tbuckley/cabot-search huggingface dataset:
Abstract 336: The Novel and Useful Scoring System to Predit Massive Transfusion for Trauma Patients: Traumatic Bleeding Severity Score (TBSS)
Authors: Takayuki Ogura, Minoru Nakano, Yoshihiko Nakamura, Eiji Takahashi, Mitsunobu Nakamura, Dai Miyazaki, Hiroshi Machida, Hiroyuki Suzuki, Kenji Fujizuka, Yu Amemiya, Tomofumi Harasawa
Journal: Circulation (2012)

Background: There is no clear criterion to activate massive transfusion (MT) for trauma patients. Several studies showed that Trauma Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) Score were high accuracy in predicting the necessity of MT for trauma patients. However, some study showed that the accuracy of these scoring systems for elderly patients was not perfect. In japan, since the population is aging and the number of elderly trauma patient increases, these scoring systems are not useful so much. The aim of this study was to create new scoring system and predict the necessity of MT for trauma patients using it. Methods: In the first analysis, new scoring system was created. We enrolled 119 severe trauma patients admitted to our center between January 2008 and December 2010. MT predictors were found by statistical methods from clinical and laboratory variables in the Primary Survey. Each MT predictor was converted into the simple score based on each odds ratio in multivariate logistic regression analysis. TBSS was defined as the total of each score. In the second analysis, the accuracy of TBSS was tested. 114 patients admitted between January 2010 and March 2012 were examined. Receiver operating characteristic curve analysis were performed to compare the accuracy between TBSS and conventional scoring systems (TASH Score and ABC Score). Results: In the first analysis, five preditors of MT were identified: age (&gt; 60 year-old = 6pts), systolic blood pressure (&lt; 110 mmHg = 4pts, &lt; 100 mmHg = 8pts, &lt; 90 mmHg = 12pts), positive focused assessment with sonography for trauma (FAST) ( [the number of regions with positive FAST] × 3pts), severity of pelvic fracture (stable fracture = 3pts, incomplete unstable fracture = 6pts, complete unstable fracture = 9pts), and lactate (&gt; 2.5 mmol/L = 4pts, &gt; 5.0 mmol/L = 8pts, &gt; 7.5 mmol/L = 12pts). In the second analysis, TBSS excellently predicted MT (area under the curve (AUC) =0.985, p&lt;0.01). The AUC of TBSS was higher than that of TASH Score (AUC=0.887) and ABC Score (AUC=0.809) (both Bonferoni adjusted p&lt;0.05). Conclusion: TBSS based on the Primary Survey is high accuracy in predicting the necessity of MT. TBSS provide more useful information to predict MT compared with TASH Score and ABC Score.
Abstract 8454: High Resolution Echocardiography Can Detect Myocardial Damage in the Right Ventricle: A Feasibility Study
Authors: Sarah K Yang, Shahryar Ashraf, Sheetal Krishnakumar, Anugraha Rajendran, Nicole Chang, Galyna Kovch, Muhammad Ashraf, David J Sahn
Journal: Circulation (2011)

Background: The unique geometry and thinner walls of the right ventricle (RV) present a challenge for strain imaging. Methods: We studied 5 freshly harvested pig hearts. Each heart was mounted in a water bath for ultrasound imaging. A pulsatile pump was attached to the RV through a latex balloon inserted into the cavity with a fixed volume of water. Pulsatile flow into the RV cavity was generated by delivering 6 calibrated stroke volumes (15-40 ml) at 60 beats/min. Cardiac motion was scanned with 10S probe to acquire 2D short axis views on a GE Vivid 7 Dimensions ultrasound system at frame rates of 80-100fps. After baseline imaging, we injected 1-2ml of glutaraldehyde into the RV free wall to simulate myocardial fibrosis or scarring. The study was repeated at the same stroke volumes. Images were exported to EchoPac PC for analysis of circumferential and radial strain using speckle tracking by three observers. Results: Incremental increases in stroke volumes resulted in well correlated increases in stretching and thinning of RV walls, increased circumferential strain (r=0.87) and decreased radial strain (r=0.79). At each stroke volume, the modeled RV scar showed significantly diminished circumferential and radial strain deformation, with high reproducibility among observers (r=0.82). Conclusions: Speckle tracking based determination of cardiac mechanics provides a robust method for evaluation of altered function in the “infarcted” segments of the RV.
Abstract 9167: Fetoscopic Placental Laser Photocoagulation Improves Right Ventricular Outflow Tract Obstruction in Twin-Twin Transfusion Syndrome
Authors: Shari L Wellen, Michael Bebbington, Zhiyun Tian, Jack Rychik
Journal: Circulation (2011)

Background: Twin-twin transfusion syndrome (TTTS) is a disease of monochorionic, diamniotic twin gestation associated with recipient twin cardiac manifestations, such as abnormal growth of the pulmonary artery (PA) and right ventricular outflow tract obstruction (RVOTO). Untreated, mortality is &gt;80%, however fetoscopic placental laser photocoagulation (LP) improves survival. Objectives: To characterize the impact of LP on PA abnormalities and RVOTO in recipient TTTS twins. Methods: TTTS gestations with abnormal recipient PA growth and RVOTO that underwent LP between 1/1/2009 to 12/31/2010 were identified. We previously developed a comprehensive cardiovascular scoring system for TTTS (CHOP Score), which includes a domain grade for right-sided outflow abnormality (0 = no obstruction, 1 = PA equal in size to aorta, 2 = PA smaller than aorta, and 3 = frank RVOTO with pulmonary stenosis or atresia). Fetal echocardiograms were reviewed to determine the CHOP Score before, 1 day, 1 week, and 4 weeks after LP. Results: Of 76 twin pairs with TTTS who underwent LP at our center, 28 (36%) had right-sided outflow abnormality. Prior to LP, 15 had a PA equal in size to the aorta (group 1), 5 had a PA smaller than the aorta (group 2) and 8 had frank RVOTO (group 3). Median gestational age at LP was 20 wks (17 6/7-25 5/7 wks). The impact of LP is shown. All group 1 and group 2 fetuses had complete resolution by 4 wks after LP. In group 3, 1 patient with “functional” pulmonary atresia (no antegrade flow but with pulmonary insufficiency) had complete resolution 1 day after LP. Five patients (63%) with RVOTO at diagnosis did not respond to LP, of whom four required a catheter-based intervention after birth. All four remained biventricular repairs. There were 11 cases of fetal demise (6 donor, 5 recipient). Conclusions: Placental LP interrupts the pathophysiology of TTTS and leads to improvement in RVOTO. The disease model of TTTS provides an opportunity to study the unique plasticity of the human fetal heart.
Abstract 19161: Pregnancy-Induced Disorders Identify High-Risk Women who Benefit from Cardiovascular Screening: Results from the Women's Heart Health Initiative, an OB/GYN Screening Pilot Program
Authors: Jennifer Yu, Jerri A Johnson, Kleanthis Theodoropoulos, Sudhir Mungee, Michele A Couri, Beth Malasky, Robert A Wild, David Dobies, Auroa Badin, Raj Vadde, Samantha Sartori, Ziad Sergie, Usman Baber, Roxana Mehran
Journal: Circulation (2012)

Introduction . Prior studies have suggested that pregnancy-induced conditions (PIC) such as hypertension, diabetes, and pre-eclampsia are associated with increased long-term cardiovascular (CV) risk. However, many women see their obstetrician/gynecologist (OB/GYN) as their primary care physician, and their CV risk factors may be underdiagnosed and undertreated. Our hypothesis was that women presenting to an outpatient OB/GYN clinic with a history of PIC would have a higher prevalence of CV risk factors and symptoms compared with women with no PIC. Methods. From May 2010 to January 2012, 2,236 patients in 16 OB/GYN centers completed a simple one-page CV survey. Blood pressure was measured in all patients with no prior screening. We compared responses in 295 patients with a history of PIC versus 1,939 patients with no PIC. Results. Compared to women with no PIC, women with PIC were younger but more likely to have hypertension, diabetes, a family history of premature coronary artery disease, and to be overweight (Table). Women with PIC were more likely to report CV symptoms such as exertional chest pain, dyspnea or claudications. A similar proportion of women with and without PIC considered their OBGYN their primary care physician (15.1% vs. 18.7%, p=NS). As a result of screening, 33.5% of women with a history of PIC (vs. 23.9% no PIC, p=0.006) were referred to another health care provider (e.g. primary care physician, cardiologist, endocrinologist). Conclusion. Amongst middle aged women screened in community OB/GYN clinics, PIC was associated with a higher prevalence of CV risk factors and symptoms, but with no difference in whether the OB/GYN was the primary care provider. Specific CV screening in this setting may improve the early diagnosis and treatment of CV risk factors and disease in this high risk group of patients.
Abstract 19498: Abnormal Left ventricular Volumes Identified by Computed Tomography Improves Risk Stratification and Discrimination of Patients At Risk of Increased Mortality: Results from 3706 Patients in the Prospective Multicenter International CONFIRM Study
Authors: Reza Arsanjani, Troy Labounty, Victor Y Cheng, Fay Y Lin, Stephen Achenbach, Mouaz Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Kavitha Chinnaiyan, Benjamin J Chow, Augustin Delago, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Leslee J Shaw, Todd C Villines, Daniel S Berman, James K Min
Journal: Circulation (2012)

Background: Prior studies have evaluated the prognostic value of abnormal left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes by cardiac CT angiography. These studies were limited to smaller studies and single centers. We evaluated whether left ventricular volumes improves risk stratification and discrimination for mortality prediction in a large prospective study. Methods: From 27125 subjects in the CONFIRM registry, we identified subjects without prior known coronary artery disease (CAD) who underwent CCTA with quantitative LVESV and LVEDV assessment. LVESV and LVEDV were categorized as normal (&lt; 90ml and 90ml and &gt; 200ml, respectively). CAD extent and severity was categorized as none (0%), non-obstructive ( 50%) 1-, 2- and 3-vessel disease. LVESV, LVEDV, and CAD were examined in relation to risk prediction and discrimination for future mortality employing Cox proportional hazards models and area under the receiver operating characteristics curve (AUC), respectively. Results: In a follow-up of 2.2+0.9 years, 3706 patients (59.1 + 12.6 years, 54.2% male) were studied with 207 (5.6%) with abnormal LVESV and 190 (5.1%) with abnormal LVEDV. Abnormal volumes were associated with male gender, hypertension, smoking and younger age (p&lt;0.05 for all). In multivariable analyses, increased volumes was independently associated with mortality for abnormal LVESV (hazards ratio (HR) 6.56, 95% confidence interval (CI) 3.75-11.46, p&lt;0.001) and abnormal LVEDV (HR 4.00, 95% confidence interval 1.98-8.08, p&lt;0.001). Abnormal LVEDV (AUC 0.8178) and LVESV (0.8335) improved discrimination for identification of individuals at risk of death, when compared to CAD risk factors alone (0.7745) or CAD extent and severity and risk factors (0.7819) [p&lt;0.001]. Conclusions: Incremental to clinical variables and CAD extent and severity, abnormal left ventricular volumes by CCTA offers improved risk prediction and discrimination for future mortality.
Abstract 8143: Prevalence of Iron Deficiency Screening in Patients with Acute Myocardial Infarction Who Develop Hospital-Acquired Anemia
Authors: Adam C Salisbury, Amit P Amin, Kimberly J Reid, Frederick A Masoudi, Tracy Y Wang, Karen P Alexander, John A Spertus, Mikhail Kosiborod
Journal: Circulation (2011)

Background: Hospital-acquired anemia (HAA), a new onset anemia in patients with normal admission hemoglobin (Hgb), is common, frequently develops in the absence of overt bleeding, and is associated with poor outcomes in acute myocardial infarction (AMI) patients. Iron deficiency may be an underlying modifiable risk factor for HAA, but the prevalence of iron deficiency screening and the frequency of iron deficiency is unknown in AMI patients. Methods: We studied 17676 AMI patients from 57 US hospitals in the Health Facts database who were not anemic at admission. HAA was defined as a nadir Hgb below age, gender and race specific thresholds and moderate-severe HAA was defined as nadir Hgb &lt; 11 g/dl. All laboratory tests obtained and all in-hospital medications were recorded from the electronic medical record. We identified the proportion with and without HAA who had any laboratory evaluation of iron stores (ferritin, serum iron or iron binding capacity), and the frequency of iron deficiency among those who were tested (using established thresholds for patients with comorbid heart failure and kidney disease of a ferritin &lt; 100 ng/ml or between 100 and 299 when transferrin saturation was &lt;20% and a ferritin of &lt; 45 ng/ml for all other patients). Results: Both mild (n=6615, 37%) and moderate-severe HAA (n=3551, 20%) were common. Assessment of iron stores was rare in all groups, but increased with greater HAA severity (no HAA: 52 (0.7%), mild HAA: 117 (2%) and moderate-severe HAA: 364 (10%), p&lt;0.001). Among patients who had iron testing, iron deficiency was common regardless of HAA status (no HAA: 14/52 (27%), mild HAA: 24/117 (21%) and moderate-severe HAA (106/364 (29%), p=0.24). Few iron deficient patients received in-hospital iron supplementation (no HAA: 0/14, mild HAA: 2/24 (8%) and moderate-severe HAA: 16/106 (15%), p=0.25). Conclusions: Testing for iron deficiency is rare in AMI patients and is only slightly more common in those who develop HAA. Although only a select fraction of patients were screened, iron deficiency was common in these patients, and was infrequently treated. Studies are needed to determine the prevalence of iron deficiency in AMI patients with HAA and whether diagnosing and treating iron deficiency in AMI patients with HAA improves outcomes.
Abstract 19458: Prevalence of Neoplastic and Non-Neoplastic Incidental Findings as Detected by Computed Tomography in Severe Aortic Stenosis: Single Center PARTNER Trial Data
Authors: Niraj S Doctor, Hasan S Jilaihawi, Chakravarty Tarun, Rafiq Asim, Lauren A Contreras, Stegic Jasminka, Mohammad Kashif, Doumanian Aik, Gheorghiu Mitch, Nakamura Mamoo, Gerald Friede, Raj Makkar
Journal: Circulation (2012)

Background: In the emerging era of Trans catheter aortic valve replacement (TAVR), CT is important tool for precise screening and procedural outcomes. Non cardiac incidental findings of malignancy are an important clinical concern. Methods and results: We retrospectively evaluated the findings from 64-slice screening CT scans performed on 318 patients with severe aortic stenosis (AS) prior to evaluation forTAVR. A total of 235 patients received contrast imaging. Detailed analysis of cardiac and non cardiac structures revealed presence of lung cancer in 10 patients (3%) and Bronchogenic carcinoma in 5 patients (2%), breast cancer in 9 patients (3%), 4 patients with colon cancer (1%) and 4 with lymphoma(1%), 2 with prostate cancer and 1 with renal cell carcinoma and multiple myeloma(1%). Conclusions: CT is important factor in patient selection for TAVR but reporting of non-cardiac findings must be meticulous. There is a significant proportion of patients with the incidental finding of Neoplasia.
Abstract 8420: Critical Role of CIKS/Act1 In Lipopolysaccharide (LPS)-Induced Cardiac Dysfunction i <i>n vivo</i> And Cardiomyocyte Contractility <i>in vitro</i>
Authors: Anthony J Valente, Sumanth D Prabhu, Ulrich Siebenlist, Bysani Chandrasekar
Journal: Circulation (2011)

The innate immune system and inflammatory cytokines are critical in the initiation and perpetuation of tissue injury. Toll-like receptor (TLR)4 recognizes bacterial LPS, and is currently known to signal via distinct MyD88-dependent and MyD88-independent (TRAM-dependent) pathways to activate NF-κB and AP-1, and induce proinflammatory cytokines such as interleukin (IL)-18. Since the adapter molecule CIKS (connection to IκB kinase and stress-activated protein kinases; also known as Act1 or traf3ip2) lies upstream of IKK and JNK, and since both TLR4 and CIKS contain TIR (Toll/Interleukin-1 receptor) domains , we hypothesized that CIKS can interact with TLR4, and contribute independently to LPS-induced contractile depression. Treatment with LPS inhibited adult mouse cardiomyocyte contractility by 54% (IonOptix), an effect partially reversed by MyD88 or TRAM knockdown. Significantly, CIKS knockdown also reversed LPS-induced contractile depression. Using GST pull-down and reciprocal immunoprecipitation/immunoblotting, we found that TLR4 can physically associate with CIKS, and this association is enhanced by LPS. LPS upregulates CIKS protein expression, and CIKS knockdown inhibited LPS-induced IKK/NF-κB and JNK/AP-1 activation, IL-18 expression, and contractile depression. LPS-mediated contractile depression was reversed by IL-18 neutralizing Ab and IL-18 binding protein (IL-18BP, a natural inhibitor of IL-18). These results were confirmed in cardiomyocytes isolated from TLR4-mutant, CIKS null, IL-18 null and IL-18BP Tg mice. Notably, systemic LPS administration reduced cardiac ejection fraction by 43% at 6 h in wild type mice, and this effect was markedly attenuated in TLR4-mutant, CIKS and IL-18 null, and IL-18BP Tg mice. These novel observations identify a TLR4/CIKS pathway in NF-κB and AP-1 activation in cardiomyocytes, and appears to be distinct from the well-characterized MyD88 and TRAM-dependent LPS/TLR4 signaling. These data also show that LPS induces contractile dysfunction in part via CIKS-mediated IKK/NF-κB and JNK/AP-1-dependent IL-18 expression. These data identify CIKS as a novel therapeutic target in conditions of innate immune activation and inflammation such as myocardial injury and congestive heart failure.
Abstract 8857: Iron Restriction Prevents the Progression of Diabetic Nephropathy in db/db Mice
Authors: Yasumasa Ikeda, Hideaki Enomoto, Soichiro Tajima, Yuki Izawa-Ishizawa, Yoshitaka Kihira, Keisuke Ishizawa, Shuhei Tomita, Koichiro Tsuchiya, Toshiaki Tamaki
Journal: Circulation (2012)

Background: Iron is well-known as an essential trace metal for all living body. On the other hand, excess iron causes oxidative stress through catalyzing highly toxic hydroxyl radical via Fenton/Haber-Weiss reaction. Recent studies have shown that iron reduction ameliorates diabetic condition and prevents development of adipocyte hypertrophy. In the present study, we studied the protective effect of iron reduction against diabetic nephropathy, a diabetic complication. Methods and Results: We employed male db/db mice, a model of diabetic nephropathy and male db/m mice as control mice. db/db mice were divided into 2 groups, normal diet group (ND)(Fe 100mg/kg food) and iron-restricted diet group (ID)(Fe 10mg/kg food). Urinary albumin excretion was increasing in db/db mice with ND compared with db/m mice with ND, which was suppressed in db/db mice with ID. In renal histological analysis, increased glomerular volume and mesangial area expansion in ND-fed db/db mice were reduced in ID-fed db/db mice. Deposition of extracelluar matrix such as collagen IV and fibronectin was decreased in db/db mice with ID. Upregulated glomerular desmin expression in db/db mice with ND was diminished in db/db mice with ID. In terms with oxidative stress, ID diminished increased superoxide production in kidney of ND-fed db/db mice. Renal expression of NADPH oxidase components, p22phox and NOX4, were augmented in db/db mice with ND-fed, which was abolished by ID-fed. In terms with renal iron transporter, there were no differences of expression of transferrin receptor and divalent metal transporter-1 between db/m mice and db/db mice, increased ferroportin expression in db/db mice with ND- was reversed by ID to the same level as db/m mice. Urinary iron excretion was significantly higher in ND-fed db/db mice, which was reduced with ID administration. Conclusion: These findings suggest that dietary iron restriction exert preventive effect against development of diabetic nephropathy via the reduction of oxidative stress.
Abstract 305: The Patients’ Experiences in Emergency Research (PEER) Study
Authors: Neal W Dickert, Victoria Mah, Baren E Jill, Michelle Biros, Prasanthi Govindarajan, Arthur M Pancioli, Robert E Silbergleit, David W Wright, Rebecca D Pentz
Journal: Circulation (2012)

Background Resuscitation research requires enrolling patients under an exception from informed consent (EFIC), but there remains ethical controversy and confusion about EFIC regulations. One concern is that patients may find enrollment unacceptable, but no study has systematically assessed views and experiences of patients enrolled in an EFIC study. The “Patients’ Experiences in Emergency Research (PEER)” study addresses this gap. Methods PEER was nested within the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) of pre-hospital treatment of status epilepticus. PEER included 61 EFIC enrollees (or surrogates) from 5 sites. Interviewers used a structured interactive guide containing open and closed-ended questions focusing on views of personal and general acceptability of EFIC enrollment in RAMPART and existing regulatory protections. Closed-ended responses were directly coded. Simple descriptive and bivariate statistics were generated, consistent with our hypothesis-generating goals. Textual data were analyzed for common themes and to contextualize the data. Results 24 patients and 37 surrogates were interviewed. Two interviews were incomplete. 49 (82%) subjects were glad they (or family member) were included in RAMPART; 54 (92%) felt research on emergency seizure treatment is important. 43 (72%) found their inclusion in RAMPART under EFIC acceptable. 10 (17%) found it unacceptable, and 6 (10%) were neutral. There were no statistically significant demographic associations with enrollment attitudes. In textual analysis, 24 (41%) subjects expressed concern about absence of consent; 11 (19%) felt they were not told enough about the study. Positive responses mostly related to perceived medical benefits (53%) from RAMPART and trust in doctors/researchers (25%). More than a quarter had difficulty understanding concepts of clinical trials and EFIC. Conclusions Most subjects had positive views of their enrollment in RAMPART. A significant number were concerned about absence of consent, and many had difficulty understanding EFIC and clinical research. These approval rates cohere with data from other populations. They are largely reassuring but suggest the importance of post-enrollment communication.