tbuckley/cabot-search huggingface dataset:
Abstract 12849: Invasive Assessment of Hemodynamic Effect of Ivabradine in Post ST Segment Elevation Myocardial Infarction Associated Sinus Tachycardia
Authors: Akhil Kumar Sharma, Sudhanshu K Dwivedi, amit K singh, Gaurav K Chaudhary, Sharad Chandra, Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Monika Bhandari, Ayush Shukla, Abhishek Singh
Journal: Circulation (2021)

Introduction: Post MI tachycardia is associated with increase in cardiac morbidity and mortality. We aimed to assess efficacy and safety of ivabradine to control heart rate in post MI tachycardia patients in whom beta-blockers were intolerant. Hypothesis: We hypothesized that ivabradine in post MI tachycardia patients effectively control heart rate without deteriorating effects on hemodynamics. Methods: STEMI patients with sinus tachycardia (heart rate &gt;120/min) who had intolerance to beta blocker were enrolled. Important exclusions were cardiogenic shock, second /third-degree atrioventricular block, Killip class III/ IV. Patient’s invasive hemodynamic parameters such as MAP (Mean Arterial Pressure), iSV (indexed Stroke Volume), CVP (Central Venous Pressure), cardiac output and cardiac index were measured with help of Edwards LifeSciences Flotrac monitor. Patients received ivabradine till heart rate control (&lt;100/min.) was achieved. The primary objectives were to study ivabradine efficacy to achieve target heart rate, and its effects on hemodynamic parameters and secondary objectives were to assess any adverse events. Results: Mean age was 52.7 ± 9.8 years and 29 (81%) were male. At enrolment, mean heart rate, MAP, iSV and CVP was 128.92±3.3bpm, 87.31±10.46mmHg, 28.19±7.85ml/m 2 , 6.35±2.61 mmHg respectively. At target heart rate ≤1oo/min (mean 96.57±5.29bpm), MAP, iSV and CVP were 82.71±13.70 mmHg (P=0.559), 1.11±6.33ml/m 2 (P=0.087) and 7.7±2.54 mmHg (P=0.122) showed no significant changes. However, cardiac output and cardiac index dropped to 5.22± 1.00 L/min (P=0.005) and 2.96±0.60 L/min/m 2 (P=0.005) but within physiological limits. None of the patient reported hypotension, arrhythmia, heart failure or in-hospital mortality. Conclusions: Invasive hemodynamic evaluation showed oral ivabradine is effective and safe alternative to control heart rate in uncomplicated post MI sinus tachycardia patients who had intolerance to beta-blockers.
Abstract 13403: Data Nuggets for Matching Large Clinical Datasets: Application in a 350,000 Record Perinatal Database
Authors: Volha Tryputsen, Cande V Ananth, Davit Sargsyan, John B Kostis, William J Kostis, Javier Cabrera
Journal: Circulation (2021)

Introduction: Research based on observational designs often include examination of outcome assessments across sub-populations. The sub-populations can be small, thereby potentially losing representativeness of the target population. The exact, approximate, and propensity score matching are popular methods to address this issue but become inefficient for large data sets. Hypothesis: Data Nuggets will produce matching results that are similar to conventional methods while performing the matching orders of magnitude faster. Methods: Data Nuggets is a novel data reduction technique that preserves the structure of the data by creating a collection of representative data points and contains the information about the centers, scale and weight for each group represented by a nugget. Observational data and simulations were used to show that matching data nuggets instead of individual patients is more efficient due to using data that is orders of magnitude smaller than the original and corrects for bias. We tested a Data Nuggets matching algorithm in a perinatal database with over 350,000 records with varying number of nuggets (between 100 and 800) against a conventional matching and full model fitting. We fit models to examine the association of preeclampsia on gestational duration, after adjusting or matching on age, race and body mass-index, and infant sex. All variables were scaled before fitting the models. Results: Models with a few hundred data nuggets produced results similar to those using conventional matching. Estimates of coefficients predicting gestational age via pre-eclampsia ranged from -0.73 weeks (100 nuggets) to -0.71 weeks (1,200 nuggets) compared to -0.72 (SE = 0.01) in the approximate matching and -0.80 (SE = 0.01) in the full (unmatched) data model (figure). Conclusions: Data Nuggets matching achieved results similar to those produced by the conventional matching method and is preferable for large data sets because of speed and efficiency.
Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans
Authors: Barbra A. Dickerman, Hanna Gerlovin, Arin L. Madenci, Katherine E. Kurgansky, Brian R. Ferolito, Michael J. Figueroa Muñiz, David R. Gagnon, J. Michael Gaziano, Kelly Cho, Juan P. Casas, Miguel A. Hernán
Journal: New England Journal of Medicine (2021)

The messenger RNA (mRNA)-based vaccines BNT162b2 and mRNA-1273 are more than 90% effective against coronavirus disease 2019 (Covid-19). However, their comparative effectiveness for a range of outcomes across diverse populations is unknown.
Abstract 13894: Expenditures and Health Resource Utilization by Body Mass Index Among Those With and Without Atherosclerotic Cardiovascular Disease
Authors: Javier Valero Elizondo, Mohamad Taha, Gowtham Grandhi, Shiwani Mahajan, Kershaw Patel, Jamal S Rana, Miguel Cainzos Achirica, Khurram Nasir
Journal: Circulation (2021)

Introduction: Obesity represents a major health and economic burden worldwide and is a key target for cardiovascular disease prevention. With emerging therapeutic options to manage obesity, we aimed to quantify the overall expenditures and resource utilization in adults with and without atherosclerotic cardiovascular disease (ASCVD) across obesity categories. Methods: We used the 2018 Medical Expenditure Panel Survey (MEPS), a nationally representative US survey. BMI (calculated from self-reported height and weight) was divided into 4 groups: overweight (BMI 25 to 30), mild (BMI 30 to 35), moderate (BMI 35 to 40), and morbid obesity (BMI ≥40). Cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, insufficient physical activity) and ASCVD were ascertained by ICD10 codes and/or self-report. Two-part econometric models were used to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures. Results: Among the 19,569 sampled MEPS adults (mean age 48 years [SD 14]), 6.2% had morbid obesity (~ 14 million). Among those without ASCVD, morbid obesity was associated with higher odds for prescription medication utilization, ED and outpatient visits when compared to those with overweight (Figure). Even though individuals with ASCVD reported higher prevalence of all metrics of resource utilization, we found no statistically significant differences between BMI categories in this group. The marginal overall per capita expenditure when comparing those with morbid obesity vs overweight was $2,165 (p=0.11) in those with ASCVD, and $1,605 (p=0.03) in those without ASCVD. Conclusions: Morbid obesity was associated with increased healthcare expenditures and resource utilization, especially in those without ASCVD. Our study findings could aid in policy discussions to discern appropriate candidates for emerging novel anti-obesity therapeutics, as well as apt resource allocation.
Abstract 9842: An Implemented Medical Mockup Modelling for Personalised Medicine and Surgery
Authors: Riccardo Roggeri, Cristian Garzena, Paolo Silvestri, Amir Parsafar, Filippo Scalise, Antonio Vilasi, Luna Gargani, Gennaro D'Angelo, Claudia Torino
Journal: Circulation (2021)

Introduction: Virtual three-dimensional (3D) anatomical models can improve diagnostic and surgical medical procedures with a patient-specific approach. The advantage of these models, in opposition to CT scans or MRIs alone, is their unique ability to demonstrate anatomical spatial relationship with submillimetre accuracy. Methods: Starting from our platform Med3D VR Lab, we implemented, in the MMM project, a basic algorithm within a software, able to capture, from DICOM images (MRIs/CT scans), the cloud of points needed to build 3D images. Different areas of a tissue might have different radio-density levels. In these cases, we applied our patented algorithm to harmonize these values through a transformation matrix. Results: We created a VR Laboratory (via a supervised learned approach) to access the resulting 3D image. The user, by wearing a VR headset, can rotate and enlarge the heart’s model. By cutting the model with the scalpel tool, the user is able to see the interior of the 3D model. The sections of the heart are created according to the direction of the cut. Each section can be further cut into smaller sub-sections, and both sections and sub-sections can be saved for future use. Conclusions: We developed a software for the conversion of 2D cardiac images in 3D models, which can be further examined and sectioned in a VR environment. This technique could help cardiologists in refining diagnosis and surgeons in tailoring cardiac interventions on the basis of patients’ characteristics, thus reducing operating times and costs while also preventing possible complications in cardiac surgery- therefore allowing to precisely assess risks in advance. Moreover, our software, through the VR visor, allows patients to truly understand their clinical conditions, thus overcoming the drawbacks of expressing an informed consent based only on DICOM imaging: the patients themselves will be able to understand the risks and benefits of a given surgical operations or its alternatives.
TAMI-42. THE ROLE OF HFE AND IRON IN CELL ADHESION AND MIGRATION IN GLIOBLASTOMA
Authors: Ganesh Shenoy, Katie M Troike, Madison Kuhn, Becky Slagle Webb, Amanda Snyder, Chachrit Khunsriraksakul, Justin Lathia, Hong-Gang Wang, Elizabeth Proctor, James Connor
Journal: Neuro-Oncology (2021)

Abstract Glioblastoma (GBM) remains one of the most difficult to treat malignancies facing modern medicine. The strong migratory and invasive capacity of GBM cells allows for diffuse invasion into neighboring healthy brain which presents a significant hurdle for complete surgical resection of these tumors. Unsurprisingly, even after receiving maximal surgical resection, radiation and chemotherapy, the majority of GBM patients end up with recurrent disease. Increased expression levels of the homeostatic iron regulator gene (HFE) in brain tumors such as GBM have been associated with poorer outcomes. In order to better understand how HFE expression impacts the adhesive and migratory capacity of GBM, we utilized syngeneic mouse glioma models (KR158, CT2A) that have been transfected to either over-express or under-express HFE. We observed that knocking down HFE in the KR158 model resulted in significantly decreased migratory capacity as well as decreased adhesion to fibronectin and artificial basement membrane. Likewise, overexpressing HFE in a CT2A model resulted in increased adhesion to fibronectin or artificial basement membrane. Since HFE is known to regulate iron uptake, we studied how modulating the iron status of GBM cells impacted their ability to migrate and adhere. We found that increasing the iron pool of these mouse glioma models by exposure to exogenous iron compounds decreased migratory capacity. To better understand mechanistically how HFE and iron status impacted migration and adhesion, we probed how expression of integrins and their downstream signaling molecules, the Rho GTPases were altered in response to iron. We found that exposure to iron decreased levels of the Rho GTPases Cdc42 and RhoA. Furthermore, cells that overexpressed HFE were found to have increased expression of integrin β1 and integrin α5 suggesting that HFE and iron may impact integrins and their downstream signaling pathways to alter migration of GBM cells.
Abstract 9821: Fully Automated Measurements of Right Ventricular Strain in Children: Validation Using Conventional Manual Technique
Authors: Daisuke Matsubara, Hunter L Kauffman, Michael J Convery, Karren Miller, Michael D Quartermain, Anirban Banerjee
Journal: Circulation (2021)

Introduction: Fully automated strain measurements have been developed for the left ventricle. However, they have not been studied in the right ventricle (RV) of adults or children. Hypothesis: Automated strain measurements of RV will be comparable with manual strain measurements. Methods: We prospectively enrolled 94 patients, who underwent clinically indicated echocardiograms (mean age: 13.0±4.4 years). Strain measurements included RV free wall longitudinal strain (RVFWLS) and RV “global” longitudinal strain (RVGLS), both measured from the RV-focused apical 4-chamber view. Strain parameters were measured using three methods: 1) Fully automated (AutoStrain, Phillips Medical Systems), 2) Semiautomated (manual correction after automated measurements), 3) Manual measurements (2D-CPA, Tomtec). We also recorded the time required for measurements in all patients. Automated measurements relied on an anatomical intelligence program that was trained by adult datasets. Results: Fully automated measurements were feasible in all cases. However, 40% of patients required manual correction after automated measurements, mostly at the apex and RV lateral annulus at endsystole. The results are depicted in Table 1. Fully automated RVFWS showed moderate to good correlation with manual measurements (r=0.71, p&lt;0.001). Semiautomated measurements showed a stronger correlation (r=0.78, p&lt;0.001) and less bias than fully automated measurements ( Figure 1 ). The time needed for fully and semi-automated analyses were 9±2.6 and 68±25 seconds, respectively (p&lt;0.001). Conclusions: Automated strain may provide rapid and clinically feasible means to assess RV function in children. Presently, a significant number of patients need manual correction, especially at endsystole. We speculate that accuracy of AutoStrain may improve in the future with inclusion of pediatric training datasets, as the anatomical intelligence program currently relies on adult datasets.
Abstract 9787: Guideline Implementation Trends Following Diabetes and CVD Hospital Award Program
Authors: Melody A Halio, Heather Harpster, Susan Maynard, Renee M Sednew, Ray Niu, Katherine Overton, Liz Olson, Kathie Thomas, Michelle C Scharnott
Journal: Circulation (2021)

Background: While it is accepted that recognition drives performance improvement over time, less is known about implementation attitudes and behaviors following introduction of a new guideline recognition program. This analysis aims to understand guideline implementation trends within hospitals treating diabetes in patients with stroke and/or heart failure after launch of a diabetes recognition program. Methods: Hospitals participating in American Heart Association’s (AHA) Get With The Guidelines (GWTG)-Stroke and/or GWTG-Heart Failure modules are asked to document adherence to guidelines for diabetes care. A 26-question survey regarding implementation attitudes and behaviors related to guideline adherence for diabetes care of patients with stroke and/or heart failure was sent to a stratified random selection of 678 hospitals participating in GWTG-Stroke and 328 hospitals in GWTG-Heart Failure. A total of 311 surveys were collected. Results: Perceived value of the diabetes recognition award was higher in award-winning (34-44%) compared with non award-winning hospitals (21-24%). Both award winning and non-award winning hospitals reported "limited time due to COVID-19" as a top data entry barrier, and "reason for not prescribing an antihyperglycemic medication with proven CVD benefit" as most difficult to locate. Award-winning hospitals reported higher rates of referral for a diabetes consult as standard practice. Conclusion: This diabetes award recognition program demonstrated higher value in award-winning hospitals, with higher rates of standard practice referrals after a new diabetes diagnosis. Further barriers to achievement of standards were identified, highlighting the need for continued support of hospitals following introduction of recognition programs. Future findings may inform strategies for successful implementation of similar programs, ultimately leading to improved care of those with diabetes and CVD.
INNV-20. RADIOGRAPHIC RESPONSE AND SEIZURE CONTROL IN IDH1 MUTANT GLIOMA PATIENTS USING IVOSIDENIB
Authors: Katherine Peters, Mallika Patel, Candice Alford, Gerardo Chavez, Jung-Young Kim, Jennifer Durling, Tracy Novack, Kristen Batich, Madison Shoaf, Emily Hanzlik, Mary Affronti, Margaret Johnson, Daniel Landi, Mustafa Khasraw, Annick Desjardins, Henry Friedman, David M Ashley
Journal: Neuro-Oncology (2021)

Abstract Isocitrate dehydrogenase 1 (IDH1) is commonly mutated in grade II-III gliomas, and the mutant enzyme leads to the production of the oncometabolite 2-hydroxyglutarate (2-HG). 2-HG is responsible for the gliomagenesis associated with these tumors and the promotion of seizures via glutamate receptors. Ivosidenib, a small molecule oral mIDH1 inhibitor, has shown promise in clinical trials to treat IDH1 mutant gliomas, and providers can utilize this agent in IDH1 mutant glioma patients. We evaluated our IDH1 mutant glioma patients treated off-label with ivosidenib and described the radiographic response and seizure control in this cohort when ivosidenib was initiated between October 2020 to February 2021. Radiographic response was determined using RANO criteria, and seizure control was determined by comparing seizures per month before and after initiation of ivosidenib. All patients represented received single-agent ivosidenib dosed at 500 mg orally once a day. One patient required a dose reduction to 250 mg orally once a day because of drug-induced diarrhea. In our cohort of six patients, patient age range was 31 to 74 years with four female patients and two male patients. Diagnoses represented were astrocytoma, IDH1 mutant (n=3) oligodendroglioma (WHO), IDH1 mutant, 1p19q co-deleted (n=2), and anaplastic astrocytoma IDH1 mutant (n=1). Three patients experienced a reduction of seizure frequency, two patients did not have seizures before or after therapy, and one patient remained with the same level of seizures (1 seizure/month). Radiographic responses recorded included three patients with stable disease, two patients with minor responses, and one patient with a partial response. Treatment with ivosidenib is ongoing for this cohort of mIDH1 glioma patients. Updated information on prolonged disease control and seizure control in this cohort of IDH1 mutant glioma patients will be presented. Therapeutics, such as ivosidenib, can lead to improved seizure control and radiographic outcomes in IDH1 mutant glioma patients.
Abstract 11367: Chronic Kidney Disease and 6-12 Month Outcomes After Transcatheter Aortic Valve Replacement
Authors: Aamir Twing, Helena Dickens, Gabriel Marrero-Rivera, Sanket Gokhale, Dhairya Jarsania, Brody D Slostad, Mayank M Kansal, Elliott Groves, Adhir R Shroff
Journal: Circulation (2021)

Introduction: Chronic kidney disease (CKD) is known to accelerate the progression of aortic stenosis (AS) and portends adverse outcomes in patients treated with surgical valve replacement. Long-term outcomes in CKD patients after transcatheter aortic valve replacement (TAVR) have been less studied. The purpose of this study is to examine outcomes after TAVR in CKD patients as stratified by glomerular filtration rate (GFR). Hypothesis: CKD is associated with poorer outcomes after TAVR. Methods: Retrospective electronic medical record review from March 2018-June 2020 at the University of Illinois, Chicago and Jesse Brown Veteran’s Administration Medical Center (Chicago, Illinois) identified TAVR patients, who were included if they followed-up within 6 and 12 months of procedure. Patients were stratified into 4 classes by baseline GFR (mL/min): &gt;90, 60-89, 30-59, &lt;30 with the latter 3 groups comprising CKD patients. Outcomes were expressed as event rates and included 6 and 12-month MACE (all-cause mortality, MI, or CVA) and 30-day rehospitalization. Chi-square analysis was used to compare differences across GFR groups. Results: 118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 did so at 12-months. There were no statistically significant differences in baseline demographics or comorbidities between CKD and non-CKD patients. CKD patients were more likely to experience MACE compared to non-CKD patients at 6 (p=0.04) and 12-months (p=0.009, Fig. 1). CKD patients also had a higher rate of 30-day rehospitalization (p=0.003). Conclusion: Our results demonstrate that CKD portends adverse outcomes after TAVR with CKD patients experiencing an increased risk of 6 + 12-month MACE and 30-day re-hospitalization. Decreasing GFR correlated with higher rates of MACE at 6 and 12 months.
Abstract 9832: Automated Electrocardiographic Detection of Pulmonary Hypertension Using Deep Learning
Authors: Mandar A Aras, Sean Abreau, Hunter Mills, Lakshmi Radhakrishnan, Liviu Klein, Neha Mantri, Benjamin Rubin, Joshua Barrios, Christel Chehoud, Emily Kogan, Xavier Gitton, Anderson Nnewihe, Deborah Quinn, Charles Bridges, Atul J Butte, Jeffrey E Olgin, Geoffrey H Tison
Journal: Circulation (2021)

Introduction: Pulmonary hypertension (PH) is a progressive, life-threatening disease, often diagnosed late in its course. Treatments are available for some subtypes, including pulmonary arterial hypertension (PAH). Hypothesis: Deep learning applied to interpretation of electrocardiograms (ECGs) can detect PH and clinically important subtypes. Methods: Adults with either right heart catheterization (RHC) or an echocardiogram (echo) within 90 days before or after an ECG at the University of California, San Francisco from 2012 to 2019 were retrospectively identified and defined as PH (mean pulmonary artery pressure [mPAP] &gt;20 mmHg) or non-PH (mPAP ≤20 mmHg) by RHC or by echo, if RHC unavailable (peak tricuspid regurgitation velocity &gt;3.4 m/s or ≤2.8 m/s). A convolutional neural network (CNN) to detect PH was developed and tested using patients’ 12-lead ECG voltage data. Patients were divided into training, validation, and test sets in a ratio of 7:1:2. The ability of the CNN to detect pre-capillary PH (defined by RHC), PAH (defined as presence of any PAH-specific medication over the 3 months prior and 6 months following mPAP &gt;20 mmHg by RHC), and Group 3 PH (identified by Group 3-consistent International Classification of Disease codes in the 3 months before or after RHC) was also tested. CNN performance was assessed by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and positive and negative predictive values. Results: A total of 24,470 patients and ECGs were identified (5,016 PH and 19,454 non-PH). CNN performance is shown in the Table . When the algorithm was applied to ECGs from PH patients up to 2 years before RHC or echo diagnosis, AUC was ≥0.79 to detect PH. Conclusions: A deep learning ECG algorithm can detect PH and performs well to identify subtypes of PH. The CNN can also detect PH using ECGs up to 2 years before RHC or echo diagnosis. This approach has the potential to reduce delays in the diagnosis and management of PH.