tbuckley/cabot-search huggingface dataset:
Abstract 16382: The Surface ECG May Provide Information About Left Ventricular Systolic Function in Patients With Right Bundle Branch Block
Authors: Anshul Gupta, Behzad B Pavri
Journal: Circulation (2020)

Introduction: In patients (pts) with right bundle branch block (RBBB) and heart failure, assessment of left ventricular (LV) function is vital to management, but echocardiograms (ECHO) may not always be readily available. We studied the utility of using the Superimposed Median Format (available on digital ECG systems) in assessing LV function. This format allows visual recognition of change in dV/dT when rapid initial impulse propagation over the left bundle branch (LBB) and LV Purkinje network transitions to slower muscle-to-muscle propagation to the right ventricle (RV) in the setting of RBBB. Hypothesis: With a normal LBB and healthy LV myocardium, the transition from rapid forces to slower depolarization would occur in the 1 st half of the QRS complex ( Early Transition Group - ET) whereas in patients with abnormal LV function, this transition would occur in the 2 nd half (Late Transition Group - LT) of the QRS complex. Methods: Digital superimposed median format ECGs of 108 pts with RBBB were analyzed. Pts were divided into 2 groups: ET or LT. See figure. LVEFs were obtained from ECHO. LVEF ≥ 50% was considered normal. Results: ET: n = 69. LT: n = 39. Mean QRS durations were not different in the 2 groups. ET pts were more likely to have normal LVEF (p &lt; 0.01). See figure. PPV of ET in predicting LVEF ≥50% = 90%; NPV = 71%. Accuracy = 82%. Conclusions: These data, if confirmed, suggest that in pts with RBBB, visual analysis of the QRS complex from the surface ECG using the superimposed median format may provide valuable clues about LV systolic function, and may be clinically useful when ECHO are not readily available.
Abstract 109: Aerosol Generation During Chest Compression and Defibrillation in a Swine Cardiac Arrest Model
Authors: Cindy H Hsu, Mohamad H Tiba, Andre Boehman, Brendan M McCracken, Danielle C Leander, Stephanie C Francalancia, Zachary Pickell, Thomas H Sanderson, Kevin R Ward, Robert W Neumar
Journal: Circulation (2020)

Introduction: Respiratory infections can occur through the transmission of virus-containing aerosols from infected individuals. It remains unclear whether cardiac arrest (CA) resuscitation generates aerosols that have the potential to transmit diseases including COVID-19. Hypothesis: In a swine CA model, chest compression and defibrillation generate aerosols (≤10 μm) that could contain respiratory viruses. Methods: To simulate witnessed CA with bystander-initiated CPR, 3 female non-intubated swine underwent 4 minutes of untreated ventricular fibrillation CA followed by ten 2-minute cycles of mechanical chest compression and defibrillation without ventilation. The diameter (0.3 - 10 μm) and quantity of aerosols generated during 45-second intervals of no-flow, chest compression, and after each defibrillation were collected via a nose cone by the TSI Optical Particle Sizer. Aerosol generated from the coughs of 4 healthy human subjects were also compared to the swine data. Results: There was no significant difference between the total aerosols generated during chest compression compared to no-flow. In contrast, defibrillation followed by chest compression generated significantly more aerosols than chest compression or no-flow alone (72.4 ± 41.6 x10 4 vs 12.3 ± 8.3 x10 4 vs 10.5 ± 11.2 x10 4 ; p &lt; 0.0001), particularly at the larger-sized aerosols. Two consecutive human coughs generated 54.7 ± 33.9 x10 4 aerosols with a size distribution much smaller than post-defibrillation CPR (Table). Conclusion: Chest compression generated comparable aerosols to no-flow in a swine CA model. In contrast, defibrillation followed by chest compression generated significantly more aerosols than chest compression or no-flow alone, with a distribution shift toward larger aerosols. Additional research is needed to elucidate the mechanisms by which aerosol generation during chest compression is modified by defibrillation and to assess rescuer risk during CA resuscitation.
AB0713 PERIODONTAL DISEASES AND ITS ASSOCIATION WITH ANKYLOSING SPONDYLITIS/SPA: A SYSTEMATIC REVIEW
Authors: A. Pandey, V. Ravindran, M. Pandey, R. Rajak, V. Pandey
Journal: Annals of the Rheumatic Diseases (2020)

Background: A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis. Objectives: The aim of this systematic review was to appraise the available literature exploring the relationship between AS and periodontal disease. Methods: We searched Medline &amp; Embase databases (from their inception till October 2019) using appropriate combinations of following search items with limits ‘(English, Human)’; Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, Rheumatic disease AND periodontitis, periodontal disease, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index, bleeding on probing, probing pocket depth, clinical attachment loss. This search was supplemented by the manual search of bibliographies of articles selected and conferences proceedings of EULAR. Only be reviews, observational study of cross-sectional, cohort or case control type on adult patients with AS were selected. Data was extracted from a predesigned proforma. A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis. Results: A total number of 984 articles were identified and 12 were selcted for detailed appraisal (Figure 1, PRISMA flow chart). They were all case control studies. The prevalence of periodontitis ranged from 38% to 88% in patients with AS whereas in the control group from 26% to 71 % in controls. Out of 12 studies, two showed significant changes in Plaque Index (PI), two studies showed altered Pocket Probing Depth (PPD), three showed significant increased in Clinical Attachment Loss (CAL) and increased Bleeding On Probing (BOP) was seen in 2 studies. In 7 studies, periodontitis was seen in a significant number of patients with AS (P&lt;0.05). All studies reported that the prevalence of periodontal disease in AS patients was higher as compared to non-AS patients. Conclusion: Our systematic review found an association between AS and periodontal disease. Patients with AS show higher prevalence of periodontitis and a poor oral hygiene as compared to healthy controls. At practice level, this systematic review underscores the need for a collaboration between dentists and rheumatologist. Disclosure of Interests: None declared
Abstract #267: PEGPH20: PEGylated recombinant human hyaluronidase antitumor activity in the 4T1 orthotopic breast carcinoma model
Authors: Ping Jiang, Salam Kadhim, Gerald Fu, Jesse Bahn, Flavio Araiza, Rebecca Symons, Sean Wang, Curtis Thompson, Patrick OConnor, Gregory Frost
Journal: Cancer Research (2009)

Hyaluronan (HA) is a significant component of the extracellular matrix (ECM) in many solid tumors. In breast carcinoma, accumulation of HA is associated with tumor progression and poor prognosis. Using the 4T1-GFP murine breast carcinoma line as a model, we probed the effects of HA depletion enzymatically using a pegylated recombinant human PH20 hyaluronidase (PEGPH20). When grown as a monolayer, 4T1-GFP cells assembled large hyaluronan dependent pericellular matrices that were sensitive to a 60 minute exposure with 1,000U/mL (~30µg/mL) PEGPH20. Treatment of 4T1-GFP/3T3 hybrid spheroid multicellular aggregates with PEGPH20 (10,000 U/mL) resulted in a 10% decrease in colony diameter and a 26% reduction in colony volume as early as 1 hour after incubation. Exposure to PEGPH20 in doses ranging from 10-10,000 U/mL reduced 4T1-GFP colony number and inhibited cell proliferation by >50%. In vivo, 4T1-GFP tumors grown orthotopically in mice produced abundant HA in the ECM immediately adjacent to tumor cells. Intravenous (IV) administration of PEGPH20 with doses up to 500K U/kg depleted HA from the ECM of 4T1-GFP tumors and was well tolerated, with a dose-dependent decrease in HA labeling within 3 days of administration. Depletion of HA staining was observed following treatment with PEGPH20 doses > 50K U/kg (~1.6 mg/kg). Anti-tumor activity of PEGPH20 was evaluated using repeat (Q2D) dosing (150K - 1500K U/kg) in 4T1-GFP orthotopic tumor bearing mice, with 150K U/kg effectively removing all ECM HA. Approximately 60% tumor growth inhibition (TGI) was observed when measured 3 days after the last PEGPH20 dose. Furthermore the time for 4T1-GFP tumors to reach ~1,500 mm3 volume was also delayed by >1.7-fold, compared to control mice. Survival to 1500 mm3 tumor volume in the PEGPH20 (150K U/kg) treated group was statistically significantly different (p  Citation Information: In: Proc Am Assoc Cancer Res; 2009 Apr 18-22; Denver, CO. Philadelphia (PA): AACR; 2009. Abstract nr 267.
Abstract 15424: Tricuspid Valve Geometry and Right Heart Remodeling: Insights Into the Mechanism of Atrial Functional Tricuspid Regurgitation
Authors: Hiroto Utsunomiya, Yu Harada, hitoshi susawa, Yusuke Ueda, Kanako Izumi, Kiho Itakura, Takayuki Hidaka, Takahiro Shiota, Yukiko Nakano, Yasuki Kihara
Journal: Circulation (2020)

Introduction: Functional tricuspid regurgitation (TR) caused by chronic atrial fibrillation with structurally normal tricuspid valve (TV) leaflets, normal right ventricular (RV) function, and dilated right atrium (RA), is considered as a new clinical entity, atrial functional TR (AF-TR). We sought to investigate TV geometry and right heart remodeling in AF-TR compared with ventricular functional TR with sinus rhythm (VF-TR). Methods: Transesophageal 3D echocardiography datasets of the TV and the RV were acquired in 51 symptomatic severe TR. 3D RV endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips (Figure). Results: Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the center of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P &lt;0.001). Additionally, the posteromedial directed component of posterior PM tip position and the apically directed component of the position of all 3 PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P &lt;0.02). In subgroup analysis, massive to torrential AF-TR had a larger RV volume with more apically displaced PM tips than severe AF-TR. Conclusion: Right heart remodeling and its association with TV geometry differ between AF-TR and VF-TR, which offers distinctive therapeutic implications.
T Cells: Warriors of SARS-CoV-2 Infection
Authors: Paola de Candia, Francesco Prattichizzo, Silvia Garavelli, Giuseppe Matarese
Journal: Trends in Immunology (2020)

Severe infection with severe acute respiratory syndrome coronavirus (SARS-CoV)-2 is characterized by massive cytokine release and T cell loss. The exaggerated host immune response, incapable of viral clearance, instead aggravates respiratory distress, as well as cardiac, and/or damage to other organs. The mortality pattern of SARS-CoV-2 infection, higher in older versus younger adults and almost absent in children, is possibly caused by the effects of age and pre-existing comorbidities on innate and adaptive immunity. Here, we speculate that the abnormal and excessive immune response to SARS-CoV-2 infection partly depends on T cell immunological memory, which is more pronounced in adults compared with children, and may significantly contribute to immunopathology and massive collateral damage in coronavirus disease 2019 (COVID-19) patients.
Mutations in BRCA1 and BRCA2 differentially affect the tumor microenvironment and response to checkpoint blockade immunotherapy
Authors: Robert M. Samstein, Chirag Krishna, Xiaoxiao Ma, Xin Pei, Ken-Wing Lee, Vladimir Makarov, Fengshen Kuo, Jonathan Chung, Raghvendra M. Srivastava, Tanaya A. Purohit, Douglas R. Hoen, Rajarsi Mandal, Jeremy Setton, Wei Wu, Rachna Shah, Besnik Qeriqi, Qing Chang, Sviatoslav Kendall, Lior Braunstein, Britta Weigelt, Pedro Blecua Carrillo Albornoz, Luc G. T. Morris, Diana L. Mandelker, Jorge S. Reis-Filho, Elisa de Stanchina, Simon N. Powell, Timothy A. Chan, Nadeem Riaz
Journal: Nature Cancer (2020)
Ranking the effectiveness of worldwide COVID-19 government interventions
Authors: Nina Haug, Lukas Geyrhofer, Alessandro Londei, Elma Dervic, Amélie Desvars-Larrive, Vittorio Loreto, Beate Pinior, Stefan Thurner, Peter Klimek
Journal: Nature Human Behaviour (2020)

Assessing the effectiveness of non-pharmaceutical interventions (NPIs) to mitigate the spread of SARS-CoV-2 is critical to inform future preparedness response plans. Here we quantify the impact of 6,068 hierarchically coded NPIs implemented in 79 territories on the effective reproduction number, Rt, of COVID-19. We propose a modelling approach that combines four computational techniques merging statistical, inference and artificial intelligence tools. We validate our findings with two external datasets recording 42,151 additional NPIs from 226 countries. Our results indicate that a suitable combination of NPIs is necessary to curb the spread of the virus. Less disruptive and costly NPIs can be as effective as more intrusive, drastic, ones (for example, a national lockdown). Using country-specific 'what-if' scenarios, we assess how the effectiveness of NPIs depends on the local context such as timing of their adoption, opening the way for forecasting the effectiveness of future interventions.
Abstract 13463: Left Atrioventricular Coupling Index as a Prognostic Marker: The Multi-ethnic Study of Atherosclerosis
Authors: Theo Pezel, Bharath Ambale Venkatesh, Henrique D De Vasconcellos, Yoko Kato, Mahsima Shabani, Eric Xie, Susan R Heckbert, Wendy S Post, Steven Shea, Norrina B Allen, Karol E Watson, Colin Wu, David Bluemke, Joao A Ac Lima
Journal: Circulation (2020)

Introduction: The left atrium (LA) and left ventricle (LV) parameters have both prognostic value for cardiovascular (CV) events. We hypothesize the left atrioventricular coupling to be a strong predictor of CV events. Hypothesis: This study aimed to investigate the prognostic value of a novel left atrioventricular coupling index (LACI) and to assess its predictive value for CV events in a population without a history of CV diseases at baseline. Methods: A total of 4,124 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a cardiac MRI study. The LACI was defined by the ratio of the LA end-diastolic volume divided by the LV end-diastolic volume by MRI. Cox proportional hazard models were built to predict the endpoints of atrial fibrillation (AF), heart failure (HF), CV death and hard CV disease (CVD) defined by myocardial infarction, resuscitated cardiac arrest, fatal and non-fatal stroke or CV death. In univariable and multivariable Cox analyses, the association between LACI and time-to-event was analysed, adjusting for 14 covariables including traditional CV risk factors and biomarkers. Results: A total of 1151 CV events were observed during a median (IQR) follow-up period of 15.9 (12.9-16.6) years. LACI was associated with AF (HR 2.14, 95%CI [1.97-2.32]), HF (HR 1.70, 95%CI [1.56-1.86]), hard CVD (HR 1.34, 95%CI [1.22-1.48]), and CV death (HR 1.53, 95%CI [1.38-1.70]; for all p&lt;0.0001). In multivariate analysis, LACI had a significant independent association for AF (HR 1.86, 95%CI [1.69-2.04]), HF (HR 1.47, 95%CI [1.33-1.60]), hard CVD (HR 1.25, 95%CI [1.12-1.40]), and CV death (HR 1.29, 95%CI [1.15-1.50; for all p&lt;0.001). LACI showed better discrimination than the multivariate model for AF (C-statistic: 0.84 vs 0.79), HF (0.82 vs 0.80), hard CVD (0.77 vs 0.76), and CV death (0.84 vs 0.83). Conclusions: The LACI is a predictor of incident HF, AF, hard CV disease, and CV death in MESA.
Abstract 16761: Refining Individualized Risk Prediction for Apparent Treatment-Resistant Hypertension in a Large Multiethnic Biobank: The Million Veteran Program
Authors: Elvis A Akwo, HuaChang Chen, Bryce X Rowan, Cassianne Robinson Cohen, Cecilia P Chung, Talat A Ikizler, Yan Sun, Peter W Wilson, Philip S Tsao, Christopher J O'Donnell, Todd L Edwards, Csaba Kovesdy, Ran Tao, Adriana M Hung
Journal: Circulation (2020)

Introduction: Approximately 10-20% of treated hypertensive patients have apparent treatment-resistant hypertension (ATRH), which is associated with adverse cardiovascular outcomes. Our goal was to develop a prediction model for ATRH that combines clinical data and a genetic risk score (GRS) for ATRH. Methods: Study participants were 232,925 patients with hypertension (HTN) enrolled in the Million Veteran Program receiving care at the VA from 2004 to 2017. 21% were black and 6% were women. Incident ATRH was defined as failure to achieve outpatient blood pressure (BP) &lt;140/90 mmHg with 3 anti-HTN drugs including a thiazide or the use of ≥4 drugs. In the training data (n = 207,375), a logistic regression model was fit with age, sex, race, smoking history, body mass index, diabetes, anti-HTN drug classes, baseline systolic BP (SBP), diastolic BP, eGFR, serum potassium, serum bicarbonate and serum lipids. A weighted GRS was developed in the training data using 21 significant SNPs from a transethnic ATRH GWAS. An independent test data (n = 25,550) was used to validate the clinical model and fit a GRS-enriched (clinical model + GRS) model. Results: Over a 13.5-year follow-up, 20,536 and 2,247 incident ATRH cases were observed in the training and test data. In the training data, the clinical model had reasonable discriminant ability (C=0.706) and good calibration (Brier score = 0.085). Age, diabetes, and SBP were the strongest predictors of ATRH. In the test dataset, a 1-IQR increase in the GRS was associated with a 10% (95%CI: 1.04-1.17) higher odds of ATRH. In the test dataset, the LR χ 2 , C-statistic and Brier score for the clinical model were 1075, 0.705 and 0.077 respectively. In the GRS-enriched model, these values were 1107, 0.708 and 0.077. The net reclassification improvement was 1.5% (95% CI: 0.3-2.8, p=0.02). The GRS-enriched model had excellent calibration with an optimism-corrected calibration slope of 0.95. Conclusion: Augmenting a clinical prediction model for ATRH with a GRS comprising GWAS-significant SNPs improved model fit but not discriminant ability. Future work will evaluate whether models incorporating polygenic risk scores with a larger number of variants may refine ATRH risk prediction and stratification and evaluate race-specific performance.
Preoperative Conversations About Postoperative Risks, Outcomes, and Quality of Life—Time to Start Thinking Outside the Box
Authors: Maria Yefimova, Rebecca A. Aslakson
Journal: JAMA Network Open (2020)

Michael J. Tylee, MD; Gordon D. Rubenfeld, MD, MSc; Duminda Wijeysundera, MD, PhD; Michael C. Sklar, MD; Sajid Hussain, MD; Neill K. J. Adhikari, MD, MSc
Abstract 14356: Initial Experience With Telemedicine for Interstage Monitoring in Infants With Palliated Congenital Heart Disease
Authors: Alyson Stagg, Therese M Giglia, Monique Gardner, Bonnie F Offit, Kate M Fuller, Shobha S Natarajan, David A Hehir, Anita L Szwast, Jonathan J Rome, Chitra Ravishankar, Tamar J Preminger
Journal: Circulation (2020)

Introduction: Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. We have previously described the mediated risk for this patient population through close home monitoring. Given high rates of intercurrent illness, geographic and sociodemographic disparities in access to care, and significant family stressors, we instituted a telecardiology (TC) program in 2019. Methods: All consecutive patients discharged home were monitored from neonatal operation or intervention to subsequent surgical palliation. All had home scales and pulse oximeters. TC visits (TCVs) were held monthly, and increased to bimonthly during the COVID-19 pandemic. TCVs were launched through the electronic medical record (EMR) through a mobile device, with a full-version EMR available for access to full records and efficient documentation. We tracked how TCVs identified clinical concerns, prevented unnecessary emergency room visits (ERV) and expedited in-person assessment. Results: Between 8/2019-5/2020, we conducted 60 TCV for 29 patients (16 had stage 1 palliation, 6 with aortopulmonary shunt or stent and 7 with biventricular physiology with shunt or stents. Initial median weight was 3.4 kg (range 2.3-5.4 kg). Median monitoring time was 199 days (75-264). Median visits per patient were 2 (1-5 V) with average length per visit of 20 minutes. Most scheduled visits were completed (90%); 5% declined, and 5% canceled. Parents reported satisfaction for 97% of visits. In 6 visits (10%) significant clinical findings were identified which avoided ERV or hospital admissions, 4 TCVs (7%) visits led to expedited outpatient assessments, 1 required hospitalization. There were no missed events nor deaths. Additional issues identified included changes to medication (23%), feedings (15%) and equipment malfunction (5%). Frequency of EDV decreased from median 0.4 (0-3.7) V/patient/month the prior year to 0 (0-2.5), p=0.0004]. Conclusions: TC in these high-risk patients is feasible and effective to identify clinical concerns, no missed events and decrease in ERV per patient. TC was particularly effective during the COVID-19 pandemic allowing for easy adaptation of care to ensure patient safety in this fragile cohort.