tbuckley/cabot-search huggingface dataset:
Abstract 14369: Assessment of Hemodynamic Response to Exercise in Patients With Advanced Heart Failure
Authors: Cole Buchanan, Gregory Coe, Ashley Pratt-Cordova, William K Cornwell
Journal: Circulation (2020)

Introduction: Among patients suffering from HFrEF, outcomes are closely associated with quality-of-life and functional capacity. Data are limited regarding exertional cardiopulmonary performance measures in these patients. The objective of this study was to complete a comprehensive analysis of cardiac function among patients with advanced HFrEF during submaximal and peak exercise through an invasive cardiopulmonary exercise test (CPET) on an upright cycle ergometer. Methods: Thirty-five participants with advanced HFrEF (age 59 ± 12) underwent invasive hemodynamic assessment with Swan-Ganz catheter during CPET. Group 1 comprised individuals not on inotropes (N=23, 66%); group 2 was comprised of individuals on inotropes (N=12, 34%). Data were obtained at supine and upright rest, two submaximal levels (steady-states 1-2) of exertion below the ventilatory threshold (VT), and peak exercise. Results: Cohort characteristics are displayed in table 1 . VO 2 max for the overall cohort was severely reduced (11.8 ± 3.3), and was similar between group 1 and 2 (12.1 ± 3.2 v. 10.1 ± 3.5 ml/kg/min, P= 0.71). As displayed in figure 1 , pulmonary arterial and left-sided filling pressures increased dramatically even during submaximal exercise. Cardiac output increased minimally, with only an ~2-fold change from rest to peak exercise for both groups. Conclusions: Among patients with advanced HFrEF, exercise is limited by severe increases in cardiac and pulmonary filling pressures, even during submaximal levels of exercise that mimic real-world activities of daily living, as well as severely impaired inotropic reserve. Inotropes do not appear to improve exertional hemodynamics.
Bicameral Gallbladder With Chronic Cholecystitis on Hepatobiliary Scintigraphy
Authors: Kyu Yeoun Won, Chanwoo Kim
Journal: Clinical Nuclear Medicine (2020)

Abstract Bicameral gallbladder, also known as segmental adenomyomatosis, is not a rare benign condition with the lumen divided into 2 interconnected chambers. Here we present 2 interesting cases of the bicameral gallbladder, which shows unremarkable findings on hepatobiliary scintigraphy at first appearance. However, the CT scan revealed that the fundal chamber was not visualized on the scintigraphy unlike the ductal chamber. These cases suggest that the findings of the bicameral gallbladder on hepatobiliary scintigraphy can lead to misdiagnosis without carefully correlating with anatomic imaging findings.
Computed Tomography Coronary Angiography: A Noninvasive Escape When Stress Tests Fail (Caught Between Guidelines and Gut Feeling)⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
Authors: Pim J. de Feyter, Koen Nieman
Journal: Journal of the American College of Cardiology (2012)
Abstract 13732: Evaluation of the Mechanical Effect of Thickened IPS Derived Cardiomyocyte Patch on the Distressed Left Ventricle Using Cardiac Simulator “Ut-heart”
Authors: Hirotada Masuda, Shigeru Miyagawa, Takumi Washio, Seiryo Sugiura, Jun-ichi Okada, Takayoshi Ueno, Koichi Toda, Toru Kuratani, Toshiaki Hisada, Yoshiki Sawa
Journal: Circulation (2020)

Introduction: iPS cell-derived cardiac cell sheet (iPS sheet) transplantation is expected to have both cytokine paracrine effect and mechanical effect on the failed heart. In order to clarify the latter effect, we utilized the cardiac simulator “UT-Heart” to quantitatively evaluate the improvement of pumping function of the left ventricle with myocardial infarction covered by the thickened iPS sheet in silico. The direct mechanical impact of iPS sheet with various thicknesses was calculated first, and then the remodeling effect of fiber orientation was investigated. Patient and Method: An infarcted heart model based on the actual patient’s data was created on the computer and an iPS sheet was virtually implanted under the following assumptions: (1) electrophysiologically synchronized with the underlying cardiac muscle, (2) covered the infarct area entirely, (3) the fiber orientation of sheet was parallel to that of the epicardial tissue when attached, (4) if remodeling occurs, the fiber orientations of myocardial tissue and the attached sheet change such that the contraction force and the fiber strains are homogenized in the heart. The UT-Heart simulation was performed while changing iPS sheet thickness from 1mm to 5mm. Results: The LVEF of 18.0 % at pre-implantation was improved to 18.5 % with 1 mm thickness, and 19.6 % with 5 mm thickness without remodeling assumption as shown in the left of the figure. If LV remodeling occurs, the LVEF was improved to 20.9 % with 1mm thickness and 22.8 % with 5mm thickness. The LVESP was 10 mmHg higher than that of pre-implantation even when 1mm thickness was implanted. Conclusion: The direct mechanical effect of the thickened iPS sheet on the distressed LV was quantitatively evaluated in silico. Because changes in fiber orientation have a significant impact on pumping function, the remodeling assumption used herein should be experimentally verified in the future.
Abstract 15267: 1-Year Survival Post Trans-Catheter Aortic Replacement in Patients With Low and High-gradient Severe Aortic Valve Stenosis
Authors: Caleb Chiang, Mohamad Hemu, Jaafar Alward, Konstantinos Voudris, Hassam Suradi
Journal: Circulation (2020)

Introduction: There is limited data on trans-catheter aortic replacement (TAVR) outcomes in patients with low gradient-preserved ejection fraction aortic stenosis (LGpEF). Our study aims to compare baseline characteristics and procedural outcomes in patients with LGpEF vs. high gradient severe aortic stenosis (HGAS). Methods: Patients who underwent TAVR at our institution were divided in 2 groups: 1) HGAS (aortic valve area (AVA) &lt; 1cm 2 , mean gradient (MG) &gt; 40 mmHg); 2) LGpEF (AVA &lt; 1cm 2 , MG &lt;40 mmHg, left ventricular ejection fraction ≥ 50%). Primary outcome included 1-year all-cause mortality post-TAVR. Multivariable cox proportional hazards model was adjusted for covariates of clinical significance (age, Society of Thoracic Surgery (STS) score, chronic kidney disease (GFR &lt; 60 mL/min/1.73m2), para-valvular leak (PVL) day 1 post-TAVR, and baseline New York Heart Association (NYHA) class. Results: A total of 140 patients with HGAS (53% female, 81±9 years old) and 73 patients with LGAS (51% female, 80±9.5 years old) were identified. In multivariable analyses, there was no statistically significant difference in mortality between HGAS vs. LGpEF (HR 0.53, 95% CI 0.21-1.3; p=0.16) (Figure). PVL was independently associated with increased mortality in HGAS (HR 2.9, 95% CI 1.2-7.3; p=0.02) but this effect was not observed in patients with LGpEF. Conclusions: After adjusting for relevant patient characteristics, TAVR outcomes in patients with LGpEF were similar to those with HGAS at 1-year follow-up.
Abstract 106: Covid-19 Pandemic Impact on Ems Runs and Resuscitation Attempts
Authors: Timothy Asmar, John Snider, Robert B Dunne, Michael Feld, Joseph B Miller, Howard Klausner
Journal: Circulation (2020)

Background: The frequency of EMS runs, resuscitation attempts, &amp; out of hospital cardiac arrest survival within a pandemic period has not been studied within the Detroit and metro Detroit region in Michigan. To analyze and study the consequences associated with the spread of COVID-19 within two Michigan counties, a retrospective review from two different medical control authorities (MCA) was completed. We hypothesized the number of out of hospital cardiac arrests and EMS runs to increase during the COVID-19 pandemic, while resuscitation attempts to decrease. Methods: This is a retrospective review study. Records from two MCAs, the Detroit East Medical Control Authority (DEMCA) and the Macomb County Medical Control Authority (MCMCA), were utilized and data was extracted and extrapolated. Each of these MCAs oversee Emergency Medical Services (EMS) within their respective counties. DEMCA provides coverage for the eastern region of Wayne County and MCMCA serves all of Macomb County. Runs, dead-on-scene numbers, &amp; resuscitation attempts were each assessed from March through May of 2019 &amp; 2020. Results: There were nearly double the number of EMS runs for out of hospital cardiac arrest during the 3 main months of the pandemic. In March through May 2020 there were 1756 runs with a mean age of 62.7 years vs. 988 runs during the same period in 2020 with a higher mean age of 65.1 years (p&lt;0.01). This difference was most pronounced in April, which was the height of the pandemic in Michigan (782 vs. 312). The higher number of EMS runs was also more pronounced in Wayne county (1.86 times 2019 numbers) compared to Macomb County (1.65 times 2019 numbers). Resuscitation was attempted on 566 (32.2%) during the pandemic compared to 222 (22.5%) during the same period in the prior year (OR 0.61, 95% CI 0.51 - 0.73, p&lt;0.01). The proportion of patients transferred from the field to an ED did not change significantly (2.6% in the control period vs. 2.1% during the pandemic, p=0.325). Conclusion: There was a 1.78 fold rise in out of hospital cardiac arrest EMS runs during the peak months of the pandemic in metro Detroit compared to the same period in 2019. Despite national concerns on the safety of resuscitation with Covid-19, a higher proportion of patients had resuscitation attempted during the pandemic.
Abstract 13529: Percutaneous Coronary Intervention in Ambulatory Surgery Centers: Is It Safe?
Authors: Kevin Li, Neil M Kalwani, Paul A Heidenreich, William F Fearon
Journal: Circulation (2020)

Introduction: In January 2020, Medicare began reimbursing for percutaneous coronary intervention (PCI) performed in ambulatory surgery centers (ASCs), but little is known about characteristics and outcomes of patients who have undergone ASC PCI previously. Methods: Using commercial insurance claims from the MarketScan® Databases, we characterized patients 18 years or older who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease between April 1, 2007, and December 1, 2016. We used propensity score matching of HOPD and ASC PCI cohorts to measure the association between treatment setting and 30-day outcomes (myocardial infarction, bleeding complications, and all-cause admission). Results: The unmatched sample consisted of 95,492 HOPD and 849 ASC PCI patients. Patients were more likely to undergo ASC PCI if they were younger than 65 (OR 1.72, 95% CI 1.43-2.06), lived in the southern U.S., or were covered by managed (OR 2.31, 95% CI 1.73-3.08) or consumer-driven (OR 2.57, 95% CI 1.73-3.82) compared to comprehensive health plans. ASC PCI was less likely in patients with a history of stroke (OR 0.45, 95% CI 0.28-0.72). Intravascular imaging and physiology testing were more frequently performed in HOPD than in ASC PCI (18.3% vs. 12.5%, respectively; p &lt; 0.001). After propensity-score matching, ASC PCI was associated with increased odds of bleeding complications (OR 2.43, 95% CI 1.22-4.84, p = 0.011). Differences in other outcomes were not statistically significant. Conclusions: Patients undergoing outpatient elective PCI in ASCs were younger and more likely to live in the southern U.S or have managed or consumer-driven health insurance plans. Intravascular imaging and physiology testing were performed more frequently in HOPD than in ASC PCI. PCI in the ASC setting was also associated with an increased risk of bleeding complications. Further study of this population is warranted as ASC PCI volume increases under Medicare.
Abstract 15134: Concomitant Impella Use in Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Authors: Saraschandra Vallabhajosyula, John C O’Horo, Phanindra Antharam, Sindhura Ananthaneni, Saarwaani Vallabhajosyula, Harigopal Sandhyavenu, Shannon M Dunlay, Gregory W Barsness
Journal: Circulation (2018)

Introduction: The use of concomitant Impella in cardiogenic shock patients treated with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has demonstrated contrasting results. Hypothesis...
Abstract 13321: Pattern of Recovery of the Impaired Left Ventricle Varies by Valve Lesion
Authors: Michael Ibrahim, Audrey Spelde, Wilson Y Szeto, Michael A Acker, Pavan Atluri, Prashanth Vallabhajosyula, Joseph E Bavaria, Nimesh D Desai, Matthew Williams
Journal: Circulation (2020)

Introduction: Aortic stenosis (AS) causes pressure overload of the left ventricle, while regurgitation (AR) causes volume overload. These pathologic insults result in biologically different forms of ventricular impairment. Whether this is clinically meaningful is unknown. We hypothesized that long term clinical and echocardiographic recovery of the impaired ventricle from pressure (AS) and volume (AR) overload would be different. Methods: We compared the results of surgical aortic valve replacement (AVR) in patients with a pre-operative ejection fraction (EF) of 0.35 or less (excluding endocarditis) due to AS, AR or mixed disease. We reviewed long term echocardiographic and clinical follow-up. We constructed a mixed-effects model of EF and left ventricular end diastolic diameter (LVEDD) to understand ventricular recovery over the short (in-hospital), intermediate (3-6 month) and longer (&gt;24 months) terms. We sought to identify factors associated with clinical and echocardiographic recovery using multivariable analysis. Results: Between July 2011 and 2017, 136 patients with pre-operative EF of 0.35 or less and severe AS (83), severe AR (18) or mixed AS and AR (35) underwent AVR. There were two deaths within 30 days in the AS group (1.5% total 30d mortality). Survival at 1, 2 and 5 years did not differ significantly between AS, AR and mixed groups. Baseline EF did not differ between the groups. Ejection fraction increased significantly, but followed a different pattern in AS, AR and mixed groups over time. LVEDD was significantly higher in the AR group, and regressed in all patient cohorts, again following a different pattern for AS and AR. Baseline EF and LVEDD predicted long term fate of the LV but did not determine survival. Factors associated with poor long term survival were age, baseline albumin, length of stay prior to surgery and previous cardiac interventions. Conclusions: While the impaired ventricle appears to recover in AS, AR and mixed disease, the pattern of this recovery appears to be early in AS and delayed in AR. Baseline clinical factors, rather than echocardiographic status of the LV appear to determine late survival.
Abstract 14588: Post-discharge Readmission and Survival After Percutaneous Coronary Intervention Among Patients With a History of Recent Gastrointestinal Bleeding: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Authors: Chelsea Meloche, Milan Seth, Ryan D MADDER, Jacob Kurlander, Jessica Yaser, Joseph Chattahi, John Collins, Natesh Lingam, Dilip Arora, Devraj Sukul, Hitinder S Gurm
Journal: Circulation (2020)

Introduction: Given the use of potent antithrombotic agents during and after PCI, patients (pts) are at an increased risk of gastrointestinal bleeding (GIB). Hypothesis: We hypothesize that pts with a history of recent GIB have a higher risk of post-discharge readmission and mortality compared with those without a history of GIB. Methods: We linked clinical registry data from PCIs performed between 1/1/2013 and 3/31/2018 at 48 Michigan hospitals to Medicare claims. A recent history of GIB prior to PCI was defined in the clinical PCI registry as any occurrence of melena or hematemesis in the last 30 days or any history of GIB including peptic ulcer disease that may influence clinical management during this hospitalization. Primary outcomes of interest were 90-day readmission after PCI and long-term mortality. We used 1:5 propensity-matching to adjust for differences in characteristics between pts with and without a history of recent GIB. Log-rank testing was used to evaluate survival at 1 and 5 years. Fisher's exact testing was used to compare the rates of 90-day readmission after PCI. Results: Of 30,206 pts, 1.1% had a history of GIB. Pts with a history of GIB were more likely to be older, female, black, and have more cardiovascular comorbidities. After matching 1896 pts, those with a history of GIB (n=316) appeared to have decreased survival early after PCI (Fig); however, the differences in survival were not statistically significant at 1 yr (76.%3 vs. 80.1%; p=0.11) or 5 yrs (52.5% vs. 52.2%; p=0.50) (Fig). There was no significant difference in readmission rates among those with and without a history of GIB (33.5% vs. 30.2%; p=0.26). Conclusions: Pts with and without a history of recent GIB had similar risks of readmission and long-term mortality after PCI. Although a history of GIB has previously been shown to be associated with increased post-PCI bleeding complications, a recent history of GIB was not associated with long-term post-PCI outcomes.
Diversification of Fungal Chitinases and Their Functional Differentiation in <i>Histoplasma capsulatum</i>
Authors: Kristie D Goughenour, Janice Whalin, Jason C Slot, Chad A Rappleye
Journal: Molecular Biology and Evolution (2020)

Abstract Chitinases enzymatically hydrolyze chitin, a highly abundant and utilized polymer of N-acetyl-glucosamine. Fungi are a rich source of chitinases; however, the phylogenetic and functional diversity of fungal chitinases are not well understood. We surveyed fungal chitinases from 373 publicly available genomes, characterized domain architecture, and conducted phylogenetic analyses of the glycoside hydrolase (GH18) domain. This large-scale analysis does not support the previous division of fungal chitinases into three major clades (A, B, C) as chitinases previously assigned to the “C” clade are not resolved as distinct from the “A” clade. Fungal chitinase diversity was partly shaped by horizontal gene transfer, and at least one clade of bacterial origin occurs among chitinases previously assigned to the “B” clade. Furthermore, chitin-binding domains (including the LysM domain) do not define specific clades, but instead are found more broadly across clades of chitinases. To gain insight into biological function diversity, we characterized all eight chitinases (Cts) from the thermally dimorphic fungus, Histoplasma capsulatum: six A clade, one B clade, and one formerly classified C clade chitinases. Expression analyses showed variable induction of chitinase genes in the presence of chitin but preferential expression of CTS3 in the mycelial stage. Activity assays demonstrated that Cts1 (B-I), Cts2 (A-V), Cts3 (A-V), Cts4 (A-V) have endochitinase activities with varying degrees of chitobiosidase function. Cts6 (C-I) has activity consistent with N-acetyl-glucosaminidase exochitinase function and Cts8 (A-II) has chitobiase activity. These results suggest chitinase activity is variable even within subclades and that predictions of functionality require more sophisticated models.
Abstract 14990: Pulmonary Vein Stenosis After Epicardial Atrial Fibrillation Ablation and Epicardial Left Atrial Appendage Occlusion: A Diagnostic Dilemma and Challenges in Management
Authors: Moghniuddin Mohammed, Nachiket Apte, Mohammed Ansari, Amit Noheria, Seth Sheldon, Madhu Reddy
Journal: Circulation (2020)

Background: Pulmonary vein stenosis is a dreaded complication of endocardial atrial fibrillation (AF) ablation but rare after epicardial ablation and has not been reported after epicardial left atrial appendage occlusion (LAAO). Case: A 55-year-old male was referred to our tertiary hospital for management of left superior pulmonary vein (LSPV) stenosis causing dyspnea on exertion. About 2 years prior to presentation, he underwent quadruple coronary artery bypass grafting for non-ST elevation myocardial infarction along with modified Cox-Maze procedure with pulmonary vein and posterior wall isolation as well as epicardial LAAO with AtriClip for history of paroxysmal AF. At our institute, V/Q scan showed ventilation-perfusion mismatch and absent perfusion of the left upper lobe (Figure 1A). Cardiac CT showed persistent LSPV occlusion (Figure 1B). TEE showed atrial appendage occluded with a clip and no flow was observed from LSPV (Figure 1C). After multidisciplinary discussion between cardiology and cardiothoracic surgery teams, surgical approach to remove the AtriClip was deemed futile as it was placed 2 years ago and less likely to result in resolution of stenosis. Thus, an endovascular approach was attempted with left atrial and pulmonary vein angiography showing LSPV to be 100% occluded (Figure 1D). Pulmonary vein recanalization was attempted but was not successful. Conclusion: Our case highlights the importance of recognition of PVS as a possible complication after epicardial LAAO as early intervention can improve patient outcomes. PVS has been previously described with Maze procedure but that patient was successfully treated with catheter-balloon angioplasty. Given 100% occlusion and difficulty with recanalization makes epicardial ablation a less likely cause of occlusion in our case. More careful application of Atriclip protocols might be necessary to prevent this potential complication.
How to ventilate obstructive and asthmatic patients
Authors: Alexandre Demoule, Laurent Brochard, Martin Dres, Leo Heunks, Amal Jubran, Franco Laghi, Armand Mekontso-Dessap, Stefano Nava, Lamia Ouanes-Besbes, Oscar Peñuelas, Lise Piquilloud, Theodoros Vassilakopoulos, Jordi Mancebo
Journal: Intensive Care Medicine (2020)
The Role of Bariatric Surgery in Prevention of Kidney Disease Progression in Moderately Obese Patients With Type 2 Diabetes
Authors: Sashiananthan Ganesananthan, Timothy Woo, ChunHei Li
Journal: JAMA Surgery (2020)

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