tbuckley/cabot-search huggingface dataset:
Abstract 14412: Activation of Autophagic Flux Maintains Mitochondrial Homeostasis During Cardiac Ischemia/reperfusion Injury
Authors: Jing Yang, Geoffrey W CHO, Lihao He, Yuxin Chu, Jin He, Scott W Ballinger, Martin E Young, Sumanth D Prabhu, Thomas G Gillette, Joseph A Hill, Min Xie
Journal: Circulation (2020)

Background and Hypothesis: Reperfusion injury accounts for ~50% of myocardial infarct size, and clinically efficacious therapies are lacking. Histone deacetylase (HDAC) inhibition enhances cardiomyocyte autophagic activity, mitochondria biogenesis, and blunts ischemia/reperfusion (I/R) injury when given at the time of reperfusion. However, as HDAC inhibition has pleiotropic effects, we will test whether augmentation of autophagic flux using a specific autophagy-inducing peptide, Tat-Beclin (TB), is cardioprotective. Methods: 8-12-week-old, wild-type, C57BL6 mice were randomized into three groups: vehicle control, Tat-Scrambled (TS) peptide, or Tat-Beclin (TB) peptide. Each group was subjected to I/R surgery (45min ischemia, 24h reperfusion). Infarct size, systolic function, and mitochondrial dynamics were assayed. Cultured neonatal rat ventricular myocytes (NRVMs) were used to test for cardiomyocyte specificity. Conditional cardiomyocyte ATG7 knockout (ATG7 KO) mice and ATG7 knockdown by siRNA in NRVMs were used to evaluate the role of autophagy. Results: TB treatment at reperfusion reduced infarct size by 20.1±6.3% (n=23, p&lt;0.02) and improved systolic function. Increased autophagic flux and reduced reactive oxygen species (ROS) were observed in the infarct border zone. The cardioprotective effects of TB were abolished in ATG7 KO mice. TB increased mtDNA content in the border zone significantly. In NRVMs subjected to I/R, TB reduced cell death by 41±6% (n=12, p&lt;0.001), decreased ROS, and increased mtDNA content significantly by ~50%. Moreover, TB promoted expression of PGC1α (a major driver of mitochondrial biogenesis) both in the infarct border zone and NRVMs subjected to I/R by ~40%, and increased levels of mitochondrial dynamics gene transcripts Drp1, Fis1, and MFN1 / 2. Conversely, ATG7 knockdown in NRVMs and cardiac ATG7 KO abolished the beneficial effects of TB on mitochondria DNA content. Conclusions: Autophagic flux is an essential process to mitigate myocardial reperfusion injury acting, at least in part, by inducing PGC1α-mediated mitochondrial biogenesis. Augmentation of autophagic flux may emerge as a viable clinical therapy to reduce reperfusion injury in myocardial infarction.
Endoscopic removal of an over-the-scope clip using endoscopic submucosal dissection technique
Authors: Hirohisa Sakurai, Satoki Shichijo, Yoji Takeuchi, Kotaro Waki, Takashi Kanesaka, Noriya Uedo, Tomoki Michida
Journal: Endoscopy (2020)

Over-the-scope (OTS) clips are widely used for endoscopic closure of perforations and fistulae [1]. OTS clip-associated complications include perforation, bleeding, infection, ulceration, and luminal stenosis and obstruction. Most OTS clips fall off within several weeks, but some persist and cause problems. Bipolar cutting devices and Nd: YAG-lasers have been reported to be useful in the removal of OTS clips [2] [3] [4]. However, in Japan, these devices are not commercially available. Inject-and-resect techniques for OTS clip removal on normal mucosa have also been reported [5]. Here, we report the first case of OTS clip removal on the scar via endoscopic submucosal dissection (ESD) without injection ([Video 1]).
Abstract 16795: Fate of Dislodged Micra Transcatheter Pacing System in Coronary Sinus
Authors: Sangeeta Prabhakar Bhat, Vijay Pratap Singh, Wilson Young
Journal: Circulation (2020)

Background: Micra Transcatheter Pacing System is a leadless pacemaker for treatment of symptomatic high-grade atrioventricular block and persistent atrial fibrillation. We present a case report of dislodgement of a Micra device into the coronary sinus. Case presentation: An 87 year old man with permanent atrial fibrillation presented to the hospital with dizziness and fall. His medications included Lasix and Metoprolol. Electrocardiogram revealed atrial fibrillation with slow ventricular response. Metoprolol was held. During the hospital stay, telemetry monitoring revealed heart rates of 30-40 bpm. Micra device implantation was indicated for symptomatic bradycardia. After deployment, the Micra dislodged into the right atrium. Efforts to retrieve the device led to its embolism into mid-coronary sinus and dissection of the coronary sinus. Given comorbidities, the Micra was deactivated and a single chamber pacemaker was implanted with serial radiographic monitoring of Micra. Post procedure Chest X-ray (Fig. 1) and Computed Tomography Angiography of the chest (Fig. 2) confirmed location of Micra in the coronary sinus. Discussion: This is the first described case of dislodged Micra device in the coronary sinus. Device retrieval attempts resulted in dissection of the coronary sinus and there was no myocardial capture when pacing from the device. Serial CXR showed stable Micra position over the next two years. Conclusion: Embolization and dislodgement of Micra leadless pacemaker into the coronary sinus is possible and chronic management with serial imaging after abandoning the device is feasible.
The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial
Authors: Martin Svensson, Thomas Nilsson, Sean Perrin, Håkan Johansson, Gardar Viborg, Fredrik Falkenström, Rolf Sandell
Journal: Psychotherapy and Psychosomatics (2020)

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, –0.64; 95% confidence interval, CI, –1.02 to –0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27–0.98). There was no allocation by treatment type interaction (SMD –0.57; 95% CI –1.31 to 0.17). &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.
Abstract 17260: In Hospital Outcomes and Prevalence of Comorbidities in Patients With ST Elevation Myocardial Infarction With and Without Infective Endocarditis - Insight From National Inpatient Sample (2013-2014)
Authors: Shakeel Jamal, farah Wani, Amina Khan, Asim Kichloo, Beth Bailey, Mahin Khan, Ronak G Soni, Phoo Pwint Nandar, Muhammad Talha Ayub, Tauseef Akhtar, MUHAMMAD AJMAL, Jagmeet P SINGH, Hafeez Hassan, Rajeev Sudhakar, Bashar Al Jayyousi
Journal: Circulation (2020)

Introduction: In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Hypothesis: Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE. Methods: Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes Results: During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE. Conclusions: We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.
Abstract 15408: Risk Factors Associated With In-hospital Mortality for Cardiac Device Extraction
Authors: James B Hammock, Chad Colon, James Barrios, Blake Smith, Vedran Oruc, Hugh T McElderry, William Maddox
Journal: Circulation (2020)

Introduction: Cardiac device extraction procedures are associated with increased risk of in-hospital mortality. The objective of this study was to determine risk factors for in-hospital mortality of patients undergoing cardiac device extraction. Methods: We studied patients undergoing cardiac device removal between January 2016 and December 2019 at a single tertiary care center. Baseline patient characteristics, comorbidities, and preoperative laboratory data were obtained by database query (Table 1) . The outcome of interest was in-hospital death following cardiac device extraction. Odds ratios (OR) and confidence intervals (CI) were used to measure relationships between exposures and the main outcome. Results: Our cohort consisted of 333 patients who underwent cardiac device extraction procedures. Cardiac device infection was the indication for procedure in 48% of patients (n=161). In-hospital mortality occurred in 9% of patients (n=29). Patients that died inpatient post-operatively were more likely to be male gender (OR 3.59, 95% CI [1.2, 10.6], p = 0.02), have acute kidney failure (OR 3.17, 95% CI [1.42, 7.05], p = 0.005), have anemia (OR 3.22, 95% CI [1.49, 6.99], p = 0.003), or have a diagnosis of severe malnutrition (OR 2.88, 95% CI [1.26, 6.58], p = 0.01). In a subgroup analysis, patients with diabetes undergoing extraction for infectious reasons had an increased risk of in-hospital mortality (OR 4.36, 95% CI [1.54, 12.34], p = 0.005). Conclusion: Patients undergoing cardiac device extraction are high risk for in-hospital mortality. Patients experiencing in-hospital mortality were more likely to be male, have acute renal failure, anemia and severe malnutrition. Careful analysis of preoperative risk factors, laboratory data, and nutritional status can help stratify risk for patients and providers.
Abstract 194: Age, Gender, Race/ethnicity, and Income-related Patterns in Ideal Cardiovascular Health
Authors: Emily M Bucholz, Neel M Butala, Norrina B Allen, Andrew E Moran, Sarah D De Ferranti
Journal: Circulation (2020)

Introduction: Ideal cardiovascular health (CVH) in adulthood is rare; however, the relationship between CVH and age has not been fully delineated. The aim of this study was to characterize the association of age with ideal CVH and individual CVH metrics across the lifespan and to compare these associations across gender, race, and income subgroups. Methods: We studied participants aged 12-80 years from NHANES 2005-2016 (n=42,367). Ideal CVH was defined using the AHA’s Simple 7 criteria (range 0-14) based on smoking status, body mass index, physical activity, diet quality, total cholesterol, plasma glucose, and blood pressure. Cubic models were used to model the association of mean CVH with age. The percentage of participants with ideal (≥5) and poor (≤2) CVH were plotted by age. Results: Mean CVH declined with increasing age starting in early adolescence and reaching a nadir by age 60 before stabilizing ( Figure 1 ). At age 20, only 45% of adults had ideal CVH; &gt;50% of adults had poor CVH by age 53. Women had higher mean CVH than men at younger ages but lower mean CVH at age ≥60 ( Figure 2 ). Mean CVH scores were highest for non-Hispanic whites and higher income adults, and lowest for non-Hispanic blacks and low-income adults across all ages. Mean CVH decreased to poor levels ~30 years earlier for non-Hispanic blacks compared with non-Hispanic whites, and ~35 years earlier younger for low-income compared with higher-income adults. Conclusions: The proportion of the population with ideal CVH decreases within increasing age beginning in early adolescence and persists through adulthood. Race/ethnicity and income disparities in CVH are evident early in life and became more profound at older ages.
Abstract 16314: Late Survival After Atrial Switch in Transposition of the Great Arteries: Results From a Multi-institutional Study
Authors: Alexandra van Dissel, Alexander Opotowsky, Jamil 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 Fernandes, Jasmin Grewal, Mikyla Janzen, Jonathan CRAMER, Paul Khairy, Pastora Gallego, Clare O’Donnell, Jane Hannah, Mikael 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: Although several factors have been cited for risk stratification in patients with simple transposition of the great arteries (dTGA), no single predictor emerges consistently. We aimed to assess survival and determine factors associated with survival in a large cohort of dTGA adults with atrial switch. Methods and Results: We included 1,169 dTGA adults (median age 28.1 years, 38.7% 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 9.2 [IQR 5.5-14.2] years, 67 (5.7%) patients died, six (0.5%) patients underwent MCS and 21 (1.8%) had a heart transplant. Cumulative incidence of composite endpoint at 15 years was 12.8% [95% CI 9.8 - 15.7], see Figure). Median age at time of primary outcome was 39.5 [IQR 33.9 - 45.1] years. Leading causes of death were worsening of heart failure (34%), non-cardiac (21%) and sudden unexplained death (12%). In multivariable Cox analyses for baseline variables, age, VSD, ventricular arrhythmia and heart failure admission were each associated with increased risk of the outcome, whereas prior pacemaker (26% of patients) was not. New pacemaker implantation was performed in 107 (9.1%), ICD in 109 (9.3%), and cardiac surgery in 35 (3%) patients. Patients who died were more likely to develop arrhythmias, be admitted for heart failure or require surgery during follow-up. Conclusion: In this large contemporary cohort of dTGA adults after atrial switch, late survival was excellent and seemed to be determined by arrhythmia and heart failure-related complications. Few patients underwent advanced heart failure therapies. Figure. Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 15 years from first visit at an adult congenital heart disease clinic since 2002. Shading represents upper and lower 95% confidence limits.
Abstract 14191: Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation: A Systemic Review and Meta-analysis
Authors: Matthew J Singleton, Lin Chen, Sean P Whalen, Prashant Bhave, Elijah Beaty, Joseph Yeboah, Elsayed Z Soliman
Journal: Circulation (2020)

Introduction: The effect of intensive versus standard blood pressure (BP) lowering on the risk of atrial fibrillation (AF) is uncertain. Hypothesis: Intensive BP lowering is associated with a lower risk of AF among patients with hypertension. Methods: We searched PubMed, EMBASE, and CENTRAL for trials published between inception and June 5, 2020 for randomized controlled trials evaluating the effect of intensive versus standard (target systolic BP &lt; 140 mmHg) BP lowering on incident AF. We assessed heterogeneity using the I 2 statistic then used fixed-effects meta-analysis models to report pooled treatment effects and 95% confidence intervals. We also tested for publication bias by three funnel plot-based methods. The quality of each study was assessed with the Cochrane Risk of Bias tool. Results: We assessed 16 candidate studies for eligibility from 2,312 published articles, but only three randomized clinical trials were eligible for inclusion and included a combined 12,219 participants with hypertension: Cardio-Sis (Studio Italiano Sugli Effetti Cardiovascolari del Controllo della Pressione Arteriosa Sistolica), ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial), and SPRINT (Systolic Blood Pressure Intervention Trial). The target systolic BP in the intensive BP arm was &lt;120 mmHg for participants in SPRINT and ACCORD-BP, but &lt;130 mmHg for participants in Cardio-Sis. Participants randomized to intensive BP lowering had significantly lower risk of incident AF compared with those randomized tostandard BP lowering (AF incidence 2.2% vs. 3.0%, respectively; pooled hazard ratio (95% confidence interval ): 0.74 (0.59 - 0.93)). Conclusions: Intensive BP lowering is associated with a significantly lower risk of incident AF in patients with hypertension. These findings add to the current evidence supporting the benefits of intensive BP control.
Abstract 14957: Comparison of Coronary Tree Detection and Diameter Quantification From a Deep Learning Convolutional Neural Network With Quantitative Coronary Angiography
Authors: Kritika Iyer, Cyrus Najarian, Mullasari A Sankardas, Vijayakumar Subban, Brahmajee K Nallamothu, C Alberto A Figueroa
Journal: Circulation (2020)

Introduction: QCA (Quantitative Coronary Angiography) is an accepted standard for assessing coronary artery stenosis severity. QCA computes the percentage diameter reduction of the lesion, improving upon visual inspection since it provides a numerical quantification of stenosis severity. However, it can be costly, and it requires human input to correct the boundaries of the vessel. AngioNet is a fully-automatic deep learning convolutional neural network trained to identify coronary trees and their vessel diameters in angiograms, and could be a cost-effective alternative to QCA. To explore the accuracy of AngioNet, we compared its ability to identify vessels and their diameter when compared with QCA. Methods: Angiograms with 3-vessel QCA reports from 89 patients acquired at Madras Medical Mission were used. The entire vessel tree was segmented for each angiogram using AngioNet. A fast-marching method was used to calculate the radius along the vessel’s centerline. Vessel diameter was compared in two regions corresponding to the regions marked in the QCA report: the most proximal region, containing the maximum vessel diameter, and the region of stenosis. If no stenosis was present, the distal region containing minimum diameter was selected. The difference in maximum and minimum vessel diameter between QCA and AngioNet was computed, and a Bland-Altman plot (see figure) was used to determine the interchangeability of both methods. Results: The mean absolute difference between both measurements was 0.27mm. The standardized difference was 0.215, corresponding to a 91.5% overlap of their distributions. Lastly, 97% of data points were within the limits of agreement, suggesting minimal clinical differences and that both methods may be interchangeable. Conclusions: Deep learning convolutional networks may be used to assess vessel diameters at a level that agrees well with those of QCA. AngioNet has the potential to automate the detection of stenosis severity.
Cost Minimization Analysis of a Teledermatology Triage System in a Managed Care Setting
Authors: Adam Zakaria, Theodore A. Miclau, Toby Maurer, Kieron S. Leslie, Erin Amerson
Journal: JAMA Dermatology (2020)

Teledermatology (TD) enables remote triage and management of dermatology patients. Previous analyses of TD systems have demonstrated improved access to care but an inconsistent fiscal impact.
Abstract 14130: Effect of Angiovac on Right Ventricular Function Following Removal of Right Atrial Masses in Patients With and Without Malignancy
Authors: Daniel P OBrien, Tyler E Callese, John Moriarty, Eric Yang
Journal: Circulation (2020)

Introduction: The AngioVac thrombectomy system (AngioDynamics Inc, Queensbury, NY) is an FDA approved device for removal of thrombi and emboli. Prior studies have shown procedural success for removal of right atrial (RA) and caval masses. This study aims to assess the effect of AngioVac on right ventricular (RV) function in patients undergoing removal of RA masses. Methods: Retrospective institutional study of patients undergoing removal of RA masses with AngioVac at a single tertiary medical center were included. Right ventricular fractional change (RVFC) and tricuspid annular plane systolic excursion (TAPSE) values were collected from echocardiograms before and after AngioVac or obtained manually if not present in the report. Paired 2-sample t test was done to assess for a significant difference between the two values. Results: The mean difference in RVFC before and after AngioVac was 1.6%, with a p-value of 0.327. Ten of the 28 patients had active malignancy, with a mean difference in RVFC of 0.8% and a p value of 0.683. The mean difference in the TAPSE group was 0.07mm and a p value of 0.48. Eight of the 19 patients had active malignancy, with a mean difference in TAPSE of 0.2mm corresponding to a p-value of 0.24. There was no significant difference in left ventricular ejection fraction before and after AngioVac (mean difference of 2.5%, p-value of 0.11). Conclusions: These findings suggest that use of the AngioVac device for removal of RA masses does not cause significant derangements in RV function by echocardiographic assessment. It is a well-tolerated procedure in patients with preprocedural normal RV function. These findings also further assess the use of AngioVac in patients with both right sided cardiac masses and active malignancy.