tbuckley/cabot-search huggingface dataset:
Abstract 17219: Non-Invasive, Blood-Free Point of Care Test to Rapidly Exclude Myocardial Injury: The AI ECG
Authors: Zachi I Attia, Yader Sandoval, Rickey Carter, Suraj Kapa, Francisco Lopez-jimenez, Peter A Noseworthy, Allan S Jaffe, Paul Friedman
Journal: Circulation (2020)

Background: Myocardial injury results in release of cardiac troponin (cTn) into the bloodstream, readily detected by high-sensitivity cTn (hs-cTn) assays. A noninvasive, rapid, home-based test to exclude acute myocardial injury at the time of the test and for the next 7 hours would help manage patients with suspected myocardial infarction. Since myocyte injury is associated with ECG changes, we hypothesized an artificial intelligence ECG (AI-ECG) could identify absence of injury. Objective: To train and test an AI-ECG convolutional neural network (CNN) to identify patients using a single ECG who are suspected of myocardial infarction who are low risk, with hs-cTn levels below the 99 th percentile at test time and for the subsequent 7 hours. Methods: A CNN tuned to identify the absence of a hs-cTnT (5 th Gen cTnT Roche Diagnostics) &gt;15ng/L for men and &gt;10ng/L for women was developed. All ECGs were recorded within one hour of the hs-cTnT assay. We used 73,012 ECGs and hs-cTnT pairs from 47,542 unique patients to train the network, 9031 ECGs from 5,811 patients for internal validation to optimize hyperparameters, and 11,904 ECGs with 21,191 hs-cTnT measurements up to 7 hours after the ECG, from 11,904 different patients as a holdout test set. Results: The mean age was 63.9±17.5 years, and 30,348 of the 59,446 patients (51%) were male. 5,852 patients (49.1%) had no elevation of hs-cTnT and 6,052 (50.9%) had an hs-cTnT above the 99 th percentile at baseline or within 7 hours of the test. Of the 11,904 patients in the test set, using a sensitive threshold, the 12 lead AI ECG identified 1037 patients (8.7%) likely to have a low risk for subsequent hs-cTnT increases &gt; 99 th % (AUC 0.86), and the single lead ECG identified 685 patients. Of the 1037 low risk pts, 59 had an hs-cTnT &gt; 99 th percentile within 7 hours. The mean maximum hs-cTnT among the 59 low-risk patients was 53 ng/L ± 92 vs 184 ng/L ± 1474 in the others. None of these low risk patients died within 14 days of the test. Conclusion: Use of the AI ECG to identify patients without cardiac injury at the time of the test and for 7 subsequent hours is feasible. This may permit rapid, point of care, home-based, bloodless, painless testing to exclude cardiac injury, facilitating care and management of patients with suspected ischemia.
Antenatal screening for Down's syndrome.
Authors: J. G. Wishart
Journal: BMJ (1992)

syndrome is effective in practice and can be readily integrated into routine antenatal care.'They do not, however, deal with the thorny issue of in- formed consent.This is a crucial point because under common law patients have the right to receive sufficient information, in a way that they can understand, about the screening programme, including any substantial risks, so that they can make a balanced judgment..
Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies
Authors: Fabio Crocerossa, Umberto Carbonara, Francesco Cantiello, Michele Marchioni, Pasquale Ditonno, Maria C. Mir, Francesco Porpiglia, Ithaar Derweesh, Lance J. Hampton, Rocco Damiano, Riccardo Autorino
Journal: European Urology (2020)
Congenital heart disease risk loci identified by genome-wide association study in European patients
Authors: Harald Lahm, Meiwen Jia, Martina Dreßen, Felix Wirth, Nazan Puluca, Ralf Gilsbach, Bernard D. Keavney, Julie Cleuziou, Nicole Beck, Olga Bondareva, Elda Dzilic, Melchior Burri, Karl C. König, Johannes A. Ziegelmüller, Claudia Abou-Ajram, Irina Neb, Zhong Zhang, Stefanie A. Doppler, Elisa Mastantuono, Peter Lichtner, Gertrud Eckstein, Jürgen Hörer, Peter Ewert, James R. Priest, Lutz Hein, Rüdiger Lange, Thomas Meitinger, Heather J. Cordell, Bertram Müller-Myhsok, Markus Krane
Journal: Journal of Clinical Investigation (2020)

Genetic factors undoubtedly affect the development of congenital heart disease (CHD) but still remain ill defined. We sought to identify genetic risk factors associated with CHD and to accomplish a functional analysis of SNP-carrying genes. We performed a genome-wide association study (GWAS) of 4034 White patients with CHD and 8486 healthy controls. One SNP on chromosome 5q22.2 reached genome-wide significance across all CHD phenotypes and was also indicative for septal defects. One region on chromosome 20p12.1 pointing to the MACROD2 locus identified 4 highly significant SNPs in patients with transposition of the great arteries (TGA). Three highly significant risk variants on chromosome 17q21.32 within the GOSR2 locus were detected in patients with anomalies of thoracic arteries and veins (ATAV). Genetic variants associated with ATAV are suggested to influence the expression of WNT3, and the variant rs870142 related to septal defects is proposed to influence the expression of MSX1. We analyzed the expression of all 4 genes during cardiac differentiation of human and murine induced pluripotent stem cells in vitro and by single-cell RNA-Seq analyses of developing murine and human hearts. Our data show that MACROD2, GOSR2, WNT3, and MSX1 play an essential functional role in heart development at the embryonic and newborn stages.
Abstract 16030: Myocardial Abnormalities in Competitive Athletes on T1 and T2 Parametric Mapping by Cardiovascular Magnetic Resonance Imaging
Authors: Marc Lee, Richard Lafountain, Juliet Varghese, Christopher Hummel, James Borchers, Subha V Raman, Orlando P Simonetti, Curt Daniels, Saurabh Rajpal
Journal: Circulation (2020)

Introduction: Athletic cardiac adaptation is associated with structural changes that can overlap with disease states, unnecessarily limiting sports participation. Cardiovascular magnetic resonance (CMR) is useful in athlete’s heart and provides myocardial tissue characterization by T1 and T2 mapping. Hypothesis: CMR in competitive athletes will show abnormal T1 and T2 mapping due to intense exercise induced myocardial edema that can overlap with myocarditis. Methods: CMR data including left ventricular ejection fraction (LVEF) and T1/T2 maps were collected using standardized protocols on a 1.5 T scanner and compared between competitive athletes (N = 18, 83% male, median age 20 years), clinical myocarditis (N = 42, 71% male, median age 23 years) and controls (N = 35, 86% male, median age 22 years) between 2016-2020. T2 values of &lt;59 ms and native T1 &lt;1080 ms were defined as normal per institutional data. Extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) were compared between athlete and myocarditis groups. Results: Figure 1 (panel A) shows participating sport and indications for CMR in athletes. There were 11 athletes (61%) with elevated T2 values (&gt;59 ms), of which 9 (82%) were without clinical myocarditis. Average T2, native T1, ECV, and LVEF are shown in panels B-E. T2 values were highest in myocarditis, followed by athletes and controls (p = 0.001). ECV was higher in myocarditis compared to athletes (p = 0.002). LGE was present in 8/18 athletes and 41/42 myocarditis patients. 6 athletes had follow-up CMR after a period of deconditioning, with 3 (50%) demonstrating an improvement in T2 values and LGE. Conclusions: To conclude, we demonstrate abnormalities on T2 mapping in athletes consistent with myocardial edema or inflammation. Changes in T2 may be related to intense training. Additional studies are required to prospectively evaluate athletes for normative T1 and T2 mapping values, relationship to training, and their correlation with LGE.
Abstract 15147: Outcomes of Interventional Management of Coronary Artery Disease Prior to Renal Transplant
Authors: Hassan Mehmood Lak, Yasser Sammour, Taha Ahmed, Deepthi Gunasekaran, jasmine mutti, Sanchit Chawla, Manpreet Kaur, Johnny Chahine, John Mansour, Conrad C Simpfendorfer, Samir R Kapadia
Journal: Circulation (2020)

Introduction: Coronary artery disease (CAD) is a main cause of mortality in kidney transplant (KT) patients. Preoperative cardiovascular risk assessment is a crucial step before clearance for KT. Hypothesis: We seek to compare long term outcomes in patients who underwent PCI prior to KT as compared to those who did not need PCI. Methods: We identified patients who underwent KT from January 2008 to November 2019 at our institution and had coronary catheterization prior to KT. Results: We included 272 patients, of whom 54 (19.9%) underwent percutaneous coronary intervention (PCI), while the remaining 218 patients did not need PCI. The median age in the PCI group was 57.4 (46.9 - 61.2) years, while it was 53.9 (44.6 - 61) years in the control group. Baseline characteristics including gender, race, hypertension, diabetes, smoking, and hyperlipidemia were comparable in both groups. The median time to KT was 2.4 (1 - 5) years in the PCI group vs. 1.2 (0.6 - 3.3) years in the control group (p=0.001). Among patients who underwent PCI, 51.1% had single-vessel disease and 40.4% had multi-vessel disease on the coronary angiograms as compared with 15.4% and 11.8% in the control group (p&lt;0.001). The rate of acute kidney injury within 72 hours after the catheterization was 33.3% in PCI group vs. 14.13% in those who did not need PCI (p=0.01) after excluding dialysis patients. Overall, there was no difference in mortality in the PCI group compared to control group after 10 years of follow-up (p=0.416). In a subgroup analysis of patients who underwent cardiac catheterization within 2 years prior to transplant, there was still no significant difference in mortality between PCI (n=23) and control group (n=139) (p=0.451). The need for PCI after the initial cardiac catheterization was similar between the 2 groups after 10 years of follow-up (p=0.904). Conclusion: Patients with CAD can be safely treated with PCI prior to kidney transplant and have comparable outcomes as compared to those who do not require PCI.
Abstract 312: The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurological Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Takamitsu Ikeda, Yusuke Miyazaki, Eizo Marutani, Fumito Ichinose
Journal: Circulation (2020)

Introduction: The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although most CA survivors are sedated during targeted temperature management, the effects of sedation on post-arrest outcomes remain to be determined. Hypothesis: Sedation after CA improves neurological outcomes by modulating cerebral electrical activity and metabolism. Methods: Ten to 14 days after implantation of EEG transmitters, adult male C57BL/6J mice were subjected to CA and cardiopulmonary resuscitation (CPR). After return of spontaneous circulation (ROSC), mice received intravenous infusion of propofol, dexmedetomidine (DEX), or normal saline (vehicle) for 2 hours. Body temperature was maintained at 37°C, and was subsequently lowered to 33°C. Cerebral blood flow (CBF) was measured for 4 hours following ROSC. To quantify time-dependent EEG changes, we calculated the sum of the Delta, Theta, and Alpha band power in consecutive 12-hour intervals after ROSC (D 0-12 and D 12-24 , T 0-12 and T 12-24 , and A 0-12 and A 12-24 , respectively). Because the increase in fast EEG activity over time may reflect neurological recovery after CA, we compared the ratios of D 12-24 to D 0-12 , of T 12-24 to T 0-12 , and of A 12-24 to A 0-12 among groups. Results: As compared with vehicle-treated mice, propofol- or DEX-treated mice exhibited improved survival rate and neurological function after CA, though no difference was found between propofol- and DEX-treated mice. In the vehicle group, CBF was higher than the baseline after ROSC, while the increase in CBF was attenuated in the propofol and DEX group. The values of A 12-24 /A 0-12 and T 12-24 /T 0-12 were significantly higher in propofol- and DEX-treated mice than in vehicle-treated mice ( P = 0.017 and P = 0.004, respectively, propofol vs vehicle; P = 0.038 and P = 0.002, respectively, DEX vs vehicle), but there was no significant difference in D 12-24 /D 0-12 among groups. In all post-arrest mice, both A 12-24 /A 0-12 and T 12-24 /T 0-12 were positively correlated with better neurological function at 24 and 48 hours after CA. Conclusions: Post-arrest sedation was associated with a reduction in CBF and a greater recovery of fast EEG activity after CA, and improved neurological outcomes and survival in mice.
Abstract 16716: Comparison of Blood Troponin I Complexes and Free Form in Acute Myocardial Infarction and End Stage Renal Disease
Authors: Vikram Sharma, Ruchi Sharma, Shehab A Alansari, Mohan L Maradumane, Conner P Witherow, Wai Hong W Tang, Sathyamangala Prasad, Venu Menon
Journal: Circulation (2020)

Introduction: Circulating blood troponin complexes and free fractions remain poorly characterised in different conditions where troponin is detectable in blood Hypothesis: The aim of the study was to compare the differences in troponin-I(TnI) complexes/free-forms in end stage renal disease (ESRD) compared to acute myocardial infarction(AMI) Methods: Blood was collected from patients with AMI(n=7) or ESRD(n=4) at two time points (a)As early as possible after AMI or at initial contact with ESRD patients and (b)24-48 hours later. Western blotting was carried out with HyTest cTnI-560cc antibody on plasma extracted from whole blood. Densitometry analysis was performed and evaluated using the independent samples T-test and paired T-test as appropriate Results: Prominent bands were noted at ~45,~37 and ~25 kDa respectively representing low molecular weight(LMW) TnI-TnT-TnC complex, binary TnI-TnC complex and free-TnI. At time-point (a), there was no difference in these bands between STEMI and CKD patients. Interestingly, at time-point (b), AMI patients had significantly lower intensity of the 45kDa and 37kDa bands compared to CKD patients(for 45 kDa band mean difference was 54.3±19.4 AU, p=0.02; for 37 kDa band mean difference was 27.7±10.5 AU, p=0.03) as well as compared to the initial STEMI samples taken at time-point (a)(for 45 kDa band mean difference was 41.4±8.1 AU, p=0.002; for 37 kDa band mean difference was 16.7±6.3 AU, p=0.002) ,however there was no difference in the 25kDa band Conclusions: AMI patients had progressively lesser quantities of circulating LMW-ITC and binary IC complexes following AMI compared to ESRD patients, but similar quantities of circulating free TnI. This indicates a constant release of LMW-ITC and binary-IC complexes from the myocardium or reduced glomerular filtration of these complexes in ESRD while in the AMI patients, the LMW-ITC and binary I-C complexes appear to be progressively eliminated from plasma after the initial release
Abstract 13936: Practitioners’ Inaccuracy in Decision-making With Assessing NYHA Functional Class of Patients With Heart Failure
Authors: Marilyn A Prasun, Kelly D Stamp, Thomas P McCoy, Lisa Rathman
Journal: Circulation (2020)

Introduction: Heart failure (HF) is a major public health problem and timely evidence-based guideline directed treatment is essential to ensure optimal patient outcomes. New York Heart Association (NYHA) functional class of HF patients is a clinically important assessment as it relates to treatment recommendations. Purpose: The purpose of this study was to examine HF providers’ decision making and ability to correctly assign NYHA functional class. Methods: A cross-sectional, correlational study using survey methods with 244 physicians, advanced practice nurses and physician assistants practicing in the United States in acute and ambulatory care settings that treat adult patients with HF was conducted. Providers completed 8 validated clinical vignettes focused on decision making that related to the four NYHA functional classes. Descriptive statistics and multivariable regression were used to analyze the data. Results: Participants were predominately female (83%), Caucasian (87%) and were on average 51 years of age (SD=11). Sixty-five percent were nurse practitioners and 18% physicians, most were certified in HF (59%) and on average worked with HF patients for 15.1 years (SD=9.6). Providers reported assigning NYHA class to 83% of their patients, with 39% reporting it was useful. Accurate identification of NYHA Class I was 78.7%, for Class II 57.4%, for Class III 59.8% and for Class IV 36.9%. Correct NYHA class scores were associated with providers who typically reported assigning HF stage (p&lt;0.001), increased number of HF patients seen per week (p=0.024) and MD/DO providers relative to other advanced practice providers (p=0.021). Correct NYHA class scores were not associated with years working in a healthcare role, years working in HF, or years of certification adjusting for other provider and practice characteristics. Conclusions: Advanced practice providers who saw fewer HF patients had greater difficulty with accurately assigning NYHA Functional Class. When patients are incorrectly classed, they may not be recommended for evidence-based therapies at the optimal time, thus decreasing patient outcomes. Future research should focus on ways to improve accuracy in assigning NYHA Functional Class to improve patient outcomes.
Abstract 14963: Accelerometer-measured Activity in Non-obstructive Hypertrophic Cardiomyopathy: Patient-generated Activity Measures Correlate With, and Are Convolutional Neural Network Predictors of, Clinical Parameters in the MAVERICK-HCM Study
Authors: Priyanka Agarwal, Anna Shcherbina, Sharlene Day, Sara Saberi, Matthew E Mealiffe, Jay M Edelberg, Yunfan Li, Euan Ashley
Journal: Circulation (2020)

Introduction: Overall activity characteristics for patients with hypertrophic cardiomyopathy (HCM) have not been quantified previously. The relationship between physical activity quantified by accelerometry and biomarkers, exercise capacity, and quality of life in patients with HCM is also unknown. Methods: MAVERICK-HCM was a double-blind, placebo-controlled, 16-week study of mavacamten in 59 patients with symptomatic non-obstructive HCM. Patients were asked to wear ActiGraph GT9X Link wrist-worn monitors for ≥11 days between screening and day 1, and between weeks 12 and 16. Features derived from raw accelerometry data included average daily accelerometer units (ADAU) and step count. Univariate Pearson correlation coefficients were calculated between accelerometry data and clinical parameters among all patients. A multi-task convolutional neural network (CNN) was trained on raw accelerometry datapoints to jointly predict clinical markers of HCM severity. Test and training sets were derived by randomly segmenting each patient’s triaxial accelerometry data into non-overlapping minute intervals. Results: Fifty patients wore the accelerometer for ≥1 compliant day. Mean wear time was 12 days during screening and 10 days during treatment. Activity measures are summarized and average step count was 3,076 steps at baseline ( Table ). Activity features correlated with peak oxygen uptake (pVO 2 ), log NT-proBNP, and KCCQ score ( Table ). CNN predictions of clinical measures from activity data found Spearman R correlations of 0.82 for pVO 2 , 0.92 for log NT-proBNP, 0.82 for KCCQ, and 0.79 for E/e’. Conclusions: HCM patients in the MAVERICK study averaged only 3,000 steps/day. Markers of physical activity drawn from accelerometry are associated with standard clinical markers of HCM severity. Deep learning models can be constructed to predict markers of HCM severity from patients’ raw accelerometry data.
Noninvasive Oxygenation Strategies for Acute Hypoxemic Respiratory Failure
Authors: Elio Antonucci, Manuela Giovini, Antonio Maria Dell’Anna
Journal: JAMA (2020)

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Abstract 293: Detection of Pseudo-Pulseless Electrical Activity with Electrical Impedance Tomography
Authors: Alexander L Lindqwister, Weiyi Wu, Alexander Ivanov, Ethan K Murphy, Samuel B Klein, Saeed Hassanpour, Karen L Moodie, Alexandra P Hamlin, Joseph M Minichiello, Justin E Anderson, Norman A Paradis
Journal: Circulation (2020)

Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. p-PEA may constitute up to 40% of reported cases of cardiac arrest and its management may be different from ventricular fibrillation or even true-PEA. Currently, diagnosis of p-PEA requires either echocardiography or intravascular catheterization, neither of which are ideal in the prehospital setting. Electrical impedance tomography (EIT) uses skin surface electrodes to generate images based on cross sectional resistance. We investigated the ability of EIT and machine learning (ML) to detect p-PEA. Methods: Female swine (N = 14) under intravenous anesthesia were instrumented with aortic and central venous micromanometer catheters. p-PEA was induced by ventilation with 6% O 2 in 94% N 2 , defined as a systolic aortic pressure less than 40 mmHg. Continuous EIT renderings were obtained from circumferential thoracic and abdominal electrode arrays. A deep learning model was utilized to detect p-PEA using EIT sequences. Twelve pigs were randomly selected as training data and 2 pigs as a test set. EIT images were saved as 30 second clips, resulting in 3033 clips generated. To increase generalizability, random epochs ranging from 30 - 100% of the total clip length were generated, resulting in a model capable of detecting this disease state with limited video fragments. Results: This technique yielded a receiver operator characteristic curve - area under the curve (ROC-AUC) of 0.91 for detection of p-PEA in the testing dataset (Figure 1), with 84% accuracy, 88% sensitivity, and 84% specificity. Conclusions: EIT combined with machine learning may be able to reliably delineate p-PEA in a hypoxic porcine model. This approach may be promising for non-invasive operator-independent p-PEA detection.