tbuckley/cabot-search huggingface dataset:
Abstract 202: Video Laryngoscopy for Out of Hospital Cardiac Arrest
Authors: Ryan M Huebinger, Hutch Stilgenbauer, Jeffrey L Jarvis, Daniel Ostermayer, Kevin Schulz, Henry E Wang
Journal: Circulation (2020)

Introduction: Intubation is an essential component of cardiac arrest resuscitation. While prior studies have evaluated video laryngoscopy (VL) to assist intubation for in hospital cardiac arrest, there is a paucity of research evaluating VL for out of hospital cardiac arrest (OHCA). We sought to evaluate the association of video laryngoscopy with first pass success and ROSC. Hypothesis: Video laryngoscopy improves first pass success rate and improves the rate of ROSC Methods: We analyzed the 2018 data from ESO Inc. (Austin, TX), a national prehospital electronic health record used by 1289 EMS agencies in the US. We included all adult (age &gt;18 years), non-traumatic cardiac arrests that were intubated with an endotracheal device. We applied a chi2 test to evaluate the first pass success rate for VL vs direct laryngoscopy (DL). We then created a mixed model, fitting agency as a random intercept and adjusting for age, gender, race, location of arrest, witnessed arrest, initial shockable rhythm, and bystander CPR. We applied the mixed model to analyze the association between VL and first pass success rate, ROSC, and sustained ROSC (survival to ED or ROSC for greater than 20 minutes). Results: We included 22,097 patients cared for by 914 agencies. 5,674 (25.7%) patients were intubated with video laryngoscopy. The median age was 66 (IQR 55-77). 61.9% of patients were male and 73.0% were white. 71.9% of cardiac arrest happened at home, 56.8% of were witnessed, 37.4% had bystander CPR, and 20.6% had a shockable rhythm. Compared to DL, VL had a lower rate of bystander CPR (41.4% v 36.1%, p&lt;.001), but other characteristics were similar between the groups. We found that VL had a higher first pass success rate than DL (75.1% v 69.5%, p&lt;.001). Using a mixed model analysis, VL was associated with a higher rate of first pass success (OR 1.5, CI 1.3-1.6), but VL was not associated with improvement in ROSC (OR 1.1, CI 0.97-1.2) or sustained ROSC (OR 1.1, CI 0.9-1.2). Conclusion: VL had a higher first pass success rate than DL, and on adjusted, mixed-model analysis, VL use was associated with increased rate of first pass success. However, VL was not associated with increased rate of ROSC
THU0191 HAS THE DOSE OF METHOTREXATE IN RHEUMATOID ARTHRITIS BEEN OPTIMIZED BEFORE INITIATING BIOLOGICAL TREATMENT? RESULTS OF AN ALGERIAN MULTICENTER STUDY
Authors: R. Benaziez, F. Mechid, M. Bercache, I. Bencharif, H. Ayed, S. Slimani, N. Bahaz, S. Lefkir, F. Rahal, F. Hanni, A. Abi Ayad, C. Makhloufi-Dahou
Journal: Annals of the Rheumatic Diseases (2020)

Background: Methotrexate (MTX) is the gold standard treatment for rheumatoid arthritis (RA). The international guidelines recommend optimizing its dose before the introduction of a biologic treatment in cases where it is well tolerated1. Objectives: The objective of this study is to evaluate the dose of MTX before the initiation of biological treatment in RA patients with MTX ineffectiveness. Methods: This is a multicenter, cross-sectional, prospective study including adults RA, over a period of 6 months (January-June 2019). We collected the following data: sex, age, comorbidities (diabetes, hypertension), rate of RF and ACPA, dose of MTX, rate of patients on corticosteroids, Disease Activity Score (DAS 28-vs), Health Assessment Questionnaire (HAQ) and SHARP Score. Results: Number of patients: 239 (187 women / 52 men); average age: 48.3 years (19 - 81); average duration of the disease: 13.6 ± 8.2 years. Comorbidities: arterial hypertension (14,6 %) - diabetes (13 %),The RF were positive in 59.8%. The average value of ACPA is 228.76 ± 287.08 IU / L, positive in 73% case. The average DAS28vs is 4.77 ± 1.46 (0.77 - 12.26). The average modified SHARP 111.67 ± 98.16 (0-448), the average HAQ is 1.13 ± 0.82 (0 - 2.87). 86.7% of patients are under corticosteroids.Only 18.5% of patients had a dose of MTX between 20 and 25 mg / week. the remaining 82% of patients the average dose of MTX was 14 mg / week (10-18.5). Conclusion: These results suggest that the dose of MTX was not optimized before the initiation of biotherapy in the majority of patients with RA. References: [1]Smolen JS, Landewé R, Bijlsma J , et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update Annals of the Rheumatic Diseases 2017;76:960-977. [3]Claire Daiena, Charlotte Huac, Cécile Gaujoux-Viala, et al. Update of French society for rheumatology recommendations for managing rheumatoid arthritis. Joint Bone Spine 86 (2019) 135–150 [2]Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res. 2016 Jan;68(1):1-25. Disclosure of Interests: None declared
Abstract 17265: Prognostic Value of Serial D-dimers in Severe COVID-19 Infections
Authors: Songhon Hwang, Mallika Gopal, Nicole Ilonzo, Christopher Faries, Ajit Rao, Peter Faries, Michael Marin, Windsor Ting
Journal: Circulation (2020)

Introduction: COVID-19 infection causes a thrombotic state and elevation in D-dimer. This study characterizes the contour and nature of D-dimer elevation during severe COVID-19 infections. Methods: Retrospective review of 100 consecutive COVID-19 patients selected for severe infection at a tertiary medical center in New York City admitted to four COVID units and three ICU units on 04/15/2020. Admission D-dimer and serial D-dimer values during hospitalization were obtained as were demographic data, major thrombotic complications, and other significant hospital events. Data was analyzed with the Mann-Whitney U test, student’s t-test, and chi-squared test. Results: Hospital mortality was 28% among these 100 study subjects, ventilatory support 47%, ICU stay 40%, discharged in 61% and 11% remained hospitalized on 5/15/2020. Admission D-dimer elevated in 89% (mean D-dimer 3.36+/-4.84 mg/L) and 97% of hospitalized patients had elevated D-dimer (peaked mean D-dimer 7.33+/-7.34 mg/L). There was no significant difference in the admission D-dimers between patients who died versus those who survived (3.50+/-0.81 vs 3.02+/-0.55 mg/L, p=0.19), however; the contours of the subsequent D-dimers were significantly different between those who died versus survivors. Mean in hospital D-dimer remained without significant change in the survivor group but increased significantly in the deceased group (3.06+/-0.53 vs 4.62+/-0.48 mg/L, p&lt;0.001). The final D-dimer measurement prior to a patients discharge or death was significantly higher in the deceased group vs the survivor group (5.53+/-0.86 vs 1.98+/-0.39 mg/L, p&lt;0.001). There were 27 thrombotic complications (CVA 10, MI 4, PE 6, DVT 5, arterial thrombosis 2) diagnosed in 22 patients. Elevated peaked D-dimers were significantly associated with ICU (12.04 +/-6.96 mg/L, R 0.27-20, 95% CI 2.23) vs. no-ICU stay (5.13 +/- 6.49 mg/L, R 0.3-20, 95% CI 1.68, p&lt;0.001), and thrombotic complications (12.60 +/- 7.62 mg/L, R 0.27-20, 95% CI 3.38) vs. no thrombotic complication (6.57 mg/L +/- 0.3-20, 95% CI 1.47, p&lt;0.001). Conclusions: D-dimers were near universally elevated in severe COVID-19 infection but a marked upward trending of D-dimers presaged COVID-associated complications and a poor outcome.
Systemic tumour suppression via the preferential accumulation of erythrocyte-anchored chemokine-encapsulating nanoparticles in lung metastases
Authors: Zongmin Zhao, Anvay Ukidve, Vinu Krishnan, Alexandra Fehnel, Daniel C. Pan, Yongsheng Gao, Jayoung Kim, Michael A. Evans, Abhirup Mandal, Junling Guo, Vladimir R. Muzykantov, Samir Mitragotri
Journal: Nature Biomedical Engineering (2020)
Abstract 16356: Higher Mortality Up to 36 Months in ST-Segment Elevation Myocardial Infarction Patients Without Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry
Authors: Gemma A Figtree, Stephen T Vernon, Nermin Hadziosmanovic, Johan Sundstrom, Joakim Alfredsson, Margret Leosdottir, Emil Hagstrom
Journal: Circulation (2020)

Introduction: While prevention strategies that target S tandard M odifiable cardiovasc u lar R isk F actors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to reduce coronary heart disease risk, myocardial infarction (MI) in the absence of SMuRFs is not infrequent. Methods: We examined the presenting features, treatment, short- and long-term outcomes of patients with ST-segment-elevation MI (STEMI) without SMuRFs compared to STEMI patients with &gt;0 SMuRFs in the national Swedish MI registry SWEDEHEART between 2006-2018. Adjusted logistic regression models were used to determine outcome predictors of all cause 30-day mortality. Kaplan Meir survival analysis was performed. Results: 8,400 (14%) of 60,692 patients without a history of coronary artery disease had no SMuRFs. Patients with and without SMuRFs had the same rate of primary PCI but lower rate of multivessel disease (37% vs. 44%). SMuRF-less patients had higher rates of unadjusted all-cause mortality at 30 days (12% vs. 8%, P &lt;0.0001) and at 36 months (20% vs. 17%, P &lt;0.0001). In adjusted models, having SMuRFs vs. being SMuRF-less (OR 0.63 [95% CI 0.54-0.73]), female sex, LVEF &lt;40%, pre-hospital cardiac arrest, higher heart rate and creatinine, and lower systolic blood pressure were predictors of 30-day mortality (P &lt;0.0001 for all). All-cause mortality rate at 30 days was highest among SMuRF-less females and those with LVEF &lt;40% (Figure 1). The proportion on preventive pharmacotherapy at discharge was lower in SMuRF-less patients. Conclusions: 14% of STEMI presentations occurred in the absence of SMuRFs. Higher rates of 30-day mortality in SMuRF-less STEMI patients, especially among women, highlight the need for improved risk stratification and evidence-based pharmacotherapy during the post MI period, irrespective of baseline risk factors and sex. Figure 1. Kaplan Meier survival curves for patients with and without SMuRFs. A) Women. B) Men. C) LVEF &lt; 40%. D) LVEF &gt; 40%.
Detection of Dural Metastases Before the Onset of Clinical Symptoms by 16α-[18F]Fluoro-17β-Estradiol PET in a Patient With Estrogen Receptor–Positive Breast Cancer
Authors: Jorianne Boers, Carolina P. Schröder, Geke A. P. Hospers, Erik F. J. de Vries, Andor W. J. M. Glaudemans
Journal: Clinical Nuclear Medicine (2020)

We offer an illustrative case about estrogen receptor (ER) imaging (also known as 16α-[18F]fluoro-17β-estradiol ([18F]-FES) PET) and the detection of metastatic lesions in the dural region. We present a case of a woman with ER-positive metastatic breast cancer and high [18F]-FES uptake in the dural region on PET imaging, without associated clinical symptoms. These lesions were missed on [18F]-FDG PET because of physiological [18F]-FDG uptake in the brain. This case highlighted some difficulties in the interpretation of imaging of brain metastases and demonstrated the added value of [18F]-FES PET imaging. [18F]-FES PET could be used to prove the presence of ER-positive metastases in the brain.
Abstract 14221: Right Ventricular Adaptation to Pressure Overload: Differences Between Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Arterial Hypertension
Authors: Natalia J Braams, Joost W van Leeuwen, anton vonk noordegraaf, Harm Jan Bogaard, Lilian J Meijboom, Frances S De Man
Journal: Circulation (2020)

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (iPAH)) are both associated with right ventricular (RV) failure and death. Although both conditions develop in the pre-capillary pulmonary vasculature, patient characteristics are different. CTEPH patients are older, predominantly male and more often have a history of venous thromboembolism. Therefore, the RV might be affected differently in CTEPH compared to iPAH. We aimed to compare RV adaptation in CTEPH and iPAH. Methods: Between 2000 and 2019 all treatment naive iPAH and CTEPH patients diagnosed in the Amsterdam UMC were included if a right heart catheterization and cardiac magnetic resonance imaging (CMR) were performed at the time of diagnosis. RV volumes, mass and function were assessed with CMR. RV contractility, afterload, RV-pulmonary artery (RV-PA) coupling and diastolic stiffness (Eed) were obtained using single beat pressure-volume loop analysis. Differences in RV phenotypes between iPAH and CTEPH were analyzed using multiple linear regression with interaction testing after correcting for confounders. Results: A total of 235 patients were included, 116 with CTEPH and 119 with iPAH. CTEPH patients were older, predominantly male, had a higher systemic blood pressure and a lower pulmonary vascular resistance at the time of diagnosis. After correcting for these confounders, RV function and RV-PA coupling were similar in both groups. However, CTEPH patients had a higher RV end-diastolic volume index (87±27 ml/m2 vs. 82±25 ml/m2), and a lower RV wall thickness (0,6±0,1 g/ml vs. 0,7±0,2 g/ml; figure 1A). The increase in afterload in CTEPH was associated with a disproportionally larger increase in diastolic stiffness compared to iPAH, independent of RV wall thickness (figure 1B). Conclusions: Despite a similar RV function, the RV in CTEPH is more dilated and stiffer than the RV in iPAH, independent of age, sex and afterload.
Collision of Solid Pseudopapillary Tumor and Neuroendocrine Tumor of the Pancreas on 18F-FDG PET/CT
Authors: Hongyan Yin, Jing Lv, Lingli Chen, Yan Xiu, Hongcheng Shi
Journal: Clinical Nuclear Medicine (2020)

Abstract We report a rare case of pancreatic collision tumor of solid pseudopapillary tumor and neuroendocrine tumor in a 43-year-old woman. A pancreatic mass was found by abdominal ultrasound. A mainly cystic mass with solid component progressive enhancement was revealed using abdominal enhanced CT. Staging 18 F-FDG PET/CT demonstrated a pancreatic tail mass with an increased uneven 18 F-FDG uptake. Distal pancreatectomy was performed. Postoperatively, the mass was diagnosed as pancreatic collision tumor of solid pseudopapillary tumor and neuroendocrine tumor.
Abstract 16321: Does Yoga Based Cardiac Rehabilitation (Yoga-CaRe) Programme Improve Endothelial Function and Reduce Oxidative Stress in Patients With Acute Myocardial Infarction?
Authors: Satish G Patil, Christa Edmin, Ambalam M Chandrasekaran, Kalpana Singh, Shankar Patil, ambuj roy, Kishore kumar Deepak, Ashok Jaryal, Sanjay Kinra, Dorairaj Prabhakaran
Journal: Circulation (2020)

Introduction: Endothelial function and oxidative stress play a vital role in the prognosis following acute myocardial infarction (AMI). We evaluated the effect of Yoga-based Cardiac Rehabilitation (Yoga-CaRe) programme on markers of endothelial function and oxidative stress. Methods: Yoga-CaRe trial is a multi-centre randomized controlled trial. Participants with AMI were assessed for eligibility and following randomization, participants underwent Yoga-CaRe program (13 in-hospital sessions supervised by an instructor with encouragement to practice regularly at home) or enhanced standard care (3 educational sessions). We estimated asymmetric dimethylarginine (ADMA), endothelial nitric oxide (eNOS), total nitric oxide concentration (NOx), endothelin-1 (ET-1), oxidized-LDL (Ox-LDL), superoxide dismutase (SOD), total anti-oxidant capacity (TAOC), tumor necrosis factor-alpha (TNFα), C-reactive protein (CRP), P-Selectin, E-selectin, ICAM-1 and VCAM at baseline and at 12 weeks. Blood samples were collected as part of two sub-studies. All the laboratory analysis were conducted in a standardized laboratory. We used ANCOVA to assess the difference between the groups. Results: Eighty-two blood samples (43 in Yoga-CaRe and 39 in enhanced standard care) were included in the analysis. The mean age of participants was 52.5±10.6 years and 19.5% were females. At 12 weeks, Yoga-CaRe reduced ET-1 (p&lt;0.001), ADMA (p=0.02) and ICMA-1 (p=0.019) and increased TAOC (p=0.03) than enhanced standard care group. Reduction in E-selectin (p=0.02) and VCAM (p=0.003) were higher in enhanced standard care than Yoga-CaRe group. We found no difference in other parameters. Conclusion: These results suggest that Yoga-CaRe may improve the endothelial function (through reduction in ET-1), anti-oxidant status and modulate adhesion molecules in patients following AMI. Our study was exploratory and the findings are intriguing. This needs evaluation in a larger trial.
Abstract 16797: Heart Failure Outcomes in Patients With Ischemic Cardiomyopathy After Ventricular Tachycardia Ablation
Authors: Himanayani Mamillapalli, Viorel G Florea, Mackenzie Mbai, Sravya Veligandla, Smitha Murthy, Jian-Ming Li, Venkatakrishna N Tholakanahalli
Journal: Circulation (2020)

Introduction: Patients with congestive heart failure (CHF) are at an increased risk of developing ventricular tachycardia (VT). It is unclear how VT ablation affects CHF outcomes. Hypothesis: The goal of this study is to evaluate CHF exacerbations and echocardiogram findings based on location of myocardial scar in patients with Ischemic Cardiomyopathy (ICM) who have undergone VT ablation. Methods: This was a selected cohort of consecutive patients with ICM who underwent VT ablation at Minneapolis Veterans Affairs Health Care System between July 2008 and September 2019. CHF outcomes and echocardiogram variables were assessed. Results: Seventy-five patients with ICM underwent VT ablation, average age was 67.6 ± 7 years old and 100% male. Inferior wall scar (IWS) was the most prevalent (Figure, Table 1A). On pre-ablation echocardiogram, anterior wall scar (AWS) group overall had a lower mean ejection fraction (EF) of 26%, compared to IWS group of 32% (Table 1B). On post-ablation echocardiogram, patients with AWS had statistically significant (p &lt; 0.03, two-tailed test) lower mean EF of 23% compared to IWS group of 30% (Table 1C). Twenty-five patients had admissions for CHF exacerbation post-ablation, 17 were in the first year after ablation (12 IWS and 5 AWS). Average time from ablation to CHF exacerbation was 2.1 years. Patients with IWS presented earlier with CHF exacerbation compared to AWS group (1.6 vs 1.8 years). Conclusions: Patients with ICM and AWS had a statistically significant mean lower EF post VT ablation compared to IWS group. However, patients with IWS had higher rates of admission for CHF exacerbation.
Abstract 12810: Cardiac Injury and Outcomes of Patients With Covid-19 in New York City
Authors: Toshiki Kuno, Tetsuro Maeda, Reiichiro Obata, Dahlia Rizk
Journal: Circulation (2020)

Background: Prior studies demonstrated COVID-19 patients with elevated troponin were associated with increased in-hospital mortality, however only 27% of patients with cardiac injury were assessed with an electrocardiogram (ECG). The aim of this study was to investigate the association of cardiac injury and ECG abnormality, as well as in-hospital mortality. Methods: We conducted aretrospective cohort study of 224 consecutively admitted patients with confirmed COVID-19 who needed hospitalization between March 13 and March 31, 2020. Those patients with troponin I measurement (N=181) were divided into patients who had elevated troponin I (cardiac injury group), and those who did not (no cardiac injury group). Results: The mean age was 64.0±16.6 and 55.8% were male. The cardiac injury group was more likely to be older, have coronary artery disease, prior atrial fibrillation, as well as congestive heart failure compared to the no cardiac injury group (all P&lt;0.05). Notably, both groups had non-significantly different, relatively low rates of chest pain (cardiac injury group versus no cardiac injury group: 17.0% versus 22.5%, P=0.92). The cardiac injury group had a significantly higher value of brain natriuretic peptide, procalcitonin, interleukin-6 and d-dimer (all P&lt;0.05). Moreover, the cardiac injury group had a relatively low proportion of ECG abnormalities such as T wave inversion (13.2%) and ST depression (1.9%). Cardiac injury group had significantly higher in-hospital mortality than no cardiac injury group (42.3% versus 12.6%, P&lt;0.001). With a multivariate logistic regression model, age (odds ratio (OR) [95% confidential interval (CI)]: 1.033 [1.002-1.065], P=0.034), cardiac injury (3.25 [1.40-7.54], P=0.006), were significant predictors to estimate in-hospital death. Conclusion: COVID-19 patients with elevated troponin had relatively low proportion of chest pain and ECG abnormality. Cardiac injury was associated as an independent predictor to estimate in-hospital death.
Abstract 16329: Survival Prospects in Congenitally Corrected Transposition of the Great Arteries: Results From a Multi-institutional Study
Authors: Alexandra van Dissel, Alexander Opotowsky, Jamil A Aboulhosn, Martijn Kauling, Salil Ginde, Eric Krieger, Sangeeta Shah, Tripti Gupta, Fred Rodriguez, Anitha JOHN, Sandra Jaidzeka, Timothy Cotts, Mary Stumpf, Cindy Dwight, Patty Woods, Jeremy Nicolarsen, Berardo Sarubbi, Flavia Fusco, Petra Antonova, Susan M Fernandes, Jasmine Grewal, Mikyla Janzen, Jonathan CRAMER, Paul Khairy, Pastora Gallego, Clare O’Donnell, Jane Hannah, Mikael G Dellborg, Isabelle Vonder Muhll, Stephen Pylypchuk, Anthony Magalski, Christopher DeZorzi, Frank Han, Amanda Sammons, Joseph Kay, elizabeth yeung, David Baker, David Celermajer, Luke Burchill, Craig Broberg
Journal: Circulation (2020)

Background: Occasionally patients with congenitally corrected transposition of the great arteries (ccTGA) exhibit little clinical evidence of cardiovascular limitation even to their 8th decade. We aimed to assess survival prospects in a large cohort of ccTGA adults. Methods &amp; Results: We included 555 ccTGA adults (median age 33.0 years, 48.3% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 8.1 [IQR 4.4 - 13.3] years, 56 (10.1%) patients died, 10 (1.8%) patients underwent MCS and 14 (2.5%) had a heart transplant. Median age at time of primary outcome was 51.1 [IQR 37.5 - 63.2] years and cumulative incidence at 15 years from baseline was 21.5% [95% CI 16.1 - 26.5]. Leading causes of death were worsening of heart failure (43%) and sudden death (10%). Patients who died were more likely to use heart failure (HF) medications. In multivariable Cox analyses for baseline variables, age, prior atrial arrhythmia and HF admission were each associated with an increased risk of the primary outcome. Figure shows cumulative incidence according to history of atrial arrhythmia. During follow-up, 91 (16.4%) were admitted for HF, pacemaker implantation was performed in 68 (12.3%) patients, ICD in 82 (14.7%), and major cardiac surgery (mostly for systemic AV-valve) in 89 (15.8%) patients. Conclusion: In this large cohort of ccTGA adults, survival seemed to be primarily determined by heart failure-related complications. Prior atrial arrhythmia also seems to be a harbinger for adverse outcome. Few patients underwent advanced HF therapies. Figure: Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 14 years from first visit at an adult congenital heart disease clinic since 2002 stratified according to history of atrial arrhythmia. Shading represents upper and lower 95% confidence limits.