tbuckley/cabot-search huggingface dataset:
Abstract 14337: Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension
Authors: Leah B Rethy, Matthew J Feinstein, Chad J Achenbach, Raymond R Townsend, Adam P Bress, Sanjiv J Shah, Jordana Cohen
Journal: Circulation (2020)

Background: People with HIV(PWH) have a high risk of hypertension and hypertension-related cardiovascular diseases (CVD). Objectives: Given unique pathways contributing to hypertension among PWH, we sought to determine whether antihypertensive class was associated with CVD events in PWH. Methods: Among veterans with HIV and new onset hypertension (2000-2019), we used propensity score-matching with Cox regression to evaluate the risk of CVD events (ischemic heart disease, heart failure, stroke) or death by initial antihypertensive class. In supplementary analyses we used marginal structural modeling to account for time-updated antihypertensive class and confounding. Results: Among 8041 PWH with hypertension, 24% were initiated on angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEi/ARB) monotherapy, 23% on thiazide/thiazide-like diuretic monotherapy, 13% on β-blocker monotherapy, and 11% on calcium channel blocker (CCB) monotherapy. Median (IQR) follow-up was 6.5 (3.2-10.5) years and 25% experienced a CVD event. In propensity score-matched analyses, β-blockers, but not CCBs or thiazide/thiazide-like diuretics, were associated with an increased risk of 1) CVD or death 2)incident CVD or death and 3)incident CVD compared with ACEs/ARBs (Incident CVD: HR [95% CI] β-blockers 1.90 [1.24, 2.89]; CCBs 1.02 [0.77, 1.34]; diuretics 1.06 [0.86,1.31]; Figure) . Similar risks were associated with β-blockers in time-updated analyses. In veterans without CKD, initial ACEi/ARB use carried a lower risk of incident heart failure compared with all other classes. Conclusions: We observed high rates of CVD events in PWH with hypertension, and a high prevalence of β-blocker use for initial hypertension management, even among those without indications. Our findings highlight the potential harm associated with β-blockers and the possible benefit associated with ACEI/ARBs for hypertension management in PWH.
Abstract 17227: Tobacco Use Prevalence and Transitions Among Adults With a History of Cardiovascular Disease
Authors: Cristian Zamora, Lindsay M Reynolds, Un Jung Lee, Andrew Stokes, Benjamin Emelia J, Aruni Bhatnagar, Thomas Payne, Carlos J Rodriguez
Journal: Circulation (2020)

Introduction: Although tobacco product transitions have been characterized in the general population, few studies have examined use in individuals with established cardiovascular disease (CVD). Methods: We examined tobacco use prevalence, and longitudinal patterns of tobacco product transitions in adult respondents (≥18 years) of the 2013-2014 (Wave 1) through 2016-2018 (Wave 4) Population Assessment of Tobacco and Health Study. Analysis was restricted to adults with prevalent CVD. Prevalent CVD was defined based on self-report at Wave 1 to the question from a health professional if she/he had: 1) a heart attack, 2) heart failure, 3) a stroke, or 4) some other heart condition. Factors associated with tobacco use (cigarette, e-cigarette, cigar, pipe tobacco, hookah, smokeless, dissolvable, or snus) and tobacco product transitions were investigated using logistic regression. Results: At Wave 1, 28.8% reported tobacco use among adults with CVD, the most commonly product was cigarettes (82.8%), followed by use of any type of cigar (49%) and e-cigarette use (23.2%), including 5.4% reporting dual use of cigarettes and e-cigarettes. E-cigarette use without concurrent cigarette use was uncommon (1.1%). Young male with lower level of education and lack of knowledge about the association between smoking and heart disease, were associated with tobacco use. Transition rates reported between Waves 1 and 4 demonstrate decreased cigarette use over time, with increased use of e-cigarette but less dual use. Male with prevalent CVD were less likely to use e-cigarettes compared to female (OR = 0.5, 95% CI: 0.4 - 0.8). Conclusions: Despite known harmful cardiovascular effects, almost a quarter of adults with prevalent CVD smoke cigarettes and few are quitting smoking.
Abstract 16739: Right Ventricular Size and Exercise Capacity in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Bethel Woldu, Paul Scheel, Hugh G Calkins, Cynthia James, Harikrishna S Tandri, Julia Agafonova, Crystal Tichnell, Brittney Murray, Nisha A Gilotra, Allison Hays
Journal: Circulation (2020)

Introduction: With improved survival of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC), progressive heart failure is increasingly recognized. Cardiopulmonary exercise testing (CPET) can play a role in prognostication. However, correlation of morphologic disease severity and exercise capacity is lacking. Hypothesis: Increased RV size and decreased RV function measured by two-dimensional echocardiography (2D echo) are associated with impaired exercise capacity parameters (peak oxygen consumption (pVO 2 ) and ventilator efficiency (VE/VCO 2 slope)). Methods: We retrospectively examined 21 patients who underwent 25 echocardiography and cardiopulmonary exercise testing (CPET) studies within 6 months of each other. A Spearman rank correlation was used to determine the relationship between RV dimensions and CPET parameters. Seven (28%) had submaximal effort defined as respiratory exchange ratio &lt;1.05 and were excluded in the analysis of pVO 2 . Results: Patients’ mean age was 44 ± 11 years and 28% were women. Despite more than half of patients (54%) being New York Heart Association Class I, mean pVO 2 was decreased at 19 ± 5 mL/kg per minute (63% ± 22% predicted for age and sex). There was a moderate negative correlation between pVO 2 and RV basal diameter ( r s = -0.46, p =0.05) and RV area in diastole ( r s = -0.55, p =0.02). There was no significant correlation between RV size or function with VE/VCO 2 slope. Conclusion: In this small study of ARVC patients, abnormalities on echo including increased RV basal diameter and RV diastolic area were associated with worse pVO 2 but not VE/VCO 2 slope. These findings suggest that RV structural abnormalities are related to reduced oxygen uptake on CPET, and larger studies are warranted to investigate the prognostic value and clinical course of ARVC patients with regards to the development of heart failure.
A Critical Role for Notch Signaling in the Formation of Cholangiocellular Carcinomas
Authors: Steffen Zender, Irina Nickeleit, Torsten Wuestefeld, Inga Sörensen, Daniel Dauch, Przemyslaw Bozko, Mona El-Khatib, Robert Geffers, Hueseyin Bektas, Michael P. Manns, Achim Gossler, Ludwig Wilkens, Ruben Plentz, Lars Zender, Nisar P. Malek
Journal: Cancer Cell (2016)
RNAs competing for microRNAs mutually influence their fluctuations in a highly non-linear microRNA-dependent manner in single cells
Authors: Carla Bosia, Francesco Sgrò, Laura Conti, Carlo Baldassi, Davide Brusa, Federica Cavallo, Ferdinando Di Cunto, Emilia Turco, Andrea Pagnani, Riccardo Zecchina
Journal: Genome biology (2017)

Recent studies reported complex post-transcriptional interplay among targets of a common pool of microRNAs, a class of small non-coding downregulators of gene expression. Behaving as microRNA-sponges, distinct RNA species may compete for binding to microRNAs and coregulate each other in a dose-dependent manner. Although previous studies in cell populations showed competition in vitro, the detailed dynamical aspects of this process, most importantly in physiological conditions, remains unclear. We address this point by monitoring protein expression of two targets of a common miRNA with quantitative single-cell measurements. In agreement with a detailed stochastic model of molecular titration, we observed that: (i) crosstalk between targets is possible only in particular stoichiometric conditions, (ii) a trade-off on the number of microRNA regulatory elements may induce the coexistence of two distinct cell populations, (iii) strong inter-targets correlations can be observed. This phenomenology is compatible with a small amount of mRNA target molecules per cell of the order of 10-100.
Abstract 267: Impact of Regular Comprehensive Simulation Training for Extracorporeal Cardiopulmonary Resuscitation to Improves the Outcome in Patients with Refractory Cardiac Arrest
Authors: Daisuke Takagi, Takashi Unoki, Tomoko Nakayama, Tamura Yudai, Kametani Motoko, Konami Yutaka, Hiroto Suzuyama, Inoue Masayuki, Yufu Tetsuo, Kodama Kazuhisa, Eiji Taguchi, Sawamura Tadashi, Nakao Koichi, Tomohiro Sakamoto
Journal: Circulation (2020)

Background: Extracorporeal CPR (E-CPR) has been utilized as a rescue strategy for cardiac arrest (CA) patients unresponsive to conventional CPR. Although the time from cardiac arrest to starting extracorporeal membrane oxygenation (ECMO) is known as a predictor for a good outcome, the opportunities to establish the E-CPR initiation flow are limited. Objective: We developed a protocol for the E-CPR simulation program and investigated whether the faster deployment of ECMO improves the neurological outcome and mortality in patients with refractory CA. Methods: In this single-center observational study, we enrolled 140 consecutive patients who received E-CPR from January 2012 to May 2020. E-CPR simulation training was carried out twice a year with the participation of doctors and co-medicals using a mock vascular model to practice ECMO cannulation and initiation since October 2017. 86 patients received E-CPR in the pre-simulation period (from January 2012 to September 2017), and 54 received in the post-simulation period (October 2017 to May 2020). We assessed the 30-day survival rate and the rate of the Cerebral Performance Category grades 1 and 2 as favorable neurological prognosis. Results: No significant difference in age, the rate of the male sex, witnessed CA, by-stander CPR, shockable rhythm at the initial contact, acute coronary syndrome (ACS) as a cause of CA, and out of hospital CA (OHCA). The collapse to ECMO placement time (CTET) was significantly shorter in the post-simulation group compared to the pre-simulation group (44 min [IQR; 27-74] vs. 32 min [IQR; 15-46]; P&lt;0.01). The rate of 30-day survival and favorable neurological outcome was significantly higher in the Post-simulation group compared to the pre-simulation group (16% vs. 20%; P=0.02, 9% vs. 13%; p=0.03, respectively). Cox regression analysis including data on the age, male sex, OHCA, initial shockable rhythm, ACS, and CTET revealed that CTET was significantly associated with the 30-day mortality (HR for 5 minutes increase, 1.12 [95%CI; 1.07-1.16]; p&lt;0.01). Conclusion: A regular comprehensive simulation-based E-CPR training improves the 30-day mortality and the neurological outcome in patients with refractory CA as a result of the shortening of the ECMO deployment.
Abstract 16720: Cardiovascular Toxicities of Cyclin Dependent Kinase (cdk) 4/6 Inhibitors in Metastatic Breast Cancer Patients
Authors: Michael G Fradley, Nam Nguyen, Yiqing Chen, Avirup Guha, Jenica N Upshaw, Bonnie Ky, Yan Gong
Journal: Circulation (2020)

Introduction: Cyclin Dependent Kinase (CDK) 4/6 inhibitors are a novel class of cancer therapeutics which have significantly improved survival in patients with hormone receptor positive, HER2 negative metastatic breast cancer. There is little data regarding the epidemiology of cardiotoxicity with these therapies. Methods: Using the OneFlorida Data Trust , adult patients without prior cardiovascular disease who received at least one CDK 4/6 inhibitor between January 1, 2012 and December 31, 2018 were included in the analysis. CAEs identified from ICD 9/10 codes include: new hypertension (HTN); arrhythmias (excluding sudden cardiac death); new hypertension (HTN); heart failure/cardiomyopathy; ischemic heart disease, pericardial disease. Log-rank tests were performed to compare time to all-cause mortality in patients with or without CAE. Multivariable cox proportional hazard regressions were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for mortality adjusting for age, gender, race, obesity, HTN, diabetes (DM) and hyperlipidemia (HLD). Results: A total of 1,035, predominantly female (96%) patients were included in the analysis. The mean age was 61±13 years, and CV risk factors were prevalent at baseline: obesity (17.1%), HTN (22.2%), DM (9.9%), HLD (10.5%). Cardiotoxicity occurred in 174 (16.8%) patients of which 30 (17.2%) died (p&lt;0.001). There were 61 cases of arrhythmias with 15 (24.6%) deaths (p&lt;0.001) and 97 cases of new HTN with 15 (15.5%) deaths (p&lt;0.001). Unadjusted and adjusted HRs and 95% CIs for mortality are shown in the figure. Effects were similar across all CDK 4/6 inhibitors. Conclusions: Cardiotoxicity is common with CDK 4/6 inhibitors and are associated with overall increased mortality and arrhythmias and HTN accounting for a significant proportion of this finding. Patients taking CDK 4/6 inhibitors should be monitored for CAEs with aggressive risk mitigation strategies to minimize morbidity and mortality.
Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter
Authors: Zaniar Ghazizadeh, Chad Gier, Avinainder Singh, Lina Vadlamani, Maxwell Eder, Justin Pacor, Jakob Park, Manan Pareek, Zain Ahmed, Kim G Smolderen, Judith L Meadows, Tariq Ahmad, Nihar R Desai, Rachel J Lampert, James V Freeman
Journal: Circulation (2020)

Introduction: The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear. Methods: The Yale Cardiovascular COVID Registry is a cohort study of adult patients &gt;=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression. Results: Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004). Conclusion: AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.
Abstract 16706: Chronic Kidney Disease Among U.S.-Born and Foreign-Born U.S. Adults in the 2011-2018 National Health and Nutrition Examination Survey
Authors: Oluwabunmi Ogungbe, Ruth Alma N Turkson Ocran, Diana Baptiste, Uchenna Nwokeji, Yvonne Commodore-mensah
Journal: Circulation (2020)

Introduction: Chronic Kidney Disease (CKD) is a major risk factor for cardiovascular disease (CVD) and death. Hispanic and African American persons have poorer control of CVD risk factors and are disproportionately affected by CKD, CVD, and their associated complications compared to White persons. Objective: To compare the prevalence of CKD and Reduced Kidney Function (RKF) by nativity status in the U.S. Methods: Using pooled 2011-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the prevalence of CKD in a weighted sample of U.S.- and foreign-born adults. RKF was defined as eGFR &lt;60mL/minute/1.73m 2 (CKD-EPI equation), and CKD was defined as eGFR &lt;60mL/minute/1.73m 2 and an albumin-creatinine ratio ≥30 mg/g. We used multivariable Poisson models to estimate the association between CKD and nativity status, adjusting for covariates. Results: We included a sample of 39,143 adults; mean age was 46.8(±0.31) years, 52% female, and 18% were foreign-born. The prevalence of CKD among U.S.-born adults was 14.8%, compared to 11.8% of foreign-born adults. After adjusting for covariates, foreign-born adults were 21% less likely to have CKD (prevalence ratio: 0.79, 95%CI 0.67-0.91) and 29% less likely to have RKF (PR: 0.71, 95% CI 0.56-0.89) compared to U.S.-born ( Table ). Conclusions: Foreign-born persons were less likely to have CKD and RKF than U.S.-born adults. Public health efforts are needed to maintain this health advantage among foreign-born adults and to reduce the burden of CKD in the U.S.-born population.
Abstract 16375: The Association Between Pregestational Hypertension and Cardiovascular Events in Pregnant Females, a Population-based Study
Authors: Mohamed M Gad, Jasmin Abdeldayem, Devora lichtman, Islam Y Elgendy, Anas M Saad, Ahmed M Mahmoud, Omar M Abdelfattah, Toshiaki Isogai, Maria M Mountis, Joanna Ghobrial, Samir R Kapadia
Journal: Circulation (2020)

Introduction: Pregestational hypertension is associated with poor fetal and maternal outcomes, however, the impact on maternal cardiovascular outcomes is not well defined. In this study, we aim to study the impact of pregestational hypertension on maternal cardiovascular outcomes. Methods: Pregnant women hospitalized from January 2016 to December 2017 were identified in the Nationwide Inpatient Sample. Pregnant females with pregestational hypertension were identified using AHRQ comorbidity measures. Outcomes of interest were mortality, myocardial infarction (MI), and stroke. Multivariate regression analysis adjusting for differences in baseline comorbidities was used for odds ratio (OR) and 95% confidence interval (CI). Results: Among 8,141,277 pregnant women, 224,295 (2.76%) had pregestational hypertension. Pregnant females with pregestational hypertension were significantly older (mean age of 31.52 +/- 6.03 vs. 28.65 +/- 5.84, p-value&lt;0.001), and had a higher burden of comorbidities includingpregestational diabetes mellitus (10.4% vs. 1.1%, p-value&lt;0.001), gestational diabetes (26.3% vs. 8.1%, p-value&lt;0.001), obesity (27.6% vs. 7.7%, p-value&lt;0.001), smoking (16.4% vs. 9.8%,p-value&lt;0.001), hyperlipidemia (2.1% vs. 0.2%, p-value&lt;0.001), and depression; 6.6% vs. 3.0%, p-value&lt;0.001. Females with pregestational hypertension had more cesarean section; 46.6% vs. 29.2%, p-value&lt;0.001, intra-uterine death; 1.3% vs. 0.4%, p-value&lt;0.001, and spontaneous abortion; 0.6% vs. 0.3%, p-value&lt;0.001. Pregetational hypertension had higher mortality rate (55.7 vs. 10.1 per 100,000 hospitalizations, p-value&lt;0.001), MI rate (207.3 vs. 9.3 per 100,000 hospitalizations, p-value&lt;0.001), and stroke rate (288.4 vs. 22.6 per 100,000 hospitalizations, p-value&lt;0.001). Pregestational hypertension was associated with significantly worse outcomes including in-hospital mortality (aOR 3.01, 95% CI 2.48-3.67), MI (aOR 8.27, 95% CI 7.30-9.35), and stroke (aOR 9.31, 95% CI 8.47-10.24). Conclusions: Pregestational hypertension is associated with poor maternal cardiovascular outcomes in pregnancy. Further efforts should be directed to identifying high-risk females and better approaches to management are warranted.
Abstract 10559: Regional Variations in Heart Failure Quality of Care and Outcomes
Authors: Luke Cunningham, Gregg Fonarow, Clyde Yancy, Shubin Sheng, Roland Matsouaka, Adam DeVore, Hani Jneid, Anita Deswal
Journal: Circulation (2018)

Introduction: Patient characteristics, care quality, and outcomes may vary based on a variety of factors among patients hospitalized with acute heart failure (HF). Short-term morality has been show...
Abstract 15864: Measured versus Estimated Resting Metabolic Rate in Heart Failure With Preserved Ejection Fraction
Authors: Theresa Anderson, Thomas Cascino, Daniel Perry, Gillian Grafton, Todd M Koelling, Scott L Hummel
Journal: Circulation (2020)

Introduction: Obesity is common in heart failure with preserved ejection fraction (HFpEF) and dietary weight loss can improve functional capacity, but sarcopenia and frailty are also frequently present. Little evidence is available regarding resting metabolic rate (RMR) or how commonly used equations to estimate RMR compare to measured RMR in HFpEF. This information is vital for counseling patients on individual caloric needs. Hypothesis: Commonly used estimation equations do not accurately reflect measured RMR in patients with HFpEF. Methods: Resting metabolic rate (RMR) was measured with a metabolic cart for consecutive patients with HFpEF (EF ≥50%) referred for right heart catheterization at the University of Michigan from 2011-2015. Patients with congenital, infiltrative, hypertrophic, or restrictive cardiomyopathy were excluded. The RMR was calculated using the Weir formula: RMR= 1440*[3.94 VO 2 (l/min) + 1.11*VCO 2 (l/min)] kcal/day. Measured RMR and estimations of RMR using the Harris Benedict Equation (HBE), Mifflin-St Jeor Equation (MSJE), and World Health Organization (WHO) equation were compared using paired t-tests and Bland-Altman plots. Results: Patients (n=43) were aged (mean ± SD) 62 ± 11.6 years, 53% female, and BMI 34.9 ± 11. Mean measured RMR from Weir equation was 1514 ± 479 kcal/day. Estimated RMR by HBE was 1784 ± 530, MSJE was 1685 ± 457, and WHO equation was 1816.8 ± 485 kcal/day. All estimations significantly overestimated RMR when compared to the Weir method (&gt;10% difference and p&lt;0.01 for all; Figure A-C). The MSJE had the closest range of agreement to the measured RMR. Conclusions: Estimations of resting metabolic rate in patients with HFpEF demonstrated a fixed bias towards overestimation when compared to measured RMR by metabolic cart. Given HFpEF populations are often obese and are counseled routinely on weight loss, understanding the implicit bias of equations estimating RMR is vital when providing nutritional and dietary counseling.