tbuckley/cabot-search huggingface dataset:
Abstract 16727: Cardiac Complications of SARS CoV-2 Associated Multi-System Inflammatory Syndrome in Children (mis-c)
Authors: Ashraf S Harahsheh, Craig A SABLE, Yue-hin Loke, Roberta L DeBiasi, Laura Olivieri, Mary T Donofrio, Kavita Parikh, Charles I Berul, Ashley Austin, Michael Bell, Adam Christopher, Russell R Cross, Niti Dham, Lowell Frank, Jaclyn N Kline, Tova Ronis, Karen L Smith, Christopher Spurney, Hemalatha Srinivasalu, David L Wessel, Jing Zhang, Anita Krishnan
Journal: Circulation (2020)

Introduction: A novel pediatric disease, MIS-C, has emerged during the COVID -19 pandemic. The majority of cases were reported from European and Northeastern US centers. We present our experience of MIS-C with cardiac findings from a large tertiary pediatric cardiac center. Methods: We conducted a retrospective study of all MIS-C patients evaluated and treated from 03/29/2020 to 6/18/2020 at our center. Demographics, clinical, echo and ECG data were extracted from the echo database and EHR. Abnormal cardiac findings during the acute phase were defined as coronary artery abnormality (CAA), decreased ejection fraction (EF) and rhythm abnormality. CAAs were defined as dilation (z-score of &gt; 2 to ≤ 2.49) or aneurysm (2.5 to &lt; 5) as well as reviewed for qualitative changes. Results: 32 children, 17 (53%) males have been treated for MIS-C. The median (IQR) age was 9 (7 - 13) years. Underlying medical conditions were noted in 9 (28%) patients including 2 with cardiac conditions (one with previous history of atypical Kawasaki Disease (KD) and one with previous history of pericardial effusion s/p pericardial window). Ten (31%) patients had abnormal cardiac findings; 4 had isolated CAA, 3 had combined CAA and low EF and 2 had isolated low EF. One patient had aneurysms in all 3 CA’s, 2 patients had abnormalities in 2 CA’s (LMCA and RCA aneurysms in 1 and LMCA aneurysm and LAD dilation in 1 patient), and 4 patients had single CAA (RCA dilation in 1, LAD aneurysm in 1, and LAD dilation in 2 patients). No patient with CAA had morphologic evidence of saccular or fusiform changes. CAA persisted on subsequent echo in 3 patients and normalized in 3 patients. EF normalized on subsequent echo in 3 patients. One of the patients with isolated low EF was also found to have intermittent high grade atrioventricular (AV) block. The 10 th patient had normal echo but 1st degree AV block, sinus bradycardia, and long QTc. No arrhythmia was noted. No mortality occurred and overall length of stay was 13.6±9 days. Conclusion: Our MIS-C patients had a high rate of cardiac findings in the acute phase which exceeded rates historically observed in the setting of KD. Further long term study is needed to assess if the cardiac abnormalities persist, improve with immune modulation or are associated with major cardiac events.
Evaluation of Preoperative Chemotherapy or Radiation and Overall Survival in Patients With Nonmetastatic, Resectable Retroperitoneal Sarcoma
Authors: Sung Jun Ma, Oluwadamilola T. Oladeru, Mark K. Farrugia, Rohil Shekher, Austin J. Iovoli, Anurag K. Singh
Journal: JAMA Network Open (2020)

This cohort study compares overall survival among patients with nonmetastatic, resectable retroperitoneal sarcoma treated with surgical treatment alone vs surgical treatment and chemotherapy or radiation.
Abstract 15944: Fondaparinux: A Low-hanging Fruit in Heparin-induced Thrombocytopenia
Authors: JosÃ© P Sousa, rogerio teixeira, Carolina Lourenço, Lino Gonçalves
Journal: Circulation (2020)

Introduction: Heparin-induced thrombocytopenia (HIT) is a life-threatening disease associated with thromboembolic complications. Therefore, its treatment should comprise non-heparin anticoagulants. As opposed to direct thrombin inhibitors (DTI) and danaparoid, fondaparinux use is generally regarded as off-label. Purpose: To perform a meta-analysis to appraise fondaparinux efficacy and safety in the setting of HIT. Methods: We systematically searched Embase, MEDLINE, Web of Science, Cochrane CENTRAL and Google Scholar databases, using the terms “heparin-induced thrombocytopenia” and “fondaparinux”, form inception to June 1, 2020. Studies targeting thrombotic complications, bleeding events, platelet count and mortality were included. The primary endpoint was a composite of arterial and venous thromboembolism, amputation, gangrene and HIT-related mortality. Therapeutic arms were those of fondaparinux and a standard non-heparin anticoagulant. A random-effects model with Mantel-Haenszel method was performed to calculate pooled odds ratios (OR) and their 95% confidence interval (CI). Results: We encompassed 7 retrospective studies, which accounted for 630 patients, of which 302 were under fondaparinux. The remaining were treated with danaparoid, argatroban, lepirudin or bivalirudin. There were 109 primary endpoint events, 80 hemorrhages, 13 persistent or recurring thrombocytopenia cases and 98 deaths. Fondaparinux was found not only to numerically reduce thromboembolism (6 studies, OR 0.28, 95% CI 0.06-1.20, P 0.09, i 2 45%) but also to significantly lessen primary endpoint events (7 studies, OR 0.26, 95% CI 0.10-0.67, P 0.006, i 2 66%). In parallel, a tendency towards a lower rate of bleeding with fondaparinux use was also unveiled (7 studies, OR 0.78, 95% CI 0.50-1.21, P 0.27, i 2 0%). Likewise, thrombocytopenia cases were less common in the fondaparinux arm (4 studies, OR 0.16, 95% IC 0.05-0.57, P 0.004, i 2 0%). Finally, fondaparinux use was also associated with a survival benefit (6 studies, OR 0.26, 95% IC 0.08-0.90, P 0.03, i 2 54%). Conclusions: Fondaparinux seems to be at least as safe and more effective than other non-heparin anticoagulants, in the setting of HIT. Prospective studies are needed to demonstrate this hypothesis.
Abstract 17137: Risk Factors for New-onset Aortic Stenosis and Aortic Valve Replacement in End-Stage Renal Disease Patients - Results From the Swedish Renal Registry
Authors: Georgios Vavilis, Magnus Back, Peter Barany, Karolina Szummer
Journal: Circulation (2020)

Introduction: Risk of aortic valve calcification increases in CKD. The incidence and the risk of new-onset AS among dialysis patients (DP) remains unknown. Objectives: We aimed to evaluate the IR and predictors of AS and AVR in DP. Methods: All DP (n= 14,054) in the national Swedish Renal Registry between 1993-2018, with no prior AS or AVR, were included. AS was defined by ICD-10 codes or surgical procedure codes. Results: During a median follow-up time of 2.8 years (IQR 1.1-5.7), 596 (4.2%) DP were diagnosed with AS; IR of 15/1000 (95% CI: 13-16/1000) p-y (Figure 1a). AVR was done in 113 (0.8%) patients; IR 2/1000 p-y (95% CI:2-3/1000) Figure 1b. DP with new-onset AS were older (70.4±11 vs 64.8±15.3, p&lt;0.001), males (76% vs 66%, p&lt;0.001), had AF (19% vs 15%, p=0.010), hypertension (97 % vs 95%, p=0.033) and CAD ((23.3% vs 19%, p=0.008). There was no difference in the risk for AS between hemo-or peritoneal dialysis (HR 1.1, 95%CI: 0.64-1.15 p=0.32). In adjusted Cox models, only male gender (HR 1.44, 95 CI 1.18- 1.76) and AF (HR 1.34, CI 1.07 - 1.67) were associated with new-onset AS. Patients undergoing AVR were comparable in age with the entire cohort (64 ±10 vs 65±15, p=0.51), but had less often HF (7.1% vs 13.6%, p=0.041) and PAD (3.5% vs 11.2%, p=0.011) (Table 1). In adjusted Cox models, only male gender (HR 1.97, 95%CI: 1.12 - 3.46) was associated with AVR. Conclusions: Both new-onset AS diagnosis and AVR in DP is associated with male gender. Kaplan-Meier curves with overall cumulative incidence of:Figure 1a. New onset AS in DP. Log-rank (p&lt;0.0000) test. Figure 1b. Of AVR. Log-rank (p&lt;0.000) test. Both outcomes were censored at time of death or renal transplantation
Abstract 13945: Omega-3 Fatty Acids, Triglyceride Concentrations, and Cardiovascular Outcomes: The Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Lisa Kreft, Christina Byrne, Muthiah Vaduganathan, Tor Biering-srensen, Michael H Olsen, Deepak L Bhatt, Manan Pareek
Journal: Circulation (2020)

Background: Mixed omega-3 fatty acid preparations have shown inconsistent effects on triglyceride concentrations and cardiovascular (CV) events. Nevertheless, several formulations are widely available as prescription medications. Purpose: To assess the frequency of omega-3 fatty acid use and its association with triglyceride concentrations and CV outcomes in high-risk subjects from the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: SPRINT was a randomized, controlled trial in which non-diabetic individuals aged ≥50 years, at high CV risk, and with a systolic blood pressure (BP) 130-180 mmHg were randomized to intensive (systolic BP target &lt;120mmHg) or standard BP control (systolic BP target 135-139 mmHg). The primary outcome was the composite of acute coronary syndromes, stroke, heart failure, or CV death. Omega-3 fatty acid use was extracted via review of medication records of study participants. We first assessed the association between use of omega-3 fatty acids and triglyceride levels at baseline. We then examined associations between omega-3 fatty acid use and CV events. Finally, we tested whether use of omega-3 fatty acids affected the efficacy of other lipid-lowering agents and of intensive BP control. Results: Of 9361 participants, 680 (7.3%) used omega-3 fatty acids at baseline (632 marine-based, 27 plant-based, and 21 both). Median triglyceride concentrations did not differ between patients on omega-3 fatty acids versus those without (110 (range 25-1701) mg/dl versus 106 (range 23-3340) mg/dl; P=0.08). Median follow-up duration was 3.3 (range 0-4.6) years. Omega-3 fatty acid use was not associated with a reduction in the primary endpoint (adjusted hazard ratio 0.90, 95% confidence interval: 0.65-1.25; P=0.54), any of its individual components, or death from any cause (P≥0.05 for all). Moreover, omega-3 fatty acid use did not modify the effect of any other lipid-lowering agent or of intensive versus standard BP control (P≥0.05 for all). Conclusions: More than 7% of high-risk individuals in SPRINT used omega-3 fatty acid preparations. These agents did not affect CV outcomes. Indiscriminate prescription of omega-3 fatty acids should be discouraged, and only preparations with documented efficacy and safety should be used.
Psychopathology in children exposed to trauma: detection and intervention needed to reduce downstream burden
Authors: Andrea Danese, Katie A McLaughlin, Muthanna Samara, Carla S Stover
Journal: BMJ (2020)

The clinical implementation of assessment and evidence based interventions is lagging behind research, with huge cost to individuals and society, write <b>Andrea Danese and colleagues</b>. To provide the best possible care to some of the most vulnerable children, specialist training, clinical capacity, and access to care must be increased
Abstract 13452: Sex Differences in Presentation, Management, and Outcomes Among Patients Hospitalized With Acute Pulmonary Embolism
Authors: Abby M Pribish, Sebastian Beyer, Anna K Krawisz, Ido Weinberg, Brett J Carroll, Eric A Secemsky
Journal: Circulation (2020)

Introduction: The presence of gender disparities in cardiovascular disease has been well-described, but there is a paucity of data regarding the impact of gender on the presentation, management and outcomes of acute pulmonary embolism (PE). Hypothesis: We hypothesized that there are no gender-based differences in PE management or outcomes. Methods: We identified all patients admitted to our institution with acute PE from 8/1/2012-7/1/2018. We stratified presenting characteristics, management and outcomes between women and men. Outcomes included major bleeding, survival, 90-day readmission, and 90-day recurrent venous thromboembolism (VTE). Inverse probability of treatment weighting was used to evaluate the independent association between sex and in-hospital and short-term outcomes. Results: The study included 2031 patients with PE, 53.2% of whom were women. Women had a higher mean age (63.8 years vs 62.3 years, P=0.04). PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; P=0.19), but women were more likely to present with dyspnea (59.8% vs 52.0%, P&lt;0.001) and had higher median NT-pro-BNP levels (605 pg/mL [IQR 143-2582] vs 319 pg/mL [IQR 82-1576], P&lt;0.001). Although the comorbidity burden was similar, women were less likely to have a history of PE (19.3% vs 24.2%, P=0.01), smoking (43.1% vs 53.3%, P&lt;0.001), or myocardial infarction (6.6% vs 9.7%, P=0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, P=0.04), but after adjustment, there was no gender-based survival difference. There were also no gender differences in PE-related diagnostic studies, use of advanced therapies, or other short-term outcomes, before and after adjustment (p&gt;0.05 for all) (Fig 1). Conclusions: In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations than men. Despite this, there were no gender disparities in PE management or outcomes.
Hematoxylin binds to mutant calreticulin and disrupts its abnormal interaction with thrombopoietin receptor
Authors: Ruochen Jia, Thomas Balligand, Vasyl Atamanyuk, Harini Nivarthi, Erica Xu, Leon Kutzner, Jakob Weinzierl, Audrey Nedelec, Stefan Kubicek, Roman Lesyk, Oleh Zagrijtschuk, Stefan N. Constantinescu, Robert Kralovics
Journal: Blood (2020)
Abstract 14453: Ventilatory Inefficiency Associated With Stage a Heart Failure
Authors: Elizabeth L Potter, Mary N Woessner, Christopher Neil, Thomas H Marwick, Erin Howden
Journal: Circulation (2020)

Introduction: Peak oxygen utilisation (VO 2 ) and ventilatory efficiency (VE/VCO 2 slope) provide strong prognostic information in symptomatic heart failure (HF). Transition from subclinical to symptomatic HF is poorly understood. Cardiopulmonary exercise testing (CPET) in subclinical HF may advance risk profiling. Hypothesis: HF risk factors are associated with metabolic and ventilatory abnormalities that may serve as risk markers. Methods: Sedentary subjects (n=81; 67 (66-72) years; 65% female; BMI 29.9[26.6-33.9] kg/m 2 ) with ≥1 HF risk factors (Stage A HF, SAHF) without pulmonary disease and healthy sedentary subjects (controls, n=21; 70 (67-73) years; 52% female; BMI 25.1 [24-25.9] kg/m 2 ) underwent treadmill CPET to determine peak VO 2 , ventilatory threshold (VT, V-slope method) and VE/VCO 2 slope (linear regression). Global longitudinal strain≤16%, diastolic dysfunction or left ventricular hypertrophy defined subclinical left ventricular dysfunction (LVD). Results: LVD was present in 41 (51%) with SAHF. CPET parameters did not differ by presence of LVD. There were no differences in peak RER or VT (% peak VO2) between controls and SAHF. VO 2 peak was higher in controls vs. SAHF (22.1±4.6 vs. 19.9±4.6ml/kg/min, p=0.047). VE/VCO 2 slope was markedly steeper in SAHF vs. controls (40.2±6.2 vs. 29.3±6.1, p&lt;0.001) (Figure). VE/VCO 2 slope was &gt;34 (prognostic in symptomatic HF) in 83% vs. 19% for SAHF vs. controls (p&lt;0.001). BMI was the only independent predictor (β 0.45 (0.19-0.72, p=0.001) (r 2 0.16) of VE/VCO 2 slope (SBP and heart rate reserve were not). BMI was not associated with increment in respiratory rate or tidal volume (β0.18(-0.07-0.42) and β3.9 (-10.8-18.7)). Conclusions: Cardiorespiratory exercise parameters do not differ in SAHF by presence of LVD. Ventilatory inefficiency is pronounced in SAHF compared with healthy controls suggesting it may be a risk marker, but prognostic significance is unknown.
Abstract 12759: Diagnostic and Prognostic Utility of T1 Mapping and Extracellular Volume by Magnetic Resonance Imaging for Cardiac Amyloidosis: A Meta-analysis
Authors: Tom Kai Ming Wang, Maria Vega Brizneda, Deborah H Kwon, Scott D Flamm, Mazen A Hanna, Brian P Griffin, Bo Xu
Journal: Circulation (2020)

Background: Cardiac magnetic resonance imaging (CMR) is central to the evaluation of cardiac amyloidosis (CA). Native T1 mapping and extracellular volume (ECV) are novel CMR techniques with evolving utility in cardiovascular diseases including CA. This study aims to meta-analyze the diagnostic and prognostic data of native T1 mapping and extracellular volume (ECV) techniques for assessing CA. Methods: Pubmed, Cochrane and Embase were searched until 31 March 2020 for studies reporting the accuracy of native T1 mapping and ECV for diagnosing CA or predicting all-cause mortality. Area under the receiver-operative characteristics curves (AUC) and hazards ratios (HR) with 95% confidence intervals (95% CI) respectively were pooled using random-effects models and Open-Meta(Analyst) software. Results: Amongst 459 records obtained from the literature search, 41 full-text articles were assessed and 10 studies were eligible totalling 2364 subjects and 1528 patients with confirmed CA. Pooled AUCs (95% CI) for diagnosing CA were 0.924 (0.889-0.959) for native T1 mapping and 0.963 (0.925-1.000) for ECV (Figure panel A/B). Both techniques had similarly high detection rates for AL- and ATTR CA (pooled AUCs of 0.935 and 0.916 for native T1 mapping and 0.980 and 0.952 for ECV). Pooled HRs (95% CI) for predicting all-cause mortality were 1.15 (1.08-1.22) for native T1 mapping as a continuous parameter, 1.19 (1.01-1.40) for ECV as a continuous parameter (Figure panel C/D), and 4.93 (2.64-9.20) for ECV as a binary threshold. Conclusion: Both native T1 mapping and ECV had high diagnostic performance for CA and predicted all-cause mortality after CA. These CMR techniques can play important roles in the multi-modality imaging assessment of CA, including when contrast administration is contraindicated.
Abstract 14950: Absolute Change in Highly Sensitive Troponin T Concentration 2 Hours After an Initial Sample Out-Performs Other Highly Sensitive Troponin Diagnostic Models for the Early Diagnosis of Myocardial Infarction
Authors: James A Shand, Andrew Howe, Michael Connelly, Ian B Menown, Pascal McKeown, David J McEneaney
Journal: Circulation (2012)

The current universal definition of MI requires the observation of a rise or fall in troponin for the diagnosis of acute MI. Conventionally, a relative change (delta) of 20% is taken as significant...
Abstract 16698: Cardiopulmonary Exercise Testing With an In-Line Filter During the COVID-19 Pandemic
Authors: Rohan R Bhat, Mark W Schoenike, Alyssa Kowal, Casey White, Jennifer Rouvina, Charles C Hardin, Rajeev Malhotra, Gregory D Lewis
Journal: Circulation (2020)

Introduction: During maximum incremental exercise expiratory flow rates increase &gt; 10-fold and minute ventilation can exceed 100L/min, raising concern for possible spread of COVID-19 in asymptomatic patients undergoing exercise testing. Moreover, use of surgical or N95 masks that limit airflow are recognized to limit the ability to perform maximum exercise. Hypothesis: Use of an in-line filter during cardiopulmonary exercise testing is feasible and will not adversely impact measurements of exercise capacity. Methods: We conducted a proof-of-principle study in which a commercially available electrostat filter (Figure 1A), which has &gt;99.9% viral efficiency without affecting spirometry measurements during pulmonary function testing, was placed in-line, upstream of the flow meter and gas analyzer sample line for use during cardiopulmonary exercise testing. A single healthy subject completed incremental exercise with a 3 min period of unloaded exercise followed by 4-min stages of exercise at 50, 100, 150, and 200W with and without the filter in place on the same day. Mechanical dead space was 53 ml with the filter and 45 ml without. Results: In comparison to no internal filter, use of an in-line filter resulted in VO 2 measurements of 99%, 97%, 98%, and 97% during 50W, 100W, 150W, and 200W, respectively (Figure 1A). VO 2 /work slope measurements and measurements of minute ventilation were also highly consistent throughout exercise with and without use of an in-line filter (Figure 1B). Conclusions: Exercise testing is an integral part of cardiovascular care delivery. Our findings require further validation but suggest that an in-line filtration system can be utilized in an effort to reduce droplet and viral dissemination without impacting measures of cardiopulmonary performance.
Abstract 14450: Association of Trajectory of High Sensitivity C-reactive Protein and Incident Heart Failure in African Americans: The Jackson Heart Study
Authors: Arsalan Hamid, Wondwosen Yimer, Adebamike A Oshunbade, Shahzeb Khan, Rodney K Kipchumba, Daisuke Kamimura, Ambarish Pandey, Robert J Mentz, Donald CLARK, Ervin R Fox, Jarett D Berry, Richard Stacey, Amil Shah, Adolfo Correa, Javed Butler, Michael E Hall
Journal: Circulation (2020)

Introduction: Elevation in the inflammatory marker high sensitivity C-reactive protein (hsCRP) is associated with worse outcomes in patients with heart failure (HF). We aimed to determine if baseline or trajectory of hsCRP levels over time predict incident HF hospitalization. Methods: Jackson Heart Study (JHS) participants’ (n=4203 African Americans) hsCRP levels were measured over 3 visits (visit 1: 2000 to 2004; visit 2: 2005 to 2008; visit 3: 2009 to 2013). We assessed the association of a single hsCRP level measurement at baseline (visit 1) with incident HF hospitalization using Cox proportional hazard models. Furthermore, we assessed the association of trajectory of hsCRP over repeated measurements (visit 1-3) with incident HF using a joint model, which incorporates estimated hsCRP from a linear mixed effects model into a Cox hazards model to predict incident HF hospitalization while incorporating trajectory of hsCRP over visits. All hazard ratios (HR) are presented as an increase in hsCRP by 1 standard deviation on a Log 2 scale. Results: At baseline, mean age of participants was 55±13 years, 63.4% were women, and mean hsCRP level was 0.5±0.7 mg/dl. Over a median follow-up of 12 years, 353 (8.4%) participants were hospitalized with incident HF. After adjustment for covariates, baseline hsCRP was not associated with increased risk of incident HF hospitalization (Table, p&gt;0.05). However, increases in hsCRP levels on follow-up were associated with a significantly increased risk of incident HF hospitalization (Table, p&lt;0.05). Conclusions: While an elevated hsCRP level at one time point may not be associated with incident HF, the increasing trajectory of change in hsCRP over time is predictive of increased risk for incident HF hospitalization in African Americans. These data support the role of increased inflammatory status in the development of heart failure.