tbuckley/cabot-search huggingface dataset:
Abstract 13370: The Relationship Between Longitudinal Changes in Left Ventricular Ejection Fraction and Survival From 57,823 Patients in a Large Regional Health System
Authors: Linyuan Jing, Samuel Fielden, Gregory J Wehner, Joseph Leader, Christopher M Haggerty, Brandon Fornwalt
Journal: Circulation (2020)

Introduction: An intriguing U-shape relationship between left ventricular ejection fraction (LVEF) and survival has recently been reported, with LVEFs of 60-65% associated with the lowest mortality risk. In heart failure, LVEF recovery has been linked to improved outcomes; however, the relationship between changes in LVEF (ΔLVEF) and survival in a general clinical population has not been studied. We hypothesized that ΔLVEF would have a non-linear relationship with all-cause mortality. Methods: A total of 194,599 echocardiograms from 57,823 patients with physician-reported LVEF were identified from Geisinger health records, along with dates of death or last living encounter, age, sex, smoking status, height, weight, and active diagnoses. ΔLVEF for a given echocardiogram was calculated for 136,776 studies as the difference between the most recent previous and current LVEF. Cox Proportional Hazards Regression was used to relate interaction between ΔLVEF and current LVEF to all-cause mortality while adjusting for confounders. Results: Death occurred in 15,419 patients who underwent 39,562 (29%) echocardiograms. Median follow up duration was 3.6 years (IQR, 1.3-7.2), and median time between tests was 1.0 year (IQR, 0.2-2.3). The interaction between LVEF and ΔLVEF ( P &lt; 0.001) demonstrated that a stable LVEF of 60-65% was associated with the best survival (Figure). A decreased LVEF was universally associated with increased mortality, while LVEFs that had increased showed non-linear interactions. In general, an LVEF of 35-55% that had increased from the previous test was associated with a similar or slightly lower mortality than the same LVEF that was unchanged or had decreased, while an LVEF &gt;55% that had increased was associated with an increase in mortality risk compared to those with a stable LVEF. Conclusions: Changes in LVEF have a non-linear relationship with all-cause mortality. In general, a constant, stable LVEF associates with the lowest risk of mortality.
Abstract 14655: Diffusion Neuroimaging of Adults With D-Transposition of the Great Arteries Reveal White Matter Alterations in the Connectomic Rich Club
Authors: Ai Wern Chung, Borjan Gagoski, Jane W Newburger, P. Ellen Grant, Michelle GURVITZ
Journal: Circulation (2020)

Introduction: The population of adults with d-transposition of the great arteries (TGA) continue to grow. As this group has underlying neurocognitive impairment and longer-term neurovascular damage, advanced neuroimaging to identify markers for treatment is required. Diffusion (d)MRI tractography quantifies the structural integrity of white matter (WM) pathways in the brain - where lower FA (fractional anisotropy) and higher ADC (apparent diffusion coefficient) typify WM damage. The brain’s structural backbone is its rich club (RC), a set of highly interconnected regions established before birth and vital for effective cognitive function. Moreover, there are Feeder and Seeder subnetworks peripheral to the RC, which are thought to form later and may be more adaptive. Hypothesis: We hypothesize that adults with TGA have alterations in both the brain’s structural RC and in peripheral connections. Methods: Subjects were TGA adults from the Boston Circulatory Arrest Study (n = 25, mean age 28.46 ± 1.14yr) and Controls (n = 13, 28.35 ± 1.70). Multi-shell, high-angular resolution dMRI data were acquired and fitted with a multi-fiber model (Fig). After tractography, a connectome of the number of tracts connecting pairwise cortical regions was computed. A priori RC regions were bilateral superior frontal and parietal frontal gyri, precuneus, posterior cingulate and insular regions. Connections were grouped into subnetworks and mean FA and ADC computed. Results: Cohorts were age-matched (p=0.801, unpaired t-test). Overall, patients had lower FA and greater ADC than controls in all subnetworks. Group differences (unpaired t-tests) were significant in the RC (ADC p=0.029), Feeder subnetwork (FA p=0.041; ADC p=0.042), with trends in Seeder subnetworks (FA p=0.061; ADC p=0.062). Conclusions: Widespread WM alterations exist in adults with TGA not only in the brain’s most central system, but also connections feeding into the RC suggesting prenatal and adaptive changes.
Abstract 16459: Racial and Ethnic Differences in Echocardiographic Abnormalities and Myocardial Injury in Patients With Covid-19: The CIRC-19 Registry
Authors: Michael S Miller, Gennaro Giustino, Annapoorna Kini, Giulio Stefanini, Renato Bragato, Eman Rashed, Marco Vicenzi, Tatyana Danilov, Nina Kukar, Nada Shaban, Fabio Fazzari, Irene Rota, Connor P Oates, Anton Camaj, Solomon Bienstock, Samin K Sharma, Jeffrey Silbiger, Stamatios Lerakis, Martin E Goldman, Lori B Croft
Journal: Circulation (2020)

Introduction: Myocardial injury is common amongst patients hospitalized with Covid-19 and is associated with a poor prognosis. It is unknown whether its incidence and its mechanisms differ by race and ethnicity. Methods: We conducted a multicenter, international cohort study at 7 hospitals in New York (United States) and Milan (Italy) between March and May 2020. All patients were hospitalized, had laboratory-confirmed Covid-19, and received a transthoracic echocardiogram (TTE) during their hospitalization. We evaluated the association between race/ethnicity and myocardial injury in multivariable logistic regression models. Myocardial injury was defined as any cardiac troponin elevation above the upper limit of normal at each enrolling site. Results: A total of 305 consecutive patients were included, of whom 280 had self-reported race/ethnicity. Key demographic, laboratory and echocardiographic characteristics are presented in the Table. All minority groups had higher incidence of a composite of major echocardiographic abnormalities compared to whites, and Asian and Hispanic patients had increased incidence of RV dysfunction. In multivariable models, compared with Whites, Black (adjOR 2.7 [1.1-6.4]), Asian (adjOR 3.3 [1.1-10.2]), and Hispanic (adjOR 2.8 [1.4-5.8]) patients had increased odds of myocardial injury. After adjusting for baseline demographic and clinical variables, both Asian (adjOR 9.9 [2.6-38.6]) and Hispanic (adjOR 5.7 [2.1-15.6]) patients had increased odds of in-hospital mortality compared with White, but not Black (adjOR 2.0 [0.6-7.0]) patients. Conclusions: Among hospitalized patients with Covid-19 who received a TTE, minority groups had higher incidence of echocardiographic abnormalities and increased risk of myocardial injury. After adjustment for baseline confounders, only Asian and Hispanic patients remained at increased risk for in-hospital mortality.
Pulmonary Artery Sarcoma With Low 18F-FDG Uptake
Authors: Juan José Rosales Castillo, Laura García, Juan Fernando Bastidas, Ángela Bronte, María José García-Velloso
Journal: Clinical Nuclear Medicine (2020)

A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension (>54 mm Hg). A CT pulmonary angiogram showed a filling defect in the pulmonary trunk, right and left pulmonary arteries, raising the possibilities of pulmonary embolism or artery sarcoma. FDG PET/CT was performed for further evaluation and showed low uptake in the pulmonary wall, which supported the diagnosis of pulmonary embolism. Patient was treated with anticoagulants with no changes on repeated CT pulmonary angiogram. Patient underwent surgery, and histopatological examination revealed a pulmonary artery sarcoma.
ACCF/AHA 2011 Health Policy Statement on Therapeutic Interchange and Substitution
Authors: David R. Holmes, Jeffrey A. Becker, Christopher B. Granger, Marian C. Limacher, Robert Lee Page, Cathy Sila
Journal: Circulation (2011)

This document is an American College of Cardiology Foundation (ACCF) health policy statement and is intended to promote or advocate a position, be informational in nature
My <i>Autohistoria-Teoría</i> (trans)formational experience: An autoethnographical case study of a transgender BIPOC teacher’s experience with racial healing
Authors: Mario I. Suárez
Journal: International Journal of Transgender Health (2020)

Visibility of the transgender community has increased, particularly in the media. Trans teachers face a challenge, as their professional roles are both public and private. In an effort to seek personal and professional support, trans teachers have turned to social media outlets. Additionally, current research does not always encompass intersectional experiences of trans BIPOC teachers.This paper presents an autohistoria-teoría, or autoethnographical case study account of the author's experience coming out in the workplace as a trans teacher in Texas.Guided by Slavin et al. multicultural model of the stress process coupled with intersectionality, this paper attempts to describe how a trans teacher of color navigates the workplace. The data for this study are a collection of all of the author's social media posts from 2005 to 2015.Findings reveal that allies provided some support, and that this trans teacher used deflection as a coping strategy in posts.The results suggest that administrative and peer support can impact transgender workers' mental well-being. In this paper, autohistoria-teoría is used as a powerful way for a trans BIPOC teacher's narrative to be told, which contributed to cultural healing.
Reprogramming the rapid clearance of thrombolytics by nanoparticle encapsulation and anchoring to circulating red blood cells
Authors: Mohit Pratap Singh, Nicholas H. Flynn, Sri Nandhini Sethuraman, Saeed Manouchehri, Jerry Ritchey, Jing Liu, Joshua D. Ramsey, Carey Pope, Ashish Ranjan
Journal: Journal of Controlled Release (2020)
Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction
Authors: Are Annesønn Kalstad, Peder Langeland Myhre, Kristian Laake, Sjur Hansen Tveit, Erik Berg Schmidt, Paal Smith, Dennis Winston Trygve Nilsen, Arnljot Tveit, Morten Wang Fagerland, Svein Solheim, Ingebjørg Seljeflot, Harald Arnesen
Journal: Circulation (2020)

Background: High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after myocardial infarction, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. Methods: The OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) is an investigator-initiated, multicenter, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg eicosapentaenoic acid and 660 mg docosohexaenoic acid) versus placebo (corn oil) daily to standard of care in patients aged 70 to 82 years with recent (2–8 weeks) AMI. The primary endpoint was a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after 2 years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. Results: In total, 1027 patients were randomized. Follow-up data were available for 1014 patients who were included in the intention-to-treat analysis. Mean±SD age was 75±3.6 years, 294 (29%) were female, and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA versus 102 (20.0%) on placebo (hazard ratio, 1.08 [95% CI, 0.82–1.41]; P =0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA versus 15 (4.0%) on placebo (1.84 [0.98–3.45]; P =0.06). Median changes in eicosapentaenoic acid and docosahexaenoic acid were +87% and +16% for n-3 PUFA versus −13% and −8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively ( P =0.87). Similar results were found in per-protocol analysis (n=893). Conclusions: We could not detect reduction in clinical events in our elderly patients with recent AMI who were treated with 1.8 g n-3 PUFAs daily for 2 years. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01841944.
Abstract 14703: Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States
Authors: Dhiran Verghese, Sri Harsha Patlolla, Saraschandra Vallabhajosyula
Journal: Circulation (2020)

Background: Sex disparities exist in acute cardiovascular care. Despite sex-specific cardiac arrest (CA) research being identified as a priority by professional societies, there are limited studies on this topic. Objectives: To assess sex disparities in management and outcomes of CA complicating acute myocardial infarction (AMI) in a contemporary United States population. Methods: Adult admissions with a primary diagnosis of AMI and concomitant diagnosis of CA were identified using the National Inpatient Sample. Outcomes of interest included sex disparities in in-hospital mortality, coronary angiography (CAG), percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS) use. Results: Between January 1, 2000 and December 31, 2017, 11,622,528 admissions for AMI were identified, of which 584,216 (5.0%) were complicated by CA. Men had higher prevalence of CA compared to women (5.4% vs 4.4%, p&lt; 0.001) in both STEMI and NSTEMI (2017 vs 2000, STEMI-men: 12.3% vs 7.8%, STEMI-women: 10.4% vs 7.5%, NSTEMI-men: 3.1% vs 2.7%, NSTEMI-women: 2.4% vs 2.5%). Women with AMI-CA were on average older (70.4 vs 65.0, p&lt;0.001), of black race (12.6% vs 7.9%, p&lt;0.001) and had higher comorbidity. Women were more likely to present with NSTEMI (36.4% vs 32.3%, p&lt;0.001) and a non-shockable rhythm (47.6% vs 33.3%, p&lt;0.001). Women less frequently received CAG (56.0% vs 66.2 %), early CAG (32.0% vs 40.2%), PCI (40.4% vs 49.7%), MCS (17.6% vs 22.0%), and CABG (all p&lt;0.001). Women had significantly higher unadjusted in-hospital mortality (52.6% vs 40.6%, p &lt; 0.001). In a multivariable logistic regression analysis, female sex was associated with higher in-hospital mortality (OR 1.13 [95% CI 1.11-1.14]; p&lt; 0.001). When stratified by type of rhythm, type of AMI, presence of cardiogenic shock and location of CA, women consistently received less frequent CAG and experienced higher in-hospital mortality. Conclusion: In the largest 18-year study evaluating management and outcomes of CA in AMI, we identified the presence of significant sex disparities. Women with AMI-CA were older, with higher rates of non-shockable rhythm, were less likely to undergo therapeutic procedures including CAG, PCI, and MCS. Women had higher unadjusted and adjusted in-hospital mortality.
Prostate-Specific Membrane Antigen Uptake in a Peripheral Nerve and Respective Ganglia on 68Ga–Prostate-Specific Membrane Antigen–HBED-CC PET/CT
Authors: Jasmin Mettler, Alexander Drzezga, Markus Dietlein, Tim Hucho, Carsten Kobe
Journal: Clinical Nuclear Medicine (2020)

A 74-year-old man with a history of prostate cancer with proven osseous metastatic disease underwent Ga-prostate-specific membrane antigen (PSMA) PET/CT under antiandrogen therapy. The scan revealed a long segment of increased PSMA tracer uptake within the right sciatic nerve, which appeared edematous and swollen, and the respective ganglia. Clinically, the patient suffered from pain and paresis in the right leg. As infiltration of a long segment of a single nerve seems unlikely, primarily neuronal disease such as neuritis (induced by metastases or radiotherapy) was considered. The observed uptake of PSMA-targeting PET tracers may then represent a peripheral nerve disorder.
Advanced Breast Cancer Definitions by Staging System Examined in the Breast Cancer Surveillance Consortium
Authors: Karla Kerlikowske, Michael C S Bissell, Brian L Sprague, Diana S M Buist, Louise M Henderson, Janie M Lee, Diana L Miglioretti
Journal: JNCI Journal of the National Cancer Institute (2020)

Advanced breast cancer is an outcome used to evaluate screening effectiveness. The advanced cancer definition resulting in the best discrimination of breast cancer death has not been studied in a breast imaging population.A total of 52 496 women aged 40-79 years participating in the Breast Cancer Surveillance Consortium diagnosed with invasive cancer were staged using the 8th edition of American Joint Committee on Cancer (AJCC) anatomic and prognostic pathologic systems and Tomosynthesis Mammographic Imaging Screening Trial (TMIST) tumor categories. We calculated the area under the receiver operating characteristic curve for predicting 5-year breast cancer death and the sensitivity and specificity for predicting 5-year breast cancer death for 3 advanced cancer classifications: anatomic stage IIB or higher, prognostic pathologic stage IIA or higher, and TMIST advanced cancer.The area under the receiver operating characteristic curves for predicting 5-year breast cancer death for AJCC anatomic stage, AJCC prognostic pathologic stage, and TMIST tumor categories were 0.826 (95% confidence interval [CI] = 0.817 to 0.835), 0.856 (95% CI = 0.846 to 0.866), and 0.789 (95% CI = 0.780 to 0.797), respectively. AJCC prognostic pathologic stage had statistically significantly better discrimination than AJCC anatomic stage (difference = 0.030, bootstrap 95% CI = 0.024 to 0.037) and TMIST tumor categories (difference = 0.067, bootstrap 95% CI = 0.059 to 0.075). The sensitivity and specificity for predicting 5-year breast cancer death for AJCC anatomic stage IIB or higher, AJCC prognostic pathologic stage IIA or higher, and TMIST advanced cancer were 72.6%, 76.7%, and 96.1%; and 78.9%, 81.6%, and 41.1%, respectively.Defining advanced cancer as AJCC prognostic pathologic stage IIA or higher most accurately predicts breast cancer death. Use of this definition by investigators will facilitate comparing breast cancer screening effectiveness studies.
Mis-GUIDED—The Importance of Negative Trials of Health Care Delivery and Implementation Science
Authors: Larry A. Allen, Colleen K. McIlvennan
Journal: JAMA Cardiology (2020)

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Abstract 12885: Sleepless Nights and Squeamish Days: A Conundrum of Recurrent Myocardial Ischemia
Authors: H Immo Lehmann
Journal: Circulation (2020)

A 63-year old Caucasian female with history of aortic valve replacement and CAD with prior drug-eluting stent placement (DES) to proximal LAD and LCX, presented as a hospital transfer with recurrent episodes of chest pain. Chest discomfort was described as severe chest pressure, radiating to bilateral upper extremities. Episodes were not associated with significant exertion and frequently occurred at night/early morning. Of note, the patient had undergone coronary angiography at the outside hospital, revealing no in-stent restenosis or new coronary lesions. Soon after the patient’s arrival in the CCU, she developed profound chest pressure, accompanied by hypotension, diaphoresis and nausea. Her 12-lead ECG revealed 2-mm ST-elevation in aVR, accompanied by ST-depression in inferior, anterior, and apical leads. Initial high-sensitivity (hs)-troponin T was 26 ng/L. She was given sublingual nitroglycerin and was started on a nitroglycerin and nicardipine infusion, with resolution of symptoms after ~30 minutes, followed by normalization of hs-troponin T. A transthoracic echocardiogram did not reveal focal left ventricular (LV) wall motion abnormalities, mild LV hypertrophy was present. Given the patients’ presentation with no in-stent restenosis or new lesions, frequent episodes of chest pain-not related to exertion with occurrence at nighttime and early morning, her presentation was deemed to be consistent with epicardial coronary vasospasm. Subsequently, the patients’ anti-anginal regimen was uptitrated to include extended-release nitrates, calcium-channel blockade, and I Na blockade. Unfortunately, she continued to have frequent episodes of profound angina, accompanied by hypotension, and significant ischemic ECG changes. This prompted us to pursue bilateral sympathectomy. Subsequently, the patient had resolution of prior symptoms. She was continued on an anti-vasospastic regimen, consisting of extended release nitrates and calcium-channel blockade. This case represents the challenging management of medication-resistant epicardial coronary artery vasospasm. As previously described, sympathectomy remains an effective therapeutic option for management in these difficult and life-threatening situations.