tbuckley/cabot-search huggingface dataset:
Abstract 16917: The Forgotten Prolapsed Mitral Valve in a Patient With Sudden Cardiac Arrest
Authors: Mark W Vanderland, YinnShaung Ooi, Muhammad Shakir, Douglas Esberg
Journal: Circulation (2020)

Current literature suggests that the incidence of sudden cardiac arrest (SCA) attributable to mitral valve prolapse (MVP) is more common than historically presumed. Although its true incidence remains unknown, this novel realization suggests that the presence of MVP after resuscitated SCA should prompt exploratory identification of a causative association between MVP and SCA, even in the presence of other plausible explanatory findings. Case Description: A 60-year-old male with a history of hypertension presented with an out-of-hospital cardiac arrest due to ventricular fibrillation (VF). Coronary angiography revealed a 99% occluded 1st diagonal branch which was stented. TTE showed normal biventricular function and coincidentally found a myxomatous mitral valve with bileaflet prolapse. The patient was discharged without further work up under the rationale that the ischemic etiology of his arrest was reversed. 6 months later, he presented with another episode of VF arrest. EKG showed sinus bradycardia and a QTc of 534ms. Troponin was negative. Coronary angiography revealed a patent stent and coronary vessels. A cardiac MRI was obtained to investigate the arrhythmic significance of his MVP and showed late gadolinium enhancement in the basal inferolateral wall and tips of the mitral papillary muscles. A dual chamber implantable cardiac defibrillator was placed with a plan for future mitral valve repair. Discussion: Recent studies suggest that the estimated annual risk of SCA due to MVP is 0.2% to 1.9%, a figure higher than previously reported. Certain EKG, TTE and cardiac MRI findings have been associated with an increased risk of ventricular arrhythmias and SCA. In this patient, this included bileaflet MVP, mitral antral disjunction, and inferobasal wall and papillary muscle fibrosis. Currently, there are no society guidelines to assist in the identification of patients with MVP at high-risk for SCA. Nonetheless, in patients with MVP resuscitated from SCA, further workup to identify high risk features is reasonably justified to guide secondary SCA prophylaxis, even in the presence of other explanatory findings for SCA.
Abstract 14176: Pulmonary Effective Artery Elastance as a Novel Predictor of Adverse Events in Patients With Pulmonary Embolism
Authors: Hayaan Kamran, Essa Hariri, Jean-Pierre Iskandar, Aditya Sahai, Ihab haddadin, Joseph Campbell, Serge C Harb, Joseph M Delehanty, John R Bartholomew, Gustavo Heresi, Scott J Cameron
Journal: Circulation (2020)

Introduction: Risk stratification tools including the Pulmonary Embolism Severity Index (PESI) and BOVA rely on complicated calculations that give less attention to hemodynamic parameters predictive of cardiogenic shock in acute pulmonary embolism (PE). We explored the possibility that simultaneous measurement of right sided and left sided non-invasive hemodynamic parameters by echocardiography may predict adverse sequelae in the context of acute PE. Methods: We retrospectively reviewed all Pulmonary Embolism Response Team (PERT) activations between 2014 and 2020. The PESI and BOVA scores were calculated and their performance in predicting adverse events was compared to pulmonary artery elastance (PAE). PAE (mmHg/mL) was calculated by dividing the Pulmonary Artery Systolic pressure (PASP) by the LV Stroke (SV). Blood biomarkers (troponin T, NT-proBNP, and lactate) were recorded. The composite primary outcome was: 1) need for advanced intervention, 2) cardiac arrest, and 3) in-hospital mortality. Multivariate and univariate regression was used to analyze outcomes. Results: 215 of 343 patients met inclusion criteria. Baseline characteristics were similar in patients with PAE &lt;1 and PAE ≥ 1. PAE ≥ 1 was common in intermediate-high risk PE (85.7% vs 63.1%, p &lt;0.001), with greater [NT-proBNP, pg/mL] (3599 vs 1427.5, p=0.001) and [lactate, mM] (2.9 vs 1.8. p=0.003). PAE ≥ 1 predicted the composite endpoint with odds ratio (OR) of 2.31 (95% CI 1.3-4.2, p=0.005), Comparatively BOVA had adjusted OR of 1.3 (95% CI, 1.1-1.6, p = 0.01) and PESI was not significant with OR of 1.4 (95% CI, 1 -2.1, p = 0.055) in predicting composite outcomes. Conclusion: In the context of acute high risk PE, PAE ≥ 1.0 is a novel and independent predictor of adverse cardiovascular events and mortality that should be prospectively validated.
Is Rehospitalization After Heart Failure Admission a Marker of Poor Quality?: Time for Re-Evaluation⁎⁎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: Christopher M. O'Connor, Mona Fiuzat
Journal: Journal of the American College of Cardiology (2010)
Abstract 16368: Establishment of Administration Protocol of Immunosuppressive Drug for Ips Cell Derived Cardiomyocytes Patch Transplantation in Rat Myocardial Infarction Model
Authors: Emiko Ito, Shigeru Miyagawa, Ai Kawamura, Maki Takeda, Takuji Kawamura, Akima Harada, Kenji Oyama, Noriko Mochizuki-oda, Yoshiki Sawa
Journal: Circulation (2020)

Background: Although Cardiomyogenesis therapy using iPS cells for heart failure should overcome immune rejection because of allogenic cell source, appropriate protocol of immunosuppressant to promise efficacy and safety has not been fully elucidated. In this study, we investigated the duration of immunosuppressant administration that could promise the efficacy of human iPS cell derived cardiomyocytes (hiPSCs-CM) patch transplantation as well as safety. Methods: The hiPSCs-CM patch were transplanted to myocardial infarction model rats with normal immune function in immunosuppressant treatment groups. Control were underwent sham operation and treated with no immunosuppressant (Group1). Immunosuppressant treatment groups were divided into three groups as follows: treated with tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisolone (PSL) for 1month and 1 month tapering period (Group2); treated with TAC, MMF, and PSL for 2month and 1 month tapering period (Group3); and treated with TAC, MMF, and PSL for 3month and 1 month tapering period (Group4). After 6 months, cardiac function and histology were analyzed. Results: hiPSC-CM patch transplantation showed significant improvement cardiac fraction compared to the Group1 (ΔLVEF; Group2 22 ± 3 %, Group3 28 ± 5 %, Group4 23 ± 4 % versus Group1 -15 ± 8 %, P &lt; 0.05) and did not show any differences in immunosuppressant treated groups. The hiPSCs-CM patch were detected for 2 months post-transplant and Improved Cardiac functions were maintained for at least 6 months despite disappearance of the transplanted patch. Fibrosis and cardiomyocyte size were significantly ameliorated in Group2-4 compared with Group1, however, there were significant differences in immunosuppressant treated groups. Furthermore, the Group 2, 3 and 4 showed a greater amount of structurally mature blood vessels compared with Group1, however, there were no significant in immunosuppressant treated groups. Tumor formation was not observed 6 months after transplantation in the Group 2, 3 and 4. Conclusion: 2 months administration of immunosuppressive agent may promise the safety and efficacy of hiPSCs-CM patch transplantation for rat ischemic heart failure model, proposing appropriate recipe of immunosuppressant in clinical trial.
Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey
Authors: Heidi Moseson, Laura Fix, Jen Hastings, Ari Stoeffler, Mitchell R. Lunn, Annesa Flentje, Micah E. Lubensky, Matthew R. Capriotti, Sachiko Ragosta, Hannah Forsberg, Juno Obedin-Maliver
Journal: International Journal of Transgender Health (2020)

Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study - a national, online, longitudinal cohort study of sexual and gender minority people - and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt "at risk" for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient's presumed or stated gender or engagement with gender-affirming hormone therapy.
COVID-19 Outbreak in an Amish Community — Ohio, May 2020
Authors: Hammad Ali, Karthik Kondapally, Paran Pordell, Brandi Taylor, Gisela Medina Martinez, Ellen Salehi, Stacey Ramseyer, Susan Varnes, Nikki Hayes, Sietske de Fijter, Spencer Lloyd
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

In the United States, outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), were initially reported in densely populated urban areas (1); however, outbreaks have since been reported in rural communities (2,3).Rural residents might be at higher risk for severe COVID-19-associated illness because, on average, they are older, have higher prevalences of underlying medical conditions, and have more limited access to health care services.*In May, after a cluster of seven COVID-19 cases was identified in a rural Ohio Amish community, access to testing was increased.Among 30 additional residents tested by real-time reverse transcription-polymerase chain reaction (RT-PCR; TaqPath COVID-19 Combo Kit), † 23 (77%) received positive test results for SARS-CoV-2.Rapid and sustained transmission of SARS-CoV-2 was associated with multiple social gatherings.Informant interviews revealed that community members were concerned about having to follow critical mitigation strategies, including social distancing § and mask wearing.¶ To help reduce the ongoing transmission risk in a community, state and county health department staff members and community leaders need to work together to develop, deliver, and promote culturally responsive health education messages to prevent SARS-CoV-2 transmission and ensure that access to testing services is timely and convenient.Understanding the dynamics of close-knit communities is crucial to reducing SARS-CoV-2 transmission. Investigation and FindingsOn May 9 and May 11, 2020, respectively, a husband and wife in an Amish community in Wayne County, Ohio, experienced COVID-19-related symptoms.Both had nasopharyngeal samples tested and SARS-CoV-2 infection confirmed by receipt of positive RT-PCR results on May 14.The husband, who had a history of chronic obstructive pulmonary disease, participated in church services on May 2 and 3.He was hospitalized on May 15 with fever, cough, and shortness of breath, and received a diagnosis of COVID-19-related pneumonia; he was discharged on May 17.Another adult family
Abstract 15870: External Validation of a Risk Score for Heart Failure in Acute Myeloid Leukemia
Authors: Gregory Cascino, Peter Doukas, Borko Jovanovic, Jessica Altman, Yu Kang, Marielle Scherrer-Crosbie, Nausheen Akhter
Journal: Circulation (2020)

Introduction: HF is a major cause of morbidity and mortality in AML patients. This study was designed as an external evaluation of a risk score to determine the risk of HF in patients treated with anthracyclines for AML. Methods: A validation cohort was composed of 204 consecutive patients with AML treated with anthracyclines. 2DSTE was performed using TomTec software to obtain baseline GLS values. LVEF was calculated using modified Simpson’s biplane method. HF hospitalizations were defined using standard clinical criteria. The HF risk score included a baseline GLS &gt; - 15% (6 points), baseline LVEF&lt;50% (4 points), pre-existing cardiovascular disease (4 points), anthracycline dose &gt;/= 250 mg/m 2 (2 points), and age &gt; 60 years (1 point). Patients were stratified into low (0 to 2 points), medium (3 to 9 points), and high risk (10 to 17 points). Statistical analysis was performed to evaluate event-free survival of the risk categories. Results: The average age of the cohort was 54 with an average risk score of 7 points. 55% of the patients were male. In total, 44 patients (21%) experienced a hospitalization for HF (median time to hospitalization 1 month) within the follow-up period (median 18 months). The observed incidence of HF by risk category was 14% (18 of 130) in the low, 31% (19 of 61) in medium, and 54% (7 of 13) in high risk group. The association between HF and the risk group category was highly significant (p = 0.001). Event-free survival by risk category (Figure 1) was also statistically significant (p = 0.05), with individuals in the high risk category having a reduced event-free survival. Conclusions: This is the first external validation study of a risk score for HF in AML patients. The risk score that we evaluated was successful at identifying patient who were at higher risk of hospitalization for HF. This may be a useful tool in clinical practice to counsel patients regarding the risk of HF after induction chemotherapy with anthracyclines.
Abstract 16778: Ventricular Tachycardia Ablation Outcomes Based on Scar Location in Patients With Ischemic Cardiomyopathy
Authors: Himanayani Mamillapalli, Viorel G Florea, Sravya Veligandla, Smitha Murthy, Jian-Ming Li, Venkatakrishna N Tholakanahalli
Journal: Circulation (2020)

Introduction: Catheter ablation of ventricular tachycardia (VT) reduces implantable cardioverter defibrillator (ICD) therapies, improves hospitalization, and improves survival in patients with ischemic cardiomyopathy (ICM). Hypothesis: The goal of this study is to evaluate outcomes of patients with VT ablation by scar location in patients with ICM. Methods: Consecutive retrospective review of patients with ICM who underwent VT ablation at Minneapolis Veterans Affairs Health Care system between July 2008 and September 2019 were assessed for clinical outcomes. Results: Seventy-five patients with ICM underwent VT ablation during the study period. Average age was 67.6 ± 7 years old and 100% Male. Three patients were lost to follow up. Overall mortality was 53.3% and was highest in the inferior wall scar (IWS) group (Figure 1A, Table). Mean survival after ablation was 2.2 years. Most common cause of death was cardiac which included congestive heart failure, myocardial ischemia, and cardiac arrest (VT and pulseless electrical activity) (Figure 1B). On post-ablation echocardiogram, patients with anterior wall scar (AWS) had a lower mean ejection fraction (23%) compared to IWS group (30%) and this was statistically significant (p &lt; 0.03, two-tailed t-test). The average number of ablations for recurrent VT was 1.4 with no significant difference between the groups. Fifty-five percent of patients were on anti-arrhythmics post ablation. Conclusions: VT ablation patients with IWS mediated VT have a trend towards higher mortality compared to those with AWS. This may be due to neuroregulatory pathway of VTs based on cardiac innervation.
Surgical hepaticogastrostomy as a method for resolving stent migration in endoscopic ultrasound-guided hepaticogastrostomy
Authors: Passakorn Sodarat, Thanawat Luangsukrerk, Pradermchai Kongkam, Orathai Seabmuangsai, Chatchawan Wachiramatharuch
Journal: Endoscopy (2020)

A 54-year-old woman presented with a 1-month history of jaundice. Abdominal CT showed a perihilar hypodense mass measuring 21 × 16 mm in diameter with dilated bilateral intrahepatic bile duct (IHD). Hilar cholangiocarcinoma was diagnosed and palliative biliary drainage was scheduled. Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) was performed with the patient under general anesthesia. A linear echoendoscope along with a 19-gauge EUS-FNA needle, a 0.025-inch guidewire, a 6-French cystotome, and serial bougie dilators up to 8.5 French were used. A 120-mm partially covered stent with distal flared end (Giobore biliary stent; Taewoong Medical Co., Ilsan, Korea) was used to bridge the left IHD and stomach using the extra-scope channel deployment technique. The proximal end was successfully placed into the left IHD, but the distal end unfortunately displaced into the peritoneal cavity. We immediately converted EUS-HGS to exploratory laparotomy ([Video 1]). The displaced distal end of the HGS stent and a hole on the serosal side of the stomach were identified ([Fig. 1]). The distal end of the HGS stent was placed back into the stomach ([Fig. 2]) and sutured to the stomach wall. Surgical hepaticogastrostomy was then successfully performed with the HGS stent. No postoperative adverse events occurred. The patient resumed a regular diet on day 4 and was discharged on day 7. She has been well without a need for biliary reintervention during 15 months of follow-up.
Abstract 16295: Smaller Stent Area and Eccentric Expansion are Associated With Increased Adverse Events After Drug-eluting Stent Implantation in Hemodialysis Patients
Authors: Aritomo Katsura, Yoshiyasu Minami, Kiyoshi Asakura, Masahiro Katamine, Ayami Kato, Takuya Hashimoto, Kentaro Meguro, Takao Shimohama, Junya Ako
Journal: Circulation (2020)

Introduction: Factors for adverse cardiac events after drug-eluting stent (DES) implantation among patients with hemodialysis (HD) remain to be elucidated. Hypothesis: Suboptimal DES implantation is associated with the increased incidence of adverse events in patients with HD. Methods: A total of 109 consecutive patients with HD who underwent optical coherence tomography (OCT)-guided DES implantation were included. The impact of post-stent OCT findings on the incidence of device-oriented clinical endpoints (DoCE) at 1 year was investigated. DoCE included cardiac death, target vessel-related myocardial infarction, target lesion revascularization, and stent thrombosis. Results: There was no significant difference in baseline clinical characteristics and pre-stent lesion characteristics between patients with DoCE (n=15) and those without DoCE (n=94). Significant hazard ratio (HR) for the incidence of DoCE was not observed in the presence of edge dissection, irregular protrusion, or incomplete stent apposition (Panel A). In receiver operating characteristic curve analyses, the best cutoff of minimum stent cross-sectional area (MSA), %stent expansion [MSA / mean reference lumen cross-sectional area х 100], and eccentricity index (minimum stent diameter / maximum stent diameter) at MSA site for detecting DoCE was 3.4 (mm 2 ), 72.0 (%), and 0.71, respectively. Significant HR for the incidence of DoCE was observed in the presence of MSA&lt; 3.4 (HR 3.58, 95% confidence interval [CI] 1.04 - 12.4, p=0.035) and eccentricity index&lt; 0.71 (HR 6.68, 95% CI 1.94 - 23.0, p=0.001) (Panel B). Conclusions: Smaller stent area and eccentric expansion were associated with increased incidence of DoCE after DES implantation in patient with HD, although the presence of other post-stent suboptimal findings were not associated with the incidence of DoCE. The present results suggest the importance of larger stent area and concentric stent expansion in patients with HD.
Abstract 338: Relationship Between Post-arrest Care Cardiac Index and Clinical Outcomes in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial
Authors: Juan J Russo, Paul Boland, Simon Parlow, Rudy Unni, Pietro Di Santo, Jordan Bernick, Christina Osborne, Derek Y So, Benjamin M Hibbert, Sophie De Roock, Christopher Fordyce, Sean Van Diepen, Michel R Le May
Journal: Circulation (2020)

Introduction: Comatose survivors of out-of-hospital cardiac arrest (OHCA) have decreased cardiac index (CI) following return of spontaneous circulation. Although reversible, a reduced CI can contribute to cerebral hypoperfusion and impaired neurologic outcomes. We sought to examine the relationship between CI and clinical outcomes following OHCA. Methods: CAPITAL-RETURN was a prospective study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management. Between August 2016 and December 2017, comatose survivors of OHCA with an initial shockable rhythm underwent continuous, blinded monitoring of CI using bioimpedance (Cheetah Medical, Portland, OR, USA) for 96 hours after intensive care unit (ICU) admission. In the present study, we examined the association between CI and the composite of death or severe neurologic dysfunction at 6 months (primary outcome) using logistic regression. Severe neurologic dysfunction was defined as a modified Rankin Scale score ≥4. We excluded patients who died or had withdrawal of advanced life support within 72 hours of ICU admission. Results: In 53 patients in this analysis (mean age 59±13 years, downtime 24±13 minutes, STEMI 35%), the rate of the primary outcome was 25%. The mean CI was lower in patients with (3.0±0.5 L/min/m 2 ) versus without (3.3±0.5 L/min/m 2 ) the primary outcome (p=0.018). A higher mean CI during the first 96 hours of ICU admission was associated with lower rates of the primary outcome (OR 0.85 per 0.1L/min/m 2 increase in CI; p=0.025). This association persisted after adjusting for age and downtime (OR 0.78 per 0.1L/min/m2 increase in CI; p=0.014). Cardiac index was similar in patients with versus without the primary outcome at the end of the 96-hour monitoring period (Figure). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI during the first 96 hours of ICU admission is associated with lower rates of death or severe neurologic dysfunction.