tbuckley/cabot-search huggingface dataset:
Abstract 13499: Racial Disparities in Revascularization in Female Patients Admitted for STEMI
Authors: Juan Daniel Del Cid Fratti, SRIVIJI KUMARAN, Anjali R Desai, Sudhir Mungee, Ekanka Mukhopadhyay, Tinoy J Kizhakekuttu
Journal: Circulation (2021)

Background: Management of STEMI has improved in the last decade with early PCI. Prior data has shown that minorities have less access to medical services and have decrease rates of PCI and CABG when compared to Whites. We aim to evaluate the revascularization of female patients admitted with STEMI according to race in a contemporary era. Methods: A retrospective analysis of the National Inpatient Sample from 2016-2018 of female patients admitted with a primary diagnosis of STEMI. Patients were subdivided according to race. The primary outcome was in-hospital mortality. Secondary outcomes were health-care utilization, revascularization rates (PCI with BMS, DES, fibrinolytic, and CABG), and complication. A multivariate regression analysis was constructed to adjust for confounders. Results: 642,665 STEMI admission were identified, of those 32.6% were female. Of those 76% were White, 11.3% Black, 7.4% Hispanic, 2.4% Asian, and 4.3% other races. African-American, Hispanic, and Asian had higher comorbidity index scores, lower incomes, and to use more Medicaid. Revascularization rates with PCI was 57.4% White, 51.2% in African-American, 53.7% in Hispanic, 50.5% in Asian, and 57.7% in other races (p=&lt;0.01). CABG rates were 3.6% in White, 3% in African-American, 4.2% in Hispanic, 4.4% in Asian and 4.8% in other races. After adjusting for confounders African-Americans, Hispanic, and Asian were less likely to receive PCI in the index admission when compared to whites. Blacks were less likely to undergo CABG when compared to whites (Figure 1). Conclusion: Rates of revascularization in female patients with PCI after STEMI are low and are even lower in minority groups. Minorities have less odds of having PCI when compared to Whites, and African-Americans are less likely to have CABG when compared to Whites after STEMI. Further data are needed to evaluate the low rate of revascularization in female patients and these racial disparities.
Abstract 10797: Applying Cardiotoxicity Risk Prediction Scores in Women with Early-Stage Breast
Authors: Sivisan Suntheralingam, Oscar Calvillo Arguelles, Husam Abdel Qadir, Eitan Amir, Paaladinesh Thavendiranathan
Journal: Circulation (2021)

Background: Cardiotoxicity is a common complication of anthracyclines and HER2-targeted therapies in breast cancer patients. Despite recognized risk factors, accurate prediction of cardiotoxicity risk remains a challenge. We applied 3 published risk prediction scores (Table) to a cohort of women with HER2+ breast cancer treated with anthracycline and trastuzumab and described their predictive accuracy. Methods: Women with stage I-III HER2+ breast cancer treated at the Princess Margaret Cancer Centre (Toronto) between 2006-2019 were identified retrospectively. Those with a pre-therapy MUGA scan or 2D echocardiography and ≥ 3 follow up scans using the same modality were included. CREC criteria were applied to define cardiotoxicity. Three risk prediction scores (Ezaz et al., Romond et al., and HFA-ICOS proformas) were used to classify patients into low/medium/high cardiotoxicity risk according to pretreatment characteristics. The proportion of patients who developed cardiotoxicity across risk categories were compared within each score using chi-square test. Results: Of 629 women (mean age 52.4 ± 10.9 years), 151 (24%) met CREC cardiotoxicity criteria. With the Ezaz et al. score , proportion of patients that developed cardiotoxicity was 24.4% (n = 141/577), 20% (n = 9/45) and 14.3% (n =1/7), in the low, medium, and high predicted risk groups, respectively (p = 0.665). With Romond et al. score , this was 17.9% (n = 40/223), 24.5% (n = 50/204) and 30.5% (n = 61/200), respectively (p = 0.01). HFA-ICOS was 15.5% (n = 30/193), 26.9% (n = 109/404), and 37.5% (n = 12/32), respectively (p = 0.002). Conclusion: In women with early stage HER2+ breast cancer receiving trastuzumab therapy, risk scores by Romond et al., and the HFA-ICOS proformas predict cardiotoxicity risk. However, for both these scores the incidence of cardiotoxicity in the “low” predicted risk group remains high (15.5%-17.9%). Therefore, there remains a need to develop more accurate risk prediction scores.
Abstract 11024: Interferon-Gamma Impairs Human Coronary Artery Endothelial Glucose Metabolism via Tryptophan Catabolism and Activates Fatty Acid Oxidization
Authors: Laurel Y Lee, William M Oldham, Huamei He, Ruisheng Wang, Ryan Mulhern, Diane E Handy, Joseph Loscalzo
Journal: Circulation (2021)

Introduction: Endothelial cells depend on glycolysis for much of energy production. Deranged endothelial glycolysis has been associated with various vascular pathobiologies. Interferon-gamma (IFN-γ) producing T-cells have been identified as the predominant pathologic cell subset in human atherosclerotic plaque. While the immunological consequences of these cells have been evaluated, their metabolic effects on endothelial cells remain unknown. The objective of this study was to determine the metabolic consequences of IFN-γ on human coronary artery endothelial cells (HCAEC). Hypothesis: We hypothesized that IFN-γ inhibits endothelial glucose metabolism and results in pathologic phenotypic changes in HCAEC. Methods: The metabolic effects of IFN-γ on primary HCAEC were assessed by unbiased transcriptomic and metabolomic analyses combined with real-time extracellular flux and molecular mechanistic studies. Relevant cellular phenotype was assessed by measuring endothelial intracellular cGMP content and wound healing capacity. Results: IFN-γ inhibited glycolysis of HCAEC by 20 % ( p = 0.006) via global transcriptional suppression of glycolytic enzymes resulting from decreased basal nuclear hypoxia inducible factor 1α (HIF1α) availability. HIF1α destabilization (FC 0.72; p = 0.0039) was mediated by the sequestration of its binding partner HIF1β by aryl hydrocarbon receptor via a kynurenine surge (FC 6.24; p &lt; 0.0001) resulting from IFN-γ-induced tryptophan degradation. Endothelial fatty acid oxidation (FAO) increased by 19% ( p = 0.014) with its inhibition leading to a 23% ATP deficit ( p &lt; 0.0001). These metabolic derangements were associated with pathologic endothelial phenotypic changes, including decreased intracellular cGMP by 29 % ( p = 0.025) and impaired wound healing capacity by 38 % ( p = 0.0098). Conclusions: IFN-γ impairs endothelial glucose metabolism via tryptophan catabolism destabilizing HIF1α and results in a metabolic shift toward increased FAO. These findings suggest a novel mechanistic basis for pathologic T-lymphocyte-endothelial interaction in coronary artery disease mediated by IFN-γ, linking endothelial glucose, amino acid, and fatty acid metabolism and their adverse endothelial functional consequences.
Abstract 11441: The Smarter Weight Loss Intervention Trial: The Effect of Real-Time Feedback on Weight Loss at 12-Months
Authors: Lora E Burke, Susan M Sereika, Zhadyra Bizhanova, Jacob K Kariuki, Bambang Parmanto, Britney Beatrice, India Loar, Jess Cheng, I Wayan Pulantra, Yuhan Wang, Maribel Cedillo, Molly Conroy
Journal: Circulation (2021)

Introduction: Obesity prevalence exceeds 40%, yet availability of standard behavioral treatment to those with overweight/obesity is limited; moreover, its in-person format and intensity is unappealing to some. Evidence indicates that providing feedback (FB) to self-monitoring (SM) of lifestyle behaviors improves outcomes. We tested the efficacy of delivering tailored FB messages remotely compared to no FB on weight loss outcomes. Hypothesis: At 12 mos participants receiving feedback (SM+FB) would have greater weight loss than those in the SM only group. Methods: We randomized 502 adults with overweight/obesity to either SM+FB (n=251) or SM alone (n=251). We delivered 3 smartphone pop-up messages/day to SM+FB group that were tailored to SM entries and delivered at random during waking hours. SM tools included a smartphone app to self-report diet, Fitbit Charge 2 to monitor physical activity, and a digital scale to track weight. All had a 90-min 1:1 intervention session with a dietitian at baseline that focused on behavioral changes to achieve weight loss. Percent weight loss from baseline and percentage of participants having ≥5% weight loss at 12 mos were compared between treatment groups using an intention-to-treat approach. Missing assessment weights at 12 mos were imputed using participants’ weight tracking data. Results: The sample was mostly female (79.5%) and white (84.3%) with a mean BMI of 33.1 ± 3.93 kg/m 2 . Based on the linear mixed modeling of weight, only a significant time main effect was observed ( F = 61.43, P &lt;.0001), suggesting that on average there was significant change in weight over the 12-month period. Both groups had similar percent weight loss at 12 mos, SM+FB group: mean [95% CI] -2.12% [-3.04, -1.20] and SM group: -2.39% [-3.32, -1.47] (P= .679). The percentage achieving ≥5% weight loss at 12 mos was also similar between the groups (26.3% for the SM+FB group and 29.1% for the SM group) (P= 0.485). Conclusions: The results did not support our hypothesis that participants in the SM+FB group would show greater weight loss at 12 mos than those in the SM group; however, the data support clinical efficacy for both approaches to a weight loss intervention.
Abstract 16176: Prediction and Validation of Witnessed Cardiac Arrest in EMS Patients Using the National EMS Information System Database
Authors: Andrew R Bohm, Todd A MacKenzie, James C Suozzi, Jeremiah R Brown
Journal: Circulation (2018)

Introduction: For Emergency Medical Service (EMS) providers, identifying those patients who are at the greatest risk of deteriorating into cardiac arrest during transportation is vital. Early ident...
NCOG-50. CHARACTERIZING MENINGIOMA IN YOUNG PATIENTS UNDER 40
Authors: Moshe Attia, Yehoshua Mirkin, Rotem Hershcovitch, Zvi Cohen, Zion Zibly, Jacob Zauberman, Anton Wohl, Sagi Harnof, Roberto Spiegelmann, Moshe Hadani, Orit Furman, Leor Zach
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Meningiomas are the most common primary CNS tumor in adults, with a median age at diagnosis of 65 years. Younger patients usually have a genetic background or history of prior radiation exposure. Population-level studies suggest 80-85% of meningiomas are WHO grade I (benign), 15-18% grade II (atypical), and 1-3% grade III (anaplastic). This case series describes a single center experience of meningiomas in patients under 40. METHODS We reviewed the Sheba Medical Center Neurosurgery and radiotherapy databases containing patients operated on for meningioma between 2011-2020. Digital medical records were retrieved, including pathology reports, surgical reports, clinical and radiological data, and use of radiotherapy or medical treatments. RESULTS Of 600 patients in the database, 47 patients under 40 (7.8%) were identified and 54 tumors were reviewed (five patients had multiple operation). 32 patients were female (68%) ; 2 were under 20 years old, 17 were age 20-30 and 28 were age 31-39 at first presentation. Seven patients had received prior radiation therapy for a childhood malignancy. 28 meningiomas were histology confirmed grade I (52%), 22 were grade II (41%), 2 were grade III (4%), and 2 (4%) were grade undetermined. 22 tumors were located in the skull base (41%) and 32 (59%) in the brain convexity. 16 skull base tumors were grade I, five were grade II, and one was grade III. 12 convexity tumors were grade I, 16 were grade II, and two were grade III. Median follow-up was 35 months (range 1 - 98 months). CONCLUSION Our experience with meningioma patients under 40 revealed a different grade segregation than the older population, with younger patients showing a higher incidence of grade II tumors. These tumors are generally more aggressive, and require careful resection and consideration for post-surgical radiotherapy. Further validation with population based databases is required.
Abstract P326: Nicotinamide Riboside Kinase-2 Deficiency Promotes Pressure Overload- Induced Dilated Cardiomyopathy And Heart Failure
Authors: Syeda K Shahzadi, Rizwan Qaisar, Firdos Ahmad
Journal: Circulation Research (2021)

Dilated cardiomyopathy (DCM) is one of the leading causes of heart failure with a poor prognosis. Nicotinamide riboside kinase-2 (NRK-2), a muscle-specific β1 integrin-binding protein, is predominantly expressed in skeletal muscle and upregulates in several heart failure models. Emerging pieces of evidence suggest that NRK-2 plays a key role in cardiac pathogenesis, however, its role in chronic pressure overload (PO)-induced cardiac remodeling is largely unknown. To investigate the potential role of NRK-2 in PO-induced DCM and delineate the underlying molecular mechanisms, NRK2 knockout (KO) and littermate control mice were subjected to trans-aortic constriction (TAC) or sham surgeries and cardiac function was assessed by serial M-mode echocardiography. A mild cardiac contractile dysfunction was observed in the KOs at the early adaptive phase of remodeling followed by a significant LV chamber dilatation [LVIDd(mm); 5.32±0.36 vs. 4.75±0.39, P =0.001] and functional deterioration [LVEF(%); 20.53±8.81vs. 31.2±7.0, P =0.003] during the maladaptive cardiac remodeling phase (6 week). Consistently, NRK2 KO hearts displayed increased cardiac hypertrophy and heart failure reflected by morphometric parameters as well as increased fetal genes ANP and BNP expressions. Histological assessment revealed an extensive left ventricular (LV) chamber dilatation accompanied by elevated cardiomyopathy and fibrosis in the KO hearts post-TAC. In a gain-of-function model, NRK-2 overexpressing AC16 cardiomyocytes displayed significantly attenuated fetal genes expression and, NRK-2 further suppressed the fetal gene expression when challenged with angiotensin II. Consistently, NRK-2 overexpression attenuated angiotensin II-induced cardiomyocyte death. Mechanistically, NRK-2 was identified as a critical regulator of JNK MAP kinase and NRK-2 overexpression markedly suppressed the angiotensin II-induced JNK activation. Overall, our results demonstrate that NRK-2 regulates dilatative cardiac remodeling and, genetic ablation exacerbates dilated cardiomyopathy, interstitial collagen deposition, and cardiac dysfunction post-TAC due, in part, to increased JNK activation.
Abstract 16645: Comparison of Primary Care Providers and Pediatric Cardiologists in the Appropriateness Use Criteria and Associated Cost Differences for Outpatient Pediatric Echocardiograms
Authors: Benedicto A Fernandes, Tracey M Thompson, Ty E Hasselman, David Jantzen
Journal: Circulation (2018)

Introduction: Appropriate use criteria (AUC) have been established for the transthoracic echocardiogram (TTE) in pediatric cardiology, but, in many labs, echocardiograms can be ordered by the primary care provider (PCP). There is limited data comparing appropriateness between pediatric cardiologists and PCPs and the associated costs of rarely appropriate echocardiograms. Hypothesis: Pediatric cardiologists order less rarely appropriate TTEs and have a lower proportion of cost attributed to rarely appropriate studies. Methods: Patients with initial outpatient pediatric or congenital TTE ordered by a pediatric cardiologist or PCP and interpreted at our institution from November 2016 to October 2017 were included. Appropriateness of TTE indications were classified as appropriate, maybe appropriate, rarely appropriate, and unclassifiable. TTE findings were classified as normal, incidental or abnormal. TTE cost was estimated using the Healthcare Bluebook. The sum cost of rarely appropriate TTEs was divided by total number of patients in each group (pediatric cardiologists vs. PCPs). Data was compared using chi-squared testing. Results: 311 pediatric cardiology and 193 PCP patients were included for analysis. Two percent of pediatric cardiology and 18% of PCP TTE indications were unclassifiable. Of those classified, pediatric cardiologists had a higher rate of appropriate TTEs compared to PCPs (69% vs. 35%; p&lt;0.001) and lower rate of rarely appropriate TTEs (17% vs. 62%; p&lt;0.001). Abnormalities were present in 13% of TTEs ordered by pediatric cardiologists compared to 3% ordered by PCPs (p&lt;0.001). Based on cost of $526 per TTE, $326 per patient was attributed to rarely appropriate indications when ordered by PCPs compared to $90 per patient for pediatric cardiologists. This cost difference decreases substantially when taking referral and ECG costs into account ($326 vs $273). Conclusions: PCPs order more rarely appropriate TTEs, and subsequently have a higher cost incurred per TTE for rarely appropriate indications. However, this cost difference decreases substantially when taking into account referral and ECG costs. Therefore, PCP education of the AUC would have a significant impact in reducing cost for rarely appropriate indications.
Abstract 13853: A Fully Automated Deep Phenotyping of Late Gadolinium Enhancement Cardiac MRI for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy
Authors: Ahmed S Fahmy, Ethan J Rowin, Warren J Manning, Martin S Maron, Reza Nezafat
Journal: Circulation (2021)

Introduction: Myocardium scar volume in late gadolinium enhancement (LGE) MRI is associated with cardiac adverse outcomes in hypertrophic cardiomyopathy (HCM). However, scar quantification is time-consuming and challenging. Also, LGE contains information about scar heterogeneity, location, and shape not readily quantified by current LGE analyses. Hypothesis: Automated deep phenotyping of LGE images can extract novel imaging markers of heart failure (HF) progression in HCM. Methods: We developed a deep convolutional neural network (CNN) (Fig 1) to extract LGE image features associated with progressive HF in HCM. We developed the CNN using data for 572 HCM patients (183 F; 51±16 years) evaluated at Tufts medical center. The CNN input was 5 LGE images and the output was the probability of developing a HF outcome (defined as a change of New York Heart Association class I/II at baseline to class III/IV during follow-up). The dataset was split into training, 50%, validation, 25%, and independent testing, 25%. We trained the CNN for 50 epochs (learn-rate = 0.001, batch size = 12, class-weighted cross-entropy loss). To avoid overfitting, the model that best predicted HF outcomes in the validation cohort was used as the final model. We compared the CNN model to a single-variable logistic regression (LR) model (L2 regularization, class-weighted loss) that predicts HF outcomes using scar volume (manually quantified by an expert reader). Results: Progressive HF occurred in 96 (17%) patients during follow-up (4±2 years). In the testing cohort (n = 138), CNN correctly predicted HF in 60% of patients with positive HF outcomes (n = 22; specificity 77%, accuracy 73%, AUC = 0.73). Using the same dataset, the LR classifier showed much lower HF prediction power with AUC = 0.54 (accuracy 38%, specificity 30%). Conclusions: Deep phenotyping of LGE allows accurate prediction of progressive HF in HCM patients and outperforms classical LR models that use scar volume as a sole predictor of HF.
Abstract 10021: Prediction of Intracerebral Hemorrhage in Out-of-Hospital Cardiac Arrest Patients with Post-Resuscitation Electrocardiogram
Authors: Ryota Kaichi, Masanobu Ishii, Takafumi Mikami, Sou Ikebe, Masafumi Takae, Takayuki Mori, Soichi Komaki, Reiko Toida, Kazumasa Kurogi, Yasuhiro Nagamine, Masakazu Matsuyama, Tetsuro Yamaguchi, Takao Yano, Kenichi Tsujita, Nobuyasu Yamamoto
Journal: Circulation (2021)

Introduction: The appropriate patient selection for urgent coronary angiography after return of spontaneous circulation (ROSC) are still unclear. Hence intracerebral hemorrhage (ICH) show non-specific ST-changes on post-resuscitation electrocardiogram (ECG) and lead to misdiagnosis and incorrect therapeutic decisions. Therefore, we evaluated the characteristics of patients with ICH in nontraumatic out-of-hospital cardiac arrests (OHCA) after ROSC to identify patients who need brain computed tomography (CT) as the next diagnostic work-up. Methods and Results: We studied 1303 consecutive patients who transported to our hospital due to OHCA between 2008 and 2020, and 1,235 (95%) were assessed their cause of death by CT. After excluding 126 patients with obvious extracardiac causes, 329 patients with ROSC were finally included, and categorized into 2 groups: those with ICH (n=32, 10%) and those with suspected cardiac origin group (n=297). Logistic regression analyses showed that younger age (&lt;75 years), female, no shockable rhythm change, tachycardia (≥100bpm), lateral segment elevation, inferior segment depression on ECG were independently associated with ICH. We developed a new predictive model for ICH by adding 1 point for each of the 6 factors. The ICH positive rate increased by a factor of 2.36 for each 1-point increase (P&lt;0.001). Three points or less corresponded to a negative predictive value of 94% and 4 points or more corresponded to a positive predictive value of 31% for ICH (Figure). Conclusion: Our new predictive model might be useful for risk stratification of ICH in OHCA patients with ROSC.
Abstract 13105: Coronary CT Angiography Predicts Major Adverse Events in Dialysis Dependent End-Stage Renal Disease Patients
Authors: Geoffrey W Cho, Carlos G Quesada, Ahmed K Ghanem, Audelia Arasheben, Christopher Dailing, Matthew J Budoff, Ronald P Karlsberg
Journal: Circulation (2021)

Introduction: Coronary atherosclerosis is prevalent in the end-stage renal disease population. Cardiovascular complications are the primary cause of morbidity and mortality in this group due to advanced CAD. Coronary CT angiography (CTA) in this population is challenging due to their severe coronary atherosclerosis, often with dense calcifications that limit diagnostic specificity and sensitivity. We characterized the CAD-RADS Classification of 62 ESRD patients on chronic dialysis to assess whether CAD-RADS stratification correlates the severity of disease to major adverse cardiac events. Methods: 62 patients (mean 69 years; range 41-95 years; 59% male) underwent coronary CTA. All patients were on dialysis (83% HD, 10% PD, 7% transition between PD-HD). Average creatinine was 3.9 mg/dL. 38% of patients had history of revascularization either via CABG or PCI. CAD-RADS, coronary artery calcium score (CAC), and other parameters (diabetes mellitus, creatinine, LVEF) were investigated as predictors of cardiac events. Results: Of the 62 patients in this study, 42 patients had significant CAD (CAD-RADS 3 or greater). Average CAC score was 1999.8 Agatston Units (AU). 46 patients (74%) had interpretable CT angiograms. Higher CAC-score moderately correlated with higher CAD-RADS in patients with CAD (R = 0.58, 95% CI, 0.38-0.73, p&lt;0.0001). Analysis revealed that higher CAD-RADS score (&gt;4) is a significant predictor for the presence of major adverse cardiac events (ACS Odds-Ratio 4.03, 95% CI, 1.33-10.68, 61.7% vs 28.5%, p&lt;0.012). In addition, patients with CAD-RADS 4 or greater (including N-scores due to severe calcification), also trended towards higher mortality (Mortality Odds-Ratio 2.0, 95% CI, 0.70-5.57, 52.9% vs 35.7%, p&lt;0.20). Higher CAD-RADS, especially scores &gt;4, had higher incidence of heart failure and decreased cardiac function (LVEF 60.5% vs 47.2%, p&lt;0.003). Conclusions: CAD-RADS classification can be determined in a significant portion of ESRD patients on dialysis, even in the setting of high CAC scores. Higher CAD-RADS scores demonstrated increased incidence of major adverse cardiac events, including heart failure and ACS. This study suggests that cardiac CTA in Dialysis-Dependent-ESRD patients is feasible and prognostic.