non-vasodilatory beta blocker. Propensity matching variables included baseline demographics, cardiovascular risk factors, Charlson comorbidity index, other cardiovascular medications, and duration of follow-up. Results: There were 1395 patients taking nebivolol, and 20208 patients taking atenolol or metoprolol. Patients were predominantly female (54%, 11681 of 21603) and non-Hispanic white (75%, 16185 of 21603), with mean age of 60. The primary outcome occurred in 19% (259 of 1395) of those taking nebivolol, 29% (1891 of 6527) of those taking atenolol, and 40% (5500 of 13681) of those taking metoprolol. In propensity matched logistic regression, nebivolol is associated with reduced odds of incident cardiovascular events when compared to the non-vasodilatory beta blockers atenolol and metoprolol (OR 0.33, 95% CI 0.28 to 0.40). This association was also found with individual comparison with atenolol (OR 0.47, 95% CI 0.39 to 0.57) and metoprolol (OR 0.26, 95% CI 0.21 to 0.32). Conclusions: The vasodilatory beta blocker nebivolol is associated with reduced odds of incident cardiovascular events compared to non-vasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect, or is specific to nebivolol.
Unprecedented increase of West Nile virus neuroinvasive disease, Spain, summer 2020
Authors: Lucía García San Miguel Rodríguez-Alarcón, Beatriz Fernández-Martínez, María José Sierra Moros, Ana Vázquez, Paula Julián Pachés, Elena García Villacieros, María Belén Gómez Martín, Jordi Figuerola Borras, Nicola Lorusso, Julian Mauro Ramos Aceitero, Elena Moro, Aránzazu de Celis, Salvador Oyonarte, Beatriz Mahillo, Luis José Romero González, María Paz Sánchez-Seco, Berta Suárez Rodríguez, Ulises Ameyugo Catalán, Santiago Ruiz Contreras, Mayte Pérez-Olmeda, , Fernando Simón Soria
Journal: Eurosurveillance (2021)

Cases of West Nile neuroinvasive disease (WNND) in Spain increased in summer 2020. Here we report on this increase and the local, regional and national public health measures taken in response. We analysed data from regional surveillance networks and the National Epidemiological Surveillance Network, both for human and animal West Nile virus (WNV) infection. During the 2020 season, a total of 77 human cases of WNV infection (median age 65 years; 60% males) were detected in the south-west of Spain; 72 (94%) of these cases developed WNND, presenting as meningoencephalitis, seven of which were fatal. In the previous two decades, only six human cases of WNND were detected in Spain. Reduced activities for vector control this season, together with other factors, might have contributed to the massive increase. Public health measures including vector control, campaigns to raise awareness among physicians and the general population, and interventions to ensure the safety of donations of blood products, organs, cells and tissues were effective to reduce transmission. Going forward, maintenance of vector control activities and an update of the vector-borne diseases response plan in Spain is needed.
Abstract 13023: Incremental Diagnostic Accuracy of Hybrid Single Photon Emission Computed Tomography Coronary Angiography in Suspected Coronary Artery Disease
Authors: Shoko Hachiya, Hisanori Kosuge, Yasuhiro Fujita, Satoshi Hida, Taishiro Chikamori
Journal: Circulation (2020)

Background: Single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) are often undertaken independently in patients with suspected coronary artery disease (CAD). Hypothesis: We assessed the hypothesis that hybrid SPECT/CTCA imaging results in higher diagnostic accuracy than either method alone, allowing some false positives to be ruled out in the non-invasive testing phase. Methods: A total of 129 vessels (43 patients) were screened by SPECT with cadmium-zinc-telluride semiconductors and CTCA with a 256-detector row CT of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex (LCX) segments. Patients who were diagnosed with myocardial ischemia then went on to undertake CAG. A diameter stenosis &gt; 50% and any non-diagnostic segment in CTCA were considered abnormal. CAG results were classified as positive for stenosis when either a diameter stenosis was over 75% or fractional flow reserve was under 0.8. These were then compared to an image fusion of SPECT and CTCA data sets performed on a dedicated workstation. The results were categorised as a match or a mismatch (same as or different to the CAG, respectively). Results: Matched findings at SPECT, CTCA, and hybrid imaging were found in vessels of 75%, 67%, and 92%, respectively. Compared to the individual diagnostic performance of SPECT or CTCA in detecting significant CAD, hybrid imaging exhibited greater results in all of sensitivity, specificity, and accuracy (Fig 1). Segmental reclassification of perfusion abnormalities by hybrid imaging occurred at 10% for LAD, 56% for LCX, and 5% for RCA. Moreover, hybrid imaging allowed for accurate diagnosis of 22 vessels with severe calcification which CTCA alone could hardly evaluate correctly (Fig 2). Conclusions: Hybrid imaging showed higher diagnostic accuracy compared to single modalities, enabling physicians to make better decisions about the necessity for invasive CAG procedure.
Superior efficacy of co-targeting GFI1/KDM1A and BRD4 against AML and post-MPN secondary AML cells
Authors: Warren Fiskus, Christopher P. Mill, Behnam Nabet, Dimuthu Perera, Christine Birdwell, Taghi Manshouri, Bernardo Lara, Tapan M. Kadia, Courtney DiNardo, Koichi Takahashi, Naval Daver, Prithviraj Bose, Lucia Masarova, Naveen Pemmaraju, Steven Kornblau, Gautam Borthakur, Guillermo Montalban-Bravo, Guillermo Garcia Manero, Sunil Sharma, Matthew Stubbs, Xiaoping Su, Michael R. Green, Cristian Coarfa, Srdan Verstovsek, Joseph D. Khoury, Christopher R. Vakoc, Kapil N. Bhalla
Journal: Blood Cancer Journal (2021)

Abstract There is an unmet need to overcome nongenetic therapy-resistance to improve outcomes in AML, especially post-myeloproliferative neoplasm (MPN) secondary (s) AML. Studies presented describe effects of genetic knockout, degradation or small molecule targeted-inhibition of GFI1/LSD1 on active enhancers, altering gene-expressions and inducing differentiation and lethality in AML and (MPN) sAML cells. A protein domain-focused CRISPR screen in LSD1 (KDM1A) inhibitor (i) treated AML cells, identified BRD4, MOZ, HDAC3 and DOT1L among the codependencies. Our findings demonstrate that co-targeting LSD1 and one of these co-dependencies exerted synergistic in vitro lethality in AML and post-MPN sAML cells. Co-treatment with LSD1i and the JAKi ruxolitinib was also synergistically lethal against post-MPN sAML cells. LSD1i pre-treatment induced GFI1, PU.1 and CEBPα but depleted c-Myc, overcoming nongenetic resistance to ruxolitinib, or to BETi in post-MPN sAML cells. Co-treatment with LSD1i and BETi or ruxolitinib exerted superior in vivo efficacy against post-MPN sAML cells. These findings highlight LSD1i-based combinations that merit testing for clinical efficacy, especially to overcome nongenetic therapy-resistance in AML and post-MPN sAML.
Obinutuzumab As Consolidation after Chemo-Immunotherapy Is Highly Effective in Achieving MRD Clearance from Bone Marrow and Peripheral Blood- Initial Results of UK NCRI Phase II/III Galactic Trial
Authors: Talha Munir, Peter Hillmen, Lucy McParland, Dena Cohen, Anna Hockaday, Jamie Oughton, Fabrizio Messina, David Phillips, Jeffrey R. Neilson, Nicholas Pemberton, Shankara Paneesha, Ben Kennedy, Andy Rawstron
Journal: Blood (2017)
Abstract 16853: Retrograde Peripheral Limb Perfusion for Formidable Femoral Arterial Access in Veno-Arterial ECMO Treatment
Authors: Laszlo Gobolos, Maurice Hogan, Vivek Kakar, Stefan Sanger, Nuno Raposo, GOPAL BHATNAGAR, Woosup Park
Journal: Circulation (2020)

Introduction: VA ECMO has emerged to a well-established therapeutic method in severe acute heart failure. In the case of peripheral ECMO placement, especially applying direct arterial cannulation, the limb perfusion is often compromised by an occlusive effect of the cannula positioned in the femoral artery. The classical proximal femoral arterial reperfusion branch provides sufficient blood flow via a small auxiliary cannula, but in patients with severe peripheral arterial vasculopathy or with significant tissue depth resulting from obesity, the placement of a peripheral arterial perfusion loop may pose a technical challenge. Methods: In case of emerging peripheral ischemic symptoms at femoral VA ECMO placement, ultrasound scanning of the lower limb vessels is performed. In an uncomplicated vascular situation, antegrade distal perfusion can be established. If a significant vasculopathy is present in the proximal vessels, or any further hindrances, including extreme obesity, physically not allowing a subtle perfusion cannula placement resulting from the discrepancy between the tissue depth and cannula length, retrograde peripheral perfusion could be established via the dorsal pedal artery utilising the Seldinger method. An ultrasonographic guidance is essential; hence there is sometimes no backflow present on the inserted cannula in a critically ischemic limb. Following sufficient de-airing manoeuvres, the retrograde femoral flow can be safely established; NIRS confirms the successful reperfusion in a short timeframe. If the dorsal pedal artery is not sufficient for cannulation purposes, the postmalleolar posterior tibial artery segment or the anterior tibial artery through the similarly named muscle can be utilised for cannulation purposes. Results: Two patients showed a pre-reperfusion calf saturation of 29% and 38%, which has increased to 61% and 64% after re-establishing the distal flow within minutes, respectively. We have experienced no complications emerging during the application of the above method. Conclusions: In case of peripheral vascular disease or the body habitus does not allow safe installation of an antegrade flow device, our retrograde perfusion option can save the affected limb on VA ECMO therapy.
Abstract 16101: Factors Associated With Implantable Cardioverter-Defibrillator Placement Among U.S. Veterans With Left Ventricular Ejection Fraction ≤35% at Least 40 Days After Acute Myocardial Infarction
Authors: Gregory L Judson, Beth Cohen, Anoop Muniyappa, Merritt Raitt, Hui Shen, Gary Tarasovsky, Mary Whooley, Sanket Dhruva
Journal: Circulation (2020)

Introduction: Implantable cardioverter defibrillators (ICD) reduce the risk of sudden cardiac death among patients with persistently low (≤35%) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). There are limited data about clinical factors associated with ICD placement following AMI. Hypothesis: We hypothesized that increasing age and number of comorbidities would decrease the odds of ICD placement post-AMI among patients with low (≤35%) LVEF, while revascularization for AMI would increase odds of ICD use. Methods: We used ICD-9 and 10 codes to identify all Veterans hospitalized for AMI from 2004-2017 and excluded Veterans with prior ICD and those who died during AMI hospitalization. We used a validated natural language processing algorithm to determine LVEF from echocardiograms performed 40-365 days post-AMI and identified patients with LVEF ≤35%. Using multivariable logistic regression, we examined the association of demographics, comorbidities, revascularization status for AMI, and prescription of guideline-directed medical therapy (GDMT) with the primary outcome of ICD placement 41-365 days post-AMI. Results: Of 10,447 Veterans eligible for an ICD, 1,966 (18.8%) received an ICD. Of 1,966 patients who received an ICD 7.1% died within 1-year, compared with 26.8% of patients who did not receive an ICD. In multivariable analysis, younger age, fewer comorbidities, revascularization during AMI hospitalization, and use of GDMT were associated with increased odds of receiving an ICD (Table). Eligible Black patients were less likely (OR 0.78, 95% CI 0.67-0.90) to receive an ICD than White patients. Conclusions: Many factors affect ICD placement among patients with reduced LVEF post-AMI. In particular, Black patients were less likely to receive ICDs than White patients. Future qualitative work could provide a deeper understanding of how patient and clinician factors influence decisions around ICD use.
Abstract 16272: The Mechanism of Lean Body in SOD1 Deficient Mice With High Fat High Sucrose Diet: The Role of Activated AMP-Activated Protein Kinase With Oxidative Stress
Authors: Atsushi Sato, Yasunaga Shiraishi, Ayumu Osaki, Toyokazu Kimura, Takumi Toya, Risako Yasuda, Takayuki Namba, Hirotaka Yada, Nobuyuki Masaki, Takeshi Adachi
Journal: Circulation (2017)

Introduction: Intracellular reactive oxygen species (ROS) not only injure cells, but play as signaling molecules. Cu/Zn superoxide dismutase (SOD1) is predominantly expressed in cytosol and modulat...
Abstract 12997: Impact of Baseline Atrial Fibrillation/Flutter on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement With Sapien-3 Valve
Authors: Yasser Sammour, Hassan Mehmood Lak, Sanchit Chawla, Cameron Incognito, Arnav Kumar, Kinjal Banerjee, Lars G Svensson, James J Yun, Zoran B Popovic, Khaldoun Tarakji, Oussama M Wazni, Grant W Reed, Rishi Puri, Amar Krishnaswamy, Samir R Kapadia
Journal: Circulation (2020)

Introduction: Pre-existing atrial fibrillation has been linked with poor outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Objective: We sought to study the impact of baseline atrial fibrillation/flutter (AF) on outcomes after TAVR with SAPIEN-3 (S3) valve. Methods: All consecutive patients with severe symptomatic aortic stenosis who underwent TAVR with S3 valve at the Cleveland Clinic between April 2015 and December 2018 were included. Results: We included 1028 consecutive patients. Overall, the mean age of our study population was 81 ± 8.9 years, 58.8% were males, 95.8% were Caucasians. Pre-existing AF was present in 432 patients (42%). STS risk score was higher with AF compared to no AF (6.7 ± 3.8% vs. 5.4 ± 3.4%; p &lt; 0.001). Baseline left ventricular ejection fraction (LVEF) was lower with AF (54% vs. 58%; p &lt; 0.001). The rates of 30-day permanent pacemaker (PPM) implantation were similar between AF and no AF (11.4% vs. 9.4%; p = 0.326), as were the rates of new-onset left bundle branch block (LBBB) at discharge (9.6% vs. 9.4%; p = 0.901). There was also no difference in stroke rates at 30 days between the 2 groups (1.6% vs. 1%; p = 0.385). Post-TAVR mild or greater aortic regurgitation (AR) was higher with AF compared to no AF (21.5% vs. 16%; p = 0.022). LVEF was lower with AF at both 30 days (56% vs. 58.5%; p &lt; 0.001) and 1 year (56% vs. 59%; p &lt; 0.001). However, the change in LVEF (Δ) after TAVR was similar between AF and no AF (+1.1% vs. +1.4%; p = 0.624). At 2 years, all-cause death was higher with AF (22.9% vs. 12.8%; log-rank p = 0.011). There was no mortality difference between persistent versus paroxysmal AF (log-rank p = 0.714). Conclusions: Among our S3 TAVR patients, AF did not affect PPM, new-onset LBBB or stroke rates after the procedure. AF was associated with higher mild or greater AR at 30 days, as well as lower LVEF at both 30 days and 1 year compared to no AF. There was significantly higher all-cause mortality in the AF group at 2 years after TAVR.
Abstract 17000: Quantifying Mitral Annular Calcification Using Echocardiography: Comparison to MAC Calcium Score From Gated Computed Tomography
Authors: William Harvey, Sheldon Litwin
Journal: Circulation (2020)

Introduction: Mitral Annular Calcification (MAC) is present in 25-40% of people ≥ 60 years old and has associations with atrial fibrillation, stroke, endocarditis, mitral regurgitation, and mitral stenosis. MAC poses major challenges to surgical or transcatheter mitral valve interventions. Current echocardiographic methods for assessing MAC are limited. Goals: To assess transthoracic echocardiographic (TTE) approaches for quantifying MAC severity compared to a gold standard of MAC calcium score by gated computed tomography (CT). Methods: 75 patients undergoing evaluation for TAVR had TTE and CT in close proximity. MAC area and circumference were measured in parasternal long-axis (PLAX), parasternal short-axis (PSAX), and apical 2, 3, and 4-chamber views on TTE. Mitral valve gradients and left atrial volume were recorded. The curvilinear length of MAC in the PSAX view on TTE and cardiac CT were also measured. Associations between various TTE measures and MAC calcium score were assessed using linear regression. Results: Median age was 75.3, 50.4% female, 85.3% Caucasian. MAC area and circumference in PSAX on TTE showed moderate correlations (R 2 =0.32-0.37) with MAC calcium score. Curvilinear MAC length measures on SAX TTE and CT had improved correlation with MAC score (R 2 =0.41 &amp; 0.78, Figure). Combined circumference of MAC from PLAX+PSAX had the strongest association (R 2 = 0.48). Interobserver variability on CT and TTE had coefficients of variation ranging 17-37%. Left atrial volume and mitral valve gradients had weak associations with MAC severity (R 2 =0.03-0.12). Tertiles of MAC calcium scores were 2650, 5150 and 7750. Conclusions: MAC length in the PSAX view showed the strongest association with MAC severity. Dedicated PSAX views of the mitral annulus may improve the ability to reproducibly grade MAC severity by echo.
Abstract 12098: Early Detection of Hemorrhagic Myocardial Infarction With Multidetector Computed Tomography Immediately After Primary Angioplasty in Patients With Acute Myocardial Infarction
Authors: Koichi Tamita, Shuichiro Kaji, Toshiharu Iwamura, Mika Maeda, Toshiki Fujiwara, Kazunori Yoshida, Junichi Yoshikawa
Journal: Circulation (2012)

Background: Recent studies have shown that transmural delayed enhancement pattern on multidetector computed tomography (MDCT) without iodine re-injection immediately after primary percutaneous coro...
Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci
Authors: Davide Cao, Matthew A Levin, Samantha Sartori, Anastasios Roumeliotis, Rishi Chandiramani, Johny Nicolas, Zaha Waseem, Rashi Bedekar, Bimmer E Claessen, Ridhima Goel, Mauro Chiarito, Bonnie Lupo, Jeffrey Jhang, George Dangas, Usman Baber, Deepak L Bhatt, Samin K Sharma, Annapoorna Kini, Roxana Mehran
Journal: Circulation (2020)

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.