tbuckley/cabot-search huggingface dataset:
Abstract 13616: Dismantling Structural Racism Starts With Understanding the Type of Hospitals That Provide Segregated Cardiovascular Care
Authors: Khadijah Breathett, John Hollingsworth, Addison Shay, Sitara Murali, Phyllis Yan, Xianshi Yu, Ji Zhu, Brahmajee K Nallamothu
Journal: Circulation (2021)

Background: Black patients receiving coronary artery bypass grafting (CABG) have higher likelihood of mortality if care is received in a highly segregated care settings, where healthcare professional care (HCP) teams predominantly treat either White or Black patients. It is unclear what factors are associated with being a hospital that provides segregated healthcare. Methods: Using the 100% Medicare Provider Analysis and Review file, we identified Fee-for-Service beneficiaries who underwent CABG from 2012 to 2018. We fit a multivariable logistic regression model to assess factors associated with higher odds of receiving high versus low segregated care for CABG. We accounted for the nested data structure (patients within hospitals) using a robust variance estimator and included in our model factors like patient sociodemographics, level of comorbidity, and hospital and hospital service area characteristics. Analogous to the dissimilarity index, care segregation equated to differences between relative frequency of Black and White patients summed over all billing HCP. Results: Among 312,503 patients (69.9% male, 84.5% White race) from 563 U.S. hospitals, a higher number of Black patients undergoing CABG at a hospital center [OR: 0.93 (95%CI 0.90-0.96)] and higher number of billing HCP [OR: 0.68 (95%CI 0.59-0.78)] were both associated with significantly lower odds of delivering high segregated care than low segregated care in fully adjusted analyses (Table). No other factors were associated with care segregation, including geographic region of hospital. Conclusions: Hospitals which routinely provide CABG to higher numbers of Black patients and employ a larger number of HCP were less likely to deliver segregated care. Dismantling structural racism in healthcare requires investigation of how to replicate cultural and business models of the low segregation hospitals that promote care of diverse patient populations.
IMMU-16. CHARACTERISTICS OF EGFRVIII-DIRECTED CART CELL INFUSION PRODUCT ASSOCIATED WITH CLINICAL RESPONSE IN RECURRENT GLIOBLASTOMA
Authors: Oliver Tang, Zev Binder, Lifeng Tian, Wan-Jung Chang, Todd Yoder, Simon Lacey, Jos Melenhorst, Donald M O’Rourke
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND A therapeutic approach for chimeric antigen receptor T (CART) cell therapy in glioblastoma is targeting the epidermal growth factor receptor variant III (EGFRvIII), present in approximately 30% of glioblastomas. While earlier research demonstrated that phenotypic and genotypic characteristics in patient T cells and CART product may predict therapeutic success for hematologic malignancies, no study has investigated such determinants for clinical response in glioblastoma. METHODS We analyzed apheresis and infusion products for patients in the first-in-human trial of EGFRvIII-directed CART for recurrent glioblastoma (NCT02209376, n=9). Inherent T cell phenotypes were characterized by flow cytometry assay using a panel of 27 markers. Clinical response was quantified via engraftment in peripheral circulation and time-on-trial (ToT). RESULTS Mean area under the curve (AUC) peripheral CART engraftment for the study period was 213 log10 copies/μg (SD=173) and mean ToT was 134 days (SD=173). For the CAR+/CD4+ population in the infusion product, PD1 positivity was positively associated with AUC engraftment (r=0.753, P=0.012) and ToT (r=0.800, P=0.010). On immune checkpoint inhibitor analysis, CTLA-4, TIM3, and LAG3 did not exhibit significant associations with AUC engraftment or ToT. For activation markers, PD1/GRZB (r=0.794, P=0.011) and PD1/HLA-DR (r=0.769, P=0.016) were directly associated with ToT. PD1/GRZB was also predictive of AUC engraftment (r=0.794, P=0.011). For the CAR+/CD8+ population, PD1 positivity correlated with elevated AUC engraftment (r=0.639, P=0.047). In the CAR-/CD4+ population, PD1 remained positively correlated with AUC engraftment (r=0.690, P=0.027) and ToT (r=0.726, P=0.027). No significant associations were observed for apheresis products. CONCLUSION PD1 in CART infusion products predicted peripheral engraftment and ToT in recurrent glioblastoma. Double-positive cells for PD1 and activation markers also displayed a positive correlation, suggesting PD1 highlights a population of activated CAR T cells. Further characterization of predictors of EGFRvIII-directed CART treatment efficacy may improve selection of patients and starting T cell populations for clinical expansion.
Abstract 12122: Impact of Periodontal Bacteria Detected in Periodontal Pockets in Patients with Congestive Heart Failure on Long-Term Clinical Outcomes
Authors: Yuji Matsuda, Taishi Yonetsu, Norio Aoyama, Yasuhiro Maejima, Mitsuaki Isobe, Takanori Iwata, Tetsuo Sasano
Journal: Circulation (2021)

Backgrounds: Periodontal disease is known as a risk of cardiovascular events, but the impact of periodontal bacteria on the clinical outcomes has not been elucidated in patients with congestive heart failure (CHF). Aim: We sought to investigate the association between the presence of periodontal bacteria in periodontal pockets. Methods: Between May 2012 and August 2015, consecutive 149 patients who admitted in our department due to non-ischemic CHF were retrospectively included. Periodontal examinations including the presence of major periodontal bacteria (MPB) were performed by the independent trained periodontists. MPB consisted of Porphyromonas gingivalis , Aggregatibacter actinomycetemcomitans and Prevotella intermedia , known as inflammatory bacteria of severe periodontitis. The clinical events of these patients were assessed, and major adverse cardiovascular cerebrovascular event (MACCE) was defined as the composite of cardiovascular death, non-fetal myocardial infarction, non-fetal stroke. Results: A total of 135 patients composed of 98 patients with MPB in the periodontal pocket and 37 patients without that were identified. Median follow up duration was 4.6 years (interquartile: 1.8 - 6.6 years). The Kaplan-Meier curve analysis about MACCE suggested that the free survival rate in MPB group was significantly worse than non-MPB group (p for log-rank test = 0.01). Regarding Kaplan-Meier curve analysis of each MACCE component, only that of cardiovascular death showed MPB group had significantly worse free survival rate (p = 0.02). Multivariate Cox hazard regression model analysis revealed that MPB group was an independent risk of MACCE (HR 9.70; 95% CI 1.27 - 74.39, p = 0.03), and this finding appeared to be obtained from mainly cardiovascular death (HR 8.74; 95% CI 1.13 - 67.71, p = 0.04). Conclusions: In non-ischemic CHF patients with MPB in periodontal pocket were associated with an increased risk of long-term cardiovascular events.
Abstract 13793: The Impact of Right Ventricular Trabeculation in Patients With Left Ventricular Noncompaction
Authors: Anna Reka Kiss, Zsofia Gregor, Adrian Popovics, Kinga Grebur, Szabo Liliana, Zsofia Dohy, Attila Kovacs, Balint Lakatos, Béla Merkely, Hajnalka Vágó, Andrea Szucs
Journal: Circulation (2021)

Right ventricular (RV) involvement in left ventricular noncompaction (LVNC) remains unknown. We aimed to describe the RV volumetric, functional, and strain characteristics and clinical features of patients with LVNC and good LV ejection fraction (EF) using cardiac magnetic resonance, to identify differences between LVNC patients with (RV-HT) and without RV hypertrabeculation (RV-NT) and to describe the relationship between RV and LV trabeculation and RV volume and function. One hundred Caucasian patients with LVNC and good LV-EF and 100 age- and sex-matched healthy controls were included in this retrospective study. Patients were further divided into two subgroups by the amount of RV indexed trabecular mass (RV-TMi). We measured the LV and RV volumetric, functional and TMi values using threshold-based postprocessing software and the RV and LV strain values using feature tracking and collected the patients’ LVNC-related clinical features. Patients had higher RV volumes, lower RV-EF and worse RV strain values than controls. A total of 22% of patients had higher RV-TMi values than the previously described reference range; furthermore, RV-HT patients had higher RV and LV volumes, lower RV- and LV-EF and worse RV strain values than RV-NT patients. We identified a strong positive correlation between RV- and LV-TMi and between RV-TMi and RV volumes and a significant inverse relationship between both RV- and LV-TMi and RV function. The prevalence of LVNC-related clinical features was similar in the RV-HT and RV-NT groups. These results suggest that some LVNC patients might have RV noncompaction with subclinical RV dysfunction, raising further questions about its prognosis.
Abstract 12189: The Ratio of Cyclic Guanosine Monophosphate to Brain Natriuretic Peptide (cGMP/BNP) Stratifies The Risk of Heart Failure Hospitalization in Cardiac Resynchronization Therapy (CRT) Patients
Authors: Akihito Ideishi, Nobuhiko Ueda, Yasuhiro Yokoyama, Naoya Kataoka, Yuichiro Miyazaki, Akinori Wakamiya, Tsukasa Kamakura, Mitsuru Wada, kohei ishibashi, Kenichiro Yamagata, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Naoto Minamino, Kengo Kusano
Journal: Circulation (2021)

Background: Cardiac Resynchronization Therapy (CRT) is established treatment for patients with heart failure, however, there are various predictors of prognosis. Although CRT responder is reported to have a better prognosis than CRT non-responder, some cases have poor clinical outcomes even among CRT responders. Meanwhile, brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) are associated with the severity of heart failure. Little is known about the efficacy of prognostic value of BNP and cGMP in CRT patients especially among CRT responders. Methods: Among 246 consecutive CRT patients, we retrospectively analyzed 86 patients whose biomarkers were measured at the time of implantation. The patients were divided into two groups by the median value of cGMP/BNP (0.26). The endpoint was heart failure hospitalization, and the CRT responder was defined as an improvement of end-systolic volume (ESV) ≥ 15% or ejection fraction (EF) ≥ 10% at 6 months after CRT implantation. Results: The patients were 65.4 ± 13.6 years old, 64 (74%) patients were male, 17 (20%) patients were ischemic cardiomyopathy, and 47 (55%) patients were CRT responders. During a median follow-up period of 830 (interquartile range: 482-1246) days, 27 patients (31%) had heart failure hospitalization (high cGMP/BNP group: 8 vs low cGMP/BNP group 19, p = 0.016). Kaplan-Meier analysis revealed the risk of heart failure hospitalization was higher in high cGMP/BNP group than in low group (log-rank p = 0.0025), and the same result was observed even among CRT responders (log-rank p=0.018). cGMP/BNP increased in responders (p = 0.0045) but not in non-responders (p = 0.23) at 6 months after CRT implantation in Wilcoxon signed-rank test. Univariate analysis showed that BMI, chronic kidney disease, diabetes mellitus, hemoglobin, CRT responder, and cGMP/BNP were predictors of heart failure hospitalization. Conclusion: cGMP/BNP is useful for the heart failure risk stratification in CRT patients.
Abstract 13330: Deep Learning Algorithm Predicts Angiographic Diameter Stenosis in Stable Patients Using Only a Standard 12-lead Electrocardiogram
Authors: Michael Leasure, Michael Leasure, Utkars Jain, Veronica A Covalesky, Daniel J McCormick, Gary S Mintz
Journal: Circulation (2021)

Introduction: Current standard electrocardiogram analysis algorithms cannot predict the presence and extent of coronary artery disease (CAD), especially in stable patients. Hypothesis: A novel artificial intelligence algorithm (ECGio) is able to predict the presence, location, and severity of coronary artery lesions in a minimally selected stable patient population as verified by coronary angiography. Methods: A cohort of 1659 stable outpatients were randomly divided into training (86%) and validation (14%) subsets, maintaining population characteristics. ECGio was trained and then validated using electrocardiograms paired with angiograms collected from electronic medical records. Coronary artery lesions were evaluated by a continuous measure of stenosis ranging from 0% - 100%. The prediction was then compared to the angiogram result (worst diameter stenosis in each vessel) with the error calculated per patient and per vessel. Results: In the primary analysis of the validation cohort, 22 had no angiographic CAD and were grouped with 56 patients with mild CAD (DS ≤30%), 31 had moderate CAD (DS 30-70%), and 113 had severe CAD (DS ≥70%). On a vessel level ECGio was able to predict stenosis severity with an overall average error of 16% as well as vessel specific errors of 18% in the LAD, 19% in the LCX, 18% in the RCA, and 8% in the Left Main. Absolute Error and Left Main error can be seen in the Figure. Conclusion: This validation study strongly suggests that it is possible to utilize an artificial intelligence algorithm to determine the presence and severity of CAD in stable patients using data from a standard 12- lead electrocardiogram.
Abstract 9684: Admission Ecg May Predict Short-Term Mortality Among Adults Hospitalized With Covid-19 Infection
Authors: Kevin O'Day, Sarah Ferreira, Jean-Claude Asaker, Hannah Hamad, Kedar Mahagaokar, Laurel O'Connor, Christopher Phelan, Dennis Tighe, David McManus, Apurv Soni, Lara Kovell
Journal: Circulation (2021)

Introduction: Cardiovascular complications of novel SARS-CoV-2 infection remain poorly understood with outcomes limited to index hospitalizations. Methods: This retrospective cohort study included patients with proven COVID-19 who received care at a single hospital network in Massachusetts from March 11, 2020 to May 23, 2020 and received an electrocardiogram (ECG) within 24 hours of hospital presentation. We investigated mortality and cardiovascular complications within 90 days from initial COVID-19 diagnosis. Data were electronically abstracted and confirmed by manual chart review. Results: A total of 1,744 patients tested positive within the hospital network during the study period. Nearly half of them (49.3%) were hospitalized and 15.5% died within 90 days. A total of 278 patients received an ECG within 24 hours, representing 23.6% of all hospitalized patients. These patients were disproportionately older (38.5 vs 58.1% over the age of 60, p &lt; 0.01), male (49.6 vs 56.2%, p = 0.05), and white (48.1 vs 56.2, p &lt; 0.01). Admission ECGs demonstrating ischemic changes (ST-elevations, ST-depressions, and T-wave inversions) or new arrhythmias (atrial fibrillation/flutter, bradyarrhythmia, supraventricular tachycardia) were identified among 10.1% and 9.0% of the patients, respectively. Heart failure and cardiomyopathy were rare findings (&lt;1%). After adjusting for age, sex, and past medical history, ischemic changes or new-onset arrhythmias were associated with nearly five-times greater risk of death (OR: 4.9; 95% CI 1.7 - 14.4). Conclusions: In this retrospective study among hospitalized adults with a proven COVID-19 infection, admission ECGs demonstrating ischemic changes or new-onset dysrhythmia predict a higher risk of death in the short-term.
Abstract 14268: PKM2 to PKM1 Isoform Switching in Fibroblasts Attenuates Cardiac Dysfunction in Infarcted Mice
Authors: Lindsey A McNally, Parul Mehra, Andrew Gibb, Kenneth Brittian, Anna Gumpert, Sujith Dassanayaka, Steven P Jones, Bradford G Hill
Journal: Circulation (2021)

Introduction: The muscle isoform of pyruvate kinase, PKM, has two splice variants, with PKM2 having important roles in cardiomyocytes during development. The goal of this study was to understand the role of PKM2 in the adult failing heart. Methods: To determine how PKM2 expression changes after myocardial infarction (MI), wild-type (WT) mice were subjected to permanent coronary ligation followed by measurement of PKM2 abundance and localization by Western blotting and immunofluorescence imaging. To delineate the role of PKM2 in fibroblasts after MI, PKM2 fl/fl mice were bred with a fibroblast-specific, tamoxifen-inducible Cre driver (Col1a2-CreER; Cre). The Cre + and Cre - PKM2 fl/fl mice of both sexes were treated with tamoxifen (i.p. 20 mg/kg/d; 5 d), followed by tamoxifen washout and MI surgery. Four weeks after MI, cardiac function was examined by echocardiography. Results: Hearts from infarcted WT mice had 10-fold higher levels of PKM2 compared with sham WT hearts (n=8/gp, p&lt;0.05). Immunofluorescence staining revealed PKM2 localized to areas of replacement fibrosis in infarcted hearts, and immunoblotting of isolated, adult cell populations showed PKM2 expressed in fibroblasts, smooth muscle cells, and endothelial cells, but not in cardiomyocytes. Furthermore, PKM2 levels were higher in cardiac fibroblasts isolated from infarcted mice compared with sham mice (n=3/group; p=0.005). Cardiac fibroblasts isolated from tamoxifen-treated Cre + /PKM2 fl/fl mice had decreased PKM2 expression and increased PKM1 expression. In naïve mice, PKM2 to PKM1 isoform switching did not affect cardiac function for up to 5 wk after tamoxifen administration. Although survival was not different between Cre - and Cre + PKM2 fl/fl mice after MI (n=18-20/gp; p=0.6383), PKM2 to PKM1 switching in Cre + PKM2 fl/fl male mice improved cardiac function compared with Cre - PKM2 fl/fl controls (n=7-12/gp), with a 15% improvement in ejection fraction (p=0.03), a decrease in LVIDd (p=0.04), EDV (p=0.04), and ESV (p=0.03), and an increase in LVPWd (p=0.01) and LVPWs (p=0.01); however, in female mice, PKM isoform switching did not improve cardiac function. Conclusions: Fibroblast-specific switching of PKM2 to PKM1 prior to MI prevents cardiac functional decline in male mice.
Abstract 11346: Overcoming Barriers to Complete and Early Extraction for CIED Infection: A Narrative Review of the Epidemiological, Clinical and Economic Evidence
Authors: Ami Sood
Journal: Circulation (2021)

Background: As the number of patients with cardiac implantable electronic devices (CIEDs) grows, they are likely to present with issues to diverse groups of physicians. Clinical guidelines have Class I recommendations for complete CIED extraction for infection. Guideline-adherent management is associated with improved prognosis in patients with CIED infection. However, this is insufficiently implemented in practice and there is limited discussion on barriers and solutions to optimizing treatment. Purpose: The objective is to provide a comprehensive overview of CIED infections with respect to (1) current guidelines for treatment of CIED infection (2) awareness of those guidelines in clinical practice, and (3) overcoming barriers to the guideline adherence. Methods: This review assessed the current literature landscape from January 1, 2005 to October 21, 2020 on the burden of CIED infection, clinical outcomes for CIED extraction, and guideline recommendations pertaining to CIED extraction. Results: Fifty-seven publications were included for this review. Five clinical practice guidelines reported a Class I indication for complete device and lead removal in all patients with defined CIED infection (systemic, local, bacteremia, or infection endocarditis). CIED infection rates ranged between 0.8% to 4.2% globally and such infections were found to be associated with substantial clinical and economic burden. Clinical studies assessing CIED extraction for infection consistently reported high procedural success (~95%), low major procedural complication rates (0% to 4.8%) and very low procedural mortality rates (0% to 2.4%). Furthermore, several studies reported that complete and early extraction has significant clinical and economic benefit compared with no extraction or late extraction. However, a large physician survey reported poor compliance with recommendations globally. Conclusions: The research indicates that barriers to optimal treatment may include challenges with infection diagnosis and patient referral to extraction centers, as well as misconceptions regarding extraction procedures. To help address these barriers, a multiprong quality initiative to optimize patient care pathways and increase awareness is necessary.
Abstract 12768: Development of a Clinical 3D Modeling Program to Guide Pediatric Cardiothoracic Surgery and Intervention
Authors: Reena M Ghosh, Matthew Jolley, Christopher Mascio, Jonathan M Chen, Stephanie M Fuller, Jonathan J Rome, Elizabeth Silvestro, Kevin K Whitehead
Journal: Circulation (2021)

Introduction: Surgical and catheter-based interventions for congenital heart disease require precise understanding of complex anatomy. The use of three-dimensional (3D) visualization techniques to enhance visuospatial understanding has been well documented, but integration of these methods into routine clinical practice has not been well described. We report the growth and development of a clinical 3D modeling service to inform procedural planning within a high-volume pediatric heart center. Methods: Clinical 3D modeling was performed using cardiac magnetic resonance (CMR) or computed tomography (CT) derived data. Image segmentation and post-processing was performed using FDA-approved software. Patient-specific anatomy was visualized using 3D printed models, digital flat screen models and virtual reality. Surgical repair options were digitally designed using proprietary and open-source computer aided design (CAD) based modeling tools. Results: From 2018 to 2020 there were 112 individual 3D modeling cases performed, 16 for educational purposes and 96 clinically utilized for procedural planning. Over the 3-year period, demand for clinical modeling tripled and in 2020, 3D modeling was requested in more than one-quarter of STAT category 3, 4 and 5 cases. The most common indications for modeling were complex biventricular repair (n = 30, 31%) and repair of multiple ventricular septal defects (VSD) (n=11, 12%). Conclusions: Using a multidisciplinary approach, clinical application of 3D modeling can be seamlessly integrated into pre-procedural care for patients with congenital heart disease. Rapid expansion and increased demand for utilization of these tools within a high-volume center demonstrate the high value conferred on these techniques by surgeons and interventionalists alike.