tbuckley/cabot-search huggingface dataset:
Abstract 9014: Difference in Contribution of Hypertension According to the 2017 American College of Cardiology/American Heart Association Guidelines to Cardiovascular Outcomes in Adult Cancer Survivors and General Population Without History of Cancer
Authors: Kyuwoong Kim, Sanghyun Oh, Jihwan Lee, Yoo S. Hong
Journal: Circulation (2021)

Introduction: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline changed the definition of hypertension, which has generated newly defined population with hypertension in the United States and elsewhere. However, there is limited evidence for the difference in contribution of hypertension according to the 2017 ACC/AHA guideline to cardiovascular outcomes in adult cancer survivors and general population without history of cancer. Hypothesis: We hypothesized that both adult cancer survivors and the general population with hypertension according to 2017 ACC/AHA definition (blood pressure ≥130/80 mm Hg) would be at higher risk of cardiovascular outcomes compared to those without hypertension and magnitude of this association would be different between the two populations. Methods: We used data from the National Health Insurance Service-National Sample Cohort (2002-2015) to identify adult (≥19 years) cancer survivors who survived more than 1 year after the first-ever cancer diagnosis and those without history of cancer matched for age and sex with 1:1 ratio. In both populations, those with history of cardiovascular disease were excluded. Cox proportional hazards model adjusted for the shared cardiovascular risk factors in the two populations and Q-statistic were used for analyses. Results: In this age and sex matched cohort, we identified 5,163 adult cancer survivors matched to their controls. The adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) for cardiovascular outcomes in adult cancer survivors with hypertension compared to those without hypertension was 1.95 (95% CI: 1.21-3.15). Hypertension was also associated with an increased risk of cardiovascular outcomes in the general population (adjusted HR=1.67, 95%: CI 1.07-2.66). However, magnitude of this association did not differ significantly between the two populations ( P heterogeneity =0.646). Conclusions: Both adult cancer survivors and the general population with hypertension according to the 2017 ACC/AHA guideline are at higher risk of cardiovascular outcomes compared to those without hypertension. Difference in the magnitude of increased risks for cardiovascular outcomes between the two populations was not discernable.
Abstract 10250: Unique Lived Experiences of Partners of Individuals Living with Single Ventricle Congenital Heart Disease -A Pilot Investigation
Authors: Andrew Well, Kate Taylor, Chris Ulack, Kathleen Carberry, Jose Colucci, Eileen Stewart, Jeremy T Affolter, Scott Wallace, Elizabeth Teisberg, Charles D Fraser, Carlos M Mery
Journal: Circulation (2021)

Introduction: With advances in care, an increasing number of individuals with single-ventricle congenital heart disease (SVCHD) are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. This pilot qualitative research study explores the lived experiences of partners of individuals with SVCHD. Methods: Partners of SVCHD patients ≥18 years were recruited and participated in Experience Group (EG) sessions and 1:1 interviews. EG sessions are lightly moderated groups that bring together individuals with similar experiences and place them as the experts to discuss lived experiences. Formal qualitative coding was performed to identify salient themes. Results: A total of 6 partners, 4 male, 4 married and all partners of someone of the opposite sex, participated. Themes identified included uncertainty of their partners future health and mortality, becoming a lay SVCHD specialist, balancing multiple roles, and providing positivity and optimism.(Table) Participants expressed a steep learning curve initially, which transforms into a strong understanding of the condition. Over time they took on the advocacy role as a repository of medical history and navigating the health system, which is often a role of parents of younger SVCHD patients. They struggled with taking on the role of primary medical caregiver of their partner while managing greater responsibility at home, and changes to their role as a spouse and a parent. Despite the uncertainties, participants described many facets of championing positivity and optimism for the future for their partner. Conclusions: In this first of its kind pilot study, partners of individuals with SVCHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners of SVCHD patients cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.
Abstract 10642: A Novel Way to Predict Obstructive Coronary Artery Disease Requiring Revascularization: The Use of Magnetocardiography
Authors: Nicholas Coriasso, Robert B Takla, David Rodriguez, Claire Pearson, Margarita Pena, Edouard Daher
Journal: Circulation (2021)

Introduction: Coronary artery disease (CAD) causes one-third of total deaths in people over the age of 35. The evaluation of suspected obstructive CAD includes H&amp;P, ECG, and cardiac enzymes. These tests can often lead to diagnostic uncertainty which can then lead to unnecessary testing such as stress tests and/or coronary angiography. Magnetocardiography (MCG) has been proposed as a noninvasive, radiation free, rapid adjunctive test in predicting coronary ischemia requiring revascularization. MCG measures the magnetic fields produced by electrical currents in the heart with unique and distinct advantages over traditional electrocardiographic approaches. Methods: One hundred patients (62% male, 69% white, age 60.9 years), suspected of having obstructive CAD, were evaluated at a large urban community hospital. All patients underwent MCG prior to coronary angiography which was interpreted by readers blinded to clinical data. MCG was considered positive if the scan displayed findings of “RT angle”, “multipolar”, or “island”. Of the 100 patients, 72 MCG studies were interpretable. Results: Of the 72 MCG studies, 25 were considered positive. Of the 25, 17 revealed obstructive CAD on angiography and underwent PCI with balloon or stent. Of the 47 negative, 35 revealed no obstructive CAD on angiography. Sensitivity was 58.6% and specificity was 81.4%. Removing patients with “island” MCG features resulted in 65 studies which improved specificity to 92.1% at a slight penalty in sensitivity at 55.6%. There were 11 patients where stress testing and MCG could be compared to angiography revealing a diagnostic accuracy of 54.5% and 81.8%, respectively. Discussion: MCG was able to predict obstructive CAD leading to PCI with a specificity of 81.4%. Refining interpretation criteria improved specificity to 92.1% plus better diagnostic accuracy than stress testing. MCG shows promise as an adjunctive test for patients with suspected CAD who may require revascularization with PCI.
Abstract 13654: Can a Novel Earbud Technology Detect Severe Aortic Stenosis? Modernizing the Wiggers Diagram Through Infrasonic Hemodynography Synchronized With Echocardiography and Cardiac Catheterization
Authors: Carly E Waldman, Siddarth Patel, Carmen M Wheeler, Jal Panchal, Rajbir Sidhu, Monika Krol, Tomasz Szepieniec, Pratistha Shakya, Saumya Gupta, Karlen Shahinyan, Anna Barnacka, Hayley Engstrom, Kayla Southard, Misty Daniel, Curtiss Stinis, Steven Romero, Charles Bridges, Sanjeev Bhavnani
Journal: Circulation (2021)

Introduction: Severe aortic stenosis (AS) produces a typical systolic ejection sound detected by clinical auscultation with a characteristic feature on Doppler echocardiography (ECHO) &amp; hemodynamics at cardiac catheterization (CC). We propose a new assessment of AS through ‘infrasonic hemodynography’ (IH) - cardiovascular monitoring by infrasound (&lt;20 Hz) measured by a novel digital device. To assess AS, we aim to compare IH to standard ECHO &amp; CC measurements. Methods: We report an N-of-1 analysis from an ongoing prospective clinical trial to validate IH on cardiac function. A study subject with severe AS wore the IH ear-bud (MindMics, Figure A) &amp; underwent simultaneous measurements with IH-ECHO &amp; IH-CC-ECG, with IH waveforms (in-ear acoustic pressure in Pascals) synchronized (via cross-correlation), stacked (11 heart beats), &amp; averaged over the QRS complex of the ECG. The QRS complex was then used as a reference to generate a quantitative Wiggers diagram, aligning IH &amp; CC waveforms with the aortic valve on ECHO. Time of aortic valve opening (AVO) &amp; closure (AVC) were determined from the ECHO image. The systole &amp; diastole were assessed by creating Wiggers diagrams from the LV outflow &amp; mitral valve inflow ECHO images. Results: The peak systolic pressure in CC occurred close to the AVC derived from ECHO (Figure B), as is typical of the delayed peak pressure in severe AS. This was captured in the IH waveform &amp; visualized by overlaid LV &amp; AO pressures simultaneously collected during CC (Figure C). Additionally, the blood pressure increase seen on CC in response to AVC (the dicrotic notch) was also delayed &amp; aligned with the drop in flow &amp; the start of the E wave on ECHO, consistent with severe AS, &amp; detected on IH. Conclusions: We describe in-ear IH as a new method for non-invasive measurement of severe AS. Infrasound assessment of cardiac function represents a potentially important development to modernize the Wiggers Diagram &amp; to detect valvular disease that is independent of ECHO &amp; CC.
Experience with polyethylene glycol allergy‐guided risk management for COVID‐19 vaccine anaphylaxis
Authors: Knut Brockow, Sonja Mathes, Jörg Fischer, Sebastian Volc, Ulf Darsow, Bernadette Eberlein, Tilo Biedermann
Journal: Allergy (2021)

Polyethylene glycol (PEG) may elicit anaphylaxis to COVID-19 mRNA vaccines, and guidance for patients at risk is needed.In retrospective patients with PEG allergy collected from 2006 till 2019, clinical, skin, and basophil activation test (BAT) characteristics discriminative for PEG allergy were analyzed and compared with the literature. In 421 prospective real-life patients asking for allergy workup for COVID-19 vaccine hypersensitivity in 2020/2021, risk assessment was performed and tolerance of the recommended vaccination approach was assessed.Ten patients with PEG allergy were found in the retrospective cohort. Patients reacted with immediate anaphylaxis (100%) not only to PEG-based laxatives/bowel preparations or injections, but also to cold medication, antiseptics, analgetics, or antibiotics. Skin tests ± BAT with PEG ± elicitors were positive in 10/10. Provocation tests were positive in 7/9 patients. From the prospective cohort, 370/421 patients self-reporting increased risk for vaccine allergy lacked criteria necessitating allergy workup and were recommended for routine vaccination. A total of 51/421 patients were tested, and three (6%) with PEG allergy were identified, whereas 48 patients remained negative in skin tests. Vaccination was recommended in all those patients. No hypersensitivity reactions were reported to vaccination including six PEG-allergic patients tolerating COVID-19 vaccination.Taking a detailed history excluded PEG allergy in most referred patients and enabled direct safe vaccination. Immediate urticaria/anaphylaxis to typical elicitors identified patients requiring PEG allergy workup. Skin tests ± BAT identified PEG allergy and helped to select the vaccine and the vaccination approach. Even PEG-allergic patients can tolerate COVID-19 vaccines.
Abstract 13800: The CardioNerds Case Report Series: The Role of Asynchronous Medical Education in Cardiovascular Training
Authors: Karan Desai, Daniel Ambinder, Nosheen Reza, Venu Menon, Amit Goyal
Journal: Circulation (2021)

Background: The COVID-19 pandemic created numerous challenges for graduate medical education, including defining the role of asynchronous virtual education in general cardiovascular (CV) fellowship training. The CardioNerds podcast introduced the CardioNerds Case Report (CNCR) series to provide continued high-quality cardiovascular education during the pandemic. Moving forward, the role and value of asynchronous education, and specifically medical podcasts, remain unknown. Methods: The CNCR series included a wide range of case-based episodes involving cardiology fellows, content experts, and program leadership from participating programs. Every accredited general cardiology fellowship program in the United States was invited. A survey assessing attitudes on a likert scale towards cased-based cardiology podcasts and medical podcasts was administered to all participating programs. Results: 44 cardiology fellowship programs participated in the CNCR series representing 137 fellows and 59 program directors and leaders (PDs). At this time, 76% of fellows and 63% of program directors have responded. 90% of both fellows and PDs agreed that the CNCR series was an effective way to teach core CV concepts and 74% of fellows felt that contributing to the CNCR series improved their clinical reasoning skills. 70% of PDs and 94% of fellows felt that medical podcasts in general added to their knowledge base. Fellows were more likely to strongly agree that medical podcasts changed their clinical practice compared to PDs (46% vs 8%, p = 0.02). Conclusion: Medical podcasts are becoming increasingly popular in cardiovascular education and training. Specifically, the CNCR platform has been well received by fellowship programs and has potentially influenced clinical practice. CV training programs and professional societies should invest in ensuring high quality medical podcasts are incorporated into CV training moving forward to supplement traditional CV education.
Abstract 9849: Self-Reported Health Care Utilization Patterns in Type 2 Diabetes Adults with and without Comorbid Heart Failure in Ethiopia
Authors: Fekadu Aga, Sandra B Dunbar, Melinda Higgins, Tedla Kebede, Senbeta Guteta, Rebecca Gary
Journal: Circulation (2021)

Introduction: Health care utilization (HCU) is an important outcome measure in type 2 diabetes (T2D) management. Little is known concerning differences in HCU patterns between T2D adults with and without heart failure (HF). Aim: This cross-sectional study compared differences in sociodemographic, clinical characteristics and self-care behaviors on HCU patterns between T2D adults with and without HF. Methods: Participants included 210 T2D adults (105 without HF and 105 with HF) from Tikur Anbessa Specialized Referral Hospital in Ethiopia. The Diabetes Health Care Utilization (DHCU) tool was adapted to measure self-reported HCU. It consists of 5 questions asking about the frequency of visits to provider, emergency room, foot examination, total days in hospital in the past 6 months, and last month(s) of eye examination. The score range from 0 (no HCU) to 7 (high utilization) with high score indicating higher utilization in all dimensions except for eye examination. The Mann-Whitney U and Kruskal-Wallis tests were used for data analysis. Results: HCU ranged from 0 to 7 visits to provider, 0 to 3 emergency room visits, 0 to 6 foot examinations, 0 to 11 days in hospital, and 0 to 96 months since previous eye examination. T2D adults with HF had significantly higher emergency room visits ( p = 0.03) and total days in hospital ( P = 0.021). In T2D adults with HF, persons who lived alone had significantly higher provider visits ( p = 0.023), emergency room visits ( p = 0.007), and total days in hospital ( p = 0.015) but lower months since previous eye examination ( P = 0.024). Men had a higher frequency of foot examination than women ( p = 0.028). In T2D adults without HF, unmarried persons had higher days in hospital ( p = 0.009). Participants who performed blood glucose self-monitoring more often had a higher frequency of foot examinations ( p = 0.036). Conclusions: Findings show that HF increases HCU in T2D adults and is higher among those who live alone. Future studies should examine strategies to provide social support on HCU.
TAMI-67. INVESTIGATION OF THE COMPLEMENT SYSTEM IN THE IRRADIATED BRAIN TUMOR MICROENVIRONMENT
Authors: Rebecca Rosberg, Karolina Smolag, Vasiliki Pantazopoulou, Anna Blom, Alexander Pietras
Journal: Neuro-Oncology (2021)

Abstract Glioblastoma is the most common and aggressive primary brain tumor in adults. Despite treatment through surgery, irradiation and chemotherapy all patients suffer recurrence of treatment-resistant tumors and the survival prognosis remains poor. The recurrence of tumors is driven by the invasive nature of the tumor and appears to be related to cells with stem like characteristics that are present in perivascular and hypoxic niches. Previous studies from our lab showed that astrocytes grown in hypoxic or irradiated conditions increase the stemness of glioma cells. The altered behavior of the astrocytes leads to increased cell size and a change in secreted cytokines. Reactive astrocytes are important in other central nervous system (CNS) diseases involved in tissue repair such as traumatic brain injury and Alzheimer’s disease. Interestingly, in several neurological diseases, reactive astrocytes upregulate complement proteins, especially complement component 3 (C3). However, it remains relatively unexplored how these complement proteins in stromal astrocytes are expressed in glioblastoma. Tissue sections from our glioma mouse model shows presence of C3 around hypoxic areas where there is an abundance of astrocytes. We have also shown that astrocytes grown at 21%, 1% and 0.1% oxygen upregulate complement protein C3 as well as other proteins associated with a more extensive infiltrative phenotype of glioblastoma. Datasets with human patients showed that C3 expression was correlated with higher grade tumors and that patients with tumors expressing C3 had more risk to get new tumors after primary treatment (including but not limited to radiotherapy). In this ongoing project, we are investigating whether activation of the complement system in the tumor microenvironment contributes to tumor progression. The upregulation of C3 in astrocytes in hypoxic conditions could therefore through local complement activation possibly led to tumor promoting signaling leading to beneficial survival of therapies of nearby glioma cells.
Abstract 12936: A Critical Role of Deubiquitinase OTUB1 in Adaptive Cardiac Hypertrophy
Authors: Wenjuan Wang, Jie Li, Jianqiu Zou, Juan Ayala, Shao-Cong Sun, Huabo Su
Journal: Circulation (2021)

Ubiquitin-mediated proteolysis is essential for protein homeostasis, and its defects lead to the development of various cardiomyopathies and heart failure. By reversing the ubiquitination and degradation of target proteins, deubiquitinases (DUBs) play a crucial role in protein homeostasis. However, the importance of DUBs in cardiac pathophysiology is largely unknown. Here we addressed the role of the DUB OTU domain aldehyde binding-1 (OTUB1) in the heart. Bioinformatics analysis reveals an upregulation of OTUB1 in hypertrophic and failing human hearts. In cultured cardiomyocytes, adrenergic agonists induced upregulation and activation of OTUB1. Silencing OTUB1 in repressed adrenergic agonists-induced fetal gene re-activation, protein synthesis and cardiomyocyte hypertrophy. In vivo , mice deficient of OTUB1 in the heart developed dilated cardiomyopathy and heart failure, leading to premature lethality. The severe cardiac phenotype is accompanied by lipid accumulation, ER dilatation, prevalent autophagic vesicles containing ribosomes, as well as dysregulated expression of metabolic and ribosome genes. Delivery of wild-type OTUB1, but not the enzymatic dead mutant, via AAV9 to OTUB1-deficient hearts attenuated cardiac dysfunction and prolonged the lifespan of mice. Mechanistically, loss of OTUB1 suppressed the degradation of Deptor, an inhibitory mTOR regulator, leading to impaired mTOR signaling in cultured cardiomyocytes and mouse hearts. Collectively, these findings suggest OTUB1 is required for physiological cardiac growth by fine-tuning mTOR signaling and identify OTUB1 as a novel regulator of cardiac homeostasis.
Abstract 13978: Concomitant Mitral Valve Repair During LVAD Implantation Does Not Improve Outcomes
Authors: Farnoosh Shariati, Antonio Duran, Austin Tutor, Amber Sleem, SELIM KRIM, Sapna Desai, Clement C Eiswirth, James Wever-Pinzon, Hector Ventura
Journal: Circulation (2021)

Introduction: Significant mitral valve regurgitation (MR) is common in those with advanced heart failure and encompasses approximately half of patients who are undergoing left ventricular assist device (LVAD) implantation. LVAD can decrease the severity of MR by LV decompression, however not all patients undergoing LVAD implantation achieve optimal LV decompression. In this study, we assessed the effect of concomitant mitral valve repair (MVr) during LVAD implantation. Methods: Retrospective study of LVAD (HM3 devices exclusively) between 8/2015 to 7/2020 at our institution. We divided our population based on whether they underwent concomitant MVr or not at the time of LVAD implant. We compared one-year outcomes between groups. Primary endpoint was a composite outcome of HF admission and mortality. Secondary endpoints were HF admissions, mortality, and heart transplantation. In a secondary analysis, we analyzed only those patients with &gt; moderate MR. Results: Total of 195 patients were included. Mean age at implant was 52.2, male accounted for 78.5%, non-ischemic cardiomyopathy 74.4%. Concomitant MVr was performed in 83 (43%) and no repair in 112 (57%) of patients. There were no differences in any of the primary or secondary endpoints between both groups (Table 1). Secondary analysis evaluation of only those with &gt; moderate MR also showed no differences in outcomes at one year. (Figure 1) Conclusion: In a homogeneous population of HM3 LVADs, concomitant MVr was not associated with improved outcomes regardless of MR severity. Our study adds to prior literature that MVr does not have an additive benefit over LVAD unloading.