tbuckley/cabot-search huggingface dataset:
Abstract 14300: The Relationship Between the American Heart Association’s Life Simple 7, Ectopic Fat and Insulin Resistance Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Parag A Chevli, Morgana Mongraw-chaffin, Anurag Mehta, Muhammad Imtiaz Ahmad, Alka M Kanaya, Michael J Blaha, Ron Blankstein, Khurram Nasir, Sameera Talegawkar, Jiaqian Xu, Michael D Shapiro
Journal: Circulation (2020)

Introduction: The inverse association between ideal cardiovascular health (CVH) as measured by AHA’s Life simple 7, and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and surrogate markers of cardiometabolic disease, including ectopic fat depots, insulin resistance, and β-cell dysfunction is sparse. Methods: Among 906 South Asian participants (mean age 55 y, SD=9.4, 46% women) in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we assigned each LS7 component a score of 0, 1, and 2, and summed these scores to derive an overall CVH score. Visceral, subcutaneous, pericardial, and intermuscular fat and hepatic fat attenuation were measured using computed tomography. We used a homeostasis model assessment for insulin resistance (HOMA-IR) for insulin resistance and HOMA-β for β-cell function. We used multiple linear regression to model the associations between CVH score and natural log-transformed ectopic fat measures, HOMA-IR, and HOMA-β. Results: In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 53.9% (95% CI, 39.7 - 69.4) higher visceral fat area, 66.5% (50.5 - 84.2) higher pericardial fat volume, and 35.1% (23.0 - 48.4) higher subcutaneous fat area, but only 8% (3.1 - 13.0) higher intermuscular fat area and 15.9% (11.2 - 20.4) higher intrahepatic fat (all p&lt;0.001). Also, poor CVH was associated with 154% (117.5 - 198) higher HOMA-IR. Similarly, participants with intermediate CVH demonstrated significantly larger measures of ectopic fat and HOMA-IR. There was no significant association between CVH and HOMA-β. Conclusion: We found that poor and intermediate CVH, as defined by LS7 metrics, was associated with significantly higher measures of ectopic fat and insulin resistance among South Asians. Long-term follow-up of the MASALA cohort will examine the association of LS7 metrics with the incident CVD events.
Abstract 14239: Risk Factors for One-year Mortality and Allograft Loss in Pediatric Heart Transplant Patients Using Machine Learning: Analysis of the Pediatric Heart Transplant Society Database
Authors: Bethany L Wisotzkey, Alfred Asante-Korang, James K Kirklin, Ryan Cantor, Devin Koehl, Byron Jaeger, Phillip Thrush, Benjamin Mantell, Melanie D Everitt, Molly Brickler, Micheal A Kuhn
Journal: Circulation (2020)

Background: Pediatric heart transplant (TX) patients are at greatest risk of graft loss (GL) in the first year, which may increase due to accumulated risks in the pre-TX period. Machine learning (ML) may identify clinically relevant outcome characteristics without prior statistical assumptions. We assessed whether ML could improve risk assessment for one-year patient or graft survival in pediatric heart TX. Methods: Patients in the PHTS database from January 2010 to December 2016 and January 2017 to June 2019 were included in training (TRN) and testing (TST) sets, respectively. Primary outcome was time until death, GL, or censoring. Using TRN, we selected the 12 most important recipient predictors based on contributions to model fit by applying boosted decision trees. Proportional hazards, boosting, and oblique random survival forest models were developed using these predictors. Discrimination and calibration were compared at 1 year post-TX using TST. The contribution of each predictor to patient’s predicted log-hazard was estimated using SHapley Additive exPansion (SHAP) values. Results: TRN (N=2,686) included 1,368 (51%) patients with cardiomyopathy (CM), 1,247 (46%) with congenital heart disease (CHD), and 71 (2%) other. TST (N=1,101) included 509 (46%) with CM, 569 (52%) with CHD, and 23 (2.1%) other. Incidence of GL or death (95% CI) in TRN and TST was 8.13 (7.07, 9.25) and 9.04 (6.93, 11.3) events/100 person years. Among the three models fitted to TRN, boosting obtained the highest concordance index at 1-year post-TX in TST, 0.752 (95% CI 0.695-0.810), and exhibited no evidence of miscalibration. Primary diagnosis of non-CM was the strongest predictor according to the boosting model (mean SHAP 0.398), followed by cardiopulmonary bypass time (mean SHAP 0.308);( Figure 1 ). Conclusions: ML can identify salient predictor variables and develop generalizable risk prediction equations using data from pediatric TX patients and may improve patient selection.
Minimal residual disease quantification in ovarian tissue collected from patients in complete remission of acute leukemia
Authors: Florian Chevillon, Emmanuelle Clappier, Chloé Arfeuille, Jean-Michel Cayuela, Jean Hugues Dalle, Rathana Kim, Aurélie Caye-Eude, Céline Chalas, Chrystelle Abdo, Véronique Drouineaud, Régis Peffault de Latour, Marion Alcantara, Madalina Uzunov, Michael Degaud, Véronique Meignin, Hervé Dombret, Nicolas Boissel, Catherine Poirot, Nathalie Dhédin
Journal: Blood (2020)
Abstract 17140: Impact of Atrial Fibrillation on the Outcomes of Heart Failure With Preserved Ejection Fraction- A National Inpatient Sample Based Study
Authors: Tauseef Akhtar, Parth V Desai, Jayakumar Sreenivasan, Poonam Bhayan, Roshini Syed, Jishanth Mattumpuram, Sagar Ranka, Tarun Dalia, Juan Del Cid Fratti, Axi Patel, Smit Vasaiwala, Abhishek Deshmukh
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) adversely affect the outcomes in the patients of heart failure (HF) with reduced ejection fraction, however there are limited data exploring such an association in HF with preserved ejection fraction (HFpEF). Hypothesis: AF is associated with worse outcomes in HFpEF. Methods: We included all the patients with the primary diagnosis of HFpEF from the national inpatient sample (NIS) database (2012-2014) using ICD-9 codes. Exposure of interest was AF. Primary outcome was in-hospital mortality and secondary outcomes were rates of sudden cardiac arrest (SCA), syncope, cardiogenic shock, embolic stroke, acute myocardial infarction (AMI), acute kidney injury (AKI), passive hepatic congestion, ventricular fibrillation (V fib) and flutter, ventricular assist device (VAD), AICD, cardiac resynchronization therapy (CRT), intra-aortic balloon placement (IABP) placement and heart transplantation. Hospitalization cost was also studied. Results: Our study cohorts included 26,51,970 patients of HFpEF with AF and 37,44,101 patients of HFpEF without AF. AF cohort had more numbers of older patients and less female representation. In-hospital mortality was more in AF cohort. Similarly, the odds of SCA, cardiogenic shock, embolic stroke, passive hepatic congestion, Vfib and flutter, AICD and CRT placement were higher in AF cohort. The odds of syncope, AMI and AKI were lower in AF cohort as compared to non-AF cohort. While the odds of heart transplantation and VAD and IABP use remained comparable between the study cohorts, AF cohort incurred greater of cost of hospitalization. Conclusion: AF in HFpEF patients is associated with increased in-hospital mortality and cardiogenic shock and should be aggressively treated for improved outcomes.
Abstract 14555: Trends, and Impact of Atrial Fibrillation in Patients With Cardiac Amyloidosis
Authors: Temidayo Abe, Jalal K Ghali, Mtanis Khoury, Valery S Effoe, Kikelomo Olaosebikan, Dolphurs Hayes, Tolulope abe
Journal: Circulation (2020)

Introduction: The prevalence of atrial fibrillation (AF) in patients with cardiac amyloidosis (CA) can be as high as 40%, depending on the amyloid protein involved. There is a lack of data, however, concerning the temporal trends and prognostic implications of AF in these patients. Hypothesis: AF is associated with worse outcomes in patients with CA Methods: We identified 21,661 patients with the primary diagnosis of CA from the 2006 to 2014 National Inpatient Sample, of which 5,279 (25%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF from 2006 to 2014. We compared overall mortality, stroke, length of stay (LOS), and total cost in patients with those without AF. Results: The prevalence of AF increased from 1.3% in 2006 to 17.7% in 2014 (p&lt;0.0001). Patients with AF were older and had more comorbidities. After propensity matching, overall mortality (8.7% vs 7.5%; p= 0.027) and rates of stroke (21.0% vs 18.0%; p&lt;0.0001) were significantly higher in patients with CA and AF, compared to those with CA alone. There was no difference in median LOS (5 (3,9) vs 5(3,10); p= 0.065) and median total hospital cost ($36163 vs $34706; p= 0.114). The strongest predictors for overall mortality were hemodialysis, stroke, cardiac arrest, and congestive heart failure. Conclusions: Over a decade period, the prevalence of AF increased among CA patients and was associated with a higher risk of stroke and overall mortality.
Development of a Dynamic Diagnosis Grading System for Infertility Using Machine Learning
Authors: ShuJie Liao, Wei Pan, Wan-qiang Dai, Lei Jin, Ge Huang, Renjie Wang, Cheng Hu, Wulin Pan, Haiting Tu
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Many indicators need to be considered when judging the condition of patients with infertility, which makes diagnosis and treatment complicated. <h3>Objective</h3> To construct a dynamic scoring system for infertility to assist clinicians in efficiently and accurately assessing the condition of patients with infertility. <h3>Design, Setting, and Participants</h3> This prognostic study reviewed 95 868 medical records of couples with infertility in which women had undergone in vitro fertilization and embryo transfer at the Reproductive Center of Tongji Medical College, Huazhong University of Science and Technology, in Wuhan, Hubei, China, from January 2006 to May 2019. A dynamic diagnosis and grading system for infertility was constructed. The analysis was conducted between May 20, 2019, and April 15, 2020. <h3>Main Outcomes and Measures</h3> Patients were divided into pregnant and nonpregnant groups according to eventual pregnancy results. The evaluation index system was constructed based on the test results of the significant difference between the 2 groups of indicators and the clinician's experience. Random forest machine learning was used to determine the weight of the index, and the entropy-based feature discretization algorithm classified the abnormality of the index and the patient's condition. A 10-fold cross-validation method was used to test the validity of the system. <h3>Results</h3> A total of 60 648 couples with infertility were enrolled, in which 15 021 women became pregnant, with a mean (SD) age of 30.30 (4.02) years. A total of 45 627 couples were in the nonpregnant group, with a mean (SD) age among women of 32.17 (5.58) years. Seven indicators were selected to build the dynamic grading system for patients with infertility: age, body mass index, follicle-stimulating hormone level, antral follicle count, anti-Mullerian hormone level, number of oocytes, and endometrial thickness. The importance weight of each indicator obtained by the random forest algorithm was 0.1748 for age, 0.0785 for body mass index, 0.0581 for follicle-stimulating hormone level, 0.1214 for antral follicle count, 0.1616 for anti-Mullerian hormone level, 0.2307 for number of oocytes, and 0.1749 for endometrial thickness. The grading system divided the condition of the patient with infertility into 5 grades from A to E. The worst E grade represented a 0.90% pregnancy rate, and the pregnancy rate in the A grade was 53.82%. The cross-validation results showed that the stability of the system was 95.94% (95% CI, 95.14%-96.74%). <h3>Conclusions and Relevance</h3> This machine learning–derived algorithm may assist clinicians in making an efficient and accurate initial judgment on the condition of patients with infertility.
Abstract 20267: The Relation of Right Ventricular Strain Component to the Right Ventricular Ejection Fraction and to the Pulmonary Arterial Pressure
Authors: Qizhi Chen, Harjot Singh, Jie J Cao
Journal: Circulation (2017)

Objective: Right ventricular (RV) function assessment is important in risk stratification for heart failure management. Despite the recognition of strain evaluation for the left heart the strain va...
Abstract 14906: Predictors and Outcome Impact of Mitral Regurgitation in Transcatheter Aortic Valve Replacement
Authors: Giorgio A Medranda, Kunal Brahmbhatt, Khaled Salhab, Richard K Schwartz, Stephen Green
Journal: Circulation (2020)

Background: Mitral regurgitation (MR) frequently accompanies aortic stenosis (AS). Several studies have reported that certain patients see improvement in their MR following transcatheter aortic valve replacement (TAVR) alone using earlier generation valves. The purpose of this study was to determine the predictors and short-term outcome impact of MR in patients undergoing TAVR using all generation valves across all risk groups. Methods: In this retrospective, study from 2012-2019, we reviewed data on 1,626 low, intermediate and high-risk patients who underwent TAVR. Included were patients with baseline MR who underwent transfemoral TAVR. We excluded prior valve replacement and aborted TAVR. Our primary outcome was persistence or worsening of baseline MR post-TAVR. Additional endpoints included an inpatient composite (intensive care unit length of stay &gt;24 hours, post-TAVR length of stay &gt;2 days and inpatient death), 30-day composite (30-day death or 30-day readmission) and 1-year composite (1-year death or readmission). Results: Of the 1,626 patients screened, 552 had significant baseline MR (&gt;moderate), which improved in 79.7% of patients. Female patients, those with higher right ventricular systolic pressures and those who underwent TAVR using earlier generation valves were more likely to have persistence or worsening of significant baseline MR. Patients whose significant baseline MR (&gt;moderate) persisted or worsened, had higher rates (92.2 vs. 84.1%, p=0.0343) of our inpatient composite and higher rates (36.6% vs. 25.5%, p=0.0243) of our 1-year composite when compared to patients whose significant baseline MR (&gt;moderate) improved post-TAVR. Conclusions: Our study identifies certain clinical characteristics, which could help identify the subset of patients who may require closer post-procedural follow-up and warrant possible staged mitral valve intervention post-TAVR across all risk groups.
Abstract 143: The Modified Shock Index Separates Survivors from Non-Survivors in a Swine Model of Hemorrhagic Shock and Traumatic Brain Injury
Authors: Jenna Mendelson, Matt Maggio, Salvatore Aiello, Jeejabai Radhakrishnan, Alvin Baetiong, Raul J Gazmuri
Journal: Circulation (2020)

The ratio between heart rate and arterial blood pressure during hemorrhagic shock has been shown useful to identify individuals at risk of death. We herein compared the index using the systolic arterial pressure (SI) and using the mean arterial pressure (MSI) along with other measurements including cardiac index and lactate in a swine model of hemorrhagic shock and traumatic brain injury developed to model injury in the battlefield. The parent study was designed to compare three different types of vasopressin agonists with control solution while practicing fluid-restricted resuscitation. The present analysis included 60 experiments focused on the initial 240 minutes with induction of hemorrhagic shock by liver laceration removing approximately 1,000 ml of blood in 30 minutes. Eight animals died during the acute phase and compare to 52 survivors, they had higher (median, IQR) MSI (4.6; 3.3 - 5.4 vs 2.5; 2.0 - 3.1; p &lt; 0.001), SI (2.7; 2.1 - 3.1 vs 1.8; 1.6 - 2.2; p &lt; 0.001), lower cardiac index (2.8; 2.3 - 3.4 vs 3.7; 3.2 - 4.2; p &lt; 0.001), but no differences in lactate levels. Three of the eight non-survivors (37.5%) and 42 of the 52 survivors (80.1%) received a vasopressin analog (p = 0.019). Compared to other measurements of hemodynamic stability, monitoring the ratio between the heart rate and mean arterial pressure is a feasible and practical approach to deploy in various out of hospital settings including the battlefield as well as in civilian trauma. This approach could also guide interventions including the use of vasopressor agents, which our studies demonstrate having a survival effect during acute bleeding caused by hemorrhagic shock.
Abstract 13889: The Influence of Depression on Dementia Risk in Patients With Atrial Fibrillation
Authors: T Jared Bunch, Tami L Bair, Stacey Knight, Benjamin A Steinberg, Jeffrey L Anderson, Joseph B Muhlestein, Kirk U Knowlton, Benjamin Horne, Heidi T May
Journal: Circulation (2020)

Background: Atrial Fibrillation (AF) is a significant risk factor for multiple forms of dementia. Although late-life depression may be a manifestation of dementia, earlier-life depression is a risk factor for dementia. The influence of earlier-life depression in patients with AF as a risk factor for dementia is unknown. Methods: AF patients (January 1, 1990-August 8, 2016) with no history of dementia and at least 3 years of follow-up derived from the Intermountain Healthcare Registry were included. Patients were compared by the presence or absence of depression at baseline. The primary endpoints were the development of dementia (total)imer’s disease. Results: Among 132,703 AF patients, 19,757 (14.9%) had a history of depression. Of these, 10,044 (50.8%) had SSRI use prior to AF diagnosis. The mean time from depression diagnosis to AF diagnosis was 5.0±4.8 years. AF patients with a history of depression were younger, more often female, and had higher rates of hypertension, diabetes, and heart failure. Patients with depression had a significantly higher multivariable-adjusted risk of dementia at 3 years (HR: 1.74 (1.59, 1.90), p&lt;0.0001) and 5 years (HR: 1.73 (1.61, 1.86), p&lt;0.0001), independent of the length of time between depression and AF diagnosis. Landmark analysis showed patients with depression and AF have much higher rates of dementia after 3 years (HR 1.51 (1.40, 1.63), p&lt;0.0001) and after 5 years (HR 1.47 (1.34, 1.61), p&lt;0.0001), Figure. These relative risks with depression are greater than composite risks of AF and dementia alone (HR 1.36) derived from multiple population-based studies. Conclusions: Patients with a history of depression prior to AF diagnosis have much higher rates of dementia after the onset of the arrhythmia. The presence of earlier-life depression should be recognized as an important risk factor for dementia in AF patients and may represent a therapeutic target to lower risk of cognitive decline.
Kinetics and seroprevalence of SARS-CoV-2 antibodies in children
Authors: Cathal Roarty, Claire Tonry, Lisa McFetridge, Hannah Mitchell, Chris Watson, Thomas Waterfield, Elizabeth Waxman, Derek Fairley, Gala Roew-Setz, James McKenna, Peter Mallet, Ryan Christy, Katherine Christie, Emma McManus, Christian Bennison, Kate Mullan, Aleksandra Metryka, Rebecca Moore, Kathryn Ferris, Alison Watt, Claire McGinn, Steven Foster, Jennifer Evans, Mark D Lyttle, Shazad Ahmad, Shamez Ladhani, Michael Corr, Julie-Ann Maney, Sharon Christie
Journal: The Lancet Infectious Diseases (2020)
Treatment of gestational diabetes
Authors: S. J. Meltzer
Journal: BMJ (2010)

The question is not whether to treat, but how and who?

Gestational diabetes mellitus is the most common medical condition complicating pregnancy, and in the face of the rising prevalence of diabetes, particularly in women of child bearing age, the problem is growing.1 2 In the linked systematic review and meta-analysis (doi:10.1136/bmj.c1395), Horvath and colleagues evaluate the effectiveness of screening, diagnosis, and treatment of gestational diabetes.3 The review concludes that treatment significantly reduces specified “combined” end points (any of perinatal death, shoulder dystocia, bone fracture, or nerve palsy) and birth trauma (fetal and maternal); in addition, one randomised controlled trial suggests a reduction in pre-eclampsia. Importantly, the outcome that responded most to treatment was the risk of large for gestational age infants (odds ratio 0.48, 95% confidence interval 0.38 to 0.62), an effect that is consistent with a previous systematic review (0.27, 0.09 to 0.76).4 

The lack of randomised trials from areas where people are most affected by diabetes, such as South East Asia and China (studies were mainly in white women), means that the results have limited applicability to other populations. The included trials also span decades, and during this time medical and obstetric care has changed dramatically.5 6

Owing to the heterogeneity of diagnostic methods for gestational diabetes, which …
Abstract 13507: The Role of Weight Loss in Mediating the Effects of a 2-year Caloric Restriction Regimen on Cardiometabolic Risk Markers in Individuals Without Obesity
Authors: James L Dorling, Leanne Redman, Eric Ravussin, Kim Huffman, Susan B RACETTE, Sai Krupa Das, William E Kraus, Christoph Höchsmann, Corby K Martin
Journal: Circulation (2020)

Introduction: Caloric restriction (CR) improves cardiometabolic risk, even among individuals without obesity. However, it is unclear whether these aging-related benefits are mediated by weight loss. Mediation analyses inform mechanisms underlying relationships between an exposure and outcome. Using mediation analyses, our aim was to test if 2-year weight loss mediates the beneficial effects of CR on cardiometabolic risk markers in individuals without obesity. Methods: Participants without obesity were randomized 2:1 to CR or ad libitum (AL) as part of the 2-year trial, Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE). The CR group aimed to enact 25% CR for 2 years, while AL maintained habitual energy intake. Baseline and year 2 assessments included weight and cardiometabolic risk markers. Using the approaches of Valeri and VanderWeele, mediation was quantified as the natural indirect effect (NIE), defined as the impact of an exposure on an outcome through a mediator. Here, the NIE was the effect of CR (exposure) on cardiometabolic risk markers (outcome) that was accounted for by weight change (mediator). Results: In total, 117 and 71 participants in the CR and AL groups, respectively, completed the trial. The CR group achieved 11.9 (± 0.7)% CR and 7.6 (± 0.3) kg of weight loss ( P &lt; 0.01 versus AL). Weight loss significantly mediated the CR-induced improvements in total cholesterol (NIE = -10.4 ± 3.5 mg/dL), low-density lipoprotein cholesterol (NIE = -8.5 ± 2.8 mg/dL), high-density lipoprotein cholesterol (NIE = 2.9 ± 1.3 mg/dL), triglycerides (NIE = -0.20 ± 0.05 log mg/dL), the homeostatic model assessment of insulin resistance (NIE = -0.22 ± 0.06), and C-reactive protein (NIE = -0.39 ± 0.15 log ug/mL) ( P ≤ 0.02). Weight loss did not mediate CR-induced reductions in systolic (NIE = -0.9 ± 1.4 mmHg) and diastolic (NIE = -1.0 ± 1.1 mmHg) blood pressure ( P ≥ 0.37). Conclusion: In individuals without obesity, CR-induced improvements in multiple cardiometabolic risk markers are driven by weight loss after 2 years. These findings emphasize that, even in individuals without obesity, weight loss after prolonged CR plays a role in improving cardiometabolic disease risk; however, some CR benefits still occur independent of weight loss.