tbuckley/cabot-search huggingface dataset:
Abstract 13662: The Arrhythmogenic Impact of Heart Failure With Preserved Ejection Fraction on Diabetics: Insights From A Nationally Representative Sample
Authors: Mahmood Mubasher, Mouhand Mohamed, amir hanafi, Tausif Syed, Mohamed Magdi, Shaban Mohammed, Abdullah S Abdullah, Mohammed Danjuma, Richard Alweis, Harry McCrea, Mohan C Rao, Ryan Hoefen
Journal: Circulation (2020)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is emerging as a significant clinical concern among people with DM with recent studies showing that 45% of patients with HFpEF have DM. Sudden death accounts for around 20% of deaths in the HFpEF population, with diabetics running the highest risk. DM and HFpEF are associated with endothelial dysfunction, interstitial fibrosis, and repolarization changes that may predispose to ventricular arrhythmias (VA). However, the burden of VA in people with DM and HFpEF is not well elucidated. Hypothesis: We hypothesize that patients with DM and HFpEF have a higher prevalence of VA than patients with DM only. Methods: We queried the national inpatient sample (NIS) from 2012 to 2014 for patients age&gt;=18years. We excluded heart failure with reduced ejection fraction and hypertrophic cardiomyopathy. Subsequently, we used ICD-9-CM codes to identify discharges associated with HFpEF, DM, VT, VF, and QTc prolongation. We divided patients into two groups: DM/HFpEF vs. DM/non-HFpEF. 1ry-outcome was VT Prevalence. 2ry-outcomes are VF prevalence, QTc prolongation, length of stay (LOS), and in-hospital mortality. We used multivariate logistic regression (MLR) to devise the propensity scores. Propensity score matching (PSM) was performed. Standardized mean difference &lt;0.1 indicates covariate homogeneity. Results: We Identified 326545 hospitalizations among the HFpEF group and 3625130 among the non-HFpEF group. HFpEF group tended to be older, females, and had higher rates of obesity and other comorbidities and. On PSM+MLR, HFpEF group had higher Odds of VT (2.1% vs. 1.9%; OR, 1.06; 95%CI, 1.03-.10; P, &lt;0.001) and higher LOS. Nonetheless, VF and In-hospital mortality were surprisingly higher in the non-HFpEF group. No difference in QTc prolongation between both groups. Conclusions: HFpEF was associated with higher rates of VT among patients with diabetes, although there was no change in in-hospital mortality.
Abstract 16636: Cardiac Microstructural Associations With Metabolic Syndrome Differ by Sex
Authors: Gerran Salto, Alan C Kwan, Ewa Osypiuk, Plamen Stantchev, Elizabeth H Kim, Pranoti Hiremath, Susan Cheng
Journal: Circulation (2020)

Background: Alterations in the orientation and integrity of myocardial fibers can be assessed using ultrasonic image analysis. The ability to detect such microstructural abnormalities may shed light on sex differences in the progression from metabolic risk factors to overt cardiac disease. Methods: In a community-based cohort of N=2510 adults (age 66±9 years, 56% women) without overt cardiovascular disease, we evaluated whether a novel echocardiography-based assessment of left ventricular myocardial microstructure, the signal intensity coefficient (SIC), could detect tissue-level alterations that are associated with metabolic risk factors, such as body mass index (BMI) and the metabolic syndrome. Results: In multivariable models adjusting for age and BMI, women had a significantly greater degree of cardiac microstructural alteration (coeff 0.15; s.e. 0.06, P=0.007) in the presence of metabolic syndrome, whereas this association was only borderline significant in men (coeff 0.11; s.e. 0.06, P=0.07) ( Figure ). Notably, there was no sex-specificity in the associations of either age or BMI with cardiac microstructure. Conclusion: A novel index of myocardial tissue alteration is significantly associated with presence of metabolic syndrome, even after adjusting for body size, and more prominently in women than in men. Further research is needed to examine the extent to which cardiac microstructural abnormalities may mediate the metabolic risks for cardiac disease, particularly in women.
COVID-19 and IBD drugs: should we change anything at the moment?
Authors: Charlie W Lees, Peter M Irving, Laurent Beaugerie
Journal: Gut (2020)

The COVID-19 pandemic has raised questions about the management of people with inflammatory bowel disease (IBD).1 To date, there have been over 43 million confirmed cases of COVID-19 globally, including over 1.1 million deaths (https://COVID-19.who.int). What have we learnt about the risks of SARS-CoV-2 infection in patients with IBD and is there any evidence to support a change in IBD management?

Established risk factors for poor COVID-19 outcomes are older age, male sex, obesity, non-white ethnicity, type 2 diabetes, social deprivation and a range of comorbidities (respiratory disease, cardiovascular disease, stroke, malignancy and liver disease).2 Based on prior knowledge and early observations from China and Italy, patients with IBD felt to be at higher risk included older patients with comorbidities, patients on higher doses of systemic corticosteroids and patients with active disease.1 3 However, they were generally advised not to stop IBD treatment in order to minimise the risk of flare, steroid prescription and hospitalisation during the pandemic.1 

The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) Registry was set up to collect data on confirmed SARS-CoV-2 infections in people with IBD to address the urgent need for information guiding decisions about drug therapy during a time of great uncertainty. This physician-reported registry has accrued over 2700 cases to date (https://covidibd.org/current-data/). An initial analysis of 521 patients reported an association between corticosteroids and adverse COVID-19 outcomes.4 Ungaro and colleagues now report an expanded analysis on the first 1439 cases.5 These cases were 34.5% from the USA, 51.4% male individuals and 82.1% white. Overall, 38.5% of patients were on anti-tumour necrosis factor (TNF) therapy and 30.6% were taking a 5-amino salicylic acid (5-ASA) preparation. The primary outcome measure of severe COVID-19 disease was …
Abstract 13829: Index Event, Clinical Outcomes and Response to Vericiguat in the Victoria Trial
Authors: Carolyn Lam, Karen S Sliwa, Anna Giczewska, Kevin Anstrom, Frank Edelmann, Jens Refsgaard, Edimar A Bocchi, Justin Ezekowitz, Adrian F Hernandez, Christopher O'Connor, Lothar ROESSIG, Mahesh J Patel, Burkert Pieske, Paul W Armstrong
Journal: Circulation (2020)

Introduction: The VICTORIA (Vericiguat Global Study in Subjects with HF with Reduced EF) trial included 5050 patients in 3 discrete subgroups reflecting their index worsening heart failure (HF) event: &lt;3 months after HF hospitalization (HFH) (n=3366), 3-6 months after HFH (n=871), and those requiring IV diuretic therapy without HFH within the prior 3 months (n=813). We evaluated clinical characteristics, outcomes and treatment response to vericiguat across these index event subgroups in VICTORIA. Methods: We compared primary composite (CV death and HFH) and secondary (all-cause death and HFH) outcomes across index event subgroups, both before and after adjusting for clinical covariates (HF duration, NYHA class, medical history, heart rate, HF medications and laboratory values including baseline NT-proBNP), as well as their response to vericiguat. Results: Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow up of 10.8 months, the absolute primary event rates were high in all subgroups (20.5 - 42.5 per 100 patient-years, Figure). Compared to the IV diuretic group highest relative risk was in HFH &lt;3 months (HR 1.69, 95% CI 1.46-1.95), followed by HFH 3-6 months (HR 1.26, 95% CI 1.06-1.50). After multivariable adjustment, this difference remained significant only in HFH &lt;3 months (adjusted HR [vs IV diuretic] 1.47, 95% CI 1.26-1.72). Vericiguat was associated with reduced risk of the primary outcome overall (HR 0.90, 95% CI 0.82-0.98) and in all 3 subgroups, with no evidence of treatment heterogeneity. Similar results were evident for the secondary composite outcome. Conclusions: Among patients with worsening chronic HF, those within a 3 month window of HFH had almost a 1.5 times risk of CV death or HFH compared to those requiring IV diuretics but not HFH , irrespective of age or clinical risk factors. Vericiguat added to standard therapy was associated with similar benefit across the spectrum of risk in worsening HF.
Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function
Authors: Raj K Dalsania, Kaitlyn Ibrahim, Rohit Soans, Abdullah Haddad, Vikram J Eddy, Lauren Tragesser, Liti Zhang, Isaac R Whitman, Joseph J McComb, Martin G Keane
Journal: Circulation (2020)

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.
Analgesia and sedation in patients with ARDS
Authors: Gerald Chanques, Jean-Michel Constantin, John W. Devlin, E. Wesley Ely, Gilles L. Fraser, Céline Gélinas, Timothy D. Girard, Claude Guérin, Matthieu Jabaudon, Samir Jaber, Sangeeta Mehta, Thomas Langer, Michael J. Murray, Pratik Pandharipande, Bhakti Patel, Jean-François Payen, Kathleen Puntillo, Bram Rochwerg, Yahya Shehabi, Thomas Strøm, Hanne Tanghus Olsen, John P. Kress
Journal: Intensive Care Medicine (2020)
Abstract 15018: Incremental Prognostic Utility of Adverse Right Ventricular Remodeling in Patients With Covid-19 Infection: A Multicenter Cohort Study
Authors: Alexander Volodarskiy, Razia Sultana, Meridith P Pollie, Brian Yum, Arindam RoyChoudhury, Romina Tafreshi, Hannah Mitlak, Leslee J Shaw, Evelyn M Horn, Parag Goyal, Monika M Safford, Richard B Devereux, Jonathan W Weinsaft, Jiwon Kim
Journal: Circulation (2020)

Introduction: COVID-19 is a growing pandemic that confers augmented risk for RV dysfunction and dilation; prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. Hypothesis: To test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. Methods: Consecutive adult COVID-19 patients undergoing clinical transthoracic echo at three NYC hospitals were studied; images were analyzed by a central core lab blinded to clinical and biomarker data. Results: Of 510 patients (64±14 years, 66% male) studied, RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p=0.015). During inpatient follow-up (median 20 days), there were 165 deaths (32%) and 229 discharges (45%). RV dysfunction (HR 2.25 [CI 1.26-3.98]; p=0.006) and dilation (HR 1.82 [CI 1.11-2.97]; p=0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR 1.39 [CI 1.01-1.90]; p=0.04). Figure 1A demonstrates prognostic utility for each echo-quantified RV parameter (p&lt;0.05) in relation to all-cause mortality. Figure 1B shows RV indices to provide risk stratification beyond biomarker strata, as evidenced by greatest risk for death among patients with both adverse RV remodeling and positive biomarkers, and lesser risk among patients with isolated biomarker elevations. RV remodeling conferred over a 2-fold increase in mortality risk (HR 2.68 [CI 1.70-4.23]; p&lt;0.001), which remained significant when controlling for biomarker elevations, irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. (p&lt;0.01). Conclusions: Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.
Abstract 16752: Cumulative Social Determinant of Health Risk Score and Prevalent Atherosclerotic CVD Among National Representative Adult Population in US
Authors: Ramzi Dudum, Javier Elizondo, Tamer Yahya, Mohammad Hashim Jilani, Julia Andrieni, Adnan Hyder, Ron Blankstein, Garima Sharma, Salim S Virani, Michael J Blaha, Miguel Cainzos Achirica, Khurram Nasir
Journal: Circulation (2020)

Introduction: Social determinants of health (SDOH) are contextual factors and shared experiences that impact an individual’s life and health. Unfavorable SDOH are recognized as a major source of excess cardiovascular disease (CVD) risk; however, prior studies have focused on restricted sets of SDOH domains. We aimed to assess the burden of multiple unfavorable SDOH at the population level, and the association between increasing cumulative burden of unfavorable SDOH features and atherosclerotic CVD (ASCVD) prevalence. Methods: Using a nationally-representative sample of 164,696 adults from the National Health Interview Survey (2013-17) we identified 39 parameters (classified as favorable or unfavorable) from the Healthy People 2020SDOH domains: Economic stability, Education, Food access, Neighborhood conditions, Social context, Health systems. An aggregate score of these features ranging 0-36 was then divided into quartiles-- the most unfavorable scores in the highest quartile. ASCVD was ascertained via self-report. Results: 15,758 individuals (8%), representing ~19.6 million Americans, had ASCVD and were more likely to experience economic instability, adverse neighborhood and social cohesion, psychologic distress, food scarcity, and significant cost and non-cost-related healthcare barriers than those without ASCVD. The age adjusted mean (SD) SDOH risk score among ASCVD vs non-ASCVD participants was 12.5 (0.13) vs 0.9 (0.03) respectively. We observed a graded increase in ASCVD prevalence with higher SDOH quartiles (Figure). In multivariate analyses, adults with highest SDOH scores had 2-fold higher odds of having ASCVD compared to those with lowest scores (Figure). Conclusions: In the US, aggregate SDOH risk significantly discriminate risk of prevalent ASCVD among US adults. Standardized SDOH risk scores have the potential to inform risk stratification models at the individual level for addressing avoidable social inequities in health status.
Abstract 16243: Co-existing Amyloidosis is Associated With Increased Inpatient Mortality in Patient Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample
Authors: Iriagbonse Asemota, Emmanuel Akuna, Ehizogie Edigin, Hafeez Shaka, precious O Eseaton, Mavi Rivera Pavon, Praise Nwachukwu
Journal: Circulation (2020)

Introduction: Amyloidosis is associated with conduction disturbances of the heart such as atrial fibrillation (AF). The outcomes of atrial fibrillation in patients with concomitant diagnosis of amyloidosis is not clearly established. This aim of this study is to compare outcomes of AF hospitalization with and without a secondary diagnosis of amyloidosis Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without a secondary diagnosis of amyloidosis (irrespective of specific organ involvement) using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were total hospital charge, rates of electrical cardioversion, pharmacologic cardioversion, and pacemaker implantation. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 715 (0.09%) had amyloidosis. AF hospitalizations with amyloidosis had higher inpatient mortality (AOR 4.56, CI 2.15-9.68, P&lt;0.001) compared to those without amyloidosis. There was no difference in rates of ablation (AOR 0.59, CI 0.22-1.63, P=0.314), pacemaker implantation (AOR 1.18, CI 0.38-3.70, P=0.780) and electrical cardioversion (AOR 0.91, CI 0.58-1.41, P=0.650) and pharmacologic cardioversion (AOR 0.99, CI 0.97-1.02, P=0.560) compared to those without amyloidosis. Conclusion: Patients admitted primarily for AF with co-existing amyloidosis have increased inpatient mortality compared to those with amyloidosis. Rates of ablation, pacemaker implantation, electrical, and pharmacologic cardioversion were similar in both groups.
Transcriptional Activation of MYC-Induced Genes by GCN5 Promotes B-cell Lymphomagenesis
Authors: Aimee T. Farria, Joshua B. Plummer, Andrew P. Salinger, Jianjun Shen, Kevin Lin, Yue Lu, Kevin M. McBride, Evangelia Koutelou, Sharon Y.R. Dent
Journal: Cancer Research (2020)

Abstract Overexpression of the MYC oncoprotein is an initiating step in the formation of several cancers. MYC frequently recruits chromatin-modifying complexes to DNA to amplify the expression of cancer-promoting genes, including those regulating cell cycle, proliferation, and metabolism, yet the roles of specific modifiers in different cancer types are not well defined. Here, we show that GCN5 is an essential coactivator of cell-cycle gene expression driven by MYC overexpression and that deletion of Gcn5 delays or abrogates tumorigenesis in the Eμ-Myc mouse model of B-cell lymphoma. Our results demonstrate that Gcn5 loss impacts both expression and downstream functions of Myc. Significance: Our results provide important proof of principle for Gcn5 functions in formation and progression of Myc-driven cancers, suggesting that GCN5 may be a viable target for development of new cancer therapies.
Abstract 14194: Triple Vessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia
Authors: Franz Schweis, Ara Rostomian, Derek Phan, Mingsum Lee, Anne Ichiuji, Albert Yuh-Jer Shen, Naing Moore
Journal: Circulation (2020)

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare albeit well-established etiology of myocardial infarction and most commonly involves a single coronary vessel. We present a unique case of a patient presenting with chest pain and found to have triple vessel SCAD with associated findings suggestive of coronary artery fibromuscular dysplasia (FMD). Case Presentation: A 53 year-old woman with a past medical history of hypertension and chronic headaches presented with intermittent exertional substernal chest pain for two days. Labs were significant for an elevated Troponin-I of 0.12 ng/mL (normal &lt; 0.04 ng/mL). Coronary angiogram revealed tortuous vessels with evidence of SCAD in multiple coronary arteries including the left anterior descending artery (LAD), posterior descending artery (PDA), and posterior left ventricular artery (PLV) (Figure A, B). Intracoronary nitroglycerin was administered during the procedure to ensure the findings were not due to coronary vasospasm. Due to the known association of SCAD and FMD, a renal angiogram was performed, which demonstrated a “beading” appearance of the right renal artery consistent with renal artery FMD. She was conservatively managed with medical therapy.A head computed tomography angiogram (CTA) was performed, which showed evidence of FMD of the bilateral vertebral arteries. A repeat coronary angiogram was performed six weeks after discharge. She was found to have complete resolution of SCAD in the LAD and PLV (Figure C, D). Interestingly, the PDA displayed a “string of beads” appearance concerning for intracoronary artery FMD (Figure D). Conclusion: Our case demonstrates evidence that coronary artery FMD may contribute to the underlying etiology of the coronary artery dissection. A conservative management approach resulted in a favorable outcome and the patient was able to avoid unnecessary intervention and potential related complications.
Abstract 14311: Qt Interval Correlation Between Telemetry and 12-lead Electrocardiogram
Authors: Mohamed Farhan Nasser, Ahmad Jabri, Saima Karim, Elizabeth Kaufman
Journal: Circulation (2020)

Introduction: QT prolongation is associated with increased risk of ventricular arrhythmias.As many patients with COVID19 may be started on QT prolonging drugs, measuring and monitoring QT is imperative to prevent fatal ventricular arrhythmias. However, we need to limit exposure of staff to patients with confirmed COVID19 and judiciously use personal protective equipment. Thus, it is important to find alternatives to doing frequent 12-lead ECGs. Hypothesis: We hypothesize that the QT interval measured from telemetry is similar to the QT interval on 12-lead ECG. Methods: Telemetry recordings and 12-lead ECGs were obtained from 15 patients at the same time and identical heart rates. Patients were from two different inpatient units with the same telemetry monitoring service. QT intervals were measured manually using calipers with the tangent method, excluding U waves. Telemetry recordings included lead I and II or a precordial lead. QT from telemetry was compared to the corresponding leads and to the longest QT on the 12-lead ECG. In cases of atrial fibrillation (AF), the QT from all the complexes was averaged. Results: Of 15 patients, 2 were in AF and 2 had RBBB. One patient had abnormal T-wave morphology and QT prolongation (abnormal repolarization). In all patients, QT intervals from the same leads as telemetry matched the QT measured from 12-lead. In 14 of 15 patients, telemetry QT matched the longest QT on the 12-lead ECG. However, in the patient with abnormal repolarization, maximum QT on 12-lead ECG was substantially longer than telemetry QT (Figure 1). Conclusion: When using the same lead, QT intervals were identical on telemetry and 12-lead ECG. However, in the patient with abnormal repolarization, the longest QT on 12-lead ECG was not represented on telemetry. In patients with abnormal repolarization on 12-lead ECG, we recommend serial 12-lead ECGs while on QT-prolonging drugs. Telemetry may suffice as a surrogate for 12-lead ECG to follow QT intervals in most patients.