tbuckley/cabot-search huggingface dataset:
Abstract 9364: Drug Eluting Stents Appear Superior to Bare Metal Stents for Vein Graft Pci in a Propensity Matched Cohort
Authors: Kassem Safwan, Dan Jones, Krishna Rathod, Shaun Gallagher, Oliver Guttmann, Roshan Weerackody, Ajay Jain, Charles Knight, Anthony Mathur, Andrew Wragg
Journal: Circulation (2013)

Background: Research trials have shown improved short-term outcome with drug-eluting stents (DES) over bare metal stent (BMS) in Saphenous vein graft (SVG) PCI, primarily by reducing target vessel revascularization (TVR) for In-Stent Restenosis (ISR). Because of the high event rates in these patients it is not clear if these benefits are maintained long term. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS, over a prolonged follow-up period using a propensity matched analysis. Methods: Clinical information was analysed from a prospective database on 512 patients who underwent PCI for SVG lesions between 2003 and 2010. 293 patients had PCI with BMS and 219 with DES. Propensity scores representing the estimated probabilities of patients receiving either DES or BMS were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 219 patients each balanced for baseline factors. We assessed major adverse cardiac events (MACE) ) out to a median of 3.3 years (IQR: 2.1-4.1) MACE defined as •All Cause mortality •Myocardial infarction (MI) •Target vessel revascularisation (TVR) •Stroke Results There was a significant difference in MACE between the two groups in favour of DES (17.9% DES v 31.2% BMS group [P=0.04] over the 5-year follow-up. MACE was driven by ISR in both groups and the difference between groups was due to increased TVR in the BMS group. There was no difference in death, MI or stroke.(Figure 1) Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence intervals 0.52-0.94) with no difference in the hazard of all cause mortality (HR: 1.08 95% CI: 0.77-1.68). Conclusion: In our cohort of patients who had PCI for treatment of SVG disease the use of DES resulted in lower MACE rate compared to BMS over a 5-year follow-up.
Abstract 9817: Unlocking the Mystery of Symptom Severity in Patients With Heart Failure: Depressive Symptoms and Excess Sodium Intake are Associated With Severe Physical Symptoms
Authors: Seongkum Heo, Debra K Moser, Terry A Lennie, Mary Fischer, Eugene Smith, Mary N Walsh
Journal: Circulation (2013)

Background: The majority of patients with heart failure (HF) suffer from physical symptoms. In order to improve physical symptoms, the first step is to determine the modifiable factors associated with them. Purpose: To examine the modifiable psychosocial and behavioral factors associated with physical symptoms in patients with HF. Methods: Data on physical symptoms (Symptom Status Questionnaire-HF), psychosocial variables (depressive symptoms [Patient Health Questionnaire], perceived control [Control Attitudes Scale-Revised], and social support [Multidimensional Scale of Perceived Social Support]), and behavioral variables (medication adherence [Micro-Electro-Mechanical Systems], sodium intake [24-hour urine], and self-care management [Self-care management subscale of the Self-Care of Heart Failure Index]) were collected from 109 patients with HF (mean age 58 ± 14 years, 46% male, 59% New York Heart Association class [NYHA] II/III). Age and comorbidities were selected as covariates based on the literature. Hierarchical multiple regression analyses were used to analyze the data. Results: Among psychosocial variables (depressive symptoms, perceived control, and social support), only depressive symptoms were associated with physical symptoms. Among behavioral variables (medication adherence, sodium intake, and self-care management), only sodium intake was associated with physical symptoms. Those who had more severe depressive symptoms and higher sodium intake experienced more severe physical symptoms controlling for covariates (F = 11.633, R 2 = 48%, p &lt; .001). Conclusion: The findings of this study showed that improvement in depressive symptoms and reduction of dietary sodium intake are primary of HF intervention targets to improve physical symptoms.
Abstract XXXXX: Antipsychotic drugs are associated with pulseless electrical activity: The Oregon Sudden Unexpected Death Study
Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uy-Evanado, Harpriya Chugh, Karen Gunson, Jonathan Jui, Sumeet S. Chugh
Journal: Circulation (2013)

Carmen Teodorescu, 2013 Finalist and Presenting Author
Abstract 19086: Gene Recruitment to the Nuclear Periphery
Authors: Defne Egecioglu, Jason Brickner
Journal: Circulation (2013)

The regulation of gene expression plays an essential role in cellular function and behavior. Heart conditions that arise as a result of response to various forms of stress, as well as altered cholesterol levels are both associated with changes in transcriptional programs. Transcriptional regulation is therefore a crucial step before the progression of any cellular response to stress. Recent work has shown that the localization of genes in the nucleus plays an important role in regulating transcription; a gene’s location can impact its transcriptional activity and its chromatin structure. In brewer’s yeast, many genes are targeted from the nucleoplasm to the nuclear periphery, through association with the Nuclear Pore Complex (NPC), upon activation. Similar phenomena have been reported in metazoans. Targeting to the NPC promotes transcription and is controlled by cis-acting “DNA zip codes” in the promoters of these genes. Interestingly, the two zip-code harboring genes we have closely analyzed are both induced as a response to various forms of stress. To determine the molecular basis of zip code-mediated targeting, we have identified the transcription factor Put3 as a DNA zip code binding protein. We seek to determine how the DNA binding properties of Put3 affect the movement of chromosomal loci to the NPC, and how this singular transcription factor can have two distinct roles in the yeast nucleus: the activation of PUT genes, and relocalizing genomic loci by binding to zip codes. By assaying for the binding properties of Put3 to various zip codes in both in vitro and in vivo contexts, we have mapped the important residues within and flanking the DNA zip code core sequence. A number of upstream zip code residues play an important role for Put3-based gene targeting, as demonstrated by live yeast cell microscopy. The two nuclear roles for Put3 suggest that this protein associates with distinct groups of other proteins for each of its functions, and possibly in different conformations. Mutations within Put3 can separate these two functions. On the broader scale, this work aims to provide important fundamental insight into how eukaryotic genomes regulate their expression through alteration of their spatial organization within the nucleus.
Abstract 9856: Left Atrial Passive Emptying Function Determined by Cardiac Magnetic Resonance Predicts Atrial Fibrillation Recurrence After Pulmonary Vein Isolation
Authors: John A Dodson, Thomas Neilan, Siddique Abbasi, Ravi Shah, Hoshang Farhad, Ronald Blankstein, Michael Jerosch-Herold, Raymond Y Kwong
Journal: Circulation (2013)

Background: While pulmonary vein isolation (PVI) has become a mainstream therapy for selected patients with AF, late AF recurrence is common and its risk factors remain poorly defined. The purpose of our study was to test the hypothesis that reduced left atrial passive emptying function (LAPEF) has a strong association with late recurrent AF after PVI. Methods: 346 patients with AF referred for CMR pulmonary vein mapping prior to PVI from 9/2005-6/2011 were included. Left atrial volumes (LAV) were determined by the biplane area-length method. LA maximum volumes (VOLmax) and volumes before atrial contraction (VOLbac) were measured, and LAPEF was calculated as (VOLmax - VOLbac)/VOLmax x 100. The primary outcome was late recurrent AF (≥ 3 months after PVI). Late AF-free survival curves stratified by LAPEF quintiles were plotted using the Kaplan-Meier method. Cox proportional hazards assessed the prognostic association of LAPEF with recurrent AF, adjusting for known markers of AF recurrence (BSA, VOLmax, hypertension, non-paroxysmal AF, diabetes, heart failure, ≥1 PVI procedure, sleep apnea). Results: Over a median follow-up of 27 months, 124 patients (35.8%) experienced recurrent AF. Patients with recurrence were more likely to have non-paroxysmal AF (75.8% vs. 51.4%, P&lt;0.01), larger mean LA volumes (60.2 ml/m2 vs. 52.8 ml/m2, P&lt;0.01), and lower mean LAPEF (19.1 vs. 26.0, P&lt;0.01). Patients in the lowest quintile of LAPEF (worst function) were at the highest risk of developing recurrent AF (Figure); at two years, the recurrence rate was 60.5% in the lowest quintile, compared to 17.3% in the highest quintile. After adjusting for historic markers of recurrent AF, patients with low LAPEF remained significantly more likely to recur (HR lowest vs. highest = 3.92, 95% CI 2.01-7.65). Conclusions: We found a strong association between LAPEF and recurrent AF after PVI that persisted after multivariable adjustment. LAPEF may be used to risk stratify PVI candidates for late recurrence.
Abstract 9634: Reclassification of Cardiovascular Risk by Including Ultrasound Detected Plaque of the Femoral and Carotid Arteries Improves Identification of High-Risk Subjects
Authors: John Postley, Yanting Luo, Nathan D Wong, Julius M Gardin
Journal: Circulation (2013)

Background: Current Cardiovascular Disease (CVD) predictive algorithms recognize traditional risk factors in populations but have failed to identify many of those at highest risk because of detectable vascular disease. We compared an enhanced algorithm, "Lifetime Risk" (LR), with Framingham Risk Score (FRS) algorithms both 10-yr and 30-yr in their ability to identify subjects at highest risk for developing an initial CVD event by including ultrasound detected carotid or femoral artery plaque. Methods: We performed Ultrasound Examination (UE) of both carotid and femoral arteries in 939 adults (36% women) between the ages of 30 and 60 after excluding those with previous CVD (myocardial infarction, angina, stroke or claudication). Subjects were categorized into low-, intermediate- and high-risk groups on the basis of respective published criteria for the algorithms. Subjects in the low- and intermediate-risk groups were reclassified as high risk if UE showed any arterial plaque. Results: Overall, low- and intermediate-risk men allocated by LR required less reclassification(17%) than men allocated by 30-yr FRS (24%) (p&lt;0.001) or 10-yr FRS (37%) (p&lt;0.001) because of plaque detected by UE. Similarly, low- and intermediate-risk women allocated by LR required less reclassification (14%) than women allocated byy 30-yr FRS (24%) (p&lt;0.001) or 10-yr FRS (31%) (p&lt;0.001) (Table). Of men categorized as low risk by 10-yr FRS (23%) and LR (24%) were reclassified as high-risk and of women categorized as low-risk by 10-yr FRS (25%), 30-yr FRS (13%) and LR (24%) wre reclassified as high-risk because of plaque detected by UE. Conclusions: Our study which included UE of easily accessible arteries showed increased sensitivity of LR, compared to 10-yr and 30-yr FRS, for the identification of both males and females at high risk for CVD events based on the presence of easily detectable arterial plaque.
Abstract 9454: Arterial Baroreflex Dysfunction Impairs Angiogenesis in Response to Hindlimb Ischemia
Authors: Chang-ning Hao, Zhen-hao Huang, Shu-wei Song, Yi-qin Shi, Xian-wu Cheng, Toyoaki Murohara, Ding-feng Su, Jun-li Duan
Journal: Circulation (2013)

Objective: We examined whether ischemia-induced angiogenesis was reduced by the arterial baroreflex (ABR) dysfunction, and if so, we further examined whether the reduced angiogenesis was associated with a reduction of endothelium-derived acetylcholine (Ed-ACh) release using a rat model of hindlimb ischemia (HLI). We also determined whether this effect would be restored by the administration of pyridostigmine (Pyr), a cholinesterase inhibitor. Methods and Results: Male Sprague-Dawley rats were randomly assigned to 3 groups that received 1) sham operation (control), 2) sinoaortic denervation (SAD)-induced ABR dysfunction, 3) SAD rat diet with Pyr. 4 weeks after the SAD intervention, HLI was surgically induced in all groups. Infrared spectrum analyses showed that the recovery of the ischemic/normal limb temperature ratio in the SAD rats remained impaired throughout the follow-up period. At postoperative day 14, immunohistochemical analyses in the ischemic limb revealed significantly lower capillary densities in the SAD group than in the control, which were associated with decreased tissue expression of choline acetyltransferase (ChAT) and acetylcholine transporter (AChT). Pyr significantly improved the temperature ratio and capillary densities, accompanied by elevation of ChAT and AChT protein in the ischemic muscles. Interestingly, Pyr not only elevated the levels of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) proteins of ischemic muscles but also improved functional recovery following hindlimb ischemia in α7-nicotinic ACh receptor (α7-nAChR) knockout mice. Furthermore, in vitro, acetylcholine analogue (carbachol) stimulated the expression of VEGF and phosphorylation of VEGF receoptor-2 (VEGFR2) in umbilicus vein endothelial cells, and these changes were diminished by methyllycaconitine, a nicotinic receptor blocker. Conclusions: These findings suggest that the ABR dysfunction likely triggers and impairs angiogenesis in response to ischemia and that the Pyr-mediated augmentation of tissue Ed-ACh activity stimulates VEGF expression and VEGFR2 phosphorylation by the α7-nAChR-dependent/-independent activation of the Pyr, thereby improving vascular angiogenic action.
Abstract 15062: Circulating Brain-derived Neurotrophic Factor concentrations and the risk of cardiovascular disease in the community
Authors: Bernhard M Kaess, Sarah R. Preis, Wolfgang Lieb, Alexa S. Beiser, Qiong Yang, Tai C. Cheng, Demetrios Vorgas, Christian Hengstenberg, Jeanette Erdmann, Heribert Schunkert, Sudha Seshadri, Ramachandran S. Vasan
Journal: Circulation (2013)

Bernhard M. Kaess, 2013 Finalist and Presenting Author
Abstract 19078: Pre-Existing Left Atrial Fibrosis and Diastolic Dysfunction is Associated With Deterioration in Diastolic Function Following Left Atrial Ablation In Patients With Recurrent Atrial Fibrillation
Authors: Irfan Khurram, Farhan Maqbool, Jane Dewire, Roy Beinart, Ronald D Berger, Joseph Marine, David D Spragg, Hiroshi Ashikaga, Hugh Calkins, Saman Nazarian
Journal: Circulation (2013)

Background: Radiofrequency (RF) ablation for treatment of atrial fibrillation (AF) is known to induce left atrial (LA) fibrosis. LA diastolic dysfunction has been associated with AF and has shown predictive value for AF recurrence post ablation. This study is designed to evaluate the pattern of change in LA diastolic function following RF ablation. Methods: A total of 127 consecutive AF patients were enrolled in the AF Ablation MRI cohort. Fourteen underwent a repeat ablation for recurrent AF and were selected. During routine ablation procedure, LA pressures were acquired in sinus rhythm following trans-septal puncture and prior to ablation. LA diastolic function was evaluated by measuring the slope of the passive LA filling curve and was quantified using diastolic function scores defined by the ratio of change of LA pressure (as defined by invasive pressure measurements) to volume (as defined by MRI) during passive filling of LA (ΔP/ΔV) mmHg/ml and was measured prior to both ablations. The change in LA diastolic function was considered significant if &gt;25% change from baseline was observed. Percent left atrial fibrosis was quantified by using the image intensity ratio as previously described. Results: The mean diastolic function score for the 14 AF patients (62±7yrs, 79% male) was 0.76±0.28 mmHg/ml (Paroxysmal AF 0.58±0.18 and persistent AF 0.90±0.28, p=0.031). Of these, 4 (28.6%) patients had no substantial change &gt;25% in their diastolic function score (grp A) at repeat imaging. Six had improvement, 4 remained stable, grp B and 4 had deterioration-grp C. When compared with group A, group C had worse baseline LA diastolic function (0.6±0.2 v 1.1±0.3, p0.019) and greater baseline fibrosis (8.0±2.4% v 15.3±7.0, p0.042). Conclusion: Deterioration of diastolic function in patients with AF recurrence after LA ablation is associated with more extensive baseline fibrosis and worse baseline LA diastolic function.
Abstract 9675: Does the Degree of Left Ventricular Dysfunction or Symptom Status Influence the Risk of Stroke or Systemic Embolism Among Patients With Atrial Fibrillation and Heart Failure?-Results From the ACTIVE Study
Authors: Roopinder K Sandhu, Stuart J Connolly, Stefan Hohnloser, Marc Pfeffer, Finlay McAlister, Jeff Healey
Journal: Circulation (2013)

Background: Heart failure (HF) is a major component of widely applied stroke risk stratification schemes in atrial fibrillation (AF). However, data regarding the relationship between left ventricular (LV) dysfunction or HF symptoms and risk of stroke/systemic embolism among HF patients remains sparse. Methods: A total of 3487 participants from the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE) trials with HF at baseline were randomized to anti-platelet therapy. Patients with HF were categorized as having preserved vs reduced ejection fraction (PEF ≥ 0.50, REF &lt; 0.50). If reduced, the degree of LV dysfunction was classified as mild, moderate or severe. HF symptoms were assessed using New York Heart Association (NYHA) class I-IV. Cox proportional-hazards models were used to estimate hazard ratios (HR, 95% CI) for stroke/systemic embolism across categories of LV dysfunction and NYHA class. Results: At baseline, 875 (47%) had HF-PEF, 982 (53%) had HF-REF; the degree of LV dysfunction was classified as mild in 25%, moderate in 25% and severe in 14%. During 3.6 years of follow-up, 211 patients had stroke/systemic embolism. In multivariable analysis, independent predictors of stroke were age ≥ 75 years (HR 2.83, 1.80-4.44), diabetes (HR 1.45, 1.03-2.03), diastolic blood pressure (per 1 mmHg, HR 1.02, 1.01-1.04), peripheral arterial disease(HR 1.94, 1.10-3.41), female(HR 1.48, 1.07-2.05) and prior stroke/transient ischemic attack (HR 1.77, 1.23-2.54) however EF &lt; 0.50, LV dysfunction or NYHA class were not predictors. Compared to those with HF-REF, patients with HF-PEF exhibited similar risk of stroke/systemic embolism: 4.18% vs. 3.83% per year, HR 0.89, 95% CI 0.65-1.22 after controlling for AF risk factors. Compared to normal LV function, there was no significant trend across categories of LV systolic dysfunction (p for trend, 0.57). The risk of stroke/systemic embolism was similar in HF patients with NYHA class I (4.0% per year, referent category), II (4.0%, HR 0.87, 0.60-1.26), III (3.9%, HR 0.62, 0.38-1.02), or IV (2.8%, 0.60, 0.14-2.55). Conclusion: Among patients with a history of HF, the presence or absence of LV dysfunction or severity of HF symptoms did not influence the risk of stroke/systemic embolism.
Abstract 9569: Assessment of Bi-ventricular Functional Reserve During Dobutamine Stress Offers a Significant Prognostic Impact for Patients With Dilated Cardiomyopathy
Authors: Kensuke Matsumoto, Hidekazu Tanaka, Kazuhiro Tatsumi, Yoshiki Yamadori, Takuma Sawa, Yasuhide Mochizuki, Yoshiki Motoji, Tatsuya Miyoshi, Yuko Fukuda, Ken-ichi Hirata
Journal: Circulation (2013)

Background: Right ventricular (RV) function has been increasingly recognized as an important prognostic factor for heart failure patients as well as left ventricular (LV) function. The objective of this study was thus to investigate the prognostic importance of RV functional reserve in patients with dilated cardiomyopathy (DCM), and whether combined assessment of bi-ventricles can further enhance the prognostic evaluation. Methods: Seventy-three DCM patients with ejection fractions of 32±9% were recruited, and speckle-tracking echocardiography was used to assess both RV and LV functional reserve under dobutamine stress (20 mg/kg/min). RV contractile function was determined as peak global longitudinal strain from RV free wall (RV-free), whereas LV contractile function was calculated by averaging of peak global longitudinal strain from standard apical views (GLS). Event-free survival was tracked over an 18-month. Results: Multivariate Cox proportional-hazards analysis revealed that RV-free during dobutamine stress (ΔRV-free) as well as that in GLS (ΔGLS) were the two major independent predictors of cardiovascular events (p&lt;0.001 and p=002, respectively). The Kaplan-Meier curve analysis disclosed that patients with RV reserve (ΔRV-free ≥16.5%) and with LV reserve (ΔGLS ≥10.0%) had a significantly better prognosis than those without (log rank p&lt;0.01, respectively). Of special interest was that a pattern of both RV and LV functional reserve was associated with favorable outcome, whereas a pattern of neither RV nor LV functional reserve was associated with poor outcome (event rate: 2.3% vs. 82%, p&lt;0.001). Patients with heterogeneous pattern of either RV or LV functional reserve had an intermediate risk of cardiac events (26.3%). Conclusions: RV functional reserve as well as LV was associated with prognostic impact in patients with DCM. Combined assessment of bi-ventricular functional reserve may play a key role for better management of such patients.
Abstract 283: Disparities in Bystander CPR and Neurologic Outcomes From Cardiac Arrest According to Neighborhood Ethnicity Characteristics in Arizona
Authors: Sungwoo Moon, Wes Kortuem, Marvis Kisakye, Bernadette White, Sangdo Shin, Rogelio Martinez, Tyler Vadeboncoeur, Daniel Spaite, Bentley Bobrow
Journal: Circulation (2013)

Background and Objectives: There are a growing number of Hispanic citizens in the US and language or other barriers may impede them receiving bystander CPR (BCPR). Our aim was to determine if there are differences in BCPR provision and outcomes for out-of-hospital cardiac arrest (OHCA) occurring in mainly Hispanic neighborhoods compared to mainly White non-Hispanic neighborhoods in Arizona. Methods: We analyzed our prospectively-collected statewide Utstein-compliant OHCA database between 1/1/10 - 12/31/11. OHCA cases were geocoded according to the incident address using ArcGIS 10.1 (Esri, Redlands, CA). Census-tract data was used to determine neighborhood characteristics of ethnicity. Neighborhoods were classified as mainly Hispanic or mainly White, non-Hispanic when each population was over 60% in the census-tract. Results: There were 4531 adult OHCA victims during the study. Cases were excluded from analysis (n=1380) due to incident location, cause of arrest, or because the arrest occurred after EMS arrival. Among 3151 cases, 2839 cases (90.1%) could be geocoded using incident address. CPR performance and outcomes by neighborhood ethnicity are shown (Table). When compared with patients who arrested in mainly White, non-Hispanic neighborhoods, those in mainly Hispanic neighborhoods were less likely to receive BCPR (odds ratio, 0.67; 95% confidence interval [CI], 0.52 to 0.84). Although no statistically significant differences were identified in the rate of survival to hospital discharge by main neighborhood ethnicity, patients who arrested in mainly Hispanic neighborhoods were less likely to have favorable neurologic outcomes (Cerebral Performance Score 1 or 2) than those in White, non-Hispanic neighborhoods (odds ratio, 0.16; 95% CI, 0.05 - 0.53). Conclusion: In Arizona, OHCA victims in mainly Hispanic neighborhoods received BCPR less frequently and had worse neurologic outcomes than those in mainly White, non-Hispanic neighborhoods.