tbuckley/cabot-search huggingface dataset:
Abstract 14514: The Incidence and Natural Progression of New Onset Post-Operative Atrial Fibrillation
Authors: Marcella Meykler, Sahar Abdelmoneim, Emelie Rosenberg, Bimal Patel, Bharath Reddy, Jean Ho, Igor Klem, Jaspal Singh, Berhane Worku, Robert F Tranbaugh, Terrence Sacchi, John F Heitner
Journal: Circulation (2020)

Introduction: New onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery that is associated with an increased risk for stroke and all-cause mortality. Long term data on POAF recurrence and anticoagulation remains sparse. We aimed to characterize the natural progression and recurrence of new onset POAF during a long-term follow up post cardiac surgery utilizing continuous event monitoring. Methods: This is a single-center, prospective observational study evaluating 42 patients undergoing cardiac surgery and diagnosed during indexed admission with new onset, transient POAF who were discharged in sinus rhythm between May 2015 and December 2019. Prior to discharge, all patients received implantable loop recorders (ILR) for continuous monitoring. Study outcomes were the presence and timing of AF recurrence (first and repeated AF recurrence), all-cause mortality and cerebrovascular accidents (CVA). Results: Forty-two patients [mean age 67.6± 9.6 years, 74% male, mean CHADS 2- VASc 3.5±1.5] were evaluated during a mean follow-up of 1.7 ± 1.2 years. AF recurrence after discharge occurred in 30 patients (71%). Twenty-four of these 30 patients (80%) had their first AF recurrence within the first month, 3 (10%) patients during months 1-12, and 3 (10%) patients beyond 1 year. Repeated AF recurrence occurred in 13 (43%) patients between 1 and 12-months. Beyond one year of follow-up, 5 (17%) patients had either their first AF recurrence (3) or repeated AF recurrence (2). During follow-up, there was one death ((-) AF recurrence) and two CVAs ((+) AF recurrence). Conclusions: In this study of continuous monitoring with ILR , the recurrence of AF in patients who develop transient POAF is common. Seventy percent of patients had either their first AF recurrence 6 (20%) or repeated episodes of recurrent AF 15 (50%) after 1-month post-operative follow-up.
Abstract 14965: Atrial Conduction During Obstructive Sleep Apnea: Comparison of Stacked Versus Isolated Apnea Episodes
Authors: Krishan Patel, Hussain Basrawala, Pavan Reddy, Edwin Valladares, Vincent Grbach, Richard J Castriotta, Virend K Somers, Howard N Hodis, Michael C Khoo, Tomas Konecny
Journal: Circulation (2020)

Introduction: Obstructive sleep apnea (OSA) is associated with increased rates of atrial fibrillation (AF). Recent randomized data suggest that traditional scoring of OSA needs to evolve to improve cardiovascular outcomes. Traditional scoring of OSA does not fully reflect pathophysiological links between OSA and AF, particularly regarding OSA-induced prolongation of p-wave duration (PWD), which is the most powerful predictor of AF occurrence. Hypothesis: We hypothesized that OSA episodes that closely follow each other (serially stacked apneas, ssOSA) exert greater effect on PWD compared to isolated OSA (iOSA) episodes. Methods: Sleeping patients (adults with mild-moderate OSA and presence of both iOSA and ssOSA, but without other cardiovascular comorbidities) undergoing diagnostic polysomnography were recorded by continuous 8-lead ECG. iOSA was defined as OSA episodes with no other episode within 30 seconds. ssOSA consisted of ≥3 consecutive apneas with inter-OSA intervals &lt;30 seconds. PWD was defined from onset of p-wave in any ECG lead to termination in any lead (measured by digital calipers, averaged over 3 beats from first half of OSA and 3 beats from second half of OSA). Wilcoxon rank-sum test was used. Results: We analyzed 208 OSA episodes (51.0% iOSA, 49.0% ssOSA) which occurred in 12 patients (7 women; age 63.1±11.5 years; apnea hypopnea index 16.8±5.4). PWD was longer during ssOSA compared to iOSA (median 117.7ms vs 109.6ms; p&lt;0.0001). The following variables did not differ between ssOSA and iOSA: PR interval (p=0.3139), RR interval (p=0.7531), peripheral oxygen saturation (p=0.7776). Conclusions: The impact of OSA on atrial conduction delay is exacerbated by the phenomenon of OSA stacking, which seems independent of oxygen desaturation and heart rate. Stacking of OSA episodes may be an underused and cost-efficient variable in evaluating the severity of OSA and the effectiveness of OSA treatments with the ultimate goal of reducing occurrence of AF.
Abstract 14172: Impact of Sex on Survival With Preserved Neurologic Function Following Out-of-Hospital Cardiac Arrest
Authors: Fatima Lakhani, Brendan Caprio, Elena Deych, David L Brown
Journal: Circulation (2020)

Introduction: Females experience worse survival than males following out-of-hospital cardiac arrest (OHCA). Proposed explanations include previous observations that females less often have an initial shockable rhythm or a witnessed arrest and less often receive bystander CPR. Methods: We utilized a prospective, population-based registry of patients experiencing OHCA responded to by EMS from 2011-2015. We included patients 18 years or older who were admitted to the hospital. Univariate comparisons were performed with chi-squared test for categorical variables and t-test for age. Additional analysis compared outcomes stratified by age &gt; 50 years as a surrogate for menopausal status. A multivariate logistic regression model was constructed to evaluate the independent association of sex with outcomes. The primary outcome was survival to hospital discharge with Modified Rankin Score (MRS) ≤3. Results: Of 13,651 patients, 4894 were female and 8757 were male. The average age was 65 years for females and 64.2 years for males (P=0.005). Females were less likely than males to arrest in a public location (13% vs 27%; P &lt;0.001), have bystander witnessed arrest (48% vs 57%; P &lt;0.001), receive bystander CPR (44% vs 49%; P &lt;0.001), have an initial shockable rhythm (29% vs 48%; P &lt;0.001), have achieved ROSC upon ED arrival (76% vs 78%; P=0.014), have an ED arrival time less than 30 minutes from dispatch call (10% vs 12% P=0.008). Among males, 27% had a favorable outcome compared to 16% of females (P &lt;0.0001). Among individuals of age ≤ 50 years, 31% of males and 26% of females had a favorable outcome (P= 0.004). Among those of age &gt; 50 years, 26% of males and 14% of females had a favorable outcome (P &lt;0.0001). After adjustment for differences in age and presentation, female sex was found to be independently associated with lower rates of survival with intact neurologic function (OR 0.79, 95% CI 0.71-0.89, P =0.0001). Conclusions: Compared to males, females have less favorable OHCA presentations and worse survival to hospital discharge with preserved neurologic function. However, even after adjustment for the differences in presentation, female sex remains a significant predictor of worse survival with preserved neurologic function.
Abstract 353: Resuscitation Science Training Programs: A Review
Authors: K.H. Benjamin Leung, Tiffany Jefkins, Dakota Gustafson, Julie E Moore
Journal: Circulation (2020)

Introduction: While training in the practice of resuscitation is standardized by AHA guidelines and ACLS protocols, training in resuscitation science research has generally relied on mentorship by current researchers. Formal research-focused training programs in resuscitation science exist but the nature of such programs is not well known. We sought to determine the current state of graduate or professional-level research-focused programs in adult resuscitation science using scoping review methodology. Methods: We conducted an online web search for the phrases “resuscitation science education”, “resuscitation science training”, “resuscitation medicine education”, and “resuscitation medicine training” in May 2020. Entries were screened for relevance by their title and web text by two independent researchers. Entries were excluded if they did not contain a sizable research foundation or major project component for students. After the screening process, entries were analyzed descriptively and thematically categorized by aspects of program delivery. Results: We identified 16 programs that satisfied all inclusion criteria, consisting of 9 instructional programs and 7 research fellowships. Instructional programs were divided between stand-alone programs (4) or electives/add-ons within existing degrees (5). These programs were highly varied in their research requirements with some requiring minimal academic output. Electives/add-ons within existing degrees were generally shorter in length with most averaging only 4 weeks to completion. Two programs offered programs discussing pre-hospital, in-hospital, and post-hospital considerations for patients/caregivers and/or clinicians. Only one stand-alone program was degree-granting. Research fellowships generally varied between 1-2 years. The vast majority of all programs were limited to those with a clinical background, with emphasis on physicians specializing in emergency medicine. Conclusion: There is a relative lack of standardized research-focused training programs within resuscitation science. Moreover, existing programs tend to be constrained to those with a clinical background, presenting a barrier of entry for non-clinicians.
Phase III Trial of Avelumab Maintenance After First-Line Induction Chemotherapy Versus Continuation of Chemotherapy in Patients With Gastric Cancers: Results From JAVELIN Gastric 100
Authors: Markus Moehler, Mikhail Dvorkin, Narikazu Boku, Mustafa Özgüroğlu, Min-Hee Ryu, Alina S. Muntean, Sara Lonardi, Marina Nechaeva, Arinilda C. Bragagnoli, Hasan S. Coşkun, Antonio Cubillo Gracian, Toshimi Takano, Rachel Wong, Howard Safran, Gina M. Vaccaro, Zev A. Wainberg, Matthew R. Silver, Huiling Xiong, Janet Hong, Julien Taieb, Yung-Jue Bang
Journal: Journal of Clinical Oncology (2020)

The role of maintenance therapy for gastric (GC) or gastroesophageal junction cancer (GEJC) is unclear. We investigated avelumab (anti-programmed death ligand-1 [PD-L1]) maintenance after first-line induction chemotherapy for GC/GEJC. JAVELIN Gastric 100 was a global, open-label, phase III trial. Eligible patients had untreated, unresectable, human epidermal growth factor receptor 2-negative, locally advanced or metastatic GC or GEJC. Patients without progressive disease after 12 weeks of first-line chemotherapy with oxaliplatin plus a fluoropyrimidine were randomly assigned 1:1 to avelumab 10 mg/kg every 2 weeks or continued chemotherapy, stratified by region (Asia v non-Asia). The primary end point was overall survival (OS) after induction chemotherapy in all randomly assigned patients or the PD-L1-positive randomly assigned population (≥ 1% of tumor cells; 73-10 assay). A total of 805 patients received induction; 499 were randomly assigned to avelumab (n = 249) or continued chemotherapy (n = 250). Median OS was 10.4 months (95% CI, 9.1 to 12.0 months) versus 10.9 months (95% CI, 9.6 to 12.4 months) and 24-month OS rate was 22.1% versus 15.5% with avelumab versus chemotherapy, respectively (hazard ratio [HR], 0.91; 95% CI, 0.74 to 1.11; P = .1779). In the PD-L1-positive population (n = 54), the HR for OS was 1.13 (95% CI, 0.57 to 2.23; P = .6352). In an exploratory analysis of the PD-L1-positive population, defined as combined positive score ≥ 1 (22C3 assay; n = 137), median OS was 14.9 months (95% CI, 8.7 to 17.3 months) with avelumab versus 11.6 months (95% CI, 8.4 to 12.6 months) with chemotherapy (unstratified HR, 0.72; 95% CI, 0.49 to 1.05). With avelumab and chemotherapy, treatment-related adverse events (TRAEs) occurred in 149 (61.3%) and 184 (77.3%) patients, including grade ≥ 3 TRAEs in 31 (12.8%) and 78 (32.8%) patients, respectively. JAVELIN Gastric 100 did not demonstrate superior OS with avelumab maintenance versus continued chemotherapy in patients with advanced GC or GEJC overall or in a prespecified PD-L1-positive population.
Abstract 13550: Understanding Associations of Hospital Admission or Observation With Patient Outcomes After Emergency Department Evaluation for Suspected Acute Coronary Syndrome
Authors: Adam L Sharp, Aniket A Kawatkar, Aileen S Baecker, Rita F Redberg, Mingsum Lee, Maros Ferencik, Yi-Lin Wu, Ernest Shen, chengyi zheng, Stacy J Park, Benjamin C Sun
Journal: Circulation (2020)

Introduction: Evaluation for suspected acute coronary syndrome (ACS) results in millions of emergency department (ED) visits annually, and accounts for billions in health care costs. Understanding the benefits of hospitalization among patients who ruled out for an acute myocardial infarction (AMI) will inform physician decision making and future health care policies. Hypothesis: Hospital admission does not improve 30-day patient outcomes (death/AMI) compared to those discharged after ED evaluation for suspected ACS. Methods: We compared the effectiveness of hospitalization vs outpatient follow-up for a cohort of patients with chest pain presenting to one of 13 EDs within the Kaiser Permanente Southern California region between January 1, 2015 and December 1, 2017. The primary outcome was AMI or all-cause mortality, and secondary outcomes included revascularization and a composite MACE outcome within 30-days of ED visit. Adjusting for patient age, gender, race, ACS risk factors and chronic co-morbidities an instrumental variable (IV) analysis was used to evaluate the effect of hospitalization on patient outcomes Results: Of 77,562 chest pain patient encounters not identified as an AMI during the ED encounter, 322 (0.4%) went on to have an AMI (n=193, 0.2%) or died (n=137, 0.2%) within 30-days of ED visit (1.5% admitted vs 0.2% discharged). This included 200 (0.3%) patients who underwent coronary revascularization (0.7% admitted vs 0.2% discharged). IV analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI -0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI -0.002 to 0.007). Conclusions: Among ED patients with chest pain who are not identified with an AMI, there does not appear to be a benefit in 30-day outcomes for patients who are hospitalized compared to those discharged with outpatient follow-up.
Abstract 15482: Variation in Right Atrial Sizes Affects Locations of the His Bundle and Coronary Sinus Os
Authors: Chin C Lee, Michael Eskander, Katherine Lowe, Jonathan Chung, Jonathan Hsu, David E Krummen, Gregory Feld, Ulrika Birgersdotter-Green, Elliot McVeigh, Gordon Ho
Journal: Circulation (2020)

Background: Difficulties in HIS bundle (HBP) and coronary sinus (CS) lead delivery may be contributed by differences in right atrial (RA) anatomy. The distance from the lateral superior vena cava / right atrial junction (SVC) to the HIS bundle or CS os reflects the distance required by a delivery sheath to reach the cannulation target. However, RA geometry is not well characterized using standard 2D echo, but is well characterized by cardiac computed tomography (CT) and invasive electroanatomic mapping (EAM). Objective: The objective of this study is to characterize the variations in the distance from the SVC-RA JXN to the 1) HIS bundle and 2) coronary sinus os, and determine the correlation of these distances to standard measurements obtained from 2D echo. Methods: Cardiac CT (256 slice), electroanatomic maps, and 2D echo from patients undergoing ablation for atrial and ventricular arrhythmias were analyzed using 3D modeling software (Horos). The distances from the SVC were measured to the HIS and CS os on the CT which were co-registered to electroanatomic mapping (Fig 1A). Pearson’s coefficient analysis was performed to assess the correlation of these RA measurements with standard left-sided 2D echo measurements. Results: 41 patients (age 6210 yrs, 31% female, 69% AF ablation) were analyzed. The mean distance between SVC-HIS was 37.2 mm 8.3 mm (range 22-56mm), and the mean distance between SVC-CS os was 66.1 mm 10.1 mm (range 49-92mm), Fig 1B. Both RA measurements correlated (Fig 1B) with LA volume index (R=0.6, p&lt;0.001) but not LV diameter (R=0.079, p=0.3). Conclusion: The distance from the SVC/RA JXN to the HIS and CS os varies widely and may contribute to difficulties in HIS bundle and CS lead implantation. In the absence of pre-procedural cardiac CT or EAM, left atrial measurements from 2D echo may correlate with RA dimensions. Prospective studies are needed to test whether these measurements may help predict optimal delivery sheath sizes for HBP and CS lead placement.
Abstract 15357: P2Y12 Inhibitor Monotherapy After Short-term Dual Antiplatelet Therapy in Patients Receiving Percutaneous Coronary Intervention
Authors: Ahmad Naeem Lone, Safi U Khan
Journal: Circulation (2020)

Introduction: The safety and effectiveness of new strategy of de-escalating short-term dual antiplatelet therapy (DAPT) (≤ 3-month) followed by P2Y12 inhibitor monotherapy versus 12-month DAPT after percutaneous coronary intervention (PCI) is unclear. Hypothesis: Short-term DAPT followed by P2Y12 inhibitor therapy might be safer and equally effective compared with 12-month DAPT. Methods: Five randomized controlled trials (n=32,181) comparing P2Y12 inhibitor monotherapy with DAPT after PCI were selected from MEDLINE and EMBASE databases through June 2020. Meta-analysis was performed using random effects model. Results are reported as absolute risk differences (ARDs) with 95% confidence intervals (CIs). Results: Short-term DAPT followed by P2Y12 monotherapy was associated with lesser risk of major bleeding compared with 12-month DAPT (ARD, -0.73% [95% CI, -1.32%, -0.14%]). There were no differences between all-cause mortality (ARD, -0.22% [95% CI, -0.50%, 0.07%]), cardiovascular mortality (ARD, -0.24% [95% CI, -0.51%, 0.03%]), myocardial infarction (ARD, -0.13% [95%CI, -0.40%, 0.14%]), MACE (ARD, -0.25% [95% CI, -0.73%, 0.24%]) and stroke (ARD, 0.03% (95% CI, -0.22%, 0.29%]). These results were consistent across use of clopidogrel or ticagrelor. Conclusions: Short term DAPT followed by P2Y12 inhibitor monotherapy after PCI is safer and equally effective compared with 12-month DAPT.
Abstract 220: Public Defibrillator Accessibility and Mobility Trends During the Covid-19 Pandemic in Canada
Authors: K.H. Benjamin Leung, Rejuana Alam, Steven Brooks, Timothy C Chan
Journal: Circulation (2020)

Introduction: The COVID-19 pandemic has led to widespread closures of non-essential businesses and buildings. The impact of such closures on public automated external defibrillator (AED) accessibility compared to mobility trends is unknown. Methods: We identified all publicly available online AED registries in Canada last updated May 1, 2019 or later. AEDs were classified by location type using addresses and registry notes, and deemed completely inaccessible, partially inaccessible, or unaffected using government-issued closure orders as of May 1, 2020. We mapped AED location types to categories used by Google’s COVID-19 Community Mobility Reports and calculated the median percent change in daily traffic between Feb. 15 - May 1, 2020 (excluding Apr. 10-12). We compared the percent of completely inaccessible AEDs to the median percent change in traffic for each category. Results: We identified three provincial (British Columbia, Alberta, Nova Scotia) and two municipal (Mississauga and Toronto in Ontario) online AED registries, collectively covering 13.1 million people. Of the 5,845 AEDs identified, 69.9% were completely inaccessible, 18.8% were partially inaccessible, and 11.3% were unaffected. AEDs in parks (n=141), almost all retail and recreational locations (n=1,539), and two-thirds of workplaces (n=3,633) were completely inaccessible, grocery and pharmacy-based (n=173) AEDs were partially inaccessible, and transit station (n=277) and residential (n=85) AEDs were unaffected. The largest discrepancies between AED accessibility and mobility occurred in parks (100% completely inaccessible vs. 10.5% traffic decrease), retail and recreation (99.0% completely inaccessible vs. 48.0% traffic decrease), and transit stations (100% unaffected vs. 63.0% traffic decrease). Conclusion: Government-mandated closures due to the COVID-19 pandemic have led to a greater reduction in AED accessibility than mobility in many locations across Canada.
Abstract 16733: Immune Response Following Allogenic Cardiac Progenitor Cells Transplantation in Rat Myocardial Infarction Model
Authors: Muthukumar Gunasekaran, Rachana Mishra, Progyaparamita Saha, Aakash Shah, Davidson Lauren, Xuebin Fu, Yasir M Arfat, Mohamed Abdullah, Sudhish Sharma, Sunjay Kaushal
Journal: Circulation (2020)

Cardiac progenitor cells (CPCs) are well-characterized stem cell type shown to potentiate cardiac regeneration in myocardial infarct (MI) model. However, auto and allo immune response to transplanted adult CPCs (aCPCs) reduces cell retention and MI recovery. We aimed to increase the regenerative potential of aCPCs by reducing immune response directed to the transplanted aCPCs using cyclosporine A (CsA). Adult CPCs isolated from Wister Kyoto rat was transplanted into Brown Norway MI rats. MI rats transplanted with aCPCs+CsA demonstrated significant increase in MI recovery and cell retention compared to MI rats with aCPCs, CsA and Iscove Modified Dulbecco Media controls (p&lt;0.05). MI rats transplanted with aCPCs showed increased infiltration of CD68 + cells and apoptotic cells in the infarcted myocardium compared to aCPCs+CsA group (p&lt;0.05) analyzed by immunohistochemistry. Sera collected on day 2 and 7 of aCPCs group showed increased inflammatory cytokines (IL-2, IL-17, IFN-γ, TGF-β), antibodies to cardiac SAgs (Troponin-T and Myosin) allo antigens (RT1A, RT1B and RT1D) and reduced anti-inflammatory cytokines (IL-10). In contrast MI rats transplanted with aCPCs+CsA showed reduced inflammatory cytokines, abs to SAgs, allo antigens and increased anti-inflammatory cytokine IL-10 (p&lt;0.05). In conclusion, MI rats transplanted with allogeneic aCPCs with immune suppressant CsA showed increased cell retention, reduced inflammatory cells and cytokines compared to aCPCs, CsA and IMDM control. Therefore, CsA reduces auto and allo immune response and increases regeneration potential by increased transplanted aCPCs retention that resulted in enhanced myocardial recovery.